Medical Error stats

Bradford Winters bwinters at JHMI.EDU
Thu Jul 7 15:23:11 UTC 2016


Any thoughts on the risk of ovarian cancer from talc? Another notable case that draws on the same issues.

Sent from my iPhone

On Jul 7, 2016, at 11:20 AM, Leonard Berlin <lberlin at LIVE.COM<mailto:lberlin at live.com>> wrote:

Dear Joe, Martine, et al.,
I am very familiar with the de Gonzalez article that was published six and one-half years ago, and has been refuted many times.  Permit me to quote from a Federal Court decision that,  although delivered 32 years ago, has never been challenged  since, and is just as true today:

"In matters of determining the cancer risk from low doses of radiation, scientists do not deal with what exists in fact;  rather, they deal with                                                                       theory, hypothesis, and assumption which cannot be used to establish legal cause....Law needs to be founded on                                                                        more than a theory or hypothesis."
                                                                                                                               Johnston v. United States, 597 Supp 374 (D Kansas 1984)

There is no evidence that radiation emanating from diagnostic radiologic procedures causes cancer.  Nevertheless, manufacturers have lowered the amount of ionizing radiation emanating from CT and other X-ray equipment, and the American College of Radiology and entire radiology community have been diligent in making efforts -- and continue to make efforts ---  in reducing  unnecessary radiologic procedures using equipment that emits ionizing radiation.

Here is link to an article authored by Cynthia McCollough, a Mayo Clinic nationally-known and highly-respected radiation physicist  that was just published this past month in the American Journal of Radiology <http://www.ajronline.org/doi/pdf/10.2214/AJR.15.15651>. Here’s the abstract:

June 2016, Volume 206, Number 6:  Medical Physics and Informatics: Opinion - The Role of the Medical Physicist in Managing Radiation Dose and Communicating Risk in CT; Cynthia H. Mccullough; Affiliation: Department of Radiology, Mayo Clinic, 200 First St SW, East-2 Mayo Bldg, Rochester, MN 55905.

Citation: American Journal of Roentgenology. 2016;206: 1241-1244. 10.2214/AJR.15.15651

ABSTRACT :OBJECTIVE. This article discusses the discrepancy between the public's perception of radiation risk and the actual risks from low doses of ionizing radiation. Resources from the medical physics community that can be used to manage dose levels in CT examinations are reviewed. An approach is described for presenting information aboutradiation risks and benefits to patients that supports dose management and acknowledges that risks from the low doses of radiation used in medical imaging either are too low to be reliably detected or do not exist.CONCLUSION. When asked by a patient or a patient's family about the risk of radiation, it is incumbent on each of us to remember the tenet of justification first and foremost: If the examination is needed, the benefit will outweigh any small or potentially nonexistent risk. The next responsibility is to image the patient with care by adjusting the delivered dose to the patient size and to the diagnostic task.

Leonard Berlin, MD, FACR, Skokie, IL; Professor of Radiology, Rush University, and University  of Illinois, Chicago


________________________________
Date: Wed, 6 Jul 2016 20:15:45 -0700
From: mge at MARTINEEHRENCLOU.COM<mailto:mge at martineehrenclou.com>
Subject: Re: [IMPROVEDX] Medical Error stats
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>

Joe,
Thank you for providing the study on cancer risks from CT scans.  In addition thank you for your eloquent response about the number of patient safety incidents and citing the number of reported deaths and their sources.  Don't think many will argue with the math.
Martine

Martine Ehrenclou, M.A
Thetakechargepatient.com<http://thetakechargepatient.com>
Martineehrenclou.com<http://martineehrenclou.com>
310-502-5244

On Jul 6, 2016, at 5:37 PM, Joe Graedon <jgraedon at GMAIL.COM<mailto:jgraedon at gmail.com>> wrote:

Dr. Berlin,

Your response reminds me a bit of the reaction we once heard from someone else:

“I wouldn’t believe it even if it were true.”

Here is the abstract referred to below. You may wish to argue with the authors. We are merely the messengers:

Arch Intern Med.<http://www.ncbi.nlm.nih.gov/pubmed/?term=berrington+de+gonzalez+projected+cancer+risks+computed+tomographic#> 2009 Dec 14;169(22):2071-7. doi: 10.1001/archinternmed.2009.440.
Projected cancer risks from computed tomographic scans performed in the United States in 2007.
Berrington de González A<http://www.ncbi.nlm.nih.gov/pubmed/?term=Berrington%20de%20Gonz%C3%A1lez%20A%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>1, Mahesh M<http://www.ncbi.nlm.nih.gov/pubmed/?term=Mahesh%20M%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>, Kim KP<http://www.ncbi.nlm.nih.gov/pubmed/?term=Kim%20KP%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>, Bhargavan M<http://www.ncbi.nlm.nih.gov/pubmed/?term=Bhargavan%20M%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>, Lewis R<http://www.ncbi.nlm.nih.gov/pubmed/?term=Lewis%20R%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>, Mettler F<http://www.ncbi.nlm.nih.gov/pubmed/?term=Mettler%20F%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>, Land C<http://www.ncbi.nlm.nih.gov/pubmed/?term=Land%20C%5bAuthor%5d&cauthor=true&cauthor_uid=20008689>.
Author information<http://www.ncbi.nlm.nih.gov/pubmed/?term=berrington+de+gonzalez+projected+cancer+risks+computed+tomographic#>
Abstract
BACKGROUND:
The use of computed tomographic (CT) scans in the United States (US) has increased more than 3-fold since 1993 to approximately 70 million scans annually. Despite the great medical benefits, there is concern about the potential radiation-related cancer risk. We conducted detailed estimates of the future cancer risks from current CT scan use in the US according to age, sex, and scan type.
METHODS:
Risk models based on the National Research Council's "Biological Effects of Ionizing Radiation" report and organ-specific radiation doses derived from a national survey were used to estimate age-specific cancer risks for each scan type. These models were combined with age- and sex-specific scan frequencies for the US in 2007 obtained from survey and insurance claims data. We estimated the mean number of radiation-related incident cancers with 95% uncertainty limits (UL) using Monte Carlo simulations.
RESULTS:
Overall, we estimated that approximately 29 000 (95% UL, 15 000-45 000) future cancers could be related to CT scans performed in the US in 2007. The largest contributions were from scans of the abdomen and pelvis (n = 14 000) (95% UL, 6900-25 000), chest (n = 4100) (95% UL, 1900-8100), and head (n = 4000) (95% UL, 1100-8700), as well as from chest CT angiography (n = 2700) (95% UL, 1300-5000). One-third of the projected cancers were due to scans performed at the ages of 35 to 54 years compared with 15% due to scans performed at ages younger than 18 years, and 66% were in females.
CONCLUSIONS:
These detailed estimates highlight several areas of CT scan use that make large contributions to the total cancer risk, including several scan types and age groups with a high frequency of use or scans involving relatively high doses, in which risk-reduction efforts may be warranted.


On Jul 6, 2016, at 2:57 PM, Leonard Berlin <lberlin at LIVE.COM<mailto:lberlin at LIVE.COM>> wrote:

I can't comment on the accuracy about any of the other following "stats," but I certainly can about the
 "Excessive radiation CT scans:  29,500 (JAMA Int. Med.)! "

 IT IS ABSOLUTE NONSENSE, based not  one iota on fact or data.  The figure  is pure, unadulterated hypothesis and "projection."
There has never been even one death supposedly due to radiation from a CT scan!

Lenny Berlin, MD FACR
Skokie, IL.



________________________________
Date: Wed, 6 Jul 2016 11:58:42 -0400
From: jgraedon at GMAIL.COM<mailto:jgraedon at GMAIL.COM>
Subject: Re: [IMPROVEDX] Medical Error stats
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

David,

We have been fascinated with the push back from the medical community. Shooting the messenger is a time-honored tradition. Admitting that there is a patient safety epidemic is a very hard thing to do.

There is another way to assess health care harm. If one considers data that has been collected from other sources this is what you discover:

DEATHS ANNUALLY:

Healthcare-associated infections: 75,000 (CDC data)

Adverse drug reactions:
>100,000 (FDA)

Misdiagnosis:
40,000 to 80,000 (Pronovost, et al)

C diff infections in nursing homes:
16,599 (CDC)

Excessive radiation CT scans:
29,500 (JAMA Int. Med.)

Unnecessary surgery:
12,000 (JAMA)

DVT/PE:
119,000 (Cleveland Clinic) mostly occur in healthcare settings

Surgical and post-op complications:
32,591 (JAMA)

There is some overlap, but when you consider most of these stats do not include the outpatient setting I would argue that Makary's estimate is low! Deaths from prescribed medications in the outpatient setting have been estimated to be as high as 200,000 but no one really tracks them.

Bottom line, how do we begin to fix a problem that remains out of sight (not on the CDC mortality stats) and out of mind?

Joe Graedon



On Jul 6, 2016, at 10:51 AM, David Katz <d.katz at MAIL.UTORONTO.CA<mailto:d.katz at mail.utoronto.ca>> wrote:


Martine,



I disagree with your point. Nobody on this forum disagrees about the importance of diagnostic errors, however, this paper was all about the numbers. If an article about statistics and numbers is published in a peer-reviewed scientific journal, like BMJ, then the numbers are extremely important.

I don’t disagree the issue is important regardless of the stats. As a physician I am mortified that one mistake could lead to a single patient death but the purpose of this paper was to comment on the stats and therefore they must be held to the rigorous expectations of a well-respected scientific journal.



David




From: martineehrenclou <mge at martineehrenclou.com<mailto:mge at martineehrenclou.com>>
Date: Wednesday, July 6, 2016 at 12:10 AM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>>, David Katz <d.katz at mail.utoronto.ca<mailto:d.katz at mail.utoronto.ca>>
Subject: Re: Medical Error stats



Worth the read but worth discarding as well.  Makery doesn't have to publish his own study to justify the number of medical errors that end in death.  It's certainly credible to cite other studies.

I don't doubt that certain clinicians need to doubt medical error as the third leading cause of death.  Even if it is the fifth, it's still too much.  There is no way to eradicate the damaging stats given workplace stress, short staffing, the unreliability of diagnosis, medication errors, and more.

All you have do is become a hospitalized patient yourself to realize the number of medical errors that occur every day.  Try becoming a caregiver for a patient with a serious illness or chronic medical condition, and you'll wake up to the number of diagnostic errors, medication errors, patient safety incidents in hospitals and ambulatory settings.  Until you've been there it's too easy to dismiss.



Martine Ehrenclou, M.A

Healthcare consultant

Freelance journalist

Award-winning author

310-502-5244

Martineehrenclou.com<http://martineehrenclou.com/>



On Jul 5, 2016, at 8:06 PM, David Katz <d.katz at MAIL.UTORONTO.CA<mailto:d.katz at mail.utoronto.ca>> wrote:

I am not sure if this has been circulated to the group yet but it is a rebuttal to the BMJ Paper that claims medical error is the 3rd leading cause of death.

Definitely worth a read.

http://www.bmj.com/content/353/bmj.i2139/rr-54



David Katz


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