The iPad Has Applications for the Disabled

The unfortunately named tablet device may have reach beyond the dreams of even Steve Jobs, our benevolent god of gadgets and culture. From The New York Times: 

OWEN CAIN depends on a respirator and struggles to make even the slightest movements — he has had a debilitating motor-neuron disease since infancy.

Owen, 7, does not have the strength to maneuver a computer mouse, but when a nurse propped her boyfriend’s iPad within reach in June, he did something his mother had never seen before.

He aimed his left pointer finger at an icon on the screen, touched it — just barely — and opened the application Gravitarium, which plays music as users create landscapes of stars on the screen. Over the years, Owen’s parents had tried several computerized communications contraptions to give him an escape from his disability, but the iPad was the first that worked on the first try.

“We have spent all this time keeping him alive, and now we owe him more than that,” said his mother, Ellen Goldstein, a vice president at the Times Square Alliance business association. “I see his ability to communicate and to learn as a big part of that challenge — not all of it, but a big part of it. And so, that’s my responsibility.”

Since its debut in April, the iPad has become a popular therapeutic tool for people with disabilities of all kinds, though no one keeps track of how many are used this way, and studies are just getting under way to test its effectiveness, which varies widely depending on diagnosis.

A speech pathologist at Walter Reed Medical Center uses text-to-speech applications to give patients a voice. Christopher Bulger, a 16-year-old in Chicago who injured his spine in a car accident, used an iPad to surf the Internet during the early stages of his rehabilitation, when his hands were clenched into fists. “It was nice because you progressed from the knuckle to the finger to using more than one knuckle on the screen,” he said.

Parents of autistic children are using applications to teach them basic skills, like brushing teeth and communicating better.

For a mainstream technological device like the iPad to have been instantly embraced by the disabled is unusual. It is far more common for items designed for disabled people to be adapted for general use, like closed-captioning on televisions in gyms or GPS devices in cars that announce directions. Also, most mainstream devices do not come with built-ins like the iPad’s closed-captioning, magnification and audible readout functions — which were intended to keep it simple for all users, but also help disabled people.

“Making things less complicated can actually make a lot of money,” said Gregg C. Vanderheiden, an engineering professor at the University of Wisconsin at Madison who has worked on accessibility issues for decades.

Here's the full story.

Shrinks on the Take: Talk About Betrayal

The big doctor-payment database we reported on last week has shed light on a dirty little secret about shrinks: There are more psychiatrists collecting payments from the pharma industry than any other type of specialist. And psychiatry was the most common specialty among doctors paid more than $100,000 in consulting or speaking fees. So it may not be paranoid to ask your shrink why he or she is prescribing all the expensive meds.

Of the 384 doctors paid more than $100,000, 116 were psychiatrists. That's 30 percent. Medscape Medical News theorizes more psychiatrists are paid pharma consultants because of the high volume of psychotropic drug sales. Last year, antipsychotics alone topped $14.6 billion, with antidepressants at $9.9 billion. Considering that exercise has beat anti-depressants in alleviating moderate depression in numerous studies, one could reasonably theorize the prescribing frenzy is at least partly financially motivated.

Adam Linker of the North Carolina Justice Center has a slightly different theory: Psychiatric drugs carry bigger price tags than many other meds. "Some of these drugs are the most expensive," Linker told WFAE radio. "They're some of the best-sellers, and they're driving some of the increases in drug costs. I think drug companies want to keep increasing those prescriptions."

Even the head of the National Institute of Mental Health is crying foul. In a March editorial for the Journal of the American Medical Association, Dr. Thomas Insel decried the "culture of influence" and called on his fellow psychiatrists to "clean up our act." He wants all financial ties between drugmakers and psychiatry to be disclosed, and for psychiatrists to take a step back from branded meds in favor of generic drugs and non-drug treatments such as talk therapy.

Over the past three years, congressional probes have repeatedly highlighted influential psychiatrists' financial relationships with industry. In some cases, payments from drugmakers went undisclosed even though researchers were obliged to report them to their universities.

Psychiatrists themselves say that speaking on behalf of drugmakers doesn't sway their prescribing habits. The highest-paid psychiatrist on ProPublica's database, Dr. Roueen Rafeyan, told Medscape that he mostly prescribes generic drugs. "The day I'm influenced by that is the day I'm not fit to practice medicine," Rafeyan said.

Perhaps he should go back to his diagnostic manual and look up denial.

Read about it at Fierce Pharma.

A Cure For The Common Inbox

Because a laugh a day--at least one--is good for general well-being, we respectfully submit this hilarious take on modern communication, by Martin Marks in the New Yorker:

 

E-MAIL AUTO RESPONSE

Dear Friend, Family Member, Loved One, and/or Business Associate:

Thank you for your e-mail, which, if it is under three (3) sentences long, I have read. Owing to the large volume of e-mails I’m receiving at this time, please note that it will sometimes take up to fourteen (14) calendar days, though sometimes longer (and sometimes much longer), to respond to your e-mail; in the interim, please rest assured that I am attempting to address, resolve, or think about the matter you have described, unless, of course, I’m avoiding the matter entirely. Some possible reasons for this include:

—Thinking about the matter gives me a headache.

—Thinking about the matter takes longer than forty-five (45) seconds.

—Thinking about the matter is simple enough, and takes less than forty-five (45) seconds, but, when combined with all the other e-mails in my in-box, it creates a synergy of matterdom, exacerbating the headaches mentioned at the beginning of this list.

Please note that if your e-mail is more than three (3) sentences in length I have read the first three (3) sentences, skimmed the opening paragraph, and sort of eyeballed the rest of it. Please do not expect a response to your e-mail anytime soon, if at all, for I am not a mind reader, and therefore cannot guess the nature of anything beyond the first three (3) sentences. For those of you who continue to insist on sending e-mails longer than three (3) sentences, here is a Wikipedia entry on haiku. Reformat your e-mails accordingly, as in this example:

               I am busy now;
               The Internet has stolen
               So much precious time.

Under certain circumstances, you may feel as though you cannot express the matter at hand in less than three (3) sentences. Below, please find some possible reasons for this, and their solutions:

—If your e-mail attempts to provide a detailed update on what you’ve been doing since high school, or to “fill me in” on a time period longer than five (5) calendar years, then please call the number provided at the bottom of the e-mail.

—If your e-mail refers to nuanced emotional matters relating to but not limited to a current, prior, potential, or perceived romantic involvement, then please call the number provided at the bottom of the e-mail.

—If your e-mail has been cc’d to three (3) or more people, and includes complicated yet unresolved logistical information regarding the location, time, or general coördination of an upcoming social gathering involving five (5) or more people, then please wait until two (2) hours after the last respondent has answered and then please call the number provided at the bottom of the e-mail. (Be prepared to detail the conclusions reached by the e-mail chain.)

On rare occasions, I will respond almost immediately to your e-mail with a one-to-two-word response. Here is a guide to those responses:

LOL: I am laughing out loud, owing to the absurdity, humor, or sheer stupidity of the matter about which you are writing.

Haha!: See LOL.

Thank you!: Thank you.

THANK YOU!!!!!: Thank you!

Yes!: I approve of, give my consent to, or agree with that which you have written.

Yes!!!!!: I wholeheartedly approve of, give my consent to, or agree with that which you have written.

No: I in no way approve of, give my consent to, or agree with that which you have written.

No!: I am upset and/or disheartened by that which you have written.

Boo!: I am palpably disappointed and/or trying to frighten you.

PPPSSEOT(3)SIL: Please, please, please stop sending e-mails over three (3) sentences in length.

Should you receive a speedy one-to-two-word response, please do not read anything into it. More often than not, such a response doesn’t even correspond to the content of your e-mail. Please note that this auto-response should not be perceived as granting you permission to send any future e-mails, of any length, for any reason.

In closing, I would like to say that the Internet has become a veritable buzzing, stinging hornet’s nest of pings and pongs and klings and klangs, so please do not e-mail, text-message, instant-message, direct-message, Facebook-message (if you’re still on MySpace or Friendster, that’s just plain creepy), Facebook-chat, iChat, tweet, retweet (don’t even mention Twitter mentions), StumbleUpon, LinkIn with, zoom into, Google Buzz, Plaxify, Jigsaw, Digg, Skype, Spoke, poke, flick, or tag me. Don’t boxball, squareball, jingl, jangl, mingl, mangl, FairShare, Foursquare, twosquare, do-si-do, or swing your laptop round and round. I just want to be left alone.

Thanking you for your anticipated coöperation and understanding in this matter,

               [Name]

               [Fake Telephone Number] ♦

A Beautiful Health Hazard at the Tate Modern

The curators and artist who created a participatory installation of porcelain sunflower seeds at the Turbine Hall at the Tate Modern in London have nixed the participatory part. Only days after "Sunflower Seeds" opened to the public, visitors can no longer interact with the exhibit because the roughly 100 million artificial seeds created by villagers for Chinese artist Ai Weiwei are a potential source of toxic dust that may harm people's lungs.

"I could say I told them so, except I didn’t. I merely commented to my husband, as we looked down from the bridge a few days earlier, that the piece looked like an upper-respiratory disaster waiting to happen. It had not yet opened to the public, and was empty — except for one person off in the distance who was raking the seeds and wearing a surgical mask. That was a big clue," Roberta Smith writes in her Critics Notebook for The New York Times.

It turns out Weiwei's sunflower seeds are made using an unusual technique not normally used on porcelain; they are painted with a liquid clay, but not glazed. And so the paint simply rubs off. Visitors have reported their hands were coated with a grey film after touching the seeds. And little clouds of paint dust were seen floating in the air where people walked.

Understandably, visitors want to interact with the art, but not inhale it.

Dr. Money

The website ProPublica compiled a database of the top docs paid by pharmaceutical companies to "consult" on their drugs, and its fascinating to peruse. Paying for prescribing is illegal, but drug companies can pay fees for "speaking engagements" and other consulting work. The information came to light after a series of whistle-blower lawsuits forced seven major companies (including Eli Lilly, Pfizer, Merck and Johnson & Johnson) to disclose the details of the Rx-booty. Over the past year drug companies have payed nearly $7 billion for settlements in the cases.

Federal prosecutors have made headway in unraveling the dollars that bind docs to drug companies. In documents, one drug sales-rep said drug companies rigorously tracked whether or not their payments to physicians were worthwhile. In another lawsuit, involving Wyeth Pharmaceuticals, that's still ongoing, a former sales rep alleged, “Wyeth management was able to exclude speakers who did not promote Rapamune [used to prevent kidney-transplant rejection], and reward those who did so with repeated speaking engagements and resulting honoraria,” according to an amended complaint. Yet another lawsuit (involving Cephalon) alleges doctors were dropped from speaking engagements for not writing enough off-label prescriptions for the narcotic lollipop, Actiq.

Perhaps if insurance companies payed doctors decently this wouldn't be happening. In any case, it sure sounds like paying for prescriptions to us.

Update on Friday, November 5, 2010 at 10:44AM by Kathy

As further evidence that some doctors are reaping financial rewards for prescribing certain drugs, The New York Times uncovered documentation of a secret rebate program operated by Genentech for prescribing a costly drug for macular degeneration, the leading cause of blindness in the elderly.

Read the story.

Update on Tuesday, November 9, 2010 at 11:07AM by Kathy

A new study published in the Archives of Internal Medicine, found that physicians are taking less money overall from pharmaceutical companies than they were five years ago. Researchers surveyed a random sample of 1,891 doctors and compared it to a random sample of the same size five years ago. The biggest change occurred in the number of doctors who accepted drug company money to attend medical meetings, which fell from 35% in 2004 to 18% last year. It would seem public outcry over the too-cozy relationship between pharma and docs is getting through to some physicians, and so they've finally learned to go Dutch...

Read an article about the study in USA Today.