Last Updated: Jun 21, 2016
Note: Guest blogger Shyam Sabat, MD, practices neuroradiology in Hershey, PA. He is also Vice-Chair of PAMED's Young Physician Section and Secretary-Treasurer of the Dauphin County Medical Society.
The BMJ (formerly the British Medical Journal) published a paper titled "Medical Error: The Third Leading Cause of Death in the U.S.," authored by Makary M & Daniel M in its 353th issue dated May 3, 2016.
The paper, which likely purposefully has a tabloid type spicy headline, has expectedly already garnered widespread attention in the print, online and TV media as well as the blogosphere and social media. The paper is being cited in the same breath as the very famous Institute of Medicine (IOM) 1999 paper titled: "To Err is Human."
But luckily for the U.S. medical/paramedical personnel and patients (and unfortunately for the authors and publishers), the paper is a shoddy piece of scientific and statistical work which cannot stand the close scrutiny of peer physician researchers and professional statisticians.
We reviewed the paper with expert statistician Dr. Vernon Chinchilli (Prof. and Chair Department of Public Health Sciences, Penn State College of Medicine), who found it shoddy science that the paper which calls itself a meta-analysis of four studies, is actually just a borrowed summary of a single study (by Healthgrades published in 2004). The other three studies just have 795, 838 and 2341 patients respectively versus 37 million in the Healthgrades study.
Thus, these other three studies don't have enough statistical power to be clubbed with the first study to form a meta-analysis since the larger study will dominate all results. Hence the final result numbers in this so called new meta-analysis study actually belong to the much downplayed Healthgrades 2004 study, which consisted of only Medicare patients (65 years and above).
Moreover, the authors borrowed the mortality rates from this Medicare population study and applied it to all U.S. inpatient admissions (all ages from 0-100+ years) without any correction of any form. It is common knowledge that the Medicare inpatient population is older, sicker and more vulnerable, and hence will have a higher morbidity and mortality for a given medical error than the general U.S. population. The Healthgrades study had not done any sort of such outrageous projection and hence does not contain these errors.
How a reputed group such as the BMJ could not see through these simple but outrageous statistical blunders is anyone's guess. Did the overwhelming incentive to get a spice tabloid-type, eye-catching headlined paper, prevent the editorial process from taking common sense decisions?
The result is that the U.S. medical community is being ridiculed by media and people not only from the U.S. but the whole world who cannot understand how U.S. medical system is so incompetent despite spending the maximum in the world and attracting the best talents from all over the world.
We demand that the BMJ group immediately retract the paper and issue a widely circulated apology to counter the blame and shame the U.S. medical community has already received from its reckless act. This paper has also possibly done a lot to harm to the provider-patient relationship.
I along with Dr. Virginia Hall (Assoc. Prof. OBGyn and AMA Delegate from Pennsylvania) have done a change.org petition calling upon the BMJ to retract the paper and issue an apology to the U.S. medical community. Please support it by signing it here and forwarding it to your physician, PA, CRNA, CRNP and other nurse colleagues.
(Our sincere thanks to Dr Vernon Chinchilli Prof. and Chair Dept of Public Health Sciences, Penn State College of Medicine, for reviewing the article for statistical accuracy and providing valuable input.)