Sunday, January 24, 2010

Radiation Errors, Malpractice and how do you decide

The New York Times has an article recounting two tragic cases of extreme radiation errors in Cancer treatment. Their column is the first in a series on the increasing use of radiation in medical treatments.

One thing really jumped out at me from the story that is not about the very personalized stories of tragedy and error they recount: since 1980, the amount of radiation the typical patient receives has jumped 7 fold. The first question in my mind is what are the benefits of this, and what are the costs? I don't know the answer.

There are a lot of ways to view this story. As tragedy, which of course it is. As an example of mistakes/errors in the medical system. As an attempt to sensationalize tragedy/errors, when most people don't suffer same. As an example that when you are sick and scared, that the medical personnel treating you are not superhuman, but just human, which is good and bad. As calling out for more systematic data to help answer the questions about whether the costs outweigh the benefits. As evidence that computers/technology has upsides and downsides.

Regarding the medical error/malpractice angle, no matter whatever you think is messed up about the system, it is likely worse than you think. It is probably also messed in a manner that is opposite of whatever perspective is what you mostly worry about. Meaning, around 40% of malpractice cases filed are not due to negligence according to the best research....but the same research shows that less than 5% of the cases of true negligence result in a lawsuit. I wrote about this back in the summer in the News and Observer. Here is the blog post on the day of that column with multiple data sources about malpractice research and medical errors.

Most profoundly, I realize that if I or a family member will someday have to make decisions about treatments, I want better data [probabilistically speaking, causes of death are: heart disease about 42%; cancer 25%; stroke 18%]. I want to know whether the benefits outweigh the costs, realizing that the final calculus is likely to differ across patients. We have to come up with a system that demands the questions be asked; allows for the assemblage of the best data; communicates this in an understandable manner to patients; and then allows individual variation to figure out final decisions.

At present, we as a society seem to go vaguely insane at the first point--even asking the question, do the benefits outweigh the costs? We need to grow up.


  1. Huntsville Hospital in Alabama has been overradiating patients for years (brain perfusion scans) and continued even after they knew patients had been overradiated and after the FDA warnings. This is criminal. The hospital and the FDA are involved in the cover-up. There is no recourse but lawsuits to stop this arrogance.