The best doctors in the world are Dr Diet, Dr Quiet and Dr Merryman
– Jonathan Swift
Nothing too serious or taxing, as is this column's wont in its post-long-weekend scribblings. Preventing Chronic Disease, an online journal from the US Centres for Disease Control and Prevention, produced a quirky map last week.
It is based on an analysis by Francis Boscoe, a researcher with the New York State Cancer Registry, who wanted to see what was the most distinctive cause of death in each of the American states.
Prompted by a state-by-state map of distinctive musical artists that was based on the online listening habits of people across the country – in other words, which artist was listened to much more often in one state than the others – he began to think about distinctive modes of death.
“I wondered what it would look like if you applied this to something more serious, such as mortality data,” he told National Public Radio (NPR).
Using standardised mortality data for each state overlaid on similar national data, Boscoe produced a map that had each state labelled with the local cause of death that was, essentially, the largest multiple of the corresponding national rate.
Causes of death
The results are interesting: not unreasonably, tuberculosis is the most distinctive cause of death in Texas, while black lung disease, or pneumoconiosis, stands out in the coal-mining states of West Virginia and Kentucky.
In Maine, influenza is a big killer while, for some reason, syphilis, despite the ready availability of antibiotics, appears to be a big killer in Louisiana.
In Nevada, he noted, atherosclerosis (furring of the arteries) and legal intervention (which is a death in the context of a crime scene and could involve someone in law enforcement or a civilian) were both quite high. Legal intervention also featured as number one in Oregon.
But you begin to question the reliability of the data when you see that “hyperplasia of the prostate” is the distinctive cause of mortality in California, and nowhere else.
Now this raises some obvious issues: enlargement of the prostate is a benign disease (not the same as cancer) and is an unlikely cause of death; and unless women in the Golden State are uniquely endowed with some tissue from the male organ normally found at the base of the penis, something somehere isn’t quite adding up.
However, it has a certain cartoonishness in drawing attention to what is normally dry and boring data and has sparked public debate, which is what I suspect the researcher was really up to when he came up with the idea of mapping the most distinctive causes of death across the US.
Meanwhile, an interesting study of health perceptions, carried out by Prof Amartya Sen of Cambridge University, showed that the more a society spends on healthcare the more it perceives itself to be sick.
The people of the deprived Bihar region in India report very low rates of illness despite high rates of disease and death.
People in the US are about 15 times more likely to report being ill than those who live in Bihar, which spends a fraction of the US budget on health.
Calling St Munchausens
Finally, Dr Merryman asked me to share this with you:
“Hello, and thank you for calling the psychiatric unit at St Munchausens.
“If you are anxious, start pressing numbers at random.
“If you have low self-esteem, please hang up now. All our operators are too busy to talk to you.
“If you are feeling delusional, we know who you are and what you want. Stay on the line while we trace the call.
“If you are feeling paranoid then, yes, this call is being recorded.
“If you are anally retentive, please hold.”
mhouston@irishtimes.com muirishouston.com