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Copyright Claim Sets Back Cognitive Impairment Testing
Kilrah_il writes "A recent New England Journal of Medicine editorial talks about the mini-mental state examination — a standardized screening test for cognitive impairment. After years of being widely used, the original authors claim to own copyright on the test and 'a licensed version of the MMSE can now be purchased [...] for $1.23 per test. The MMSE form is gradually disappearing from textbooks, Web sites, and clinical tool kits.' The article goes on to describe the working of copyright law and various alternative licenses, including GNU Free Documentation License, and ends with the following suggestion: 'We suggest that authors of widely used clinical tools provide explicit permissive licensing, ideally with a form of copyleft. Any new tool developed with public funds should be required to use a copyleft or similar license to guarantee the freedom to distribute and improve it, similar to the requirement for open-access publication of research funded by the National Institutes of Health.'"
btw this post is copyrighted. $1.23 per download
That's fine. I won't quote you and I'll compose my own post.
But you used the thought of independence. Which he used before you. You owe him $975,235.45. Maybe that will teach you about "thinking", smart ass.
I sincerely hope that all of the authors either have a stroke, Alzheimer's, or some other disease that impairs mental faculty and the attending doctor doesn't know how to perform this test due to their idiotic copyright enforcement.
Any new tool developed with public funds should be entered into the public domain.
FTFY
All the medical discoveries, procedures or other elements that have immediate clinical application should be under a copyleft type of licensing, patent encumbrance is the number one reason why healthcare costs have skyrocketed in recent years compared to other public service areas. As a side note patents slow down the speed of advances in research by promoting hoarding of data instead of open sharing and it's also detrimental for the patient community as patents increase the costs of new life-saving life-improving medicine. One might argue that patents are an incentive for pharmaceutical companies to invest in research and recover their money but let's look like other domains like astronomy, there have been major breakthroughs in the way we understand the universe due to community collaboration and sharing of data although there was no immediate monetary incentive, this can also happen in medicine but considering there's a huge monetary incentive it's going to remain a slow developing field in desperate need of disruption.
Copyright covers the actual content of the test, not the concept of a short battery of simple test of various cognitive skills.
So... Rewrite the damned test. Use different math problems, different spatial problems, different linguistic problems, which gets around the copyright issue entirely but still fundamentally measures the same underlying capacity.
17+34 doesn't magically measure basic math ability "better" than 15+29 just because Folstein, Folstein, and McHugh blessed it.
The authors were letting everyone download the new test for free; a corporation, PAR, to which the old test had been licensed is to blame for claiming copyright over (elements of) the new test which may eventually replace the old one.
Unfortunately, there's no easy way to leave them a comment about one's opinion of their behavior on their website. I looked.
They created this in 1975 and waited until 2000 to start taking steps to enforce their rights after it had basically become standard practice.
Copyright is so broken it's not funny. When this country started Copyright was for 17 years and distribution was painfully slow. Now distribution is ridiculously fast and yet Copyright keeps getting extended (it's at what life + 75).
If this goes to court the delay and the public importance of this work should mean it gets ruled as public domain.
...uh, I don't understand...
For your security, this post has been encrypted with ROT-13, twice.
The authors did. That didn't help them against the infringement claims of the corporation which benefits from an older test.
This is one example why many believe copyright does on the whole more damage than benefit to society.
According to the article, an alternative test called Sweet 16 was produced and was subsequently killed by the MMSE copyright owners' legal action. It sounded like the Sweet 16 used completely new copy but similar logic. Can you copyright logic if all the words are completely different? I'd love to see a comparison of those two tests.
On a side note, I hope no one owns the copyright on the eye chart. I like getting my eyes checked every year or two.
People who say "money does not buy happiness" are just people without money trying to make themselves feel better.
Sorry, I didn't see that the summary incorrectly states that the authors of the older test were claiming infringement. AFAIK, they're not.
I guess I failed the comprehension test. Actually, I didn't really read the summary carefully, since I was already familiar with the actual facts.
Any tool developed using public funds should be placed in the public domain.
I use copyleft for my own works, but I do so as a defense against anyone else trying to claim a standard "all rights reserved" copyright over my works. I would public-domain them if I could do so safely. I use copyright law and its ability to place restrictions upon the free flow of information merely to make sure someone else can't take a piece of information I wish to offer freely and wrap it in their own, non-free, worse "all rights reserved" copyright and license.
So, whereas I personally support the restrictions that copyleft creates, in the broadest sense, one must admit that copyleft's restrictions are as much restrictions as standard copyright's are. "No" is "no" whether or not you agree with it. It's an individual, political/ideological decision to copyleft a work rather than use a standard copyright.
And works paid for by the public---paid for by everyone, without their explicit consent---should not be subject to political/ideological decisions. Everyone paid for these works, including people who strongly oppose the spirit of copyleft. Therefore, these works should be returned to the public with no restrictions placed upon them.
Liberty in your lifetime
The corporation, PAR, to which the older test is licensed, is behind this. AFAIK, the doctors who authored the older test haven't personally claimed infringement. My guess is that they received a single payment for licensing their test to PAR, and therefore they have no financial stake in the success or failure of the newer test.
This world is CRAZY.
Come on, copyright on a medical test oO;
This is like a band doing cover song of other bands song, and being forbidden to do that due to copyright. Which afaik is a form of fair use.
Next someone has copyrighted showing the middle finger.
Pulsed Media Seedboxes
The corporation PAR, which benefits from the older test, the MMSE, has caused a newer, openly licensed test called "The Sweet 16", to be taken down by claiming infringement on elements of the older test, even though as far as anyone knows, they have no legal basis for doing so.
Part of the oath says:
'I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.'
'I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.'
It seems that lately the business people in the medical sector should request a change in something like this:
'I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. If they empty their pockets and make me rich'
'I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. But will make sure I can buy myself whatever luxury item I ever wanted.'
This money hunting in the medical sector realy is making me angry. It clearly shows some people realy have no respect for the sick & wounded.
Fortunatelly there still are some people willing to help without making profit, a thanks to all volonteers who put their abbilities availble around the globe.
A similar situation, where copyright shows its ugly leash, appears in everyday medical practice. The Current Procedural Terminology (CPT) codes describe the type of service that a doctor has provided (e.g. simple office visit, complex office visit, appendix operation, etc.) and is used a few dozen times a day by insurance companies all around the USA to determine payment for services. It becomes essential for every doctor and every clinic/hospital to know the definition of these codes in order to remain financially solvent. If you surgically extracted a lipoma, but didn't know that the correct code for that particular case was 11424 (if the incision was 4cm long and the location was on the foot), then the insurance company just got a free ride and your other patients are subsidizing the cost of that operation.
You'd think that, for such an important part of daily operations, there'd be a list of all the CPT codes and what they mean. It should be a plain text file. I myself tried to get such a list --a simple text file, to call up on my laptop or handheld or something. Alas, nothing so simple. Yes, there's a list available for purchase, published on paper in thick books the size of a white page phone book (remember those?). If you wanted an electronic version, you'll have to hope someone wrote an app for your particular platform to display the text, because the American Medical Association holds the strings to that piece of text and doesn't want you to do your own searches in your favourite editor or sort the text alphabetically, etc. I'm not sure why such a code is not in public domain if it's so essential to keeping healthcare running smoothly.
I'm told that doctors are one of the most developmentally delayed professions when it comes to adapting to technology, and this is not the first time they seem woefully ignorant of issues in the information age which are screwing them over. I imagine that if someone held the intellectual property rights to the names of diagnoses ("You're not allowed to say 'appendicitis', doctor, because you haven't paid the licensing fees!") then doctors would just bend over and hand over some lube.
404555974007725459910684486621289147856453481154 in hex is "You sank my Battleship?"
[GPG key in journal]
This clearly illustrates that cognitive impairment is caused by copyright, not junk food, as the above mentioned study concludes.
Should Tolkien's estate sue every author who writes about elves, dwarves, and dragons? No. The whole concept of Intellectual Property is corporate tyranny which has been imposed upon us by corrupt politicians.
IANAL, but the fact that the authors chose not to enforce their rights makes it much harder for them to enforce them in the future. The enforcement is actually being handled by a third party. http://www.geripal.org/2011/12/copyrights-and-copylefts-in-medicine.html Righthaven is all over this matter. The trick is to find someone to defend this matter to the end.
Until this is resolved, boycott the MMSE. There are already other alternatives, such as MoCA, that can be used.
btw this post is copyrighted. $1.23 per download
This one costs whatever one quote plus two downloads of your post makes. Additionally, for some obscure reason I now have the rights to anything you write using Microsoft Word.
That's fine. I won't quote you and I'll compose my own post.
With blackjack and hookers!
"Never let your sense of morals prevent you from doing what is right" - Salvor Hardin
“The Sweet 16 is a copyrighted instrument. It can be used free of charge only by nonprofit organizations and educational institutions (such as universities).” As well as: “All for-profit organizations or entities must contact the Aging Brain Center at: 617-971-5390 or email: AgingBrainCenter@hsl.harvard.edu for permission to use the Sweet 16.”
It's no better than the PAR MMSE in the regard of copyright hassle and possibly cost. Most doctors work for for-profit organizations. Hospitals are generally nonprofits, but most of the doctors that work in hospitals work for for-profit physician groups that are contracted to the hospital. The vast majority of physicians' offices are also for-profit organizations.
MoCA test seems to better in that regard.
...and again a drastic copyright term reduction to 20 years (same protection duration as patents offer) strangely doesn't come up. This "test" was first published in 1975! The year the Altair 8800 was released, birth year of Jolene Blalock and Tiger Woods.
The people who devised the test spent time and money to do so. They created the original work. Why shouldn't they be able to license it for fee to others? They've got college loans to pay off. OH so now educators and researchers have to live under the specter of copyright laws! Boo hoo welcome to the real world!
Isn't public research supposed to be public domain? They probably weezled out of that with some kind of corporate contract that made it private research funded with public money. 1. That needs to stop. 2. The research should be public domain--the most liberal "open source" license there is. 3. Whenever this kind of thing comes up we need to remind ourselves that it's just part of the larger problem. "Separation of corporation and state" should be a mantra for our government as much as separation of church and state is.
This reminds me of the Time Zone Database debacle of this year, when that astrology products company bought out the atlas/almanac from which much of the data was derived, and then immediately turned around and sued the two individual authors of the Database, even though they never made a dime from it and included a full attribution of the source in the Database. How did that turn out? It's been months with no further word here or anywhere else frequent.
These are two of the best anecdotes to highlight the surreptitiously greedy stupidity of current (and most historical) copyright law.
As someone who administers cognitive tests for both research and clinical work, I can state that the Mini-Mental is not a very useful test (we sometimes use it clinically {because medical doctors want it} and for research {because some reviewers think that it's necessary information, which is ridiculous given the amount of other cognitive data we collect}). It's a screener that is easy to administer but it is neither sensitive nor specific. The test, frankly, doesn't tell us very much. There are other alternative and better screeners out there, the MMSE is just the most widely used. The sooner that it stops being used, the better; then we can start giving more useful tests. I'm not saying the MMSE is useless, it's just no big loss if there is copyright being claimed now. We'll move on to something else.
The legal doctrine of estoppel says that you can't give a work away freely for decades and then suddenly start charging for it. The rights holders are estopped from enforcing their rights.
Copyright covers an expression, not an implementation (the domain of a patent).
All that is necessary is for someone to rewrite the description of how to do the test, and disclaim copyright. Voila, the problem is solved.
In the social work field, this is not how it works. No agency I have ever worked for has ever had legit copies of anything. (Unless, it was the first copy they obtained). Copyright with actual normalized tests is really limited to the university publishing arena. Most individuals actually giving the MMSE or other basic tests have never seen a copy from any publisher, just from the nearest copier.
People will still get their MMSE, and be referred to a doctor if he/she fails for further testing. It is useful and it works for people administering the test, especially intake workers who may just have a high school diploma or an certificate.
Its why we don't have nice things.
Ive never seen a clearer cut case. They allowed people to become dependent on using their tool for a period of twenty years.
For a while there I thought that maybe to start asking someone who does or says something lame, "Who is the President of the United States? What State (of the Union) are we living in? What did you have for lunch?" was a malicious yet funny put-down, much as the terms "Florida driver" and "I've fallen, and I can't get up!" have become part of the lexicon. But for now, the Mini-Mental is a dark inside-joke, a kind of battlefield humor for those of us who have gone into medical exam rooms with parents or other family members. I had long heard those questions, but I never heard the term "Mini-Mental" until it was used by an elder-care advocate.
So to those of you who have taken offense already, why do I consider the mini-mental to be "funny"? Aging and the memory loss and loss of cognitive ability with the diseases of aging along with the gradual yet complete destruction of a human being, when that human being is first Grandma, and then Ma and then followed by Poppa is not funny. And to reflect that one has inherited the same genes and it won't be funny at all when it happens to you, pal! But it is funny, because sometimes to see the dark humor in a situation is the only coping mechanism we have, especially when it is some kind of slow-motion train wreck over which we have no control.
So what is so funny about the Mini-Mental? For one thing, that test is administered by the people who are supposed to be helping you, but there is very little help they can offer apart from pulling your driver's license by writing to DMV under the authority of their medical certificate and by inducing you into a kind of prison, from the halfway house of an assistant living facility, to the nursing home or perhaps a Memory Unit with locked doors, or maybe even a state-run mental hospital if the disease process gets to the part of your brain affecting social control before it gets to that part taking your ability to get up and walk. So the Mini-Mental is part of the process of social control where Grandma gets evicted from her apartment because the neighbors don't want to have anything to do with her wandering and knocking on their door.
So now that the test is under copyright, does this mean when my wife gives me the stink-eye for doing something stupid, and I start my litany of self-deprecation to deflect the impending criticism by suggesting I am going senile by saying "Who is the President of the United States? What State are we living in? What did you have for lunch" that I have to write some dude a check for $1.23? That my wife and I cannot have our private joke about the horrors my parents went through and with some high likelihood in 20 years here husband will go through? That I will have to pay someone money for reenacting what happened in my family?
As to the dude's who want to collect that money, I have some questions I want to ask you. Who is the President of the United States? What State are we living in? What did you have for lunch . . .
I read the title as; "Copyright Claims Set Back Cognition: Impaired Testers."
Actually, sometimes a Freudian Slip is more insightful than the actual statement.
>>"ad space available -- low rates!!!"
I'm sorry, I have patented the process of creating new posts, and you'll have to pay me for each one you make. I'm a reasonable man, unlike those copyright goons, and I'll only charge $0.73.
The world's burning. Moped Jesus spotted on I50. Details at 11.
It appears from their website that what PAR wants you to do is order sets of test forms, then use the test forms once per exam. But they can't actually require you to do it that way. You can make a scoring sheet (without the questions) and record the patient's scores on the scoring sheet, while giving the exam from a legitimate copy (perhaps one ordered from PAR, perhaps one obtained from the original journal) or even an illegitimate one, without violating copyright. The same exam sheet can be used over and over again.
Copyright 101 (and 106):
Copyright covers reproduction, distribution, derivative works, public performance, and public display. Giving a screening exam is not _public_ performance of the work.
I am a neurologist. During training, an MMSE was basically a required component of a history and physical exam of any patient with cognitive complaints. It has its limits, but within them it is very useful.
It's pretty hard to believe that a collection of cognitive tests, almost all of which can be and are used separately in a more customized examination of the patient's sensorium, can be so creative as to be copyrighted.
The idea that the Sweet 16 could infringe because it contains "orienation" and "memory recall" items similar to the MMSE is absurd; questions about orientation and immediate/delayed recall are standard with or without the MMSE.
This is absolutely infuriating from a clinical perspective.
Tenemus pyrobolos atqui jacimus cognitiones.
Sounds like a job for ripoff.com
I just hope some clinician who managed to download the newer test, in the few weeks it actually was available, will have the good idea to ask a favor from a friend who knows how to anonymously publish information on the net.
You mean like this?
©2009, Sharon K. Inouye, M.D., MPH, Aging Brain Center, Hebrew Rehabilitation Center
SWEET 16 INSTRUMENT
1. What is the year? [1]
2. What is the date? [1]
3. What is the day of the week? [1]
4. What is the month? [1]
5. Can you tell me where we are? (What is the name of this place?) [1]
6. What city are we in? [1]
7. What state are we in? [1]
8. What floor of the hospital are we on?
(What room of the house are we in?)? [1]
9-11. I am going to name 3 objects. After I have said them, I want you to repeat them. Remember what they are because I am going to ask you to name them again in a few minutes. The three items are: “Apple”.”Table”.”Penny”. [PRESENT WORDS CLEARLY AND SLOWLY. WORDS MAY BE PRESENTED UP TO 4 TIMES, BUT SCORE ONLY ITEMS REPORTED AFTER FIRST PRESENTATION]
APPLE [1]
TABLE [1]
PENNY [1]
12-13. Now I am going to say some numbers. Please repeat them back to me.
[SAY DIGITS AT RATE OF ONE PER SECOND]
2 - 4 - 9 -- [0]
8 - 5 - 2 - 7 -- [0]
Now I am going to say some more numbers. But this time, when I stop, I want you to say them backward. For example, if I say 7-1-9, what would you say? [IF RESPONSE IS INCORRECT REPEAT DIRECTIONS AGAIN ONE TIME ONLY. SAY DIGITS AT RATE OF ONE PER SECOND. ONCE STATED, DO NOT REPEAT NUMBERS]
4 - 1 - 5 -- [1]
3 - 2 - 7 - 9 -- [1]
14-16. Now, what are the 3 objects I asked you to remember?
APPLE [1]
TABLE [1]
PENNY [1]
TOTAL SCORE: / 16