Wednesday, February 22, 2006

Reading the Times

It's conventional to beat on the New York Times as outdated, unreliable, politically suspect (which way depends on your own wingerhood), but it's still got some good and important material in it and I like its online layout better than any of the other major dailies.

Here's a disturbing story about the "fee for service" nature of criminal justice
Almost every encounter with the criminal justice system these days can give rise to a fee. There are application fees and co-payments for public defenders. Sentences include court costs, restitution and contributions to various funds. In Washington State, people convicted of certain crimes are also charged $100 so their DNA can be put in a database.

Private probation companies charge $30 to $40 a month for supervision. Halfway houses charge for staying in them. People sentenced to community service are required to buy $15 insurance policies for every week they work. Criminals on probation and parole wear global positioning devices that monitor their whereabouts — for a charge of as much as $16 a day.

The sums raised by these ever-mounting fees are intended to help offset some of the enormous costs of operating the criminal justice system. But even relatively small fees — $40 per session, say, for a court-ordered anger management class or $15 for a drug test — can have devastating consequences for people who emerge from prison with no money, credit or prospects, and who live in fear of being sent back for failing to pay.

"The difference between 30 years ago and today," said George H. Kendall, a lawyer with Holland & Knight in New York who represents Mr. Rideau, "is that people who everyone agrees are poor are leaving the courthouse significantly poorer."

Prosecutors and political leaders often say it is only fair that criminals rather than taxpayers pay for what it costs to protect the public.

But Judge James R. Thurman of the Magistrate Court in Lee County, Georgia, said his state's many fees, known there as add-ons, are a backdoor way to make poor people pay for the free lawyers guaranteed to them by the United States Supreme Court's decision in Gideon v. Wainwright in 1963.
I have no problem with restitution to victims; but "debt to society" is a metaphor, people!

Something which the Grand Rounds should address: error rates for doctors in major cases are unchanged by modern technology:
With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.
I have a little trouble with cause and effect here: by definition, people have to die of something; that one fifth of deaths result from misdiagnosis at the very end doesn't mean that people don't benefit from advances in medicine delaying that end more effectively.

The question where are the moderate Muslims has several answers; this article points out the legal obstacles to social, political and religious criticism in many majority-Muslim countries.

Also, not from the Times, but about tempora and mores see Dan Kahan's summary of Scalia's AEI presentation on his resistance to foreign law citations in US opinions. There's more details here, which clearly states that Scalia believes international law (not just "foreign" law) is irrelevant unless explicitly adopted and enacted by Congress.
Update: Scalia also said, at that event, "Legal text should be interpreted neither strictly nor loosely. It should be interpreted reasonably." Well, sure. That's what the "living document" people have been saying for years. When's he gonna start?


protected static said...

Quick point: I don't think that the article about diagnostic software meant that the 20% misdiagnosis rate is at the end of life; rather, fatal illnesses are misdiagnosed (and only identified after autopsy) 20% of the time.

Ahistoricality said...

I'm gonna just go ahead and admit that I don't get the difference. How do you misdiagnose a fatal illness other than at the end of life? And if it's not what caused the fatality, then why would you call it a "fatal" illness?

I'm not trying to be snide: I honestly don't know what distinction you're trying to make. If I'm making a statistical or methodological faux pas, I'd like to know what it is.

protected static said...

Personally, I think the sentence is poorly-written - what I think is significant is that potentially up to 20% of people with illnesses that can kill them are misdiagnosed. Case in point: the article talks about a child with an atypical form of leukemia - even under the best-case scenario, the child probably only had 18-24 months to live, but had the doctors not realized their error in administering chemotherapy, they would have killed that child. Period.

I can't speak to quality of life issues faced by that child and their family over those 18 months, but at least a proper diagnosis gave them a possible treatment, however remote that chance might be. They had at least a partial fighting chance because the diagnosis was corrected - otherwise, they would have had no chance at all.

Imagine a treatable chronic condition that has the potential to eventually kill you, but if correctly diagnosed in a timely fashion, proper treatment will allow you to enjoy many more years of life. Also imagine that this condition will kill you if left untreated.

Now imagine that your physician misdiagnoses you...

That's the distinction that I think the article failed to draw clearly.