The U.S. health care system may contribute to poor health or death.  According to Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health, 250,000 deaths per year are caused by medical errors, making this the third-largest cause of death in the U.S., following heart disease and cancer.

Writing in the Journal of the American Medical Association (JAMA), Dr. Starfield has documented the tragedy of the traditional medical paradigm in the following statistics:

* The term iatrogenic is defined as "induced in a patient by a physician's activity, manner, or therapy.  Used especially to pertain to a complication of treatment."

 

Furthermore, these estimates of death due to error are lower than those in a recent Institutes of Medicine report.  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 U.S.

Dr. Starfield offers several caveats in the interpretations of 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 the many 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.¹  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 (cerebro-vascular disease).

Another analysis¹¹ concluded that between 4 percent and 18 percent 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 it 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 percent of patients receive inappropriate care.  An estimated 44,000 to 98,000 among these patients die each year as a result of medical errors.²

This might be tolerable if it resulted in better health, but does it?  Out 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 U.S. on several indicators was:

• 13th (last) for low-birth-weight percentages

• 13th for neonatal mortality and infant mortality overall¹⁴

• 11th for post-neonatal 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 U.S. was recently confirmed by a World Health Organization study which used different data and ranked the United States as 15th among 25 industrialized countries.

Lifestyle

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 percent in Japan to 41 percent in Denmark;  in the United States, it is 24 percent (fifth best).  For males, the range is from 26 percent in Sweden to 61 percent in Japan;  it is 28 percent in the United States (third best).

The U.S. ranks fifth best for alcoholic beverage consumption.

The U.S. has relatively low consumption of animal fats (fifth lowest in men aged 55 to 64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.

Technology

Lack of technology is certainly not a contributing factor to the low ranking of the United States.  Among 29 countries, the U.S. 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 U.S. ranks among the lowest.  It is possible that the high use of technology in Japan is limited to diagnostic technology that is not matched by high rates of treatment, whereas in the U.S., the 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.  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 of the American Medical Association, Vol. 284, July 26, 2000.

It has been known that drugs are the fourth leading cause of death in the U.S.  This makes it clear that the more frightening number is that doctors are the third leading cause of death in this country, killing nearly a quarter million people a year.  These statistics are further confused because most medical coding only describes the cause of organ failure and does not identify iatrogenic causes at all.

Japan seems to have recognized 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 become increasingly dangerous for chronic disease cases.  Facilitating the God-given healing capacity by improving the diet, exercise, and lifestyle is the key.  Effective interventions for the underlying emotional and spiritual wounding behind most chronic disease is critical for the reinvention of our medical paradigm.  These numbers suggest that reinvention of our medical paradigm is called for.

(NaturoDoc comments:  This is a powerful indictment of conventional allopathic medical care.   Articles published in JAMA are circulated in the largest and most respected peer review journal in the world.  The major wire services did not carry this article, which is consistent with whose interests they represent.)

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/whr2001/2001/archives/2000/en/index.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.  Annual Rev. Public Health. 2000; 21:569-585.

8. Leape L.  Unnecessary surgery.  Annual Rev. Public Health. 1992; 13:363-383.

9. Phillips D, Christenfeld N, Glynn L.  Increase in U.S. 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 statistics, 1998.   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.

Acknowledgement

Thanks to Dr. Joseph Mercola's Optimal Wellness Center at mercola.com for permission to reprint this article.  This article copyright 2001 by Joseph M. Mercola, DO.

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