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Medical Errors in Perspective

Medical error rates have been exaggerated by a popular myth and should not be used to spread fear, uncertainty and doubt

Paul Ingraham • 8m read

Medical errors are not the “third leading cause of death” in the US, despite the 2016 headlines that have now solidified into a popular myth, like excrement fossilizing. Is medicine dangerous? Bad things definitely happen in hospitals, and some of them are indeed preventable, and that’s tragic — no one disputes that. Medicine has many problems.

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 came from a sloppy estimate published in the British Medical Journal in 2016.1 This myth has a specific origin story: a sloppy estimate published in the British Medical Journal in 2016 (see Makary). 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.23

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 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 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 deep 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 about4). 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.

Think about how many TV medical dramas there are. Now, how many of them feature chiropractors? Naturopaths? Why? Because they don’t routinely deal with serious health care issues.

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

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

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:

See also …

What’s new in this article?

Aug 31, 2021 — Added a new intro with more information and citations about the claim that medicine is the “third leading cause of death in America.” (It’s not.)

2016 — Clarified a key point and added a couple links.

2012 — Publication.

Notes

  1. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 05;353:i2139. PubMed #27143499 ❐
  2. www.mcgill.ca [Internet]. Jarry J. Medical Error Is Not the Third Leading Cause of Death; 2021 August 31 [cited 21 Aug 31].

    “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.”

  3. 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].

    “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.”

  4. 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.

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