As early as 19 58, methodological nerds were writing papers about why french doctors are really, weirdly reluctant to write hard attack on death certificates. In france, for whatever reason, they're reluctant to say that somebody had a heart attack unless they can prove it. If you'e an american, you're about 30 % more likely to have ahard attack than if you're french. So is that nothing ike, no, that's acually a pretty big difference. But 30 percent more likely and 200% more likely are like, very different sociological phenomena and imply very different public policy responses.