The No. 3 killer in the United States may have been lurking unknown right before our very eyes, all thanks to the way we gather — or rather, don't gather — data.
That's the argument made by a new study out of Johns Hopkins University, which suggests that medical errors are the third leading cause of death in the country after heart disease (No. 1) and cancer (No. 2).
The study, published today in the general medicine journal The BMJ, argues that medical error should be counted as responsible for nearly one in 10 hospital deaths in the United States. According to the authors of the paper, the way the U.S. Centers for Disease Control and Prevention tracks deaths in the U.S., and the way the hospitals classify and report them, doesn't reflect the full scope of reality.
"Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics," says Dr. Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine and an authority on health reform, in a press release accompanying the study's publication.
While the phrase "medical error" may conjure thoughts of misdiagnoses, wrong prescriptions, malpractice or even a surgeon's ill-timed sneeze, the study makes clear "bad doctoring" isn't to blame and lawsuits aren't the solution. Rather, the authors define medical error more broadly, using the term to describe systemic problems: variation between treatments, a complicated accountability system and "poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets."
According to the CDC, 2,596,993 people died in the United States in 2013, the most recent year with available data. Of that number, 611,105 people (23.5 percent) died of heart disease, while 584,881 died of cancer (22.5 percent) and 149,205 (5.7 percent) died of chronic respiratory disease, the No. 3 killer.
Makary and his team analyzed four separate studies of medical death rate data spanning 2000-2008. Based on that data, they extrapolated that of the total 35.4 million hospitalizations in 2013, 251,454 deaths (9.5 percent) were the result of a medical error, which would place the cause between cancer and respiratory disease.
How could something like this go unaccounted for?
The U.S. adopted an international form to tally deaths in 1949, using International Classification of Diseases codes. But as those codes are often linked to billing and insurance, they did not include a way to account for medical error, argues Makary.
"The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used," says Makary. "At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone's death, and because of that, medical errors were unintentionally excluded from national health statistics."
Why does it matter whether we know exactly why people die? Much like knowing if medieval invaders will bring catapults or tunnel diggers influence how you defend your castle, knowing what kills us influences both research funding and public policy. Makary believes the problem of medical error gets neither the funding nor the attention it deserves.