Lies, D*#! Lies and Statistics

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“There are three kinds of lies: lies, damn lies and statistics.”

-Mark Twain

Some in our profession are quick to be critical of medical care. Most of the time it is so we can feel better about ourselves, as if there was a correlation between the failure and shortcomings of medicine and the value and greatness of chiropractic. While the failure or success of medicine has nothing to do with chiropractic, there are other reasons why we should not get caught up in these issues. One reason is that some of the statistics are simply not correct, and if we use them we look foolish to those who know better. For example, one that I have always found of concern is the high infant mortality rate in the US compared to other industrialized nations. I have heard from numerous platform sources that we rank as low as 38th. I am no fan of the health care delivery system in this country, but I always found that statistic to be pretty difficult to accept, especially considering it came from the World Health Organization for whom I have little respect.

Recently, with the increased focus on health care and the use of the above statistic to denigrate our present health care system, the reason for this statistic has come to light. The truth is infant mortality rate as a whole is the result of the sum of rates across an extremely diverse population. African-Americans have a higher rate compared with Hispanics and Caucasians regardless of socio-economic, age, or income levels. No one knows why this is true, but the higher number of African-Americans in this country compared to Europe skews the statistics. So what we end up doing is comparing apples with oranges with respect to infant mortality rates. In the United States we count every baby who breathes after birth regardless of size or weight at birth. In much of Europe, babies born before 26 weeks gestation are not considered “live births.” Switzerland only counts babies who are 11 inches long or longer. Canada, Austria, and Germany do not count babies weighing less than a pound as a live birth, no matter how long they live. In excluding those births as “infant” mortality and classifying them as miscarriages they distort the statistics. In France, Hong Kong, and Japan (the country with the lowest infant mortality rate) they do not count infant deaths that occur during the first 24 hours of life. They too are “miscarriages.” It should be noted that almost half of infant deaths in the US occur in the first day.

Knowing all this, we cannot really blame our health care system, at least not entirely, for the cause of our high infant mortality rate. The primary cause of true infant mortality is major birth defects. There are legitimate factors that lead to the high infant mortality rate in the US. Some of these cannot be blamed on the medical profession or our health care system. They are products of the society we live in. For example, low birth weight leads to infant mortality and low birth weight is in part caused by factors such as illegitimacy, teenage pregnancy and maternal smoking. Illegitimacy and teenage pregnancy usually cause a lack of health care as these two groups tend to see a doctor late in their pregnancy or not at all.

We have the best practiced medicine in the world. The problem is not the application of the health care delivery system. The problem is the philosophy of health care in this country. Our country’s philosophy is one of disease care rather than true health care. The solution is not to reduce the quality of disease care, but to truly adopt health care. As long as we focus on what’s wrong with the system and ignore what’s wrong with the philosophy, we are not going to see any significant changes. No government program is designed to solve that problem.

If we as chiropractors are going to have any impact, we need to stop being critical of the practice of medicine and begin to educate people as to the difference between the outside-in philosophy of medicine and the above-down philosophy of true health care. Without that change in philosophy, there will be no improvement in the system, regardless of who is in charge of it. V25n2

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