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Yes, an ounce of prevention is worth a pound of cure, but a pound isn’t that heavy—why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Previously, I noted that patients tend to wildly overestimate the ability of cancer screening and drugs like cholesterol lowering medications to prevent disease. So much so that if patents were told the truth about how little they’d benefit, 90% said they wouldn’t even bother taking them.

The reason we eat healthier, rather than just counting on a medical technofix, is that same over confidence may exist for treatment too. In a massive study of more than 200,000 trials, they discovered that yes, pills and procedures, can certainly help, but genuine very large effects with extensive support from substantial evidence appear to be rare in medicine and large benefits for mortality, making people live significantly longer, are almost entirely nonexistent. We're great for broken bones and curing infections, but for chronic disease—our leading causes of death and disability, modern medicine doesn’t have much to offer, and in fact can sometimes do more harm than good.

In my Uprooting the Leading Causes of Death talk, I noted that side-effects from prescription drugs kill an estimated 100,000 Americans every year, in effect, making medical care, the sixth leading cause of death in the United States. But that’s just from the deaths from taking medications as prescribed. Another 7,000 deaths from getting the wrong medicine by mistake, 20,000 deaths from other errors in hospitals. Hospitals are dangerous places. An additional 80,000 of us die from hospital-acquired infections. More recently estimated at 99,000 deaths. But can you really blame doctors for these deaths? You can when they don’t wash their hands. We’ve known since the 1840’s that the best way to prevent hospital-acquired infections is through handwashing, yet compliance rates among healthcare workers rarely exceeds 50%, and doctors are the worst. Even in a medical intensive care unit, even if you slap up a contact precautions sign, signaling particularly high risk, less than a quarter of doctors washed their hands. Many physicians greeted the horrendous mortality data due to medical error with disbelief and concern that the information would undermine public trust. But if doctors still won’t even wash their hands, how much trust do they deserve?

So we could go in for a simple operation and come out with a life-threatening infection, or not come out at all. And 12,000 die from surgeries that were unnecessary in the first place. For those keeping score, that’s 225,000 people dead from iatrogenic causes, meaning death by doctor, death by medical care. And that’s mostly just for patients in a hospital. In an outpatient setting, adverse effects can send millions to the hospital and result in perhaps 199,000 additional deaths. And this is not including all those just non-fatally injured, like oops, we just accidently amputated the tip of your penis. And these estimates are on the low end. The Institute of Medicine estimated that deaths from medical errors may kill up to 98,000 Americans. That would bump us up to 284,000 dead, but even if we use the lower estimate, the medical profession constitutes the third leading cause of death in the United States. It goes heart disease, cancer, then me.

One responder pointed out that it was misleading to call medicine the 3rd leading cause of death since many of those we kill also had heart disease or cancer. Doctors aren’t out there gunning down healthy people. Only people on medications are killed by medication errors of side-effects. You have to be in the hospital to be killed by a hospital error, and the most common reasons people are on drugs and in hospitals is for diseases that can be prevented with a healthy diet and lifestyle. The best way to avoid the adverse effects of medical care is to not get sick in the first place.