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Medical Errors Are Number 3 Cause of US Deaths, Researchers Say (npr.org)

An anonymous reader quotes a report from NPR: A study by researchers at Johns Hopkins Medicine says medical errors should rank as the third-leading cause of death in the United States -- and highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye. The authors, led by Johns Hopkins surgeon Dr. Martin Makary, call for changes in death certificates to better tabulate fatal lapses in care. In an open letter, they urge the Centers for Disease Control and Prevention to immediately add medical errors to its annual list reporting the top causes of death. Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank just behind heart disease and cancer, which each took about 600,000 lives in 2014, and in front of respiratory disease, which caused about 150,000 deaths. Medical mistakes that can lead to death range from surgical complications that go unrecognized to mix-ups with the doses or types of medications patients receive. The study was published Tuesday in The BMJ, formerly the British Medical Journal.

38 of 247 comments (clear)

  1. Best Care in the World! by amiga3D · · Score: 4, Insightful

    We spend so much money for so little.

    1. Re:Best Care in the World! by Trax · · Score: 3, Interesting

      A major portion of the money that is spent in the United States healthcare system is for end of life care. No one wants their elderly mother, father, grandmother, grandfather, etc. to die and wants "everything to be done" despite our recommendations that these interventions will not prolong their life. See http://khn.org/morning-breakou.... The emergency department is most likely the most efficient part of our health care system. See http://newsroom.acep.org/fact_...

    2. Re: Best Care in the World! by Dog-Cow · · Score: 2

      The plague doesn't avoid doctors, you idiot.

    3. Re:Best Care in the World! by Shadow99_1 · · Score: 4, Interesting

      My grandmother (on my mother's side) passed away about a decade ago after 'routine' heart surgery (no double or triple bipass). However it wasn't the heart surgery that got her, it was the infection after. The doctor's however had been 'confused' by her lack of progress and didn't believe she had an infection. At the same time I picked up on her having an infection after one visit and with no tests. She was never treated for an infection, though the autopsy proved that was the cause of death in the end. After that I truly understood why the US has such a high malpractice rate. The Doctor's had continued to rely on tests which told them the wrong answers and had so little time to actually see a patient that she was never treated properly.

      In my own personal experience I had a diseased gall bladder since I was a teenager, however it went misdiagnosed for a decade and a half as IBS. However it finally got so bad that I couldn't function normally and for about the fifth time in my life I returned to the hospital to finally get a real explanation of what was wrong with me. When they removed my gal bladder the doctor who had performed the surgery had said it was the most diseased gal bladder he'd ever seen in a living patient.

      All that money we pay for medical care seems utterly wasted between the insurance companies and the hospitals.

      --
      we are all invisible unless we choose otherwise
    4. Re:Best Care in the World! by dave420 · · Score: 4, Insightful

      You missed the cause of all of this: no nationalized healthcare.

      A single-buyer can negotiate prices from Big Pharma and limit their meddling with doctors and practices. Government-run hospitals don't have to spend money on marketing and all sorts of things traditionally associated with car dealerships rather than treating people. Government-run healthcare can include a reasonable arbitration system for dealing with claims of medical malpractice, etc. Plus if people aren't paying out of pocket for treatment, there are far fewer financial issues relating to needing extra/different treatment. No more government picking up the massively-inflated bill for someone who wandered in to an ER with holes in them.

      This is hardly esoteric - just look at the other developed countries with comparable/better healthcare systems, and see how much they actually cost. This experiment has been running for decades, and the outcome is staggering.

    5. Re:Best Care in the World! by Ol+Olsoc · · Score: 2

      You missed the cause of all of this: no nationalized healthcare

      There is that - I agree wholeheartedly. There is also some incompetency involved. Some years back my mother in law had a TIA - a mini stroke. At the hospital she noted that she was peeing a lot. While talking with the doctor, the doctor expressed concern that my MIL's potassium level was low. I noted that they probably administered a powerful diuretic, because she was urinating a lot, and that was likely the cause of the low potassium level. The number of expressions that flew across the doctor's face were amazing, from the "Who are you to decide that?", to "Oh, shit, he's right!" to finally recomposing herself and agreeing.

      My wife then and there decided to post herself and verify everything they did, and found a couple life altering mistakes that almost happened.

      --
      The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
  2. US healthcare by Anonymous Coward · · Score: 3

    Is the worst in the world. Cuba is the best, by far.

    1. Re:US healthcare by dcw3 · · Score: 3, Informative

      Nope, Cuba is behind us.

      http://thepatientfactor.com/ca...

      --
      Just another day in Paradise
    2. Re:US healthcare by Malc · · Score: 4, Insightful

      37th rank vs. 38th is hardly much to boast about though.

  3. Perspective by Anonymous Coward · · Score: 5, Insightful

    "250,000 Americans die each year from medical errors"

    Fuck fighting terrorism. This deserves more attention.

    1. Re:Perspective by Anonymous Coward · · Score: 3, Insightful

      and yet doctors sneer at you when you tell them you looked something up on the internet.

    2. Re:Perspective by sir1963nz · · Score: 5, Funny

      Next thing we will find is that they are training doctors and sending them to America because it is a more effective way to kill more americans.

    3. Re:Perspective by ShanghaiBill · · Score: 2

      To be fair, many of the people dying from these medical errors are really sick, and would have soon died from something else anyway. Also, killing off old people helps keep Social Security and Medicare from going bankrupt. I am not saying killing them is a good thing, just that it is not all bad.

      Some hospitals have dramatically cut medical errors using a very simple tool: Checklists.

    4. Re:Perspective by Trax · · Score: 3, Insightful

      I don't sneer at my patients in the ED (emergency department) when they say they've looked up their symptoms on the internet. Most of the time they have been looking them up in WebMD or other non-clinical websites that ultimately tells them that they are either having a heart attack, cancer, or our about to die. I hear them out and see what their worries are and attempt to assuage them of their fears. I'm hearing to teach them about their symptoms and get them involved in their care. There's nothing wrong with looking up symptoms but it is incumbent on us to teach patient where to look up this information, what questions to ask their doctors, and what to worry about or not worry about.

    5. Re:Perspective by JaredOfEuropa · · Score: 2

      They have introduced checklists here as well recently, and they were oh so proud of coming up with this wonderful "new" tool that pilots have been using for about 80 years. What took doctors so long to follow suit?

      One magazine (might have been the Economist) called medical care the "least innovative industry" a few years ago. Not medical technology or medicine, both of which are making tremendous strides, but the way we organize and administer that care.

      --
      If construction was anything like programming, an incorrectly fitted lock would bring down the entire building...
    6. Re:Perspective by compro01 · · Score: 3, Insightful

      What took doctors so long to follow suit?

      Same reason it took pilots a long time to adopt them : Ego.

      --
      upon the advice of my lawyer, i have no sig at this time
    7. Re:Perspective by GuB-42 · · Score: 4, Insightful

      What took doctors so long to follow suit?

      Same reason it took pilots a long time to adopt them : Ego.

      Most pilots I know put their ego aside when it comes to flying.
      Unlike doctors, they put their own life on the line and self-conservation instincts keep them in check.

    8. Re:Perspective by KGIII · · Score: 2

      I just give mine a fist-full of antibiotics and enough opiates to make them settle down and not worry about anything.

      Yes, yes I really am a doctor.

      No, I'm not a medical doctor. I prescribe four quadratic equations and tell 'em to call me in the morning.

      --
      "So long and thanks for all the fish."
    9. Re:Perspective by Gilgaron · · Score: 2

      It is interesting that as a male and a scientist, whenever I make small talk with a doctor they are always thrilled to hear I am a microbiologist and switch gears to discussing things with me as a peer. My wife has the same education but gets this response less frequently from what she's told me. When I was in school I started pre-vet, and working with a veterinarian he said that in that field, anyhow, you generally just treat symptoms and see if they get better since diagnostics are so expensive. For medicine anecdotally I think it is similar: it isn't like they regularly type out what kind of infection you have, they just give you a broad spectrum antibiotic and switch if it doesn't work. The vet also hated when people looked things up online as they were generally not educated enough to know if they were doing harm or not following some goofy protocol. Perhaps some basic medicine would be more useful in high school health class...

    10. Re:Perspective by aaarrrgggh · · Score: 4, Interesting

      Not to judge, but when I was having an appendicitis and thinking it was food poison searching on the internet gave me better control of the situation than the ED Doctor. He was so excited after the CAT Scan that it actually was an appendicitis and I was going to need surgery, rather than discharging me.

      Point being we all have access to different information. As a patient, I didn't know how to filter relevant from non-relevant information. My pain was somewhat asymptomatic due to another problem that I didn't fit neatly into the right box.

      I have know three other people who were discharged from the ED, only to be back an hour or three later when their appendix bursts. As a patient, you need to be your own advocate. The "guess what's wrong with me"game just doesn't work.

    11. Re:Perspective by phantomfive · · Score: 2

      Yeah, last time I went to the doctor, she listened carefully to my self-diagnosis, and what symptoms I had that led me to that diagnosis. Then she gave me warnings about other things to watch for. She was actually great.

      --
      "First they came for the slanderers and i said nothing."
  4. Oblig Redd Foxx quote by NotQuiteReal · · Score: 2

    Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.

    --
    This issue is a bit more complicated than you think.
  5. Re:The Low Hanging Fruit by sjames · · Score: 2

    Yes, but that something shouldn't be medical errors, especially in the most expensive healthcare system in the world.

    It also shouldn't be choking on unpeeled pineapples.

  6. Burnout, Depression, Anxiety in Em Dept staff by BoRegardless · · Score: 5, Informative

    When you look up the rates for problems, you see huge % of the staff have problems.

    The non-stop pressure from management to work faster coupled with major decisions being made with often not enough diagnostics or time means burnout is high and part of that is the recognition they make mistakes.

    A friend who works the ED noted he had an inconclusive diagnosis of a new patient and took extra time to get other tests done. He got the results and the patient was moved into the hospital and he was on to his next patient when a 'bean counter' shows up and says "We noticed you took an extra 20 minutes on your last patient. You are slowing down. etc. etc."

    Then to counter the stress and sometimes double shifts, they start taking drugs.

    1. Re:Burnout, Depression, Anxiety in Em Dept staff by Trax · · Score: 5, Interesting

      I am an ER doctor and I can say that this occurs throughout hospitals throughout the United States every day. I have friends who work in emergency departments (ED) who have such bean counters tell them to see more patients and admit or discharge patients too soon. I work in an emergency department that does not have these bean counters yet but we do have "patient satisfaction" scores based on Press Ganey surveys. We are graded on how well we kept patient informed, spent time with patient, our friendliness, our skill, etc. Patients can score us from 1 (poor) to 5 (excellent) in 7-8 different categories. Most give us 1s or 5s and those that give us low numbers go on to state in the comments that "I didn't get a blanket, water, pain medication, etc" fast enough or "doctor didn't care about my condition". Mind you, most of these folks should not be in the ED in the first place and are at most urgent care patients. No one cares that you were tied up in the back with 4-5 critical patients who are trying to die on us and that we were busy for the past 2 hours to get them up into the ICU with the appropriate interventions made so that they will have a successful outcome. Instead, people are pissed off that you didn't take care of them right away for their symptom(s) or condition(s) and don't care that you (I) was busy elsewhere.

      This is the reality of medicine in the United States these days. A doctor who must appease every patient (paying or non-paying thanks to EMTALA) as a waiter must his or her tables so that our patient satisfaction scores do not drop appreciably or else the bean counters will not be happy. if the bean counters are not happy, then you will be looking for another job.

      If you want to be treated as a real patient, you better start looking for direct primary care physicians who take your money on a monthly or annual basis. In exchange they will give you their undivided attention in the form of hour long visits, communication via email, and your ability to reach them 24/7 as needed.

      http://epmonthly.com/article/2...

    2. Re:Burnout, Depression, Anxiety in Em Dept staff by ShanghaiBill · · Score: 5, Interesting

      Do you want treatment by a stressed out doctor, or no treatment at all?

      False dichotomy.

      There is more need than can be met by the supply of doctors.

      Many other countries deal with this by having PAs and nurses handle routine cases, and only get a doctor involved if symptoms are unusual. Oh, and these countries have far lower costs and better health outcomes than America.

    3. Re:Burnout, Depression, Anxiety in Em Dept staff by dcw3 · · Score: 3, Interesting

      Trax, correct me if I'm mistaken, but I think you're referring to concierge style service, no? My wife and I signed up for this kind of service about a year ago, at a cost of $2k each. It's been night and day better than my old primary care. We get same day appointments, email responses (from our doctor) to medical questions, and it included the most complete (4-5 hour) physical I've ever been through, and additional time with a personal trainer and dietitian. For me, it's been well worth the cost.

      --
      Just another day in Paradise
  7. Not really that surprising by Solandri · · Score: 3, Interesting

    People vastly overestimate how infallible people are (especially themselves). The rate at which humans make errors is about 0.5%. Which if you think about all the things you do in the course of a day, is a really big number.

    About 7.3% of the population were hospitalized overnight or longer (23 million people).

    If 250,000 of them died, then fatality rate due to medical errors is about 1.1%. Which is in line with the average error rate compounded over multiple ways in which errors could kill a hospital patient.

    If you want to reduce the fatality rate, you either need to get people out of the system (e.g. autonomous cars - but they make people uncomfortable even though they're statistically safer), or implement automated checks to supplement people's work. We're already doing the latter with prescriptions - computers now automatically check for dangerous interactions between medications prescribed to the same person. More operating rooms scan all equipment used during surgery, and re-scans at the end to make sure it's all accounted for, and nothing has accidentally been left inside the patient. And some hospitals are starting to use barcode and RFID scanners to double-check that the medication being administered is the proper one for that particular patient.

  8. I was almost one of them by Sir+Holo · · Score: 2

    I was almost one of these statistics.

    A 'pain physician' providing after-care for a skull fracture prescribed me 80 mg of straight oxycodone every three to four hours, as needed. That is over HALF A GRAM of oxycodone per day! Talk about a pain roller-coaster... My fiancee would spend the entire day watching me, just to make sure that my chest was moving. It was a deadly dose.

    I went back to this bad MD, once, and she tried to place all the blame on me. "You follow what's on the label". I replied, "YOU wrote the scrip, which determined what was on the label!" This idiot was blaming me for her near-deadly error, trying to escape the risk of losing her medical license. Well, she soon got fired from a third institution within a year...

    I immediately found an actual Pain Management Physician. He prescribed a 24-hour time-release oxycodone, plus a few on the side for pain-spikes. I got off of that crap in less than three months with no withdrawal issues at all.

    This is just an example of how physician errors kill people.

    1. Re:I was almost one of them by dbIII · · Score: 2

      Oh, I forgot to mention that she was lecturing me like a school-child

      Indeed. One book you may be interested in is "A leg to stand on" by the recently late Dr Oliver Sachs. He was a world leader in his field of medicine and even had a movie made about his achievements (with Robin Williams playing his role) but when he was in hospital with a broken leg he was lectured like a school-child. The bits where he got to see the doctor-patient relationship from the other side and how ridiculous it can be sometimes were interesting.

  9. Facing facts by Kiuas · · Score: 5, Insightful

    I work for the single payer health care system of Finland on the administrative side (IT & stats related) and partly because of that, health care has always been one of my favorite subjects to discuss. However something I've noticed when talking with Americans about it is a certain type of illusion/fallacy that many seem to be under, which is that because you pay so much for it, it must be the best system out there.

    Just yesterday I had a lengthy conversation on fb about the problems with a purely insurance based model, and even though I tried linking a couple of studies as to the amount of deaths caused by lack of access due to costs, I was labeled a liar because apparently 'everyone in the US now has the opportunity to get health insurance" (a direct quote from him) despite the fact that it's known that there are people who do not meet the criteria under the ACA to qualify for the cheaper/low income insurances whilist also not being able to afford a private one AND that there are also still issues with insurances not covering certain operations. Don't get me wrong, the ACA was a small step in a better direction but the gutting of the public option for all sort of killed the best potential about it. Yet my counterpart in said discussion was adamantly of the opinion that anyone who dies in the US for not getting treatment dies purely because he/she didn't bother to get insurance and hence the system is not to blame.

    You've plenty of things where you lead the world, and the medical R & D and high level expertise in the US is unparalleled. However I do wish that more Americans would realize how much you're paying for simple base level health care. I've seen hospital invoices from the states where simple over the counter ibuprofen pills are billed at several dollars a piece. That's a a margin of several thousand percentages. The fact that this is allowed is unfathomable to me. Even if one is of the opinion that a life-saving basic service should be allowed to remain a profit-driven business, having no controls on pricing combined with the insurance lobby has created a gigantic price bubble. This is why the US spends combined (private and tax spending) the most money on the planet per capita on health care, and still the results are far from the top. (Source (wiki))

    The profit motive needs to be either removed or curtailed heavily, so that more of the money that's spent can actually be used to improve the level of care and oversight, instead of just increasing the profits of the insurance giants and private hospitals.

    We get comparable treatment results and universal coverage (at about 3500 dollars a year per capita) than the US does when it comes to life expectancy, cancer survival rates (in fact, with certain types of cancers we're ahead of the US even) and so on. You spend more than DOUBLE that (8700 dollars according to OECD when totaling private and public spending, though interestingly, the CDC puts this figure even higher at 9500) and the massive increase in spending doesn't get you the kind of results that such an investment should.

    You could and should easily be able to arrange for the hands down best universal health care system without spending a dime more than you already are. Don't spend more, spend smarter.

    Just my 2 cents, feel free to mod me down for being a socialist scum now.

    --
    "It is the business of the future to be dangerous" -Alfred North Whitehead
    1. Re:Facing facts by ledow · · Score: 4, Insightful

      America doesn't understand that certain things everyone has to pay for, and then everyone benefits from.

      Police and other emergency services
      Street lighting and road maintenance.
      Healthcare.

      Why anyone would want to involve a third-party insurance company into their payment of such things, or be able to "opt-out" of any of those, I can't fathom. You can't just say "Oh, I'll save a few dollars and the police won't be available to me". That's ridiculous and dangerous and burdensome.

      Same with healthcare. Provide basic healthcare for everyone. If you want, provide "above-and-beyond" healthcare that can be insured for. Like almost every other first-world country that provide "state" and "private" healthcare side by side.

      But if you need to pay into a fund just to ensure that if you accidentally break your leg you're not going to be put out on the streets because you can't work and/or pay the medical bills, then that fund needs to be centralised, non-profit and available to all. Not some private stash.

      You honestly might as well not have any healthcare at all, and just pay for the operations YOU need. It's honestly how it works out, but with a 50% profit for the insurers thrown in for good measure. At least without the insurers the poor would still die, the sick would still have to fund an unfair proportion according to how sick they are, but the insurers wouldn't be taking their cut.

      The biggest problem with America is that it doesn't see outside its own borders. The next is that, because of that, it thinks it's the best at everything. Sure, you're the best. If you never look at anyone else, ever. But the second you start to compare, it all falls apart.

      Maybe that's why they never do that comparison.

    2. Re:Facing facts by mindstormpt · · Score: 2

      How nice for you. Finnish incomes are also thousands of dollars less per year compared to Americans, and that already takes into account the money you "save" on medical care; sounds like you're getting a bad deal.

      Depends on how you look at it. While the average household income in the US is significantly higher, it is top-biased. The average income for the bottom 20% is higher in Finland at $13253/year vs $11194/year in the US. Suffice it to say that it is not the top 20% who need universal health care.

      Furthermore, you're living in a tiny, sparsely populated monoculture at the ass end of Europe (...) Scaling that up to the whole population wouldn't reduce medical spending, it would massively increase it.

      There's plenty of countries larger than Finland with effective and efficient single-payer health care.

  10. Re:The Low Hanging Fruit by Anonymous Coward · · Score: 2, Interesting

    One should ask where is all the money going. It isn't going to the doctors. It is going to the parasitic medical establishment. e.g. the lawyers, the administrators, the FDA, the AMA, the insurance companies, etc.
    If you want to solve the health care crisis:

    1) eliminate the health care companies. We need direct pay!
    2) eliminate the AMA. There are not enough doctors. Patients are dying in the emergency room waiting to be seen.
    3) kill all malpractice lawyers. A doctor practising in good faith should never ever be sued
    4) curtail the power of the FDA. The FDA does more harm than good.

    Our current system has the doctors working for the hospitals, who work for the insurance companies, who work for the patient's employer. Can you see the problem? This is not how capitalism is supposed to work. It is no wonder health care costs have risen astronomically. The patient is only a very very marginal control over her or his health care and associated costs. It is all controlled by third parties who have a vested interest in not providing care.

    There is no difference between big government and big corporations. You do not want you health care being run by the insurance companies or the government. Re-establish a doctor patient relationship with the direct pay system. It worked in the United States for 215 years. It can work again. Medical costs rose astronomically with the advent of wide spread insurance and malpractice lawyers. It used to be a few people fell through the cracks, now just about everyone falls through the cracks of the medical bureaucracy.

    Direct Pay will save the day!
    Disagree with me, you are probably a lawyer, or a medical industry bureaucrat.

  11. Simple but wrong ideas by sjbe · · Score: 5, Insightful

    1) eliminate the health care companies. We need direct pay!

    The costs are too large to not have either insurance companies or the government involved. The majority of Americans would be bankrupted by a single major surgery and that would be true even if healthcare costs weren't completely out of hand.

    2) eliminate the AMA. There are not enough doctors. Patients are dying in the emergency room waiting to be seen.

    First off, the AMA has nothing to do with the quantity of doctors. They do not directly control the supply of doctors and in fact the number of medical schools has been increasing in the last decade. Second, there is no epidemic of patients "dying in the ER waiting to be seen". Emergency Departments (they aren't typically called Emergency Rooms because - well, they're not a room) are actually quite good at triaging patients and taking care of those in greatest need first. There is however the problem of people coming to the Emergency Department for conditions that clearly are NOT emergencies because our screwed up system gives them no other options.

    3) kill all malpractice lawyers. A doctor practising in good faith should never ever be sued

    And exactly how do you plan to distinguish between doctors acting in good faith and those that aren't? While the vast majority of doctors are good, hard working people who care greatly about their patients, there are exceptions. Furthermore there sometimes are doctors of questionable competence. An incompetent person acting in good faith is just as dangerous as a competent person acting in bad faith. Either one is dangerous and there has to be a mechanism for dealing with them.

    4) curtail the power of the FDA. The FDA does more harm than good.

    Spare me. While nobody would argue that the FDA is without problems, the FDA is one of the most successful and vital government organizations we have. Their prime directive is to actually make sure that medical treatments actually work before they can be sold to the public. Without the FDA you would have absurd levels of quackery and fake "treatments" being sold to people who don't know any better. One merely has to look at the market for "alternative medicine" (particularly homeopathy) to see what would happen. You know what they call alternative medicine that is proven to work? Medicine.

    There is no difference between big government and big corporations. You do not want you health care being run by the insurance companies or the government.

    If you think there is no difference between government and business you don't understand either one adequately. There are no other payment options available without involving either insurance or government. Most countries have (sensibly) picked the government option since EVERYONE needs health care at some point but insurance can be made to work. But unless you are privately wealthy there aren't any third options. Your notion of everyone paying directly is pure fantasy because the costs are and will remain too high to be feasible.

  12. Doctors think they're smart by drinkypoo · · Score: 2

    And hey, they're right, but they're not infallible.

    Neither are computers, but they're closer.

    Right now, expert systems are ALREADY better than doctors at making diagnoses. The only part they can't handle is doing the actual inspection and questioning of the patient, and that part is coming fast.

    What will prevent us from using them? The AMA. They lobby to make it harder to become a doctor, in order to keep down the supply of health care professionals. The AMA is evil, and must be destroyed.

    --
    "You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
  13. Re:The Low Hanging Fruit by Applehu+Akbar · · Score: 2

    "4) curtail the power of the FDA. The FDA does more harm than good."

    The FDA performs the vital function of getting new compounds and devices tested, but I would strip it of the power to keep products off the market. Let "FDA Approved" be taken as a gold standard of quality for those who insist on it, while allowing patients to try drugs that are still in the testing process if they and their doctors want to take the risk. And for approved medications, putting an end to the FDA's ability to support the pharma monopoly would allow Americans to shop overseas for branded drugs - the real thing, not knockoffs - exactly as we shop for electronics. The effect on prices would be similar.

  14. Maybe more opiates is the answer by swb · · Score: 4, Interesting

    A friend's wife is senior management with a hospital system and we were talking about some of the impossible challenges of medical care and cost.

    I kind of wondered if more opiates, doled out in small doses & quantities, wasn't actually partly the answer.

    1) Pacifies the hypochondriacs and people with vague and poorly defined "symptoms" who end up getting a bunch of expensive tests to rule out rare conditions they don't have. They go home, feel better from the opiates and maybe find something else to be distracted about because they feel better. Eliminates a lot of doctor time, lab time and expensive time on limited access equipment like MRIs.

    2) Masks symptoms in people who have chronic conditions and have no actual cure. These people may have expensive and marginally effective therapies for what actually ails them, but quite often these are expensive drugs, demanding physical therapies or other treatments that don't much improve their actual condition or how they feel and won't cure them anyway. A lot of the time is strikes me that these people are on expensive medications with weird side effects and marginal primary effects whose principal value seems to be they aren't opiates.

    OK, there would be downsides, some of these people would develop low-level habits, but that's where the small doses and quantities part comes in. Given opiates under managed conditions, most would not spiral into raging junkies and many may actually experience an improved quality of life because they *feel* better. Even if they did have low-level, maintenance habits they could be on opiates for years without any significant side effects, and as drugs they are dirt cheap.

    The up side is that a lot of people who clog the medical system with non-problems and conditions that mainly need to be managed to keep them living functional lives, probably saving a bunch of money and resources for people with treatable or more life-threatening conditions.

    In a way, it's kind of a rationing of medical resources but with potential state-of-mind improvement for those rationed out of the system.