Talk:A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care

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Quackery[edit]

This entry is the quackery it laments. Instead of being about the titled article, it uses (abuses) it to create an almost evidence-free riff about the imagined harms of quackery. The closest it comes to evidence is a linked newspaper article reporting that "Eighty-six people have been accidentally killed by badly trained acupuncturists over the past 45 years" by acupuncture. Readers are supposed to be horrified by that, not the likely more than 400,000 annual deaths in American hospitals estimated by the author of the titled article. The entry is so speculative and preposterous that it should cause anyone with a dispassionate interest in the topic to burst out laughing. If it is characteristic of what passes for rational on this site, I'm in for hours of great comedic entertainment. Nicmart (talk) 14:25, 23 November 2015 (UTC)

The reader should - and probably is - disturbed by the accident rate in hospitals. What is more disturbing is those evil quacks who use this accident rate to promote snake-oil like acupuncture.
You are more disturbed by promotion of quackery than by hundreds of thousands of actual deaths and millions of injuries. That says what about your values? Nicmart (talk) 15:14, 23 November 2015 (UTC)

Acupuncture may not harm you but neither will it cure you. Doxys Midnight Runner (talk) 14:45, 23 November 2015 (UTC)

It probably doesn't cure, but there is evidence that it has analgesic properties. Does ibuprofen "cure you." (Generally speaking, it is illness that we want to cure, not ourselves.) Nicmart (talk) 16:29, 23 November 2015 (UTC)
It's also about the response to the article, not the article, as it states in the opening paragraphs. 400,000 is the amount of preventable harms estimated...not deaths. If you want dispassionate truthful conversations it doesn't help to open the conversation with falsehoods. -EmeraldCityWanderer (talk) 14:50, 23 November 2015 (UTC)
Try reading it. From the Pubmed abstract: "Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm." [Emphasis added to assist poor readers.] Now you can retract your falsehood. Nicmart (talk) 15:11, 23 November 2015 (UTC)
Well, EmeraldCityWanderer, I'll patiently await your mea culpa. That the 400,000 refers to deaths rather than the "amount (sic) of preventable harms estimated" is even stated in the entry itself. I'm the only one who seemed to notice or to mind that you misstated it here among these valiant pursuers of Truth. Nicmart (talk) 16:45, 23 November 2015 (UTC)
Nic, I agree on this issue. Thanks for pointing out that one person messed up and then castigating the rest of us for it. FuzzyCatPotato of the Throbbing Bistros (talk/stalk) 18:05, 23 November 2015 (UTC)
Nic, notice how there's an immense lack of information surrounding alternative medicine, because there aren't any reporting mechanisms? Meaning that you cannot compare death or harm rates between alternative and mainstream medicine? And yet alternative medicine pushers do exactly that, and claim to be the ones with the best rates? Yeah. That's why this article exists. FuzzyCatPotato of the Sheer Chiffons (talk/stalk) 15:06, 23 November 2015 (UTC)
The entry should be about the study which provides the title, not another topic for another entry. Nicmart (talk) 15:11, 23 November 2015 (UTC)
It isn't. Shoo. SockTheory 15:13, 23 November 2015 (UTC)
Nic, can you imagine how the misuse of scientific publications might be more important than the publication itself? FU22YC47P07470 (talk/stalk) 15:15, 23 November 2015 (UTC)
The major misuse I've seen is this entry, which uses the study as ideological cover for poorly sourced attack on quackery.Nicmart (talk) 15:18, 23 November 2015 (UTC)
[EC] How is the study used to "cover" an attack on quackery? It's explaining how it's often impossible to compare alternative medicine (and so using this study to hate on allopathy is dumb) and, in some of the instances where alternative medicine has been examined, it's often been found wanting. oʇɐʇoԀʇɐϽʎzznℲ (talk/stalk) 15:21, 23 November 2015 (UTC)
The small fact that there is hardly anything about the details of the study is a clue. This entry's huge contribution is to provide an article in The Guardian newspaper claiming that dozens of people have been killed over 45 years by acupuncture. That's akin to the fear-mongering over vaccines, GMO, artificial sweeteners, and the rest. Mencken covered quackery a whole lot more honest and more funny a century ago. Nicmart (talk) 15:36, 23 November 2015 (UTC)
Actually, I think the article's most important point is that "unlike hospital deaths, which are increasingly well-reported, deaths from acupuncture or herbal medicine or faith healing or almost any alternative medicine have effectively no reporting system. It's entirely possible that alternative medicines kill at higher rates than allopathic medicines. Little is known due to the lack of regulation on supplements and treatments until regulators start looking into incidences of people being hospitalized at legitimate medical centers." FuzzyCatPotato!™ (talk/stalk) 17:58, 23 November 2015 (UTC)
Do you have improvements to suggest? You know this is a wiki and you can edit it (though it is often a good idea to discuss large changes first)? I'm open to the idea of making this article more about the study and shunting off some discussion of the abuse of statistics by quacks to another article. --Ymir (talk) 15:29, 23 November 2015 (UTC)
I know better than to adjust the work of true believers. It would be like trying to convince Jenny McCarthy that vaccines are safe. Nicmart (talk) 15:32, 23 November 2015 (UTC)
Then why talk here? The FCP Foundation (talk/stalk) 18:05, 23 November 2015 (UTC)

"(Mostly) valid"[edit]

"The study itself appears (mostly) valid.." That is a value judgement that requires proof. If the study is "mostly" valid then some of it must not be valid. What part is that? Why is that part not identified? Why is no evidence offered to show which portion is not valid? Nicmart (talk) 15:45, 23 November 2015 (UTC)

No study is entirely valid. No one is disputing the scale of accidental deaths in hospitals. What's your point? Doxys Midnight Runner (talk) 15:47, 23 November 2015 (UTC)
No study is entirely valid? Absolute nonsense, but let's pretend you are right, then there is no reason for this entry to claim this study is "(mostly) valid" unless it explains what part is not valid. Nicmart (talk) 15:55, 23 November 2015 (UTC)
I see no problem with changing that part. But it doesn't change to tone of the article. There is still a serious problem with woo merchants using accidental deaths in hospital to push cures which don't work. Doxys Midnight Runner (talk) 15:57, 23 November 2015 (UTC)
So, about 10 percent of the article is sloppily devoted to the study, and the rest to grinding axes. Very proportionate. Nicmart (talk) 15:59, 23 November 2015 (UTC)
We're not a web site looking at care in hospitals, we're a web site dealing with woo pushers. Therefore we look at this study as something misused by woo pushers. And I've removed the 'mostly'. Doxys Midnight Runner (talk) 16:02, 23 November 2015 (UTC)
So, apart from a minor quibbling over the word 'mostly' your only problem is with the focus of the article? Or do you have any other problems? Doxys Midnight Runner (talk) 16:04, 23 November 2015 (UTC)
It purports to be something which it is not: an article about a study, not a badly sourced and written think piece about quackery. It might has well start as "Sexy New Swimsuits Highlight Fall Collection," and quickly move on to the actual purpose of the entry. It's clickbait and then a lot of unproved hints about how dangerous quackery is. If there is not much data about the hazards of quack remedies, that's because they don't do much harm. It's easy to prove, and has been proven, that they don't do much good, but their alleged harm is nowhere near that of conventional medicine. Produce one study that puts quack health remedies among the top 30 causes of death. Nicmart (talk) 16:23, 23 November 2015 (UTC)
1: The article is about the study, in particular the public's reception of said study.
2: Clickbait? Do you get unwittingly drawn in by scientific journal titles?
3: If there is not much data about the hazards of quack remedies, that's because they don't do much harm. This is ridiculous. The article clearly explains why there's not much data about quack remedies -- it's not being collected. That doesn't mean that there aren't harms to be reported.
4: Produce one study that puts quack health remedies among the top 30 causes of death. Perhaps you fail to understand the relative scale of the allopathic vs alternative medicine, or that many modern alternative medicine treatments kill people not through being lethal, but by making people turn away from allopathic medicine and die of "natural" causes, which would not be reported as such. 18:03, 23 November 2015 (UTC)

Now the entry has been changed to "The study itself appears valid." Valid to whom? When held under a bright light? What does this mean, and what evidence is adduced to support this assertion? Nicmart (talk) 16:37, 23 November 2015 (UTC)

It means that we don't think the study is false. Are you finished JAQing off yet? Herr FuzzyKatzenPotato (talk/stalk) 18:03, 23 November 2015 (UTC)

The number[edit]

Having just finished reading the report, I think I may have found a very significant error in the calculation of the 210,000. Dr James multiplies the number of hospital admissions (33.4m) by the percentage of adverse events that were preventable (69%) by the percentage of adverse events that were fatal (0.89%). It seems to assume that every hospital admission has an adverse event. The previous estimate was based on a adverse event percentage of 3.7% (although had a much higher fatality rate of 13%).203.3.232.28 (talk) 05:40, 18 January 2016 (UTC)

Yeah, that is odd.

Among the records reviewed, there were 38 total deaths associated with adverse events. The ratio projects to a death rate from adverse events of 0.89%. This is well below the percentages from Medicare and tertiary-care studies (1.1%–1.4%) and well above the data from the North Carolina study (0.60%). There were an estimated 34.4 million hospital discharges in 2007,26 and the average percentage of preventable adverse events among all adverse events in the 3 studies where this was reported or postulated was 69% (averaged from Table 2). Thus, the best estimate from combining these 4 studies is 34,400,000 × 0.69 × 0.0089 = 210,000 preventable adverse events per year that contribute to the death of hospitalized patients—based primarily on evidence in hospital medical records found by the GTT method.

"34,400,000 [million discharges per year] * 0.69 [preventable adverse events per adverse event] * 0.0089 [deaths per adverse event]" does not equal "210,000 preventable adverse events per year that contribute to the death of hospitalized patients".
And Table 2 only seems to support this.
Am I misreading this? Sir ℱ℧ℤℤϒℂᗩℑᑭƠℑᗩℑƠ (talk/stalk) 16:26, 18 January 2016 (UTC)
Seems like the math is close (outside of rounding) 34,400,000 * 0.69 * 0.0089 is 211,250.40. Which is inline to the CDC's hospital inpatient care stats of about 35 million with a ALOS of 4.8 days (first one I found is from 2010). I question using adverse events stats to just IP admits, where OP visits (2010 125 million) and ED visits (2010 136 million) are much higher, while the "adverse event stats" don't really differentiate I could find. In outpatient settings, especially ED settings, these events can be much higher due to rushed circumstances or lack of information. I didn't really see where it detailed the rates out...and how stringently they put the cutoff to "adverse events". Which can be everything from minor hypoglycemia or a tech having to go to a bathroom while monitoring a patient...to wrong medications given resulting in death. -EmeraldCityWanderer (talk) 17:17, 18 January 2016 (UTC)