Medical care is 3rd leading cause of death in U.S.

morgueThe 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.

Recommended links

  • Is US Health Really the Best in the World?

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  1. paresh’s avatar

    nice analysis.

  2. Chris’s avatar

    Thanks for your comment Paresh.

  3. Joe Touchole’s avatar

    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 ,

  4. Chris’s avatar

    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.

  5. James’s avatar

    “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.

  6. Chris’s avatar


    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?

  7. monik amelia’s avatar

    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?

  8. Chris’s avatar


    Here’s the abstract. Unfortunately, you may need an account with JAMA to read the entire paper. You can probably access it at a medical library at a local university as well.


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  10. rj’s avatar

    What about the thousands of unreported errors!!!!!!!!!!!!!!!!!!!!

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  15. Ron Lavine’s avatar

    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.

  16. Chris Kresser’s avatar

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

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