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 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)

Update 29/4/2012 – Australian Bureau of Statistics figures run a year or so behind the calendar. The number of deaths in the country in 2009 (the latest year available in April, 2012, was 141,070. This larger number has no significant effect on the comments made in my 2002 article.

"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 needless 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.

This was a response to something I'd written elsewhere, but it has relevance to the "doctors kill" non-debate.

Subject: Response to September Issue Cam or Scam
Date: Thu, 06 Nov 2008 16:44:50 +1100
From: "Mark Smith"

Hi,

I was surprised to find your article on homeopathy, acupuncture and chiropractic. [See this article here. PB] I didn't realize there where people "out there" dedicated to look for anything negative related to "alternative" therapies.

Why not? Did you assume that quackery would be immune from investigation?

In fact, I would have thought that if this were the case that allopathic medicine would have been your first port of call, as the leading cause of death in the USA is from iatrogenic sources

Ah, yes – The Lie That Will Not Die. I don't know why later figures aren't available, but here are the 10 leading causes of deaths in the USA in 2005. If you have any later information you might like to let the CDC know so that they can update their web site.

• Number of deaths: 2,448,017
• Death rate: 825.9 deaths per 100,000 population
• Life expectancy: 77.8 years
• Infant Mortality rate: 6.87 deaths per 1,000 live births

Number of deaths for leading causes of death:

1. Heart disease: 652,091
2. Cancer: 559,312
3. Stroke (cerebrovascular diseases): 143,579
4. Chronic lower respiratory diseases: 130,933
5. Accidents (unintentional injuries): 117,809
6. Diabetes: 75,119
7. Alzheimer's disease: 71,599
8. Influenza/Pneumonia: 63,001
9. Nephritis, nephrotic syndrome, and nephrosis: 43,901
10. Septicemia: 34,136

http://www.cdc.gov/nchs/fastats/deaths.htm

(it is the third leading cause of death in Australia).

Australian numbers are more up to date, but again I encourage you to contact the Australian Bureau of Statistics with your later information so that they can update their web site. Here is the situation in 2006:

1. Ischaemic heart diseases – angina, heart attacks, and blocked arteries of the heart (I20-I25): 22,983
2. Strokes ( I60-I69): 11,465
3. Trachea and lung cancer (C33-C34): 7,348
4. Dementia and Alzheimer's disease (F01-F03, G30): 6,542
5. Chronic lower respiratory diseases – asthma, bronchitis and emphysema (J40-J47): 5,443
6. Colon and rectum cancer (C18-C21): 3,858
7. Blood and lymph cancer (including leukaemia) (C81-C96): 3,693
8. Diabetes (E10-E14): 3,662
9. Diseases of the kidney and urinary system (N00-N39): 3,192
10. Prostate cancer (C61): 2,952

http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0

From what YOU say alternative medicine (I prefer to use the term complementary) has no effect (other than placebo).

I didn't say that at all. What I said was, and I quote, "All of the above treatments work. They work provided that the patient has a self-limiting or mild psychosomatic condition". Real medicines have a placebo effect as well. The objective of clinical trials is to see if the medicines have an effect greater than placebo. If all you can claim is placebo then all you can claim is nothing, so there should be no charge. Why do quacks want to charge money for things that do nothing? Surely that would be fraud.

If this was the case then at least the mortality rate would be a lot less!!!

Are you saying that the mortality rate for alternative medicines is the same as for real medicine and can be reduced? I'm pleased about that and I look forward to reading the research on how that can be achieved. A good start would be a system of reporting adverse effects.

I agree that there are charlatans out there that exploit people who will do anything to relieve their symptoms but that is not due to the professions out there, it is more related to those individuals, and it occurs in medicine also. The biggest charlatans are the pharmaceutical companies who drive the medical machine, their guinea pigs are the general public. If their product kills or maims enough people they take it off the market and repackage it as something else.

So all alternative and complementary medicines undergo extensive safety trials involving millions of test subjects to prove absolute safety before they are sent to market, do they? As an example, the day after Vioxx was withdrawn from the market I was offered a quack substitute that was guaranteed to be safe. How could this be known? (By the way – the people who suffered ill effects from Vioxx were not using it according to the clear instructions on the label, but why should that fact mean anything to the critics?)

Yet, if someone has an allergic reaction to royal jelly, the AMA wants to shut down the whole naturopathic community.

You might like to point me to the safety trials for royal jelly that were undertaken before it was sold to the public. You might also like to consider risk/benefit ratio. As the risk of allergic reaction to bee products is quite high and there are no trials or research indicating any benefit of royal jelly (except to the wealth of those selling it), the ratio is infinite. Here's something else to think about – should royal jelly be "prescribed" for someone who is also taking one of the large number of alternative products which "boost the immune system"?

By the way – the AMA has no say over who practices what in the medical field. They can express an opinion but they can't stop anyone doing anything.

I would have thought that if you were going to make comments such as you have that you would have done a little research (there is a plethora of research articles out there on the benefits of "alternative medicine") beforehand. Having said that I understand that everyone is entitled to their own opinion, even if you feel the need to spread your opinion to as many people as possible. But I would be interested to find out your opinion based on the same scrutiny of the pharmaceutical and medical industry.

And I would be interested in your explanation of how the mutually exclusive world views of chiropractic (or in your case, osteopathy), homeopathy and acupuncture can be reconciled. Do bacteria and viruses cause disease?

Mark Smith
Osteopath