Drugs That Kill Instead of Cure

Copyright 1998 The New York Times
April 18, 1998

A report this week estimated that more than 100,000 hospital patients die each year from adverse drug reactions, more than from diabetes, pneumonia or many other serious illnesses. According to the report, in the Journal of the American Medical Association, an additional two million hospital patients suffer nonfatal reactions to drugs. What makes these numbers especially alarming is that the study says it does not count drug incidents resulting from mistaken prescriptions by doctors or the administration of wrong doses by nurses.

The numbers, nevertheless, may be somewhat misleading. Much of the data come from teaching hospitals, which treat sicker patients and administer more risky drugs, and therefore produce more adverse drug reactions than do other hospitals. The study also uses a controversial technique that combines imprecise studies to reach a statistically definitive conclusion.

The nation's leading expert on drug incidents in hospitals, Dr. Lucian Leape of Harvard Medical School, says the report leaves unanswered how many of the estimated drug reactions are truly mistake-free. Some cancer drugs are particularly dangerous and risk damaging the heart or other vital organs. Mishaps from these drugs are inevitable no matter how careful a hospital's procedures. But other drugs -- like coumadin, which controls blood clotting -- pose risks that can be partially controlled by scrupulous monitoring and recalibration.

The report does not say how many of its estimated fatalities and other problems could have been avoided with better monitoring procedures.

Besides mistake-free accidents, perhaps an additional 200,000 hospital patients suffer preventable injuries. Dr. Leape and his colleagues help hospitals devise procedures for preventing wrong prescriptions and incorrect doses. But many error-prevention procedures are not commonly used. One reason is that neither Federal, state nor private systems are in place to track drug mishaps, the first step toward prevention.

There is no epidemic of drug accidents. Two million adverse reactions represent less than 1 percent of the more than 200 million drug treatments administered to hospital patients each year. Nor can drug-related injuries and deaths be eliminated, no matter how scrupulous the nation's hospitals become. But there would be fewer if more hospitals paid more attention to the problem.

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