Sunday, 1 August 2021

More Good News about Bad News

    In a recent argument about alternative medicine, someone showed me the link to this article, about how medical errors are the third leading cause of death in the U.S. My opponent in this debate was trying to make the point that we shouldn't trust modern medicine so much, because doctors make so many mistakes. Now, this is an infuriatingly common strategy, screaming and hollering about how often science has been wrong and therefore we shouldn't trust those scientists and so by default we should turn to whoever is screaming and hollering as if mistakes not screamed and hollered about don't exist. 

    But I'm not going to rant about that particular rhetorical ploy now. Instead, I want to talk about why it's actually amazingly good news, if more deaths are attributable to medical errors. Indeed, I would want to argue that the best possible case would be if 100% of deaths were caused by medical errors.

    Consider. If 100% of all deaths were caused by medical errors, that would mean that nobody ever died of anything else. In other words, there would be no circumstance in which a doctor could sadly tell a grieving family, "I'm sorry, we did everything we could, but the injuries were just too severe" or the disease had no cure or whatever. Every potential cause of death could be cured if only no errors had been made. If 100% of all deaths were the result of medical error, that would mean that medical science had advanced to a point where we were in principle immortal, because medicine applied without error could always save us. 

    Statistics are tricky. It's really easy to misinterpret what they mean, especially if you don't look at the full context. A similar argument can be made about rising cancer mortality rates, which is also potentially good news overall, depending on what is happening with average lifespans. Cancer is one of those things that you can, as a rough approximation, associate with old age: the older you get, the more opportunities there are for oncogenic mutations, and the more time there is for tiny proto-tumours to develop into life-threatening ones. (You, yes you, actually have several of these tiny prototumours right now, but they may take longer than your natural lifespan to become dangerous.) So if it's reported that more people are dying of cancer than they used to, that can actually be evidence that we're getting better at preventing earlier deaths from other things. The more people die of old age related illnesses like cancer, the more successful we have been at helping people live longer. It's not that cancer is becoming a bigger threat; it's that all the other threats are getting smaller.

    So obviously, if doctors are becoming more careless and making more mistakes, that's a bad thing, and naturally we want them to make fewer mistakes than they are, no matter how many or how few they're making. But statistically, pointing out that a larger proportion of deaths are due to medical error doesn't mean medicine is untrustworthy. It may actually mean the very opposite.


  1. I always look at myself as a very Aging Organism and if I were a Machine I would have been obsolete or likely broken down long before I actually have as a Human Being granted the privilege of attaining Old Age. All Doctors are Mortals, so none are without some margin of error and some mistakes. I'd venture to guess that unless they were grossly negligent ones, the percentage of Success they had far outweighs the percentage of Mistakes they've made during their Careers. We always tend to fixate upon the most Negative things that happen, however tragic they may be, I would say most people who choose the Medical Profession, did so to make a Positive difference and to Save Lives.

  2. Your perspective is interesting. More deaths by cancer does mean that the things that killed people at a younger age are much more under control. I never thought of applying it to the mistakes doctors make.
    I'm guessing there must be studies about what mistakes are most prevalent and why they occur?

    1. I don't know the specific details of what kinds of mistakes are common, but these are all addressable problems. We can and should make any particular kind of medical error rarer, and we can and should always be trying to reduce the absolute numbers of medical error deaths.

      But a very important number left out of these sorts of rankings is that absolute number, and the absolute number of other deaths. If I can trade a 10% chance of getting killed by [A, B, C or D] cause for a 1% chance of getting killed by [A, C, or E], the fact that my risk of dying from E has increased is a tiny price to pay for the fact that my risks from A, B, C and D has dropped so much more.