# Are more people accidentally killed by doctors than accidentally killed by guns and traffic combined?

The actual claim is something like this

The top five causes of death in the United States, in order, are tobacco, alcohol, medical malpractice, traffic and firearms. According to JAMA, doctors kill more people than auto accidents and guns.

Another website looks at the above claim and finds that they are comparing oranges to apples and with out any solid data. But then they do their own math and finds it could be true?

• There are 700,000 physicians in the United States.
• There are 120,000 accidental deaths in the United States caused by physicians every year, and the accidental death percentage per physician is 17.1%.
• There are 80 million gun owners in the United States.
• There are 1,500 accidental deaths from guns every year, regardless of age group, and the accidental death percentage per gun owner is 0.001875%.

This means, the letter points out, that doctors are 9,000 times more deadly than gun owners.

What is the actual statistics. Lets talk about current years. If data is not available, older data is acceptable.

• People "killed" by doctors were probably already in a rather poor state? – UncleBens Feb 1 '12 at 19:15
• The second claim is ridiculous and it's not a good fit. It's an argument on definitions. How many patients does a doctor see? How many die? How many targets does a gun owner shoot by accident? How many die? – Sklivvz Feb 1 '12 at 21:32
• The fallacy of this comparison is that it tries to make "failed to save" synonymous with "killed". – vartec Feb 3 '12 at 13:17
• @vartec: Really? It seems to be talking of medical errors only. (More of a distortion: it only talks about accidental shootings.) – Oddthinking Feb 4 '12 at 4:38
• @Believer: that's where I disagree. According to me cancer killed that patient, however doctor failed to save that patient. Now, I have no problem using word "killed", if for example M.D. prescribed medicine which caused septic shock if he neglected to check medical records. – vartec Feb 4 '12 at 16:43

Doctors do kill a disturbing number of patients from avoidable mistakes, but the comparative statistics in the claim are mostly meaningless

Before looking at the actual statistics on medical errors it is important to dispose of some of the meaningless statistics in the claim. "doctors are 9,000 times as deadly than gun owners" is a meaningless comparison, for example, as there is nothing comparable between owning a gun and being a doctor. Most doctors interact with hundred or thousands of patients a year; most gun owners won't use their gun at all. And what does the percentage of deaths per physician mean?

However, if we avoid silly percentages we can look at the number of avoidable deaths. The classic US study of this is To Err is Human: Building a Safer Health System from the year 2000. Their headline number (which is the source of many press reports) is described in context thus:

• Sizable numbers of Americans are harmed as a result of medical errors. Two studies of large samples of hospital admissions, one in New York using 1984 data and another in Colorado and Utah using 1992 data, found that the proportion of hospital admissions experiencing an adverse event, defined as injuries caused by medical management, were 2.9 and 3.7 percent, respectively. The proportion of adverse events attributable to errors (i.e., preventable adverse events) was 58 percent in New York, and 53 percent in Colorado and Utah.

• Preventable adverse events are a leading cause of death in the United States. When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of these two studies imply that at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors.

Note the method: detailed studies in local hospitals extrapolated to the whole USA. This might justify putting even bigger error bounds on those totals, but the numbers are disturbing even if they have big error bars.

It is also worth noting that many studies or reported statistics might underestimate the real avoidable deaths as any admission of error might lead to legal liability (medicine seems to adopt the opposite approach to aviation where reporting of near misses and mistakes in encouraged so procedures can be tightened to avoid future errors). So we have to be wary of many of the numbers.

The ballpark figures from the USA don't appear out of line with other studies. An analysis done for the NHS was reported in this BMJ paper in 2004 (NB the links to the references were broken when I checked the article). It uses several sources and comes up with estimates of up to 40,000 deaths (from about 30% of the number of admissions as the US system) from one source to only about 4,000 from another (but excluding infections which are a major killer).

A more recent BMJ paper suggests the UK is again broadly similar the the USA but doesn't give overall estimates. A 2005 survey by the UK's National Audit Office provides several useful numbers for judging the scale of the problem and conveniently summarises both the estimates and some of the problems with them:

A retrospective study of patient records in two English hospitals found 10.8 per cent of patients experienced an adverse incident; of which around half (5.2 per cent) were judged to have been preventable. These adverse incidents caused permanent impairment in six per cent and contributed to death in eight per cent of cases.

Our analysis of trust surveys found that 169 trusts were able to provide data on the number of deaths as a result of patient safety incidents. This showed that in 2004-05 there were some 2,181 deaths recorded but it is acknowledged that there is significant under reporting of deaths and serious incidents. Other published estimates of death as a result of patient safety incidents range from 840 to 34,000 but in reality the NHS simply does not know.

These estimates are broadly consistent with the estimates from the USA.

Another perspective is the Institute for Healthcare Improvement's 100,000 lives campaign which set a target of (crudely) avoiding 100,000 deaths in hospitals over a two year period.

Yet another perspective that provides some quantification of how many deaths are avoidable comes from the use of aviation-style checklists in surgery (NEJM article from 2009) where the rates of death from complications were reduced from 1.5% to 0.8%. This study doesn't extrapolate directly to all hospital admissions, but the size of the gain suggests a large number of avoidable deaths in the current system.

It wouldn't be outrageous to say that the rates of accidental death across several health systems seem to be between 0.1% and 0.4% of hospital admissions (compared to the numbers used in the original question in the USA, this is equivalent to a range of about 30,000- greater than 120,000 deaths).

So, in summary, it is hard to estimate the number of avoidable deaths in hospitals exactly, but it is likely to be large and is probably one of the top ten causes of death.

• This answer is voted up so let me point out, it does not addresses the question. We know ppl get killed because of doctors mistakes, no doubt about that. The question is here to put this claim/theory to rest. Not just add ambiguity. You cannot just say the numbers are wrong. Give me your numbers! – Believer Feb 2 '12 at 13:36
• @Believer I'm not trying to cast doubt on the doctor's numbers just to put sensible error bars on them. What i meant to cast doubt on is the utility of comparing the medical accident rate to, for example, the number of accidental shootings. – matt_black Feb 2 '12 at 14:15
• No the answer is in the clouds, I need numbers. No personal prejudiced is required. Not that I am discouraging you. – Believer Feb 2 '12 at 14:25
• @DVK: saying X is worse than Y is not a justification for continuing to do Y. It is a justification for spending more effort on stopping X than Y. – Oddthinking Feb 4 '12 at 4:43
• In such a black-and-white scenario, sure. In the real world, where (appropriately) more money IS spent on health than gun-control, we have to negotiate with the marginal effect. Would another $1m in health-care save more years-of-healthy-life than another$1m in gun-control? – Oddthinking Feb 4 '12 at 12:54

Matt's answer addresses the accuracy of the risks of health care given in the original quote, and also whether the comparison is fair.

I plan to address the other side of the equation: the real "danger" of gun owners.

For US firearm deaths, Wikipedia points to:

The data is from 1993 - that is dated, and should be taken with a grain of salt, but I am going with it.

The accidental death rate is quoted as 0.59 per 100,000 population.

Google estimates the population of the US as 307 million.

That gives an estimate of 1535 deaths per annum, so the quoted 1500 is right on the money.

How many gun-owners are there?

All the estimates I found eventually pointed back the NRA's estimate of 70-80 million gun-owners. The source of this estimate isn't clear. It was consistent with other figures I saw, such as the estimate that 25% of US adults live in a household with a gun, or the estimated number of guns in the USA.

So, the quoted figure of 80 million gun owners is within the error range of the best estimate I could find.

So the numbers given are supported by other sources. But the analysis suggests that the only danger of gun owners is accidental shooting.

It ignores:

• there are 12 times as many deaths (7.35/100,000) due to firearm-related suicide. Arguably, suicides are not "dangerous". (Also, a fair proportion of those suicides would presumably have still been carried out with other means, if the firearms were not available.)

• there are 12 times as many homicide deaths (7.07/100,000) as accidental deaths. When evaluating the danger of a gun-owner, the risk that they shoot you deliberately must surely be considered.

• the non-fatal gun-shot injuries: a rate of 27/100,000 in 2000 (Source: Federal Bureau of Investigation. Uniform Crime Reports for the United States: Crime in the United States 2000: Uniform Crime Reports. Washington, D.C: U.S. Department of Justice; 2001.) To be fair, this should be weighed against accidental injuries in the medical field.

• violent crimes, including robberies and rape, that are facilitated through threatening with firearms.

Conclusion

The statistics about gun-ownership and accidental fatalities seem to be supported by reasonable estimates.

However, the decision to only consider accidental fatalities underplays the dangers associated with gun-ownership.

• Am I correct in interpreting your numbers if I say there are about 40k gunshot deaths per year from all causes (suicide and homicide)? I wasn't sure whether your bas population was guns, gun owners or all people. – matt_black Feb 7 '12 at 13:11
• I think it is about accidents and accidental deaths, not accidental injuries. The answer should compare data between doctors, traffic accidents and guns. I by no means say Guns are not dangerous. No question about that. And speaking of that I once got skipped by the bullet from my fathers hands and I know relatives who died because of misdiagnosis by Doctors! – Believer Feb 18 '12 at 16:42
• You could say that assassins are safer than doctors as they cause less accidental deaths than doctors do. I'm not sure this comparison is meaningful though, and I would rather include the deliberate murders as well as the accidental deaths... – Nick Jul 26 '12 at 10:59
• @matt_black: Yes, that is the same conclusion I drew. Population is all people. (Sorry about the delay in responding.) – Oddthinking Jul 26 '12 at 13:02
• @Nick, Believer: We seem to be arguing about whether or not to it is proper to include crabapples when comparing apples to oranges. Data for both are there; neither comparison gives you any data for making any meaningful decisions. – Oddthinking Jul 26 '12 at 13:06