When they die, often there is no apparent cause. People are said to die of simple "old age." Their bodies just wore out. "The problem is it's not considered a legitimate cause of death. We can code it as a condition, but it is an ill-defined condition."
I wondered if there might be emotional reasons – say a reassurance to the family – to use such a term as old age. "Uncle Harry ran five miles every day until he was 102 and climbed Mt. Whitney last year. But yesterday, after breaking his lap record in the pool, he just died."
"There are situations where there are people who are apparently healthy and have no obvious disease. And when they die, what do you put down? Multiple organ failure? How does that tell us more?" Anderson asks.
At first, I didn't like the idea. Even at 100, I want to know a cause of death, especially if there are a lot of people ahead of me who get to be that age. Only then will we be suggest ways to live to be 110, if anyone really wants to live that long.
But Anderson explains that right now, there is just too much imprecision. Many hospitals have developed "a culture" of writing one cause of death down simply out of expediency, he explains.
"We saw it happen in New York City," where a few hospitals had a standard practice of certifying 95% of patients as dying of atherorschlerotic disease. "No way that was true. They were just using that as a default," Anderson says. "They knew it would get passed and no one would bother you."
When the statistics were examined, 40% of the patients who died in New York City from the late 1990s into around 2005 were dying of heart disease, "twice the national average," he says. It wasn't possible.
Anderson says that when city health inspectors investigated, they discovered "there was just a lack of understanding of what the data were used for. It turns out, doctors just thought it was an administrative document" with no real purpose.