The Wild & Crazy World Of Inhalers

My wife had asthma as a kid and it has been coming back recently, usually when it’s time for the dog to have a bath. Every few weeks she gets a mild attack, and the last time it happened (during a snow storm) I asked her “well, can we do something about this instead of just waiting for it to pass? What did you do in the past?”

The Culprit

That resulted in my heading out to buy an over-the-counter (OTC) inhaler for mild cases such as hers – only to find out that at 4 out of 4 stores I visited, after being told the aisle in which I could find them, they were no longer stocked. None of the pharmacists seemed to have a clue as to why, except for the last fellow, who believed they had been discontinued…but didn’t have any details. The only alternative? Being told that perhaps taking some medicines designed to treat a multitude of unrelated things might help, or taking the one product I could find (in only 1 of the 4 stores) that was supposed to treat asthma….which turned out to be a pill, subsequently took hours to kick in, and kept my wife up all night. Score!

We had no idea why OTC inhalers were no longer available, just that they weren’t – and nobody seemed to know why. Even those who really should be in the know said it was a pretty mysterious thing and didn’t have any additional insight. To me, that felt like reaching out for a banister that had always been there – and finding it missing. It would only take escalation of a few conditions to turn that into a trip to the emergency room instead of just up to the drug store. I want to know why I can’t get that good hot salsa at my local grocery store anymore, but I really want to know why I couldn’t get my wife something she had previously relied on when she was short of breath and there was no decent substitute. Not only does the lack of communication feel insulting and make me resent those responsible, it’s downright dangerous. When they discontinued the contraceptive sponge, everyone knew it (heck, I did, and I was just a kid) and was abuzz about it – where was the communication this time?

So I turned to my most reliable source of information – Crazy Aaron, who, before I ever even asked him, sent me an article he had read in “Spray – Technology & Marketing for the Aerosol Industry” (I kid you not), because he was intrigued by the human factors issues involved with the discontinuation of CFC emitting inhalers. You can’t make this stuff up.

Spray didn’t provide an answer as to why there are no new OTC inhalers (although the change from CFC is probably at the root of it), but it seems that the folks in charge of the change-over to the new HFA 134a-propelled prescription inhalers (buy stock!) missed a few opportunities when switching to the new product. New mandates were designed to improve the product, but resulted in a bit of a bumpy rollout (particularly for life-long users of the previous versions) due to a lack of understanding of the full needs and habits of the audience. Here’s what some good solid user-testing could have helped avoid/better manage:

1. Dose Counter

Older products would, as you got close to the last few doses, become noticeably weaker – a strong indicator to replenish. A new regulatory requirement states that every dose has to be the same strength and potency. Sounds good on the surface, but how do you know when it’s kicked? You don’t, until it is. We can all do the math on the dangers of that scenario. Suggestions included telling patients that they’d have to keep track of the doses they’d already used themselves (talk about user-friendly). But chalk one up for GSK: they are (so far) the only ones to introduce an inhaler that has a built-in clicker on the side that tells you how many times you’ve used it. Win!

2. Taste

Apparently, the old stuff that everyone was used to had a mild taste of “rubber or cabbage” (sweeeeet). Not ideal, but it went with the turf and people had learned to deal. There are two kinds of formulations available now – one without alcohol in it (which is more tasteless than before and surprisingly garners mixed reviews for that reason), and one that has 10% ethanol and produces a burning sensation at the back of the throat and can taste weird due to impurities in the alcohol. I wonder if the lack of a standing ovation for that little development came as a surprise?

3. Speed/Energy

Older products would give patients a “punch” of “chilled” air that many of them equated to it “working” and getting into their lungs faster. The newer products deliver a slower moving plume of air with finer particles in it – proven to be more effective. Some patients think it is weaker and not working as well as the old ones. Sounds like solid communication and training might be the answer for that one.

4. Finer Particles = Nozzle Blockage

Those finer particles mentioned above? They get the medicine to the lungs more effectively, but they’re more likely to clog the nozzle – so now patients have to regularly clean it to prevent that – something they never had to do before. Is there a mechanical fix here that was too cost prohibitive to undertake? Is there some alternative to adding additional maintenance chores?

Beyond that are a few other issues like storage (the new inhalers are much more susceptible to moisture and can be rendered ineffective much more quickly depending on the environment) and even electrostatic charges making doses less effective. Did they miss the boat entirely? Absolutely not – the negative feedback came from a minority of patients, and we all know that when it comes to pharmaceutical regulations, you can have your hands tied in so many ways that you’re lucky if you ever get a helpful product to market – let alone one that doesn’t have associated gripes. But, things like the dose clicker in particular are easy wins that some more focus on the psychological needs of the patient, not just the physiological, can achieve.

Oh, and I never did find out for sure why OTC inhalers seemed to have vaporized. Anyone have any idea?

8 Random Reasons You Shouldn’t Have Panicked Over Facebook’s New T.O.S.

This is a bit of a departure from typical Think Blog postings, but it’s been running through my head for a few days so I thought I’d share this with you.

Recently, Consumerist noted that Facebook (FB for those of us in the know) revised their Terms of Service (ToS) to claim more ownership of content posted on their site. Other media outlets quickly followed the story. FB quickly responded in order to avoid the perception that they were salivating over the pennies they could make selling your profile photo – but as the firestorm continued to rage, a few days later FB retracted their new ToS entirely.

Many people in our industry are hissing and honking about it like a flock of geese at a breadcrumb convention. Not me. Here’s why I’m not concerned and why you shouldn’t be either:

1. Your Stuff Isn’t Worth Anything

I know it hurts for you to hear this, but that status update about your toes needing to be waxed, that photo of your kid kissing a one-legged goat, and that poem you wrote about your love for cheese isn’t really of any commercial value to anyone. FB doesn’t want to publish it. I’m going to make an educated guess here and say that approximately ALL* of the content on FB has no commercial value on its own. The value of FB to you is the ability to keep in touch with other people – the value of FB to FB is that they can focus advertising to you based on your profile, postings and behavior. I did a quick survey of some artists (one musician, one painter) last year and they both speculated that the folks who don’t get over this culture of ownership will be left behind.

(*margin of error +/- .0001%)

2. Stealing Your Stuff Isn’t Part of Facebook’s Business Model

They make money off of advertising, not selling your 2nd grade class photo. Sure, they could explore other ventures like publishing a book of the 25 worst “25 Random Things About Me” lists – but if they were smart, they’d go to the authors and offer them a few bucks for the mention in the book. If they DO publish that book, they’re not that interested in the pennies they’d make from it. It’s an idea from their marketing department to generate more traffic to the site.

3. Copyright Does Not Transfer That Easily

If I had purchased Andy Warhol’s original Campbell’s Soup 1 in 1968 and then sold 1000 prints of it, I’d be in trouble. Why? Because owning the painting does not immediately grant me the copyright to it. Andy would still have to sign it over to me.

I’m fairly confident that if FB started taking the small percentage of content on their site that is valuable and attempted to make a mint off of it, no passive ToS agreement would stand up in court. Under US copyright law, ownership doesn’t transfer unless there is an agreement signed by the owner (that’s you). Read all about copyright law here. So is a passive ToS agreement sufficient? I’m sure there are several copyright attorneys who would love to charge you $200/hr to advise you on that.

So, back to that Consumerist article. Technically, when they say, “Make sure you never upload anything you don’t feel comfortable giving away forever, because it’s FB’s now”, they’re being irresponsible. You are still the copyright holder, you’ve just passively given FB some rights to it. As they tried to explain, they thought those rights would help them maintain a feature set.

4. You’re a Thief

This again applies to approximately ALL of us (with a few self-righteous exceptions). You are likely to have something that someone else created and should have been paid for. It is probably in your music collection, or in that box of VHS tapes in your basement. If you’re over 35, you may remember that mix tape you stayed up all night making for that special someone…well, the second you handed it over, you became a thief.
Many agree that copyright laws are antiquated and need to be changed to reflect our digital world. This is enough justification for most people to yank that copy of “My Humps” from their friend’s iTunes and store it in theirs. I renamed mine “Pachelbel’s Canon.”

Guess what? You stole it. Guess what else? The publishing industry is starting to care less about you doing so, because you don’t have a lot of money. Guess who has money? Facebook! To protect themselves they wrote a ToS that – for the most part – they wouldn’t have used unless they needed to protect that huge pile of money they roll around in like Scrooge McDuck.

5. Technically You Don’t Have the Right to Publish a Lot of Your Content Either

Here’s one example: everyone has a right to their own image. These laws exist to protect you from libel, slander and other malicious behavior. Consider that photo of your college roommate lying in a pool of his own vomit in his bed. If he becomes a senator and you want to sell the photo to the New York Times, you may not be able to do it. The NYT will ask you for the signed image waiver. You can’t use a private photo of anyone for commercial purposes without an image waiver. If FB wanted to sell your work of art to the paparazzi, they’d need more than just your passive acceptance of their ToS to do it. The paparazzi get around it by taking photos in public places, where we don’t have a reasonable expectation of privacy.

6. You’re Not Stupid

At least I hope you’re not. Look, if you finalized your plans for an engine that runs off of water or if your new toe-tapper is going to be the next “Safety Dance” – then don’t post it on FB. If you’re putting something you believe has some kind of commercial value on the Internet then you ARE stupid. Don’t blame FB.

7. The Folks at Facebook Aren’t Stupid

FB’s main revenue stream is likely going to remain advertising. That advertising is dependent on their ability to grow their user base. If they start alienating their users by stealing their stuff and making what amounts to pocket change off of it, someone will come along and create a FB clone and promise not to steal content.
Remember MySpace? It was all the rage way back in 2006. FB stole a ton of their users from them simply by making their site more usable, extensible and avoiding the clutter of poorly placed advertising. This market is volatile and users are fickle. FB knows not to mess with you. Everything will be OK.

8. Their New ToS Was About Protecting Their Business, Not Getting At Your Content

So why did Facebook do it? Beyond Mark Zuckerberg’s reasons, my guess is simply to protect FB. Call me naïve, but I doubt they have a grand scheme to use your content for some huge commercial gain. They claim it’s because they need these protections to share your content with other users. My guess is that they also want to be able to promote FB without having to deal with your petty lawsuits. So if they put a screenshot of a friend list in an ad, your face happens to be in it, and you decide to sue, their battalion of lawyers can march into court with the ToS and make you go home.

What Have We Learned?

There actually IS a User Experience lesson in here: your decisions have consequences. FB wanted the content you shared with people to persist beyond your life on the site. Some lawyer realized that didn’t jibe with the ToS agreement… so they changed it AFTER THE FACT. This caused an uproar.

Good UX designers know the landscape they work in and try to anticipate issues before they come up. What’s the outcome of the FB issue? Someone in UX may have to go back and write up a series of requirements around your content being pulled from every nook and cranny if you close your account.

Well, hey, the economy is a mess and jobs are scarce, at least FB is keeping a gang of UX designers, developers and testers busy as they change their minds.

2/19/09 Update

Something I didn’t articulate in the original article, but should have: FBs speedy reaction and apparent desire to include users in the formation of their ToS is what we should expect and demand from our social networking providers.

We are also starting to hear some rumbles in the press that call for more effective privacy laws. As KS notes in the comments of this post – privacy IS something to be concerned about when participating in any Social Media outlet. Much of our current legal system is antiquated when it comes to User Generated Content and Social Media. Perhaps this event is the catalyst for some actual reform.

False Interfaces are Today’s Loc-Bloc

My parents did a fine job raising their children – five kids, and not a felon among us. Not yet, anyway.

In my opinion they made only one critical error in judgment. This error will haunt them for the rest of their lives – mostly because I refuse to stop bringing it up. Sometime in the late 1970′s, my parents gave me a massive set of LOC BLOCs. What? You have no idea what a LOC BLOC is? Nobody did. All the cool kids had Legos. I was a Pariah.

Warning: these are not Legos

My father cited that the LOC BLOC set was ‘close enough.’ My mother noted that we got a lot more LOC BLOCs than Legos for the money. That’s all fine, but as the Wikipedia article states:

Incompatible

The blocks were of a very similar grid pattern to the Lego system, but not quite. The knobs were too tall and spaced just a little bit off. The result was that children who owned the much cheaper LOC BLOCs were often excluded from group play with other children who owned the overpriced, but more popular, Lego bricks. – (wikipedia, 2/12/2009)

Anyway, where am I going with this? Well, the feeling I had when I first tried to attach my LOC BLOC rocket ship to my neighbor’s Lego space station is the same feeling of disappointment that I experience when I encounter app-like interfaces on the web only to learn that they only look like apps – they don’t act like them. For example, behold the “Pictures of the Week” interface on time.com:

Time.com's deceptive interface

When I encounter what looks like a photo flipper with dedicated “Back” and “Next” buttons – I expect the items within the frame to update when I click a button. In the example above, the entire page refreshes. This was acceptable in 1998, but today, clicking on that “Next” button and watching the whole page refresh just feels like someone went for the cheaper, “close enough” version. Why pretend to be something you’re not? At the very least, simple text links outside of the image frame might have deterred me from thinking I would be interacting with a self-contained app.

I understand that there are business reasons for not wanting an actual image flipper on your site. Page refreshes provide those much-desired view counts advertisers want. Just don’t trick me into thinking I won’t have to sit through an entire refresh when I click your button. Apps are becoming more and more ubiquitous, and even casual users now have expectations regarding the style and speed with which they react. Be what you are, not a wolf in sheep’s clothing. Or, a LOC BLOC in the Lego pile.

UPDATE: there is hope out there. Some traditional print media outlets are exploring actual app behaviors in their interfaces – such as the New York Times’ Article Skimmer Prototype. Now, if I can only resist the temptation to rob a toy store for a set of Legos, maybe I’ll make my Mom proud and run for public office.