The mainstream media and the AMA suffer from the same disease

Drudge Report recently put up a link to an AP story about the contraction of traditional large newspapers who are slashing jobs, selling real estate, and have fallen into “survival mode.”   Glenn Reynolds at Instapundit followed up with a comment from a reader stating that as an effort at “ethical consumerism,” the commenter was cancelling his subscription to the Chicago Tribune because of the Trib’s slanted coverage of Second Amendment issues.

 This made me think of something I have seen in my profession as well.  In the public eye, the medical profession is represented by the American Medical Association, which claims to be the voice of medicine to the nation.  However, the AMA has been dropping in terms of percentage of physician members for decades.  Currently, only about 22% of physicians are members of the AMA.  As noted in the article that provided that number,

Of those members, 20.5% are medical students, 9% are residents, and 36.5% are 56 or older. As one delegate put it, “we have a lot of students and a lot of old docs, but not a lot of practicing physicians.”

 It seems to me that the dinosaur media and the AMA suffer from the same disease.  Both of them have a very specific viewpoint, agenda, and bias.  Both are in a quandry.  They want to have broader appeal and be more responsive to the customers or memebers they are losing, but in order to do so, they would have to abandon the self-selected bias that makes the organizations so attractive to the few that remain.  They want the money and support of a broad base, but they don’t want to be responsive to that broad base — either in terms of policy or services.

This came home to me most recently when I found out that the AMA has declared a common practice in my subspecialty to be “unethical.”  A recent decision by the AMA has declared that it is unethical for a physican to be in attendance during a police interview.  I understand the underlying concern they had — that a physician in attendance to an interview may be put in a bad position if there was abuse during that interview.  However, consider the position of a forensic pathologist, for whom being able to observe an interview is profoundly important to the diagnosis.  For us, that data is the equivalent of the history and physical for the clinician.  It is not merely common, but it is a very *good* practice, for instance, for a forensic pathologist to work with the police and the parents in reconstructing the events in the case of a child death.  The idea that such cooperation is “unethical” is simply ludicrous.

 The disconnect between attitudes of AMA members compared to the general physician population of the US has been measured.  For instance, members of the AMA have dramatically different ideas about assisted suicide compared to US physicians in general.

 Recently, an AMA-type organization was proposed for the intelligence community.  In response, I noted:

…the authors note the importance of the AMA [American Medical Association] as an early force in the standardization and professionalization of medicine. It should be noted that the role of the AMA has evolved since that time, and may provide a cautionary note. As the AMA assumed its role in the leadership of the medical profession in the eyes of those outside of it, it became increasingly politicized. The increasing involvement of the AMA with specific political agendas at the expense of medical professionalism has resulted in a widespread disillusionment with the organization; as of 2005, less than 30 percent of physicians belong to the organization

Membership in some subspecialties is so low that their respective subspecialty organizations risk losing representation in the AMA; this has been true for the National Association of Medical Examiners as well as the American Society of Neuroradiology. Most physicians identify more strongly with their subspecialty organization than with the AMA, and competing (albeit even smaller) umbrella organizations have developed, such as the Association of American Physicians and Surgeons and the National Physicians Alliance.

The AMA now represents a self-selected subpopulation of physicians with specific political views, and is caught in the paradox of both wanting to increase its membership yet not wanting to change that agenda. This may be pertinent to the Intelligence Community in light of recurring complaints that intelligence agencies advance a political agenda at odds to that of the Administration by means of leaks, background interviews, etc. A professional organization that views itself in terms of ultimate professional and policy authority stands a great risk of evolving away from its professional anchor point.

The same thing is true of traditional newspapers.  They have the choice of publishing an insular product in line with their narrow but comfortable biases, or of publishing a product with a broader appeal but at the cost of the protection of those biases.  They have chosen the former, as has the AMA.  However, like the AMA, they pretend that they are doing the latter.

Religion of Peace arrests Christians for converting to Christianity

via persecution.com

On May 12, Iranian police arrested 12 known Muslim converts to Christianity and confiscated their books, computers and printers in the southern Iranian city of Shiraz.

According to Compass Direct News, “The arrests began at 5 a.m. on May 11, when two couples were taken into custody before boarding their flights at the Shiraz International Airport and sent directly to jail. All four were subjected to hours of interrogation, questioning them solely ‘just about their faith and house church activities.’”

Compass Direct News added that the detained Christians had been identified as: Homayon Shokohie Gholamzadeh, 48; his wife, Fariba Nazemiyan Pur, 40; Amir Hussein Bab Anari, 25; and his wife, Fatemeh Shenasa, 25. Although the two wives were released the same day, Anari was detained until May 14, and Gholamzadeh remains in jail.

“Two hours after the early arrests of May 11, police authorities invaded the home of Hamid Allaedin Hussein, 58, arresting him and his three adult children: Fatemah, 28; Muhammed Ali, 27; and Mojtaba, 21. All the family’s books, CDs and computers were hauled off as well. Hussein, his daughter and one son were released later the same day, but son Mojtaba remains in prison,” Compass Direct added.

Pray for our brethren in Iran.

Religion of peace arrests Christian for carrying Bible

via persecution.com

On April 29, a court in Djilfa, south of Algiers, charged a 33-year-old Muslim convert to Christianity with “printing, storing and distributing” illegal religious material. According to Compass Direct News, “An Algerian Christian detained five days for carrying a Bible and personal Bible study books was handed a 300-Euro (US $460) fine and a one-year suspended prison sentence.”

Compass reported this conviction was the latest in numerous detentions and court cases against Algerian Christians. “Since January, police and provincial officials have ordered the closure of up to half of the country’s estimated 50 Protestant congregations,” Compass Direct said.

Pray for our brethren in Algeria

Religion of Peace kidnaps and beats Christians yet again

 via persecution.com

On June 21, 16 Christians were abducted by Muslim extremists when they gathered to pray in Academy Town, Peshawar, Pakistan.

According to The Voice of the Martyrs contacts in Pakistan, “Salamat Masih and 30 of his family and close friends were gathered to pray and celebrate the birth of his daughter, when 12 Taliban [members] of the Lashka-e-Islam group broke into his house yelling and shouting. They held the believers at gunpoint. The Muslim house-owner, Haji Muhammad Saraj, was also present at the time to collect rent.”

VOM contacts added, “With machine and automatic guns, they forcibly separated the men from the women and children. Slapping the Christian men, they commanded all 16men, including Pastor Zulifqar and Haji Muhammad Saraj, to get into the five waiting vehicles.”

The 16 Christian men were held captive for an hour. “They were beaten and abused, and had all their money and mobile phones stolen from them. During this time, the Taliban attempted to persuade Pastor Zulifqar to convert to Islam, which he unquestionably refused. After sunset the Taliban took them to another place where they were kept in a cave until their release 10 hours later,” VOM contacts reported.

Pray for our bretheren in Pakistan

Religion of Peace closes another Christian Church

via persecution.com

Recently, Muslims closed a church in Jatimula, Bekasi, West Java, Indonesia and blocked Christians from entering and holding services.

According to The Voice of the Martyrs contacts in Indonesia, “Muslims blocked the alley leading to the church building. Pastor Anna and Huta Julu had to lead worship outside their church building and believers had to sit in the dirty alley to pray outside their church.”

VOM contacts added, “The sign outside the church building stated, ‘This church building is sealed,’ and it was written on a letterhead belonging to the Tambun Selatan district of Bekasi local government.”

This is the second time Muslims have closed the church in Bekasi. The church was first closed on September 10, 2005 when a mob of 100 Muslims nailed boards over doors and windows and prohibited believers from entering the building.

Pray for our brethren in Indonesia.

More stupid Canadian court tricks

The slow slide of Canada into socialist authoritarianism with respect to free speech has been a sad spectacle to watch.  But it seems that’s just the tip of the iceberg.  According to the Sydney, Australia Herald, a *12-year-old* was grounded by her father for posting inappropriate pictures of herself on the internet.  She appealed her gounding to the Canadian courts which, having solved all the other important social issues facing the world, decided to overturn the father’s discipline and order that she have her access to the internet restored. be allowed to go on a field trip.

Good God.  What *is* in the water up there?  But, of course, it’s easy to laugh at the Canadian slide into nanny-statism but that’s exactly what Obama wants to give us.  Or, as Hillary says “It takes a village.”  The Dems don’t say what to do when the village is run by idiots.  Is this really the “change” we want?

via Fark

Dude,where’s my global warming?

Indeed.  It’s funny to watch the global warming religionists scramble now that their predictions are failing.  The mark of real science is if you propose a theory and make predictions, and those don’t pan out, you have disproved the theory.  Turns out that the religious global warmers have based their theories on false measurements, inaccurate models, and hyperbole.  If the current lack of sun activity continues and temperatures continue to fall, you have to wonder if they will continue with “falling temperatures are a sign of warming” mantra or flip and say that we have to have state control of every aspect of our lives to avoid “global cooling.”  Via Drudge

A Victory for Truth in Ohio

The Ohio Supreme Court recently ruled that Coroners may retain organs during death investigations.

This is a profound victory for Medical Examiners and Coroners, and is one small step in stopping the increasing criminalization of our profession.  It has always been interesting to watch people’s perceptions of my work as a Medical Examiner — they are both fascinated and repelled.  Both reactions are understandable, but unfortunately both are dangerous when people pander to them.

Pandering to the fascination is dangerous because it leads to unrealistic expectations of what we can do.  The infamous “CSI effect” (though studies have indicated that it is overstated) can lead jurors to expect that we should do unnecessary and expensive tests on cases that don’t require it, and further that we should be able to provide exact answers to questions when we cannot.  A classic case is that of “time of death.”  In the movies, the ME looks at the body and says “he clearly died between nine and nine-thirty last night.”  It never works that way.  The traditional methods of determining time since death (cooling of the body, rigor mortis, livor mortis, etc), are filled with error.

Consider rigor mortis.  Rigor mortis is the stiffening of the body after death.  It is the result of the particular biochemistry of muscles.  It turns out that the molecules that make muscles contract act like a ratchet — there is one molecule that is a long string with teeth on it, and another that is a hinged arm that catches and pulls those teeth.  The important thing to note is that *both* the pulling of the teeth *and* the release of them requires energy.  Thus, while it takes obvious energy to, say, flex your arm, it *also* takes energy to relax it and allow the arm to fall. The use of that energy requires oxygen (by the generation of a high energy molecule called adenosine triphosphate, or ATP), which the cells get from the bloodstream.  In addition to the oxygen in blood, muscles also maintain their own limited supply of oxygen in the form of myoglobin.  When the body dies and blood flow stops, the muscles continue to use that myoglobin to allow the formation of the energy molecules that power the cells, both to maintain the cellular structure and to allow movement of the limbs.

Of course, the nerves are no longer telling the muscles to move once a person is dead, but an observer can passively cause them to move by lifting the limbs and moving them.  That movement will use energy from that limited supply.  After awhile, that limited supply is gone, and the muscles become stiff — there’s no energy to disengage that ratchet mechanism.  The muscles remain stiff until the ratchet itself starts to fall apart as part of decomposition, at which point the muscles relax.

 Consider all of the things that are involved here:  the storage of energy, the use of energy, the pace of cellular metabolism, etc. All of these have a lot of variables.  If a person had been exercising (such as running away from or fighting an assailant), then there will be less energy stored.  If it is hot, then all the cellular processes speed up; if it is cold, then they all slow down.  If the body is clothed or obese, it will cool more slowly, and thus the cells will stay more active and use up energy faster.  Toxins and drugs can affect it. Disease can affect it.  And on and on and on.

Thus, the use of rigor for the determination of time of death is a broad estimate, as are the other indicators.  Most Medical Examiners don’t give an estimate of time of death based purely on these features.  Instead, they ask “When did someone last see him alive?” and see whether or not that’s consistent with the changes.  If someone says “Yesterday” and the body is fully skeletonized, then it’s probably inconsistent.  That 15-minute window they give you on Law and Order simply doesn’t exist.  Unfortunately, sometimes juries think it does, and will misjudge evidence when they hear it.

Pandering to the revulsion, however, is even worse.  It’s worse because it misrepresents our motivations and gives the absolutely wrong impression about what we do.  And the legislation that panders to it is destroying forensic medicine in the US.  Why?  Because it, in a slow and creeping manner, is criminalizing what we do.

 The best example is the so-called “Dale Earnhardt” law in Florida, which makes it a class D felony for Medical Examiners to share images of cases with each other.  The law arose from a FOIA (or FOIA-equivalent) request for autopsy photographs of Dale Earnhardt after his NASCAR accident.  Understandibly, the family did not want those photographs used for exploitation.  However, the law was written so that Medical Examiners could not easily use cases for teaching and certainly not for research or publication.  The law has, I believe, been tweaked, but the bottom line is that it has had a profoundly chilling effect on forensic pathology education and research in Florida.  Why?  Because even if the law is written fairly liberally, Medical Examiners will choose to be “safe than sorry,” which means that there is no reason to stick our necks out.  Even if some of the things that Medical Examiners shy away from may be within the line of legality, who needs the hassle of being investigated or sued?

I have had colleagues in Florida ask me for case illustrations for their lectures and testimony because they believe that they cannot legally use their own case photos.  In a recent case of alleged malpractice against a Medical Examiner, *neither* the accusers nor the target of the allegations were allowed to show the photograph that would have trivially answered the issue at hand.

Other laws in other states have essentially made all research impossible other than datamining old cases for statistics.  The only way that we can do research is somehow contrive the process as part of an investigation.  I personally have some very intriguing findings involving child abuse that I am sitting on simply because I am not sure of  legal liability issues for performing some of the tests I performed.  I don’t believe I did anything illegal, and can justify everything I did as part of my investigations, but why risk the hassle?  If I publish, I might have a problem.  If I don’t, I know I won’t.  The choice is simple. The legislatures of these states have simply determined that they would prefer to have unsolved child homicides and pander to the hyperbole of the press.

 After all, it’s *easy* for a legislator to propose a law limiting what we do.  Who *really* cares about advances in forensic medicine — it’s an abstract kind of thing that *other* states can do.  On the other hand, a family member tearfully complaining that their loved one was some how abused by having a piece of tissue tested after their death makes great press and great politics.

A new twist on this is the issue of organ retention.  In many postmortem examinations, the significant pathology is not obvious at the time of the initial dissection.  Instead, the tissues must be treated with preservatives and dissected or analyzed using special procedures.  This takes time.  In order to allow the family to bury its dead, we release the body but keep the organ in question for examination.

This is particularly true of the brain.  In life, the brain is a gelatinous organ with the consistency of Jello.  It is essentially impossible to do fine dissection on a fresh brain.  In most cases, where the brain is obviously not involved with death (such as a gunshot wound to the chest), we just slice through the brain to look for something unusual.

In cases where important pathology may be in the brain, however, it is often necessary to “fix” the brain prior to dissection.  In this, we place the brain in a large container of formalin and allow the formalin to diffuse into the tissue.  Because the formalin diffuses in very slowly, we commonly allow the brain to fix for up to six weeks before beginning the dissection.  During the dissection, the brain is reduced to numerous small fragments, some of which are processed for histology and the rest, at most places, incinerated.

A family took exception to this in Ohio, and a class action lawsuit was brought against the Ohio Coroners.  In a clear example of good sense, the Ohio courts found in favor of the Coroners.  The plaintiffs are now appealing to the federal courts. 

 As always, the Coroners are being cast as people who don’t care about the dead or their families and who are doing this out of some sort of spite.  They ignore that we do this for a *purpose.* An editorial in the Columbus Dispatch plays on that theme and notes:

 Coroners fear that giving such property rights to families could impede law-enforcement investigations and delay autopsies. This need not be the case.

Criminal cases should take priority, and that can be spelled out in legislation.

This ignores the fact that in many of these cases in which the organs are retained to *determine* whether or not it is a “criminal case.” If we knew beforehand, we might not need to do the study.  Even notification issues are not as trivial as many seem to think.  Issues of *who* is really next of kin are often nontrivial, both in cases where none is known, but also in cases of atypical families where the determination of who really is the next of kin ends up in court.  What happens when we notify the “wrong” next of kin?  These issues arise a lot; the Medical Examiner office is not the place to make those determinations, and we should not be made liable when we fail after acting in good faith. 

We are trying to answer questions about cause and manner of death important to the law, important to public health, and important to the families themselves.  We care deeply about these issues and about the families and the dead.  But more, we care about the truth.  We believe we owe it to the victims and to society to provide the best answers we can.  And, unfortunately, sometimes that means that we have to do things that the next of kin don’t like.

 I remember when I was a medical student many, many years ago.  I was in a jurisdiction where the next of kin had to give permission for an autopsy at all — even a forensic one.  As you probably know, the next of kin are frequently the culprits in homicides of family members.  When this is the case, they are unlikely to consent to an autopsy.  I had a patient who suffered “the dwindles” — slow weight loss, uncertain peripheral neuropathy, headaches, nonspecific mental symptoms, etc.  He died shortly after admission.

I and a friend suspected arsenic poisoning, but the next of kin refused an autopsy.  I snuck into the morgue, collected a hair sample, and tested it myself.  It was full of arsenic.  I asked about what to do, and was told that what I had done was likely illegal, and was not admissible in court in any case.  It was clearly a murder, but the law about autopsies did not allow investigation.

We have come some ways in the past 30 years away from that, but the movement is now to return to magical thinking about forensics, play on that stereotype of the Medical Examiner as some sort of ghoul that lives in the basement,  and applaud the criminalization of forensic medicine. A few months ago, I was vigorously criticized for doing an extensive subcutaneous dissection on a baby (where the skin is largely peeled away to look for underlying bruises) as “mutilating” the baby so that she couldn’t have an open-casket funeral.  In fact, a good funeral home could have prepared the baby for an open casket funeral; it simply didn’t want to do the work.  But even if the claim were true, and while I certainly understand the desire for such a kind of funeral, I believe that the mother’s anger would have been better directed at the boyfriend who beat the child to death.  Instead of attacking me for providing evidence of that beating, I believe that it serves a better purpose to use that data to prosecute the murderer.

These attacks on my profession are now occuring as those same lawyers who want to inhibit research and testing complain about the quality of “science” in forensic medicine.  Most Medical Examiners agree that we need more research in forensic medicine.  Unfortunately we are not funded for it — most Medical Examiner’s offices are local offices with poor funding, and the medical establishment prefers to fund other initiatives.  But, in fact, many Medical Examiners would love to do independent research even on their own time and on their own dime; many projects would not require a great deal of money.  However, we face the further hurdle that most such projects are now illegal — to the point that even sharing data between pathologists is a felony — all because of pandering to the kind of hyperbole that legislators, the press, and the public find so appealing.

 You can’t have it both ways. You can’t complain about the state of science in forensic medicine, and place such hurdles to investigation that it is either financially ruinous to a small office, or illegal altogether.

 We care deeply about those victims we investigate.  We care deeply about their families.  When members of our families die, we share the same experience.  Unfortunately, sometimes you can’t serve both the truth and the feelings of survivors.  We try to accomodate families as much as we can, but this trend to remove discretion from us, and to criminalize our basic work will do a *real* disservice to the families of victims.  It limits of what we can do now, and by stopping the progress of forensic science it keeps us from providing better answers in the future.

Technorati Tags: autopsy, Ohio, organ retention, forensic medicine, forensic pathology, medical examiner

Canada is no longer a free country (from Samizdata).

From Samizdata:

I don’t know who has been following the bizarre destruction of liberty in Canada, but that country has now officially become non-free. It is now illegal to say anything someone finds offensive. No other rights — religion, speech, assembly — trumps the right of the censor. The so-called Human Rights Commission is not bound by the constitution, and there is no defense against their findings — truth is not a defense, intention is irrelevant, and even damage need not be shown. As one inquisitor noted: Freedom of speech is an American concept, so I don’t give it any value.

So much for freedom of speech. Now the so-called Human Rights Commission has decided that freedom of religion is of no value, either. In this case an academic took offense at religious expression. Even though nobody was damaged or hurt, or as the HRC noted: In this case, there is no specific individual who can be compensated as there is no direct victim who has come forward…” (See Ezra Levin’s column).

However, someone simply took offense “Dr. Lund, although not a direct victim, did expend considerable time and energy and suffered ridicule and harassment as a result of his complaint. The Panel finds therefore that he is entitled to some compensation.” In other words, the religious speech did not cause him harm, just the ridicule he received for filing a stupid complaint. Nonetheless, that’s enough to shut down religious speech in Canada. “Mr. Boissoin and [his organization] The Concerned Christian Coalition Inc. shall cease publishing in newspapers, by email, on the radio, in public speeches, or on the Internet, in future, disparaging remarks about gays and homosexuals.”

That’s forever, folks. No more preaching on this subject. Not *hateful* speech. Not speech advocating violence. Merely *criticizing* it is illegal. Reading the wrong passage in the Bible is now illegal. Just on the basis of an accusation. Without recourse. Without constitutional protections.

The HRC’s take on religious freedom is particularly frightening: ” In balancing the freedom afforded under the Charter and the degree of protection afforded through the provincial legislation, I considered s. 2(b) of the Charter in regards o the fundamental freedoms of conscience and religion, the freedom of thought, belief, opinion and expression, including the freedom of the press and other media, the freedom of peaceful assembly and the freedom of association. Having considered the Charter and the balancing of the freedoms set out in the Charter, I have interpreted the Act in a manner which respected the broad protection granted to religious freedom. However, I have found that this protection does not trump the protection afforded under the Alberta human rights legislation in s. 3. to protection against hatred and contempt. I also take the view that s.3(2) required a balancing of these freedoms afforded to individuals under the Charter, with the prohibitions in s. 3(1) of the Act. In this case, the publication’s exposure of homosexuals to hatred and contempt trumps the freedom of speech afforded in the Charter. It cannot be the case that any speech wrapped in the ‘guise’ of politics or religion is beyond reproach by any legislation but the Criminal Code.”

In other words, in Canada, you have freedom of religion — as long as nobody disagrees with you on any important issue and brings a complaint. The HRC found that “moral criticism of homosexuality” constitutes “contempt” and “disparagement,” and is thus illegal.

The defendant is ordered not only to pay a fine but to apologize for “his views on homosexuality.” Welcome to the world of thought crime.

Canada, welcome to the third world.

This bodes ill for the kangaroo court brought up against Mark Steyn for criticizing terrorists.

And, America, think about this before voting for Obama. That’s the road he wants us to travel.

Religious discussions about *anything,* including homosexuality, will sometimes be contentious. No moral issue will be without debate. The correct response is not to criminalize the debate. This is not about homosexuality. It is about fundamental freedom, and the ultimate hatred for such freedoms inherent in the left.