Who killed Cock Robin? The martyred scientist

Abstract

Assertions that selected diseases are the “great killers of mankind” are common in high places. National societies promoting campaigns for funds to study those diseases contend for each death to be assigned to the disease of their special interest; thus will their claims for priority in charitable donation gain the desired weight provided by statistical evidence. Vital statisticians routinely respond in such ways as fall within their province to “fix the blame,” or, in more formal language, to secure with scientific accuracy, from the medical profession, coroners, or others, a specification of the cause of each death. Pursuit of this objective is certainly laudable from all conventional view‐points, but in so conforming one may become a victim of habit rather than an alert pursuer of well reasoned objectives. … It is a false proposition that each death is a response to a single cause. Of this we are well aware. Admission of multiple causation for each death is tacit in the [death] certificate itself. We have long striven for entry of a sequence of causes rather than a single cause. As a result of this, the selection of one cause for tabulation purposes has itself become a major problem for us, leading to much juggling of terms, rules, and instructions to the distress of the medical profession as well as the statisticians. Efforts in recent years to solve the problems of tabulation and interpretation of aSSignment of multiple causes represent an attack on a basic problem and clearly indicate that causation of death is not considered singular.