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BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:530

Resurrect autopsies for the benefit of the living

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Autopsies are dying out in the US. Fewer and fewer are done each year—even in the big teaching hospitals—and if the trend continues to its natural conclusion, doctors, patients, and the wider public will lose an important source of information about how and why people die, say two observers. Autopsies fine tune diagnoses and sometimes change them altogether. They help doctors improve their diagnostic skills and provide hospitals with an important tool for improving the quality and delivery of diagnostic imaging and laboratory services. It is also important for relatives to know that their father or brother died from an aortic dissection not a heart attack, one of the most common mistakes reported by autopsy studies.

Pathologists are losing interest in autopsies, new trainees are failing to learn the techniques, and quality is suffering. The lack of financial incentives for hospitals to perform autopsies hasn’t helped.

These experts say it is too late and too uneconomical to reverse the trend completely, but it may be possible to concentrate the necessary skills in regional centres. These hospitals could help maintain a service that benefits the living by improving the accuracy of death certificates, increasing the reliability of studies analysing causes of death, and teaching doctors where they have gone wrong.

Erythropoietins linked to excess deaths in people with cancer

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Further evidence has emerged that synthetic erythropoietins can reduce survival in patients with anaemia and cancer. A meta-analysis of 51 phase III trials reports an overall hazard ratio for death of 1.10 (95% CI 1.01 to 1.20) for patients given epoetin or darbepoetin compared with placebo. The same agents were associated with a larger 57% increase in the risk of venous thromboembolism (relative risk 1.57, 1.31 to 1.87) in an analysis of …

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