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ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION All the statistics above represent a one-year time span. ANNUAL PHYSICAL AND ECONOMIC COST OF Imagine the numbers over a 10-year period. Working with the MEDICAL INTERVENTION most conservative figures from our statistics, we project these Condition Deaths Cost Author 10-year death rates (see above). Hospital ADR 106,000 $12 billion — Lazarou', Suh® Our projected statistic of 7.8 million iatrogenic deaths is more Medical error 98.000 $2 billion IOM* than all the casualties from wars that America has fought in its Bedsores 115,000 $55 billion —_Xakellis’, Barezak* entire history. ; ; Infection 88,000 $5 billion Weinstein’, MMWR" Our projected figures for unnecessary medical events occurring Malnutrition 108,800 __ Nuree@onlitiont over a 10-year period are also dramatic. Outpatient ADR 199,000 $77 billion _ Starfield”, Weingart'? Unnecessary Reecines AGS Gb Ge’ TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION Surgery-related 32,000 $9 billion = AHRQ® Unnecessary Events 10-year Number _ Iatrogenic Events are Hospitalisation 89 million‘ 17.8 million OWN Ss Somes sz bilion Procedures 75 million’ 13.0 million ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS TOTAL 164 million 30.8 million iat (eee Tetropenit Events These projected figures show that a total of 164 million people, approximately 56% of the population of the United Procedures 7.5 million’ 1.30 million” : . States, have been treated unnecessarily by the medical TOTAL 16.4 million 3.08 million industry—in other words, about 50,000 people per day. We have added, cumulatively, figures from 13 references of ABSTRACT (continued) annual iatrogenic deaths. However, there is invariably some We could have an even higher death rate by using Dr Lucien _ degree of overlap and double-counting that can occur in gathering Leape's 1997 medical and drug error rate of three million.“ —_non-finite statistics. Death numbers don't come with names and Multiplied by the fatality rate of 14%, which Leape used in _ birth dates to prevent duplication. On the other hand, there are 1994,'* we arrive at an annual death rate of 420,000 for drug many missing statistics. errors and medical errors combined. If we put this number in As we will show, only about 5-20% of iatrogenic incidents are place of Lazarou's 106,000 drug errors and the Institute of even recorded.'******* And, our outpatient iatrogenic statistics'” Medicine's (IOM's) 98,000 medical errors (which may have a only include drug-related events and not surgical cases, diagnostic drug error overlap with Lazarou's study), we could add another _ errors or therapeutic mishaps. We have also been conservative in 216,000 deaths, making a total of 999,936 deaths annually. our inclusion of statistics that were not reported in peer-review The enumerating of unnecessary medical events is very —_ journals or by government institutions. For example, the Chicago important in our analysis. Any medical procedure that is invasive Tribune of July 21, 2002, published an analysis of records from and not necessary must be considered as part of the larger patient databases, court cases, 5,810 hospitals as well as 75 iatrogenic picture. federal and state agencies which found 103,000 cases of death due Unfortunately, cause and effect go unmonitored. The figures _to hospital infections, 75% of which were preventable.'” We do on unnecessary events represent people ("patients") who are thrust —_ not include this figure, but report the lower Weinstein figure of into a dangerous health-care system. They are helpless victims. 88,000. Each one of these 16.4 million lives is being affected in a way that Another figure that we withheld, for lack of proper peer review, could have a fatal consequence. was from the National Committee for Quality Assurance's Simply entering a hospital could result in the following: September 2003 report which found that at least 57,000 people 1. In 16.4 million people, a 2.1% chance of a serious adverse die annually from lack of proper care for common diseases such drug reaction! (186,000); as high blood pressure, diabetes or heart disease.'* 2. In 16.4 million people, a 5—6% chance of acquiring a Overlapping of statistics in "Death by Medicine" may occur nosocomial infection’ (489,500); with the Institute of Medicine's paper that designates "medical 3. In 16.4 million people, a 436% chance of having an _ error" as including drugs, surgery and unnecessary procedures.° iatrogenic injury in hospital (medical errors and adverse drug Since we have also included other statistics on adverse drug reactions)’* (1.78 million); reactions, surgery and unnecessary procedures, perhaps as much 4. In 16.4 million people, a 17% chance of a procedural error” as 50% of the IOM number could be redundant. However, even (1.3 million). taking away half the 98,000 IOM number still leaves us with iatrogenic events as the number-one killer at 734,936 annual TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION deaths. Even greater numbers of iatrogenic deaths will eventually come Condition 10-Year Deaths Author to light when all facets of health care delivery are measured. Adverse Drug Reaction 1.06 million (1) Most iatrogenic statistics are derived from hospital-based studies. Medical error 0.98 million (6) However, health care is no longer typically relegated to hospitals. Bedsores 1.15 million (7, 8) Today, health care is shared by hospitals, outpatient clinics, Nosocomial Infection 0.88 million (9, 10) transitional care, long-term care, rehabilitative care, home care Malnutrition 1.09 million (11) and private practitioners’ offices. Outpatients 1.99 million (12, 112) In the current climate of reducing health-care costs, the number Unnecessary Procedures 371,360 (3, 13) of hospitals and the length of patient stays are being slashed. Surgery-related 320,000 (85) These measures will increase the number of patients shunted into TOTAL 7,841,360 (7.8 million) outpatient, home care and long-term care, and the iatrogenic morbidity and mortality will also increase. Cost $12 billion $2 billion $55 billion $5 billion $77 billion $122 billion $9 billion 10-year Number 89 million‘ 75 million’ Tatrogenic Events 17.8 million 13.0 million $282 billion 783,936 164 million 30.8 million People Affected 8.9 million’ 7.5 million’ Tatrogenic Events 1.78 million'® 1.30 million® 16.4 million 3.08 million ABSTRACT (continued) We could have an even higher death rate by using Dr Lucien Leape's 1997 medical and drug error rate of three million. “ Multiplied by the fatality rate of 14%, which Leape used in 1994,'* we arrive at an annual death rate of 420,000 for drug errors and medical errors combined. If we put this number in place of Lazarou's 106,000 drug errors and the Institute of Medicine's (IOM's) 98,000 medical errors (which may have a drug error overlap with Lazarou's study), we could add another 216,000 deaths, making a total of 999,936 deaths annually. The enumerating of unnecessary medical events is very important in our analysis. Any medical procedure that is invasive and not necessary must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people ("patients") who are thrust into a dangerous health-care system. They are helpless victims. Each one of these 16.4 million lives is being affected in a way that could have a fatal consequence. Simply entering a hospital could result in the following: 1. In 16.4 million people, a 2.1% chance of a serious adverse drug reaction! (186,000); 2. In 16.4 million people, a 5-6% chance of acquiring a nosocomial infection’ (489,500); 3. In 16.4 million people, a 4-36% chance of having an iatrogenic injury in hospital (medical errors and adverse drug reactions)'° (1.78 million); 4. In 16.4 million people, a 17% chance of a procedural error” (1.3 million). TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION Condition 10-Year Deaths Author Adverse Drug Reaction 1.06 million (dd) Medical error 0.98 million (6) Bedsores 1.15 million (7, 8) Nosocomial Infection 0.88 million (9, 10) Malnutrition 1.09 million (11) Outpatients 1.99 million (12, 112) Unnecessary Procedures 371,360 (3, 13) Surgery-related 320,000 (85) TOTAL 7,841,360 (7.8 million) 10-Year Deaths 1.06 million 0.98 million 1.15 million 0.88 million 1.09 million 1.99 million 371,360 320,000 18 = NEXUS ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS 7,841,360 (7.8 million) www.nexusmagazine.com AUGUST - SEPTEMBER 2004