Medical Errors: Leading Cause of Death or Urban Legend?

Originally Published MDDI November 2001

Medical errors do happen, but exaggerating the scope of the problem will impede efforts to address serious threats to the healthcare system.

Thanks in part to the prevalence of e-mail and spam, we've all encountered urban legends. Whether it's that Nigerian official who needs to store $100 million in your bank account for a few days or a friend who passes on a warning about an imminent postal-service plan to tax e-mail, there is no dearth of people ready and willing to propagate unlikely myths.

Somehow, despite their implausibility, these urban legends are passed around as truths by people too shocked to raise questions. In most cases, the implications are relatively harmless. But sometimes, the failure to critically examine assertions presented as facts can have serious consequences.

One pertinent example for the medical device industry is the widely quoted statistic that medical error kills 100,000 people every year. Based on a report by the Institute of Medicine (IOM) released in 1999—which actually cited estimates of between 44,000 and 98,000 deaths a year caused by medical errors—this claim received extensive coverage in the news media.

Much less attention was paid to a subsequent article, published in the Journal of the American Medical Association (JAMA) last July 25, which called into question the conclusions of the IOM report. According to authors Rodney Hayward and Timothy Hofer, the results of their study suggest that "these statistics are probably unreliable and have substantially different implications than have been implied in the media." Hayward has suggested that the number of deaths due to error is probably closer to between 5000 and 15,000 annually.

The core argument of the JAMA article was not to reject absolutely the IOM estimate. Rather, it was to caution against accepting it as a factual statistic. As the authors found, opinions among the doctors reviewing the records that were examined varied considerably about whether a particular error led to a death, and even on whether an event was in fact an error. Moreover, previous studies had not considered whether the patient would have died regardless of the error.

Unfortunately, the JAMA article appears to have had little moderating effect on the holding power of the IOM figure. The 100,000 number shows signs of having become another urban legend. More than a month after the JAMA article was published, for instance, a full-page ad published in The Wall Street Journal referred to the original estimate. "Medical error," said the ad, "ranks with cancer and highway accidents as a major killer in the United States."

This may be good ad copy, but it's misleading rhetoric. To take up this debatable estimate as accepted fact is to misidentify the enemy. Yes, medical error is a problem. But if society exaggerates its scope, precious resources may be diverted away from other serious threats to the healthcare system.

Obviously, medical errors do happen, and medical device malfunctions are sometimes contributing factors to such terrible mistakes. To the extent that the delivery of healthcare has been improved by the publicity over medical errors, it has been a good thing. But if too much emphasis is put on errors, it will end up hampering the efforts of the healthcare system and medical device companies to implement further improvements.

The healthcare system is far from perfect, but it is hardly a threat comparable to cancer. Let's not try to fix what isn't broken.

The Editors

Copyright ©2001 Medical Device & Diagnostic Industry