Among the rarest causes of death listed in the CDC’s national mortality registry are such ailments as “mouth breathing,” “pathological fire setting,” “flatulence and related conditions,” and “sexual aversion and loss of sexual enjoyment.” Stuart Buck provides an even longer list, and links to his data analysis, in a recent article for Scientific American. It’s a silly list, populated with decidedly non-lethal maladies, but it raises serious questions. Chief among them: Who in their right mind would list something like flatulence (or amnesia, or social phobia, or joint pain) as the official explanation for someone’s death?
In his piece, Buck calls these misdiagnoses a shortcoming of big data, which isn’t exactly right*. In point of fact, they reveal problems with the way we investigate death in the U.S. Buck’s interview with Dr. Dwaryne Wolf, Deputy Chief Medical Examiner at the Harris County Institute of Forensic Sciences in Houston, Texas, supports this observation:
The first reason for the odd fatalities, according to Wolf, is that medical schools provide “minimal training” on how to complete a death certificate. Even skilled physicians might err in how they record a person’s cause of death. Worse, if a physician has not added any information about the cause of death, and the record shows only that the person was originally hospitalized for “low back pain,” then “low back pain” can show up as the official cause of death.
Second, coroners can be elected with no medical training whatsoever. In Texas, for example, only a handful of counties have medical examiners. In the rest of the state, an elected justice of the peace supervises death investigations. Wolf said these individuals are often “flying by the seat of their pants” due to their lack of medical training. As a National Academy of Sciences report pointed out, “The disconnect between the determination a medical professional may make regarding the cause and manner of death and what the coroner may independently decide and certify . . . remains the weakest link in the process.”
It’s not just Texas. A Bureau of Justice Statistics report from 2007 counted 1,590 county coroners serving in 27 states, and noted that, “coroners may be lay persons.” Indeed, a few years back, an 18-year-old girl in Indiana made the news for becoming the state’s youngest coroner while still in high school.
A recent episode of the podcast 99 Percent Invisible highlighted another drawback of the voter-determined coroner system: When medical professionals, or non-medical professionals, must run for office based on what happens in the morgue, clear conflicts of interest can arise—for instance, cases where someone dies in police custody.
For more on America’s hodgepodge of death investigation systems and the many problems with the coroner system, in particular, check out the 2011 Frontline documentary “Post Mortem.”
*His point “that mistakes and sloppy records [recorded and accessed in the form of big data] can lead to the misallocation of resources, or worse,” still stands, obviously.