Showing posts with label death by doctoring. Show all posts

Monday, 26 September 2016

Medical Errors Killing Multitudes

Misdiagnosis in America: Shocking Statistics

by Dr. Mercola

In 1999, the Institute of Medicine (IOM) reported that up to 98,000 people die each year due to hospital mistakes [in the USA]. A health advisory committee with IOM has built on this knowledge in a new, yet equally concerning, report released in September 2015.¹

Most people will suffer from at least one wrong or delayed medical diagnosis during their lifetime, according to the latest data. Americans experience about 12 million diagnostic errors a year, the IOM report revealed.

Conservatively, the report found that 5 percent of US adults who seek outpatient care will experience a diagnostic error. Further, such errors are thought to contribute to 10 percent of patient deaths and 17 percent of adverse events in hospitals.

They’re also the leading type of paid medical malpractice claims and are nearly twice as likely to have resulted in the patient’s death compared to other claims.

Devastating Diagnostic Mistakes Are Claiming Patients’ Lives

“Getting the right diagnosis is a key aspect of health care: It provides an explanation of a patient’s health problem and informs subsequent health care decisions.

For decades, diagnostic errors — inaccurate or delayed diagnoses — have represented a blind spot in the delivery of quality health care. Diagnostic errors persist throughout all settings of care and continue to harm an unacceptable number of patients,” the IOM report stated.

Diagnostic errors are often incredibly harmful to patients as they may lead to delays in treatment, lack of treatment, inappropriate, or unnecessary treatment. This, in turn, can have physical, psychological, and financial consequences.

Causes are varied but include inadequate communication between physicians and patients, a health care system design that does not support the diagnostic process, limited feedback to clinicians about diagnostic performance, and a health care culture that discourages transparency, so diagnostic mistakes are typically not reported (and not learned from).

Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, told CNN:²

“It’s probably one of the, if not the, most under-recognized issues in patient safety… Much of the harm that we once labeled as inevitable we’re now seeing as preventable.”

CNN noted several examples of diagnostic mistakes included in IOM’s report:³

A 51-year old woman with a family history of heart disease repeatedly asked her doctors’ office to refer her to a cardiologist for a stress test. Three months after her initial request, on the day of her appointment, she died because of significant coronary artery disease.
A doctor mistook a blood clot in the lungs of a 33-year old woman for an asthma attack, leading to her death.
An urgent care clinician misread an X-ray and diagnosed a 55-year old man with an upper respiratory infection instead of pneumonia. He died as a result.
Doctors at a trauma center decided not to perform a CT scan on a 21-year old stabbing victim and missed a knife wound penetrating several inches into his skull and brain.
A newborn baby suffered preventable brain damage when doctors failed to test for high levels of a chemical in his blood that had turned his skin yellow from head to toe.

‘Urgent Change Is Warranted’

The IOM committee concluded “urgent change is warranted” to protect patients from diagnostic errors, although there’s likely no quick fix available. They recommended a slew of changes, including:

More training (in medical school and continuing education) in making diagnoses	Federal agencies and employers should encourage the reporting of diagnostic errors to help others learn how to avoid them
Increased monitoring of how health care facilities are diagnosing patients	Encouraging patients to be involved in their care and share concerns about diagnostic errors
Ensuring patients have access to electronic health records, diagnostic testing results, etc. so they can review for accuracy	Increased collaboration among pathologists, radiologists, other diagnosticians, and health care professions to improve the diagnostic process

At the heart of the recommendations is one that virtually everyone reading this should take to heart: a call for patients to become advocates for their own care and voice any concerns or questions. Dr. Pronovost added: “We need to encourage patients to speak up and ensure that when they do speak up, it’s well received.”⁴

The National Patient Safety Foundation and the Society to Improve Diagnosis in Medicine have a checklist you can use to help ensure you get the correct diagnosis. It includes recommendations such as the following:

Tell your story well (when symptoms started, what makes symptoms better or worse, etc.)	Remember what treatments you’ve tried in the past and how the illness has progressed over time
Keep records of test results, medications, and hospital admissions	Learn about your illness, tests or procedures you’re having done, and/or medications you’re taking
Take charge of managing your health, and be sure each doctor you’re seeing is aware of other doctors’ visits, medications you’re taking, test results, treatments, etc.	Be actively involved in your health care decisions
Know your tests results, including what the results mean	Ask questions, including whether there could be other reasons or causes for your illness

Medical Errors May Cause Nearly Half a Million Deaths Annually

Diagnostic errors are just one type of error that occurs in the medical field, and you might be surprised at just how common errors occur. While the 1999 IOM report blamed 98,000 deaths a year on hospital errors, a 2013 study in the Journal of Patient Safety projected that medical errors now account for 210,000 to 440,000 US deaths annually.⁵

Even at 210,000, this makes medical errors the third-leading cause of death in the US, right after heart disease and cancer. And when you consider instances where medical errors cause some form of harm but not necessarily death, the incidence rate may be as high as 40,000 per day!⁶ These are frightening numbers that deserve immediate attention, as the researchers noted:

“In a sense, it does not matter whether the deaths of 100,000, 200,000, or 400,000 Americans each year are associated with PAEs [preventable adverse events] in hospitals. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients.

Yet, the action and progress on patient safety is frustratingly slow; however, one must hope that the present, evidence-based estimate of 400,000+ deaths per year will foster an outcry for overdue changes and increased vigilance in medical care to address the problem of harm to patients who come to a hospital seeking only to be healed.”

Seniors May Be Particularly at Risk

Yet another study of more than 12,500 Medicare patients (with an average age of 76) found that nearly one in five suffer from medical injuries when receiving care.⁷ Injuries included:

Being given the wrong medicationd
Having an allergic reaction to a medication
Receiving treatment that led to more complications of an existing medical problem

Those who had experienced a medical injury had a death rate nearly double those who had not, along with greater use of medical services and increased health care costs in the year following the injury. While the media often focuses on medical injuries in hospitals, this study actually found that two-thirds of injuries occurred during outpatient care (such as doctor’s offices).

Previous studies have found about 13.5 percent of hospitalized patients suffer from adverse medical events, but the featured study found about 19 percent of seniors are harmed by medical care. Older people, men, those with lower incomes, and people with disabilities were at an even greater risk. Further, the risk of an adverse medical event rose 27 percent for each chronic medical condition a person had.⁸ The study’s lead researcher noted:

“These injuries are caused by the medical care or management rather than any underlying disease… The rate of these injuries is probably higher than has been estimated.”

What Medical Errors Should You Watch Out For?

Hospitals often make such egregious errors as treating the wrong patient, leaving behind surgical tools in a person after surgery, losing patients, or operating on the wrong body part. Air bubbles in your blood after a chest tube is removed, mix-ups involving medical tubing, and hospital-acquired infections are other examples of sometimes fatal medical errors that are all too common – and preventable.

Any time you’re in a health care setting, be sure to ask questions – double check the treatments you’re receiving, the dosages of medications, and the diagnosis you’re given – and if possible bring a family member or friend with you for an extra set of eyes and ears.

Further, be aware that more than 2 million people are affected by hospital-acquired infections each year, and a whopping 100,000 people die as a result. According to the 2011 Health Grades Hospital Quality in America report, analysis of approximately 40 million Medicare patients’ records from 2007 through 2009 showed that 1 in 9 patients developed such hospital-acquired infections!⁹ The saddest part is, most of these cases could likely have been easily prevented with better infection control in hospitals — simple routines such as doctors and nurses washing their hands between each patient, for example.

So make sure doctors, nurses, and other health care providers wash their hands before touching you; if you feel uncomfortable speaking up… realize that doing so could literally save your life.

One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management is because it can help keep you OUT of the hospital and other health-care danger zones. You can use this site to find well-proven strategies that will address most chronic health problems.

Please remember you can always use the search engine at the top of every page on the site to review previous articles we have written. If you have an acute injury or life-threatening medical situation, of course you need to seek immediate competent care.

How to Stay Safe If You’re Hospitalized

Dr. Martin Makary is the author of The New York Times bestselling book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Healthcare, which is a story about the dangerous practices and mistakes of modern medicine. In the interview above, you can learn some important tips to stay safe if you find yourself in a hospital. Once you’re hospitalized, you’re immediately at risk for medical errors, so one of the best safeguards is to have someone there with you. Dr. Andrew Saul has also written an entire book on the issue of safeguarding your health while hospitalized.

One of the best suggestions is simply to have someone there to act as your personal advocate, or to take the time to stay with your loved one who is hospitalized. This is particularly important for pediatric patients and the elderly.

“Sometimes, we rely on a competent talking patient to help verify what we’re doing before we go in the operating room. But if we got somebody who’s not mentally coherent because they’re elderly or a kid and there’s no family member around, these are danger zones. These are high-risk areas for medical mistakes,”

Dr. Makary warns,“It’s important to ask what procedure’s being done or why is the procedure being done. ‘Can I talk to the doctor?’ You have a right to know about what’s being done to you or your loved one in the hospital. When you’ve got a kid in the hospital, I think it’s particularly important to ask the questions.”

For every medication given in the hospital, ask, “What is this medication? What is it for? What’s the dose?” Take notes. Ask questions. Building a relationship with the nurses can go a long way. Also, when they realize they’re going to be questioned, they’re more likely to go through that extra step of due diligence to make sure they’re getting it right — that’s human nature. Dr. Makary also co-developed a checklist for surgeons to use before surgery or any other hospital procedure.

Dr. Pronovost, who is Dr. Makary’s research partner, created a checklist in the ICU for patients who are in the intensive care unit. The World Health Organization (WHO) ended up taking an interest in their checklists and used some of their principles to develop the official World Health Organization checklist.

The WHO surgical safety checklist and implementation manual,¹⁰ which is part of the campaign “Safe Surgery Saves Lives” that Drs. Makary and Pronovost were a part of, can be downloaded here. If a loved one is in the hospital, print it out and bring it with you, as this can help you protect your family member or friend from preventable errors in care.

From Dr Mercola @ http://articles.mercola.com/sites/articles/archive/2015/09/30/diagnostic-errors.aspx via http://www.wakingtimes.com/2016/09/04/misdiagnosis-america-shocking-statistics/

For more information about medical malpractice see http://nexusilluminati.blogspot.com/search/label/medical%20malpractice

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Thursday, 9 June 2016

Nearly all of our medical research is wrong

https://qzprod.files.wordpress.com/2016/01/testtubes.jpg?quality=80&strip=all&w=1600

So many negative results we never hear about. (Reuters/Danish Siddiqui)

by Danielle Teller Physician and researcher

Something is rotten in the state of biomedical research. Everyone who works in the field knows this on some level. We applaud presentations by colleagues at conferences, hoping that they will extend the same courtesy to us, but we know in our hearts that the majority or even the vast majority of our research claims are false.

When it came to light that the biotechnology firm Amgen tried to reproduce 53 “landmark” cancer studies and managed to confirm only six, scientists were “shocked.” It was terrible news, but if we’re honest with ourselves, not entirely unexpected. The pernicious problem of irreproducible data has been discussed among scientists for decades. Bad science wastes a colossal amount of money, not only on the irreproducible studies themselves, but on misguided drug development and follow-up trials based on false information. And while unsound preclinical studies may not directly harm patients, there is an enormous opportunity cost when drug makers spend their time on wild goose chases. Discussions about irreproducibility usually ends with shrugs, however—what can we do to combat such a deep-seated, systemic problem?

Lack of reproducibility of biomedical research is not the result of an unusual level of mendacity among scientists. There are a few bad apples, but for the most part, scientists are idealistic and fervent about the pursuit of truth. The fault lies mainly with perverse incentives and lack of good management. Statisticians Stanley Young and Alan Karr aptly compare biomedical research to manufacturing before the advent of process control.

Academic medical research functions as a gargantuan cottage industry, where the government gives money to individual investigators and programs—$30 billion annually in the US alone—and then nobody checks in on the manufacturing process until the final product is delivered. The final product isn’t a widget that can be inspected, but rather a claim by investigators that they ran experiments or combed through data and made whatever observations are described in their paper. The quality inspectors, whose job it is to decide whether the claims are interesting and believable, are peers of the investigators, which means that they can be friends, strangers, competitors, or enemies.

Lack of process control leads to shoddy science in a number of ways. Many new investigators receive no standardized training. People who work in life sciences are generally not crackerjack mathematicians, and there’s no requirement to involve someone with a deep understanding of statistics. Principal investigators rarely supervise the experiments that their students and post-docs conduct alone in the lab in the dead of night, and so they have to rely on the integrity of people who are paid slave wages and whose only hope of future success is to produce the answers the boss hopes are true.

The peer review process is corrupted by cronyism and petty squabbles. These are some of the challenges inherent in a loosely organized and largely unregulated industry, but these are not the biggest reasons why so much science is unreproducible. That has more to do with dumb luck.

Randall Munroe has a wonderful cartoon at xkcd that neatly summarizes the reason why most published research findings are false. In the cartoon, scientists ask whether jelly beans cause acne and determine that they don’t. They then proceed to do subgroup analyses on 20 different colors of jelly beans, and excitedly announce that green jelly beans are associated with acne “with 95% confidence!” This is a reference to the traditional gold standard for whether or not a research finding is considered to be statistically significant. Over the last century, scientists have somewhat arbitrarily agreed that if something has only a 1-in-20 chance of happening purely by chance, then when that thing happens, we will consider it to be meaningful.

For instance, if the first time you asked someone out on a date that person declined in favor of attending a nephew’s birthday party, you might think of it as a coincidence. If the same excuse came up a second time, you might find it strange that the birthday parties always fell on Friday nights. By the third time, you would have to sadly conclude that there was a less than 1-in-20 chance that yet another nephew had a Friday night birthday party, and that the pattern of rejection was statistically significant.

One could quibble about whether or not 95% confidence is high enough to be truly confident. We wouldn’t fly on planes that had a 5% chance of crashing, but we would probably go on a picnic if there were a 5% chance of rain. Whether it’s the right number for scientific studies isn’t clear, but it is clear that this cutoff for statistical significance should not apply to multiple testing or multiple modeling.

The jelly bean cartoon illustrates this point nicely. If the scientists had found an association between jelly beans and acne on the first try, they might reasonably think that it wasn’t just chance—maybe jellybeans cause acne, or maybe acne causes jelly bean cravings. After testing 20 colors of jelly beans, though, the 1-in-20 chance of finding an association by pure chance becomes meaningless. If you test enough jelly beans, you are bound to find an association by pure chance, and that association will be spurious and irreproducible, just like many scientific studies.

When scientists run experiments in labs or model large datasets in multiple different ways, they generate heaps and heaps of negative data, but these don’t get reported. All that gets published is the 100th experiment or analysis that “worked.” Furthermore, scientists are rarely required to state upfront how they will measure primary outcomes. To understand why this is a problem, imagine that I claim to have a magic coin. I tell you that I’m going to flip it 10 times, and if it is magic, it will it come up heads every single time. That’s a pretty good study. But what if instead I flip my coin a 1,000 times and comb through the data for patterns. When I find any pattern in a series of 10 flips, and I tell you that the probability of that sequence occurring by luck alone is less than one in 1,000. That’s correct, but are you impressed by the magic of my coin?

There are some potential solutions to the irreproducibility of medical science, but they would require an extensive overhaul of the system. For observational studies, Young and Karr have proposed sensible measures, like making data publicly available, recording data analysis plans upfront, and splitting the data to be analyzed into test and validation sets. For basic science, public money could be used to set up large testing facilities where experiments can be run by impartial technicians and all results, positive or negative, can be made available to the scientific community. If such changes were implemented, however, the number of published studies would plummet precipitously. Journals would go out of business and so would most scientists, unless new criteria were devised for doling out grant money and handing out promotions.

Some areas of research would be invalidated if everyone had access to negative studies, and researchers would be discredited. The biomedical research community isn’t ready for these kinds of painful changes. One piece of evidence for this is that nobody knows which 47 studies Amgen was unable to reproduce. To gain the cooperation of the principal investigators of those studies, Amgen was forced to sign non-disclosure agreements about the results of their inquiries. It seems that the authors of the “landmark” cancer studies knew that they would be found out, and unsurprisingly, setting the record straight wasn’t high on their list of priorities.

From Quartz @ http://qz.com/603356/why-scientific-studies-cant-be-reproduced/

Study Suggests Medical Error Is Third Leading Cause of Death in US

by Jackie Syrop

Medical error is the third-leading cause of death and Johns Hopkins University School of Medicine researchers are calling for better reporting on death certificates to help understand the scale of the problem and how to tackle it.

Medical error is the third-leading cause of death, after heart disease, and cancer, in the United States, according to a study published in BMJ. As a result of the findings, Johns Hopkins University School of Medicine researchers are calling for better reporting on death certificates to help understand the scale of the problem and how to tackle it.

Martin Makary, MD, MPH, professor of surgery, and Michael Daniel, a research fellow, say their research shows that US death certificates are not useful for acknowledging medical error because they rely on assigning an International Classification of Disease (ICD) code to the cause of death. If a cause of death is not associated with an ICD code, it is not captured; thus, if human and system factors are associated with a death, that is not reflected on the death certificate.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” explained Makary.

Medical error is defined as an unintended act either of omission or commission or one that does not achieve its intended outcome; the failure of a planned action to be completed as intended (an error of execution); the use of a wrong plan to achieve an aim (an error of planning); or a deviation from the process of care that may or may not cause harm to the patient. This kind of error can be at the individual or system level.

Makary and Daniel used death rate data from 4 studies from 2000 to 2008, including one from the HHS’ Office of the Inspector General and the Agency for Healthcare Research and Quality. Then they used hospital admission rates from 2013 and extrapolated that based on 35,416,020 hospitalizations, there were 251,454 deaths from medical error, which translates to 9.5% of all deaths each year in the United States.

Comparing their estimate to the CDC’s list of the most common causes of death in the United States, the authors calculated that medical error is the third most common cause of death, surpassing respiratory disease—the CDC’s currently listed third leading cause of death.

Makary noted that top-ranked causes of death as reported by the CDC drive the nation’s research funding and public health priorities. While cancer and heart disease get a lot of attention, medical errors do not, and thus do not get deserved funding. More research is needed, they say, because although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences.

From American Journal of Managed Care @ http://www.ajmc.com/newsroom/study-suggests-medical-error-is-third-leading-cause-of-death-in-us

For information about medical malpractice see http://nexusilluminati.blogspot.com/search/label/medical%20malpractice