Medical care can diagnose illness and injury, but lack of medical care does not cause illness or injury. Medicine is more art than science. Cutting-edge care changes with the times. In 1972, when I was in medical school, a medical professor began a lecture by saying, “

Aspirin has not been given to people who have had a heart attack since 1980, but it is now routinely administered even before the victim reaches the hospital. Until the 2000s, postmenopausal women were given estrogen to replace hormones they no longer produced, and one study found that use of the treatment slightly increased life expectancy. Most people now consider this practice harmful.

Consider comparing medical care across countries for conditions that need to be addressed. For many conditions medical care has little to offer, but there are many other conditions where medical care can be beneficial, such as bacterial infections, diabetes, heart attack, HIV/AIDS, high blood pressure, maternal bleeding during childbirth, and leukemia in young people. There is. The United States is not even doing well on these issues. Repeated studies show significantly higher rates of death from treatable conditions than in other wealthy nations. Shame on you. Comparing avoidable deaths in wealthier countries with 10-year mortality declines (2009-2019), the Commonwealth Fund shows the United States to be the worst.

Why are medical deficiencies not emphasized? Because they compete with healthcare wins.

We doctors take pride in saving lives. I remember attending my first emergency code as a medical student at Stanford University. Someone’s heart stopped beating, and a doctor-in-training administered a defibrillating shock to restart the heart. After the head resident arrived, he asked who had shocked the patient. His hand moved and he solemnly said, “You saved a life.” Saving a life is a medical metaphor instilled in his mind as a child.

But is it true? Most of the time it’s not medical that saves.

One evening in 1973, as a medical intern, infectious disease journalincludes an article by Edward Kass, MD, PhD, Distinguished Infectious Disease Physician at Harvard University. In that article, Infectious Diseases and Social Change, Cass presented data on deaths from various infectious diseases since the 1850s in England and Wales, where reliable records were kept. He noted that poorer people were more likely to succumb to infectious diseases consistently. He presented data showing that deaths from these problems had declined significantly. Kass argued that this decline in mortality was due to improved socioeconomic conditions and living standards, not medical care. . He called it “the most important event in the history of human health.” It took decades for the concepts I read that day to take hold, but reading Kass’s article prompted me to ask important questions. One of those questions, he said, was how one could distinguish between the benefits and threats of medicine.

Consider providing different levels of care to two groups of people. One group gets as much free treatment as they need, and the other group has to pay part of the cost out-of-pocket. The Rand Health Insurance Study randomly assigned over 4,000 adults to one of these two groups. Those who had to pay a portion of their medical bills used services one-third less and were hospitalized one-third less than those who received free care. increase. result? There is basically no difference in mortality.

A more extreme version of this approach considers what happens to mortality when doctors go on strike. A review of the literature suggests that mortality actually decreases when doctors do not go to work. For his month-long strike of anesthesiologists in Los Angeles County in 1976, one of his studies of people who were out of treatment because of the doctors’ strike was conducted. The county coroner’s mortality rate dropped during the strike.

This unexpected finding – that neglect of care does not necessarily impair health – has been confirmed time and time again, but the reasons behind it are not clear. whenever is considered as a possible cause of death, it is always one of the major contributing factors.

The first major study of medical hazards was published in 1991. Researchers at Harvard Medical School reviewed a sample of New York hospital charts in 1984 and recorded “adverse events” resulting from the care provided. Common problems were reactions to prescribed medications and infections of surgical wounds. There have been complications from technical procedures, such as instruments left in the body during surgery and devices not functioning properly. Adverse events were found to be common and resulted in a significant proportion of deaths.

Since then, many studies in different countries by different researchers have found that medical harm is common. The more severe the illness and the longer the hospital stay, the higher the risk.

People die in search of medical care. These fatalities vary. In the 2015 issue of Best Hospitals, US News & World Reportan article on patient safety, revealed that one analysis found that “preventable deaths alone amount to 440,000 each year.” was shown to be third in the new york times In 1998, it was reported that over 100,000 people died each year from drug side effects.

However, little media attention is paid to the fact that approximately 500,000 people in the United States die annually from treatment-related deaths. But it deserves far more media attention than it receives.

All of this is not meant to compromise access to needed medical care. Universal access to adequate healthcare is the benchmark for a healthy society. Millions of people in this country lack such access. The United States has a long way to go to reach this goal.

This excerpt was adapted from the book: Inequality Kills Us All: Health Lessons COVID-19 Brings to the World (Routledge, 11 November 2022, Paperback), by Stephen Bezruchka. Used with permission. all rights reserved.

Stephen Bezruchka, MD, MPH is Associate Professor Emeritus in the Department of Health Systems and Population Health and Department of Global Health at the University of Washington School of Public Health.