Changing the Cause of Death

"Patients don't die of their disease," William Osler once wrote, "they die of the physiologic abnormalities of their disease."1Advances in medical care now make it necessary to reexamine Osler's observation. In this issue ofThe Journal(p 1055), Hook and co-workers give us such an opportunity, by indicating that despite sophisticated physiological support in an intensive care unit, mortality rates for pneumococcal bacteremia have not changed since major review of the disease by Austrian and Gold nearly 20 years ago.7 The article by Hook and colleagues is important for two reasons: (1) it provides an update on a long-recognized disease, and (2) it highlights a widely held misperception of the ability of a new therapy to save lives by correcting physiological abnormalities. What do we know about outcome from pneumococcal bacteremia? As Hook and colleagues point out, older patients, especially those with serious underlying health problems, such