By Dr. Mercola
History tells us it can take decades before a medical truth becomes
accepted as fact, and recent headlines are a perfect example of this.
Sixteen years ago, I read an article in the Journal of the American
Medical Association (JAMA) that stunned me. I was shocked JAMA
published it. Although the article did not explicitly state it, the
data was very clear.
So I published my summary of the study, which revealed that doctors are in fact the third leading cause of death in the U.S.1
You likely have seen this statistic or headline, but you may not be
aware that I was the one who created that headline, which has been
widely circulated on the internet and virtually never attributed to me
as the person who saw through the data to make that conclusion.
Dr. Barbara Starfield was the author of that JAMA study, published
in 2000, and her research documented how a staggering 225,000 Americans
die from iatrogenic causes, meaning their death is caused by a
physician's or hospital's activity, manner, or therapy. Her statistics
showed that each year:
12,000 die from unnecessary surgery
7,000 die from medication errors in hospitals
20,000 die from other errors in hospitals
80,000 die from hospital-acquired infections
106,000 die from the negative side effects of drugs taken as prescribed
Back then, few people believed it, but in recent days headlines
echoing my original 2000 article have made the rounds in many of the
major media outlets.2,3,4,5,6,7
One of the reasons why many are still surprised by these statistics is due to fundamental flaws in the tracking of medical errors, which has shielded the reality of the situation and kept it out of the public eye.
Medical Errors Are STILL the Third Leading Cause of Death
Dr. Starfield's findings 16 years ago still stand today. In fact,
recent research suggests matters have only gotten worse, and the reason
for this is because no affirmative action was ever taken to address
and correct the situation.
According to a new study8
published in the British Medical Journal (BMJ), medical errors now
kill an estimated 250,000 Americans each year, an increase of about
25,000 people annually from Dr. Starfield's estimates.
That means medical errors are STILL the third leading cause of death,
right after heart disease and cancer. These numbers may actually be
vastly underestimated, as deaths occurring at home or in nursing homes
are not included.
As shown by Dr. Starfield's research, side effects from drugs, taken as
prescribed, account for the vast majority of iatrogenic deaths.
Research9
published in 2013 estimated that preventable hospital errors kill
210,000 Americans each year — a figure that is very close to the latest
statistics.
However, when they included deaths related to diagnostic errors, errors
of omission, and failure to follow guidelines, the number skyrocketed
to 440,000 preventable hospital deaths each year. This too hints at the
true enormity of the problem.
Cause of Death Reporting Needs an Overhaul
According to Centers for Disease Control and Prevention (CDC)
statistics, the third leading cause of death is respiratory disease,
which claims 150,000 lives each year, not iatrogenic causes. In fact,
the CDC doesn't publish any information relating to medical errors at
all. As reported by Newsweek:10
"The researchers for the study from Johns Hopkins say their
findings suggest the CDC's method for collecting data on causes of
death is flawed, leading to inaccurate estimates on just how dangerous a
visit to your local hospital has become.
Death certificates currently don't have a separate coding
classification for medical errors, which means estimates are not
accurate.
The medical coding system used by the CDC was originally developed
for physicians and hospitals to determine what to bill health insurance
companies for individualized patient care. The authors recommend an
overhaul of how cause of death data is collected."
The researchers suggest adding an extra field to the death certificate,
asking whether a preventable complication or medical error contributed
to the death. At present, no such checkbox exists. Instead, when a
patient dies from a medical error, the original complaint is listed as
the cause of death.
They also recommend a number of strategies to reduce the number of
deaths from iatrogenic causes, including increased transparency and
communication. As long as health care providers and hospital
administrators remain in the dark about the severity of the problem,
few course corrections are likely to be made.
Iatrogenic Deaths Are a Global Problem
Bob Anderson, chief of the mortality statistics branch for the CDC, claims there are
codes that capture iatrogenic causes of death. However, the published
mortality statistics do not take them into account. They only look at
the condition that led the individual to seek medical treatment in the
first place.
As a result, even if a doctor lists medical errors in the death
certificate, they are not included in the CDC's mortality statistics.
Anderson defends the agency's approach, saying it's "consistent with
international guidelines." In essence, most countries tally their
deaths in a similar fashion, in order to be able to compare mortality
statistics internationally.
All that really means is that this is a global problem, and all
nations really need to take a closer look at how deaths are recorded
and counted. According to Anderson, the CDC is unlikely to change the
recording of deaths unless there's a really compelling reason to do so.
But what could be more compelling than the fact that modern medicine is
a leading cause of preventable deaths!?
Dr. Starfield's Ironic Tragedy — A Victim to What She Chronicled
Ironically, Dr. Starfield became a statistic to her own research.
She died suddenly in June 2011, a death her husband attributed to the
adverse effects of the blood thinner Plavix
taken in combination with aspirin. However, her death certificate
makes no mention of this possibility. In the August 2012 issue of
Archives for Internal Medicine11 her husband, Neil A. Holtzman, M.D., M.P.H., writes, in part:
"Writing in sorrow and anger, I express up front my potential
conflict of interest in interpreting the facts surrounding the death of
my wife, Barbara Starfield, MD, MPH... Because she died while swimming
alone, an autopsy was required. The immediate cause of death was "pool
drowning," but the underlying condition, "cerebral hemorrhage," stunned
me...
Barbara started taking low-dose aspirin after coronary
insufficiency had been diagnosed 3 years before her death, and
clopidogrel bisulfate (Plavix) after her right main coronary artery had
been stented 6 months after the diagnosis. She reported to the
cardiologist that she bruised more easily while taking clopidogrel and
bled longer following minor cuts. She had no personal or family history
of bleeding tendency or hypertension.
The autopsy findings and the official lack of feedback prompted me
to call attention to deficiencies in medical care and clinical research
in the United States reified by Barbara's death and how the
deficiencies can be rectified. Ironically, Barbara had written about all
of them."
US Health Care System Is an Unmitigated Failure at Treating Chronic Illness
The U.S. has the most expensive health care
in the world, spending more on health care than the next 10 biggest
spenders combined (Japan, Germany, France, China, the U.K., Italy,
Canada, Brazil, Spain and Australia). If the U.S. health care system
were a country, it would be the 6th largest economy on the entire
planet.
Despite that, the U.S. ranks last
in health and mortality when compared with 17 other developed nations.
We may have one of the best systems for treating acute surgical
emergencies, but the American medical system is clearly an unmitigated
failure when it comes to treating chronic illness. The fact that
properly prescribed and administered drugs kill at least 106,000 should
really be food for some serious thought. For starters, drug safety
needs to become a priority, not an afterthought.
Indeed, one of Dr. Starfield's points of contention was the lack of
systematic recording and studying of adverse events, and her own death
highlights this problem. It was the Plavix-aspirin combination that
actually killed her, yet if it hadn't been for an autopsy and her
husband insisting on an adverse event report, no one would ever have
been the wiser about such a connection.
Only a tiny fraction of all adverse drug reactions are ever reported to the FDA; according to some estimates, as few as 1 percent.
In order to truly alert the FDA to a problem with a product they've
approved, they must be notified by as many people as possible who
believe they have experienced a side effect.
By filing a report, you help make medicine safer for everyone. So,
if you believe you've experienced a side effect from a drug, please
report it. Simply go to the FDA Consumer Complaint Coordinator page, find the phone number listed for your state, and report your adverse reaction.
In all, preventable medical mistakes may account for one-sixth of all deaths that occur in the U.S. annually.12
To put these numbers into even further perspective, medical mistakes
in American hospitals kill four jumbo jets' worth of people each week.13 According to statistics published in a 2011 Health Grades report,14
the incidence rate of medical harm occurring in the U.S. may be as
high as 40,000 harmful and/or lethal errors DAILY. According to
co-author John T. James:
"Perhaps it is time for a national patient bill of rights for
hospitalized patients. All evidence points to the need for much more
patient involvement in identifying harmful events and participating in
rigorous follow-up investigations to identify root causes."
Many Tests and Treatments Do More Harm Than Good
Overtesting and overtreatment are also part of the problem. Instead
of dissuading patients from unnecessary or questionable interventions,
the system rewards waste and incentivizes disease over health.
According to a report by the Institute of Medicine, an estimated 30
percent of all medical procedures, tests and medications may in fact be
unnecessary,15
at a cost of at least $750 billion a year. To learn which tests and
interventions may do more harm than good, browse through the Choosing
Wisely website.16
It's also important to be aware that many novel medical treatments gain
popularity over older standards of care due mostly to clever
marketing, opposed to solid science. An investigation17
by the Mayo Clinic published in 2013 proved this point. To determine
the overall effectiveness of our medical care, researchers tracked the
frequency of medical reversals over the past decade. They found that
reversals are common across all classes of medical practice, and a
significant proportion of medical treatments offer no patient benefit at all.
In fact, they found 146 reversals of previously established practices,
treatments and procedures over the past 10 years. The most telling data
in the report show just how many common medical treatments are doing
more harm than good. Of the studies that tested an existing standard of
care, 40 percent reversed the practice, compared to only 38 percent
reaffirming it.
The remaining 22 percent were inconclusive. This means that anywhere
between 40 and 78 percent of the medical testing, treatments, and
procedures you receive are of NO benefit to you — or are actually
harmful — as determined by clinical studies.
Once you're hospitalized, you're immediately at risk for medical
errors, so one of the best safeguards is to have someone there with
you. Dr. Andrew Saul
has written an entire book on the issue of safeguarding your health
while hospitalized. Frequently, you're going to be relatively
debilitated, especially post-op when you're under the influence of
anesthesia, and you won't have the opportunity to see the types of
processes that are going on. This is particularly important for
pediatric patients and the elderly.
It's important to have a personal advocate present to ask questions and
take notes. For every medication given in the hospital, ask questions
such as: "What is this medication? What is it for? What's the dose?"
Most people, doctors and nurses included, are more apt to go through
that extra step of due diligence to make sure they're getting it right
if they know they'll be questioned about it.
If someone you know is scheduled for surgery, you can print out the WHO surgical safety checklist and implementation manual,18 which is part of the campaign "Safe Surgery Saves Lives." The checklist can be downloaded free of charge here.
If a loved one is in the hospital, print it out and bring it with you,
as this can help you protect your family member or friend from
preventable errors in care.
Basic Tenets of Optimal Health
All in all, leading a common-sense, healthy lifestyle is your best bet
to achieve good health, and avoid dying from preventable causes.
Following is a list of some of the basic tenets of health that have
withstood the test of time. Following these healthy lifestyle
guidelines can go a very long way toward keeping you from becoming
another preventable death statistic:
Eat real food
For a comprehensive guide on which foods to eat and which to avoid, see my nutrition plan. Generally speaking, focus your diet on whole, ideally organic, unprocessed foods. Avoid sugar, and fructose in particular.
All forms of sugar have toxic effects when consumed in excess, and
drive multiple disease processes in your body, not the least of
which is insulin resistance, a major cause of chronic disease and
accelerated aging.
Avoid sitting, and get plenty of non-exercise "nutritional movement" and high intensity exercise
Even
if you're eating the healthiest diet in the world, you still need to
exercise to reach the highest levels of health, and you need to be
exercising effectively, which means including high-intensity
activities into your rotation.
High-intensity interval-type training boosts human growth hormone (HGH) production, which is essential for optimal health, strength and vigor. HGH also helps boost weight loss.
Non-exercise movement is another critical component. I recommend
walking more on a daily basis, over and above your scheduled
exercise, and avoiding sitting as much as possible.
Implement stress reduction strategies
Your emotional state plays a role in nearly every physical disease — from heart disease and depression, to arthritis and cancer.
Meditation, prayer, social support and exercise are all viable
options that can help you maintain emotional and mental equilibrium.
I also strongly believe in using simple tools such as the Emotional Freedom Techniques (EFT) to address deeper, oftentimes hidden, emotional problems.
Stay well hydrated
Drink plenty
of pure, clean water. Considering how widespread water pollution has
become, investing in a high quality water filtration system is
advisable.
Maintain a healthy gut
Mounting
research shows that beneficial microbes affect your health in a
myriad of ways; it can even influence your ability to lose weight.
A healthy diet is the ideal way to maintain a healthy gut, and regularly consuming traditionally fermented foods is the easiest, most cost effective way to help optimize your gut flora.
Optimize your vitamin D levels
Research has shown that increasing your vitamin D levels helps reduce your risk of death from ALL causes.
Avoid toxic exposures
This
includes tossing out your toxic household cleaners, soaps, personal
hygiene products, air fresheners, bug sprays, lawn pesticides, and
insecticides, just to name a few, and replacing them with non-toxic
alternatives.
Even if you do everything else right, you cannot be optimally healthy if you do not sleep well.
Regularly catching only a few hours of sleep can hinder metabolism
and hormone production in a way that is similar to the effects of
aging and the early stages of diabetes.
Chronic sleep loss may speed the onset or increase the severity of
age-related conditions such as type 2 diabetes, high blood pressure,
obesity, and memory loss.
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