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.
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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 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
- 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.
Mistakes Kill 100,000 per year
US Health Care
System Most Expensive in the World
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
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