The Hazards of Modern Medical and Surgical Care

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The Hazards of Modern Medical and Surgical Care

Iatrogenic (physician-caused) illness is now recognized as a health

hazard of global proportions. Harmful, even lethal effects of

pharmaceuticals, diagnostic procedures and treatments are associated

with every major modality of modern medicine. Adverse events have

become so extensive as to prompt the use of the

term " iatroepidemic. " Literally tens of thousands of articles have

been published in medical journals describing these hazardsãa high

heap of hazardsãand more are published every month! The data from

these articles are compelling and frightening.

 

Dr. Lucien Leape of the Harvard School of Public Health calculated

that " 180,000 people die in the U.S. each year partly as a result of

iatrogenic injury. " His research was reported in the widely read

Journal of the American Medical Association (JAMA) (Leape, 1994).

Another article in JAMA pointed out that the death rate from medical

treatment in the U.S. " dwarfs the annual automobile accident

mortality of 45,000 and accounts for more deaths than all other

accidents combined " (Bates, Cullen, et al., 1995).

 

Side Effects of Pharmaceuticals

 

Adverse drug reactions are the most common cause of treatment-

induced injury. An average of ten percent of all hospital admissions

have been attributed to the use of medicines, and this may be a very

low estimate (Holland & Degruy, 1997). Hospitalized patients who

have an adverse drug event have been found to have an almost twofold

increased likelihood of dying (Classen, Pestonik, et al., 1997). A

more recent article reported estimates that are truly shocking: 2.2

million serious adverse drug reactions annually in the U.S.

resulting in 106,000 deaths (Lazarou, Pomeranz, et al., 1998).

 

 

 

Studies have found that hospitalized patients commonly suffer

iatrogenic injury. For example, Steel found that 36 percent of

patients admitted to a university hospital suffered iatrogenic

injury, with 25 percent of events being serious or fatal. More than

half of these injuries were related to the use of medicines. These

findings were reported in the New England Journal of Medicine

(NEJM), one of the most prestigious medical publications (Steel,

Gertman et al., 1981).

 

A study of heart attacks in a teaching hospital found that 64

percent were preventable. Inappropriate use of drugs was the leading

cause of these preventable heart attacks (Bedell, Deitz, et al.,

1991).

 

Nosocomial Infections

 

Patients are also likely to acquire serious, even fatal infections

while in the hospital. These nosocomial (hospital-acquired)

infections often are caused by bacteria that are resistant to many

antibiotics, making them especially difficult to treat. The Study on

Efficacy of Nosocomial Infection Control estimated that about two

million patients or five percent of hospital patients contract

bacterial infections (Girou and Brun-Buisson, 1996). Other

researchers found that 77,000 patients die each year due to

nosocomial infections. (Martone and Jarvis, 1992).

 

Medical Errors

 

Physicians and patients have come to accept medical hazards as a

necessary price to pay for modern diagnosis and therapy. The same is

true for medical errors. Studies have shown errors in health care to

be so pervasive that mistakes are considered to be an inevitable

part of the medical system, giving rise to the term " necessary

fallibility " (Anderson, Hill, et al., 1989). The National Patient

Safety Foundation of the American Medical Association reported that

1997 data obtained by random survey showed that " more than 100

million Americans are touched by what they consider to be a medical

mistake " and pointed out that " the number of injuries caused by

medical errors in inpatient hospital settings nationwide could be as

high as 3 million and could cost as much as $200 billion " (National

Patient Safety Foundation, 1997). Studies have estimated that in the

U.S. there are 12,000 deaths per year from unnecessary surgeries

(Leape, 1992), 7,000 deaths per year due to errors in administering

medications (Phillips, et al., 1998), and 20,000 deaths per year

from other errors in hospitals (Lazarou, et al., 1998).

 

 

It is difficult to understand why we tolerate so much injury and

death from medical care. We get terribly concerned when a plane

crashes and kills a few hundred people. The story is in the news for

days, even weeks, and a major investigation results. However, we

face 180,000 people killed annually by medical careãa rate equal to

about 400 jumbo jet crashes per yearãand yet only a few people

publicly demand accountability and insist on a total reevaluation of

our health care system.

 

 

 

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References

Anderson, R. E., Hill, R. B. Key, C. R. (1989). The sensitivity and

specificity of clinical diagnosis during five decades: Toward an

understanding of necessary fallibility. Journal of the American

Medical Association 261(11): 1610–1617.

 

Bates, D., Cullen, D. Laird, N. Petersen, L. Small, S., et al.

(1995). Adverse drug events and potential adverse drug events.

Journal of the American Medical Association 274(1): 29–34.

 

Bedell, S., Deitz, D. Leeman, D. Delbanco, T., (1991). Incidence and

characteristics of preventable cardiac arrests. Journal of the

American Medical Association, 265: 2815–2820.

 

Classen, D.C., Pestonik, S.L., Evans, R.S., Lloyd, J.F., Burke,

J.P., (1997). Adverse drug events in hospitalized patients. Excess

length of stay, extra costs, and attributable mortality. Journal of

the American Medical Association 277: 301–306.

 

Girou, E., Brun-Buisson, C.. (1996) Morbidity, mortality and the

cost of nosocomial infection in critical care. Current Opinion in

Critical Care, 2: 347–351.

 

Holland, E.G., Degruy, F., (1997). Drug-induced disorders. American

Family Physicians 56: 1781–1788.

 

Lazarou, J., Pomeranz, B.H., Corey, P.N., (1998). Incidence of

Adverse Drug Reactions in Hospitalized Patients: a meta-analysis of

prospective studies. Journal of the American Medical Association 279

(15):1200–1205.

 

Leape, L. (1992). Unnecessary surgery. Annu Rev Public Health. 13:

363–383.

 

Leape, L. (1994). Error in Medicine. JAMA 272(23): 1851–1857.

 

Martone, W.R., Jarvis, W.J., Culver, D.H., Haley, R.W., (1992).

Incidence and nature of endemic and epidemic nosocomial infections.

Hospital Infections, 3rd Ed. J.V. Bennet and P.S. Brachman, (Eds.).

Boston: Little Brown & Co. pp. 577–596.

 

National Patient Safety Foundation (1997, October 9). Nationwide

poll on patient safety. Press release, American Medical Association.

 

Phillips D, Christenfeld, N., Glynn, L., (1998) Increase in US

medication-error deaths between 1983 and 1993. Lancet. 351: 643–644.

 

Steel, K., Gertman, P.M., Crescenzi, B.S., Anderson, J., (1981).

Iatrogenic illness on a general medical service at a university

hospital. New England Journal of Medicine, 304: 638–642.

 

 

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