Death by Medicine

[Barbarannamated]

DEATH BY MEDICINE

Life Extension Magazine, March 2004

By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD

 

http://www.lef.org/magazine/mag2004/mar2004_awsi_death_03.htm

 

 

ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED (p.3)

 

An article in Psychiatric Times (April 2000) outlines the stakes involved in reporting medical errors. (26) The authors found that the public is fearful of suffering a fatal medical error, and doctors are afraid they will be sued if they report an error. This brings up the obvious question: who is reporting medical errors? Usually it is the patient or the patient's surviving family. If no one notices the error, it is never reported. Janet Heinrich, an associate director at the U.S. General Accounting Office responsible for health financing and public health issues, testified before a House subcommittee hearing on medical errors that "the full magnitude of their threat to the American public is unknown” and "gathering valid and useful information about adverse events is extremely difficult." She acknowledged that the fear of being blamed, and the potential for legal liability, played key roles in the underreporting of errors. The Psychiatric Times noted that the AMA strongly opposes mandatory reporting of medical errors. (26) If doctors are not reporting, what about nurses? A survey of nurses found that they also fail to report medical mistakes for fear of retaliation. (27)

 

Standard medical pharmacology texts admit that relatively few doctors ever report adverse drug reactions to the FDA. (28) The reasons range from not knowing such a reporting system exists to fear of being sued. (29) Yet the public depends on this tremendously flawed system of voluntary reporting by doctors to know whether a drug or a medical intervention is harmful.

 

Pharmacology texts also will tell doctors how hard it is to separate drug side effects from disease symptoms. Treatment failure is most often attributed to the disease and not the drug or doctor. Doctors are warned, “Probably nogwhere else in professional life are mistakes so easily hidden, even from ourselves.” (30) It may be hard to accept, but it is not difficult to understand why only 1 in 20 side effects is reported to either hospital administrators or the FDA. (31, 31a)

 

If hospitals admitted to the actual number of errors for which they are responsible, which is about 20 times what is reported, they would come under intense scrutiny. (32) Jerry Phillips, associate director of the FDA's Office of Post Marketing Drug Risk Assessment, confirms this number. “In the broader area of adverse drug reaction data, the 250,000 reports received annually probably represent only 5% of the actual reactions that occur.” (33) Dr. Jay Cohen, who has extensively researched adverse drug reactions, notes that because only 5% of adverse drug reactions are reported, there are in fact 5 million medication reactions each year. (34)

 

A 2003 survey is all the more distressing because there seems to be no improvement in error reporting, even with all the attention given to this topic. Dr. Dorothea Wild surveyed medical residents at a community hospital in Connecticut and found that only half were aware that the hospital had a medical error-reporting system, and that the vast majority did not use it at all. Dr. Wild says this does not bode well for the future. If doctors don't learn error reporting in their training, they will never use it. Wild adds that error reporting is the first step in locating the gaps in the medical system and fixing them. Not even that first step has been taken to date. (35)

 

OUTPATIENT IATROGENESIS (p. 5)

 

In a 2000 JAMA article, Dr. Barbara Starfield presents well-documented facts that are both shocking and unassailable. (12) The U.S. ranks 12th of 13 industrialized countries when judged by 16 health status indicators. Japan, Sweden, and Canada were first, second, and third, respectively. More than 40 million people in the US have no health insurance, and 20-30% of patients receive contraindicated care.

 

Starfield warns that one cause of medical mistakes is overuse of technology, which may create a "cascade effect" leading to still more treatment.

 

*She urges the use of ICD (International Classification of Diseases) codes that have designations such as "Drugs, Medicinal, and Biological Substances Causing Adverse Effects in Therapeutic Use" and "Complications of Surgical and Medical Care" to help doctors quantify and recognize the magnitude of the medical error problem. Starfield notes that many deaths attributable to medical error today are likely to be coded to indicate some other cause of death. She concludes that against the backdrop of our poor health report card compared to other Westernized countries, we should recognize that the harmful effects of health care interventions account for a substantial proportion of our excess deaths.

 

Starfield cites Weingart's 2000 article, “Epidemiology of Medical Error,” as well as other authors to suggest that between 4% and 18% of consecutive patients in outpatient settings suffer an iatrogenic event leading to:

 

1. 116 million extra physician visits

2. 77 million extra prescriptions filled

3. 17 million emergency department visits

4. 8 million hospitalizations

5. 3 million long-term admissions

6. 199,000 additional deaths

7. $77 billion in extra costs (112)

[Altostrata]

Very interesting. Thanks, Barb.

[Skyler]

Good reading.