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  #281  
Old 04-11-2018, 05:46 PM
Don Quijote Don Quijote is online now
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An earlier post from JMO referred to data mistakes as a potential cause for odd mortality spikes.

https://www.texastribune.org/2018/04...w-methodology/

Quote:
Some of the state’s top health experts released a report in the medical journal Obstetrics & Gynecology on Monday that used a new method for counting — and found that the number of women who died dropped from 147 to 56.

...snip...

In 2016 Marian MacDorman, a professor at the University of Maryland Population Research Center, released a study in Obstetrics and Gynecology showing that in 2012, 148 Texas women died from pregnancy-related complications, including excessive bleeding, obesity-related heart problems and infection. Two years earlier, 72 women had died from those causes.

MacDorman wrote at the time that “in the absence of war, natural disaster, or severe economic upheaval,” such a rise seemed unlikely. The study made national and international news and raised questions over how Texas was addressing women’s health.

The state researchers addressed MacDorman’s findings in Monday’s study: “Given the significant reduction in the maternal mortality ratio when using confirmed maternal deaths, this high estimate reported was likely the result of data error.”

It seems that the death registries added a box to check for anytime that the deceased female was pregnant at time of death. Like any manual process, sometimes that box got checked in error. When measuring a small number of deaths, the error in the box checking was enough to overwhelm the actual results.
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Old 05-15-2018, 10:40 AM
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https://www.brookings.edu/blog/futur...ntent=62903165

Quote:
Premature mortality and the long decline of hope in America
Spoiler:
For the first time in this millennium, unemployment in the United States is below 4 percent.

Most parts of the economy are growing at a respectable rate, and market confidence is up. So why are Americans so despondent? The answer to this question matters not just for America but—as the political and policy shifts of the last two years have shown—for many other parts of the world.

Author

Carol Graham
Leo Pasvolsky Senior Fellow and Research Director - Global Economy and Development
cgbrookings
In part, the despair is due to the happenings in the “other America”: blue-collar workers who have experienced declining incomes even as new technologies and skills power success in thriving sectors. Those activities are so far removed from their daily lives they might as well be happening in another country. Many of these people live in the heartland, in hollowed out manufacturing towns and decaying cities. As these places have lost business, people who still live there have lost hope.

DEATHS OF DESPAIR
One marker of this lost hope is the 15 percent of prime-age males who have dropped out of the labor force. For the purpose of calculating the headline unemployment rate, they have ceased even to be a statistic. Another is the surprising amount of support for an antiestablishment, anti-immigrant, and xenophobic political agenda intended to incite anger in lieu of proposing realistic remedies. The starkest marker, though, is the rise of “deaths of despair” in the United States: preventable deaths due to suicide, opioid and other drug overdoses, and deaths related to poor health behaviors. The U.S. is the only rich country in the world where mortality rates are increasing rather than falling.

In recent work published in the Journal of Population Economics, Sergio Pinto and I explore the role of hope—or its absence—in explaining recent trends in premature mortality. We use metrics of well-being and ill-being from Gallup surveys and county-level Center for Disease Control data on deaths of despair. Our metrics of desperation, stress, and worry map closely with trends in deaths of despair at the level of the individual, race, and place. The dimension of well-being that is most closely associated with higher mortality rates is lack of hope, a marker that is starkest among whites who have not completed college. Conversely, individuals and places with higher levels of hope, which tend to be urban and more racially diverse, display much lower levels of deaths of despair.

In a new paper with Kelsey O’Connor, we take a historical look and ask how optimism was related to mortality before the rise in “deaths of despair” that began in the late 1990s. Using the U.S. Panel Study of Income Dynamics, we find evidence from as early as 1968 that more optimistic people live longer. The relationship depends on many factors, including gender, race, health, and education.

A HEAVY HEARTLAND
We explored these and other variables as determinants of individual optimism between 1968 and 1975. Greater education was associated with greater optimism; so was having wealthy parents. Back then, women and African Americans were less optimistic than the average. In recent years, this pattern has changed markedly. Now, on average, women and African Americans are more optimistic than their male/white counterparts.

We then predicted optimism for the same individuals in subsequent years, thereby generating our best guess as to how optimism changed for various demographic groups between 1976 and 1995. We found that people with less than a high school degree show the greatest declines in optimism, suggesting long-run links to premature mortality and deaths of despair. This is the same demographic with the lowest levels of hope today. Keep in mind that the pool of people with less than a high school degree over the same period shrank as high school completion rates increased, and the cohort with less than a high school diploma 40 years ago is comparable to the less than college-educated cohort today.

While the loss of hope in America does not apply across the board—and poor minorities in particular are far more optimistic than poor whites—the deep despair in parts of the country is having negative consequences for our society, political and civic discourse, economy, and longevity. Better understanding its causes and consequences—and its historical roots—is an important part of finding a solution. Tracking well-being metrics regularly, meanwhile, as many countries are already doing, is an efficient way to monitor social health along the way. Local and community level initiatives that seek to enhance community well-being—as in the City of Santa Monica and in the What Works Well-Being initiative in the U.K.—can provide another part of the solution, particularly in places where economic solutions are unrealistic or insufficient.


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  #283  
Old 07-09-2018, 03:52 PM
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Some interesting graphs from PartnerRe

https://partnerre.com/opinions_resea...n-era-for-now/

Quote:
Mortality Rate Improvements – End of an Era, For Now…
Spoiler:
Improvements in mortality rates characterized the twentieth century – the trend of living ever longer and healthier lives seemed assured.

Recent mortality rates, however, point to a change. The positive trend has slowed. But why? Are all ages affected? And surely medical advances will anyway have us back on track asap?

To answer those questions, we look at high-level developments in the main causes of mortality and their relevant risk factors. The recommendation is for caution: The future will remain less rosy, for now at least…

A slowing improvement in mortality rates
Figure 1 shows the overall trends in mortality rates and life expectancy at birth for the US population. US data is predominantly used throughout this paper as detailed mortality data is available for the US.

The graph shows that the positive trends of the past began to level off in 2010. Comparing 2000-2010 to 2010-2016, mortality rate improvements deteriorated across all ages, with the worst deterioration in males aged 35-441. Similar trends are mirrored in other developed markets: e.g. in the UK, male mortality improvements averaged 3.1% per year from 2000-2011, falling to 0.7% a year from 2011-20162.

Figure 1: Age-adjusted mortality rates (blue line) and life expectancy at birth (orange line), both sexes, all races, US population, 1900-2015. Mortality rates show steady improvement (reduction) over the period, but in fact began to level off in 2010. Life expectancy at birth has likewise increased, but shows a similar levelling off in recent years. Looking far back, the impact of the 1918 flu pandemic is clearly visible, as is the bounce back in rates and life expectancy after this event. Source: CDC3.

We now break down this data by cause-of-death (leading causes, US); coronary heart disease, stroke and cancer, see figure 2. For each cause, we consider which, if any, age groups are most impacted by slowing mortality rate improvements, and how the evolving medical expectations and relevant risk factors for each cause might impact the future trends for these diseases.

Figure 2: Age-adjusted mortality rates by major cause of death, US population, both sexes, all races, 1960-2015. Most notably, heart disease rates (green line) fell significantly since the 1960s, being the major contributor to overall population mortality improvements during that time period, but flattened out in the last five years. Cancer rates (red line) continue to steadily fall. ‘Accidents’ refers to ‘unintentional injuries’, i.e. excludes suicide. After these main causes of death, Alzeimer’s disease and diabetes were the next two leading causes in the US in 2015-164. Source: CDC3.

The trends for the main natural causes of death
Coronary heart disease and stroke (28% of deaths5): Five decades of mortality rate improvement from these diseases in the US across all age groups was a major contributor to falling overall population mortality rates. In the UK, for example, 70% of all improvements from 1968-2010 were due to the decline in deaths from circulatory diseases2.

“In the UK, 70% of all improvements from 1968-2010 were due to the decline in deaths from circulatory diseases.”

However, over the last few years, rate improvements from coronary heart disease and stroke have reduced (figure 2); for heart disease (US population, age-adjusted, both sexes, all races), the average annual mortality improvement rate for the period 1999-2016 was 2.7%, whereas this fell to 0.9% for the more recent five-year period 2011-2016. This is important given that this is the leading cause of death. The only age groups not seeing a deterioration were ages 1-4 and 25-34. Ages 65-74 were worst affected, with improvements of 3.4% for 1999-2016, versus just 0.3% for 2011-20165.

“Over the last few years, mortality rate improvements from coronary heart disease and stroke have reduced.”

The earlier improvements can be attributed to lifestyle changes (especially reduced smoking) and medical advances, including bypass surgery and pacemakers in the 1970s, followed by coronary stents and stroke units in the 1990s.

Rate improvements are now reducing and further significant rate improvements from medical treatment are not anticipated for this disease group: most therapeutic innovations are already widely implemented, clinical trials for heart drugs significantly lag behind those for cancer6, and although new drugs offer hope within the next two decades, these are primarily for smaller subgroups of heart patients.

Overall, and before any meaningful implementation of next generation medicine, the period of strong mortality rate improvements for coronary heart disease and stroke would appear to be behind us.

2.7% 0.9%
Fall in US mortality rate improvements for heart disease,
1999-2016 cf. 2011-2016, Worst affected ages: 65-74

Cancer (21% of deaths5): After many decades of gradually increasing mortality rates, cancer deaths began to fall in around 1990 and have continued to steadily decline (figure 2) at a relatively consistent 1.5% (US population, age-adjusted, both sexes, all races) since 1999. The highest average annual improvement 2015-2016, 3.2%, was seen in the 45-54 age group, while ages 25-34 and 35-44 recorded slight deteriorations, respectively 1.1% and 0.2%5, something to watch.

1.5%
Steady US mortality rate improvement
for cancer since 1999

As for coronary heart disease and stroke, improved lifestyle has been a contributor to the positive trend. From a medical perspective, improvements from radiation therapy and chemotherapy in the last century are expected to be succeeded by future applications in cancer genomics, personalized medicine such as immunotherapy and earlier detection from liquid biopsy over the next 10-15 years. The high number of compounds in clinical development for cancer adds to the positive future outlook6.

External (c.f. natural) causes of death increasing in significance in the US
Now the third highest cause of US mortality (6% of deaths5).

Mortality rates from external causes (e.g. from traffic accidents, homicide and self-harm, including suicide and poisonings (mainly drug/opioid addiction)) have been slowly increasing in the US since 1999 (1.8% over the period 1999-2016, with variations by cause and age group).

Rates accelerated upward in 2015-2016. From 2014-2016, age groups 25-34 and 35-44 respectively experienced substantial 16.1% and 14.4% increases in accident mortality rates5. In 2016, the leading cause of death for ages 25 to 44 was poisonings, followed by suicide and then traffic accidents7.

Opioids are a significant contributor to the upward trend in the US, impacting all ages (above 15 years) and social classes, but with higher mortality rates observed for lower socio-economic groups8. Canada9 and the UK10 are also affected, but to a lesser extent.

+27%
Increase in US opioid mortality rates 2015 to 2016
Worst affected ages: 15-44

From 2015 to 2016, US opioid mortality (all ages) rose by a staggering 27.4% (figure 3; ages 15 to 74 all experienced over 20% mortality rate increases, ages 15-44 being the worst affected at over 30%5. US overdose deaths (all drugs) rose to 64,000 in 2016, a 20% increase on 201511.

Figure 3: Age-adjusted opioid mortality rates, 1999-2016, US population, all races. The upward trend followed by a sharp increase in 2015 is apparent. Source: SOA5.

Despite potential future improvements for some external causes of death from developments such as driverless cars and stricter weapons controls, the overall outlook for the US remains negative. If the statistics for these causes of death continue to worsen, the impact on future mortality rates will be meaningful.

AMR – the potential to undo future steps forward
With increased understanding of infectious diseases and how they are spread, combined with the power of antibiotics, mortality rates from infectious diseases have been in strong decline since the beginning of the twentieth century.

Future rates, however, are threatened by increasing antimicrobial resistance (AMR), which is rising at an accelerating rate, and by the fact that there is a lack of investment in new antibiotics12; only 1.6% of drugs in clinical development by the world’s 15 largest pharmaceutical companies were antibiotics13.

Next generation medicine could get things back on track – but not yet
Next generation medicine represents a sea change in our capabilities to improve mortality rates. But when will this happen? Digital health, for example, is already upon us and developing fast (e.g. artificial intelligence, eHealth, wearables, electronic health records, telemedicine and health apps). Genomics, the key to a new level of disease understanding, innovations in disease prevention, new drug targets14 and better drug efficiency, is also developing fast but still has many challenges to overcome, most likely requiring at least another two decades. The two combined (e.g. for simulations of an individual’s likelihood of disease and targeted, preventative surveillance) offer even greater future potential through precision, individualized medicine.

Impact of socio-economic factors
While overall mortality rates in the US are falling across all socio-economic groups and ages, global studies observe variations linked to socio-economic factors such as wealth, marital status, level of education and race15,16,17. For example, as previously noted for opioids, higher social class can be a general proxy for lower mortality. How socio-economic inequalities in mortality are changing is complex and varies, for example, by age18: inequalities have decreased for younger ages (0-20), notably increased for those aged over 50, remained steady for women aged 20-50, and decreased for men aged 20-50 (closing the gap between men and women in this age group).

And the overall prognosis?
Mortality rate improvements, largely driven by wins from healthier lifestyles (smoking reduction) and advances in diagnostics and the treatment of common diseases, have slowed in the last decade.

For heart disease, US ages 65-74 experienced the worst slowing. Cancer rates are still showing some promise, but the cohort effect (see below, ‘Background insights’) that helped to boost the past in some regions is fading, external causes of death (accidents and suicide) are increasing in significance in some regions (in the US, especially since 2015 and in ages 25-44; for opioids, ages 15-74), and AMR is on the rise. Next generation medical progress, digital health and genomics in particular, may begin to claw back some of that downward trend in coming years, but any meaningful impact from these areas will need more time.

We find ourselves in a dynamic, interim phase of mortality rate improvement. Caution is needed. Slowing will remain in place in some regions, at least for a while. Thereafter, the new mortality landscape will be drawn out by the interaction and timing of next generation medical advances and by the specific progression of AMR, lifestyle and socio-economic risk factors.

“We find ourselves in a dynamic, interim phase of mortality rate improvement. Caution is needed.”

Your partner for Life risks
Our experts – a closely collaborative team of Life actuaries, underwriters, market specialists and medical experts – continually analyze the trends in and determinants of mortality data to ensure best practice for supporting our clients’ Life term and annuity portfolios.

We are a forward-looking discussion partner for our clients for all Life risks. Please contact us to find out more about our Life risk solutions or to discuss how the trends summarized in this paper could impact your portfolio.

Background insights
The cohort effect – past driver of mortality rate gains now losing its impact

The cohort effect refers to the observation that those born in a particular period, for example in the UK the cohort comprising those born between 1925 and 1944 (centered on 1931), experienced better mortality improvements than other generations19. The cohort in question had a very significant and positive impact on overall historic population mortality rate improvements. The contribution of this cohort to mortality rate improvements, however, now won’t repeat, an effect that is contributing to the observed slowdown in mortality rate improvements.

The effect has been documented in the UK, US20 and Canada21, but is most pronounced in the UK. There is no clear documentation of it in other countries. The specified cohort experienced the depression, war, smoked, quit smoking in their masses, and later benefitted from major medical advances in the 1960s and 70s. It experienced materially improved mortality compared to the preceding cohort and subsequent cohorts have not improved as much.

1 WillisTowersWatson ‘Insights’, 2016. https://www.willistowerswatson.com/e...y-improvements
2‘Mortality Improvements in Decline’, The Actuary, August 2017.
3https://www.cdc.gov/nchs/data-visualization/mortality-trends/
4https://www.cdc.gov/nchs/products/databriefs/db293.htm
5US Population Mortality Observations, Updated with 2016 Experience, Society of Actuaries (2018).
6e.g. https://www.sciencedirect.com/scienc...35109715008232
7Center for Disease Control: http://www.worldlifeexpectancy.com/u...ge-and-genders
8e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418844/ – Study “found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group”.
9e.g. https://www.theglobeandmail.com/news...ticle36257932/
10e.g. https://www.ons.gov.uk/peoplepopulat...6registrations
11e.g. https://www.theguardian.com/us-news/...ths-doubled-us .
12e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159373/
14Identifying and proving that DNA, RNA or a protein molecule is directly involved in a disease process and can be a suitable target for the development of a new therapeutic drug.
15e.g. Gapminder.org – https://www.gapminder.org/GapminderM...World-2012.pdf
16https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/trendinlifeexpectancyatbirthandatage65bysocioecono micpositionbasedonthenationalstatisticssocioeconom icclassificationenglandandwales/2015-10-21
17Rogot, Eugene, Paul D. Sorlie et al .1992. “Life Expectancy by Employment Status, Income, and Education in the National Longitudinal Mortality Study.” Public Health Reports 107(4):457–61.
18http://www.nber.org/papers/w22199.pdf
19e.g. ‘The Cohort Effect: Insights and Explanations’, R.C.Willets, 2004.
20e.g. ‘Mortality Improvement Scale MP-2016’, Society of Actuaries, October 2016.
21http://www.cia-ica.ca/docs/default-source/2017/217097e.pdf
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  #284  
Old 07-10-2018, 10:41 AM
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Any idea what the right y-axis is in the graph? Seems silly anyway since it's almost the exact same scale as the left axis.
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Old 07-10-2018, 11:13 AM
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Quote:
Originally Posted by DES View Post
Any idea what the right y-axis is in the graph?
The original data on the CDC site doesn't appear to have a right axis. https://www.cdc.gov/nchs/data-visualization/mortality-trends/
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  #286  
Old 07-10-2018, 11:20 AM
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Yeah, that looks like an error. There was an earlier graph with a secondary axis that made sense, and maybe they just copied over the graphs and dumped in new data without realizing.

I'll email them about that.

and I found where they grabbed their data (as they linked to it):
https://www.cdc.gov/nchs/data-visual...tality-trends/
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Old 07-26-2018, 04:13 PM
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KENTUCKY
OPIOIDS

https://apnews.com/cb1f10e639eb406a901bdd1d2919f58e

Quote:
Kentucky drug overdose deaths jump 11.5 percent in 2017
Spoiler:
FRANKFORT, Ky. (AP) — Since 2011, a year when Kentucky was flooded with 371 million doses of opioid painkillers, state officials have cracked down on pain clinics, sued pharmaceutical companies and limited how many pills doctors can prescribe.

The result is nearly 100 million fewer opioid prescriptions in 2017 — and an 11.5 percent increase in drug overdose deaths.

That’s the sobering findings of a new report from the Kentucky Office of Drug Control Policy in a state on the front lines of the nation’s opioid epidemic. The report says 1,565 people died from drug overdoses in 2017, a 40 percent increase in the past five years.

Deaths attributed to prescription painkillers and heroin are declining. But other drugs have taken their place. Fentanyl, a synthetic opioid, accounted for more than half of all the deaths. And methamphetamine has made a comeback, accounting for 360 deaths. That’s a 57 percent increase in just one year.

“We are in a crisis state,” Republican Gov. Matt Bevin said. “While we are putting money at it and while we are drawing attention to it, until we start to truly address this and look at underlying causes of these things and what is leading to this it is not going to be addressed.”

Nationally, opioids accounted for more than 42,000 deaths in 2016. States with the highest rates of drug overdose deaths that year were West Virginia, Ohio, New Hampshire, Pennsylvania and Kentucky, according to the Centers for Disease Control and Prevention.

Every year, Kentucky lawmakers have been passing more laws designed to address the opioid problem. They have increased penalties for heroin dealers. They have diverted more money to drug treatment programs. And they limited patients to a three-day supply of prescription painkillers unless a doctor gives them written permission for a larger amount.

State officials spent $500,000 to create 1-833-8KY-HELP, a hotline to connect people with treatment options. And they have spent thousands of dollars giving first responders naloxone, medicine that can reverse an opioid overdose.

Anti-drug advocates celebrate those changes, but their celebration is tempered once a year when the new numbers come out detailing how many more people have died.

“Most of the things we do we realize are not going to take that immediate effect,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. “It just never gets any easier.”

Many anti-drug advocates have credited the Affordable Care Act with helping people get treatment. The law, known as Obamacare, expanded the Medicaid program to give more than 400,000 Kentuckians health coverage. Many used that coverage to get drug treatment.

Bevin wants to require people in Kentucky’s expanded Medicaid population to get a job, go to school or do volunteer work to keep their coverage. He also wants to charge them small monthly premiums to model private insurance plans.

Critics have said the result will be fewer people on Medicaid with fewer treatment options. But Bevin’s plan would exempt people with substance abuse disorder from complying with the new rules. Those rules were supposed to go into effect July 1, but were blocked by a federal judge.
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Old 08-01-2018, 10:36 AM
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http://www.governing.com/topics/heal...m_medium=email

Quote:
Dead Reckoning
America's system of coroners and medical examiners is facing unprecedented challenges.

Spoiler:
immy Pollard has been the coroner of Henry County, Ky., since 1986. Growing up in the small county of just 15,000, he spent a lot of time in the local funeral home, where the director took him under his wing from an early age. Pollard eventually became a licensed funeral home director himself and ran for office at the behest of many in the community when the coroner at the time decided to retire. For the past 30 years, he’s run unopposed for all but two elections, and one of those was a write-in campaign. “It’s not a job you can say you like,” Pollard says, “but the part I get out of it is helping families get closure. And I do enjoy investigations.”

Kentucky has historically been considered a national model in its death investigations. It was the first state to implement a dual coroner and medical examiner system, something it’s had in place since 1973. That has given the state an important balance of elected leadership and forensic know-how. Coroners are elected county officials responsible for investigating any death that’s deemed unnatural. Once elected, they go through death investigation training with the Kentucky Department of Criminal Justice and are expected to keep up 18 hours of continuing education. They work with state medical examiners to determine the exact cause of death and decide whether an autopsy or toxicology test is needed, which a medical examiner would have to perform.

But it’s a system that has been strained in recent years. Pollard, who also serves as director of the Kentucky Coroner’s Association, made headlines last year for convincing one state medical examiner to stay on after the doctor had announced his resignation, citing a lack of funding and resources to properly do his job. The National Association of Medical Examiners recommends that professionals not perform more than 250 autopsies a year; Kentucky is averaging about 280, according to Pollard. “We need two more doctors. That would ease our caseload tremendously,” he says. In Henry County, Pollard used to investigate around 26 cases in his county per year in the 1990s. In recent years, that number has risen to around 66.

These issues aren’t singular to Kentucky. Coroners, medical examiners, forensic pathologists -- and people who wear more than one of those hats -- say their profession is more vital than ever before, particularly in the midst of the opioid epidemic. But low pay, long hours and heavy debt loads carried by young physicians make it hard to recruit and retain talented people.

America’s system for investigating deaths is a patchwork quilt of different laws, procedures and job descriptions. From state to state -- and even from one county to the next -- there can be variations in how sudden deaths are handled. “Unlike primary care or obstetrics, it’s the one specialty in medicine that’s practiced differently depending on where you live,” says Gregory Davis, former associate chief medical examiner for Kentucky.

Confusing matters even more, qualifications for each title also vary depending on state statute. Coroners are overwhelmingly an elected or politically appointed position, a tradition that dates back centuries to when they were simply tax collectors for the deceased; America’s first coroner took office in 1636 in Plymouth County, Mass. Some states require a coroner to be a physician; other states only stipulate that you must be 18 and have no felony convictions.

Medical examiners, on the other hand, must be licensed physicians. But even among the states that rely on medical examiners instead of coroners, there can be inconsistencies: A medical doctor doesn’t necessarily have a background in forensics, which is key for accurate autopsies. “How much death investigation training did we get in medical school?” Davis asks. “None.”

There’s been a debate raging for several years in the fields of death investigations and forensic pathologists on the right path forward. The National Academy of Sciences recommended in 2009 to abolish the coroner system and transition fully to using medical examiners for all death investigations. It’s a move that’s gaining some traction: Sixteen states and the District of Columbia now only have medical examiner offices. Eleven states just use coroners, and the rest have a mix of medical examiners and coroners, all with different qualifications and hierarchies. However, in states with a mix of both, coroners usually handle the death investigation, and medical examiners handle the actual medical aspect of it, like completing autopsies.





Kim Collins, the president of the National Association of Medical Examiners, says she understands where the National Academy of Sciences is coming from with the recommendation to move solely toward the medical examiner system. But she argues that it ignores the larger problems of funding, resources and culture that can’t be fixed by a title change. “One size isn’t going to fit all,” she says. It’s an entrenched system and “these coroners have been here since colonial times. You’re just going to have to improve research and training.”

In many states, the office of coroner operates with a surprising lack of accountability. In 49 of California’s 58 counties, for instance, the coroner is also a sheriff, which experts say is a severe conflict of interest. In San Joaquin County earlier this year, a forensic pathologist accused the sheriff-coroner of pressuring him to change autopsy findings in cases that involved law enforcement. A 2016 county audit found that the same thing had happened four times that year. Similarly, a forensic pathologist in Boulder County, Colo., sued the coroner’s office in June, arguing that she was wrongfully terminated for refusing to change the manner of death on a death certificate when the coroner insisted. Colorado is a coroner-only state that stipulates merely that the elected coroner go through death investigation training.

“The bad systems are the ones where people without medical training think they can do it all,” says Mary Ann Sens, the coroner for Grand Forks County, N.D. Sens says she is the only coroner in the state with a forensic pathology background. She doesn’t have a problem with coroners not holding medical degrees, she says, as long as they defer to or consult with an independent medical professional, similar to the Kentucky system. “The real hallmark [of a good system] is when medical decisions are made by a medical professional and are independent. If there was a jail death, I need to be able to say law enforcement messed up.”


Flipping through primetime network television, it would be easy to assume that America is overflowing with medical examiners. More than a dozen shows in recent years have centered on coroners or examiners. But the reality is that it’s becoming extremely hard to find enough qualified professionals to fill the job. There are currently only 500 board-certified forensic pathologists in the U.S., which is less than half of what the National Association of Medical Examiners recommends.

Part of the problem is low pay. “It’s the one subspecialty of medicine where your pay goes down once you get that training,” says Davis, the former examiner in Kentucky. On average, public-sector forensic pathologists make about half of what a primary care doctor in a private practice can make. And with medical student debt averaging near $150,000, accepting a public-sector job with a public-sector salary isn’t enticing for many newly minted doctors. “Whenever I have a presentation about my job, the first slide always says, ‘I have the coolest job in the world,’ because I do,” says Andrew Baker, chief medical examiner of Hennepin County, Minn. “But I’m worried about my profession. At the risk of sounding crass, the economics of being a forensic pathologist don’t make sense when compared to a pathologist at a private hospital.”

The shortage of examiners has been worsened exponentially by the current opioid crisis. “Prior to the opioid epidemic, we needed about 1,000 forensic pathologists across the country. So even before, we were already underserved by half,” Baker says. Now, thanks to the explosive rise in opioid deaths, he estimates that America needs “another 250 forensic pathologists just doing drug overdose autopsies.”

Coroners and examiners across the country have had to get creative to handle the surge of drug overdose deaths. The St. Louis County Medical Examiner’s office started using refrigerated trailers to hold bodies last year. Other counties have had to build more space or borrow room from local funeral homes or hospitals. Some jurisdictions are now forgoing a full autopsy and only conducting toxicology tests if an overdose is suspected.



(AP)


Despite the national attention on the drug crisis, its impact on coroners’ offices can be less well known. “I’m not sure how many lawmakers know who their medical examiner or coroner is, and know how many of the offices are on the brink of complete collapse,” Baker says. “They don’t have enough money to do routine examinations, so they are on the verge of losing accreditation.”

The Connecticut Office of the Chief Medical Examiner lost its accreditation briefly in 2017 when the National Association of Medical Examiners found the office had inadequate staffing and storage space for bodies. The Los Angeles County Coroner’s Office came close to losing its accreditation in 2016 because of delays in autopsies and toxicology tests.

Back in Kentucky, Pollard says he is continually lobbying the county judge for a bigger budget, which isn’t easy. “I tell him that I can’t say how many cases I’m going to have, but I am going to have to complete them. More people are just dying in ways that need to be investigated,” he says.

Davis similarly recalls asking a state lawmaker for more resources. The lawmaker responded, “Dead people don’t vote,” he says. “I said, ‘No, but their pissed-off relatives do.’ Like so many things, this just comes down to an issue of money.”

Spending more on death investigators isn’t just important for keeping track of overdose deaths and giving closure to loved ones. It can be a vital public health tool in identifying new diseases and alerting the public to new strains of potentially lethal viruses. “When deaths are adequately investigated, you notice patterns. In Albuquerque, for example, they are seeing a lot of respiratory-related deaths this year, which was pinpointed to be caused by deer mice urine,” Davis says. “We’re on the frontline of public health surveillance. An investment in medical examiners and county coroners’ offices is an investment in public health. By learning how people die, it helps us all live.”
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Old 08-01-2018, 02:21 PM
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That's an interesting trend. I recall when I went into teaching there was a program in my state whereby if you went to a state university you could get a certain type of loan and if you taught in a public school in that state for five years they would forgive the loan.

Maybe they need something like that for MEs and public universities. Or even if they don't totally forgive the loan, they could forgive a portion of it. A way of making those jobs more attractive to folks with big med school loans.

Military does something sort of similar for doctors. They pay for med school and in fact docs make O1 pay the whole time they're in med school and then as soon as they graduate they're O3s with no debt. I think they owe the military something like 8 years of service after they graduate and then they can opt to stay in or leave.
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Old 08-07-2018, 10:16 AM
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DRUNK WALKING

https://www.washingtonpost.com/natio...=.183ef47b29e1

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Thousands of inebriated pedestrians die each year in traffic accidents
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It’s 11 p.m. on a Saturday on U Street in Washington, and music is blaring from the glittery bars and clubs. Many of the partyers will stick around till the bars close at 3 a.m., then pour out onto the sidewalks — and sometimes into the streets.

“I’ve seen drunk people wandering into the street around 2 or 3 in the morning like zombies,” said Austin Loan, a bouncer checking IDs at Hawthorne, a restaurant with five bar areas and DJs on the weekends. “When you get drunk, you think you can rule the world. You may not be paying attention to anything else.”

That can have deadly consequences.

Whether they’re emptying out of bars, going home from football watch parties or trying to get across the highway, drunk walkers are dying on the roads in alarming numbers nationwide.

A third of pedestrians killed in crashes in 2016 were over the legal alcohol limit for drivers, according to the National Highway Traffic Safety Administration. That’s nearly 2,000 people — up more than 300 since 2014.

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“Those numbers are pretty shocking,” said Jonathan Adkins, executive director of the Governors Highway Safety Association, which represents state highway safety offices. “We think this is a big problem.”

Being drunk can affect your judgment and reaction time and result in poor decision-making and risky behavior, such as crossing an intersection against the light or cutting across a road midblock, safety experts say. You may not even be thinking about whether drivers can see you.

And while there are lots of programs designed to reduce drunken driving and improve pedestrian safety, there’s little out there aimed at impaired walkers.

“We’ve done a good job of educating people about drunken driving and the dangers,” Adkins said. “But we haven’t reminded people that if you’re too hammered to get behind the wheel, you may be too hammered to walk home in the dark.”

Drunk walkers
Pedestrian deaths jumped 27 percent from 2007 to 2016, even as other U.S. traffic deaths dropped.

Distracted walking and alcohol consumption are contributing to the problem, federal data shows.

And when alcohol factors into a pedestrian death, it’s more often the walker than the driver who is drunk.


“Most people don’t realize how big a problem it is to be walking when you’re impaired,” said Jessica Cicchino, a vice president at the Insurance Institute for Highway Safety (IIHS), a research group funded by insurers. “You’re probably not going to be putting anyone else at risk, but you could be hurting yourself.”

Drivers often don’t see drunk pedestrians until it’s too late, Cicchino said, especially at night, when most deaths occur. The victims, typically men ages 21 to 59, are not crossing at an intersection, research shows.

“If your reflexes are impaired, you might be stumbling into the road and not able to act as quickly,” Cicchino said.

In Austin, where a dozen drunk walkers died in 2016 and seven died in 2017, many crashes were on a stretch of Interstate 35, an eight-lane, high-speed highway divided by a concrete barrier, said Pat Oborski, a police detective. The highway is lined with fast-food restaurants on one side and low-cost motels on the other.


Drunk pedestrians cross the highway, going back and forth between the motels and restaurants on frontage roads, Oborski says. While there’s a bridge over the highway about a quarter-mile away, some people figure it’s easier to run across than to walk to the bridge.

Austin’s pedestrian safety coordinator, Joel Meyer, said officials are aware of the problem and are working to make pedestrians more visible, such as by providing safer crossings and improving street lighting.

In Delaware, 77 impaired walkers have died in crashes in the past five years, accounting for about half of all pedestrian traffic deaths.

“We know it’s a problem,” said Delaware Office of Highway Safety spokesman Mitch Topal. “People are having a good time at their hotel or their rental. And there are a lot of bars and restaurants. People are going from one place to another.”


Officials have launched a media campaign to alert the public about the problem, Topal said. They’ve also sent out teams to talk to pedestrians at beaches and hand out reflective wristbands.

Preventing deaths
But little has been done nationwide to address deaths of drunk pedestrians, according to an IIHS study. There aren’t many educational campaigns alerting people about the risk of alcohol impairment when walking or bicycling, the study found, and more research is needed to figure out how to prevent such deaths.

Among the study’s recommendations: lowering speed limits, improving roadway lighting and marketing ride-hailing services to pedestrians and bicyclists in addition to drivers who have had too much to drink.

Safety experts say states also need to broaden their campaigns against drunken driving to encourage pedestrians and bicyclists to opt for alternatives after heavy drinking.


Some pedestrian advocates caution that officials need to be careful not to send out a message that blames the victims, who sometimes have tried to do the right thing by not getting behind the wheel when they’ve had too much to drink.

Instead, the priority should be on designing safer roadways, which will influence drivers’ behavior and curb speeds where people are walking, said Brendan Kearney, a spokesman for WalkBoston.

Adkins said that while drivers and pedestrians have a shared responsibility to minimize risks, roads should be re-engineered to include pedestrian medians, barriers and bridges to create a safe system for pedestrians and drivers.

“We want to help everyone get home safely,” he said. “Humans are always going to make an error. It shouldn’t cost them their life.”


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