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Put your fears in perspective

I’m having a helluva Sunday.  My father-in-law’s in the hospital,  it’s 2 degrees out with a wind chill of 40 below, my clothes all smell like latkes, my daughter is having a melt-down, and I screwed up the .xml file for my podcast. The last part reminds me of something—science is hard, and when we step out of our areas of expertise, it’s easy to make some pretty silly mistakes.

If you don’t understand the basics of a subject, it’s easy to form conclusions that seem logical, but these same conclusions seem silly to those who have a deeper understanding of a subject.

With may damned podcast, I’m writing xml files based on templates—little thinking is involved.  I’m looking at other people’s code and inserting my own details, hoping it works.  If I actually understood the syntax of xml files, I could write a correct one based on a solid understanding of the specifics of the subject.

Medicine is one of those areas in which we all feel we should be experts.  After all, we all have a body, and we figure that our bodies follow a logic that we can plainly see—if you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? It all seems so logical.

Colons are full of poop. Poop is yucky. Therefore, cleaning out a colon is good.

Except that it’s not true. The human body is rather complex, and the study of the aggregate of all human bodies living together (e.g. public health) is more complex still.

Since the world of cult medicine hasn’t bothered to learn real science,  they often rest on what sounds “right”.  Like poop being yucky, this is often based on a sliver of fact that is horribly misused due to ignorance.

One of the more popular canards propagated by cult medicine leaders and their followers is that modern medical care kills.  Rather than exploring what the data are and what they mean in order to find a problem and correct it, they manufacture a problem out of whole cloth and come up with non sequitor solutions.


This little gem, for example, gets it wrong from the start:

As the use of pharmaceuticals drugs has become a leading cause of death in North America, patients want options. Naturopathic Doctors are the only regulated health professionals who study these medications for four years, write licensing examination upon them and whose scope of practice specifically focuses upon these.

First, the data do not point toward “pharmaceuticals drugs” (sic) as a leading cause of death.  The Institute of Medicine found that medical errors in aggregate are a serious problem.  And  Dr. Atwood very effectively debunked the claim that naturopaths have some special insight into pharmacology, refined or otherwise.

Joe Mercola and Gary Null have very long articles on their websites bemoaning the dangers of medicine versus the safety of their own brands of made-up medicine.  They love to make statements like, “It is now  evident that the American medical system is the leading cause of death and injury in the US.”

When cultists cite their terror statistics they leave out a few important facts.  There is no doubt that medical errors, and even medical therapy without errors, can harm.  No one would argue otherwise.  The flip side is, it also helps—a lot.

The document that has fed this conflagration of idiocy is a landmark study by the Institute of Medicine.  One of its findings was that somewhere between 44,000 and 98,000 deaths yearly in the U.S. may be due to medical errors. That’s a lot.  Of course, the lengthy report is somewhat more complex than a single statistic.  Before and after the IOM report, there has been a great deal of research into medical error.  I’ve written a bit about the topic, and the more I study it, the more complexity I see in the problem.  But it’s not an insurmountable complexity.  The question implied by the alties is, “if modern medicine kills so many, why bother with it at all?  Wouldn’t it be safer to do [insert absurdity here]?”

In a word, no.  No, no, NO!  A thousand times NO!

There is no guarantee that coffee enemas, St. John’s Wort, or reiki are any safer than real medicine (not the least because they may make one avoid real treatment).  There is also a huge ethical problem in using unproven and disproved treatments.

But there is a more important fact that should keep you from being scared away from real medicine.

Advances in the treatment of coronary artery disease, the number one killer of Americans,  reduced the number of deaths by over 340,000 in 2000 alone.  And that’s just one disease.

So, in one year, medical errors may cause a few tens of thousands of deaths (and these are preventable deaths), but real medicine, in one disease alone, saves an order of magnitude more.

Of course there are risks to modern medicine—it’s active treatment, not placebo, so it can be expected to hurt some people.   But it helps far more.  Reducing medical errors is important, and is an active field of research.  As we improve our error rates, we can increase the lives saved by modern medicine by thousands per year. (It is impossible to prevent all deaths due to errors.  It’s just statistically unlikely.  Also, if you fail to treat someone for fear of error, that’s an error too.) Abandoning modern medicine out of fear will not save us from ourselves, it will deny us the chance to increase the benefits we are already getting from science-based medicine.  The solution to medical errors isn’t voodoo, it’s science.  Anyone who tells you different is trying to sell you something.

Posted in: Science and Medicine

Leave a Comment (27) ↓

27 thoughts on “Put your fears in perspective

  1. Karl Withakay says:

    If medical ERRORS are the problem, wouldn’t it seem obvious that the goal should be to reduce the number or errors since the problem would be errors in the practice of medicine, not correctly practiced medicine?

    It’s a false dichotomy to say there are problems with A, or that A is not perfect, therefore B must be better. You need to show me that B is both safer AND equally or more effective.

    Isn’t one of the fundamental basis’s for any medical intervention something to the effect, “Does it do more benefit than harm, and is this balance between benefit and harm better than any alternative intervention?” ?

  2. Dr Benway says:

    Scariest thing I’ve seen in a while was this:

    N Engl J Med. 1982 Aug 5;307(6):339-42.Links An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic.

    Ewww. I mean, ewww! So disgusting on so many levels.

    Remind me never to shake hands with a chiropracter.

  3. Peter Lipson says:

    Actually, we in the medical community have had our troubles too (http://articles.latimes.com/2003/feb/13/local/me-colon13), but that was do to poor practices rather than useless practices.

  4. pec says:

    No, we should not abandon mainstream medicine, but we should not have blind faith in the experts either.

    There is a problem with your XML file analogy, because computer science and medical science involve very different kinds of expertise. Although computer systems are very complicated, they are created by humans and therefore can in principle be completely understood. Biological systems, on the other hand, are poorly understood, even by the most knowledgeable experts.

    The public has noticed that mainstream medical treatments tend to be reductionist and often focus on symptoms or neglect to seek the causes of disease. They know that treatments may be toxic and sometimes create more health problems than they solve. People know that mainstream medicine often fails, so it often makes sense to look for alternatives.

    If you need your computer system fixed, you can find someone with the expertise to fix it. Maybe it won’t be easy, but it is practically certain that it can be done.

    In fields like medicine, economics, psychology, sociology, etc., being an expert doesn’t prevent you from being extremely ignorant. You’re just a bit less ignorant than the non-experts. And we have good reasons not to trust you.

  5. khan says:

    I think we all want to feel that we are in control, that crap doesn’t occur at random, that we can prevent & cure bad stuff.

    We can have a bit of influence on the occurrence of crap, but much of it is random or hereditary.

    It doesn’t matter how many chickens I sacrifice, I will still have hereditary arthritis.

  6. oderb says:

    You cited Null and Mercola as cultists. What you didn’t discuss were their estimates of medically related deaths. Mercola cites a JAMA article estimating deaths at 250,000 and Null in a detailed analysis
    http://www.healthe-livingnews.com/articles/death_by_medicine_part_1.html

    estimates a number north of 750,000 annually. Add in uncounted morbidity, human suffering and cost and it’s not a pretty picture.

    I would appreciate if someone could provide links to detailed rebuttals of either or both of these ‘cultist’ studies.

    In the absence of a resounding refutation it seems that this blog is a massive waste of energy bemoaning CAM while hundreds of thousands DIE due to conventional medicine.

  7. teeps29 says:

    More comedy from pec, who seems to try to restate the cultists’ view in more palatable terms, no matter what kind of woo we’re talking about.

    pec is the gateway drug for woo.

  8. HCN says:

    Dr. Lipson, this is a kind of related question that I think can be addressed here in a bit more depth. Over in Dr. Novella’s blog, someone is claiming that medical errors are a leading cause of death (see http://www.theness.com/neurologicablog/?p=441, comments starting on Dec. 22nd).

    The reference this person is claiming is a commentary by a Dr. Barbara Starfield written in 2000 (see http://drug-education.info/documents/iatrogenic.pdf ). Doing a simple Google search shows this commentary turning up all all sorts of anti-real-medicine websites.

    Doing a simple Google search on Dr. Starfield shows that she herself still claims that medical errors are a third leading cause of death, in a commentary. One recent one in bostonreview.net/BR30.6/starfield.html (sorry about munging the URL, I don’t know the limit) has her saying “An estimated one third of interventions (surgical and medical) are unnecessary. Although the medical literature does not dwell on the damage caused by inappropriate care, several studies have shown that the third leading cause of death in the United States, after heart disease and cancer, is medical intervention, including both tests and therapies.”

    Is she right, or has she gone from respected researcher to going over the edge with this one issue?

  9. Jules says:

    I always wonder about the numbers. I mean, it’s pretty easy to tally up pathology reports that say, “Patient X died of medical errors”, but someone who doesn’t die now will still have the disease and will probably die of it later. So what’s it really mean when you say that 340,000 people have been saved? Did 500,000 people have an acute event and you saved 340,000 this year? If the number were 3 million rather than 500,000 who had an acute event, does 340,000 still mean the same thing?

    Philosophy aside, while I agree that modern medical practice is a lifesaver, I still maintain that the longer you can stay out of a hospital, the better–MRSA and all those other fun bugs…not good for the heart and soul, literally.

  10. HCN says:

    oderb, the most recent JAMA report (or is it a commentary) referenced in your link was ten years old. Do you live in a cave? Have you not heard that certain reasons for death have decreased, and that for those under age 45 accidents and adverse events are the major killers, that in none of the statistics do they go to three quarters of a million deaths?

    See http://www.disastercenter.com/cdc/ … show me where on those tables that ANY cause of death adds up to 750000 for anyone under age 65 (by the way the deaths from heart disease for those over 65 is over 600000).

  11. HCN says:

    oops, realized the Disaster center data are 12 years old… oh, well — it fits into derailing the old stuff used in the other dire death from medicine papers.

  12. DLC says:

    Okay, let’s assume that the higher figure of 98,000 is correct, and that number of people die every year due to medical mistakes.
    How many people are treated overall in the United States ?
    As in, how many enter hospitals ill or seriously injured, are treated and later released in a condition better than they arrived in ?
    How many is it ? 15 million ? 20 ? I have no data, but I have to assume it’s a fairly large number.
    so, 100,000 (rounding up the higher number) die due to mistakes, out of 15 million who do not ?
    a little basic math shows that this is an error rate of around 6/10 of one percent. While I abhor any preventable deaths, aren’t these people making a mountain out of a molehill ?
    And aren’t you much more likely to survive conventional medical treatment than quack nostrums and con-man cures ?
    I think so.

  13. weing says:

    Personally, I put very little trust into the IOM statistics. They appear to have a hidden agenda of looking to compare the US unfavorably to other countries in order to get money for their pet projects. Are bedsores really iatrogenic? Depends how you look at it. If the patient died from the stroke, he/she may never have developed bedsores. Since medicine was inadequate to prevent or reverse the stroke, he/she developed a bedsore and died from it’s complications. Now if the patient received acupuncture or colon cleansing for the stroke, the bedsores would probably never occur.

  14. thecardiffgiant says:

    erratum: At the end of paragraph 8 read ‘non sequitur’.

  15. urology-resident says:

    This is the cultist reasoning:

    100 patients with an obstructive infected kidney stone

    They all have surgery.

    1-5 may die from the procedure/anesthesia

    Surgery= you die

    These 100 patients with an obstructive infected stone, eating “healthy diet, and exercising” would most likely all 100% die.

  16. pmoran says:

    Sometimes conventional medicine has to take its lumps and this is one of those times. We must do all we can to eliminate medical mistakes and minimize adverse reactions to treatments, exaggerated as these often are by those wanting to advance other agendae.

    Nevertheless the implication that “alternative” medicine could deal with the same spectrum of illness more safely is utterly ridiculous.

    Chiropractors, TCM practitioners, naturopaths etc. may seem safer to some but that is because they are selected by the public for less serious problems and because they can themselves select what to treat and what level of responsibility to take for outcomes. Their patients only die if they do something mind-bogglingly stupid like persuading type l diabetics to stop their insulin or overdosing an autistic child with intravenous chelating agents.

    So when a patient dies it is always the doctors’ fault. The “alternative” practitioner was doing his very best to get the “innate” flowing, the meridians balanced, or the nutrition fine tuned but the blessed doctors kept getting in the way with “reductionist” diagnoses like cancer and blocked arteries. .

    This polemic serves a special role for the Nulls and the Mercolas because for them medicine is something that everyone does, or should do. Health is actively achieved, not a passive state. There is not much money or Oprah time to be made out of alternative medicine unless essentially well people can be induced to buy the products, books and lifestyles.

    This is in contrast to conventional medicine. which sees preventive medicine as mainly the province of Public Health and Education and, with a few clearly defined exceptions, the role of doctors as treating people when they are sick.

    This is why conventional medicine has to be portrayed as a threat to everyone. Doctors are pulling people off the street to give them bedsores.

  17. oderb says:

    HCN, (and others)

    I’ve come out of my cave to ask you a couple of simple questions.

    Which of the 163 references that Null and his colleagues cite have been superceded by studies that show lower incidences of iatrogenic deaths? (And by the way many of the cited studies are from 2002 and 2003)

    Alternatively which of the 8 categories of medical intervention that comprise his estimate of 783,000 deaths annually do you disagree with and why?

    In other words some evidence please…..and you’ll have to do better than the irrelevant link you presented…..

  18. pmoran says:

    I have allowed that there is a problem that needs constant attention, and that IS getting constant attention, at least in my area.

    But surely you yourself have reservations about a quarter of supposedly medically caused deaths being attributed to malnutrition and bedsores! These may get a mention on death certificates, but do you seriously believe that these are PRIMARY causes of “death as the result of medical treatment”?

    In the case of bedsores, the quality of nursing care is the dominant factor in causation and that is mainly determined by levels of funding for staff and for complex pneumatic beds for those at risk.

    The accompanying text makes it clear that malnutrition is a problem specific to nursing homes for the aged, and that again is mainly related to level and quality of nursing staff. Much is unavoidable. I have personal experience of trying to get an adequate diet into two aged relatives, even when intensely spoon-fed by their own family. I can assure you nothing short of intravenous feeding would succeed. I am sure some nursing homes could do better, but the issues are specific to that context, just as the extent to which some kinds of investigation or surgery are unnecessary and adverse drug reactions are preventable needs its own analysis.

  19. The Blind Watchmaker says:

    OK, the prospect of medical errors makes medicine too dangerous.

    Let’s see what happens. Starting tomorrow, everyone stop your blood pressure medicines, antiarrhythmics, diabetes medicine, asthma inhalers, chemotherapy drugs, thyroid medicines, anti-psychotics and any other dangerous substances you might be on.

    Everyone boarded for surgery tomorrow, skip it. Sign out against medical advice.

    Get all of your sick loved one’s off of their ventilators and tube feedings.

    Spinal manipulations, vitamins, herbs, ancient Chinese needles, and magic water for everyone!! Yeah.

    No, wait….DON’T. Just kidding.

    What would the death rate be in 2009 if everyone did this?

  20. The Blind Watchmaker says:

    BTW, what podcast?

  21. HCN says:

    oderb, I don’t care how many references Null uses. He is not a good source of information. So I would ignore anything he writes. period

    Or as Orac puts it (http://scienceblogs.com/insolence/2008/10/the_huffington_post_adds_another_antivac.php): “Word to the organizers of this rally: If you really want to have just a little bit of credibility when you claim that your rally is not “antivaccine,” don’t–I repeat, don’t–invite HIV/AIDS denialist, coffee enema advocate, supporter of cancer quackery, and antivaccinationist Gary Null to give a speech. It doesn’t exactly enhance your credibility.”

    Blind Watchmaker, this podcast:
    http://scienceblogs.com/denialism/2008/12/podcast_update.php

  22. Harriet Hall says:

    I wrote about this last June: Death by Medicine – http://www.sciencebasedmedicine.org/?p=136

    Whatever the numbers, it is illogical to look at the number harmed without simultaneously looking at the number helped.

  23. Peter Lipson says:

    Thanks, HH. When you aren’t the primary writer in a blog, it’s easy to forget what has and hasn’t been done!

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