Doctors Are The Third Leading Cause of Death in the US, Causing 225,000 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 followed up 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
describes how the US health care system may contribute
to poor health.

ALL THESE ARE DEATHS PER YEAR:

* 12,000 -- unnecessary surgery
* 7,000 -- medication errors in hospitals
* 20,000 -- other errors in hospitals
* 80,000 -- infections in hospitals
* 106,000 -- non-error, negative effects of drugs

These total to 225,000 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.

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 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.

This might be tolerated if it resulted in better
health, but does it? Of 13 countries in a recent
comparison, 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
* 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.
* 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.

References:

Journal American Medical Association
July 26, 2000;284(4):483-5

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).