Bangladesh has a lower MMR than America?!? — caveat lector…

A recent article I read discussed Bangladesh, and the strategy to reduce maternal deaths. It said that from the years 1996-2000, the maternal mortality ratio was 512 per 100,000 live births; but that was reduced to 3.2/100,000 as of 2007.

My eyes about bugged out of my head — 3.2/100,000? In Bangladesh?? I couldn’t believe it. If you’re unaware, the official MMR for the United States is somewhere around 15/100,000, with the CDC recognizing that it doesn’t catch all maternal deaths, so the real figures are even higher. Most of Europe has MMRs of around 8/100,000 — some less, some more; I think Ireland has the lowest MMR of 1/100,000. So for Bangladesh to be lower than the United States and, well, just about everybody else in the world, was incredible. Plus, reducing their MMR to less than 1% of their rate of 7 years before was likewise astounding.

But it was with good reason that the words “unbelievable” and “incredible” popped into my mind. Because it’s not true. It’s a typographical error. The actual rate is 320/100,000 — about twenty times higher than the U.S. rate. Obviously somebody misplaced a decimal point somewhere… except that there shouldn’t be a decimal point, since the denominator is always 100,000. Perhaps one source cited it as a rate of 3.2/1,000 and then numerator remained the same while the denominator changed to the typical? “Caveat lector” — reader beware!

It is understandable that an editor might not catch that mistake — after all, s/he might not realize what a typical Western MMR is, and how illogical it would be for impoverished Bengali women to die at less than half the rate of Western women. The extremely dramatic drop in MMR ought to have tipped somebody off. But it didn’t. It made it into print (or at least cyber-print) that way. Not too surprising, really — I am appalled and overwhelmed by the number of typographical and grammatical and spelling errors I see in articles written by supposed journalists (Associated Press bylines and such). We’re not talking about my penny-ante local twice-weekly newspaper who can’t even get “adds” in the newspaper spelled “corectly” — we’re talking serious journalists (supposedly), who are actually being paid to write these articles, and they look like they were written by middle-school kids. Typos happen to the best of us — particularly when writing quickly, under deadline, when tired, etc. — I make tons of typing mistakes; but I correct them. I proof-read my work. Sometimes I still miss errors, but I trust these are rare. It’s sad that I am more careful with what I say and how I say it than people who are actually paid to do this. Do editors not actually edit any more?

This is one reason why I like to go to original sources. Like the old game “telephone” or “gossip” — where you put a group of kids in a line, and whisper something into the first kid’s ear, and he tells the next person what he thinks he heard, and then she tells the next person, and so on, until finally you get to the end of the line and the last person says out loud what he thinks he was told… and it bears almost no resemblance to what was actually said at the first. Things get garbled and miscommunicated. There have been numerous times before, and I’m sure there will be more times in the future when something is said to me that I mis-hear or misunderstand, or was purposefully or accidentally skewed prior to my reading/hearing it. And I might pass that on unintentionally. It happens all the time all over the world, from small-town gossip to world-wide politics, and everything in between.

When I was in college, my friend’s father cut his finger when making a doll-house for his little girl. The accident happened early in the morning; by the time our family was told about it, we heard that he had definitely lost his index finger and maybe part of another finger or two. By the time I got to college, the story was, “Joseph’s daddy is dead!” What really happened was that he cut off the tip of his index finger, from about the top knuckle upward. When it was all healed, except for not having a fingernail and his finger being a tad too short, it wasn’t even that obvious. But the day it happened, as the story drifted from one source to another, it likely got spread the following way: “Mike cut the tip of his finger off using the power saw; it’s pretty bad bloody, and we’re going to the hospital to get it sewed up.” The next person likely said, “He cut part of his finger off…” The next person likely dropped the “part of” leaving only “cut his finger off.” The next person probably wondered, “How can you cut only one finger off? It had to be pretty bad — I bet he was holding his hand like this, and cut this finger off and this one half-off…” and so forth and so on. Part truth and part speculation passed on as full truth — because after all, so-and-so wouldn’t lie! Well, no, but so-and-so might not remember or know which part is truth and which part is mere speculation! Perhaps somebody heard from one source that he cut off a finger and from another source that he cut his hand pretty badly, so it morphed into “he cut his hand off” — and of course, you know if you slit your wrists, you can bleed to death, so if you cut your hand off, you’re bound to be pushin’ up daisies!” [Actually, you’re less likely to bleed to death if you accidentally cut your hand off, because shock causes the blood vessels to shut down; and that typically doesn’t happen with severing an artery. But not everybody knows that.]

So, reader beware — it’s not just “you can read anything on the internet” — although you can! — but even trusted sources may mislead you, accidentally or intentionally.

On a slight tangent, this year marks the 20th anniversary of the Tiananmen Square massacre. It’s hard to believe it’s been 20 years. Even harder to believe that in China it’s regarded as a Western-fabricated myth, to those who don’t know it for sure. Wonder how you say “Big Brother” in Chinese…? I read recently that the top Chinese search engine goes to such a page when people look for information regarding the massacre — lying to millions of Chinese, telling them that it never happened at all, or that it was just a small uprising — not that thousands were killed and wounded, jailed, and perhaps even executed, for demonstrating. And that in China, Google censors itself, so that such topics like this do not have the light of truth shed on them. Also, that the Chinese government has sophisticated filters that block access to sites that do speak the truth, should these other measures fail. So far as I know, these things aren’t happening in the West — at least not on a large scale. I’ve heard of Google throwing its power around to squash sites they don’t like — using its search engine technology to keep certain sites from coming up at all, or putting them very far down on the list, while promoting sites that they agree with, bumping them up to the top of the list, even though they shouldn’t be there, just based on how many hits they’ve gotten, compared to others. Many of us are familiar with YouTube removing birth videos for being too graphic (I know that Laura Shanley has complained of her unassisted birth videos being taken down), yet other videos that are sexual in nature and therefore more explicit, are left up.

So, be on the lookout for errors, and also for intentional deception. Most of the time, errors aren’t going to be big ones — small typographical errors taht dont realy change the meaning of hte sentence. But sometimes small errors birth big errors; and one simple story can take on a life of its own and become a huge behemoth. You can read anything on the internet. Reader beware.

3 Responses

  1. WOW! For a moment there I was like… DANG! How is it possible?

    Stupid errors!

  2. Thanks for posting about this. Human error is one of the research flaws we rarely hear about. In this case, the error was obvious to anyone who knows anything about maternal mortality. But it makes you wonder how many other examples are out there that are much more subtle. I’ve come across a few clear errors in published, peer-reviewed studies before. And I’m a peer reviewer myself, and can tell you that there rarely is a way to know for sure that data were calculated or reported correctly.

  3. Very nice blog. You make an important point!
    I came across your site while doing a search for MMR rate.

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