The Starfield study is the most explosive revelation about modern healthcare in America ever published. The credentials of its author and the journal in which it appeared are, within the highest medical circles, impeccable.
Yet, on the heels of Starfield’s astonishing findings, although media reporting was extensive, it soon dwindled. No major newspaper or television network mounted an ongoing “Medicalgate” investigation. Neither the US Department of Justice nor federal health agencies undertook prolonged remedial action.
All in all, it seemed that those parties who could have taken effective steps to correct this mind-boggling situation preferred to ignore it.
On December 6-7, 2009, I interviewed Dr. Starfield by email.
What has been the level and tenor of the response to your findings, since 2000?
My papers on the benefits of primary care have been widely used, including in Congressional testimony and reports. However, the findings on the relatively poor health in the US have received almost no attention. The American public appears to have been hoodwinked into believing that more interventions lead to better health, and most people that I meet are completely unaware that the US does not have the ‘best health in the world’.
In the medical research community, have your medically-caused mortality statistics been debated, or have these figures been accepted, albeit with some degree of shame?
The findings have been accepted by those who study them. There has been only one detractor, a former medical school dean, who has received a lot of attention for claiming that the US health system is the best there is and we need more of it. He has a vested interest in medical schools and teaching hospitals (they are his constituency). They, of course, would like an even greater share of the pie than they now have, for training more specialists. (Of course, the problem is that we train specialists—at great public cost---who then do not practice up to their training---they spend half of their time doing work that should be done in primary care and don’t do it as well.)
Have health agencies of the federal government consulted with you on ways to mitigate the effects of the US medical system?
Since the FDA approves every medical drug given to the American people, and certifies it as safe and effective, how can that agency remain calm about the fact that these medicines are causing 106,000 deaths per year?
Even though there will always be adverse events that cannot be anticipated, the fact is that more and more unsafe drugs are being approved for use. Many people attribute that to the fact that the pharmaceutical industry is (for the past ten years or so) required to pay the FDA for reviews---which puts the FDA into a untenable position of working for the industry it is regulating. There is a large literature on this.
Aren't your 2000 findings a severe indictment of the FDA and its standard practices?
They are an indictment of the US health care industry: insurance companies, specialty and disease-oriented medical academia, the pharmaceutical and device manufacturing industries, all of which contribute heavily to re-election campaigns of members of Congress. The problem is that we do not have a government that is free of influence of vested interests. Alas, [it] is a general problem of our society—which clearly unbalances democracy.
Can you offer an opinion about how the FDA can be so mortally wrong about so many drugs?
Yes, it cannot divest itself from vested interests. (Again, [there is] a large literature about this, mostly unrecognized by the people because the industry-supported media give it no attention.
Would it be correct to say that, when your JAMA study was published in 2000, it caused a momentary stir and was thereafter ignored by the medical community and by pharmaceutical companies?
Are you sure it was a momentary stir? I still get at least one email a day asking for a reprint---ten years later! The problem is that its message is obscured by those that do not want any change in the US health care system.
Do medical schools in the US, and intern/residency programs in hospitals, offer significant "primary care" physician training and education?
NO. Some of the most prestigious medical teaching institutions do not even have family physician training programs [or] family medicine departments. The federal support for teaching institutions greatly favors specialist residencies, because it is calculated on the basis of hospital beds. [Dr. Starfield has done extensive research showing that family doctors, who deliver primary care—as opposed to armies of specialists—produce better outcomes for patients.]
Are you aware of any systematic efforts, since your 2000 JAMA study was published, to remedy the main categories of medically caused deaths in the US?
No systematic efforts; however, there have been a lot of studies. Most of them indicate higher rates [of death] than I calculated.
What was your personal reaction when you reached the conclusion that the US medical system was the third leading cause of death in the US?
I had previously done studies on international comparisons and knew that there were serious deficits in the US health care system, most notably in lack of universal coverage and a very poor primary care infrastructure. So I wasn’t surprised.
Has anyone from the FDA, since 2000, contacted you about the statistical findings in your JAMA paper?
NO. Please remember that the problem is not only that some drugs are dangerous but that many drugs are overused or inappropriately used. The US public does not seem to recognize that inappropriate care is dangerous---more does not mean better. The problem is NOT mainly with the FDA but with population expectations.
… Some drugs are downright dangerous; they may be prescribed according to regulations but they are dangerous.
Concerning the national health plan before Congress—if the bill is passed, and it is business as usual after that, and medical care continues to be delivered in the same fashion, isn’t it logical to assume that the 225,000 deaths per year will rise?
Probably---but the balance is not clear. Certainly, those who are not insured now and will get help with financing will probably be marginally better off overall.
Did your 2000 JAMA study sail through peer review, or was there some opposition to publishing it?
It was rejected by the first journal that I sent it to, on the grounds that ‘it would not be interesting to readers’!
Do the 106,000 deaths from medical drugs only involve drugs prescribed to patients in hospitals, or does this statistic also cover people prescribed drugs who are not in-patients in hospitals?
I tried to include everything in my estimates. Since the commentary was written, many more dangerous drugs have been added to the marketplace.
106,000 people die as a result of CORRECTLY prescribed medicines. I believe that was your point in your 2000 study. Overuse of a drug or inappropriate use of a drug would not fall under the category of "correctly prescribed." Therefore, people who die after "overuse" or "inappropriate use" would be IN ADDITION TO the 106,000 and would fall into another or other categories.
‘Appropriate’ means that it is not counter to regulations. That does not mean that the drugs do not have adverse effects.
Some comments from the interviewer:
I’m aware there are reports, outside the mainstream, which conclude far more than 225,000 people in the US die every year as a result of medical treatment. For example, see the work of Carolyn Dean, Trueman Tuck, Gary Null, Martin Feldman, Debora Rasio, Dorothy Smith.
This interview with Dr. Starfield reveals that, even when an author has unassailable credentials within the medical-research establishment, the findings can result in no changes made to the system.
Yes, many persons and organizations within the medical system contribute to the annual death totals of patients, and media silence and public ignorance are certainly major factors, but the FDA is the assigned gatekeeper, when it comes to the safety of medical drugs. The buck stops there. If those drugs the FDA is certifying as safe are killing, like clockwork, 106,000 people a year, the Agency must be held accountable. The American people must understand that.
As for the other 119,000 people killed every year as a result of hospital treatment, this horror has to be laid at the doors of those institutions. Further, to the degree that hospitals are regulated and financed by state and federal governments, the relevant health agencies assume culpability.
It is astounding, as well, that the US Department of Justice has failed to weigh in on Starfield’s findings. If 225,000 medically caused deaths per year is not a crime by the Dept. of Justice’s standards, then what is?
To my knowledge, not one person in America has been fired from a job or even censured as result of these medically caused deaths.
Dr. Starfield’s findings have been available for nine years. She has changed the perception of the medical landscape forever. In a half-sane nation, she would be accorded a degree of recognition that would, by comparison, make the considerable list of her awards pale. And significant and swift action would have been taken to punish the perpetrators of these crimes and reform the system from its foundations.
In these times, medical schools continue turning out a preponderance of specialists who then devote themselves to promoting the complexities of human illness and massive drug treatment. Whatever the shortcomings of family doctors, their tradition speaks to less treatment, more common sense, and a proper reliance on the immune systems of patients.
The pharmaceutical giants stand back and carve up the populace into “promising markets.” They seek new disease labels and new profits from more and more toxic drugs. They do whatever they can—legally or illegally—to influence doctors in their prescribing habits. Some drug studies which show negative results are buried. FDA panels are filled with doctors who have drug-company ties. Legislators are incessantly lobbied and supported with pharma campaign monies.
Nutrition, the cornerstone of good health, is ignored or devalued by most physicians. Meanwhile, the FDA continues to attack nutritional supplements, even though the overall safety record of these nutrients is good, whereas, once again, the medical drugs the FDA certifies as safe are killing 106,000 Americans per year.
Physicians are trained to pay exclusive homage to peer-reviewed published drug studies. These doctors unfailingly ignore the fact that, if medical drugs are killing a million Americans per decade, the studies on which those drugs are based must be fraudulent or, at the very least, massively incompetent. In other words, the whole literature is suspect, unreliable, and impenetrable.
At the same time, without evidence, doctors off-handedly tout their work with great confidence. Some years ago, a resident at a major New York hospital harangued me about the primacy of controlled studies. She boasted, in passing, that the hospital’s heart-bypass surgery team was considered the best in the city, and one of the best in the country. I asked her for a reference. Was her statement a combination of folk-wisdom and rumor, or was there a proper study that confirmed her opinion? A bit chagrined, she admitted it was hearsay. I was sure she would repeat her tune, however, many times.
Claiming evidence where there is none, and denying the evidence that the medical system does great harm, are apparently part of the weave of the modern Hippocratic Oath.