Thursday, July 31, 2008

Guns and suicide

Got a link to this information through the NAME listserv and I thought I’d post it here:
A study by the Harvard School of Public Health of all 50 U.S. states reveals a powerful link between rates of firearm ownership and suicides.
… states where guns were prevalent—as in Wyoming, where 63 percent of households reported owning guns—rates of suicide were higher. The inverse was also true: where gun ownership was less common, suicide rates were also lower.
… Says HSPH Professor of Health Policy David Hemenway, the ICRC’s director: “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”

Just as I mentioned before these impulse suicides need to be a real target of prevention measures, including telling folks that if they own guns keep them locked up or out of the house at the very least.

Tuesday, July 29, 2008

Sailor Heroin Deaths

Headline from the Great Lakes Bulletin:
“These shipmates made a life-changing decision…R.I.P.”
“Bad decisions lead to deadly consequences”

It then lists the names of three Sailors who have died this year, actually within the last 5 months, of heroin intoxication (some with other drugs in the mix). These were young men who made “bad” choices that cost them their lives, their potential lost.

The article concentrates on one the young men enough that you really get to know him. He really is just a kid wanting to enjoy life and with plans for the future. All that snuffed out with these decisions.

Did any of these young men know or consider the real risks of these actions? Drugs they can make you high and they can make you die.

Friday, July 25, 2008

Another drug-related death

Another drug-related death of a young man (in his 20s) this week (not to mention the gentleman in his 50s or the woman in her 30s, they are no less tragic and they also died drug-related deaths this week)

He died of heroin intoxication, abuse, over-use. What also stood out with this young man is that when we tested several items from his room for drug residue we came up with results that beg action or reaction. We found a dollar bill with heroin residue, cocaine residue on his dresser, cocaine and THC residue on a small scale in his room, and a part of a jeweler’s screwdriver with THC residue.

Youthful experimenting? To me it screams the need to get honest information repetitively out to the public (how do you get it to the youth of our community?). Among other important bits of information, that the heroin on our streets right now is potent and particularly deadly. We must develop and push prevention; we must develop and push treatment.

It will be work, hard work, but aren’t these folks worth it?

This ain’t CSI

Another in my “this ain’t CSI” posts:

About 5:20 pm yesterday I got an email that said: “I hope this doesn’t make it on your blog!” If you wrote that I’d advise you to stop reading now. I couldn’t resist.

Over several hours and multiple emails yesterday I and a very patient staff member of Finance tried to set up a meeting to go over my FY2009 budget with County Administration.

In one of my emails I described the interaction “like a game of Twister or Checkers on crack”. Over 20 emails rocketed over the wires and airwaves back and forth to get all of the folks scheduled together for the meeting. Last I heard it was still pending responses from 2 folks, so I am watching for more emails.

Our budget setting process might be “fun”, but I don’t think it will ever make an episode of CSI. I begin with my proposal shoe-horned into their forms and format. At times their forms seem arcane and not a good fit for what or how I want to submit stuff. That stuff is reviewed by Finance staff and some changes are made based on that back and forth give and take.

The next stage is the face-to-face review with a group of County administrators with my justifying changes from last year (e.g. a latex shortage in Asia threatening to drive up the cost of gloves in a few months). Heady stuff, but not the stuff of TV drama.

After that they review my budget without me present, figure how it fits with the County’s overall budget, and decide what they will recommend to the County Board. Then it’s through the Board committees and the full Board for approval in a few months.

On second thought, I think I’ll begin work on the script proposal, I think it has potential.

Tuesday, July 22, 2008

Preventing Death by Train

I just got a “save the date” card for an upcoming conference that sounds interesting. I was talking recently about the need to better secured train tracks (fencing and the like), both in reference to my impulse suicide post of a few days ago and with the incident of a recent suicide by train. Low and behold, I got a card in the mail about a conference entitled “Sealed Corridors”, put on by the DuPage Railroad Safety Council in September.

Looking at the DuPage Railroad Safety Council website, I was impressed with their various initiatives and projects. They undertake education to kids, educational materials at train stations, promoting legislation and enforcement, etc.

I think more “secure” tracks could prevent some impulse death by suicide, as well as some of the accidents we see involving trains. We have had cases (pedestrians and in vehicles) who ignore warnings, or who misjudge time to impact, or who are distracted to the point of fatal error.

The DuPage Railroad Safety Council efforts and their conference sound interesting. I look forward to learning more and supporting what I can.

Friday, July 18, 2008

Drug combinations multiply lethality

I came across this reminder that drug combinations are almost always more lethal than single drugs alone. (Actually I had been corresponding with the author of this article before he published this in the paper/on the Internet. He had picked up on my blog as a source of information after a recent death involving a sorority “sister”)

The combination ingestion (by different routes but at the same time) of alcohol and cocaine is more lethal that either alone, at least in part because of the metabolite formed in the body (there may also be an effect on metabolic pathways seperate from the formation of this metabolite).
Research into the lethality of cocaethylene use compared to cocaine use alone is young, but anecdotal experiments have pointed towards an increase in mortality rates from a combination of cocaine and alcohol consumption. One of these, a 1999 study of drugged rats by the Kyoto University Graduate School of Medicine, found cocaethylene 46 percent more lethal than the control group of cocaine use alone.
Additionally, a study appearing in the July 1997 issue of the Journal of Addictive Diseases stated that cocaethylene has been associated with seizures, liver damage and compromised functioning of the immune system and found an 18 to 25 fold increase in risk for immediate death over cocaine use alone

Don’t take chances, make good choices, think

Wednesday, July 16, 2008

Health Promotion to Forestall Death

I agree with the author of an article I just got around to reading: Improving Public Health Through Prevention.

Not only do we need access to healthcare and healthcare coverage for all, we need what the author calls “Universal Coverage PLUS”:
A high-performing national health-care system must also focus on the prevention of disease and promotion of optimal health for all its citizens…
The existing system focuses primarily on diseases -- once symptoms are well established and treatments are costly. The system needs to include a logic of targeting investments and interventions earlier in the evolution and development of diseases. Improvements in the natural, social, and built environments in which individuals live, as well as enhancements in diet, exercise, and lifestyle, can have a profound effect on health trajectories, adult medical needs, and the overall costs of care. Recalibrating our health system to address this undeniable reality will require more than universal coverage.

As I heard someone say recently we need to “make sure you are around for all the birthdays you possibly can”. To do that we must make certain everyone has access to medical care, not just episodic acute care in an ER but a long-term healthcare provider relationship with chronic disease diagnosis and management as needed. Along with that, we need to push folks to get healthy and stay healthy. We need to work on healthy communities and healthy environments so folks can get out and get healthy without the potential of others affecting their health and their new healthy lifestyle (i.e. with violence,etc.).

If the working for the common good isn’t enough of a reason for you, think of it as an investment in “human capital” (to borrow once again from the author).

Monday, July 14, 2008

“The City of Broken Men”

I read an article from the July GQ magazine yesterday (not my usual reading material, my wife saw the article at the spa at which she works). The article was about the military hospital, Landstuhl Regional Medical Center, and the work they do there. The article should be required reading for every American.

Every soldier injured severely enough to leave their units in Iraq or Afghanistan go through that hospital in Germany. They do incredible work there. The article centers on one injured soldier who had his leg blown off, in telling the story of the medical center, its staff, and its work.

Two things in the article really grabbed me. They drove home to me the enormity of this side of the war. The enormity of which we regular citizens don’t see, don’t hear about, don’t know enough about. As the author points out it is and enormity that will affect us as a nation and as people for a long time to come.

The soldier the article focuses on is “more or less the 44,360th person hurt badly enough to be evacuated out of Iraq or Afghanistan”. 44,360th and that was months ago.

And then the article’s thought provoking closing:
“We can send you to a broiling desert across the world to fight precision battles in a country you know nothing about; and we can beam you up when you’re hurt and put you down in the middle of Germany, rebuild your leg, get you free cheese and $50,000. But there are some things we just can’t do. And what it is we couldn’t save Mike Brown from what he’ll find out next [back home].”

What we do for all the Mike Brown’s into the future is our challenge as well.

[“The City of Broken Men” by Devin Friedman, GQ, July, 2008]

Friday, July 11, 2008

Suicide: premeditated v. "crime" of passion

I came across an interesting article this week (via the NAME listserv) about suicide. Early on it brings up an interesting statistic that “the nation’s suicide rate (11 per 100,000 inhabitants) is almost precisely what it was in 1965”. Despite all the research, all the programs, all the new medications, the rate has not changed in over 40 years. That really is startling.

The author, as well as some researchers, feels that that is due to a dichotomy in suicidal behavior, much as there is in homicide. He discusses a premeditation vs. passion division amongst deaths by suicide. The premeditated suicides are most easily impacted by programs, medications, and therapy. The passion or impulsive suicides not so much. His discussion resonates with my experience.

The impulsive suicides are best impacted by creating “barriers to suicide or means restriction”. This was well documented (and then ignored) in the 60s and 70s in Great Britain. Death by suicide dropped by a third with the change from coal-gas to natural gas stoves during those decades. In the 50s “sticking one’s head in the oven” accounted for half of all British suicides. "Many of those were impulsive acts using a means with little time for second thoughts". “Remove it, and the process slowed down; it allowed time for the dark passion to pass".

We need to modify how we address death by suicide, how we think about death by suicide. They are not homogenous (neither the individuals nor the methods) and likely require multiple, varied interventions. Youth particularly fall into the more impulsive category, making brief, timely interventions critical. This recognition of differences can lead to more successful intervention.

But never lose sight of the underlying condition:
"They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution."

Thursday, July 10, 2008

Coroner speaks to alcohol pushers

Last night I practiced what I preach. I have been preaching that we need to change the social norm surrounding alcohol consumption. We don’t need alcohol served at every celebration or get-together. We don’t need alcohol to have fun or as a social lubricant. We need to step up and speak out against this “social norm”. That is one way we can change teen/youth conviction that we need to consume alcohol.

I was at an event where several upcoming events/parties were announced. Every one had alcohol as the first word in what would be happening at each of them. After listening, I stood and spoke out. I told them that what I was going to say might be uncomfortable, but that it is not right for alcohol to be “the guest of honor”. I am not against responsible drinking by adults, but it should only be a side, not a main course. I cautioned them that if they were serving, they would share responsibility if any over-drinking occurred. Just as I tell teens: Think, make good choices, don’t take chances.

Now it is your turn to speak out. Only with speaking out can we alter that social norm.

On another related topic: I am appalled by a commercial that I have heard several times on the radio. To quote (or come close anyway): “…two things you should know about morning hangover…” Both those things pertain to their product. No. The 2 things you should know have nothing to do with their product (yes, something I learned a long time ago): You drank too much and don’t do it again.

Wednesday, July 09, 2008

“21” saves lives, enough said

The Substance Abuse Policy Research Program put out a press release a while back that I just got through my ASAM listserv:
… the study published in the July 2008 issue of the journal Accident Analysis and Prevention found that laws making it illegal to possess or purchase alcohol by anyone under the age of 21 had led to an 11 percent drop in alcohol-related traffic deaths among youth; secondly, they found that states with strong laws against fake IDs reported 7 percent fewer alcohol-related fatalities among drivers under the age of 21.

Controlling for possibly confounding variables, this study presents convincing research results that should quiet discussions about lowering the legal age limit. No longer should “21” opponents be able to confuse the issue with issues of improved car safety, for example.

The other finding of the study was:
…the authors … found that tougher sanctions against fake identification cards may represent the second-best legislative tool that states have in combating drunk driving deaths among young people.
“We found a 7 percent drop in youth alcohol-related fatalities in states that are willing to take strong actions, such as automatically suspending the driver’s license of a young person caught with a fake ID.“

Still more needs to be done pushing for consistency in the various laws encompassed in “the legal drinking age of 21” (across states and other jurisdictions)and a push is needed for consistent enforcement as well, but there is proof that this is the way to go to prevent deaths of teens.

Enough of the talk, featured recently on one of the news channels (I forget which), of the talk of a return to 18 as the legal age for drinking. “21” saves lives, enough said.

Tuesday, July 08, 2008

Coroner Business as a Profession

I was interviewed for an article that will be used by “Bridges…the Student Success Company” to acquaint teens with the Coroner business as a profession. I liked it when they sent it to me for checking, so I thought I’d put it up here:

"As a coroner you also have to deal with the politics, administrative, and personnel issues that don't show up on CSI," says Dr. Richard
Keller. He is a coroner in Illinois.

"It is great work, but it is not for everyone. It is difficult work mentally and physically. The deaths of kids, dealing with a decomposed body or a gruesome death are all tough. Equally tough are working in the cold, rain, mud, and all the locations and conditions that can surround a death," says Keller.

One of the main responsibilities of a coroner is to determine the cause of death.

In one of Keller's cases, deduction and reasoning among all the staff in the coroner's office was necessary. They suspected that the man had died of cocaine intoxication based on circumstances and his history. But there was no blood or other body fluid available for testing to prove their suspicion. They found a solution.

"We used a blender on the colony of maggots that was where his brain should have been -- long before the somewhat similar CSI episode. On testing the resultant mass ... in our toxicology laboratory, we found that he had indeed died from the use of cocaine. The maggots were positive for cocaine that they had acquired by consuming him," explains

Keller is a physician who became a coroner to target the public health aspects of the job. He is interested in educating the public to help prolong life by avoiding similar untimely deaths.

"Certainly, learning and investigating all the different ways people die is interesting and exciting, but by the same token, getting out and talking to folks, particularly youth, about our work and how they can forestall their own death is really great as well," says Keller.

Keller says that most science and medicine educational backgrounds are useful for future coroners [and their investigative staff].

"There are some good forensic science programs in various places, but there is also some coursework that has been thrown together to catch the wave of interest. Look for older, established programs," says Keller.

In Illinois, coroners are elected and only required to be 18 years old and registered as a voter. Keller is the first physician the office has seen since the 1940s. His deputies have two-year associate degrees in criminal justice or healthcare.

"As populations grow, the numbers of deaths also grow, necessitating increasing numbers of medico-legal death investigations and the personnel to do them. I am sure that there will be an ongoing increase in demand for more sophistication, training and education among this personnel," says Keller.

"Verbal and written communication is incredibly important and is one of the most important skills high school students can work to develop when thinking of this field," says Keller.

Dr. Richard Keller is a coroner in Illinois. "There will always be deaths and the need for investigating them. There is some trending nationwide to changing from coroner to medical examiner systems, as well as increased credential requirements," he says.

"There are other options for jobs in this field beyond coroner and/or medical examiner," says Keller. He adds that the Bureau of Justice reports 1,998 coroner and medical examiner offices nationwide.

"When I ran for office, I pledged to also investigate 'medical misadventures'. Just as our office obviously is there to serve [the deceased] who can no longer serve themselves, just as much, we are here to protect the living residents of Lake County and to forestall death when we can," says Dr. Richard Keller. He is a coroner in Illinois and was faced with this exact circumstance and decision in real life.

There was a coroner's jury (a body convened to assist a coroner in determining the cause of death) in the case, and Keller told them that,
"The definition of homicide that I give to the jury is either a willful and wanton act, or recklessness on the part of someone, whether that's by their actions or by their inactions. Certainly, by that definition, this is a homicide."

The coroner's jury agreed with Keller, and ruled the woman's death a homicide. This meant that her death would be investigated further, including the hospital's practices.

"This is a social justice, a greater good issue," says Keller. He used the media attention that the case received to call for better care. "The quality of medical care must be improved. No more excuses about an overburdened system. Develop systems (quality) to ensure this never happens again."

Thursday, July 03, 2008

Young people die using/abusing drugs

Young people use/abuse drugs. Young people die from using/abusing drugs. We need to stop young people from dying from drug use/abuse. (The same goes for older people, but it always seems more shocking when it is young people who die. Is more potential lost?)

I was reading an interview with Dr Drew Pinsky (currently rehab doctor to the stars) recently and he sure makes it sound tough. Although he wasn’t talking about young people in particular, he laid out the 3 events that motivate change in his experience, i.e. motivate folks to quit abusing drugs:
Near death experience (i.e. the drug abuser nearly dying)
Looking in the mirror and feeling genuine disgust
Loss of your children, having them taken away (particularly true of women)

I feel there must be other ways to motivate the desire to make the life change involved in quitting the abuse of the drugs, particularly in young people. Or do we work at instilling self-disgust, if his motivating events are all-inclusive. The younger the person is when we begin to intervene the less entrenched the drug abuse behavior is. That should make available more intervention options. Of course, prevention is an even better goal to drug abuse prevention.

“Just say no” isn’t working, as evidenced by multiple studies. We need real, evidence-based intervention strategies. Scaring them straight doesn’t work. Their minds are still developing, but their intellect is there. Interventions need to use that fact.

There has to be something that we can do. The 24 year-old young lady didn’t need to die today.