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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.'"
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
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.
...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.
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.
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.
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.
The Hippocratic Oath begins with the invocation:
I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
While fine by me (they sound as reasonable as the rest of the loonies in Godville) it's hard to take everything the Oath says at face value.
Faster! Faster! Faster would be better!
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
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.
I'm one of the authors of the NEJM article.
People already are moving on. In our practice we mostly use the Montreal Cognitive Assessment (MOCA) for screening, which is much more sensitive and has liberal licensing terms for non-commercial use.
But this is a general issue. The Sweet 16 was an attempt to move on, halted by PAR. I'm surprised that PAR hasn't already sued the MOCA authors given that the MOCA includes recall and orientation, like the Sweet 16. Even if it survives, the MOCA is not perfect- it has laudably generous licensing terms for copying, but no provision for derivative works. In 80 years, the heirs of the MOCA authors might well start suing researchers who use a trails test, clock draw and animal recognition in a new test.
Whether we move on from the MMSE or not, the threat to scientific progress will remain.
I am one of the authors of the NEJM op/ed article.
It is all a little confusing. There are three parties here:
1. The original authors of the MMSE, who through PAR are strictly enforcing copyright protections of the MMSE
2. The authors of a new tool, the Sweet 16, which was created as an open-access alternative to the MMSE but was "taken down" by PAR in a copyright dispute
3. Us, the authors of TFA, who have no relationship to #1 or #2 but are very worried about what this all means for the practice and progress of medicine
I am one of the authors of the NEJM op/ed article.
"permissive licensing, ideally with a form of copyleft." permissive licensing is copycenter NOT copyleft.
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.
My apologies, I meant permissive-with-a-small-p only as an antonym for restrictive. I admit I wasn't aware of the technical meaning. Thank you for pointing it out. I think the phrasing still made sense to most readers. Remember that for most of the physicians who read NEJM this was probably the first time they had even heard of copyleft.