Debunking a Common Pro-Gun Argument : Health

It’s no secret that pro-gunners aren’t particularly fond of the medical and public health field especially when it comes to the gun control debate [SOURCE] [SOURCE]. So, when a statistic originating from a supposed John Hopkins study claiming that there are between 250,000 to 400,000 deaths due to medical errors comes around, it’s no surprise that pro-gunners cite it as a ‘gotcha moment’ against “antigun doctors”, arguing that, “Doctors kill more Americans than guns!” [SOURCE]

However, the claim that there are between 250,000 to 400,000 deaths due to medical errors is highly dubious at best and the “study” it originated from is massively flawed.

For starters, the “study” was NOT a scientific study at all, but only an opinion piece. It presented NO new research, it was not peer reviewed, and the studies relied on for data were not new [SOURCE].

The authors simply took the arithmetic average of four estimates since the publication of the IOM report, including one from HealthGrades, a for-profit company that markets quality and safety ratings, a report from the US Office of the Inspector General (OIG) and two peer-reviewed articles. The paper did not apply any established methodology for quantitative synthesis nor did it include a discussion either of the intrinsic limitations of the studies used or of the errors associated with the extrapolation process [SOURCE].

Another problem with the “study” is the fact that the data was never meant to be generalized to the entire U.S. hospitalized population [SOURCE]. Two of the studies were done in medicare patients, one study was done in 3 tertiary care hospitals and one was done in 10 hospitals in North Carolina.

Three of the four studies had a combined total of 35 deaths. In a commentary piece on this “study”, Gerard J. Gianoli, MD stated that they can only find 14 preventable medical error deaths (using the “study’s” definition of the term) [SOURCE].

The fourth study had 389,000 deaths which is quite significant until you realize these were medicare patients. It should be noted that about 75% of inpatients who die in the hospital are aged 65 and over [SOURCE].

What’s worse is the fact that some of the widely quoted estimates of deaths due to medical error, including the IOM estimates, Makary and Daniel and James, are based on studies that in fact did not set out to estimate the rate of mortality linked to medical error. Instead, these primary studies sought to measure the prevalence of harm from medical care (ie, adverse events).

Consistent with their primary purpose, these studies included no methodology for making judgements about the degree to which adverse events played a role in any deaths that subsequently ensued. For instance, a patient admitted to the intensive care unit with multi-system organ failure from sepsis might develop a drug rash from an antibiotic to which he has exhibited a past allergic reaction. This patient has certainly experienced a preventable adverse event. But, if the patient eventually dies of progressive organ dysfunction a week after the antibiotic was changed, the medical error probably did not cause the death. An error that has occurred close to a death is not a sufficient basis for concluding that the error is the cause of death. Yet these studies do not have an explicit methodology for handing this situation—for distinguishing deaths where error is the primary cause from deaths where errors occurred but did not cause a fatal outcome [SOURCE]..

Considering the fact that there are around 700,000 hospital deaths, that would mean that around 35% – 55% of hospital deaths are from preventable medical error which doesn’t make any sense and flies in the face of clinical experience [SOURCE].

The number of deaths due to preventable medical error is likely far lower.

A study by Sunshine et al. 2019 [35] examined all adverse effects of medical treatment (AEMT) which includes medical error from 1990 – 2016. They found the absolute number of deaths in which AEMT was the underlying cause increased from 4180 (95% UI, 3087-4993) in 1990 to 5180 (95% UI, 4469-7436) in 2016. From 1990 to 2016, there were an estimated 123,603 deaths. AEMT contributed an additional 20 deaths for each death when it is the underlying cause which means for 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year. Reminder the number includes all adverse events. Please also keep in mind that those 70 years or older had mortality rates nearly 20-fold greater compared with those aged 15 to 49 years and 8.5% of the underlying deaths were from “misadventure” which are events likely to represent medical error.

A year later, a systematic review and meta-analysis by Rodwin et al., 2020 on preventable deaths due to medical error found that, in the USA, there was approximately 22,165 preventable deaths annually. That number is significantly lower than the number of firearm deaths in the US. Of course, this number is still slightly larger than the number of firearm homicides. However, for patients with greater than 3-month life expectancy, that 22,000 number dropped to 7,150 deaths. The authors concluded, “…implies that the vast majority of inpatient deaths are due to underlying disease and not due to variation in quality of care [SOURCE].

Of course, let us not forget the countless many lives that have been saved by those in the medical and public health fields as well as the concerted effort to actually reduce medical errors [SOURCE] [SOURCE] [SOURCE].

Furthermore, Covid-19 is now currently the third leading cause of death in the US.

While the number of deaths due to medical error is still being disputed and deaths due to medical error is still a very serious issue, the notion that, “Doctors kill more Americans than guns!” and that “medical error is the third leading cause of death“, rests on extremely shaky ground.

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