patrick.net

This report follows other reports on pharmacy errors, and decades of reports finding that hospitals injure 20% of patients. These reports remind me of an article on what Google looks for when hiring people:

"The least important attribute they look for is “expertise.” Said Bock: “If you take somebody who has high cognitive ability, is innately curious, willing to learn and has emergent leadership skills, and you hire them as an H.R. person or finance person, and they have no content knowledge, and you compare them with someone who’s been doing just one thing and is a world expert, the expert will go: ‘I’ve seen this 100 times before; here’s what you do.’ ” Most of the time the nonexpert will come up with the same answer, added Bock, “because most of the time it’s not that hard.” Sure, once in a while they will mess it up, he said, but once in a while they’ll also come up with an answer that is totally new. And there is huge value in that."

In America, our system of mandatory subsidized insurance enforces dependence on official expertise. Our system operates as designed, maximizing power (including revenue) for the people and institutions that designed it. It is "winning" in the sense that it extracts more than twice the revenue of other countries' systems, while delivering less value. USA is #1 in costs, and the medical sector accounts for the largest share of the economy (20% of GDP and going higher thanks to Obamneycare), but how long can that continue to crowd out other sectors? What happens if we can't keep borrowing to pay for everything? And aside from the "medical misadventures" and resulting injuries and deaths, what are the broader consequences of infantilizing the population, conditioning them to learned helplessness?

And why, I must ask, do the Democrats fail to apply the logic of their pro-choice rhetoric to the subject of health? When saying "Get your laws off my body," why don't Democrats recognize that Obamneycare and the Byzantine legislation enthroning the medical-industrial complex is the most comprehensive set of laws swaddling everyone's bodies from cradle to grave? Justice Sandra Day O'Connor, a lifelong Republican, wrote that women had a right to choose abortion without "undue burden" from government; the White House argued before the Supreme Court that if any woman made that choice, she had chosen to participate in the commerce of healthcare and could be required, for her whole life, to submit to involuntary contracts with insurance corporations of the administration's choosing.

Call it Crazy says

I would think it's higher than 1 out of 20...

You're probably right. Hospital studies show an injury rate of 20%. Outpatient studies might under-report errors because most errors don't get detected or reported.

For me the larger issue is the mandatory dependence. If people want to make smart decisions about their own health, they may seek advice from knowledgeable sources, including doctors. But from around 1950 through 2010, we have seen government used as a tool to maximize revenue and dependence. Instead of seeking doctors' knowledgeable advice, patients actually lie to doctors to get permission to buy drugs they saw on TV, and shift the cost via insurance. It's the most lucrative system, but not the wisest or most healthful.

Maybe because "diagnosis" isn't as easy as people think it is. Symptom clusters and medical tests are all subject to interpretation to some extent. A lot of conditions are scarcely clear cut black and white as patients want or demand. The same "disease" can have different severity, consequences and manifestations from patient to patient.

Also, diagnosis, per se, tends to be far more sophisticated than therapeutic modalities, which tend to often be crude, non specific, or highly variable from patient to patient with less than predictable outcomes.

Biology is vastly complex, changeable, and much is still unknown or speculative. The same therapy that can have miraculous results in one patient can harm or sometimes kill another.

Big Pharma is clearly operating on the current assumption that the old fashioned way of capturing doctors and their scrip pen hands (i.e. pharmaceutical representatives offering free lunches, vacations, perks monogrammed pens and scrip pads etc.) is far less effective than mass direct advertising, which gets the patients to browbeat the doctors directly and bend them into submission.

This is how I consoled myself for all the years I was uninsured and had scant access to healthcare: Iatrogenisis trails only heart disease and cancer in causing death in America.
If you stay away from the fuckers they can't kill you!

Also interesting is this Mayo study from last year: http://www.advisory.com/daily-briefing/2013/07/26/mayo-clinic-146-common-practices-we-should-reconsider
"Of the 363 articles that tested a current medical practice:
40% concluded that the methods were ineffective, which the researchers referred to as "medical reversals";
38% reaffirmed the practice's value; and
22% were inconclusive."

62% of current medical practice is ineffective or inconclusive!

Of course there is also the issue of faked research……...
http://www.sciencedaily.com/releases/2010/11/101115210944.htm

Ceffer says

Maybe because "diagnosis" isn't as easy as people think it is. Symptom clusters and medical tests are all subject to interpretation to some extent. A lot of conditions are scarcely clear cut black and white as patients want or demand. The same "disease" can have different severity, consequences and manifestations from patient to patient.

That illustrates the flawed model we are using, and why (contrary to politicians' claims) interventions marketed as "preventative care" do not save money and are often injurious. Scientific study can tell you a lot based on the experience of other people, but ultimately nobody knows your health better than you do, and you must take ownership of it. In our revenue maximizing system, you are not even allowed to do that, and the reported science is badly distorted by PhRMA:

"Deadly Medicine

"Why Almost Everything You Hear About Medicine Is Wrong"

You might care personally about your own health, but the political ecosystem favors ever more complex power structures that are primarily concerned with their own survival and expansion. Scientists opine that wherever life exists in the universe, it must be Darwinian life, and that evolution favors complexity. We have created a political ecosystem in which the most complex lobbying coalitions (what FDR called "special interests") exert influence for their own purposes, to the detriment of individual persons. The model is predation: they can form a coalition to outnumber you, and overpower you, such that they can literally feed on your demise.

Going to doctors and hospitals is a form of calculated risk. You are taking the chance that going to where there is some kind of accumulated knowledge, discipline and experience is better than being at the random, tender mercies of unbridled Nature, which tends to solve such problems by just killing/crippling the weak or diseased at the end of variant periods of suffering, take your pick.

The idea that medical practice is supposed to offer canned, compeltely predictable, and invariant outcomes, or that every medical problem has a stock in trade, complete packaged solution, is just naive.

curious2 says

This figure amounts to 1 out of 20 adult patients

According to the US Census Bureau there are
1. 316,128,839 people in the U.S.
2. 23.5% are minors.
3. Leaving 241,838,562 adults.

12 million people represents 5% of all adults, not 5% of all adults seeking treatment unless 100% of adults seek treatment every single year. I guarantee you that is not correct. Most young people don't see a doctor for anything except getting access to the pill, and men don't do that.

So, what percentage of people are misdiagnosed? If the number is 12 million, it's a lot more than 5%.

Dan8267 says

Most young people don't see a doctor for anything except getting access to the pill, and men don't do that.

Ah, but now they're all required to prepay for an annual "free" appointment for "preventative care," which they've been told (falsely) will save money and it's marketed as their civic duty.
1) more appointments -> more revenue + more misdiagnoses
2) more misdiagnoses -> more appointments, return to step 1
rinse, repeat, endless loop

BTW, birth control pills and RU486 are so old now they're off patent, so they would cost pennies if ppl could buy them without prescriptions. That's why they're restricted to Rx and now subject to mandatory "preventative care" insurance, so new brand name reformulations can be advertised on Lifetime, and viewers/victims can shift the entire artificially inflated cost onto everyone else. Nevermind the reformulations are barely tested and might cause unknown side effects, PhRMA and the commercial media win, lobbyists and prescribers and pharmacists all get their cuts, and everyone else loses.

In any case, the math in the article is clearly wrong. If there are 12 million adults misdiagnosed, that's way more than 5% of adult patients. I'd guess it's more like 25%.

curious2 says

PhRMA and the commercial media win, lobbyists and prescribers and pharmacists all get their cuts, and everyone else loses.

The "free" market isn't free. It's rigged. That's why regulation is needed.

Dan8267 says

In any case, the math in the article is clearly wrong. If there are 12 million adults misdiagnosed, that's way more than 5% of adult patients. I'd guess it's more like 25%.

Their math might be better than you give them credit for. Most people are required to buy insurance via their employers. Even a simple thing like a flu vaccine requires at least one visit to a doctor. (With my Obamneycare insurance, I had to see at least two doctors before I got the required Rx for a flu vaccine, then a third location actually provided it, along with diagnostic tests I didn't want or need.) You assume most adults don't go to doctors, but that's based on your awareness that they don't really need to go; they are nevertheless required to go, or at least to prepay. You mentioned birth control pills, I would add vaccines, and of course they're told endlessly that they should go for "preventative" care or if they have any symptoms. I think most people go.

Dan8267 says

The "free" market isn't free. It's rigged. That's why regulation is needed.

The issue is, the regulatory and legislative processes have been captured by the revenue recipients, which is why the market is rigged. At least in the case of Obamneycare, more regulation from that same process, literally written by the same revenue recipients, compounds the problem rather than solving it.

curious2 says

In America, our system of mandatory subsidized insurance enforces dependence on official expertise.

Flawed supposition. People might be required to have insurance, but they aren't required to go to the doctor. Therefore, they aren't dependent on official expertise - they merely have access to official expertise.

People won't seek out professional opinions simply because they have access to insurance. They will, however, have access to healthcare should they choose to seek such a professional opinion.

Many people had no choice before the Affordable Healthcare Act was enacted; they had no access to treatment other than to go to the ER. They were treated & streeted asap so that the hospital didn't lose money - so they weren't part of the study.

I wonder how many of the uninsured who weren't admitted nor were tests run were misdiagnosed? Told that their needs weren't emergent and that they should follow up with their primary MD (even though they didn't have one, nor did they have access to one)?

The other day on Facebook some idiot posted the following: "Every drug that was recalled by the FDA was first proven to be safe and effective by the FDA."

Duh.

elliemae says

People might be required to have insurance, but they aren't required to go to the doctor.

They are required to prepay for the visit whether they go or not, and if they actually do need or want something (e.g. a vaccine) that requires an Rx then they are required to go for permission.

elliemae says

Many people had no choice before....

Now, nobody has a choice anymore.

elliemae says

I wonder how many of the uninsured who weren't admitted nor were tests run were misdiagnosed?

Fewer than the number of insured who were admitted and injured or killed as a result. Even the most ardent advocates of Obamneycare, who point to inflated numbers of people who supposedly died from lack of insurance, can't get anywhere near the numbers who die from nosocomial infections and malpractice. And, having Obamneycare insurance doesn't mean having access to the right doctors, or the right drugs, though it probably does enable access to teratogenic SSRIs.

curious2 says

They are required to prepay for the visit whether they go or not, and if they actually do need or want something (e.g. a vaccine) that requires an Rx then they are required to go for permission.

They don't prepay for the visit - many people have low or no cost insurance. And if they require something that needs an RX they do have to go for permission. But they've always had to do this. You do realize that, before "obamacare," medical practices required stuff like prescriptions and MD visits?

curious2 says

Now, nobody has a choice anymore.

People do have a choice as to whether they wish to seek treatment or not. They don't have to go, but they now have access.

curious2 says

And, having Obamneycare insurance doesn't mean having access to the right doctors, or the right drugs, though it probably does enable access to teratogenic SSRIs.

And, we're back to SSRI's? Before affordable healthcare many people had no access to healthcare. Now they have access - not sure how the reasonable person can gauge which is the "right" doctor...

Am I to deduce from your last statement that under the Affordable Healthcare Act they should have mandated that all doctors should be forced to see all patients and that all patients should have access to all drugs? That you believe that the ACA didn't go far enough?

Oh, the horror!

elliemae says

You do realize that, before "obamacare," medical practices required stuff like prescriptions and MD visits?

Yes, as I said above those problems began around 1950, but everyone wasn't required to buy into that system. And, you do realize that people elected Barack Obama to reform the old system, not aggravate it? People wanted something that would cost less.

elliemae says

many people have low or no cost insurance.

That isn't true in this country. They have terribly overpriced insurance, but many don't even realize the cost because it is either shifted onto their neighbors via subsidies or their own future via Medicaid recapture or both. In Mexico, where private insurance is not mandatory, many people have low cost insurance; not here.

elliemae says

Am I to deduce...they should have mandated....

No, definitely not.

elliemae says

That you believe

it went the wrong way.