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U.S. 'Cause of Death' Information Often Flawed.
According to an article in the December 22nd issue of The New York Times, information about the cause (or causes) of death, as stated on death certificates in the United States, is often wrong. The importance of death certificates as sources of cause of death data has grown in recent years as the autopsy rate has fallen to about 10% from about 50% in the 1960s. Without autopsies, death certificates become official declarations of why people have died.
New evidence of flawed death certificate information comes from researchers at the federally financed Framingham Heart Study in Massachusetts. The study, begun in 1948 and involving about 10,000 people, suggests that doctors overstate coronary artery disease as a cause of death on death certificates when doctors are not sure of the cause of death. It appears that coronary artery disease is the default diagnosis for cause of death on death certificates, particularly among the elderly.The situation, however, is complicated. Many cases are so medically complex that assigning a single cause, particularly in older people with multiple ailments, can be virtually impossible.
But doctors must still cite a primary cause of death and can add secondary causes. In such cases, doctors may differ about the main cause. Despite the importance of the death certificate, the message about their frequent flaws is unpopular in medical circles because it implicitly criticizes medical education and practice.
According to the Times, various studies in the United States and elsewhere have documented various inaccuracies in death certificate data, with some studies finding an error rate of 30 to 40 percent. Critics say that improving the accuracy of death certificate data will permit more reliable detection of trends in deaths from various diseases. Although doctors have been required death certificates since at least 1933, formal instruction in assigning cause of death has been spotty. Instead, the learning generally comes informally during residency training when doctors may ask colleagues how to fill out a death certicicate. Recently, the National Center for Health Statistics (NCHS) distributed instructional laminated cards, audiotapes, and videotapes to hospitals through state health departments. Yet examinations for doctors rarely include questions about death certificate procedures.
Because heart disease is the most common cause of death in the United States, a team at the Framingham Heart Study resolved to determine the accuracy of death certificate data for heart disease. (The Framingham Heart Study has become arguably the most influential heart disease research project, helping to shape the understanding and treatment of heart disease throughout the world). The team compared the cause of death listed by a patient's doctor on the death certificate with the cause of death determined by three experts. The panel routinely reviews each death in the Framingham study after examining the patient's medical records and interviewing the next of kin. The panel does not use the death certificate in making its determination. The Framingham panel also considers that treating physicians may have information that is not in the patient's medical records.
According to the Framingham physician panel, its review of patients' medical records assigned 24.3% fewer deaths due to coronary artery disease in all age groups compared to death certificate data. For the 2,683 patients in the Framingham Heart Study who died between 1948 and 1988, the expert panel agreed with 67% of the coronary causes of death listed on the death certificate.
In the Framingham physician panel's review, the tendency of those filling out death certificates to assign more deaths to coronary heart disease increased with the patients' age. In those aged 85 and older, death certificates listed coronary artery disease twice as often as the panel did.
According to Framingham panel physician Daniel Levy, "It would make it difficult, if not impossible to identify risk factors for a disease when the level of misclassification on death certificates is similar to what we observed for coronary disease."
The article was written by Lawrence Altman, M.D., and appears on page D7.
CPI Component To Be Updated Every Two Years
The U.S. Labor Department will update the consumption expenditure weights in the consumer price index every two years instead of once a decade, according to The Wall Street Journal. The change, which will take place beginning in 2002, will change the weights every two years instead of once a decade as is now done.
A more timely and flexible measure of consumer spending patterns is expected to give a more accurate picture of inflation in the U.S. economy. The new weights will replace the 1993-95 weights and reflect prices of the 1999-2000 period. The goal is to make the CPI reflect, as much as possible, the inflation currently experienced by consumers, according to BLS commissioner Katherine Abraham.
The expenditure weights use household spending patterns to measure the relative importance of certain items in the CPI. The index is a measure of prices at the consumer level for a fixed basket of goods and services. It is used to peg cost of living adjustments for Social Security and wage adjustments in the private sector. To achieve its goal, the BLS said it will collect data on prices of goods to expand the sample size of its consumer expenditure survey, starting in 1999. The bureau also plans to change the way the index's item samples are updated, paying particulatr attention to areas that are affected by rapid advances in technology.
Under the new plan, expenditure weights willl never be more than four years old. The report appears on page A2 and was written by Journal staff reporter Alejandro Bodipo-Memba.
Nielsen and Networks Battle Over 'Missing' Viewers
On December 21st The New York Times reported that serious conflicts have risen between Nielsen Media Research and major television networks like NBC. The disputes concern the data and data collection methods Nielsen uses to assess national television audiences for network advertisers.
According to Nielsen, the young adult viewing audience (ages 18 to 34) was down 6 percent during the fall 1998 viewing season. The decline was for all channels, both broadcast and cable. NBC media researchers disagree with Nielsen's data and claim that the data is seriously flawed. NBC also argues that the button pushing methods employed by Nielsen's "people meter" system are incompatible with the TV watching habits of younger viewers and create problems in obtaining accurate samples and reliable data.
One potential outcome of the dispute is renewed hope for a rival ratings service, Smart (Systems for Measuring and Reporting Television), which is being tested by Statistical Research, Inc., based in Westfield, New Jersey. The Smart system is designed to streamline viewer button pushing while also using program codes that automatically track each show that the television tunes in. Tests of viewers with the Smart system during the fall viewing season produced a slight increase in the number of 18-34 year old viewers. Now NBC and Nielsen are arguing whether data quality problems are responsible for the decline in the number of young viewers. The article was written by Bill Carter and appears on page C1.
How 'Real' Are American Films?
Two recent newspaper articles, one on December 26th in The Wall Street Journal and the other on December 23rd in The New York Times, compare historic events that form the basis for several recent American motion pictures with the film portrayal of those events. The films range from feature length cartoons ("The Prince of Egypt") to courtroom dramas ("A Civil Action"). The question both articles ask is how much credibility film audiences should give to what they see on the screen.
According to a Times article by James Sterngold, audiences do not necessarily want films to be "real," but films must be believable. For example, not much is known historically about William Shakespeare, but audiences viewing the film "Shakespeare in Love" want to believe that the events portrayed in fhe film could have happened, based on quality acting, cinematography, location, and costumes. To put it another way, film audiences appear to be more impressed by high quality visual and audio data than about who really wrote "Romeo and Juliet," or how the play was written and produced in the early 16th Century.
According to the Times, film studios and production companies are hiring historians and other experts to help create a sense of "verisimilitude" that filmmakers regard as an essential ingredient of success. Obviously, there are conflicts between historians who are concerned about what really happened and studio executives who want to draw as large an audience as possible. Consequently, there is often a gulf between fact and fantasy. For example, if one questions veterans of the U.S. 29th Division who were the first to wade ashore on Omaha Beach, Normandy, on June 6, 1944, it is disconcerting to realize how much fiction was added and how much factual information was omitted from the film "Saving Private Ryan." In the few recent feature films that feature American manufacturing, the plots typically involve workers, managers, and excutives stumbling from crisis to crisis. In reality, few American manufacturing corporations could remain solvent, let alone produce high quality products, like cameras and film, if they were run according to Hollywood scripts. The Times article appears on page A23.
The Wall Street Journal article takes an adversarial approach to film portrayals versus facts. In an article written by Walter Olson, the Journal takes exception to the screenplay of the feature length courtroom drama "A Civil Action." Unlike the author of the Times article, Mr. Olson criticizes specific instances when and where the film's "story" diverges from reality.
The film is based on a book by Jonathan Harr, which is about industrial polluters in and around Woburn, Massachusetts, and subsequent litigation arising from a cluster of leukemia cases allegedly caused by industrial pollution. The nexus of the lawyer-protaganist's case is that he believed two corporations (Beatrice Foods and W.R. Grace) were responsible for the cluster of leukemia cases. Based on this belief, he succesfully sued Beatrice and Grace and recovered millions of dollars in damages for his clients. According to the Journal, there was never convincing scientific evidence to link the plaintiff corporations to the leukemia cases. According to the article's author, the film's producers (Disney/Touchstone) took great liberties with both the facts of the case and with characterizations of the defendants and those representing the defendants. The article appears on page A14.
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