False Positives

What do we mean by false positives?  It is like the false alarms.  It’s when we think someone is guilty but they really are innocent.

First of all, where do false positives come from.  They come from casting a wide net or using broad criteria as opposed to narrow criteria.  Broad and narrow are concepts used in law.  These concepts are found in intellectual property law and commonly in Supreme Court Decisions.

Statistically, a broad test is one that is very sensitive.  High sensitivity is the same thing as a low threshold.  At the same time it is not very specific, it has low specificity.

Casting a wide net gathers in everybody who is possibly positive.  This captures all the true positives and some false positives.  False positives are the innocents.

How do we tell who are the false positives from the true positives?  We use tests with greater specificity.  The National Highway Traffic  Safety Administration (NHTSA) evaluation does not have that specificity.  The NHTSA evaluation casts a wide net; uses broad criteria not narrow ones.  It is  very sensitive and has a very low threshold and is not very specific.

Therefore, the NHTSA evaluation gathers in a large population of individuals.  Some are guilty and necessarily include some who are innocent, the innocents are the false positives.

The Diagnostic Statistical Manual (DSM) is just the opposite.  It is much more specific which makes it less sensitive.

This decreased sensitive satisfies the Blackstone imperative.  Sometimes called the Blackstone Imperative (sometimes called ratio or formation).  The English Jurist, William Blackstone’s seminal work Commentaries of the Laws of England states: “it is better than 10 guilty persons escape than that one innocent suffered” and was published in the 1760’s.  This idea can be traced back to Abraham ammonites and was well known to the Founding Fathers.

What is DSM?  DSM is the official nomenclature by the America Psychiatric Association (APA) and 60 other professional organizations. It is used in the healthcare industry by medical professionals, the insurance industry and  the government, domestically and internationally.  It has been incorporated into the International Classification of Diseases (ICD), which dates back to the original classifications of diseases in 1893.

DSM is produced by a 27 member task force.  There are 13 work groups with 5 people per work group and 50 to 100 consultants per work group.  It is put out for notice of common two years prior to release and one year rior to release.  There are 119 named authors of the DSM and many of them are department Chairmen at United States Medical Schools.

DSM is to be used by a clinician not a technician.  Technicians collect data.  The DSM specifically states it is not to be used in a cookbook fashion.  It requires judgment, otherwise it is a recipe for disaster.

A clinician uses judgment based u\upon education training and experience.  Contrarily, a technician just collects and handles data.  In medicine w use medical technicians, X-ray technicians, nurses, lab technicians, etc.  These people diagnose or operate.  Just as in law, there are receptionists, secretaries, transcriptionists, paralegals, but they do not try cases.

Clinicians must apply to the DSM criteria.  The criteria are like the elements of a crime.  For example, the elements of burglary are breaking and entering of a glowing place at night with the intention of committing a felony therein.  Whereas, law uses elements, theDSM medicine use those laws to define a crime; medicine uses criteria to define a diagnosis.

In this instance, the crime is 39:4-50 Driving While Intoxicated (DWI) and alcohol intoxication is DSM 303.00.  The diagnosis of alcohol is a pass for criteria ABC&D.  AB& C are inclusionary criteria while D is an exclusionary criteria.  From a legal perspective the inclusionary criteria are like accusatory elements of the law, while exclusionary criteria would be an escalatory element in the law.  An escalatory fact.

Criteria D is often satisfied by the existence of medical conditions, particularly those that result in inflammation.  However, there are  numerable other medical conditions that satisfy Criteria D.