# Routine Autopsies
**URL:** https://boards.straightdope.com/t/routine-autopsies/727854
**Category:** Cecil's Columns/Staff Reports
**Created:** [August 14, 2015, 5:37pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854 "2015-08-14T17:37:49Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)
#### Post date: [August 14, 2015, 5:37pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/1 "2015-08-14T17:37:49Z")
I’ve a couple three observations about the article [“Is medical error the third leading cause of death in America?”](http://www.straightdope.com/columns/read/3242/is-medical-error-the-third-leading-cause-of-death-in-america) and a comment extending **The Master’s** line-of-reasoning.
> [@](#):
>
> As critics of the 1999 report pointed out, that 13.6 percent of patients who died in the New York study all had life-threatening conditions in the first place …
That would mean that 86.4% of patients who died in NY hospitals _didn’t_ have a life threatening condition until they were actually _in_ the hospital. Does that mean 5 out of every 6 people who walk into a hospital and die would be alive today if they hadn’t walked into the hospital? Cathedrals of Death indeed …
> [@](#):
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> they concede that had the adverse events not occurred, the life expectancy for many terminally ill patients wouldn’t have been improved
If a patient has an illness for which no amount of medical intervention will save their lives, and the medical intervention is mistake-free, the patient still dies … okay … makes perfect sense … though it’s not really clear what this fact has to do with death rates due to mistakes in non-terminal patients … if patients are terminal, they’ll be dying anyway.
> [@](#):
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> errors may just be part of the game.
Errors happen in the game of baseball, but it’s just a stupid game and no one dies. Errors happen in commercial air travel, and every one that results in death is thoroughly investigated and corrections implemented. If some part on a car is prone to failure and is linked to some deaths, every car effected will be recalled and a better part installed. How would we feel if the EPA said toxic spills is just part of the game, get over it … and, no, we have no idea how common mines are like the Gold King mine.
This doesn’t seem the case with hospitals. **The Master** elegantly and correctly disputes what statistics are available, but **He** doesn’t give us any better … simply because none are available. Hospitals do not routinely conduct autopsies, so there’s no verification of the doctor’s cause of death. Errors aren’t even looked for, yet people are dying.
Paying this kind of money deserves better value.
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### Author:  [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)
#### Post date: [August 14, 2015, 8:08pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/2 "2015-08-14T20:08:08Z")
> [@watchwolf49](#):
>
> That would mean that 86.4% of patients who died in NY hospitals _didn’t_ have a life threatening condition until they were actually _in_ the hospital. Does that mean 5 out of every 6 people who walk into a hospital and die would be alive today if they hadn’t walked into the hospital? Cathedrals of Death indeed …
I think you misunderstood what Cecil was saying. The key passage:
> [@Cecil](#):
>
> (The figures) relied in part on a study of 30,000 records from New York hospitals in 1984, which researchers used to calculate the rate of adverse events per hospitalization (3.7 percent), how many were due to negligence (27.6 percent), and how many led to death (13.6 percent), and then weighted the numbers to estimate figures for the state overall…As critics of the 1999 report pointed out, that 13.6 percent of patients who died in the New York study all had life-threatening conditions in the first place, but the authors never establish a baseline rate for how many would have died anyway; they concede that had the adverse events not occurred, the life expectancy for many terminally ill patients wouldn’t have been improved, but don’t work this into their death figures.
As I understand it, Cecil is saying that of the total number of patients affected by “adverse events” (a little over one-quarter of which were ascribed to negligence), 13.6% died, and that all patients in that group had life-threatening medical conditions - NOT that 86.4% of deaths in the medical error group involved patients with non-life threatening conditions.
Of course, “life-threatening” does not equate to “would have died anyway no matter what we did”. Still, the points raised in the article are valid, and should make one cautious about accepting the “third-leading cause of death” proposition.
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### Author:  [@Chronos](https://boards.straightdope.com/u/Chronos)
#### Post date: [August 15, 2015, 3:52pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/3 "2015-08-15T15:52:50Z")
Cecil doesn’t go far enough in his analysis. Suppose, for instance, we have a patient who’s just been diagnosed with insulin-dependent diabetes. With proper ongoing treatment, such a patient can live nearly as long as a healthy individual, with high quality of life. Without proper ongoing treatment, such a patient will die very quickly. Now suppose that the doctor who prescribes the insulin makes a typo on the prescription, and gives a much smaller dose than is appropriate. The patient doesn’t get the needed insulin, and dies. This is very clearly a medical error, and the patient died, and if it weren’t for the medical error, the patient would have lived. But what is the cause of death? You can say that the error was the cause of death, but it’s perhaps even more fair to say that the diabetes was the cause of death: If the patient had had no medical attention at all, the result would have been the same, or worse (the insufficient dose of insulin might have been enough to stave off death for a short time). But if the patient hadn’t had diabetes, there would have been no problem at all.
Of course, this is on top of the fact that lists of the _n_ leading causes of death are always problematic to begin with, as they depend on just how you’re classifying causes of death. We could call the causes of death “Accidents”, “Disease”, and “Homicide”, or we could break that down into categories like “car accidents” and “heart disease” and “firearm murders”, or we could break it down into silly things like “Accidents involving red Hondas”.
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### Author:  [@sevenwood](https://boards.straightdope.com/u/sevenwood)
#### Post date: [August 15, 2015, 6:30pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/4 "2015-08-15T18:30:20Z")
> [@Chronos](#):
>
> or we could break it down into silly things like “Accidents involving red Hondas”.
OMG! My wife drives a red Honda! She’s doomed!
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### Author:  [@Irishman](https://boards.straightdope.com/u/Irishman)
#### Post date: [August 16, 2015, 5:33am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/5 "2015-08-16T05:33:36Z")
> [@watchwolf49](#):
>
> That would mean that 86.4% of patients who died in NY hospitals _didn’t_ have a life threatening condition until they were actually _in_ the hospital. Does that mean 5 out of every 6 people who walk into a hospital and die would be alive today if they hadn’t walked into the hospital? Cathedrals of Death indeed …
No, as **Jackmannii** said, you have misread. What Cecil says the critics point out is that 13.6% of the cases in the study had fatal outcomes, and all 13.6% had life-threatening conditions to begin with. That doesn’t mean all 13.6% would have died, but there doesn’t seem to be any accounting for how many would have died despite the best medical intervention, no errors.
How can you measure the seriousness of the error if you don’t account for the cases where the bad outcome was not due to the error?
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### Author:  [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)
#### Post date: [August 16, 2015, 4:53pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/6 "2015-08-16T16:53:41Z")
Misunderstandings can indeed lead one to plug numbers that distort the conclusions one can get.
It is fascinating to me to check what doctors and experts reported about the issue, and the most important item here is that there was a lower estimate that was ignored in favor of the higher one was then used by the mainstream media then.
[http://ecp.acponline.org/novdec00/dentzer.htm](http://ecp.acponline.org/novdec00/dentzer.htm)
> [@](#):
>
> Perhaps it was only fitting that news coverage of the Institute of Medicine’s (IOM) report on medical errors should start with a slip-up. When the IOM distributed its meaty 223-page report last year, it imposed a routine press embargo to give journalists sufficient time to review the document carefully before the contents were made public. But NBC’s health correspondent, Robert Bazell, obtained a copy ahead of time, outside of the normal IOM distribution process.
>
> Feeling free to ignore the embargo, he broke the story on November 29, 1999, two days before the embargo was to have been lifted. As a result, the report’s dramatic conclusions–especially the projection that anywhere from 44,000 to 98,000 Americans would die in 1999 from errors in hospitals–led that evening’s NBC and ABC evening news broadcasts, even though the news conference at which the IOM was planning to unveil the document was still two days away.
> [@](#):
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> Probably the single most important factor in the saturation coverage was how the media conveyed the sources and method used in the IOM report to estimate the number of Americans killed by medical errors in hospitals. These numbers were derived from data from two large previous studies of adverse events–a then-unpublished study of adverse events in Colorado and Utah and the well-known Harvard Medical Practice Study of adverse events in New York hospitals published in The New England Journal of Medicine in 1991. As explained in the executive summary of the IOM report:
>
> When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors. The results of the New York Study suggest the number may be as high as 98,000. (1)
>
> When this paragraph was distilled in the popular press, however, all subtleties were lost. First to go was the lower-range estimate of 44,000; in follow-up stories, even reporters for The New York Times and The Washington Post referred only to the high-end estimate of 98,000. Only a handful of news stories clarified that both of these estimates were based on extrapolations from the Colorado-Utah and New York studies, at least one of which was 15 years old. Nor was it widely noted that these numbers at best refer only to estimated deaths in hospitals, rather than to total deaths from errors throughout the health care system–a significant omission now that more than half of all surgical procedures takes place outside of a hospital setting. (2)
Still, as I read in other articles, even if it was just 20,000 a year, it was important to do something about it, and there was progress made in items like electronic records and advances in technology to help prevent errors.
More about the media misunderstandings from the AMA can be found here:
> **[To Err is Human: Understanding the Data](https://journalofethics.ama-assn.org/article/err-human-understanding-data/2004-03)**
>
> The Institute of Medicine's ground-breaking report on medical errors has helped to make patient safety a priority goal, but the findings of the report are often interpreted by the media.
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### Author:  [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)
#### Post date: [August 16, 2015, 5:15pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/7 "2015-08-16T17:15:14Z")
> [@Chronos](#):
>
> Cecil doesn’t go far enough in his analysis …
I agree, however how much further can we carry out the analysis with the data we have without venturing into pure speculation? Just seems very strange that of all human endeavors, health care seems to have almost no effective oversight. In your example, the doctor just writes down “death due to diabetes” perhaps never knowing about the typo. If no one tells the doctor he’s prone to typos, he’ll just keep making them …
> [@Irishman](#):
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> No, as **Jackmannii** said, you have misread …
Yes, I get it … I whooshed myself !!!
> [@sevenwood](#):
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> OMG! My wife drives a red Honda! She’s doomed!
She’s fine, it’s everyone else who’s doomed [grin].
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### Author:  [@kopek](https://boards.straightdope.com/u/kopek)
#### Post date: [August 17, 2015, 12:19am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/8 "2015-08-17T00:19:03Z")
> [@sevenwood](#):
>
> OMG! My wife drives a red Honda! She’s doomed!
> [@watchwolf49](#):
>
> She’s fine, it’s everyone else who’s doomed [grin].
Of course, I did note that he didn’t specify if that was a _good_ OMG/thing or a _bad_ OMG/thing. With some of the people I know around here, it would take further research to be sure.
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### Author:  [@jinni73](https://boards.straightdope.com/u/jinni73)
#### Post date: [August 17, 2015, 8:17am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/9 "2015-08-17T08:17:34Z")
> [@Irishman](#):
>
> No, as **Jackmannii** said, you have misread. What Cecil says the critics point out is that 13.6% of the cases in the study had fatal outcomes, and all 13.6% had life-threatening conditions to begin with. That doesn’t mean all 13.6% would have died, but there doesn’t seem to be any accounting for how many would have died despite the best medical intervention, no errors.
>
> How can you measure the seriousness of the error if you don’t account for the cases where the bad outcome was not due to the error?
good point but the medical industry also ignore advice and are not allowed to tell patients if a natural treatment would work Here are 3 examples of how its done in Australia.
in the 1940s two medical doctors who were brothers called Shute discovered that Vitamin E was essential to preventing heart disease all of the doctors ignored this advice and when it was tested in the 1980s and confirmed it, it would of prolonged 500,000 peoples lives by an extra 20 years.
A friend of mine had marijuana poisoning in his liver and the hospital staff could do nothing and were even dubious of his claims that he was not an alcoholic his stomach was in intense pain and the only thing that relieved it was to take showers then a specialist came to see him who had written a book on the subject and confidentially told him to take two herbs one being slippery elm bark he can’t remember the other but it maybe silymarin the doctor told him If the hospital found out he would lose his job even though they had no cure to it.
1000 people a year were dying purely because the hospitals were not doing a magnesium test they did not change the rules for quite a while.
the hospitals are not what you think up to 90% of nurses doctors contain the MRSA virus in there mouths/throats yet elderberry juice has been proven to prevent this virus so how many people are being infected only 40% of people are now given an autopsy over here as well.
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### Author:  [@jinni73](https://boards.straightdope.com/u/jinni73)
#### Post date: [August 17, 2015, 8:23am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/10 "2015-08-17T08:23:35Z")
and one other thing is how many people die from arthritis every year, arthritis can be cured with boron and magnesium yet your pharmaceutical companies are getting your governments to ban Boron,
both governments and pharmaceutical corporations are doing an extremely suspicious job of sacrificing American and European lives to further there own pockets.
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### Author:  [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)
#### Post date: [August 17, 2015, 12:39pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/11 "2015-08-17T12:39:33Z")
Doctors bury their mistakes, no questions asked.
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### Author:  [@Chronos](https://boards.straightdope.com/u/Chronos)
#### Post date: [August 17, 2015, 12:46pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/12 "2015-08-17T12:46:06Z")
> [@](#):
>
> Quoth **jinni73** :
>
> good point but the medical industry also ignore advice and are not allowed to tell patients if a natural treatment would work
Correction: They’re discouraged from telling patients about them at all unless it’s confirmed that they do work. The medical establishment has nothing at all against natural treatments, and in fact they’re all over the place. What the medical establishment has something against is treatments that don’t work. Many natural treatments cause harm, potentially great harm, and it’s not always known which ones.
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### Author:  [@grude](https://boards.straightdope.com/u/grude)
#### Post date: [August 17, 2015, 1:01pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/13 "2015-08-17T13:01:29Z")
> [@jinni73](#):
>
> A friend of mine had marijuana poisoning in his liver
:dubious:
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### Author:  [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)
#### Post date: [August 17, 2015, 1:15pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/14 "2015-08-17T13:15:29Z")
> [@jinni73](#):
>
> good point but the medical industry also ignore advice and are not allowed to tell patients if a natural treatment would work
Oh, bull.
Physicians can and do recommend “natural” treatments; if however they push (or worse, sell) unproven therapies and supplements for serious ailments where effective treatments exist (and patients come to harm) they may well get into big trouble.
> [@jinni73](#):
>
> both governments and pharmaceutical corporations are doing an extremely suspicious job of sacrificing American and European lives to further there own pockets.
News flash: the “medical industry”, “governments” and “pharmaceutical corporations” are made up of millions of people, all vulnerable to the same diseases as the rest of us, along with all their friends and families. If these supposedly marvelous “natural” treatments worked, they’d jump to use them. Nobody is sacrificing his/her life and the the lives of their loved ones to “further there own pockets”.
Getting back to Cecil’s article, I do think the tone is a bit overly weighted toward “we’re all human and make mistakes”. There’s a lot that can be and is being done to prevent medical errors, both voluntarily and with nudges from payers.
Contrast those efforts with the spectacular lack of initiative by “natural” treatment providers, for whom quality improvement is a foreign term, and who hardly ever dump a therapy or drug that is shown to be useless and/or harmful.
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### Author:  [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)
#### Post date: [August 17, 2015, 2:34pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/15 "2015-08-17T14:34:00Z")
> [@Chronos](#):
>
> Correction: They’re discouraged from telling patients about them at all unless it’s confirmed that they do work. The medical establishment has nothing at all against natural treatments, and in fact they’re all over the place. What the medical establishment has something against is treatments that don’t work. Many natural treatments cause harm, potentially great harm, and it’s not always known which ones.
Additionally, natural treatments all start with a _ **healthy diet** _. If you’re eating right, then your own body will use his/her/its natural defenses against most any illness.
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### Author:  [@outlierrn](https://boards.straightdope.com/u/outlierrn)
#### Post date: [August 17, 2015, 5:11pm UTC](https://boards.straightdope.com/t/routine-autopsies/727854/16 "2015-08-17T17:11:32Z")
MRSA is a bacteria, not a virus.
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### Author:  [@Irishman](https://boards.straightdope.com/u/Irishman)
#### Post date: [August 19, 2015, 7:24am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/17 "2015-08-19T07:24:06Z")
**jinni73** , I call “bullshit”.
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### Author:  [@qazwart](https://boards.straightdope.com/u/qazwart)
#### Post date: [August 20, 2015, 1:54am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/18 "2015-08-20T01:54:30Z")
> [@Irishman](#):
>
> **jinni73** , I call “bullshit”.
And bullshit is a proven natural treatment for psoriasis!
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### Author:  [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)
#### Post date: [August 20, 2015, 2:10am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/19 "2015-08-20T02:10:43Z")
> [@Irishman](#):
>
> **jinni73** , I call “bullshit”.
No kidding, what’s suspicious about these published returns on investment?
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### Author:  [@jinni73](https://boards.straightdope.com/u/jinni73)
#### Post date: [August 20, 2015, 6:50am UTC](https://boards.straightdope.com/t/routine-autopsies/727854/20 "2015-08-20T06:50:24Z")
> [@grude](#):
>
> :dubious:
Wow ok he had poisoning in his liver because of marijuana consumption.
all those that think the doctors don’t do this you do not have a clue this is the top specialist in Australia and his words out of his mouth were that he would get the sack.
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