Top Killers in America

• by Marco Cáceres

• Published September 2, 2024
• Opinion

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A study published in 2016 in the British Medical Journal (BMJ) identified “medical error” as the third leading cause of death in the United States. Study authors reported that medical errors are responsible for the deaths of about 251,000 Americans each year—up from the nearly 100,000 Americans estimated by the Institute of Medicine (IOM) in 1999 to die annually after errors committed by doctors and other medical personnel.^{1 2 3 4} Co-authored by Martin Makary, MD and research fellow Michael Daniels of Johns Hopkins University School of Medicine, the study defined medical error as:

an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient.¹

“There’s vast underrecognition, underpreparation, and underfunding of the problem of medical care gone awry, even though it has a significant impact on public health,” Dr. Makary said. “It boils down to people dying from the care that they receive rather than the disease for which they are seeking care.”^{3 5}

The study by Makary and Daniels placed medical error behind only heart disease, which accounted for 614,348 deaths annually, and cancer, responsible for 591,699 deaths per year, as the deadliest killers and well ahead of respiratory disease (147,101), accidents (136,053), stroke (133,103), Alzheimer’s (93,541), diabetes (76,488), influenza and pneumonia (55,227), kidney disease (48,146), and suicide (42,773).^{1 2}

CDC Releases New Data on Leading Causes of Death

Recently, the U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) released provisional data on the top causes of deaths in the U.S. in 2023. According to the NCHS, heart disease remained the leading killer in the country, estimated to have caused 680,909 deaths. The second leading killer was cancer, with 613,331 deaths.^{6 7}

The third leading killer was unintentional injuries, with 222,518 deaths, followed by stroke (162,639), chronic lower respiratory disease (145,350), Alzheimer’s disease (114,034), diabetes (95,181), kidney disease (55,250), chronic liver disease and cirrhosis (52,220), COVID-19 (49,928), suicide (49,303), and influenza and pneumonia (45,182).⁶

Medical Error Should Be Counted

It’s worth noting the third leading killer, unintentional injuries, in that it is so vague—almost as if there is an attempt to hide something or a lack of interest in being more specific. Makary alluded to this when he wrote to the CDC in 2016:

Currently the CDC uses a deaths collection system that only tallies causes of death occurring from diseases, morbid conditions, and injuries. The information on death certificates filled out by physicians, funeral directors, medical examiners, and coroners form the basis of an annually list of the most common causes of death. We found that the death certificate form has a major limitation.

We suggest that the CDC allow physicians to list medical error as the cause of death, and, in the interim, the CDC should list medical error as the third most common cause of death…^{8 9}

If you look closely, what Makary and Daniels did in their study was to break out the unintentional injuries category into medical error and accidents. These are still broad categories, but at least the medical error category provides an indication of a problem that can be addressed. Under the current CDC system for identifying the leading killers, it is unclear just how many Americans are being harmed and killed as a result of mistakes made by the medical trade industry.

It is likely that the number of deaths caused by medical error is contained within the unintentional injuries and that it accounts for a large portion, if not most, of the deaths in that category. But there is no way to know for sure.

It only makes sense to understand precisely how and how much medical error contributes to mortality in the U.S. “Recognizing the role of medical error in health care has enormous implications for medicine,” wrote Makary. “At minimum, listing the death burden of medical error would help create an open dialog about the problem. … We need more honest conversations about the problem.”

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