research obstacles forensic pathology

7/28/2019 Research Obstacles Forensic Pathology

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Kurt B. Nolte, MD

Office of the Medical InvestigatorUNM School of Medicine

Research Obstacles in

Forensic Pathology


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NAS Report

Currently, little research is being conducted

in the areas of death investigation & forensicpathology in the United States.

Congress should appropriate resources...tosupport research

NIH with NIFSshouldallocate funding for

collaborative research by ME offices &medical universities.


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Research Issues inForensic Pathology

Academic practice

Fellowship training

Funding availability

Literature


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Academic Medicine &Research Infrastructure

Pre-award

Contract & grant accounting

Compliance

IRB COI

Animal care

Biohazard Animal facilities

Grants management & research training

Core laboratories


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Academic Forensic Pathology

Full-time faculty - 14/125 (11%) medicalschools

Run state and regional ME offices

Contract autopsies for ME or coroners

Adjunct relationships - more common &support teaching


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Academic Forensic Pathology

Questionnaire - 14 institutions, 100%

response 39 total faculty forensic pathology

positions

21 tenure track

18 clinical & other tracks

25 positions (10 institutions) requireresearch/scholarly output

Nolte KB: Hum Pathol 35:532-535, 2004


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Academic Forensic Pathology:

Grant Funding

Principal Investigator on grant 2 (8%)

Co-Investigator on grant 1 (4%)


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Forensic Pathology Fellowship :Training in Research-ACGME

Provide research opportunity

Maintain environment of inquiry &

scholarship Guidance & technical support for

research (e.g.,design & statistics)


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Forensic Pathology Fellowship :Training in Research

Fellowship training available at 6 of 14

academic institutions

Research requirement for 4 of 6 Research training 4 of 6

Nolte KB: Hum Pathol 35:532-535, 2004


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Forensic Pathology Fellowship :Training in Research, 2010-11

~38 programs ~70 slots Pathology Training Programs 25programs described

11 (44%) research opportunity/requirement None specify research training

Incentives: Best resident paper awards:NAME, AAFS

Shortage of qualified investigators


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Potential Funding Sources

CDC- Health Dept Centered, involves ME/Cs National Violent Death Reporting System

Sudden Unexplained Infant Death Surveillance

NIJ Research & Development on Forensic Crime Scene

& Medicolegal Death Investigations

Fundamental Research to Improve Understandingof the Accuracy, Reliability, & Measurement Validity

of Forensic Science Disciplines Social Science Research in Forensic Science


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Potential Funding Sources

AAFS

Pathology/Biology Section

2 awards/year of $3000

SAMHSA

DAWNLimited funds to MEs for drug abuse mortality

surveillance


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Funded Projects

NIH- Active 2010 Studies that use medical examiner cases/data or

tissues - non-forensic pathologist PIs

Procurement & characterization brain tissue Postmortem human brain collection core

CNS mechanisms of cocaine related death

Hangovers & traffic injuries

$68 million for SIDS in 2010 Forensic pathologist PI None

NIOSH- Active 2010 Studies that use medical examiner cases/data -

non-forensic pathologist PIs Young worker fatalities & labor violations

Iowa occupational health surveillance


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Forensic Pathology J ournals

J ournal of Forensic Sciences

American J ournal of Forensic Medicine& Pathology


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Forensic Pathology J ournals, 2002

Total Scientific Reports J FS + AM J FMP- 113 Descriptive studies 79 (70%)

Hypothesis driven scientific studies 31 (27%)

US authors 11 (35%)Total funded studies 9 (29%)

US funded studies 5 (16%)

Forensic pathologist PI None


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Forensic Pathology Studies:US Funding Sources

Private foundations (4)

NIJ (2)

NIH

National SIDS Alliance

NIMH


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Other Limitations on Research

Time - priority to publically fundedservice work

Isolation from academiccenters

Lack of priority withinacademic centers


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Other Limitations on Research

Study subjects-tissue use issues (legal, ethical)* Confidentiality

Poorly standardized data acquisition &

information technology Fragmented jurisdictions restrict population-

based epidemiology

*Roberts LW et al : Arch Pathol Lab Med 2000;124:1485-1495


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Summary of Problem

Few medical schools with forensic pathologists(No jobs)

Handful of medical schools prioritize research by

forensic pathologists (No support) Rare fellowship programs provide research

training (No training)

Scant federal funds available (No resources)

Anemic forensic pathology literature (No results)


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Why should we be concerned?

Forensic pathology practice - evidence-based

Medicolegal testimony - informed by robustmedicolegal literature

National data for all unnatural deaths & manynatural deaths based on ME/C conclusions methods for standardizing & analyzing ME/C

data should be a research priority


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Forensic Pathology:Research Assets

Last stronghold of autopsy pathologyand tissues

Window on all unnatural deaths - manyoffices data-rich

Many jurisdictions population-based

Epidemiology treasure trove


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How do we strengthen theconnection between academic health

centers and the medicolegal deathinvestigative community?


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What incentives would leadacademic health centers with facultyforensic pathologists to prioritizeresearch?


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Can we facilitate forensic pathologyresearch outside of academic medicine?

If so, how?


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How can we strengthen researchtraining for forensic pathologyfellows?

How can we keep them in theresearch pipeline?


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How can federal agencies createresearch awards that build researchcapacity?

research obstacles forensic pathology

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