Join host Dr. Bradley Block as he sits down with Jonathan Jarry to debunk the myth that medical error is the third leading cause of death in the US. Jarry exposes the flawed 2000 Institute of Medicine report and 2016 BMJ paper by Dr. Marty Makary, which rely on shaky extrapolations from small studies. He discusses how this inflated statistic fuels fear, drives patients to unproven alternatives, and erodes trust in healthcare. Learn how to address this myth while prioritizing patient safety and evidence-based care in this critical conversation.
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In this episode, host Dr. Bradley Block welcomes Jonathan Jarry to tackle the persistent myth that medical error is the third leading cause of death in the US. Jarry traces the claim to a 2000 Institute of Medicine report and a 2016 BMJ paper co-authored by Dr. Marty Makary, exposing their flawed extrapolations from small, non-representative studies. He highlights issues like erroneous assumptions, small sample sizes, and the challenge of determining causality in deaths linked to errors. Jarry explains how this inflated statistic fuels fear, drives patients toward unproven alternative treatments, and erodes trust in healthcare. He offers practical ways to push back against the myth while acknowledging the need for improved patient safety systems. This episode is essential for healthcare professionals and patients seeking clarity on medical errors and their true impact.
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About the Show
Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!
About the Guest
Jonathan Jarry is a science communicator with McGill University’s Office for Science and Society (OSS), dedicated to separating sense from nonsense in science. With a background in clinical lab work and podcasting, he tackles pseudoscience and misinformation, making complex topics accessible. His work at OSS, established in 1999, focuses on debunking myths and promoting evidence-based understanding.
Website: mcgill.ca/oss
BlueSky: https://bsky.app/profile/jonathanjarry.bsky.social
About the host:
Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts The Succeed In Medicine podcast, focusing on personal and professional development for physicians
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[00:00:00] Is having a doctor really more dangerous than owning a gun? No, that's ridiculous. And medical error is not the third leading cause of death. Let's debunk this and find out why it's important to do so. Jonathan Jarry is a science communicator with McGill University's Office for Science and Society OSS dedicated to separating scent from nonsense on the scientific stage.
Jonathan Jarry. Thank you so much for being on the podcast. Well, thank you so much for the invitation. So there's this myth that medical error, and it is a myth, so we're gonna be talking about that all show, that medical error is the third leading cause of death in the US after heart disease and cancer, implying that.
Physicians and the healthcare practitioners in general are either careless or incompetent or dangerous. Right. But physicians, we take our patients home with us, not literally, but their complications, their adverse outcomes, they keep us up at night. And so the last thing we need is more of a burden [00:01:00] when it's not correct.
Right. so what I wanna start with is. Is it a myth or is it true that medical error is the third leading cause of death? So it's not true. and it would be surprising if it were, and it's quite scary to find out just how weak the paper is that led to this very, very sticky claim.
So let's start with the original paper, which is, to air as human building, a safer health system that was in the Institute of Medicine. So what was this report? So it was published in 2000 and its heart was absolutely in the right place. It's a 300 plus page report about patient safety, about why errors happen in healthcare, about voluntary reporting systems, how to protect them, about how to design better systems around this topic.
but the problem is that to map out the extent of the problem, it looked at two studies. One was done in Colorado and Utah in 1992 and the other in New York in 1984, and they took numbers from these small and very regional [00:02:00] studies and they extrapolated to all hospital admissions in the United States.
And their conclusion based on this extrapolation was that somewhere between 44,090 8,000 Americans were dying each year as a result of medical errors. Which would place this type of error at least as the eighth leading cause of death in the us, and they define error as the failure of a plan action to be completed as intended, or the use of a wrong plan to achieve an aim.
That seems fine to me, and I'm not a physician, but extrapolating from two limited studies to the entirety of a country. Is problematic. And unfortunately the problem just got worse with a paper that was published years later. And that paper I think was interesting and for one of the reasons, which is a little silly, but I think it bears mentioning, so it was written by one of the co-authors was the current commissioner of the FDA, Dr.
Marty Macari, a surgeon from Hopkins. and it catapulted him in his career, into fame. And it was [00:03:00] medical error, the third leading cause of death in the us. And it was published in the British Medical Journal. And so first starters, I just wanna know why a paper about medical error in the US was published in a British journal .
Well, I mean, I suspect because the BMJ is a highly prestigious journal, I think that at this point the BMJ is no more British than the New England Journal of Medicine is limited to Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Right. So think I'm pressed how quickly I think there's, as a Canadian.
You were able to rattle those off. That was very impressive. But that's the point. I mean, the point is, I think know the BMJ is just at this point is just like the Lancet and the new regional medicine. Yeah. It's just a very prestigious medical journal. Yeah. and of course that, lends a lot of weight to this quote unquote study that was published in it.
And it gets repeated over and over and over again. And I'm trying to add some levity to the situation. I recognize that. so. that was the, follow paper where Dr. McCarry built on to air as human. Right. and then, made these claims that have now become part of the zeitgeist.
And so what were [00:04:00] some of the big flaws where we can say that it really isn't true, that medical error is the third leading cause of death.what you're saying is there was a weak foundation and so then we built upon this weak foundation So this is a publication that keeps getting cited, right?
So 2016 BMJ, as you pointed out, co-written with Michael Daniel, who was at the time a research fellow. This is not a study, it's labeled an analysis and what it really is it's a call for better reporting of medical errors that is backed up by a very troublesome back of the envelope calculation.
And so there are a number of sort of erroneous assumptions that underlie this whole thing. First of all, the studies that were used, much like in the Institute of Medicine report 16 years earlier, they were never meant to be generalized to the entirety of the hospitalized US population. One of these studies was done in beneficiaries of Medicare, so people who are 65 years old or older, people with disabilities, people who have end stage renal disease requiring dialysis or transplant, [00:05:00] are they representative of Americans who are currently in hospital?
No, it's a skewed sample. Turns out that one in 10 people in American hospitals is there to deliver a baby. So here you're not comparing apples to oranges. You are turning apples into oranges to generate your data. So medical errors might be more prevalent in a patient population that requires much more care and many more medical actions than in somebody who is there for a routine birth.
And so it inflates the numbers. Another big problem with Macy's analysis is that. The studies it combines with, rare exceptions, reported very few deaths. One of them had 12 deaths, another had nine and another 14. Those are small numbers, and when you blow them up. To the entirety of the United States, I doubt that extrapolation will be representative, right?
So that extrapolation is kinda like having a small sample size. You've got a small sample size. [00:06:00] Your statistics are not going to be very convincing. And so because they're using a small dataset, the extrapolation is much more likely to be erroneous on, top of another thing, which is, that you talk about in your article, which is it's difficult to determine.
Causality. So it was really interesting to hear from someone that later went on to be a COVID denier, right? Not he didn't deny the existence of it, but rather a minimizer, right? And so how do we know? Well, actually we can listen to my podcast from, a year or two with Jonathan Howard, where he wrote a whole book about these, basically most of the current administration in the United States right now.
and so a lot of what they were saying was. They didn't die of COVID. They died with COVID. Right? And so. The reverse was done in this paper where it's hard to determine did you die of a medical error or did you die with a medical error, right? Like if you were given two medications that interact with each other that you shouldn't, but there wasn't any untoward impact, right?
That led to your demise, but then you [00:07:00] went on to die. Did you die with a medical error? Which you know, you discussed is very hard to determine because if you show that. Two medical experts, they very often disagree whether it was or wasn't a cause of death. So it seems really hypocritical effectively to say people died with COVI, not of COVID.
And yet here you're saying they died of medical errors and not with medical errors. it's a very astute observation and it shows that we're all to one degree or another. We're all driven by motivated reasoning, right? We look for evidence that reinforces what we already believe in, and especially those of us with, university degrees.
We're very good at convincing ourselves that we're being objective and consistent because we read fancy papers, right? And we understand them. And as you point out. again, one of the central criticisms of this BMG McCarry paper about medical errors is indeed that the studies that were used, they looked at medical errors followed by death.
But it doesn't necessarily mean that these errors caused these deaths. [00:08:00] That was a very good commentary, in the BMJ actually about this, by Dr. Shanya and Professor Dixon Woods. And the example they give is of a patient in the ICU with multi-system organ failure due to infection. And the doctor makes a mistake, gives an antibiotic that the patient had an allergic reaction to in the past.
The patient gets a rash, a new antibiotic is prescribed, but then a week later the patient dies from organ failure. Was there a medical error? Yes. Did the rash cause the organ failure? No. So just because an error was made, which is bad, does not necessarily mean that the error caused a death. Are there any other, either erroneous assumptions or egregious extrapolations that you'd like to mention about the Macari paper?
I think that's pretty much it. I mean, those, are the really important points, and those are very, important points. and so when you look at all of these counterarguments, it's really hard to stand by the numbers that, [00:09:00] that are, shown in this analysis.
Again, not even an actual study, because the, underlying data set and how the data set is being used is so egregiously wrong that you can't trust the end result. But why does it matter? Right. Why does it matter? Because we know that medical error is something we should address, right? In the same way the airline industry, anytime there's a crash, right?
Anytime there's an accident, they're gonna rigorously go over what happened and what systems could be put in place to prevent that from happening. And so healthcare really should be using that same kind of rigor. And so whether it's the. Third or the 15th or the 30th leading cause of death. You know, why does it matter where it falls in the statistics?
If we should just continue to do our best to minimize the likelihood of something happening because it can drive patients away from medical care. I mean, when you're saying that medical error is a third leading [00:10:00] cause of death in the United States. That is extremely scary. here are some, spinoffs of the McCarry paper that I've seen online.
So some, exemplifications made using Macy's numbers that I've seen online. I've seen the claim based on this analysis that more Americans are killed in US hospitals every six months than died in the entire Vietnam war. That medical errors kill the equivalent of three fully loaded, jumbo jets crashing every other day.
And that these, errors and injuries are epidemics born of a cult of denial and complacency. So, these are things that people read. And if you're being told that you might think to yourself that going to the hospital for your cancer is a bad idea and instead you go see a naturopath or an acupuncturist or a homeopath, and these alternatives to medicine, they offer very little benefits beyond temporary placebo effects.
While your medical condition progresses. So to me, as someone who reports on pseudoscience for a living, that [00:11:00] is the biggest harm from this grossly inflated number that will not go away is that it's, unnecessarily scaring people away from medicine and, defacto it is seducing people into the arms of.
Unproven and disproven interventions. So you might have answered it already with what you just said, but why do you think this number, despite being so incorrect and debunked, has been so sticky? It taps into primal emotions, right? Fear, disgust, anger. I think that most of us have experienced, if not physical harm from, medicine that at least.
Episodes of being dismissed, of being disbelieved, of, not being given the right diagnosis fast enough. And so this sticky idea of third leading cause of death, it echoes on a much larger scale, these bad experiences. And it also taps into this grand conspiracy theory that a lot of people believe in, which is that medical doctors are uncaring people who are paid [00:12:00] for by the pharmaceutical industry.
And they're there to collect a paycheck. And whatever happens to our patients is none of their concern. And in fact, it's more lucrative to keep a patient sick than it is to heal them. There's a shocking study by Oliver and Wood in jama, internal Medicine, which used a, representative sample of, American adults that were pulled online and it shows that.
Over a third of them, and I will repeat this over a third of them, agree that the FDA is deliberately preventing the public from getting natural cures for cancer because of big pharma. And another third, neither agrees nor disagrees. So this distrust of the medical establishment is deeply entrenched in American life.
So we had an episode, a couple of weeks, or at this point, might be a couple of months ago, with a physician. His name is Jordan. Grumet, he's a hospice physician, but he wrote a book about purpose and what we talked about there is how physicians are not driven by [00:13:00] profit. I mean, certainly we do well with what we do, and there are incentives to either see more patients and unfortunately sometimes do more procedures.
But if we were driven solely by profit, we wouldn't be able to sleep at night because we'd behave so egregiously and As such, we are driven primarily by purpose and our purpose is to help our patients. And if we didn't genuinely believe in our heart of hearts that we doing that we wouldn't be able to sleep at night because we're not.
Psychopaths, right? And so to think that we're withholding cures, people are intentionally doing this on a systemic level. It just shows a complete lack of understanding of how we work as humans. And I think, this works also to dehumanize us, and therefore they can use this statistic to their leverage because that, gets them to think like we're ghouls.
It's horrific to think that people will behave like this. I agree. But, you know, grand [00:14:00] conspiracy theories are very popular. Yeah. and they give people this very simple narrative of good guys and bad guys. And it explains everything that is wrong with the world. It's just these mustache twirling villains who are part of a cabal and they meet in secret that they're manipulating the world.
And of course there is some truth to that. there are power differentials and all that kind of stuff. But, a lot of people believe in these very simplistic narratives. And, it's sad. I mean, I've worked with a lot of medical doctors, you know, back when I was a student and when I was working in a clinical lab and I did a podcast with a cardiologist for many, years.
And, that is not the view of, doctors that I got of like these, mustache twirling villains who are just trying to, earn as much money as they can. These people really care about what they do. They're part of a system that is often, deeply flawed and filled with bad incentives, and they're trying to make the best of it.
I myself, have. been dismissed by certain doctors, and such a thing. I've had a doctor misread a laboratory report, so I've been the [00:15:00] victim of a medical error, though, a fairly minor one. so I understand that when you go through these experiences, and if you're not familiar, if you don't have a doctor in your life and nobody in your family is a doctor, it's easy to authorize this profession.
and to see them as these cold robots who are utterly corrupted by the pharmaceutical industry. but that has not been my experience. I mean, if you're looking for a mustache twirling villain, there are plenty of them out there. They're the ones that manipulate the algorithms so that teenage girls feel more insecure about themselves and causes, mental health issues in middle schoolers.
Right. you're looking for a villain. They're front and center. It's very clear who the villains are in this story. but we, digress. So, I do want to ask, because it's gonna come up in conversation, right? It's gonna get brought up again. We're going to hear it, the listeners are going to hear it.
That medical error is the third leading cause of death. And so how do we push back against [00:16:00] that without. Being dismissive of legitimate patient safety concerns. So I will repeat a point that was made by, Benjamin Maser and Chad Navan, in a publication about this topic that when you look at MCC Carey's highest estimate in his analysis, restaurant napkin, you know, doodle, his highest estimate is that
62% of all hospital deaths are due to medical error. I think that most people, unless they're deeply distrustful of medicine and these people are out there, but I think that most people will acknowledge that it makes no sense that two thirds of people dying in a hospital do so because a doctor or a nurse made a mistake.
I think that's the first part to explain to people. So In order for that to be the actual number, you would need almost two thirds of people in the hospital. Or at least two thirds of hospital deaths to be due to medical error. So in order for it to be the third lead and cause of death, that would need to be the case, [00:17:00] which is absurd, right?
Yeah. and so you can then point out that this was not a study, but it was a clumsy bit of overgeneralization that was filled with major gaps, that we have better, more reliable numbers now, and that the issue is real and that there are no useful fictions in medicine. Amazing. Amazing. is there anything else on this topic that you, because I think we've covered it, I think we've covered it quite thoroughly, but just in case there's something else you wanna discuss, is there anything else, that you think Bears mentioning with, regards to this?
Well, yeah, I mentioned that we have better numbers now. it is genuinely challenging to know because, many people believe that these numbers are under-reported. And I agree with that sentiment. Yeah. People may be afraid of losing their job. if instead of looking at it through the lens of ranking cause of deaths and more as a percentage of hospital deaths, as I mentioned, so again, this top end estimate from the McCarry paper was 62%, which is ridiculous.
what would we have? We have a study in the UK that reported 3.6% of hospital deaths due to preventable medical error. There's a [00:18:00] Norwegian study coming up with 4.2% and there's a meta-analysis, which I believe used worldwide data, that reported an estimate of 5%. For preventable harm with 12% of this 5%, meaning a total of 0.6% dying because of this harm.
So it's much less than what McCarey guesstimated. It's still too much. It's still a real problem. But those are the best numbers that I could find, back when I wrote about this for the McGill Office of Science and Society back in, in 2021. So, what you're saying is it's not 62, but possibly.
Point six. So one, 100th of what was stated. it is much, much, much smaller than what was stated in this incredibly, sticky paper that just will not go away. Yeah. Well. This was a great conversation. I really appreciate one, the article that you wrote, taking it all down and the time you took to talk to us today and all the work you do for science communication.
So, [00:19:00] I've been following you for a long time online, so it's great to finally meet you right. Little fanboy, situation here. But if my listeners wanna find you, wanna follow you as well, where can we find you online? So McGill ca slash oss is the website of our office at McGill. It's an office that is dedicated to separating sense from nonsense, unscientific issues.
it's been in existence since 1999. and so people can go there and read our articles. if people want to find me on social media, pretty much the only place that I'm, still on social media these days is Blue Sky. so they can just, search for my name on Blue Sky and I will pop up.
Excellent. Well, Jonathan, Jerry, thank you so much for your time. Thank you very much for having me.