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Doctors Are The 3rd Leading Cause of Death in the US, Causing 225,000 Deaths Every Year
This information was published in JAMA which is the most widely circulated medical periodical in the world.
The author of the article is Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and she describes how the US health care system may contribute to medical mistakes and poor health.
DEATHS PER YEAR:
This is a total of 225,000 deaths per year from a physician's activity, manner, or therapy.
Dr. Starfield reminds us to keep the following in mind when interpreting these numbers:
If the higher estimates are used, the deaths would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the 3rd leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are an overestimate, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).
Another analysis concluded that between 4% and 18% of patients experience negative effects in outpatient settings, with:
The high cost of the health care system seems to be tolerated under the assumption that better health results from more expensive care.
However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.
According to one study(2), an estimated 44,000 to 98,000 among them die each year as a result of medical errors.
This situation might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison,(3,4) the U. S. ranks an average of 12th (one up from the bottom) for 16 available health indicators. More specifically, the ranking of the United States on several indicators was:
The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the U. S. as 15th among 25 industrialized countries.
Lack of technology is certainly not a contributing factor to the United States 's low ranking.
Among 29 countries, the United States is 2nd only to Japan in the availability of computed tomography (CT) scanners and magnetic resonance imaging (MRI) units per million population. (17)
Japan, however, ranks highest on health whereas the United States ranks among the lowest.
Journal American Medical Association 2000 Jul 26;284(4):483-5
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1. Schuster M, McGlynn E, Brook R. How good is the quality of health
care in the United States?
2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
3. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.
4. World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. Accessed June 28, 2000.
5. Kunst A. Cross-national Comparisons of Socioeconomic Differences in Mortality. Rotterdam, the Netherlands: Erasmus University; 1997.
6. Law M, Wald N. Why heart disease mortality is low in France: the time lag explanation. BMJ. 1999;313:1471-1480.
7. Starfield B. Evaluating the State Children's Health Insurance Program:
8. Leape L.Unecessarsary surgery. Annu Rev Public Health. 1992;13:363-383.
9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.
10. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA. 1998;279:1200-1205.
11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.
12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. London, England: Routledge; 1996.
13. Evans R, Roos N. What is right about the Canadian health system? Milbank Q. 1999;77:393-399.
14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics1998. Pediatrics. 1999;104:1229-1246.
15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.
16. Donahoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596-1607.
18. Mold J, Stein H. The cascade effect in the clinical care of patients. N Engl J Med. 1986;314:512-514.
19. Shi L, Starfield B. Income inequality, primary care, and health indicators. J Fam Pract.1999;48:275-284.
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