Iatrogenic Disease: The 3rd Most Fatal Disease in the USA
Iatrogenic Disease is defined as a disease that is caused by medical treatment.
Read major headlines around the globe on this serious disease.
How Prepared are You to Not Become a National Statistic?
If a Jumbo Jet crashed and killed 280 people everyday... 365 days a year... year after year... would you be concerned about flying??
Would you question the Federal Aviation Administration? Would you demand answers??
Think about it!
Close to 100,000 people dying every year from plane crashes?
Well think again. What if you were told that over 100,000 people are killed and over 2 million people maimed and disabled every year...year after year from modern medicine...would you believe it??
Well these may be my words...but read the following articles from the most respected medical journals and institutions (Journal of the American Medical Association, Harvard University, Centers for Disease Control, British medical journal The Lancet, New England Journal of Medicine and national news (New York Times, Washington Post, CNN, US World Report) and you be the judge.
Writing in the Journal of the American Medical Association (JAMA), Dr. Starfield has documented the tragedy of the traditional medical paradigm in the following statistics:
* The term iatrogenic is defined as "induced in a patient by a physician's activity, manner, or therapy. Used especially to pertain to a complication of treatment." Furthermore, these estimates of death due to error are lower than those in a recent Institutes of Medicine report.
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 U.S.
Dr. Starfield offers several caveats in the interpretations of 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 the many 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 (cerebro-vascular disease).
Another analysis concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings, with:
The high cost of the health care system is considered to be a deficit, but it 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 these patients die each year as a result of medical errors.
This might be tolerable if it resulted in better health, but does it?
Out 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 U.S. on several indicators was:
The poor performance of the U.S. was recently confirmed by a World Health Organization study which used different data and ranked the United States as 15th among 25 industrialized countries.
It has been known that drugs are the fourth leading cause of death in the U.S.
This makes it clear that the more frightening number is that doctors are the third leading cause of death in this country, killing nearly a quarter million people a year.
These statistics are further confused because most medical coding only describes the cause of organ failure and does not identify iatrogenic causes at all.
In their study, Leape and his colleagues examined patient records at hospitals throughout the state of New York. Their 1991 report found that one of every 200 patients admitted to a hospital died as a result of a hospital error.
That number of deaths is the equivalent of what would occur if a jumbo jet crashed every day; it is three times the 43,000 people killed each year in U.S. automobile accidents.
"It's by far the number one problem" in health care, said Leape, an adjunct professor of health policy at the Harvard School of Public Health.
Researchers such as Leape say that not only are medical errors not reported to the public, but those reported to hospital authorities represent roughly 5 to 10 percent of the number of actual medical mistakes at a typical hospital.
"The bottom line is we have a system that is terribly out of control," said Robert Brook, a professor of medicine at the University of California at Los Angeles.
"It's really a joke to worry about the occasional plane that goes down when we have thousands of people who are killed in hospitals every year." Brook's recognition of the extent of hospital errors is shared by many of medicine's leaders.
Care -- not treatment -- is the answer. Drugs, surgery and hospitals become increasingly dangerous for chronic disease cases. Facilitating the God-given healing capacity by improving the diet, exercise, and lifestyle is the key.
Effective interventions for the underlying emotional and spiritual wounding behind most chronic disease is critical for the reinvention of our medical paradigm. These numbers suggest that reinvention of our medical paradigm is called for.
The 220-page report, written by a 19-member committee of the Academy's Institute of Medicine, set as a goal a 50 percent reduction in the nation's "stunningly high rate of medical errors" within five years.
It estimated that errors from medical treatment kill up to 98,000 people in U.S. hospitals every year and characterized the problem as among the nation's leading causes of death and injury.
Several members of the committee said in interviews yesterday that the report was intended as a loud call to action for the health-care industry, which it said has not acted swiftly enough to address the causes of errors.
"What it says is 'enough already,' " said Lucian Leape, a committee member and adjunct professor of health policy at the Harvard School of Public Health. "It's a matter of holding people's feet to the fire and stop talking about errors and start doing something."
Based on a recent report by the Institute of Medicine, which estimates 36 error-related hospital deaths per 100,000 people, 3,534 Michiganians died last year due to medical mistakes.
Patients reported 2,027 complaints about health care organizations to the state, but Tom Lindsay, director of the Michigan Bureau of Health Services, said those likely represent just a fraction of the mistakes.
The NEW YORK TIMES reported that 5% of people admitted to hospitals, or about 1.8 million people per year, in the U.S. pick up an infection while there. Such infections are called "iatrogenic" -- meaning "induced by a physician," or, more loosely, "caused by medical care."
Iatrogenic infections are directly responsible for 20,000 deaths among hospital patients in the U.S. each year, and they contribute to an additional 70,000 deaths, according to the federal Centers for Disease Control CDC). The dollar cost of iatrogenic infections is $4.5 billion, according to the CDC.
A new poll from the nonprofit National Patient Safety Foundation (NPSF) finds that 42 percent of people say they've been affected by physician errors, either directly or through a friend or relative.
If the survey of roughly 1,500 people accurately represents the general public, it could mean that more than 100 million Americans have experience with medical mistakes.
More alarming, according to the survey, is the fact that in one out of three cases the error permanently harmed the patient's health.
Dr. Leape is a board member of the NPSF, which was founded by the American Medical Association in June of this year to improve health care safety.
AMA leaders say it's time to bring the issue out into the open, rather than living in constant fear that any admission of error will launch a flood of malpractice lawsuits.
Leape's own research has shown that the tally of medical mistakes made each year could reach 3 million, with total costs as high as $200 billion.
The survey found that 40 percent of the people who had experienced a medical mistake pointed to misdiagnoses and wrong treatments as the problem. Medication errors accounted for 28 percent of mistakes.
And 22 percent of respondents reported slip-ups during medical procedures.
Half of the errors occurred in hospitals, and 22 percent in doctors' offices.
What Causes Errors
When asked what may have caused their doctors to make such errors, patients cited carelessness, stress, faulty training and bad communication.
Three out of four believe the best solution to the problem would be to bar health care workers with bad track records.
But Leape disagreed, arguing that punishment simply encourages people to cover up their errors. "We need to shift emphasis away from individuals," he said. "Errors are not the disease, they're the symptoms of the disease."
Instead, he said, poorly designed health care systems may be largely to blame. Doctors and nurses often work double shifts, making them more prone to error. And in this age of computer technology, Leape noted, the hand-written drug prescription should be a relic of the past.
Experts say medical mistakes occur all the time, and doctors often fail to tell patients about them. A recent report estimates that up to 98,000 patients a year die from medical errors.
About 1,200 people died in public hospitals in Britain last year because of mistakes in prescribing and administering medicine, according to a report published by a government watchdog group.
Outlined in a report by the Audit Commission, the errors included administering the wrong medicine - in one case, a breast cancer patient was given the sleeping drug Temazepam instead of the cancer drug Tamoxifen - to giving out the wrong dosage of the right drug, to unknowingly prescribing a drug that caused a fatal reaction.
The death toll was five times higher than that in 1990, according to the report. In addition, the thousands of patients who survive medicine-related mistakes each year invariably become sicker, requiring more treatment that create an extra expense for the National Health Service, the report said.
"The health service is probably spending $725 million a year making better people who experienced an adverse incident or errors, and that does not include the human cost to patients," said Nick Mapstone, an author of the report.
"The number of drugs is increasing, the effectiveness - and therefore often the toxicity - of drugs is increasing, the number of people on multiple medications is increasing, and that increases the risk of interaction," Dr. Pickersgill told the BBC.
A number of highly publicized cases of drug-related error in recent months has brought home the problem. In one case, a cancer patient was prescribed and administered a drug at 1,000 times the recommended dose, according to the report.
In another case, at Queen's Medical Center in Nottingham, a teenager, who was a cancer patient in remission, fell into a coma and died after an anticancer drug was mistakenly injected into his spine.
"The recent events at Queen's Medical Center illustrate how day-to- day pressures can lead to acknowledged best practice being ignored," the report said.
Jackie Glatter, a spokeswoman for the Consumers' Association, which lobbies for patients' rights, said: "The report shows there is a strong need for detailed and clear patient information about treatments and medicines - not just in hospitals, but also when people are taking medicine at home."
The study by a research team at the University of California at San Diego found that the sharpest increase in deaths was among outpatients.
Deaths from accidental poisoning by drugs and other medicines climbed from 851 to nearly 2,100. Of those, outpatient deaths increased from under 200 to just under 1,500.
By 1993, outpatients were 6.5 times more likely to die from medication mistakes than inpatients.
The report was based on death certificates, and it was unclear whether the deaths were caused by a medical professional's error or patient error.
Such reactions -- which do not include prescribing errors or drug abuse -- rank at least sixth among causes of death in the United States, behind heart disease, cancer, lung disease, strokes and accidents, according to a report published in this week's Journal of the American Medical Association. The report was based on an analysis of existing studies.
"Serious adverse drug reactions are frequent ... more so than generally recognized," the researchers said.
Researchers at the University of Toronto examined 39 studies and estimated that an average of 106,000 deaths at U.S. hospitals in 1994 were due to bad reactions to drugs.
For years, the American Medical Association, hospitals, medical magazines and various other health care groups have been beating the drums for more gun laws.
And some of us have pointed out their chutzpah, since -- according to the official figures, the National Center for Health Statistics, more than twice as many are killed every year in medical accidents than in gun accidents.
Yesterday, an independent report from the Institute of Medicine, an arm of the National Academy of Sciences, said the number of deaths from medical mistakes every year may total 98,000 -- about three times the number of deaths due to accidents, homicides and suicides with firearms.
The study says medical mistakes may cost the nation as much as $29 billion a year and may be the fifth highest cause of death -- behind heart disease, cancer, stroke and lung obstructive lung diseases.
That 98,000 total is over twice as many as die in auto crashes each year.
Overwhelmed and inadequately trained nurses kill and injure thousands of patients every year as hospitals sacrifice safety for an improved bottom line, a Tribune investigation has found.
Since 1995, at least 1,720 hospital patients have been accidentally killed and 9,584 others injured from the actions or inaction of registered nurses across the country, who have seen their daily routine radically altered by cuts in staff and other belt-tightening in U.S. hospitals.
Medical error is the third most frequent cause of death in Britain after cancer and heart disease, killing up to 40,000 people a year - about four times more than die from all other types of accident.
Provisional research figures on hospital mistakes show that a further 280,000 people suffer from non-fatal drug-prescribing errors, overdoses and infections.
The victims spend an average of six extra days recovering in hospital, at an annual cost of £730m in England alone.
A pilot study investigating the issue - the first attempt to measure the problem in Britain - shows that one in 14 patients suffers some kind of adverse event such as diagnostic error, operation mistake or drug reaction.
Charles Vincent, head of the clinical risk unit at University College London, who is leading the study, has pioneered efforts to examine the extent of clinical errors in Britain.
His team has so far concentrated on two London hospitals. The first data from one hospital showed that 32 out of 480 patients in four different departments were victims of hospital mistakes.
Vincent's estimate of 40,000 deaths comes from studies showing that 3-4% of patients in the developed world suffer some kind of harm in hospital. For 70% of them the resulting disability is short-lived, but 14% subsequently die.
"It is a substantial problem," Vincent said. "There is a need to find out the true extent of error, what kind of things are going wrong and the cost." He believes the death rate may be even higher than indicated by the preliminary figures.
Britain's death rate is comparable to that in America, where recommendations in a report produced by the Kellogg Foundation three weeks ago are likely to result in the creation of a new federal agency to protect patients from medical error.
The report drew on studies that examined the records of 30,195 patients and found a 3.7% error rate. Of those injured, 14% died. Researchers concluded that 70% of the errors - and 155,000 deaths - were avoidable.
Department of Health officials are now examining a proposal for a £1.2m three-year national study of 20 hospitals and 10,000 medical records to establish exactly how these avoidable deaths occur and how to prevent them.
In a recent emailed response to the British Medical Journal (BMJ), Ron Law, Executive Director of the NNFA, in New Zealand and member of the New Zealand Ministry of Health Working Group advising on medical error, offered some enlightening information on deaths caused by drugs and medical errors.
He notes the prevalence of deaths from medical errors and also from properly researched and prescribed medications in Australia and New Zealand, which serves as a reminder to us that the US is not alone in having this problem.
He cites the following statistics and facts:
Official Australian government reports reveal that preventable medical error in hospitals is responsible for 11% of all deaths in Australia, which is about 1 of every 9 deaths.
If deaths from properly researched, properly registered, properly prescribed and properly used drugs were added along with preventable deaths due to private practice it comes to a staggering 19%, which is almost 1 of every 5 deaths.
New Zealand figures are very similar. According to Mr. Law:
Put another way, the equivalent of New Zealand's second largest city (Christchurch) has been killed by preventable medical error and deaths from properly researched, properly registered, properly prescribed and properly used drugs in Australasia in the past decade and its biggest city Auckland either killed or permanently maimed.
Put another way, more than 5 million people have been killed by Western medical practice in the past decade (Europe, USA, Canada, Australia, and NZ) and 20 million killed or permanently maimed. Sounds like a war zone, doesn't it?
Put another way, the economic impact of deaths due to preventable medical error and deaths from properly researched, properly registered, properly prescribed and properly used drugs is approximately $1 trillion over the past decade.
He notes that only 0.3% of these deaths are properly coded and classified in official statistics as being attributed to these causes.