Thursday, July 31, 2014

Judge and Jury

I have read a recent article about of course electing Judges and in turn the issues that this presents in a community when money talks, juries balk and the criminal pays and pays.  

Money in politics is one significant issue on its own then to add Judges solicting for donations puts them in the same beholden camp as it does Politicians.  We have seen this with MADD and other acronym groups that use donations and in turn lobbying to elicit laws and in turn loopholes to favor their issues over another.  So we have this excessive and bizarre legislation that overcriminalizes, under regulates and in turn unequally distributes justice to those who enter its gates.

First up was this election for a Judge doing what the pols do, soliciting for campaign contributions.  In that the Florida Bar Association filed a charge against a prospective Judge for violating campaign rules with her campaign tactics.  This later went to Court over First Amendment issues. The very legalese Concurring Opinions discusses the implication of this case here. 

But here is the issue - we should not be electing Judges.  And we need to rethink the lifetime appointments of the Supreme Court, but that is for another blog.. but as many of us are in election season ask yourself and those around you what do you actually know about the Judges in your area running for election. My guess is not much.  Do you even know how to find assessments and fair unbiased views on these people?  Probably no. And even those are often badly done ABA or League of Women Voter surveys of a select few who have their own bias or views whom we also know nothing.  So in other words it is working well for those who want to be a Judge.

Many Judges have incredibly bad assessments by their local bar and yet are repeatedly re-elected.  I looked into one Judge here and concerns about this woman go back decades and yet she still sits behind a bench utterly without any supervision or concern about competence.  How fantastic! So if this is happening here it is happening in your community.

Why Judicial Elections Are a Bad Thing
Jamelle Bouie
The Nation
April 7, 2011
This was lost in the uproar surrounding Representative Paul Ryan’s budget proposal, but yesterday—in his home state of Wisconsin—incumbent judge David Prosser lost to Assistant Attorney General JoAnne Kloppenburg in his re-election bid for the state Supreme Court. A Republican, Prosser, was widely known as an ally of Governor Scott Walker, and as such, was an obvious target for state Democrats. His defeat, by a slim margin of 208 votes, is the first electoral repudiation of Walker’s anti-worker agenda, and in all likelihood, a sign of things to come for Wisconsin Republicans. 
While this is good news, it’s worth noting that—on the whole—electing judges is a terrible idea. To wit, the United States is virtually alone among advanced democracies in its commitment to the practice. 
Why shouldn’t we trust individual citizens with the task of staffing a judiciary? Well, first, it runs counter to the entire idea of an independent judiciary. Elections require cash, and absent full and mandatory public financing, this means fundraising. Even in the best of circumstances, it’s difficult for a judge to appear impartial when, as a candidate, she relied on donors and special interests for support. This might not be a huge concern on a high-profile body, like a state Supreme Court, but it’s undoubtedly a problem among the thousands of lower-court judges chosen by popular ballot. 
Indeed, election-year pressure can lead judges to alter their decisions; in a Pennsylvania study, for example, researchers found that all judges increase their sentences in election years, “resulting in some 2,700 years of additional prison time, or 6 percent of total prison time, in aggravated assault, rape and robbery sentences over a 10-year period.” 
Beyond the possibility of undue influence, is simply true that judicial elections are low on the radar for most voters. 
The problem with electing judges is similar to the problem with electing treasurers or the problem with electing dogcatchers; with so many elections, voters don’t have the time or knowledge to evaluate the candidates. As such, there are far fewer eyes watching the conduct of judicial candidates and far fewer barriers to bad behavior. 
In other words, judicial elections provide the illusion of popular control, at the expense of actual accountability. In an ideal world, we’d dispense with them entirely.

And this is from Harvard... and when they think it well... they are the bestest at everything!

Judges as Candidates: The Good, the Bad, and the Political

by; Caroline Cox
Harvard Political Review
November 4, 2010

 Impartiality and the judiciary are frequently considered synonymous.  Even outside of the U.S., the Supreme Court, judges on state supreme courts and other higher-level positions enjoy lengthy terms, a good degree of freedom from political pressure, and the promise of being appointed based upon their merits rather than party affiliation. Or at least they should.

An actual look at how judges are appointed to state supreme courts throughout the country reveals an unsettling truth:  many of these judges are elected. To most citizens the idea of electing judges seems reasonable.  After all, elections are the basis of a strong democracy.  However, there is always an exception to the rule, and the judiciary is just that exception.

 Take the recent Supreme Court elections in Iowa as a prime example.  While most of the nation was focused on election results of the U.S. House and Senate, three Iowa Justices lost their positions at the bench because of their controversial ruling to allow gay marriage in the state.  While in Iowa justices are initially appointed by the Governor from a pool of applicants chosen by special commissions, they are also subjected to reconfirmation elections every few years.

These elections are only supposed remove justices for gross misconduct, but, as elections are wont to do, they tend to get more political than originally thought.  Interest groups, some even from out of the state, poured money into campaigns against the justices.  The campaign worked, and now the Iowa Supreme Court lacks three justices simply because of political whims of the public.

The problem with these elections is fundamental.  Judges are ultimately not accountable to the opinions of the people, but rather to the laws of the United States.  An independent judiciary is supposed to interpret the laws, not act as a second legislative branch that is subject to public opinion.  A startling 23 states hold elections for their supreme courts, while another 17 use a modified form such as a retention election after the initial appointment.  That’s a total of 40 states where interest groups, business leaders, and political parties can hold a great deal of influence on the judicial branch.

Those who are concerned, however, have at least one influential figure on their side.  Former Supreme Court Justice Sandra Day O’Connor has stepped up as the champion of reforming judicial elections.  For several years now she has passionately criticized election of judges, frequently writing editorials, appearing on talk shows, and speaking at events about the issue.  Her crusade is admirable, but the lack of attention given to it is troublesome.

In the typical fashion of the modern media, the most recent story involving the retired Justice featured little of her campaign to replace judicial elections with nomination processes, but focused instead on robo-calls that awoke potential Nevadan voters in the middle of the night.  While a call at one in the morning is certainly inconvenient, the criticism leveled at Justice O’Connor for her involvement was both misplaced and ignorant of the more important issues.

If states do not consider reforming their appointment processes, the results will be far worse, but less immediately noticeable than an annoying call in the middle of the night.  Judges at the state level, where citizens are far more likely to be involved in a case than the U.S. Supreme Court, will continue to bow to political pressure and interest groups.  An independent judiciary is critical for a strong democracy, but it simply cannot exist when judicial elections are the norm.

If the State has a problem with judicial impartiality, it is largely one the State brought upon itself by continuing the practice of popularly electing judges.  Justice Sandra Day O’Connor (2002)

Wednesday, July 30, 2014

Affirmative Action

As the old adage goes "its not what you know its who" and with the University of Austin managing to overcome both the Supreme Court and the Court of Appeals with regards to their Affirmative Action policies you would think Texas would have clear policies in place that demonstrate their equality and equanimity when it comes to admissions.  I would of course be wrong as this is Texas and that pretty much right there sums that up.

It appears that morons are being admitted to UT's law school due to their relationships to lawmakers.  Well color me shocked! (or is this redundant as we are talking prospective Lawyers here)   Why I think this is important is after all of the challenges to the UT's policies you would think that the Plaintiff in this case would have done her homework to show how this type of backdoor admissions  affects enrollment and in turn fails to meet the standards as established by the University.   The other the fact is that these idiots are now graduates with law degrees who will become future Lawyers and in turn Judges or Legislators.  So if you wonder why we have the problems we have this might be a contributory reason.

The article is from a site called Watchdog and of course they do what mainstream media fails to do, actually investigate and find information. Who knew that you can still do that?

But this was not the first time that law schools favor the the connected. The same issue was discovered in Illinois, another state known for its upstanding respect of the cronyism of politics. There are other links and discussion about this issue at Overlawyered. A site hilariously run by lawyers in politics complaining about lawyers in politics.  Hypocrite or Lawyer? Should be the new question du jour.

But if you think it is limited to these states I would have question those state lines as nothing in politics that lives in isolation and exception.

And on that note I was reading a hard core libertarian's blog the other day about the problems with Government, he of course cited one of the many "blawgs" or blahogs (as I think is by far a better name)  with regards to Police and their role in the current state of disrepair.   Again add the Lawyers as they have nothing to say or sometimes they do it just depends on the briefs.. and by that I am making a pun.. as I am thinking every time a Lawyer whines I shit my pants.  Hard knock life Annie.   But he was discussing that our State of Democracy is an non-existent one and on that I do agree. 

And while I elected to not respond to some of his more extreme thoughts, I wished I had,  as frankly let us not forget that many of these Attorney's that bemoan the criminal justice system and its failures are doing the typical lawyer speak - two sides of their mouth - as without it they would have no living. They have a strong financial incentive to maintain the status quo and yet they have all the ability to actually implement change and yet don't.   Why? Well money that is why. This same blawger constantly discusses the issues with regards to free information and the issues of billing always comparing his "service" to car salesman.  Worst metaphor ever, no wonder he blogs he has no real clients in which to actually serve.  But I digress. 

And once again I agree with another blogger that the concept of broken windows with regards to crime should be applied to the Police and see how well that works out.  His rant is here.

We have no one accountable and yet we elect and respect those we believe will do the right thing. We have this concept that by one group "less government" or even "no government" will somehow manage to right the wrongs, we have another group that believes in government but then all they do is knee jerk, write laws and continue to invest in the status quo with little connection or regard to the real world outside the state lines of Washington D.C.  Read the book This Town by Mark Leibovich and realize how fucked up our nation is.  You will laugh and you will cry but you will be horrified at how incompetent and how thoroughly vested in that our nations elected officials are. 

We have the power of Affirmative Action by simply no longer electing anyone who has been in office for over a decade.   They need to leave, even K street doesn't have enough revolving doors to take that flood in their offices if over 300 or more Congressman or Senators showed up with CV in hand.  They simply could not create that many jobs.... or could they? Hmm there is your job creation and well like the law schools its all about who you know and not what you know.  Stupid is the new black for the rich and orange is for the poors. 

Tuesday, July 29, 2014

And he had a great fall

The death on the street of the 50 cent cigarette hawker is one of many that die at the hands of police brutality. There is this belief that they have it tough, these Sherriff's, the Prison Guards, these Police  and yet they have all the weapons, the gear, the training to supposedly handle any situation.

Here is a mentally ill man in a 5x5 cell and yet all the kings horses and all the kings men couldn't put Humpty Dumpty back together again.

If you truly believe this is what is needed to be done you need to really check yourself at a cell door and see if this is what defines rehabilitation.

When Cell Door Opens, Tough Tactics and Risk

JULY 28, 2014

NASHVILLE — The August night was hot, but Charles Jason Toll wrapped himself in a coat and covered his mouth to protect against the electrical shocks and gas he thought might come his way.
Outside the door of his solitary confinement cell at Riverbend Maximum Security Institution here, five corrections officers in riot gear lined up, tensely awaiting the order to go in. When it came, they rushed into the small enclosure, pushing Mr. Toll to the floor and pinning him down with an electrified shield while they handcuffed him and shackled his legs.

Mr. Toll, 33, a heavyset man who suffered from diabetes and mental illness, said, “I can’t breathe” — a complaint he would repeat, with increasing urgency, at least 12 times that night.

“You’re not going to be able to breathe,” an officer, Capt. James Horton, can be heard telling him on a prison video. And then, “You wanted this.”

In the insular world of correctional institutions, it is known as cell extraction, the forcible removal of a prisoner from a cell by a tactical team armed with less-lethal weapons like Tasers, pepper spray and stun shields.

Jails and prisons routinely make use of the tactic in response to threatening behavior or disciplinary infractions. Mr. Toll, who was in prison on a parole violation and whose death in 2010 the state medical examiner ruled a homicide, had been accused of splashing an “unknown liquid” at a guard through the doorjamb.

While cell extractions are not new, a series of lawsuits and cases around the country are demonstrating the dangers of their widespread use, especially with mentally ill inmates like Mr. Toll, who represent an increasing segment of the jailed population and who are disproportionately the targets of force, statistics from several states indicate.

Videos made public in California last fall showed corrections officers at state prisons dousing severely psychotic inmates with large amounts of pepper spray before forcibly removing them from their cells, images that a federal district judge, Lawrence K. Karlton, who ordered the release of the videos, termed “horrific.” And in Florida in May, an inmate who was reportedly mentally ill died during a cell extraction at the Charlotte Correctional Institution.

Even when scrupulously conducted, cell extractions carry risks. Officers suit up in Kevlar vests and kneepads to protect themselves from assaults with homemade weapons or other objects. Injuries to inmates — from bruises and lacerations to concussions and broken bones — are common, though no government agency tracks them. In some cases, prisoners have died as a direct result of extractions, like Mr. Toll, whose death was caused by “asphyxia and suffocation” from force applied while he was in restraints, the medical examiner found.

Yet despite the frequent use and inherent dangers of cell extractions, states and localities vary widely in when and how they are carried out and in the level of training required of officers who conduct them. Many corrections experts say they believe that extractions are vastly overused.

Yet despite the frequent use and inherent dangers of cell extractions, states and localities vary widely in when and how they are carried out and in the level of training required of officers who conduct them. Many corrections experts say they believe that extractions are vastly overused.
But in many facilities, training is minimal, supervision is lax and forcible removals are conducted reflexively, with little or no attempt at alternate solutions. Corrections officers who are so inclined can easily turn the process into a vehicle for beatings or other prisoner abuse.

“It can move from a proper tactical exercise to a punitive and retaliatory exercise,” said Steve J. Martin, a lawyer and corrections consultant who has served as a federal monitor and is an expert on the use of force in prisons and jails.

A few months before Mr. Toll died, another inmate at Riverbend was kicked, beaten and slammed into a concrete wall while handcuffed and shackled,tion is viewed as a last resort. Training emphasizes the need to defuse the situation in other ways if possible, and extractions are tightly supervised. Special care is taken when mentally ill inmates are involved.

But in many facilities, training is minimal, supervision is lax and forcible removals are conducted reflexively, with little or no attempt at alternate solutions. Corrections officers who are so inclined can easily turn the process into a vehicle for beatings or other prisoner abuse.

“It can move from a proper tactical exercise to a punitive and retaliatory exercise,” said Steve J. Martin, a lawyer and corrections consultant who has served as a federal monitor and is an expert on the use of force in prisons and jails.

A few months before Mr. Toll died, another inmate at Riverbend was kicked, beaten and slammed into a concrete wall while handcuffed and shackled, splitting open his forehead, according to a lawsuit filed in the case. And in Los Angeles in 2008, deputies at the county jail — armed with Tasers, rubber bullets and rubber ball grenades — systematically moved down a tier extracting one inmate after another. Prisoners were choked, beaten unconscious and then shocked back into awareness, court documents show. More than 100 broken bones and other injuries resulted. One inmate required a metal plate in his right eye after multiple fractures to the eye socket; another received Taser shocks to his testicles and buttocks.

Jeffrey Schwartz, a correctional consultant who has worked with a large number of jails and prisons around the country, said that in his view, only about 20 percent of the cell extractions carried out in the United States were necessary.

Inmates, he said, often feel compelled to fight back during an extraction so as to not lose face in front of other prisoners. Officers, too, gear up, like soldiers preparing for battle.

“Once they put on those heavy pads and the adrenaline is flowing, they want to go in,” Dr. Schwartz said.

An Inmate’s Past

He was 14 when things began to go wrong.

His stepfather died. He started experimenting with drugs. He was arrested for setting fire to a trash can with a cigarette and then for stealing his father’s car. When he was 18, a series of house burglaries and an escape from a county jail work crew sent Mr. Toll to state prison.

Medical records from his years behind bars show his mental and physical health slowly declining. He developed diabetes and high blood pressure. He made suicide attempts.

At various times in prison, he received diagnoses of schizoaffective disorder, bipolar disorder, drug abuse and depression. He carried the scars of self-inflicted injuries, including a deep slash on his right forearm from 2006, after he reported that two other inmates had raped him. A tattoo on each arm depicted a demon’s head — to ward off voices that told him to harm himself, he told people.
Mr. Toll had more than 50 disciplinary infractions, many of them minor. But in one instance, in 2009, when he was off his psychiatric medication, Mr. Toll was accused of throwing scalding water on an officer, which led to his placement in solitary confinement at Riverbend.
“He was real anxious,” Ms. Luna said of her son, recalling a phone conversation she had with him the Sunday before his death.

Shortly after 9 p.m. that Tuesday, Aug. 17, 2010, Captain Horton assembled a cell extraction team to pull Mr. Toll out so that it could confiscate any containers he could use to throw liquid.

A prison videotape shows how the cell extraction unfolded. (Most prisons and jails monitor extractions by videotaping them, although prison videographers have been known to point cameras at ceilings and floors when they want to hide what is taking place. In this case, the cameras were trained on Mr. Toll, but much was obscured by the bodies of the officers and the darkness of the recreation yard.)

At 9:24 p.m. on the video, Captain Horton can be heard ordering Mr. Toll, who had jammed the cell door, to unblock it.

When he did not — “Let’s get it on, goddamn it,” Mr. Toll said — the team members, dressed in body armor, black jumpsuits and black helmets, moved in, led by Gaelan Doss, a guard weighing more than 450 pounds and carrying a curved stun shield.

As the officers carried Mr. Toll out of the cell — face down, hands cuffed behind his back — Captain Horton threatened to shock him with a Taser if he did not stop moving. The extraction team took Mr. Toll to the farthest cage in the outdoor recreation yard, where they placed him face down on the ground and began to search him, working in the dark with only a single flashlight.

“Please, please. I can’t breathe,” Mr. Toll said.

“Quit resisting, Mr. Toll,” Captain Horton responded.

At 9:38 p.m., Marina Tucker, a nurse who accompanied the extraction team, was called to check on Mr. Toll. When she found that his lips were blue and he did not respond to his name, she began cardiopulmonary resuscitation.

An ambulance was summoned. At 10:32 p.m., Mr. Toll was declared dead.

Protocols and Dangers

Removing a recalcitrant inmate from a cell was once achieved by brute force. Guards in regular uniforms went in and did whatever they needed to subdue a prisoner. But with the rise of super-maximum-security prisons in the 1980s and 1990s, steel and concrete fortresses designed to hold inmates whom politicians called “the worst of the worst,” prison officials codified the procedure to make it safer for officers, using specially trained teams equipped with body armor and less-lethal weapons.

In most jails and prisons, extraction teams are called when an inmate poses an immediate danger — holding a homemade knife or other weapon, for example. Acts of defiance, such as covering the window of a cell, refusing to return a food tray or barricading the door, can also result in an extraction 

Yet despite the addition of formal protocols and protective clothing, the process remains dangerous.
“It’s always violent, and it’s always unsafe for staff. It’s unsafe for inmates,” said Brad Hansen, emergency management supervisor for the Department of Correctional Services in Nebraska.
Officers have been stabbed with homemade knives. They have slipped on cell floors slick with water or shampoo. They have been spit on or bitten by prisoners with H.I.V. or hepatitis C and sustained cuts and bruises from wrestling prisoners to the floor. Dr. Schwartz, the corrections consultant, recalled an officer whose leg was badly cut during the making of a training film on cell extractions.

The highest risk, however, is for prisoners, who wear no body armor and are greatly outnumbered.
Mr. Toll, who had been forcibly removed from a cell once before, described to his mother feeling “like a rag doll.” Todd White, the inmate at Riverbend whose head was slammed into a wall by guards after he was in restraints, said: “You feel helpless. They just come in there and beat the hell out of you and do what they want to do.”

In most jails and prisons, policies on the use of force specify in some detail how an extraction should unfold: An officer, for example, is assigned an inmate’s arm or leg and told to keep that limb under control. But once the team goes in, the reality often bears little resemblance to the paper directives, looking more like a barroom brawl than a tightly orchestrated exercise, said Joseph Garcia, a security consultant.

“It’s chaos,” Mr. Garcia said.

His own method, which has been adopted by some jails and prisons, uses only two officers, and they do not enter the cell. The officers use weapons like Tasers and 12-gauge shotguns that fire less-lethal ammunition to subdue an inmate, and then restrain him. The method is not free of controversy, but Mr. Garcia said that the mother of an inmate might prefer that her son receive a bad bruise on a leg or a Taser shock to having him suffer a broken bone, concussion or worse from a traditional extraction.

As jails and prisons become more populated with mentally ill inmates — in some institutions, 40 percent or more of inmates suffer from mental illness — the situations that provoke extractions have increased. In a system ill equipped to handle psychiatric symptoms, the behavior of inmates is often treated as a disciplinary problem.

Yet for an inmate who is severely mentally ill, the arrival of a cell extraction team is more likely to instill terror than compliance, mental health experts say.

“It’s demeaning, it’s degrading, it’s frightening,” said Dr. Edward Kaufman, a psychiatrist who has worked extensively in prison settings and served as an expert witness in the California lawsuit. He noted that one psychotic inmate in the California case, shown in a video being pepper sprayed multiple times, had delusions that the guards were trying to rape him. The corrections officers kept ordering him to back up to the cell door and place his hands through the port for the handcuffs, increasing the inmate’s fears.
Some states, concerned about injuries and aware that mentally ill inmates are more vulnerable, have begun to provide prison staff members with special training. Officers are encouraged to use what Mr. Martin, the corrections consultant, calls “time and distance,” waiting out a situation or negotiating with a prisoner rather than rushing in with a team.

“The use of force, to a certain degree, means you’ve lost,” said Dan J. Pacholke, deputy secretary for operations for the Department of Corrections in Washington, one of several states that have taken steps to try to minimize cell extractions. He added that his department makes extensive use of crisis negotiators and gives staff members special training. Having national standards for how and when cell extractions should be done would help, he said.

Mr. Pacholke noted that most extractions take place in solitary confinement units, where inmates are kept under tight control and have extensive idle time, conditions that exacerbate problematic behaviors. To address this, the department has increased activities for maximum-security prisoners and reduced the number of inmates in isolation. At most, 10 to 12 extractions a month are carried out across the state, he said.

Nebraska’s Department of Correctional Services has also taken steps to reduce the use of extractions.
“We got to the point where we thought that there had to be some other way to do it,” said Mr. Hansen, the Nebraska official. The number of cell extractions carried out in state prisons dropped to 98 in 2013 from a high of 232 in 2008, he said.

Mr. Hansen added that a mental health negotiator is summoned when a disturbed inmate is causing problems, and the department’s policy now dictates that three attempts must be made to talk the prisoner into submitting to restraints before a more aggressive step is taken.

If more severe tactics are required, pepper spray, pumped in from outside the cell, is viewed as preferable to sending in a team of officers, because inmates are more likely to capitulate quickly and no physical combat is involved.

“Cell extractions are the last resort,” Mr. Hansen said.

Examining the Events

Ricky J. Bell, the warden at the time of Mr. Toll’s death, said in a telephone interview that his officers did nothing wrong that night.

“It’s unfortunate that Mr. Toll died in that extraction,” said Mr. Bell, who is now retired. “But I feel the staff did exactly what they should.”

No criminal or disciplinary charges were brought against the officers involved. Last year, a jury in the civil rights lawsuit brought by Ms. Luna found that Mr. Bell, Captain Horton and Mr. Doss were not liable for the death.

“At the end of the day we found 12 jurors who said: ‘He’s an inmate. He’s a criminal. So what?’ ” said David Weissman, one of the two lawyers who argued the case for Ms. Luna.

But former employees of Riverbend who were present that night, as well as three independent corrections consultants and a forensic medical expert who reviewed the videotape of the cell extraction, the autopsy report and other documents at the request of The New York Times, said that Mr. Toll should not have died that night and blamed the way the cell extraction was conducted.

“This was such a needless — clearly, objectively needless — death,” said Mr. Martin, who has testified in use-of-force cases on behalf of both corrections officials who were defendants and inmates who were plaintiffs.

During the course of the extraction, the officers violated training guidelines, applied force in a dangerous manner, ignored clear signs that Mr. Toll was in distress and failed to provide competent emergency care, the former employees and corrections experts said.

Training at the prison was also inadequate, Mr. Weissman said. Mr. Bell, the warden, discontinued refresher courses in cell extraction at Riverbend for budgetary reasons about three years before Mr. Toll’s death, he said in a deposition. Only one officer involved was up-to-date in training, and two had never participated in an extraction before.

A former employee of the prison who was present that night said that the extraction had been mishandled from its start.

“Wrong is wrong,” said the former employee, who spoke on the condition of anonymity for fear of endangering his current job. “It’s wrong in the light and it’s wrong in the dark, and that whole deal was wrong.”

He said that the officers placed far too much pressure on Mr. Toll’s back and upper body, something that training courses routinely warn increases the risk of suffocation.

“I could see they put their knees against him, against the shield on top of him,” the former employee said, adding that it was hot and that Mr. Toll was wearing several layers of clothing, which may have increased his respiratory distress.

Dr. Michael M. Baden, a former chief medical examiner for New York City who reviewed videotape of the extraction, as well as the autopsy report and photographs from the autopsy, said that bruising over Mr. Toll’s windpipe appeared to be from “pressure from hands or an arm squeezing on the neck.”
Other marks on Mr. Toll’s nose, face and forehead, he said, “are typical for an altercation where force is applied to the face.”

The way the extraction team transported Mr. Toll was also problematic, the corrections experts said, running contrary to what is taught in most training courses, which advise against carrying inmates face down by the arms and legs except in an emergency. And although the officers said in legal proceedings that they did not hear Mr. Toll say that he could not breathe, the former employee said that all the officers present that night heard the complaints and ignored them.

Perhaps most troubling, the extraction team took Mr. Toll to the dark recreation yard instead of a well-lighted multipurpose room or another cell, an option prescribed by training procedures. Prison officials said the decision was made to get him away from the other inmates. But the lights in the yard had been broken for three years, the former employee said, and the darkness made it impossible to monitor Mr. Toll’s safety.

“It was a recipe for disaster,” he said.

Even the attempts to provide emergency aid were bungled.
Ms. Tucker, the nurse, placed a piece of medical gauze over Mr. Toll’s mouth when she began rescue breathing, further obstructing his airway. And compressions were not started until well after rescue breathing began, although the current protocol for CPR advises that compressions should be applied first.

In a telephone interview, Ms. Tucker said that her training in CPR predated the current protocol.

She said she had been worried about the way that the officers were carrying Mr. Toll. “They kind of had him upside down, and I thought they were putting strain on his arms and legs,” she said.

Neysa Taylor, a spokeswoman for the Tennessee Department of Correction, declined requests to interview department officials or officers about Mr. Toll’s death. Captain Horton did not respond to interview requests left with his lawyer and the department. Mr. Doss, reached by telephone, refused to comment, and messages left on voice mail and social media for other officers who participated in the extraction were not returned.

Unanswered Questions

After Mr. Toll died, internal-affairs investigators at the prison concluded in their report, obtained by The Times, that Mr. Toll’s death was “in no way caused by the actions of staff.”

But the investigators, corrections experts who reviewed the report said, failed to interview crucial witnesses, did not ask basic questions in the interviews they did conduct and failed to preserve relevant evidence from the scene.

“It was the most incompetent investigation I’ve ever seen,” said Ron McAndrew, a corrections consultant and former warden at the Florida State Prison, who served as an expert witness for the plaintiff in the Toll case.

At least one officer involved in the cell extraction quit his job in part because of the way the investigation was handled.

In a resignation letter sent to Mr. Bell, a copy of which was obtained by The Times, the officer, William Amonette, wrote that he had been treated badly at the prison “ever since I asked questions in your office about the witnesses in the Charles Toll case that were not spoken to by Internal Affairs.”

“I cannot work somewhere where asking questions or trying to do what is right is punished,” he wrote.
The morning after Mr. Toll died, the phone rang at Ms. Luna’s house at 5:30. A man who identified himself as the prison chaplain told Ms. Luna that her son had been found dead in his cell during the night, the cause an apparent heart attack. Nothing was said about the cell extraction.

Since her son’s death, Ms. Luna said, she has found it difficult to move on with her life. She has been too depressed to work. The house she shares with a friend is cluttered with boxes, some filled with legal documents, others with mementos from her son.

“I can’t see a future,” she said. “He was my only child. He was my life, and I can’t seem to find my next step to go on.”

For the Children

I hear that mantra every time someone on the talking head shows wants to defend their proposition, belief, supposition or whatever shit they want to shove down your throat that this is about future generations.   We need to ban that phrase too.

In the last week I have been overwhelmed with articles and tragedies that are about children. A 14 year old boy who brutally raped a 8 year old girl and informed authorities that he had raped many girls, his brother was a convicted rapist and clearly when you do hear the phrase "rape culture" this is where it applies.  It is clearly obvious that something is very wrong in that home.  What of course goes unexplored and unexamined that not one but two boys from the same family feel it is okay to rape and abuse girls and women.  The 14 year old was tried as an adult and sentenced to an adult prison. He will come out at 21 more damaged then he went in with no rehabilitation nor mental health assessment and in turn those needs met so expect more if not worse, in other words a "career felon."

This followed the histrionics here about the alleged sexual assault on a field trip at a local school here two years ago and a family so aggrieved that despite their pleas locally through official channels,  they did manage to get the Dept. of Education to include the school on the list of those who failed under Title IX (this is the same statue that is being applied in the College cases).  Of course the peasants here just finding this out, thanks to the new news forum - Facebook - are screaming Monster and running into the woods with lights and pitchforks in hand with no Monster clearly identified and when we all know it is the Doctor Frankenstein who created the beast.   In this case we are not even sure who is the Doctor, so its off with all of their heads, a pox on all their  houses.  Of course this family no longer live in the State and the little girl who is now becoming a woman at one point I suspect would like to move on and heal but no we need revenge.   Adam Walsh has never rested in his grave his father John has ensured that.

And again if anyone thinks I am talking out of my ass, the answer is no.  No one knows better than I how hard it is to seek help, file lawsuits and face immense challenges to do so and finally at some point you want to heal and move on with life and leave the punishment and in turn forgiveness to a higher order or power.

And then we have a family being charged for their care of their Autistic sons.  The diagnosis of Autism rivals ADHD when it comes to labeling those whose thinking process is different.  The spectrum is now so long it needs Neil deGrasse Tyson to measure it in relation to the Cosmos.

When you work with Autistic kids you can see where that line falls and it is not that long or complex.  Many can communicate and process and many cannot at all. So the care and in turn educational needs do vary on a case by case basis.  And we all know how well that works out in America - one size, one shoe, fits all.

So when I read about this family my heart broke in two. They were beyond the tether attached to the rope which is affixed to the ever increasing spectrum.  So prosecuting them perhaps was a way to rescue them from this, their sons were not rescued.  Clearly they are now attached to a system that will neglect and in turn imprison them the same way our prisons are largely used to house the mentally ill.

And the needs for kids who are special also run a wide spectrum so another article about another child whose needs were not met, the bureaucracy that stifled no strangled the child to die on his own spit is just another example of how parents desperately will do whatever they need to help their child and find a system so broken, so damaged that the children seem less so in comparison.

We have more acronym named groups then there are those whose groups they serve. The all start with the best of intentions then they are absorbed into the system they were fighting in the first place.  And nothing changes. But for the requisite 15 minutes they get the attention that they deserved and the rest of us get to gnash our teeth, blog incessantly, create a social media campaign and feel better.  Then live goes on and the road is patched til the next storm creates a new pothole and we start all over again.

There ought to be a law.. oh wait there is!

Monday, July 28, 2014

Eyes Have It

There is an innate ability to read faces and feel others pain.  We seem to have a real problem in this country managing to do either.  This editorial explains it all for you.   Rich people are assholes. Why? They are rich. But that goes along with the better educated who may not necessarily be rich but due to their positions in life - Attorney, Judges, Doctors (irony or oxymoron) - are hard wired to be the assholes they are.

This is not shocking but to think that it is exclusive proprietary of the upper class needs to meet some of the white trash and other downtrodden poor that dominate society.  They are so angry and disconnected that for them trashing others somehow provides them with a misguided sense of entitlement and in turn superiority. These are usually the ones that have the talking class go "why are they voting against their self interest?" or they are frequently toting their well worn copy of the Fountainhead to support their beliefs.  That group is usually college educated but underemployed so they embrace Libertarian ethics to somehow validate that degree.  College is when most idiots find Ayn Rand and demonstrate why we really do have a problem in Education post secondary as well.

But the working class and the poor get it. They have a community and in turn often are members of organized religion. and despite all of its own issues it does provide community. And that is where empathy is born.

Powerful and Coldhearted

JULY 25, 2014
Michael Inzlicht & Sukhvinder Obhi

 I FEEL your pain.

 These words are famously associated with Bill Clinton, who as a politician seemed to ooze empathy. A skeptic might wonder, though, whether he truly was personally distressed by the suffering of average Americans.

Can people in high positions of power — presidents, bosses, celebrities, even dominant spouses — easily empathize with those beneath them?

 Psychological research suggests the answer is no. Studies have repeatedly shown that participants who are in high positions of power (or who are temporarily induced to feel powerful) are less able to adopt the visual, cognitive or emotional perspective of other people, compared to participants who are powerless (or are made to feel so).

 For example, Michael Kraus, a psychologist now at the University of Illinois at Urbana-Champaign, and two colleagues found that among full-time employees of a public university, those who were higher in social class (as determined by level of education) were less able to accurately identify emotions in photographs of human faces than were co-workers who were lower in social class. (While social class and social power are admittedly not the same, they are strongly related.)

Why does power leave people seemingly coldhearted?

  Some, like the Princeton psychologist Susan Fiske, have suggested that powerful people don’t attend well to others around them because they don’t need them in order to access important resources; as powerful people, they already have plentiful access to those.

We suggest a different, albeit complementary, reason from cognitive neuroscience. On the basis of a study we recently published with the researcher Jeremy Hogeveen, in the Journal of Experimental Psychology: General, we contend that when people experience power, their brains fundamentally change how sensitive they are to the actions of others.

The human brain can be exquisitely attuned to other people, thanks in part to its so-called mirror system. The mirror system is composed of a network of brain regions that become active both when you perform an action (say, squeezing a rubber ball in your hand) and when you observe someone else who performs the same action (squeezing a rubber ball in his hand). Our brains appear to be able to intimately resonate with others’ actions, and this process may allow us not only to understand what they are doing, but also, in some sense, to experience it ourselves — i.e., to empathize.

In our study, we induced a set of participants to temporarily feel varying levels of power by asking them to write a brief essay about a moment in their lives. Some wrote about a time when they felt powerful and in charge, while others wrote about a time when they felt powerless and subordinate to others. The selection process was random, so that each participant had an equal chance of being powerful or powerless.

Next, the participants watched a video of a human hand repeatedly squeezing a rubber ball. While they watched, we assessed the degree of motor excitation occurring in the brain — a measure that is widely used to infer activation of the mirror system. This motor excitation was determined by the application of transcranial magnetic stimulation and the measurement of electrical muscle activation in the subject’s hand. We sought to determine the degree to which the participants’ brains became active during the observation of rubber ball squeezing, relative to a period in which they observed no action.

We found that for those participants who were induced to experience feelings of power, their brains showed virtually no resonance with the actions of others; conversely, for those participants who were induced to experience feelings of powerlessness, their brains resonated quite a bit. In short, the brains of powerful people did not mirror the actions of other people. And when we analyzed the text of the participants’ essays, using established techniques for coding and measuring themes, we found that the more power that people expressed, the less their brains resonated. Power, it appears, changes how the brain itself responds to others.

Does this mean that the powerful are heartless beings incapable of empathy? Hardly. Recall that we induced power in our participants randomly. This sort of manipulation cannot fundamentally change empathic capability. So the bad news is that the powerful are, by default and at a neurological level, simply not motivated to care. But the good news is that they are, in theory, redeemable.

Sunday, July 27, 2014

Add the Stupid

I have a philosophy a very simple one:  If I disagree with the management or the corporate philosophy I don't do business with them.  I often make exceptions because it is the front line staff that can really make a break a business and in turn my commitment to do or not do business with a company.  I finally had to bail on one of my local coffee shops as one clerk is just too big of a bitch and I am done with it. I get that these jobs suck and pay is low but I have had enough and cannot deflect that the constant rotating door of  people are not affecting the overall quality and in turn my loyalty.

But I have many companies that the front line staff are so exemplary that regardless of how idiotic the management is I simply continue to do business with them  and some examples are Wells Fargo, Federated Department Stores (I have had some shitty and some great service but I now shop only at Bloomingdale's and not Macy's as the former still holds it own), United Airlines and occasionally I get a McDonald's fry but I doubt that $3 bucks every 6 months is really breaking the bank.

So I laugh when I read the hysterical ## campaigns on Twitter over Chick-Fil-A or Hobby Lobby or fill in the blank.  They are almost always related to some religious bullshit and not economic interests. So I love when I see progressives shoving a Chipotle down their gullet while bemoaning Goldman Sachs, a company that they have no business with.

I read this hilarious article about price increases and who was number one on the list - Chipotle.  Hershey's and Mars were there and again I don't buy their crap, period.  If i feel compelled to buy candy it is not even about organic or politics, it is about quality. Period. I would rather save the money and when compelled buy something I really enjoy and the cost is irrelevant.   I like to drink a decent latte everyday and I  don't buy Starbucks for the primary reason - it sucks.  The rest of their varying other problems  are just additional justifications for why I avoid the joint but frankly Stumptown is better - period.  Now if I find out that Stumptown is exploiting countries or workers well I guess I will finally resort to home brewing.. oh wait who are we kidding!

The article below discusses the price raises and how the hip validate it by that same reasoning - the quality.  Well I have never shoved any of that crap down my throat - I actually hate cheap versions of Mexican food and this is just another Taco Bell only with less cowbell.

And then I read about the CEO's - as in plural - they have two CEO"s - and their excessive pay that they provide themselves while their workers make minimum wage was no shock.  You can have the bullshit green philosophy while simultaneously raking in the green.  But in reality, Chipotle is just a Walmart of fast food.  Their executive compensation package is so astronomical the shareholders rejected it.  So progressives ## that one the next time you need a burrito.  Make one.

 Trendy Chipotle burritos show how pricing power belongs to the hip
 By Jeffrey Dastin (Reuters) -

Corporate America can learn a lot from a chicken burrito. As many companies struggle to boost prices without alienating consumers, they may want to study Mexican-food chain Chipotle, which has managed to do both.

 Companies including Chipotle Mexican Grill Inc, Apple Inc and PepsiCo  have shown they're able to take advantage of quality, trendiness, and, in the case of Pepsi's snack foods, market dominance, to maintain high prices or even raise them faster than the inflation rate, now at about 2.1 percent in the U.S. Chipotle raised chicken-dish prices by 5 percent this year after leaving them untouched since 2011, and sales went up 29 percent last quarter.

 The Denver-based Mexican food specialist "has done a great job cultivating a brand that commands pricing power," especially among millennials, who are mainly people in their 20s, said Morningstar analyst R.J. Hottovy. "They've developed a very loyal following."

 As the U.S. economy remains sluggish - full-year growth may now struggle to reach 2 percent – other companies such as mass market automaker Hyundai Motor Co have felt the squeeze, with earnings under pressure from deep discounting in the U.S. Hershey Co  is raising candy bar and other product prices by an average of eight percent because of higher cocoa and dairy costs, even as it acknowledges the move will hurt its short-term sales.

M&M maker Mars is following suit with a 7 percent increase. Chipotle is prospering even as it raises prices on burritos that are already expensive – about twice as much as those sold by Taco Bell.

 Besides its naturally-raised meats and organic ingredients such as beans and avocados, the company occupies the center of fast-casual dining - the booming "sweet spot of the restaurant industry," according to Hottovy - in which customers order at a counter but eat quality products inside a hip space.

And Chipotle is still growing. The chain runs about 1,700 restaurants in the U.S., and analyst Stephen Anderson at Miller Tabak estimates that it could grow to 3,100, expanding in less populated areas beyond its urban strongholds.

Chipotle hadn't raised menu prices for three years, but the higher cost of ingredients compelled it to roll out up to a 6.5 percent average increase in the second quarter.

To be sure, the hike did not go unnoticed: some customers said goodbye to steak burritos because their price jumped on average 4 percentage points more than Chipotle's chicken-based dishes, the company said.

Other fast food chains haven't fared as well. Dunkin' Brands Group Inc  cut its outlook for the year on Thursday, while quarterly profit fell more than expected at McDonald's Corp.

The world's largest hamburger seller and other fast food chains have become "hooked" on discounting, Anderson said. While they built their reputations by delivering quick bites, new menu additions have often slowed their service, frustrating customers.

"What [McDonald's needs] to do is further simplify the menu. It is too operationally complex, and I think that leaves a lot of potential for errors," Anderson said.

In the last year, McDonald's converted its dollar menu to a "$1-plus" selection in its roughly 14,000 U.S. restaurants, but Anderson says increased competition both from convenience stores and the likes of Chipotle hurt its sales.

Still, the tepid economy has mostly made consumers reluctant to spend on food, analysts say. In the absence of robust market growth, only the best and trendiest stand out, sometimes thanks to a more affluent customer cohort.

Chipotle patrons tend to earn more than McDonald's customers, said Dan Greenhaus, the chief strategist at BTIG, making them "more tolerant" of higher prices.

Another pricing powerhouse, Apple, has studiously cultivated its high-end aura for years, and its iPhones and iPads continue to command a higher price tag on average than its rivals. In 2013, the company briefly turned to discounting to fend off competition by Samsung Electronics Co , but analysts say Apple has so far stuck to its knitting in 2014 – save for recent price cuts on its MacBook Air and iPod Touch.

"Do they have a price premium [compared to the] competition? Absolutely," said Cross Research co-founder and analyst Shannon Cross. While she explained that Apple has refrained from hiking prices except when major currency movements occur, she said, "In the consumer electronics world, keeping pricing flat is impressive."

Apple has now exceeded Wall Street gross-margin projections for three straight quarters – topping forecasts for around 37 percent with near-40 percent gross margins in the June quarter, as reported Tuesday - which contributed to its fastest earnings-per-share growth in seven quarters.
PepsiCo recently succeeded in raising prices, too.

Second-quarter sales rose 5 percent in its snack business and 2 percent for beverages, both buoyed by price increases. New product launches and inflation in regions such as Latin America caused the hikes, the company said.

"For the balance of the year we feel comfortable that we can sustain pricing," PepsiCo chairman and CEO Indra Nooyi said Wednesday in a conference call.

At Coca-Cola Co, on the other hand, juice drink sales slowed after it raised prices to account for higher ingredient costs, the company said. Coke has no presence in the snack business, a fragmented market that PepsiCo dominates, according to Owen Fitzpatrick, head of U.S. equities at Deutsche Bank Asset and Wealth Management.

"Snack foods are growing in terms of consumption, but when you look at carbonated soft drinks, people are moving away from them," Fitzpatrick said.

Pepsi's snack strides suggest another source of pricing power: market dominance. Airline consolidation and fewer flights have also allowed for a steady increase in prices in that industry, according to Fitzpatrick.

Yet competition is the reality that most face. While U.S. companies are hiring - the government said unemployment had reached a six-year low in June - many consumers still lack the confidence to spend unless a business truly gives them value.

"If the [business] concept is old and tired, people just stop going to them," Anderson said.

Got Drugs?

When the strongest treatments and medical science clearly in the rear view mirror you have to ask if we are dumber and that the wonder of polio cures, TB and vaccines that prevented an epidemic are just those things of the past that we wax rhapsodic about like AM Radio and penny candy rather than marvel at what all modern technology has done to reduce and cure disease that were once thought incurable.

The list of deadly disease is like a hit list of golden oldies with Polio now Ebola back and coming ever closer with each plane ride across the globe.

But if there is an orphan disease with about 1 out of 1000 contracting it and can be treated at 20K a pop well don't worry Big Pharma has that covered.

The below article addresses those questions and others as we read every day with the increasing overseas mergers between drug companies taking up the headlines as a way of tax dodging rather than science solving tells you everything you need to know about these companies priorities. Health and wellness is an afterthought clearly.

A Dearth in Innovation for Key Drugs

JULY 22, 2014
Eduardo Porter

There is clearly something wrong with pharmaceutical innovation.

Antibiotic-resistant infections sicken more than two million Americans every year and kill at least 23,000. The World Health Organization has warned that a “post-antibiotic era” may be upon us, when “common infections and minor injuries can kill.” Even the world’s tycoons consider the proliferation of antibiotic-resistant bacteria one of the crucial global risks of our times, according to a survey by the World Economic Forum.

Yet the enthusiasm of the pharmaceutical industry for developing drugs to combat such a potential disaster might be best characterized as a big collective “meh.”No major new type of antibiotic has been developed since the late 1980s, according to the W.H.O. From 2011 to 2013, the Food and Drug Administration approved only three new molecular entities to combat bacterial diseases — the lowest rate since the 1940s. “No sane company will develop the next antibiotic,” said Michael S. Kinch, who led a team at the Yale Center for Molecular Discovery tracking the evolution of pharmaceutical innovation over the last two centuries.

And this is hardly the drug industry’s only problem. Antibiotics, Professor Kinch told me, “are the canary in the coal mine.”

This is particularly striking at a time when the pharmaceutical industry is unusually optimistic about the future of medical innovation. Dr. Mikael Dolsten, who oversees worldwide research and development at Pfizer, points out that if progress in the 15 years until 2010 or so looked sluggish, it was just because it takes time to figure out how to turn breakthroughs like the map of the human genome into new drugs. The pipeline today, which includes tailored treatments for cancer, newfangled vaccines and therapies for tough diseases like hepatitis C, is robust.

So far this decade, the F.D.A. has approved drugs at a pace second only to the 1990s. In 2012, the FDA approved 37 new drugs, the most in 15 years.

But the economics of the drug development, argues Professor Kinch, who in July was appointed associate vice chancellor of Washington University in St. Louis, are not conducive to creating the highest levels of public health.

More and more antibiotics are going out of circulation every year — either because of bacteria have become resistant to them or because they have been replaced by better or less toxic drugs. The pharmaceutical arsenal against bacterial infections shrank to only 96 different molecules by the end of last year, 17 fewer than at the turn of the century.

Nevertheless, many of the big drug companies that produced the antibiotic breakthroughs of the past have decided to drop this line of research. And few new entrants are jumping in.

“It has become very difficult to find new drug classes to fight infections,” Dr. Dolsten of Pfizer acknowledged. “There haven’t been enough incentives for the industry to take on 10 or 15 years of research.”

Antibiotics face a daunting proposition. They are not only becoming more difficult to develop, but they are also not obviously profitable. Unlike, say, cancer drugs, which can be spectacularly expensive and may need to be taken for life, antibiotics do not command top dollar from hospitals. What’s more, they tend to be prescribed for only short periods of time.

Importantly, any new breakthrough antibiotic is likely to be jealously guarded by doctors and health officials for as long as possible, and used only as a drug of last resort to prevent bacteria from developing resistance. By the time it became a mass-market drug, companies fear, it could be already off patent and subject to competition from generics that would drive its price down.

Antibiotics are not the only drugs getting the cold shoulder, however. Research on treatments to combat H.I.V./AIDS is also drying up, according to the research at Yale, mostly because the cost and time required for development are increasing. Research into new cardiovascular therapies has mostly stuck to less risky “me too” drugs.

Neuropsychiatric diseases, including Alzheimer’s and depression, are the leading cause of disability across most of the industrial world. And they are going to get worse. Yet researchers have underscored a dearth of investment into these diseases.

Instead, pharmaceutical and biotechnology firms are betting on personalized therapies — mostly targeting specific varieties of cancers — and drugs for so-called orphan diseases, which affect very small populations. “More people are studying orphan diseases than have orphan diseases,” Professor Kinch said jokingly. Of the new drugs that the F.D.A. approved in 2013, about 70 percent were specialty drugs — which are used by less than 1 percent of the population, according to the drug benefits manager Express Scripts.

The problem, of course, lies in the industry’s incentives. The cost of developing a new drug has skyrocketed over the last three decades. A research paper by scientists from Eli Lilly suggested that in 2010, it cost $1.8 billion to bring a big new drug from conception to rollout, through the costly gantlet of clinical trials needed to prove that it is both safe and more effective than existing therapies.

Developing orphan drugs is cheaper. They receive expedited approval from the F.D.A. Clinical trials are inherently less expensive because the drugs are aimed at a small population. And insurance companies are willing to pay $100,000 a year for a drug that few patients will use.

“Companies are flocking to rare diseases,” said John LaMattina, a former head of research at Pfizer who now writes a blog about pharmaceutical research. “They might only make $500 million in sales a year, but their costs are much lower.”

Similar considerations have pushed pharmaceutical companies into newfangled biological drugs at the expense of old-fashioned compounds. Standard brand-name drugs lose 80 percent of the market within a year of patent expiration. Biologicals face much less generic competition, protected both by regulation and the fact that it is tough to determine the equivalency of different biological agents.

The wave of protests over the $84,000 cost per course of Gilead’s blockbuster new drug to treat hepatitis C, Sovaldi, highlights the kind of strain that can be caused when mass market therapies are priced like niche specialty drugs.

“I’ve seen nothing as potentially harmful as the exorbitant pricing displayed by Gilead,” wrote Dr. Steve Miller, the chief medical officer of Express Scripts. Regardless of whether that is worth it for the individual patient or society at large — which it probably is — the price could bankrupt Medicaid budgets around the country.

Can drug makers’ incentives be fixed? Some argue that the patent system governing drug innovation is not up to the task, and suggest handing over most drug research and development to the National Institutes of Health, which already spend tens of billions on basic research.

Tweaking the existing system might be a more feasible proposition, however. Research on new antibiotics could be encouraged by allowing shorter clinical trials for the promising molecules or guaranteeing minimum returns for groundbreaking drugs.

Patricia Danzon of the Wharton School of the University of Pennsylvania suggests recalibrating the regulatory burden to favor research in drugs with a broader potential footprint. “The decks have been stacked in favor of orphan drugs,” she said.

At the same time, new mechanisms are needed to constrain prices.

The National Health Service in Britain may have a bad reputation in the United States, but Americans could benefit from something like the country’s National Institute for Health and Care Excellence, which determines what therapies will be covered, based on their efficacy and their price.

There’s a myth in the United States that market forces are working to control prices,” Professor Danzon said. It’s clear that they aren’t. But the market isn’t delivering the innovation we need, either.