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Opinion and Commentary from TMA

Cause of Death: Unknown

(Public Health) Permanent link

By Steve Levine

It’s a modern-day whodunit — on a massive scale. And the detectives are stymied or stumped — or hoodwinked.

Consider these recent headlines:

  • Puerto Rico Orders Review and Recount of Hurricane Deaths.” This story chronicles the ongoing dispute over just how many people died in Puerto Rico during Hurricane Maria in September. Was it 64, as the official numbers have long maintained? Or more than 1,000, as news organizations and humanitarian groups claim? Finally, in mid-December, the island’s governor ordered a new tally. “This is about more than numbers, these are lives: real people, leaving behind loved ones and families,” Gov. Ricardo A. Rosselló said in a statement.
  • Hundreds of children are dying of starvation in Venezuela.” The collapse of oil prices and the ineptitude/stubbornness/corruption of the nation’s leaders have turned one of South America’s economic powerhouses into a land of abject poverty. “Hunger has gripped the nation for years. Now, it’s killing children,” the New York Times reported. “The Venezuelan government knows, but won’t admit it. … The Venezuelan government has tried to cover up the extent of the crisis by enforcing a near-total blackout of health statistics, and by creating a culture in which doctors are often afraid to register cases and deaths that may be associated with the government’s failures.”
  • Can Texas do death better?” In January’s Texas Medicine cover story, reporter Sean Price tells us that filling out death certificates can be confusing and difficult for Texas physicians, and that can lead to errors that skew death statistics.

Death story photoIt’s as if our morgues are being flooded with John and Jane Does on whose toe tags someone has scrawled big question marks.

But what does it matter? So what if the cause of death isn’t quite right on official documents? The patient is dead, right? Mere words won’t bring him or her back.

In some instances, as in Puerto Rico and Venezuela, observers blame politics. The government in power doesn’t want to look bad. The leaders don’t want to be blamed for poor disaster planning … or for turning their economy into a disaster.

Here in Texas, as Sean explains, the causes are less sinister. They include the 2006 switch from traditional paper death certificates to a balky and buggy computerized system; a lack of training for many physicians; medically untrained justices of the peace divining the cause of death in rural areas; and the patients’ final attending physicians, who might know little about their patients' overall medical history but who are legally responsible for completing the form.

Foul or not, the outcome is the same. Inaccurate death records, Sean writes, have “serious repercussions for public health because death certificates are the foundation of many vital statistics, such as the leading causes of death. If physicians and policy makers don't have an accurate picture of what is killing people, they cannot accurately shape health care policies.”

As my favorite old-time TV detective Lt. Frank Columbo would say, “I worry. I mean, little things bother me. I'm a worrier. I mean, little insignificant details - I lose my appetite. I can't eat.”

Think about it. Are diabetes, heart disease, or cancer being under-reported or over-reported as the cause of death? Do we give too much - or too little - weight to the social determinants of health? If we knew more about any one person’s death, could we do something different to stop the next one? Where do we allocate research dollars? Prevention dollars? Pharmaceutical R&D dollars?

Most of us - journalists, lawmakers, bureaucrats, researchers - automatically give a certain amount of credence to numbers typed neatly in a table, especially when those numbers come from credible sources like the U.S. Centers for Disease Control and Prevention or the Texas Department of State Health Services. Maybe, like Barry Bonds’ home run totals, some of those numbers deserve an asterisk.