Heart deaths increase on 'unlucky' days

December 20, 2001

The Hound of the Baskervilles effect: natural experiment on the influence of psychological stress on timing of death, BMJ Volume 323, pp 1443-6

Chinese and Japanese people are more likely to die from heart disease on the fourth day of the month because the number 4 evokes superstitious stress among this group, finds a study in this week's Christmas issue of the BMJ.

David Phillips and colleagues found evidence that Chinese and Japanese Americans associate the number 4 with death. They then compared death certificates for Chinese and Japanese Americans with white Americans from 1973 to 1998.

On the fourth of each month, cardiac deaths were significantly more frequent than on any other day of the month, and were 7% higher than the average for the rest of the week. This effect was not evident in white Americans, nor was it evident in Chinese and Japanese Americans who die from causes other than chronic heart disease, say the authors.

The authors call this peak "the Baskerville effect" because in The Hound of the Baskervilles, by writer and doctor, Sir Arthur Conan Doyle, Charles Baskerville dies of a heart attack induced by extreme psychological stress.

The fourth day peak does not seem to occur because of changes in the patient's diet, alcohol intake, exercise, or drug treatment, say the authors. At present, the only explanation is that psychological stress linked to the number 4 elicits additional deaths among Chinese and Japanese patients, they say.

"Our findings are consistent with the scientific literature and with a famous, non-scientific story," say the authors. "The Baskerville effect exists both in fact and in fiction and suggests that Conan Doyle was not only a great writer but a remarkably intuitive physician as well," they conclude.


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