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recalcitrant tunnel-vision and refusal to use available non-drug alternatives is absolutely inappropriate when the CDC is desper- ately trying to curb the nightmare of overuse of antibiotics. The CDC should also be called to task because it is only focusing on the overuse of antibiotics. There are similar nightmares for every class of drug being prescribed today. that response to therapy prolongs survival, an opinion which is based on a fallacy and which is not supported by clinical studies." Over a decade after Dr Abel's exhaustive review of chemotherapy, there seems to be no decrease in its use for advanced carcinoma. For example, when conventional chemotherapy and radiation have not worked to prevent metastases in breast cancer, high-dose chemotherapy (HDC) along with stem cell transplant (SCT) is the treatment of choice. However, in March 2000, results from the largest multi-centre randomised controlled trial conducted thus far showed that, compared to a prolonged course of monthly conventional-dose chemotherapy, HDC and SCT were of no benefit.” There was even a slightly lower survival rate for the HDC/SCT group. And the authors noted that serious adverse effects occurred more often in the HDC group than in the standard-dose group. There was one treatment-related death (within 100 days of therapy) in the HDC group, but none in the conventional chemotherapy group. The women in this trial were highly selected as having the best chance to respond. There is also no all-encompassing follow-up study like Dr Abel's that tells us if there is any improvement in cancer survival Statistics since 1989. Drugs Pollute Our Water Supply We have reached the point of saturation with prescription drugs. We have arrived at the point where every body of water tested contains measurable drug residues. We are inundated with drugs. The tons of antibiotics used in animal farming, which run off into the water table and surrounding bodies of water, are conferring antibiotic resistance to germs in sewage, and these germs are also found in our water supply. Flushed down our toilets are tons of drugs and drug metabolites that also find their way into our water supply. We have no idea what the long-term consequences of ingesting a mixture of drugs and drug- breakdown products will do to our health. It's another level of iatrogenic disease that we are unable to measure completely.” since | 989. Specific Drug latrogenesis: NSAIDs ; It's not just America that is In fact, we need to research plagued with iatrogenesis. A whether chemotherapy itself, survey of 1,072 French general instead of progression of the origi- practitioners (GPs) tested their nal disease, is responsible for sec- basic pharmacological knowledge ondary cancers. and practice in prescribing non- We continue to question why steroidal anti-inflammatory drugs It's not just America well-researched alternative cancer (NSAIDs). NSAIDs rank first L treatments aren't used. among commonly prescribed drugs that Is plagued for serious adverse reactions. The with iatrogenesis Drug Companies Fined results of the study suggested that GPs don't have adequate knowledge of these drugs and are unable to manage adverse reactions effectively. A cross-sectional survey of 125 patients attending speciality pain Periodically, a drug manufacturer is fined by the FDA when the abus- es are too glaring and impossible to cover up. The Washington Post [May 18, 2002] reported that the maker of Claritin, Schering—Plough Corporation, was to pay a US$500 clinics in South London found that possible iatrogenic factors million fine to the FDA for quality-control problems at four of its such as "over-investigation, inappropriate information and advice factories.” given to patients as well as misdiagnosis, over-treatment and The FDA tabulated infractions that included 90% or 125 of the inappropriate prescription of medication were common".” drugs the pharmco had made since 1998. Besides having to pay the fine, the company had to stop manufacturing 73 drugs or suf- Specific Drug latrogenesis: Cancer Chemotherapy fer another $175 million fine. The company's PR statements told In 1989 a German biostatistician, Ulrich Abel, PhD, after pub- another story, assuring consumers that they should still feel confi- lishing dozens of papers on cancer chemotherapy, wrote a mono- dent in its products. graph entitled "Chemotherapy of Advanced Epithelial Cancer". It The indictment came after the Public Citizen Health Research was later published in a shorter form in a peer-reviewed medical Group, led by Dr Sidney Wolfe, called for a criminal investigation journal [Biomed. Pharmacother. 46(10), 1992].” of Schering-Plough, charging that the company distributed Dr Abel presented a comprehensive analysis of clinical trials albuterol asthma inhalers even though it knew the units were and publications representing over 3,000 articles examining the missing the active ingredient. value of cytotoxic chemotherapy on advanced epithelial cancer. Such a large settlement against Schering—Plough serves as a Epithelial cancer is the type of cancer we are most familiar with; warning to the drug industry to maintain strict manufacturing it arises from epithelium found in the lining of body organs such _ practices, and it has given the FDA more clout in dealing with as breast, prostate, lung, stomach or bowel. From these sites, can- drug company compliance. cer usually infiltrates into adjacent tissue and spreads to bone, According to the Washington Post article, a Federal Appeals liver, lung or the brain. Court ruled in 1999 that the FDA could seize the profits of From his exhaustive review, Dr Abel concluded there is no companies that violate "good manufacturing practices". direct evidence that chemotherapy prolongs survival in patients Since that time, Abbott Laboratories, Inc. has paid $100 million with advanced carcinoma. He said that in small-cell lung cancer _ for failing to meet quality standards in the production of medical and perhaps ovarian cancer, the therapeutic benefit is only slight. test kits. In 2000, Wyeth Laboratories, Inc. paid $30 million to Dr Abel went on to say: "Many oncologists take it for granted settle accusations of poor manufacturing practices. It's not just America that is plagued with iatrogenesis. Specific Drug latrogenesis: Cancer Chemotherapy In 1989 a German biostatistician, Ulrich Abel, PhD, after pub- lishing dozens of papers on cancer chemotherapy, wrote a mono- graph entitled "Chemotherapy of Advanced Epithelial Cancer". It was later published in a shorter form in a peer-reviewed medical journal [Biomed. Pharmacother. 46(10), 1992].” Dr Abel presented a comprehensive analysis of clinical trials and publications representing over 3,000 articles examining the value of cytotoxic chemotherapy on advanced epithelial cancer. Epithelial cancer is the type of cancer we are most familiar with; it arises from epithelium found in the lining of body organs such as breast, prostate, lung, stomach or bowel. From these sites, can- cer usually infiltrates into adjacent tissue and spreads to bone, liver, lung or the brain. From his exhaustive review, Dr Abel concluded there is no direct evidence that chemotherapy prolongs survival in patients with advanced carcinoma. He said that in small-cell lung cancer and perhaps ovarian cancer, the therapeutic benefit is only slight. Dr Abel went on to say: "Many oncologists take it for granted NEXUS = 33 OCTOBER — NOVEMBER 2004 www.nexusmagazine.com