10/28/2013 01:26 pm ET Updated Jan 23, 2014

Dare to Be 100: Best Medical Article -- Ever

Lets see now: I started reading articles in medical journals as a second-year student in medical school in 1952. That was 61 years ago. I estimate that on average I've been reading 10 articles per day ever since, some days more, some days less. Sometimes the articles were chosen for targeted content. Often they simply popped up randomly only to lead to other fascinations.

Ten per day times 61 years equals 22,650, give or take a few. This sounds like a lot of articles, but it pales in comparison with the total number that were written.

A paper from the University of Ottawa a few years ago estimates that there have been maybe 50 million scientific papers in the recent literature. (1) In 2009, 1.3 articles were written every minute.

My favorite out of this massive jumble stands out, the single article that represents the essence of what the other 49 million+ should be writing about. The article was written by Drs. Mike McGinnis of the IOM and Bill Foege of the Gates Foundation. The article title was, "Actual Causes of Death in the United States." (2) It was published in the Journal of the American Medical Association in 1992.

Its significance derives from its insistence that the terms on the death certificates of our nation's forms are wrong. Heart, and stroke, and cancer aren't the actual causes of death. The actual causes are the antecedent behaviors, the lifestyles factors, which lead to the terminal events. The ultimate, behavioral causes, the gluttony, the sloth, the smoking are the real villains, instead of the supposed clinical proximate issues implicating heart, cancer, stroke, diabetes, etc.

Such a basic relabeling is similar to that of Aristotle who chided Homer for inventing the demigods of the Iliad and Odyssey. The misadventures of Achilles were not due to metaphysical fantastic figures. Instead, mankind's, aka Achilles's, challenges, deaths and so forth, are actually knowable.

Our individual and collective life courses are thereby subject to rational scientific analysis. Instead of our lives being ruled by the whims of Fate, the determinative agencies reside in domains that are ultimately results of physical forces which we can observe, measure, and choose. Matters of Fate became matters of Choice.

Aristotle's insistence birthed modern science. The world in all its manifestations is knowable. Pasteur in 1865 showed that illness was not the result of sin, but resulted from a physical agent, bacteria. Modern medicine was born after this disclosure.

Therefore, in my view the McGinnis, Foege JAMA article is the epitome of the knowability of the causes of death. It places the actual causes in the context that they represent rather than the pseudo-actual causes in current vogue.

The implication of this article is that medical science is derelict in not focusing on behavior. This is what the essence of human well-being dictates. Modern medicine needs to morph into next medicine, and its emphasis on health rather than disease.

Prevention rather than repair should become medicine's focal strategy.


1) A. Jinha. 2011 Learned Publicity; 23:258-263.

2) J. M. McGinnis, W.Foege "Actual Causes of Death in the USA" 1992 J. Amer. Med. Assoc.;240: 2207=2212.