Journal of the American Medical
Starfield of the Johns Hopkins School of
Hygiene and Public Health describes how the US health care
may contribute to poor health.
ALL THESE ARE DEATHS PER YEAR:
-----unnecessary surgery (8)
7,000 -----medication errors
in hospitals (9)
20,000 -----other errors in hospitals
80,000 -----infections in hospitals (10)
----non-error, negative effects of drugs (2)
to 250,000 deaths per year from iatrogenic causes!!
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
First, most of the data are derived from
studies in hospitalized patients.
Second, these estimates
are for deaths only and do not include negative
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
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
experience negative effects in outpatient settings, with:
116 million extra physician visits
77 million extra
17 million emergency department visits
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
However, evidence from a few studies indicates that
as many as 20% to 30%
of patients receive inappropriate
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
ranking of the US on several indicators was:
for low-birth-weight percentages
13th for neonatal
mortality and infant mortality overall 14
11th for post
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
life expectancy at 65 years for females, 7th for males
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
There is a perception that the American public
"behaves badly" by smoking,
drinking, and perpetrating
violence." However the data does not support
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
The US ranks fifth best for alcoholic beverage
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
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
leading cause of death in the US, following heart disease and
Lack of technology is certainly not a contributing
factor to the US's low
Among 29 countries,
the United States is second only to Japan in the
availability of magnetic resonance imaging units and
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
not matched by high rates of treatment, whereas in
high use of diagnostic technology may be linked to more
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
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
that the best wire service in the world, Reuter's, did not
this article. I have no idea why they let it slip
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
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
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
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
underestimated as much of the coding only describes the cause
organ failure and does not address iatrogenic causes at
Japan seems to have benefited from recognizing that
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
answer to chronic health problems. Facilitating the God-given
capacity that all of us have is the key. Improving
the diet, exercise, and
lifestyle are basic. Effective
interventions for the underlying emotional
wounding behind most chronic illness are also important clues
to aximizing health and reducing disease.
Medical Mistakes Kill 100,000 per year
Health Care System Most Expensive in the
Department of Health Policy and Management, Johns
School of Hygiene and Public Health, Baltimore, Md.
Corresponding Author and Reprints: Barbara Starfield, MD,
Department of Health Policy and Management, Johns
Hopkins School of
Hygiene and Public Health, 624 N
Broadway, Room 452, Baltimore, MD
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