Respecting the Dignity of the Deceased: The Importance of Determining the Cause of Death in Forensic Medicine
Dr. Ako Sasao, Assistant Professor,
Department of Forensic Medicine, Faculty of Life Science
Department of Forensic Medicine at Kumamoto University conducts autopsies on deceased individuals with unclear causes of death. Dr. Ako Sasao, an assistant professor with a background in pharmacology, is in charge of analyzing the potential influence of drugs and toxins on these cases. Forensic medicine has gained wider recognition in recent years, often depicted in dramas and other media. But what is the reality of this field? What joys and challenges do professionals like Dr. Sasao encounter in their work?
Department of Forensic Medicine, the only institution in Kumamoto Prefecture handling autopsies of unnatural deaths
Could you tell us more about Department of Forensic Medicine you are a part of?
Department of Forensic Medicine at Kumamoto University is responsible for conducting autopsies on unexplained deaths in Kumamoto Prefecture. Unnatural deaths include those that are not clearly attributed to natural causes, such as deaths resulting from crimes, suicides, disaster-related deaths and accidental deaths where the cause is unknown, and solitary deaths where the individual passes away alone with no one present.
In our department, we conduct approximately 120 to 150 autopsies annually. The surgeries are performed by physicians, and my role, coming from a pharmacology background, is to investigate whether drugs or toxins have influenced the cause of death.
What is the current state of forensic autopsies in Japan?
In cases of unnatural deaths, the police and the attending physician jointly decide whether an autopsy is necessary.
In Japan, autopsies are conducted in only about 10% of cases where the police are called to the scene. In contrast, in countries like the UK and Australia, the autopsy rate is around 50%, and in countries with a well-established welfare system, the rate is as high as 70-80%. This means that Japan’s autopsy rate is relatively low. Furthermore, Kumamoto Prefecture has a lower autopsy rate compared to the national average, which indicates that the current situation is not ideal.
If an autopsy is not performed, there is a risk of missing the true cause of death. In the case of the drugs and poisons I work with, particularly, many things can only be determined through a thorough investigation.
One reason for Japan’s low autopsy rate is that, compared to other countries where doctors decide whether an autopsy is necessary, in Japan, the decision is often left to the police. This system has been in place for a long time, and I believe changing it would be very challenging. Another problem is the shortage of forensic doctors who conduct autopsies. The police are also struggling with the lack of forensic specialists.
What do you think about the significance of clarifying the cause of death?
I think that another reason why there are so few autopsies in Japan is that many people may think, “There is no point in trying to find out why, once someone has died.” It is as if people tend to give up on clarifying the cause of death too easily. I always find that a little disappointing.
Doctors of forensic department strive to investigate thoroughly why someone has passed away. For example, if something genetic is involved, it could be an important message for the family left behind. Forensic medicine is a field dedicated to preserving the dignity of the deceased. I hope that people will not give up easily on learning about the person who has passed away. It would be sad if people thought that there was no point in investigating the cause of death after someone had lived their life to the full and then died.
The department of forensic medicine, which focuses on death, may be seen as being in the "shadowy" part of the field, but the staff always works together in a cheerful and friendly atmosphere. Research on deceased individuals is still under development in many areas, making it a fascinating field of study. I would like people to visit and learn more about our department.
Photo: Staff of Department of Forensic Medicine of Kumamoto University and medical students undergoing practical training
Research and Development of Testing Kits that Match the Current Situation of Drug Poisoning in Japan
I have heard that you are also conducting research related to autopsies and dissections.
At the Department of Forensic Medicine at Kumamoto University, we use blood from the deceased to test for drug poisoning. We use large analysis equipment for this. It is expensive and the operation is complicated, so a certain level of skill is required to handle it. If a simple testing kit capable of detecting drugs were available, anyone could conduct relatively accurate tests immediately and easily.
Currently, drug testing kits are used in on-site autopsies, but many of these are manufactured overseas. As a result, they are primarily designed to detect substances like stimulants, cannabis, and cocaine, which are commonly abused in other countries. In contrast, in Japan, a significant number of deaths are caused by pharmaceutical drugs. Particularly concerning is the rise in suicides using psychotropic medications, such as sleeping pills, antidepressants, and drugs for schizophrenia. My research focuses on developing testing kits that target these psychotropic drugs.
Figure: Drug detection kits used in the field
Is it difficult to make a test kit for psychotropic drugs?
A test kit requires antibodies that specifically target the desired drug or toxin. Actually, it is quite difficult to produce these antibodies. If the target is a protein, for example, antibodies can be easily created by immunizing an animal. However, because drugs are very small molecules, antibodies cannot be produced directly. To overcome this, the drug is attached to another substance, which is then used to immunize an animal to produce antibodies.
Furthermore, after producing antibodies from the immunized animal, the genes responsible for the antibodies are extracted. These genes are then modified to create a variety of antibody stocks. From these, the antibodies that specifically react to the target drug are isolated. We think this process will enable us to create a testing kit.
If we can develop a testing kit that can detect psychotropic drugs, it will be useful not only for the police investigating unnatural deaths, but also for emergency medical care to help people who have overdosed. If doctors can quickly find out what drug a patient has taken too much of, it will make it easier for them to respond.
Currently, testing kits targeting psychotropic drugs are not being actively developed even overseas. It's very troublesome to produce antibodies for drugs, so companies don't do much research on them either. I believe conducting this type of research is one of the core missions of universities.
Is there any joy you feel in your research?
The field of toxicology is at the border between medicine and pharmacology, making it an area that is often overlooked. Personally, I think that pharmacology should be responsible for this area. There are various research areas in pharmacology, but the social study of drug poisoning is also very important. It would be a real shame if someone died, but the data related to the cause of death can be used as a reference in the future, and it is my mission to leave this information in the form of a paper for the world to see, and I am happy to be able to do this. I think this is the rewarding aspect of my job.
I join the Department of Forensic Medicine Because of a Job Opening, by My Interest Grew Over Time.
What brought you to the Department of Forensic Medicine?
I gradated from School of Pharmacy at Kumamoto University and hold a pharmacist’s license. Returning to my hometown in Kagoshima to work as a pharmacist was one possible path for me. However, one day, my professor suggested, “The Department of Forensic Medicine at School of Medicine is looking for an assistant. Why don’t you give it a try?” So, I came here, and as I worked, I found myself growing more and more interested in the field.
Research is something that continues endlessly, but it never involves simply repeating the same things. It constantly evolves, and that sense of progression makes me feel like I’m always moving forward and improving. That’s what I find fascinating about research. Also, while I have remained in the same place, many students come and go. Meeting and interacting with them always excites me and brings me joy.
I heard you are also a coordinator for the Equity, Diversity and Inclusion Office.
When I was younger, I had so many questions about how soon I could return to work after getting married, having children, and raising them, and how I could maintain my research. I used to ask senior female researchers about their experiences. One senior told me she returned to work two months after giving birth, so I did the same. But when I did, everyone was shocked, saying, "You actually came back in two months?!" (laughs).
During my maternity leave and childcare period, the university provided research support by assigning research assistants. They took care of the parts of my work I couldn’t manage, allowing me to continue my research without interruption. That’s why I felt it was my turn to give back, so I took on the role of coordinator. I want to be the kind of person who can provide answers to people’s concerns and be a resource they can rely on when they’re in trouble. I strive to keep that door open for them.
What message would you like to share with young women?
I would like to tell them: “Desire power.”
Many people may feel that power is something negative or corrupt, but I believe that without power, you can’t change things. I encourage them not to shy away from power, and when the opportunity arises, aim for leadership roles.
Nowadays, universities as a whole are working to increase the ratio of female researchers and are actively supporting women’s careers. Don’t think, “I’m not capable of that.” Even if you feel like you lack the ability, I hope you’ll first take on a higher-level position and continue striving to grow and improve.
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