Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Dr Mary Sheppard’s letter on “Pathologists and coroners must cooperate on retaining tissue” raises concerns around the lack of clarity over retaining samples from coronial post-mortem examinations.
We are aware of similar problems creating risks to public health.
There have been instances where TB was suspected as an incidental post-mortem finding, but could not be proven because there does not appear to be enough provisions in these circumstances for the pathologist to send human tissue to rule out causes of public health concern.
As per the 2004 HTA Act, if prior consent is obtained this would not be difficult. But as it happens there could be scenarios where the pathologist has not obtained consent as the possibility of finding pulmonary TB at post-mortem for instance was not anticipated. Again as per the coroners act the duty of the coroner is to establish the cause of death and not in investigating causes of public health concern.
Even if the lung is teeming with TB bacilli and on gross appearance looks like pulmonary TB to the pathologist, it appears that they do not have adequate provisions for tissue sampling to rule this out. This would spell far reaching consequences in public health. A tissue diagnosis of TB will go a long way in assessing the need for extensive contact screening exercises. Clearly there seems to be a huge void here. In this day and age of DNA finger printing and other investigative modalities, can tissue sampling be ignored?
Perhaps the Royal College of Pathologists can provide advice here.
No competing interests
05 September 2012
Kent Health Protection unit
Kent health protection unit , Level 2 , Civic Centre , Tannery lane,Ashford ,TN23 1PL