Gut Check is a periodic look at health claims made by studies, newsmakers, or conventional wisdom. We ask: Should you believe this?
The Claim: People on the verge of death due to a chronic illness can delay their demise by a few days, allowing them to, for instance, spend a last holiday with loved ones, see a child marry, or celebrate a last birthday — as David Bowie did, two days before dying of cancer on Sunday.
The Backstory: After Gut Check examined the claim that suicides peak around Christmas (they don’t, instead rising in January), several readers asked whether deaths that are less under one’s control — such as those from a chronic illness — can be timed. Eli Bortman, who teaches law at Babson College in Wellesley, Mass., recalled how his father, who was dying of liver cancer, “hung on until just after my daughter’s bat mitzvah.” That resonated with Bortman in part because he’d heard that some Jews postpone their impending deaths until just after Passover, the weeklong holiday that marks the Israelites’ exodus from Egypt.
That claim dates to at least 1988, when two sociologists reported a death dip of 8 percent in the week before Passovers (compared to the week after Passover) among Californians with “probably Jewish” surnames. In 1973, one of the researchers had reported a small decline in deaths (in New York City and Budapest) in the weeks before Yom Kippur, the Jewish Day of Atonement. Similarly, a 1992 study of deaths among the elderly in New Haven, Conn., concluded that some were postponed until after important Christian or Jewish holidays. On the other hand, a 2004 study in the Journal of the American Medical Association of just over 300,000 cancer deaths found no evidence of a death dip before Christmas, Thanksgiving, or birthdays.
First Take: Economist Gary Smith of Pomona College has become the leading debunker of death-takes-a-holiday claims, showing how statistical and other flaws invalidate them. For instance, the California Passover study didn’t actually know who among the dead were Jewish. When Smith examined 5,111 definitely Jewish deaths (the deceased had Jewish funerals), he found the opposite of the folk wisdom: namely, somewhat more deaths before Passover than after.
When Smith examined the idea that famous people can postpone death until just after their birthday, he found that one study making that claim counted as “postponements” deaths that fell during someone’s birth month — even when the death occurred before the actual birthday. Of the 26 people who died during their birth month, “13 died before their birthdays, one died on his birthday, and 12 died after,” he said. We “found no evidence that people are able to postpone death.”
Rather than getting mired in the statistical muck of individual studies — though for the gory details you should read Smith’s delightful book “Standard Deviations: Flawed Assumptions, Tortured Data, and Other Ways to Lie with Statistics” — consider some general cautions.
If you look for a link between death rates and holidays, the more pairs you test — California Jews and Passover, Hungarian Jews and Yom Kippur, Boston Christians and Easter — the more likely you are to find a hit by chance alone. Some seemingly legitimate (but actually spurious) associations will pop up. That’s what studies finding postponed deaths did, Smith said: “The data had been mangled, mauled, and manipulated to give the desired result.”
And given journals’ preference for studies that find something over those that don’t, these are more likely to be published.
On the other hand, when studies look for associations between holidays and all deaths, they risk missing a “death takes a holiday” effect if it exists for only some deaths. Presumably, any postponement effect would apply only to some causes of death — not accidents, for example. Also presumably, not everyone can or wants to time his death. The existence of a phenomenon that occurs in only a small number of deaths can, therefore, be obscured.
Second Take: The debate over whether death takes a holiday had had little input from end-of-life experts. STAT therefore checked in with Dr. Joseph Andrews, a veteran palliative medicine specialist now at Greenwich Hospital in Connecticut. “There is quite a bit of evidence for some control over the precise timing of death,” he said.
He had one pancreatic cancer patient years ago whose wife was entitled to a significantly higher survivor’s pension if he lived into January 1. On New Year’s night, Andrews recalled, a nurse wished the patient happy new year. He asked her the time. It’s 1:10, she told him. He thanked her — and 15 minutes later was dead. Andrews is certain the patient willed himself into the new year to help his wife financially.
Other palliative-care specialists recall patients who held on for a very different reason: they did not want to die when their loved ones were in the room, waiting until they were alone.
“It’s a mystery to me, how you can willfully let go or hold on” for a few hours or days, Andrews said. “I can’t explain the physiology of that. It does seem that if patients are comfortable and free of pain” — the purpose of palliative care — “they’re better able to hold on, but that still leaves the question of how.”
The Takeaway: If death takes a holiday, for birthdays, or Passover, or anything else, the effect is too small to reliably show up in statistics. But a few individuals at the end of their lives can and do choose to hang on for a few more days.