Monday, November 26, 2007

Kickbacks to Doctors for pushing CIs

A good friend of mine, who is Deaf, sent this to me today. It is from the blog Grumpy Old Deafies. The words are not mine, but I agree with the sentiment...

Cochlear's dirty marketing tricks

We've been told that a complaint was filed in USA earlier this year against Cochlear. Upon investigation, we found out that the case focused on Medicare and exaggerated claims made by providers and possible competition practices.


Background
So what's this about? Someone called Brenda March worked as the Chief Financial Officer and Vice President of Cochlear from 1998-2004. She became a whistleblower, and filed a complaint (with the US government) [PDF], via her lawyers. This case has now been referred to the US HHS Office of the Inspector General, by the US Department of Justice. Whilst this complaint focuses on specific American laws around Medicare, and the fairness of payments, it also contains useful facts about how cochlear implants are sold and marketed.


Incentives to use Cochlear's products (implant CIs)
In 1997 Cochlear established a 'Partners Program' (and subsequent schemes), which gave surgeons 'points' each time they implanted a CI. A points programme worked in the same way as rewards programmes you would get at your local supermarket. E.g. when you go shopping in Sainsburys you can get Nectar points. Get enough points and you can get some freebies or rewards. Shop elsewhere, and perhaps you can collect Air Miles, AAdvantage etc. The company buys in your loyalty, thus you feel obliged to buy from them. Its a clever marketing technique, and most of us will participate.

The okay thing about all the above marketing, is you are making decisions which affect *your* life, and *your* finances, and that is where it ends. You are fully aware this is happening, thus able to make an informed decision. Secondly, it usually has no direct implications on anyone's health.

The case of Cochlear points, works in a similar way. Surgeons, audiologists and other front line staff would get points each time their service brought a CI from Cochlear. In other words, the more Cochlear implants a surgeon implanted, the more 'points' they would get, and thus bigger and more freebies from Cochlear.

Purchasing these devices for medical staff, was not for personal use, but they would then need to sell the benefits of a CI to a deaf person or parents of deaf children to get rid of the device, so in turn they could buy more CIs from the manufacturer, and get more points or bigger freebies.

Freebies
Freebies included (to woo medics and encourage cochlear implantation):
- golf tournaments- first class airfares and also for spouses or guests

- exotic holidays- all expenses flights/trip to Australia twice a year, with significant free time & recreational activity

- payment of salaries of employees, and general operating expenses of clinics (which means more profit for physicians or practices)

- free products (which they could then sell on - device costs £16,500, so that much free money)

- direct cash payments


On a points system, these freebies would increase the more CIs implanted. Implant more, and you get a bigger personal prize.


To quote from the complaint brought by the US government and a former Vice President of Cochlear: "The express purpose of such payments are and were to encourage Physicians to direct hospitals ... to purchase Cochlear Implant Systems".


Other dubious practices
Other marketing techniques included such people involved must agree to purchase between 5-10 implants to attend an event. You would obviously then need to pass on this purchase decision to a deaf person, by marketing or selling the idea of a CI to them.

In addition, Cochlear required provide certain outcome evaluations i.e. make sure the results were favourable to Cochlear. Perhaps modify statistics or influence these, and lack impartiality.

Unethical?
See the mentality here? Lets sell the benefits of a CI to deaf people, perhaps tap into their vulnerability, so I can have some more freebies. Perhaps tell them they won't get through education (I've been told this) if they don't have a CI. Abuse and play on fear. Perhaps tell parents that alternatives such as sign language is a bad, and their child will never be normal (again I've seen it happen in clinical situations).

The problem with this, is two things:

- there is a conflict of interest between a surgeon getting a reward, and what is in the best interest of the patient. A surgeon might want some freebies, thus could go for a hardcore marketing technique (implant will really change your life etc), whether it is good for the patient or not. This brings the medical profession into disrepute.

- who is in control? When you go shopping at Sainsburys, you make an active decision to do this, and making an informed decision. The process is more transparent. How many end users are aware of the above?

Cochlear has publically stated that it wanted a 20% target growth internationally, and has beaten these targets, thus one can only assume that such aggressive marketing techniques (and what I would call unscrupulous), are happening elsewhere including the UK. For an international company, it would not single out one country in terms of incentives.


Who is protecting deaf people?
Okay, exactly what are deaf organisations doing about this? Pussyfooting around in case they offend someone, as they have done so for years? Too scared to jeopordise their positions, and put their neck on the line?

Do they receive money too or some other incentive to shut the hell up? Balanced information cannot exist just by taking CI information vs cultural information, money and power structures get in the way.

Hmm ...
A good example of money being the root of all evil?

For the record, if an adult wants an implant then they can have 100 for all I care. However, the over marketing strategies has always scared the hell out of me. It plays on fear of being in a minority and seeks to makes millions from this.

As for Cochlear shareholders, you should all be ashamed of yourselves. The sad thing is, due to how society is constructed, these people will probably think its an ethical investment.

Thursday, November 22, 2007

Thanksgiving

There are so many things to be thankful for, not just on Thanksgiving. I am thankful for the obvious things...the health of my family and friends, food in the fridge, a job that pays the bills. I am also so very thankful for my good friends, far and near. From MLG to my north, to KAG to the south - my dear friends help get me through the most trying of times. They are my sounding boards, my safe harbor, and my sanity. Thank you so very much.

Although I do not show it or express it nearly enough, I am thankful to my wife JAL. She does so much for the kids and I, things I do not even think of or realize. She keeps me stocked on my favorite chewing gum while managing to keep the cabinets and fridge full our varied needs and requests. She runs the kids around, takes the animals to the vet, and manages to work 40+ hours a week while helping kids with homework and juggling multiple loads of laundry. It is my generous wife who has made it possible for me to go to school 2 nights a week to purse my passion for ASL.

Speaking of ASL, I find that I am thankful for the numerous good friends I have made in and around the Deaf community. You have been inspirational teachers, wonderful mentors, and now cherished friends. I am so happy to have been embraced into your community and given the opportunity to learn your language and culture.

Safe travels to everyone as they venture far and near this holiday...

Thursday, November 15, 2007

Factoids

50 random thoughts and facts about me...

1. I have stuck my arm inside the back end of a horse – with an elbow-length glove – to help deliver her foal.

2. I am terrified of snakes, spiders, and needles

3. My tonsils were removed when I was 6

4. Red wine makes me vomit

5. So does cottage cheese and yogurt

6. I cannot play any musical instruments

7. I can talk to people who cannot hear

8. My sister and I were jilted when it came to body distribution – I have too much butt and she has too much boob. She got the better end of the deal.

9. I detest bologna

10. No matter how hard I try, I cannot stop chewing on my fingernails

11. I am too lazy to shave my legs in the winter

12. I like the aroma of vanilla, but the smell triggers a migraine for me

13. My hair started turning gray at age 23, half way through my first pregnancy

14. I am a sushi-wimp – I will eat the tempura but the really raw slimy stuff stays on the plate

15. Beer – yuck – never touch the stuff

16. When I was skinnier, I did not snore

17. I wish I had more friends

18. Spiders are best sucked up by a vacuum cleaner

19. I am allergic to bee stings

20. Snow is pretty to look at, but I do not want to be in it

21. My favorite color is red, but I cannot wear it because it clashes with my hair

22. I am a very shy person – I have no public speaking aspirations what so ever

23. My son and I are now the same height – 5’10”

24. I am fascinated by ASL, but do not know what to do with the skills I have

25. Cheese is my favorite food group

26. Growing up I could not stand Barbie Dolls – I preferred to rip their heads off and float them in the toilet

27. I preferred to play with cars - hmmm no wonder I became a lesbian

28. My eyeliner is tattooed on

29. I do not like the way I look in videos

30. Reading at night makes me sleepy

31. I am a terrible housekeeper

32. My right wrist has tendonitis

33. Vodka and whisky are lost on me – I prefer rum drinks

34. I am jealous of the Deaf community because they have very close relationships

35. Sometimes I wish I lived alone

36. I am afraid to play blackjack because counting under pressure intimidates me

37. Writing is the one area of school I enjoyed and excelled in

38. I was a pretty good artist back in the day

39. Diamonds match every outfit

40. I enjoyed watching Barney with my young son

41. I come from a very Masonic family

42. OJ was guilty – period

43. I confess to watching Survivor

44. I was married before I could legally drink

45. Hilliary is not the person I will vote for

46. I have two tattoos and one piercing (not my ears…)

47. I helped castrate a baby pig with a razor blade

48. Ancient Egypt fascinates me

49. I regret not getting a degree when I was younger

50. Christmas decorations before Thanksgiving are just wrong

Friday, November 9, 2007

ABC Story


I swear this has to be one of the hardest things to learn in ASL. The ABC Story is a staple of Deaf performance art, but I think you have to be Deaf to be successful at this naturally.


From the Color of Language:

"A treasured part of the heritage of the Deaf Community is their language, ASL. It is, as with any culture, an important part of their identity. One of the fun and special traditions enjoyed and shared by the Deaf Community is signing stories using Alphabet hand shapes. In these stories, various hand shapes do not stand for the letters themselves, but are used as signs or gestures to convey concepts. They are signed in alphabetical order, and used in amazing ways to sign or act out a story."


I will freely admit that I can't do this worth dog doo-doo. I get hung up on the handshapes or trying to correctly form the signs. The last time I had to do an ASL story was in my ASL3 class a few years ago. It was scripted for us so all we had to do was memorize the gestures. Having to come up with this from scratch is a bit more challenging.

Maybe there is some coincidence with the fast that ASL ABC Stories are gesture-based. I can't do Charades worth diddley doo either, unless I can use real signs.

My luck (and a prediction) we will have to submit an ASL story on video tape for evaluation. Perhaps I should start practicing now knowing this is a weak spot for me.

Wednesday, November 7, 2007

Attendance


I had to miss class last night - something I hate to do. My teenage son was sick and needed someone to stay home with him. Being a mom does not stop when the baby becomes 5'10" tall.

Apparently I missed some new games and practice opportunities. I am sure I will catch up, but I worry about the absence. Teacher has a policy of only 2 absences permitted. Last night was #3. He knows I am a serious and dedicated student so I am thankful to be able to continue in the class.

I am starting to think about Spring 2008 semester and what my next ASL course should be. I have two options - continue on to ASL 104 or stay in ASL103 for the second semester. I am not on any strict timeline for completing the ASL classes, so it would not be the end of the world to have a go at 103 again. The plus side is that I would have a head start since I already know the material and the class format. I think 2nd semester ASL103 has an additional assignment (book report) which is no biggie. The down side is that I don't want to necessarily take the "easy route" and become lazy or over-confident. Perhaps it is good to push on to ASL104 to continue challeging myself.

Perhaps a conversation with teacher is in order. He told me before that I was ready for ASL104, but I want to make sure that opinion remains the same after the submission of my recent video story and after missing class last night.

Friday, November 2, 2007

November Meetup

Tonight was my monthly ASL Meetup group at the local Starbucks. I was happy to spend time with several new and old friends playing an ASL handshape card game. Most of the folks are ASL1 students with a sprinkling of ASL2 students in the mix. Everyone told me they enjoyed the game and learned a bit of new vocabulary. It makes me feel good to be able to share some of what I have been learning all these years.

As I was posting the information for the December Meetup, I noticed that I started this group in March of 2006. My how the time passes quickly! The group has 81 registered members, although only 10-15 participate actively. I have made some very good friends through this group and hope to continue making more friends and sharing my knowledge of ASL.

Thursday, November 1, 2007

Chimpanzee who knew sign language dies...

By NICHOLAS K. GERANIOS, Associated Press Writer Wed Oct 31, 7:13 PM ET

SPOKANE, Wash. - Washoe, a female chimpanzee believed to be the first non-human to acquire human language, has died of natural causes at the research institute where she was kept.

Washoe, who first learned a bit of American Sign Language in a research project in Nevada, had been living on Central Washington University's Ellensburg campus since 1980. She had a vocabulary of about 250 words.

She died Tuesday night, according to Roger and Deborah Fouts, co-founders of The Chimpanzee and Human Communications Institute on the campus. She was born in Africa about 1965.
She was taken to the veterinary hospital at Washington State University on Wednesday for a necropsy. Her memorial will be Nov. 12.

"Washoe was an emissary, bringing us a message of respect for nature," Dr. Mary Lee Jensvold, assistant director of the nonprofit institute, said Wednesday.

The Fouts went to Central Washington from Oklahoma in 1980 to create a home for Washoe and other chimps.

"The entire CWU community and the Ellensburg community are feeling the loss of our friend, Washoe, one of our daughters," said CWU President Jerilyn S. McIntyre.

Washoe also taught sign language to three younger chimps who remain at the institute, Central Washington spokeswoman Becky Watson said. They are Tatu, 31, Loulis, 29, and Dar, 31.

Washoe was the only chimpanzee at the institute born in Africa and was the matriarch of the chimpanzee family. She was named for Washoe County, Nev., where she lived with Drs. Allen and Beatrix Gardner of the University of Nevada, Reno, from 1966 to 1970.

In 1967, the Gardners established Project Washoe to teach the chimp ASL. Previous attempts to teach chimpanzees to imitate vocal languages had failed. Roger Fouts was a graduate student of the Gardners.

For Washoe to be considered "reliable" on a sign, it had to be seen by three different observers in three separate instances. Then it had to be seen 15 days in a row to be added to her sign list.
But there was controversy over whether the chimp was really using ASL. Cognitive scientist Steven Pinker has contended the notion that Washoe was the first non-human to acquire a human language was without scientific support.