false positives

More than 2,000 false convictions in past 23 years

http://usnews.msnbc.msn.com/_news/2012/05/21/11756575-researchers-more-than-2000-false-convictions-in-past-23-years?lite

EKGs and protecting young athletes from cardiac death

Given the infrequent but harrowing experience of young competitive athletes having sudden cardiac death, some are advocating that highschool and college athletes should undergo EKG to determine if they have hypertrophic cardiomyopathy (a thickening of the heart muscle).  

In past, EKGs had a 20% rate of false positives.  Improvements in standards for reading EKGs have reduced this rate.  The belief is that when coupled with a thorough physical, including an EKG for young athletes will identify those at risk for heart failure.  In an article on NYTimes.com, Anahad O'Connor reportss:

In a study published in 2010 in Annals of Internal Medicine, Dr. Matthew T. Wheeler and colleagues at Stanford University found that adding EKGs to sports physicals for young athletes would create “a large benefit in a small number of individuals.” But they would save enough lives to be considered cost effective, with a net cost of roughly $89 per person screened.

Based on their analysis, however, Dr. Wheeler said that EKGs make sense only for high school and college athletes — in children and adolescents, the risk of sudden cardiac death is lower — who compete in high-intensity sports like basketball, football and soccer. (Low-intensity sports, he said, include golf and bowling.)

“We are not advocating this as a mandatory test for all students or all athletes,” said Dr. Wheeler, a fellow in cardiology at Stanford Medical School.

Some experts think the time has come for thorough heart screenings for all young athletes. Researchers at the Texas Heart Institute are even looking at the prevalence of heart abnormalities in middle-school students and the feasibility of complete screenings, combining EKGs and imaging tests.

The goal of the project, which is financed through a $5 million private grant, is to screen 10,000 students in Houston middle schools, said Dr. Jim Willerson, the lead investigator and president and medical director of the Texas Heart Institute. “If we save even one life, it will be worth it,” he said.

What Dr. Willerson does not say is how many unnecessary procedures and concerns will be foisted on healthy youths in an effort to save that one life.

Death Penalty, errors vs deterrence

Andrew Gelman on the death penalty:

My larger perspective on the death penalty, informed by my research with Jim Liebman several years ago, is that you can only accept capital punishment if you’re willing to have innocent people executed every now and then. And, the more effective you want the death penalty to be, the more innocents you have to execute.

The occasional execution of innocent people might be deemed ok in some settings—-they shoot deserters in wartime, and if a country is in the midst of a big enough crime wave, I could see people accepting the need for the occasional lethal mistake of the judicial process. My point here is just that if you want to execute people on a regular basis, you’re gonna make some mistakes. We saw this in our research on death-sentencing reversals, which were not merely the actions of a few liberal court panels.

He also wrestled with the topic in 2006:

The death penalty as a decision-analysis problem?

Policy questions about the death penalty have sometimes been expressed in terms of the number of lives lost or saved by a given sentencing policy. But I think this direction of thinking might be a dead end. First off, as noted above, it may very well be essentially impossible to statistically estimate the net deterrent effect of death sentencing–what seem like the “hard numbers” (in Richard Posner’s words, “careful econometric analysis”) aren’t so clear at all.

More generally, though, I’m not sure how you balance out the chance of deterring murders with the chance of executing an innocent person. What if each death sentence deterred 0.1 murder, and 5% of people executed were actually innocent? That’s still a 2:1 ratio (assuming that it’s OK to execute the guilty people). Then again, maybe these innocent people who were executed weren’t so innocent after all. But then again, not every murder victim is innocent either. Conversely, suppose that executing an innocent person were to deter 2 murders (or, conversely, that freeing an innocently-convicted man were to un-deter 2 murders). Then the utility calculus would suggest that it’s actually OK to do it. In general I’m a big fan of probabilistic cost-benefit analyses (see, for example, chapter 22 of my book), but here I don’t see it working out. The main concerns–on the one hand, worry about out-of-control crime, and on the other hand, worry about executing innocents–just seem difficult to put on the same scale.

 

False alarms on airplanes

http://www.nytimes.com/aponline/2012/04/20/world/europe/ap-eu-britain-emergency-landing.html?hp

Following an emergency landing, 15 passengers were injured while evacuating a Virgin Atlantic Airbus 330-300.  All 300 passengers had to use slides to evacuate from the plane, and Gatwick airport was closed for 90 minutes.

A series of alarms had gone off during the flight.  An investigation revealed that there was nothing wrong with the plane, rather, the alarm system was faulty.

Entrepreneurial doctors and rare cancer screening

Entrepreneurial doctors are now advocating for screening of rare cancers, like esophageal cancer.  Dr. Jonathan Aviv, a gastroenterologist in Tarrytown NY, for instance, advocates for the use of a screening esophagoscopy --- which involves putting a camera up a patient's nose, and then down their throat.  However, there is no evidence that screening for this cancer reduces the risk of dying from the disease.  Moreover, The American College of Gastroenterology and the American Cancer Society recommend against routine screening.

The procedure's costs and risks are described in a Reuters article by Frederik Joelvig:

Because the device does not trigger a gag reflex, and thus eliminates the need for sedation, it shaves about $1,000 off the cost of a traditional endoscopy and trims an hour-long exam to just a couple of minutes. The main physical risk is a nose bleed, and experts warn that a false-positive test result is another.

Labs charge between $250 and $350 to analyze a biopsy like the one Henry had, and insurers reimburse similar amounts to doctors for the procedure. Follow-up tests and preventive treatments can be more expensive.

When one of Aviv's biopsies turns out positive, he sends his patient to Mount Sinai Medical Center, which is affiliated with Aviv's practice. There, gastroenterologists perform an in-depth exam with sedation to determine whether the patient should be treated immediately or undergo follow-up testing. At that point, Aviv says, "in my mind, I've saved their life. And in the patient's mind, I've saved their ass."

The hospital's endoscopy suite says it receives eight or so such referrals a month from Aviv's practice. Yet the suite's director doesn't support Aviv's campaign. "I am not recommending (routine) screening," says Dr. Sharmila Anandasabapathy, a gastroenterologist. She does think all people over 40 with chronic reflux symptoms should be checked.

Dr. Gaelyn Garrett, who heads the voice center at Vanderbilt University in Nashville, Tennessee, says Aviv is "a visionary guy," but that "it is overstepping what the evidence is telling us to suggest that everybody over 50 get esophagoscopy."

 

Shaken baby syndrome

From Slate:

In 1971, pediatrician Norman Guthkelch helped come up with the medical diagnosis of shaken-baby syndrome. Guthkelch and another pediatrician each wrote a paper proposing that unexplained bleeding in the brain of infants could occur because of whiplash—via shaking—without causing a visible neck injury and without direct impact to the head. That diagnosis became the basis for “do not shake” campaigns and, over the years, hundreds of criminal prosecutions for child abuse.

Now Guthkelch is worried that medical examiners and prosecutors have been too quick to turn to the shaken-baby diagnosis—and that innocent people may be in prison as a result.

 

http://www.slate.com/articles/news_and_politics/crime/2012/03/when_babies_die_are_doctors_too_quick_to_blame_it_on_shaken_baby_syndrome_.html

False kidnapping alarms in maternity wards can get fathers busted

 

http://usnews.msnbc.msn.com/_news/2012/02/24/10502120-rfk-son-arrested-in-ny-hospital-maternity-unit-clash-police-say

According to a Mount Kisco, N.Y. police report obtained by NBC New York, Douglas Kennedy, 44, took his baby from the newborn unit of Northern Westchester Hospital on Jan. 7, against the instructions of hospital staff who told him the infant needed to stay there. He faces misdemeanor charges.

Elliot Taub, the two nurses' attorney, said Lane and Luciano "called a ‘code pink,’ that is, it looks like its someone trying to abscond from the hospital with a newborn. That alerts the security staff and when it escalated, they hit what's called a 'code purple,' which means there is someone who is acting inappropriately, highly offensive, is a danger in the hospital."

using false positives in personality disorders to discharge soldiers

http://www.nytimes.com/2012/02/25/us/a-military-diagnosis-personality-disorder-is-challenged.html?pagewanted=1&hpw

The New York Times explores the case of Captain Susan Carlson, who enlisted in the army in her 50s, and was subsequently discharged for having a personality disorder.

She disputed the diagnosis, but it was not until months later that she found what seemed powerful ammunition buried in her medical file, portions of which she provided to The New York Times. “Her command specifically asks for a diagnosis of a personality disorder,” a document signed by the psychiatrist said.

Veterans’ advocates say Captain Carlson stumbled upon evidence of something they had long suspected but had struggled to prove: that military commanders pressure clinicians to issue unwarranted psychiatric diagnoses to get rid of troops.

“Her records suggest an attempt by her commander to influence medical professionals,” said Michael J. Wishnie, a professor at Yale Law School and director of its Veterans Legal Services Clinic.

Since 2001, the military has discharged at least 31,000 service members because of personality disorder, a family of disorders broadly characterized by inflexible “maladaptive” behavior that can impair performance and relationships.

For years, veterans’ advocates have said that the Pentagon uses the diagnosis to discharge troops because it considers them troublesome or wants to avoid giving them benefits for service-connected injuries. The military considers personality disorder a pre-existing problem that emerges in youth, and as a result, troops given the diagnosis are often administratively discharged without military retirement pay. Some have even been required to repay enlistment bonuses.

By comparison, a diagnosis of post-traumatic stress disorder is usually linked to military service and leads to a medical discharge accompanied by certain benefits.

 

False confessions

http://www.nytimes.com/2012/02/26/opinion/sunday/why-do-innocent-people-confess.html?hp

Mistaken identity/wrongful arrest cases in Denver

Per the NYTimes:

there were more than 500 cases from 2002 and into 2009 in which Denver authorities, armed with warrants, arrested or jailed the wrong person.

This month the A.C.L.U. received a second trove of records that show about 100 additional such cases since August 2009, the group said.

http://www.nytimes.com/2012/02/16/us/lawsuit-in-denver-over-hundreds-of-mistaken-arrests.html?hpw