Substantial Liability Research Articles

Obligations and liabilities concerning the active removal of foreign space debris: A global governance perspective

Eliminating space debris in valuable Earth orbits is an urgent challenge for the sustainable development of outer space, and active removal is considered the most effective measure for debris elimination. In terms of legal jurisdiction, any country intending to remove space debris belonging to other countries undergoes a legality review encompassing obligations and liabilities. According to the fundamental principles of international space law, both threatened and capable countries possess the right to actively remove identifiable space debris of foreign nations, subject to strict legal obligations towards the registry country unless authorized by the United Nations, granted an agreement on jurisdiction transfer of debris, or justified by emergency necessity. Moreover, active removal may result in third-party space objects or personnel damage, imposing a substantial liability burden that could restrict space operation. Henceforth, it is imperative to establish a more rational legal regime for space liability allocation purposes. The international community can establish a mechanism for liability sharing and cross-waiver agreements among relevant countries while also considering potential fund establishment, involvement of non-governmental entities in cost-sharing efforts, and promoting commercial recycling initiatives as potentially motivating measures towards active removal.

A New Generation of IMiDs as Treatments for Neuroinflammatory and Neurodegenerative Disorders.

The immunomodulatory imide drug (IMiD) class, which includes the founding drug member thalidomide and later generation drugs, lenalidomide and pomalidomide, has dramatically improved the clinical treatment of specific cancers, such as multiple myeloma, and it combines potent anticancer and anti-inflammatory actions. These actions, in large part, are mediated by IMiD binding to the human protein cereblon that forms a critical component of the E3 ubiquitin ligase complex. This complex ubiquitinates and thereby regulates the levels of multiple endogenous proteins. However, IMiD-cereblon binding modifies cereblon's normal targeted protein degradation towards a new set of neosubstrates that underlies the favorable pharmacological action of classical IMiDs, but also their adverse actions-in particular, their teratogenicity. The ability of classical IMiDs to reduce the synthesis of key proinflammatory cytokines, especially TNF-α levels, makes them potentially valuable to reposition as drugs to mitigate inflammatory-associated conditions and, particularly, neurological disorders driven by an excessive neuroinflammatory element, as occurs in traumatic brain injury, Alzheimer's and Parkinson's diseases, and ischemic stroke. The teratogenic and anticancer actions of classical IMiDs are substantial liabilities for effective drugs in these disorders and can theoretically be dialed out of the drug class. We review a select series of novel IMiDs designed to avoid binding with human cereblon and/or evade degradation of downstream neosubstrates considered to underpin the adverse actions of thalidomide-like drugs. These novel non-classical IMiDs hold potential as new medications for erythema nodosum leprosum (ENL), a painful inflammatory skin condition associated with Hansen's disease for which thalidomide remains widely used, and, in particular, as a new treatment strategy for neurodegenerative disorders in which neuroinflammation is a key component.

Third-Party Liability for the Payment of Taxes and Their Fundamental Rights

This article examines, from a human rights perspective, certain instances establishing the liability of third parties, other than the taxpayer himself, for the payment of taxes, such as the obligation to withhold taxes or the joint and several liability of a third party (i.e. a company’s director) for the payment of taxes due by another person. Such obligations may imply a substantial liability for taxes and often are coupled with sanctions, and also a liability for the infringement of a growing number of formal obligations, including filing returns and reporting data, raising concerns of compatibility with the fundamental rights of taxpayers and private parties. The authors argue that it is doubtful whether the need to secure a more effective protection of the interest to collect taxes can justify exposing third parties to substantive obligations in connection with taxable events for which they are not directly liable or where no specific involvement of that person in a scheme of tax avoidance or evasion is established. Moreover, such compulsory involvement, which is currently imposed without remuneration and without any consideration of the additional burdens that it creates, raises some concerns from the perspective of fairness. The authors propose that a possible solution to some of these problems in the cross-border scenario could be found by amending the Recovery Directive (2010/24), so that states could rely more on mutual assistance within the European Union and less on third-party liability for the collection of taxes.

Dissecting liabilities in adversarial surgical robot failures: A national (Danish) and EU law perspective

Over the last decade, surgical robots have risen in prominence and usage. They are not merely tools, but have also become advanced instruments with network connectivity. Connectivity is necessary to accept software updates, accept instructions, and transfer sensory data, but it also exposes the robot to cyberattacks, which can damage the patient or the surgeon. These injuries are normally caused by safety failures, as seen in accidents with industrial robots, but cyberattacks are caused by security failures instead. We create a taxonomy for both types of failures in this paper specifically for surgical robots. These robots are increasingly sold and used in the European Union (EU), hence it is natural to consider how surgical robots are viewed and treated by EU law. Specifically, which rights regulators and manufacturers have under it, and which legal remedies and actions a patient or manufacturer would have in a single national legal system in the union, if injuries were to occur from a security failure caused by an adversary that cannot be unambiguously identified (attribution of cyberattacks is often hard). Given that the Medical Device Regulation (MDR) has only recently entered into force, we also offer some general considerations of the regulation. We find that the selected (Danish) national legal system can adequately deal with attacks on surgical robots, because it can on one hand efficiently compensate the patient, and at the same time protect the patient by not shying away from dealing with the problem concretely. This is because of its flexibility; secondly, a remarkable absence of distinction between safety vs security causes of failure and focusing instead on the detrimental effects, thus benefiting the patient; and third, liability can be removed from the manufacturer by withdrawing its status as party, if the patient chooses a separate public law measure to recover damages. Furthermore, we find that current EU law does consider both security and safety aspects of surgical robots, without it mentioning it through literal wording, but it also adds substantial liabilities and responsibilities to the manufacturers of surgical robots, gives the patient special rights and confers immense powers on the regulators, which can end up affecting any future lawsuits.

Structure-Based Design of a Chemical Probe Set for the 5-HT5A Serotonin Receptor.

The 5-HT5A receptor (5-HT5AR), for which no selective agonists and a few antagonists exist, remains the least understood serotonin receptor. A single commercial antagonist, SB-699551, has been widely used to investigate the 5-HT5AR function in neurological disorders, including pain, but this molecule has substantial liabilities as a chemical probe. Accordingly, we sought to develop an internally controlled probe set. Docking over 6 million molecules against a 5-HT5AR homology model identified 5 mid-μM ligands, one of which was optimized to UCSF678, a 42 nM arrestin-biased partial agonist at the 5-HT5AR with a more restricted off-target profile and decreased assay liabilities versus SB-699551. Site-directed mutagenesis supported the docked pose of UCSF678. Surprisingly, analogs of UCSF678 that lost the 5-HT5AR activity revealed that 5-HT5AR engagement is nonessential for alleviating pain, contrary to studies with less-selective ligands. UCSF678 and analogs constitute a selective probe set with which to study the function of the 5-HT5AR.

Medicinal cannabis in the treatment of chronic pain.

Chronic pain is a major health issue, adversely affecting millions of Australians and costing billions of dollars annually. Current pharmaceutical treatments may be limiting, and in some cases ineffective, while carrying substantial liabilities. Medicinal cannabis is an increasingly popular, albeit controversial, alternative. The aim of this article is to briefly review the scientific evidence related to medicinal cannabis for the treatment of chronic pain and update physicians on relevant issues and optimal prescribing practices. To date, >130,000 medicinal cannabis approvals have been issued in Australia, mostly by general practitioners, with approximately 65% of these to treat chronic non-cancer pain. Available products deliver Δ9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD). Despite robust supportive data from animal models, current clinical trial evidence for THC and CBD efficacy in chronic pain is incomplete. In their prescribing decisions, doctors must balance patient demand and curiosity with caution regarding potential risks and limited efficacy.

Evolution and Diversification of the Going Concern Uncertainties Disclosed in the Auditor’s Report

The going concern of an entity's activity is a fundamental accounting principle. The practical application of this principle has accounting, legal and financial implications. From an accounting point of view, the management of the entities shall be responsible for drawing up the financial statements in accordance with this principle. From a legal perspective, entities that go into liquidation are no longer obliged to respect the going concern principle. When auditing financial statements, auditors shall be responsible for assessing the adequacy of compliance with the principle of going concern and for including the appropriate references in their report. The objective of the paper is to analyse the reasons for including in the auditors' report the paragraph on going concern uncertainties, in the light of their evolution over time, their frequency and diversification. The sample included 120 companies listed on European stock exchanges, included in the main stock indexes for the period 2010-2020. The data was gathered from reports published by auditors that were included in the Audit Analytics database. The results showed that there was an average trend of 20 reported situations per year, but with a significant increase over the last two years analysed mainly due to the situations arising from the impact of the Covid-19 pandemic. The most common reasons were liquidity risk, substantial liabilities and the refinancing of activities. In recent years there has been a diversification of reasons, but with a reduced frequency, such as the working capital, the decrease in stockholder equity and competitor threat. Reporting on going concern issues is of particular importance so that increasing transparency in the publication of this information can contribute to a higher degree of investor confidence in the entities' financial statements.

The Victory of Hope Over Angst? Funding, Asset Allocation, and Risk-Taking in German Public Sector Pension Reform

Public employee pension systems have traditionally been of the pay-as-you-go defined benefit (DB) variety, where retiree payments are financed by taxes (contributions) levied on the working generation. The same holds for Germany, where civil servants are promised a (mostly) unfunded, noncontributory, tax-sponsored DB pension, representing substantial liabilities currently not recognized as explicit obligations to the public sector. This paper analyzes the risks and rewards of moving to a (partially) prefunded pension system for most civil servants in the German federal state of Hesse. First, we conduct an actuarial valuation of pension promises to retired and active civil servants, which we conservatively put at € 44 billion in present value, or about 150 percent of explicit state debt. Second, we project 50 years into the future and estimate the payroll-related contribution rate sufficient to fund the civil servant pension obligation. Next, using a Monte Carlo framework and a stochastic present value approach, and a Conditional Value at Risk measure, we identify an asset allocation for plan assets that minimizes worst-case pension costs. Prefunding the pension with a tax worth about 20 percent of payroll, and investing the assets 30 percent in equities and 70 percent in bonds, substantially reduces expected and minimizes worst-case pension costs. Finally, we illustrate contribution rates and asset allocation when the plan sponsor is limited to a particular risk budget. In one interesting case, current taxpayers are asked to pay additional regular contributions of only 15 percent while the portfolio is held 43 percent in equities. This mix allows future generations to benefit from possible contribution holidays and withdrawals, while providing an acceptable level of risk of supplementary contributions resulting from underfunding.

State-Owned Enterprises and Debt Sustainability Analysis: The Case of the People’s Republic of China

The paper aims to combine balance sheet analysis at the firm level with the International Monetary Fund's public debt sustainability assessment framework to assess state-owned enterprises' (SOE) leverage as a contingent liability to the public sector. Based on company data and the interest coverage ratio as a measure of debt at risk, aggregate baseline scenarios are projected to gauge the magnitude of SOE debt as a contingency. SOE's financial and debt ratios are first bootstrapped to generate firm-level distributions and then averaged into a fan chart of the economy-wide SOE contingent liability. Applied to the People's Republic of China as an example, the study finds that by the end of 2015 SOE leverage had grown to a substantial liability. However arbitrary the assumptions underlying these projections, it would appear that even if authorities had to mop up as much as 20% of SOE debt at risk gone bad, this would have been manageable at roughly 2.7% of the gross domestic product in 2016 or 5.5% by 2021. This projection framework is fully amenable to alternative assumptions and settings, which makes it a useful analytical tool to monitor contingent liabilities from non-financial corporate debt that have been building in emerging and advanced economies alike.

Too Big to Fail and Too Big to Save: Dilemmas for Banking Reform

‘Too big to fail’ traditionally refers to a bank that is perceived to generate unacceptable risk to the banking system and indirectly to the economy as a whole if it were to default and be unable to fulfill its obligations. Such a bank generally has substantial liabilities to other banks through the payment system and other financial links, which can be sources of ‘contagion’ if a bank fails. The main objectives in this paper are to identify the different dimensions of too big to fail and evaluate various proposed reforms for dealing with this problem. In addition, we document the various dimensions of size and complexity, which may contribute to or reduce a bank's systemic risk. Furthermore, we provide an assessment of economic and political factors shaping the future of too big to fail.

Too Big to Fail and Too Big to Save: Dilemmas for Banking Reform

“Too big to fail” traditionally refers to a bank that is perceived to generate unacceptable risk to the banking system and indirectly to the economy as a whole if it were to default and unable to fulfill its obligations. Such a bank generally has substantial liabilities to other banks through the payment system and other financial links, which can be sources of contagion if a bank fails. The main objectives in this paper are to identify the different dimensions of “too big to fail” and evaluate various proposed reforms for dealing with this problem. In addition, we document the various dimensions of size and complexity, which may contribute to or reduce a bank’s systemic risk. Furthermore, we provide an assessment of economic and political factors shaping the future of “too big to fail.”

Can new business ventures compete with established suppliers?

New business ventures are ubiquitous in today’s business environment but often struggle to engage into exchange relationships with buying firms when confronted with established competitors. Purchasing managers often hesitate to source from new business ventures because they perceive them as unreliable. Although a plethora of research exists on how financial investors perceive new business ventures as investment opportunities there is relatively little empirical evidence on how purchasing managers perceive new business ventures as suppliers. This research effort builds on institutional theory and signaling theory in order to enhance our understanding of how buying firms view new business ventures as suppliers. Results from a discrete choice analysis indicate that new business ventures face a substantial liability of newness in supplier selection when competing with established firms. Furthermore, results suggest that firms can proactively improve their chances of being selected as supplier by employing sym...

Microsatellite Instability Testing in Colorectal Carcinoma: A Practical Guide

In this month’s “Road Ahead” article, we continue last month’s theme that focused on the role of pathology in the care of our GI patients. Many gastroenterologists have successfully incorporated pathology into their core practices either within a business infrastructure or as part of a larger health care system. Dr Gibson and her colleagues at Yale University School of Medicine have helped inform us about a particularly difficult management problem: how to handle the genetically high-risk patients we see frequently in our hospitals and endoscopy units. New comprehensive practice guidelines concerning management of hereditary colon cancer syndromes are in development, but this short article provides a clear and concise guide for the practicing gastroenterologist.

Sacrificing Children's Safety for Vaccine Supply: Nonexistent Safeguards for Remedying Mandatory Defectively Designed Vaccines

With growing public fear about vaccine safety, declining vaccination rates and reports of pertussis outbreaks, this article is a thought-provoking and critical account of vaccine policymaking and vaccination law in the United States. This topic is of utmost importance to current public health policy. Vaccines are legally classified as unavoidably unsafe products, yet they are mandated for day care or school entry for all American children unless an exemption is granted. Vaccines are the only medical intervention mandated for healthy children, and each child is at risk of adverse side effects. U.S. government health officials and U.S. vaccine manufacturers endorse them as a safe and effective means of preventing infectious disease. Mounting evidence, however, suggests otherwise.This article provides a unique commentary on morality and justice in our society through the prism of the diphtheria-tetanus-pertussis vaccine. A historical account of this vaccine highlights its known dangerous propensities as an example of an unsafe vaccine and defectively designed vaccine. History demonstrates how the U.S. has lagged behind international countries on vaccine safety. Since the 1950’s U.S. government health officials were aware of this vaccine causing serious adverse reactions including death and severe neurological impairment in children. Despite this knowledge and U.S. vaccine manufacturers having the methodology and technology to develop a safer alternative feasible vaccine, it took many decades of litigation, consumer advocacy, international scientific research and congressional action to effectuate change for a safer vaccine for children.In the 1980’s, increasing lawsuits against U.S. diphtheria-tetanus-pertussis vaccine manufacturers and mounting political pressure led to a crisis. Instead of making vaccine safety a top priority by having U.S. vaccine manufacturers develop a safer alternative feasible vaccine, Congress enacted the National Childhood Vaccine Injury Act of 1986. Effectively, this legislation was a government bailout of the U.S. vaccine manufacturing industry as it gave U.S. vaccine manufacturers, physicians and health care professionals who administer vaccines substantial liability protection from vaccine injury claims. The immense liability protection granted to U.S. vaccine manufacturers is particularly troubling given its pervasive influence and significant omnipresence in vaccine policymaking. U.S. government health officials in charge of promulgating vaccine policy are often in the same circle as those who profit financially from vaccine sales. With liberal grants of waivers to numerous and substantial conflict of interests, U.S. government health officials allow the approval of unsafe vaccines on the market. As a result, this law not only insulated U.S. vaccine manufacturers from liability, but it also created perverse incentives and paved the way for potentially more unsafe vaccines to flood the market.Since 1986 rights to compensation for vaccine injuries have significantly narrowed. Through administrative and judicial interpretation, the vaccine injury compensation process has become increasingly adversarial, expensive, difficult and lengthy. In 2011, the U.S. Supreme Court ruled that U.S. vaccine manufacturers cannot be held liable for defectively designed vaccines. This decision greatly exacerbates the danger facing American schoolchildren and allows unsafe vaccines to remain on the market and bypass all current safeguards under the law.Based upon the evidence, U.S. government officials, U.S. medical organizations and individuals with substantial financial relationships with U.S. vaccine manufacturers generate propaganda to endorse the belief that vaccines are safe and effective despite knowledge they are not; use scare tactics, coercion and other deceptive means to increase vaccination rates; withhold vaccine safety information from the public; and disseminate false information about the risks of infectious disease, infectious disease outbreaks and adverse side effects following vaccination. Furthermore, there is credible evidence U.S. vaccine manufacturers exert undue influence in Congress and in other government entities to systematically restrict the rights to vaccine injury compensation while simultaneously use that influence to generate vast financial profits for themselves. Based upon the evidence, corruption, fraud and malfeasance leave little choice for parents and forces them to participate unwillingly or unknowingly in a dangerous and fraudulent financial scheme. Lastly, this compelling article provides original recommendations for Congress to rectify the grave, immediate danger in order to provide better protection and give justice to our nation’s children.

Medicolegal Sidebar: Corporate Relationships and Increased Surgeon Liability Risk

In our last column (January 2013; http://dx.doi.org/10.1007/s11999-012-2686-8) [1], we addressed the subject of corporate malfeasance and associated surgeon liability in relation to off-label marketing of Norian bone void filler by device manufacturer Synthes. The federal criminal complaint in that case was directed at the company, and corporate executives at Synthes received jail sentences for their misconduct. The concern for consulting surgeons who helped market and promote Norian for a non-FDA-approved use—vertebroplasty—was that the corporate malfeasance could exaggerate surgeon liability, as injured patients sued individual surgeons for damages related to Norian used in vertebroplasty. In this column, we examine the unusual outcome of a civil lawsuit filed against an orthopaedic surgeon and a device company, with the goal of understanding the mechanisms of surgeon-industry relations; while financially rewarding, they can expose surgeons to substantial liability risk. The case described below has educational value for the orthopaedic community; all identities and factual information below are drawn from publicly available sources [3, 4]. We conclude by offering practical pointers to help avoid the scenario described below.

The Law and Economics of Tax Strategy Patents

Since the famous Federal Circuit case of State Street Bank & Trust Co. v. Signature Financial Group, Inc., the practice of patenting business methods has increased substantially. This has led some inventors to apply for patents on strategies to save or defer taxes. Tax lawyers and accountants now face increased costs and substantial liability for unknowingly infringing on patents that may very well cover methods that they have been using for years. Patents on tax strategies should not be allowed because they preempt taxpayers other than the patent holder from utilizing or complying with certain provisions of the tax law. Additionally, patents on tax strategies do not promote the progress of the “useful Arts,” as required by the Constitution. The purpose of the patent system is to encourage innovation in science and technology, not to prevent people from interpreting and complying with the law as intended by the legislature. Although current case law may prohibit the patentability of tax strategies, a lack of resources at the United States Patent & Trademark Office prevents patents applications from obtaining adequate examinations. In addition, courts are not in the position to make patentability decisions on the basis of policy. Thus, Congress should take legislative action to define tax strategies and limit the patent law to exclude methods that may prohibit some taxpayers from taking advantage of certain interpretations of the law.

Data Caps: How ISPs are Stunting the Growth of Online Video Distributors and What Regulators Can Do About it

Many high-speed Internet Service Providers (ISPs) have begun limiting the aggregate data usage of subscribers. These limits, or 'data caps,' have received relatively little regulatory, legislative or media attention compared to Net Neutrality issues, described by some commentators as setting a 'speed limit' for internet users. But if Net Neutrality principles will decide the internet’s speed limit, data caps will determine the end user’s mileage.Comcast and other ISPs have attempted to justify these programs on two grounds: first, that limiting data usage is necessary for a fair allocation of costs; second, that limiting data usage will help limit network congestion. However, neither of these justifications survives scrutiny. Not all uses of an ISPs network cost the ISP the same amount. In particular, video providers like Netflix, which make up a plurality of the data received by end-users, create profit center for many ISPs, because Netflix and others pay for the privilege of connecting more directly to customers through 'paid peering' arrangements. On the second point, there is no evidence that data caps will ease congestion and Comcast’s own engineers admit that data caps will not affect network congestion.Instead, the primary benefit to ISPs is it allows them to cling to a cable or satellite based subscription video service. With data caps, customers are free to augment, but not replace, their cable viewing with services like Netflix and Hulu. This unfair use of market power suggests substantial antitrust liability for Cable ISPs, and potential liability under recent FCC regulation as an unreasonable “network management” practice. Regulators should take action against ISPs imposing data caps, not only for the sake of consumers, but to ensure the continued exponential growth of online communication.

Synthesis of conolidine, a potent non-opioid analgesic for tonic and persistent pain

Management of chronic pain continues to represent an area of great unmet biomedical need. Although opioid analgesics are typically embraced as the mainstay of pharmaceutical interventions in this area, they suffer from substantial liabilities that include addiction and tolerance, as well as depression of breathing, nausea and chronic constipation. Because of their suboptimal therapeutic profile, the search for non-opioid analgesics to replace these well-established therapeutics is an important pursuit. Conolidine is a rare C5-nor stemmadenine natural product recently isolated from the stem bark of Tabernaemontana divaricata (a tropical flowering plant used in traditional Chinese, Ayurvedic and Thai medicine). Although structurally related alkaloids have been described as opioid analgesics, no therapeutically relevant properties of conolidine have previously been reported. Here, we describe the first de novo synthetic pathway to this exceptionally rare C5-nor stemmadenine natural product, the first asymmetric synthesis of any member of this natural product class, and the discovery that (±)-, (+)- and (-)-conolidine are potent and efficacious non-opioid analgesics in an in vivo model of tonic and persistent pain.

Non-Invasive Imaging Tests for the Evaluation of Low Risk Patients in Chest Pain Units: Availability, Contributions and Drawbacks in Real Practice

Patients presenting with chest pain or other symptoms consistent with myocardial ischemia are a common problem throughout the world. In the United States alone, there are over 8 million visits to the emergency department (ED) for chest pain annually, such that it is the secondmost frequent cause of adult ED visits. The presence of hemodynamic stability or ischemic electrocardiogram (ECG) changes identifies a high risk cohort; in the absence of these, the majority of the remaining patients are at lower risk for an acute coronary syndrome (ACS), and can be further risk stratified based on symptoms and history of coronary disease. The challenge to clinicians is rapidly and accurately identifying patients from this group who actually have unsuspected ACS. Failure to detect ACS patients can lead to inadvertent ED discharge, a situation associated with significantly increased morbidity and mortality, with resultant substantial liability. In an effort to improve risk stratification and identification of ACS and other serious conditions in the ED, a wide array of new imaging techniques have been applied, each with potential advantages and disadvantages. With all of these modalities, clinical judgment is essential for optimal application and interpretation. The simplest test for evaluating chest pain patients is the exercise treadmill test without imaging. Although very early exercise stress testing (ETT), prior to complete exclusion of myocardial infarction (MI), has been applied in some centers successfully, most would be reluctant to exercise a patient without serial markers and symptom resolution. Additional limitations of an ETT alone strategy include baseline ECG changes precluding the ability to interpret the ECG, and exercise tolerance insufficient to exclude ischemia with high confidence. In contrast to ETT, acute imaging is typically applied to patients with and without ongoing symptoms, frequently with only one set of cardiac markers. Advantages of acute imaging include more

DRD2 promoter region variation predicts antipsychotic-induced weight gain in first episode schizophrenia

Many antipsychotic medications carry a substantial liability for weight gain, and one mechanism common to all antipsychotics is binding to the dopamine D2 receptor. We therefore examined the relationship between -141C Ins/Del (rs1799732), a functional promoter region polymorphism in DRD2, and antipsychotic-induced weight gain in 58 first episode schizophrenia patients enrolled in a randomized trial of risperidone versus olanzapine. Carriers of the deletion allele (n=29) were compared with Ins/Ins homozygotes (noncarriers, n=29) in a mixed model encompassing 10 weight measurements over 16 weeks. Deletion allele carriers showed significantly more weight gain after 6 weeks of treatment regardless of assigned medication. Although deletion carriers were prescribed higher doses of olanzapine (but not risperidone), dose did not seem to account for the genotype effects on weight gain. Given earlier evidence that deletion carriers show reduced symptom response to medication, additional study of appropriate treatment options for these patients seems warranted.