May 6, 2016

Things happen

The story

Surgeon and author Martin Makery made waves this week with an analysis claiming medical error as the third-leading cause of death in the dear old USA. Hold on a sec.

What he's saying

'Medical error data is so secretive and poorly tracked that we really don't know what's going on' seems to be the gist of his argument. So he combined error rates from other studies and applied that rate to the annual number of US hospital admissions, though a nuts and bolts approach to his estimate is notably absent. The resulting figure places errors as the third-largest cause of death in 2013 by a wide margin. Makery calls his estimate of roughly 250,000 deaths 'conservative'.

What they're saying

Critics say the analysis doesn't pass the smell test. For one thing, an error that contributes to a death does not directly cause death. For another, some of the involved patients were so sick that they were certain to pass away, error or not.

The takeaway

Call the headline sensational, but Makery is trying to draw attention to a larger issue. If you can't measure and track error, then it's hard to move beyond past mistakes. Makery recommends a national or international system to share errors.

Say it on rounds

When your friends forget you don't know a thing about pediatrics

Go ahead, fake it. The oh-so-cleverly named EAT trial found that infants introduced to six allergenic foods at the age of 3 months had about one-third the risk of developing food allergies as infants introduced at 6 months, but only if their parents adhered to a rigorous trial protocol. In the intention-to-treat analysis, which included non-adherents, rates of allergy development in the two groups were similar. Our robot friend is happy to explain more.

When a Z-pack is the only way to get your clinic patient out the door 

Hold strong. An analysis of two national surveys from 2010 - 2011 estimated that 30% of outpatient scripts were inappropriate according to national prescribing guidelines. Only 50% of antibiotics prescribed for respiratory illness, compared to 70% of antibiotics for all illnesses, matched guideline recommendations.  

When your ED night shift devolves into chaos

Time to step up and take control. That's what the FDA did for e-cigarettes, bringing the long-unregulated tobacco product under its jurisdiction. Starting this summer, sales to minors will be banned, and buyers will have to show photo ID. E-cigarette makers will have to register with the agency and disclose details on their manufacturing process and ingredients. 

Brush up

Cystic fibrosis (CF)

CF develops from mutations to CFTR, a gene that regulates anion transport and airway clearance. Treat airway obstruction and infections to boost life expectancy, and consider lung transplant workup when patients have declining lung function, frequent exacerbations, and FEV1 of less than 30% of predicted.

What's the evidence

For small molecule therapy in CF? Therapies are tailored to class mutations in the CFTR gene. The most well studied is ivacaftor, which helps open CFTR electron channels. In combination with lumacaftor, a small molecule that helps CFTR proteins reach the cell surface, the drugs showed a 30% decrease in pulmonary exacerbations in a phase III trial. They're now FDA-approved.

What your fashion friends are talking about

IBM's Watson – great at Jeopardy, not bad at cancer, and a surprise stud at eveningwear.

Spread the word


Not a subscriber? Sign up at
Copyright © 2016 Medicine Scope. All rights reserved.