08 September 2012

Combined Type ADHD=Oppositional Defiant Disorder

Attention Deficit/Hyperactivity Disorder (ADHD) is classified in the DSM-IV into three types - a predominantly hyperactive type, a predominantly inattentive type, and a combined type.

Studies attempting to see what clusters of symptom patterns emerge from the evidence, however, have found more latent class subtypes of ADHD based on ADHD symptom type, commorbidity with oppoistional defiant disorder (or its close cousin conduct disorder), and commorbidity with anxiety disorders. As the study explains:

Characteristics of the Sample

The total sample consisted of 1,010 individuals, 55% of whom were male; 10.6% were ages 4 to 11 years at intake, 26.6% were 12 to 17 years, and 62.8% were 18 years and older. Based on our clinical assessment, 49.6% of subjects were affected with ADHD, 46.6% were unaffected, and 3.8% had an indeterminate diagnosis. . . .

LCA of ADHD

LCA [Latent Cluster Analysis] using the 18 VAS-P [diagnostic test] items in 107 children revealed a best fit for a five-cluster model and LCA in 269 adolescents produced a six-cluster model as the best fit; LCA using the 18 VAS-P items in 634 adult subjects found a seven-cluster model fit the data best. . . .

Common to all of the age groups were clusters demonstrating severe combined ADHD symptoms, moderate combined symptoms, mild inattentive symptoms, and few ADHD symptoms.

A talkative-hyperactive cluster was found in 4- to 11-year-olds; a similar group was found in the adults but with lower symptom severity. This group was not found in the adolescents.

Two symptom clusters were found in the adult and adolescent age groups but not in 4- to 11-year-olds: a severe inattentive ADHD cluster and a mild combined ADHD cluster.

With the exception of the three symptom clusters mentioned above (talkative-impulsive, severe inattentive, and mild combined), similar clustering trends were found in the three age groups. However, the older age groups showed a marked decrease in symptom severity scores for hyperactivity questions . . . .

[W]e compared ADHD status as defined by the DSM-IV best estimate and posterior cluster membership. . . . The proportion of ADHD cases affected in particular clusters was similar between age groups with the exception of the mild combined ADHD symptom cluster.

All of the individuals who were assigned to the severe combined and the severe inattentive groups had DSM-IV ADHD. Most of the individuals assigned to the moderate combined group had DSM-IV ADHD. The proportion of affected individuals in the mild combined cluster differed between adults and adolescents. Adolescents assigned to this cluster were largely affected with DSM-IV ADHD; adults assigned to this cluster were a mixture of affected and unaffected individuals.

LCA of VAS-P ADHD and Comorbid Symptoms

In LCA of ADHD and comorbid symptoms in children ages 4 to 11, a six-cluster model showed the best fit; seven-cluster models provided the best fits for the adolescents and adults. . . . Overall, the pattern of ADHD symptom endorsement among the clusters resembled the LCAs limited to only ADHD symptoms. Inclusion of comorbid symptoms appeared to separate certain ADHD subgroups.

In 4- to 11-year-olds, the severe combined cluster split into two clusters, one with high anxiety symptom endorsements and one with low anxiety. Those with higher anxiety also had higher ODD compared to the group with lower anxiety.

In 12- to 17-year-olds, the symptom endorsements for ADHD items appear similar after addition of comorbid symptoms, the exception being the disappearance of a cluster corresponding to mild inattentive symptoms. There the two groups displaying severe combined ADHD symptoms appeared to differ most dramatically on externalizing symptoms, although there were differences in internalizing symptoms to a lesser extent. The two groups displaying predominantly inattentive symptoms differed in the extent of internalizing symptoms.

In adults, like adolescents, a cluster demonstrating mild inattentive symptoms was no longer present when comorbid symptoms were added to the analysis. The cluster size of the talkative-impulsive group also decreased after comorbid symptoms were added. In addition, in the adult group, both internalizing and externalizing symptoms appeared to differentiate clusters displaying similar ADHD symptoms. The two moderate combined ADHD groups in adults appeared to differ most notably in internalizing symptoms.


DSM-IV and the Results Compared

The results are something of a muddle.

The Purely ADHD Symptom Based Clusters

Looking at ADHD symptoms alone, there were six clusters of people exhibiting some symptoms (in addition to a category for asymptomatic people). All six were found in adults. But, one category "hyperactive-talkative" wasn't found in teens, and two categories (mild combined and severe inattentive) weren't found in pre-teens.

Three of the six clusters categories (hyperactive-talkative, mild combined and mild inattentive) were predominantly below the clinical threshold to diagnose ADHD under DSM-IV, except in the case of most of the mildly inattentive pre-teens.

Two of the clusters (severe combined type and severe inattentive type) seems to be a close match to combined type and predominantly inattentive DSM-IV diagnoses.

A "moderate combined type" cluster was largely above the clinical threshold of the current DSM-IV standard, but fit a mix of predominantly hyperactive, predominantly inattentive and combined type cases in the DSM-IV system.

The Clusters Produced With Co-Morbidity Considered

Considering comorbid oppositional defiant disorder and anxiety disorders as well as ADHD symptoms produces twelve clusters of people exhibiting some symptoms which don't neatly align with the ADHD symptom alone clusers or show stability across age ranges. Nine of the twelve clusters were found in only one of the three age groups (pre-teen, teen and adult). Only two clusters (moderate in everything and severe in everything) were found in all age groups.

Three of the twelve clusters were ADHD at only subclinical levels by current DSM-IV standards (hyperactive-talkative with moderate ODD, mild combined with mild ODD and anxiety disorder, and mild inattentive with mild ODD and anxiety disorder).  A fourth cluster of the twelve, the moderate ADHD with mild ODD and mild anxiety disorder cluster, found only in adults, was predominantly subclinical by current DSM-IV standards: about one in five were predominantly inattentive ADHD and one or two were predominantly hyperactive/impulsive by current ADHD standards.

Three of the twelve clusters mapped fairly closely to combined type ADHD by current DSM-IV standards (severe combined type with severe ODD and severe anxiety disorder, severe combined type with moderate ODD and moderate anxiety disorder, severe combined type with severe ODD but not anxiety disorder), although in older age ranges there is some shift from a combined type to a predominantly inattentive type under DSM-IV. Severe combined type ADHD is apparently almost always accompanied by moderate to severe ODD, but sometimes comes with anxiety disorders and sometimes doesn't.

As in the ADHD symptom only analysis, the latent cluster analysis conducted with comorbidity considerations produces a moderate ADHD combined type cluster that includes a large share of all predominantly hyperactive diagnoses under the DSM-IV system, in addition to a significant number of predominantly inattentive diagnoses, and a significant number of combined type diagnoses. The cluster also is accompanied by moderate ODD and moderate anxiety disorder, and is one of just two that is found in all age groups.

The twelve cluster analysis also produces four clusters that align roughly with a predominantly inattentive diagnosis under DSM-IV, but none of them are found in more than one age group. In pre-teens, a significant number of mild attention cases that are overwhelmingly subclinical in teens and adults rate as predominantly inattentive ADHD under DSM-IV. One cluster of inattentive teens has no real comorbid conditions, while the other has moderate ODD and severe anxiety disorder. In adults, the only predominantly inattentive cluster exhibits moderate ODD and mild anxiety disorders.

Analysis

One important finding of the study is that there are a significant number of people out there with subclinical levels of ADHD symptoms who clearly cluster separately from people with few symptoms at all. For pre-teens, there is about one subclinical case for every two diagnosable cases. For adults, there are about two subclinical cases for every one diagnosable case. For teens, the ratio is in between (but closer to the pre-teen ratio). 

The inconstant cluster patterns for predominantly inattentive type ADHD may, in part, have something to do with this condition being less consistently diagnosed than combined type ADHD whose hyperactivity symptoms are far less subtle.

The moderate to severe combined type diagnosis declines greatly with age, while the inattentive type becomes more common.  This confirms prior research showing that hyperactive symptoms of ADHD are more prone to abate with age than inattentive symptoms, and suggests that a diagnostic tool for adult ADHD might benefit from treating what would be a subclinical level of hyperactivity symptoms in a child or a teen as more significant when seen in an adult.

The finding of the study that moderate ADHD cases cluster together, rather in the subtypes of the current DSM-IV diagnosis, is notable.  This may be a product of the diagnostic instrument which is tuned to discriminating subtypes in severe cases rather than mild ones.  Subtyping by relative symptom severity, rather than on an absolute scale, might produce less puzzling results.

The other important finding of the study is that combined type ADHD is highly comorbid with oppositional defiant disorder, to the point where it isn't at all obvious that they are separate conditions at all.  Put another way, the symptoms of ODD in DSM-IV may be what I have called "non-diagnostic symptoms" of ADHD combined type.  The DSM-IV doesn't used these ODD symptoms to diagnose ADHD combined type, but these symptoms are correlated strongly enough with the definition of combined type ADHD that they could be used to diagnosis it.

Since this correlation isn't nearly so strong in the inattentive type, one wonders if it wouldn't be appropriate to add the symptoms of oppositional defiant disorder to the list of hyperactivity symptoms and redefine ODD to exclude cases comorbid with combined type ADHD (favoring ADHD over ODD on the theory that ODD is a more "loaded" diagnosis and sounds more like a recidivist delinquent determination by legal authorities than a true psychiatric diagnosis in many cases).  ODD, Conduct Disorder and Anti-Social Personality disorder cover a myriad of sins.  A lot of ODD, Conduct Disorder and some cases of Anti-Social Personality Disorder (or whatever it is that they call it these days) seem to basically involve poor management of the hyperactivity-impulsivity dimension of ADHD rather than something distinct.  The rest of anti-social personality disorder cases, in contrast, involve something entirely different in root cause, mechanism and more carefully defined symptoms: psychopathy.  Someone who is hyper and impulsive and defiant and doesn't know how to manage that but has empathy for others is probably ADHD combined type.  Sometone who is cold as ice and lacks empathy but can consicously gaslight and glibly lie is probably a psychopath.

The comorbidity of ADHD of both DSM-IV types with anxiety disorders is high, but the fit is not nearly so perfect.  There are plenty of people who are in clusters with ADHD combined type or ADHD inattentive type who lack anxiety disorders, while almost everyone with ADHD combined type has corresponding levels of ODD.  This intuitively makes sense.  Lots of people with ADHD are the opposite of the classic anxiety disorder diagnosis, laid back to a fault rather than borrowing worry that they don't need.  So, maintaining separate diagnosis regimes for ADHD and anxiety disorders, as the DSM-IV status quo does, makes sense.

Why Is Christian Literature So Bad?

Every once and a while I read something total out of my normal fare. A recent example was "Anything but Normal" by Melody Carlson (2010), which is a consciously Christian fiction (I believe they call it "inspirational") take on a teen "issues" novel.

Imagine a version of the movie "Juno" (to which its characters refer disparagingly) where all of the characters sound like something out of a "Left Behind" novels of Tim LaHaye and Jerry B. Jenkins (a consciously Christian science fiction series about the Biblical Apocalypse of Revelations actually happening), and you have this book.

Apparently, there is a market for it. Carlson's biography claims that she has written more than a hundred novels.

Both Carlson's book and the Left Behind series, like most of the fiction and music in the inspirational Christian fiction genre (although there are some emerging bright lights in the white Christian music scene a few decades after it really took off), are simply dreadful.

It could be, I'm not close enough to the Evangelical Christian world personally to know, that these books are dreadful simply because people in real life who are part of the culture really do think and act the way that the people in the fictional accounts do, and I don't get them.  I've seen people act like that in isolation, but it has always come across to me as false.  It seems so two dimensional, driven by empty mantras, shallow, emotionally stunted, and brain dead. 

It could also be that this is simply a genre convention in inspirational literature. There is a rich tradition of secular Southern and Appalachian fiction with real human beings in it, so I suspect it is mostly the latter, a conscious attempt to be didactic and follow Christian doctrine, verisimilitude be damned.  Then again, the quality secular fiction tends to be about less pious individuals.

But, when you do encounter someone who really does to the outside world seem to act that way, you wonder.  People buy this stuff, so maybe they relate to it.  I sincerely hope that isn't true.  That would undermine my faith in humanity a little.  But it is hard to know.

Grocery Store Mark Up

I saw in the newspaper today a brief summary of the latest quarterly report from Kroger, which owns the Colorado grocery store chains King Soopers and City Market as well as other grocery store brands around the country. 

The part that interested me its profits as a percentage of its gross revenues, 1.3%.  So, when you buy $100 of groceries, you are contributing just $1.30 to the profits of the company.  I'd heard that grocery stores had thin profit margins before, but it was interesting to see this confirmed in print.

In Between

I have an old fold up paper map of Denver.  The core metropolitan I-225 loop, but not quite all of DIA fits on one side of it when it is unfolded.  On that map, I have a vaguely central position, not perfect center, but a clear view of where I am in relationship to the rest of the area.

I like it, but it is an old map.  The seams are fraying.  It doesn't have the Stapleton or Lowry developments on it, doesn't show Dick's Sporting Goods Park, predates the conversion of Rocky Mountain Arsenal to the wildlife preserve, and is otherwise out of date.  So, I bought a new fold up paper map of Denver.

The new map isn't arranged quite the same way.  It puts the northern part of the Denver metro area on one side and the southern part on the other side of paper.  The two parts don't quite match up.  About a centimeter of the roughly four foot by four foot on each side map is omitted.

Of course, I happen to live in that missing centimeter.  Is fate trying to tell me something?

07 September 2012

The Shortage Of American Judges

One of the least acknowledged but most pervasive drivers of American judicial culture is that the American legal system has fewer judges, relative to the number of lawyers, relative to the number of lawyers who have litigation practices, relative to population, relative to the number of cases in the system, or by just about any other measure you would care to chose, than any other country in the world.

The U.S. Has Fewer Judges 

This is true of every U.S. state and territory.  Most of the variation from state to state within the United States arises from the fact that some places have limited jurisdiction courts staffed by full time judges, while other places have limited jurisdiction courts staffed by part-time judges sometimes called justices of the peace.  There is less variation in the staffing patterns of general jurisdiction courts and appellate courts, although obviously there is some variation in these staffing decisions as well.  Something on the order of 90% of U.S. judges are state or local government employees, rather than federal government employees.

This conclusion is robust across a wide variety of definitions of judges applied consistently (e.g. including or excluding federal judges, including or excluding magistrates and administrative law judges, including or excluding staff lawyers in the judicial branch including or excluding ADR professionals such as mediators and arbitrators in the public and/or private sectors).

The number of judges in the Europe, whose population is perhaps a third that of the United States, is on the order 700,000 according to a recent report from the "Eurocracy" reported at the Legal Theory Blog, yet Europe has fewer "lawyers" than the United States.  This appears to include lay judges who are not legally educated, chosen on a non-random basis, and sit for limited terms in more serious cases (typically criminal ones or labor disputes).  Other civil law jurisdictions (e.g. Japan and South Korea) are generally similar, although the number of judges per capita declines significantly in the Third World.  Definitional issues become deeply problematic in places like China, Iran, and Saudi Arabia that don't adhere closely to European style arrangements of formal dispute resolution.

The number of lawyers in the United States (which is larger than the number of lawyers in other countries at least in part as a function of the broader definition of who counts as a lawyer in the United States - fewer professionally trained legal professionals count as lawyers in other most countries) is about 1,400,000 and the number of judges in the United States with the title of judge or federal administrative law judge is something under 28,000.

Thus, Europe has about one and a half lawyers for every judge, while the United States has about fifty lawyers for every judge.

This Is Still True If One Adjusts For The Uniquely American Version Of Jury Trials

The two complicating factors that would even these scales are that the United States military justice system uses non-legally trained soldiers in a variety of courts-martial system roles, particularly in less serious cases, although not particularly more than any other modern military force, and that the United States makes much greater use of juries than other countries (even relative to countries in the Anglo-American legal tradition like England). 

Many countries around the world make use of juries in criminal cases, but most of those countries reserve them for very serious charges (typically aggravated felonies), while juries usually of at least six ordinary individuals in misdemeanor cases and twelve in a felony cases.  Jurors are chosen for a particular case in a manner that is at the first cut random from the general adult population, are routinely utilized in American criminal cases involving even minor misdemeanors.  Grand juries who are likewise chosen at random but to serve for longer terms on multiple cases during their terms are used to screen charges prior to trial and judicially investigate alleged criminal conduct in all federal criminal cases, in most serious state criminal cases in perhaps a third to a half of U.S. states, and in exceptional cases with political or organized crime implications in almost every U.S. state.

Juries are virtually absent from all but the narrowest class of exceptional cases in civil law countries and in England.  In the United States, juries are available in perhaps 80% of non-family law, non-juvenile civil cases in courts of general jurisdiction (waivers of the right to jury trial without arbitration clauses are routine in large dollar debt-collection practice), compared to perhaps 1%-2% of comparable cases in England (although juries are allowed in some claims for money damages against the government in England where they are not available in most U.S. states). 

No country other than the United States utilize juries so routinely in ordinary contract and tort disputes, although civil jury trials are increasingly very rare, especially in cases where an award of damages for pain and suffering or emotional distress is not available, in the United States.  About three-quarters of civil juries hear personal injury cases involving run of the mill accidents from car collisions to slip and fall cases to more exceptional incidents.

About sixty jurors sit in jury trials at petite jury members (as opposed to grand jurors) each year per judge.  So, including jurors, the United States has something on the order of 1,708,000 judicially acting individuals in any given year.  In addition, the number of grand jurors serving in a given year in the United States is something on the order of 60,000-90,000.

On a full time equivalent basis, however, jurors make up something on the order of 16,800 FTE equivalents.  The number of grand jurors serving in a given year on a FTE equivalent basis is something on the order of 5,000-7,5000 people.  Given that not every judge is a full time judicial official either, the number of FTE equivalent judges in the U.S. and the number of FTE equivalent jurors in the U.S. is roughly equal, and the total number of FTE judicial decision making officials in the U.S. in any given year is about 56,000, roughly one per 25 lawyers admitted to practice in the United States.  This is still an order of magnitude less than the number of European judges, some of whom are also part-time, possibly bringing the ratio of FTE European judges to something like 2.5 per European lawyer.

The U.S. Judiciary Is Bottom Heavy

The mix of judges in non-Anglo-American law cases is also quite different from those in the United States.  The mix of judges in civil law countries is typically much more top heavy. 

In the U.S., the U.S. Supreme Court has nine judges, while the state supreme court's have five to nine judges each.  Every U.S. Supreme Court judge and many state supreme court judges (and not an insignificant number of well respected intermediate federal appeals court judges) are minor celebrities.  In civil law countries, it isn't unusual for the highest ordinary court to have scores of judges who are assigned to cases on a subject-matter expertise basis, and except for the chief justice and heads of each subject-matter division, they are no more well known than comparable intermediate appellate court judges in the United States.  The celebrity and relevance to interpreting the law that we heap on the written opinions of elite appellate judges in the United States is mostly carried in civil law countries by leading law professors in various specialties, with the written opinions of elite appellate judges playing a much less prominent role due to the deceased quasi-regulatory authority of civil law judges to make law and rule on public law questions commonly addressed by U.S. judges such as civil rights violations and rulings on the constitutionality of statutory laws.  In civil law countries, these tasks are often delegated to a specialized and prominent constitutional court whose appointments are quite political relative to ordinary judges and who don't involve themselves in routine private law issues of torts, breaches of contract, and the like.

In civil law countries, cases that would be handled by a single U.S. general jurdisdiction court judge supported by a jury at the trial stage, are typically handled by three or five civil law judges (sometimes including one or two lay judges) one of whom takes a lead and manages most of the non-dispositive stages of the process such as taking testimony from witnesses, and the intermediate appellate court panel which would typically consist of three judges in the U.S. would typically have a couple more judges than the first instance court in civil law countries and would typically take some new evidence as well as legal argument.  The only cases typically handled by a single judge in civil law countries are the kinds of cases that would be handled by limited jurisdiction trial court judge or magistrate (often without jurors) in the United States, i.e. minor criminal matters and small civil claims.

Notably, the mix of judges in civil law countries more closely matches the mix of lawyers in comparable U.S. litigation.  It is almost routine in general jurisdiction civil cases and felony criminal cases that go to trial for at least two lawyers to handle the case at trial, and in very high stakes cases each side's team of lawyers is routinely larger.  It isn't unusual to have half a dozen lawyers work directly on a case before the U.S. Supreme Court and to have many more file amicus briefs solicited by one party or another.

Judicial Career Tracks

The career track of judges in civil law countries (and even England, to a lesser extent) also influences this structure.  In civil law countries, one goes directly from law school into the judiciary, starting in traffic or parking court and working one's way up the ranks with a decent shot of becoming a rank and file supreme court judge before the end of one's career if you are smart and competent.  Judicial appointments (other than to the constitutional court) are often no more political than the appointment of any other civil service professional in the U.S. would be, and the vast majority of judges have never been lawyers who represent individual clients (although some countries treat serving as prosecuting attorneys and serving as judges as part of the same profession in the judicial branch allowing for some exchange between those two groups). 

The career track of civil law judges is more like that of U.S. prosecutors or attorney-general's office lawyers than it is like that of American judges.  And, unlike American law professors, who typically have only entry level experience practicing law beyond a judicial clerkship, if any, law professors in civil law countries (unlike judges), at least until they have reached a rank equivalent to that of a tenured full professor and sometimes even afterwards, will typically maintain a part-time private practice of law in which the professors act like wily lawyers instead of stodgy professors (civil law law school academics are far more stuffy and doctrinal, and far less ideologically boundary pushing and teaching oriented than U.S. legal educators).

In contrast, in the U.S., most judges are fairly well politically connected individuals in a second career that followed a successful career as a litigation lawyer in public or private practice, most often as a prosecuting attorney, but not infrequently also or instead as a criminal defense lawyer, or a private civil litigator.   The track of moving from a less prominent career to a position as a subordinate magistrate judge to taking the job their judge-boss held is also increasingly common in the U.S.  And, sometimes, particularly in the case of high profile appellate judge appointments, a judge's first career is as a law professor or legally trained senior civil servant or a legally trained politician, although each of these kinds of appointments would be exceptional.  Until roughly the 1950s it wasn't all that uncommon, particularly in rural areas, for a prominent local citizens who was a non-lawyer to be appointed as a part-time trial judge in a limited jurisdiction trial court, and the practice hasn't entirely ended.  Colorado, the last time I checked, had at least four non-lawyer county court judges, and also at least some non-lawyer municipal judges in small towns and non-lawyer parking magistrates.  But, in New York State outside metropolitan New York City (at least until very recently) and many other states, part-time non-lawyer judges outside major cities with jurisdiction only over small claims cases and minor misdemeanor, traffic and ordinance violation cases remain fairly common.

The prestige judicial appointments in the U.S. most often, but not always, follow a previous judicial appointment as a less prestigious appellate judiciary position, a stint as a general jurisdiction trial court judge, or less often, a position in a state or federal solicitor general's office (the branch of the attorney-general's office that argues cases in front of the relevant supreme court), or as a renowned law professor.

The exception to the general rule would be members of the French Council of State and public law institutions crafted in its image in civil law countries and constitutional courts.  These institutions staffed at the entry level with elite civil servants who are graduates of top universities drawn from the ranks of the kind of people who in the United States might serve as judicial law clerks out of law school, as kitchen cabinet political aides to elected officials and senior political appointees (e.g. as a Congressman's legislative aid or Congressional committee staffer), as entry level professional employees in elite government agencies like the solicitor-general's office or CIA or SEC, or as associates at Big law firms or entry level investment bankers.  At first, they are assigned in pairs to public law cases, sometimes representing a complaining member of the public as a devil's advocate, and sometimes representing the government, and their cases are judged by more senior members of the same institution who have come up through the ranks.  The overall process is more akin to Congressional and executive agency constituent service work than it is to conventional lawyering.

Implications For American Law

How does this play out in the legal life of an American lawyer?

* The shortage of judges has produced a strong institutional bias in favor of negotiated settlements over judicial resolution of litigated disputes on the merits in American courts, and in favor of arbitration and mandatory mediation processes.

* The shortage of judges and a bottom heavy distribution of judges has encouraged doctrines affording exceptionally high levels of finality to trial court decisions and relatively weak appellate review of trial court decisions.  U.S. judges and juries have far more effectively unreviewable discretion than civil law judges.  For example, outside the U.S. when a decision of a judge is reversed for abuse of discretion, the case is almost automatically assigned to a different judge when it is remanded for further proceedings.  In contrast, in the U.S., in all but the most rare and exceptional of cases verging on a gross ethical violation by the judge, a decision of a judge that is reversed for abuse of discretion is automatically remanded to the same judge who must exercise his discretion again subject to the appellate court's order that may still afford him considerable authority to reach a similar, although less extreme, decision.

* Doctrines and procedures that reduce judicial case loads by resolving cases prior to the taking of any evidence in a trial (with or without a jury), or in a preliminary hearing limited to more narrow issues, have thrived in U.S. courts, because they reduce judicial time constraints.  Doctrines that resolve cases on narrow procedural grounds, rather than on a consideration of the merits based upon all of the evidence are favored.

* Doctrines and procedures that reduce attorney work loads, for example by narrowing the scope of discovery through close judicial supervision of the process or reducing the uncertainty involved in trial preparation, without actually getting a case off the docket, have not thrived in the U.S. courts despite being at the core of civil law country civil procedure.

* The administrative and litigation process strongly favors rules and procedures that delegate more of the time consuming components of the process to the lawyers and limits the judges to a final decision making mode whenever possible. 

Most of the trial court level testimony in civil law jurisdictions is conducted in the presence of a judge in a first official examination of a witness by anyone involved in the case, and the judge personally takes notes in lieu of a verbatim transcript; in the U.S., most of that testimony would have taken place in depositions in the absence of a judicial official other than a court reporting preparing a verbatim transcript, in a lawyer's office, before trial, and only critical portions of the deposition transcripts are presented to the judge in support of pre-trial motions. 

The first draft of longer court orders in U.S. courts are routinely drafted by counsel for the prevailing party for review, consideration, modification or adoption by the judge.   U.S. judges rely more heavily on briefing from counsel relative to their own legal research and knowledge than civil law judges, and are more likely to have their own legal research done by a subordinate law clerk rather than doing the research personally, in an ordinary case.

In criminal cases, investigations are conducted mostly by non-lawyer police aided from time to time by mass producible search warrants and subpoenas.  So, unlike civil litigators who must develop the evidence themselves, criminal prosecutors have considerable staffs of sworn police officers and other investigative officials to do the work that would fall to the discovery process and extra-judicial investigations managed by lawyers in civil litigation.  In civil law countries, some of the investigative work in criminal cases that is the responsibility prosecutors in the United States is the responsibility of the judge.

* The shortage of judges and their career track in the United States have conspired to make the U.S. judiciary a very elite group of individuals, even compared to the already elite professional ranks of U.S. lawyers.  U.S. judges are not only the cream of the crop in a way that judges elsewhere are not, they are also at intermediate levels of the system more likely to have a wealth of experience in some kind of litigation and considerable social clout in elite political and business circles.  While many non-U.S. judges are merely "middle class", the vast majority of U.S. judges are upper middle class and many have roots at least in the upper class and are working as judges as much for the prestige and out of a sense of civic obligation, as for money.  For them, it is a form of reduced pay early retirement.

These dynamics produce a group that collectively sees the opportunity to exercise power as a perk in and of itself.  U.S. judges are relatively speaking, ambitious and power hungry.  The classic problem in U.S. legal practice is how to restrain a judge who abuses his authority, not how to encourage a judge to act boldly where necessary.

The elite status of judges has produced a quality of decision making that has facilitated considerable legislative and public trust in the judiciary.  Judges are entrusted with political sensitive common law decision making on emerging private economic and family issues, loose discretionary standards for decision making in equity matters, vaguely drafted statute and regulations, substantial public law decision making power including the power of judicial review of statutes for constitutionality (contrary to popular myth, is shared by every judge from the traffic court judge to appellate court judges, not just the U.S. Supreme Court), the contempt power (using fines or imprisonment to punish those who disobey their court orders, at least until compliance is secured, or to punish people engage in courtroom misconduct), the power to decide cases without the involvement of other judges on a panel, the power to manage cases with potential unlimited punitive damage awards, with potential long terms of imprisonment, with resolution of custody and citizenship maters, and in death penalty cases, because they tend to be far more intelligent than even the average politician, are more willing to show self-restraint in the interest of applicable but effectively unenforceable rules, and are also not politically tone deaf or naive.  U.S. judges are almost immune to performance reviews that personally impact their lives during their terms of office for anything other than gross ethical breaches.  Even high rates of appellate reversal do not personally impair a judge's career or employment situation in most cases.

Non-U.S. judges mostly lack contempt of court power, have much narrower public law jurisdiction, i.e. authority over governmental entities (if any), do not have the power of judicial review, must often make decisions on important matters as part of a panel, have legal standards to implement that afford them less discretion, implement more tightly drafted statutes and regulations, can have their factual decisions as well as their legal decisions reviewed de novo on a first appeal of right, have less of an ability to make precedents that have force beyond the current case, have more finely nuanced layers of jurisdictional authority with a far small proportion of judges having the full authority of a U.S. general jurisdiction trial court judge, less personal clout, less elite backgrounds, smaller caseloads, less opportunity to make politically sensitive decisions, less practical legal experience in most cases, and less ambition.  Non-U.S. judges, by virtue of their career tracks, have far more incentive to fit managerial expectations in order to move up the ranks with attendant higher pay, greater power and more interesting cases.

* Judges, by virtue of their far greater case loads and among trial judges, minimal need to sway a group to their judgments, have far more personal influence on their cases and on the legal environment in their jurisdiction.  Conversely, judicial decision making in the U.S. is less consistent.

* Some of the perennial proposed civil procedure reforms, like "active case management" routinely flounder, because judges with huge case loads simply cannot spare the time to devote more attention to cases that are likely to eventually through the discovery process and either settlement or a straight forward culminating motion, be resolved prior to trial with minimal judicial involvement.  Any case where both sides are represented by lawyers is particularly likely to resist active judicial involvement since the lawyers often are capable of working things out.  These reforms will only succeed if a sustainable solution to a lack of judicial resources is devised for the class of cases receiving additional judicial attention.

* Two factors among many that has driven low judicial staffing levels have been the twin desires to keep court filing fees low so that access to the judicial system is not formally barred by public official's rules, and the desire to have civil courts (where judicial resource constraints are even more acute than in criminal cases) fund themselves as much as possible from filing fees.  Policy makers have tended to disfavor the equation of higher filing fees and lower case loads found in private sector non-consumer arbitration procedures. 

* Policy makers have also tended to favor having fewer elite judges over having more less elite judges, because our legal system gives all judges considerable power and non-elite judges in this system have great potential to do mischief.  This has removed one option to reconcile low filing fees with adequate staffing levels.

05 September 2012

Smoking and Internet Addiction Mechanisms Similar

The researchers . . . compared the genetic makeup of the pro­blematic Internet users with that of healthy control individuals. This showed that the 132 [Internet addicts] . . . are more often carriers of a genetic variation [on the CHRNA4 gene that changes the genetic make­up for the Alpha 4 subunit on the nicotinic acetylcholine receptor] that also plays a major role in nicotine addiction. "What we already know about the nicotinic acetylcholine receptor in the brain is that a mutation on the related gene promotes addictive behavior," explains Dr. Montag. Nicotine from tobacco fits -- just like acetylcholine, which is produced by the body -- like a key into this receptor. Both these neurotransmitters play a significant role in activating the brain's reward system. "It seems that this connection is not only essential for nicotine addiction, but also for Internet addiction," reports the Bonn psychologist.


From here.

The abstract states:

Recent studies from Asia provided first evidence for a molecular genetic link between serotonergic and dopaminergic neurotransmission and Internet addiction. The present report offers data on a new candidate gene in the investigation of Internet addiction—the gene coding for the nicotinic acetylcholine receptor subunit alpha 4 (CHRNA4). A case-control study was carried out. The participants were recruited from a large gene data bank, including people from the general population and from a university setting. A total of 132 participants with problematic Internet use and 132 age- and sex-matched controls participated in the study. Participants provided DNA samples and filled in the Internet Addiction Test Questionnaire. The T- variant (CC genotype) of the rs1044396 polymorphism on the CHRNA4 gene occurred significantly more frequently in the case group. Further analyses revealed that this effect was driven by females. Combined with the findings from other studies, the present data point in the direction that rs1044396 exerts pleiotropic effects on a vast range of behaviors, including cognition, emotion, and addiction.


Other questions naturally follow and will have to be answered by those who can get behind the paywall or in future studies.

What are the raw numbers of percentages of persons with or without the gene mutation? What is the statistical signficance of this finding and how does it compare with the referenced prior study of the same gene? Are there look elsewhere effects from other studies done with the same methods drawn from the same gene data bank that weren't reported? Why is this gene more important in women than in men and does that confirm prior research?

Is this receptor and the associated genetic mutation implicated in other mental health conditions? Are there additions that have distinct genetic and biochemical pathways that have nothing to do with this receptor and genetic mutation? Are there therapies that target this biochemical pathway, either cognitive or drug based? Are their benefits that come with the vulnerability to addiction? Is the gene linked to a personality type?

The study is Christian Montag, Peter Kirsch, Carina Sauer, Sebastian Markett, Martin Reuter. The Role of the CHRNA4 Gene in Internet Addiction. Journal of Addiction Medicine, 2012; 6 (3): 191 DOI: 10.1097/ADM.0b013e31825ba7e7

Looking For Friends In High Places In Syria



From here.

04 September 2012

Which Environmental Effects Matter When?

It is widely understood that there are a variety of environmental exposures that have immense impact during pregnancy but much less impact at other times (e.g. folic acid deficiency, or fetal alcohol syndrome).  There is also a lot of medical literature that points to links during particular time periods during pregnancy, or for that matter, development generally, that there is enhanced vulnerability to particular environmental conditions. 

Generally speaking, these tend to be front loaded.  The first trimester of pregnancy is a more vulnerable time, in general, than the third trimester, which is more vulnerable than the first year after birth, which is more vulnerable than preschool, which is more vulnerable to elementary school, until in adulthood, one is much, more robust.

I've seen charts describing what happens at particular stages of pregnancy and after birth developmentally.  But, perhaps because I've never studied the right subjects in sufficient depth academically, I've never seen a chart really mapping out particular conditions arising from particular exposure periods (ideally, footnoted with peer reviewed journal references) in a comprehensive way.  I would welcome anyone who can point me to such a chart in the comments, either with a link or a reference to a print source.  I could embark on the task myself, but reinventing the wheel in this case would be a real waste.

Apple Amazingly Dominant

Apple became the world’s most valuable-ever company two weeks ago. It is worth $624bn, more than all the listed companies in Portugal, Ireland, Greece and Spain together. The employer of 63,300 people – each valued at $10m – is more valuable than all the shares available to investors in the MSCI China index, the international benchmark.
 
Via this post.

Given that Apple must have many employees who contribute below average amounts to market valuation, the contribution of the core and difficult to replace employees to market valuation must be high indeed.

According to a recent article at Fortune, Apple sells 8.8% of mobile phones, but it has 73% of profits in the market. Samsung sells 23.5% of phones and earns 26% of profits. Everyone else is barely breaking even or losing money.

Via this post.


 

03 September 2012

Twenty Four Seven Service

I was looking over the traffic statistics for Wash Park Prophet over the last week and noted that there was only a single hour in the last 168 hours (one week), 7 a.m. on Saturday, that no one visited this blog.  Thank you for reading.

31 August 2012

Charismatic Leaders Set Tone For Movements

How do you tell the difference between a movement on the verge of violence, a potentially violent movement still far from taking decisive action, and one that will instead choose non-violent direct action? A recent U.S. Department of Defense sponsored study argues that the emotional character of major public speeches from its leader. In other words, charismatic leaders can play their followers like violins and attentive observers can hear the implicit emotional directions that the leaders are offering.

The researchers analyzed the pattern of emotions conveyed when leaders spoke about their rival group and examined speeches given at three points in time before a specific act of aggression. They compared the results with the content of speeches delivered by leaders whose groups engaged in nonviolent acts of resistance such as rallies and protests.

Among leaders of groups that committed aggressive acts, there was a significant increase in expressions of anger, contempt and disgust from 3 to 6 months prior to the group committing an act of violence. For nonviolent groups, expressions of anger, contempt and disgust decreased from 3 to 6 months prior to the group staging an act of peaceful resistance.

Matsumoto says the findings suggest a leader's emotional tone may cause the rest of the group to share those emotions, which then motivates the group to take part in violent actions.

"For groups that committed acts of violence, there seemed to be this saturation of anger, contempt and disgust. That combination seems to be a recipe for hatred that leads to violence," Matsumoto said.

Anger, contempt and disgust may be particularly important drivers of violent behavior because they are often expressed in response to moral violations, says Matsumoto, and when an individual feels these emotions about a person or group, they often feel that their opponent is unchangeable and inherently bad.


From here.

Of course, domestically, in a society with strong legal protections for the freedom of speech, there is little that authorities can do with this kind of information. The leader who is driving the movement, quite possibly intentionally, doesn't actually rely on overt direct threats to achieve his objective, so it may be impossible to take direct legal action against a potentially violent group's leader. Violence seems to be driven more by the emotional subtext and framing in the speeches than by the particular calls to action themselves.

On the other hand, this analysis could be useful in formulating counterpropoganda initiatives designed to defuse the violent frenzy (or call for non-violent resistance) that a movement's charismatic leader is trying to whip up. Anti-terrorism rhetoric, presumably, ought to focus on defusing anger, destabilizing the sense of superiority that makes contempt possible, and densensitizing movements members to whatever it is that has incited their disgust. More succinctly, counterterrorist rhetoric ought to focus on a message of forgiveness, humility, and tolerance.

Afghan War Takes Horrific Turn

KABUL, Aug. 31, 2012 (Reuters) . . . A 12-year-old boy was kidnapped and killed in southern Kandahar province on Wednesday, his severed head placed near his body to send a warning to police, said provincial governor spokesman Jawid Faisal.

The brother of the boy, neither of whom were named by officials, was a member of the Afghan Local Police (ALP), a U.S.-trained militia charged with making Afghans in Taliban strongholds, like Kandahar, feel more secure, Faisal said.

"It's a Taliban warning to the ALP and to others who support the government," Faisal said of the killing, which happened in Kandahar's Panjwai district.

Taliban spokesman Qari Yousuf denied the group was involved.

Separately, a 6-year-old girl was beheaded in eastern Kapisa province on Thursday, said provincial police chief Abdul Hamed.

"We are not sure if she was beheaded by her family or the Taliban, but we know the Taliban control the area," Hamed said of the killing in Jalukhil village. He added that he could not send investigators to the area out of fears for their safety.

The murders follow the shooting or beheading of 17 young revelers attending a party in southern Helmand province this week, which officials said was the work of the Taliban, a charge the group also denied. . . .

In Kandahar's Zhari district, officials also said on Friday that a 16-year-old boy accused by the Taliban of spying for the government was beheaded and skinned in late July.

Such incidents highlight the difficulty that Taliban leaders have in enforcing discipline across an estimated 20,000 fighters spread from Afghanistan to Pakistan.

The central Taliban leadership is trying to improve the group's image in case it wants to push forward tentative reconciliation steps and perhaps even enter mainstream politics. But some militant units are hard to control, roaming the countryside and attacking those deemed immoral.


From here.

The only other places in the world that I can recall with recent cases where this level of brutality has been used as a political tactic are Mexico, as a part of their drug war, and a number of places in Africa, where interethnic conflicts seem to be at the root of the wars in question.

History and Context

The U.S. involvement in Afghanistan's civil war started shortly after 9/11 in 2001 and after more than a decade of U.S. military involvement is the longest U.S. military conflict in history other than the "Indian Wars", although certainly not the largest in terms of the number of troops involved or the number of U.S. casualties inflicted. But, Afghanistan has endured civil wars more or less continuously, with only brief respites, for more than three decades. Afghanistan is the most wretched non-African country in the world as measured by a wide variety of public health and economic measures. Yet, in the 1970s, before everything fell apart, it has seemed as if it was on track to become a fairly Westernized, modern, central Asian nation.

During the Reagan administration, the U.S. secretly supported Afghan insurgents against Soviet power brokers who eventually abandoned Afghanistan. The Taliban was a Saudi Arabian funded initiative that had almost achieved the goal of impose an orderly strict fundamentalist Islamic theocracy on Afghanistan and controlling almost the entire territory of Afghanistan against which a handful of warlords had been holding out when the U.S. took their side when the Taliban failed to hand over Osma bin Laden and shut down his terrorist organization's demands.

At first, the U.S. involvement (mostly consisting of CIA agents and U.S. Special Forces) and a newly created civilian democratic government put in place with a light U.S. diplomatic touch had seemed to have definitively vanquished the Taliban. But, this turned out to be an illusion. The organization had relocated to Northwestern Pakistan's frontier provinces where an entirely different insurgency against the Pakistani government was underway, and in a few years, insurgent activity in Afghanistan had surged and so had U.S. troop levels together with a few coalition partners such as the United Kingdom. The violent conflict is mostly concentrated in a handful of the country's provinces, while most of its provinces remain almost violence free, a pattern that to some extent reflects the ethnic coalition that has backed the Taliban in this multilingual and multiethnic patchwork of an "in between" country whose boundaries are to some extent arbitrary colonial era relics that are part of the large narrative of the collapse of the Ottoman Empire that culminated in its total collapse after World War I.

President Obama has pledged to leave the country (which the U.S. also uses to hold detainees in an wide ranging covert international war on terrorism) by the end of 2014. So far, there has been little organized and well articulated opposition to this time frame for U.S. withdrawal.

U.S. military involvement in Afghanistan and Iraq has led to major advances in tactics, military personnel skill sets, military equipment, and weapons systems relevant to fighting asymmetric counterinsurgency operations more effectively and efficiently, notwithstanding Defense Department distaste for devoting resources to and developing capabilities pertinent to these kinds of conflicts. Senior military officials have long perferred to focus on large scale conventional military conflicts with "near peers" like Russia and China with its most powerful weapons system - warships, nuclear attack submarines, fighter jets and heavy tanks. But, recent Defense Department cuts that reduce Army and Marine active duty force levels more deeply than the expensive weapon system oriented Air Force and Navy, threaten to deprive the U.S. military of the "soft" counterinsurgency skills that have recently been developed by veterans of U.S. involvements in conflicts including Bosnia, Kosovo, Iraq and Afghanistan.

U.S. military involvement in the region has produced regime change and eliminated a capacity to engage in international warfare in both Iraq and Afghanistan, two of Iran's most threatening neighbors. The region has also recently seen regime change in Tunisian, Libya (a transition in which the U.S. military played a role), Egypt, South Sudan, Kosovo (with U.S. military involvement), Bosnia (with U.S. military involvement) and Yemen. The U.S. is also playing a low key military and/or CIA role in the current insurgency in Syria. Israeli agents are widely believed to have been involved in recent instances of apparent sabatogue of Iran's nuclear program.

30 August 2012

Republicans Still Racist

A black camerawoman who works for CNN says she was "not surprised" to have two people at the Republican National Convention throw peanuts at her and say "this is what we feed animals."
From here. It is worth recalling that the people acting this way aren't just any ignorant, uninformed Republicans whose decision to affiliate with the party is a unilateral one made on a voter registration card. They are party leaders who worked their way up through a long and convoluted process one must weather to be selected as a delegate to the national convention by their Republican party official peers. They are "party insiders" who have an outsized say in running partisan politics in their home states. They are the embodiment of the party's values.

And, the comments aren't notable only because it shows that there are some bad apples in an event with a cast of thousands. Far more telling is the fact that someone could possibly think that this was socially acceptable behavior in the Republican political community in front of a member of the mass media. It is one thing to be unsuccessful at screening out every last racist from your political organization, and it is another to have an organization where racists feel comfortable revealing themselves.

Silver Lining: RNC Delegates Are Irrelevant

The only silver lining is that the delegates in this year's Republican National Convention have essentially no say in any issue of real public policy. The nomination was decided months ago in primary elections and caucuses. Romney's victory was conceded then by all candidates except Ron Paul, who never came close to having enough delegates to defeat Romney. By virtue of powerful traditions in American politics, a Presidential nominee always has more or less unfettered discretion to appoint his own running mate without consulting the delegates to the national convention. Party platforms are interesting historical documents but have almost no influence on the behavior of the party's elected officials.

Delegates in certain committees at the convention can tweak the formula for nominating a Presidential candidate a bit. But, the national party leadership's influence on how funds donated to the party are raised and managed is minimal in an era where most campaign contributions are raised by candidates and political action committees. The conventions of the national political parties are about networking and providing party leaders with bully pulpits, not about making decisions (except in the very rare cases where the primary and caucus results are inconclusive and there is a "brokered convention").

The United States made a decision more than a century ago to gut the power of rank and file parts of political parties relative to candidates, and by and large, its political institutions have adhered to that policy consistently ever since then. Modern American political parties are primarily a brand and a tool for organized networking of politically like-minded individuals. They are not directly an important source of funds for candidates, they don't have strict control over who their nominees are in elections, they engage in only modest amounts of candidate recruitment, and rather than imposing policy coordination or generating new policy ideas they merely articulate ideas that have independently been introduced and become popular among its members already. There is virtually no policy coordination between partisans at the local level and those at the state and federal level, there is only minimal interstate and state-federal policy coordination in either of the two major political parties, and political parties are only minimally involved in the process of making law by citizen initiative. The heavy lifting of partisan politics in America has been delegated to other institutions. The residual political party institutions merely provide a framework within which prospective candidates for elected office can be vetted in a somewhat organizated manner and act collectively in the process of litigating election law issues. (Of course, the situation in state legislatures and Congress where political parties are viable and powerful institutions is quite another thing.)

Texas Voter ID Law Struck Down

In a nutshell:
[T]he [unanimous] court bases its analysis [striking down a Texas voter ID law] on three basically uncontested facts:

(1) Minority voters are at least proportionately as likely as white voters in Texas to lack the documents needed for Texas’s new id law (which the Court calls perhaps the most “stringent” in the nation);

(2) the new i.d. law will put high burdens on poor people who lack id (many of whom would have to travel up to 200 or 250 miles at their own expense to get the i.d. as well as pay at least $22 for the documents needed to get the i.d.); and

(3) minority voters in Texas are more likely to be poor.

Using this simple structure, the court concludes that Texas, which bears the burden of proof in a section 5 case, cannot prove its law won’t make the position of protected minorities worse off. And the court suggests this was a problem of its own making: Texas could have made the i.d. law less onerous (as in Georgia, which the court suggests DOJ was probably right to preclear) and Texas could have done more to produce evidence supporting its side at trial, but it engaged in bad trial tactics.


A Texas claim that the Voting Rights Act provision striking down its voter ID law is unconstitutional is unlikely to prevail. An emergency order from the U.S. Supreme court staying the Court's ruling until the election is over is also unlikely.

Earlier this week, the 2012 Congressional redistricting plan for part of Texas by the Republican controlled legislature was also recently found to be invalid and that its drafted intentionally discriminated against minority voters. This ruling keeps the Court redrawn interim maps in place for the November election.

The decision . . . appears unlikely to affect the November elections because those electoral maps were drawn as interim replacements by a federal court in San Antonio. The interim maps were not at issue before the judges in Washington.

Gov. Rick Perry signed the Legislature’s maps into law last summer. But the federal court in Washington refused to grant preclearance, prompting the San Antonio judicial panel to create the interim maps to allow this year’s elections to proceed. The federal judges in Washington presided over a trial in January and issued their decision on Tuesday.
The finding that the redistricting process was conducted by sitting Texas Republicans in the state legislature in an intentionally discriminatory way also undermines an appeal by Texas of ruling invalidating the Texas voter ID law, enacted by the same Republican controlled state legislature, because there is recent judicially found evidence of intentional discrimination in Texas politics that shows that Section 5 preclearance of voting changes for Texas is necessary.

Time is not on the side of Texas in its efforts to appeal the redistricting ruling or the voter ID ruling. The closer a court making a ruling is to election day, the less inclined it will be to use its discretion in a close case to wreck havoc on the complicated electoral process by changing the status quo at the last minute.

Generally speaking, both rulings help Democrats in the state. The rulings are unlikely to impact the Presidential election, however, since Texas is generally viewed as an easy win for Romney anyway and electoral votes in the Presidential race are an all or nothing affair. Polling strongly favors Republican Ted Cruz in the open U.S. Senate race in Texas (which is not affected by Congressional redistricting since it is a statewide race), so that race won't likely be influenced much by these decisions either. But, Texas could have some close Congressional races and the redistricting ruling makes it more likely that the voter ID law ruling will matter in the Congressional races.

In the long run, this ruling once again cements the image of the Republican party as the anti-minority, anti-Hispanic party, which doesn't help them with the nation's long run demographic trends.

29 August 2012

Prenatal Risk Factors For Autism?

A New York Times opinion piece from last week by a research who argues for prenatal effects in the womb as a cause of some share of autism cases in a trade non-fiction book. Some of the key observations and evidentiary points from the scientific literature that the author is advocating for regarding the pressing health issue are as follows:

At least a subset of autism — perhaps one-third, and very likely more — looks like a type of inflammatory disease. And it begins in the womb. . . . In autistic individuals . . . [i]nflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved in inflammation are switched on. . . .

A population-wide study from Denmark spanning two decades of births indicates that infection during pregnancy increases the risk of autism in the child. Hospitalization for a viral infection, like the flu, during the first trimester of pregnancy triples the odds. Bacterial infection, including of the urinary tract, during the second trimester increases chances by 40 percent.

The . . . mother’s attempt to repel invaders — her inflammatory response — seems at fault. . . .Inflaming pregnant mice artificially — without a living infective agent — prompts behavioral problems in the young. In this model, autism results from collateral damage. It’s an unintended consequence of self-defense during pregnancy.

Yet to blame infections for the autism epidemic is folly. . . . the epidemiology doesn’t jibe. . . . Better clues to the causes of the autism phenomenon come from parallel “epidemics.” The prevalence of inflammatory diseases in general has increased significantly in the past 60 years. As a group, they include asthma, now estimated to affect 1 in 10 children — at least double the prevalence of 1980 — and autoimmune disorders, which afflict 1 in 20. Both are linked to autism, especially in the mother. One large Danish study, which included nearly 700,000 births over a decade, found that a mother’s rheumatoid arthritis, a degenerative disease of the joints, elevated a child’s risk of autism by 80 percent. Her celiac disease, an inflammatory disease prompted by proteins in wheat and other grains, increased it 350 percent. Genetic studies tell a similar tale. Gene variants associated with autoimmune disease — genes of the immune system — also increase the risk of autism, especially when they occur in the mother. . . .

Mothers of autistic children often have unique antibodies that bind to fetal brain proteins. A few years back, scientists . . . injected these antibodies into pregnant macaques. (Control animals got antibodies from mothers of typical children.) Animals whose mothers received “autistic” antibodies displayed repetitive behavior. They had trouble socializing with others in the troop. In this model, autism results from an attack on the developing fetus. . . .

A mother’s diagnosis of asthma or allergies during the second trimester of pregnancy increases her child’s risk of autism. . . . Amniotic fluid collected from Danish newborns who later developed autism looked mildly inflamed. . . .

Why are we so prone to inflammatory disorders? . . .

[P]eople living in environments that resemble our evolutionary past, full of microbes and parasites, don’t suffer from inflammatory diseases as frequently. . . . Generally speaking, autism also follows this pattern. It seems to be less prevalent in the developing world. Usually, epidemiologists fault lack of diagnosis for the apparent absence. A dearth of expertise in the disorder, the argument goes, gives a false impression of scarcity. Yet at least one Western doctor who specializes in autism has explicitly noted that, in a Cambodian population rife with parasites and acute infections, autism was nearly nonexistent.

For autoimmune and allergic diseases linked to autism, meanwhile, the evidence is compelling. . . . asthma and autism follow similar epidemiological patterns. They’re both more common in urban areas than rural; firstborns seem to be at greater risk; they disproportionately afflict young boys. In the context of allergic disease, the hygiene hypothesis — that we suffer from microbial deprivation — has long been invoked to explain these patterns. . . . it should apply to autism as well. (Why the male bias? Male fetuses, it turns out, are more sensitive to Mom’s inflammation than females.)


A few points of context and emphasis are in order here:

* A variety of past data has already established a very strong genetic component to autism associated with rare rather than common genetic variants (sometimes in the form of deletions and copy number variants, rather than specific SNPs), in a particular complex of genes with particular functions. A majority of all autism cases probably have a genetic basis, although the particular mutations that are involved in any particular case vary widely. Non-genetic pre-natal causes are, at most, an important cause of only a minority of autism case.

* The autoimmune hypothesis offered above is not exclusive of genetic causes. In a significant share of the up to one third of pre-natal inflamation associated cases cited, the inflamation has a genetic component. In those cases where there is not a genetic component, the mechanism described sounds like an epigenetic effect in many cases. Epigenetic effects can be hereditary, although unlike true genetic effects, they usually persist for only a few generations and can be induced during someone's lifetype by means other than mutations.

* Childhood vaccination does not cause autism. Few cases of non-causation are better established.

* Even in cases where the environmental effects described above are at work, autism is still congenital, i.e. present at birth. Indeed, all of the evidence of maternal inflamation during pregnancy increasing autism risk involved the first two-thirds of the pregnancy, with a significant share of that risk attributable to early parts of the pregnancy when the mother may not even know that she is pregnant. Autism has not been convincingly linked in published scientific studies to the child's diet or parenting styles, for example.

* Controlling inflamation during pregnancy poses its own risk, and can't be limited to the period when people know that they are pregnant alone since the high risk period is front loaded. Many, if not all, anti-inflammatory drugs may present their own risks to a fetus during pregnancy. The author of the article quoted above argues for a comprehensive rethinking of our public health measures to address the problems associated with an overly hygenic environment, without definitively proposing a single solution. But, this calls for a balancing analysis. Lack of hygene causes deadly and unpleasant diseases. Excessive hygene can promote succeptibility ot excessive autoimmune responses. Even though Cambodia has lower rates of autoimmune disorders and autism, very few people would trade that benefit for the overall public health harms associated with its relative lack of hygene. Some level of excessive autoimmune disfunction may be a price worth paying for a reduced incidence of infectious disease agents.

* Autism is the fever of mental health conditions. It is a common symptom of a disorder with a non-specific cause. Indeed, this is more than just an analogy. Autism symptoms, like fevers, appear to be associated with inflamation.

* Regardless of the epidemiology of autism, if a large subset of autism cases involve an autoimmune inflamation mechanism, then early diagnosis and treatment designed to reach that mechanism, particularly during period key to brain development, such as anti-inflammatory drugs, in theory, might be effective. Treatments designed to selectively reverse epigenetic methylation of a child's genome related to autoimmune function also look like a promising avenue to investigate. But, please don't rely on me in turning to a totally unproven theory as a medical treatment without advice from a doctor. I'm a lawyer with a solid background in mathematics who stays abreast of the literature, not a doctor.

* Universal health care has collective public health benefits. One reason that really good population genetic and epidemiological studies often come from Scandinavia is that countries like Denmark have comprehensive national medical records in a well indexed form that is linked to other data about the patients that can be used for medical research. Strict American medical privacy and human subjects research laws make these kinds of studies almost impossible to conduct in the United States with the same level of rigor and statistical power. Nothing has more statistical power than a complete data set for an entire national population.

20 August 2012

What If Someone Else Wrote Lord of The Rings?

Explorations about how the fantasy epic might have been written in the hands of the likes of Ayn Rand, Ernest Hemingway, and Oscar Wilde are linked here.

17 August 2012

About 40% of U.S. Suicides Linked To Parasite

About 10-20 percent of people in the United States have Toxoplasma gondii, or T. gondii, in their bodies, but in most it was thought to lie dormant. . . . In fact, it appears the parasite can cause inflammation over time, which produces harmful metabolites that can damage brain cells. "Previous research has found signs of inflammation in the brains of suicide victims and people battling depression, and there also are previous reports linking Toxoplasma gondii to suicide attempts. . . . In our study we found that if you are positive for the parasite, you are seven times more likely to attempt suicide."
From here (emphasis added).

If these numbers are right, infected people make up about 15% of Americans, but about 55% of all Americans who attempt suicide. (The study itself was conducted in Sweden with 54 probands and 30 controls.)

This is huge. To be clear, the study itself looked only at non-fatal suicide attempts and not completed suicides. But, the linked article notes that there were 36,909 suicides in 2009 in the United States. Thus, if the percentage of suicide attempts resulting in death is similar for both infected and non-infected individuals, this parasite may be the statistical proximate cause of more than 14,000 suicides a year in the United States; 40% of the total number of U.S. suicides.

The only other infectious agent with a comparable mortality impact in the United States is influenza. But influenza deaths, which are predominantly among infants, people with compromised immune systems, and the elderly, while suicide is found in appreciable frequencies at all ages from adolescence onward.

Also, "90 percent of people who attempt suicide have a diagnosed psychiatric disorder. If we could identify those people infected with this parasite, it could help us predict who is at a higher risk."

The mere fact that one has a parasite that infects 45,000,000 people in the U.S. of whom 20,300 a year commit suicide, does not itself create an overwhelming individualized risk, and some of those people who were infected with the parasite (statistically) would have committed suicide anyway.

But, the presence of this infection is a much more powerful screening tool when combined with the stastically powerful screen of a previously diagnosed psychiatric disorder (and, in fact, only some diagnosed psychiatric disorders, not all of them, are associated with elevated suicide risk), which is probably mostly independent of the incidence of infection with this common parasite. There are tens of millions of Americans who have diagnosed psychiatric disorders as well, but the intersection of the two categories is probably small enough to justify increased vigilance for the individuals of the appropriate ages (i.e. not young children) who have both risk factors.

Also, knowing that this parasite has a profound mortality impact, at least in certain populations, may make finding a way to treat this infection, previously viewed as mostly harmless, a major new public health priority. An effective diagnosis and treatment for this parasitic infection, if affordable, could be the biggest advance for public health since the invention of vaccines again common viral diseases and antibiotics against bacterial diseases.

The underlying study is:

Yuanfen Zhang, Lil Träskman-Bendz, Shorena Janelidze, Patricia Langenberg, Ahmed Saleh, Niel Constantine, Olaoluwa Okusaga, Cecilie Bay-Richter, Lena Brundin, Teodor T. Postolache. Toxoplasma gondiiImmunoglobulin G Antibodies and Nonfatal Suicidal Self-Directed Violence. The Journal of Clinical Psychiatry, 2012; DOI: 10.4088/JCP.11m07532

GDP Doesn't Measure Economic Well Being

Gross national product aka GNP (or the slight variant on it, gross domestic product aka GDP) are measures of aggregate national production in the monetary economy.  Two calendar quarters of GDP decline is the standard definition of a recession.  GDP growth is the standard measure of a healthy economy that has the virtue of being readily comparable internationally and between units within federal states. 

GDP per capita is a reasonable useful first order approximation of economic standard of living, and of value creation, but is flawed in both respects, and one does not need to resort to something far more subjective and hard to compare like Bhutan's National Happiness Index to address these flaws.

Intra-Household Production

One of the big flaws of GDP is that it fails to adequately measure intra-household production.  Paying for child care or a maid service or eating out increases GDP.  Caring for your own children, or cleaning your own home, or adding value by cooking, serving and cleaning up after your own meals as part of a family, even if it provides an identicial or superior value to paying for these services, does not increase GDP.  Selling agricultural products in a marketplace increases GDP, while growing food for personal consumption as a gardener or subsistance farmer does not.

As long as the proportionate share of intra-household production over time, or between compared regions stays more or less constant, this isn't all that serious a problem.  The trendlines and comparisons remain valid, even though the absolute numbers are wrong.  But, it is problematic if there is a material shift from market production to intra-household production (or visa versa), or if two compared regions have very different levels of intra-household production.

This is serious problem in development economics, because GDP is a very poor measure of economic production in less developed countries where a very large share of economic activity, for example, involves subsistance farming.

Notably, GDP already includes one important category of intra-household value creation: imputed rental value of homes occupied by homeowners.  Extending GDP measures to impute value to intra-household personal services and other forms of intra-household production would not be a revolutionary reform of the measure.

Leisure and Other Non-Monetary Goods

Another big issue, which isn't so much a flaw in the metric as it is a flaw in how to use the metric, is that it doesn't capture tradeoffs between work and leisure.  It is possible to look at GDP per hour worked, or per average number of working days per year, which measure productivity and which also implicitly place an economic value on leisure.  People in a nation where the average worker voluntarily goes on vacation for one month a year are both more productive and more affluent than people in another nation where the per capita GDP is the same, but the average worker voluntarily goes on vacation for just two weeks a year.

A similar problem arises with positive and negative externalities that the monetary economy fails to capture.  GDP does not take into account air quality, for example, or if it does, may actually treat air pollution as something that increases GDP because it increases health care spending.  A cost-benefit analysis valid air regulation that reduces health care spending by more than it costs to implement the pollution control measures could very easily reduce GDP even though it improves quality of life and makes people more economically prosperous.  But, because the benefit from the non-market good (clean air) doesn't get traded monetarily, it doesn't go into the GDP computation.

Quality

A third big issue, which was a huge problem in non-market Soviet economies that were trying to boost GDP, and is also a big problem in making intertemporal comparisons, is measuring changes in quality over time.  If you can buy a better TV than could have ten years ago for the same price, a nation is better off even if the amount of money spent producing TVs in the same now as it was ten years ago, but GDP does not capture this reality.

Similarly, if two countries spend the same amount per capita on health care, but one country uses modern medical methods and gets good outcomes from that spending, while the other uses leeches and snake oil and gets bad outcomes from that spending, nothing in the GDP measure distinguishes between the two cases.

In general, quality issues tend to overvalue past economic production relative to current economic production, and also tend to be particularly problematic for comparing GDP between regions when a good or service is not easily traded. 

In  theory, market mechanisms in international trade will tend to resolve cases where the same dishwasher sells for $100 in one country and $1,000 in another, for the same good.  But, prescription drugs and medical equipment, for example, present just that conundrum.  An MRI machine sold in the United States contributed much more to the U.S. economy than the same MRI machine sold in Japan where identical medical equipment is much cheaper. 

Many services like health care and education, are not easily traded or commoditized, so it is particular hard to compare them, even though at some level it may be clear that better outcomes are being provided for similar expenditures in different places.

Zero Value Or Inefficient Production

Perhaps the most difficult correction to GDP, conceptually anyway, is the notion that some activity in the monetary economy may have zero or negative value.  More generally, GDP doesn't measure the efficiency with which inputs and converted into outputs.  This raises many of the same issues as the quality issue.

Health care is one place where this can be well illustrated.  Suppose that one country spends $2,000 per capita to receive a particular set of healthcare outcomes, and another country spends $5,000 per capita to receive the same healthcare outcomes.  By this measure, the country with the more efficient health care system looks more prosperous by GDP measures than the one with the less efficient health care system, all other things being equal, when in fact, their prosperity would be identical.  The marginal $3,000 per capita that the second country is spending to receive the same product is adding no value to its economy.

In the Soviet economies, again, this was a huge issue, because the Soviet economies often produced too much of goods that no one needed, and too little of goods that people did need.  But, GDP isn't designed to measure the use to which good are produced are put.  If the economy churns out too many televisions and people start to use them as dinner plates, GDP doesn't care, even though the actual value the excess televisions are adding to the economy has plummeted.

In a well functioning market economy, the private sector is supposed to produce goods at efficient prices and in efficient amounts, so neither of these distortions are material.  But, all economies are mixed economies to some extent, and the private sector may have systemic distortions.

Another place this comes into play is in the guns v. butter issue.  GDP, in general, assumes that production purchased by government is worth what government adds value to the economy proportionate to what government pays for it.

Many economists aren't too worried about the zero value production issue in the private sector because they assume that goods produced for consumption in the private sector are appropriately valued for aggregate economic purposes based on actual production at market prices because the mechanism of a reasonable functional market economy place natural checks on the production of useless goods or overpriced goods.  In a reasonably functional market economy, this isn't a grossly unreasonable assumption and has immense practical administrative value in calculating GDP.

But, few economists are equally comfortable in saying that a decision of the elected officials who make spending decisions for government is as an effective a means of preventing the production of useless or overpriced goods as a private market mechanism.  A bridge to nowhere that costs $100 million to build adds the same amount to GDP as a bridge that is used constantly.  A $1 billion dollar warship adds $1 billion to GDP whether it greatly enhances the nation's military might or is actually worthless.  Likewise, if the government spends $1 billion on a military cargo plane when an identical one could be purchased in the private sector for $100 million, because the Defense Department is bad at getting good prices on defense contracts, GDP goes up by $1 billion rather than $100 million.  Certainly, military spending, in general, does not directly impact consumer stadnard of living.  Prison spending on a wrongfully convicted inmate adds the same amount to GDP as prison spending on someone who committed a serious crime and would reoffend if not incarcerated.

Valuing all spending at actual transaction prices makes GDP computation much less subjective.  But, if ignores the capacity of the economy to add value by increasing efficiency or quality rather than merely increasing production in the narrow sense.  The problems related to zero marginal value production in GDP computation are essentially a more subtle variation on the problems with using Marx's labor theory of value, which economists have long derided.

Progressive Insurance Not

I care more about what companies do than what they say.  Call you company what you will.  Spend millions on advertising.  But, what matters from a casualty insurance company is that it won't screw you over when the chips are down. 

Progressive Insurance failed that test in a recent highly publicized case, not only denying benefits to its insured in a fairly run of the mill accident, but intervening in the litigation brought by their insured against the other driver against their insured.  Bad viral Internet PR launched by Matt Fischer, the brother of the insured, Katie, who was killed in the accident, persuaded the insurance company to ultimately back down.  But, the damage was done.  I would not recommend that anyone I know buy casualty insurance from them.

03 August 2012

Scalia's Absurd Take On Gun Control (Again)

In light of the July 20 massacre in which a gunman killed 12 moviegoers in Colorado, Scalia was asked whether legislatures could ban the sale of semiautomatic weapons. He said the 2008 [Heller] ruling stated that future cases will determine "what limitations upon the right to bear arms are permissible. Some undoubtedly are."


Scalia -- a proponent of the idea that the Constitution must be interpreted using the meaning of its text at the time it was written -- cited "a tort called affrighting" that existed when the Second Amendment was drafted in the 18th century making it a misdemeanor to carry "a really horrible weapon just to scare people like a head ax."
"So yes, there are some limitations that can be imposed," he said. "I mean, obviously, the amendment does not apply to arms that cannot be hand-carried. It's to 'keep and bear' (arms). So, it doesn't apply to cannons. But I suppose there are handheld rocket launchers that can bring down airplanes that will have to be ... decided."
From here.

What did the United States ever do to deserve a Supreme Court justice who thinks that it might be constitutional to ban carrying a head ax, but thinks banning a handheld rocket launcher that can bring down an airplane might be a hard question?  And, why would a Supreme Court justice reach the linguistically inaccurate assumption that "bearing arms" in this context means literally carrying them by hand?


To restate my own view on the matter, I think that any coherent modern individual right to bear arms under the Second Amendment cannot properly to be viewed as a political right incident to the collective right of the People to replace their governments by revolution as expressed in the Declaration of Independence, in scenarios like the one currently unfolding in Syria.  The constitution is not a suicide pact.  It also simultaneously declares that taking up arms against the United States or a State constitutes the crime of treason punishable (then at least) by death (although no longer working a "corruption of blood").


Instead, the most sensible theory of an incorporated individual right to bear arms under the Second Amendment is that it is the flip side of the absence of an affirmative duty in American law on the part of the state to protect an individual from private violence. 


In other words, it is an imperfect alternative to governmental indifference or delay in the face of rapists, murders, robbers, homoe invasion burglars, lynch mobs and the like, without regard to whether the cause of law enforcement inaction in inability, negligence, or deliberate indifference to a person's safety.  By its own reference to a well regulated militia, it implies that reasonable regulation of the right to bear arms is permissible, and the courts should analyze reasonableness in the context of backstopping the ability of individuals to protect themselves from private violence in the face of potential law enforcement inaction.  The reference to a militia in this context also dovetails with the notion that in the 18th century volunteer citizen's patrols, sometimes called militias, rather than professional police departments that would not be invented for another half a century at least, were a central institution for the enforcement of criminal laws.


This theory of the Second Amendment still leaves many hard cases related to the issue of what regulation is reasonable.  But, it at least provides an intelligible way of weighing the relevant considerations in the modern era, that does not rely on esoteric accounts of the detailed state of the common law and statutory law in 18th century colonial America, and respects the values that makes sense in the large individual human rights oriented interpretation that we have given to the Bill of Rights as a whole over two centuries (well mostly the last century, before which the Bill of Rights was mostly ignored as a means to declare laws unconstitutional) of interpretation.  The Constitution was kept short, in part, in order to retain flexibility that wouldn't keep our political system hidebound by the kind of accidental and long forgotten precedents that Scalia puts so much stock in under his crabbed version of originalism.


Yes, the intent of the Founders is relevant to the analysis of the meaning of the constitution, but a drafters intent analysis ought to be conducted at a much higher level of generality.  Judges should be trying to discern from the Founders statements and the overall context, the core principles behind a constitutional provision, rather than minutae of how cases that could never have come up then would have been decided by those particular people at that particular time.  Originalism also needs to recognize that not every law and common law decision in force in 1791 was necessarily constitutional even then under the newly adopted Bill of Rights, which marked a revolutionary step in law making and not simply a rubber stamping of the status quo.  It was adopted because the Founders were concerned that the 1789 status quo might be flawed.  The Bill of Rights was adopted because the Founders felt that some of the rights it protected could be in the near future, or already were being, violated by the new federal government of the independent and united States who had adopted the new constitution in 1789 that replaced the Articles of the Confederacy (not to be confused with the Confederate States of American in 1861) that had preceded it. 


The nation was just a quarter century old at the time, and no one was thinking about how the exact language its provisions might apply in a science fiction future where a man could fly, or another man could hold in his hands a weapon that might shoot hundreds of people out of the sky, two centuries later.  Even mass produced semi-automatic or revolving pistols were far in the future at that point.


This isn't to say that the Second Amendment should exclude any weapon that didn't exist at the time of the Founding, but the opposite assumption makes no more sense.  The issue is why the Founders thought it made sense have the Second Amendment, and why the drafter of the 14th Amendment under the authority of which the Second Amendment is applied to the states felt it was necessary to expand the scope of federal power over state law in the 1860s, not what its specific scope the Second Amendment was believed to have in 1791.