Medical Data Integrity

US maternal mortality has been chronically undercounted for decades through the same death certificate mechanism, with pregnancy frequently absent from death certificates of women who died during or after pregnancy. Different hospitals, regions, and states used incompatible death certificate coding conventions, making aggregate national COVID data a comparison of incompatible schemes. Retractions of COVID articles by the New England Journal of Medicine and The Lancet are evidence that the scientific vetting system functions, not that it has failed. The pandemic revealed that US health data infrastructure is in critical condition and created explicit national recognition that it must be modernized. Early pandemic mortality data was distorted because death certificates almost always list cardiopulmonary arrest first, often obscuring COVID as an underlying cause.