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Do medical errors really kill a quarter of a million people a year in the US? (2019 edition)

The claim that medical errors are the third leading cause of death in the US has always rested on very shaky evidence; yet it’s become common wisdom that is cited as though everyone accepts it. But if estimates of 250,000 to 400,000 deaths due to medical error are way too high, what is the real number? A study published last month suggests that it’s almost certainly a lot lower and has been modestly decreasing since 1990.

There is a myth promulgated by both quacks and, sadly, by academics who should know better that medical errors constitute the third leading cause of death in the United States. You’ll see figures of 250,000 or even 400,000 deaths each year due to medical errors, which would indeed be the third leading cause of death after heart disease (635,000/year) and cancer (598,000/year). When last I discussed this issue three years ago, specifically a rather poor study out of The Johns Hopkins that estimated that 250,000 to 400,000 deaths per year are due to medical errors, I pointed out how these figures are vastly inflated and don’t even make any sense, which would be obvious if anyone bothered to put them into context. For one thing, there are only 2.7 million total deaths per year in the US, which would mean that these estimates, if accurate, would translate into 9% to 15% of all deaths being due to medical errors. Those numbers just don’t make sense. It’s even worse than that, though. This particular study looked at hospital-based deaths, of which there are around 715,000 per year, which would imply that these estimates, if accurate, would mean that medical errors cause between 35% and 56% of all in-hospital deaths, numbers that are highly implausible, something that would be obvious if anyone ever bothered to look at the appropriate denominators. Unfortunately, in the three years since its publication, the Makary study has taken on a life of its own, and it’s basically become commonly accepted knowledge that medical errors are the third leading cause of death, even though this estimate is based on highly flawed studies and these numbers are five- to ten-fold greater than the number of people who die in auto collisions every year.

Annoyingly, I see this number popping up in the most unexpected places, mentioned matter-of-factly, as though it were truth that everyone accepts:

Yes, Arthur Allen, a writer I’ve admired since his book Vaccine, casually included that factoid in his story. It wasn’t a major part of the story, just a figure mentioned as though it were fact included as background. That’s how deeply this estimate has embedded itself into the national zeitgeist. I don’t mean to pick on Allen, either. Reporters all too often just take the “third leading cause of death” figure as unquestioned, and Allen quickly admitted that he’d had no idea that the number was even controversial, which rather made my point for me about how deeply this incorrect factoid has embedded itself into the dialog about medical errors. What distinguished Allen, though, is that he went back and corrected his article. Meanwhile, ambulance-chasing lawyers use this fictitious figure to advertise:

Medical error propaganda
Hint: No, medical errors are not the third leading cause of death in the US, the claims of quacks, ambulance-chasing lawyers, and academics who should know better notwithstanding.

Seriously, do they even stop to think how implausible such a figure is? Of course, not.

The attempt to quantify how many deaths are attributable to medical error began in earnest in 2000 with the Institute of Medicine’s To Err Is Human, which estimated that the death rate due to medical error was 44,000 to 96,000, roughly one to two times the death rate from automobiles. At the time, in response to the study, the quality improvement (QI) revolution began. Every hospital began implementing QI initiatives. Indeed, I was co-director of a statewide QI effort for breast cancer patients for three years. Yet, as Mark Hoofnagle points out in the Twitter thread above, the estimates for “death by medicine” keep increasing. They went from 100,000 to 200,000 and now as high as 400,000. On quack websites, the number is even higher. For instance, über-quack Gary Null teamed with Carolyn Dean, Martin Feldman, Debora Rasio, and Dorothy Smith to write a paper “Death by Medicine,” which estimated that the total number of iatrogenic deaths is nearly 800,000 a year, which would be the number one cause of death, if true and nearly one-third of all deaths in the US. Basically, when it comes to these estimates, it seems as though everyone is in a race to see who can blame the most deaths on medical errors. It wouldn’t surprise me if one day I see a quack estimate

How did we get here? As Mark Hoofnagle put it:

Mark was referring to the use of the Institute for Healthcare Improvement’s Global Trigger Tool, which is arguably way too sensitive. Also, as I explained in my deconstruction of the Johns Hopkins paper, the authors conflated unavoidable complications with medical errors, didn’t consider very well whether the deaths were potentially preventable, and extrapolated from small numbers. Many of these studies also used administrative databases, which are primarily designed for insurance billing and thus not very good for other purposes.

So, if the estimates between 200,000 and 400,000 are way too high, what is the real number of deaths that can be attributed to medical error? How would we go about estimating it? As part of that Twitter exchange, Mark pointed me to a recent publication that suggests how. Not surprisingly, its estimates are many-fold lower than the Hopkins study. Also not surprisingly, it got basically no press coverage. The study was published two weeks ago in JAMA Network Open; it’s by Sunshine et al. out of the University of Washington and is entitled “Association of Adverse Effects of Medical Treatment With Mortality in the United States: A Secondary Analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study“.

The first thing you should note is that the study doesn’t just look at medical errors, but rather all adverse events, and their association with patient mortality. That basically means any adverse event, whether it was due to a medical error or not. The study itself is a cohort study using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study, which uses the GBD database to estimate changes in the rate of death due to adverse events from 1990 to 2016. This database is described thusly in the paper:

The 2016 GBD study is a multinational collaborative project with an aim of providing regular and consistent estimates of health loss worldwide. Methods for GBD 2016 have been reported in full elsewhere. Briefly, data were obtained from deidentified death records from the National Center for Health Statistics; records included information on sex, age, state of residence at time of death, and underlying cause of death. Causes were classified according to the International Classification of Diseases, Ninth Revision (ICD-9), for deaths prior to 1999 and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) for subsequent deaths. Each death was categorized as resulting from a single underlying cause. All ICD codes were mapped to the GBD cause list, which is hierarchically organized, mutually exclusive, and collectively exhaustive.

And:

The GBD methodology also accounts for when ill-defined or implausible causes were coded as the underlying cause of death. Plausible underlying causes of death were assigned to each ill-defined or implausible cause of death according to proportions derived in 1 of 3 ways: (1) published literature or expert opinion, (2) regression models, and (3) initial proportions observed among targets.

If you want more detail about the database, the paper in which it was reported is open access, but here’s a bit about the data sources:

The GBD study combines multiple data types to assemble a comprehensive cause of death database. Sources of data included VR and VA data; cancer registries; surveillance data for maternal mortality, injuries, and child death; census and survey data for maternal mortality and injuries; and police records for interpersonal violence and transport injuries. Since GBD 2015, 24 new VA studies and 169 new country-years of VR data at the national level have been added. Six new surveillance country-years, 106 new census or survey country-years, and 528 new cancer-registry country-years were also added.

Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other. The authors used a method known as cause-of-death ensemble modeling (CODEm), a standard analytic tool used in GBD cause-specific mortality analyses. This method was used to generate mortality rate and cause fraction (percentage of all-cause deaths due to a specific GBD cause) estimates for the years 1990 through 2016. Finally, the authors analyzed the cause-of-death chains for all deaths from 1980 to 2014 to determine how frequently AEMT was (1) anywhere within a death certificate’s cause-of-death chain (ie, not underlying cause) and (2) which other contributing causes were most frequently found in the causal chain when AEMT was certified as the underlying cause.

Let’s look at the author’s primary results. First, they found 123,603 deaths (95% UI, 100,856-163,814 deaths) in which AEMT was determined to be the underlying cause of death. I must admit that when I first read that, for some reason I had a brain fart in which I thought the authors were saying that they had found 123,603 deaths per year due to AEMT. (Too much IOM and Hopkins on the brain, I guess.) Actually, that was the total number for the entire period.

Here’s the rest of the primary findings of the study:

The absolute number of deaths in which AEMT was the underlying cause increased from 4180 (95% UI, 3087-4993) in 1990 to 5180 (95% UI, 4469-7436) in 2016. Most of this increase was due to population growth and aging, as demonstrated by a 21.4% decrease (95% UI, 1.3%-32.2%) in the national age-standardized AEMT mortality rate over the same period, from 1.46 (95% UI, 1.09-1.76) deaths per 100 000 population in 1990 to 1.15 (95% UI, 1.00-1.60) deaths per 100 000 population in 2016 (Figure 1A). When not exclusively measured as the underlying cause of death, AEMT appeared in the cause-of-death chain in 2.7% of all deaths from 1980 to 2014, which corresponds to AEMT being a contributing cause for an additional 20 deaths for each death when it is the underlying cause. Mortality associated with AEMT as either an underlying or contributing cause appeared in 2.8% of all deaths.

Let’s unpack this a minute. We’re looking at a number of deaths due to AEMT that’s 50- to nearly 80-fold smaller than the numbers in the Hopkins study. More than that, the number normalized to population is falling, having fallen 21% over 36 years.

So what’s the difference between this study and studies like the Hopkins study and the studies upon which the Hopkins study was based? First, it uses a database designed to estimate the prevalence of different causes of death, rather than for insurance billing. Second, it used rigorous methodology to identify deaths that were primarily due to AEMTs. One thing about this study that makes sense comes from its observation that AEMT is a contributing cause for 20 additional deaths for each death for which it is the underlying cause. For 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year, which is in line with the IOM estimates. It’s also in line with my assertions that one major issue with previous studies is that the unspoken underlying assumption behind them is that that if a patient had an AEMT during his hospital course it was the AEMT that killed him. As for the studies finding up to 400,000 deaths a year due to medical errors, they are, as Monty Python would say, right out.

Remember, too, that this is a study of all AEMTs, but the authors did try to estimate what proportion of these AEMTs were due to medical error, or, as they put it, “misadventure.” Take a look at this graph, Figure 3 from the paper:

Medical errors 2019

First of all, notice how, not unexpectedly, AEMTs increase with patient age. Older patients, of course, have more medical comorbidities and tend to be more medically fragile, with less room for things to go wrong. Second of all, notice that for all age ranges save one, how small a fraction of the total AEMTs were deemed to have been due to misadventure representing probable medical error. As the authors put it:

In the secondary analysis, in which AEMT was listed as the underlying cause of death, 8.9% were due to adverse drug events, 63.6% to surgical and perioperative adverse events, 8.5% to misadventure, 14% to adverse events associated with medical management, 4.5% to adverse events associated with medical or surgical devices, and 0.5% to other AEMT (eTable 6 in the Supplement). The ranking of the subtypes was stable over time (Figure 3A) but with increasing rates of adverse drug events and decreasing rates of misadventure and surgical and perioperative adverse events. Adverse events related to medical or surgical devices and other AEMT were nearly absent in the 1990s but have been responsible for a stable proportion of overall AEMT since the switch to ICD-10 coding of death certificates. Surgical and perioperative adverse events were the most common subtype of AEMT in almost all age groups and increased in importance with age (Figure 3B); misadventure was the largest subtype in neonates, and adverse drug events predominated in individuals aged 20 to 24 years.

So what we can say from these data are that (1) AEMTs are not uncommon; (2) the vast majority of AEMTs that occur in patients who die aren’t the primary cause of death; (3) only a relatively small fraction of AEMTs are due to misadventure or medical error; and (4) population-adjusted AEMT rates have been slowly decreasing. The study is not bulletproof, of course. No study is. For instance, the GBD approach uses ICD-coded death certificates, which have shown varying degrees of reliability in identifying medical harm. In addition, it is probable that a significant number of deaths involving AEMT are not captured because of incomplete reporting. There are also issues with GBD methodology that might not accurately capture every AEMT:

…the GBD study’s cause classification system that assigns each death to only a single underlying cause means that some events associated with AEMT may be grouped elsewhere. Such groupings are dependent on which ICD code was assigned as the underlying cause. For example, adverse drug events from prescribed opioids leading to death would likely be assigned to the GBD study’s cause of “opioid abuse” (ICD-10 code, F11) or “accidental poisoning” (ICD-10 code, T40) based on the mechanism of death, whereas they are included with medical harm in many other studies based on the association with a prescription. Somewhat analogously, nosocomial infections (ICD-10 code, Y95) are often coassigned with a pathogen or type of infection when responsible for a death, and, because Y95 does not end up as the single underlying cause on such death certificates, they are not classified in the GBD study as AEMT.

So let’s say that this study’s estimates of how many people die from AEMTs and, in particular, from medical misadventure, are better estimates than the “third leading cause of death” studies. (I happen to think that it is, even if it might have somewhat underestimated AEMTs.) Does that mean there’s no problem? Of course not, one death from medical error is too many. Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are too many. However, we do no one other than quacks any favors by grossly exaggerating the scope of the problem, and several lines of evidence show that deaths due to AEMTs are decreasing modestly, not skyrocketing, as the “death by medicine” crowd would have you believe. We can do better. We should do better. We won’t do better by spreading myths that medical errors are the third leading cause of death.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

112 replies on “Do medical errors really kill a quarter of a million people a year in the US? (2019 edition)”

Cup cake? Seriously? Is it because you are craving sweets that you failed to read the article enough to make a cogent comment?

Oh good grief. He falls, hits his head so hard he’s allegedly diagnosed with traumatic brain injury but it’s the vaxxeens man! This poor man has obvious issues but Polly just eggs him on and exploits him. Disgusting.

All you’d done is make a feeble attempt at name calling. Please provide evidence for why Orac’s claims are wrong.

Long live cup cakes!

BUT megsaint, aren’t cupcakes just loaded with GLUTEN, SUGARS, trans-fats, acrylimides, artificial emulsifiers/ preservatives and GMOs leading to glycation, hypertension, neoplasm and DEATH!

They are tiny ( lusciously filled with pastry crème) efficient harbingers of destruction**
.
** according to some

Denice, the cupcake shop across the street from my house is currently advertising “Death Cakes” for Valentines day. They’re large and chocolate and something else and very popular.

So because Orac is a cancer-specialist and researcher, is opinion isn’t valid?
I think the opion from somene, who works in hospitals is far more valid than that of someone who might have studied at the university of google.

I still remember when my dad had his last CVA, the hospital administered something, to solve a bloodcloth. There was some risk involved, which they took. If my dad would have died, would that be death by medical error? I don’t think so. Sometimes with acting, there is a risk involved, but the alternative is doing nothing, which also has a risk, so it’s often a balancing act. Even I can understand that and I don’t have any medical education. My only hospital experience is a a patient and as a family-member of a patient.

On this we agree. ORAC is a cancer specialist. If you listen to his advice you will get a very special form of cancer which he can then profit off of. Sad Sad state of affairs for those who iisten to this ahem “Cancer Specialist”.

I don’t think a cancer-specialist makes much profit from one specific treatment. But I suppose to you any medical specialist is only interested in making the most profit of his patients and not in curing them. I think the only ones that really are so cynical, are the quacks.
I suppose you don’t trust your car-dealer, the garage, where you bring your car, the airplane-industry, the plumber or any other craftsman, because they are only out there to make the most profit and are not interested in providing you with a real solution. So what do you do if your car breaks down, or you have a leak? Do you hire someone with the right qualifications, or do you trust some idiot on the internet, who tells you, you can fix anyting with a piece of soap, or something else.

Orac writes,

Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are too many. We can do better. We should do better.

MJD asks,

Will the development and implementation of artificial intelligence (AI) reduce deaths due to AEMTs?

Q. In a garden of respectful insolence, is it possible to smell the AI-for-medicine roses.

With my very limited knowledge of medicine, I’m not sure if AI will have very much effect. Medical developpements often mean, people who would have died from some condition in the past, might be saved by medicine that has been developped. But of course, this life-saving threatments are not fail safe. It’s always a risk analysis. Do nothing and have the patient die, or do something, that might save the patients life, but that also might cause the death of the patient.

The biggest problem with AI will likely be “overfitting”. If you train neural networks on data found on the internet, the neural network can pick racist attitudes from the data on which it is trained. Likewise, if you train artificial intelligence on medical records, you pick up all the biases that are in the records: if the records on which AI is trained do not mention medical errors for whatever biases there may be, this bias will ultimately be picked up by the neural network.

Applying AI to medical care means first and foremost having the highest quality data available, and be aware of all the biases in the data. Medical errors is one of them.

In the end, we will have to judge the performance of AI on measurable metrics: randomized trials for starters.

I know MDJ is just craving for attention. He has books he wants to sell. Perhaps he should try to write books that are worth to buy.

Michael
Your right, in a perfect world there would be no medical errors, but we need to look at the figures.

In the USA in 2017 there were over 36.5 million people admitted to one of over 5000 hospitals, and a staggering 16 million people are employed by the health system.

These numbers are enormous, and yes, even one preventable death is one to many. But take it from me, health services devote enormous amounts of their time, money and resources to reduce the chance of incidents occurring.

To answer your musings on AI – haven’t you seen the Terminator movies or 2001 A Space Odyssey?

To answer your musings on AI – haven’t you seen the Terminator movies or 2001 A Space Odyssey?

MJD, despite his vanity publication on the subject, has no idea what the term means. The current buzzword certainly does not mean what we meant when I was a grad student.

Anyway, to MJD…

Will the development and implementation of artificial intelligence (AI) reduce deaths due to AEMTs?

how? Did you look at the charts? Do you imagine robot surgeons and Rosie the Robot perioperative nurses?

It won’t be robot surgeons. It will be diagnosis assisted by AI. Such as radiographies or medical records fed to some neural network. To some extent…

It won’t be robot surgeons. It will be diagnosis assisted by AI.

And the big orange bars in the plot are surgical and perioperative AEs.

@Narad: A member of my family rather recently had two surgeries. The first one because the diagnosis was wrong. The second one because they realized the first diagnosis was wrong.

Maybe you do surgeries without making a prior diagnosis where you live. Nothing would surprise me any more anyhow.

Given that when Amazon tried to apply AI to their hiring they ended up with a system that only suggested white men (because that was the database they fed it), i think it is safe to say that AI has a very, very, very long way to go before it is more useful than the existing systems that flag drug interactions.

For example, and I forget where I saw it, there was an AI trained to spot serious Pneumonia. The first cut AI predicted that persons with heart disease were less likely to die from Pneumonia. Why? Because those with Heart disease were the most likely to go to the emergency room when they noticed breathing problems.

Isn’t that like the AI that was supposed to figure out the difference between pictures of dogs and pictures of cats? It got very good very quickly, because it was actually sorting “grass” vs “no grass” because most pictures of dogs are taken outside, and most pictures of cats are taken inside. Not exactly what it was asked to do.

If it was sorting grass vs. no grass, it was doing exactly what it was supposed to do: sorting the most relevant information out of the data. In that case, it was grass vs. no grass. It will do the same when analyzing your medical records in 20 years: extracting predicting information that the medical doctor is not trained to see.

Would it be possible to eliminate these weird constructions that involve “an AI,” “the AI,” and so forth? They’re devoid of meaning. Give me algorithms and subfields.

The only guy in my program who actually got a degree (out of about two dozen) was doing radiotherapeutic targeting, now that I think back.

There was a driverless car that, when there were a bug, stopped in the middle of the road. Programmers do strange things.

The most recent multi-part update of Death by Medicine ( see PRN.fm) is subtitled : “needed Now More than Ever”- so I assume that they think that this is a good thing!

Well, they would because they want to scare the public away from doctors into their greedy, grasping hands. Each show includes a section on “health and healing” where the woo-meister recites studies showing how foods and supplements cure various ills- well really, the studies say no such things- more along the lines that people who eat more fruits and vegetables may have less cancer- but he distorts them to fit his own schtick, selling supplements and powdered fruits and vegetables.

More realistically, if these figures- either woo-meisters; or more SB ones- were true, wouldn’t most people have experience with a family member or friend being a victim? Of course, grieving people may view any death as preventable and blame medical staff or hospitals BUT most don’t.

Most people do not experience harm from doctors because they do not overuse their services, nor do they seek to blame doctors for everything. Alas, there are situations were people are overusing medical services. And the more they use them, the more they end up complaining. So you come full circle where most people being harmed by medicine do not even realize it, and where most people complaining about their medical care will have imagined things they barely understand in the first place.

Assessing medical errors and assessing iatrogenic harm should not be subservient to whether or not people have realized or imagined that their medical care has gone astray.

UPDATE:

Orac: Death by Medicine estimates “the total number of iatrogenic deaths is nearly 800,000 a year”

Believe it or not, TODAY, the hoary old woo-meister ( ” JImmy Wales and Wikipedia……” new article at prn.fm) has increased the figure to…
987,507 a year for the past 30 or 40 years yet
AND that’s leaving out some

-btw- from the torrents of articles being dumped, I imagine that lost income must be at least 900K per annum. He admits losing speaking gigs and book deals. Heh.

If this dire trend continues it won’t be long before 3 out of every 2 deaths will be due to medical error. Then we’ll all be sorry. Or dead. Or both.

“Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other.”
But these categories are by no means exclusive of one another, at least as presented; and in particular events in categories (1) and (4) may well also be categorizable (or possibly should be categorized) as category (3) events. For example, although incorrect dosage of a drug is mentioned in category (3), giving a drug that is inappropriate for the patient, so that the patient suffers an adverse drug event, e.g. giving penicillin to a penicillin-allergic patient who suffers an anaphylactic reaction, surely ought to be classed as a category (3) event. And what is an adverse event associated with medical management if not a medical error, i.e. a category (3) event? – if the medical management had been correct (non-erroneous), the adverse event would not have occurred.
I don’t disagree with the ORAC’s conclusion from the paper that AEMT deaths are fairly rare, but the misadventure category may be undercounted.

I think that (4) ” adverse events associated with medical management” is most likely to be things like patients falling out of bed and injuring themselves (a serious problem). I spent some time as a hospital intern in high school and one of my projects was reviewing a collection of adverse events from two hospitals, looking for cases of surgical objects left behind in patients. I didn’t find any, but I did see several “patient fell out of bed”, which seems common in elderly patients who are disoriented.

It may also cover hospital-based infections caused by medical interventions (ventilator pneumonia, catheter bladder infections, central-line infections).

of course the medical field is going to say that to protect their profits. Of course they will put out false misleading studies. They are PROS at that. The reality is, People are not buying this BULLSHIT any longer. So good luck with it…

Sir, you are free to not make use of any medical system in any country.
If this is your desire it may be advantageous to seek the advice of an attorney to determine the most effective markings (alert bracelets, tattoos, etc) to prevent others from applying aid in case of your incapacitation.

It rather begs the question that, if Big Medicine puts out false and distorted figures to make them selves look good, where does Thomas get the figures to disagree with this. I mean, the only figures available are from people he doesn’t trust. I suspect some anal mining has been going on.

Success at long last!!! After years of scholarly effort I have finally absolutely and undeniably proved that evolution is false! Yes, false. How you might ask? I had the entire theoretical framework worked out in its entirely a year ago but for one critical missing piece. But I’ve found it, here, on RI. A living example of what I’ve coined “unextendible simplicity”. This is an organism so simple that it cannot have possibly arisen by evolutionary processes. The thomas sample is representative of the class. This organism is so simple that it is prey to every predator since it cannot shelter or feed itself. It never survives to maturity and therefore never reproduces. Indeed it is provably unfit to every environment and every conceivable environment. It could only have been designed.

As l put the finishing touches on my magnum opus I can breathe a deep sigh of relief and contentment. Now I have only to await the call from Stockholm.

@ rs:

Your research might be enhanced by viewing the organism’s eponymous you tube channel which feature 911 Truth, the Jimmy Dore Show and Dr Sherry Tenpenny.

Exactly! And not only that, but, look at the progress that all the safety and quality initiatives have had over the past thirty-odd years.
It’s almost like checklists and infection prevention protocols and all the other stuff have actually had a positive impact on patient outcomes.

JustaTech writes,

It’s almost like checklists and infection prevention protocols and all the other stuff have actually had a positive impact on patient outcomes.

MJD says,

Keeping the real-life story short, a friend had a freak accident wherein a steel pipe skewered the roof of the mouth. A tetanus shot then emergency surgery was successful (vaccine hesitant individual). The nurse described a list of post-operative medications which most importantly contained an antibiotic. After MJD picked up the medications at the pharmacy, and reviewed the list, an antibiotic was absent. The nurse apologised for erroneously providing a list of medications free of an antibiotic.

@ Orac’s minions,

Should the individual have been given the tetanus shot several weeks after the emergency surgery instead of immediately before the emergency surgery? Think about the rate-limiting-step of antibody formation based on secondary bacterial-infections, in the absence of an antibiotic, while contemplating a response.

There’s obviously a lack of accounting precision in that claim: iatrogenic harm occurs statistically at a given rate for every medical act. Patient 1 will benefit while patient 2 may suffer. Obviously, the goal is for more patients to benefit than to be harmed. But nevertheless, there will be harm to some. Even when no medical errors are responsible for the choices made.

You do not need medical errors for iatrogenic harm to occur: it’s a price to pay to care for those who will benefit from medical care.

Serious, cautious and nuanced accounting is more needed than throwing numbers. We’re not there yet.

English muffin, you only come here to be obnoxious and use moronic nicknames. You have nothing to contribute. You are wasting your own time, and likely you are a waste of carbon.

I knew that 250k number was wrong. There was a CDC study that looked at causes of death nationwide, that included what it called unintentional injury as a cause of death. Footnotes explained that this category included medical errors in that figure. It isn’t easy to break out the numbers, but my recollection is that the total number of deaths by medical error was around 40,000 annually, or an average of 8 per hospital spread over 5000 hospitals. My memory is not perfect, but I believe the data in question are here : https://www.cdc.gov/nchs/nvss/deaths.htm somewhere in that federal data mess.

It is often someone else’s job to report errors. Not all adverse events are caused by human mistakes. Many different systems of adverse event reporting are used in concert to make sure that as many as possible are identified, because if you don’t identify problems you can’t prevent them.

These can be paperwork exercises (looking a prescriptions for interactions) or they could be things like “the hand washing narc” (as my nurse friend call it) who does spot checks on clinicians to see if the hand washing protocols are being followed.

So I’m not saying that there aren’t biases (conscious and unconscious) but that a lot of effort goes into reporting fully and accurately.

Below is a link to the official Australian figures for adverse events occurring in Aust hospitals. Interestingly the study shows that the rate of adverse events for emergency admissions is double that for non emergency admissions. Overall there were 5.4 adverse events per 1000 separations and over half of these were classified as “abnormal reactions or complications” the hardest to prevent of all iatrogenic incidents.

https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/adverse-events-treated-in-hospital

That makes a lot of sense. It’s not like you can ask the unconscious person who was just in a car accident if they’re allergic to anesthesia (or does Australia have shared medical records?). And emergency admissions are also likely to be more complex and more time-limited (ie, it’s three things and the patient is actively dying).

I wonder if biological-based emergency admissions are more likely to have adverse events associated with them than mechanical-based emergencies? Like, do more people who come in with snake bites or serious infections have more adverse events than people who come in from traffic accidents? (Because biology is so amazingly complex.)

We have shared records only within each health region and there are 15 regions in NSW.

As for biological vs mechanical, my guess (and it’s only a guess) would be that you have more chance of having a human error in mechanical simply because you have more people doing more “things” to you.

With biological emergencies, they tend to have preexisting treatment pathways based on best practice and EBM which would, I would think, actually reduce the risk of an adverse event caused by human error – also remember over half the recoded adverse events were unforeseen
complications and not someone doing something that they shouldn’t.

If you’re interested in biological emergencies you should check out all the work that has gone into the “Sepsis Kills” campaigns, the pulling together of research, statistics and pharmacology is a wonderful example of EBM working at its best.

That makes sense. I was more thinking that people are more likely to have an unexpected reaction to antibiotics or snake antivenom than they are to sutures and X-rays. So I totally agree the human error part would be less but the “abnormal reactions” might be higher.

Funny thing: one of my aunts is the driver of the “Sepsis awareness” campaign at her hospital in California. It’s an amazing program.

Why, yes. Yes they do.

In other news,

“It is gratifying that the World Health Organization has recognized the scientific fact that cannabis and its derivatives have demonstrable therapeutic properties and can be the base for safe and effective medicines. It is now incumbent upon governments of the USA and other nations to eliminate the barriers to research on cannabis and allow its free commerce across state lines and international frontiers.”

https://www.wikileaf.com/thestash/world-health-organization-cannabis/

And fourth, CBD would be treated like bonbons.

https://www.cannalawblog.com/the-world-health-organization-steps-up-on-cannabis/

the members of the European Parliament voted on a resolution that calls on the Commission on use of cannabis for medicinal purposes and the states member of the European Union to “address the regulatory, financial and cultural barriers” that stunted scientific research on the cannabis and its medical uses.

https://www.forbes.com/sites/javierhasse/2019/02/13/european-parliament-passes-cannabis-resolution-joins-who-in-supporting-medical-marijuana/

Of course, The US will stand in the way; It all started over textiles,anyways, when DuPont patented how to make shit out of oil. Nonetheless, ORAC, get ready to bone up on how to refute all the coming ‘studies to show’.

This is about bones and looks like a side effect, like osteoporosis. Existence of cannaboid receptor does not mean that cannabis cures anything.

@Aarno: Did I claim that cannabis cures everything? Check for yourself: you have my post just up there.

It seems more than a side effect. It seems that cannabidiol/THC or synthetic cannabinoid ligands may regulate osteoclast behavior, and the endocannabinoid system is a reasonable thing to investigate for things like rheumatoid arthritis or atherosclerosis.

https://onlinelibrary.wiley.com/doi/full/10.1002/art.37684

Did I claim smoking pot cures rheumatoid arthritis? No.

If it’s medicine, why would it make sense that “CBD would be treated like bonbons”?

Medicine should be medicine, not food. Food or food ingredients may be a carrier for medicine (syrups and alcohol) but I don’t eat a handful of ibuprophen because I’m hungry. And I’d be very upset if someone put amoxicillin in my cake.

You do not eat ibuprofen because you’re hungry for the same kind of reason that you don’t smoke pot because you want to be healed. Finally some common sense in that “debate”.

Medicine should be medicine, not food.

And therein lies the problem here. The way the FDA is structured, anything deemed of medicinal value is locked up behind (sometimes insurmountable) prescription walls and not allowed to be consumed no matter how safe it is. Ohh, there is asprin but it is not so safe, after all. But with CBD, you seem to be advocating that it be locked away BECAUSE it is safe and effective. Are you saying that if something that treats some condition that just happens to be in food should be restricted?

I hold that something can be benificial (even called ‘medicine’) without having to be regulated and stifled. Why is it that when something is shown to be ‘medicinal’
that it can only doled out by pharma???

Another thing about ‘medicine’. A while back on these forums, I discussed clinical trials of CBD for seizures and epilepsy. There were some indications of elevated liver enzymes during the trials which I attributed to concurrent valproic acid administrations and suggested that they should do the study without the poisonous Depakote. — I was admonished for suggesting it because it would be ‘unethical’ to test an experimental treatment while withdrawing the ‘standard of care’ (which has been totally ineffective in those cases, anyways).

Well, now here is GW Pharmaceuticals’ recommendation for those taking epidiolex that show elevated liver enzymes:

The majority of ALT elevations occurred when coadministered with valproate and, to a lesser extent, with clobazam (see Drug interaction overview)
The incidence of ALT elevations >3 x ULN was 30% in patients taking both concomitant valproate and clobazam, 21% if taking concomitant valproate (without clobazam), 4% if taking concomitant clobazam (without valproate), and 3% in patients taking neither drug; consider discontinuation or dose adjustment of valproate or clobazam if liver enzyme elevations occur

https://reference.medscape.com/drug/epidiolex-cannabidiol-1000225

I’ll also note that the valproic acid is an anti-seizure which is prescribed off label as a ‘mood stabilizer’. I would assume that the aforementioned CBD will also be acceptable as a ‘mood stabilizer’ since that is what people used it for before it was designated anti-seizure.

Finally, a note to Aarno.

Good reading comprehension there:

This is about bones and looks like a side effect, like osteoporosis

Um, no. That is not what it is saying. “Inhibiting bone resorbtion” is a remedy for osteoporosis.

Ohh, I forgot.

It doesn’t mean that doctors will allow patients to smoke joints in the psych ward.

Well, F68.10

I would assume that the aforementioned CBD will also be acceptable as a ‘mood stabilizer’

So they shove valproic acid (prescribed off-label as a ‘mood stabilizer’) down one’s throat and tell them that if they don’t take it that they will thow all the drugs away in front of one and one will never get outta there.

Well, maybe not a full-spectrum, smoked joint — but I fully expect that those in the psych ward will be allowed to vape their CBD at least as freely as the cheap bastards give one smoke breaks every hour but only supply their shitty smokes that inmates make with the rolling machine all day.

Ohh, JustaTech; I guess I see where you’re coming from::

the WHO’s assessment of CBD could have the most immediate impact. Readers of this blog may recall that the U.S. Drug Enforcement Administration (DEA) has taken the position that the U.S. would “not be able to keep obligations under the [Single Convention] if CBD were decontrolled under the CSA”. The Food and Drug Administration (FDA) ultimately fell in line with the DEA’s interpretation, scheduled Epidiolex (an approved CBD drug), and recently issued a public statement warning that it is unlawful “to introduce food containing added CBD … into interstate commerce.”

If the WHO recommendation is adopted by the UN, though, the FDA may reverse course quickly.

https://www.cannalawblog.com/the-world-health-organization-steps-up-on-cannabis/

Schadenfreude. Excuse me, pharma shills, while I vape this new CBD e-cig juice that I customized by adding raw nicotine to it — They seem to complemint each other nicely, I think it is called the entourage effect; much like CBD and THC and other aromatic terpines and phyto-cannabinoids.

Medicine should be medicine, not food.

You are literaly adamantly adhearing to ‘medicine’ can’t be in food? You may as well gain a patent that would preclude ‘healthy’ not being legitimate in ‘food’. No matter how methinks otherwise, I’m reserving the pharma shill tag because you just ignant.

Ahh; forgive me JustaTech. I’ve been harshly silly.

I can think of one prescription ‘medication’ that is also put into food, though:

Thiamine. Thiamine is available as a prescription and as a supplement with insanely high DV amounts to treat or prevent Wernicke’s Encephalopathy, particulary in alchoholics. Thiamine is also stuffed into all kinds of enriched flour foods such as breads and cereals (to be fair, in many cases those nutrients may have been stripped out during processing in the first place). The FDA seems to think such ‘fortification’ is a good idea; So be it. But I do wish they would take a closer look at the harms of folic acid added to food when there is a non-toxic, safe at any dose, prescription medication (Deplin – (6s)-5-methyltetrahydofolic acid) folate that could be added instead.

My goodness, that certainly touched a nerve.

And I’m going to firmly stand by my statement. You don’t put amoxicillin in a cake, you don’t put progesterone in a soda. Either CBD is a purified and dosed medication, or it is a fun additive for food. Pick one or the other.

Tim: folic acid prevents the most horrific birth defects and is stable in food. Saying you want to take folic acid out of food is the same as saying you want more babies born without most of their brains. It’s simple to purchase food that isn’t fortified, if someone has told you it is scary. But unless you are an elderly Dutchman with dementia, there’s no evidence that folic acid has any negative effects. Folic acid fortification SAVES LIVES so you can just go stuff it.

Move to Colorado or Oregon or Washington and enjoy your weed, just stop putting a health halo on it.

JustaTech, were you aware that pregnant women are no longer advised to take ‘folic acid’? Well, they are not. They are given a prescription for the bioavailable folate that is not toxic — Deplin, et al.

You see? Half of the human race has trouble converting the ‘folic acid’ (a petroleum product, by the way) to a useable form such that it builds up in the blood stream and is detrimental. Furthermore, excess folic acid downregulates the absorption of natural folate further fomenting the problems.

I understand that many women may not know that they are pregnant or lack access to health care; but this form of the shit they put in almost everything (with it seeming to be a marketing ploy — Cherrios with boatloads of folic acid in the ingredients actually bold it as A B vitamin. I can’t for the life of me figure that one out.) Is literally shortening life spans for most — It is like a Kurt Vonnegut tale where it is the great equalizer, the Handicapper General, of quality of life and life expectancy; Those with poor nutrition sometimes benefit from it but those with good nutrition otherwise see there lives depricated. I see that and recognize that is to be avoided like so much sodium.

Non-prescription folic acid is not the same as the active folate found in CerfolinNAC. Unlike CerfolinNAC, non-prescription folic acid needs to be broken down (or activated) by the body before it can be used. Unfortunately, about 50% of all people have a compromised ability to complete this activation.

https://www.cerefolinnac.com/

Also listed as “medical food”, by the way. Lots of those ‘drugs’ seem to just be folate.

https://www.google.com/search?q=%22prescription+medical+food%22&gbv=1&sei=8klnXPr6EY6O_wTIvIXQAQ

Hey Tim, if folic acid fortification didn’t work to prevent neural tube defects, then why does the rate of neural tube defects fall dramatically when common foods are fortified with folic acid? Because it does, in every single country where folic acid fortification is used.

You do know that neural tube defects due to lack of folate happen in the very first weeks of pregnancy, long before almost all women know they are pregnant? So there’s no chance to change the diet or take supplements? And that the women most likely to be impacted by this are the poorest, who can’t afford a diet rich in leafy greens?

Based on your name, Tim, I’m going to assume that you are a man, and therefore will never suffer the horror of finding out that the fetus you are carrying has no brain. Or needs surgeries you’ll never be able to afford.

Basically, you’re endorsing cruelty to poor women based on absolutely no evidence of harm to you at all. In case it wasn’t clear to everyone else from your stupid YouTube link, you are a horrible person.

All women of reproductive age should get 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet

https://www.cdc.gov/ncbddd/folicacid/recommendations.html

I’m just saying that there is the bioavailable form out there without all the baggage of serum folic acid build up. But I guess that can’t be put into food because it is considered medical food or something. IDK, maybe that form is not stable through all the processing of the crap food like folic acid is so there may be that.

I might be a woman; I’ve used the alias Mitzi Dupree but I’ve never been unknowingly pregnant so I’ve not personally been touched by the horrors of neural tube defects.

Disclosure: I get all my folate from unfiltered craft IPA beer.

In case it wasn’t clear to everyone else from your stupid YouTube link, you are a horrible person.

Well, you have to listen to the whole 10 hours before you judge.

a petroleum product, by the way

Just when I thought things couldn’t get any dumber….

How’s about you lay out the parts of organic chemistry that don’t rely on petroleum products, Gilbertimmeh?

Well Narad,

If you want to make an apple pie from scratch, you must first create the universe.”

—Carl Sagan

Then, you have to preheat the oven…. Oh, fuck it; you got me there– I’m no organic chemist FICS.

We will always have 1,000,053 deaths a year from medical errors until main$tream medicine learns to treat the whole person holistically, instead of dividing them into body parts and cell types and getting distracted among the gallbladders, spleens, islets of Langerhans, Hassall’s corpuscles and suchlike. Who could keep track? Mistakes will be made.

I am pretty sure Thomas has hit the nail on the head and closed the barn door on the horse with his eloquent “ahahahahahahahaha”; that’s a devastating rejoinder in any discussion in which the Pharma $hills attempt to silence free speech with their “facts” and “evidence”.

Who could keep track? Certainly not a “holistic” MD: he cannot substantiate a claim of being able to keep track.

gallbladders, spleens, islets of Langerhans, Hassall’s corpuscles
You are making those names up! Respectable physicians speak of the four humours.

Anytime anyone starting throwing around big numbers of anything, the first thing I do is look at the number and see if it even passes the “sniff test.” Just like anti-vaxers claiming that Big Pharma is conducting a global conspiracy to silence criticism of vaccines (and hide the injuries), I just do the math & come to well north of 100 Billion dollars (using the figure of 1 million people, pay 100K per year to keep silent), which is nearly 3 times the total global revenue of vaccines.

As for this article, just breaking down the number of deaths in the US & looking at causes – the “medical error” number just smelled bad right from the beginning.

So how do you estimate the frequency of medical errors? Just “looking at the cause”? That seems oversimplistic.

I have a link below which gives a simple and clear explanation for what an adverse event is in healthcare.

What I think Lawrence means is that for the numbers just don’t add up. If you work at the pointy end of health care you just don’t see that level of damage occurring on a regular basis.

Major events causing death are actually rare, and they are a very big deal – police involved, coroners court, TV coverage big. So if up to half of all hospital deaths were iatrogenic then everyone who works in a health system would know of not just one but of dozens of these cases and we don’t, we really don’t.

Also remember that the term includes unforeseen complications, so if I give penicillin to someone who has never had it, and they have an allergic reaction to it, that is an adverse event, even if I did everything absolutely correctly.

https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/adverse-events-treated-in-hospital

@Shelly: my experience is that healthcare workers often fail to discriminate whether their actions have adverse consequences. Many reasons. For instance, the person inflicting the harm and the person that will provide subsequent care are two different persons and hence will fail to realize or report that an adverse event took place. I know more than one story of nurses keeping their mouth shut for fear of incriminating a colleague, for starters.

And half a percent of hospital admissions is not a small number when you think about it. Some people get repeatedly hospitalized. That increases their risk of an adverse event over their lifetime. It’s compound probabilities, sure, but it does matter.

F68.10
I agree that it a patient’s journey through the health care system can be extremely complicated, and yes there have been coverups and incompetence and maliciousness in health systems. It’s just that the sector is so bloody big, with so many clinicians and patients.

That said the system spends enormous amounts of time and money and human effort identifing and investigating the causes of adverse patient outcomes. The very culture of the health sector is being changed to try and reduce adverse incidents. Incident reporting is evolving and staff are made aware in no under terms that not reporting somebody else’s failings in patient care will only make things worse for everyone, themselves included.

A frequent criticism of those who criticize medical quackery is “modern medicine kills (gazillions), why don’t you concentrate on THAT”.

Actually, practicing physicians are constantly involved in quality assurance efforts to decrease preventable errors.

But some of us spend a little time to expose damaging altie beliefs as well. 🙂

@F68.10 It is not good that your molecule has receptor in many tissues. You will end having osteoporosis medicine with lots of phychological side effects.

@Aarno: You’re completely misreading me. I have not claimed I have a cure for osteoporosis. I’m just saying that there are things worth investigating with the endocannabinoid system. Two points: 1. it shows that research on that system, while stifled for various reasons, is still going on. 2. Nothing is stopping research for making a ligand having higher affinity to GPR55 than to CB1 and CB2 anyway.

I’m not interested in the cannabis “debate” anyway.

Besides, all that research into cannabinoids is probably being engineered by Big Pharma to wipe out cheaper, all-natural products that prevent or cure all diseases, like apple cider vinegar (with “the mother”), or any number of superfoods.

@F68.10 What I am trying to say is that cannabis as a drug would have known side effects. And if the bioactive part would be used as a drug, these would be more serious.

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