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Re: Quote mining Relative Risks

"Studies" showing deaths caused by smoking or SHS or most other causes, use death certificates as a source and are of no use and have no validity.

Professor Alvan Feinstein, of Yale, a world authority on epidemiology (the study of the causes of disease), has said firmly that death certificates are merely "passports to burial", and for more than 50 years, every time someone has studied the causes of death listed on the death certificates, the conclusion has been that the information is 'grossly inaccurate and unreliable".

A joint report by the Royal Colleges of Pathologists Surgeons and Physicians ("The Autopsy and Audit", 1991), says: "In autopsies (post-mortems) performed on patients thought to have died of malignant disease (cancer) there was only 75% agreement that malignancy was the cause of the death and in only 56% was the primary site identified correctly."

(So if you are told you have cancer there is a one in four chance that you haven't, and even if you have there is almost a fifty-fifty chance that you're being treated for one in the wrong place).

The report ended: "Such high levels of discordance mean that mortality statistics which are not supported by autopsy examinations must be viewed with caution." The rate of post-mortems in England and Wales is 27%.
(That was in 1991,rate of post-mortems today is probably much lower.)

A survey in Hungary, which has a very high rate of postmortems, showed that even when they'd cut you up pathologists couldn't be dead sure of what had killed you in almost 20% of the cases.

A study that focused on myocardial infarction (heart attack) as a cause of death found significant errors of omission and commission, i.e. a sizable number cases ascribed to myocardial infarctions (MIs) were not MIs and a significant number of non-MIs were actually MIs.
A large meta-analysis suggested that approximately one third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died.

Other information
The principal aim of an autopsy is to discover the cause of death, to determine the state of health of the person before he or she died, and whether any medical diagnosis and treatment before death was appropriate.

Studies have shown that even in the modern era of use of high technology scanning and medical tests, the medical cause of death is wrong in about one third of instances unless an autopsy is performed.

In about one in ten cases the cause of death is so wrong that had it been known in life the medical management of the patient would have been significantly different.

In most Western countries the number of autopsies performed in hospitals has been decreasing every year since 1955.
Concern at declining hospital autopsy rates

By Julie Robotham
March 15, 2004

The number of autopsies on people who die in hospital has plummeted in the past 10 years, raising concern that many certified causes of death could be wrong.
A national survey of hospitals and pathologists found autopsies were performed in fewer than 5 per cent of in-hospital adult deaths between 2003 and 2002, compared with 14 per cent when research was conducted in 1992-1993.

Study leader David Davies said a recent international survey suggested 9 per cent of autopsies uncovered errors in diagnosis that, if acted on while the person was alive, "could affect the patient's prognosis and outcome".

Professor Davies, area pathology director for South Western Sydney Area Health Service, said 24 per cent of autopsies revealed "clinically missed diagnoses involving a principal underlying disease or primary cause of death", which probably would not have affected the patient's treatment or survival.

Evidence Report/Technology Assessment: Number 58
Autopsy as an Outcome and Performance Measure
An extensive literature documents a high prevalence of errors in clinical diagnosis discovered at autopsy.

Multiple studies have suggested no significant decrease in these errors over time.

In 1994, the last year for which national U.S. data exist, the autopsy rate for all non-forensic deaths fell below 6 percent.
Institute of Medicine of Chicago, IL 60604, USA.
PRINCIPAL FINDINGS: The average Chicago area hospital autopsy rate rose from 11% in 1920 and peaked at 49% in 1955. The average autopsy rate declined steadily to 14% in 1985, and has continued to decline slowly since that year.
CONCLUSIONS: ....... It also suggests that epidemiological data on diseases and causes of death may be inaccurate.