Although the full original is easy enough found on line here is also a mirrored pdf of the article.
This page contains :
an introduction to the article by Jon Rappoport,
a summary by Kah Ying Choo
a 2009 interviewed of Dr. Starfield, again by Jon,
This page contains :
an introduction to the article by Jon Rappoport,
a summary by Kah Ying Choo
a 2009 interviewed of Dr. Starfield, again by Jon,
Introduction by Jon Rappoport.
On July 26, 2000, the US medical community received a titanic shock to the system, when one of its most respected and honored public-health experts, Dr. Barbara Starfield, revealed her findings on healthcare in America.
The landmark Starfield study, “Is US health really the best in the world?”, published in the Journal of the American Medical Association, came to the following conclusions:
Every year in the US there are:
This makes the medical system the third leading cause of death in the US, behind heart disease and cancer.
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.
The landmark Starfield study, “Is US health really the best in the world?”, published in the Journal of the American Medical Association, came to the following conclusions:
Every year in the US there are:
- 12,000 deaths from unnecessary surgeries;
- 7,000 deaths from medication errors in hospitals;
- 20,000 deaths from other errors in hospitals;
- 80,000 deaths from infections acquired in hospitals;
- 106,000 deaths from FDA-approved correctly prescribed medicines.
- The total of medically-caused deaths in the US every year is 225,000.
This makes the medical system the third leading cause of death in the US, behind heart disease and cancer.
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.
"Is US Health Really the Best in the World?"
Summary by Kah Ying Choo:
This Journal of the American Medical Association article illuminates the failure of the U.S. medical system in providing decent medical care for Americans.
In spite of the rising health care costs that provide the illusion ofimproving health care, the American people do not enjoy good health, compared with their counterparts in the industrialized nations. Among thirteen countries including Japan, Sweden, France and Canada, the U.S. was ranked 12th, based on the measurement of 16 health indicators such as life expectancy, low-birth-weight averages and infant mortality. In another comparison reported by the World Health Organization that used a different set of health indicators, the U.S. also fared poorly with a ranking of 15 among 25 industrialized nations.
Although many people attribute poor health to the bad habits of the American public, Starfield (2000) points out that the Americans do not lead an unhealthy lifestyle compared to their counterparts. For example, only 28 percent of the male population in the U.S. smoked, thus making it the third best nation in the category of smoking among the 13 industrialized nations. The U.S. population also achieved a high ranking (5th best) for alcohol consumption. In the category of men aged 50 to 70 years, the U.S. had the third lowest mean cholesterol concentrations among 13 industrialized nations. Therefore, the perception that the American public’s poor health is a result of their negative health habits is false.
Even more significantly, the medical system has played a large role inundermining the health of Americans. According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments.
Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.
One of the key problems of the U.S. health system is that as many as 40 million people in the U.S. do not have access to healthcare. The social and economic inequalities that are an integral part of American society are mirrored in the inequality of access to the health care system. Essentially, families of low socioeconomic status are cut off from receiving a decent level of health care. By citing these statistics, Starfield (2000) highlights the need to examine the type of health care provided to the U.S. population. The traditional medical paradigm that emphasizes the use of prescription medicine and medical treatment has not only failed to improve the health of Americans, but also led to the decline in the overall well-being of Americans.
Starfield’s (2000) comparison of the medical systems of Japan and the U.S. captures the fundamental differences in the treatment approach. Unlike the U.S., Japan has the healthiest population among the industrialized nations. Instead of relying on sophisticated technology and professional personnel for medical treatment as in the U.S., Japan uses its technology solely for diagnostic purposes. Furthermore, in Japan, family members, rather than hospital staff, are involved in caring for the patients.
The success of the Japanese medical system testifies to the dire need for Americans to alter their philosophical approach towards health and treatment. In the blind reliance on drugs, surgery, technology and medical establishments, the American medical system has inflicted more harm than good on the U.S. population. Starfield’s (2000) article is invaluable in unveiling the catastrophic effects of the medical treatments provided to the American people. In order to improve the medical system, American policymakers and the medical establishment need to adopt a comprehensive approach and critically examine the failure of the richest country in the world to provide decent health care for its people. (Original here)
In spite of the rising health care costs that provide the illusion ofimproving health care, the American people do not enjoy good health, compared with their counterparts in the industrialized nations. Among thirteen countries including Japan, Sweden, France and Canada, the U.S. was ranked 12th, based on the measurement of 16 health indicators such as life expectancy, low-birth-weight averages and infant mortality. In another comparison reported by the World Health Organization that used a different set of health indicators, the U.S. also fared poorly with a ranking of 15 among 25 industrialized nations.
Although many people attribute poor health to the bad habits of the American public, Starfield (2000) points out that the Americans do not lead an unhealthy lifestyle compared to their counterparts. For example, only 28 percent of the male population in the U.S. smoked, thus making it the third best nation in the category of smoking among the 13 industrialized nations. The U.S. population also achieved a high ranking (5th best) for alcohol consumption. In the category of men aged 50 to 70 years, the U.S. had the third lowest mean cholesterol concentrations among 13 industrialized nations. Therefore, the perception that the American public’s poor health is a result of their negative health habits is false.
Even more significantly, the medical system has played a large role inundermining the health of Americans. According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments.
- 12,000 deaths per year due to unnecessary surgery
- 7000 deaths per year due to medication errors in hospitals
- 20,000 deaths per year due to other errors in hospitals
- 80,000 deaths per year due to infections in hospitals
- 106,000 deaths per year due to negative effects of drugs
Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.
One of the key problems of the U.S. health system is that as many as 40 million people in the U.S. do not have access to healthcare. The social and economic inequalities that are an integral part of American society are mirrored in the inequality of access to the health care system. Essentially, families of low socioeconomic status are cut off from receiving a decent level of health care. By citing these statistics, Starfield (2000) highlights the need to examine the type of health care provided to the U.S. population. The traditional medical paradigm that emphasizes the use of prescription medicine and medical treatment has not only failed to improve the health of Americans, but also led to the decline in the overall well-being of Americans.
Starfield’s (2000) comparison of the medical systems of Japan and the U.S. captures the fundamental differences in the treatment approach. Unlike the U.S., Japan has the healthiest population among the industrialized nations. Instead of relying on sophisticated technology and professional personnel for medical treatment as in the U.S., Japan uses its technology solely for diagnostic purposes. Furthermore, in Japan, family members, rather than hospital staff, are involved in caring for the patients.
The success of the Japanese medical system testifies to the dire need for Americans to alter their philosophical approach towards health and treatment. In the blind reliance on drugs, surgery, technology and medical establishments, the American medical system has inflicted more harm than good on the U.S. population. Starfield’s (2000) article is invaluable in unveiling the catastrophic effects of the medical treatments provided to the American people. In order to improve the medical system, American policymakers and the medical establishment need to adopt a comprehensive approach and critically examine the failure of the richest country in the world to provide decent health care for its people. (Original here)
Jon Rappoport interview Dr. Starfield..
December 6-7, 2009 by email
JR. What has been the level and tenor of the response to your findings, since 2000?
BS. 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’.
JR. 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?
BS. 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.)
JR. Have health agencies of the federal government consulted with you on ways to mitigate the effects of the US medical system?
BS. NO.
JR. 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?
BS. 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.
JR. Aren’t your 2000 findings a severe indictment of the FDA and its standard practices?
BS. 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.
JR. Can you offer an opinion about how the FDA can be so mortally wrong about so many drugs?
BS. 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.
JR. 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?
BS. 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.
JR. Do medical schools in the US, and intern/residency programs in hospitals, offer significant “primary care” physician training and education?
BS. 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.]
JR. 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?
BS. No systematic efforts; however, there have been a lot of studies. Most of them indicate higher rates [of death] than I calculated.
JR. 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?
BS. 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.
JR. Has anyone from the FDA, since 2000, contacted you about the statistical findings in your JAMA paper?
BS. 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.
BS. … Some drugs are downright dangerous; they may be prescribed according to regulations but they are dangerous.
JR. 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?
BS. 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.
JR. Did your 2000 JAMA study sail through peer review, or was there some opposition to publishing it?
BS. It was rejected by the first journal that I sent it to, on the grounds that ‘it would not be interesting to readers’!
JR. 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?
BS. I tried to include everything in my estimates. Since the commentary was written, many more dangerous drugs have been added to the marketplace.
JR. 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.
BS. ‘Appropriate’ means that it is not counter to regulations. That does not mean that the drugs do not have adverse effects.
(original, here)
In Memory of Barbara Starfield
BS. 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’.
JR. 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?
BS. 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.)
JR. Have health agencies of the federal government consulted with you on ways to mitigate the effects of the US medical system?
BS. NO.
JR. 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?
BS. 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.
JR. Aren’t your 2000 findings a severe indictment of the FDA and its standard practices?
BS. 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.
JR. Can you offer an opinion about how the FDA can be so mortally wrong about so many drugs?
BS. 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.
JR. 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?
BS. 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.
JR. Do medical schools in the US, and intern/residency programs in hospitals, offer significant “primary care” physician training and education?
BS. 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.]
JR. 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?
BS. No systematic efforts; however, there have been a lot of studies. Most of them indicate higher rates [of death] than I calculated.
JR. 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?
BS. 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.
JR. Has anyone from the FDA, since 2000, contacted you about the statistical findings in your JAMA paper?
BS. 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.
BS. … Some drugs are downright dangerous; they may be prescribed according to regulations but they are dangerous.
JR. 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?
BS. 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.
JR. Did your 2000 JAMA study sail through peer review, or was there some opposition to publishing it?
BS. It was rejected by the first journal that I sent it to, on the grounds that ‘it would not be interesting to readers’!
JR. 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?
BS. I tried to include everything in my estimates. Since the commentary was written, many more dangerous drugs have been added to the marketplace.
JR. 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.
BS. ‘Appropriate’ means that it is not counter to regulations. That does not mean that the drugs do not have adverse effects.
(original, here)
In Memory of Barbara Starfield