Ohm Laboratories in Gloversville, New York, a manufacturer of oral medications wholly owned by the Indian drug maker Ranbaxy Laboratories, is being investigated by the FDA for serious manufacturing violations.  Ranbaxy had a checked reputation in this respect. It was accused for the last two years of manufacturing violations at two of its plants in India.

According to published report by the FDA, Ohm failed to properly investigate quality-control problems at the plant, including black particles found in a bottle of metformin oral solution and floating cardboard particles found in batches of ranitidine solution. The Gloversville plant also failed to test an adequate number of each drug product, failed to train employees in certain procedures required by good manufacturing regulations, and failed to notify regulators of product problems in a timely fashion, the inspection report said. “There are no written procedures for production and process controls designed to assure that the drug products have the identity, strength, quality, purity they purport or are represented to possess.”, said the FDA report.

The FDA. has periodically cited generic and name-brand drug makers for manufacturing or quality-control issues. That includes a warning letter sent earlier this year to McNeil Consumer Healthcare, a unit of Johnson & Johnson, for failure to adequately investigate and notify regulators about consumer complaints of a moldy smell emanating from some Tylenol bottles. McNeil has recalled some lots of Tylenol and other over-the-counter products. But Ranbaxy stood out as a repeat violator in the past year.

In 2008, the FDA cited Ranbaxy for manufacturing violations at two of its facilities — in Dewas and Paonta Sahib, India. The agency also barred the import into the United States of more than 30 drug products made at those sites. And last year, after federal regulators determined that one of the plants falsified data and test results, the agency stopped reviewing new or pending drug approval applications from that plant, pending corrective action by Ranbaxy.

Deborah M. Autor, the director of compliance for the FDA’s centre for drug evaluation and research, said on Friday that the agency was troubled by Ranbaxy’s overall record of manufacturing and data integrity problems.

“We will continue to focus on this company until we are fully satisfied with the quality of its drugs and the integrity of its data. Companies have a responsibility to patients to ensure that their drugs are safe, effective and high quality.

While there is no evidence that local generic drugs manufacturers behave in similar cavalier manner on quality issue, the unwelcomed public attention in the US on foreign manufacturers will only reinforce the unwarranted view that foreign imports are of dubious quality. Coming close on the heel of the Chinese milk products scandal, it may take a long while for our biotech products to shake the ‘guilt by association’ in US. And that would be a great pity.

During my childhood days, two local singers made a huge impression on me. I used the term local loosely because they recorded their works in Holland under Philips (a Dutch conglomerate) for distribution in the Far East.

In 1960 Anneke Gronloh, an Indonesian of Dutch parentage released Asmara in Holland and SE Asia concurrently. While it made little headway in Europe, it stayed on the local charts for months. To me, the quaint Bahasa Baku (pronounced as it is written) also added to its appeal. In the following years, she followed up with numbers like Bengawan Solo , Soerabaja, Nina Bobo, Mak Inang, Oh Papa Dja, Dari Ketjil, Penganjung, Boeroeng Kaka and Widuri (notice the Dutch influenced Indonesian spelling), which were hugely popular in Indonesia as well as here locally. Asmara and Widuri were my personal favourite, and I used to sing along whence they came on over the jukebox. In fact songs like Nina Bobo, Mak Inang and Boeroeng Kaka were much more successful here than in Indonesia. To this day, many Malaysians believe that Burong Kaka (Malay spelli ng) is their own home grown composition, so much so that it became an unofficial anthem of Malaysia (like Waltzing Matilda to the Australian). Well, you only have to listen out for the Baku pronunciation to realise the truth. (Lecong mula lah would sound as lecong mu-ler lah in Malay pronunciation, while everyone knows it is sung as lecong mu-la-la).

In 1963, the year Malaysia was formed Philips released a comemberative compilation called Oh Malaysia! featuring Anneke Gronloh’s Oh Malaysia, a track she released simultaneously in Holland as Brandend Zand. Timed to capture the surge of optimism and sense of impending nationhood, it went down very well here because it flew in the face of Indonesia’s opposition to the formation of Malaysia during the konfrantasi (1963-1967). Her popularity in Indonesia took a dive because of this, and she stopped recording material for the Asian market after that. However she did had a successful career in entertainment in Europe.

The other tracks on Oh Malaysia! were Midnight In Malaysia and Sunrise In Malaysia by Boy and the Rollin’ Kids (my version here is by the Stylers) and Singapura by Sandra Reemer.   Sandra (Alexandra) was another Indonesian singer of Dutch parentage. Her wonderfully clear voice and open throat singing style was very different from the soft crooning voice of traditional Malay singers. She was only 12 when she topped the chart in Holland with Al Di La (Net Als Wij) (Just like us) in 1962.  The Indonesian version Adillah Tjiptaan Duniaku (Creator of my world) was released with Singapura the same year. This was followed by Kopi Susu and Nona Zaman Sekarang (Modern day ladies).  When the 45 EP was released here a year later, Al Di La was replaced by Kapal Ladju (Speed boat), a popular Indonesian song then, to enhance the local appeal. She recorded a number of Indonesian/Malay songs in the next few year and became very popular in the SE Asia during the 60’s. Meanwhile she was also winning fans in Holland with hits like Sluimer Zacht (Summertime), ‘T is Een Mooie Dag Vandaag (It’s a Beautiful Day Today), Duizenden Sterren (Thousands of Stars), Als de Wilde Rozen Bloeien (As the Wild Roses Bloom) and Mijn Concert (Lover’s Concerto). As you listen to these polished performance, it’s really difficult to believe they were recorded while she was between 13 and 15. When Philips disengaged from the local recording industry in early 70’s, she switched focus to Europe and established herself as a popular Dutch singer, and went on to represent Holland three times at the Eurovision Song Contest in 1974, 1976 and again in 1979.

Her original version of Singapura remained my favourite because the easy to understand lyric and her amazing voice invoked in me then a vision of an enchanting land that draws you back again and again, thus began my longing to come visit this wonderful place. I also love her impeccable diction of the Malay words. For example, Singapura was correctly pronounced as sin-nga-pura, not sing-ga-pura as most Singaporeans would say it. I’ll end this piece by posting the lyrics that pulled me gently by the heart to come to Singapore all those years ago.

Park is believed to operated around funeral homes attached to the Samsung Medical Center in Seoul.  The facilities have up to 40 rooms where grieving families receive guests. They usually arrive in their best shoes and invariably leave them outside. They also linger for a while, eating, drinking and catching up with relatives, old friends or colleagues who have come for the same service. Park would masquerade as a mourner dressed in black, strolled into the funeral parlor, took off his cheap footwear, paid his respects and then slipped on an expensive pair and left.

Police records showed that he was sentenced to one and a half years in prison in 2005 for stealing shoes, but that the sentence was suspended. In 2008, when he was arrested again and fined $4,300 for the same crime, he was found with 1,200 pairs of shoes.

The police said there was a decent chance that Mr. Park would eventually keep most of these shoes that were unclaimed, as the police could not prove that they all were stolen.

Source: NY Times – Seoul Police Link 1,700 Pairs of Shoes to 2 Feet

Robert Watson, a top ingredient buyer for Kraft Foods, was in need of some $20K to cover his taxes. So he called a middle-man for SK Food that for years had been paying him bribes to get its products into Kraft’s plants. He was told that the cheque would be dispatched right away as an advance from his regular ‘commissions’, an euphemism for bribes. Unknown to both, the conversation was monitored by FBI.

Days later, FBI agents descended on his office near Chicago and confronted him. He confessed, thus busted wide open a startling vein of corruption in the food industry. Since then, 4 purchasing managers from various food giants have pleaded guilty to taking bribes. Five others in SK Food have also been implicated as spearheading the far-reaching scheme. The owner of SK Foods, Frederick Scott Salyer, was arrested at Kennedy Airport in New York City on the 4th of February after getting off a flight from Switzerland. He was indicted last week on racketeering, fraud and obstruction of justice charges.

It was revealed that senior executives at SK Foods had bribed a handful of corporate buyers in exchange for lucrative contracts and confidential information on bids submitted by competitors. And for years, SK Foods shipped its customers millions of pounds of bulk tomato paste and puree that fell short of basic quality standards — with falsified documentation to mask the problems. Often that meant mold counts so high the sale should have been prohibited under federal law; at other times it involved breaching specifications in the sales contracts, such as acidity levels or the age of the product.

The scope of the tainted shipments was much broader than the bribery scheme, touching more than 55 companies. In some cases, companies detected problems and sent the products back — but in many cases, they did not, and the tainted ingredients wound up in food sold to consumers.

There’s been a lot of hype about inferior-quality products being made in China and then sold to the U.S. consumer. This is exactly the same thing, but it’s based in the U.S.

Kraft, the nation’s largest food manufacturer, appears to have been among the biggest companies skimmed by the bribes. Court papers say that Kraft bought about 230 million pounds of processed tomatoes from SK Foods from 2004 to 2008, as Mr. Watson took $158,000 in bribes. In 2007, faced with a product shortage, Mr. Salyer allegedly ordered subordinates to ship 3.4 million pounds of moldy tomato paste to Kraft. It was accompanied by documentation falsely claiming that it met federal mold limits.

Then there was also the allegations of collusion and price fixing involving SK Foods and other tomato processors.  All these eventually lead to the demise of SK Food in 2009.

Now that the processing plants are controlled by Olam International as Olam Tomato Processors, I hope they weed out the corrupt practices and uphold the prescribed Food Safety Standards of the host country.

The Committee carried out an evidence check to test if the Government’s policies on homeopathy were based on sound evidence. In preparing its report, the committee, which scrutinizes the evidence behind government policies, took evidence from scientists and homeopaths, and reviewed numerous reports and scientific investigations into homeopathy. It found no evidence that such treatments work beyond providing a placebo effect. The Committee found a mismatch between the evidence and policy. While the Government acknowledges there is no evidence that homeopathy works beyond the placebo effect, it does not intend to change or review its policies on NHS funding of homeopathy.

This was a challenging inquiry which provoked strong reactions. We were seeking to determine whether the Government’s policies on homeopathy are evidence based on current evidence. They are not.

It sets an unfortunate precedent for the Department of Health to consider that the existence of a community which believes that homeopathy works is ‘evidence’ enough to continue spending public money on it. This also sends out a confused message, and has potentially harmful consequences. We await the Government’s response to our report with interest.

The committee also urges governments in other European countries where homeopathy is popular – notably Germany, France and Austria – to be equally wary of funding homeopathy. “We feel there’s a real message, not just in the UK,” says committee chairman: Liberal Democrat MP Phil Willis.

The report draws attention to homeopathic remedies derived from body parts such as hip joints and colons, animals such as iguanas and dragonflies, and even products exposed to different kinds of sunlight. In the case of remedies derived from fragments of archaeological monuments such as the Great Wall of China and Stonehenge, they point out that it is hard to understand how even homeopathy’s own principle of “like cures like” could apply.

Edzard Ernst of the Peninsula Medical School in Exeter, Devonshire says the MPs’ report should be noted in other countries where homeopathy is widely practised but not subjected to serious critical scrutiny. “The evidence is negative, and it’s internationally negative, because there’s no difference between countries in terms of evidence,” he says.

The Prince’s Foundation for Integrated Health, which backs complementary therapies, including homeopathy, acknowledges that homeopathy is “scientifically implausible”, but defends the use of such remedies nonetheless.  In a published response to the committee’s report, the foundation wrote “For patients suffering from long term disease, where no scientific, evidence based medicine can offer effective treatment, it does not matter how it works. What matters to them is whether they get better, whether pain and other symptoms are alleviated.” It added that “Science is a vital tool in healthcare, but so are compassion and caring and treating patients with dignity. It is not clear that the Committee took that into account.”

More extensive coverage in New Scientist – Stop funding homeopathy, say British MPs

“Rosiglitazone should be removed from the market,” one report, by Dr. David Graham and Dr. Kate Gelperin of the Food and Drug Administration, concludes. Both authors recommended that Avandia be withdrawn.

Avandia (Rosiglitazone) is a widely used treatment for Type 2 diabetes. It works to control blood sugar by increasing the body’s sensitivity to insulin. It is often taken as part of a regimen that includes other diabetes medications. Approved in 1999 by the Food and Drug Administration as a safer alternative to Rezulin, banned because it caused liver problems. Avandia was heavily marketed and quickly became one of the biggest selling products manufactured by GlaxoSmithKline. In 2006, sales of Avandia were $3.4 billion.

Concerns that Avandia increases the risk of a heart attack were widely publicized in May 2007 in an article in The New England Journal of Medicine [1]. The article’s lead author, Dr. Steven E. Nissen of the Cleveland Clinic, estimated that users of Avandia faced a 43 percent higher risk of a heart attack or other cardiovascular events. Other doctors raised questions about whether Avandia should remain on the market, as alternative like Actos, which is manufactured by Takeda Pharmaceuticals, did not appear to carry the same risks.

Dr. Nissen’s findings were based on the results of a meta-analysis, a compilation of studies. GlaxoSmithKline disputed Dr. Nissen’s conclusions and released preliminary results of its own study that did not show significantly increased risks among users of the drug.

The debate highlighted internal dissension at the Food and Drug Administration. GlaxoSmithKline had presented data similar to Dr. Nissen’s findings to the FDA in 2005, but the agency did not take action or inform the public because of disagreements among officials about the importance of the data.

Following Dr. Nissen’s article, the Food and Drug Administration convened a special advisory panel to review the drug’s safety risks in July 2007.  But after reviewing Dr. Nissen’s findings, as well as other data, panel members concluded that the evidence was too murky to warrant removing Avandia from the market, voting 22-1 to recommend that it remain available, and opted to issue a news alert instead [3].

Sales of the drug declined dramatically after that. In a related decision, the FDA decided to strengthen labels on Avandia and Actos warning that patients using the drugs should watch for fluid accumulation in the legs, ankles and lungs that could lead to heart failure [2].

Since 2007, more studies have been done. In a December 2009 internal memorandum, the director of the FDA’s drug centre wrote that “there are multiple conflicting opinions” about Avandia within the agency, and she ordered officials to assemble another advisory committee to reconsider whether the drug should be sold.

“I await the recommendations of the advisory committee,” the agency’s commissioner, Dr. Margaret Hamburg, said Friday night. “Meanwhile, I am reviewing the inquiry made by Senators Baucus and Grassley and I am reaching out to ensure that I have a complete understanding and awareness of all of the data and issues involved.”

The multiyear Senate investigation — whose results are expected to be released publicly on Monday — sharply criticizes GlaxoSmithKline, saying it failed to warn patients years earlier that Avandia was potentially deadly.

Mr. Grassley said the internal agency battle showed that the agency needed to be restructured to give more power to safety officials over their counterparts who approve medicines and deal more directly with drug makers.  “It doesn’t make any sense to have these experts who study drugs after they have been on the market for several years under the thumb of the officials who approved the drug in the first place and have a natural interest in defending that decision.”

1. New England Journal of Medicine – Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes 14 June 2007
2. FDA NEWS RELEASE – FDA Adds Boxed Warning for Heart-related Risks to Anti-Diabetes Drug Avandia  14 November 2007
3. FDA NEWS RELEASE – FDA Issues Safety Alert on Avandia  21 May 2007

There are no detailed description of  Nian [年兽], presumably because no one ever survived an encounter with the beast. So the ancient conjured up a creature that is a direct opposite of what they knew.  So instead of a beast of ill fortune, it becomes a harbinger of great fortune.  Instead of living in remote seclusion and invade our habitat come spring time, it now hibernates in our midst, and comes awake to usher in the annual spring festival [春节 chun1 jie2]. In its presence, crops grow and flowers bloom. Instead of an ugly and ferocious beast, it’s a big, athletic cat with a collar bestowed with bells and plums, implying that it’s somewhat domesticated.

By now you would, no doubt, have guessed what I am describing. Yes, I am talking about the Chinese lion [醒獅 xing3 shi1].  A point of clarification though: As the lion is not native to China, it is unknown to ancient Chinese. Thus the Chinese lion that is being spoken of here is also a mythical animal, quite different from the big cats that roam the plains in Africa. In fact, when the Ming court officials first set eyes on a live lion that Admiral Cheng Ho [镇和] brought back from Africa,  they coined the term 獅子 (little Shi or offspring of Shi) to refer to lion, believing lions are really 獅 in the flesh. (They also believed that giraffes are 麒麟 [qi2 lin2 Chinese unicorns], but that’s another story).

To bring the mythical lion to everyday life, the people carved stone lions to keep watch over entrenches of important buildings.  But the most common appearance is the lion dance. In this, the beast is portrayed as a benign and playful creature awakening from a long slumber. And to be absolutely certain that it’s harmless, the dancing lion [舞狮 wu3 shi1] is made a herbivore. So instead of hunting for preys, it scale tall poles to plug greens [采青 cai3 qing1] strung up high (with hidden red packets). The dancing lion is so loved that it is easy to  overlook its origin. But if you pay attention to the head, you will notice that it has retained a distinctive feature of Nian, its horn.

But it had not always been like this. In fact, according to ancient Chinese folklore, this used to be a time of fear and misery, a time to leave home en mass for the refuge of the jungle. How so ? The Chinese term 过年 [guo4 nian2] is taken to mean ‘transition to a new year’ in modern time, but [年] dose not mean year in an earlier period (before the Zhpu dynasty 周朝 in 1020 BC), when year is represented by the characters 岁 (sui4) and 载 (zai3, one revolution of the heavenly bodies). Thus the passage of time is 过岁月 (literally to ferry across years and months). So a more accurate translation for 过年 is ‘make it through Nian’. In fact in Chinese literature there are commonly found expressions such as 熬年 (ao2 nian2, endure or suffer through Nian) and 过年关 (guo4 nian2 guan1, to survive the Nian ordeal) to describe the event.

So what is the Nian that our ancients so dreaded ? Nian [年兽 nian2 sou4] is a beast of ill fortune in Chinese mythology. It lived in remote seclusion deep undersea (or in dense forest, by some account). It was an ugly, horned beast of extreme ferocity.  In its presence, plants withered and crops failed. As a carnivore, it devoured any living fish, bird and animal, a different kind of creature each day. Thus on the last day of the year, it would invade human habitat to feast on human flesh exclusively. Therefore new year’s eve was not a day to look forward to, and every villager and town dweller would pack up and head for the mountain and jungle to  seek refuge from this visitation by Nian, which lasted from sundown to dawn. Of course the supposed refuge posed danger of its own, such as tigers and bears. It’s a measure of the fear of Nian that people would willingly chance an encounter with these other predators just to get away from Nian.

As the years passed, some people got to understand the habits and behaviour of Nian better, and devised a set of routines and practices to help them survive the ordeal [熬年关]. Thus on new year’s eve :

1. Prepare a sumptuous dinner as survival is not assured;
2. Snuff out all embers and clean out the stove when done cooking the reunion dinner;
3. Lock up all livestock indoors;
4. Seal all entrances when everyone’s home;
5. Before dinner, pray to the ancestors for protection and safe passage of the night’;
6. In some regions, dinner is eaten slowly, dragging till past midnight;
7. After dinner, stay up and chit-chat to keep a vigil [守岁 shou3 sui4] through the night;

When Nian entered the community after sundown, it found the streets deserted and all dwellings locked down with heaps of sesame sticks [芝麻软糖 zhi1 ma2 ruan3 tang2] (a traditional Chinese confectionery) piled up in front. Unable to find prey, it would gnaw the sweets and return to its lair at sunrise. The people then throw open their main door and rush into the streets to greet and congratulate each other for making it through another year unscathed. Parents give a single coin to each child to mark the safe passage (压岁 ya1 sui4, literally ‘locking down the age’). Each child would string up these coins on bedside (or under pillow) as a record of his age, kind of like tree rings. This tradition also lead to the common practice of over-stating a child’s age. For example an infant born in the closing month of the year will be given a coin by new year and reported as one year old.

With the widespread adoption of these practices, many years passed without any attack. The people began to slacken in their vigilance. So one year in the south a whole village was practicality wiped out in an attack. The only survivors were a newly wed couple dressed in bright red wedding gears huddling in their bedroom with red curtains and a group of children playing around a bonfire of dried bamboo trunk. Speculation was that Nian abhorred the colour red or was tricked into believing the bedroom had been bloodied (implying there was no one left alive). It was also frighten off by the brightness and loud popping of burning bamboo. Thus started the practice of dressing in red, hanging red lanterns and sticking red paper on the front door. With the communities brightly lit and lots of noise from gongs, drums and fire crackers, the was no more reports of attack by Nian.

Today, many of our custom and practices during New Year can be traced back to these measures. For example, giving of red packet [红包] has its root in locking down the age [压岁]. Hanging of auspicious couplets [对联 dui4 lian2] originate from sticking red paper on doors. And the Chinese term for fire crackers [爆竹 bao4 ju4] literally mean exploding bamboo.

During my second year in the university, I was elected to the position of social secretary for the students’ Pharmaceutical Society, not because I was popular, but because it was a job that nobody wanted. You see the social secretary exists mainly for one purpose: to raise fund and to organized the society’s annual dinner and dance. It was a monumental task for any team imaginable. I had a hard time forming a team because I can’t find even one person in my class who’d sit on my committee. (I don’t blame them, I would have done the same under the circumstance.) To make matter worse, the school decided from that year on to stop direct admission, choosing to select from those who had completed first year in Science. As I don’t have a pool of juniors to fill my committee, I am alone holding a very hot potato.

I called some hotels for quotes and did a quick estimate. Due to the small number of seat (the total number of students in Pharmacy is under 60) and the resultant high overhead, the price per head came to a whopping $120. As i didn’t want to ask the society of limited means to subsidies, I would have to raise about $6,000 (excluding door gifts and prizes) just to keep ticket price at $40 each. I realize right away I stood no chance of raising that kind of money on my own. In addition, there are also the work of coordination, getting sponsorship for prizes, hiring a band, games, etc; way too much details for just one person to handle.

For the next few months I tried to find help and guidance from the seniors in the third year, but they all have withdrawn into the mugging mode. I was desperate for any idea to get started but no one came to offer assistance or suggestions. My study started to go downhill as I became increasingly more irritable and unkempt. Then one day Dr Alagaratnum, my Pharmaceutics lecturer took me aside in his lab and asked me: “How do you eat a big, fat salami sausage ?” After a few moment of dumb silence from me, he answered: “One thin slice at a time.” Then he kept silent and just looked at me with his big round eyes. When realization finally dawned on me after what felt like a long, long time, he nodded knowingly and paced off.

That encounter with Dr Alagar had given me the insight on the approach to take: Break down the task into the smallest chunks possible and just go at it one tiny bit at a time. So I decided NOT to bother with raising fund as it was an unattainable goal given the circumstance, and just concentrate on organising the event. In short, I worked my butt off in the following months, one task at a time, and managed to hold the Annual Dinner (no Dance) at the middle of the second semester. It was a casual evening by the pool of the then Medical Alumni building. If anyone was unhappy about how it turned out, he kept it to himself. In any case, I really couldn’t care less for any grievance raised as I had done my upmost, with my conscience and sanity intact.

If I learned anything in this episode, it was these:

• Any task, however large,can be overcome by breaking it into more manageable chunks,
• If I had done my best to complete the tasks, I can rest easy with no fear of recrimination.

Thanks, Dr Alagar, for the salami lesson.

Distracted driving has gained much attention because of the inflated crash risk posed by drivers using cell-phones to talk and text. But there are other kinds of problems caused by lower-stakes multitasking like distracted walking, which combines a pedestrian, an electronic device and an unseen step, the pole of a stop sign, a toy left on the living room floor or a parked (or moving) car.

The era of the mobile gadget is making mobility that much more perilous, particularly on crowded streets where too many multi-taskers jostle for road surface on foot or wheels while immersed in the beat of their own devices like cell-phones and MP3/video players. But cell-phone is by far the most dangerous because it requires active participation from its users. Texting (and Twittering) is increasingly popular and newer devices like the iPhone have thousands of new, engaging applications to preoccupy phone users.

Most times, the mishaps for a distracted walker are minor, like the lightly dinged head or a jammed digit or a sprained ankle, and a nasty case of hurt pride. Of course, the injuries can sometimes be serious — and these are on the rise. According to a study conducted by Ohio State University (the first study to tabulate such accidents), slightly more than 1,000 pedestrians visited emergency rooms in 2008 because they got distracted and tripped, fell or ran into something while using a cell-phone to talk or text. That was twice the number from 2007, which had nearly doubled from 2006.

The actual number of mishaps is probably much, much higher considering that most of the injuries are not severe enough to require a hospital visit, thus going unreported. Examples of those that are reported include a 16-year-old boy who walked into a telephone pole while texting and suffered a concussion; a 28-year-old man who tripped and fractured a finger on the hand gripping his cell-phone; and a 68-year-old man who fell off the porch while talking on a cell-phone, spraining a thumb and an ankle and causing dizziness. About half were by people under 30, and a quarter were 16 to 20 years old. But more than a quarter of those injured were 41 to 60 years old.

Pedestrians, like drivers, have long been distracted by myriad tasks, like snacking or reading on the go. But the constant interaction with electronic devices has made single-tasking seem boring or even unproductive. Cognitive psychologists, neurologists and other researchers are beginning to study the impact of constant multitasking, whether behind a desk or the wheel or on foot. It might stand to reason that someone looking at a phone to read a message would misstep, but the researchers are finding that just talking on a phone takes its own considerable toll on cognition and awareness.

Walking and chewing are repetitive, well-practiced tasks that become automatic. They don’t compete for resources like texting and walking. …  the cell-phone gives people a constant opportunity to pursue goals that feel more important than walking down the street. … An animal would never walk into a pole, survival instincts would trump other priorities.

Sometimes, pedestrians using their phones do not notice objects or people that are right in front of them — even a clown riding a unicycle. That was the finding of a recent study published in the journal Applied Cognitive Psychology [abstract and full text PDF]. One of the researchers dressed as a clown and unicycled around a central square on campus. About half the people walking past by themselves said they had seen the clown, and the number was slightly higher for people walking in pairs. But only 25 percent of people talking on a cell-phone said they had.

The term commonly applied to such preoccupation is “inattention blindness,” meaning a person can be looking at an object but fail to register it or process what it is. As people walking in pairs were more than twice as likely to see the clown as were people talking on a cell-phone, it suggests that the act of simply having a conversation is not the cause of inattention blindness.

It’s possible that a cell-phone conversation taxes not just auditory resources in the brain but also visual functions, causing the listener to create visual imagery related to the conversation in a way that overrides or obscures the processing of real images. By comparison, walking and chewing gum (that age-old measure of pedestrian skill at multitasking) is a snap.