8:55 AM 11/6/2007
Medical Interventions a Leading Cause of Death
Not long ago I read a report that made the astonishing claim that the leading cause of death in the US is the American medical system. Medicare's recent announcement that it will no longer reimburse hospitals for the cost of treating certain "serious preventable events," such as an object left in a patient's body after an operation or giving a patient the wrong kind of blood, and particular infections amounts to a frightening acknowledgement of how bad things have gotten in mainstream health care.
Authors of the report on causes of death, published in Life Extension magazine, attributed nearly 800,000 deaths each year to medical interventions, in contrast to approximately 650,000 deaths from heart disease and 550,000 from cancer. The methodology they used to calculate that number didn't stand up to our analysis, so I don't think the numbers are quite so high. However, it did get my attention since the figures came from credible sources including peer-reviewed medical journals, citing for instance, 106,000 deaths annually from adverse drug reactions, 98,000 from medical errors and 88,000 from infections. This compares with 160,000 deaths from lung cancer anticipated for 2007, for instance. Death can't be held off forever, of course -- but preventable deaths from hospital-acquired infections, especially if due to poor hygiene such as those transmitted by not washing hands, are particularly egregious.
For greater insight into the risks we face, I spoke with David J. Sherer, MD, a board-certified anesthesiologist in Falls Church, Virginia, and the coauthor of Dr. David Sherer's Hospital Survival Guide: 100+ Ways to Make Your Hospital Stay Safe and Comfortable (Claren). He said that although this report is controversial and somewhat alarmist, it has elements of truth. Numbers can always be crunched and interpreted in different ways, but the indisputable point here is that medical errors and complications or adverse effects from medical interventions have reached a crisis point in this country -- one that needs to be addressed. That's beginning to happen.
Dr. Sherer and I discussed what's behind this alarming trend and how we can protect ourselves.
BEHIND THE RISE IN MEDICAL-RELATED DEATHS
First of all, the problem is not that medical practitioners have suddenly and inexplicably become sloppy and careless. That's far too simplistic an explanation. Instead, Dr. Sherer chalks up the alarming statistics to a number of different factors:
The American public is getting older and sicker. Growing numbers of graying baby boomers are developing the diseases of aging -- heart disease, diabetes, orthopedic problems, etc. In the meantime, in people of all ages, ballooning rates of obesity contribute to these same health challenges. More sick people mean more medical interventions... and in hard numbers, that adds up to more mistakes or complications.
In a kind of medical "perfect storm," just as more Americans are developing serious health problems, we're struggling with a shortage of medical support personnel including nurses, which decreases the attention paid to patient needs and details of treatment. Also, managed care has meant doctors have less time to devote to patients during office visits and, as a result, are less likely to know the particulars of their history. Dr. Sherer warns that this sets up a system ripe for errors.
Americans today take more medications than anyone else in the world -- and drug companies are working hard to get us to take even more. Spending on direct-to-consumer drug advertising has increased over 300% in nearly a decade, to $4.2 billion in 2005 from $1.1 billion in 1997. With that much money aimed at advertising drugs not just to save lives, but to enhance mood or correct erectile dysfunction or alleviate restless legs syndrome, Dr. Sherer points out that drugs are often being taken by people who don't need them. More drugs mean more drug reactions and interactions to juggle than ever before... again, many more opportunities for errors.
We're paying closer attention to medical errors and preventable complications and -- paradoxically, the harder we look for them, the more we find. This makes the numbers look terrible in the short run, but in the long run this increased vigilance and accountability should result in improved care.
HOW TO PROTECT YOURSELF
Forewarned is forearmed: There are many proactive steps you can take to shield yourself and your loved ones from this epidemic of deaths related to medical interventions. At the doctor's office or in the hospital, Dr. Sherer recommends...
Bring an up-to-date list of all medications you take. Make sure that you list not only prescription drugs, but also over-the-counter medications, herbal remedies, vitamins and other dietary supplements. These can all react with one another. Also list the condition for which you take each drug.
Include correct name, spelling, usage and dosage. Dr. Sherer cautions that many drugs -- for example, Xanax (for anxiety) and Zantac (to treat ulcers) -- sound similar. A comprehensive and accurate list that includes the condition for which a drug or supplement has been prescribed will help ward off confusion and errors. This is especially important when dealing with health-care professionals who don't speak English as their first language.
Tell practitioners about any drug allergies or sensitivities and all pre-existing conditions. For example, perhaps you are allergic to penicillin. While this information should appear on your chart, don't take for granted that it does. Reminding health-care providers of your medical history, including drug allergies, is a simple and effective way to avoid potentially life-threatening medical errors.
Do your homework. If you are scheduled to take a new drug or undergo a test or procedure, first research it at reliable government, hospital or university-based Web sites such as www.medlineplus.gov or www.mayoclinic.com or www.jhu.edu (Johns Hopkins). Peer-reviewed journals such as the Journal of the American Medical Association (jama.ama-assn.org) and the New England Journal of Medicine (content.nejm.org) can also be excellent sources of information. An objective non-biased drug assessment database is available through both print and on-line subscription (www.factsandcomparisons.com/) -- ask your health-care provider and/or pharmacist whether they use it.
Speak up. Ask your doctor the right questions. Why do I need this drug/test/procedure? What are the risks versus benefits? Is this the best drug/test/procedure for my condition? What about side effects? In the case of tests, are the results typically straightforward or subject to interpretation? How often is this test/procedure performed at your facility? How often does the surgeon or other medical practitioner perform it? In both cases, the more often, the better. Will there be pain or discomfort? If your physician can't or won't take the time to answer your questions, it's time to get a new physician.
Designate a friend or family member to be your advocate. When you're ill, it's all too easy to become nervous and forget the questions you want to ask, or fail to recall your physician's advice. It's not only comforting to have a trusted advocate by your side at such moments, it also contributes to a better understanding of the situation on your part, and more accountability on the part of your caregivers. If you're in the hospital, try to have someone with you or visiting frequently so that they can get help/nurse's attention if need be.
Take personal responsibility. In the long run, you remain in charge of your own health. Responsibility includes not just your interactions with medical practitioners, but also making lifestyle changes that reduce your risk of illness.
No doubt we will continue to hear more about this vitally important health topic -- and I'll continue to cover it in upcoming issues of Daily Health News. Given that hospitals will now have to absorb the costs of their mistakes due to Medicare's refusal to provide coverage for "serious preventable events," with a stipulation that prevents billing patients for them, too, it's clear that they will focus intently on reducing these events, which can only be good news. And meanwhile, Medicare's new hospital inpatient provisions will result not only in an estimated savings for the government of more than $20 million annually -- but, we can only hope, the saving of many lives as well.
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