ALLENTOWN, Pa. — Federal prosecutors have ratcheted up their pursuit of two former Pennsylvania judges accused of taking $2.8 million in kickbacks to place youth offenders in private detention centers.
[. . . ]
The indictment accused Ciavarella and Conahan of extorting kickbacks from the former co-owner of PA Child Care LLC and its sister facility, Western PA Child Care.
Conahan shut down Luzerne County’s existing juvenile detention facility in 2002, saying it was unsafe. In 2004, the county entered a 20-year, $58 million agreement with PA Child Care to lease its new Pittston Township facility.
The indictment said that Ciavarella, as juvenile court judge, sent youths to PA Child Care and later to its sister facility while he was accepting payments. To keep the prison beds full, Ciavarella routinely deprived young defendants of their right to counsel, ordered juveniles into detention even when probation officers didn’t recommend it, and pressured probation officials to change their recommendations, the indictment said.
[ . . . ]
Former PA Child Care owner Robert Powell, a lawyer, pleaded guilty July 1 to paying kickbacks to the judges. Prominent construction company owner Robert K. Mericle, who built the detention centers, pleaded guilty earlier this month to a charge of withholding information on a crime.
Former Pa. judges indicted in kids-for-cash scheme
By MICHAEL RUBINKAM, AP
3 hours ago
(from Associated Press)
[And, there’s the US health care system / prison for private profit / mental health and “behavioral” health modification systems / pharmaceutical based cooperation cocktails for behavior modification systems at work as it has been for the last thirty years – and they want to make that more pervasive, rather than less, rather than fixing it, rather than making it right? Apparently.]
My Note –
I listened to the President and the Congressional address about health care last night at least three times to hear it all. I listened to it carefully and it is obvious that both the President and the Legislature are overstepping the bounds of their authority. But, apparently –
They plan to extort a required tax against every living, breathing citizen of the United States, exempting illegal immigrants of course who gets to keep all of the money they make here. And, that tax will be put into the profit glut of every insurance company in America – that’s what it means to require every citizen to have health insurance. It denies the freedom of choice, it is unfair taxation going into private hands, it is illegal and it will require each and every citizen, business and child born into this country to pay to be alive in the United States of America.
At the same time, doctors and hospitals and pharmaceutical companies will be exempt from accountability when their all too typical malpractice occurs. And yet, we all must be registered with some health care insurance provider and pay each month for each member of our families, our children, ourselves and our businesses to be covered by their services without recourse, simply because we are alive and citizens of the United States. They may as well have just taken 50% of everyone’s income off the top in the first place and provided something in return for it. That would be less than the percentage we are paying now, to get virtually nothing but corruption and Nazi Germany style oppressions and tyrannies across virtually every state and every administration regardless of political party.
It seemed a little off to me that, the people in politics whose funding comes directly from the big insurance companies, health industries and pharmaceutical companies, would be pursuing “health care reform.” Well, now it is obvious that there is no reform in it. The only pursuit they have been making is to charge a tax per head extorted from the freedoms of our citizenship here in order to line the pockets of their campaign contributors.
Now, when any person gives birth to a child in the United States of America, they will be registered and stamped for citizenship with a required registration to a health insurance provider which will legally require those parents and that individual to pay to those insurance revenue streams for every day that they are alive in the United States of America or elsewhere as long as their membership as a citizen of the US is maintained.
And, there will be no recourse against a health system, doctors and industries that have been pervasively known for causing more harm than good on a regular basis, so consistently, in fact as to be unimaginable. Every day across America, health care industry professionals cause harms which were preventable and inexcusable. Nothing in this bill fixes that. The members of Congress and the Administration have no intention of fixing that.
Apparently, their only intention was to jeopardize our freedoms, our rights, our inalienable rights, our basis of freedom and our basis of citizenship. Also, apparently they don’t like the limitations of their power guaranteed by the Constitution to prevent their overstepping the bounds of that oath of office they took. It certainly overstepped those bounds when they decided to impose a privately profitable “tax” called “health care insurance” on every citizen and every business by virtue of their existence.
And then, it begs the question – just as with auto insurance which is required of every vehicle and driver but is no more than a tax on the right to drive in a world that demands personal transportation in order to work, to have a business, or to make a living – what happens when people don’t have the money to continue paying those health insurance premiums? Then do they lose the right of citizenship in the United States, despite being born here, taken the oath of citizenship here, being a consummated and valuable member of the citizens of the United States and despite being guaranteed that citizenship by the Constitution?
Will that be done in the same way the car insurance companies send license and personal information to the State Office of No Insurance to legally dismiss our drivers’ license, as is done now? Will they take away the rights to our own children and to our own citizenship, beyond what they’ve already been doing in that arena through health and human services / social services, simply because they are born without the required registrations and payments to the health insurance industries and we failed to “sign them up for it” and remit those payments to them?
How about this – what if we directly and immediately take to task those insurance companies as we should’ve done in the first place. They are the ones who have driven up the costs of health care beyond all measure. They are the ones who have tolerated shoddy health services, malpractice, incompetence, dispassionately destroyed the health of people for profit motives, paid themselves like kings and lobbied to get out of any accountability to the public and their customers. They are the ones that need to be changed. We sure don’t need to keep paying them to continue slaughtering us. They’ve done enough damage for several lifetimes and now they intend to further that profit machine to serve their own interests to an even greater and more oppressive extent. They are inherently evil – why give them even one more dime to use to do more damage?
– cricketdiane, 09-10-09
And, oh by the way, they plan on robbing over $500 Billion dollars from the social security system, Medicare and Medicaid funds that we have all paid into the government trusts for it, under the guise of this “health care reform.” That isn’t their money and is not free money, but every time they can find an excuse to get their hands on it – even paying the interest on the national debt out of it – there they go without anyone saying a word. And they are doing it again. It was written into the first bill and it will be found in the second one that will come to vote. Neither Congress nor the office of the President has any right given to them by the Constitution and by our laws, to levy a tax against every citizen for the right to be alive. And neither do they have the power offered to them which legislates health care to every person under their jurisdiction. It denies the fundamental rights and freedoms we are guaranteed.
Looking at how easily those judges in the story above, denied the rights and opportunities of those who were to be protected by them and did so with no more conscience about right and wrong than their insatiable desire for money could offer, I am horrified at the thought that more of that kind of power would be put into the hands of judges, insurance companies, government agency officials, states, health care businesses, prison for profit businesses, mental health agencies and industries or pharmaceutical companies / lawyers / academics / legislatures / state agencies / health and human services / hospitals / or in fact, anybody.
For the same reason that Congress could not legislate the salaries or bonuses of bankers and financiers, nor could limit or restrict them legally – they also cannot legally legislate health care. It is outside the authority of the President and the Congress, which constitutes a taking and assuming powers that do not legally belong to them. Anything they do in that process by exceeding their bounds of authority and doing it in that way will contest the foundation of authority they have been granted and break the validity of the legal and consensual premise of that authority.
It is a shame that so many shed their blood and gave their lives to insure our democracy, freedoms, individual rights and noble ideals when the real enemies of those tenets were in our businesses and seated in our own government all along, both of whom were so quick to disregard them, and found it painlessly easy to disavow the importance of those core foundations, then undermine them as a possibility guaranteed to everyone or, in fact, to anyone.
Medical malpractice cases from one law firm – these aren’t small negligence cases that are being pursued – it is obscene how far the health care system and health care industries have strayed away from offering health –
- Sued Woodstock Residence Nursing Home on behalf of one patient who died as the possible result of a morphine overdose. The Illinois Department of Public Health found six mysterious deaths at the home and two employess face criminal charges. 
- $3 million awarded on behalf of woman who choked to death at a nursing home when her trachea tube got clogged. 
- $7.62 million verdict against an HMO doctor who ignored a mother’s complaints of postpartum bleeding, resulting in her bleeding to death.
- $10 million settlement on behalf of a 5-year-old boy who, while playing in an open fire hydrant, was struck by a City of Chicago Fire Department truck and ultimately lost his leg and half of his pelvis.
- $14 million verdict on behalf of a patient who’s diagnosis of lung cancer was delayed after doctors ignored abnormal chest x-ray results. 
A 2004 study of medical malpractice claims in the United States examining primary care malpractice found that though incidence of negligence in hospitals produced a greater proportion of severe outcomes, the total number of errors and deaths due to errors were greater for outpatient settings. No single medical condition was associated with more than five percent of all negligence claims, and one-third of all claims were the result of misdiagnosis.
A recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors. Researchers examined 37 million patient records and applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a study published in the Journal of the American Medical Association (JAMA) in October 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. Some researchers questioned the accuracy of the 1999 IOM study, reporting both significant subjectivity in determining which deaths were “avoidable” or due to medical error and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in JAMA estimated that only 1 in 10,000 patients admitted to the hospital would have lived for 3 months or more had “optimal” care been provided.
A 2006 follow-up to the 1999 Institute of Medicine study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates. In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million – and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.
From Wikipedia, the free encyclopedia
Medical malpractice is professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. Standards and regulations for medical malpractice vary by country and jurisdiction within countries.
From Wikipedia, the free encyclopedia
Medical error is an inaccurate or incomplete diagnosis and/or treatment of a disease; injury; syndrome; behavior; infection or other ailment.
In the U.S., medical errors are estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. One older extrapolation suggests ‘180,000 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days’. It is estimated that in a typical 100 to 300 bed hospital in the United States, excess costs of $1,000,000 to $3,000,000 attributable to prolonged stays and complications just due to medication errors occur yearly.
However, medical error definitions are subject to debate, as there are many types of medical error from minor to major, and causality is often poorly determined. The Health Grades study statistics, based on AHRQ MedPAR data, were based on administrative records, not clinical records, and largely overlooked multi-causality of outcomes.
Medical care is frequently compared adversely to aviation: while many of the factors which lead to errors in both fields are similar, aviation’s error management protocols are regarded as much more effective.
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents, breast cancer, or AIDS–three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.
In 2000, The Institute of Medicine released “To Err Is Human”, which asserts that the problem in medical errors is not bad people in health care–it is that good people are working in bad systems that need to be made safer.
Examples of errors
- Giving the wrong drug or (wrong patient, wrong chemical, wrong dose, wrong time, wrong route);
- Giving two or more drugs that interact unfavorably or cause poisonous metabolic byproducts;
- Wrong-site surgery, such as amputating the wrong limb.
- Gossypiboma, a surgical sponge left behind inside the patient after surgery.
[ . . . ]
[from above wikipedia entry link]
From Wikipedia, the free encyclopedia
Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient.
The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Iatrogenesis is not restricted to conventional medicine and can also result from complementary and alternative medicine treatments.
Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some are less obvious and can require significant investigation to identify, such as complex drug interactions. And, some conditions have been described for which it is unknown, unproven or even controversial whether they be iatrogenic or not; this has been encountered particularly with regard to various psychological and chronic pain conditions. Research in these areas is ongoing.
Causes of iatrogenesis include medical error, negligence, and the adverse effects or interactions of prescription drugs. In the United States, from 120,000 to 225,000 deaths per year may be attributed in some part to iatrogenesis.
In his 1861 book, Semmelweis presented evidence to demonstrate that the advent of pathological anatomy in Vienna in 1823 (left vertical line) was correlated to the incidence of fatal childbed fever there. Onset of chlorine handwash in 1847 marked by vertical line at far right. Rates for Dublin maternity hospital, which had no pathological anatomy, is shown for comparison (view rates).
Etymologically, the term means “brought forth by a healer” (iatros means healer in Greek); as such, in its earlier forms, it could refer to good or bad effects.
Since the time of Hippocrates, the potential damaging effect of a healer’s actions has been recognized. The old mandate “first do no harm” (primum non nocere) is an important clause of medical ethics, and iatrogenic illness or death caused purposefully, or by avoidable error or negligence on the healer’s part became a punishable offense in many civilizations.
The transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever at maternity institutions in the 1800s, was a major iatrogenic catastrophe of that time. The infection mechanism was first identified by Ignaz Semmelweis.
With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death would be more easily avoided. Antiseptics, anesthesia, antibiotics, and better surgical techniques have been developed to decrease iatrogenic mortality.
Sources of iatrogenesis
Examples of iatrogenesis:
Causes and Consequences
Medical error and negligence
Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic; for example, radiation therapy or chemotherapy, due to the needed aggressiveness of the therapeutic agents, frequent effects are hair loss, anemia, vomiting, nausea, brain damage etc. The loss of functions resulting from the required removal of a diseased organ is also considered iatrogenesis, e.g., iatrogenic diabetes brought on by removal of all or part of the pancreas.
In other situations, actual negligence or faulty procedures are involved, such as when drug prescriptions are handwritten by the pharmacotherapist. It has been proven that poor handwriting can lead a pharmacist to dispense the wrong drug, worsening a patient’s condition.
A very common iatrogenic effect is caused by drug interaction, i.e., when pharmacotherapists fail to check for all medications a patient is taking and prescribe new ones which interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect). Significant morbidity and mortality is caused because of this. Adverse reactions, such as allergic reactions to drugs, even when unexpected by pharmacotherapists, are also classified as iatrogenic.
The evolution of antibiotic resistance in bacteria is iatrogenic as well.Finland M (1979). “Emergence of antibiotic resistance in hospitals, 1935-1975”. Rev. Infect. Dis. 1 (1): 4–22. PMID 45521. Bacteria strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.
Certain drugs are toxic in their own right in therapeutic doses because of their mechanism of action. Alkylating antineoplastic agents, for example, cause DNA damage, which is more harmful to cancer cells than regular cells. However, alkylation causes severe side effects and is actually carcinogenic in its own right, potentially leading to the development of secondary tumors. Similarly arsenic-based medications like melarsoprol for trypanosomiasis cause arsenic poisoning.
A related term is nosocomial, which refers to an iatrogenic illness due to or acquired during hospital care, such as an infection. Sometimes, hospital staff can be unwitting transmitters of nosocomial infections (in one of such instances, many hospitals have forbidden physicians to wear long ties, because they transmitted bacteria from bed to bed when the doctor swept the tie over the patients when bending over them). The most common iatrogenic illness in this realm, however, are nosocomial infections caused by unclean or inadequately sterilized hypodermic needles, surgical instruments, and the use of ungloved hands to perform medical or dental procedures. For example, a number of hepatitis B and C infections caused by dentists and surgeons on their patients have been documented. One of the most horrid cases of massive death caused in recent times by iatrogenic infection has been reported on several bush hospitals in Zaire and Sudan, where the intensive reuse of poorly sterilized syringes and needles by nurses spread the Ebola virus, probably causing hundreds of deaths. 
In psychology, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy).
Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder, dissociative identity disorder, fibromyalgia, somatoform disorder, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, antisocial youths and others though research is equivocal for each condition. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial.
The over-diagnosis of psychological conditions is due to clinical dependence upon subjective criteria. The assignment of pathological nomenclature is rarely a benign process and can easily rise to the level of emotional iatrogenesis, especially when no alternatives outside of the diagnostic naming process have been considered.
Medical treatment does not only have an effect on the mind and body of patients but also on their wallet. Meessen et al used the term “Iatrogenic Poverty” to describe impoverishment induced by medical care. Impoverishment is described for households exposed to catastrophic health expenditure or to hardship financing. Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. Especially in countries in economic transition, the willingness to pay for health care is increasing and the supply side does not stay behind and develops very fast. But, the regulatory and protective capacity in those countries is often lagging behind. Patients easily fall in a vicious circle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets and eventually poverty.
Incidence and importance
Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten were considered major, and in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications. In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.
In the United State alone, recorded deaths per year (2000):
- 12,000—unnecessary surgery
- 7,000—medication errors in hospitals
- 20,000—other errors in hospitals
- 80,000—infections in hospitals
- 106,000—non-error, negative effects of drugs
Based on these figures, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Also, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).
This totals 225,000 deaths per year from iatrogenic causes. In interpreting these numbers, note the following:
- most data were derived from studies in hospitalized patients.
- the estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
- the estimates of death due to error are lower than those in the IOM report. If higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.
- ^ a b Starfield B (2000). “Is US health really the best in the world?”. JAMA 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID 10904513.
- ^ Fisher-Hoch SP (2005). “Lessons from nosocomial viral haemorrhagic fever outbreaks”. Br. Med. Bull. 73-74: 123–37. doi:10.1093/bmb/ldh054. PMID 16373655.
- ^ a b Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective. American Psychological Association (APA). ISBN 1-55798-340-2.
- ^ Pruett Jr, John R.; Luby, Joan L. (2004). “Recent Advances in Prepubertal Mood Disorders: Phenomenology and Treatment“. Curr Opin Psychiatry 17 (1): 31–36. doi:10.1097/00001504-200401000-00006. http://www.medscape.com/viewarticle/466375_print. Retrieved 2008-05-04.
- ^ Braun, B.G. (1989). Dissociation: Vol. 2, No. 2, p. 066-069: Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD (Morose Parasitic Dynamism). https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1425/1/Diss_2_2_3_OCR.pdf. Retrieved 2008-05-04.
- ^ Hadler, N.M. (1997). “Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients?“. Postgrad Med 102 (6): 43. http://www.ncbi.nlm.nih.gov/pubmed/9270707. Retrieved 2008-05-04.
- ^ a b Abbey, S.E. (1993). “Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome“. Ciba Found Symp 173: 238–52. http://www.ncbi.nlm.nih.gov/pubmed/8491101. Retrieved 2008-05-04.
- ^ Boscarino, JA (2004). Evaluation of the Iatrogenic Effects of Studying Persons Recently Exposed to a Mass Urban Disaster. http://mailer.fsu.edu/~cfigley/IatrogenicEffectsfinal3p1.pdf. Retrieved 2008-05-04.
- ^ Moos, R.H. (2005). “Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence , predictors, prevention” (abstract). Addiction 100 (5): 595–604. doi:10.1111/j.1360-0443.2005.01073.x. http://pt.wkhealth.com/pt/re/addi/abstract.00008514-200505000-00006.htm;jsessionid=LpCb6sF6cx1sMvkMlc5h62MCCWh1Gj5vyLBz0ydpfn36tl31Y8Kn!1379360954!181195629!8091!-1.
- ^ Weiss, B.; Caron, A.; Ball, S.; Tapp, J.; Johnson, M.; Weisz, J.R. (2005). “Iatrogenic effects of group treatment for antisocial youths“. Journal of Consulting and Clinical Psychology 73 (6): 1036–1044. doi:10.1037/0022-006X.73.6.1036. http://eric.ed.gov:80/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ734173&ERICExtSearch_SearchType_0=no&accno=EJ734173. Retrieved 2008-05-04.
- ^ Kouyanou, K; Pither, CE; Wessely, S (01 Nov 1997). “Iatrogenic factors and chronic pain” (abstract). Psychosomatic Medicine 59 (6): 597–604. PMID 9407578. http://www.psychosomaticmedicine.org/cgi/content/abstract/59/6/597. Retrieved 2008-05-04.
- ^ Meessen,B., Zhenzhong,Z., Van Damme,W., Devadasan,N., Criel,B., Bloom,G. (2003). “Iatrogenic poverty.”. Tropical Medicine & International Health 8 (7): 581-4.
- ^ Xu et al. (2007). “Protecting Households from Catastrophic Health Spending”. Health Affairs 26 (4): 972-83. doi:10.1377/hlthaff.26.4.972.
- ^ Kruk et al. (2009). “Borrowing And Selling To Pay For Health Care In Low- And Middle-Income Countries”. Health Affairs 28 (4): 10056-66. doi:10.1377/hlthaff.28.4.1056.
- ^ Steel K, Gertman PM, Crescenzi C, Anderson J (1981). “Iatrogenic illness on a general medical service at a university hospital”. N. Engl. J. Med. 304 (11): 638–42. PMID 7453741.
- ^ Weingart SN, Ship AN, Aronson MD (2000). “Confidential clinician-reported surveillance of adverse events among medical inpatients”. J Gen Intern Med 15 (7): 470–7. doi:10.1046/j.1525-1497.2000.06269.x. PMID 10940133.
- Valenstein, Elliot S. (1986). Great and desperate cures: the rise and decline of psychosurgery and other radical treatments for mental illness. New York: Basic Books. ISBN 0465027105.
My Note –
In medical journals and other statistical analysis portals / academics / study / dissemination – the terms can be Iatrogenesis, as above, or medical error, or pharmaceutical error or who knows how many other things. It seems to be divided up rather than placed in the same category by the same terms where an overview of the problem and of the pervasiveness of the problems would be self-evident.
Adverse drug reaction
From Wikipedia, the free encyclopedia
An adverse drug reaction (abbreviated ADR) is an expression that describes harm associated with the use of given medications at a normal dose. The meaning of this expression differs from the meaning of “side effect”, as this last expression might also imply that the effects can be beneficial. The study of ADRs is the concern of the field known as pharmacovigilance.
ADRs may be classified by e.g. cause and severity.
- Type A: Augmented pharmacologic effects – dose dependent and predictable
- Type B: Bizarre effects (or idiosyncratic) – dose independent and unpredictable
- Type C: Chronic effects
- Type D: Delayed effects
- Type E: End-of-treatment effects
- Type F: Failure of therapy
Types A and B were proposed in the 1970s, and the other types were proposed subsequently when the first two proved insufficient to classify ADRs.
 Seriousness and Severity
The American Food and Drug Administration defines a serious adverse event as one when the patient outcome is one of the following:
- Hospitalization (initial or prolonged)
- Disability – significant, persistent, or permanent change, impairment, damage or disruption in the patient’s body function/structure, physical activities or quality of life.
- Congenital Anomaly
- Requires Intervention to Prevent Permanent Impairment or Damage
Severity is a point on an arbitrary scale of intensity of the adverse event in question. The terms “severe” and “serious” when applied to adverse events are technically very different. They are easily confused but can not be used interchangeably, require care in usage.
A headache is severe, if it causes intense pain. There are scales like “visual analog scale” that help us assess the severity. On the other hand, a headache can hardly ever be serious, unless it also satisfies the criteria for seriousness listed above.
 Overall Drug Risk
While no official scale exists yet to communicate overall drug risk, the iGuard Drug Risk Rating System is a five color rating scale similar to the Homeland Security Advisory System:
- Red (High Risk)
- Orange (Elevated Risk)
- Yellow (Guarded Risk)
- Blue (General Risk)
- Green (Low Risk)
Adverse effects may be local, i.e. limited to a certain location, or systemic, where a medication has caused adverse effects throughout the systemic circulation.
For instance, some ocular antihypertensives cause systemic effects, although they are administered locally as eye drops, since a fraction escapes to the systemic circulation.
As research better explains the biochemistry of drug use, fewer ADRs are Type B and more are Type A. Common mechanisms are:
- Abnormal pharmacokinetics due to
- Synergistic effects between either
- a drug and a disease
- two drugs
Interactions with other drugs
The risk of drug interactions is increased with polypharmacy.
Comorbid disease states
Various diseases, especially those that cause renal or hepatic insufficiency, may alter drug metabolism. Resources are available that report changes in a drug’s metabolism due to disease states.
Abnormal drug metabolism may be due to inherited factors of either Phase I oxidation or Phase II conjugation. Pharmacogenomics is the study of the inherited basis for abnormal drug reactions.
Many countries have official bodies that monitor drug safety and reactions. On an international level, the WHO runs the Uppsala Monitoring Centre, and the European Union runs the European Medicines Agency (EMEA). In the United States, the Food and Drug Administration (FDA) is responsible for monitoring post-marketing studies.
Examples of adverse effects associated with specific medications
- Abortion, miscarriage or uterine hemorrhage associated with misoprostol (Cytotec), a labor-inducing drug (this is a case where the adverse effect has been used legally and illegally for performing abortions)
- Addiction to many sedatives and analgesics such as diazepam, morphine, etc.
- Birth defects associated with Thalidomide and Accutane.
- Bleeding of the intestine associated with aspirin therapy
- Cardiovascular disease associated with COX-2 inhibitors (i.e. Vioxx)
- Deafness and kidney failure associated with gentamicin (an antibiotic)
- Death, following sedation in children using propofol (Diprivan)
- Dementia associated with heart bypass surgery
- Depression or hepatic injury caused by interferon
- Diabetes caused by atypical antipsychotic medications (neuroleptic psychiatric drugs)
- Diarrhea caused by the use of orlistat (Xenical)
- Erectile dysfunction associated with many drugs, such as antidepressants
- Fever associated with vaccination (in the past, imperfectly manufactured vaccines, such as BCG and poliomyelitis, have caused the very disease they intended to fight).
- Glaucoma associated with corticosteroid-based eye drops
- Hair loss and anemia may be caused by chemotherapy against cancer, leukemia, etc.
- Headache following spinal anesthesia
- Hypertension in ephedrine users, which prompted FDA to remove the status of dietary supplement of ephedra extracts
- Insomnia caused by stimulants, Ritalin, Adderall, etc.
- Lactic acidosis associated with the use of stavudine (Zerit, for anti-HIV therapy) or metformin (for diabetes)
- Liver damage from paracetamol
- Melasma and thrombosis associated with use of estrogen-containing hormonal contraception such as the combined oral contraceptive pill
- Irreversible Peripheral neuropathy associated with the use of fluoroquinolone medications 
- Rhabdomyolysis associated with statins (anti-cholesterol drugs)
- Seizures caused by withdrawal from benzodiazepine
- Drowsiness or increase in appetite due to antihistamine use. Some antihistamines are used in sleep aids explicitly because they cause drowsiness.
- Stroke or heart attack associated with sildenafil (Viagra) when used with nitroglycerine
- Suicide, increased tendency associated to the use of fluoxetine and other SSRI antidepressants
- Tardive dyskinesia associated with long-term use of metoclopramide and many antipsychotic medications
- Spontaneous Tendon rupture associated with fluoroquinolone drugs  even occurring as late as 6 months after treatment had been terminated.
My Note – so how is this possible?
A recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors. Researchers examined 37 million patient records and applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a study published in the Journal of the American Medical Association (JAMA) in October 2003.
The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. Some researchers questioned the accuracy of the 1999 IOM study, reporting both significant subjectivity in determining which deaths were “avoidable” or due to medical error and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in JAMA estimated that only 1 in 10,000 patients admitted to the hospital would have lived for 3 months or more had “optimal” care been provided.
A 2006 follow-up to the 1999 Institute of Medicine study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates.
In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million – and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.
Medical Errors Costing U.S. Billions
Wednesday, April 9, 2008; 12:00 AM
TUESDAY, April 8 (HealthDay News) — From 2004 through 2006, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the Medicare program $8.8 billion, according to the fifth annual Patient Safety in American Hospitals Study.
Of the 270,491 deaths that occurred among patients who experienced one or more patient safety incidents, 238,337 were potentially preventable, the researchers said.If all hospitals performed at the level of the top-ranked hospitals, about 220,106 patient safety incidents and 37,214 patient deaths could have been avoided, and about $2 billion could have been saved.
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Starting Oct. 1, the federal Centers for Medicare and Medicaid Services will stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain kinds of post-surgical infections.
My Note –
The health care reform being legislated currently only includes preventing people from suing doctors, hospitals, pharmaceuticals and to legally require every citizen to have health insurance which amounts to a tax per head levied and extorted from every American in order to exist anywhere in this country. Not only is it not going to solve the health care crisis in this country, it will continue to contribute to the problems we already endure and allow them to get worse. Medicine and profits are not compatible by any sensibilities of conscience and good health.
– cricketdiane, 09-13-09