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The Epidemiologic Necropsy-Reply

Michael J. McFarlane, MD; Alvan R. Feinstein, MD; Carolyn K. Wells, MPH; Charles K. Chan, MD
JAMA. 1987;258(22):3256. doi:10.1001/jama.1987.03400220053024.
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In Reply.—  We thank the correspondents for their comments. We did not expect that the proposed new method would be happily accepted by epidemiologists who are content with the status quo, and we are pleased that the protests are so relatively mild. We shall respond to each letter individually.Dr Robinson fears that many of the "surprise" cases of lung cancer did not have "access to medical care in their lifetimes." Since all of these people died at a university medical center, they at least had such care during their terminal illness. As for racial composition of the necropsy population, a study at another university hospital suggests that no racial disproportion exists between deaths and selection for necropsy.1Dr Rhoads cites the old epidemiologic formula about prevalence, incidence, and duration, while ignoring the point we made in our necropsy article and elsewhere2 about the difficulty of obtaining valid

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