“Innocent Prattle” and the Quality of Scientific Discourse

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We read with interest the editorial titled “Innocent Prattle” by Dr. Lagasse1that accompanied our article on anesthesia mortality.2As we described, the recent 10th revision of the International Classification of Diseases (ICD-10) codes now includes extensive data on anesthesia complications. Its adoption by the United States to classify death certificate data offers both the opportunity and the obligation for researchers to engage in thoughtful analyses of these data. Our study was the first to accept that challenge. As stated in our article,2our objectives were “to develop a comprehensive set of anesthesia safety indicators based on the latest version of the ICD and to apply these indicators to a national data system for understanding the epidemiology of anesthesia-related mortality.” By any measure, we have achieved these objectives despite Dr. Lagasse's critique. It is well recognized and extensively discussed in our article that administrative data, such as those from ICD-coded, multiple-cause-of-death files, may underestimate the true incidence of adverse outcomes of medical care. It has been estimated, for example, that adverse drug effects reported to the US Food and Drug Administration account for substantially less (< 20%) than the true incidence.3However, such data can and have been crucial in detecting trends, identifying safety problems, and defining strategies to improve drug safety. In addition, thoughtful analyses will allow further granularity to be either detected from the current data or built into future ICD editions. Dr. Lagasse seems to disagree with our view that the opportunity should not be lost to analyze the ICD-10–coded mortality data as presented in our article and seems to view such analyses as “innocent prattle.”Although vigorous argument, discussion, and even disagreement are essential and useful parts of the scientific process, derogatory comments about colleagues' work are not. It would be a pity if learned publications fall into the trap of adopting the headline style of some popular tabloid newspapers. A deeper reading of the message of Hans Christian Andersen might be that substance and reality (read: scientific data) trump posturing and belief regardless of one's perceived status. We will look forward to the application and validation by the scientific community of the techniques described in our article to monitor anesthesia safety and improve patient outcomes in the future.*Columbia University College of Physicians and Surgeons, New York, New York. GL2240@columbia.edu