Doctors Are The 3rd Leading Cause of Death in the US, Causing 225,000
Deaths Every Year

In July of 2000 there was a great article in the Journal of the
American Medical Association (JAMA) , one of the best articles ever
written in the published literature documenting the tragedy of the
traditional medical paradigm.

This information was published in JAMA which is the most widely
circulated medical periodical in the world.

The author of the article 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 medical mistakes and poor
health.

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

This is a total of 225,000 deaths per year from a physician's
activity, manner, or therapy.

Dr. Starfield reminds us to keep the following in mind when
interpreting these numbers:

1st, most of the data are derived from studies in hospitalized
patients.
2nd, these estimates are for deaths only and do not include negative
effects that are associated with disability or discomfort.
3rd, the estimates of death due to error are lower than those in the
IOM report.1
If the higher estimates are used, the deaths would range from 230,000
to 284,000. In any case, 225,000 deaths per year constitutes the 3rd
leading cause of death in the United States, after deaths from heart
disease and cancer. Even if these figures are an overestimate, 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 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 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.

According to one study(2), an estimated 44,000 to 98,000 among them
die each year as a result of medical errors.

This situation might be tolerated if it resulted in better health, but
does it? Of 13 countries in a recent comparison,(3,4) the U. S. ranks
an average of 12th (one up from the bottom) for 16 available health
indicators. More specifically, the ranking of the United States on
several indicators was:

13th (last) for low-birth-weight percentages
13th for neonatal mortality and infant mortality overall (14)
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 U.
S. as 15th among 25 industrialized countries.

Lack of technology is certainly not a contributing factor to the
United States 's low ranking.

Among 29 countries, the United States is 2nd only to Japan in the
availability of computed tomography (CT) scanners and magnetic
resonance imaging (MRI) units per million population. (17)

Japan, however, ranks highest on health whereas the United States
ranks among the lowest.

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

If this information is surprising to you, you can find out more about
the medical establishment in the United States and how public
relations firms shape and manipulate the public's beliefs on the "Why
you believe what you believe" page.

References
1. Schuster M, McGlynn E, Brook R. How good is the quality of health
care in the United States?
Milbank Q. 1998;76:517-563.

2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human:
Building a Safer Health System. Washington, DC: National Academy
Press; 1999.

3. Starfield B. Primary Care: Balancing Health Needs, Services, and
Technology. New York, NY: Oxford University Press; 1998.

4. World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm.
Accessed June 28, 2000.

5. Kunst A. Cross-national Comparisons of Socioeconomic Differences in
Mortality. Rotterdam, the Netherlands: Erasmus University; 1997.

6. Law M, Wald N. Why heart disease mortality is low in France: the
time lag explanation. BMJ. 1999;313:1471-1480.

7. Starfield B. Evaluating the State Children's Health Insurance
Program: critical considerations.
Annu Rev Public Health. 2000;21:569-585.

8. Leape L.Unecessarsary surgery. Annu Rev Public Health.
1992;13:363-383.

9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-
error deaths between 1983 and 1993. Lancet. 1998;351:643-644.

10. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug
reactions in hospitalized patients. JAMA. 1998;279:1200-1205.

11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and
medical error. BMJ. 2000;320:774-777.

12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality.
London, England: Routledge; 1996.

13. Evans R, Roos N. What is right about the Canadian health system?
Milbank Q. 1999;77:393-399.

14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D.
Annual summary of vital statistics1998. Pediatrics.
1999;104:1229-1246.

15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and
outcomes of care for generalists and specialists. J Gen Intern Med.
1999;14:499-511.

16. Donahoe MT. Comparing generalist and specialty care:
discrepancies, deficiencies, and excesses. Arch Intern Med.
1998;158:1596-1607.

17. Anderson G, Poullier J-P. Health Spending, Access, and Outcomes:
Trends in Industrialized Countries. New York, NY: The Commonwealth
Fund; 1999.

18. Mold J, Stein H. The cascade effect in the clinical care of
patients. N Engl J Med. 1986;314:512-514.

19. Shi L, Starfield B. Income inequality, primary care, and health
indicators. J Fam Pract.1999;48:275-284.

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© 2002 by Marc Leduc

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