The 6th leading cause of death; and a glaring symptom of stupidity
We are in the midst of a large hospital-construction boom. A recent USA Today article described it as one trending toward luxurious suburban buildings with high tech equipment and hotel-like amenities designed for treating the affluent and well insured. I hope they will be safe. Certainly they will ban smoking. Many, if not most, other hospitals have bans or are considering them. Such a policy just feels good. Hospitals should promote health. And think of the lives that would be saved by eliminating the exposure of hospital workers to secondhand smoke (SHS).
With all of the studies our health experts inundate us with these days, I thought I’d look that number up. It would be good to have on hand in case I run into any patients smoking cigarettes a block or so from their hospital. No doubt, they would complain about how they are discriminated against. Some might even claim that since they are paying for their stays, and more than their fair share of taxes, there should be designated smoking areas inside or at least some kind of shelter out back with minimal protection against rain, snow, wind, cold, etc.
I could say, “Who cares. They are smokers” and leave it at that. However, I’d rather be able to say that by degrading smokers in this way, hospitals save N additional lives annually. Very smart medical professionals run our hospitals. They know what’s best for people and N lives are worth any inconveniences or indignities smokers may consequently suffer. To them, smokers are a despicable minority.
Well, I couldn’t find any of those studies. So I decided to estimate N myself. It turns out that the information needed is readily available from government statistics and an upper bound is easily calculated.
According to the EPA, SHS kills up to 3000 people per year. These people are the spouses and coworkers of smokers. This means that roughly 47 million smokers (21% of the adult population) kill 3000 people by exposing them to SHS over a period of 45 or more years. If hospitals allowed smoking, then roughly 169,680 patient smokers (21% of the 808,000 hospital bed population) would expose their doctors and nurses to SHS. Assume that, in the general population, each smoker exposes a spouse and 2 coworkers and that, in the hospital population, each smoker would expose 1 doctor and 2 nurses.
Numerically, an exposure rate of 3 people per smoker is the same in both the general and hospital populations. However, it should be abundantly clear that the exposure level experienced by doctors and nurses would be dramatically less. For one thing, neither doctors nor nurses spend much actual time in any patient’s room. For another, hospitals never experience continuous, 100% occupancy. Finally, even the most inveterate smokers would douse their butts when doctors and nurses showed up to treat them. Thus, my worst-case estimate is
N = (3000/47,000,000) x 169,680 = 10.83 lives saved.
This number is pretty small and, given the exposure levels assumed for hospital personnel, a much smaller value is more likely. Hospital smoking bans seem like they are hardly worth the effort. I suspect, however, that hospitals would strongly disagree. Surely it would take a much bigger number to scare people – even stupid people. They would want to do their own study.
But before they get out their calculators, hospitals should read a couple of the articles I stumbled across while researching this one. For example, in 1999, the Institute of Medicine (IOM), a division of the National Academy of Sciences, found that between 44,000 and 98,000 Americans die annually from mistakes made in hospitals. Why would hospitals worry about smokers killing 11 people when they kill as many as 98,000?
I remember when the story broke and thinking “Wow, the press is going to have a field day with this.” And that’s about what happened – one field day. After a day of headlines, the lack of news coverage was more astounding than the news. Other than a few health experts and politicians mouthing perfunctory vows to do better, there was little else – no public outrage, no media outcries of a huge scandal, no patient demonstrations, no class actions. Hospitals didn’t even dispute the findings. In terms of front-page coverage, the story was gone in a few days.
Fast-forward to July 2004. A new study, this time conducted by HealthGrades Inc., found that “as many as 195,000 people a year could be dying in U.S. hospitals because of easily prevented errors.” The IOM estimate had been off by a bit. Maybe they only counted the hard to prevent errors.
Later in November, WebMD Medical News reported that over the past 5 years little progress had been made to improve medical care safety. Incredibly, they were referring to the old 1999 IOM estimate. They missed the July news of the HealthGrades study that doubled the estimate and made hospital errors the 6th leading cause of death. I guess that’s understandable. Our health experts are really busy and, as with the 1999 study, there was little news coverage. The media was evidently busy too, probably covering the proposed smoking ban on California beaches.
Over the last 10-15 years, I can’t count the number of SHS studies, bans, lawsuits, public service announcements, warnings and so forth engendered by our health experts. This has been a major, largely tax funded, scientifically unfounded, crusade that has instilled in Americans a near hysterical fear of SHS. Even the 3000 annual SHS casualties is an exaggerated, if not a fictitious, statistic designed solely to scare. For example, the risk ratio associated with getting lung cancer from SHS is 1.19:1. The risk ratio associated with getting lung cancer from consuming citrus fruit or fruit juices is 2.52:1 or over two times greater. Do hospitals ban oranges? No! This is probably because risk ratios of less than 3 are considered to be statistically insignificant. But wait. Doesn’t that mean SHS is even less significant?
Yet the crusade continues. Smoking bans in hospitals have become feel-good measures – we should feel good about saving up to 11, but more likely, 0 lives. But it continues in the stark face of 195,000 annual deaths due to mistakes in our hospitals. And such deaths are worse than SHS deaths. People do not die shortly after coming into contact with SHS. It takes many years of confined exposure with the net effect being somewhat shortened lives. In contrast, a patient, even a young one, can die quite shortly after coming into contact with a medical error. Ask the families of low-risk patients who died from hospital-acquired infections or incorrectly prescribed medications.
Allowing people to smoke in hospitals may sound ridiculous, especially in our grand, new hotel hospitals. Designed to keep out the poor, it’s not much of a stretch to keep smokers out too. However, the money spent to ban smoking and denigrate smokers would be better spent banning hospital errors and denigrating those who commit them.
How ridiculous is the travesty of 195,000 persistent, annual deaths caused by in-hospital mistakes? Gross incompetence must surely be behind the cause. And a hospital culture that discourages error reporting is no excuse. It is what the media would otherwise excoriate as a cover-up and, with this many lives in the balance, it is nothing less than corruption of the grandest scale. And let’s not forget the unbridled arrogance behind the tacit condemnation of smokers, drinkers, and, now, over-eaters. Such incompetence, corruption and arrogance is supremely ridiculous. That we feel good about hospital smoking bans and delude ourselves that we are safer because of them is colossal stupidity.
So if you are walking near a hospital some day and see a couple of patients standing on the curb smoking, go over and give them one of those Rodney Dangerfield “OK” signs. And if by chance, or bad luck, you are on your way to that hospital, pause for a moment and think carefully about going inside. You’ll be exposing yourself to the real despicable minority. And while you may feel good about the probability of anyone dying from SHS exposure, the probability is several orders of magnitude higher that the last thing you hear will be “Oops.”