Medical Errors in Perspective

This is not a statue of a “facepalm”: it’s a depiction of “Cain After Killing His Brother Abel,” by Henri Vidal, found in the Tuileries Garden in Paris. In this framing, however, it is perfectly suited to the more modern intepretation!

Medical errors are not the “third leading cause of death” in the US, despite the 2016 headlines that solidified into a popular myth, like excrement fossilizing. Is medicine dangerous? Bad things do happen in hospitals, and some of them are preventable, and that’s tragic — no one disputes that. Medicine has many problems. Big Pharma is legendary for its corruption,1 even among skeptics (though “Big Suppla” is plenty bad as well).2 As a general rule, doctors do too much, and some medical minimalism would be a huge upgrade.3 Much of what is considered good modern mainstream pain treatments and injury rehab options is actually closer to quackery than evidence-based medicine.4

Many problems indeed.

But is medicine almost as deadly as cancer and heart disease? 🤣 Not even close!

The cringe-inducing idea that medicine is nearly as deadly as cancer and heart disease has a specific origin story: a sloppy estimate published in the British Medical Journal in 2016.5 It was not a “study” — it was an editorial, a dubious “analysis,” an expert opinion piece so deeply flawed that it cannot be taken seriously.67

Oy, that horrendous headline! It was catnip for anyone with an axe to grind about “mainstream medicine.” It has been gleefully repeated by countless chiropractors, naturopaths, acupuncturists, and anti-vaxxers ever since. It’s a textbook case of fear-mongering enabled by a single sensationalistic headline, and an impressive self-inflicted wound: a major medical journal handed this win to the ideological enemies of scientific medicine on a silver platter, a dangerous blow. What better time to fan the flames of fear, uncertainty, and doubt about medicine, with a major global pandemic just around the next bend of history? Oops!

The alleged dangerousness of mainstream medicine is pure FUD

I saw the acronym “FUD” many times before I finally paused to look it up: it means “fear, uncertainty, and doubt,” which are often bundled together in marketing, public relations, and politics for the purposes of herding people away from something “scary” … and towards an alternative product or idea. Make them afraid … and then sell them a solution, either literally or figuratively. FUD is mostly disingenuous and has the stink of propaganda and extreme vested interest.

The idea of FUD explains a lot. Once I knew what it was, I started seeing it everywhere. FUD about “toxins” is a great example. Unfortunately, it’s extremely common for alternative medicine to spread FUD about their competition — physicians practicing “mainstream” or “allopathic” medicine.

Is medicine dangerous? Is alternative medicine safer?

Alternative medicine practitioners often point angrily and accusingly to medical error rates, these days almost always repeating the “3rd leading cause of death” nonsense (mostly without even knowing about the Makary piece, let alone its flaws). Regardless, they say that chiropractic, naturopathy and other alternative care is much safer than medicine. It’s probably true … in the sense that walking is much safer than driving, but also doesn’t get you as far. If you routinely had to treat huge numbers of people with life-threatening injuries and dire illness, your profession would have scary error rates, too — guaranteed.

Medicine is dangerous mainly because being in serious medical trouble is dangerous.

There is no question that bad things happen in hospitals, and legitimate stats about iatrogenic (doctor-generated) medical errors can be alarming. In particular, many surgeries are probably pointless as well as dangerous (especially orthopedic surgeries, as I have often written about8). However, to simply state that medicine kills and hurts people is unethical, dangerous, misleading fear-mongering. Cars kill and hurt people too, and for pretty much the same reason: sure, it’s risky, but the benefits are apparently worth the risk, because almost everyone alive is willing to take their chances.

Medical systems deal with vastly greater numbers of much more serious cases than any chiropractor or naturopath, and many of them are no-win, rarely-win, or sometimes-lose situations with the highest stakes, terrible suffering, and death. We should be careful criticizing that from the outside.

Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters!

None of this means there aren’t serious systemic and institutional problems that need solving — there definitely are — but it’s all because good health care is just inherently extremely challenging. People who point and blame and sneer without any sympathy for or first-hand knowledge of those challenges are not helping.

A personal example

Sneering at “Western” medicine really pisses me off, because the people who do it also often concede that, of course, you need a doctor when you’re badly injured or really sick. But then they carry right on insulting doctors — apparently oblivious to the fact that they’re still talking about the same professionals, who are apparently only worthy of respect when they are stitching you up. The rest of the time they are close-minded fools, apparently.

That hypocrisy is just awful.

This issue means a great deal more to me after my wife’s survival of a terrible vehicle accident in 2010. With a major head injury and a badly crushed vertebra, she easily could have died or been paralyzed. There was nothing even remotely “safe” about fixing her. Big, complex, fallible human institutions are the only way to create the kind of care that saved her spine and probably her life.

She started out spending 48 hours in the basement of a shabby, overwhelmed hospital in Vientiane, Laos. It was terrible, and her life hung in the balance, but it was better than nothing. Laos is poor and the hopistal didn’t have enough of anything, but they still stopped the bleeding and stabilized her spine. Then it was into an ambulance, across the border, and into a private Thai hospital that was clean and modern — where whole teams of earnest people got to work on her while I flew across the Pacific Ocean. She was one of the most injured people in that hospital. We watched patient after patient leave before she did. Even after a month of recovery, flying her home required a medical escort with a $20,000 bill.

Alternative medicine has nothing to offer that can even begin to compete with that.

Was the care perfect? Was “the system“ flawless? Was it risk-free? Good grief, of course not! But it was pretty dang good, and those doctors and nurses — from the poor hospital in Laos, to the Canadian surgeon who removed her titanium fixtures in Vancouver two years later — deserve far better than to be sneered at by alternative practitioners who have never once held someone’s life in their hands … let alone daily.

About Paul Ingraham

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:

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See also …

• Are medical errors really the third most common cause of death in the U.S.?
• Medical Error Is Not the Third Leading Cause of Death — An alarming statistic shared by countless people is based on a highly problematic bit of data extrapolation and has been used to paint all of medicine as untrustworthy.
• “Quack Word #20: ‘Iatrogenic’,” Andy Lewis, Quackometer.net.
• Alternative Medicine’s Choice: What should alternative medicine be the alternative to? The alternative to cold and impersonal medicine? Or the alternative to science and reason?
• Death By Medicine
• How Many Die From Medical Mistakes In U.S. Hospitals?

Notes

1. Goldacre B. Bad pharma: how drug companies mislead doctors and harm patients. 1st American ed. Faber and Faber; 2013.

   British science journalist Ben Goldacre is fascinating and awesome. Read this book, or at least watch this TED talk about it. [munches popcorn]

2. Many nutritional supplements, vitamins, and minerals, are taken like drugs as a treatment for aches and pains (e.g. glucosamine, curcumin, protein, vitamin D). Most are considered either anti-inflammatory or a healing stimulant. The science is either negative or barely there, and contamination of these unregulated substances is common. Despite a few rays of hope, not a single one that is clearly useful for pain. For more information, see Vitamins, Minerals & Supplements for Pain & Healing: Critical analysis of most popular “nutraceuticals” — food-like pseudo-medicines taken for medicinal purposes, especially glucosamine and creatine, mostly as they relate to pain, arthritis, and recovery from exercise and injury.
3. Roberts, Russ. Jacob Stegenga on Medical Nihilism. EconTalk. April 1, 2019.

   How good is modern medicine? Almost everyone loves to hate it, but routinely for the wrong reasons. We are used to hearing criticism of medicine mostly from cranks and quacks, and about 90% of it is just in service of selling their bullshit “alternatives.”

   I’d like to recommend this extremely skeptical, high-quality take on the state of art and science of medicine, from the podcast EconTalk, interviewing Jacob Stegenga. Stegenga is harsh but absolutely fair. He gives credit to medicine where due (and it certainly gets some), but only where due.

   This is the kind of criticism medicine actually needs.

   There's a book. See a short British Medical Journal editorial on the topic. But listening to Stegenga talk about it himself is well worth yours while.

4. Not all quackery is obvious — not even to skeptics. Many forms pass as mainstream. Pseudo-quackery is unusually rampant in physical therapy. Because it hides right in the mainstream, it may do much more harm than more overt quackery, which is marginalized and relatively rare. For more information, see Pseudo-Quackery in Physical Therapy: The large, dangerous grey zone between evidence-based care and overt quackery in rehab and pain treatments.
5. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 05;353:i2139. PubMed 27143499 ❐
6. www.mcgill.ca [Internet]. Jarry J. Medical Error Is Not the Third Leading Cause of Death; 2021 August 31 [cited 21 Aug 31]. PainSci Bibliography 52126 ❐

   “This ranking is an exaggeration that was arrived at by combining a small number of studies done in populations that were not meant to be representative of the entire U.S. population and that were not designed to prove a link between a medical error and death.”

7. Sciencebasedmedicine.org [Internet]. Gorski D. Are medical errors really the third most common cause of death in the U.S.?; 2021 August 31 [cited 21 Aug 31]. PainSci Bibliography 52127 ❐

   “How many deaths in the US are due to medical errors? The answer is: I don’t know! And neither do Makary and Daniels—or anyone else for sure. … It’s just not anywhere near plausible that one-third to over one-half of all inpatient deaths in the US are due to medical error. It just isn’t.”

8. Harris I. Surgery: The ultimate placebo. NewSouth Publishing; 2016.

   What if a fake surgery had the same effect as a real one, because the “active ingredient” in surgery is just the dramatic ritual? What if surgery delivers a huge placebo effect?

   This often appears to be case, as shown in a few well-known examples. Most surgeries have still never been subjected to the gold standard of evidence-based medicine, the randomized controlled trial. Instead, they are based mainly on tradition, authority, and the “common sense” of surgeons, who have been slow to embrace the need to subject their methods to trials, citing a list of typical reasons — none of which stand up to scrutiny, and sound more like turf-defending excuses every year.

   In this superb book, orthopedic surgeon Dr. Ian Harris explores the shameful history of untested surgeries in detail. It’s fascinating, and mostly easy enough reading even for patients. There’s a free excerpt from the book that you can read to get started.

   Many scientific papers before and since publication of the book have supported Harris’ position.