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MODERN MEDICINE

The third-leading cause of death

in US most doctors don't want
you to know about
A recent Johns Hopkins study claims more than 250,000 people in the U.S. die
every year from medical errors. Other reports claim the numbers to be as high as
440,000.
Medical errors are the third-leading cause of death after heart disease and
cancer.
Advocates are fighting back, pushing for greater legislation for patient safety.

Ray Sipherd, special to CNBC.com

Published 9:31 AM ET Thu, 22 Feb 2018 | Updated 9:39 AM ET Wed, 28 Feb 2018
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MODERN MEDICINE
Courtesy of Chris Jerry
Modern Medicine: Gene therapy for
Emily Jerry was two years old when she lost her life after a pharmacy technician filled her
intravenous bag with more than 20 times the recommended dose of sodium chloride. hemophelia  

"My little angel" is how Christopher Jerry describes his daughter James A grandpa's hope for hemophilia cure
Emily. Addie with leads him to gene therapy clinical trial 
his BioMarin's clinical trial of a gene therapy for
At just a year and a half, Emily was diagnosed with a massive grandson Andrew
hemophilia is providing hope to patients with
the disease. It is an experimental treatment that
Michael.
abdominal tumor and endured numerous surgeries and rigorous uses a virus to deliver a healthy copy of a gene
Both to make up for one that causes excessive
chemotherapy before finally being declared cancer-free. But just to have hemophilia.
bleeding. 
be sure, doctors encouraged Chris and his wife to continue with
Emily's last scheduled chemotherapy session, a three-day treatment Big Big pharma companies vie for hemophilia
that would begin on her second birthday. pharma gene therapy breakthrough  
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On the morning of her final day of treatment, a pharmacy technician A flu shot If you have not gotten your flu shot yet,
being now might be the best time
prepared the intravenous bag, filling it with more than 20 times the
administered The effectiveness of the flu shot wanes over
recommended dose of sodium chloride. Within hours Emily was on in Concord, time so it's best not to get it too early in the
season, according to several recent studies. It
life support and declared brain dead. California.
takes 10 to 14 days to get the vaccine levels in
your system so you are protected. 
Three days later she was gone.

Sadly, Emily's case is not unique. According to a recent study by

Johns Hopkins, more than 250,000 people in the United States die MORE FROM MODERN MEDICINE

every year because of medical mistakes, making it the third leading
cause of death after heart disease and cancer.
Other studies report much higher figures, claiming the number of
deaths from medical error to be as high as 440,000. The reason for
the discrepancy is that physicians, funeral directors, coroners and
medical examiners rarely note on death certificates the human
errors and system failures involved. Yet death certificates are what
the Centers for Disease Control and Prevention rely on to post
statistics for deaths nationwide.
The authors of the Johns Hopkins study, led by Dr. Martin Makary of
the Johns Hopkins University School of Medicine, have appealed to
the CDC to change the way in which it collects data from death

certificates. To date, no changes have been made, Makary said.

'The system is to blame'
 LATEST SPECIAL REPORTS ›
Makary defines a death due to medical error as one that is caused by
skilled staff, error in judgment or care, a system defect
inadequately
or a preventable adverse effect. This includes computer breakdowns,
the doses or types of medications administered to
mix-ups with
patients and surgical complications that go undiagnosed.
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"Currently the CDC uses a deaths collection system that only tallies The Edge
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causes of death occurring from diseases, morbid conditions, and innovation.
injuries," Makary stated in a letter urging the CDC to change the way
it collects the nation's vital health statistics. CNBC Disruptor 50
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"It's the system more than the individuals that is to blame," Makary
said. The U.S. patient-care study, which was released in 2016,
explored death-rate data for eight consecutive years. The
researchers discovered that based on a total of 35,416,020 HEALTH AND SCIENCE ›
hospitalizations, there was a pooled incidence rate of 251,454
The World Junk food ads banned across London's
deaths per year — or about 9.5 percent of all deaths — that stemmed Health public transport network
from medical error. Organization The mayor of London has announced a ban on
junk food commercials across the city's public
seeks to
transport network, which will come into force in
Now, two years later, Makary said he hasn't seen the needle move eliminate February. 
Trans Fats
much.
PillPack PillPack may be gearing up to serve
"Medical-care workers are dedicated, caring people," said Chris co-founders Amazon employees before broader
TJ Parker rollout
Jerry, "but they're human. And human beings make mistakes." Amazon's PillPack has filed for a few new
and Elliot
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According
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hospital pharmacy was short-staffed, the pharmacy computer was
not properly working, and there was a backlog of physician orders.
Afterward Chris said he discovered that pharmacy technicians,
rather than well-trained and educated pharmacists, are
compounding nearly all of the IV medications for patients. And
many states have no requirements, or proof of competency, for these
pharmacy technicians.
Washington, which may point to a plan to serve
the company's employees first.
Sameer It's time to stop flushing away our most
Berry, a vital health information, argues doctor
Both doctors and patients could benefit if we
gastroenterologist-
figure out a way to stop flushing away some of
in-training 
our most vital health information, argues Dr.
Sameer Berry, a third-year resident physician at
Cedars-Sinai Medical Center in Los Angeles.

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Cramer on a company like United Rentals
Medical errors, one of the leading
 causes of death  
8:59 AM ET Thu, 5 May 2016 | 00:34
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Money."
Jim Cramer outlines why the industrial giant is
getting beaten down by the bears in an
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A couple China's air 'as bad as cigarettes'

wear face Chinese pollution has become such a problem
To seek greater safeguards for patients, Chris founded the Emily
 masks in that it has actually become an unexpected
moneymaker for some large companies.
Jerry Foundation in 2008. EJF focuses primarily on medication Tiananmen
safety and better training for pharmacy technicians, as well as
backup procedures that will improve the health-care system. Last
 the Emily Jerry Foundation's National Pharmacy
year he unveiled HOSPITALS ›
Technician Initiative, an interactive scorecard to make the public

aware of unsafe pharmacy practices in the United States. He also
A Warby Retirees can buy Warby Parker glasses
Parker's for under $50 with UnitedHealth
store in The Medicare
 the country, speaking out about key patient
travels throughout
Standard, UnitedHealth says it will offer about 2 million of
safety-related issues and best practices proven to minimize the its Medicare Advantage beneficiaries access to
Los Angeles,
"human error" component of medicine. Warby Parker's prescription eyewear.
California

Any new tools 'will be a game changer' Rudy Obamacare early enrollment rate drops in
Figueroa (R), first sign-up season since GOP changes
an insurance Obamacare sign-ups on the federal health
Pascal Metrics, based in Washington, D.C., designs ways to increase insurance marketplace fell by 20 percent in the
agent from
patient safety and improve clinical reliability at health organizations. first two weeks of this enrollment season
Sunshine compared to last year, according to new federal
Life and data.
Pascal's chief medical information officer, Dr. David Classen, is also
associate professor of medicine at the University of Utah and an John As Amarin stock drops, CEO says
active consultant in infectious diseases at the University of Utah Thero, CEO, investors should 'understand our data
School of Medicine in Salt Lake City. He admits there are problems: Amarin  better'
Amarin CEO is defending results from a major
"The system of care is fragmented," he said. "Any tools that enable clinical trial of its Vascepa heart drug after
researchers raise questions about early results
patients to manage their health-care needs will be a game changer."
that sent stocks up in September.

To improve the safety of medication use, Classen developed and

implemented a computerized physician order-entry program at LDS
Hospital in Salt Lake City. "Harnessing health information HEALTH CARE IT ›
technology through the use of electronic health records of A woman Walgreens and Humana are reportedly in
hospitalized and ambulatory patients is essential," he said. on an talks to take stakes in each other
escalator in The reportedly wide-ranging talks include the
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Many hospitals, for their part, are seeking to keep pace with Cynthia Student borrowers battling cancer can
Thomas now pause their payments
increasingly available technology to improve patient safety. Kim A new amendment allows cancer patients to
Reher was
Lanyon, a senior ICU nurse at Danbury Hospital in Connecticut, postpone their student loan payments
diagnosed
throughout their treatment. 
said all electronic records there are double-checked, and fail-safe with cancer
devices are in place."
A Warby Retirees can buy Warby Parker glasses
Parker's for under $50 with UnitedHealth
At Mount Sinai Hospital in New York City, Dr. Vicki LoPatchin store in The Medicare
oversees a Good Catch Award, given to medical personnel who Standard, UnitedHealth says it will offer about 2 million of
its Medicare Advantage beneficiaries access to
identify potential or existing errors related to their patients' care. Los Angeles,
Warby Parker's prescription eyewear.
California
Similarly, most physicians' offices now keep records electronically,
as well as recording conversations among doctors, nurses and their
patients in order to make certain there is clarity and that no mistakes
result.

Even so, Makary said ordinary complications can occur, especially

from unneeded medical care. According to him, "Twenty percent of
all medical procedures may be unnecessary." He faults also the
overprescription of medication following surgery, particularly
opioids.

Doctors, he said, have been encouraged by drug companies,

sometimes through cash payments, to "promote" their products, as
revealed bythe website Dollars for Docs.

What patients can
 do to protect themselves
According to Dr. John James, a patient-safety advocate and author of
A Sea of Broken Hearts: Patient Rights in a Dangerous, Profit-Driven
System, patients need to take charge. "There needs to
Health Care
be a balance between the provider community and the patients. It is

not an even relationship at all."

In 2002 James lost his 19-year-old son after he collapsed while

running. He had been diagnosed with a heart arrhythmia by a
cardiologist a few weeks prior and was released from the hospital
with instructions not to drive for 24 hours.

"His death certificate said he died of a heart arrhythmia," he said,

but my son really died as a result of "uninformed, careless, and
unethical care by cardiologists." He explained: "If you have a patient
with heart arrhythmias of a certain level and low potassium, you
need to replace the potassium, and they did not. And they didn't tell
him he shouldn't go back to running." Communication errors, he
said, are "unfortunately very common."

In 2014 James retired early to devote his life to improving patient

safety. His mission: to teach people how to be empowered patients.
He has created a patient bill of rights, which he's been pushing to
become federal law. Yet so far he said his letters to the Centers for
Medicare & Medicaid Services have gone unanswered.
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"Makary has a lot of courage," James said. "A lot of the retired
doctors will tell you it's a mess and it's terrible. But for a young
physician to come out and say what he did, that's pretty bold.
Makary is a brave guy."

James' site, Patient Safety America, lists the three levels in which
patients can protect themselves. These include being a wise
consumer of health care by demanding quality, cost-effective care
for yourself and those you love; by participating in patient-safety
leadership through boards, panels and commissions that implement
policy and laws; and by pushing for laws that favor safer care,
transparency and accountability.

"Too often, the health-care system silences

people around a problem."
-Dr. Martin Makary, surgical oncologist and chief of the Johns Hopkins Islet Transplant Center

Here are some other ways patients can be vigilant right now:

Ask questions. Gain as much insight as you can from your health-
care provider. Ask about the benefits, side effects and disadvantages

of a recommended medication or procedure. Use social media to
learn more about the patient's own condition, as well as those

medications and procedures for which they were prescribed.

Seek a second opinion. If the situation warrants or if uncertainties
exist, get a
second opinion from another doctor: A good doctor will
welcome confirmation of his diagnosis and resist any efforts to
discourage the patient from learning more — or what Makary calls,
"attempts to gag the patient."

"Too often," he said, "the health-care system silences people around

a problem." Why? Many doctors are reluctant to speculate, but some
admit the answers range from simple ego to losing a patient to
another doctor they trust more.

Bring along an advocate. Sometimes it's hard to process all the

information by yourself. Bring a family member or a friend to your
appointment — someone who can understand the information and
suggestions given and ask questions.

Ilene Corina, president and founder of the Pulse Center for Patient
Safety Education & Advocacy, based in Wantagh, New York, urges
both the patient and their advocate to be "respectful but assertive" in
seeking answers to the questions they may have. In some cases, she
recommends a "designated medication manager" to be a safety
check on the advice the care provider gives.

Download an app. By having your medical information literally in

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cut your risk for medical errors. Health-care apps can be simple or
complex, and depending on your age and condition, you can manage
your well-being, medications and more.

More from Modern Medicine:

Disturbing YouTube content reveals tech's dark side on young minds
Scientific breakthrough may finally lead to an effective anti-obesity
drug
New treatment aims to prevent hair loss in cancer patients

Correction: The story has been updated to revise Dr. Martin Makary's
first name.

— By Ray Sipherd, special to CNBC.com

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