Thursday, March 27, 2008

Misestimating Peer Activities Contributes to Death

In support of other social norms research a study recently published in the Journal of the National Medical Association (Vol. 100, No. 3, Mar 08, sorry no link) found
“that 90% of subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase risk of smoking.”

Perceptions of use patterns and use acceptability have been shown to influence a number of behaviors, including both smoking and alcohol consumption. But the effect occurs with life activities as diverse as tax compliance, energy consumption, violence, and risky sexual behavior. This effect seems particularly prevalent and strong among adolescents. We need to learn to harness social norms “marketing” for prevention efforts.

What is the best way to convince folks that they overestimate the amount of smoking and drinking that is occurring amongst their peers? Who is the best spokesperson? How do we reinforce healthy, non-detrimental behaviors using social norms “marketing”? How do we expand social norms-based education to other behaviors that are detrimental to health and longevity?

I am sure this holds great promise with improving health and forestalling death, I’m just not sure how best to utilize this technique. But as awareness of this technique spreads, who knows?

Wednesday, March 26, 2008

Ten Deadliest Drugs

I was pointed to an article about a study published in the Archives of Internal Medicine rating the top 10 deadliest drugs based on deaths related to their use. The top 2 are potent pain meds, oxycodone and fentanyl. Deaths with these are most often related to misuse, either intentional (over-medicating yourself looking for release) or unintentional (over-medicating yourself looking for relief). But we have seen a very few related to over-prescribing because of lack of familiarity with their potency, pharmacokinetics, and/or synergism of side-effects with other meds (i.e. respiratory depression) and medical conditions (e.g. sleep apnea).

The 4th med on the list is morphine. I would have to wonder (without seeing the original study) if some of these might be heroin deaths in which the characteristic metabolite of heroin (and diagnostic of heroin use) was missed in the analysis. The 6th on the list is methadone which I have written about several times before.

The 5th med is acetaminophen, as alluded to in the article its ranking is likely due to its often being in combination forms of narcotic pain meds.

The one drug missing from the list is hydocodone (a frequently used and abused pain med) and I am a loss to explain that.

This study was based on voluntary reports to the FDA, so there is a possibility of some under-reporting and, pretty significantly, does not include illicit drugs. The caveat to be aware of and “respectful” of these drugs is well taken.

Tuesday, March 25, 2008

Is There a CSI Effect on Juries?

A recent study in the National Institute of Justice Journal casts serious doubt on at least part of what is feared as the CSI effect.

The biggest fear engendered by the perceived CSI effect is the fear that if there is not enough scientific evidence in a given case the jury (versed in the CSI way of investigating cases) will acquit on that basis alone.

This is a major concern because as many as 30 million folks watch CSI on a given night. Over 100 million folks watch CSI and similar criminal case shows in a given week. That is a lot of folks.

One interesting point that came up in the study is that the more individuals watch CSI and similar shows the more “real” they felt those shows to be. I don’t know if they watch them because they feel that they are “real” or if the watching convinces the individuals that they are “real” portrayals. Either way TV shows are TV shows, more entertainment than reality and we ought to keep reminding folks of that fact.

The study found that while CSI viewers had higher expectations of scientific evidence, at least in discussions of possible court trial scenarios, that did not result in acquittals in cases where that evidence was lacking. The biggest factor in decision making seemed to be the testimony of the victim or other witnesses, just like in the old days.

Nonetheless, while anecdotal evidence is not very good evidence, there are enough stories (and I have had a few experiences at inquest) that more research needs to be done before we can put to rest all of our fears of the CSI effect on juries. We, as a people, also need to do better at separating fact from fiction when we watch anything on TV. Just because you see it on TV, it doesn’t make it so.

Wednesday, March 19, 2008

Uninsured to Death

The data isn’t available yet for Illinois, but Family USA is looking at the lethal effect of lack of medical insurance on a state-by-state basis and the results are terrible a exemplified in Ohio:

Families USA researchers are doing a state by state analysis of people 25 to 64 to highlight the effects of what they see as a disjointed and broken U.S. health system.
"For this group of people, lack of health insurance is the third leading cause of death after heart disease and cancer," Ron Pollack, executive director of Families USA said…
Families USA took their lead from a 2002 Institute of Medicine study that found a link between avoidable health-related deaths and lack of health insurance, finding that uninsured adults were 25 percent more likely to die early than adults with private health insurance. They estimated that 18,000 adults nationwide died in 2000 because they did not have health insurance.
A more recent study found that uninsured people 55 to 64 are even more likely to die early.

We, as a humane society, can not continue to ignore the plight of uninsured and underinsured people in our country. We must support the frayed safety net of care provision we have now and work to a more universal and permanent solution, whether that is universal healthcare in some form or a solid amalgam of private and public efforts at providing access to healthcare.

I have talked about this before and likely will again as close to this topic as I have been for a number of years.

Monday, March 17, 2008

Heroin use spikes in Lake County

Heroin use spikes in Lake County

Lake County law enforcement officials say they're seeing a disturbing trend: an increase in heroin traffic.
The evidence county officials point to is the amount of heroin seized and several overdose deaths so far this year...
"It's something we are definitely keeping our eye on," he said. "It seems like it's becoming more popular out here."

As I am quoted in the article: “I am really concerned” (I think it is more a throw away quote so they could use my data). My intent of the longer quote I gave him was that if this is indeed a trend of increased heroin use and death it is concerning on many levels.

Beyond just the toll of the heroin itself, its use is associated with increased participation in crime and violence, certainly negatively impacting the community. To address this problem we need a multipronged approach with targeted law enforcement, and social prevention programs with treatment availability, to mention just a few parts of the attack. We must also be mindful that this is but one of the many problems that need to be addressed, but if we look for commonalities in approaches we might be able work effectively using a broadened scope and work under a rubric of community healing and wellness beyond individual wellness.

Thursday, March 13, 2008


Waukegan, Illinois – The Lake County Coroner’s Office is once again asking the public to help identify the human remains found at Countryside Golf Club last March.

The remains, believed to be those of an older male, were found March 19, 2007, when golf course workers were preparing the course for the spring opening. Also found at the scene, was an upper denture with distinct characteristics. The denture contains two gold teeth, one on each side. Additionally, one tooth near the front has a gold R and a front tooth is marked with a gold star. A picture of the denture is attached in hopes that someone will recognize the denture and notify the authorities.

If you have information about this case, please contact the Lake County Coroner’s Office at 847-377-2200.

* * *

Wednesday, March 12, 2008

Yes, folks are dying to get into Coroner's office

It has seemed busier at work. My phone seems to go off a bit more often at night and my staff consultations and media calls continued through my recent brief vacation. So we looked at the numbers:

Last year (December 1, 2006 through March 12, 2007) we had a total of 1086 deaths looked at through our office, with 60 classified as “inquiries” and 54 classified as “inquest” cases. Inquiries are somewhat extended investigations to make decisions whether the case is a “natural” death or should be moved to the inquest category. Inquest cases are full investigations of cases that include questionable deaths, homicides, suicides, accidents and drug intoxication/overdose cases.

This year (December1, 2007 through March 12, 2008) we have looked at a total of 1137 deaths with 56 “inquiry” and 75 “inquest” cases. For the mathophobes, that is about a 40% increase in inquest cases, our most labor intensive case category. That is a huge increase in casework and staff involvement in just a year.

We really haven’t, as yet, looked at the jump in detail as to which categories of death have contributed to this increase. It is, however, my feeling that it is related to increased drug related deaths. For example, at our last case conference (which has replaced our jury inquest) 5 of the 10 deaths we reviewed for manner of death were directly drug-related and it is possible drugs contributed in at least 2 of the others.

We work hard in the office. Thank goodness I have such great staff willing and able to step up to this work load and to perform it most professionally. They are second to none.

Thursday, March 06, 2008

Lake Barrington Homicide

This sort of stuff doesn’t happen in Lake County. You don’t think it happens anywhere. It so closely borders the surreal that it seems more TV fiction than real life, unless you were involved like I was involved in the case.

The material from my media release today:
Lake Barrington Homicide

On Saturday, February 23, 2008, a man was pronounced dead at 28031 Lakeview in Lake Barrington, Illinois. The victim was found pinned underneath a pickup truck which had burned. Based on circumstantial evidence, he was tentatively identified as Ari Squire. The burning of the body hindered positive identification.

An autopsy performed on February 23, 2008 revealed the cause of death to be a crushing injury to his chest, which ruptured his heart. The level of carbon monoxide in his blood demonstrated that the fire had occurred after his death.

DNA blood specimens were obtained during the autopsy for assistance with identification. Tattoos that should have been present did not appear to be on the body of the deceased. The severity of the burns on his hands precluded the use of fingerprints for identification purposes.

On Sunday, February 24, our forensic dentist examined the deceased and took dental x-rays to assist with ongoing attempts at scientific identification. Although we encountered difficulty in obtaining Mr. Squire’s dental records, we were able to secure them one and a half weeks after the autopsy. A review of these records by our forensic dentist consultant found that they were not consistent with the x-rays of the deceased. We then began efforts to obtain dental records of other possibilities for the victim.

On Sunday, March 2, my office was notified that the body of a male matching the description of Ari Squire was discovered dead of an apparent self-inflicted gunshot wound in a motel room in Eureka, Missouri.

As the events unfolded in Missouri, DNA samples from the victim being held in our facility since February 23rd were compared to family members of a Missing and Endangered Person. We have now positively identified the victim as Justin M. Newman, 20-year old male from Arlington Heights.

Other information revealed at the press conference today:

The decedent received his burns primarily from heat conducted from the very hot truck fire (a fire of uncertain origin) as the truck sat on his chest after his death, most were not direct burns. Was he unconscious before the truck dropped on his chest?

When Mr. Newman was found under the burned truck he had on Mr. Squire’s clothing and boots and had Mr. Squire’s wallet in his back pocket.

Mr. Squire had purchased blue contact lenses an hair dye (Mr. Newman had blue eyes and brown hair)

The events in Missouri: Eureka, Missouri police while running plates of cars in a motel parking lot (something they routinely do) had the plates come back as belonging to Justin Newman listed in LEADS as a missing and endangered individual. The front desk staff reported that the room was rented under the name of Justin Newman. Mr. Squire killed himself as police approached his motel room (single gunshot to the head).

The investigation continues into several matters, such as who else was involved, was there indeed email communications between Mr. Squire and his wife after his supposed death on February 23rd?

Is fact stranger than fiction?