The headline in The New York Times (Friday, Sept 21) “Reversing Trend, Life Span Shrinks for Some Whites,”reports that the life-span of uneducated, poor white women has regressed dramatically since 1990. “We’re used to looking at groups and complaining that their mortality rates haven’t improved fast enough, but to actually go backward is deeply troubling.”
The focus of this Infomail is America’s acute healthcare crisis that affects average Americans—not just the poor. Specifically, our focus is the critical safety issues that plague US healthcare which are neither acknowledged, much less, addressed by ObamaCare, its progenitor, RomneyCare, nor any healthcare overhaul proposal being kicked around in Washington. Those who formulate healthcare policy seem to be oblivious to the alarming decline in the performance of US healthcare when compared to the rest of the industrialized world.
Is their vision obscured by propaganda pronouncements? —i.e. “The United States has the best healthcare system in the world” Or do they pretend not to see the magnitude of harm produced by preventable hazards that are imbedded in America’s profit-driven healthcare system—as a defensive corporate political strategy whose goal is to maintain control?
The “see no evil…” monkey strategy has been coined “strategic ignorance” by a British sociologist. It has been used effectively by executives of major corporations, academic institutions, and government agencies—as a defense against wrongdoing in public hearings and litigation.
We have compiled a list of more than 100 current books by prominent physicians and knowledgeable academic and independent healthcare analysts who confront the real healthcare crisis from varying aspects. Not only are commercially-driven medical practices—such as over prescribing new, not better drugs, overuse of diagnostic radiology tests, and invasive interventions–bankrupting American taxpayers, the treatments are causing an epidemic of preventable, iatrogenic injury and death.
The following are inconvenient truths about US healthcare that are obscured from public awareness by stakeholders in the business of healthcare:
I. America’s healthcare crisis is demonstrable:
· America’s health ranking has plummeted compared to the industrialized nations of the world.
· Americans have the lowest life-span and highest infant mortality rate.
· Americans spend the most on healthcare—who benefits?
· Our commercially-driven healthcare system is harmful, wasteful, inefficient and costly—resulting in sacrifice of human lives.
· Fraud and conflict of interest undermines the integrity of medical research, FDA’s approval process, and the performance of healthcare institutions.
An analysis in the New England Journal of Medicine (2010):
“The big picture—the poor and declining performance of the United States, which goes far beyond the challenge of universal insurance —will inevitably get lost if we do not routinely track performance and compare the results both among countries and among states and counties within the United States.”
America has been falling behind the industrialized nations of the world on the two most important indicators of well-being and healthcare quality, namely; life expectancy and infant mortality.  
Life Expectancy: In 1975 the US ranked 3rd among other nations. In 2012 the US ranks 50th
Americans’ life expectancy is 78—compared to Japan (83.9); Singapore (83.7) Australia (81.9); Italy, Canada and France (81.5); Israel (81); Germany, UK, and Ireland (80).
A study by the Mailman School of Public Health, Columbia University  compared US life expectancy rates and per capita healthcare spending to 12 other rich countries—Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom. Their findings show that despite American’s extraordinary high expenditure for healthcare, the system is failing to provide Americans with comparable health benefits that citizens of other wealthy countries enjoy.
Peter Muennig, MD, the lead author stated: “It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them. But what really surprised us was that all of the usual suspects—smoking, obesity, traffic accidents, homicides, and racial and ethnic diversity are not the culprits.”
“The findings suggest that life expectancy rates are tied to challenges in the current U.S. health system itself—specifically, its reliance on unregulated fee-for-service and specialty care, and lack of care coordination—which may explain both rising costs and deteriorating relative life expectancy.” 
America’s infant mortality rate highest compared to other industrialized countries.  
Infant Mortality measured by the number of deaths per 1,000 live births:
In 1960 the US infant mortality rate ranked 12th among nations. But with each passing decade, as other nations’ infant mortality rates improved, the US infant mortality rate ranked less and less favorably compared to other industrial nations.
In 2012, the US ranks 49th among nations of the world6 with 6 infant deaths per 1,000 live births. According to the US Centers for Disease Control and Prevention (CDC, 2009) the US international ranking in infant mortality has been falling from 12th in 1960, to 23rd in 1990, to 29th in 2004, and 37th in 2005.
Another CDC report concludes: ‘‘The relative position of the United States in comparison to countries with the lowest infant mortality rates appears to be worsening.’’
A contributing factor to the high infant mortality rate is the high rate of premature births in the US—one in 8 compared with 1 in 18 in Ireland and Japan.
However, it is not the only factor. The CDC acknowledges that: “infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.” 
An insightful analysis by Dr. Starfield  specifically refuted a specious claim to explain America’s poor performance:
“The long existing poor ranking of the US with regard to infant mortality is not a result of the high percentage of low birth weight and infant mortality among the black population, because the international ranking hardly changes when data for the white population only are used.”
II. The third leading cause of death in the US is not a disease, but medical intervention which ranks after heart disease and cancer.
Although the Centers for Disease Control does not include iatrogenic (treatment caused) deaths in its list of leading causes of death tabulations, authoritative studies have estimated the number of deaths attributed to treatment in hospitalized patients.   The study by Barbara Starfield MD, of Johns Hopkins School of Public Health, was most perceptive and notable for identifying the specific causes of iatrogenic preventable annual deaths in US hospitals:
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.
Dr. Starfield’s findings are not disputed. Indeed, subsequent studies found the number of preventable deaths due to medical intervention to be higher.
The Institute of Medicine acknowledged (2001):
“Health care today harms too frequently and routinely fails to deliver its potential benefits. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. Yet there is strong evidence that this frequently is not the case…. Between the health care we have and the care we could have lies not just a gap, but a chasm… there is substantial evidence documenting overuse of many services—services for which the potential risk of harm outweighs the potential benefits…”
No one tracks the total annual deaths from hazardous or malfunctioning FDA-approved medical products. No one tracks the number of non-fatal, severely disabling injuries.
III. A Commercially Profitable, Wasteful, Inefficient and Exceedingly Harmful System:
The US healthcare budget FY-2010 was $2.3 Trillion. The three highest expenditures were: 31% for hospital care, 20% for physicians, and 10% for pharmaceutical drugs. Health analysts at the Kaiser Family Foundation note that “for several years, spending on prescription drugs and new medical technologies has been cited as a primary contributor to the increase in overall health spending.”
“The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation. The committee calculated that about 30 percent of health spending in 2009—roughly $750 billion—was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005…”
However, the IOM report fails to identify the specific industries that engaged in fraud, manipulated medical research and medical practice guidelines, and profited from costly unnecessary interventions that wasted resources. For example, the inordinate influence of the pharmaceutical industry has penetrated public, private, academic and government institutions, and has led to the adoption of medical practices and healthcare policies that have greatly enhance industry’s profit margins by sacrificing public safety. As will be discussed below, prescription drugs have attained the dubious distinction of being the fourth leading cause of death in the US. The worst offenders are drugs that have been aggressively marketed.
See, List of drugs recalled for safety issues from 1980-2011.
Dr. Starfield raised the concern US reliance on specialists rather than primary care physicians—which contrasted sharply with other countries—may be a factor contributing to America’s comparative poor ranking in overall health and survival. The following demonstrates how US medical treatment guidelines are determined by medical specialists whose self-interest may not coincide with patients’ medical need.
Medicare treatment guidelines are established by a powerful, little known group of medical specialists who are unaccountable to the public. Regulatory oversight for the Centers for Medicare and Medicaid (CMS)—including determination of physician reimbursement rates—is entrusted to one little-known panel of specialists of the American Medical Association—the Relative Value Scale Update Committee (RUC). Its influence is enormous: since 1991, the CMS accepted 94% of the 7,000 recommendations submitted by RUC. The RUC panel does not comply with transparency requirements under the Federal Advisory Committee Act—the membership is not disclosed and they vote by secret electronic ballot.
The RUC is clearly motivated by self- interest, as acknowledged by RUC‘s chairwoman, “We assume that everyone is inflating everything when they come in. They are wanting to fight for the best possible values for their specialties.”19 As a result, the CMS reimbursement scale favors use of high priced specialists who order prescribe costly, often unnecessary treatments that expose patients to increased risks without clinical benefit.
Congress can change this indefensible set-up—if they can wean themselves from Big Pharma.
Part I of IV.
See Part II: What Do We Get for All That Money?
 Muennig, PA and Glied, SA, “What Changes in Survival Rates Tell Us About US Health Care” Health Affairs, Vol. 29, No. 11 (October 7, 2010).
 McGoey, L The Logic of Strategic Ignorance, British Journal of Sociology, 2012, Vol. 63:533-76.
 A 1998 review estimated that more than 2.2 million hospitalized patients suffered an adverse drug reaction–of these 106,000 to 137,000 died. Lazarou J, Pomeranz BH, Corey PN. Incidence of Adverse Drug Reactions in Hospitalized Patients: a Meta-Analysis of Prospective Studies, JAMA, 1998.
 An example of wasted human resources: 4,700 people awaiting a kidney transplant died while 2,600 available kidneys were discarded because of systemic inefficiencies. See, Sack, K. In Discarding of Kidneys, System Reveals Its Flaws, New York Times, Sept. 19, 2012.
 See, Medicine Hijacked: Books That Document The Real Health Care Crisis; See also, Angell, M. Big Pharma, Bad Medicine: How Corporate Dollars Corrupt Research and Education. Boston Review June 2010; Union of Concerned Scientists. Science Integrity. FDA Managers Value Drug Maker Relations Over Patient Safety.
 Murray, CJ and Frenk J. Ranking 37th—Measuring the Performance of the U.S. Health Care System, NEJM, 362:98-99, January 14, 2010.
 Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine (IOM) 2001.
 Joe Eaton Little-Known AMA Group Has Big Influence On Medicare Payments, Center For Public Integrity, Oct 27, 2010. See also, Brian Klepper and Paul Fischer “The Most Important Health Care Group You’ve Never Heard Of,” Care and Cost. August 8, 2012
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