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). REFERENCES

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