Stop Iatrogenesis - The number three killer in America is preventable

Thursday, January 05, 2012 by: Kiva Bottero
Tags: iatrogenesis, accidental death, medicine

(NewsTarget) In 1999 the Institute of Medicine (IOM) awakened the nation with their landmark study "To Err is Human," which found that accidental deaths due to medical errors in hospitals account for as few as 44,000 and as many as 98,000 deaths per year in the U.S. Even at the bottom end of the spectrum, these preventable deaths, which include improper transfusions, surgical injuries, and wrong-site surgery, cause more deaths than either breast cancer or motor-vehicle accidents.

The following year the Journal of the American Medical Association (JAMA) reported that iatrogenic causes of death -- medical errors in hospitals and adverse drug reactions to medications -- total approximately 225,000 deaths annually, making it America`s #3 killer.

Adverse drug reactions

A University of Toronto study found that pharmaceuticals kill more people in the U.S. than motor-vehicle accidents (as reported by the Cancer Cure Foundation). Of the two million hospitalized Americans, who suffered a serious adverse drug reaction within the 12 months prior to the study, 100,000 died from their reaction. Of those deaths, 75% were not due to allergic reactions, but were preventable.

The exceptions

Iatrogenic deaths don`t always happen as a result of medical errors or dangerous pharmaceuticals. Physicians sometimes knowingly prescribe highly toxic drugs to people who are critically ill. Equipment failure has also been cited as an unavoidable error in some circumstances.

Why so many deaths?

A problem as widespread as iatrogenesis rarely originates from a single source. In their report, the IOM Committee pointed to a few possible causes for medical error:

Faulty systems and operating processes

The health professional licensing process doesn`t pay enough attention to preventing medical errors

Efforts to teach prevention have often encountered resistance from healthcare providers and organizations

Lack of financial incentives to improve safety and quality of service

According to JAMA, the most common causes of adverse drug events (without counting the inherent danger certain drugs pose) are the following:

Dose error

Known allergy

Wrong drug/patient

Route error

Frequency

Missed dose

Wrong technique

Illegible order

Duplicate therapy

Drug-drug interaction

Iatrogenesis now

The FDA, through its Adverse Events Reporting System, keeps a record of adverse events resulting from drug and therapeutic biologic product use. In 2000 they received 266,866 reports. By 2010 that figure nearly tripled to 758,890. And that`s a conservative figure as, according to a report titled Death by Medicine, only a fraction of medical errors ever get reported.

Regarding the IOM`s 1999 estimate of medical error related deaths, the Department of Health and Human Services states on its website that "this statistic has not improved much in the following decade." The lack of significant patient safety progress has prompted the Department to launch Partnership for Patients, a public-private partnership with specific goals that includes reducing preventable hospital-acquired conditions by 40% between 2010 and 2013.

But to the surviving spouse of a patient who succumbed to a hospital-acquired infection (HAI), even reducing 80% of HAIs is not enough. Perhaps now, with a failing economy and Medicare costs projected to rise 91% in the next decade, the double punch of human and economic costs will provide the motivation needed to knockout iatrogenic deaths.

References:

Dr Barbara Starfield, "Is US Health Really the Best in the World?" The Journal of the American Medical Association (JAMA) Vol 284, No 4 (2000): 483 - 485.
Committee on Quality of Health Care in America, Institute of Medicine, Linda T. Kohn and Janet M. Corrigan, To Err is Human: Building a Safer Health System (Washington: The National Academies Press, 2000)
The Cancer Cure Foundation: Medical Errors - A Leading Cause of Death (http://www.cancure.org/medical_errors.htm)
AHRQ: Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs (http://www.ahrq.gov/qual/aderia/aderia.htm)
FDA: Reports Received and Reports Entered into AERS by Year (http://www.fda.gov/Drugs/GuidanceComplianceR...)
Institute of Medicine, The Richard and Hinda Rosenthal Lecture 2011: New Fontiers in Patient Safety (Washington: The National Academies Press, 2011)
HealthCare.gov: Partnership for Patients (http://www.healthcare.gov/compare/partnershi...)

Resources:

Agency for Healthcare Research and Quality (http://www.ahrq.gov/)
The Empowered Patient Coalition (http://www.empoweredpatientcoalition.org/)

About the author

Kiva Bottero works with a collective to publish The Mindful Word journal of engaged living. You can visit him online at http://www.themindfulword.org .