Freakonomics has really interesting podcasts, and the last one of a three part series on August 20, entitled “Bad Medicine” did not disappoint. The long standing view of the big three causes of death was Heart, Cancer and Respiratory. According to The Center For Disease Control, here is the list for 2014 sorted by the number of deaths:
- Heart disease: 633,842
- Cancer: 595,930
- Chronic lower respiratory diseases: 155,041
- Accidents (unintentional injuries): 146,571
- Stroke (cerebrovascular diseases): 140,323
- Alzheimer’s disease: 110,561
- Diabetes: 79,535
- Influenza and pneumonia: 57,062
- Nephritis, nephrotic syndrome, and nephrosis: 49,959
- Intentional self-harm (suicide): 44,193
This was before researchers at Johns Hopkins actually began to question the data. It turns out that the third leading cause of death in the US is not respiratory related at all, but rather medical error. Think of the millions of decisions including NIH funding, charitable giving, medical school curriculum, hospital protocols, career choices, doctor reputation and malpractice insurance premiums that were all predicated on faulty data.
Medical Error Was Not A Choice
This occurred because the death certificate process has an international code that does not include medical error as a cause of death and the medical profession, medical examiners, and funeral directors often controlled the answer. For decades the medical person filling out the death certificate usually listed the problem you were being treated for rather than the proximate cause of death. So if you were being treated for a heart problem, but the surgeon nicked an artery during a heart valve repair and you died on the table, the cause of death was heart disease.
Medical error includes a spectrum of mistakes both passive and active, ranging from misdiagnosis to acts of negligence like a surgical mistake, or injecting the wrong dosage of insulin. Johns Hopkins research also showed that the more experienced the doctors were, the more likely to cause your death than the least experienced. As the number of procedures increase so does the possibility of medical error.
Business World Has No Equivalents
The analogy to the business world would be faulty reporting on 10Ks and 10Qs because management selected the accounting treatment they were using, without disclosing how it impacted the result and without oversight from auditors or SEC. I am sure there are thousands of CEOs who would have supported a reporting category called gross revenue that was selected by the sales team! In that case an investor, lacking the true information might lose money on his investment, but at least he would not have lost his life.
The greater issue raised by this massive misclassification is why did it take so long for someone to figure it out? I wonder how many times a week some medical person was aware that the Center For Disease Control classification codes did not allow truth to be told? I am also shocked that the tort industry did not figure this out but it is probably because the misclassification helped their chances at trial. If a medical expert had a choice of medical error and did not mark it, that evidence from an expert would be hard to rebut. The trial lawyers were actually benefitted by the conspiracy of silence.
Unfortunately, the Freakonomics podcast missed an opportunity to explode the myth of expertise. There is too much fake news, bad science and intentional deception based on shaky experts who want to promote a social or political point of view whose opinion also serves a financial interest. We should all bring a healthy dose of skepticism to any point of view that cannot be tested, debated or validated, and an even a more suspicious eye when a lot of money is involved.
Experience Trumps Credentials In My World
For me, an expert must pass the Lisa Vito test. Lisa is Vinny’s fiancee in “My Cousin Vinny” and introduced by Vinny as an expert witness on general automotive matters. Given she is a woman in a southern courtroom and she speaks with a New Jersey accent, the prosecutor, Jim Trotter, objects to her expertise. Evidently working in her father’s garage was not enough. Prosecutor Trotter thinks he can disqualify her by asking a tricky question on ignition timing:
Jim Trotter: Now, uh, Ms. Vito, being an expert on general automotive knowledge, can you tell me… what would the correct ignition timing be on a 1955 Bel Air Chevrolet, with a 327 cubic-inch engine and a four-barrel carburetor?
Mona Lisa: (scoffing) That’s a bullshit question.
Jim Trotter: Does that mean that you can’t answer it?
Mona Lisa: It’s a bullshit question, it’s impossible to answer.
Jim Trotter: Impossible because you don’t know the answer!
Mona Lisa: Nobody could answer that question!
Jim Trotter: Your Honor, I move to disqualify Ms. Vito as a “expert witness”!
Judge Haller: Can you answer the question?
Mona Lisa: No, it is a trick question!
Judge Haller: Why is it a trick question?
Vinny: (to Bill) Watch this.
Mona Lisa: ‘Cause Chevy didn’t make a 327 in ’55, the 327 didn’t come out till ’62. And it wasn’t offered in the Bel Air with a four-barrel carb till ’64. However, in 1964, the correct ignition timing would be four degrees before top-dead-center.
Jim Trotter: Well… um… she’s acceptable, Your Honor.