Monday, April 20, 2009

Health Care in America

A few random quotations (OK, not entirely random):

1. From this month's report Beyond Health Care: New Directions to a Healthier America, from the Robert Wood Johnson Foundation:
Although medical care is essential for relieving suffering
and curing illness, only an estimated 10 to 15 percent of
preventable mortality has been attributed to medical care.
2. From an article entitled "Death by Medicine":
As shown in the following table, the estimated total number of iatrogenic deaths — that is, deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures — in the US annually is 783,936. It is evident that the American medical system is itself the leading cause of death and injury in the US. By comparison, approximately 699,697 Americans died of heart in 2001, while 553,251 died of cancer.
3. From Barbara Starfield, "Is US Health Really the Best in the World?," JAMA 284 (2000):483-485.
The health care system also may contribute to poor health through its adverse effects. For example, US estimates8-10 of the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error include:

* 12,000 deaths/year from unnecessary surgery
* 7000 deaths/year from medication errors in hospitals
* 20,000 deaths/year from other errors in hospitals
* 80,000 deaths/year from nosocomial infections in hospitals
* 106,000 deaths/year from nonerror, adverse effects of medications

These total to 225,000 deaths per year from iatrogenic causes. Three caveats should be noted. First, most of the data are derived from studies in hospitalized patients. Second, these estimates are for deaths only and do not include adverse 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.
4. From Jason Lazarou, Bruce Pomeranz, and Paul Corey, "Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-analysis of Prospective Studies," JAMA 279 (1998): 1200-1205.
The overall incidence of serious [adverse drug reactions] was 6.7% (95% confidence interval [CI], 5.2%-8.2%) and of fatal [adverse drug reactions] was 0.32% (95% CI, 0.23%-0.41%) of hospitalized patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious [adverse drug reactions] and 106000 (76000-137000) had fatal [adverse drug reactions], making these reactions between the fourth and sixth leading cause of death.


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