Central PA Medicine - February 2017 - 24

daup h i n cm s .org
 .org

Practice Management

THE BMJ'S

SCARE
By SHYAM SABAT, MD

T

he BMJ (formerly the British Medical
Journal) published a paper titled
"Medical Error: The Third Leading Cause of Death In the U.S.,"
authored by Makary M. & Daniel M. in its
353th issue, dated May 3, 2016. 

The paper, which likely purposefully, has
a tabloid-type spicy headline, has expectedly
already garnered widespread attention in
print, online media, and TV, as well as the
blogosphere and social media. It was covered
by CNN, ABC news, Medscape and several
other reputed media outlets. The paper is
being cited in the media as being similar to
the very famous Institute of Medicine (IOM)
1999 paper titled: "To Err is Human." 
THE RESISTANCE
Luckily for the U.S. medical/paramedical
personnel and patients (and unfortunately
for the authors and publishers), the paper is
an extremely shoddy piece of scientific and
statistical work which cannot stand the close
scrutiny of peer physician researchers and
professional statisticians. 
I reviewed the paper with expert statistician
Dr. Vernon Chinchilli (Professor and Chair
Department of Public Health Sciences at the
Penn State College of Medicine), who found
that the paper which calls itself a meta-analysis of
four studies, is actually just a borrowed summary
24 February 2017 Central PA Medicine

of a single study by HealthGrades published in
2004. The other three studies just have 795, 838,
and 2,341 patients respectively versus 37 million
patients included in the HealthGrades study,
and thus don't have enough statistical power
to be clubbed together. The final conclusion of
this so-called new meta-analysis study actually
belong to the much downplayed HealthGrades
2004 study, which consisted of Medicare patients
(aged 65 years and above). 
Moreover, the authors of the BMJ article
borrowed the mortality rates from the Medicare
population study and outrageously applied it
to all U.S. inpatient admissions (aged 0-100+
years) without any correction of any form. It is
common knowledge that the Medicare inpatient
population is older, sicker and more vulnerable,
and hence has a higher morbidity and mortality
for a given medical error than the general U.S.
population. The HealthGrades study had not
done any sort of such projection and does not
contain these errors. 

Unfortunately, the result is that the U.S.
medical fraternity is being ridiculed by media
and people not only from the U.S., but the
whole world. They cannot understand how
the medical system could be so incompetent
despite spending the maximum funding and
attracting the best talents from all over the world. 
A few years from now, no one will question
how the conclusion in the paper was reached;
everyone will just cite the result as if it were
some gospel truth. For this reason, I believe
it is important to speak up against this paper
right now. 
I, along with Dr. Virginia Hall of Penn State
Hershey Obstetrics and Gynecology, formed an
online change.org petition demanding that the
BMJ group immediately retract the paper and
issue an apology to counter the blame and shame
the U.S. medical fraternity has already received
from this wreckless paper and the damage done
to provider-patient relationship. I also wrote in
the Pennsylvania Medical Society's (PAMED)
blog about this issue.

How a reputed group such as the BMJ could
not see through these simple but outrageous
statistical blunders is anyone's guess. Did the
The petition gained about 300 signatures
overwhelming incentive to get a spicy, tab- from various states of the U.S. Surprisingly,
loid-type, eye-catching headline paper prevent there were also physician signatories from
the editorial process from taking common the UK, Germany, Poland, Canada, Saudi
sense decisions?
Arabia, France, Israel and Mexico. The petition,
as well as the blog, did get the attention of
print and online media like Pennlive.com,
http://www.dauphincms.org http://www.change.org http://www.Pennlive.com
Table of Contents for the Digital Edition of Central PA Medicine - February 2017
