To the Editor.
—The article entitled "Actual Causes of Death in the United States"1 was misleading in a number of ways. First, the title should have been something like "Nongenetic Causes of Death" or "Potentially Preventable Nongenetic Causes of Premature Death," or adjustments should have been made so that ordinary causes of death not credited to one of Drs McGinnis and Foege's major external factors were kept in. Otherwise, listing nine or 10 leading "actual causes" misleadingly suggests that heart disease and cancers are not leading causes of death. In fact, subtract those cancers and heart diseases that McGinnis and Foege attribute to external causes, lifestyles, and the like, and heart disease remains comfortably in third place as a cause of death, and cancers not attributable to outside influences kill more than toxic agents do.Second, either some deaths are counted twice or virtually no firearm-related deaths are attributed
Blackman PH. Actual Causes of Death in the United States. JAMA. 1994;271(9):659-660. doi:10.1001/jama.1994.03510330037019