Bit of a problem for the health scare de jour people

He checked 8,000 death certificates from the Sheffield area against detailed medical notes and case histories but found inaccuracies in about 2,000 of them.

Often doctors had listed the immediate trigger for a patient’s death, rather than the root cause.

Examples included patients with terminal cancer who were classed as dying from pneumonia as that was the condition which caused their final deterioration.

In about 40 per cent of those – or a tenth of the overall total – the cause of death given on the certificate was a different category of disease.

If we don\’t actually know what people are dying of then we can\’t really use our inadequate knowledge to prove that x, y or z (say, for example, booze, food etc) are killing people.

For example a patient who was bed-bound with severe dementia which led to pneumonia was classed as dying as a result of respiratory illness rather than a neurological condition.

Everyone\’s going to project their own personal prejudices onto this and mine is that, at a guess, we\’re under recording such \”neurological\” deaths and over recording some others.

10 thoughts on “Bit of a problem for the health scare de jour people”

  1. Not so much a case of “if you can’t measure it you can’t manage it”.
    More of, can’t measure it so the data will support my favourite theory of the day.

  2. Oi, Worstall, it’s DU jour, not de jour.

    Tim adds: I’m afraid that I will have to consider banning you. You really should know that on this blog it is spelt “pendanto”……

  3. And, of course, the death, at no matter what advanced age, of a smoker is always smoking related. (I seem to remember that was the late Dr. Shipman’s favourite explanation on the Death Certificates he issued.)

  4. A cause of death on a death certificate is a best guess and everyone knows it. If you do a PM on these cases about 40% are shown to be wrong.

    And the forms are filled out incorrectly.

  5. Determining primary cause of death almost always requires you to pick one thing of a chain of causality – being vapourised by a direct meteor strike is pretty much the only unambiguous way to go. Even being vapourised by a volcanic eruption could be suicide, meteor really can’t be.

    And still some damn medic will get it wrong. I’ve seen – in clinical trial data – i.e. data produced by the best of the best of the best with honours sir doctors, and passed unflagged and unnoticed through the hands of several of the finest statisticians and clinicians of most impeccable reputation a nameless major pharma can pay ludicrous salaries to, a patient who supposedly died of a tumour on their finger, in a study in which we were looking at gut tumours.

    And another thing – different habits between countries are probably to blame for the “Mediterranean” effect on heart disease. As we all know all Brits drop dead of heart attacks because we eat lots of fat, smoke, and booze too much. But somehow the French and Italians, despite an almost identically high-fat, smoky, boozy lifestyle, do not all drop dead of heart attacks. So we were told for decades to swap lard for olive oil and beer for red wine (but for some reason not to switch B&H for Gauloises).

    The difference is actually in recording of cause of death. British doctors are in the habit of reporting the proximate cause – which in a lot of cases really is cardiac arrest, no matter what the underlying condition. French and Italian doctors are more likely to report the underlying disease, rather than which organ failed first.

  6. There’s plenty of room in the “cause of death” section of UK death certificates. Doctors usually list the proximate cause and then any underlying condition which may have contributed. It would be unusual to list a particular cancer as the proximate cause: mortality studies look at the whole section, which may well result in over rather than underestimates of mortality for some cancers.

  7. You certainly could commit suicide by meteor if you knew where one was calculated to land and went there.

  8. So a British death certificate will tell you how you came to shake hands with St Peter, but not how you actually arrived at the Pearly Gates.

    When you think about it, there’s really only one cause of death: “Life”.

    BTW: There are other ways of being “vaporised” than a meteor. Guess which Japanese city this is from?
    http://theabysmal.files.wordpress.com/2012/08/hiroshima-shadow-2.png?w=300

    What would a Brit doc attribute his cause of death to? Heart burn?

  9. Often a doctor may have to see a reacentrly dead person and when they are very old just take a guess at the likely cause (s) .
    Does it matter if the certificate is all that wrong?
    As long as there are no bullet holes, knife wounds or large sums of money around..

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