Study authors miss own findings about soaring cost of dog attacks

26% jump in dog attacks as percentage of deaths caused by non-venomous animals.

            STANFORD,  California––At least fourteen major news agencies worldwide and even the authors of a newly published study entitled “An Update on Fatalities Due to Venomous and Nonvenomous Animals in the United States (2008–2015)” appear to have overlooked data included in the study documenting a calamitous rise in fatal dog attacks and what dog attacks cost the American health care system.

Published on February 28,  2018 in the peer-reviewed scientific journal Wilderness & Environmental Medicine,  the “Update” was assembled by physicians Jared A. Forrester,  Thomas G. Weiser,  and Joseph D. Forrester of the Department of Surgery at Stanford University in Stanford, California.

$2 billion in health care spending

“Each year in the U.S. alone,”  the Forresters and Weiser found,  “over one million emergency room visits and approximately $2 billion in health care spending are attributable to problematic animal encounters.  Both deaths and high medical costs could be cut down through education,  prevention methods, and targeted public policy.”

Dog attacks alone account for about a third of the animal-related emergency room visits,  according to Agency for Healthcare Research & Quality data.  Insurance Information Institute data indicates that dog attacks cost more than $600 million per year in insurance payouts for treatment and aftercare.

Missed pit bull component

But the Forresters and Weiser overlooked not only the steep recent rise in dog attack fatalities,  but also that the rise is entirely attributable to soaring pit bull attack fatalities.

The oversight was probably because the Centers for Disease Control & Prevention data base the researchers used does not include breed-specific attack information.

The Centers for Disease Control & Prevention has not collected breed-specific dog attack information since 1989.

Pit bull-inflicted deaths per year meanwhile more than doubled from 1990 to 2006.

The Michael Vick effect

Then the 2007 arrest of former football star Michael Vick and impoundment of his dogs made “rescuing,”  rehoming,  and boosting the image of pit bulls a focal activity of major animal advocacy organizations,  including the American SPCA,  Best Friends Animal Society,  Humane Society of the U.S.,  and Maddie’s Fund.

Pit bull-inflicted deaths per year have tripled since 2007,  and pit bull-inflicted disfigurements have increased more than tenfold.

(See Pit bull advocates owe Michael Vick bigtime, at victims’ expense.)

Even the publisher’s flack missed the changes

“Number of people killed by animals each year in the US remains unchanged,” headlined media contact Theresa Monturano of Elsevier News,  above a “Eureka Alert” distributed by the American Academy of Sciences to publicize “Update on Fatalities Due to Venomous and Nonvenomous Animals in the United States.”

Elsevier News is the publicity arm of the Elsevier company,  a leading publisher of scientific and medical journals which describes itself as “a global information analytics business that helps institutions and professionals progress science,  advance healthcare and improve performance.”

But neither Elsevier News nor any of the major news media reporting about “Update on Fatalities Due to Venomous and Nonvenomous Animals in the United States” appear to have looked at the study data beyond reciting the gross totals and repeating brief comments offered by the study authors.

What did not change

Almost all of the mass media reports appear to have been written entirely from information included in the “Eureka Alert.”

The headline “Number of people killed by animals each year in the U.S. remains unchanged” was technically correct,  if inaccurate in implication.

Jared A. and Joseph D. Forrester,  with a different third collaborator,  C.P. Holstege,  in 2012 published a similar analysis in Wilderness & Environmental Medicine,  entitled “Fatalities from venomous and nonvenomous animals in the United States (1999-2007).”

Comparing the two studies confirms that the average number of people killed by animals per year increased only slightly to 201 during the 2008-2015 time frame,  reflecting 1,610 deaths over eight years.

The average over the 1999-2007 time frame was 200,  reflecting 1,802 deaths over nine years.

What changed hugely

But the “Update” study data showed a 21% increase in the average number of fatal dog attacks per year during the 2008-2015 time frame­.

This reflected,  though the study authors appear not to have known this,  that fatal attacks by non-pit bulls declined even as pit bull fatalities exploded.

The “Update” data also showed a 22% increase in dog attacks as a percentage of all deaths counted within the scope of the study.

Most significantly,  the “Update” data showed a 26% jump in dog attacks as a percentage of all deaths caused by non-venomous animals.

The previous study by Forrester,  Forrester et al counted 250 fatal dog attacks,  an average of 28 per year,  while the more recent study counted 272 fatal dog attacks,  an average of 34 per year.

Excluded “proximate cause” deaths

The abstracts of both studies explain that,  “The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database was queried to return all animal-related fatalities” for the time frames in question.

“Inclusion criteria,”  according to the abstracts,  “included all mortalities that were a consequence of bite,  contact,  attack,  or envenomation.”

This definition excluded deaths resulting from heart attacks or strokes suffered by victims of dog attacks during the attacks or immediately afterward;  deaths from infectious diseases transmitted by dogs;  and deaths from complications of prolonged hospitalization resulting from dog attack.

(See Pit bulls & “proximate cause” deaths.)

“Proximate cause” deaths are recognized by law

Dog attack deaths in these categories,  called “proximate cause” deaths,  are recognized by law as inflicted by dogs when cases are prosecuted as criminal negligence or in civil lawsuits filed by survivors of the victims.  The CDC-WONDER data base,  however,  records only immediate causes of death:  what literally results in heart stoppage and cessation of brain activity,  not what triggered the sequence of events leading to it.

The ANIMALS 24-7 log of fatal and disfiguring dog attacks in the U.S. and Canada,  maintained since 1982,  documents approximately the same numbers of deaths over the 1999-2015 time frame when “proximate cause” deaths and Canadian dog attack deaths are excluded.

Data “has some limitations”

As New York Times “Vital Signs” columnist Nicholas Bakalar observed,  the CDC-WONDER data “has some limitations,”  including that it “does not include fatalities from car crashes with deer and other animals,”  which “results in about 200 deaths a year [189 in 2016,  according to insurance industry sources.]  And causes of death may have been misclassified because of the limitations of information provided by death certificates.”

Since the CDC-WONDER data does not include the breeds of dog involved in fatal attacks,  this information was not part of either of the studies of “Fatalities Due to Venomous and Nonvenomous Animals in the United States” assembled by Forrester,  Forrester,  et al.

Breed-specific comparative data

But the ANIMALS 24-7 log is breed-specific.  It shows that pit bulls and pit bull mixes inflicted at least 97 of the 250 dog attack deaths counted by Forrester,  Forrester,  et al in the 1999-2007 time frame (39%),  doubling to 218 of the 272 deaths Forrester,  Forrester,  et al counted in the 2008-2015 time frame (80%).

Rottweilers,  then at their peak of popularity,  accounted for 38 dog attack deaths in 1999-2007,  but only 26 in 2008-2015,  a 32% drop.

Forrester,  Forrester,  et al did not ignore dog attack deaths,  but underplayed the significance of the increase that they reported in concluding that “Dog-related fatality frequencies are stable.”

“These are preventable deaths”

Forrester,  Forrester,  et al qualified this finding by noting that “the fatality frequency of 4.6 deaths per 10 million persons among children four years of age or younger” was almost twice as high as among persons older than 65 years of age,  and was four times higher than among other age groups.

The previous Forrester,  Forrester,  et al study of “Fatalities Due to Venomous and Nonvenomous Animals in the United States” concluded by recommending that “Prevention measures aimed at minimizing injury from animals should be directed at certain high-risk groups such as farm workers,  agricultural workers,  and parents of children with dogs.”

The current “Update” repeated that recommendation verbatim.

“The burden of fatality upon young children after dog encounters remains troubling,” lead researcher Jared A. Forrester said.  “These are preventable deaths.”

Hornets,  wasps & bees

Forrester,  Forrester,  et al found that “Deaths attributable to Hymenoptera (hornets, wasps, and bees) account for 29.7% (478) of the overall animal-related fatalities” in the 2008-2015 time frame,  up only slightly from 28.2% of the animal-related fatalities in the 1999-2007 time frame,  “and have been steady over the last 20 years,”  although up steeply since 1950.

“During the study period, there were about 86 deaths annually from venomous animal encounters,”  Elsevier News summarized.  “This is up from 79.5 in 1999-2007,  69 in 1991-2001,  60 in 1979-1990,  and 46 from 1950-1959.”

“With an estimated 220,000 annual visits to the emergency department and nearly 60 deaths per year due to stings from hornets, wasps, and bees, effective and affordable treatment for anaphylaxis from Hymenoptera is critical,”  Jared A. Forrester said,  urging that “People with known allergic reactions to bee stings should carry a portable epinephrine delivery device with them at all times.

“Socially responsible price point”

“Public health practitioners, policymakers, and the public should encourage industry to provide proven public health interventions,  like the EpiPen,”  Jared A. Forrester continued,  “at a socially responsible price point that serves the best interests of the U.S. population.”

The drug company Mylan,  the maker of the EpiPen epinephrine delivery device,  in early 2017 jacked the price of EpiPens up to $600 for a two-pack.  The CVS drug store chain responded by cutting the price of a generic alternative from Impax Laboratories,  called Adrenaclick, from $200 to $109.99.

The health insurance company Cigna announced that it would cover only use of Adrenaclick.  Mylan then said it would introduce a cheaper generic version of EpiPen.

Wildlife encounters relatively safe

“Importantly,”  said Jared A. Forrester,  “most deaths [from animal attack] are not actually due to wild animals like mountain lions,  wolves,  bears,  sharks,  etc.,”  which are the species feared most by humans,   “but are a result of deadly encounters with farm animals,  anaphylaxis from bees,  wasps,  or hornet stings,  and dog attacks.  So,  while it is important that people recreating in the wilderness know what to do when they encounter a potentially dangerous animal,  the actual risk of death is quite low.”

“The animals that caused death at the highest rate,”  other than venomous insects and dogs,”  observed Sean Rossman of USA Today,  “were mammals such as cats,  cows,  raccoons and horses.  The researchers seemed to pin the blame on horses and cattle,  saying previous research shows the two types of farm animal overwhelmingly contribute to farm deaths”––90% according to some sources.

Little done to improve farm worker safety

Using the same Centers for Disease Control & Prevention data base,  the Iowa Fatality Assessment & Control Evaluation Program found that cattle killed 108 people,  nationwide,  from 2003 through 2007,  an average of just under 22 per year.

About 20 people per year die in horse-related accidents,  mostly from head injuries.

“Little in the way of public health policy in the farm workplace has changed since our previous paper,” Jared A. Forrester said.  “Increased specificity in the coding of deaths due to animals in farm environments would help public health professionals target interventions.  Appropriate education and prevention measures aimed at decreasing injury from animals should be directed at the high-risk groups of agricultural workers,”  Forrester added.

“No one was killed by a rat”

“Only six people a year died from snakebite,  and six after being bitten by a venomous spider.  Two people were killed by marine animals over the eight-year period,”  only one by an alligator,  “and no one was killed by a rat,”  noted New York Times “Vital Signs” columnist Nicholas Bakalar.

One of the two people killed by marine animals was Sea World trainer Dawn Brancheau,  mauled by the captive orca whale Tilicum before an audience at Sea World/Orlando on February 24, 2010.

The most detailed analysis of “Update on Fatalities Due to Venomous and Nonvenomous Animals in the United States”––before this one––appears to have been by Cato Institute immigration policy analyst Alex Nowrasteh.

Found Nowrasteh,  “The annual chance of being killed by an animal was 1 in 1.6 million per year from 2008 through 2015.  The chance of being murdered in a terrorist attack on U.S. soil was 1 in 30.1 million per year during that time.  The chance of being murdered by a native-born terrorist was 1 in 43.8 million per year,  more than twice as deadly as foreign-born terrorists at 1 in 104.2 million per year.

Terrorists & dogs compared

“In addition to the data analyzed in the Forrester,  Forrester et al paper,”  Nowrasteh wrote,  “the CDC has mortality data for animals back to 1968.  This period includes the 9/11 attacks,  the deadliest terrorist attacks in world history.

“From 1975 through the end of 2016, 7,548 people have been killed by animals [in the U.S.],”  about 10% of them by dogs according to the ANIMALS 24-7 dog attack log,  and 6% by pit bulls,  “while 3,438 have been killed by all terrorists.

“Even during this time,”  Nowrasteh concluded,  “the annual chance of being killed by an animal is far higher than being killed in a terrorist attack.”

Subtracting the official 9/11 death toll of 2,996,  442 Americans have been killed in terrorist attacks;  more than 800 by dogs,  including more than 420 by pit bulls.

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