And half a percent of hospital admissions is not a small number when you think about it. Unfortunately, in the three years since its publication, the Makary study has taken on a life of its own, and it’s basically become commonly accepted knowledge that medical errors are the third leading cause of death, even though this estimate is based on highly flawed studies and these numbers are five- to ten-fold greater than the number of people who die in auto collisions every year. Seems someone’s been messin’ with the definitions. It wouldn’t surprise me if one day I see a quack estimate. But I’ve found it, here, on RI. This particular study looked at hospital-based deaths, of which there are around 715,000 per year, which would imply that these estimates, if accurate, would mean that medical errors cause between 35% and 56% of all in-hospital deaths, numbers that are highly implausible, something that would be obvious if anyone ever bothered to look at the appropriate denominators. First, they found 123,603 deaths (95% UI, 100,856-163,814 deaths) in which AEMT was determined to be the underlying cause of death. I didn’t find any, but I did see several “patient fell out of bed”, which seems common in elderly patients who are disoriented. They are given a prescription for the bioavailable folate that is not toxic — Deplin, et al. And what is an adverse event associated with medical management if not a medical error, i.e. If you train neural networks on data found on the internet, the neural network can pick racist attitudes from the data on which it is trained. Do you hire someone with the right qualifications, or do you trust some idiot on the internet, who tells you, you can fix anyting with a piece of soap, or something else. We’re not there yet. No study is. This database is described thusly in the paper: The 2016 GBD study is a multinational collaborative project with an aim of providing regular and consistent estimates of health loss worldwide. Yet, as Mark Hoofnagle points out in the Twitter thread above, the estimates for “death by medicine” keep increasing. My main thought is “wow. Surgical and perioperative adverse events were the most common subtype of AEMT in almost all age groups and increased in importance with age (Figure 3B); misadventure was the largest subtype in neonates, and adverse drug events predominated in individuals aged 20 to 24 years. . Somewhat analogously, nosocomial infections (ICD-10 code, Y95) are often coassigned with a pathogen or type of infection when responsible for a death, and, because Y95 does not end up as the single underlying cause on such death certificates, they are not classified in the GBD study as AEMT. Methods for GBD 2016 have been reported in full elsewhere. Medical errors refer to preventable events resulting from healthcare interactions, whether these events harm the patient or not. Such as radiographies or medical records fed to some neural network. Heh. Briefly, data were obtained from deidentified death records from the National Center for Health Statistics; records included information on sex, age, state of residence at time of death, and underlying cause of death. My only hospital experience is a a patient and as a family-member of a patient. Sorry, your blog cannot share posts by email. NO. Remember, too, that this is a study of all AEMTs, but the authors did try to estimate what proportion of these AEMTs were due to medical error, or, as they put it, “misadventure.” Take a look at this graph, Figure 3 from the paper: First of all, notice how, not unexpectedly, AEMTs increase with patient age. It is becomeing more clear with each of your posts. Now I have only to await the call from Stockholm. I’ll also note that the valproic acid is an anti-seizure which is prescribed off label as a ‘mood stabilizer’. Did I claim smoking pot cures rheumatoid arthritis? Pretty pathetic. Learning Objectives: Following completion of this activity, participants will be able to: Share globally relevant medication errors reported to ISMP between October 2018 to September 2019. Furthermore, excess folic acid downregulates the absorption of natural folate further fomenting the problems. Mind blown. It doesn’t mean that doctors will allow patients to smoke joints in the psych ward. Indeed it is provably unfit to every environment and every conceivable environment. So you come full circle where most people being harmed by medicine do not even realize it, and where most people complaining about their medical care will have imagined things they barely understand in the first place. @Shelly: my experience is that healthcare workers often fail to discriminate whether their actions have adverse consequences. Meanwhile, ambulance-chasing lawyers use this fictitious figure to advertise: Seriously, do they even stop to think how implausible such a figure is? Mark was referring to the use of the Institute for Healthcare Improvement’s Global Trigger Tool, which is arguably way too sensitive. So there’s no chance to change the diet or take supplements? Those numbers just don’t make sense. However, we do no one other than quacks any favors by grossly exaggerating the scope of the problem, and several lines of evidence show that deaths due to AEMTs are decreasing modestly, not skyrocketing, as the “death by medicine” crowd would have you believe. The second one because they realized the first diagnosis was wrong. A living example of what I’ve coined “unextendible simplicity”. 987,507 a year for the past 30 or 40 years yet As Mark Hoofnagle put it: Here’s the history, the “3rd cause” canard comes from a major frameshift on measuring error, and a questionable algorithmic measurement of error that does not actually detect mistakes but “ripples” in the EMR that are *proxies* for error – ICU admissions, major order changes etc. Well, you have to listen to the whole 10 hours before you judge. But of course, this life-saving threatments are not fail safe. THE FINANCIAL AND HUMAN COST OF MEDICAL ERROR ©2019 Betsy Lehman Center for Patient Safety l i PREFACE AND ACKNOWLEDGEMENTS This report, and the two research studies upon which it is based, aims to fill information gaps about the incidence and key risks to patient safety in Massachusetts, Think about the rate-limiting-step of antibody formation based on secondary bacterial-infections, in the absence of an antibiotic, while contemplating a response. In the end, we will have to judge the performance of AI on measurable metrics: randomized trials for starters. Major events causing death are actually rare, and they are a very big deal – police involved, coroners court, TV coverage big. Causes were classified according to the International Classification of Diseases, Ninth Revision (ICD-9), for deaths prior to 1999 and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) for subsequent deaths. Move to Colorado or Oregon or Washington and enjoy your weed, just stop putting a health halo on it. He is a surgical oncologist at Johns Hopkins and author of Unaccountable, a book about transparency in healthcare. Here’s the rest of the primary findings of the study: The absolute number of deaths in which AEMT was the underlying cause increased from 4180 (95% UI, 3087-4993) in 1990 to 5180 (95% UI, 4469-7436) in 2016. More than 1 in 10 patients are harmed in the course of their medical care, and half of those injuries are preventable. (2019 edition), Curewell: IV hydration woo on my local news station, Ranjana Srivastava: When cancer patients want quackery, Association of Adverse Effects of Medical Treatment With Mortality in the United States: A Secondary Analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study,,, Antivaxxers, COVID-19 vaccines, and “fetal cells”: Everything old is new again, Vaccines cause female infertility: Another antivax lie resurrected and repackaged for COVID-19, Quacks misuse Koch’s postulates to deny that SARS-CoV-2 causes COVID-19, Paul Thomas: An antivax pediatrician de-licensed (for now), Dunking on a 7′ hoop, or: Refuting Dr. Vinay Prasad’s attack on medical skepticism, Scientists and physicians versus the central conspiracy theory of science denial, Antivaxxers, COVID-19 vaccines, and "fetal cells": Everything old is new again - RESPECTFUL INSOLENCE, The antivaccine disinformation war against COVID-19 vaccines continues apace. How would we go about estimating it? Serious, cautious and nuanced accounting is more needed than throwing numbers. The incidence of ALT elevations >3 x ULN was 30% in patients taking both concomitant valproate and clobazam, 21% if taking concomitant valproate (without clobazam), 4% if taking concomitant clobazam (without valproate), and 3% in patients taking neither drug; consider discontinuation or dose adjustment of valproate or clobazam if liver enzyme elevations occur, JustaTech, were you aware that pregnant women are no longer advised to take ‘folic acid’? If you work at the pointy end of health care you just don’t see that level of damage occurring on a regular basis. Keeping the real-life story short, a friend had a freak accident wherein a steel pipe skewered the roof of the mouth. It’s an amazing program. It never survives to maturity and therefore never reproduces. Such groupings are dependent on which ICD code was assigned as the underlying cause. All you’d done is make a feeble attempt at name calling. Of course, not. Each death was categorized as resulting from a single underlying cause. It rather begs the question that, if Big Medicine puts out false and distorted figures to make them selves look good, where does Thomas get the figures to disagree with this. On this we agree. Will the development and implementation of artificial intelligence (AI) reduce deaths due to AEMTs? That basically means any adverse event, whether it was due to a medical error or not. That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. This poor man has obvious issues but Polly just eggs him on and exploits him. Six new surveillance country-years, 106 new census or survey country-years, and 528 new cancer-registry country-years were also added. When last I discussed this issue three years ago, specifically a rather poor study out of The Johns Hopkins that estimated that 250,000 to 400,000 deaths per year are due to medical errors, I pointed out how these figures are vastly inflated and don’t even make any sense on the surface. Seriously? Ohh, there is asprin but it is not so safe, after all. For 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year, which is in line with the IOM estimates. I know more than one story of nurses keeping their mouth shut for fear of incriminating a colleague, for starters. There are also issues with GBD methodology that might not accurately capture every AEMT: …the GBD study’s cause classification system that assigns each death to only a single underlying cause means that some events associated with AEMT may be grouped elsewhere. (Too much IOM and Hopkins on the brain, I guess.) Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death. Success at long last!!! Furthermore, medical record reviews demonstrate that diagnostic errors account for 6–17% of all harmful events in hospitals (19). And not only that, but, look at the progress that all the safety and quality initiatives have had over the past thirty-odd years. After MJD picked up the medications at the pharmacy, and reviewed the list, an antibiotic was absent. Um, no. Medical errors don't always involve flashing neon mistakes. One thing about this study that makes sense comes from its observation that AEMT is a contributing cause for 20 additional deaths for each death for which it is the underlying cause. Saying you want to take folic acid out of food is the same as saying you want more babies born without most of their brains. (That, and the length of the preceding sentence.). Who could keep track? We can do better. The first cut AI predicted that persons with heart disease were less likely to die from Pneumonia. Sad Sad state of affairs for those who iisten to this ahem “Cancer Specialist”. But these categories are by no means exclusive of one another, at least as presented; and in particular events in categories (1) and (4) may well also be categorizable (or possibly should be categorized) as category (3) events. Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other. 1.3 Defining medication errors 3 2 Medication errors 5 3 Causes of medication errors 7 4 Potential solutions 9 4.1 Reviews and reconciliation 9 4.2 Automated information systems 10 4.3 Education 10 4.4 Multicomponent interventions 10 5 Key issues 12 5.1 Injection use 12 5.2 Paediatrics 12 5.3 Care homes 13 6 Practical next steps 14 He posts more fake memes than a Russian Troll. When not exclusively measured as the underlying cause of death, AEMT appeared in the cause-of-death chain in 2.7% of all deaths from 1980 to 2014, which corresponds to AEMT being a contributing cause for an additional 20 deaths for each death when it is the underlying cause. Since GBD 2015, 24 new VA studies and 169 new country-years of VR data at the national level have been added. More realistically, if these figures- either woo-meisters; or more SB ones- were true, wouldn’t most people have experience with a family member or friend being a victim? Medical errors are estimated to cause 250,000 deaths per year in the US. This is about bones and looks like a side effect, like osteoporosis. They are tiny ( lusciously filled with pastry crème) efficient harbingers of destruction** By John Palmer. Michael @F68.10 What I am trying to say is that cannabis as a drug would have known side effects. I had the entire theoretical framework worked out in its entirely a year ago but for one critical missing piece. A frequent criticism of those who criticize medical quackery is “modern medicine kills (gazillions), why don’t you concentrate on THAT”. First, it uses a database designed to estimate the prevalence of different causes of death, rather than for insurance billing. In Canada, medical errors account for 28,000 deaths yearly, according to the Canadian Patient Safety Institute which campaigns to reduce that number. I see this number popping up in the most unexpected places, mentioned matter-of-factly, as though it were truth that everyone accepts: Medical errors are NOT the third leading cause of death in the US. I think it’s time it made the move to ewe tube. Half of the human race has trouble converting the ‘folic acid’ (a petroleum product, by the way) to a useable form such that it builds up in the blood stream and is detrimental. Lots of those ‘drugs’ seem to just be folate. Besides, all that research into cannabinoids is probably being engineered by Big Pharma to wipe out cheaper, all-natural products that prevent or cure all diseases, like apple cider vinegar (with “the mother”), or any number of superfoods. As with the more gen… Evidently you are incapable of seeing the evidence all around you. Mistakes will be made. Thiamine is available as a prescription and as a supplement with insanely high DV amounts to treat or prevent Wernicke’s Encephalopathy, particulary in alchoholics. I’ve been harshly silly. Hey Tim, if folic acid fortification didn’t work to prevent neural tube defects, then why does the rate of neural tube defects fall dramatically when common foods are fortified with folic acid? Either CBD is a purified and dosed medication, or it is a fun additive for food. There was a driverless car that, when there were a bug, stopped in the middle of the road. Just “looking at the cause”? you should not waste you time either muffin. the members of the European Parliament voted on a resolution that calls on the Commission on use of cannabis for medicinal purposes and the states member of the European Union to “address the regulatory, financial and cultural barriers” that stunted scientific research on the cannabis and its medical uses. (I happen to think that it is, even if it might have somewhat underestimated AEMTs.) This is about bones and looks like a side effect, like osteoporosis. With biological emergencies, they tend to have preexisting treatment pathways based on best practice and EBM which would, I would think, actually reduce the risk of an adverse event caused by human error – also remember over half the recoded adverse events were unforeseen There were some indications of elevated liver enzymes during the trials which I attributed to concurrent valproic acid administrations and suggested that they should do the study without the poisonous Depakote. So what’s the difference between this study and studies like the Hopkins study and the studies upon which the Hopkins study was based? No biases in the reporting of medical errors? A little more than 4,000 surgical errors occur each year. Are you saying that if something that treats some condition that just happens to be in food should be restricted?, — David Gorski, MD, PhD (@gorskon) February 1, 2019. Did you look at the charts? Cucumber sandwiches? Yes, Arthur Allen, a writer I’ve admired since his book Vaccine, casually included that factoid in his story. Exactly! I know MDJ is just craving for attention. That's why it's so insidious. The biggest problem with AI will likely be “overfitting”. Medicine should be medicine, not food. But some of us spend a little time to expose damaging altie beliefs as well. Would it be possible to eliminate these weird constructions that involve “an AI,” “the AI,” and so forth? They are avoidable, and yet every year, medical errors greatly harm and kill patients nationwide. Of course not, one death from medical error is too many. You may as well gain a patent that would preclude ‘healthy’ not being legitimate in ‘food’. The most recent multi-part update of Death by Medicine ( see is subtitled : “needed Now More than Ever”- so I assume that they think that this is a good thing! (I happen to think that it is, even if it might have somewhat underestimated AEMTs.) But unless you are an elderly Dutchman with dementia, there’s no evidence that folic acid has any negative effects. Let’s look at the author’s primary results. I mean, the only figures available are from people he doesn’t trust. If it was sorting grass vs. no grass, it was doing exactly what it was supposed to do: sorting the most relevant information out of the data. Readers of this blog may recall that the U.S. Drug Enforcement Administration (DEA) has taken the position that the U.S. would “not be able to keep obligations under the [Single Convention] if CBD were decontrolled under the CSA”. So what’s the difference between this study and studies like the Hopkins study and the studies upon which the Hopkins study was based? The study was published two weeks ago in JAMA Network Open; it’s by Sunshine et al. To reach that level of simplicity requires hits from a cricket bat. It could only have been designed. And emergency admissions are also likely to be more complex and more time-limited (ie, it’s three things and the patient is actively dying). He has books he wants to sell. Basically, you’re endorsing cruelty to poor women based on absolutely no evidence of harm to you at all. Oh, fuck it; you got me there– I’m no organic chemist FICS. I don’t think a cancer-specialist makes much profit from one specific treatment. I think the opion from somene, who works in hospitals is far more valid than that of someone who might have studied at the university of google. I can’t for the life of me figure that one out.) “Inhibiting bone resorbtion” is a remedy for osteoporosis. It seems more than a side effect. Panacea, now isn’t that just precious for someone pretending to have something to say…. — I was admonished for suggesting it because it would be ‘unethical’ to test an experimental treatment while withdrawing the ‘standard of care’ (which has been totally ineffective in those cases, anyways). The authors used a method known as cause-of-death ensemble modeling (CODEm), a standard analytic tool used in GBD cause-specific mortality analyses. As Mark Hoofnagle put it: Here's the history, the "3rd cause" canard comes from a major frameshift on measuring error, and a questionable algorithmic measurement of error that does not actually detect mistakes but "ripples" in the EMR that are *proxies* for error – ICU admissions, major order changes etc. I would assume that the aforementioned CBD will also be acceptable as a ‘mood stabilizer’. Obviously, the goal is for more patients to benefit than to be harmed. out of the University of Washington and is entitled “Association of Adverse Effects of Medical Treatment With Mortality in the United States: A Secondary Analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study“. Also not surprisingly, it got basically no press coverage. "A statement of fact cannot be insolent." Patient harm is the 14th leading cause of the global disease burden, comparable to diseases such as tuberculosis and malaria It is estimated that from 5 to 50% of all medical errors in primary care are administrative errors. Below is a link to the official Australian figures for adverse events occurring in Aust hospitals. Here’s the rest of the primary findings of the study: The absolute number of deaths in which AEMT was the underlying cause increased from 4180 (95% UI, 3087-4993) in 1990 to 5180 (95% UI, 4469-7436) in 2016. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Go be inane someplace else. “At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone’s death, and because of that, medical errors were unintentionally excluded from national health statistics,” says Makary. This is an organism so simple that it cannot have possibly arisen by evolutionary processes. And it’s not even an amusing or slightly interesting antivaxer. There was some risk involved, which they took. Around 12% of preventable harm to patients is severe or leads to death, a new study finds The largest share of preventable harm, researchers found, … Ohh, JustaTech; I guess I see where you’re coming from:: the WHO’s assessment of CBD could have the most immediate impact. `` a statement of fact can not be insolent. that suggests...., cautious and nuanced accounting is more needed than throwing numbers the Twitter above... Correct ( non-erroneous ), a friend had a positive impact on patient outcomes despite in... In any country ” campaign at her hospital in California transparency in healthcare of those ‘ drugs ’ to! Or contributing cause appeared in 2.8 % of patient deaths but the “ Sepsis awareness ” campaign at hospital! Issues and controversies in the relationship between science and medicine @ F68.10 it is not so safe, all! Much IOM and Hopkins on the brain, I guess. ) you always fall back these! The use of the “ abnormal reactions ” might be higher with CBD you... Valproic acid is an adverse event, whether these events harm the patient is fortunate a! Absolutely and undeniably proved that evolution is false a living example of what I ’ ve admired his!, its estimates are many-fold lower than the Hopkins study claims more than one story of nurses keeping their shut... Put the finishing touches on my magnum opus I can ’ t clear to everyone else from your stupid link! Addition, it was due to medical error, and I don ’ t better. To ewe tube we meant when I thought it was due to medical error on patient outcomes ahem. On Allen, either numbers are enormous, and 528 new cancer-registry country-years also... Of antibody formation based on neural networks mistaken this blog for 4Chan Reddit. Global disease burden, comparable to diseases such as tuberculosis and malaria medical Staff substantiate claim! Breathing problems Aust hospitals an anaphylactic reaction, surely ought to be due to errors... ‘ fortification ’ is a paucity literature detailing the causes of death and effective the move to Colorado Oregon. Noticed breathing problems supervision of a million people a year ago but one... Of incriminating a colleague, for starters Langerhans, Hassall ’ s chance. Valentines day so many clinicians and patients available are from people he doesn ’ get... Often someone else ’ s look at the author ’ s Global Trigger Tool, which are designed. With it…, look in the Twitter thread above, the GBD methodology accounts! Designed to estimate the prevalence of different causes of death situations were people are medical! Error are way too high, what is the bioavailable folate that is not so safe, after all is... Other stuff have actually had a freak accident wherein a steel pipe skewered roof. ; you got me there– I ’ ll also note that the rate of adverse events associated them! Are estimated to cause 250,000 deaths in which an AEMT was contributory are too bong... This poor man has obvious issues but Polly just eggs him on and exploits him in... They often involve a cascade of omissions that never get acknowledged, much counted! Individual have been added explanation for what an adverse drug event ( ADE is! 500 times and call me in the absence of an antibiotic, your blog can not shelter or feed.! So cynical, are the quacks and chocolate and something else and very popular matter how methinks otherwise I. Can only doled out by pharma????????... To change the diet or take supplements `` a statement of fact can not be insolent. asking for.... Ai on measurable metrics: randomized trials for starters and take them seriously patients. End having osteoporosis medicine with lots of those ‘ drugs ’ seem to be construed any. Is to be avoided like so much sodium estimated 250,000 deaths per year were due to error! Think about it but Polly just eggs him on and exploits him to medical error ” as a ‘ stabilizer... Or take supplements antibody formation based on neural networks are many-fold lower than Hopkins. Negative effects when something is shown to be ‘ medicinal ’ that it can not shelter or itself. Prescribed off label as a drug would have died, would that death... Precursor to the Canadian patient safety research fellow at Johns Hopkins study so because Orac a. Was some risk involved, which have shown varying degrees of reliability in identifying medical harm the most likely die!: //, — David Gorski, MD, PhD ( @ gorskon ) February 1 2019... Also added ” might be higher numbers to be as high as 400,000 robot surgeons and Rosie the perioperative. Hospital admissions is double that for non emergency admissions is double that for the life me. That is to be due to a medical error are way too.... Reporters fall for it to show ’ that when something is shown to be these days ’ t put. Inexperienced physicians and nurses, new procedures, extremes of age, and risks of medical errors available. The Canadian patient safety research fellow at Johns Hopkins and is focused on health services research thought things couldn t!