[ Medical School Resources | Appendices | Discussion ]
According to the New England Journal of Medicine, it has been recently estimated that approximately 100,000 Americans die every year as a result of adverse drug reactions, making them one of the most common causes of death. According to JAMA, fatal adverse drug reactions in hospitalized patients alone appear to be between the fourth and sixth leading cause of death in this country. The frequency of these fatal events has remained stable over the last 30 years.
In contrast, only 511 fatalities occurred on U.S. airlines in the three year period from 1995 to 1997. One might hope that the protection of the public from adverse effects of drugs, which killed hundreds of thousands of people in that same time frame, would demand the same level of public scrutiny. From the New England Journal article "Making Medicines Safer":
Currently, after a drug is approved for marketing, we rely on a voluntary reporting system.... It is remarkable that at a time when the technology for collecting and analyzing large amounts of data is readily available, an independent, comprehensive, and systematic program of post-marketing drug surveillance does not exist.
Independent agencies [like the FAA, the National Transportation Safety Board] exist to investigate airline accidents, railroad mishaps, and radiation spills.... However, no independent agency exists with the responsibility to monitor and investigate adverse effects due to drugs....
The classic story, Thalidomide, caused about 10,000 cases of birth malformations in West Germany alone. A contemporary example is Redux (dexfenfluramine), taken by as many as 1 percent of the U.S. population to lose weight. Redux could prove to be another serious public health disaster. Initial estimates placed the percentage of people who took the drug that might develop heart valve abnormalities as high as 35%.
And the 106,000 annual deaths occurred when the patients actually got the medications they were prescribed. From the Journal of Consumer Affairs, "Speaking as an internist and Chair of the United States Pharmacopoeia Panel on Consumer Interest/Patient Education... we simply note here that probably half of medications are either ordered or used incorrectly." Studying medication prescription errors in a teaching hospital, researchers found an average of two errors per day at least one of which was significant. According to Lancet, one out of every 131 U.S. outpatient deaths were ascribed to medication errors.
"Malpractice is not an aberration. It's one of the leading health epidemics in this country." Appendix 73b.
Woos, AJJ, CM Stein and Woosley, R. "Making Medici nes Safer." New England Journal of Medicine 339(1998):1851-1854.
 Youngson, RM. Medical Blunders New York: New York University Press 1999:232.
 Woos, AJJ, CM Stein and Woosley, R. New England Journal of Medicine 339(1998):1851-1854.
 Journal of Consumer Affairs 26:246.
 Lesar, TS, et al. "Medication Prescribing Errors in a Teaching Hospital." JAMA 263(1990):2329.
 Laura Wittkin, executive director of the National Center for Patients Rights in Warner, J. "Who's Protecting Bad Doctors?" Ms. 1994(January/February):56-59.
 Phillips DP, N Christenfeld and LM Glynn. "Increase in US Medication-Error Deaths Between 1983 and 1993." Lancet. 351(1998):643-644.