None of that stopped Makary and Daniel from taking this one study of less than 1,000 hospital admissions and extrapolating it to 400,000 preventable deaths in hospitals per year. That is the peril from extrapolating from such small numbers.

    I also note that, like Classen et al, Landrigan et al made no effort to extrapolate their findings to the whole of the United States. That was not the purpose of their study. Rather, the purpose of their study was to ask whether rates of adverse events were declining in North Carolina hospitals from 2002 to 2007. None of that stopped Makary and Daniel from extrapolating from Landrigan’s data to close to 135,000 preventable deaths.

    So just from the fact that this is a study of Medicare recipients, who are much older than non-Medicare recipients, you know that this study is going to skew towards sicker patients and a higher rate of adverse events, even if the care they received was completely free from error. Still, that didn’t stop Makary and Daniels from including this study and estimating 251,000 potentially preventable hospital deaths per year.

    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. I do know that there might be a couple of hundred thousand possibly preventable deaths in hospitals, but that number might be much lower or higher depending on how you define “preventable.”


The real problem, from both "sides" of this debate, is that nobody looks at numbers, they look at the interpretations of the numbers to score their points. "Medical errors are the third most common cause of death in the United States" is one way to report these numbers. Another is "imperfect treatment more likely to kill you than COPD." Still a third is "as patients age, opportunity to fuck up their care increases." The last two aren't likely to make headlines. It's like the Oregon birth study: are you going to go with "planned home births drop c-section rate from 25% to 5%?" Maybe "planned home births increase risk of fetal death from one in a thousand to two in a thousand?" Or shall we go with the tried and true "home births twice as deadly as hospital births?"

It's funny to me that whatever your persuasion, you demand perfection from your opponent but argue semantics when the data makes you look bad. Compare and contrast: the Dutch decided to integrate both sides and the home birth rate dropped by a third while complications dropped by half.

But for some reason, in this country, we just can't go there.

posted by thundara: 1042 days ago