Sawbones: A Marital Tour of Misguided Medicine - Death Certificates

Episode Date: September 11, 2020

You may have recently heard a statistic that just six percent of COVID-19 deaths are attributed to COVID alone. This statistic was based on death certificates. This week on Sawbones, we explain, through the history of this odd document, why that's a really terrible idea.Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were sawed through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow! Hello everybody and welcome to Salbone's Emerald Tour of Miss Guy and Medicine. I'm your co-host, Justin McElroy. And I'm Sydney McElroy. Well, I'm excited for another fun episode. You know, it's hard to meet when everything's kind of dire on the planet Earth.

I really look forward to recording Salbone's because it's a little bit of levity. Well, in my day, kind of a fun time that you and me can just kind of spend together and relax and goof about stuff. And I can't wait to hear about what our topic is this week. Okay. Well, see, Justin, I try to do things that speak to medical history, but are also relevant to issues of today.

Like find that blending point, you know, especially with everything that's happening with the pandemic. And so this specific topic is a little, you know, not as light maybe. Okay, what is the topic? Go ahead, I'm pretty much ready for whatever. I mean, I'm sure it's gonna be pretty silly

but what's the topic? Go ahead, I'm pretty much ready for whatever. I mean, I'm sure it's gonna be pretty silly, but what's the topic? Death certificates? Okay. All right, well, okay, here's why. I know this seems, I know this seems like a bummer. But there's been a lot of talk in the media about death certificates, what's on them. There was the recent, supposed like report

that was put out by the CDC, although it was really just them, they've been releasing statistics constantly. So I don't think any, nothing new was really done. It was just somebody looked at the data differently is the way I would say it. But basically, there was a report that was circulated widely and was trending on Twitter for a while that only 6% that was what was trending, by the way, only 6% of the deaths that have been attributed to COVID in this country are only from COVID.

are only from COVID. And the way that it was worded, it sort of insinuated that all these other people that we've been told had to come to this disease actually died of something else and we've been lied to. That was not explicitly said, but I feel like that was the message a lot of people received and that was being amplified. And this data is coming from what was put on death certificates. And so I think it is important for us to understand what's put on a death certificate.

Where did this idea come from? Why do we have them? Who fills them out? What are they for? I think it's useful to talk about the history of that, to understand why these claims that only 6% of these deaths are attributable to COVID are completely false. Does that okay for us to talk about? Fine, I'm gonna live it, it's fine.

I'll give my levity somewhere else. I mean, we still got a lot of taskmaster to watch, so I'm sure that'll pick up my spirit. So. I'm gonna start with a West Wing reference. Does that bring you joy? I was thinking about like, ex-istentially, why do we have a desertificate first? Mm-hmm.

Like, because these are the idea that is fairly old. I mean, not, I guess, saw bones old, because we talk about ancient stuff. But like, you know, is fairly old. It's not a new creation. And certainly there are like very practical applications for a document now that certifies someone is no longer living. I feel like the main use of death certificates, as I understand them, is to find them in an old filing cabinet in a very darkened room

and pull it out and look at it with a flashlight. It says right here, the cause of death was murder. Like, this did murder. The modern beast thing. and be seeing. Well, actually the practical application now is to get like things canceled, like accounts canceled. Edgeflix Netflix goes into your house and literally I think you do need it sometimes to cancel an app. Facebook goes into your your old cabinets and zucco nerds like, uh,

Hey, look, I found it. This they're really dead. So we can put the little flower on their counterway as we do. So I think that like today in a world where everything is documented, I think that they have a lot of practical applications, but why? I kept thinking like why when these first were a thing, because we're going to go back to the 1500s for this story. Why did it matter? What was the reason that we recorded this? What were we doing with this document? I kept thinking of that West Wing as if it matters how a man falls down, which is actually a

misquote. I've learned this from the lion and winter. So, just still not bringing you joy. Well, I mean, you didn't really set that up. I think it just like referenced a misquote on West Wing. Kind of done with it. I feel like half of that. I love you. I feel like half of that anecdote was in your head and the other half was in your mouth. And we only got the mouth fart. Why don't you back up just a little bit. Okay. The West Wing. You know, in the episode of West Wing, when Toby says to the president, he says, I was

watching the line and winner just the part of the scene where he's there telling him, like, everybody like be a man, face it like a man, take death like a man kind of thing. And he's like, as if it fool, as if it matters how man falls down. And then he responds when the fall is all that's left, it matters very much. And thus for the line of winter. And this is a reference to when everybody's about to find out he has a mask, right? Yes.

Oh, yeah. Okay. See, good. There. We've contextualized. It wasn't always, obviously, in ancient history, we didn't record the way somebody died. There were lots of rituals surrounding burial, right?

We know that. We know that there are throughout different cultures, There are lots of like things that you would do ceremonies surrounding. For most of history, we didn't really understand why people died. There was only two causes of death, rock and curse. Either you were hit by a rock or a rock fell on you or a curse killed you. Those are the two causes of death early on rock and curse. Well, you're not you're not wrong. This is this is part of why there weren't recorded probably recorded documents for why people died is because the what we didn't know and for a lot of cultures the reason someone died is the God or gods or whatever beans, immortal

beans, your society worshiped, willed it so. Medical examiner back then was an easy job because my dad died. Ah bummer rock, nope, ah curse. Hate to hear it. Anyway, buy you. That'll be 200 pebbles. This is 200 grams of salt. Also if you look to, if you look to some cultures, if you consider life, depending on what your beliefs

are, if you consider your living state to just be like a preamble to the big show, which is the afterlife, why does it matter? I don't know. The important thing is you get there. Yeah, woof. This one, yeah, yeah, let's, yeah, okay. This is dire. Let's keep moving.

So why would we write it down? That's the point. Why would we write it down? Tell me. What would you write it on? Who would keep it? Where would it go? Like, what would we do with it?

We'll be etch it in a stone and then put it somewhere. Who would you show it to? Who would care? But would there just, I mean, there wasn't a good reason for it for a long time. So it didn't exist. So the idea of recording how people died in some sense was brought to us by the plague. A lot of things, mostly bad. We brought to us by the plague.

A lot of things, mostly bad, brought to us by the plague. We don't give a plague and I'm afraid it for all the greats that have brought us. The cruel mass. Because I was gonna say, there is that great plague, Dr. Costume. Oh man, I'm reading that I just finished the seven and a half deaths of a villain hard castle,

which a mystery novel about, it's kind of a mystery, mixed with Groundhog's Day of the Matter. But one of the antagonists in that book is a plague doctor who wears a plague mask. And every time I think of it, it's like, it's just so creepy. It is. It's a creepy look. It's not pleasing.

I don't know why they thought that would bring sugar to people who are like, it's by the plague. And if you remember, it wasn't really about that. I know, but they could have put some teddy bears on it or something, a star sticker, right? Like something. Well, I don't think there was any intention to cheer anybody up because the reality was,

the plague was really bad. And if you got it, there was a good chance you would die. And so I think the doctors were just, you know, kind of being honest. I don't want to get it. So I'm wearing the scary costume. Fair. I'm carrying a stick to poke you with

because I'm not going to touch you. Like I don't think there's any dressing it up. Yeah. But the original recordings of deaths were not just, we're not like death certificates. Like we'd think of them today. Everybody didn't get one. It was just like a list.

Here is a list of causes of death and it would be divided in like, here's how many men died, how many women died, how many children died, and then here's a list of things that they died of. So in these very early documents, they were really just for plague. How many people died of plague? It seems like an important thing to know. That was and that was the the reason that the first one which and initially by the way they were called bills of mortality. So it is a list

1512 in London is where we see the first one and this one just certainly said one just simply says, in this specific time period over the last couple weeks, 34 people died of plague and 32 people died of other stuff. Literally it just says like odor diseases or whatever in Old English, but like. Rocks. Or something.

Oh, no, it doesn't even list that stuff. It just says 34 plague, 32 other diseases, and that's it. So it's kind of more of a census than an individual thing. And it usually just inform people about plague. That was the original idea, because it was, they were tied to locations. So I guess you could kind of think like, well, that bill of mortality from that part of the city

or from that region of the country or whatever is higher like in plague. So I won't go there. Mm-hmm. I don't understand how you get disease, but plague seems to be there. So I won't go there. Yeah, I guess.

Yeah. So that was like the very. Yeah, I guess, yeah. So that was like the very early idea. Why would you write this down? Well, here's a reason. We don't understand that this is infectious, but we do understand that we don't like to be around it. Perfect. Then in the early 1600s, we start to see

that kind of made a weekly thing. You know what, this is a good idea. We need to keep track of this. The plague, at that point, it would, you'd have good and bad years. The plague was always there. And then there would be years where it hit people really hard and like whole courses of years where it did. And then other times where it wasn't such a big deal. But they started doing them weekly. And then in 1629, which happened to be not a particularly bad year for the plague, King James the first said, you know, let's just keep doing it anyway. Why don't we start, you know, weekly coming out with a bill of mortality that lists every

way people died in this area, not just the plague. That's actually how us weekly got started. That's actually how us weekly got started. It used to go up weekly. And it is. How long have you been thinking about that? That you just now said it. Not long just came to. Okay. So the names were still not part of these documents, right? We still don't have like, when I'm talking lists, again, we are just saying like, initially it was like the heading was plague and then it was like men, 20 women, 18, whatever, you know, children. 5,000, we got to the control. Now these documents would have lists of diseases with a number

next to each disease. Here's how many people died of each of these diseases this week. More of a scorecard. Yes. But still no names of anybody. We're still not breaking it down into who are these actual humans that have died. It's just a list. We only knew of so many ways that people could die at this point. We've moved beyond rock and curse, but we still don't have like a huge, complete list of all the things that could fell a human. So we kind of made

some up. Some of these are real diseases just with some wild names, and some of them aren't things you die of. For instance, a common cause of death on these documents would be teeth. That was how it was listed. And these are probably deaths related to teething. And if you remember from our episode on teething, you don't die from teething, but teething got blamed for a lot of probably vaccine preventable diseases that we don't die of today commonly because of thank you vaccines. Instead, we didn't die of today commonly because of

thank you vaccines. Instead, we didn't know about all that, so we blamed it on teething. So teeth would be a common cause, King's Evil. Wow. Which was a kind of tuberculosis. Okay. Planet struck, I like that one.

What's that? That was probably just some sort of like sudden attack or something. You were stricken all at once in some way, and it happened all at once. So I don't know, it could have been a stroke, it could have been a heart attack, it could have been, who knows, but some sort of all at once. Rising of the lights had something to do with the lungs, it was some sort of respiratory connotation. There was mold fallen, which had to do with the lungs. It was some sort of respiratory connotation. There was mold fallen, which had to do with the head. Anything it had to do with like, especially like trauma to the head or like in a child that was born where like the skull was malformed.

Molded. Mold fallen. And then there were some really obvious ones like Scalded in a brewers mash at St. Giles So there you go If you have no idea you could just say suddenly There were always a number of deaths attributed to quote unquote suddenly We don't know and there were other good ones. We didn't see a rock anywhere around there folks Tough to say this one's Mystery for history. There was wind blasted itch, liver grown, excessive drinking. I think we could figure that one out. Yeah. Wolf. There was one bill that attributed eight deaths to Wolf.

It's a bad wolf. It's a bad. So they just listed all these things and they would try to kind of categorize them if they could. Obviously, like in the case of the brewers mash incident, that's probably not a category. That's enough to read off right there. I mean, it's interesting because you can look at these bills of mortality and see very specific incidents that occurred listed. Like, oh, that was Steve, because you know who were scalded in the brewer's mash, but then there would be just numbers of things like blasted, which I don't know, could be anybody. The way that they came up with these lists is really interesting. So the parish clerks were put in charge of the whole process, of compiling and printing

and releasing these documents. The city would like contract them to do it. And what they would do then is outsource the actual like dirty work, go find out how people died, to people called seekers. And this has nothing to do with a golden snitch. Thank you. Yes. Thanks.

No, not a lot of mood. No, not those kind of seekers. These are usually low old ladies. And they would usually like param up. And they would pay them to go out when what would happen is if somebody died within a parish, they would ring the chapel bell, and the sexton would hear the bell ring, and then go tell the seekers like,

hey, there's been a death, go figure it out. And so then they would go investigate to try to ask questions. Okay, what time period is this? We're talking about like the 1600s. They were also called sometimes searchers or specifically plague searchers. Please continue, I've got to Google

to see if this is a series of mystery novels. It absolutely has to be. Are you telling me there's a period in history where we were tasking old women with investigating murders and it's not just like the basis of all these? So I mean, it didn't have to be old ladies, but what you wanted is like these people didn't necessarily have any medical training or any kind of any training, but you wanted people who could go and like ask questions and

poke around and find out some information and not be, I mean, because you, you were trying to be sensitive. Like you didn't want them to, you wanted to get the information for whatever purposes, for government purposes. But at the same time, it was dictated by the local parish so they were trying to be aware that someone has lost someone, you know. So like, you needed people who could get the information, find things out, but also be sensitive.

Did you find any mystery novels? No. Apparently, this is like, untapped. So, that once they came up with something, they'd go back, they'd report it to the parish clerks, they would make up the documents, they'd print them weekly, they always had to be released by the way to the authorities first. Like the Lord Mayor had to review it before the public could get it or the press could get it. That was a big thing. It was like before the press could open it, there were like three locks on the chest held by different authorities who all had to unlock it before the press got their copy of the bill of

mortality. Control of this, especially during a plague, was very vital. You didn't want this to just get out and alarm people. So they kept it under lock and key until the authority said, okay, fine. You can release the bill of mortality. Eventually, they made like a blank sheet with just all the diseases listed on them that you could just easily fill in numbers just for expediency, you know, and then what this did though is it caused you to Need to shuffle all these different causes of death into this list, right? Like you begin to narrow your idea of how a person could die because they Because of the document that was pre-printed that you had to put the numbers on right? so

occasionally they would have to like add a category for like Drown in the mode or whatever but for the most part they they had to add a category for drown in the moat or whatever, but for the most part they had to try to fit them into these different categories. In 1662 is when we first see a use for this data. You have these bills of mortality. You're printing them and giving them to the public weekly. What do you do with all that? You got all this data. You have all this info. It's a shame your dad was in life back then. He would love

that. He would have loved that. What weekly paper, that just is causes of death for people, he would pop up his feet, get some coffee and really make a meal of it. That would be every Sunday dinner for us that would be him telling us. You see this? 62 from rock this week. 62 from rock this week. The rock sometimes gets a problem. So a Haberdasher named John Grant. For whatever reason, I guess maybe he was like my dad, he liked these mortality bills. He was really into them.

And so he decided I'm gonna collect all these mortality bills I can, he got ones from 1629 through 1660. And he started taking all these numbers and compiling them into tables of information. I guess he just liked statistics. So this makes sense, right? Like this is so frustrating when he realized he couldn't upload that data to Reddit.

Like I'm history's first internet weirdo. I can't upload this to Reddit, because it hasn't invented it, won't for many hundreds of years. But it's wild to think like it makes total sense to us now because what he was making were like common causes of death. What kills people? And once you decide you want to know what is a common cause of death, what's taking us out. You automatically begin to ask the next question, which is, well, can we stop it?

Can we prevent it? How can we prolong life? We're here the most common reasons that it is, so let's address them. So it was really a huge step forward that this guy who made hats for a living took by compiling this data. It's a really fascinating moment in medical history where we all went, oh, well, if we got these numbers, let's do something about them.

Let's not die. So but before we do that, not die, not die. We have to get a little more personal. So I want to tell you about how did the actual deserterative get a rise from this, but before I do that, let's go to the billing department. Commerce before not dying. That is the American way. I love it. Let's go.

The medicines, the medicines that I skill in my God for the mouth. Okay, so Sydney. So we have these bills of mortality. We still don't have names. If we're going to get to a death certificate, we have to care about who these individuals are that died of itch or wind or wool for whatever. Right. You need a little more info because so far, all we have occasionally gender, a vague idea of age with man, woman, children, whatever that means.

But you still don't have any other data about it. What really changes the bills of mortality to death certificates is the revolutionary period of human history where we start to see this focus on individual rights, it's the idea that the individual matters. As opposed to just this kind of collection of humanity that we can put on a piece of paper, all of a sudden that seemed very cold to people, that seemed very dehumanizing. And along with us demanding our rights to assemble or free speech or a press or casting off authoritarian leaders alongside all that, is that happened across the globe.

You see bills of mortality moving to lists of actual people who died, moving to individual sheets of paper for each person who died. It's really fascinating how it's connected to this idea that... Documenting it gives it value. Yes. An individual life now matters.

You have a certificate when you're born and you get a certificate when you're born and you get a certificate when you die because you matter, not the collective you. And so this came about with it. You're getting moved about death certificates. Oh, it's a moving idea that you matter. I'll grant you. Now, what was put on them didn't change a lot at first, right? Because we only knew about so many ways people could die. And we really didn't know what they were. Rock, nice rock, big rock, curse, suddenly.

And a mash, beer mash. At some point in here, it has to be said, because as a saw bones, the doctor probably did it by accident while trying to cure me, right, needed to be added to the list, right, right, right, right, blood to death by doctor. I'm unfortunate historical timing of existence. Oops. Now, in the 1830s, William Far, who was an early kind of epidemiologist before we had, before I think we've talked about him in epidemiologic terms.

He created a registry for deaths and came up with a whole lot more causes of death to include on these documents. And as we look at this period of history where the taxonomy of different medical illnesses was expanding, our idea of putting things into categories and Then branching those off into trees of diseases and all that was happening Then we naturally expanded our causes of death from that as well, right?

So we go from a few dozen to over a hundred and Jacques Bertillion who was a French 100 and Jacques Bertillion, who was a French statistician, would eventually restructure the whole thing into categories that like would make sense to us today. So like, here are causes of death from respiratory illness, here are causes of death from infectious disease, here are causes of death. Well, commune. Anyway, using the terms of the day, it really Bertillion, what he structured really mirrors our understanding of what can go wrong and why we die today. What we do now, though, really out of this time period grew the system we use to categorize illness and death today. The international statistical classification of diseases and related health problems or the ICD, which currently ICD-10, is how we list what happened

to a human, whether it be you're coming to see me in the office and You're there for a well-checkup. There's an ICD code for that if you're there because you have an ingrown toenail There's an ICD code for that if you're for Non-specified upper respiratory viral illness whatever if you have died there is an ICD code For what do you do in the office at that point? ICD code. For what do you do in the office at that point? The history of that actually dates back to the International Statistical Institute, which was founded in 1853. So this is a really old organization that was collecting data and having congresses regularly to like talk about what is happening to humans worldwide to compile these numbers and like make it an international global effort.

And in the late 1800s, they added to their efforts a list of causes of death. I bet the happy hours that those congresses were just like mad, right? Just a bunch of death obsessed people. Like, well, they were, they were, they were, the sexual energy is just like palpable in there, right?

They were compiling. They were compiling a lot of like statistics, not just death, but death was among. A lot of good stuff then, too, Sid. Was there some good things from there? Probably just like numbers of like parfee and how individual humans and, you know, all the statistics, all the things that people like to compile,

but among them also illness and death. And it's also probably orgyastic, a bachanol, basically, is what we're saying. And like I said, this is really old. So like far contributed to this, initially, Bertilion would contribute to this. And by the turn of the century, we have a list of diseases for humans.

And we can refer to that for study purposes, or just to understand where we should focus our efforts to You know extend save life, etc Now in this country the use for this list took a turn After World War 2 because initially like if you have a list. This is our way of understanding One like I said, research study, where do we need to put our efforts, our dollars, our time to try to like help humanity, right?

Into the most common causes of diseases would make sense. That's what people were thinking at first. And also like things that are easily preventable. If you're thinking of making a vaccine, a list like this is very helpful, because you start looking at statistics, like, where can I make the biggest impact? Where should I focus my energy first to save the most lives? After World War II, it occurred to people that this list would make it really easy for insurance companies

to keep track of illnesses that their clients had and billing and who was a higher risk person to insure and who wasn't and so on and so forth. So this data in this country got really tightly tied to what we now would call billing and coding. So, my interactions with the ICD-10 have been all electronic, essentially, and clicking buttons in order to code the appropriate thing that goes with a visit, goes with a doctor's visit, and that information, yes, can be used for research purposes and certainly is.

I'm not saying it isn't, but also goes for billing. And the importance of it for you as a patient is, well, one, you want your data to be accurate, of course, and two, I need to code the right thing so your insurance company covers it, right course, and two, I need to code the right thing so your insurance company covers it, right? Because if my codes are incorrect, you might get slapped with a big bill. Anybody outside of the U.S., I know this sounds wild. Strange. But if you live here, you know that it's true because you've had the calls from the insurance company where they said, well, your doctor

needed to put this or that. And then you've called your doctor and tried to explain it. And your doctor seems like they don't understand why. And it's true because the medicine we're practicing and the framework of the billing are connected, but they're not a direct relationship. You know, I communicate, a lot of us communicate in our documentation what's happening and what we need to know outside of the, outside of the codes. Because because those are just click boxes and those don't tell us as much. But the insurance companies, their computers speak that language. So anyway, how did death certificates fit into this landscape? position point, once all of this gets connected to billing and coding, we're expected to put like ICD diagnoses on a desertificate.

You know, we're supposed to use these same things that we click boxes in our electronic health records. We're supposed to put these on your desertificate. And so we need to know what people die of so that we can focus our research efforts still, right? We can monitor things like infectious diseases like we're doing now with COVID. So it would seem really important who fills them out. Who do you think fills out your destitute? The doctor that pronounces you dead, like in the movies?

The pronouncing physician does sign it, yes. So who feels like the death certificate? So it depends. A lot of times in a busy hospital setting, it may, it's like a lot of paperwork, right? It goes to the lowest person in the chain of command. So the resident or like a first year resident, an intern, we call them maybe task with filling out a desk certificate. Sometimes they're sent to your primary care doctor's office. So the person in the hospital

signs that yes, this person has died. So you have the doctor who actually pronounced and says, because that's part of it, right? Making sure that we're not declaring people dead who are not dead. Because, you know, we've talked about on the show, we used to do that. So that's part of it. But then the other part is why did this person die? Sometimes that part will actually be sent to the primary care doctor's office who may, I can attest to this, have not yet been informed that you have passed away.

Wow. I can attest to this, have not yet been informed that you have passed away. Well. So I have sometimes, now in a smaller community, like ours, a lot of times I'm in contact with family, I knew the person was ill, I know before I get that, that's certificate that someone has passed away, but not always, sometimes that's your notification. And so then you're working backwards to try to figure out what happened in order to accurately fill out

This very important government document correct. I mean it should it should be accurate But you may not have been there or have any idea what happened and you're the one who has to fill it out And when you talk about what's on a death certificate and you can pull up there, I mean, hundreds, thousands of images of these online. So if you want to pull up what a blank death certificate looks like, so you can see what I'm talking about, it's really easy to find. I think that they're state by state. So you can look at the one in your individual state. But you'll see that there are usually four lines listed as cause of death because what you're writing is like

the immediate cause of death online one, and then it will say, which was caused by, and you list that online too, which was caused by, and you list that online three, and complicated by, and- I'm an old lady who swallowed the fly for a situation. And you have another line for complicating illnesses.

So like, it wasn't caused by this chronic disease that the person had, but this chronic disease contributed to the process that eventually led to their death. All of that is always listed on a death certificate. So I can't think of a time where I would have ever just filled out like if we're talking about specifically coronavirus COVID-19, it is very rare that you would just put COVID-19 on that certificate because people don't die of, it would be weird to say that you just died of this infection as opposed to what did the infection do to you.

And I think that's half of the problem. So did the infection cause you to have pneumonia which then caused you to go into respiratory failure? So did you die of acute respiratory failure secondary to pneumonia secondary to COVID-19? That's how it would be listed. So already we've taken that specific example I just gave you comes out of that 6%. It goes into the 94%. Somebody who had cardiac arrest secondary to COVID goes on that list. Somebody who had a stroke, secondary to COVID goes on that list. All these

people who are who wouldn't have died had they not gotten COVID are going into this big percentage that they're claiming Well, but these people didn't die of COVID. They died of something else. No, they they died of COVID. Right. Just caused Yes, so that's part of it the other part of it is we always list things that might put you at higher risk For something like that. So you're gonna to see on that fourth line, things listed like perhaps diabetes type 2. You know, I mean, respiratory, any kind of illness that can be caused by smoking would probably be on there at COPD. Smoking isn't traditional. You can put smoking on there though. We probably should more often, right? Because if we're talking about someone who died of a heart attack and they were a smoker, it would be really helpful

for our data to put that on there. But that's not always on there. And that's part of the problem with test certificates as we're getting to is one, we don't always know exactly what happened. If someone passes away at home, it is, it's a lot of educated guesswork because quite often there isn't an autopsy. And so the doctor is doing their best with what they know of the patient and what they know might have happened. But there's always the phrase that that is used a lot, unknown natural causes, or undetermined natural causes. Meaning, I don't know. Curse basically.

But that, so we have this, we don't know exactly what happened. It's hard for us to categorize. Maybe we weren't there. We're trying to be accurate, but we don't want to claim anything that we're not 100% sure of. It's all very uncomfortable. And then there's also like, I think when we talk about this conversation

in regards to like, well, but these people already had these other illnesses, I think there's a lot of ableism in this conversation because what's being reflected is this idea that like well People are only dying of COVID if they have and then list whatever other chronic disease that that's a permissible death Right, and then it's only the old people. It's like okay. Well exactly ages them to like well, it's just old people so It's not great. I like some old people

Well, and one again, it's really terrible to say that, like, if a person is above a certain age, their life matters less. And so their death is not as meaningful. Or if a person has a chronic disease, their life matters less. So their death is not as meaningful. These are obviously immoral things to say.

But beyond that, there's also like, it's illogical. Someone who has a chronic disease that is well-managed and stable would not, you know, likelihood, have passed away today if they had not gotten COVID. And so that's what the death certificate is reflecting is they're like, well, they had that, but they would have been fine, probably, if they had not gotten the illness. So the virus is still the responsible agent. It gets the blame. So I think that there's this kind of manipulation

of this very non-specific document that none of us are quite sure what to do with and we all do our best. There are states where there are training courses required and how to fill out a desert certificate, not every state. A lot of residents, young doctors, are handed a desert certificate to fill out and have never once been told how to do it, which I know. And like, of course, as attendings,

where they are unavailable to try to help guide people through it, but this is not a standardized idea. I've had patients before say, you know, that they've lost a loved one, and they're waiting to find out on the desk certificate. And I've had to sit down and say, let me help you understand why that's not gonna give you the closure you think and why like the

doctor explaining to you what happened, it's, it, you're not going to find out anything new on this piece of paper. And I think that there's this misunderstanding of how specific and how final and what we can know that can be put on that certificate. So this seems to be like if someone is brings up to you this 6% number, this is simplified. This is very much a, it's not the fall that kills you, it's the landing sort of thing. Exactly. What people are saying is only 6% of people died from landing without falling. And it's like, well, yes, but the falling is the thing, right? The falling is, so the falling isn't dangerous.

And it's like, well, no, the fall is absolutely contributing to the landing. The landing part does kill you, but like the fall is what is to blame. Exactly, or I've seen people use this analogy, and I think it makes a lot of sense too. If your criminal defense is, yes, I shot someone, and then they died, but they didn't die from the bullet.

They died from the massive blood loss that resulted from it. So I did not kill them. I kind of like mine better. Yeah, let's stick with mine. Well, it's letting something off the hook. It's letting the coronavirus off the hook here and the coronavirus is on the hook for this. And I think that manipulating the, well, manipulating the data to make it seem like it's not that bad

will make people less cautious and they'll be less likely to comply with masking They'll be less likely to social distance They'll be less likely to do all the things that they need to do to limit the spread And it's also I think a slap in the face to every grieving loved one And it's also, I think, a slap in the face to every grieving loved one who has lost someone to this virus to turn around and go, ah, well, but they just had this too

or they were also this age or whatever. I think that's a morality problem. But I think that's the important thing to remember that that's certificates. There, we know that they're flawed. They actually tend to overestimate common stuff and underestimate uncommon stuff, and especially things that are new.

And so my thought is, and I think a lot of people of echoed this, were probably actually missing some deaths that are attributable to COVID-19. I would say the number is not overestimated. I think a lot of us fear that it's underestimated. Because again, there's that part where if I have a patient who passes away at home, I can't and they never got a COVID test. I'm not going to say that they passed away from coronavirus. I wouldn't assume that. Why would I assume that?

That would be bad medicine to just say, well, probably there's a pandemic. I bet it's this, I'll put that. I would never do that. I would put undetermined natural causes because I wouldn't have anything else. And obviously this is not in, if there's some sort of foul play scenario,

that's a totally separate thing. Then there are medical examiners and coroners and autopsies and all other things happen. We're talking about in the absence of that. So I would say that the number is probably lower than it really is and not higher, which is not meant to scare anybody, but it doesn't, information should empower us to take action,

to protect ourselves and to protect each other, to protect our whole communities, no matter what illnesses we do or don't have, and no matter what ages we are. So, well, I, you know, I grew up with that. And I'm glad someone finally said it. Thank you so much for listening to our podcast. We hope you've enjoyed yourself. We hope you learned a little something and can have this little, you know, entertained and edified. I'm sorry that it was Graham. No, it's okay. It's good.

There's some, you know, that's life or me not, I guess. Thanks to the tax finish for these Thursong medicines is the Intro and Outro Reprogram. And thanks to the Maximum Fund Network for having us as a part of their Extended Podcasting family. And thanks to you for listening. We sure appreciate you. And be sure to join us again next week until then my name is Justin McRoy. I'm Sydney McRoy.

And as always, don't drill a hole in your head. Alright! Maximumfun.org Comedy and Culture Artist Oat? Audience Supported Artist out? Audience supported.