ArcaMax

DEAR DR. ROACH: I think it would be very enlightening if you would write a follow-up piece on the third leading cause of death in the United States. I am certain you are aware that I am referring to medical errors. I am of the opinion that physicians are overprescribing medication on a regular basis.

I feel like doctors are barraged by pharmaceutical reps, who push their products for big drug companies who don't really care about patients. Their primary goal is profit for stockholders.

Further complicating this situation is that the U.S. is one of only two countries in this world that allow the advertisement of prescription drugs on television. I feel that these ads are a blatant action by drug companies to increase profit margins. -- W.M.

ANSWER: Medical errors happen on a frequent basis, and the health care system as a whole needs to do a better job at the systems level to identify what leads to these errors. We should find ways of making sure that errors do not lead to catastrophic outcomes.

Still, the research from 2016 suggesting that errors are the third leading cause of death is not credible. This would mean that at least a third of patients (as many as 60%) who pass away in the hospital die of a medical error. The majority of studies looking at the data found that the rate of preventable errors leading to death was less than 1/10 of this amount.

I'm still not arguing that medical errors are unimportant, only that the studies estimating 250,000-400,000 deaths per year from medical errors are fatally flawed. The main problem with the study was that it took data from older patients and extrapolated it to all hospitalized patients, including pediatric patients and maternity care. The authors also assumed that any error preceding death caused the death, which is also implausible.

Some physicians rely too much on information from pharmaceutical companies, and companies want to present the data from studies in the best possible light. This may lead to overprescribing, especially of new, more expensive drugs that may not have much or any advantage over older, cheaper and better-studied drugs.

However, there are now excellent independent sources that are updated much more quickly than traditional textbooks to help medical providers stay current, such as the Medical Letter and UpToDate, both of which I regularly use and find free from bias.

I agree with you completely about direct-to-consumer advertising of prescription drugs. Although there are benefits, in my opinion, the harms outweigh the benefits, and I do not think that direct advertising to consumers should be allowed. (New Zealand is the other country that allows these ads, for people who are wondering.)

Of course, you are right that these are an attempt to increase profit. They are also highly effective at doing so. They have a great deal of political power, and my voice may not count for much against the $15 million pharmaceutical companies gave to candidates in 2024. But I absolutely support reducing or eliminating direct-to-consumer advertising of prescription drugs.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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