Doctors Are The Third Leading Cause of Death in the US
Killing 225,000 People Every Year
The author is Dr. Barbara Starfield of the Johns Hopkins
School of Hygiene and Public Health and she desribes how the UShealth care system may contribute to poor health.
ALL THESE ARE DEATHS PER YEAR:
• 12,000 —
• 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
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
• First, most
of the data are derived from studies in hospitalized patients.
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
, 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
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
• 17 million
emergency department visits
• 8 million
• 3 million
• $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
ranks an average of 12th (second from
the bottom) for 16 available health indicators. More specifically, the ranking
of the US
several indicators was:
• 13th (last)
for low-birth-weight percentages
• 13th for
neonatal mortality and infant mortality overall
• 11th for
• 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
The poor performance of the US
was recently confirmed by a World Health Organization study, which used
different data and ranked the United Statesas 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.
proportion of females who smoke ranges from 14% in Japanto 41% in Denmark
in the United States
it is 24% (fifth best). For males, the range is from 26% in Swedento 61% in Japan
it is 28% in the United States(third best).
• The USranks 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
• Among 29
countries, the United Statesis second only to Japan
in the availability of magnetic resonance imaging units and computed tomography
scanners per million population. 17
however, ranks highest on health, whereas the USranks 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.
this possibility are data showing that the number of employees per bed
(full-time equivalents) in the United Statesis 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 July 26, 2000;284(4):483-5
**** Choose a Doctor
over the age of 50. That was the last
time medical school taught how to cure and prevent diseases. After that medical schools went to Managed
Care, meaning they treat a symptom, not a disease.
Health and Wellness Associates