Friday, August 27, 2010

Tainted Eggs and Scrambled Tubing

Tainted Eggs and Scrambled Tubes
Two recent news stories caught my eye. Both are fairly common stories of public health hazards, but the results and reaction to both are stunningly different. Where do the real dangers lie? You decide.
Recall expands to more than half a billion eggs
“Investigation of nationwide salmonella outbreak expands to 2nd Iowa farm
A half-billion eggs have been recalled in the nationwide investigation of a salmonella outbreak that Friday expanded to include a second Iowa farm. More than 1,000 people have already been sickened and the toll of illnesses is expected to increase.” (so far, no deaths)
How many times have we heard this story of a ‘nationwide salmonella outbreak; be it hamburger meat, tomatoes, spinach, and now eggs? In any event, the response to this public health hazard, where occasionally a few people die and many are made ill, is swift, decisive and far-reaching. The meat-packing plant and/or farm producer is shut down, and there are massive nationwide recalls of the suspected tainted animal or plant product.
Headline #2: NYTimes 08-20-2010, by Gardiner Harris
U.S. Inaction Lets Look-Alike Tubes Kill Patients
“Thirty-five weeks pregnant, Robin Rodgers was vomiting and losing weight, so her doctor hospitalized her and ordered that she be fed through a tube until the birth of her daughter.
But in a mistake that stemmed from years of lax federal oversight of medical devices, the hospital mixed up the tubes. Instead of snaking a tube through Ms. Rodgers’s nose and into her stomach, the nurse instead coupled the liquid-food bag to a tube that entered a vein.
Putting such food directly into the bloodstream is like pouring concrete down a drain. Ms. Rodgers was soon in agony. They soon learned that the baby had died…And then Robin Rodgers — 24 years old and already the mother of a 3-year-old boy — died on July 18, 2006, as well.
Their deaths were among hundreds of deaths or serious injuries that researchers have traced to tube mix-ups. But no one knows the real toll, because this kind of mistake, like medication errors in general, is rarely reported(*1). A 2006 survey of hospitals found that 16 percent had experienced a feeding tube mix-up.
Experts and standards groups have advocated since 1996 that tubes for different functions be made incompatible — just as different nozzles at gas stations prevent drivers from using the wrong fuel. But action has been delayed by resistance from the medical-device industry and an approval process at the Food and Drug Administration that can discourage safety-related changes."
How many times have we heard this story of doctor/treatment-induced (iatrogenic) patient death; be it from unnecessary surgery, to hospital-acquired infections, to adverse drug reactions, and medical tubing mix-ups, among others?
However, contrary to salmonella outbreaks where many are sickened and few, if any die, medical mishaps, which are ‘rarely reported,’ are killing people, an estimated 800,000 people per year, and are, by far, the leading cause of death and injury in the U.S. To be fair, ‘to err is human,’ and many presenting patients are seriously ill requiring drastic measures that raise all risks. However, even if 800,000 deaths per year is a gross exaggeration by a factor of four, 200,000 (*2) deaths per year by medical error would still be one of the leading causes of death.
There just is no comparison between illness and death caused by salmonella and those caused by medical error.
However, unlike the reaction to a salmonella scare, the response to chronic widespread, systemic medical mishaps is dismissal, denial and obstructionism by the AMA, the pharmaceutical companies, manufacturers of medical devices, and the FDA.
They have us afraid of the wrong things.
Important Notes:
(*1) "More than 250,000 side effects linked to prescription drugs, including injuries and deaths, are reported each year. And those "adverse-event" reports by doctors and others are only filed voluntarily. Experts, including Strom, believe the reports represent as few as 1% to 10% of all such events. "There's no incentive at all for a physician to report [an adverse drug reaction]," said Strom, who has documented the phenomenon. "The underreporting is vast."
(*2) JAMA. 12-21-1994 Error in medicine: "180,00 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jets crashes every 2 days." This is what was acknowledged in 1994. In light of note (*1) above..."the under-reporting is vast," 180,000 represents only a fraction of the problem, perhaps as little as 1% to 10%. And, the problem has only gotten worse since then.

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