Jewish World Review March 11, 2005/ 30 Adar I, 5765
Drs. Michael A. Glueck & Robert J. Cihak
The Misty Myths of Infant Mortality Data
Statistics, even at their best, don't tell a whole story. In fact, numbers don't tell any story at all. Data passively await analysis by people who may ignore or distort them, and who may, or may not, make appropriate inferences based on them. This can cause an empirical forest to be lost in the data-point trees.
A variety of people use the same medical statistics to tell their own story, or create their own myth.
Take infant mortality statistics. The officially reported U.S. infant mortality rate has been indisputably high compared with similarly industrialized countries since at least the 1920s.
That fact has led to a widely accepted conclusion among public health people in the U.S. that these rates are "caused" by poorly distributed health care resources and can be "solved" by adopting a socialized government-paid system of health care.
We heartily disagree.
Let's look at the numbers.
While comparing statistics among countries can be tricky, in the case of infant mortality figures, the comparisons are downright treacherous. For starters, different countries count differently.
According to the World Health Organization (WHO) definition, all babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth. The U.S. strictly follows this definition. But many other countries do not.
Switzerland doesn't count the death of very small babies, less than 30 cm. as a live birth, according to Nicholas Eberstadt, Ph.D., Henry Wendt Scholar in Political Economy at the American Enterprise Institute and formerly a Visiting fellow, Harvard University Center for Population and Developmental Studies. So, comparing the 1998 infant mortality rates for Switzerland and the US, 4.8 and 7.2 respectively, is comparing apples and oranges.
Other countries, such as Italy, use different definitions in various parts of their own country. Eberstadt observes that "underreporting also seems apparent in the proportion of infant deaths different countries report for the first twenty-four hours after birth. In Australia, Canada, and the United States, over one-third of all infant deaths are reported to take place in the first day...." In contrast "Less than one-sixth of France's infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths."
A UNICEF press release noted, "Under the Soviet era definition ... infants who are born at less than 28 weeks, weighing less than 1,000 grams or measuring less than 35 centimeters are not counted as live births if they die within seven days. This Soviet definition still predominates in many [formerly Soviet] CIS countries." The release also points out, "The communist system stressed the need to keep infant mortality low, and hospitals and medical staff faced penalties if they reported increases in infant deaths. As a result, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths."
Since the United States generally uses the WHO definition of live birth, economist John Goodman and others in their 2004 book "Lives at Risk" conclude, "Taking into account such data-reporting differences, the rates of low-birth-weight babies born in America are about the same as other developed countries in the OECD [Organization for Economic Cooperation and Development]." Likewise, infant mortality rates, adjusted for the distribution of newborns by weight, are about the same.
American advances in medical treatment now make it possible to save babies who would have surely died only a few decades ago. Until recently, very low birth weight babies weighing less than 3 pounds almost always died. Now, some of these babies survive with the help of breathing assistance and other recent inventions. While such vulnerable babies may live with advanced medical assistance and technology, low birth weight babies (weighing less than 5.5 pounds) recently had an infant mortality rate 20 times higher than heavier babies, according to the WHO. And these deaths count as infant deaths even though most would have been counted as stillbirths if they hadn't received a gift of life, however transitory. Ironically, American doctors' ability to save babies' lives causes higher infant mortality numbers here than would be the case with less advanced medical treatment.
Because of varying standards, international comparisons of infant mortality rates are improperly used to create myths about how the United States should allocate local or national resources. If we want to lower our infant mortality rate so it compares better with that of other countries, maybe we should bring our measuring into line with theirs to better determine the actual extent of the so-called "problem."
Enhancing the survival and well-being of our babies is vital and important. More government interference in medicine will only subject them to the unhealthy, malarious swamps of socialism infant mortality myths notwithstanding.
Editor's Note: Robert J. Cihak wrote this week's column
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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