Local Items & Events

Local Events
Check our Calendar of local activities

Local Attractions
A list of some of our best places to visit


Article Categories

Search Our Site


Advanced Search
Article Options
Popular Articles
  1. Doctors May Be Third Leading Cause of Death
  2. Introduction to Alternative Cancer Treatments
  3. The Forgotten Clue to the Bacterial Cause of Cancer
  4. Drugs & Doctors May be Leading Cause of Death
  5. Do Killer Microbes Cause Breast Cancer?
Popular Authors
  1. Joseph Mercola, D.O.
  2. News Article
  3. R. Webster Kehr
  4. Alan Cantwell, Jr. M.D.
  5. Dennis Harwood

 »  Home  »  Health News Index  »  Pharmaceutical Industry News  »  Doctors May Be Third Leading Cause of Death
Doctors May Be Third Leading Cause of Death
by Joseph Mercola, D.O. | Published  3/15/2000 | Pharmaceutical Industry News | Rating:
Joseph Mercola, D.O.

Dr. Mercola is a licensed Osteopathic physician and board-certified in family medicine. He served as the chairman of the family medicine department at St. Alexius Medical Center for five years and has been trained in both traditional and natural medicine. Dr. Mercola has been practicing natural medicine actively since 1990 and is the publisher of www.mercola.com, the most visited health site on the internet. 

View all articles by Joseph Mercola, D.O....
Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year

This week's issue of the Journal of the American Medical Association (JAMA) is the best article I have ever seen written in the published literature documenting the tragedy of the traditional medical paradigm.

This information is a followup of the Institute of Medicine report which hit the papers in December of last year, but the data was hard to reference as it was not in peer-reviewed journal. Now it is published in JAMA which is the most widely circulated medical periodical in the world.

The author is Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and she describes how the US health care system may contribute to poor health.

ALL THESE ARE DEATHS PER YEAR:

  • 12,000  — unnecessary surgery 8
  • 7,000  — medication errors in hospitals 9
  • 20,000  — other errors in hospitals 10
  • 80,000  — infections in hospitals 10
  • 106,000  — non-error, negative effects of drugs 2  
  • These total to 250,000 deaths per year from iatrogenic causes!!

What does the word iatrogenic mean? This term is defined as induced in a patient by a physician's activity, manner, or therapy. Used especially of a complication of treatment.

Dr. Starfield offers several warnings in interpreting these numbers:

  • First, most of the data are derived from studies in hospitalized patients.
  • Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
  • Third, the estimates of death due to error are lower than those in the IOM report.

If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

Another analysis (11) concluded that between 4% and 18% of consecutive patients experience negative 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

The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.

However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.

An estimated 44,000 to 98,000 among them die each year as a result of medical errors.2

This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison,3,4 the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:

  • 13th (last) for low-birth-weight percentages
  • 13th for neonatal mortality and infant mortality overall 14
  • 11th for postneonatal mortality
  • 13th for years of potential life lost (excluding external causes)
  • 11th for life expectancy at 1 year for females, 12th for males
  • 10th for life expectancy at 15 years for females, 12th for males
  • 10th for life expectancy at 40 years for females, 9th for males
  • 7th for life expectancy at 65 years for females, 7th for males
  • 3rd for life expectancy at 80 years for females, 3rd for males
  • 10th for age-adjusted mortality

The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.

 There is a perception that the American public "behaves badly" by smoking, drinking, and perpetrating violence.  However the data does not support this assertion.

  • The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range s from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).
  • The US ranks fifth best for alcoholic beverage consumption.
  • The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.

These estimates of death due to error are lower than those in a recent Institutes of Medicine report, and if the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

Even at the lower estimate of 225,000 deaths per year, this constitutes the third leading cause of death in the US, following heart disease and cancer.

Lack of technology is certainly not a contributing factor to the US's low ranking.

  • Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. 17
  • Japan, however, ranks highest on health, whereas the US ranks among the lowest.
  • It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.
  • Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.

Journal American Medical Association Vol 284 July 26, 2000


COMMENT: Folks, this is what they call a "Landmark Article". Only several ones like this are published every year.

One of the major reasons it is so huge as that it is published in JAMA which is the largest and one of the most respected medical journals in the entire world. I did find it most curious that the best wire service in the world, Reuter's, did not pick up this article. I have no idea why they let it slip by.

I would encourage you to bookmark this article and review it several times so you can use the statistics to counter the arguments of your friends and relatives who are so enthralled with the traditional medical paradigm. These statistics prove very clearly that the system is just not working. It is broken and is in desperate need of repair.

I was previously fond of saying that drugs are the fourth leading cause of death in this country. However, this article makes it quite clear that the more powerful number is that doctors are the third leading cause of death in this country killing nearly a quarter million people a year. The only more common causes are cancer and heart disease. This statistic is likely to be seriously underestimated as much of the coding only describes the cause of organ failure and does not address iatrogenic causes at all.

Japan seems to have benefited from recognizing that technology is wonderful, but just because you diagnose something with it, one should not be committed to undergoing treatment in the traditional paradigm. Their health statistics reflect this aspect of their philosophy as much of their treatment is not treatment at all, but loving care rendered in the home.

Care, not treatment, is the answer. Drugs, surgery and hospitals are rarely the answer to chronic health problems. Facilitating the God-given healing capacity that all of us have is the key.

Improving the diet, exercise, and lifestyle are basic. Effective interventions for the underlying emotional and spiritual wounding behind most chronic illness are also important clues to maximizing health and reducing disease.

Related Articles:

Medical Mistakes Kill 100,000 per year

US Health Care System Most Expensive in the World

Author/Article Information:

Author Affiliation: Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

Corresponding Author and Reprints:

Barbara Starfield, MD, MPH, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public

Health, 624 N Broadway, Room 452, Baltimore, MD 21205-1996 (e-mail: bstarfie@jhsph.edu).

REFERENCES

1. Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.

2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

3. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.

 4. World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. Accessed June 28, 2000.

5. Kunst A. Cross-national Comparisons of Socioeconomic Differences in Mortality. Rotterdam, the Netherlands: Erasmus University; 1997.

6. Law M, Wald N. Why heart disease mortality is low in France: the time lag explanation. BMJ. 1999;313:1471-1480.

7. Starfield B. Evaluating the State Children's Health Insurance Program: critical considerations. Annu Rev Public Health. 2000;21:569-585.

8. Leape L.Unecessarsary surgery. Annu Rev Public Health. 1992;13:363-383.

9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.

10. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA. 1998;279:1200-1205.

11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.

12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. London, England: Routledge; 1996.

13. Evans R, Roos N. What is right about the Canadian health system? Milbank Q. 1999;77:393-399.

14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics1998. Pediatrics. 1999;104:1229-1246.

15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.

16. Donahoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596-1607.

17. Anderson G, Poullier J-P. Health Spending, Access, and Outcomes: Trends in Industrialized Countries. New York, NY: The Commonwealth Fund; 1999.

18. Mold J, Stein H. The cascade effect in the clinical care of patients. N Engl J Med. 1986;314:512-514.

19. Shi L, Starfield B. Income inequality, primary care, and  health indicators. J Fam Pract. 1999;48:275-284.

Article Series
This article is part 1 of a 2 part series. Other articles in this series are shown below:
  1. Doctors May Be Third Leading Cause of Death
  2. Drugs & Doctors May be Leading Cause of Death
Comments

  • Comment #1  (Posted by Jason)
    Rating
    It should be considered that while JAMA states that they're the most widely circulated medical journal in the world, their impact factor is 23.5. Compared to the NEJM, which is at 44.01. (Impact factor is a measure of the number of times papers published in the previous two years have been cited in the scientific literature.) Peer-review aside, articles published in the NEJM hold more clout. Also, the author is described as publisher of "...the most visited health site on the internet". A false assertion. Not true, period. I'm certainly not disputing the fact that medical error isn't something that should be improved upon. It is convenient–however–that in presenting the argument against the perception of the American public "behaving badly" that obesity was omitted. Those statistics aren't nearly as favorable. Just food for thought.
     
  • Comment #2  (Posted by Robert Allard )
    Rating
    Doctors are not the 3rd leading cause of death. They are instead the 1st leading cause of death. Who do you think kills over a million babies in this country alone by abortion?
     
  • Comment #3  (Posted by Lawrence J. O'Brien )
    Rating
    My book 1999 "Bad Medicine: How the American Medical Establishment Is Ruining Our Healthcare System" presents the facts on morbidity and mortality resulting from iatrogenic causes in the United States. After the IOM report came out, Barbara Starfield told me that she got the idea for her JAMA special report from reading Bad Medicine, which caused her to realize that the annual number of deaths attributed to physician conduct was much greater than the number used in the IOM report. Bad Medicine includes a sort of intellectual history of how American medicine got itself into its present fix, and suggests a way of escape. This book should not continue to be overlooked. L. J. O'Brien
     
  • Comment #4  (Posted by Vishnu )
    Rating
    A friend's recently took his 3 month old daughter to the hospital as she had a 101 degree fever. The hospital put the child through every test known to manking including taking her spinal fluid to test for meningitis. If you read about it you will know how painful that can be. Finally his daughter who was very pleasant to start with, was released as a irritable, scared child and in a less healthy state than when she was admitted. I think the practice of doing unnecessary tests just because the insurance covers it is abominable and base.My friend says now that he should have stuck to what his mother told him to do, which was to keep cold towel on the child's forehead to bring down the fever.
     
  • Comment #5  (Posted by Golla )
    Rating
    It is unbelievable & needs more elaboration
     

Submit Comment