Friday, May 6, 2016

When bad research is not critically reported by journalists

Yesterday I posted a critical review of the study "Medical error—the third leading cause of death in the US."

I did not have time to address the media coverage of the paper, but fortunately the website HealthNewsReview did.

Their post started with "Seemingly all the major outlets carried the story, with headlines so alarming that they’d have any conscious hospital patient demanding an immediate discharge."

They called attention to headlines which included the word "now" such as these:

CBS: Medical errors now 3rd leading cause of death in U.S., study suggests
Washington Post: Researchers: Medical errors now third leading cause of death in United States
Nature World News: Medical Errors Now the Third Leading Cause of Mortality in U.S.

They pointed out that the headlines were similar to the title of a press release issued by the PR department at Johns Hopkins and that using "now" in the headline implies that the incidence of deaths caused by medical error has increased.

There is nothing "now" about the BMJ paper. if you read my post from yesterday, you will know that it was based on studies from the first decade of this century.

The HealthNewsReview story quoted my criticism of the extrapolation of the 35 deaths in the studies reviewed by the BMJ paper 's authors into a figure of 250,000 deaths per year nationwide and suggested that those reporting on the paper should have taken a closer look at the calculations.

HealthNewsReview ended with a concern that studies like this might frighten people into avoiding medical care.

It could be worse than that. It may provide fodder for the anti-vaccine movement. Based on the Washington Post story, a completely bizarre analysis of the BMJ paper appeared on Infowars yesterday. Note the sub-headline.
Read it to the end to grasp its full impact and enjoy the irrational comments too.

That concern that the public might take the BMJ paper's claims the wrong way was shared by some of the commenters on the BMJ website. Below are some excerpts from comments critical of not only the paper but the BMJ for publishing it.

There are many things we can do in medicine to improve patient care, but frightening the public by claiming that errors by their own caregivers constitute the third leading killer in the world, is not one of them.

Makary and Daniel’s analysis has misrepresented the true situation in 2 respects. Firstly, their extrapolations from the literature are unrealistic, based on flawed assumptions; secondly the single case study which they cite is unrepresentative of the majority of preventable hospital deaths.

Such an interpretation suggests that the authors believe that all hospital patient deaths are due to preventable errors. Most people who take care of cancer, trauma and cardiac patients know that there are many causes of death unrelated to medical errors.

In the UK, the 2015 in-hospital mortality rate was 1.05%. A recent study of UK hospital deaths estimated that 3.6% were avoidable, giving an overall preventable lethal adverse event rate of 0.04%. This is an order of magnitude lower than the 0.71% estimate calculated by Makary and Daniel. If the true rate is closer to 0.04%, the total number of annual preventable deaths in US hospitals may be 14,166 rather than 251,454.

Shame on the authors and publishers of this piece. This is a sensationalized title that harmfully misrepresents data, and seems to propel a dangerous paradigm against the medical establishment.

And my favorite (goes for all the news media too):

Congrats on the huge clickbait title. The National Enquirer would be proud.


artiger said...

It's all a conspiracy...scare people away from healthcare. Fewer patients allows more time with the remaining ones, and maybe this will allow reimbursement to rise.

Nonsense, I know, but it's about as reasonable as the "research" from Makary and his ilk.

Anonymous said...

No, artiger, it is a different conspiracy. Keep throwing mud on the current medical system, so the public will agree to socialized medicine.

Anonymous said...

@Anonymous. The risks of "socialized medicine" being? Many OECD countries, notably in northern Europe, show that you can have cheaper and still better "socialized medicine". On the contrary, unregulated quack thrives on "free initiative".

CS said...

I'm sure if we wanted to calculate preventable auto accident deaths or infant deaths due to parent inattention that were preventable, the number of lives saved could be equally astonishing.
But you know, $h!t happens and people aren't perfect.
I do trust more of my fellow docs and surgeons to care more about avoiding mistakes and striving for perfection in their daily work lives than most drivers and parents going about their activities.

Anonymous said...

To Anon of 5/7 0325 am, from Anon of 5/6 0833 pm:

The risks of "socialized medicine" might be what?

Yeah, what possibly could the government screw up? What possibly??

The last couple years, they have forced us MDs to use "templates" to chart on patients. In case you don't know, the resultant gibberish does nothing to aid patient care. In essence, the government banned MDs from using the English language in patient care: sentences and paragraphs with subjects and verbs are forbidden. Why the socialist government was allowed to foist this junk onto the American health care system is beyond me.
Now, I am forbidden to let my patient leave the clinic without first entering an ICD 10 code and a CPT code (and several other minutes of silliness) regarding the visit. Some ICD 10 codes require serious searching, but in the name of the Almighty Guberment, that patients and all others waiting to see me must chill, while I address the artificial ICD 10/CPT emergency.
We could go on and on. Socialism means the government takes your money and then tells you how it must be spent. You want socialized gas stations? Socialized supermarkets? Socialized plumbers? You want the government to tell you what to eat/drink/wear? And don't try to tell me that we control our own government -- we have a veneer of democracy only.
We have had 50% socialized medicine since Medicare in circa 1962. Why the elderly were suddenly unable to pay for their health care, and why the public bought the free lunch/"money grows on trees" fairy tale at that time, I don't know. What it definitely means now is that Joe Blow Smith, after having paid into the system for 40 years, is suddenly told by CMS et al, "no, your hospital stay/wheelchair/hospital bed/vitamins... are not medically necessary" -- who gave them the authority to steal his money under color of law and then tell him how it must be spent?
Without Medicare, we never could have had the massive health care inflation of the last 60 years that has made a return to true fee-for-service impossible.
Hint: it wasn't socialism that brought computer technology into the hands of essentially every American in my short lifetime. That was fee-for-service capitalism. Microsoft couldn't price a PC at $100,000, cause nobody could buy it, duh.

Anonymous said...

It was the government that made the Internet possible. Research that made computers possible was government funded from the time of Charles Babbage. Life expectancy in Cuba is about the same as it is in the USA.

William Reichert said...

The truth is more complicated. The assignment of a single cause
to a particular event is an interesting scientific question.
For example, according to the CDC, smoking causes 480,000
deaths in the USA each year. If this is so, then why is not smoking
listed as the #1 cause of death in America.? Getting exercise is known to prevent death and heart disease. If this is so, and it is,
why is not a lack of exercise listed as a cause of death in America?.
Recently Prince died apparently of an overdose. The headline in the WSJMay 5,2016 stated "Medical Intervention to Help Prince Did Not Occur in Time". Apparently an addiction MD
from California flew to Minneapolis to meet with Prince on the morning of his death but arrived" too late to save him". So now
is his late arrival the cause of his death? Or perhaps was Prince's
reluctance to admit he had a drug problem and failure to seek treatment earlier the cause of his death? Or was drug abuse the cause of death? Or is it the pharmaceutical industry's fault for
manufacturing the drugs.? Or perhaps it is the person who
prescribed the drugs who is the one at fault? When you look deeply at any single human death you will see that assigning all the blame on one aspect of the reality surrounding the death is
simplistic and wrong. Usually in studies of deaths, reviewers
look for an action or inaction of the physician that might play a
role in the death and then assign the entire responsibility for that death to the physician as the sole cause. Or assume that if that action or inaction did not occur, then the patient would not have died. This assumption is not based on science or evidence.
It is just a reviewer's opinion with the benefit of hindsight.
When someone dies it is natural to think "if only I had done this differently" or" if only this was done". This is natural but this is not necessarily true.Believing untrue things is not the path to progress.

Skeptical Scalpel said...

Anon from 5/6, your comments speak for themselves.

Anon from 5/8, I am not sure what point you're trying to make.

William, I agree that in many cases assigning one factor as the main cause of death is not only difficult but often inappropriate. I like your conclusion "Believing untrue things is not the path to progress."

Unknown said...

Reading this is all incredibly instructional. I was a health care fraud investigator in the Miami area from about 1989 to 1995. Back then, the health care fraud was massive for Medicare and Medicaid. I told the OIG and FBI agents that the health care fraud had a real silver lining. The vast majority of the services weren't being rendered. To this day, health care fraud, abuse, waste, tort and administrative cost soak up roughly a third of all healthcare dollars. The federal and state government instead of putting most of the culprits behind bars, simply let them settle civilly. If you can steal 500 grand and pay 200 of it back, that is not a bad return on investment. The documents the physician is complaining about, is simply trying to keep the honest guy honest. The 10 to 20% who are not, are going to go right on doing what they are doing. To put it in perspective, the federal government touting they recoupee 69 Billion, when there is 500 to 600 Billion being pilfered is, well laughable. Outcome based medicine will not cure this problem either. It simply means a whole lot more traceable documents in order to ride heard on the medical community. My fear is it will lead to a VA type system. UGH, Being a veteran, I know how, excuse the pun, that doesn't work.

Anonymous said...

I can make this personal. I saw a patient for a migraine. Just before leaving she complained that she'd been having chest pain that was pretty obviously chest wall in character. 2 days later she died of an MI. Did I killer her by treating her migraine with sumtriptan? Did I allow her to die by not holding her for 8 hours and repeating tests? Or was it just her time?

Skeptical Scalpel said...

Anon, great questions. The answers depend on the agenda of the person judging whether an event is preventable or not.

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