The leading causes of death are heart disease and cancer — Right?

As the headline news across the U.S. tracks the death toll of Hurricane Matthew — 108, as of this writing — the headline that you won’t see today concerns the growing body of evidence suggesting that the leading cause of death in the country is neither heart disease nor cancer: It’s death due to infection.

That’s the conclusion reached by a 2014 University of Michigan study, “Death Certificates Underestimate Infections as Proximal Causes of Death in the U.S.” Don’t be misled by the conservative title because the researchers contend something extraordinary: that if the count was performed by looking at patients’ Medicare billing records, which show what they were being treated for, rather than death certificates, which they say are unreliable, you would end up with the following tally (‘Malignancy’ means cancer):

 

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It’s the use of the different data set — Medicare insurance records — that gets you the significantly different result in column 3. Where infection not only comes out as the leading cause of death in the country, but does so by a full 11 percentage points over heart disease, which comes in second.

The Michigan study by no means stands alone in saying that death certificates are not a reliable indicator of what is actually killing us.

For example, U.S. Centers for Disease Control research published in 2010 found that in a survey of 521 New York City doctors: (1) 48.6% of them had knowingly reported an inaccurate cause of death on a death certificate, and (2) only 33% of them believed the current cause-of-death reporting system in New York City is accurate.

Recent eye-opening investigations by The Los Angeles Times and Reuters offer corroborating evidence.

The Reuters report, “The Uncounted: The deadly epidemic America is ignoring,” found that tens of thousands of “superbug” deaths in the U.S. are going uncounted because the death certificate omits any mention of the infection. Or because, even when it does, neither state health authorities nor the federal Centers for Disease Control bother to keep track of the numbers

The reasons for the huge undercount are indeed troubling. Reuters: “Counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.” And so hospitals will even hide the true numbers of infections.

Here’s an excellent summary of their work:

 

Just a few days ago, the Los Angeles Times published “No one knows how many patients are dying from superbug infections in California hospitals.” In a conclusion mirroring that of Reuters, the Times found that because “California does not track deaths from hospital-acquired infections [and because] California does not require hospitals to report when patients are sickened by [some] superbug[s],” that, “an epidemic of hospital-acquired infections is going unreported.”

“Science begins with counting,” writes physician-researcher Sid Mukherjee MD, in his 2011 Pulitzer prize-winning book, “The Emperor of all Maladies: A Biography of Cancer.” “To understand a phenomenon,” says Mukherjee, “a scientist must first describe it; to describe it objectively, he must first measure it. If cancer medicine was to be transformed into a rigorous science, then cancer would need to be counted somehow—measured in some reliable, reproducible way.”

To borrow from Dr. Mukherjee, then: “If infectious disease medicine is to be transformed into a rigorous science, then infectious disease would need to be counted somehow—measured in some reliable, reproducible way.” This matters, because as the emerging evidence suggests, infections may well be the leading cause of death in the U.S., and by extension, throughout the world.

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