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Wed, 17 Apr 2002 10:36:04 -0400

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I vote for doctors as well...BUT!

I don't have the most recent statistics but a few years ago there were =
far more diagnoses attributed to physician error and medical =
misadventure than to all injuries combined (in both USA & Canada =
national data bases).

Of course there is always a huge temptation to rationalize away these =
figures rather than address them, BUT!

As to your cost/benefit argument: absolutely no health economist can =
dispute the fact that the overall benefits that accrue to society from =
one dollar spent on prevention are worth much more than one dollar =
($1000 in these inflationary times) spent on medical interventions =
(especially no hope trauma cases). Does this mean we should dismantle =
all trauma centres? Of course not! Does it mean we should take the =
statistics on medical error and medical misadventure more seriously? I =
think we should.

All I am suggesting is that some common sense prevail over the excessive =
rhetoric that sometimes occurs on this list. Seems to me the purpose of =
debate on the list should be to lend some clarity to the issues and NOT =
merely demonstrate our verbal agility and debating prowess.

Don't get me wrong, overall, I think it is a great list!
  ----- Original Message -----=20
  From: Bjorn, Pret=20
  To: 'trauma-list@trauma.org'=20
  Sent: Wednesday, April 17, 2002 9:19 AM
  Subject: I vote Doctors (was Guns or Doctors)

  Mark,

  These numbers have been carelessly published in various conservative =
media.  Rarely will you find a better example of the adage, "figures =
don't lie, but liars figure." =20

  As Rick Frykberg has rightly noted, the use of "accidental deaths" is =
completely--probably deliberately--flawed.  It'd be fair and informative =
to compare intentional deaths among the same populations... but that's =
just the beginning. =20

  The number of "accidental deaths caused by physicians per year" =
(reportedly cited by a researcher named Laura Keys in the Seattle =
Post-Intelligencer, in an article which I can't prove ever existed) =
represents at least a 20% exaggeration of the Institute of Medicine's =
(IOM) 1999 report, which suggested that between 44,000 and 98,000 =
patients die annually due to adverse events resulting from physician =
error.

  The IOM document, in turn, has been roundly criticized on scientific =
grounds, and probably is itself a gross distortion of clinical reality.  =
It extrapolates from two unreproduced, uncontrolled, retrospective =
analyses of less than 50,000 hospital admissions in New York, Colorado, =
and Utah to predict adverse events among over 33 million US =
hospitalizations annually.  Accepting that several thousand deaths is =
several thousand too many, one should nonetheless seek perspective: the =
data underlying the IOM document was largely related to very sick =
patients, each of which probably enjoyed any number of physician =
encounters without an error.  The real numbers require our attention, =
but in terms of acuity and true activity, they're probably worthy of a =
small fraction of the public panic they've generated. =20

  Finally, if you want to turn an apple into an orange to permit =
comparison, I think it's important to account for both costs and =
benefits.  For every physician error resulting in death, there are an =
unknown but surely enormous number of physician decisions which save or =
improve lives.  Therefore, we should examine not gun ownership, but gun =
use: the ratio of firearm-related encounters in which the weapon =
performed in the interest of defense or safety, vs. those in which =
preventable injury or death resulted.

  Argue as you will against gun control, it's a desperate distraction to =
dump on doctors.  I expect better from the debate.

  Pret Bjorn, RN, etc.
  Bangor, ME

   -----Original Message-----
  From: Mark Swanson [mailto:viking@tznet.com]
  Sent: Tuesday, April 16, 2002 12:42 AM
  To: Traumal list
  Subject: Guns or Doctors

        Pursuant to the current discussion, I am passing these facts I =
received today for my brother-in-law,
        who is an  attorney

    >  Number of physicians in the US - 700,000
    >  Accidental deaths caused by physicians per year - 120,000
    >  Accidental deaths per physician - 0.171
    >  Number of gun owners in the US - 80,000
    >  Accidental gun deaths per year - 1500
    >  Accidental deaths per gun owner - 0.0000188

    >  Statistically, doctors are approximately 9,000 times more =
dangerous than gun owners
    >  Fact:  Not everyone has a gun, but most have a doctor
    >  Obviously, we must ban physicians before this gets out of hand

    >  As a public heath measure, I have withheld the statistics on =
lawyers for fear that the=20
        shock  could cause people to seek medical attention.

        Ain't logic (or the lack thereof) wonderful??=20

    Mark Swanson
    Marshfield, Wi. USA

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<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>I vote for doctors as =
well...BUT!</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>I don't have the&nbsp;most =
recent&nbsp;statistics=20
but a few years ago there were far&nbsp;more diagnoses attributed to =
physician=20
error and medical misadventure than to all injuries combined (in both =
USA &amp;=20
Canada national data bases).</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Of course there is always a huge =
temptation to=20
rationalize away these figures rather than address them, =
BUT!</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>As to your cost/benefit argument: =
absolutely no=20
health economist can&nbsp;dispute the fact&nbsp;that the overall =
benefits that=20
accrue to society from one dollar&nbsp;spent on&nbsp;prevention are =
worth much=20
more than one dollar ($1000 in these inflationary times)&nbsp;spent=20
on&nbsp;medical interventions (especially no hope trauma cases). Does =
this mean=20
we should dismantle all trauma centres? Of course not! Does it mean we =
should=20
take the statistics on medical error and medical misadventure more =
seriously? I=20
think we should.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>All I am suggesting is that some common =
sense=20
prevail over the excessive rhetoric that sometimes occurs on this list. =
Seems to=20
me the purpose of debate on the list should be to lend some clarity to =
the=20
issues and NOT merely demonstrate our verbal agility and debating=20
prowess.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Don't get me wrong, overall, I think it =
is a great=20
list!</FONT></DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, =
Pret</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:'trauma-list@trauma.org'">'trauma-list@trauma.org'</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Wednesday, April 17, 2002 =
9:19=20
  AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> I vote Doctors (was =
Guns or=20
  Doctors)</DIV>
  <DIV><FONT face=3DArial size=3D2></FONT><BR></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002>Mark,</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002>These numbers have been carelessly =
published in=20
  various conservative media.&nbsp; Rarely will you find a better =
example of the=20
  adage, "figures don't lie, but liars figure."&nbsp; =
</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT><FONT face=3DArial =
color=3D#800000=20
  size=3D2><SPAN class=3D380051711-17042002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN =
class=3D380051711-17042002>As=20
  Rick Frykberg has rightly noted, the use of "accidental deaths" is=20
  completely--probably deliberately--flawed.&nbsp;&nbsp;It'd be fair and =

  informative to compare <U>intentional</U> deaths among the same =
populations...=20
  b</SPAN></FONT><FONT face=3DTahoma><FONT size=3D2><SPAN=20
  class=3D380051711-17042002><FONT face=3DArial color=3D#800000>ut =
that's just the=20
  beginning.&nbsp; </FONT></SPAN></FONT></FONT></DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN =
class=3D380051711-17042002><FONT=20
  face=3DArial color=3D#800000></FONT></SPAN></FONT></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN =
class=3D380051711-17042002><FONT=20
  face=3DArial color=3D#800000>The number of "accidental deaths caused =
by physicians=20
  per year" (reportedly cited by a researcher named Laura Keys in the =
Seattle=20
  Post-Intelligencer, in an article which I can't prove ever existed) =
represents=20
  at least a 20% exaggeration of the Institute of Medicine's (IOM) 1999 =
report,=20
  which suggested that between 44,000 and 98,000 patients die annually =
due to=20
  adverse events resulting from physician=20
  error.</FONT></SPAN></FONT></FONT></DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN =
class=3D380051711-17042002><FONT=20
  face=3DArial color=3D#800000>The IOM document, in turn, has been =
roundly=20
  criticized on scientific grounds, and probably is itself a gross =
distortion of=20
  clinical reality.&nbsp; It extrapolates from two unreproduced, =
uncontrolled,=20
  retrospective analyses of less than 50,000 hospital admissions in New =
York,=20
  Colorado, and Utah to predict adverse events among over 33 million US=20
  hospitalizations annually.&nbsp; Accepting that several thousand =
deaths is=20
  several thousand too many, one should nonetheless seek perspective: =
the data=20
  underlying the IOM do</FONT></SPAN></FONT></FONT><FONT =
face=3DTahoma><FONT=20
  size=3D2><SPAN class=3D380051711-17042002><FONT face=3DArial=20
  color=3D#800000>cument&nbsp;was largely related to very sick patients, =
each of=20
  which probably enjoyed any number of physician encounters without an=20
  error.&nbsp; The real numbers require our attention, but in terms of =
acuity=20
  and true activity, they're probably worthy of a small fraction of the =
public=20
  panic they've generated.&nbsp; </FONT></SPAN></FONT></FONT></DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002>Finally, if you want to turn an apple into =
an orange=20
  to permit comparison, I think it's important to account for both costs =
and=20
  benefits.&nbsp; For every physician error resulting in death, there =
are an=20
  unknown but surely enormous number of physician decisions which save =
or=20
  improve lives.&nbsp; Therefore, we should examine not gun =
<EM>ownership</EM>,=20
  but gun <EM>use</EM>: the ratio of firearm-related encounters in which =
the=20
  weapon performed in the interest of defense or safety, vs. those in =
which=20
  preventable injury or death resulted.</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002>Argue as you will against gun control, it's =
a=20
  desperate distraction to dump on doctors.&nbsp; I expect better from =
the=20
  debate.</SPAN></FONT></DIV>
  <DIV><SPAN class=3D380051711-17042002></SPAN><FONT face=3DTahoma><FONT =

  size=3D2><SPAN class=3D380051711-17042002><FONT face=3DArial=20
  color=3D#800000></FONT></SPAN></FONT></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN =
class=3D380051711-17042002>Pret=20
  Bjorn, RN, etc.</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002>Bangor, ME</SPAN></FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20
  class=3D380051711-17042002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN=20
  class=3D380051711-17042002>&nbsp;</SPAN>-----Original=20
  Message-----<BR><B>From:</B> Mark Swanson=20
  [mailto:viking@tznet.com]<BR><B>Sent:</B> Tuesday, April 16, 2002 =
12:42=20
  AM<BR><B>To:</B> Traumal list<BR><B>Subject:</B> Guns or=20
  Doctors<BR><BR></DIV></FONT>
  <BLOCKQUOTE style=3D"MARGIN-RIGHT: 0px"></FONT>
    <DIV><FONT size=3D4>&nbsp;&nbsp;&nbsp; Pursuant to the current =
discussion, I=20
    am passing these facts I received today for my =
brother-in-law,</FONT></DIV>
    <DIV><FONT size=3D4>&nbsp;&nbsp;&nbsp; who is an&nbsp; =
attorney</FONT></DIV>
    <DIV><FONT size=3D4></FONT>&nbsp;</DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Number of physicians in the US -=20
    700,000</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Accidental deaths caused by =
physicians per year=20
    - 120,000</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Accidental deaths per physician -=20
    0.171</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Number of gun owners in the US -=20
    80,000</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Accidental gun deaths per year -=20
    1500</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Accidental deaths per gun owner -=20
    0.0000188</FONT></DIV>
    <DIV><FONT size=3D4></FONT>&nbsp;</DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Statistically, doctors are =
approximately 9,000=20
    times more dangerous than gun owners</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Fact:&nbsp; Not everyone has a gun, =
but most=20
    have a doctor</FONT></DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; Obviously, we must ban physicians =
before this=20
    gets out of hand</FONT></DIV>
    <DIV><FONT size=3D4></FONT>&nbsp;</DIV>
    <DIV><FONT size=3D4>&gt;&nbsp; As a public heath measure,&nbsp;I =
have withheld=20
    the statistics&nbsp;on lawyers for fear that the </FONT></DIV>
    <DIV><FONT size=3D4>&nbsp;&nbsp;&nbsp; shock&nbsp; could cause =
people to seek=20
    medical attention.</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT size=3D4>&nbsp;&nbsp;&nbsp;&nbsp;Ain't logic (or the lack =
thereof)=20
    wonderful??</FONT>&nbsp;</DIV>
    <DIV><FONT size=3D4></FONT>&nbsp;</DIV>
    <DIV><FONT size=3D4>Mark Swanson</FONT></DIV>
    <DIV><FONT size=3D4>Marshfield, Wi.=20
USA</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

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