How many people do those doctors kill?

"14,000 preventable medical deaths"

The proponents of quackery and medical fraud love to tell us about how many people are killed by doctors each year. In the opposition to the NSW anti-quackery committee the number of iatrogenic deaths in Australia has been mentioned several times to make the point that doctors should clean up their own act before trying to do anything about charlatans and pretend doctors. Not only has it been mentioned several times, but it has several values. The ones quoted so far are 19,000, 18,000, 14,000 and 10,000. I have done some investigating to find out where these widely-varying numbers have come from. You will have to pay attention carefully here, but it will be worth the effort.

The figure of 19,000 could possibly be a mistake, as it was only mentioned once and the same person also said 18,000 somewhere else, so we don't have to worry about that one any more. The 18,000 (with a 95% confidence interval of 12,000 to 23,000!) comes from a study published in 1995 (using data from 1992) of hospital adverse events in two states of Australia. (1) The author of that report published another report in 2001 which says that deaths may be as high as 10,000, so it looks like he has rethought his previous research. (2) The 2001 report (which says 10,000 maximum) is cited by several people who mention the number 14,000, although they never provide an actual reference for the paper so anyone can check. (The characters "1" and "4" do not appear together anywhere in the document.) They also say "14,000 preventable deaths" when the paper talks about adverse events and quite clearly says that not all of them were preventable. I am never surprised by quacks lying or acting on the assumption that their readers have no ability to check facts.

To unequivocally illustrate the lie, I will give you the words which are actually used to cite the 2001 report on several web sites:

Iatrogenic Injury in Australia - This is the executive summary of a 150 page official report revealing 14,000 preventable medical error deaths (only in hospitals - not private practice). (Full report on file).

The "Executive Summary" can be seen here.

The real mystery is the 14,000 number. Where did it come from? I first heard it before the 2001 report was published, when someone cited that report as if it existed (people knew that it was coming). The answer is that the original 1995 study, which came up with an estimate of 18,000 iatrogenic deaths per year, involved an examination of 14,000 patient records. (14,000 records examined, 2302 adverse events, 111 deaths, 80% of which were of people aged over 65.) So, in the minds of the quacks, a sample of 14,000 medical records became 14,000 preventable deaths, despite the fact that the author said 18,000 on one occasion and 10,000 on another. Simple, isn't it? But wait, there's more! In June 1995, five months before the original 18,000 (plus or minus 6,000) number was published, a politician issued a press release which said that the study would show a rate between 10,000 and 14,000, and a newspaper reported the release. This apparently makes it legitimate to use the number 14,000 when citing a paper that says 10,000.

By the way, there were 133,707 deaths from all causes combined in Australia in 2002 (the last year for which figures are available at the time of writing). The likelihood that doctors are killing, through negligence or error, half as many people as die from all cancers combined or 150% as many as die of stroke is ludicrous. Whatever it is it is too high, but it certainly isn't 18,000.

References:

1. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust 1995; 163(9):458-71.

2. Runciman WB, Moller J. Iatrogenic Injury in Australia. Adelaide: Australian Patient Safety Foundation Inc. 2001 (Read the report here)

A version of this article appeared in the December 2002 edition of The Skeptic, the journal of the Australian Skeptics

"100,000 needless deaths"

Supporters of quackery in the United States like to talk about the "100,000 needless deaths" caused by doctors. (In extreme moments of absurdity, they claim that doctors are the "third leading cause of death".) Again this figure is derived from a study which said "as many as" and the estimate has been inflated. The numbers were even more rubbery than the 1995 Australian study. The report, issued by the Institute of Medicine in November 1999, gave a range of deaths in hospitals from 44,000 (derived from a 1984 study in New York) to 98,000 (derived from a 1992 study in Colorado and Utah). Put another way, the 1999 study did not do any new research, but instead looked at old research and guessed at what the numbers might be now. There are well in excess of 30 million hospital admissions each year in the USA.

In an attempt to divert a conversation somewhere about something not related to real medicine, I was asked to comment about the "100,000 needless deaths". This was my comment:

A couple of years ago, a study was published which claimed that the number of deaths caused by medical errors in hospitals in the USA was somewhere between 44,000 and 98,000 each year. The size of this range of results is enough to indicate that the values are meaningless, and the numbers have been debunked by others so I won't repeat that work here. I am interested in the "100,000" number which gets repeated ad nauseum. Someone keeps ranting at me on newsgroups and demanding that, as well as looking at quackery, I should be investigating those real doctors who keep killing people. Constant reference is made to the "100,000 needless deaths" each year in the US, and I am asked what I have to say about this horror. On 7 December, 1999, I sent a message to the Healthfraud Discussion List commenting on the 44-98,000 numbers in which I said: "There appears to be a lot of uncertainty in the data gathering. The alt-medders will use the upper estimate, of course (rounded up to 100,000 and with the qualifier "more than" to indicate uncertainty)". So my comment on the 100,000 needless deaths is that the number is just made up. I know this because I was the person who made it up.

As well as the 100,000 needles deaths caused by hospital errors, there is always the 106,000 deaths from adverse drug reactions.

A lie that won't die (28/1/2006)
A week doesn't go past without some quackery believer spouting that old story about how 106,000 people die each year in the USA from adverse reactions to prescription drugs. It is always 106,000 (except when it's 108,000) and the number doesn't change from year to year. One of the reasons it doesn't change is, like a bug trapped in amber, it is isolated from reality and the rest of the universe. It is always mentioned that the figure comes from research, but how good was that research, and when was it done? Well, here's part of what the US Government Accounting Office had to say in 2000. Yes, 2000. Six years ago. And the research was talking about a guess of the figures in 1994. Using data from twenty years before that.

Recently, Lazarou, Pomeranz, and Corey attempted to synthesize available data on fatalities from adverse drug events (excluding cases of medication error). To derive their estimate of 106,000 fatal adverse drug reactions in the United States in 1994, they drew on data from 16 studies of adverse drug reactions published between 1964 and 1995. The studies cumulatively looked at 78 deaths, but only two of the studies had more than 10 deaths. Moreover, the 4 studies published after 1976 included a total of 5 deaths, compared with 73 in the 12 earlier studies. Consequently, the projection of fatal adverse drug reactions in 1994 is based predominately on data from 20 years earlier, when the use of pharmaceuticals was quite different. In addition, deaths were too few to arrive at a stable mortality estimate -- as even a small change in the number of deaths reported in the studies would lead to substantial changes in the number of deaths extrapolated to the national population.