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—The letters published here and the direct responses of others have been helpful in broadening the look at actual causes of death. Drs Tyson and Detmer point out the problems with death certificate classifications' obscuring true etiologies. In addition, fashions change making it even more difficult to interpret time trends. We support efforts to improve death certificate classifications.Dr Blackman points out the problem of determining how much of the firearm-related death tragedy in this country is actually alcohol-related. In the absence of good alcohol data, we decided we could not disaggregate the two risks in a meaningful way. His comment that "most premature deaths would still have occurred, simply by other means" is contradicted by all of the death trend data. It is the decline in premature mortality that has dramatically increased life expectancy both in developed and developing countries.Mr Lincoln questions the relationship of tobacco
McGinnis JM, Foege WH. Actual Causes of Death in the United States-Reply. JAMA. 1994;271(9):660-661. doi:10.1001/jama.1994.03510330037023