It's been seven years since I posted the comprehensive, footnoted research article, Death by Medicine, on this website. Authored in two parts by Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, and Dorothy Smith PhD, it described in excruciating detail how the modern American medical system had bumbled its way into becoming the leading cause of death and injury in the United States. From medical errors to adverse drug reactions to unnecessary procedures, heart disease, cancer deaths and infant mortality, the authors took statistics straight from the most respected medical and scientific journals and investigative reports by the Institutes of Medicine (IOM), and showed that on the whole American medicine caused more harm than good. The purpose of this was not to frighten you, but to help you make informed choices about your health, and to provide you with the tools you need to take control of your own health Seven years after the original article was written, an analysis in the New England Journal of Medicine November 25, 2010 piqued my interest -- the researchers found that, despite efforts to improve patient safety in the past few years, the health care system hasn't changed much at all. Instead, 18 percent of patients were harmed by medical care (some repeatedly) and over 63 percent of the injuries could have been prevented. In nearly 2.5 percent of these cases, the problems caused or contributed to a person's death. In another 3 percent, patients suffered from permanent injury, while over 8 percent experienced life-threatening issues, such as severe bleeding during surgery. In all there were over 25 injuries per 100 admissions! Shocked, I decided to do some research of my own on the state of American health care today.What I found is the grim picture that I'm sharing with you, as an update to the original Death by Medicine article.
Unfortunately, the NEJM article was just a reminder of something that the Thirteenth Annual HealthGrades Hospital Quality in America Study pointed out earlier this year. HealthGrades has been studying the quality of care in the nation's hospitals since 1988. This year they analyzed approximately 40 million Medicare patients' records from 2007 through 2009, and found that 1 in 9 patients developed a hospital-acquired infection. The HealthGrades report said that "the incidence rate of medical harm occurring is estimated to be over 40,000 each and EVERY day according to the Institute for Healthcare Improvement." Another study, in 2008, by the Office of Inspector General for the Department of Health and Human Services, also reported grave evidence that something is amiss in the hospital setting in America: One in seven Medicare beneficiaries who is hospitalized will be harmed as a result of the medical care they receive in the hospital, the study said. Authors of this study found that physician reviewers determined nearly half, or 44 percent of the adverse and temporary harm events "were clearly or likely preventable." The cost of these mistakes was estimated at $324 million in October alone. The mistakes equate to 3.5 percent of the Medicare budget.
Another study, published in the Archives of Internal Medicine this year, showed that sepsis and pneumonia caused by hospital-acquired infections killed 48,000 patients and ramped up health care costs by $8.1 billion in 2006 alone. Both these infections are mostly preventable through better infection controls. The study also found that 20 percent of people who developed sepsis died; 11 percent of those who developed pneumonia died. The authors noted that many hospital-acquired infections are super resistant to common antibiotics – and it's not just sepsis and pneumonia that they're talking about. A different study in 2006 showed that "central-line-associated" bloodstream infections caused by catheters placed directly into veins resulted in a $26,839 loss for each patient that came down with this type of hospital-acquired infection. This same study estimated that 2 million people come down with hospital-acquired infections of any type in every year, and that approximately 100,000 die from those infections.
In 2000 the Institutes of Medicine reported that medical errors were the eighth leading cause of death in the U.S., killing between 44,000 and 98,000 people each year. While the number of errors today is said to possibly be the fourth leading cause of death in a hospital, health officials agree that this type of death-by-medicine is still prevalent -- and preventable. In a June 2010 report in the Journal of General Internal Medicine, study authors said that in looking over records that spanned from 1976 to 2006 (the most recent year available) they found that, of 62 million death certificates, almost a quarter-million deaths were coded as having occurred in a hospital setting due to medication errors. They also found that these errors spiked in July, and particularly in teaching hospitals. There are four points in the medication use process at which errors may occur: when the medication is ordered (written, electronic, or oral) when the medication order is transcribed and verified when it's dispensed, and when it's administered The June 2010 report narrowed the errors down to: drug overdose prescribing the wrong drug taking the wrong drug, or accidents involving medications during surgery or medical procedures Older adults are at a higher risk of medication errors and have a greater propensity for experiencing harmful and fatal errors. The most common types of medication errors in older adults are omission and improper dose.
An estimated 450,000 preventable medication-related adverse events occur in the U.S. every year. A study published in the Journal of Gerontology in 2006 showed that adverse drug reactions are very common in frail elderly persons after a hospital stay, and polypharmacy and warfarin use consistently increase the risk. The costs of adverse drug reactions to society are more than $136 billion annually -- greater than the total cost of cardiovascular or diabetic care. Adverse drug reactions cause injuries or death in 1 of 5 hospital patients. The reason there are so many adverse drug events in the U.S. is because so many drugs are used and prescribed – and many patients receive multiple prescriptions at varying strengths, some of which may counteract each other or cause more severe reactions when combined. In 2009 there were nearly 3.68 billion prescriptions filled in the U.S. That averages to almost 12 prescriptions for every person in the U.S. Other interesting drug statistics are: Specialists give more than 2 prescriptions per visit Just over 89 percent of Medicare patients take prescription medicine daily 46 percent take 5 or more prescriptions chronically Nearly 54 percent take meds prescribed by more than one doctor One thing that the drug companies don't tell you, and that your physician may not realize, is that premarketing drug safety profiles may be very narrow: most new drugs have 3,000 or less short-term patient exposures. Another fact the drug companies don't advertise is that some drugs have rare toxicity possibilities, meaning very bad side effects could occur in as few as 1 in 20,000 patients. To detect such rare toxicity, more than 60,000 patients must be exposed AFTER the drug is marketed.
The latest study published in Health Affairs revealed that the United States now ranks 49th in the world for both male and female life expectancy, down from 24th in 1999. In 1950, the United States was fifth among the leading industrialized nations with respect to female life expectancy at birth, surpassed only by Sweden, Norway, Australia, and the Netherlands. The last available measure of female life expectancy had the United States ranked at forty-sixth in the world. U.S. infants also are in the basement when it comes to mortality rates; according to 2009 data compiled by the World Bank, the U.S. is 41 places behind other countries in infant mortality.
There's no doubt that government health care officials are worried about this country's reputation for safety in the hospital setting. If they weren't, they wouldn't have set up the Center for Quality Improvement and Patient Safety, a task force charged with developing plans and strategies for making American health care safer. The problem is that, as it always with government, things move very slowly when change is needed, so the nation has yet to have a nation adverse event reporting system for hospital medical errors. We also don't have any federal standards regarding state systems. The question is whether living the status quo is going to make us any healthier or not, and if it doesn't, what are we going to do to make a better life for ourselves?
It doesn't take a genius to figure out that the American health care system is skewed toward treating illnesses and diseases, not preventing them. In 2003, my Death by Medicine report showed that judging by health care spending alone, the U.S. should be the healthiest country in the world with the best medicine available. But it wasn't. And today, it still isn't. One reason for that is because an obscure federal panel that most people never hear about not only defines what preventive medicine is, but decides what services your health care dollars will pay for. Historically that panel, the U.S. Preventive Services Task Force, has been accused of being ultra-conservative in the way of preventive care. But when it does approve it, the definition of preventive care means some kind of diagnostic test for a possible existing illness, not a strategy for staying well. For example, if you take a look at the task force's website, you'll see lists of "preventive" medicine topics the group is considering that include such things as aspirin use and various types of disease screenings -- with only one mention of vitamin supplements as a possible upcoming preventive strategy. If you click on the task force's A to Z topic guide of existing "preventive" health care, you'll see that almost every single one is some type of disease screening or counseling for a condition you already have. And that's what's wrong with U.S. health care, whether it was seven years ago or today -- we are all too eager to embrace screenings for diseases or illnesses we may or may not have, and counseling and/or medical treatment in the form of pills and chemicals and surgeries for it, after we find out what disease it is we have. According to the Kaiser Foundation and the CDC, the main drivers of health care costs in the U.S. are technology and prescription drugs; chronic disease; aging of the population; and administrative costs. I agree that these are huge contributors to what is killing us as a nation financially and as a people. But I DON'T agree with the context in which they're presented. If you've followed all the information I've given you here, and even skimmed the 2003 Death by Medicine article, then I think you'll see why I think the major contributors have a slightly different paradigm -- and that the only way we are get healthier as a nation, and drive medical costs down too, is to change that paradigm. That's because the foundational causes of what's driving health care costs in America are: The emphasis on sickness and treatment, rather than health, fitness, and prevention which is primarily fostered by ultra-sophisticated marketing strategies employed by the drug industry. Fraud -- by both consumers and providers, including the drug industry. Unnecessary procedures, medications, hospitalizations and screenings Medical mistakes, hospital-acquired infections, and surgical and device errors If we were only to address these issues, beginning with changing the emphasis of our well-being to health and fitness, and then following the healthy lifestyle that paradigm suggests, I promise that the issue of sickness in America and what it's costing us -- as well as the death-by-medicine events will begin to fade away very quickly. It's time to quit bombarding your body with medical interventions and to reward yourself with the fit and healthy body that come from living fit and lean. And until then -- until our health care system as a whole -- changes the emphasis of what we're doing to health and healthful living, exercise, proper nutrition and diet, and vitamin supplementation, we're not going to see anything in our health care system change, even if we wait another seven years to see how it's going.
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