What alternative health advocates get wrong about medical mistakes

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My father died in the wake of a medical mistake.

He died in the hospital where I had trained and was on staff. It was nine months after his doctors neglected to inform him that a routine pre-operative chest X-ray had shown a small cancerous tumor in his lung. When he showed up seven months later coughing blood, the tumor was the size of his fist, filling the middle of his chest. He died 8 weeks to the day after the diagnosis despite aggressive treatment.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Nearly all of those who died were going to die anyway. Had they refused conventional medical care, they probably would have died sooner.[/pullquote]

He was only 60 years old.

The medical mistake that preceded my father’s death was egregious, inexcusable and fatal. I am as outraged as anyone about the number of medical mistakes that occur. But — and this is the critical point — had he never had the fateful chest X-ray and had he never interacted with the conventional medical system he would have died anyway and possibly sooner.

That why, though I abhor medical mistakes more than most, I’m not remotely persuaded to abandon conventional medicine by the rallying cry of many alternative health advocates, “medical mistakes are the third leading cause of death in the US.” That’s because most medical mistakes are “failure to rescue.”

My father’s case is a perfect example. He died because of a cancer that was so aggressive that at the time he was diagnosed its origin could not be determined. It could have been lung cancer; it could have been cancer arising in a lymph node in the chest; it could have been a metastasis from a distant organ. It was no longer possible to tell.

He died of a cancer that was so aggressive that, in the space of 7 months, had grown from the size of his fingertip to the size of his fist. But — and this is the critical point — had he never had the fateful chest X-ray, he would have died anyway and in exactly the same way since he had no symptoms until he started coughing up blood. The chest X-ray offered an opportunity to rescue him from the disease he already had and because his doctors never communicated with him or each other, he was denied that opportunity.

That’s a tragedy but it also shows why it’s absurd to use medical mistakes as justification for shunning conventional medical care like vaccinations, hospital birth and just about any treatment you can name.

The claim that medical mistakes are the third leading cause of death US ignores the fact that nearly all of those who died were going to die anyway. Had they refused conventional medical care, they probably would have died sooner.

In 2016, Dr. Aaron Carroll provided an analysis why the claim that medical errors cause 98,000 deaths per year dramatically overstates the impact of medical errors.

They focused on the study from which the 98,000 was extrapolated. It involved an observational analysis of 7,743 “high-severity” patients in a New York hospital admissions database, which found that 13.6 percent had died, at least in part, because of an adverse event.

But this didn’t account for the baseline rate of death. Using New York State Health Department data, and applying the calculated death rate for in-hospital acute care admissions, they found that about 13.8 percent of patients in the “high-severity” group should have been expected to die over all.

This means that the death rate in the group with medical errors was probably similar to the death rate in a group without medical errors, casting doubt on those errors as being the cause of death. (my emphasis)

Subsequent studies claiming that the incidence of deadly medical errors is even higher, 250,000-400,000 deaths per year, suffer from the same problem.

As Dr. David Gorski noted earlier this year:

[T]he authors conflated unavoidable complications with medical errors, didn’t consider very well whether the deaths were potentially preventable, and extrapolated from small numbers. Many of these studies also used administrative databases, which are primarily designed for insurance billing and thus not very good for other purposes.

A more recent study, using more sensitive methodology, has found that the rate of death from medical errors is only a tiny fraction of the massive numbers originally claimed.

…First, it uses a database designed to estimate the prevalence of different causes of death, rather than for insurance billing. Second, it used rigorous methodology to identify deaths that were primarily due to AEMTs (adverse effects of medical treatment). One thing about this study that makes sense comes from its observation that AEMT is a contributing cause for 20 additional deaths for each death for which it is the underlying cause. For 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year, which is in line with the IOM estimates. It’s also in line with my assertions that one major issue with previous studies is that the unspoken underlying assumption behind them is that that if a patient had an AEMT during his hospital course it was the AEMT that killed him.

So “adverse medical events” ARE common, but most are NOT medical errors and are NOT the primary cause of death in any case.

What is the practical significance of these findings?

Let’s use an analogy. Imagine if firefighters were found to have made mistakes in fighting major fires. Perhaps they took too long to arrive, had a hose with a hole in it, or attacked the fire in the wrong way. People might even have died in the wake of the mistakes. But that doesn’t mean it was the mistakes that killed them; the fire killed them and the mistakes possibly impeded their rescue. It is also possible that they could never have been saved at all, even if the fire fighters had responded flawlessly.

Moreover, any mistakes made by the firefighters wouldn’t have made it a reasonable strategy to refuse to call the fire department. The death and destruction would have been worse, not better. Fire fighters who make mistakes fail to rescue people who might have been rescued, but not calling them ensures that everyone who is trapped will die.

Similarly, refusing conventional medical care prevents medical errors but it doesn’t protect patients from disease and it is the disease that kills them. Therefore, it makes no sense at all to shun conventional medical care because of fear of mistakes.

  • Merrie

    In the discussion of medical errors, how many are errors that can’t have any adverse impact on treatment? Example, we report it as an error in our system if a drug is dispensed to a patient under the incorrect prescriber’s name. Obviously this is something that should be correct, and their treatment could potentially be impacted indirectly if eg. this leads to wasting time calling the wrong provider for refills and the patient runs out of refills. But if they receive the right med, quantity, strength, and directions, their medical progress won’t be different if the name of a different doctor is on the label of their bottle.

  • MaineJen

    Trust fire!

  • attitude devant

    I keep thinking about this post. I remember vividly reading the first study, in 1999. At the time I was reviewing large numbers of charts for our QA programs, and I remember thinking that the numbers of errors they had extrapolated didn’t reflect what I was seeing in OB/GYN. I cornered a hospitalist friend and he kept saying, yes, but that’s what the report says.

    I remember now hypothesizing why my experience didn’t match the study. Was it because we had a low-acuity, low-risk population? Possibly. Were we just better than all the other hospitals or departments? Surely not. Were we just lucky and the errors weren’t coming to my attention? Was I just dense?

    Now, twenty years later, I have the answer: they were wrong. And it’s so nice to have what I was seeing with my own eyes match up with the re-analysis. Don’t get me wrong: I’m a total safety nut. But finally, it makes sense to me.

  • attitude devant

    Thank you for this. It is soooo annoying to hear complications addressed as errors. No, dammit. A certain number of people are going to have complications from procedures and treatments. We can reduce the rate of complications by following best practices and choosing our treatment modalities, but a negative outcome is not evidence of a mistake.

  • Daleth

    “The claim that medical mistakes are the third leading cause of death US
    ignores the fact that nearly all of those who died were going to die
    anyway. Had they refused conventional medical care, they probably would
    have died sooner.”

    This is SUCH a good point. I’d never thought of it that way.

  • Outstanding post.