When Medicine Kills
It is not necessary to talk in generalities. Doctors follow “The Standard of Care” which is a set of rules/orders that govern when a patient gets a certain drug and how much, when a surgery is performed, what tests are done, etc. The problem with this set of rules is that it is biased toward harm.
A good example of this is a drug that thins blood. If the blood is too thin, the patient will bleed to death. If it is too thick, he will have a stroke. In the cast of atrial fibrillation (new onset) the standard of care is to administer the drug for 3 months then stop. When I was being taught this, I asked, if thinning the blood is so good, why doesn’t the standard of care require that the drug is continued longer than 3 months? Answer, research shows that, at the 3 month point, the number of lives saved in the form of prevented strokes equals the number of people who die as a result of taking the medication.
This answer is troubling on many levels.
First: The drug has a death rate built in. The therapeutic dose of the drug if prescribed according to “The Standard of Care” is designed to kill.
Second: If the same number of people were going to die(different causes but just as dead) if I give the drug and if I do not, why not just skip the drug?
Third: The next troubling issue is how it is determined that a certain number would have died of a stroke had the medication not been taken? If the drug manufacturer is allowed to determine this number, wouldn’t that be a conflict of interest? Wouldn’t there be a great temptation to overestimate the number of deaths prevented by the medication and underestimate the number of deaths caused by the medication?
Numbers suggest that this moral hazard has materialized. 107,000 times every year, patients die from properly prescribed medications. Doctors are not told that a certain amount of lethality is expected and will occur when “The Standard of Care” is followed. In other words, following the standard of care is more lethal than the bullets in the guns of our soldiers. More lethal than the war – planes and the tanks and all the implements of war that we deliver to our enemies on the battlefield.
The lethal nature of the drugs is routinely shared with doctors in a dismissive manner;indicating that the benefits outweigh the risks. Doctors are routinely instructed not to share this information with patients, patients are routinely provided with patient instruction sheets that omit mention of the deadly nature of the medications.
The main difference is that the Iraqis know they are in a war. They take evasive action, do not co-operate with their executioners. They do not make appointments with their executioners, pay for parking and stand in line to get murdered. I am quite sure they have been known to hide in their houses, behind bushes, and in holes in the ground. They may even stay very quiet hoping not to be detected. They certainly do not pay those sent to execute them.
Patients in the United States do not know there is a war going on. They co-operate with their executioners. Seek out the deadly intervention. Even take special care to purchase insurance so that when they are murdered, their executioners will be paid handsomely after their death.
If US citizens took evasive action, the kill rate for the US health care system would surely be much lower.
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