medical errors

Medical errors are an under-reported cause of death. In an article about the newly published Bosatlas van veiligheid (English: Forest Atlas of Safety), the newspaper Trouw headlined about death risks: “Only the kitchen step-ladder is really dangerous.” The paper showed a graphic representation of the probability of death from different causes and stated that there is a big difference in attention given to the various causes of death. “There are ways of dying that simply have a greater social impact than others. Deaths caused by a major accident (probability: 1 in 17 million) reach the headlines faster than deaths caused by particulate matter (1 in 5900),” according to Trouw.

The strange thing is that the Bosatlas left out the biggest cause of death after illness: drugs and medical errors. According to Danish professor Peter Gøtzsche, every general practitioner causes at least one death a year due to the side effects of medication. And the investigative journalism program Reporter Radio reported medication errors as the number three cause of death in the Netherlands after cancer and cardiovascular disease.

What does this mean for you and the (potential) care you receive?

By C.F. van der Horst
2 December 2017, updated 1 November 2022

According to the Central Bureau of Statistics, the number of deaths caused by medical errors in the Netherlands is not very large: in 2021 it was 36 deaths. However, those figures are inadequate. For example, a European study published in 2014 in the British medical journal The Lancet showed that in 2009-2010 in the Netherlands, 1.5% of operations within 30 days had a fatal outcome (466 deaths). In 2013, RTLNews reported that it had a list of 1,000 medical misses. 300 of them were fatalities. So there seems to be quite a lot of cover-up. And there is no end in sight, as this news program reported in 2018 that at least 20 hospital deaths from medical errors occur every month. Figures on fatalities due to wrong medication, wrong combination of drugs or wrong dosage were not included, simply because they were not (made) known.

Comparable Western countries such as Canada and the US have more known data on mortality risks. This allows you to get an idea of what the situation in Europe is likely to be as well. Although there are differences in the structure of health care, treatment protocols and medications are largely similar.

Interesting figures on the cause of death in Canada were presented in 2004 by Ron Law, former director of the National Nutritional Foods Association. He compared various death risks to the probability of crashing during an airplane flight. The mortality risk from medical errors in hospitals and from adverse drug reactions was, along with that from smoking and cardiovascular disease, the greatest—and 1,000-10,000 times greater than the risk of crashing on a Boeing 747.

Ten years later, he did the same for both the United Kingdom and the entire European community and arrived at similar figures.

Professor Martin Makary of the renowned Johns Hopkins University in Baltimore in the US wrote that, based on known figures, medical errors not only account for nearly 10% of deaths in the US, ranking third as a cause of death, but also that these numbers, “which we have derived from the literature, are a are underestimates because the studies conducted did not include outpatient deaths or home deaths resulting from medical error [emphasis added].”

In other words, the figures are incomplete, and the number of medical errors as a cause of death must therefore be considerably greater than has been assumed to date. The situation in Europe will not be much different.

The high mortality risk that exists as a result of medication and medical errors makes the lack of any figures on this in the Bosatlas van veiligheid a major flaw.

Furthermore, Professor Makary overlooked a number of other issues, making the actual numbers even worse. He defined death due to medical errors as death due to:

An error in assessment, skill or coordination of care, such as those made during surgeries. In 2015, the TV program Zembla documented some of these calamities at Utrecht University Medical Center.
A diagnostic error
A system failure [of equipment] that results in death or a failure to save a patient from death
An avoidable side effect.

Professor Martin Makary: medical errors are cause of death number three.

In this enumeration, he forgot to mention some crucial aspects:

Every medication has side effects. They are the unwanted effects of a drug. If you look on any package insert, you will see that these exceed the desired effects in number many times over. Once you give medication you inevitably have side effects because they are the normal workings of the drug. At most, you can try to avoid the most harmful ones.
Many people receive long-term medication. There are no studies showing the safety and effectiveness of long-term medication use. Long-term drug use is a risk because drugs interfere with enzyme systems and therefore can cause symptoms on their own.
Polypharmacy, the simultaneous use of multiple medications (defined as more than five), is rampant. No one knows how the chemicals in the body counteract or reinforce each other. There are no scientific studies conclusive about this.

Both chronic medication and polypharmacy are actually a kind of Russian roulette. And in all likelihood, they are important and entirely underestimated factors in the risk of death from medical errors.

Take, for example, the side effects, the undesirable effects. It affects some people more than others, but these are the usual effects of medication. Side effects make long-term medication irresponsible in the vast majority of cases, as they can cause new and different symptoms with prolonged use. Yet our elderly in particular are prescribed medication that they must take for years. Both the prolonged use and the combination of different drugs are highly questionable. Observation shows that such a chemical cocktail of several drugs simultaneously can make them depressed—among other side effects. Terrible for themselves and their surroundings, but all too often a reason to prescribe yet another drug. Unless a physician is alert to this, the end is lost.

The number of elderly people receiving a cocktail of drugs is staggering. Research by the Dutch National Institute of Public Health and the Environment (RIVM) shows that “30-45 percent of people over 65, totaling between 750,000 and one million people, use five or more different medications daily. For nearly 20 percent of those over 75 (about 200,000 people), this number rises to more than nine.” It is almost unimaginable but some elderly people are even prescribed more drugs. This practice, unfortunately, is not unusual. To illustrate, an example is shown below. It is the medication list of a random 80-year-old man. Every day he had to take as many as 16 drugs! No one knows how these chemicals interact, reinforcing or counteracting each other. There are simply no studies on this. It is, however, well established that the drugs interfere with usual body processes. And each of them has side effects.

Medical errors: medication list with no less than 16 different drugs for an 80-year-old man.

The question is whether all of these drugs are really necessary. Of the approximately 2,000 drugs on the market, one pharmacist, when asked, knew of only one that truly cures: antibiotics. The rest are symptom-fighters or deferrals. Because doctors are given few tools in their training on how to treat causes, they are forced to employ what they did learn. In many cases, that comes down to prescribing these symptom and deferral drugs. This is largely due to treatment protocols. Doctors treat according to guidelines that are largely determined by the pharmaceutical industry and are therefore primarily medicinal in nature.

Along with this, medication is also prescribed because someone is statistically in a high-risk group. In other words, someone is not yet a patient, but there is a chance of a complaint, and so the doctor prescribes something, such as blood-thinning, blood pressure-lowering and cholesterol-lowering drugs, just to be on the safe side. The book Deadly Lies: How Doctors and Patients Are Deceived, explains how this prescribing behavior is influenced by a statistical model called the Number Needed to Treat (NNT). The NNT is defined as that number of people who need to be treated over a certain period of time to prevent one from getting a disease or to ensure that he is cured. For example, a drug may need to be dispensed to 100 people so that one of them can benefit from it. 99 of them thus take medication unnecessarily. Statins are a typical example. In only one in 100 people do these drugs lower cholesterol, while having serious side effects. Moreover, lowering cholesterol levels since decades has not been shown to have any impact on preventing cardiovascular disease. This is hardly surprising, since physiologist Ancel Keys’ underlying cholesterol hypothesis turned out to be manipulated. In Deadly Lies: How Doctors and Patients Are Deceived you can read in detail how this was done. Meanwhile, statins are among the best-selling drugs.

From the staggeringly high mortality rate due to medical errors and drugs, it may be clear that medical training is woefully inadequate.

Our doctors are benevolent and helpful people. However, their training focused them on disease and pharmacy. Instead, they should learn about health and how to maintain it naturally. Nutrition should be a major part of physician training, perhaps even the lion’s share.

“Let thy food be thy medicine and thy medicine be thy food,” the Greek physician Hippocrates is attributed to have once said. Whether he truly did or not, following this advice would reduce the mortality risk from medical treatment many times over. And wouldn’t our doctors also find much more satisfaction in the art of keeping people healthy?