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Friday, September 23, 2011

It's Not What We Don't Know...

I just sent this letter to the Public Record in response to an article in their "You Need to Care About Your Healthcare" section.

The title of your article, "What You Don't Know Can Kill You," is rather ironic, in that its very first statement, "[H]eart attacks are [the] #1 cause of death for Americans," is something we don't actually know.

Why do I say this? Because eight years ago, after my mother died, I was dismayed to discover that doctors are expected to pronounce a cause of death even if they're not really sure, and that my mother's doctor declared her death as being due to heart attack without having physically examined her — based solely on a telephonic communication that was significantly incomplete as to the circumstances in which she was found. She decided to give heart attack as the cause of death simply because, she said, this often strikes people of my mother's age (78) without any prior warning.

This may well be, and it may well be that this is what my mother died from — but if doctors are often making guesses like this, they could often be getting it wrong, and we would really have no way of knowing. In fact, this sort of error would tend to feed on itself in a snowball effect: the more doctors guess heart attack as a cause of death, the higher the statistic for deaths caused by heart attack without prior warning, and so the more likely doctors are to pronounce this cause of death based simply on a guess — and so on.

In no way do I want to minimize the importance of everyone's looking after their heart health. But neither do we want to overlook other possible causes of death because of a possibly exaggerated figure for the number of deaths due to heart attack. Nor would we, in individual cases, wish to close an inquiry prematurely due to an ill-founded assumption that the cause of death is already known. By doing so, we might miss out on important information that would help us forestall our own deaths.

As a general moral principle, it is horrendous that the law actually compels doctors to pretend to a certainty that in many cases they don't really have. Pretended certainties are one of the biggest sources of mischief in our world. Stephen Hawking put it this way: "The greatest enemy of knowledge is not ignorance. It is the illusion of knowledge." Or as Mark Twain said, "What gets me in trouble isn't what I don't know, it's the things I know that just ain't so." We should urge our lawmakers to repeal this unwarranted mandate of an artificial, pretended certainty. Let's get used to openly acknowledging our ignorance, when ignorant is what we are.

I will be sending copies of this letter to my state legislators now.


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