Research Obstacles in Forensic Pathology

Kurt B. Nolte, MD Office of the Medical Investigator UNM School of Medicine

NAS Report
Currently, little research is being conducted in the areas of death investigation & forensic pathology in the United States. Congress should appropriate resources...to support research NIH with NIFSshouldallocate funding for collaborative research by ME offices & medical universities.

Research Issues in Forensic Pathology

Academic practice Fellowship training Funding availability Literature

Academic Medicine & Research Infrastructure

Pre-award Contract & grant accounting Compliance
IRB COI Animal care Biohazard

Animal facilities Grants management & research training Core laboratories

Academic Forensic Pathology

Full-time faculty - 14/125 (11%) medical schools
Run state and regional ME offices Contract autopsies for ME or coroners

Adjunct relationships - more common & support teaching

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) require research/scholarly output
Nolte KB: Hum Pathol 35:532-535, 2004

Academic Forensic Pathology: Grant Funding

Principal Investigator on grant 2 (8%) Co-Investigator on grant 1 (4%)

Forensic Pathology Fellowship : Training in Research-ACGME

Provide research opportunity Maintain environment of inquiry & scholarship Guidance & technical support for research (e.g.,design & statistics)

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

Forensic Pathology Fellowship : Training in Research, 2010-11

~38 programs ~70 slots Pathology Training Programs 25 programs described
11 (44%) research opportunity/requirement None specify research training

Incentives: Best resident paper awards: NAME, AAFS Shortage of qualified investigators

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 Understanding of the Accuracy, Reliability, & Measurement Validity of Forensic Science Disciplines Social Science Research in Forensic Science

Potential Funding Sources

AAFS
Pathology/Biology Section
2 awards/year of $3000

SAMHSA
DAWN
Limited funds to MEs for drug abuse mortality surveillance

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

Forensic Pathology Journals

Journal of Forensic Sciences American Journal of Forensic Medicine & Pathology

Forensic Pathology Journals, 2002

Total Scientific Reports JFS + 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

Forensic Pathology Studies: US Funding Sources

Private foundations (4) NIJ (2) NIH National SIDS Alliance NIMH

Other Limitations on Research

Time - priority to publically funded service work Isolation from academic centers Lack of priority within academic centers

Other Limitations on Research

Study subjects-tissue use issues (legal, ethical)* Confidentiality Poorly standardized data acquisition & information technology Fragmented jurisdictions restrict populationbased epidemiology
*Roberts LW et al : Arch Pathol Lab Med 2000;124:1485-1495

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)

Why should we be concerned?

Forensic pathology practice - evidence-based Medicolegal testimony - informed by robust medicolegal literature National data for all unnatural deaths & many natural deaths based on ME/C conclusions methods for standardizing & analyzing ME/C data should be a research priority

Forensic Pathology: Research Assets

Last stronghold of autopsy pathology and tissues Window on all unnatural deaths - many offices data-rich Many jurisdictions population-based Epidemiology treasure trove

How do we strengthen the connection between academic health centers and the medicolegal death investigative community?

What incentives would lead academic health centers with faculty forensic pathologists to prioritize research?

Can we facilitate forensic pathology research outside of academic medicine? If so, how?

How can we strengthen research training for forensic pathology fellows? How can we keep them in the research pipeline?

How can federal agencies create research awards that build research capacity?