We Need More Autopsies, to Help Save the Living

http://nautil.us/blog/we-need-more-autopsies-to-help-save-the-living

by dnetesn • 11 years ago

72 60 11 years ago

ars• 11 years ago

The United States is quite large. Even 1 out of 50 is still a very large number. We have plenty of opportunities to learn everything necessary.

andyakb• 11 years ago

If that 1 out of 50 was picked by random, then that might be correct, but the article makes it seem as though that isn't the case.

Since most of these autopsies are conducted when foul play is suspected or when the cause of death is unknown, that doesn't help doctors improve in the cases where they thought they knew the cause of death but were wrong.

mikhailt• 11 years ago

1. Many of them are natural causes, third party (murder, suicide, accidents), and so on that are not necessarily caused by diseases or unexpected pathogens of which the doctors want to learn about. Remember the early autopsy reasons in the article: "In the United States, we usually don’t autopsy people unless the cause of death is mysterious or foul play is suspected." 2. What about races, gender, blood types, ages, and so on? The progression of the disease is different in each combination, so when factoring these factors in, 1 out of 50 really isn't that big of a number.

maaku2• 11 years ago

How do I _prevent_ an autopsy from being performed on me?

As a cryonicist, I find what is being advocated for very scary...

vdaniuk• 11 years ago

Why would you?

peter303• 11 years ago

It is no longer "you" when your body is dead.

ivank• 11 years ago

You brain still has all of "you" when you're legally dead though, at least for a few hours, probably longer if cooled properly. See http://en.wikipedia.org/wiki/Information-theoretic_death

maaku2• 11 years ago

Legal death is not the same as biological death.

ggreer2• 11 years ago

You may not remember, but part of the cryo signup process involves declaring a religious objection to autopsy.[1] (No state has an irreligious objection to autopsy, but they don't ask for specifics.) In California, a court order is required to override it. I don't think that has ever happened. A medical examiner would only go to the courts if you were patient zero in some sort of outbreak.

1. http://www.alcor.org/Library/html/certificateofreligiousbeli...

mikeash3• 11 years ago

Using a religious objection for this seems appropriate. The belief that you can live forever by if your body is frozen after death is more or less the same as the belief that you can live forever if your body is intact and you worshipped the right deity.

gmarx5• 11 years ago

Tell your family not to consent to it

niels_olson7• 11 years ago

You need to die a natural death and have been seen by your physician within the last year and they have to be willing to sign the death certificate. All other bodies become the coroner's jurisdiction. They can waive them, or they may do an external examination only, but once they have jurisdiction, it's out of your hands. Even then, at least in San Diego, the medical examiner reviews all death certificates and they occasionally pull one in due to something sounding fishy.

mapt• 11 years ago

"Not really; not always; and sometimes not even with causes of death you’d think would show up easily in a good scan. Doctors take far too much confidence in scan results, feeling they see everything with certainty. They don’t. As a Florida coroner told me a few years ago, “We get this all the time. The doctors get our report and call and say, ‘But there can’t be a lacerated aorta. We did a whole set of scans.’"

I would note that postmortem scans, done once the patient is deceased, can be substantially higher fidelity, because there is no concern about radiation exposure in X-ray tomography of arbitrary contrast and number of slices, and after that metal bits can be removed at will for MRI of arbitrary strength, duration, and confinement on a nonmoving subject. Blood tests can be run in standard panels. DNA tests can reveal CoD correlations.

All of this, streamlined, without a surgical autopsy & reporting being performed, seems like a tractable middle ground.

fragsworth• 11 years ago

Wow, that would be an incredible source of data and a boon to the world. Imagine if it were 1) required by all deaths, and 2) freely released to researchers (for research purposes).

infogulch• 11 years ago

Even better if it included doctors' notes, diagnosis, prognosis, and treatment before death.

niels_olson7• 11 years ago

We do postmortem scans of all autopsies at our hospital. We still do the actual autopsy too. Lots of stuff is still required such as toxicology specimens (including toxicology of solid organ tissue like liver), There's also a fair amount of artifact in autopsy scans due to lack of blood flow, medical interventions (CPR-induced lung contusions, broken ribs, hemorrhages, etc)

MichaelCrawford2• 11 years ago

I understand that there are 1400 different brands of over-the-counter medication that contain acetaminophen.

That's what destroyed my father's liver.

MichaelCrawford2• 11 years ago

Is there some rational reason you downvoted this?

He was taking tylenol for neuralgia. It harmed his liver so bad he had severe jaundice. He was barely able to walk and was completely unable to speak.

He died at the age of 68.

mikeash3• 11 years ago

Maybe because it's completely off topic?

stephengillie3• 11 years ago

Was this discovered by an autopsy?

goodcanadian2• 11 years ago

I find this thought provoking. When my father-in-law died, the coroner declined to do an autopsy as he was over 70. Essentially, for anyone old enough, an autopsy is considered unnecessary as death isn't all that unlikely. In some respects, that is a sensible position. However, my father-in-law's death was slightly mysterious (in the medical sense; no suspicion of foul play) as he was extremely healthy and HIS father is still alive at 100.

niels_olson7• 11 years ago

The coroner may have decided it was better for the family's closure to let it go. Particularly if a physician had already signed the death certificate.

goodcanadian2• 11 years ago

No, the decision was based entirely on his age (and standard department policy); the coroner was not subtle about it. He died at home.

tajen• 11 years ago

However, the pyramid of ages shows that our generation had 95% chances of being alive at 70. Followed by a sharp decline.

starving_coder• 11 years ago

"In the United States, we usually don’t autopsy people unless the cause of death is mysterious or foul play is suspected."

In any case, health insurance doesn't cover autopsy. Turns out its classified as postmortem to deny insurance coverage. there was an hour long special on NPR sometime in 2014.

sokoloff• 11 years ago

Why should health insurance cover autopsy?

Given no chance of "recovery" from the condition, there's no health interest to the subscriber, right?

mikeash3• 11 years ago

If it's for the public good then it ought to be paid from taxes. If it's just to satisfy the curiosity of friends and family then maybe they could pay for it themselves. Unless it'll somehow bring the deceased back to life, it would be weird for health insurance to cover an autopsy.

kinghajj• 11 years ago

Not to the subscriber that has passed, but insurance companies may benefit from the knowledge acquired from autopsies. Analysis could reveal that if the company covered some drug/procedure, the overall usage rate per subscribe decreases, saving them money in the long run.

altcognito• 11 years ago

If you believe that subscribers don't have an interest in improving medicine, then yes. But medical care and the health care industry as a whole are more complicated than this.

logfromblammo2• 11 years ago

An autopsy could reveal medical malpractice. As such, I could see that there might be a benefit for a life insurance company to cover a more detailed examination of the cause of death.

After all, the insurer has been harmed to the extent that between the actual demise of the insured and the statistically predicted time of death, they can no longer collect premiums and interest. And the insured has been harmed by being deprived of life during that same span.

But given that many doctors are covered by malpractice insurance from the same company or family of companies, that would be a case of taking from Peter to pay Paul. And it would probably line the pockets of lawyers and medical examiners to a greater extent than those who suffered the harm.

anigbrowl• 11 years ago

Well, it is postmortem by definition. I don't get the argument in favor of it being treated otherwise.

zxcvcxz• 11 years ago

I'm donating my body to science. I don't see much use in having a death ceremony involving my body. Will probably be much cheaper for my family too.

niels_olson7• 11 years ago

You may still get autopsied. If you die of an accident, unexpectedly, or as the result of a homicide, suicide, or just because you're physician won't sign a death certificate or hasn't seen you in the last year.

stephengillie3• 11 years ago

Your family will likely want ceremonies to help them grieve and deal with your loss. Maybe just bury an empty casket.

Devthrowaway80• 11 years ago

Exactly. Funerals are for the living, not the dead.

gwern• 11 years ago

"Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review" http://www.pathkids.com/autopsy/hasleton%20on%20discrepancie... , Roulson et al 2005 (excerpts: https://plus.google.com/103530621949492999968/posts/e983tqSE... )

trevdarc• 11 years ago

"Doctors, meanwhile, learned humility. If you’re a doctor, it’s one thing to know, as an abstract fact, that 10 or 20 percent of patients who seemed to die of heart attack actually died from pulmonary embolism. It is quite another to have a pathologist dissect one of your patients and tell you No, this woman you took care for 25 years, and whose husband you pass on the street each day, did not die of heart attack; she died of a pulmonary embolism, and that’s probably why she complained of shortness of breath when you examined her three months ago. An angiogram might have spotted it."

If we increase the rate of autopsies, the higher degree of accountability for doctors will lead to higher stress levels in the profession. The rate of suicide in physicians is already far above average. The US should be doing more autopsies, but we should increase them in a way that supports the profession, rather than giving our culture another way to point fingers at doctors and say "your mistake killed that person".

stephengillie3• 11 years ago

In software development and system administration - automation, variables, and copy-paste (instead of retyping) can be used to remove the possibility for human error to occur. Instead of seeing the number "0x80007003" and accidentally retyping it as "0x80070003", we can just copy it, and paste it into the other system. Or have the systems talk to each other and take us out of the loop.

How do we remove opportunities for human error in medicine and health care?

logfromblammo2• 11 years ago

I worked for a medical software company for a couple of years a little while ago. One of the major ingredients in the mandatory corporate beverage was the concept of "patient safety".

As a severe simplification, you can think of the transition from older medical processes to newer ones as like pulling all the string parameters, string parsing, and string building out of old code and replacing it with strictly typed data. In doing so, you remove all errors generated by improperly formatted strings.

That, and barcoding every damned thing in the hospital.

For instance, you barcode the patient's wrist tag, and you barcode everything going out of the hospital pharmacy. When the nurses go into a room to administer a patient's meds, they scan the patient, and scan the medication. The scanner bleeps either a "yes, proceed" or a "WHOA WHOA WHOA, RIGHT THERE! WRONG MED OR WRONG PATIENT!"

That last measure alone saves thousands of lives every year.[0]

[0] This statistic is entirely made up, but sounds about right.[1]

[1] Fine. Sort through it yourself. This ought to get you started:

https://scholar.google.com/citations?view_op=view_citation&h...

niels_olson7• 11 years ago

The rate of suicide among physicians is mainly due to their higher success rate. They have a lower attempt rate compared to the population at large.

gmarx5• 11 years ago

former pathology resident here- disagree. The main reason we do fewer autopsies is because of better diagnostics while the patient is alive. The numbers they provide for significant changes in diagnosis based on autopsy seem pretty high (based only on my own experience). Even the examples they pick for the article are kind of lame- it wasn't St. louis encephalitis, it was west nile! Um...so? Do we have a treatment now for West Nile? Would they have done something different knowing that it was west nile (honestly I don't know; I've been out of the medical biz for years)

niels_olson7• 11 years ago

Would they have done something different knowing that it was west nile

Considering it reinforced the value proposition of county, state, and federal epidemiology units, all of whom are now monitoring crow populations, and it has launched a significant amount of research, and every primary care and ER doctor now looks for symptoms, yes, I do believe something is different.

CatDevURandom• 11 years ago

> former pathology resident here

The implication being that you did not complete your training. I'm curious -- if you don't mind the derailment -- why not?

gmarx5• 11 years ago

Completed it. Never practiced as an attending. Went into the computers instead

sampo3• 11 years ago

The main reason we do fewer autopsies is because of better diagnostics while the patient is alive.

The article claims that "About 15 to 30 percent of the time, the diagnoses at time of death are wrong".

gmarx5• 11 years ago

Maybe, I haven't read the study, but there is a huge selective pressure here. That is, these days you tend to order autopsies only when there was something mysterious about the death.

ams6110• 11 years ago

Statistically, there is no reason to autopsy all deaths or even most of them and to do so would be a fantastic waste of resources. A random sampling would suffice. What we do now is probably not random, and not sure it ever could be given the need to defer to family wishes, religious requirements, etc. in cases where no foul play is suspected.

sampo3• 11 years ago

"In fact, we [USA] autopsy less than 5 percent of all deaths."

Coming from a country (Finland) where about 25% of all deaths are autopsied, this was a surprise, that not all developed countries have a similar level.

morekozhambu2• 11 years ago

Load of BS!

This means we need more people dead (considering autopsy is done on every body), so that we get a chance to look at more bodies and hopefully reduce the death rate in the future!!??. Is it not same as having less people die now?

arundelo• 11 years ago

From the article, which you apparently didn't read:

In the United States, we usually don’t autopsy people unless the cause of death is mysterious or foul play is suspected. In fact, we autopsy less than 5 percent of all deaths.

morekozhambu2• 11 years ago

From my comment, which you apparently didn't read:

considering autopsy is done on every body

what I meant was, even if every body is autopsied, it wouldn't make sense

We Need More Autopsies, to Help Save the Living

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