Distracted Driving

Okay, I promise that my next post will be something more lighthearted, but I felt in important to share this compelling video.

I see a lot of distracted driving on my commute every workday: people talking on the phone or texting, eating or drinking in such a way that their vision is blocked, applying makeup, shaving, reading, wrangling kids in the back seat. Nine times out of ten, if I see someone drift in and out of their lane and then I pull up even with them at a stoplight, the person is distracted in some way or another. It's pretty scary sometimes.

Why Our Health Care System Has Gone Completely Insane

How American Health Care Killed My Father is an article in The Atlantic magazine that constitutes the most clear-thinking analysis of what's wrong with the American health care system that I have ever read. Read it. Read it right now.

(Thanks to Jim for sending me the link.)

Tech Support Cheat Sheet

Everyone should read this. Everyone. That is all.

Art and the Game

I've been thinking recently about how video games are perceived. Yes, I know, not exactly a “deep” subject, but stay with me. For some reason that I don't fully grasp, video games seem to be relegated to second-class status compared to other forms of entertainment.

It's easy to see how this could have started. A quarter century ago, video games were fairly primitive. Your character was a blocky splotch on a screen drawn in black and white, or at best, preschool colors. Music and sound were equally primitive or nonexistent. The plot (when there was one) was insulting to an adult's intelligence. Most grown-ups didn't want to play video games for the same reason that they didn't feel inclined to eat macaroni and cheese very often: maybe their kids thought it was great, but their experienced palate demanded something more sophisticated. Only a very few games rose above the crowd and had something resembling a real plot, but most of those were text-based interactive fiction, meaning you had to type out what you wanted your character to do, then read the result. The primitive text parsers of the time made this less than fun: it's kind of hard to get into the story when you're too busy trying to figure out which synonym of the word “attach” the parser will accept. And for every really good IF title, there were scores of lousy ones.

The perceptions didn't keep pace with the technology. Many games today have deep and interesting plots coupled with equally deep and interesting gameplay. The visuals are beginning to seriously rival Hollywood. The beeps that passed for sound and music have been replaced with high-quality sound effects and rich soundtracks. I have played some games with soundtracks recorded by full orchestras. There's even a rich and vibrant independent game industry.

In fact, the visuals are now becoming so realistic that I think they're starting to suffer from the opposite problem: diminishing returns. I mean, it's amazing that the technology can make a rendering of a human that is so detailed that you could count the pores on their face, but ironically, the closer a rendering gets to reality, the less impact each improvement has. Games (and CG effects in general) have been going for hyper-realism, but what I want to see is hyper-unrealism. I see pores every day when I look in the mirror; show me something that I have never seen before. In fact, this trailer for the upcoming game “Insanely Twisted Shadow Planet” is exactly the kind of thing I'm talking about.

Anyway, there's one thing that a game can do which Hollywood's offerings cannot: actively engage you in the proceedings. Because you control the actions of the protagonist, the character becomes an extension of yourself. A well-crafted game will nurture that relationship so that you feel empathy with the protagonist more than would be possible with a film. Games which employ the first-person perspective take it even one step further, having you see the world through the protagonist's eyes. Some even make the protagonist silent and give no clues to their identity, thereby allowing you to make yourself the protagonist. (Human beings seem to have an odd way of filling out missing information with parts of themselves, resulting in a combined work that's more compelling than the work alone. It's why a monster movie is scarier when you never get a good look at the monster until the end, and why people are often disappointed with movie versions of books.)

Despite these advantages, the video game remains a lesser citizen in the entertainment world. Video games are not recognized by any of the major award shows, the increasing blur between movies and games notwithstanding. While movie soundtracks can be found nearly anywhere music is sold, game soundtracks, which are often just as good these days, are rarely seen. Many people accept that some movies can be considered art, but few grant the same status to games, despite the fact that their production frequently involves many of the same artistic skills. Why can an actor perform or a composer write music for a movie, and it's art, but if they do it for a game, it's not?

If you want to experience games as art for yourself, I'd suggest the following, in no particular order:

• Prince of Perisa: The Sands of Time
• Aquaria
• Beyond Good & Evil (no relation to a certain book by a so-called philosopher)
• World of Goo
• Paper Moon
• Psychonauts

Why All Things Medical are Currently on my Bad Side

Sorry for the long silence. Not only have I been quite busy, but I haven't felt like I had anything to say on my blog for some time. Today, however... oh, do I have something to say...

For quite some time, I have taken a rather unconventional medication for attention deficit disorder, phenytoin. Typically prescribed for epilepsy, it has been helpful in the past to help me deal with ADD symptoms, but recently it has become gradually less effective. While upping the dosage might work, I wanted to find out if there was something out there that might work better.

My doctor had me try a couple of different medications, one of which did nothing for me and the other of which was no better than the phenytoin, and both were significantly more expensive. Then he wanted to do a blood test to ensure that bumping up the dosage wouldn't result in toxic levels of phenytoin in my blood. While waiting for the results, he wanted me to try one more medication. This one, called modafinil, is typically used for narcolepsy and other similar conditions, but it is used off-label as a treatment for ADD.

Usually, from my perspective, ADD medication has little noticeable effect to me, because I'm on the “inside.” My perceptions come from my brain, which is the thing being regulated, so even if there is a significant change, I may not notice much of a difference. I generally have to rely on my wife to tell me whether a medication is effective or not. Not so with the modafinil. The sample I received did remarkable things for me: I felt more alert, more aware, and more “present” than I can ever remember feeling before. If it was that much of a difference for me, you can imagine what an improvement my wife saw.

As you might imagine, I was all over this modafinil stuff, but there was a stumbling block. First of all, it's still under patent by Cephalon, Inc., marketed under the name Provigil. Provigil is quite expensive, and my insurance company refuses to cover it. Generic modafinil will not be available until at least April 2012.

Cephalon, faced with the prospect of the bottom dropping out of the market for Provigil when the patent expires, is resorting to a business tactic that could be considered pretty clever, although I'd prefer to use the term “scummy.” They raised the price of Provigil by 74% over four years, then came out with a newer, longer-acting version of the drug called Nuvigil. Nuvigil is still expensive (enough that my insurance company doesn't want to cover it, either), but it is more reasonably priced than Provigil, despite the fact that it is supposedly a superior drug. This will motivate patients to move to Nuvigil, which is covered by a patent that lasts until 2023 instead of only 2012. (Incidentally, the same company was obliged to pay a $425 million federal settlement for marketing their products in an illegal fashion.) EDIT: FallenAttorney mentions an even scummier tactic by Cephalon to wring more money out of Provigil; see his comment below. I had read about it before but had forgotten to mention it here.

Anyway, so I go back to my doctor and tell him that modafinil is unfortunately off the table. Since the phenytoin blood levels came back fine, I presumed that he would simply up my phenytoin dosage. However, he told me that the didn't want to do that because he felt that the risk of side effects was too great. My beef with this is not that he was unwilling to increase the dosage. If a doctor says it's unsafe, then I don't want to do it. What annoys me is that he charged me and my insurance for a test to see if it was safe to increase the dosage for a medication, when he had no intention of increasing it. If he felt that it was unsafe, he should have told me that up front and skipped the blood test. In the end, I'm back where I started, taking the same medication I was before, except that I'm several co-pays poorer.

So I know that there is a medication that can make a big difference in my life, but I can't afford to get it out of pocket and my insurance won't cover it. (I could probably afford it if I fired my insurance company, but that brings up a whole separate set of problems.) I have a doctor who I feel does not have my best interests at heart. All things medical are really grating my cheese these days.

While my hands are tied with regards to the insurance industry or Cephalon, there is one thing I can do: Doctor, you're fired.