Probably not.
It may be a sign of a failing immune system, which is why it is a risk to people with HIV or are being treated for cancer. I had a young cousin die from pneumonia a few years ago, just at the point he looked like he was recovering from his cancer.
The US treatment of opiate addicts is one thing; reducing the number of addicts created by prescribing them is quite another.
My own GP, who is a thoughtful type, doesn’t think doctors are able to regulate themselves well in some areas because the temptation to prescribe and get on to the next patient is very strong. Fifty years ago we had a similar outbreak of barbiturate addiction due to enormous over prescribing, so it isn’t as if there is no precedent.
To every problem there is a solution that is easy, obvious and wrong. But my solution to this one would be:
those can kill the elderly and infants more commonly with acute incidents, whereas other respiratory conditions are chronic?
Quarter of a million Americans taking out of the population every year is a surely a powerful force in population control. Maybe Drs should be applauded for their service to the environment.
While I heartily endorse the legalisation of cannabis, it simply is not an effective analgesic. It’s a decent short-term psychological painkiller, but for physical pain it isn’t in the same ballpark as even the mildest opiates.
An important point that doesn’t get enough attention is the extent to which the USA’s heroin problem is driven by the insane cost of American healthcare. I’ve heard quite a few interviews in which heroin addicts report that their use began because they could not afford the legal analgesics they were prescribed.
Incidentally, your third point would restrict a huge swathe of pharmaceuticals; perhaps the majority. Aspirin and paracetamol are definitely off the table.
In terms of therapeutic index (i.e. lethal dose divided by effective dose), the opiates are amongst the safest analgesics we’ve got.
The danger in recreational heroin isn’t that the opiates are hyper-lethal. It’s that the opiates are so predictable and safe that users can regularly get away with pushing the dosage up to entertainment levels…until they misjudge the purity of their gear.
Accidental opiate overdose is very rare in hospitals. Overdoses amongst heroin users are more the result of prohibition than pharmacology.
I thought it would be because of lack of continuity of care, due to lack of universal health insurance. However, that’s not the case. Canada also has medical error as the #3 killer of Canadians.
The gruelling working hours you point out are definitely not helping – making people make life or death decisions for 12+ hours at a stretch when there is plentiful research showing that thinking and decision making skills start to degrade after about six to eight hours on the job is definitely not helping.
However, I think the real roots of the problem lie with the whole malpractice industry, on the one hand, and the whole culture of making doctors one of our modern priesthoods, on the other. The culture of infallability plus the fear of malpractice costs is what is preventing there from being an effective accident investigation and prevention mechanism for health care.
Airplanes are one of the safest ways to travel because there is a mechanism in place to investigate each accident, determine what went wrong, and find ways to make it unlikely that that thing will go wrong again. We need the same thing for health care, but that means we need to not have malpractice and we need to not have this culture that equates an MD with godhood.
So, first of all, govenment could spend money to eliminate the malpractice industry. That means, declare that all medical costs for preventable deaths (as determined by an independent investigation) get paid in full, so you no longer have “here is your bill for our killing your spouse” (cue Brazil information retrieval reference). Also it would mean instituting some kind of no-fault, no-lawyers system of standardized compensation for preventable deaths. Both of those things would require legislation and government money. Once you eliminate the malpractice industry, you can begin treating preventable deaths as a systematic problem to be investigated and prevented, rather than a thing to blame and punish someone for.
eta: @wanderfound points out that “clinical peer review” (which exists in most hospitals) seeks to do what I was calling for, but that it’s hampered by the existence of the malpractice culture from actually working properly because the malpractice industry needs preventable deaths to be someone’s fault rather than a result of a broken system, which is the exact opposite attitude from what clinical peer review needs to do its work properly. In other words, we still need to get rid of the malpractice industry.
Because pneumonia is among the number one killers world wide (especially among the young) and if diagnosed timely and appropriately it is treatable (relatively cheaply) and survivable. Unlike cancer or congenital heart conditions which are very expensive to treat and where the outcome is far less positive.
Effective diagnosis and treatment of pneumonia can have huge positive impact on public heath for relatively small investment.
Yes, it would, if it is a hospital acquired infection. However, determining whether or not an infection is a) hospital acquired and b) was preventable is incredibly complex and requires a systematic overview, which most health care systems lack!
We do have that.
From a quick look, it seems that the current research suggests that a key problem is that a focus on assigning blame to individuals diverts attention from the more important task of improving procedures. Fear of liability discourages innovation, and scapegoating is used to deflect responsibility from systems to individuals.
The US is not unique in this. All advanced medical systems have similar numbers of adverse medical events.
It’s highly unlikely anyone would have connected the dots, unless your grieving family decided to spend the rest of their days to campaign for an investigation and / or sued the hospital in question.
EDIT to overrule idiotic auto correct.
But it’s crippled by the existence of malpractice. So, same outcome: to reduce the largest cause of preventable deaths, you have to get rid of the malpractice industry and the culture of blame-laying it fosters.
On that subject…this was my first ever published monograph.
Malpractice law in the USA does need reform, but you need to maintain a system of physician accountability.
Medical personnel hold immense power over their patients, and many of them abuse that power (via malice or negligence) on a regular basis. It’s an unfortunate but well established facet of the profession.
…As was “Acute indigestion” before they figured out that was a heart attack.
You only DIE once… This list doesn’t count mistakes that don’t kill you, like cutting off the wrong foot, or causing brain damage…
Another thing, this affects ALL of us.
One of the big costs for doctors is malpractice insurance, indeed, for just a family doctor on their own, it is a huge burden. They aren’t doing surgery or treating cancer, but they pay a very high premium. That is partly why when I have asked every doctor about cutting health costs, tort reform comes up.
So you have that expense. You also have the expense of ordering extra, mostly likely unneeded test to cover your ass. Then you have the expense of payouts when they do screw up.
So in the end, if we were able to reduce the number of medical error deaths, premiums should also fall, lowering overall healthcare costs.
Also, is this where I point out your own doctor is more likely to kill you than you dying in a crime? Stone cold killers with an MD 
These stats need to be contextualized. That’s 78.2 per 100,000 people. Canada seems to have a slightly higher rate of 83.7 per 100,000 but it’s just an estimate. I found an article reporting 17,000 deaths to medical errors in Germany in 2005, which would be a dramatically better rate of 20 per 100,000 except that the same article criticized the lack of reporting and speculated the number might be much higher.
In addition to stats being barely available, what counts as medical error might also vary so widely between jurisdictions that we can’t compare them. Maybe we really don’t want these errors reduced. Every time you treat a patient you run the risk of making a mistake. Reducing error means being more cautious about treatment, but in critical situations that may kill more people than the errors do. Maybe the rise in medical error in the US is a result of the ACA meaning people get more healthcare. Maybe every medical error has three lives saved as a counterpart.
There are a number of sources of medical error we are never going to reduce without causing more problems than we solve. But I have no way of knowing how large a portion of those medical errors are in that category.
In Canada I know we have (or recently had, maybe it’s improved) a problem with doctors not washing their hands enough, leading to a rise in hospital acquired infections, which worsens the problem of antibiotic resistant infections. That’s a real problem we can really attempt to solve. “Medical error” in general is an unknowable boogeyman that I can’t even be concerned about without more information.
Just looking at the one chart, this looks like a pretty good result. Unless someone makes a mistake, you are probably going to be ok. (Unless you have cancer or heart disease, so let’s work on those.)
Ideally, medical error would be the number one cause of death, assuming ‘old age’ gets broken out among a wide variety of causes.
Really? I thought we had this already figured out.
Reminds me of the story of the doctor who was like, “Hey guys, if we just washed our hands, our infant mortality rate and women’s deaths from childbirth would fall.” and everyone was like, “Me? Have dirty hands? Surely you jest!” And years later they finally figured out he was right.
