How We Die | Hacker News Reader

How We Die

washingtonpost.com

53 pointsacdanger48 comments

The New England Journal of Medicine has been running a series of articles with historical perspective to celebrate its 200th anniversary. The article on which this Washington Post blog post is based can be found here:

http://www.nejm.org/doi/full/10.1056/NEJMp1113569

A full list of the anniversary articles can be found here:

http://nejm200.nejm.org/explore/special-anniversary-articles...

AFTER EDIT: some other comments posted here ask about reasons for changes among the top ten causes of death. There has always been suicide in death reports,

http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMp1113...

and suicide has long been one of the top-ten causes of death among YOUNG people (who have a low death rate) in many countries. But indeed as more human beings survive infectious diseases that kill in childhood or never catch those diseases in the first place, they live long enough to be subject to more deaths from suicide and from slow-developing diseases like heart disease and cancer. The age distribution of mortality has changed immensely in the last 200 years, and that changes which causes of death show up as the top ten causes.

Suicide reporting is highly sensitive to politics/society. In some jurisdiction suicides under 18 were classified as accidents since minors couldn't legally have made a conscious decision. in others cases were "given the benefit of the doubt" to spare families

I would be much more interested in a breakdown by age group with a representation of how large a percent of the total that represents. It seems to me that as we age, we have to die of something. I would be a lot more interested in why we die young.

Edit: Here is something close http://www.cdc.gov/Injury/wisqars/pdf/10LCD-Age-Grp-US-2009-...

The big change in death rate is due to stopping infectious diseases among infants.

The causes of death among older people is trickier because of changes in medical reporting procedures. Somebody who 50years ago would have died of "old age" now has to have a reported cause of death.

Since the ultimate cause of death is stopping breathing/heart stopping - you get a lot of cases of 90+year olds who die of pneumonia / heart failure. This tends to get reported in the press as "massive rise in heart disease"

Yes. This is exactly why I wasn't happy with the original. If people live to be 90 and die of heart disease, that is a huge victory. In the chart I linked, it shows that cancer and heart disease start being the number 1 and 2 killers at 45-64, which seems like that is an important group to address. However, if more people start making it to 95 and dying of "heart disease", we are probably better off researching safer cars than cancer.

The big change in death rate is due to stopping infectious diseases among infants.

And also deaths in and following childbirth.

That's an interesting visualization. I have to assume that our increased longevity and relatively fewer deaths due to infectious diseases is the reason more people end up dying from cancer and heart disease?

That was my thought as well. Notice that Alzheimer's also makes the list.

Of particular interest is that suicide is on the new list, and wasn't on the old one. That says something about society, but I'm not exactly sure what.

They are top ten lists and three infectious diseases are eliminated from the newer list.

So it is tough to draw any conclusions about suicide. This document suggests the rate has fallen slightly since 1950:

http://www.cdc.gov/nchs/hus/contents2011.htm#039

(I wondered what the trend was and looked it up, I'm not involved in public health or anything)

Suicide isn't exactly something new -- Romeo and Juliet stand out as good examples. And it had to be common enough that the Catholic Church felt the need to oppose it. Or think about Great Depression stock traders jumping from windows.

I imagine most suicides were categorized as accidents, back in 1900.

Note that Alzheimer's wasn't even "invented" as a diagnosis in 1900, though. I'm guessing that most of the folks dying of Alzheimer's in 1900 wound up getting classified into the "senility" box.

Seeing the breakdown from 1900 makes me very worried about the reports of TB strains that can't be cured by any known antibiotic. E.G. http://www.wired.com/wiredscience/2012/01/invincible-tb-indi...

This bit stood out to me as surprising: the rate of death to "accident" per 100k was 72 in 1900 and 38 in 2010. With all our modern technology and regulation we're really only twice as safe?

I guess my suspicion is that the big contributor is auto accidents, which had no analog in 1900 (and in any case, transportation accidents at muscle-powered speeds were unlikely to be fatal). Still, my intuition had been that the world used to be a more dangerous place than it was.

At least in cities, the introduction of the motor car improved road safety. Spooked horses were a leading cause of accidents. Working horses weigh anywhere from 600-1000kg and can easily trample or kick a man to death. Carriages had completely ineffective brakes and were effectively impossible to stop in an emergency. Their large wooden wheels and open underframes could cause horrific injuries due to entanglement, even at walking pace.

Then, as now, the most common accidental cause of debilitating injury and death is quite humble - trips and falls. As our population ages, this problem becomes more and more serious due to what geriatric specialists call the cycle of falls.

The cycle starts when an elderly person has a minor fall, which causes them to be hospitalised or bedridden for a few days. This period of inactivity causes muscle atrophy and a decline in coordination, which greatly increases their risk of falling and their risk of being seriously injured when they do fall. Without appropriate intervention, a fit and healthy older person can become extremely frail within the space of two or three years due to a series of increasingly more frequent and serious falls.

Accidents presumably include falls. As people age, the likelihood of injury and death from falls increases significantly. The median age of the American population is significantly older than it was 112 years ago. Thus the death from accidents is high because people don't die at the same rate from disease.

Actually I think a 50% drop in accidents is pretty good, especially given how many new dangerous things we've invented since then.

Actually there was an article the other day about accidental death rates: death due to drug overdose has overtaken death due to car accident, due to a dramatic drop in one and rise in the other.

http://abcnews.go.com/Health/Drugs/drug-deaths-exceed-traffi...

The extent to which drug overdoses can be called "accidental" is, of course, debatable, but I guess they're classified as accidental at least in cases where it's not obviously suicide.

Autos and airplanes and the popularization of skiing, watersports, etc.

Mainline Commercial air travel (Delta, United, etc) hasn't killed anyone in a while. It's one of the safest forms of transportation there is. Certainly a lot safer than driving.

I'm just saying that the average person has contact with dangerous machines on a regular basis, compared with the past.

And they're just saying that it presents an immaterial risk compared to all the other things people get killed by and so doesn't factor in.

Autos and airplanes just aren't comparable.

I heard that if you eliminate all the microaccidents causes of death(cancer, cardiovascular disease, alzheimer), we would be able to live 700 to 1000 years and be in good health when we die.

Of course, death in the future might be more violent because that's the only way to die. You might bled out, have your skull crushed, fall to your death, get shot, committed suicide, or be murdered. It's pretty unpleasant, but the alternative is getting old and unhealthy and then dying of cancer/heart attack/neurological disease at the age of 80. I think I take my chance living up to 700-1000 years in a 20 something body.

Only if you also eliminate senescence -- cells generally lose the ability to divide over time, and a whole bunch of creeping malfunctions result in us breaking down towards a limiting age of 114.

So, we each have 114 years to transform our bio-bodies into mechanical machinery and/or our minds into digital ether.

We're becoming a holometabolous species. We just don't know how to become beautiful, space-faring butterflies yet.

That process is probably a lot harder than you think, if you haven't studied the biological sciences.

(Analogy: it's not like refactoring code in a high level language, it's like reverse-engineering a heap of spaghetti-coded self-modifying assembly written by a neural network and designed to run simultaneously on several different CPU architectures that have been glommed together in the same box. In other words, it's nightmarishly difficult.)

114 years might suffice to do it. Or to demonstrate that it's a very intractable problem (on the order of Fermat's last theorem) or to prove that it's impossible. Meanwhile, for those of us who are already pushing fifty (like me), it's probably already too late.

You missed my point: I'm not saying that from today we have 100+ years to solve the problem, but that once the problem is solved, a given human being biological body will only be a transition.

Fermat's last theorem was proven in 1995 though, uber hard, yes, but not intractable :)

There's a non-zero chance that we'll move back into asexual reproduction: clone yourself and raise as a child, or fork a copy of your brain into a simulator, or build a new body from synthetic cells and imprint your neural matrix, etc.

Aubrey de Grey suggests this in one of his TED Talks (http://www.ted.com/talks/aubrey_de_grey_says_we_can_avoid_ag...).

The main problem is that one _can_ die regardless how much infrastructure, political, religious, economic, etc. we build around death. "Graceful death" is what we should be aiming for, as ultimately such a "bubble-up" approach to dying itself will give us a way to modularize and treat its symptoms (or, as you put it, "microaccidents").

Applying principles of graceful degradation to the process of dying may have a consequence of extended life, but the main goal is to not build _unnecessary_ medical, political, doxastic institution, industry or infrastructure around this process. So, for instance, do we _really_ need hospitals or surgeons _physically_ touching patients? Whether or not one comes down on one decision or the other, there will be political, economic, pharmaceutical, technical, industrial, etc., etc. that follow. Medicine is _costly_ to practice; _triage_ is stressful and costly; ERs are costly; ambulances are costly -- Do you _believe_ in these things? Or do we simply wish to maintain our health? What is the most efficient way to do this? "Graceful dying" may be viewed as a kind of preventive, holistic therapy to this process, where all we've done historically is _react_, medically speaking, to this natural process.

"Graceful death" may, in the long run, be _cheaper_ and we get the added benefit of physiologically more rewarding life experiences.

I think it's interesting how accidents have decreased along with diseases. I imagine it has something to do with better technology and regulations.

I would think the automobile is the primary factor in why it isn't lower. (Looking at wikipedia, traffic accidents account for 2.09% of deaths, the next accident category, falls, is 0.69% http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate )

I was actually surprised at how little it has changed relative to the amount of safety regulations and technology. I always pictured the years around 1900 as being much more physically dangerous.

What we saved by having hard hats at work and guards on machines - we lost by you commuting an hour in your car without a seatbelt

And different jobs - a printer jam doesn't do quite the same damage as an explosion in a coal mine.

Accident RATES in factories have gone down a lot, construction/farming a little less so - but the number of peopel exposed to the risk environment has dropped a lot

A printer jam in 2012 doesn't mean quite the same thing as a printer jam in 1912 either.

You're thinking of the 100s killed in the great Difference Engine bug of 1868

Death rate has dropped half in a century because of medical advances, but cancer-related deaths have tripled - why?

Everyone dies eventually. The deaths that would have been from whatever is no longer killing us are being taken over by something else that still does.

Or, another way to look at it: we are living long enough now that we have a much better chance of contracting cancer during our lives.

There may be myriad other causes (on which I'm largely ignorant), but one reason cancer kills more people than it used to is that more people are living long enough to be killed by cancer instead of something else.

It frequently takes a fair amount of time for the various micro-level problems in cells to develop into cancer, and then it takes some additional time for that cancer to get bad enough to kill you - which is why young people rarely die of it, and one reason why "death by cancer" will be rare when everyone dies of something else while they're still too young to have had much cancer risk.

There are a few possible explanations for this, although three obvious ones jump to mind:

1) There is more cancer today or the cancers are more lethal.

2) We are better at diagnosing cancer today.

3) We've eliminated (or dramatically reduced) a lot of the things that aren't cancer that can kill you.

My money is that it's mostly 2+3, and that those have brought about a bit of 1.

The longer you live, the longer you have to get cancer.

People live long enough to have cancer.

Because God ran out of other ways to kill people... And everybody still has to die of something, sometime.

It's frightening to see how the levels of suicide and Cancer went up comparing to 1990. Suicide can be related to the level of stress in our modern world, but what about cancer?

Cancer rates increase as life expectancy does.

I can appreciate why it took a while for the thought to die off that "brandy drinking women" were prone to spontaneous combustion.

Speaking about Spontaneous Combustion, each time I hear about that I think of 3rd grade, when I read this... http://www.gocomics.com/calvinandhobbes/2008/12/14

"Doctors agreed that even a near miss by a cannonball — without contact — could shatter bones, blind people, or even kill them."

How can a near miss of a cannonball shatter bones etc? Something to do with air pressure?

In theory yes, although unlikely at cannonball velocities

There is/was an urban myth that the shock wave from the higher velocity rounds introduced in the Vietnam era M16 could kill with a near miss - it's essentialy impossible

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