According to FDA Commissioner Robert Califf, misdiagnosis is the most common cause of death in the United States.

At the opening session of the American Heart Association’s 2022 Scientific Sessions, FDA Commissioner Robert Califf, MD, said combating misinformation and effectively implementing change are 2 areas in which the United States is currently in decline.

Biomedical science and technology are in the midst of an exciting era of discovery and development, Califf said, but the gains have not translated into improved health outcomes for the American public. Importantly, Calif’s implementation phase is where the medical system actually declines.

“We are, and it’s just my opinion, right now we have to fail at implementation,” Khalif said. “We are not at the beginning and we are losing ground, and we better do better for our people.”

The United States spends the most on health care but has worse outcomes than other developed countries, Khalif said. For example, life expectancy at birth is now nearly 5 years higher in the United States than in other high-income countries, and China has surpassed the United States in life expectancy this year, Khalif added.

These differences in life expectancy vary greatly across the United States, with rural regions having much lower life expectancy than coastal, urban areas. Importantly, these differences are widening rather than improving.

“I think it’s the biggest trend in America that we need to pay attention to for all kinds of reasons,” Khalif said.

The use of the drug is also growing, and Calif emphasized the need to distribute naloxone throughout the country to save lives. Comparing its distribution to the use of defibrillators, he said many people died of heart attacks before their distribution.

Finally, Khalif described tobacco use as another challenge. More than 480,000 people die each year from tobacco use, and 5.6 million children are expected to die from smoking today, Califf said.

To address all these concerns, Khalif said, practitioners must change their approach.

“This word ‘calculation’ is used a lot these days, and it has many meanings,” said Khalif. “I think as Americans at heart, we’ve got a time of reckoning. We need to do more and something different than what we are doing now because what we are doing now is not working.

To this end, Caliph offered three recommendations. First, it is important to strengthen the evidence-generating system so that practitioners know what works and what doesn’t, he said, with few arguments. Second, the entire health care system should focus on interventions to address the main sources of death and disability, he said. Finally, he urged all clinicians to spend some time each day combating misinformation, which he said directly contributes to the loss of health and safety.

“I’ve been going around saying that the most common cause of death in the United States is misinformation,” says Califf. “There’s no way to prove that, but I believe that’s the case.”


Adams J, Albert M, Benjamin R, Khalif R, Patel M. Translating science into public health: lessons learned. Presented at the American Heart Association 2022 Scientific Sessions. November 5, 2022

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