[Mb-civic] The_value_of_autopsies - Boston Globe Editorial

[William Swiggard]

  The value of autopsies

January 2, 2006

SIX YEARS AGO, the federal Institute of Medicine deplored the annual 
toll of 98,000 deaths caused by errors in US hospitals. Since then, 
progress has been made in some approaches to curbing medical mistakes, 
but there has been little advance in one of the best correctives: more 
routine use of autopsies.

Autopsies are a low-tech but highly effective way to learn answers to 
medical puzzles that MRIs and other imaging devices often cannot 
explain. Until the 1960s, nearly half of all patients who died in 
hospitals were autopsied, but the rate has fallen below 5 percent now. 
No campaign to improve healthcare will be complete without a concerted 
effort by the major hospital accrediting agency and Medicare to ensure 
that this quality-control check is used more often.

Autopsies are routinely done by state medical examiners in cases of 
crimes, accidents, and many deaths that occur outside of hospitals.

Recently, the state's new chief medical examiner, Dr. Mark Flomenbaum, 
lamented that relatively few autopsies are occurring in hospitals. He 
attributed this to doctors' reluctance to broach or press the subject 
with family of the deceased.

Everyone would benefit if doctors were more willing to explain to loved 
ones how much medicine can learn from this procedure.

In 1999, autopsies in New York City uncovered the first US cases of West 
Nile disease.

The victims had been misdiagnosed as suffering from St. Louis 
encephalitis. More frequent autopsies would also result in earlier alarm 
bells if avian flu or some other new and highly contagious disease 
arrives on these shores.

Modern diagnostic measures might make autopsies less necessary but not 
superfluous, as shown in studies like the one published in 1998 by the 
Journal of the American Medical Association. Reporting on 1,100 
autopsies done over 10 years in New Orleans, the study found that of 250 
cancers detected, 44 percent had been undiagnosed or misdiagnosed.

The then-editor of JAMA, Dr. George Lundberg -- a longtime advocate of 
greater use of autopsies -- has called physicians' faith in their 
technical knowledge "a vast cultural delusion."

An autopsy can also be of use to survivors.

While the procedure may confirm that a middle- aged person died of the 
heart attack diagnosed by the physician, doctors might also learn that 
the patient was developing, without symptoms, one of the more 
inheritable cancers -- a warning to his family.

Historically, the autopsy has been at the center of humankind's 
knowledge of how the body works. If the country is serious about 
reducing the rate of medical errors and quickly detecting the arrival of 
lethal new infections, autopsies need to play a greater role.

http://www.boston.com/news/globe/editorial_opinion/editorials/articles/2006/01/02/the_value_of_autopsies/
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