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Canadian report quantifies cost of medical errors
MEDICINE AND HEALTH POLICY
Australia recognises cancer risk for “DES daughters” been a controversial drug. Campaigners and doctors have likened it to thalidomide because of its effects on pregnant mothers and their children. The TGA argues that increased rates of clear cell adenocarcinoma have only been seen in women younger than 22, so that most serious adverse effects on daughters are likely to have already been identified. But Jules Black, spokesman on diethylstilboestrol at the Royal Australia and New Zealand College of Obstetricians and Gynaecologists, says there has been a cover up of the effects of the drug. “I’ve been at our drug authorities for many years about this, but their behaviour has been just next to useless,” he says. “There’s no file [at the TGA] for these cases, so getting reliable information is enormously difficult.” Based on rates of clear cell adenocarcinoma, around 15 000 Australian women are believed to have taken the drug during pregnancy. In the USA, close to 4 million women are believed to have been prescribed
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Science Photo Library
ustralia’s pharmaceuticals regulator has warned doctors that the daughters of women who took diethylstilboestrol—a pregnancy drug widely prescribed in the early 1970s—during pregnancy are at risk of developing vaginal cancers. The bulletin from the Therapeutic Goods Administration (TGA) said that women exposed to the drug in utero—a group commonly referred to as “DES daughters”—should be reviewed by a gynaecologist and undergo regular screening for cancers of the cervix and breast. Use of the drug in pregnant women was discontinued in most countries in the early 1970s after research showed that daughters were at increased risk of developing clear-cell adenocarcinoma, a rare gynaecological cancer. TGA’s principal advisor John McEwan told ABC radio in an interview that he was not expecting a glut of cases, but advised women that “it would just be prudent in this unusual circumstance to keep up that screening.” Diethylstilboestrol has long
A
At-risk women should have regular screening tests, say doctors
diethylstilboestrol, and up to 300 000 may have taken the drug in the UK. A 1998 study by the US National Cancer Institute found that women exposed to diethylstilboestrol in utero were 40 times more likely [than non-exposed women] to develop clear cell adenocarcinoma, although there is yet to be a confirmed case of the cancer developing in a woman after her early 20s.
Diethylstilboestrol has also been linked to higher rates of vaginal and cervical adenosis and dysplasia, pregnancy complications, infertility, and several other reproductive tract problems in daughters. Mothers have a slightly increased rate of breast cancer and sons exposed in utero have higher rates of epididymal cysts. David Fickling
Canadian report quantifies cost of medical errors s many as 23 750 deaths per year, 1·1 million added days in hospital and $750 million in extra health-care spending may be attributable to medical errors by doctors, hospitals, and pharmacists, according to the Canadian Institute for Health Information’s (CIHI) first comprehensive examination of patient safety. The startling numbers show that safety must be a higher priority if Canadians’ faith in the system is to be maintained and health care costs are to be contained, says CIHI vice president of research and analysis Jennifer Zelmer. Among other statistics cited in the June 10 report Health Care in Canada 2004 were the findings that 1 in 9 Canadians received the wrong medication or wrong dose from a
A
doctor; 1 in 9 adults and 1 in 11 children contracted an infection like pneumonia while in hospital; 1 in 152 deaths in Canada are associated with preventable errors for patients in acutecare hospitals each year; 1 in 20 women suffered a third or fourthdegree tear during childbirth; 1 in 81 babies born vaginally suffered injury; 1 in 1124 seniors suffered an in-hospital hip fracture; and 1 in 6667 patients had a foreign object like a sponge or an instrument left in their body after surgery. The prevalence of adverse affects suggests multiple causes for the mistakes Zelmer said in an interview. Among technological strategies that have been show to reduce medical errors is “e-prescribing” to effectively forecast the likelihood of undesirable drug interactions “and basically catch a
lot of problems before they occur,” she adds. Other solutions are simpler and even less costly, Zelmer notes, adding that the number of wrong-side surgeries has been dramatically reduced in recent years because of new guidelines urging surgeons to pre-visit patients and mark their initials on the surgical site. The key to reducing error is to promote a “culture of safety” within treatment facilities, Zelmer argues. “It’s really hard to fix a problem you don’t know about. Until we start talking about these kinds of issues, until we start talking about what we do know and we don’t know about patient safety, and how to improve it, we’re going to have a hard time making a difference.” Wayne Kondro
THE LANCET • Vol 363 • June 19, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
2059
Australia recognises cancer risk for “DES daughters” been a controversial drug. Campaigners and doctors have likened it to thalidomide because of its effects on pregnant mothers and their children. The TGA argues that increased rates of clear cell adenocarcinoma have only been seen in women younger than 22, so that most serious adverse effects on daughters are likely to have already been identified. But Jules Black, spokesman on diethylstilboestrol at the Royal Australia and New Zealand College of Obstetricians and Gynaecologists, says there has been a cover up of the effects of the drug. “I’ve been at our drug authorities for many years about this, but their behaviour has been just next to useless,” he says. “There’s no file [at the TGA] for these cases, so getting reliable information is enormously difficult.” Based on rates of clear cell adenocarcinoma, around 15 000 Australian women are believed to have taken the drug during pregnancy. In the USA, close to 4 million women are believed to have been prescribed
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Science Photo Library
ustralia’s pharmaceuticals regulator has warned doctors that the daughters of women who took diethylstilboestrol—a pregnancy drug widely prescribed in the early 1970s—during pregnancy are at risk of developing vaginal cancers. The bulletin from the Therapeutic Goods Administration (TGA) said that women exposed to the drug in utero—a group commonly referred to as “DES daughters”—should be reviewed by a gynaecologist and undergo regular screening for cancers of the cervix and breast. Use of the drug in pregnant women was discontinued in most countries in the early 1970s after research showed that daughters were at increased risk of developing clear-cell adenocarcinoma, a rare gynaecological cancer. TGA’s principal advisor John McEwan told ABC radio in an interview that he was not expecting a glut of cases, but advised women that “it would just be prudent in this unusual circumstance to keep up that screening.” Diethylstilboestrol has long
A
At-risk women should have regular screening tests, say doctors
diethylstilboestrol, and up to 300 000 may have taken the drug in the UK. A 1998 study by the US National Cancer Institute found that women exposed to diethylstilboestrol in utero were 40 times more likely [than non-exposed women] to develop clear cell adenocarcinoma, although there is yet to be a confirmed case of the cancer developing in a woman after her early 20s.
Diethylstilboestrol has also been linked to higher rates of vaginal and cervical adenosis and dysplasia, pregnancy complications, infertility, and several other reproductive tract problems in daughters. Mothers have a slightly increased rate of breast cancer and sons exposed in utero have higher rates of epididymal cysts. David Fickling
Canadian report quantifies cost of medical errors s many as 23 750 deaths per year, 1·1 million added days in hospital and $750 million in extra health-care spending may be attributable to medical errors by doctors, hospitals, and pharmacists, according to the Canadian Institute for Health Information’s (CIHI) first comprehensive examination of patient safety. The startling numbers show that safety must be a higher priority if Canadians’ faith in the system is to be maintained and health care costs are to be contained, says CIHI vice president of research and analysis Jennifer Zelmer. Among other statistics cited in the June 10 report Health Care in Canada 2004 were the findings that 1 in 9 Canadians received the wrong medication or wrong dose from a
A
doctor; 1 in 9 adults and 1 in 11 children contracted an infection like pneumonia while in hospital; 1 in 152 deaths in Canada are associated with preventable errors for patients in acutecare hospitals each year; 1 in 20 women suffered a third or fourthdegree tear during childbirth; 1 in 81 babies born vaginally suffered injury; 1 in 1124 seniors suffered an in-hospital hip fracture; and 1 in 6667 patients had a foreign object like a sponge or an instrument left in their body after surgery. The prevalence of adverse affects suggests multiple causes for the mistakes Zelmer said in an interview. Among technological strategies that have been show to reduce medical errors is “e-prescribing” to effectively forecast the likelihood of undesirable drug interactions “and basically catch a
lot of problems before they occur,” she adds. Other solutions are simpler and even less costly, Zelmer notes, adding that the number of wrong-side surgeries has been dramatically reduced in recent years because of new guidelines urging surgeons to pre-visit patients and mark their initials on the surgical site. The key to reducing error is to promote a “culture of safety” within treatment facilities, Zelmer argues. “It’s really hard to fix a problem you don’t know about. Until we start talking about these kinds of issues, until we start talking about what we do know and we don’t know about patient safety, and how to improve it, we’re going to have a hard time making a difference.” Wayne Kondro
THE LANCET • Vol 363 • June 19, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
2059