Wednesday, August 30, 2006

Dinner Together Can Prevent Deaths

Kids die. Kids shouldn’t die before their parents. A fair number of teens die because of poor choices and taking chances. What can we, as parents, do to prevent risk taking, poor choices, and taking chances and keep our kids alive? Lecturing often results in a “deaf ear”. Telling them the horrors that will result from their bad choices and trying to scare them into ‘good” behavior often doesn’t work. What can you do? What is effective?

Amazingly there is something that is fairly easy to do, that has been shown to have a very significant impact on a broad range of behaviors and excellent positive effects, generally, on teens (and all kids). And best of all it is pretty easy to do and centers around an activity that you want to do anyway, eating dinner.

A study has been done (and replicated) by the National Center on Alcohol and Substance Abuse at Columbia University demonstrating the benefits of having family dinners together 5 or more times a week.

Teens in those families that ate together that often had lower rates of smoking, drinking, and drug use. They had better grades, were more emotionally content and had more positive peer relationships. They had healthier eating habits. They had lower risk of suicidal thoughts. They were more likely to have friends that their parents approved of. Wow, almost everything one could hope for short of whiter teeth and fresh breath (sorry, just a bit of a joke).

You can’t buy a better treatment and preventative measure for teen health and well-being, as well as death preventative. Granted it is not a “silver bullet”, substance use/abuse and risk taking can still happen, but it is much less likely with this “dinner treatment”.

Having frequent and regular dinners with your kids is the simplest and most effective way to positively affect your teen’s life (and making sure they are around to live it).

Awesome, all the more reason to keep it up despite the resistance I sometimes get from my kids. Try it, no, no, DO IT.

Tuesday, August 29, 2006

Rehabilitate don't recidivate violence

In an interesting article an interesting quote: “…almost all bad behaviors are the result of anger…The last thing you want to do is add to that anger.” Quite the truism and it certainly could be used in so many contexts. In the case of the article that it came from, it referred to the need to change the way we treat juveniles in prison.

A fair amount of violence in our society/community is caused by youths who recidivate (i.e. who “relapse” into violent and/or illegal acts). The way youths are incarcerated in our state (and other places in this country) feeds their anger with lack of opportunity for positive change in a profoundly negative environment. As the article points out we need to totally change the culture of juvenile incarceration.

Illinois has about 1400 youths in incarceration at a cost of $70,000 per youth per year with a 48% recidivism rate, while neighbor Missouri has 1200 incarcerated youths at a cost of $57,169 per youth with a 7% recidivism rate. Missouri incarcerates youth in residential facilities with case management and rehabilitation. Illinois has their youth in stark prisons and razor wire and hopelessness.

The new Illinois Department of Juvenile Justice is set to change that. They plan to improve the prisons, “beef up education and create a system of support and supervision after release” and “teach better behavior”. These youths will then return home after their sentence better off, better able to deal with life and supported in those efforts. They will be less likely to relapse into crime and violence. They will be less likely to die from violence and those who would have been their victims will also survive.

A way to decrease violence in our communities, a way to save lives, like this deserves our support. We need to return to rehabilitative incarceration (yes, we need preventative programs even more) and it will have a positive impact on our communities and society (and save a few bucks in the deal, to use for other important needs).

Monday, August 28, 2006

Maggot Dance

Imagine my surprise when I read in Eric Zorn’s blog this statement today:

“One of the problems with my life is that it doesn't have enough maggots in it.”

You see, maggots are something we have to deal with at times (actually not infrequently, depending on the season) in the Coroner’s Office. They can be interesting at times, but there does seem to be an inborn aversion to them that can be difficult to overcome. So I was very surprised to find out that there is a ‘fun’ maggot. A maggot that is a dance, not to be confused with a dancing larva (there are times that some of those little creatures are dancing, particularly when they have been exposed to ‘happy drugs’). There is always something new to learn.

Friday, August 25, 2006

Addict shares his thoughts

This guy’s description of the development of his addiction and progress to sobriety really struck me, so I thought I’d share it:

I'm a drug addict.

First off, don't y'all go worrying about me. After some months of trying and failing, falling into traps and routines that led me back to my disease, I finally surrendered and found a home within a fellowship that helps people like me.
from my earliest days of remembered consciousness, I felt this absence--some describe it as a void inside. Now today a counselor might tell me that it had to do with my adoption, with my mother's struggles with depression in my early childhood, or somesuch as that. Frankly, I have to admit that I never found the whys and wherefores very useful.
First it was Hot Wheels cars, then Star Wars stuff, then endless parambulations in the woods behind our house, making up all sorts of fanciful stories. My parents would tell me to get home when the streetlights came on. Funniest thing though. Those damn streetlights never came on! At least not for this kid. Not until more than twenty years later. Maybe six months ago by my reckoning.
At that point, a bad drinking problem nurtured in college, emboldened after the tragic death of a close friend in an automobile accident, had made its transit through all type of recreational drugs and settled into a death struggle with crack cocaine here on the streets of Brooklyn, New York. At the end I had two choices: go on to the bitter end--jails, institutions, and death. . .or find an entirely new way to live.
After going in and out of recovery meetings, I finally came back to stay, with a penitent 'never mind all that stuff I thought about doing this myself' and a willingness to take suggestions. Today I have more than two months clean, and my commitment to keeping that clean time becomes stronger every day.”

Thursday, August 24, 2006

Still death by suicide

Suicide; I don’t mean to dwell on it, but it keeps “coming up” at the office. There are always different reasons behind each one or different stories of each of these individuals’ lives before their death by suicide. Each is a bit different in method. But it comes down to death by suicide.

Remember, asking an individual if they are planning to commit suicide has not been shown to precipitate the suicide. There are potential benefits to asking, however. Asking may show them that someone cares, which may be something they need right then. Asking about means or methods considered allows those means to be removed from where they might be used. Identifying someone as suicidal may allow for mobilization of family and friends and beefing up their social support system, which may make the difference. Asking them about reasons to live may get them to expand their thinking beyond that one last choice. Asking about suicidal ideation and intent may be the first step in their getting the help they need (and yes you may need to push them to get that help).

Another “cluster” of unrelated deaths by suicide gets me thinking and hoping for a way to prevent at least some of them.

Wednesday, August 23, 2006

Drug companies sell disease and dis-ease

“Pharmaceutical companies sell disease” and the fear of disease. Life and its problems have become diseases needing medication intervention. We are nothing but consumers unable to deal with life and its problems and challenges without taking a pill. Shyness is now “social anxiety disorder”. Trouble sleeping has become insomnia in search of the right pill. Pain is not to be endured and certainly can’t be treated short of taking the right pill.

Pharmaceutical company advertising expenditures are about $4 billion a year. In 1994 (about the time I wrote “Brown Bag Syndrome”, regarding the perils of polypharmacy, for Emergency Medicine Reports) the average American had 7 prescriptions a year. In 2004 that number was up to 12 a year.

Pharmaceutical companies know that a drug ad increases the sales for all of the drugs in that category of medication. They know that the ads will return $4 for every $1 they spend. They sell the disease so you have to have the pill for the cure.

What can come of this polypharmacy (other than great profits for the pharmaceutical company)? It drives soaring system-wide medical cost and patients badgering doctors for more meds and that one “perfect” pill. People get sick (and can die) from the side-effects of one medicine, but few studies have been done on the potentiation of side effects from ‘mixing’ meds. More meds around also increase the chances of ‘punch bowl’ parties allowing for the ‘snacking’ of mixed meds as if they were jujubes. Polypharmacy can be a fatal.

Medicine should be about healing people, not persuading more of them that they are “sick”. Medicine should be advising folks about health, not pushing pills. Proper diet (weight control, general well-being, specific issues), exercise (weight reduction, general conditioning, pain control), non-toxic modalities like massage therapy and yoga, are all non-medication paths to health. It takes more work than swallowing a pill, but you can be in charge of your health and forestalling your death.

Tuesday, August 22, 2006

"Live Scan" fingerprinting

We have added new equipment and capability to our office.

Our new “Live Scan” fingerprint equipment will help us with decedent identification and with case investigation. We are the only Coroner’s Office in the state with these capabilities in-house. And being able to supplement our budget expenditure with private grant funds made it easier to bring on-board.

Instead of our previous procedure, (inking and finger printing onto “cards” and submitted via mail to the Bureau of Identification, with results in a couple of weeks) the decedent’s fingerprints are directly scanned into our computer and submitted electronically. The first day we were operational with it we had the identity of the individual back in about 30 minutes and another case the other day took 10 minutes to get the information back.

The other information we get is any criminal history and there are times when that information is valuable to us in our investigation. An individual believed to have died from an asthma attack found to have a history of drug-related charges, may test positive for drugs that contributed to their death (making it not so natural a death). A previous call to the police for suicidal ideations or actions would add evidence that their death may have been related to those previous actions. Additionally, it may allow other law-enforcement agencies to close open cases with “missing” perpetrators that turn up in our office.

The limitation to fingerprinting as a method of identification is the necessity for the individual to have been fingerprinted before and those fingerprints to be on file with the Illinois State Police and/or the FBI, otherwise there will not be a match. However, there are a growing number of non-law-enforcement related reasons for individuals to be “in the system”. Many jobs are having employees and applicants fingerprinted and submitted to the databases (and those submissions are retained). As well, certain professional license applicants are being likewise fingerprinted. All increasing the chances of a “hit” with a fingerprint check. So “Live Scan” will be a very useful technical addition to our office capabilities.

Our technical advances since I took office are really amazing. In our toxicology lab the changes have worked wonders. Next up I am waiting to hear about a grant we have applied for to add “crash data recorder” information access to our office to aid in investigating auto crash-related deaths.

Monday, August 21, 2006

Death Investigation Training

I got the flyer for St Louis University School of Medicine’s Medicolegal Death Investigator Training Course in the mail today. I often get asked about training/education sites and I would whole heartedly recommend this program. I went through it shortly after my election as Coroner and we send all of our Deputies through the training. It gave me a solid base on which to acquire/build further related information and allowed me to look at information already in my armamentarium from the medicolegal death investigation vantage point.

The intensive course covers 30 “types of death” and provides introductory information about various ancillary forensic sciences (anthropology, entomology, psychiatry, radiology and toxicology). They have been conducting the course for 27 years and the polish and topic coverage shows that history.

Taking this course also prepares you for more in-depth courses that they offer each year on a variety of related topics. If you have interest take a look, they draw from a breadth of disciplines that you would be hard-pressed to put together otherwise. In addition, they have the backing of the St Louis University School of Medicine (not all such courses have such a pedigree).

Friday, August 18, 2006


Over several years the Chicago Project for Violence Prevention designed and tested a project to reduce community violence, particularly gun-related violence. That project is CeaseFire. They drew from public health research and projects running successfully in several cities nationwide. Take a look at their statistics; it certainly looks to have been very effective in reducing shooting and homicides in Chicago. I will mention that there is a further study underway to try and separate the effect of CeaseFire from other initiatives brought to bear on the violence problem at about the same time (the results of that study will be very interesting to see).

Youth outreach and conflict resolution, to head violence off before it escalates too far and offer alternatives to violence, are the cornerstones of the program. Outreach workers, “violence interrupters” and community support and reaction are the “tools” used for intervention and “inoculation” against violence. Another very important facet is to ensure that there are “multiple messengers with the same message”, that violence can be stopped, it is a cycle that can be interrupted.

CeaseFire is spreading out of Chicago, with Chicago Project for Violence Prevention helping with technical assistance and training and the state helping with funding. I think CeaseFire will become a very useful program in Lake County and I thank those responsible for its coming here.

I am certain it can prevent deaths and decrease the growing violence problem in our society.

Thursday, August 17, 2006

Veteran Post Traumatic Stress Disorder

Another bit continuing yesterday’s post regarding concerns of a potential “epidemic” of Post-Traumatic Stress Disorder in returning veterans. This from an article that has been in my briefcase for a while.

In a report from the VA’s national advisory panel on PSTD it was reported that returning veterans have to wait an average of 60 days before they can be evaluated for PSTD, which, of course, means even longer to begin treatment. 42% of VA primary care clinics have no mental health staff and 53% of those that do have staff have only one such individual. 82% of new patients need very intensive PTSD treatment, but 40% of those programs are so full that they can only handle “a few more cases”, with 20% reporting that they are too full to take on new patients.

Particularly considering the 30% increase in PSTD-diagnosed individuals among returning veterans since 2005, unavailability of treatment is going to be a huge bottleneck. This is likely to contribute to increased risk of death by suicide, homelessness with attendant health risks (and death risk), among other personal and societal problems. We owe them more than this. What do we need to do to prevent these preventable deaths from occurring in the (not distant) future?

Wednesday, August 16, 2006

2 short posts

A couple of quick posts today; I spent a good share of today (as often happens) in meetings.

First, “ripped” from Eric Zorn and “shared casket”:
Reading the terribly sad story about the funeral of Angela Lindner, 39, of Naperville, and her sons Danny, 3, and Aidan, 1, who were killed recently in a crash on the Indiana Toll Road, I was struck by the offhand information that the three victims "shared a casket."...

The second goes to a conversation I had at the last Lake County Partnership to End Homelessness about the impact that this country will see from veterans returning with Post-traumatic Stress Disorder and whether “we” are prepared for its effects on them and on society. There has been “explosive” growth in the number of veterans with severe PSTD, but the VA has only ramped-up minimally in services to handle the care of these individuals. As a matter of fact over-all there has been an 8% decrease in funding for mental health services.

Tuesday, August 15, 2006

Needle Exchange Saves Lives

HIV/AIDS is back in the headlines (a little) long after compassion fatigue pushed it out. Yes, HIV and AIDS still exist in this country and around the world. We do hear a bit about it around the world, but not much about it in this country. Granted it is a much more treatable disease than it used to be, but it hasn’t been cured. People still get infected with HIV and people still die form AIDS (although thankfully much less often than when I first started treating individuals with HIV/AIDS, I was a “specialist” for 10 years).

The news “splash” coincides with the 16th International AIDS Conference and the 25th anniversary of the infection. I saw a headline with Bill Gates and Bill Clinton promising to eradicate HIV/AIDS (I seriously doubt it and have doubted that possibility all along). One article that did catch my attention was one on needle exchange. That is a “battle” I have fought in the past. It is a battle fought and won all over the world, won except here in the US, of course.

Providing clean needles to drug IV users is an incredibly effective way to prevent the spread of HIV among people who inject drugs and through them their partners/spouses and children. It has been demonstrated, just as conclusively, that it does this without encouraging the use of illegal drugs (as Surgeon General David Satcher reported to Congress in 2002).

While most states have at least some access to clean needles for individuals, this should be a national policy and a national program. A clean syringe costs about 10 cents. Compare that to a lifetime of care at $195,000 or the cost of a life. Needle exchange is a life-saving health intervention and we ought to be about saving lives.

Monday, August 14, 2006

Stop CPR and no trip to the hospital

Few people survive a cardiac arrest. Over 300,000 individuals in the US die of cardiac arrest each year; “sudden” cardiac arrests of cardiac origin (rhythm or perfusion) are the least likely to be resusitatable.

A recent study in the New England Journal of Medicine (not a NEJM link, that is subscription only) tested a three criteria decision-making “tool” to see if it was reasonable for rescue personnel to stop CPR “in the field” based on futility of actions. This may seem ‘cold”, but the large numbers of individuals taken to ERs by rescue personnel in whom resuscitation is unlikely to be successful ties up rescue personnel and equipment and ER personnel and capacity that might be better used for others more likely to benefit. These “cost” (not just monetary costs) vs. benefit decisions must be looked at and “tough” decisions made.

The criteria included were: arrest not while rescue personnel were present, a rhythm not correctable by defibrillation or counter-shock, and pulselessness during resuscitative interventions (adding paramedic arrival time greater than 8 minutes in a 2-tiered EMS response system and arrest without any witnesses made the “tool” even more predictive of failure)

According to the study the application of this decision-making tool would decrease by about two-thirds the number of people in cardiac arrest taken to hospitals, those with incredibly low likelihood of survival/resusitatibility (0.5% in their study group).

It is time we looked at whether this is a reasonable advancement in pre-hospital care and whether this is in the interest of the greater good, without abandoning “hope” for those without much chance of survival.

Friday, August 04, 2006

Aspirin Life Saver

Over 1 million individuals in the US suffer heart attacks (myocardial infarctions) each year. Almost 500,000 individuals die of heart attacks each year, which translates to 1 in every 5 deaths being due to a heart attack. (American Heart Association)

Certainly, as is true of every disease, it is best to prevent yourself from getting heart disease. Eat right, exercise, don’t smoke, get born with a better gene milieu. But what can you do if you suddenly develop chest pain (with or without exertion) maybe radiating into your left arm, maybe with some shortness of breath and you, as Fred Sanford used to say, think that this is the “big one”? First, get yourself to medical care and if you think you are having a heart attack calling 911 should be high on your list. Besides getting you to the ER quicker, the folks in the rescue squad can give you oxygen and medications that may be very beneficial in the situation of a heart attack. Also, if things “go bad” they can provide necessary care and resuscitation.

But the thing I want you to think about is aspirin. Yes, the lowly aspirin tablet can be a life saver. Several studies have shown that in the case of an acute myocardial infarction, an aspirin taken as soon as possible in the course of its evolution can save heart muscle (decrease the amount of damage done) and can save lives. One study projected that aspirin administration in the course of a myocardial infarction could save 10,000 people a year. If you are at risk maybe you should carry them with you or have someone grab one for you as you’re waiting for the rescue squad.

And just as Fred Sanford lived to say something comparable to “Oh, this is the biggest one I ever had. You hear that Elizabeth? I'm coming to join you honey” multiple times, snacking down (chew and swallow, no matter how bitter) a regular strength (325 mg) aspirin tablet during a heart attack may allow you to live longer.

Wednesday, August 02, 2006

Picky to avoid bitter

There is a genetic reason some kids are “picky” about eating vegetables, or at least some vegetables. And we all know we should consume more veggies than we do. It seems the sensitivity to “bitter” tasting is genetic, with some individuals more sensitive than others. Kids who are more sensitive tend to be more likely to eat sweeter veggies (e.g. carrots and bell peppers) than bitter ones (e.g. broccoli and cucumbers).

Realize there is some “use” to this sensitivity evolutionarily. Most naturally occurring “poisons” are bitter tasting, so someone highly sensitive to “bitter” is more likely to survive (and would be good at the job of royal food taster).

There is hope of expanding food options/choices, nonetheless. As one of the study authors pointed out, food preferences often change as we get older. This has been borne out repeatedly as my kids have aged and matured, although I’m not sure when I will be able to get them to eat a turnip or certain meats that look like the organ they came from.

Tuesday, August 01, 2006

Watermelon, health food

This heat does bring back memories of eating sloppy wet pieces of watermelon at my aunt’s house or the park near her home during summers of my youth.

Now science has endorsed that activity by finding great health benefits in the fruit. Most obvious to anyone who has eaten it by the slice is the high water content (94%) that can go a long way toward replacing water lost from the heat. Also found in various watermelon studies are high levels of antioxidants, particularly carotinoids and lycopene. These antioxidants are beneficial in helping the body avoid and/or repair cellular damage caused by living and outside influences such as chemicals and the sun.

Another interesting thing that was borne out by research goes back to the “old days” as well. Watermelons stored at and served at room temperature maximize the amount of anitoxidants delivered in a serving (sliced, chunked or balled). We never had watermelon chilled and I think it is much tastier a bit on the warm side.

So, if you are out and about in the heat or want a treat at home this summer seriously consider the health benefits, tastiness, and fun of having a bit of watermelon.