Journal of the American Medical Association (JAMA)

Dr. Barbara Starfield of the Johns Hopkins School of
Hygiene and Public Health describes 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 or discomfort. Third, the
estimates of death due to error are lower than those in the IOM report.

[Remember, only 60,000 Americans lost their life in the entire Vietnam war!- KSM]
(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, 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 post neonatal 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 as said if higher estimates are used,
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.
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 is 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 piritual wounding behind most chronic illness are also important clues
to aximizing health and reducing disease.

Related Articles:
Medical Mistakes Kill 100,000 per year
US Health Care System Most Expensive in the World
Author/Article Information
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).

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