 Previously, I profiled a paper that added up all the deaths caused by medical care in this country, the 100,000 deaths from medication side effects, plus all the deaths caused by errors, etc., concluding that the third leading cause of death in America was the American medical system. What was the medical community's reaction to this revelation? After all, it was published in one of the most prestigious medical journals, the Journal of the American Medical Association, by one of our most prestigious physicians, Barbara Starfield, who literally wrote the book on primary care. When she was asked in an interview what the response was, she replied that her primary care work has been widely embraced, but her findings on how harmful and ineffective healthcare could be received almost no attention. Recalling the dark dystopia of George Orwell's 1984, where awkward facts are swallowed up by the memory hole, as if they never existed at all, report after report has come out, and the response has been a deafening silence, both indeed and in word, failing to even openly discuss the problem, leading to thousands of deaths. We can't just keep putting out reports, we have to do something. The first report was in 1978, suggesting about 120,000 preventable hospital deaths. The response? Silence for another 16 years, until this scathing reminder was published. If you multiply 120,000 by those 16 years, you get 1.9 million preventable deaths, about which there was near total doctor silence. Silence meaning no substantial effort to reduce the number of those deaths. The Institute of Medicine then released its landmark study in 1999, allowing for another 600,000 deaths to take place. Now, some things have finally changed. Work-hour limits were instituted for medical trainees. Interns and residents could no longer be worked more than, you know, 80 hours a week, at least on paper, and the shifts couldn't be longer than 30 hours long. I may not sound like a big step, but when I started my internship, I was working 36-hour shifts every three days, so that's 117-hour work weeks. What's the big deal? Well, when interns and residents are forced to pull all-nighters, they make 36% more serious medical errors, five times more diagnostic errors, and have twice as many attentional failures. That doesn't sound so bad until you realize that means like nodding off during surgery. The patient is supposed to be asleep during surgery, not the surgeon. Impairing performance as much as a blood alcohol level that would have been making it, made it illegal to drive a car, but can still do surgery. So no surprise, 300% more patient deaths. Residents consider themselves lucky. They get through training without killing anyone. Not that the family would ever find out. Doctors, with rare exceptions, are unaccountable for their actions. The Institution of Medicine, Institute of Medicine, the report did break the silence and prompted widespread promises of change, but what they did not do is act as if they really believed their own findings. For if they really believed that a minimum of 120 people every day were dying preventable deaths in hospitals, you'd draw a line in the sand, like if an airliner was crashing every day, you'd expect the FAA would step in and do something. The Institute of Medicine could insistently demand that doctors and hospitals immediately adopt at least a minimum set of preventable practices, like, for example, bar-coding drugs, so there's no mix-ups, like they do for even a pack of Twinkies at the grocery store. Rather than just going on to write another report, they could bluntly warn colleagues that they would publicly censor those who resisted implementing these minimum practices, calling for some kind of stringent sanctions, but instead we get the silence. Dr. Starfield didn't stay silent, but she is, unfortunately, no longer with us. Ironically, she may have died from one of the adverse drug reactions she so vociferously warned us about. She was placed on aspirin and a blood thinner, plavix, to keep a stent she had placed in her coronary artery from clogging up. She told her cardiology she was bruising more, bleeding longer, but that's the risk you hope doesn't outweigh the benefits until she apparently hit her head while swimming and bled into her brain. Now the question for me is not whether she should have been on two blood thinners for that long, or had the stent inserted in the first place, but whether or not she could have avoided the heart disease in the first place, which is 96% avoidable in women. The number one killer of women need almost never happen.