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The article explores death investigation and certification in the U.S. as of 2021, noting how it is governed by a mishmash of laws and officials including medical examiners (MEs), coroners, justices of the peace, districts, sheriff-coroners and prosecutor-coroners. Other topics discussed include the dual purpose of death certificates as a public health document and sources of health data, and the need for better training of physicians in death certification.

The analysis of biological specimens collected at autopsy for the presence of exogenous insulin(s) is of special interest in select death investigations as they may be suspected in the cause of a death. Technical challenges include the limited stability of insulin, and the forensic requirement of differentiating endogenous insulin from pharmaceutical analogs. A novel method was developed for the detection and quantification of human insulin, Glulisine, Lispro, Aspart, Glargine and Detemir in vitreous fluid. An immunoaffinity extraction procedure is performed followed by separation of the insulin α- and β-chains. Liquid chromatography tandem mass spectrometry analysis of the β-chain allows for the unequivocal identification of each insulin analog. The analytical measurement range for each insulin was 0.5–25 ng/mL. The method was evaluated for accuracy, precision, carryover, interferences and stability. Eight vitreous fluid samples collected from cases where untoward insulin use was suspected were subjected to analysis. Positive results were obtained from three samples, and a detailed case history is provided for one of these cases. Even though insulin instability in postmortem biological fluid remains a challenge, this method allows for a reliable forensic-level analysis in vitreous fluid. [ABSTRACT FROM AUTHOR]

The authors now acknowledge that "over 30%" of the "forensic pathologist" cohort were not forensic pathologists. The authors acknowledged that "over 30%" of survey I recipients i were not board certified forensic pathologists, based on "the relative proportion of nonboarded forensic pathologists from the mailing list" that made up the original cohort of 713 survey recipients. A scientific study on the opinions of forensic pathologists must have the entire study cohort be forensic pathologists. [Extracted from the article]

Their survey was of all board-certified anatomic pathologists, not all board-certified forensic pathologists. The survey, however, was sent to 713 anatomic pathologists, not 713 I forensic i pathologists. Forensic pathologists practice a subspecialty; they not only need to be certified in anatomic pathology but also must successfully complete an additional year of training in an accredited forensic pathology fellowship and then must pass a national examination to become a board-certified forensic pathologist. [Extracted from the article]