Showing posts sorted by relevance for query PCL-R. Sort by date Show all posts
Showing posts sorted by relevance for query PCL-R. Sort by date Show all posts

June 17, 2010

Psychopathy brouhaha: It's a wrap (I hope!)

Today's Scientific American has more on the censorship controversy I've featured here in recent weeks. As regular readers know, the flap centers around allegations that psychopathy researcher Robert Hare tried to silence critics by threatening to sue. The controversial article was finally published this month in the American Psychological Association publication Psychological Assessment, but the fallout continues.

The column by J.R. Minkel, oddly titled "Fear Review," features a rundown, including commentary by prominent scholar Stephen Hart:
People familiar with the matter say the scale's author, Robert Hare of the University of British Columbia, deserves only partial blame for the delay, to be shared with the American Psychological Association (APA), the journal's publisher. But they say Hare's use of legal threats has at best subverted the peer review process that is the crux of modern scientific progress, and could at worst encourage junior researchers in the field of forensic psychology to pursue other lines of research.

"I find this action to be completely inconsistent with the man I had [great] respect and affection for," says Stephen Hart of Simon Fraser University in British Columbia, a collaborator and former student of Hare's. "People I speak with automatically think, 'Well, what's in that article that makes him so upset? What's he so afraid of?'
After reading all of the publicly available materials on the controversy, as well as numerous email posts on professional listservs, here's how I boil things down to the essence:
  • The Skeem and Cooke article is an important scientific analysis of the theoretical construct of psychopathy, which is increasingly being used as a weapon in court with grave consequences for those it is deployed against.
  • Not surprisingly, Robert Hare disagrees with Skeem and Cooke. Specifically, he does not agree with their claim that his Psychopathy Checklist or the underlying psychopathy construct centralizes criminality.
  • Hare claims that Skeem and Cooke distorted his work. In a written response, he gives three examples of alleged distortions. Presumably, since he was preparing his response for publication, he picked the best examples he could find to illustrate his complaint. Yet, these are nowhere near as egregious as I had imagined they would be, given his threat to sue.
  • Hare accuses two well respected psychology-law leaders, Norm Poythress and John Petrila, of being biased and misinformed. But nothing in his response supports this. Poythress and Petrila, in their article in the International Journal of Forensic Mental Health that set this whole ball in motion, were careful not to take sides in the underlying scientific debate over psychopathy. Rather, they focused on the threat to academic freedom and science posed by threats to sue: "Academic freedom rests on the premise that advances in science can only occur if scholars are permitted to pursue free competition among ideas. This assumes that scholars have the liberty to do their work free from limitations imposed by political or religious pressure or by economic reprisals."
  • Hare has claimed elsewhere that his "lawsuit threat was meant only to get the 'attention' of APA, Skeem, and Cooke and force changes to the article." In his essay, he expresses bafflement at the ensuing, lengthy delay in the article's publication. To claim that his threat to sue did not contribute to the lengthy delay is either disingenuous or naïve. Especially in the wake of other controversies, such as the Rind debacle in which the U.S. Congress blasted the APA's publication and peer review process, the Association is undoubtedly very gun-shy and reactive over lawsuit threats.
The bottom line:

After analyzing all sides of the issue, I find that the Skeem and Cooke article is an important and timely contribution to the field, and that threats to sue over such publications set a dangerous precedent. As Poythress and Petrila point out in their commentary, potential negative effects of defamation threats against scientific researchers include -- among other things -- that:
  1. researchers avoid critical research out of fear of lawsuits,
  2. academics avoid volunteering as peer reviewers, and
  3. journal editors self-censor on controversial topics
Censorship -- or even the appearance of censorship -- is especially dangerous when it involves critique of a construct that may be used in a partisan manner in the forensic arena.

Hare is entitled to express his opinion, but nothing in his public response changes these bottom lines. Rather, as Jennifer Skeem notes in today's Scientific American piece, all of this peripheral controversy distracts from the scientific critique of psychopathy, including her critique that was silenced for three years before finally seeing the light of day.

I sure hope this is my last blog post for a while on this topic!

PRIVATE NOTE TO TODAY'S "ANONYMOUS" BLOG COMMENTER:
I regret that I had to reject your comment about the pecuniary angle from publication.
While I found it quite interesting, I had no easy way to substantiate its accuracy.

GENERAL NOTE TO COMMENTERS:
I encourage comments, but it's nice to know who is talking;
please consider signing your name (or at least a pseudonym).

June 18, 2010

New study on juvenile sex offender treatment

Efficacy claimed, but control group questionable

I previously reviewed forensic psychologist Frank DiCataldo's excellent book on juvenile sex offenders, in which he claims there is very little good research to show that sex offender-specific treatment is useful with adolescents. As DiCataldo points out, most of the studies (and the meta-analyses of studies) purporting to show a treatment effect have serious flaws. One big problem is the lack of control groups. This makes it impossible to know whether juveniles who did well after sex-offender treatment would have done equally well without treatment or with generic treatment not focused on sex offending.

But now, a study out of Canada (where else?!) is being trumpeted as methodologically sound proof that -- drum roll here -- treatment works. The study followed 148 adolescents for up to 20 years, which is a very long time for this type of research. Overall, only 17 of the subjects (about 11.5%) picked up a new sex offense as adults, with another 7 getting a new charge only in adolescence, for a total of 24 recidivists (16%). That's in line with a growing body of data on the very low recidivism rates of juvenile sex offenders, ranging from about 4% to 15%.

When they broke it down by those who underwent their specialized treatment, compared with a comparison group that did not, they found that only 9% (5 out of 58) of the youths who had gone through their program got charged with a new sex offense over the next 20 years, compared with 21% (19 out of 90) of those who had not. That's a significant difference.

But here's the rub. The participants were not randomly assigned to treatment (versus no treatment), which is how it's supposed to be done in psychotherapy treatment outcome research. Otherwise, you never know if there is something about the selection process that affected the results. Not only was assignment to groups not random, but the researchers put the kids who refused to undergo treatment, along with those who dropped out of treatment early, into their so-called "control" group! In fact, these bad boys comprised fully half of the non-treatment group. My guess is that these dropouts and refusers were probably a whole lot more delinquent than the other kids in the first place.

So it's possible that what the research really shows is not that treatment works, but that hardcore delinquents who refuse or drop out of treatment are likely to get into more trouble in their later teens and early 20s. It would be interesting to see if the control group still showed a higher recidivism rate if they removed the dropouts and refusers from the analyses. In fact, I would love to see some qualitative analyses of who those 19 recidivists (out of the total of 90 in the control group) are.

Another potential confounder I noticed was that many of the adolescents in the non-treatment control group were apparently in some different kind of treatment at the time. That treatment is not described, so perhaps this study is more of a between-treatments design, rather than a study of treatment versus no treatment.

Again, as I've discussed previously, part of the "problem" both with accurately predicting which juveniles will reoffend and also with designing treatment programs that work is the very low overall rate of recidivism among juveniles who have sexually offended. As DiCataldo and others have pointed out, if you just predict that no juvenile caught for a sex crime will reoffend, you will be correct in the broad majority of cases.

Flattening trajectory

The study, by psychologist James Worling and his colleagues at the Sexual Abuse: Family Education & Treatment Program (SAFE-T) program in Ontario, did have some other interesting findings. The researchers found that most recidivism -- both sexual and nonsexual -- happens within the first few years. Offending flattens out significantly at about the 10-year mark, when folks hit about the age of 25. This is consistent with the recent study by Lussier and colleagues of sex offender trajectories, as well as the general criminology literature on desistance. Crime, including sex offending, is a young man's game.

The finding that only 11.5% of the participants were charged with subsequent sexual offenses as adults is also in line with other research showing very low recidivism for juveniles. A strength of this study is its long course; it followed kids all the way up to an average age of 31.

The study is: Worling, J.R., Littlejohn, A., & Bookalam, D. (2010). 20-year prospective follow-up study of specialized treatment for adolescents who offended sexually. Behavioral Sciences and the Law, 28, 46-57.

Special journal issue on adolescent sex offenders

NOTE: It looks like this entire special issue of Behavioral Sciences and the Law is available online. Other interesting articles in the issue include:

Inter-rater reliability of the PCL-R total and factor scores among psychopathic sex offenders: are personality features more prone to disagreement than behavioral features?
John F. Edens, Marcus T. Boccaccini, Darryl W. Johnson

Searching for the developmental origins of sexual violence: examining the co-occurrence of physical aggression and sexual behaviors in early childhood
Patrick Lussier, Jay Healey

Assessing risk of sexually abusive behavior among youth in a child welfare sample
Robert A. Prentky, Nien-Chen Li, Sue Righthand, Ann Schuler, Deborah Cavanaugh, Austin F. Lee

Psychological mechanisms underlying support for juvenile sex offender registry laws: prototypes, moral outrage, and perceived threat
Jessica M. Salerno, Cynthia J. Najdowski, Margaret C. Stevenson, Tisha R. A. Wiley, Bette L. Bottoms, Roberto Vaca Jr., Pamela S. Pimentel

Legal, ethical, and methodological considerations in the Internet-based study of child pornography offenders (p 84-105)
James V. Ray, Eva R. Kimonis, Christine Donoghue

April 19, 2015

Static-99: A bumpy developmental path

By Brian Abbott, PhD and Karen Franklin, PhD* 

The Static-99 is the most widely used instrument for assessing sex offenders’ future risk to the public. Indeed, some state governments and other agencies even mandate its use. But bureaucratic faith may be misplaced. Conventional psychological tests go through a standard process of development, beginning with the generation and refinement of items and proceeding through set stages that include pilot testing and replication, leading finally to peer review and formal publication. The trajectory of the Static-99 has been more haphazard: Since its debut 15 years ago, the tool has been in a near-constant state of flux. Myriad changes in items, instructions, norms and real-world patterns of use have cast a shadow over its scientific validity. Here, we chart the unorthodox developmental course of this tremendously popular tool.
 
 
Static-99 and 99R Developmental Timeline
Date
Event
1990
The first Sexually Violent Predator (SVP) law passes in the United States, in Washington. A wave of similar laws begins to sweep the nation.
1997
The US Supreme Court upholds the Constitutionality of preventive detention of sex offenders. 
1997
R. Karl Hanson, a psychologist working for the Canadian prison system, releases a four-item tool to assess sex offender risk. The Rapid Risk Assessment for Sex Offence Recidivism (RRASOR) uses data from six settings in Canada and one in California.[1]
1998
Psychologists David Thornton and Don Grubin of the UK prison system release a similar instrument, the Structured Anchored Clinical Judgment (SACJ- Min) scale.[2]
1999
Hanson and Thornton combine the RRASOR and SACJ-Min to produce the Static-99, which is accompanied by a three-page list of coding rules.[3] The instrument's original validity data derive from four groups of sex offenders, including three from Canada and one from the UK (and none from the United States). The new instrument is atheoretical, with scores interpreted based on the recidivism patterns among these 1,208 offenders, most of them released from prison in the 1970s.
2000
Hanson and Thornton publish a peer-reviewed article on the new instrument.[4]
2003
New coding rules are released for the Static-99, in an 84-page, unpublished booklet that is not peer reviewed.[5] The complex and sometimes counterintuitive rules may lead to problems with scoring consistency, although research generally shows the instrument can be scored reliably.
2003
The developers release a new instrument, the Static-2002, intended to "address some of the weaknesses of Static-99."[6] The new instrument is designed to be more logical and easier to score; one item from the Static-99 – pertaining to whether the subject had lived with a lover for at least two years – was dropped due to issues with its reliability and validity. Despite its advantages, Static-2002 never caught on, and did not achieve the popularity of the Static-99 in forensic settings. 
2007
Leslie Helmus, A graduate student working with Karl Hanson, reports that contemporary samples of sex offenders have much lower offense rates than did the antiquated, non-US samples upon which the Static-99 was originally developed, both in terms of base rates of offending and rates of recidivism after release from custody.[7]
September 2008
Helmus releases a revised actuarial table for Static-99, to which evaluators may compare the total scores of their subjects to corresponding estimates of risk.[8] Another Static-99 developer, Amy Phenix, releases the first of several "Evaluators’ Handbooks."[9]
October 2008
At an annual convention of the Association for the Treatment of Sexual Abusers (ATSA), Andrew Harris, a Canadian colleague of Hanson's, releases a new version of the Static-99 with  three separate "reference groups" (Complete, CSC and High Risk) to which subjects can be compared. Evaluators are instructed to report a range of risks for recidivism, with the lower bound coming from a set of Canadian prison cases (the so-called CSC, or Correctional Service of Canada group), and the upper bound derived from a so-called "high-risk" group of offenders. The risk of the third, or "Complete," group was hypothesized as falling somewhere between those of the other two groups.[10]
November 2008
At a workshop sponsored by a civil commitment center in Minnesota, Thornton and a government evaluator named Dennis Doren propose yet another new method of selecting among the new reference groups.  In a procedure called "cohort matching,” they suggest comparing an offender with either the CSC or High-Risk reference group based on how well the subject matched a list of external characteristics they had created but never empirically tested or validated.[11]
December 2008
Phenix and California psychologist Dale Arnold put forth yet a new idea for improving the accuracy of the Static-99: After reporting the range of risk based on a combination of the CSC and High-Risk reference groups, evaluators are encouraged to consider a set of external factors, such as whether the offender had dropped out of treatment and the offender's score on Robert Hare's controversial Psychopathy Checklist-Revised (PCL-R). This new method does not seem to catch on.[12] [13]
2009
An official Static-99 website, www.static99.org, debuts.[14]
Winter 2009
The Static-99 developers admit that norms they developed in 2000 are not being replicated: The same score on the Static-99 equates with wide variations in recidivism rates depending on the sample to which it is compared. They theorize that the problem is due to large reductions in Canadian and U.S. recidivism rates since the 1970s-1980s. They call for the development of new norms.[15]
September 2009
Hanson and colleagues roll out a new version of the Static-99, the Static-99R.[16] The new instrument addresses a major criticism by more precisely considering an offender's age at release, an essential factor in reoffense risk.  The old Static-99 norms are deemed obsolete. They are replaced by data from 23 samples collected by Helmus for her unpublished Master's thesis. The samples vary widely in regard to risk. For estimating risk, the developers now recommend use of the cohort matching procedure to select among four new reference group options. They also introduce the concepts of percentile ranks and relative risk ratios, along with a new Evaluators’ Workbook for Static-99R and Static-2002R. Instructions for selecting reference groups other than routine corrections are confusing and speculative. Research is lacking to demonstrate that selecting other than routine corrections reference group produces more accurate risk estimates.[17]
November 2009
Just two months after their introduction, the Evaluators’ Workbook for Static-99R and Static-2002R is withdrawn due to errors in its actuarial tables.[18] The replacement workbook provides the same confusing and speculative method for selecting a nonroutine reference group, a method that lacks scientific validation and reliability.
2010
An international team of researchers presents large-scale data from the United States, New Zealand and Australia indicating that the Static-99 would be more accurate if it took better account of an offender's age.[19] The Static-99 developers do not immediately embrace these researchers' suggestions.
January 2012
Amy Phenix and colleagues introduce a revised Evaluators’ Workbook for Static-99R and Static-2002R.[20] The new manual makes a number of revisions both to the underlying data (including percentile rank and relative risk ratio data) and to the recommended procedure for selecting a reference group. Now, in an increasingly complex procedure, offenders are to be compared to one of three reference groups, based on how many external risk factors they had. The groups included Routine Corrections (low risk), Preselected Treatment Need (moderate risk), and Preselected High Risk Need (high risk). Subsequent research shows that using density of external risk factors to select among the three reference group options is not valid and has no proven reliability.[21]A fourth reference group, Nonroutine Corrections, may be selected using a separate cohort-matching procedure. New research indicates that evaluators who are retained most often by the prosecution are more likely than others to select the high-risk reference group, [22]  which has base rates much higher than in contemporary sexual recidivism studies and will thus produce exaggerated risk estimates.[23]    
July 2012
Six months later, the percentile ranks and relative risk ratios are once again modified, with the issuance of the third edition of the Static-99R and Static-2002R Evaluators’ Handbook.[24] No additional data is provided to justify that the selection of nonroutine reference groups produces more accurate risk estimates than choosing the routine corrections reference group.
October 2012
In an article published in Criminal Justice & Behavior, the developers concede that risk estimates for the 23 offender samples undergirding the Static-99 vary widely. Further, absolute risk levels for typical sex offenders are far lower than previously reported, with the typical sex offender having about a 7% chance of committing a new sex offense within five years. They theorize that the Static-99 might be inflating risk of reoffense due to the fact that the offenders in its underlying samples tended to be higher risk than average.[25]
2012
The repeated refusal of the Static-99 developers to share their underlying data with other researchers, so that its accuracy can be verified, leads to a court order excluding use of the instrument in a Wisconsin case.[26]
October 2013
At an annual ATSA convention, Hanson and Phenix report that an entirely new reference group selection system will be released in a peer-reviewed article in Spring 2014.[27] The new system will include only two reference groups: Routine Corrections and Preselected High Risk High Need.  An atypical sample of offenders from a state hospital in Bridgewater, Massachusetts dating back to 1958 is to be removed altogether, along with some other samples, while some new data sets are to be added.
October 2014
At the annual ATSA convention, the developers once again announce that the anticipated rollout of the new system has been pushed back pending acceptance of the manuscript for publication. Helmus nonetheless presents an overview.[28] She reports that the new system will abandon two out of the current four reference groups, retaining only Routine Corrections and Preselected High Risk Need.   Evaluators should now use the Routine Corrections norms as the default unless local norms (with a minimum of 100 recidivists) are available. Evaluators will be permitted to choose the Preselected High Risk Need norms based on “strong, case-specific justification.” No specific guidance nor empirical evidence to support such a procedure is proffered. A number of other new options for reporting risk information are also presented, including the idea of combining Static-99 data with that from newly developed, so-called "dynamic risk instruments."   
January 2015
At an ATSA convention presentation followed by an article in the journal Sexual Abuse,[29] the developers announce further changes in their data sets and how Static-99R scores should be interpreted. Only two of the original four "reference groups" are still standing. Of these, the Routine group has grown by 80% (to 4,325 subjects), while the High-Risk group has shrunk by 35%, to a paltry 860 individuals. Absent from the article is any actuarial table on the High-Risk group, meaning the controversial practice by some government evaluators of inflating risk estimates by comparing sex offenders' Static-99R scores with the High-Risk group data has still not passed any formal peer review process. The developers also correct a previous statistical method as recommended by Ted Donaldson and colleagues back in 2012,[30] the effect of which is to further lower risk estimates in the high-risk group. Only sex offenders in the Routine group with Static-99R scores of 10 are now statistically more likely than not to reoffend. It is unknown how many sex offenders were civilly committed in part due to reliance on the now-obsolete data.

References


[1] Hanson, R. K. (1997). The development of a brief actuarial risk scale for sexual offense recidivism. (Unpublished report 97-04). Ottawa: Department of the Solicitor General of Canada.
[2] Grubin, D. (1998). Sex offending against children: Understanding the risk. Unpublished report, Police Research Series Paper 99. London: Home Office.
[3] Hanson, R.K. & Thornton, D. (1999).  Static 99: Improving Actuarial Risk Assessments for Sex Offenders. Unpublished paper
[4] Hanson, R. K., & Thornton, D. (2000). Improving risk assessments for sex offenders: A comparison of three actuarial scales. Law and Human Behavior, 24(1), 119-136.
[5] Harris, A. J. R., Phenix, A., Hanson, R. K., & Thornton, D. (2003). Static-99 coding rules: Revised 2003. Ottawa, ON: Solicitor General Canada.
[6] Hanson, R.K., Helmus, L., & Thornton, D (2010). Predicting recidivism amongst sexual offenders: A multi-site study of Static-2002. Law & Human Behavior 34, 198-211.
[7] Helmus, L. (2007). A multi-site comparison of the validity and utility of the Static-99 and Static-2002 for risk assessment with sexual offenders. Unpublished Honour’s thesis, Carleton University, Ottawa, ON, Canada.
[8] Helmus, L. (2008, September). Static-99 Recidivism Percentages by Risk Level. Last Updated September 25, 2008. Unpublished paper.
[9] Phenix, A., Helmus, L., & Hanson, R.K. (2008, September). Evaluators’ Workbook. Unpublished, September 28, 2008
[10] Harris, A. J. R., Hanson, K., & Helmus, L. (2008). Are new norms needed for Static-99? Workshop presented at the ATSA 27th Annual Research and Treatment Conference on October 23, 2008, Atlanta: GA. Available at www.static99.org.
[11] Doren, D., & Thornton, D. (2008). New Norms for Static-99: A Briefing. A workshop sponsored by Sand Ridge Secure Treatment Center on November 10, 2008. Madison, WI.
[12] Phenix, A. & Arnold, D. (2008, December). Proposed Considerations for Conducting Sex Offender Risk Assessment Draft 12-14-08. Unpublished paper.
[13] Abbott, B. (2009). Applicability of the new Static-99 experience tables in sexually violent predator risk assessments. Sexual Offender Treatment, 1, 1-24.
[14] Helmus, L., Hanson, R. K., & Thornton, D. (2009). Reporting Static-99 in light of new research on recidivism norms. The Forum, 21(1), Winter 2009, 38-45.
[15] Ibid.
[16] Hanson, R. K., Phenix, A., & Helmus, L. (2009, September). Static-99(R) and Static-2002(R): How to Interpret and Report in Light of Recent Research. Paper presented at the 28th Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Dallas, TX, September 28, 2009.
[17] DeClue, G. & Zavodny, D. (2014). Forensic use of the Static-99R: Part 4. Risk Communication. Journal of Threat Assessment and Management, 1(3), 145-161.
[18] Phenix, A., Helmus, L., & Hanson, R.K. (2009, November). Evaluators’ Workbook. Unpublished, November 3, 2009.
[19] Wollert, R., Cramer, E., Waggoner, J., Skelton, A., & Vess, J. (2010). Recent Research (N = 9,305) Underscores the Importance of Using Age-Stratified Actuarial Tables in Sex Offender Risk Assessments. Sexual Abuse: A Journal of Research and Treatment, 22 (4), 471-490. See also: "Age tables improve sex offender risk estimates," In the News blog, Dec. 1, 2010.
[20] Phenix, A., Helmus, L., & Hanson, R.K. (2012, January). Evaluators’ Workbook. Unpublished, January 9, 2012.
[21] Abbott, B.R. (2013). The Utility of Assessing “External Risk Factors” When Selecting Static-99R Reference Groups. Open Access Journal of Forensic Psychology, 5, 89-118.
[22] Chevalier, C., Boccaccini, M. T., Murrie, D. C. & Varela, J. G. (2014), Static-99R Reporting Practices in Sexually Violent Predator Cases: Does Norm Selection Reflect  Adversarial Allegiance? Law & Human Behavior. To request a copy from the author, click HERE.
[23] Abbott (2013) op. cit.
[24] Phenix, A., Helmus, L., & Hanson, R.K. (2012, July). Evaluators’ Workbook. Unpublished, July 26, 2012.
[25] Helmus, Hanson, Thornton, Babchishin, & Harris (2012), Absolute recidivism rates predicted by Static-99R and Static-2002R sex offender risk assessment tools vary across samples: A meta-analysis, Criminal Justice & Behavior. See also: "Static-99R risk estimates wildly unstable, developers admit," In the News blog, Oct. 18, 2012.
[27] Hanson, R.K. & Phenix, A. (2013, October). Report writing for the Static-99R and Static-2002R. Preconference seminar presented at the 32nd Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Chicago, IL, October 30, 2013. See also: "Static-99 'norms du jour' get yet another makeover," In the News blog, Nov. 17, 2013.
[28] Helmus, L.M. (2014, October). Absolute recidivism estimates for Static-99R and Static-2002R: Current research and recommendations. Paper presented at the 33rd Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, San Diego, CA, October 30, 2014.
Hanson, R. K., Thornton, D., Helmus, L-M, & Babchishin, K. (2015). What sexual recidivism rates are associated with Static-99R and Static-2002R scores? Sexual Abuse: A Journal of Research and Treatment, 1-35.
Donaldson, T., Abbott, B., & Michie,  C. (2012). Problems with the Static-99R prediction estimates and confidence intervals. Open Access Journal of Forensic Psychology, 4,
1-23.

* * * * *

*Many thanks to Marcus Boccaccini, Gregory DeClue, Daniel Murrie and other knowledgeable colleagues for their valuable feedback.  


* * * * *

Related blog posts:
·        Static-99 "norms du jour" get yet another makeover (Nov. 17, 2013)
·        Age tables improve sex offender risk estimates (Dec. 1, 2010)
·        New study: Do popular actuarials work? (April 20, 2010)
·        Delusional campaign for a world without risk (April 3, 2010)