Doctors Are The
Third Leading Cause of Death in the US, Causing
250,000 Deaths Every Year
This article in the Journal
of the American Medical Association (JAMA) is the best article I have
ever seen written in the published literature documenting the tragedy of
the traditional medical paradigm.
If you want to keep updated
on issues like this
click here to sign up for my free newsletter.
This information is a
followup of the
Institute of Medicine report which hit the papers in December of
last year, but the data was hard to reference as it was not in
peer-reviewed journal. Now it is published in JAMA which is the most
widely circulated medical periodical in the world.
The author is Dr. Barbara
Starfield of the Johns Hopkins School of Hygiene and Public Health and
she desribes how the US health care system may contribute to poor
health.
ALL THESE ARE DEATHS PER
YEAR:
- 12,000
-----unnecessary surgery
8
- 7,000 -----medication
errors in hospitals
9
- 20,000 ----other
errors in hospitals
10
- 80,000 ----infections
in hospitals
10
-
106,000 ---non-error, negative effects of drugs
2
These total to
250,000 deaths per year from iatrogenic
causes!!
What does the word
iatrogenic mean? This term is defined as induced in a patient by a
physician's activity, manner, or therapy. Used especially of a
complication of treatment.
Dr. Starfield offers
several warnings in interpreting these numbers:
- First, most of the data
are derived from studies in hospitalized patients.
- Second, these estimates
are for deaths only and do not include negative effects that are
associated with disability or discomfort.
- Third, the estimates of
death due to error are lower than those in the IOM report.1
If the higher estimates are
used, the deaths due to iatrogenic causes would range from 230,000 to
284,000. In any case, 225,000 deaths per year constitutes the third
leading cause of death in the United States, after deaths from heart
disease and cancer. Even if these figures are overestimated, there is a
wide margin between these numbers of deaths and the next leading cause
of death (cerebrovascular disease).
Another analysis
11 concluded that between 4% and 18% of consecutive patients
experience negative effects in outpatient settings,with:
- 116 million extra
physician visits
- 77 million extra
prescriptions
- 17 million emergency
department visits
- 8 million
hospitalizations
- 3 million long-term
admissions
- 199,000 additional
deaths
- $77 billion in extra
costs
The high cost of the health
care system is considered to be a deficit, but seems to be tolerated
under the assumption that better health results from more expensive
care.
However, evidence from a
few studies indicates that as many as 20% to 30% of patients receive
inappropriate care.
An estimated 44,000 to
98,000 among them die each year as a result of medical errors.2
This might be tolerated if
it resulted in better health, but does it? Of 13 countries in a recent
comparison,3,4
the United States ranks an average of 12th (second from the bottom) for
16 available health indicators. More specifically, the ranking of the US
on several indicators was:
- 13th (last) for
low-birth-weight percentages
- 13th for neonatal
mortality and infant mortality overall
14
- 11th for postneonatal
mortality
- 13th for years of
potential life lost (excluding external causes)
- 11th for life expectancy
at 1 year for females, 12th for males
- 10th for life expectancy
at 15 years for females, 12th for males
- 10th for life expectancy
at 40 years for females, 9th for males
- 7th for life expectancy
at 65 years for females, 7th for males
- 3rd for life expectancy
at 80 years for females, 3rd for males
- 10th for age-adjusted
mortality
The poor performance of the
US was recently confirmed by a World Health Organization study, which
used different data and ranked the United States as 15th among 25
industrialized countries.
There is a perception that
the American public "behaves badly" by smoking, drinking, and
perpetrating violence." However the data does not support this
assertion.
- The proportion of
females who smoke ranges from 14% in Japan to 41% in Denmark; in the
United States, it is 24% (fifth best). For males, the range is from
26% in Sweden to 61% in Japan; it is 28% in the United States (third
best).
- The US ranks fifth best
for alcoholic beverage consumption.
- The US has relatively
low consumption of animal fats (fifth lowest in men aged 55-64 years
in 20 industrialized countries) and the third lowest mean cholesterol
concentrations among men aged 50 to 70 years among 13 industrialized
countries.
These estimates of death
due to error are lower than those in a recent Institutes of Medicine
report, and if the higher estimates are used, the deaths due to
iatrogenic causes would range from 230,000 to 284,000.
Even at the lower estimate
of 225,000 deaths per year, this constitutes the third leading cause of
death in the US, following heart disease and cancer.
Lack of technology is
certainly not a contributing factor to the US's low ranking.
- Among 29 countries, the
United States is second only to Japan in the availability of magnetic
resonance imaging units and computed tomography scanners per million
population. 17
- Japan, however, ranks
highest on health, whereas the US ranks among the lowest.
- It is possible that the
high use of technology in Japan is limited to diagnostic technology
not matched by high rates of treatment, whereas in the US, high use of
diagnostic technology may be linked to more treatment.
- Supporting this
possibility are data showing that the number of employees per bed
(full-time equivalents) in the United States is highest among the
countries ranked, whereas they are very low in Japan, far lower than
can be accounted for by the common practice of having family members
rather than hospital staff provide the amenities of hospital care.
Journal American Medical Association Vol 284 July 26, 2000
COMMENT: Folks, this is
what they call a "Landmark Article". Only several ones like this are
published every year. One of the major reasons it is so huge as that it
is published in JAMA which is the largest and one of the most respected
medical journals in the entire world. I did find it most curious that
the best wire service in the world, Reuter's, did not pick up this
article. I have no idea why they let it slip by.
I would encourage you to
bookmark this article and review it several times so you can use the
statistics to counter the arguments of your friends and relatives who
are so enthralled with the traditional medical paradigm. These
statistics prove very clearly that the system is just not working. It is
broken and is in desperate need of repair.
I was previously fond of
saying that drugs are the fourth leading cause of death in this country.
However, this article makes it quite clear that the more powerful number
is that doctors are the third leading cause of death in this country
killing nearly a quarter million people a year. The only more common
causes are cancer and heart disease. This statistic is likely to be
seriously underestimated as much of the coding only describes the cause
of organ failure and does not address iatrogenic causes at all.
Japan seems to have
benefited from recognizing that technology is wonderful, but just
because you diagnose something with it, one should not be committed to
undergoing treatment in the traditional paradigm. Their health
statistics reflect this aspect of their philosophy as much of their
treatment is not treatment at all, but loving care rendered in the home.
Care, not treatment, is
the answer. Drugs, surgery and hospitals are rarely the answer to
chronic health problems. Facilitating the God-given healing capacity
that all of us have is the key. Improving the
diet, exercise, and lifestyle are basic. Effective interventions for
the underlying emotional and spiritual wounding behind most chronic
illness are also important clues to maximizing health and reducing
disease.
Related Articles:
Medical Mistakes Kill 100,000 per year
US
Health Care System Most Expensive in the World
Drug Induced Disorders
Author/Article
Information
Author Affiliation:
Department of Health Policy and Management, Johns Hopkins School of
Hygiene and Public Health, Baltimore, Md. Corresponding Author and
Reprints: Barbara Starfield, MD, MPH, Department of Health Policy and
Management, Johns Hopkins School of Hygiene and Public Health, 624 N
Broadway, Room 452, Baltimore, MD 21205-1996 (e-mail:
bstarfie@jhsph.edu).
REFERENCES
1. Schuster M,
McGlynn E, Brook R. How good is the quality of health care in the United
States?
Milbank Q. 1998;76:517-563.
2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human:
Building a Safer Health System. Washington, DC: National Academy Press;
1999.
3. Starfield B.
Primary Care: Balancing Health Needs, Services, and Technology. New
York, NY: Oxford University Press; 1998.
4. World Health
Report 2000. Available at:
http://www.who.int/whr/2000/en/report.htm. Accessed June 28, 2000.
5. Kunst A.
Cross-national Comparisons of Socioeconomic Differences in Mortality.
Rotterdam, the Netherlands: Erasmus University; 1997.
6. Law M, Wald N.
Why heart disease mortality is low in France: the time lag explanation.
BMJ. 1999;313:1471-1480.
7. Starfield B.
Evaluating the State Children's Health Insurance Program: critical
considerations.
Annu Rev Public Health. 2000;21:569-585.
8. Leape
L.Unecessarsary surgery.
Annu Rev Public Health. 1992;13:363-383.
9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-error
deaths between 1983 and 1993.
Lancet. 1998;351:643-644.
10. Lazarou J,
Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized
patients.
JAMA. 1998;279:1200-1205.
11. Weingart SN,
Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error.
BMJ. 2000;320:774-777.
12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality.
London, England: Routledge; 1996.
13. Evans R, Roos
N. What is right about the Canadian health system?
Milbank Q. 1999;77:393-399.
14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D.
Annual summary of vital statistics1998.
Pediatrics. 1999;104:1229-1246.
15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and
outcomes of care for generalists and specialists.
J Gen Intern Med. 1999;14:499-511.
16. Donahoe MT. Comparing generalist and specialty care: discrepancies,
deficiencies, and excesses.
Arch Intern Med. 1998;158:1596-1607.
17. Anderson G,
Poullier J-P. Health Spending, Access, and Outcomes: Trends in
Industrialized Countries. New York, NY: The Commonwealth Fund; 1999.
18. Mold J, Stein
H. The cascade effect in the clinical care of patients.
N Engl J Med. 1986;314:512-514.
19. Shi L, Starfield B. Income inequality, primary care, and health
indicators.
J Fam Pract.
1999;48:275-284.
|
