Not even when nonsensical hospital policies created, nurtured, and sustained infectious diseases to the point that we now consider them “usual?”
Because that has happened in the USA. Hospital administrators tore out oligodynamic brass hardware on doors and switches in order to put in bacteria-breeding stainless steel - they actually published standards that specified stainless steel as “hospital grade” - in order to promote a false appearance of cleanliness.
Even after it became clear (well, the science was clear as early as 1893, but medicine is a praxis, not a science) that hospitals with a “modern” shiny appearance were suffering higher rates of hospital infection, hospital administrators still fought against reversion to old-fashioned, grungy-looking brass hardware, instead implementing expensive periodic wipe-downs with various biocides… which in turn strengthened the infectious organism populations over time.
The eventual solution appears to be “copper touch surfaces”. Perhaps because copper hardware is very expensive and high-maintenance compared to brass or bronze, hospitals seem to like it better, and can eventually be persuaded to rip out stainless in favor of copper. Copper is highly oligodynamic and is the alloy component in both brass and bronze that kills viruses, bacteria and fungi.
We already have this in the UK in the form of NICE, which is an independent body. I don’t know a lot about the US, but I believe the same function is carried out by insurance companies.
It is hard to argue with your description of a systemic problem. It still is not what I would call a Kunstfehler, since it isn’t actually part of a specific treatment, but a more general problem.
BTW, I didn’t know about this, and will ask a hygienists of a larger German University clinic about her opinion how and why this happened - and if it happens everywhere.
A lot of confounding issues here. Politicians failed to regulate prescriber/drug company marketing relationships and the result was the over and inappropriate prescribing of opiates. For example, Purdue swore up and down to phsyicians that Oxycontin was non-habit forming for years. Additionally, the commoditization of health care has removed focus from health outcomes and placed it on patient satisfaction. If the doc doesn’t renew the addicts percocet script the addict nails them on a survey or simply moves their business elsewhere.
Neurontin (gabapentin) is highly abused. I’ve seen a lot of abuse in my pharmacies. Tramadol abuse has been incredible to watch. Hydrocodone went to Cii and a lot of patients moved to Tramadol and I’ve seen them just ramp up usage like anything else.
Well, OK, but if so, then that means instead of managing the resulting addictions as a medical problem (or a cause to legislate against drug company perfidy!) current policy aims to harshly punish addicts who were apparently created to feed Purdue corporate profits. It’s openly attacking the victims.
And, of course, current policy also punishes people with legitimate need for painkillers - regardless of whether such people are addicted or not. US legislators are purposely inflicting suffering on such people, just so that they can be absolutely sure they have also wrecked the lives of addicts.
US drug policy is specifically designed to do harm. The class of people suffering from this harm is being purposely increased, for a number of intersecting reasons, and the war banner under which this harm is being increased is labeled “opioid epidemic”.
And they were probably using hydrocodone, no doubt adulterated with acetaminophen, because their doctors were unable or unwilling to prescribe safer and equally addictive medications like codeine.
Whenever the CDC publishes a report that says prescription opioids are killing more Americans than heroin and cocaine combined, it’s important to remember that the component of those prescription opioids that actually kills is not an opiate - it’s acetaminophen.
I was a bit careless with the numbers for rhetorical effect; mea culpa.
The general point I was aiming at, however, is that the public perception of which drugs are safe vs dangerous in therapeutic index terms is often wildly incorrect. Many common medications that are distributed freely (e.g. aspirin and paracetamol) have a dreadful therapeutic index, while many tightly restricted drugs (e.g. opiates) do not.
That sort of thing was a major factor in my teaching and grading style. In both clinical and research psych, writing ability is a fundamental professional skill, and one that tends to be severely undertrained in the sciences. I put a lot of time into hammering basic writing skills into my students.
The quality of your science is irrelevant if nobody can understand what you’ve got to say.
BTW, this is an example of the sort of writing I used to see from my students before I got to work on them:
“These principle and terms are stimuli which are activities within the environment that are capable of forming relationship with a behaviour as a consequence or antecedent, responses which are measurable, observable and actions that stimuli presentation, consequences, positive reinforcement which demonstrated when a behaviour is followed by a consequences that increase the behaviour’s rate of occurrence, negative reinforcement which the rate of a pacific behaviour’s occurence increases when some environment mental condition is reduced in intensity or removed, punishment which describes the behaviour future rates occurence is decreased by a consequence and extinction which describes a previously reinforced condition is no longer reinforced and the occurence are decreased.”
If you try hard enough, it is possible to work out what he was trying to say, but you’ll give your brain a hernia in the process.
Well, the alternative would be to say that drug companies had done something seriously wrong. One might have to do something about it then. Something rather more than this:
“The pitch worked, and sales took off: from $45 million in 1996 to $1.5 billion in 2002 to nearly $3 billion by 2009.”
“Eventually the two sides agreed that Purdue would plead guilty to a single felony count of misbranding. In May 2007 the company agreed to pay a $600.5 million fine, and its top three executives were fined $34.5 million (though the company picked up the tab) and subsequently left Purdue.”
I take 30mg doses of dihydrocodeine (0.01 times the strength of the same amount of Tramadol) and constantly question myself about whether I need to take it right then, or should I wait to see if the pain remains. I also have codrydamol, 10mg tablets with 500mg of paracetamol, but the paracetamol scares me far more than the DHC does.
If there was a smaller tablet than 30mg I would rather take that.
Hospital acquired pneumonia is a failure of infection control. If you fail at infection control than you turn a hospital into a death trap, as by definition everyone who is admitted into a hospital, even if for routine surgery, will have to some degree a compromised immune system.
When a patient is
a) infected with a hospital acquired infection, i.e. a strain of infection which can be identified as originating in the hospital and
b) when that infection is not diagnosed and treated in a timely fashion, then that is a medical error big time (although I would prefer the term health care system error). But of course we seldom know about such cases, unless there is a huge cluster or some very persistent grieving relatives.
e.g. how would you class these cases, below? An act of god or adverse harm caused by the health care system?
The reality of a modern industrialised medicine is, that in the vast majority of instances of adverse harm (in popular parlance medical error) are caused by the system. If there were 250 000 medical errors in the US which would fall into your category of “Kunstfehler” you wouldn’t have any practicing clinicians in the US as they would all be sitting in prison.
The NIH is interested in systemic failure rather than individual criminal activity among practicing clinicians (which are negligible and for which we have the justice system).
In addition a considerable number of harm occurs through omission as in the case of @knoxblox, where there might be 100s of legitimate reasons why the first Hospital failed to diagnose his appendicitis. Categorising these as Kunstfehler would require considerable data, which is just not available. Thus the NIH’s painstaking efforts to try to understand the problem.
I resisted the impulse when NICE was brought up… because every health plan has some entity deciding who lives and who dies, and since we certainly aren’t going to allow the lower classes to decide for themselves, it seems slightly better to have a government body doing it than a religious or commercial body.
The linked case description isn’t directly treatment-related, but clearly hygienic control has terribly failed. (BTW, the US are a strange place. This really reads like the laundry was cleaned in a building possibly only accessible by a dirt road and that was completely flooded by, and NOT properly renovated after Kathrina.What the what?) If this, in general, is a systemic problem or a very rare case of carelessness, I can’t tell. But it appears preventable, and thus the responsibles should be brought to justice.
Just for the record, I didn’t define medical malpractice, or Kunstfehler. And I wouldn’t invoke Your Invisible Friend of Choice for any death, infection, or anything else.
I was just adding some thoughts on @anon50609448’s observation that there might be a difference between the definitions of medical error in different statistics. And since we don’t know what is meant in the first place, its, as they said, a bogeyman.
I think we all agree that the way of conducting medicine still can be improved, and some severe problems exist.
On a personal and positive note, despite all criticism, I am massively grateful for the achievements of modern medicine.
I think it’s the “altered states” thing - drug abusers I know have used everything from muscle-relaxers to my poppy and morning-glory seeds to try to get high. Some people like the zombie state.
It’s funny - for me, gabapentin is the only thing that is effective and doesn’t make me a zombie.
Whenever the CDC publishes a report that says prescription opioids are killing more Americans than heroin and cocaine combined, it’s important to remember that the component of those prescription opioids that actually kills is not an opiate - it’s acetaminophen.
This is absolutely false. Vicodin/Norco (hydrocodone/APAP) and Percocet (oxycodone/APAP) are not killing a lot of patients on their own. They are the “gateway” drugs that get patients moving down the pathway of Oxycontin, Opana, hydromorphone, etc… Patients are dying from opiate overdoses, acetaminophen related deaths are still exceedingly rare and insurers/Medicaid have hard halts in place to prevent patients from receiving more than 4 grams of acetaminophen daily. Many limit to 2 grams or less.
Excuse me, but if what I said was “absolutely false”, then you must mean that prescription painkillers (like the Vicodin that supposedly killed Heath Ledger) are not killing by acetaminophen toxicity? That’s what I’m reading in the medical reports. Every online source I can find (like this one) says hydrocodone itself is relatively safe - it’s just synthetic codeine - and that it’s the acetaminophen in vicodin that’s dangerous.
The whole “gateway drug” concept doesn’t work for me; I’m more of a Rat Park kind of guy. All my life I have heard that (for example) marijuana is a surefire gateway to heroin, &etc., but in real life™ what I have observed is that people looking for salvation or self-immolation through drugs progress through a sequence of progressively harder drugs until they come to their senses or find what they seek, there is no “gateway” agency in some drugs that causes one to seek other drugs. The gateway drug narrative is not evidence-based.
No, they aren’t. To quote a 2004 University of Texas study, “Acetaminophen overdose is the leading cause for calls to Poison Control Centers (>100,000/year) and accounts for more than 56,000 emergency room visits, 2,600 hospitalizations, and an estimated 458 deaths due to acute liver failure each year. Data from the U.S. Acute Liver Failure Study Group registry of more than 700 patients with acute liver failure across the United States implicates acetaminophen poisoning in nearly 50% of all acute liver failure in this country.”
And don’t forget, when looking at such studies, that they typically aren’t tracking opioid analgesic deaths. They are generally only talking about over-the-counter and prescription Tylenol, because deaths caused by the acetaminophen in opioid painkillers are reported as opioid related, not acetaminophen related.
Aceteminophen is the killing agent in the opioid analgesics that currently account for 3 out of 4 prescription drug overdoses. At least, according to CDC. And our thoroughly corrupt US Food and Drug Administration knows this, but prefers not to act against corporate drug producers.
