Doctors Are the Third Leading Cause of Death

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Doctors are the third leading cause of death in the United States, causing 250,000 deaths each year, according to a landmark study.

  According to this article, published in the Journal of the American Medical Association, the only things that kill more people than doctors are cancer and heart disease.  Each year, iatrogenic (doctor-induced) health care problems kill patients in these proportions: 

 12,000 -----unnecessary surgery
   7,000 -----medication errors in hospitals
 20,000 ----other errors in hospitals
 80,000 ----infections in hospitals
106,000 ---non-error, negative effects of drugs 

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 is 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 percent and 18 percent 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 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 percent 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:

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 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.

Technology

Lack of technology is certainly not a contributing factor to the low ranking of the United States.  Among 29 countries, the U.S. 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 U.S. ranks among the lowest.  It is possible that the high use of technology in Japan is limited to diagnostic technology that is not matched by high rates of treatment, whereas in the U.S., the 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.  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 of the American Medical Association, Vol. 284, July 26, 2000.

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.

Japan seems to have recognized 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 become increasingly dangerous for chronic disease cases.  Facilitating the 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.

"It is of interest that the 10,000 year old system of Traditional Chinese Medicine only paid the doctor when you were well and stopped paying him [or her] when you became ill" J.D. Wallach.

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