Doctors Are the Third Leading Cause of Death in the
Cause 250,000 Deaths Every Year
The U.S. health care system may contribute to poor
health or death. According to Dr. Barbara Starfield of the
Johns Hopkins School of Hygiene and Public Health, 250,000 deaths
per year are caused by medical errors, making this the third-largest
cause of death in the U.S., following heart disease and cancer.
Writing in the Journal of the American Medical
Association (JAMA), Dr. Starfield has documented the tragedy of
the traditional medical paradigm in the following statistics:
||Non-error, negative effects of drugs2 |
||Infections in hospitals10
errors in hospitals10 |
||Medication errors in hospitals9 |
||Total deaths per year from iatrogenic*
* The term iatrogenic is defined as "induced in a
patient by a physician's activity, manner, or therapy. Used
especially to pertain to a complication of
Furthermore, these estimates of death due to error are
lower than those in a recent Institutes of Medicine report. If
the higher estimates are used, the deaths due to iatrogenic causes
would range from 230,000 to 284,000. Even at the lower
estimate of 225,000 deaths per year, this constitutes the third
leading cause of death in the U.S.
Dr. Starfield offers several caveats in the
interpretations of these numbers:
First, most of the data are derived from studies in
Second, these estimates are for deaths only and do not
include the many negative effects that are associated with
disability or discomfort.
Third, the estimates of death due to error are lower
than those in the IOM report.1 If the higher
estimates are used, the deaths due to iatrogenic causes would range
from 230,000 to 284,000. In any case, 225,000 deaths per year
constitutes the third leading cause of death in the United States,
after deaths from heart disease and cancer. Even if these
figures are overestimated, there is a wide margin between these
numbers of deaths and the next leading cause of death
Another analysis11 concluded that between 4
percent and 18 percent of consecutive patients experience negative
effects in outpatient settings, with:
116 million extra physician visits
77 million extra prescriptions
17 million emergency department visits
8 million hospitalizations
3 million long-term admissions
199,000 additional deaths
$77 billion in extra costs
The high cost of the health care system is considered
to be a deficit, but it 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
percent of patients receive inappropriate care. An estimated
44,000 to 98,000 among these patients die each year as a result of
This might be tolerable if it resulted in better
health, but does it? Out of 13 countries in a recent
comparison,3,4 the United States ranks an average of 12th
(second from the bottom) for 16 available health indicators.
More specifically, the ranking of the U.S. on several indicators
13th (last) for low-birth-weight percentages
13th for neonatal mortality and infant mortality
11th for post-neonatal mortality
13th for years of potential life lost (excluding
11th for life expectancy, at 1 year for females,
12th for males
10th for life expectancy, at 15 years for
females, 12th for males
10th for life expectancy, at 40 years for
females, 9th for males
7th for life expectancy, at 65 years for
females, 7th for males
3rd for life expectancy, at 80 years for
females, 3rd for males
10th for age-adjusted mortality
The poor performance of the U.S. was recently
confirmed by a World Health Organization study which used
different data and ranked the United States as 15th among 25
There is a perception that the American public
"behaves badly" by smoking, drinking, and perpetrating
violence. However, the data does not support this
The proportion of females who smoke ranges from 14
percent in Japan to 41 percent in Denmark; in the United
States, it is 24 percent (fifth best). For males, the range is
from 26 percent in Sweden to 61 percent in Japan; it is 28
percent in the United States (third best).
The U.S. ranks fifth best for alcoholic beverage
The U.S. has relatively low consumption of animal fats
(fifth lowest in men aged 55 to 64 years in 20 industrialized
countries) and the third lowest mean cholesterol concentrations
among men aged 50 to 70 years among 13 industrialized countries.
Lack of technology is certainly not a contributing
factor to the low ranking of the United States. Among 29
countries, the U.S. is second only to Japan in the availability of
magnetic resonance imaging units and computed tomography scanners
per million population.17
Japan, however, ranks highest on health, whereas the
U.S. ranks among the lowest. It is possible that the high use
of technology in Japan is limited to diagnostic technology that is
not matched by high rates of treatment, whereas in the U.S., the
high use of diagnostic technology may be linked to more treatment.
Supporting this possibility are data showing that the
number of employees per bed (full-time equivalents) in the United
States is highest among the countries ranked. They are very
low in Japan, far lower than can be accounted for by the common
practice of having family members rather than hospital staff provide
the amenities of hospital care. Journal of the American
Medical Association, Vol. 284, July 26, 2000.
It has been known that drugs are the fourth leading
cause of death in the U.S. This makes it clear that the more
frightening number is that doctors are the third leading cause of
death in this country, killing nearly a quarter million people a
year. These statistics are further confused because most
medical coding only describes the cause of organ failure and does
not identify iatrogenic causes at all.
Japan seems to have recognized that technology is
wonderful, but just because you diagnose something with it, one
should not be committed to undergoing treatment in the traditional
paradigm. Their health statistics reflect this aspect of
their philosophy, as much of their treatment is not treatment at
all, but loving care rendered in the home.
Care -- not treatment -- is the answer. Drugs,
surgery and hospitals become increasingly dangerous for chronic
disease cases. Facilitating the God-given healing capacity by
improving the diet, exercise, and lifestyle is the key.
Effective interventions for the underlying emotional and spiritual
wounding behind most chronic disease is critical for the reinvention
of our medical paradigm. These numbers suggest that
reinvention of our medical paradigm is called for.
(NaturoDoc comments: This is a powerful
indictment of conventional allopathic medical care.
Articles published in JAMA are circulated in the largest and most
respected peer review journal in the world. The major wire
services did not carry this article, which is consistent with whose
interests they represent)
Schuster M, McGlynn E, Brook R. How good is
the quality of health care in the United States? Milbank Q.
Kohn L, ed., Corrigan J, ed., Donaldson M, ed.
To Err Is Human: Building a Safer Health
System. Washington, DC: National Academy Press, 1999.
Starfield B. Primary Care: Balancing Health
Needs, Services, and Technology. New York, NY: Oxford
University Press, 1998.
World Health Report 2000. Available at
Accessed June 28, 2000.
Kunst A. Cross-National Comparisons of
Socioeconomic Differences in Mortality. Rotterdam, the
Netherlands: Erasmus University; 1997.
Law M, Wald N. Why heart disease mortality is
low in France: The time lag explanation. BMJ. 1999;
Starfield B. Evaluating the State Children's
Health Insurance Program: critical considerations. Annual
Rev. Public Health. 2000; 21:569-585.
Leape L. Unnecessary surgery. Annual
Rev. Public Health. 1992; 13:363-383.
Phillips D, Christenfeld N, Glynn L. Increase
in U.S. medication-error deaths between 1983 and 1993.
Lancet, 1998; 351:643-644.
Lazarou J, Pomeranz B, Corey P. Incidence of
adverse drug reactions in hospitalized patients. JAMA. 1998;
Weingart SN, Wilson RM, Gibberd RW, Harrison
B. Epidemiology and medical error. BMJ. 2000;
Wilkinson R. Unhealthy Societies: The
Afflictions of Inequality. London, England: Routledge;
Evans R, Roos N. What is right about the
Canadian health system? Milbank Q. 1999; 77:393-399.
Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M,
Strobino D. Annual summary of vital statistics,
1998. Pediatrics. 1999; 104:1229-1246.
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.
Donahoe MT. Comparing generalist and specialty
care: discrepancies, deficiencies, and excesses. Arch Intern
Med. 1998; 158:1596-1607.
Anderson G, Poullier J-P. Health Spending,
Access, and Outcomes: Trends in Industrialized Countries.
New York, NY: The Commonwealth Fund; 1999.
Mold J, Stein H. The cascade effect in the
clinical care of patients. N Engl J Med. 1986; 314:512-514.
Shi L, Starfield B. Income inequality, primary
care, and health indicators. J Fam Pract.1999; 48:275-284.
For reprints of the original JAMA article,
Barbara Starfield, MD, MPH
Department of Health Policy and Management
Johns Hopkins School of Hygiene and Public Health
624 N Broadway, Room 452
Baltimore, MD 21205-1996
Thanks to Dr. Joseph Mercola's Optimal Wellness Center at mercola.com for
permission to reprint this article. This article copyright
2001 by Joseph M. Mercola, DO.