Business
Doctors Net Billions From Drug Firms
Companies Paid at Least $3.5 Billion in Last Five Months of 2013
Updated Sept. 30, 2014 7:29 p.m. ET
Drug and medical-device firms paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year. WSJ's Peter Loftus reports on the News Hub with Sara Murray. Photo: Getty.
Drug and medical-device companies paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year, according to the Open Payments - Centers for Medicare & Medicaid Services so far of the financial ties that some critics say have compromised medical care.
The figures come from a new federal government transparency initiative. The 2010 Affordable Care Act included a provision dubbed the Sunshine Act, which requires manufacturers of drugs and medical devices to disclose the payments they make to physicians and teaching hospitals each year for services such as consulting or research. The Centers for Medicare and Medicaid Services compiled the records into a database posted online Tuesday, though the agency said that about 40% of the payment information won't identify the recipients because of data problems.
The database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding AG RO.EB -1.00% 's Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin.
Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research.
The Centers for Medicare and Medicaid Services posted a database online showing payments made by makers of drugs and medical devices to physicians and teaching hospitals. Bloomberg
Some doctors disputed details of the payment data. The database shows John LeDonne, a surgeon from Baltimore, as having received about $78,200 in payments for food and beverage for the five-month period from medical-device maker Teleflex Inc. TFX -0.29%
Dr. LeDonne acknowledged he performs paid consulting work for health-care companies including Teleflex, but that he rarely received free meals. He said the total payment amount was in the right "ballpark," but should not have been classified in the food-and-beverage category.
"They certainly did not give me $78,000 in lunch money," Dr. LeDonne said in an interview. "Lunch is not a big deal in most parts of my life." Teleflex didn't immediately respond to requests for comment.
The push for greater transparency was driven by concerns that doctors' prescribing decisions are tainted by the money and gifts they receive each year from companies. Supporters expect the transparency initiative to provide useful information to patients about the relationships their doctors have with industry and to curb the influence of payments on medical care.
Calls for Transparency
- The government wants to have more disclosure about payments made to doctors and teaching hospitals.
- U.S. physicians have faced scrutiny over gifts received from companies.
- Some drug makers have reduced their payments to doctors.
- Does the Open Payments database distort what doctors receive for research?
- CMS is asked to drop some payments from sunshine database.
"The financial relationships between doctors and drug companies and medical-device companies are a source of conflicts of interest," said Allan Coukell, director of the Pew Prescription Project, which has supported the Sunshine Act. "They have the potential to influence the care that patients get and so they're a matter of interest both to individual consumers and to policy makers."
Companies have defended their payments to physicians as necessary to conduct research and communicate how products should be used. "I welcome these disclosures," said John C. Lechleiter, chief executive of drug maker Eli Lilly LLY -0.54% & Co., which was mandated to report physician payments on its website as part of a 2009 settlement with the government over illegal-marketing allegations. "We believe the payments that are spelled out in these reports can be entirely justified and in fact are critical for us to be able to discover and develop medicines and effectively communicate their value."
The payments and so-called transfers of value to an estimated 546,000 doctors and 1,360 teaching hospitals include such items as free meals that company sales representatives bring to physicians' offices, fees paid to doctors to speak about a company's drug to other doctors at restaurants, compensation for clinical trial research and consulting fees.
Some doctors have earned tens of thousands of dollars annually from drug companies by flying to various cities to give paid speeches, while some surgeons have received even larger amounts from medical-device makers, partly from royalties on products they helped develop.
Doctors have expressed concern about having their names attached to money paid by industry. Some have scaled back their interactions with industry because they know it will be reported publicly.
The information in the database is broken down by category of payment—separating out research from "general payments," which includes money paid for a range of things including consulting, travel, grants and entertainment, for instance. But some doctors are concerned the public presentation of the data will lack context that explains the possible value of the doctor's relationship with a company.
"Questions from confused patients are especially likely, given that the online database is not expected to offer much context for the financial interactions it reports between physicians and manufacturers of medical devices and drugs," the American Medical Association said. The association had asked CMS to delay publication of the payment data to give doctors more time to review the accuracy of the reports.
Among individual physicians, Stephen Burkhart was one of the top recipients of non-research payments from industry. The San Antonio orthopedic surgeon received $7.4 million in non-research payments or transfers of value for the five-month period, mostly from device manufacturer Arthrex Inc. for payments identified as "royalty or license."
Dr. Burkhart couldn't be reached for comment. Arthrex said in a statement that it has "financial relationships with a number of orthopedic surgeons and teaching hospitals," like many manufacturers, for their advice and expertise.
Chitranjan Ranawat, a New York orthopedic surgeon, received about $4 million in nonresearch payments or transfers of value, mostly from Johnson & Johnson's JNJ -0.74% DePuy Synthes unit for "royalty or license," according to the database.
Dr. Ranawat couldn't be reached for comment. A J&J spokeswoman said the company works with surgeons and other professionals to develop products, and pays royalties to inventors holding patents.
Some drug and device companies including Lilly, Pfizer Inc. PFE -0.40% and GlaxoSmithKline GSK.LN +0.25% PLC have been disclosing individual physician-payment records on their own websites for several years because of settlements of government investigations of their marketing practices.
Such company disclosures have shown that some companies have reduced spending on items such as speaking fees and meals in recent years. Some said they cut back on such items because they have reduced the size of their sales forces and have used other methods of communicating with doctors, such as online meetings.
The first batch of data released by CMS on Tuesday covers payments made from Aug. 1 to Dec. 31, 2013. Beginning next year, companies will report full-year data annually. Companies submitted the data to CMS earlier this year, using the so-called Open Payments portal. The agency has allowed physicians to register with the Open Payments system to get a preview of the payment records, before it went public, to allow time for them to dispute any reports they believed were inaccurate.
But it hasn't been a smooth process. First, CMS delayed the public reporting of the data by a year to give companies more time to prepare. The Open Payments online system has experienced technical problems, including a data mix-up that resulted in some doctors being linked to payment records for other doctors with the same surname. The preview function for doctors had a cumbersome registration process, some doctors said, and was taken offline at times in recent weeks.
The first batch of data is incomplete. CMS in August said it removed about one-third of the payment records from the physician-preview database because it said some of the state medical-license numbers that companies reported for doctors didn't match a database that the agency was using for verification, among other problems. CMS now is releasing those records but without identifying the physicians tied to them. It will update the database to include the physicians' names for those records next year. Also, CMS isn't immediately releasing payments related to proprietary research-and-development; those will be reported at a later date.
The agency's handling of the problematic records also has drawn criticism from companies, which said they reported the vast majority of data properly.
About $22 million in physician-payment records reported Eli Lilly for the five-month period of last year, for example, was removed from the physician-preview database, out of a total reported of about $85 million, said Ashish Kalgaonkar, senior director of Lilly's transparency reporting. "I'm very confident that my data is correct," Mr. Kalgaonkar said.
Industry and medical groups also have complained that CMS didn't offer advance information about how the data would be presented publicly.
"The rollout won't be perfect," Sen. Chuck Grassley (R., Iowa), a co-author of the Sunshine Act legislation, said in a written statement before Tuesday's release. "Some information will be withheld because CMS wanted to protect doctors from a small amount of reports that might be imprecise. But as the information is refined, the database will improve. It will become more complete as doctors, drug and device companies and CMS work to update and refine the information."
The new database may lend itself to a range of uses. A Justice Department spokeswoman said Tuesday the department may use the Open Payments data "to help assess the nature and extent of any financial relationships that exist between pharmaceutical and medical device manufacturers and prescribing physicians, and whether such relationships violate federal law."
One former Senate staffer who was closely involved in the effort to pass the Sunshine Act hopes the database will do some good. "This website will let patients ask a very important question: 'Is a relationship between my doctor and a drug company right for me?' It took six years of hard work to get this site together and, hopefully, it will help clean up medicine," said Paul Thacker, a former aide to Sen. Chuck Grassley (R-Iowa) who is now a fellow at the Safra Ethics Center at Harvard University. He said the "total amount of money is pretty eye popping."
—Joseph Walker, Ed Silverman and Tom McGinty contributed to this article.
Write to Peter Loftus at peter.loftus@wsj.com
Weight-Loss Programs for Surgery Patients
More Attention on Pre- and Post-Op Care With Bariatric Surgery
ENLARGE Misty Morgan of Goshen, Ohio, had weight lost surgery in April 2013 and has lost 197 pounds. Jeffery Morgan
More hospitals are offering long-term weight-loss maintenance programs to patients who undergo bariatric surgery, in a growing recognition that they may need a lifetime of care to avoid backsliding and regaining weight.
The new dietary and lifestyle regimens often start months before the surgery and continue for months or years afterward. Nutritionists, nurses and psychologists join surgeons on the medical team and offer a mix of behavior-modification techniques, including individual counseling, classes and support groups.
The aim is to help patients not only stick to eating and exercise plans, but also to overcome anxiety or depression that can be triggered by dramatic lifestyle changes.
One of the most common procedures, a gastric bypass, reduces the size of the stomach and allows food to bypass part of the small intestine, reducing the amount of food patients can eat at one time and decreasing the calories and nutrients absorbed. To qualify, patients typically have a body mass index of 40 or higher, which translates to being about 100 pounds overweight. They may qualify with a lower body-mass index if they have a serious weight-related health problem, such as diabetes, which can go into remission after surgery.
An estimated 18 million of the 78.6 million obese adults in the U.S. are eligible for surgical weight-loss procedures, according to the American Society for Metabolic and Bariatric Surgery. Between 2011 and 2013, more than a half-million patients had some form of bariatric surgery, the society says.
That number is expected to rise as more private insurers and Medicare plans cover costs for patients where other weight-loss efforts have failed. Surgical fees, depending on the type of procedure, range from $11,500 to $26,000. A federally funded study is evaluating the benefits and risks of bariatric surgery in adolescents.
Patients may lose more than three-quarters of excess weight in the first year after surgery. Maintaining half of excess weight loss five years after surgery is considered a success. Up to 30% of patients may not lose weight, though, or they may gain weight gradually with a return of conditions like diabetes, according to a Stanford University study published earlier this year in the journal Surgery for Obesity and Related Diseases. It found successful weight loss was highest among those who adhered to diets, grazed no more than once a day and attended support groups.
"We know obesity is a chronic disease, and relapses happen," says John Morton, co-author of the study, president-elect of the American Society for Metabolic and Bariatric Surgery and chief of bariatric and minimally invasive surgery at Stanford University School of Medicine.
In a 2009 report, researchers at Ochsner Health System in New Orleans said many patients have difficulty with extreme and instant lifestyle changes. People who were "stress eaters" lose that outlet, and when holidays and family life no longer revolve around a big meal, social structures can be "irreparably broken," the researchers said. With guidance, understanding and professional counseling, patients can adapt.
At Mercy Health-Cincinnati, part of the Mercy Health system formerly known as Catholic Health Partners, patients undergo a psychiatric evaluation before weight-loss surgery to help uncover eating disorders, addictions or other issues that if untreated might interfere with a new regimen after surgery. Before the operation, patients are required to lose a certain amount of weight, depending on their body mass, with a program that includes diet, exercise and some liquid meal replacement.
"There is such a behavioral change needed that if we don't start making it beforehand, it is too overwhelming," says Joe Northup, clinical director of the Mercy Health-Cincinnati bariatric surgery program.
While his team doesn't set specific pre-operative weight-loss goals, they do expect patients to make some changes in diet and behavior, such as eating small frequent meals, eliminating carbonated beverages and caffeine, planning more home-prepared meals and eating breakfast and protein at all meals and snacks.
"Surgery is just a tool, and you need ongoing support and counseling to not let those old behaviors you had before surgery creep back in," Anne Kroger, regional bariatric program coordinator for Mercy Health-Cincinnati, says she tells patients.
After surgery, patients are offered, at no extra cost, behavioral counseling in a group setting with a psychologist, surgeon, dietitian and nurse as well as nutritional and fitness counseling, support groups and cooking classes.
Mercy offers complimentary membership and personal training at its own fitness facilities for six months following surgery, with a discounted rate after that.
Group sessions focus on goal setting, overcoming body-image issues and dealing with changes in relationships. Patients may find family members withhold support or even sabotage their efforts to keep losing. They learn about mindful eating—paying attention to the process of selecting, preparing and eating food—and are encouraged to keep food diaries with entries for thoughts, feelings, moods and body sensations.
In July 2012, Misty Morgan, then 30 and a mother of two, attended an informational seminar about surgery at Mercy. At 5 feet 2 inches and 377 pounds, she had lost the confidence to seek work after losing a previous job. In September, she entered a six-month supervised weight-loss program at Mercy Health Fairfield Hospital in Cincinnati, and lost 40 pounds. Her insurance carrier approved a gastric bypass and she had the procedure in April 2013.
Months before surgery, she began posting regular video updates on YouTube that she thought would help others. She talked about trigger foods, like sugary sweets that she found hard to stop eating once she started, her struggle with bad food choices and her efforts to make her husband, Jeffery, see that buying her sweets and fast food wasn't helping.
After the surgery, she talked about the ups and downs of trying to stay on the wagon, as well as complications, such as a frightening return to the hospital five months after surgery for unrelated blood clots.
In a video post for her one-year anniversary, she announced she was down to 204.8 pounds and described "the best year of my life," including a flight to Las Vegas without needing an extra seat or seat-belt extender, and the weird sensation of driving a car without feeling her stomach touch the steering wheel.
After recovering from surgery, Ms. Morgan says she did cardio workouts three times a week at the Mercy gym, met regularly with a nutritionist and attended behavioral modification classes and support groups. A virtual grocery tour helped her make better choices when shopping, and now she reads labels religiously.
"They teach you how to change the way you look at and think of food, and to stop living to eat and eat just to live," she says.
Ms. Morgan landed a job in a medical billing office and joined a patient support group. She and other post-op patients exercise and plan activities together to stay moving and motivated.
Instead of a night out with her husband to a restaurant, she says, "we go out and do things, like to the amusement park and go on a scary roller coaster."
She has lost 197 pounds, weighing in last week at 180.6 pounds; her goal is 175, and she will try to lose in five-pound increments after that. The Mercy program "helps keep me accountable and keeps me on track," Ms. Morgan says.
Keeping It Off
Hospital weight-loss treatment can start months before surgery and last months or years afterward. It typically includes:
Before Surgery
Psychiatric evaluation to uncover eating disorders or addictions
Some supervised weight loss
Behavioral changes, such as eating breakfast and frequent smaller meals, and eliminating carbonated beverages
After Surgery
Behavioral and nutrition, counseling
Support groups and cooking classes
Complimentary gym membership and personal training for six months, followed by discounted rates
—Source: Mercy Health-Cincinnati
Germs at the Office Are Often Found on Keyboards and at Coffee Stations
Virus Went From Front Door to Half the Office in Four Hours, Study Finds
As cold and flu season nears, is it possible to avoid the germ-filled spots in the office? WSJ's Sumathi Reddy joins Lunch Break with Tanya Rivero to discuss. Photo: iStock/Thomas_EyeDesign
By
Sumathi Reddy
It's almost that time of year when you ever-so-slowly inch away from the person with the hacking cough and infectious sneeze.
Turns out it's pretty hard to avoid the germs of your co-workers, even the ones you don't know personally. Just one door contaminated with a virus spreads the germ to about half the surfaces and hands of about half the employees in the office within four hours, according to a study at the University of Arizona, in Tucson. Germs traveled through the office just as quickly when the researchers infected a single person with the artificial virus.
"The hand is quicker than the sneeze," said Charles Gerba, a professor of microbiology at the University of Arizona who presented the research at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington D.C. earlier this month.
The University of Arizona researchers conducted their study at an office building with 80 employees. They contaminated a push-plate door at the building entrance with a virus called bacteriophage MS-2. It doesn't infect people yet is similar in shape, size and survivability to common cold and stomach flu viruses.
Within two hours, the virus had contaminated the break room—coffee pot, microwave button, fridge door handle—and then spread to restrooms, individual offices and cubicles. There, researchers found, the virus had heavily contaminated phones, desks and computers. By four hours, they found the virus on more than 50% of the commonly touched surfaces and on hands of about half of the employees in the office.
"It was amazing because most of these people didn't know each other," said Dr. Gerba. The studies, funded by Kimberly-Clark Corp. , the Irving, Texas, maker of consumer brands including Kleenex and Huggies, are currently under review for publication. Dr. Gerba has worked on science-advisory boards and as a paid consultant for a number of companies including Kimberly-Clark.
In an intervention, the Arizona researchers then gave about half of the employees hand sanitizer and disinfectant wipes to use. After the intervention, detection of the virus on people's hands went from 39% to 11%.
The results were similar in an experiment in which the researchers infected a single employee with a droplet containing an artificial virus that didn't cause illness. Within four hours, half of the commonly touched surfaces in the office and the hands of half of the employees were infected with at least one virus.
Studies indicate the average adult brings their fingers to the nose, mouth or eyes about 16 times an hour. For children ages 2 to 5, the number is as many as 50 times an hour.
Germs Thrive at Work, Too
ENLARGE Illustrations by Adam Doughty
The researchers calculated that employees had a 30% chance of infection, said Kelly Reynolds, a microbiologist and associate professor at the University of Arizona who worked on the studies and has been a consultant for companies, but not Kimberly-Clark.
Germaphobes, don't freak out. Just because you are exposed to a virus or bacteria, doesn't mean you will get sick. Microbiologists say much depends on the dose, or number of virus particles that you are exposed to, whether you've been exposed to the germ before and your overall susceptibility and health.
Many people have devised low-tech methods of avoiding germs. Eloise Laird, a 51-year-old mother of three who lives in Dallas, says her weak immune system forced her to become a germaphobe. She carries her own pen and refuses to touch elevator buttons.
"I use my elbow or knuckle in the elevator, just not my fingertips," Ms. Laird, a former corporate chief financial officer, says. She keeps a paper towel in her hand as she opens the door in any public restroom.
"I don't know who uses their hand to open doors anymore when they leave the bathroom," Ms. Laird says.
Different viruses have different life spans, and they also are dependent on factors such as temperature and the material where they are harboring. Some viruses are more infectious than others.
"Our body harbors viruses all the time," said Martin J. Blaser, director of the Human Microbiome Program at New York University's Langone Medical Center. "The average person has trillions of bacteria and dozens of virus species living in us. You can do studies where you can show that germs move around, but does that mean it's a health hazard? Generally not."
Dr. Federico Laham, a pediatric infectious-disease specialist at Arnold Palmer Hospital for Children in Orlando, Fla., says some viruses, like the norovirus, the most common cause of infectious diarrhea, are superinfectious, while others may be less contagious, or more difficult to catch.
Studies conducted at daycare centers have found 30% to 40% of children without symptoms have respiratory viruses on them, Dr. Laham says.
ENLARGE Illustrations by Adam Doughty
Dr. Reynolds, of the University of Arizona, says pathogens have survival rates ranging from seconds to months. Most respiratory viruses can survive a maximum of two to four days, she said. Survival is heavily dependent on environmental conditions such as temperature: Some viruses die at high temperatures.
Material also plays a role. Microbes on porous surfaces, such as carpeting and upholstery, have better survival rates on synthetic fibers like polyester than on cotton. Pathogens are readily transferred on stainless-steel surfaces, although certain metals, such as copper, tend to have an antimicrobial effect and germ survival there probably won't last more than a few hours, Dr. Reynolds says. Microbes have comparatively good survival on plastic or Formica. And anything with textured grooves or connection points, like a keyboard or a child's toy, will have a tendency to collect dirt, which can help survival.
While the University of Arizona researchers believe the use of hand sanitizers and disinfecting wipes can sharply reduce the spread of viruses, not all experts agree.
NYU's Dr. Blaser says he generally doesn't recommend hand sanitizers and disinfectant wipes because they kill good bacteria, which can help protect against bad bacteria. Exceptions, he says, are in hospitals and during flu season.
"In our desire to get rid of bad bugs we're also getting rid of good bugs," he says.
Some researchers suggest one way to slow the spread of potentially harmful germs would be to eliminate a social norm—the handshake.
A study published this year in the American Journal of Infection Control found a handshake can transfer from 10 to 20 times as much bacteria as a fist bump. Studies have found only 40% of hospital employees wash their hands adequately, leading some doctors to suggest that handshakes should be banned in hospitals.
The University of Arizona researchers have conducted experiments in hotels, schools and health-care facilities. In a study published this year in the journal Food and Environment Virology, they found that infecting one hotel room with the virus led to the infection of nearby rooms. They speculated cleaning tools, like mops and towels, spread the germs. The virus also spread to the conference room. The study was also funded by Kimberly-Clark.
The next stop for the researchers is more detailed studies in public restrooms. Dr. Gerba said they want to contaminate a public restroom and see where and how far the virus travels.
Markets
Compromise Is Floated on Auditor Identification
Oct. 1, 2014 12:22 a.m. ET
A new compromise proposal on identifying audit-firm partners would require investors to wait longer to find out who exactly is in charge of a company's audit.
The Public Company Accounting Oversight Board plans to disclose Wednesday that it may seek comment on a new idea for identifying audit-firm partners, floated by PCAOB Chairman James Doty. The move could pave the way to disclose for the first time the names of the individual "engagement partners" in charge of each public company's audit, in an attempt to help investors and make auditors more accountable.
But in an apparent victory for the accounting industry, the new plan's disclosure requirements are more friendly to the industry than the previous PCAOB proposal had called for and that investor advocates would prefer. It would require investors to wait up to five months after a company closes its annual books to learn the audit partner's name, and two months longer than previously proposed.
Mr. Doty is envisioning a scenario that would allow the firms to disclose the partner's name in a newly created form they would file with the PCAOB for that purpose, instead of in the auditor's opinion in the 10-K annual report, as previously proposed. The new form would be filed a maximum of 60 days after the annual report is filed. Combined with the 60 to 90 days after the end of the fiscal year that companies take to file their 10-K, that could force investors to wait a total of up to five months.
The PCAOB has been moving for years toward a long-awaited rule requiring audit firms to identify their partners in charge of each client. But big accounting firms have long lobbied to keep their partners' names out of the annual report, over concerns it could lead to more lawsuits against the partners.
In an interview Tuesday, Mr. Doty underscored the regulator's commitment to investors having access to the names of audit partners.
"We are absolutely committed to getting the name of the engagement partner in the hands of investors," Mr. Doty said.
The PCAOB will disclose the move Wednesday in an update of its rule-setting agenda. Mr. Doty said he expects the PCAOB to act within the next month on issuing a request for comment on the new idea.
The public-comment period would then be open for the following 45 days or so, and so it might not yield a final rule until 2015. Previously, the PCAOB had said it expected to enact a final rule within the next few weeks.
Supporters of naming the audit partner say it will help investors assess audit quality and evaluate an individual partner's track record, and encourage auditors to perform better. The PCAOB's most recent proposal on naming the partner, last December, called for the disclosure to be in the 10-K auditor's report, which Mr. Doty and investor advocates say is the best, most prominent way to disclose the partner's name to investors.
But big audit firms have insisted that naming the partner in the 10-K boosts liability concerns and could lead to complications and delays in the disclosure.
They have wanted the name to be disclosed in the firms' PCAOB annual reports, known as a Form 2, which they say wouldn't create the same concerns and complications because it isn't a Securities and Exchange Commission filing.
Hence the new idea, to essentially split the difference by giving firms the option of naming the partner in the new PCAOB form and/or in the 10-K. Firms would also have to disclose any other audit firms that assisted them in completing the audit.
"Getting this name out is a big step," Mr. Doty said.
It isn't clear how the accounting industry will react to the new request for comment, and Mr. Doty's idea providing the option of a new form for the disclosure. It is possible that some investor advocates may be disappointed with the new idea because it would require investors to seek out an unfamiliar report.
The new form naming the partner, though it might not be until 60 days after the annual report, would address concerns that leaving disclosure of the name to the firms' Form 2 filings could delay disclosure by up to 15 months. Firms might be able to aggregate the new disclosures for filing at the same time to ease the burden of filing the partner's name for each individual client.
Write to Michael Rapoport at Michael.Rapoport@wsj.com
Android and iPhone Keyboard Apps to Turbocharge Your Typing
Software Keyboards for iPhone and Android Do What Was Never Possible With Real Keys
Typing on a piece of glass doesn't have to be frustrating. Personal technology columnist Joanna Stern teaches you about a few apps that help you become a master smartphone typist. Photo/Video: Drew Evans/The Wall Street Journal.
One day my grandchildren will gather around my dusty collection of gadgets and stare with bewilderment at the small hardware keyboards found on the first generations of smartphones. They'll laugh and ask if the phones also had to be attached to a windmill to work.
Looking longingly at the plastic keys that once felt perfect to me, I'll remember that while the transition to typing on glass screens was a hard time in my life, I couldn't imagine returning to a keyboard that wasn't smart enough to predict my words and adapt to my needs.
Now that you can install third-party keyboard apps on both Android and iOS, developers are aggressively (and creatively) working to speed up how we input text while freeing us from typos or embarrassing autocorrect flubs.
They're rethinking how we interact with the keys—even the idea of keys altogether. You can still tap letters, but you can also swipe your finger around the screen, throw in chunks of pre-typed text, draw characters or even dictate to your phone. Some are beginning to bring desktop-like shortcuts and features to the palm of our hand.
Not all the options are created equal. I looked at no fewer than 10 oddly named apps—from Minuum to Fleksy—found in the Apple App Store and Google Play store to find a handful to recommend. And since Google has permitted third-party keyboards for much longer than iOS, your options for Android phones are more advanced.
Swipe to Type
Pressing down on keys has made sense for a century or two, but on a flat surface where there's room for two fingers at most, another gesture can be better: the swipe.
Swiping to type means sliding your finger from letter to letter, while the intelligent keyboard tries to figure out the word you're suggesting. Think of it as connect the dots for words. Swiping is the main text-entry method for apps such as Swype and SwiftKey (which also let you peck out letters), and it's an option on the native Android and Windows Phone keyboards, too.
Swype and SwiftKey keyboards—available on iOS and Android—can decipher the sloppiest squiggle lines for complicated words such as "existentialism" or "unnecessary."
I've found that swiping is most handy when I've got only one hand free, especially on larger screen phones. It helps when you don't have to lift up your finger. (Try reaching for that Q key one-handed on an iPhone 6 or 6 Plus.)
But I can type faster when I have two thumbs available—especially on the roomier screens. Thanks to good key spacing, SwiftKey is also easier to type on than most replacement keyboards I tested, including Swype. At 50 words a minute with little or no typos, it beats Google's Android keyboard for me, though I can type 55 WPM on my daily driver—Apple's new iOS 8.
ENLARGE That's partially because SwiftKey has yet to bring over some of the features from its four-year-old Android app to its new iPhone app, including the ability to change the size and color of the keys, and access the emoji keyboard. (Fleksy, another keyboard for iOS and Android, is another good option if you want that custom key size, a fast delete gesture and instant emoji access.)
Many new iOS app keyboards can be glitchy, SwiftKey included. In iMessage, it frequently blocks part of the messages on screen and periodically it is slow to pop up. The company says it is working to fix those issues and to bring feature parity to the iPhone app.
Word Prediction
Still, SwiftKey remains my top keyboard replacement because, like a loved one in a decades-long relationship, it's great at finishing my sentences.
SwiftKey isn't the only app that suggests words as you type. Both Google and Apple's keyboards now do this. But in iOS 8's first month, SwiftKey is already smarter at predicting my words than the rest. It suggests my often-used phrases ("done and done" and "k"), people (my boss's name) and places (my favorite restaurant or my spin class).
To install these keyboard apps, you download them and then go into the phone's keyboard settings menu, where you enable them. To get all the features in iOS, many require you to take the additional step of granting "full access."
ENLARGE AI.Type for Android is full of features. Drew Evans/The Wall Street Journal
Apple warns that this gives the app maker the ability to "transmit anything you type." SwiftKey says the only transmission happening for its standard word prediction is from the keyboard to the phone's SwiftKey app, where the processing happens. Yet as an extra precaution, Apple's own keyboard automatically appears when you have to input a password.
If you opt into SwiftKey's Cloud feature, which scans your email and social-media accounts to offer better word choices, the app encrypts and transmits your data to the company's servers. But since the basic app works so well, I decided not to share more info.
Text Shortcuts
But what really puts a typist like me in the fast lane are apps that provide shortcuts for text I type often.
Both iOS and Android offer text expansion, which means you can insert a long string of words with a simple shortcut: Type the letters "eml" and your email address appears. But these options are buried deep in the settings menus, and you have to remember all of the shortcuts you make up.
A new $1.99 iPhone app called KuaiBoard makes adding long phrases or addresses dead simple. It isn't meant to be your main keyboard—in fact, there are no letters. Instead you toggle to KuaiBoard when you need to insert big chunks of text by hitting the Apple keyboard's globe icon.
Tap a button associated with text you've added—for me, work address, cellphone number, two email signatures and an email template I send frequently—and boom, it inserts it automatically.
KuaiBoard also requires full access in iOS, but the company's founder Kevin Wolkober says the information saved to your board is stored only on the device.
ENLARGE MyScript Stylus Beta automatically inserts spaces between words. Drew Evans/The Wall Street Journal
On Android, I became hooked to AI.Type, which offers a similar functionality while bringing a full-size keyboard with lots of other tricks: swipe-to-type input, predictive text, a row of copy, paste and undo buttons and much more.
While it isn't as good as SwiftKey at predicting my vocabulary, it is the most fully featured mobile keyboard I've used. And it's also coming to the iPhone soon.
Draw Letters, Speak Words
The hardware keyboard may be dead, but the stylus isn't. A growing number of apps convert your handwriting to text with varying results.
MyScript Stack for the iPhone hasn't been great about recognizing my sloppy penmanship. Besides, its autocorrect suggestions are often incredibly wrong. MyScript Stylus Beta for Android is much better in those areas. I don't find either as useful as the keyboard apps, but they are worth a try for those who write faster than they type.
Android's keyboard options are still richer and more fully featured than what is available for the iPhone, at least for now. When it comes to voice input, for instance, you have to use Apple's own keyboard in iOS, while in Android, third-party keyboards integrate with Google's own powerful speech recognition, or excellent alternatives such as Dragon Naturally Speaking.
Still, with leading options like SwiftKey and AI.Type available on both platforms and apps like KuaiBoard filling in the iOS gaps, it's impressive how well—and how fast—we can now express ourselves on small, flat pieces of glass.
—Write to Joanna at joanna.stern@wsj.com and follow her @JoannaStern.
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