Study: Medical Errors Are the Third Leading Cause of Death (in America)

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    https://time.com/4316818/leading-cause-of-death-medical-errors/
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    Heart disease, then cancer are the leading causes of death for Americans. Chronic lower respiratory diseases like bronchitis and emphysema take third place, according to leading health groups. But that spot really belongs to a cause of death that doesn't even make the current list, according to a new paper published in The BMJ. The third-most deadly killers of Americans are medical errors, accounting for more than 250,000 deaths each year, the analysis says.


    "Collectively, the problem of medical care gone wrong kills a substantial number of people in the United States," says Dr. Martin Makary, a surgeon and professor of health policy and management at the Johns Hopkins University School of Medicine. Makary and his colleague looked at four studies analyzing U.S. death rate data and determined that about 9.5% of all deaths result from medical errors.
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    What can be said about this?
     
    Harley Quinn said:
    https://www.bmj.com/content/353/bmj.i2139

    I haven't gone through it in full, but I assume all the relevant info is there.
    Click to expand...

    Thanks. This is really surprising to me because I had heard that deaths to cancer in the US was lower because of better medical care. I guess Ill have to double check on that and read this. There are a lot of terrible studies, so Im trying to be critical of everything here (also I have sourced bad studies before in the past, so I learned my lesson).
     
    That's honestly very scary. I don't think there's anything wrong with the BMJ study at first glance. It's a very open question as to what extent are medical errors preventable. Some institutions and hospitals take the position that they're inevitable in the same way that car accidents are inevitable - despite best practices, any system has the chance to mess up. Others take the position that you have to do everything you can to analyze medical procedures, discover those sources of error, then change those procedures to eliminate those sources of error.

    The second position is "obviously better" but it's not as pie-in-the-sky as it might seem. I watched a documentary once which mentioned how a healthcare centre managed to dramatically reduce its death rate of its procedures because there was a cadre of nurses who were investigating its procedures in depth, amending those procedures, and training the other nurses in the new procedure.
     
    This study isn't convincing. They have done little primary research themselves, stating many times that they have simply extrapolated data obtained in previous reports, of which they have only shown the data from four - and of those four, only one of them has a sample size greater than a couple of thousand (compared to their number of 35,416,020 admissions in 2013). Furthermore, the largest study which they used covering 37,000,000 admissions (https://www.providersedge.com/ehdocs/ehr_articles/Patient_Safety_in_American_Hospitals-2004.pdf) seems heavily biased from a brief skim-read. They even admit themselves that their extrapolation is very limited in terms of accuracy due to a lack of data - "Although the assumptions made in extrapolating study data to the broader US population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem". While I agree with them on this the point that it is important to document medical error, I don't think that they can soundly publish such striking results whilst admitting that these data are unlikely to be accurate. They have also been very brief on the details regarding where medical error occurs - in whose hands, where in the country and perhaps most importantly, with which diseases (more on this later). Overall I don't think this is a sound study and I wouldn't be surprised if it's been published purely for the shock factor - complete with a "scary infographic™" as one of its figures.

    A key weakness of the whole idea of defining "medical error", though, which I feel the need to point out is this:

    "Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome"

    In other words, "if the treatment wasn't effective, it was medical error that caused the death". This is a huge problem because vast numbers of late-stage diseases, particularly cancer or infections such as from drug-resistant MRSA strains which are often healthcare-associated, are able to resist the intended outcomes of treatment (in fact, it is unusual for cancer to kill without it being able to ignore the effects of a wide panel of drugs). This is no fault of the doctors; some diseases simply reach stages at which they are not possible to be cured by current medicine. This is why it is very important that the authors declare which diseases were involved since I'd imagine that a vast number of them are diseases which feature drug resistance as a major complication.

    This study therefore, in my opinion, is not very strong and without more data, less extrapolation, and more specific information regarding where "medical error" occurs, I'm not going to worry much about it.
     
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