Medical care is 3rd leading cause of death in U.S.

A reposting of a now somewhat dated (2008) article from Chris Kresser’s site.

The popular perception that the U.S. has the highest quality of medical care in the world has been proven entirely false by several public heath studies and reports over the past few years.

The prestigious Journal of the American Medical Association published a study by Dr. Barbara Starfield, a medical doctor with a Master’s degree in Public Health, in 2000 which revealed the extremely poor performance of the United States health care system when compared to other industrialized countries (Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium and Germany).

In fact, the U.S. is ranked last or near last in several significant health care indicators:

  • 13th (last) for low-birth-weight percentages
  • 13th for neonatal mortality and infant mortality overall
  • 11th for postneonatal mortality
  • 13th for years of potential life lost (excluding external causes)
  • 12th for life expectancy at 1 year for males, 11th for females
  • 12th for life expectancy at 15 years for males, 10th for females

The most shocking revelation of her report is that iatrogentic damage (defined as a state of ill health or adverse effect resulting from medical treatment) is the third leading cause of death in the U.S., after heart disease and cancer.

Let me pause while you take that in.

This means that doctors and hospitals are responsible for more deaths each year than cerebrovascular disease, chronic respiratory diseases, accidents, diabetes, Alzheimer’s disease and pneumonia.

The combined effect of errors and adverse effects that occur because of iatrogenic damage includes:

  • 12,000 deaths/year from unnecessary surgery
  • 7,000 deaths/year from medication errors in hospitals
  • 20,000 deaths/year from other errors in hospitals
  • 80,000 deaths/year from nosocomial infections in hospitals
  • 106,000 deaths a year from nonerror, adverse effects of medications

This amounts to a total of 225,000 deaths per year from iatrogenic causes. However, Starfield notes three important caveats in her study:

  • Most of the data are derived from studies in hospitalized patients
  • The estimates are for deaths only and do not include adverse effects associated with disability or discomfort
  • The estimates of death due to error are lower than those in the Institute of Medicine Report (a previous report by the Institute of Medicine on the number of iatrogenic deaths in the U.S.)

If these caveats are considered, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

Starfield and her colleagues performed an analysis which took the caveats above into consideration and included adverse effects other than death.  Their analysis concluded that between 4% and 18% of consecutive patients experience adverse 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 (equivalent to the aggregate cost of care of patients with diabetes

I want to make it clear that I am not condemning physicians in general.  In fact, most of the doctors I’ve come into contact with in the course of my life have been competent and genuinely concerned about my welfare.  In many ways physicians are just as victimized by the deficiencies of our health-care system as patients and consumers are.  With increased patient loads and mandated time limits for patient visits set by HMOs, most doctors are doing the best they can to survive our broken and corrupt health-care system.

The Institute of Medicine’s report (“To Err is Human”) which Starfied and her colleagues analyzed isn’t the only study to expose the failures of the U.S. health-care system.  The World Health Organization issued a report in 2000, using different indicators than the IOM report, that ranked the U.S. as 15th among 25 industrialized countries.

As Starfied points out, the “real explanation for relatively poor health in the United States is undoubtedly complex and multifactorial.”  Two significant causes of our poor standing is over-reliance on technology and a poorly developed primary care infrastructure.  The United States is second only to Japan in the availability of technological procedures such as MRIs and CAT scans.  However, this has not translated into a higher standard of care, and in fact may be linked to the “cascade effect” where diagnostic procedures lead to more treatment (which as we have seen can lead to more deaths).

Of the 7 countries in the top of the average health ranking, 5 have strong primary care infrastructures. Evidence indicates that the major benefit of health-care access accrues only when it facilitates receipt of primary care. (Starfield, 1998)

One might think that these sobering analyses of the U.S. health-care system would have lead to a public discussion and debate over how to address the shortcomings.  Alas, both medical authorities and the general public alike are mostly unaware of this data, and we are no closer to a safe, accessible and effective health-care system today than we were eight years ago when these reports were published.


3 responses to “Medical care is 3rd leading cause of death in U.S.

    • Mr. White:

      So good to hear from you after so long an absense.

      I offered the article without comment, thinking perhaps to add my own thoughts at a future date. I will say now that my own, admittedly somewhat limited, experience with the health care industry is that the vast majority of the expense is a complete and utter waste of time and money. I’ve also become rather convinced that the medical profession has forgotten it’s prime directive to “first do no harm”. Quite a lot of what passes for treatment will, ultimately, do more harm than good.

      As noted in your referenced (and interesting) articles, much of what passes for health care will, at great expense, have only a marginal effect on overall longevity. Here are a few thoughts (extracted from the latest CDC mortality data:

      Since 1950, the age-adjusted overall death rate has declined from 1,446 per 100,000 to only 758 per 100,000, an apparent reduction of 688 deaths. ( Of the this improvement, 60% (406) has resulted in the reduction of heart disease related fatalities and another 11% (140) for stroke. Minor, though still significant, improvements were also noted for influenza/pneumonia (31), unintentional injuries (39), and cancer (only 19). The big story, clearly is heart disease and stroke (71% combined).

      Astonishing, right? It almost seems like people just don’t die anymore. But, here’s one problem with such statistics. The non-age adjusted (crude) rates tell a much different story. Rather than a reduction of 688 deaths per 100,000, the real reduction has only been 151 deaths per 100,000. In this case, the age adjustments tend to exaggerate the earlier 1950 death rates, increasing them by 483. Why is that? Well, clearly there were fewer old people (no boomers, for one thing) and higher infant mortality rates (for another). As we must assuredly know, as these boomers continue to age, these differences will absolutely disappear….because, so far as I know, nobody lives forever. Thus, in the next ten or fifteen years, we’ll see a normalization of those rates.

      So, longevity is the real issue, right? When you look at the CDC’s life expectancy tables, you see that, yes, overall life expectancy has increased substantially…but much more signicantly for those under the age of 65 (+10 more years or so). For those over the age of 65, the improvement has been only 5 years, and for those aged 75 the improvement is only 2 years (but that’s only since 1980).

      Looking just at infant mortality, we can see that the neonatal death rate has declined from 29.2 per 1,000 live births (errr, thats 2,920 per 100,000) to 6.6 (or 660 per 100,000). That’s rather huge, don’t you think? This, all by itself, accounts for a total improvement or decline of 2,260 infant deaths per year per 100,000 live births (err, actual people). It is also worth noting that the vast majority (80% or so) of this particular improvement was achieved prior to 1980.

      But, yes, even those who make it past childhood are, in fact, living longer…just not that much longer. Through extraordinary measures (and expense) of modern health care, we’re able to keep people going an extra five years, assuming they’ve made it to the (now obsolete retirement) age of 65. Is that a big deal? Not, as noted in your referenced CATO article, if simply moving to the country would add six years or exercising would add fifteen years.

      Imagine, if you will, that in the name of “longevity” and “successful treatment”, the health of the average patient is reduced to chronic pain, a lack of mobility, regular surgery, a continual dependence on expensive doctors and drugs, and, well, poverty. Oh wait, that’s exactly what we’ve got. Not a great trade (….except that some good portion of that poverty is being passed along to their children and their children’s children).

      For me, the most compelling encouragement to work out my own long-term solutions (to my own diabetic condition) was my doctor’s rather creepy promise that I was at an age where he would become much more involved in my life. I mean, come on, man. Aside from the $6k per year that I’m already paying just for the priveledge of that promise, what else could I possibly hope for?

      Naturally, I don’t mean to discount the real desperation felt by those who face a life threatening illness. But, maybe we ought to be asking ourselves, “is living another five years worth bankrupting myself and, for good measure, my children?” Ok, maybe not that, but, well, maybe bankrupting your neighbor’s children is ok. In the mean time, we’re paying an average of $20,000 per family for health insurance. And, despite medicare coverage, the SSA estimated (in 2009) that the average couple would have to have at least $240,000 in savings just to pay their own out-0f-pocket medical expenses through the end of their own lives.

      I guess I’d rather live in the country and take a walk. Now, if I could figure out how to get out of my health insurance plan and pocket the difference. Maybe Obama can figure it out for me?


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