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Medical Care Is 3rd Leading Cause of Death in U.S.


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The popular perception that the U.S. has the highest quality of medical care in the world has been proven entirely false by several public heath studies and reports over the past few years.

The prestigious Journal of the American Medical Association published a study by Dr. Barbara Starfield, a medical doctor with a Master’s degree in Public Health, in 2000 which revealed the extremely poor performance of the United States health care system when compared to other industrialized countries (Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium and Germany).

In fact, the U.S. is ranked last or near last in several significant health care indicators:

  • 13th (last) for low-birth-weight percentages
  • 13th for neonatal mortality and infant mortality overall
  • 11th for postneonatal mortality
  • 13th for years of potential life lost (excluding external causes)
  • 12th for life expectancy at 1 year for males, 11th for females
  • 12th for life expectancy at 15 years for males, 10th for females

The most shocking revelation of her report is that iatrogentic damage (defined as a state of ill health or adverse effect resulting from medical treatment) is the third leading cause of death in the U.S., after heart disease and cancer.

Let me pause while you take that in.

This means that doctors and hospitals are responsible for more deaths each year than cerebrovascular disease, chronic respiratory diseases, accidents, diabetes, Alzheimer’s disease and pneumonia.

The combined effect of errors and adverse effects that occur because of iatrogenic damage includes:

  • 12,000 deaths/year from unnecessary surgery
  • 7,000 deaths/year from medication errors in hospitals
  • 20,000 deaths/year from other errors in hospitals
  • 80,000 deaths/year from nosocomial infections in hospitals
  • 106,000 deaths a year from nonerror, adverse effects of medications

This amounts to a total of 225,000 deaths per year from iatrogenic causes. However, Starfield notes three important caveats in her study:

  • Most of the data are derived from studies in hospitalized patients
  • The estimates are for deaths only and do not include adverse effects associated with disability or discomfort
  • The estimates of death due to error are lower than those in the Institute of Medicine Report (a previous report by the Institute of Medicine on the number of iatrogenic deaths in the U.S.)

If these caveats are considered, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

Starfield and her colleagues performed an analysis which took the caveats above into consideration and included adverse effects other than death. Their analysis concluded that between 4% and 18% of consecutive patients experience adverse 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 (equivalent to the aggregate cost of care of patients with diabetes
I want to make it clear that I am not condemning physicians in general. In fact, most of the doctors I’ve come into contact with in the course of my life have been competent and genuinely concerned about my welfare. In many ways physicians are just as victimized by the deficiencies of our health-care system as patients and consumers are. With increased patient loads and mandated time limits for patient visits set by HMOs, most doctors are doing the best they can to survive our broken and corrupt health-care system.

The Institute of Medicine’s report (“To Err is Human”) which Starfied and her colleagues analyzed isn’t the only study to expose the failures of the U.S. health-care system. The World Health Organization issued a report in 2000, using different indicators than the IOM report, that ranked the U.S. as 15th among 25 industrialized countries.

As Starfied points out, the “real explanation for relatively poor health in the United States is undoubtedly complex and multifactorial.” Two significant causes of our poor standing is over-reliance on technology and a poorly developed primary care infrastructure. The United States is second only to Japan in the availability of technological procedures such as MRIs and CAT scans. However, this has not translated into a higher standard of care, and in fact may be linked to the “cascade effect” where diagnostic procedures lead to more treatment (which as we have seen can lead to more deaths).

Of the 7 countries in the top of the average health ranking, 5 have strong primary care infrastructures. Evidence indicates that the major benefit of health-care access accrues only when it facilitates receipt of primary care. (Starfield, 1998)

One might think that these sobering analyses of the U.S. health-care system would have lead to a public discussion and debate over how to address the shortcomings. Alas, both medical authorities and the general public alike are mostly unaware of this data, and we are no closer to a safe, accessible and effective health-care system today than we were eight years ago when these reports were published.

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Join the conversation

  1. Try this on for size. The way the medical malpractice system, (insurance companies) is set up, it actually benifits a doctor to allow a patient to die when that doctor has caused harm for whatever reason. If a patient dies, there is a set price, based on several factors. If the patient lives and needs care for the rest of their life, the sky’s the limit.

  2. Please help me find the link to this study. I clicked on your recommended link and it takes me to JAMA but it says “study not available, so I put the author’s name in their search engine and I do get a list of many articles that she’s published, but the one you refer to is not among them. Can you help me with this?

  3. I love reading your posts Chris, and as an Australian I find it really interesting that “The popular perception is that the U.S. has the highest quality of medical care in the world”. This surely must be the perception in the US alone? In Australia and Europe, I’d say the perception is the opposite – America is well-known to the rest of the industrialised world as having a very poor healthcare system (at least for the lower socioeconomic groups). I was watching TV the other day, and it covered the true story of an American lady who was bitten by a rattle-snake, and as she was uninsured, her treatment cost her US$140,000! In Australia, this treatment would not have cost her a cent, and would have been covered by our Healthcare system ‘Medicare’ which is there for all permanent residents, regardless of income. It’s worth mentioning this just because it shows that in a country with a relatively small population of 23.5M, free healthcare for all can work, without sacrificing a thriving economy. Our healthcare system does have it’s faults, especially compared with Sweden and some other Nordic countries, however I’m grateful to live in a country where a little accident wouldn’t put me in debt for the rest of my life. The USA is an amazing continent, and hopefully one day your healthcare system will catch up with the rest of the developed world. See what’s working elsewhere, and model a healthcare overhaul on that.

    • Absolutely agree with you Sue.
      One good thing in Australia is the 1:1 patient nurse ratio. In America is 3:1 !!!
      How on earth 1 nurse can managed 3 critically ill patients without missing care or mistakes????

  4. Hello Chris,
    I am a Homoeopathic practitioner from India. I have no surprise to hear the statistics provided by you in the blog.
    The problem is that humanity has gone too far in a wrong way . The more they go in the wrong path, the worst things are sure to happen.
    There is only one method of cure and that is the natural principle of “Similia” the fundamental principle of Homoeopathy. It simply means, the symptoms we call as diseases are in fact the program of nature to save you and not to annihilate you.
    Even the heart diseases and cancers, the first two killers, are wrongly interpreted as enemies. They are in fact part and parcel of a biological program developed in the body through evolution and manifested through the embryological developments for better survival for the human species. If rightly approached, and understood as nature’s defensive mechanisms, none of the symptoms will be suppressed and interfered with.
    How can a medical science that does not take man as an individual with psyche (the seat of soul), brain and organ as a synchronizing unit treat the individual man?
    The medical science has gone too far in the wrong path and adopting Homoeopathy as propounded by Dr. Samuel Hahnemann and German New Medicine as propounded by Dr. Ryke Geerd Hamer is the right approach according to me who is in medical field for 40 years.
    Dr C. J. Varghese

    • You are so right, Dr Varghese. Western medicine seems to think people are machines, not sentient beings. There is no understanding at all of the causes of illness, which is why it is unable to heal people. Western doctors are totally in thrall to the greed of powerful pharmaceutical companies, which run the medical schools and train them in the use of their poisonous products. These same pharmaceutical giants bribe governments to amend laws making it illegal for these doctors to prescribe all non-pharmaceutical treatments, while they simultaneously spread massive lies about the abilities of nature to effect true healing.
      I and my husband are both long-term survivors of advanced cancers which were cured (not in remission), but totally cured,
      through natural means. Western medicine just does not even begin to understand how this can be. Orthodox doctors do not seem to realize that poison is poison, which cannot heal, and ultimately kills. Whatever happened to the Hippocratic Oath – “First do no harm”?

  5. As per my medications that are one of a kind. Every Doctor goes this way and many others goes the other way. No one knows what to do and how to handle cases like this. I did went all ready over 2 million dollars and still going and going. I did lost everything whatever I had to get a help form SSI but no other help to solve my episodes an be able to move around as a normal person as I was before. Changing Doctors, medications and all those movements around from Doctors and Hospitals do not help meat all. One Doctor says one think and the other says something else, and we are going around in circles. I did work at a retirement community here in our town and what I did see was a very wrong way to handle or help people or patients.

  6. I am a victim of medical help to improve my seizures that I had since my car accident that I had in 1998 from two teens at 5.30 am going to work at the airport. I end up at the hospital later on because I refused the help then. When I returned back to work I did had an episode and almost went off the road with two ladies on board. The did called the office and I did end up at the hospital then. I did lost my job and was going around doctors and hospitals included in Canada and in England with solution for my episodes. Eight years later I did accept the opinion of a Doctor to do an operation without causing any future problems but after the operation my life went worst and since then I did lost everything and my life went downhill big times. I have jerks every day and there are dancer to my life and all the others around. Many Doctors, many medications and now diagnose with HEMIBALLISMUS disorder wish America is not familiar with it. What is the answer for my episodes is a very big question for all of us. I did travel all over the globe and I have never problems like this. Even my lady give up and now I am by my self alone in life. I do have a nurse who comes every day to check on me how I am doing and nothing else. This is my future and who knows what else I will face.

    • Hey Dimitri, you may want to check pubmed papers for neurodegenerative diseases related to alternative approaches. That is if you are looking for alternatives at this point. There is one I found for HD.


      It contains a list of herbs which can protect – to say the least – neurons. The thing is you will need at least a herbalist who knows about neurodegenerative conditions and can make the right combinations of herbs or recommend the right supplements and dosage and he can do follow ups. I guess if nothing is available, you could try the herbs with recipes you can find over the net.

      All the best.

  7. “Popular perception that American healthcare is the best in the world” … Only inside America. No-one outside America thinks that. I know a lot of Americans who have chronic illnesses who live outside of the USA just to avoid American healthcare. Apart from anything else, you guys are being ripped off financially. For instance, a certain brand of oestrogen cream at Winn Dixie pharmacy in FL, $139. Same thing in Boots the Chemist in UK, £4.50 (about $7). And that’s not due to our “socialised medical care” … the NHS price is higher. That price is with private (paid for) healthcare!

  8. Sorry, but you didn’t publish the link to the study (the only reference you had ‘didn’t work’) ~ I’d like to read the actual study, please.

    • It is NOT a study it is a statistical analysis. There is no cause/effect relationship available here. Only conjecture based on statistics. If I say that 10,000 people died while undergoing medical treatment it cannot be taken to imply that these people died BECAUSE of undergoing medical treatment. It is just as likely that these same people would have died if there had not been any medical treatment.

  9. Any profession is, and always will be, within the confines of some for-profit system. To suggest that there is a solution outside of this reality is naïve. Within the medical field someone will always profit, either the doctor (most desirable) the insurance company, or the government (least desirable).

    • I totally agree Mike that the profit motive must of necessity be the driving force behind any system we create and to believe otherwise is naive.

      But I don’t follow you when you say that a system which benefits “the government” is the least desirable. “The government” represents the collective interests of people. So a system which benefits “the government” in effect means lower total costs to the consumer. With the current US system, we’re paying high insurance premiums plus through our taxes we’re paying for medicare, medicaid, and also indirectly for a lot of indigent care.

      I believe it would be possible for the government to collect more taxes – and/or introduce more “regulation” – in a way that would nonetheless result in lower total public costs for healthcare. That’s the intent of the Affordable Care Act.

  10. Thanks, Ron.  I saw your article about the sickness cartel, and I enjoyed it.  Keep up the good work!

  11. Thanks for the great article.  I’ve been looking for a site like yours that has relevant information.  Over the years my skepticism about the medical model (“sickness cartel”), instead of fading with maturity, has grown.
    It seems like the situation only gets worse, not better.
    When my kids were born (20+ years ago) of course we were interested in “natural childbirth” and all that.  Now I have a niece who’s committed to her study of midwifery because of the rampant and unnecessary medicalization of the birthing process.  Apparently it’s worse than it was 20 years ago, with even more caesarians, more technology. and more dehumanization.
    And I fear that the state of medical care has gotten worse in many other areas too.
    Keep up the fight.
    Ron Lavine, D.C.

  12. hi, i’m trying to make a health power point presentation and been looking a reference that says that medical care is the 3rd leading cause. is it mentioned anywhere in journals, or news? do you mind to share the reference with me?

  13. James,

    Thanks for your comment and welcome to the blog.

    I’m not exactly sure what you’re asking, but the “106,000 deaths a year from nonerror, adverse effects of medications” means that of the 225,000 people who die each year as a result of iatrogenic causes (causes related to medical care, that is), 106,000 of those deaths are due to side effects from medication that was “properly prescribed” (i.e. indicated for the particular illness or disease).

    This is different from the 7,000 deaths a year caused by medication errors (drugs improperly prescribed or contraindicated for the particular patient/condition).

    The fact that more than more than 100,000 people are dying each year from medications that are “properly prescribed” makes me think it’s time to reconsider the criteria for their prescription.

    Have you had a chance to read the full text of the study? I really recommend you do that before passing judgment on the validity of the statistics.

    What you say is certainly true about statistical measures in general; there is always the potential for bias and personal agendas distorting the numbers. But that does not mean that well-designed studies cannot produce relatively accurate statistics that are meaningful and relevant.

    As mentioned in the article, the World Health Organization did a separate analysis that arrived at many similar conclusions. If you have specific criticisms of the data analysis or methodology of the study, I’d like to hear them. To me the numbers appear to be very sound, especially because similar results have been obtained by other studies by author authors and organizations.

    I don’t see any reason to believe these statistics are skewed as you suggest. What is your reason?

  14. “106,000 deaths a year from nonerror, adverse effects of medications”

    Almost half of your affected patients. Can you go into a little more detail about this one?

    Why do these numbers seem skewed to me?

    It’s a fact that almost 90% of all statistics can be made to say anything at least 50% of the time. I think that’s what were seeing here.

  15. Hi Joe,

    Thanks for your comment. I’m very sorry to hear of your loss.

    Our current situation is the entirely predictable result of for-profit health care, in my opinion. As publicly traded corporations, HMOs and pharmaceutical companies are required by law to maximize profit for shareholders.

    Any business owner can tell you that reducing costs and increasing sales is the way to maximize profits. In the healthcare industry, reducing costs means providing less service or providing cheaper services or both. Increasing sales means selling more drugs and technology-based elective procedures that generate income. It’s all rather simple when we look at it this way.

    I’m not confident that any of this will change significantly as long as we have a for-profit system.

    • When a news article starts with new research says or the results of a new study conclude. It should set off warning bells in your head. More often than not these are articles originating from advertising agencies created to appear like legitimate news articles. Focus groups are paid to measure the effects of talking points, not for legitimacy, but for emotional strengths. The talking points are then repeated as though some new vocabulary, to entitle the all knowing and more intelligent politicians who sing along, with anything injected into the new speak culture. For far too long, the news wires have melded real stories with paid advertisements deliberately avoiding the sources. Legitimate research is published in the Journals for peer review and evaluation. When they are presented in the bold print headlines first, it speaks to a more legitimate need to deal with corruption and fraud.

      Here is an example you are likely hearing about measles as the latest “pandemic” and soon most other childhood diseases, killing one in one thousand children. Absolutely false! A fraud of the most perverse description.

      They are telling people that 1 in 1000 infected with measles will die. As an assault against those who utilize their rights of self autonomy and parental autonomy, in place of big pharma dictatorships. This little tidbit of misinformation, is gleaned from a research study found here;


      The study investigates 63,000 “reported” cases in the United States between 1987 and 2000.

      To define the accuracy of the findings and an incredible lie, one need only look at one word “reported” If you are over 40 years of age and you had measles as a child, did you go to the Doctor? In more than 95% of cases no one ever did, because they knew how to identify measles and they dealt with it just as we would a cold or the flu. With no need to pay a doctor to tell them something they already knew. So in the vast majority of cases, they remain unreported, unless severe complications arise. The cases that are reported are of the more severe variety, and of the number reported, only one third were seen to have experienced any related serious complications, and of that number 177 died over a 13 year period, in the entire US population?. To say that medicine has not progressed in the past 20 years and that 177 would still die today, is controversial to say the least. There was no separation in the study of those with severe immune deficiencies, or other coincidental ailments that could contribute to deaths, simply raw observational data listing the number who died while in care. [iatrogenic deaths ignored again?] With no estimation of how many didn’t die, among the far larger number in the millions of non reported cases, who it appears did just fine.

      With this blinded observation, that childhood diseases present significant harms, we also see another risk factor ignored. The largest preventable cause of death has always been medical mistakes or iatrogenic. Even if that risk factor has been left off the list. For all intents and purposes, it does not exist among “medical experts” Especially the “Experts” who make a living creating fear [risk] as a byproduct, of people, being evaluated as the primary, and in some cases, a singular disease.

  16. Great article

    Today would have been my Dad’s 87 birthday, he passed 9/1/07. Many would say well that’s a nice long live and normally I would agree. However he was sent to his eternal reward as a result of the efforts of the drug companies that control the medical profession and the government turns a blind eye to . As long as the checks from the drug companies keep clearing in DC, this behavior will be allowed to continue. Tell me how this is allowed to happen ,


    • because every one that this is happening to doesn’t organized and petition and picket the actual public

    • Leave it to the medical industry “Public health” to downplay the effects of their mistakes and misques. Today as we are being made to stress over the most remote of risks available. To promote drug use or simply to entitle social engineering demands at all levels of government, as paternalist politics that enable unworkable budgets. The largest risks are buried or ignored. The most extensive analysis I have seen and there are many competitors that somehow avoid the headlines. This one says it best.


      An extract from death by medicine, Gary Null-Whale

      “The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251”

      Most often the medical, or drug company, lobby group advertisements are of the finger wag variety. Painting parents who decline the shot, as if unfit to be parents. Again a lobby group effort not unlike the anti-smoker “movement” painting hateful pictures of the non compliant, to promote drug company profits, by the skilful application of hateful emotional pain.

      People who identify themselves as “Public Health”, should be ashamed of yourselves. No amount of money or ego boosting prestige, is worth what you impose on others. Risk, comes no where close to the real damages and dangers ignored, in this bandwagon process. If we look to the medical evidence for a balanced perspective? nothing in all of the most well known medical Journals caries less of a lifetime risk, than tobacco smoke exposures, and just look at us now?

      It is time someone went to jail.