Doctor's Strikes equal Lower Death Rates

[ medicine, ]
March 24, 2010

Some time ago my friend Michael told me about a case of an Israeli doctors' strike in the 80's actually resulting in reduced mortality rates, and I finally got around to searching about this.

It seems that there have been several examples of this, not just in Israel (although there are 3 from there, in the 80's and also 2000). Most of the articles trying to explain this phenomenon typically suggest the cancelling/postponing of elective surguries is likely the cause. For example, this article:

Social Science and Medicine

The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

But so this begs the massive question: huh? Shouldn't we just start cancelling all elective surgeries then? Or would the death rate go even lower if we just cancelled all surgeries.

The British Medical Journal says (registration required):


In the absence of official figures, the Jerusalem Post surveyed non-profit making Jewish burial societies, which perform funerals for the vast majority of Israelis, to find out whether the industrial action was affecting deaths in the country.

"The number of funerals we have performed has fallen drastically," said Hananya Shahor, the veteran director of Jerusalem's Kehilat Yerushalayim burial society. "This month, there were only 93 funerals compared with 153 in May 1999, 133 in the same month in 1998, and 139 in May 1997," he said. The society handles 55% of all deaths in the Jerusalem metropolitan area. Last April, there were only 130 deaths compared with 150 or more in previous Aprils. "I can't explain why," said Mr Shahor.

So maybe it's worth saying, "no" to more elective surgeries...? Further to this, some people have looked also at adverse drug reactions, such as Journal of the American Medical Association (JAMA. 1998:279:1200-1205 or copy).


We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.


The incidence of serious and fatal ADRs [Adverse Drug Reactions] in US hospitals was found to be extremely high. While our results must be viewed with circumspection because of heterogeneity among studies and small biases in the samples, these data nevertheless suggest that ADRs represent an important clinical issue.