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Study Suggests Medical Errors Now Third Leading Cause of Death in U.S. (2016)
- danuker 4y agoRelevant: the US spends double the amount of other countries on healthcare, yet has a life expectancy 3 years shorter. https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low
- Cthulhu_ 4y agoLet the market decide!11! Mark Cuban's project of selling off-brand medication for cheap is great - insurance companies don't want to work with them, but if said insurance companies still require their customers to pay for medication and that project is even cheaper than that, they'll get competed out of the market. Also that free market thing is a lie, it's in the medical industry's interest to keep prices high and to not have competition / undercutting happen.
- bambax 4y ago> insurance companies don't want to work with them I'm not familiar with the peculiarities of the US healthcare system, but why wouldn't insurance companies work with off-brand medications? If it costs less it's good for them, no?
- freeone3000 4y agoMedical insurer's profits are limited to a percentage of their gross income, so, more expensive medications and procedures are preferred to less expensive ones in order to preserve overall income.
- danuker 4y agoWell, there's a perverse incentive!
- bambax 4y agoAh... Thanks... Unintended consequences strike again.
- kuu 4y agoNot so sure it is unintended...
- willcipriano 4y agoThis predicable outcome was either on purpose or the nation is ran by a cabal of people with severe cognitive impairment. What's better?
- sokoloff 4y agoPorque no los dos? (Why can’t it be both?)
- gambiting 4y agoI don't understand. If you pay $5000 a year for your medical insurance, but it paid $10k for your medication, how have they made money? If they could purchase the same medication for $2000 instead, surely it would be more profitable for them?
- closewith 4y agoPart of the U.S Affordable Care Act is the so-called 80/20 rule, which limits profit margins to 20%. Therefore, the greater the overall healthcare spend by insurance companies, the greater the allowable profit.
- thaumasiotes 4y ago> If they could purchase the same medication for $2000 instead, surely it would be more profitable for them? If the 60% profit margin is illegally high, then no, it's worse. They'd be better off paying more money for the same thing.
- giantg2 4y agoVerticle Integration. For example, CVS Caremark is my insurance. They force me to get most medication through CVS or their mail order service.
- api 4y agoWow what a perverse incentive.
- formerkrogemp 4y agoNo, they're required to spend at a minimum 85% of the money they receive from premiums on healthcare or healthcare quality improvement. As the price of medical procedures goes up, so does the 15% amount that they're allowed to keep and so too do the premiums rise to increase their income.
- nradov 4y agoWhile the Affordable Care Act (Obamacare) did introduce a minimum medical loss ratio, insurers still have a strong incentive to hold down costs by encouraging use of cheaper generic medication so that they can offer lower prices to plan purchasers. Most medical insurance is purchased by employers and other group buyers, and they look closely at costs. In most cases, physicians have to obtain specific approval in order for more expensive medications to be covered.
- spaetzleesser 4y agoMy impression is that they mainly focus on pushing costs to the patient in the form of higher and higher deductibles.
- nradov 4y agoWho is "they"? Medical insurance companies don't really set deductibles. They offer a menu of options to customers (mainly large employers) and let them pick. Insurers are happy to offer plans with zero deductible, but the premiums will be higher. This is all based on actuarial calculations; insurers generally don't make any more profit on high-deductible plans. If you think your deductible is too high then complain to your employer. There is a tax incentive at work here as well. Individuals enrolled in high-deductible health plans (HDHP) can often receive a federal income tax break, so you have to factor that in when calculating your net cost.
- spaetzleesser 4y agoThe configuration of your health insurance is negotiated between insurance and employer. It seems pretty obvious that they are setting things up in a way that’s good for them.
- nradov 4y agoYou don't seem to understand how that negotiation works. Higher deductibles aren't good for medical insurers. In terms of insurer profit margin, higher deductibles are neutral to slightly negative. It's the employer (customer) who has complete control over deductibles. That is the reality of how the market works. Deductibles are generally going higher because healthcare providers and pharmaceutical companies raise prices every year, and because we have an increasingly unhealthy population that demands more services. Insurers try to hold down those increases but with limited success, so they pass those costs on to their customers (employers), and those customers in turn pass on the higher costs to their employees.
- evandijk70 4y agoExactly - in the Netherlands we have the reverse problem - if a generic drug exists, some insurance companies will only reimburse that drug. In some cases that leads to problems. One example was a generic drug where some patients were allergic to the excipients in the generic drug.
- basisword 4y ago>> Mark Cuban's project of selling off-brand medication for cheap is great It's great and going to help a lot of people. But it's still not cheap compared to a lot of other countries which either provide free medication or medication for a fixed fee per item (usually around $10-20, varies by country).
- arethuza 4y agoAs someone who lives in a country where medication is "free", I always like to clarify that "free" in these kinds of contexts means "free at the point of delivery" - we're all perfectly aware that they are paid using money from taxpayers.
- hobs 4y agoWho have an insanely better price anyway because of their negotiating power as a nation instead of an individual payee.
- vidarh 4y agoIt's not just negotiating power, but that they're actually allowed to negotiate. E.g. Medicare has a substantially higher demand for drugs than most single payer universal healthcare systems due to a combination of number of people covered plus covering mostly older, more expensive, patients. It's larger than the UK's NHS for example. But Medicare is subject to various legal restrictions on their ability to negotiate the best prices possible, while the NHS can use whatever leverage it pleases.
- arethuza 4y agoWhy would any government legislate to prevent a government run medical provider from negotiating with suppliers?
- vidarh 4y agoThe excuse is that they're concerned about it distorting the market. So instead they're distorting it by ensuring one of the bigger customers of pharma companies won't try to get the best prices possible...
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- 21723 4y agoOur healthcare system is an absolute travesty for the poor, but it's pretty lousy even for people who can afford care. I know plenty of people with 7- and 8-figure net worth, people who have connections to the medical system, who've still received substandard care. It's at the point where no one's winning.
- clinicalcurious 4y agoWhich healthcare system are you referring to? US? Or another country? Honest question. I am also curious to understand if European, UK and Asian healthcare systems suffer from substandard care problem.
- donatj 4y agoConsidering our diet, exercise and demographics I think that’s surprisingly decent regardless.
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- ChrisRR 4y agoWho could've expected a country that glamourises gluttony would have a shorter life expectancy?
- ncmncm 4y agoThat is not why we are sick. We are sick because practically everything pushed on us is pumped full of sugar.
- ellopoppit 4y agoSugar biochemically induces gluttony and laziness
- ncmncm 4y agoSugar causes excess uric acid in the blood, which causes type 2 diabetes and high blood pressure, among a dozen other ills. And, does not reduce hunger like real food. On a choice between fat and sugar, always choose fat. To be precise: sugar without enough fiber causes illness. With enough fiber, as is provided by all fruit except grapes, sugar absorption is delayed long enough that intestinal bacteria get to eat most of it. Keep your intestinal bacteria fed; if not, they eat you.
- oneepic 4y ago(2016, right?)
- dane-pgp 4y ago(Release Date: May 3, 2016)
- viknesh 4y agoI wonder what the average/aggregate expected loss in years of life is due to this. It's very different to make a fatal error on somebody with a life expectancy of 1 year vs 50 years. This data doesn't seem to be discussed in the article.
- 21723 4y agoOn the other hand, for-profit medicine is great for the shareholders.
- throwawaylinux 4y ago[flagged]
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- willcipriano 4y agoA video on this topic: https://m.youtube.com/watch?v=o_s5y9Ls83Q https://m.youtube.com/watch?v=o_s5y9Ls83Q
- synu 4y agoThere was a moratorium? It feels like this conversation has been happening endlessly for years now.
- throwawaylinux 4y agoYes there was. Questioning of corporations, their motives, or their claims, was verboten. Maybe it still is, someone just accused me of being "far-right" for the thought-crime of questioning Pfizer's profiteering, lmao.
- InitialLastName 4y ago> Maybe it still is, someone just accused me of being "far-right" for the thought-crime of questioning Pfizer's profiteering, lmao. Well, no, you accused yourself of that; they just played along.
- throwawaylinux 4y agoWrong on both counts. I did not, and they did.
- andreareina 4y agoOr maybe not: https://youtu.be/Jbsy7VObyyM https://youtu.be/Jbsy7VObyyM
- TheRealDunkirk 4y agoHe’s apparently so important and busy that he has to make these videos while driving in his super car from point A to point B. 15 years ago, this “content” would have been a blog post, which we could have skimmed in 30 seconds to get the gist of the counter argument. Now it’s a 10 minute video with no notes, buried behind 2 ads. Next time, give us a 2 sentence summarization of the argument you’re linking.
- fantasticshower 4y agoCan you spare the rest of us and give the aforementioned two sentence summarization?
- TheRealDunkirk 4y agoNo. I skimmed the video, and couldn’t find the point.
- andreareina 4y ago- the claim is absurd on its face: that's more deaths than from road traffic accidents, half as much as from all cancer, and accounts for a significant proportion of the number of people who die in the hospital for all causes (and would be the number one reason - the figures come from studies with methodological issues (non-representative populations, overly-broad criteria for what's counted as a death from medical error)
- rdedev 4y agoWell to be fair to the guy in the video, he is a practicing cardiologist in the UK. https://www.youtube.com/c/MedlifeCrisis/videos https://www.youtube.com/c/MedlifeCrisis/videos Afaik he does mostly videos and dont do blogs. Anyways one argument presented in the video (but dont know if its relevant to this post) is that the datasets used sometimes dont differentiate between medical error and medical harm. Medical harm is where you need to do a particular intervention, but the possible side effects of the intervention leads to the patients death. Furthermore the line between medical harm and medical error is fuzzy especially when you dont have all the information at hand when doing the procedure. The datasets for the papers mentioned in the video were retrospective
- danpalmer 4y agoThe US incentivises blaming healthcare providers in order to recoup costs. I'm sure there are issues with substandard care, but I'm not sure the data can be fully trusted given that putting the blame on a healthcare provider in any way possible is often in the best interests of the patient.
- Nevermark 4y agoI would think that the healthcare industry is very good at avoiding blame and sweeping blameworthy incidents under the rug. I expect the data can't be completely trusted in either direction.
- deltaonefour 4y agoCustomer satisfaction is more trust-able. The incentive for retaliation is simply customer unhappiness. Patients don't just sue doctors because doctors are sitting on a pile of money, people don't behave this way. Most People sue because they are pissed. However if you caused someones death and don't want to go to jail... well that can be swept under the rug, people actually do behave this way.
- ClumsyPilot 4y ago> Customer satisfaction is more trust-able. Dead men dont leave reviews
- deltaonefour 4y agoBut the family does.
- DicIfTEx 4y agoAnd a sizeable portion of that medical error is due to poor device UX: https://www.youtube.com/watch?v=_XJbwN6EZ4I https://www.youtube.com/watch?v=_XJbwN6EZ4I
- cnity 4y agoThis is a fantastic video that I'd never seen before (as a programmer who largely focuses on building user interfaces!) Thanks.
- hyperman1 4y agoAgreed. The actual real cases start at 9:00 and its blatant.
- sschueller 4y agoThank you Tesla for replacing hardware buttons with menu driven touch screens and autopilot that will drive you home safely. Additionally thank you for causing such a hype that other car manufacturers feel like they missed the boat and are copying these brilliant features. /s
- 93po 4y agoThank you for bringing up Elon in situations that are completely unrelated. There isn't enough attention on him already /s
- ChrisRR 4y agoProbably why the MDR in the EU forces new products to conduct usability testing in their product design
- buescher 4y agoA quick Google search will tell you whether the FDA in the US has similar requirements or instead perhaps medical devices in the US are the unregulated Wild West.
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- nenadst 4y agoapparently based on very flawed arguments https://gidmk.medium.com/medical-error-is-not-the-third-leading-cause-of-deaths-ff13c71851b https://gidmk.medium.com/medical-error-is-not-the-third-lead...
- lilygirl85 4y agoThose are some critical flaws
- simonh 4y agoNot just flawed argument, but wildly inaccurate data that was then grossly misapplied. Unfortunately a lot of people on HN will just read the headline and think this is true, when it's very far from being the case. I wish we could link this whole thread to the refutation instead of further propagating this misinformation.
- ncmncm 4y agoWe don't know whether it is the case or not. It could just as easily be worse than it says. Probably is. If I had to tell you about all the medical mistakes experienced by just my immediate family, just the facts, I would be at it all day long.
- TaupeRanger 4y agoUnless the mistakes led to death that wouldn't have otherwise occurred in a similar timeframe, the anecdotes wouldn't even be relevant.
- deltaonefour 4y agoBased off the fact that mistakes that lead to death are so high... If we had statistics on errors that didn't lead to death, the results would be an astronomically larger illustration of incompetence then Just mistakes that lead to death.
- ClumsyPilot 4y ago
- zeroth32 4y ago
- smcl 4y agoI don't think joking about the death of George Floyd is a particularly good direction for this discussion.
- bloak 4y agoI don't think "age" is a valid cause of death. Old people are more likely to die than young people, but they still die from particular causes that should be distinguished and recorded. For people of any age it's not obvious how to record a combination of circumstances or a cascade of conditions. For example, a very common fate for old people is to fall, break a hip ("neck of femur"), be admitted into hospital, and then die from pneumonia a week or so later. I think the bone breaks easily in old people often because of vitamin or calcium deficiency. In one case the fall was also indirectly caused by a preceding stroke, so the cause of death was ...?
- zeroth32 4y ago> I don't think "age" is a valid cause of death. > so the cause of death was ...? Age?
- bloak 4y agoOne of the main purposes of recording cause of death is so that we know what to concentrate on for improving public health. For example, perhaps we could make old people's bones less brittle by adding vitamins to bread, or do something to persuade more of them to eat something other than just bread and jam, or perhaps we could stop them getting infected with pneumonia in hospitals, or somehow make pneumonia more survivable, or ... Putting "age" as the "cause of death" would be about as useful as putting "birth" or "cessation of the vital functions".
- smcl 4y agoI agree and I might add that we probably don't want to normalise the idea that the elderly just randomly die of "old age". That could easily result in a decline of standards in hospitals and elderly residential homes, or it could even give the Harold Shipmans of the world free reign to do as they please: https://en.wikipedia.org/wiki/Harold_Shipman https://en.wikipedia.org/wiki/Harold_Shipman Everybody dies and we can't deny that, there likely won't be some breakthrough within my lifetime where we conquer death. But we should still be striving to understand the causes, to know whether someone died because of heart failing due to being really old[0], or whether it was down to something preventable or that otherwise indicates a failure in our system [0] - not a doctor, I don't know what sort of things they normally use for this. Substitute an actual cause of death if this doesn't sound right :)
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- giantg2 4y ago“Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” That's because they're hard to standardize. What qualifies as a medical error? It's easy to go back after the fact and analyze a case where someone has a poor outcome and say 'we should have done this another way'. That doesn't mean there was any indication at the time that the other way would have been better or that the poor outcome could have been foreseen. I do believe there are a lot of medical mistakes made. I'm a little skeptical that there are legitimately 250k that result in unnecessary death each year. I assume many of those 250k were being treated for serious illnesses that may have taken their lives anyways (not all medical interventions are 100% effective). It would be nice to have a standardized definition, but I'm not sure how that's possible unless we are only talking about treatment received was different than treatment ordered.
- peoplefromibiza 4y ago> It's easy to go back after the fact and analyze a case where someone has a poor outcome and say 'we should have done this another way' summarized by the meme it takes two wipes to know you need three, but three to know you needed two
- willcipriano 4y ago> What qualifies as a medical error? If we just classified things that are obvious. Wrong medication applied (ie paper says to deliver 10mg of Advil but you got a vitamin C tablet), wrong leg amputated, wrong patient data looked at leading to a bad diagnosis. We would likely find a large number of incidents, however no way on earth will you get the American medical cartel to report on them honestly.
- q1w2 4y agoCalling doctors, collectively, the "American medical cartel" isn't helpful language. It's just more polarizing politics that breaks down constructive dialogue.
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- sam_goody 4y agoIt "surpassed... respiratory disease, which kills close to 150,000 people per year." For proportion, according to the CDC[1] there were an estimated 100,300 drug overdose deaths in the United States during 12-month period ending in April 2021 Although this report is from 2016, which was before COVID and mandatory masking. WebMD says that in the interim, deaths from respiratory diseases have also soared, but I couldn't find any numbers. [1]: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/...
- whiddershins 4y agoI’ve seen this stat many times and I believe it is very misleading. I believe this isn’t compared to no intervention. It is compared to a perfect intervention. This kind of claim pollutes reasonable discussion.
- aaron695 4y ago
- BurningFrog 4y agoWhat is the "Nth leading cause of X" depends entirely on how you choose to classify causes. To say something informative, give the percentage.
- georgia_peach 4y agoI believe it. In my 40+ years of dealing with the medical profession, Dr. Google, Dr. Wikipedia, & Dr. Pubmed have wiped the floor with them, time after time. If you get sick, do the research. I can almost guarantee that it will pay off. And these days, medical research is excellent--if only by volume. I know people here like their canned responses--"small n!", "in mice!", "correlation != causation"--but when you're trying to make a diagnosis, every little clue helps! I can't honestly attribute excellence to the typical medical practitioner.
- xtracto 4y agoPeople that have lived with a chronic disease have seen this first hand. I had specialist Doctors five up on me in frustration because they just dont know what's wrong with me. I've been to several doctors in 3 different countries during 20 years. You really comprehend that doctors are just humans, not too different from say, an IT professional trying to troubleshoot a failing PC.
- deltaonefour 4y agoThe issue is if the IT professional fails too many times... he's let go. Does this happen to a doctor?
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- nradov 4y agoThe latest Peter Attia Drive podcast episode has an interview with Dr. Makary where they examine the issue of preventable medical errors in more detail. https://peterattiamd.com/martymakary2/ https://peterattiamd.com/martymakary2/
- tpoacher 4y agoTempted to use that "always has been" meme template here. As an ex-doctor, I can tell you that I very quickly realised that at the top of my "surgical sieve" (a mnemonic that helps docs consider categories of differential diagnoses) one should always start with the category "Iatrogenic" before considering other, more textbook-medicine differentials. And also that for some reason, most doctors seem to treat this category as last on the list, if they think of it at all.
- pdpi 4y agoAn important factor to consider any time you see really worrisome things like medical errors or suicide as leading causes of death: counter-intuitively, that can be good news. Every time you solve your #1 highest priority problem, your #2 becomes your new #1. At some point, if you have good-enough solution for a broad-enough range of problems, the only option left is that your biggest problem is now failing to apply those solutions correctly! By way of example, let's take a look at WHO data[0]. Across Europe, the leading cause of death for children under 4 is congenital anomalies. That sounds bad in isolation, but is actually pretty good in context. First, because the actual rate at which children die from congenital anomalies in Europe is a fair bit lower than the world-wide average, but most importantly because those anomalies float to the top simply by virtue of every other cause of death being exceedingly rare. 0. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/deaths-per-1-000-live-births https://www.who.int/data/gho/data/indicators/indicator-detai...
- npteljes 4y agoThis really is similar to the statistic of head protection increasing the number of head injuries. With the explanation being that otherwise, many of those injuries are deaths instead.
- pdpi 4y agoYes. Another, really counterintuitive scenario is Abraham Wald's "reinforce the planes'armour in the places where you don't see bullet holes".
- montjoy 4y agoDefinitely. The important thing is to not hide the facts. In a counter example sometimes a botched procedure can lead to suicide (if the person is in too much pain for example). That should probably count as a fatal medical error but I doubt it would be counted as such.
- nonameiguess 4y agoForgetting the measurement issue with no standardized definition of what even constitutes a medical error, this is still a very poor way of framing a change in rank. Is the absolute rate at which people are killed by medical errors higher than it used to be? Is it higher than in comparable countries? Or did the rank change because the old 3rd leading cause of death now kills fewer people? Those are very different pieces of news and this press release doesn't indicate which is the case.
- timcavel 4y ago
- kazinator 4y agoIf a person is depending on medical intervention to stay alive, and the situation is permanent, it seems inevitable that their death will be a "medical error".
- dontbenebby 4y agoMakes sense, everyone I met in college who said they were pre-med would immediately suffer narcissistic injury and refuse to be professional in any future context when I'd remind them Pitt has no pre-med program then go back to doing whatever I want on the wifi. (I also met a few folks who took what they needed to do well on the MCAT then also did some practical courses on information science or focused on art so they could have something to do that would let them turn off their brain after work other than binge reality tv, and most of them are doing OK.)
- permo-w 4y agowhat does this mean
- dontbenebby 4y agoIt means that someone would say I am "pre med" as in, they are sure they will one day be a medical doctor. However, not only is that not guaranteed -- you need to do a standardized test called the MCAT, as well as a number of other things. Further, while at many universities there is a defined "pre-med" major, there is no such major at the University of Pittsburgh, where I obtained my BS. So if someone who is a Pitt student says "I'm pre med", they're engaging in a best, a bit of stretching of the truth in order to impress people. When myself, more of a science oriented person, would say "There is no premed at Pitt. What do you study? Biology? Chemisty? Something else?" they would get angry and refuse to interact. This is known as "narcicistic injury": >Narcissistic injury and narcissistic scar are terms used by Sigmund Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms.[76] When wounded in the ego, either by a real or a perceived criticism, a narcissistic person's displays of anger can be disproportionate to the nature of the criticism suffered;[12] but typically, the actions and responses of the NPD person are deliberate and calculated.[2] Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.[2] https://en.wikipedia.org/wiki/Narcissistic_personality_disorder#DSM-5 https://en.wikipedia.org/wiki/Narcissistic_personality_disor...
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- m0llusk 4y agoLots of these are drug interactions. Have a symptom? Here is a drug for that. Doctors rarely check and often are not aware of the potential for harm. Seniors taking 2-3 dozen drugs regularly are not uncommon and often feel much better when medications are removed from their regimen. Data science should be able to help at both ends connecting problems with drug interactions that trigger them and then warning of possible problems when considering or prescribing medicines.
- rscho 4y agoWhat you describe exists. And does not work.
- GuB-42 4y agoIt may actually be good news. Depending on how the stats are made. That a death qualifies as a medical mistake means that proper treatment existed. For example let's say that 50% of people die from "the plague". The plague is lethal and untreatable, no medical mistakes can be made because nothing can be done. One day, a cure is found, cheap and 100% effective, unfortunately, the procedure is tricky and as a result, 1 out of 5 times, it is done improperly and the patient dies. In the end, 4/5 cases survive, which is great news, is used to be zero, but if we look at the share of deaths because of medical mistakes, it has increased a lot. Of course, it needs to be fixed, but usually, it is something we know is fixable, better than a disease without treatment.
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- eftychis 4y agoFrom personal experience and friends and family experience, I actually am surprised it is only 250k annually in the U.S. > The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability. I respectfully disagree. All these are systemic problems as indicated and need to be solved by a revamp of the whole system. They are not magically going to fix themselves, there is no financial incentive to do so.