A report from the BMJ recently claimed that medical error or misadventure was the third largest cause of death in the USA. The annual figure, estimated at 251,000, was greater than deaths from respiratory disease, stroke and accidents.

The key word is estimated. Statistics can be used in medicine to create a false impression, usually to make treatments look better. Here, the opposite.

The number is projected from papers published before 2009, showing 35 (yes 35) preventable deaths in hospitals. This number was extrapolated to the total number of hospital admissions and presto – you get a massive number.

The other issue is that medical procedures in hospitals are not without potential complications. A person may get an infection or suffer a blood clot not because of any error or negligence but because there is the potential for it to occur. In addition to this, mostly, those in hospital are there because they already have an illness.

Thus ascribing the actual cause of death can be tricky. It has been estimated (that lovely word again) that some 50% of death certificates involve a degree of guesswork. This I would absolutely agree with.

Over the last two decades there has been a push towards the use of “quality” and “safety” markers in hospitals. These assess what can be measured, and then assume that what can be measured must be relevant. Often it is not. The argument is put that if the airline industry can standardise safety why not medicine?

The answer is that airplanes are machines. Human beings are not. Hence no two people will respond exactly the same to “standardised” treatment.

There is risk in any medical procedure, treatment or even test. This is not a reason to avoid them. It is a reason to be sure that there is benefit in doing it. This has become more of an issue over the last two decades with the explosion of screening tests and the widening of diagnostic criteria.

Once upon a time tests were done on people who were unwell and looking for why they were sick. Today tests are done on healthy people looking for “early disease”.

Sounds great but it is not that simple.

When a test is on someone who is ill the significance of the result is far greater than when the same test is done on a healthy person. Every test has “false positive” results whereby the test result is abnormal but the person has nothing wrong with them.

PSA screening for prostate cancer is a good example of this. Certain thyroid cancers are about to be reclassified as non cancerous. This will save an estimated 10,000 people in the USA having the gland removed unnecessarily each year!

Those with false positive results have ended up going as far as surgery with all its potential complications. Surgery, including the risks, is justifiable when you need it.

The lowering of thresholds for diagnosing high blood pressure and even diabetes has seen many healthy people become “patients” in need of “treatment”. This is profitable but not necessarily healthy. As people age, the issue of polypharmacy (being on more than five different medications) arises and this too results in many hospital admissions.

Even simple treatments like antibiotics are not without side effects. American research has shown one in three prescriptions to be of no use. I suspect the figure may be higher. There is no value in taking tablets you do not need.

It has been re-confirmed that in mild and moderate depression the use of SSRI antidepressants is no better than a placebo. Some 10% of Australians take these medications. They can have serious side effects.

Risks and side effects are not a reason not to have treatment if it is needed. The problem is an increasing number of people do not need the treatment offered. This starts with oversold screening tests leading to over diagnosis and flows through the use of “guidelines” which encourage the use of medications, often developed by doctors with a conflict of interest.

So what is the solution? Surprisingly it is quite simple.

Be wary of “simple” screening tests, treatments for “risk factors” and procedures where the benefit is unclear. Always be questioning!

 

Dr Joe Kosterich M.B.B.S is an author, speaker, media presenter and health industry consultant, who wants you to be healthy and get the most out of life. Dr Joe also gives practical, motivational health talks for the general public and organisations where he is known as “An independent doctor who talks about health”.

His latest book “60 minutes to Better Health” is available on Amazon.