Pretextual Sanctions, Contempt, and the Practical Limits of \u3cem\u3eBearden\u3c/em\u3e-Based Debtors\u27 Prison Litigation

At the time of this writing, recent events in Ferguson, Baltimore, New York City, and elsewhere have triggered quite justified social outrage at debtors’ prisons. Our country’s state and city courts keep scores of indigent people in jail for the crime of being poor, despite the Supreme Court’s clear prohibition on the practice. Skilled litigators and their journalist allies have seized on the moment to win victories in court and in the public eye, which prevent unconscionable bond and probation practices and try to reduce our burgeoning jail populations. Lost in the uproar, though, are the many ways that a savvy anti-defendant judge could insulate herself from corrective litigation, evade effective judicial oversight, and essentially perpetuate current debtors’ prisons by using pretextual sanctions and contempt orders to circumvent Bearden v. Georgia indigency determinations

Pretextual Sanctions, Contempt, and the Practical Limits of \u3cem\u3eBearden\u3c/em\u3e-Based Debtors\u27 Prison Litigation

At the time of this writing, recent events in Ferguson, Baltimore, New York City, and elsewhere have triggered quite justified social outrage at debtors’ prisons. Our country’s state and city courts keep scores of indigent people in jail for the crime of being poor, despite the Supreme Court’s clear prohibition on the practice. Skilled litigators and their journalist allies have seized on the moment to win victories in court and in the public eye, which prevent unconscionable bond and probation practices and try to reduce our burgeoning jail populations. Lost in the uproar, though, are the many ways that a savvy anti-defendant judge could insulate herself from corrective litigation, evade effective judicial oversight, and essentially perpetuate current debtors’ prisons by using pretextual sanctions and contempt orders to circumvent Bearden v. Georgia indigency determinations

Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy

International audienceBACKGROUND Nusinersen is an antisense oligonucleotide drug that modulates pre-messenger RNA splicing of the survival motor neuron 2 (SMN2) gene. It has been developed for the treatment of spinal muscular atrophy (SMA). METHODS We conducted a multicenter, double-blind, sham-controlled, phase 3 trial of nusinersen in 126 children with SMA who had symptom onset after 6 months of age. The children were randomly assigned, in a 2: 1 ratio, to undergo intrathecal administration of nusinersen at a dose of 12 mg (nusinersen group) or a sham procedure (control group) on days 1, 29, 85, and 274. The primary end point was the least-squares mean change from baseline in the Hammersmith Functional Motor Scale-Expanded (HFMSE) score at 15 months of treatment; HFMSE scores range from 0 to 66, with higher scores indicating better motor function. Secondary end points included the percentage of children with a clinically meaningful increase from baseline in the HFMSE score (>= 3 points), an outcome that indicates improvement in at least two motor skills. RESULTS In the prespecified interim analysis, there was a least-squares mean increase from baseline to month 15 in the HFMSE score in the nusinersen group (by 4.0 points) and a least-squares mean decrease in the control group (by -1.9 points), with a significant between-group difference favoring nusinersen (least-squares mean difference in change, 5.9 points; 95% confidence interval, 3.7 to 8.1; P< 0.001). This result prompted early termination of the trial. Results of the final analysis were consistent with results of the interim analysis. In the final analysis, 57% of the children in the nusinersen group as compared with 26% in the control group had an increase from baseline to month 15 in the HFMSE score of at least 3 points (P< 0.001), and the overall incidence of adverse events was similar in the nusinersen group and the control group (93% and 100%, respectively). CONCLUSIONS Among children with later-onset SMA, those who received nusinersen had significant and clinically meaningful improvement in motor function as compared with those in the control group. (Funded by Biogen and Ionis Pharmaceuticals; CHERISH ClinicalTrials. gov number, NCT02292537.