It's been quite a week for the New England Journal of Medicine. In the current issue, we learn that fat is contagious and that cats can sense when people are about to die. Or at least one particular cat can tell. He's 2 years old, with patches of gray and white fur, and he lives in a nursing home in Providence, R.I. "Oscar the Cat awakens from his nap, opening a single eye to survey his kingdom," begins the article, by Dr. David M. Dosa of Brown University. "From atop the desk in the doctor's charting area, the cat peers down the two wings of the nursing home's advanced dementia unit. All quiet on the western and eastern fronts."
Don't be surprised if that sounds a little florid for the nation's leading medical research journal. The story of Oscar the Cat—a feline who cuddles up with patients in the moments just before they meet their makers—isn't a peer-reviewed scientific inquiry, nor is it a clinical report, a case study, or even an editorial. It's a work of creative nonfiction—an uncorroborated anecdote that makes vaguely mystical claims about the cognitive abilities of animals. And it's tucked into a section of the journal that's more often reserved for wonky reviews. "A young grandson asks his mother, 'What is the cat doing here?' " writes Dr. Dosa. "The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Let me pose a more modest question: What is the cat doing in the New England Journal of Medicine?
Gaining credibility, for one thing. Reporters were happy to attribute the news of Oscar's amazing powers to "a new report in a medical journal" by "an expert in geriatric care." ("Cat predicts patients' deaths: scientists," read one headline.) Without his prestigious turn in the NEJM, Oscar might have ended up on the local television news, like the 10-year-old tabby named Buckwheat who sniffs out dying patients in West Seattle. He might even have become as famous as the dog that dialed 911 or the monkey that joined a SWAT team. But after making his debut in the NEJM, he's an international sensation.
In fact, the popular press accounts of Oscar the Cat provide more scientific analysis than the original journal article—they quote animal behavior experts who speculate on how he might accomplish his feat. Dosa tells us only that "Oscar the Cat has had an uncanny ability to predict when residents are about to die" and that he's "presided over the deaths of more than 25 residents" by nuzzling them during their last few hours of life. That's a lot of pre-death nuzzles, but we don't know Oscar's success rate—does anyone keep track of the number of times he nuzzles people who don't die? And we can't separate out causes, effects, and correlations. (As Jay Leno said the other night, "Anyone stop to think maybe these patients are allergic to cats?")
It wouldn't be that amazing if Oscar really could tell when someone's about to die. After all, we're not that bad at figuring it out ourselves. Since Dosa's essay was published, other researchers have argued that the cat might be using its acute sense of smell to detect a patient's organs shutting down. But you don't need a superhuman nose to suss out the bouquet of death. Kidney or liver failure can cause waste products or acids to build up in the bloodstream, and patients with these conditions sometimes have a noxious or sweet aroma on their breath. A nurse who knows what he's doing can sniff out a dying patient, too.
It's possible that the "grim reap-purr" uses some exotic sense we don't know about. After all, the animal kingdom is full of sixth, and seventh, and eighth senses. Lobsters, birds, and other critters can sense the Earth's magnetic field. Crocodiles use facial bumps to sense tiny changes in water pressure. And elephants call out to each other across miles of African savannah with infrasonic rumbles. But the NEJM piece prefers to speculate on Oscar's moral powers rather than his physical ones. His visits to dying patients are described as "his work" at the nursing home. (He's even been awarded a plaque in recognition of his "compassionate, quality end-of-life care.") "I guess he helps transition people to the other side," Dosa later told Science News.
In an e-mail, a NEJM representative explained the decision to run Dosa's piece: "From time to time, we publish such personal narratives by physician writers." But this isn't just a personal narrative—it's a piece of magical realism that has been taken for science. If doctors really can use household pets as a diagnostic aid, let's find some genuine research on the subject. A few years ago, the British Medical Journal followed up on some anecdotal reports of cancer-sniffing dogs with a carefully controlled study. The authors tried to show that animals could be trained to smell the volatile organic compounds released by bladder cancer cells into a patient's urine. The experiment wasn't perfect, but the results were promising: The dogs could sometimes ID the cancerous samples of pee.
Let's do an experiment like that on Oscar, to find out if he really can smell death. Then we'll check out whether other cats can be trained to do the same. If the work is good enough, it might even end up in a top-tier medical journal. Maybe even the BMJ.
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