The anthrax story just gets weirder and weirder. More than weird, some of it reeks. A circumstantial public case first via media leaks and now via a press conference by the Justice Department is being built against Bruce Ivins, the Army scientist who reportedly committed suicide as federal prosecutors were closing in on him. Reporter Larissa Alexandrovna (at-Largely) has raised a number of significant questions about some of the sources, especially the supposed therapist Jean Duley who is the one who has accused Ivins of stalking her and alleging he was a homicidal maniac who had already tried to kill people. You can read about Duley and make your own judgments. Ivins’s friends and colleagues have also questioned the media portrayal, saying they don’t recognize him in these descriptions. I’m not an investigative journalist, so I don’t have any new facts to add, but I am a doctor and I have some real questions about some of the facts that we know about. One in particular raises red flags for me:
Ivins’s death is being investigated as an apparent suicide from a drug overdose, said Lieutenant Shawn Martyak of the Frederick Police Department’s criminal investigation division. Based on laboratory test results of blood taken from the body, the state medical examiner “determined that an autopsy wouldn’t be necessary” to determine the cause of death, Martyak said.
The Los Angeles Times, which first reported the story, said Ivins took an overdose of prescription Tylenol with codeine. (Bloomberg, Aug. 1)
I read this with disbelief. The chief suspect in one of the most notorious crimes in US history dies an unexpected death for non-natural causes and there’s no autopsy? In most states the Chief Medical Examiner has the authority to release the body to the family and isn’t required to do an autopsy but this seems like a very strange decision and I am sure I am not the only one to notice it. Two days later some ambiguity crept into the response of the medical examiner:
With Ivins dead, the Justice Department is expected to decide within days whether to close what had been one of its most high-profile unsolved cases, according to the Associated Press.
Maryland’s chief medical examiner, Dr. David Fowler, confirmed Saturday that the cause of Ivins’ death was found to be an overdose of acetaminophen, the active drug in Tylenol; and that it was ruled a suicide based on information from police and doctors, according to the AP.
Kimberly Thomas, a forensic examiner with the Maryland Office of the Chief Medical Examiner, would not comment Saturday on results from Ivins’ autopsy or confirm Dr. Fowler’s statement.
Despite the widespread publicity following Ivins’ death, Keeney and Basford Funeral Home said Saturday that the family had made no changes to funeral arrangements announced Friday in his obituary. A memorial service is scheduled for 10 a.m. Saturday at St. John the Evangelist Roman Catholic Church in Frederick, followed by a reception at the church parish hall. (Frederick [Maryland] Post News)
The implication here is that an autopsy was done, but it can also be read that one wasn’t (typically a medical examiner’s office never says anything about autopsies; they are considered personal medical records). Since everything else was leaked, including information that the cause was an overdose of acetomminophen, presumably on the basis of a tox screen according to the medical examiner himself, why not just say an autopsy was done and was consistent with an acetominophen overdose? But was there, in fact, a tox screen done at all or was this on the basis of an empty bottle near the body? For most scientists, acetominophen (the active ingredient in Tylenol) would seem an unlikely suicide weapon for a male. Statistically it is often used by women but rarely by men. Of course he could have used it. But did Ivins have guns in his house or have access to them? Did they even check? Guns are the weapon of choice for male suicides. Was anything else looked for in the tox screen if one was done? You only get what you look for. Were specialized screens done looking for unusual agents?
More to the point, what else might an autopsy have revealed besides an immediate cause of death? It could have revealed whether Ivins had a terminal disease, a frequent motive for suicide. It could have revealed that he died of other causes and the tylenol was not the main cause (e.g., cyanide or an exotic toxin like ricin). Were there pathological findings that were indicative of other causes of death? If multiple agents were involved, which one was the most likely cause of death? Who knows? So far, we sure don’t and apparently neither does the FBI.
There’s no investigation of Ivins’s death here, no exclusion of other causes, not attempt to rule out other forensic possibilities. All this kind of shoddy work does is open the door wide to speculation, skepticism and all sorts of conspiracy theories.
If, in fact, no autopsy was done on Ivins, the whole thing doesn’t just smell bad. It reeks