Forensic Epidemiology

Forensic Epidemiology

Principles and Practice

1st Edition - March 10, 2016

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  • Editors: Michael Freeman, Maurice Zeegers
  • Hardcover ISBN: 9780124045842
  • eBook ISBN: 9780124046443

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It is an inescapable fact that causation, both generally (in populations), and specifically (in individuals), cannot be observed. Rather, causation is determined when it can be inferred that the risk of an observed injury or disease from a plausible cause is greater than the risk from other plausible causes. While many causal evaluations performed in forensic medicine are simplified by the fact that the circumstances surrounding the onset of an injury or disease clearly rules out competing causes (eg, a death following a fall), there are many cases that present a more complicated picture. It is these types of investigations, in which an analysis of comparative levels of risk from competing causes is needed to arrive at a reliable and accurate determination of the most likely cause, that forensic epidemiology (FE) is directed at.In Forensic Epidemiology, the authors present the legal and scientific theories underlying the methods by which risk is used in the investigation of individual causation. Methods and principles from epidemiology are combined with those from a multitude of other disciplines, including general medicine, pharmacology, forensic pathology, biostatistics, and biomechanics, inter alia, as a basis for investigating the plausibility of injury and disease exposures and mechanisms. The ultimate determination of the probability of causation (PC) results from an assessment of the strength of association of the investigated relationship in the individual, based on a comparison between the risk of disease or injury from the investigated exposure versus the risk of the same disease or injury occurring at the same point in time in the individual, but absent the exposure. The principles and methods described in Forensic Epidemiology will be of interest to those who work and study in the fields of forensic medicine, epidemiology, and the law.

Key Features

  • Historical perspective on how epidemiologic evidence of causation has been used in courts in the US and Europe
  • Theory and science underlying the use of risk to assess individual causation
  • Primer on epidemiologic methods, and various measures used to arrive at individualized comparative risk assessments and PC
  • The use of statistical methods applied to publicly available data for ad hoc analysis of PC applicable to the specific circumstances of a case
  • Background on complementary disciplines, including forensic pathology, death investigation, biomechanics, and survival analysis
  • Examples of applied FE in the investigation of traffic injury and death, automotive and other product defect litigation, medical negligence, and criminal prosecution and defense


Primary: Forensic practitioners, public health, upper-level undergrad forensic epidemiology / forensic science instructors / students
Secondary: Legal community

Table of Contents

    • Dedication
    • List of Contributors
    • Introduction
    • Part I. Principles of Forensic Epidemiology
      • Chapter 1. Legal Considerations of Forensic Applications of Epidemiology in the United States
        • Historical Context of the Frye Standard
        • Prelude to the Federal Rules of Evidence
        • Enter the Federal Rules of Evidence
        • The Judicial Divide Interpreting the Federal Rules of Evidence
        • The Amended Federal Rules of Evidence
        • Daubert Jurisprudence Has Impacted the Frye Analysis
        • The Evolving Set of Daubert Factors
        • Further Legal Approaches to Forensic Epidemiology
        • Conclusion
      • Chapter 2. Epidemiologic Evidence in Toxic Torts
        • Introduction
        • Legal Issues Arising in Toxic Torts
        • Applying the Law of Factual Causation in Toxic Tort Cases
        • Using Epidemiology to Prove Causation
        • Judicial Treatment of Nonepidemiologic Causation Evidence
        • “Weight-of-the-Evidence”
        • Defenses
        • Special Types of Toxic Tort Litigation
        • The Future of Epidemiology in Toxic Torts
        • Conclusion
      • Chapter 3. Methods Used in Forensic Epidemiologic Analysis
        • What Is Epidemiology?
        • Research Methods to Investigate Causal Relationships
        • Factual Probability
        • Linking a Potential Causal Factor to Injury
        • Sources of Error in Epidemiologic Research
        • Multiple Concurrent Causes
        • The Hill Viewpoints
        • Test Accuracy
        • Bayesian Reasoning
      • Chapter 4. Causation in Epidemiology and Law
        • Background
        • Delimiting the Topic
        • What Is Causation?
        • What Epidemiological Evidence Says About Particular Causation
        • How Epidemiological Evidence Relates to Legal Standards of Proof?
        • Sources of Resistance to Using Epidemiological Evidence
        • Conclusion
        • Cases
      • Chapter 5. The Role of the Expert Witness
        • Introduction
        • Causal Uncertainty and the Expert
        • The Role of the Forensic Epidemiologist as an Expert
        • Is the Expert Always an Expert?
        • Remedies
        • Concluding Remarks
    • Part II. Auxiliary Forensic Disciplines
      • Chapter 6. Forensic Pathology
        • Introduction
        • Cause and Manner of Death
        • Difficulties in Determining the Cause and Manner of Death
        • Natural Deaths
        • Difficulties in Differentiating between Natural and Unnatural Death
        • Unnatural Deaths
        • Terminology of Common Wound Types
      • Chapter 7. Death Investigation
        • Introduction
        • History of the Development of Death Investigation Systems
        • The Coroner System
        • The Medical Examiner System
        • Fundamentals of Death Investigation
        • Functions of the Medical Examiner/Coroner Office
        • Manner of Death
      • Chapter 8. Injury Biomechanics
        • Introduction
        • Background
        • Types of Trauma
        • Biomechanics of Skin and Soft Tissue Injury
        • Biomechanical Properties of Bone and Fracture
        • Fracture Patterns
        • Fluid Mechanics
        • Impact Mechanics
        • Special Applications of Biomechanics in a Forensic Setting
      • Chapter 9. Biomechanical, Epidemiologic, and Forensic Considerations of Pediatric Head Injuries
        • Introduction
        • Biomechanics of Head and Brain Injury
        • Pediatric Head Injuries and Falls
        • Experimental Studies
        • Discussion
      • Chapter 10. Survival Analysis
        • Introduction
        • Definitions
        • Using Survival Analysis in a Forensic Setting
        • Survival Following a Spinal Cord Injury: An Example
        • Survival Models
        • Median Survival and the Confidence Interval
        • Simulation Study
        • Including Risk Factors and Severity Measures
        • Adjusting Existing Life Tables
        • Technical Appendix
        • Definitions
        • Variance of a Quantile
    • Part III. Applications of Forensic Epidemiology
      • Chapter 11. Traffic Injury Investigation
        • Introduction
        • Crash Injury Causation Methodology
        • Case Study Examples
        • Case Study #1: Seat Belt Efficacy Analysis
        • Case Facts
        • Attributable Risk Methodology for the Evaluation of Seat Belt Efficacy
        • Case-Specific Attributable Risk Analysis of Seat Belt Efficacy
        • Analysis of the Defendant Expert's Methods and Conclusions
        • Case Study #2: Lumbar Spinal Fracture Following a Low-Speed Crash
        • Case Facts
        • Causation Analysis
        • Case Study #3: Hip Replacement Surgery After a Traffic Crash
        • Case Facts
        • Causation Analysis
        • Case Study #4: Timing and Cause of Death
        • Conclusion
      • Chapter 12. Traffic Injury Investigation: Product Defects
        • Introduction
        • Case Study #1: Airbag Failure-Related Comparative Death Risk Analysis
        • Case Study #2: Roof Crush-Related Neck Injury Risk Analysis
        • Case Study #3: Seat Belt Latch Failure-Related Injury Pattern Risk Analysis
        • Conclusion
      • Chapter 13. Product Defect/Liability Investigation
        • Introduction
        • Case Study #1: Infant Sleep Positioner Death Investigation
        • Case Study #2: Window Blind Strangulation Investigation
      • Chapter 14. Medical Negligence Investigation
        • Introduction
        • Steps to Performing a Comparative Risk Ratio Causal Assessment in a Medical Negligence Investigation
        • Case Study #1: Locked-In Syndrome Following the Alleged Failure to Treat an Acute Ischemic Stroke With Thrombolytic Therapy (Tissue Plasminogen Activator) in a 28-Year-Old Male
        • Case Study #2: Manipulation of the Cervical Spine Followed by Vertebral Artery Dissection and Stroke Resulting in Permanent Paralysis
        • Case Study #3: Failure to Timely Diagnose and Treat a Neurologic Complication of Meningitis Resulting in Spinal Cord Stroke and Paralysis
        • Case Study #4: Cardiomyopathy Following Exposure to Doxorubicin
        • Discussion
      • Chapter 15. Criminal Investigation
        • Introduction
        • Case Study #1: Identification of the Seating Position (Driver vs Passenger) of an Ejected Occupant in a Vehicular Homicide Investigation
        • Case Study #2: Motorcycle Versus Pedestrian: Speed at Impact Investigation
        • Impact Speed Analysis
        • Case Study #3: Accidental Versus Intentional Head Injury in a Toddler
        • Case Study #4: Fetal Death Following Maternal Cocaine Ingestion
    • Glossary
    • Author Index
    • Subject Index

Product details

  • No. of pages: 434
  • Language: English
  • Copyright: © Academic Press 2016
  • Published: March 10, 2016
  • Imprint: Academic Press
  • Hardcover ISBN: 9780124045842
  • eBook ISBN: 9780124046443

About the Editors

Michael Freeman

Michael Freeman is a forensic epidemiologist and consultant in forensic medicine, working in civil, criminal, and academic venues. He has provided expert testimony more than 1,000 times in a wide variety of civil cases, including injury and death litigation, product liability, toxic tort litigation, tobacco litigation, medical negligence, as well as in homicide and other criminal matters.

Dr. Freeman has more than 170 published scientific papers, books, and book chapters, primarily focusing on issues relating to forensic applications of epidemiology and general and specific causation. He has published research on the topics of traffic crash-related injury and death, injury biomechanics and injury causation, genocide, cancer epidemiology, chronic pain mechanisms, and adult autologous stem cell therapy, inter alia.

Dr. Freeman holds academic appointments at the CAPHRI School for Public Health and Primary Care at Maastricht University Medical Center, Oregon Health & Science University School of Medicine, and Aarhus University, Department of Forensic Medicine. He serves as an Affiliate Medical Examiner with the Allegheny County Medical Examiner's office in Pittsburg, PA.

Dr. Freeman holds a doctor of medicine degree (Med.Dr., Umeå University), a doctorate in in public health with a major focus in epidemiology (Ph.D., Oregon State University), and an MPH degree (Oregon State University), inter alia.

Affiliations and Expertise

Affiliate Professor, Epidemiology and Psychiatry Oregon Health and Science University, Portland, Oregon – USA

Maurice Zeegers

Dr. Maurice Zeegers has dedicated his career to researching bladder cancer, during which he has directed numerous research studies and randomized clinical trials to investigate the relationship between nutrition and urinary bladder carcinogenesis. He has published over 250 peer-reviewed scientific papers in the highest-ranked academic journals and is regularly invited to speak on the topic at international scientific conferences. Dr. Zeegers currently holds a Chair in Complex Genetics and Epidemiology as full professor at Maastricht University in the Netherlands, where he also serves as its Head of School and as Director of CAPHRI, the Care and Public Health Research Institute. He acts as the vice-president of the European Epidemiology Federation and holds honorary professorships in England, Belgium and China.

Affiliations and Expertise

Professor of Complex Genetics and Epidemiology, Head of School - Care and Public Health Research Institute, Maastricht University, The Netherlands

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