A few days ago, I have seen a meme on Facebok:

_{Source It entered public domain via countless platforms, all clean}

Let's start from the bottom, Rifles

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Actually, this is true, According to FBI Data 1, 2, from about 13,000 - 15,000 homicides, about 300 were committed by using the rifle.

Knives were used 5 times more frequently to commit homicide.
Own fists, hands, and feet are responsible for about 600 homicides per year (x2 comparing to rifles).
And even blunt objects were used more frequently in homicide than rifles.

So, why am I complaining?

Right, the hospital errors and drugs kill people!

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Let's do the fast check, the total number of deaths in the USA is 2,626,418 per year 3

And the leading causes of death are (*I'm quoting from [3]):

Heart disease: 633,842
Cancer: 595,930
Chronic lower respiratory diseases: 155,041
Accidents (unintentional injuries): 146,571
Stroke (cerebrovascular diseases): 140,323
Alzheimer’s disease: 110,561
Diabetes: 79,535
Influenza and Pneumonia: 57,062
Nephritis, nephrotic syndrome and nephrosis: 49,959
Intentional self-harm (suicide): 44,193

Some quick math, just from the head...
~2.000.000

And half of all the rest 600.000 cases of death are caused by Medical Errors?!

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How...

Let's Check the Internet...

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Go to Google, type: the third leading cause of death in the US

Wooow!!! 38,300,000 hits?!

_{I have no idea how this girl is related to anything but there are not that many photos of doctors in public domain. And they are all smiling for no good reason. Maybe they sniffed some anesthesia...}

But this was actually published, in the Scientific journal

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And not just any scientific journal but in the BMJ with impact factor 20!

Makary, Martin A., and Michael Daniel. "Medical error-the third leading cause of death in the US." BMJ: British Medical Journal (Online) 353 (2016).

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And it's already cited 586 times, it must be the greatest science of all the times?!

Let's read it together and find out

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You can open the pdf from the Reference 5 and read in parallel, just to be sure I haven't skipped something important

However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.1 As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured.

So, there is no data and we will spend our lives reading following 5 pages?!
Ok... All for Steemit and Statistics!
Fortunately, there are less than 2 pages of text. More than 10 impacts per page :)

By the way, here are some ICD Codes that doesn't exist, just trust authors, don't check...

• Y62-Y84 Complications of medical and surgical care (Y62-Y84)

Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome

So, the intended outcome is to survive, but the poor man dies = error?!
Ok... Maybe that patient caught another disease. Got failure of an unrelated organ or fell from his bed - error?!

The role of error can be complex.

Seriously? So, if a religious fanatic refuses the transfusion or sampling, is that an error? It was preventable...
If someone doesn't want to check the cancerous bump before it's too late, it's also a preventable error?

Moving away from a requirement that only reasons for death with an ICD code can be used on death certificates could better inform healthcare research and awareness priorities.

Again, if the cause of death was relatively successful suicide of a terminally ill cancer patient, what was the cause of death:

• bullet in the head
• terminate stage of cancer
• it was an error because he was still alive and better surgery could save him

A 2004 report of inpatient deaths associated with the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population estimated that 575 000 deaths were caused by medical error between 2000 and 2002, which is about 195 000 deaths a year (table 1⇓)

And the estimates are between 134 581 and 400 201?!
Let's summarize again: 2 600 000 deaths per year.
In other words, their estimates are that 1 of 6.5 - 20 deaths were caused by errors?
Each one of us must have experienced that, right?

Similarly, Landrigan et al reported that 0.6% of hospital admissionsin a group of North Carolina hospitals over six years (2002-07) resulted in lethal adverse events and conservatively estimated that 63% were due to medical errors.14 Extrapolated nationally, this would translate into 134 581 inpatient deaths a year from poor inpatient care.

STOP! just STOP, you are hurting my eyes!
You can't extrapolate. If you can, go to the stock market and become the richest man in the world!!!

And I was crazy enough to check the source of that claim

Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2)

Extrapolating the data from 2341 admissions, from some 10 hospitals, from North Carolina to the whole nation is absurd.

_{Source, CC0, all clean}

We calculated a mean rate of death from medical error of 251 454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013

Again, if you are good in extrapolation - go to Wall Street.

We believe this understates the true incidence of death due to medical error

You calculated, but you don't believe what you calculated?

Strategies to reduce death from medical care should include three steps: making errors more visible when they occur so their effects can be intercepted; having remedies at hand to rescue patients

I agree that the data collection should be better, but it's a ** the wrong strategy** to harm the healthcare system on a planetary level to get some attention!!!

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference

You are admitting again you have no data.

Instead of simply requiring cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.

And again...

And the conclusion...

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We have estimated that medical error is the third biggest cause of death in the US and therefore requires greater attention.

You have no data, you extrapolated from the small sample and got 4 fold scattering (shotgun is more precise...), and than you said that you actually underestimated before admitting two more times you had no data to even start with.

I was crazy enough to enter the key Reference 11 from the paper, and I found this :

Physicians determined that 44 percent of all events were preventable and 51 percent were not preventable. (For the remaining 5 percent of events, physicians were unable to make determinations.)

In other words, there was "an error", Michael Jordan missed the shot, but was it his fault?

This reminds me of Consumer Reports about the car, where the statements like "this GPS is not intuitive" counts as "my wheels fell off at the highway and I broke 3 bones".

How is that equal - I don't know.

Conclusion of the pointless reading

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Don't trust before you read.

It's sad but true, even for scientific journals.

Just like on SteemIt, there are whales in science too.
If you do a fantastic job in Mathematics, you will publish in some journal with the impact factor 2-3.
If you do a fantastic job in Biology, you will publish in some journal with impact factor 10 - 20.

But if you "catch the whale" in a medical journal you can publish in 20 - 120 impact factor journal some conglomerate of logical fallacies.

There are "dolphins" as well, reviewers who politely ask you to include 3 (irrelevant) papers written by them, just to, you know, promote them.

Such FUD generating papers are literally killing people.
In my country, 6 people died from measles, first deaths after 20 years.

And let me extrapolate this to the USA: 275 deaths
And to extrapolate to EU: 435 deaths

References

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1. FBI Reports, homicides, 2010 - 2014, link
2. FBI Reports, homicides, 2012 - 2016, link
3. CDC, Causes of Death in the USA, link
4. National Vital Statistics, link
5. Makary, Martin A., and Michael Daniel. "Medical error-the third leading cause of death in the US." BMJ: British Medical Journal (Online) 353 (2016). link

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