I stopped watching Rogan when he abandoned reason for madness.
On to the topic at hand, I remember feeling superior knowing these numbers growing up and knowing there was very low hanging fruit that wasn’t being picked up. But what I really needed was an anecdotal education in healthcare for old people.
An endoscopy (or literally 100 other low risk procedures) in a very frail patient could kill them, but if it did, they’d probably have died of pneumonia or some such within weeks anyway, bedridden. That these are low risk and have potentially large benefits for diagnosis and management, they’re done *all the time*. Lots of old, frail patients means lots of dying to what are not particularly scary procedures simply due to volume. But the numbers add up fast, and soon it looks like hospitals are in fact killing factories (which is silly). If you review the cases individually you would see barely any length of life lost due to “medical accidents”, and that doesn’t factor in the benefits at all.
Your numbers look right and feel right. I really like this post.
The 1999 book, To Err Is Human: Building a Safer Health System, claimed large numbers of inpatient deaths were occurring each year. Its conclusions were often discussed during my medical training from '08-'16.
So much has changed since that report/book was published, and I've long wondered what a better system of reporting harms, errors, injuries, and deaths world look like. With the incredible spread of electronic health records since about 2008, it is sad that more reliable vital statistics are still so frustrating to get and riddled with the types of complications you described (and more!)
The rate of preventable deaths associated with adverse events where the adverse event (rather than age or other comorbidities) was the cause of death was 1.3 per 1,000 in our representative study of New Zealand public hospitals from about 30 years ago.
Good piece and I appreciate it. It’s one of those situations where the fact that this needs to be debunked, rather than simply laughed at, is frightening.
the "if you control the inputs, you control the outputs" line is the whole post in one sentence, four numbers that were never measurements of the thing being claimed, averaged together and laundered into a stat solid enough for rogan and huberman to gasp at on camera to 600k views. the actual defensible estimate buried at the bottom, ~24k using Rodwin's preventability rate against real AHRQ inpatient counts, doesnt even crack a tenth of the viral number, and that gap between "what survives scrutiny" and "what goes viral" is basically the whole essay in miniature
On another note, with healthcare providers increasingly denying or tapering long-term pain management medications, a critical question arises: How many chronic pain patients, left without adequate medical relief, turn to the unregulated illicit drug market—and subsequently suffer fatal overdoses?
When I started as an infection control professional in 2012 the handwashing rates were ~ 50%. With doctors ~ 20%. It was years of fighting the anti handwashing culture in healthcare. When dialysis got 85% HH rates things changed. Yes you can wash your hands a lot! When I started it was not uncommon for an admission to the hospital would wander through the system and end up with MRSA and possibly die. When HH rates hit over 80% about 5 years later this amounted to almost zero.
Most advancements in other infections like central line or pneumonia in the ICU have declined due to bundles that were implemented and eventually just became regular practice.
The biggest risks are - unusual conditions that have little or no protocols for, and doctors who act like cowboys. I’ve seen and investigated medical errors and outbreaks and they are very rare but become more common with new and unusual situations, when HC professionals cut corners and are stressed.
I stopped watching Rogan when he abandoned reason for madness.
On to the topic at hand, I remember feeling superior knowing these numbers growing up and knowing there was very low hanging fruit that wasn’t being picked up. But what I really needed was an anecdotal education in healthcare for old people.
An endoscopy (or literally 100 other low risk procedures) in a very frail patient could kill them, but if it did, they’d probably have died of pneumonia or some such within weeks anyway, bedridden. That these are low risk and have potentially large benefits for diagnosis and management, they’re done *all the time*. Lots of old, frail patients means lots of dying to what are not particularly scary procedures simply due to volume. But the numbers add up fast, and soon it looks like hospitals are in fact killing factories (which is silly). If you review the cases individually you would see barely any length of life lost due to “medical accidents”, and that doesn’t factor in the benefits at all.
Your numbers look right and feel right. I really like this post.
The 1999 book, To Err Is Human: Building a Safer Health System, claimed large numbers of inpatient deaths were occurring each year. Its conclusions were often discussed during my medical training from '08-'16.
So much has changed since that report/book was published, and I've long wondered what a better system of reporting harms, errors, injuries, and deaths world look like. With the incredible spread of electronic health records since about 2008, it is sad that more reliable vital statistics are still so frustrating to get and riddled with the types of complications you described (and more!)
The rate of preventable deaths associated with adverse events where the adverse event (rather than age or other comorbidities) was the cause of death was 1.3 per 1,000 in our representative study of New Zealand public hospitals from about 30 years ago.
https://www.researchgate.net/profile/Peter-Davis-4/publication/7196869_Representative_case_series_from_New_Zealand_public_hospital_admissions_in_1998_-_III_Adverse_events_and_death/links/02bfe50ff180608670000000/Representative-case-series-from-New-Zealand-public-hospital-admissions-in-1998-III-Adverse-events-and-death.pdf
Good piece and I appreciate it. It’s one of those situations where the fact that this needs to be debunked, rather than simply laughed at, is frightening.
the "if you control the inputs, you control the outputs" line is the whole post in one sentence, four numbers that were never measurements of the thing being claimed, averaged together and laundered into a stat solid enough for rogan and huberman to gasp at on camera to 600k views. the actual defensible estimate buried at the bottom, ~24k using Rodwin's preventability rate against real AHRQ inpatient counts, doesnt even crack a tenth of the viral number, and that gap between "what survives scrutiny" and "what goes viral" is basically the whole essay in miniature
Great post, one Joe and Mark should read.
On another note, with healthcare providers increasingly denying or tapering long-term pain management medications, a critical question arises: How many chronic pain patients, left without adequate medical relief, turn to the unregulated illicit drug market—and subsequently suffer fatal overdoses?
When I started as an infection control professional in 2012 the handwashing rates were ~ 50%. With doctors ~ 20%. It was years of fighting the anti handwashing culture in healthcare. When dialysis got 85% HH rates things changed. Yes you can wash your hands a lot! When I started it was not uncommon for an admission to the hospital would wander through the system and end up with MRSA and possibly die. When HH rates hit over 80% about 5 years later this amounted to almost zero.
Most advancements in other infections like central line or pneumonia in the ICU have declined due to bundles that were implemented and eventually just became regular practice.
The biggest risks are - unusual conditions that have little or no protocols for, and doctors who act like cowboys. I’ve seen and investigated medical errors and outbreaks and they are very rare but become more common with new and unusual situations, when HC professionals cut corners and are stressed.