Tuesday, July 26, 2016

The Clinton campaign health care policy position

Well, I posted about "The Trump campaign health care policy position" last week during the Republican National Convention in Cleveland. Now, as the Democrats convene in Philly, here's the Hillary position:
As president, Hillary will:
  • Defend and expand the Affordable Care Act, which covers 20 million people. Hillary will stand up to Republican-led attacks on this landmark law—and build on its success to bring the promise of affordable health care to more people and make a “public option” possible. She will also support letting people over 55 years old buy into Medicare.
  • Bring down out-of-pocket costs like copays and deductibles. American families are being squeezed by rising out-of-pocket health care costs. Hillary believes that workers should share in slower growth of national health care spending through lower costs.
  • Reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. It’s no wonder that almost three-quarters of Americans believe prescription drug costs are unreasonable. Hillary believes we need to demand lower drug costs for hardworking families and seniors. Read more here. 
  • Fight for health insurance for the lowest-income Americans in every state by incentivizing states to expand Medicaid—and make enrollment through Medicaid and the Affordable Care Act easier.
  • Expand access to affordable health care to families regardless of immigration status. Hillary will expand access to affordable health care to families regardless of immigration status by allowing families to buy health insurance on the health exchanges regardless of their immigration status.
  • Expand access to rural Americans, who often have difficulty finding quality, affordable health care. Hillary will explore cost-effective ways to make more health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics.
  • Defend access to reproductive health care. Hillary will work to ensure that all women have access to preventive care, affordable contraception, and safe and legal abortion.
  • Double funding for community health centers, and support the healthcare workforce: As part of her comprehensive health care agenda, Hillary is committed to doubling the funding for primary-care services at community health centers over the next decade. Hillary also supports President Obama’s call for a near tripling of the size of the National Health Service Corp.
Strikingly different from the Trump stance. The entire 51 page Democratic Party 2016 platform paper is here (pdf). The health care section spans pages 34 - 39.

Noteworthy that Bernie Sanders has pushed Hillary leftward toward "universal health care." Trump, on the other hand, remains committed to the (totally beneficent, totally mythical) "free market."
"We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans."
And, as of yet, the Libertarian Johnson-Weld campaign remains silent on health care policy.

I guess I should also cite the Green Party Jill Stein Presidential campaign, notwithstanding that I continue to see her as a rounding error.
Health Care as a Right:
Establish an improved “Medicare For All” single-payer public health insurance program to provide everyone with quality health care, at huge savings.
That position has been pretty much co-opted by the Clinton campaign, who are now touting support for a Medicare "public option."

BTW, see my 2009 post "Public Optional" on another of my blogs. Seven years ago:
I am really sick of hearing about the "public option" wrangle 24/7 in the media these days. I am increasingly skeptical of its inclusion of any final legislation that may or may not reach the President's desk, and likewise skeptical that it would comprise much of an improvement even should it pass the Congress (and, it looks increasingly to me like a slickly orchestrated "misdirection" strategy). Without a "public option" (our having taken Single Payer off the table a priori), it is difficult to see what "health care reform" would truly amount to. But, then, "public option" as currently proffered (e.g., H.R. 3200) merely looks like -- as I've said before -- [1] corporate welfare ("Play or Pay" forcing everyone to buy health insurance policies under threat of tax penalty for non-compliance), and [2] outright "welfare" (means-tested government subsidy for health insurance "affordability").
Also, re: "Single Payer," I had a run at that in grad school in 1994 (pdf).

Relatedly, from PNHP:

Government funds nearly two-thirds of U.S. health care costs: American Journal of Public Health study
Contrary to popular perceptions, taxpayers fund 64 percent of U.S. health care, more public dollars per capita than the citizens of other nations – including those with universal health programs

January 21, 2016

Tax-funded expenditures accounted for 64.3 percent of U.S. health spending – about $1.9 trillion – in 2013, according to new data published today [Thursday, Jan. 21] in the American Journal of Public Health. The Affordable Care Act will push that figure even higher by 2024, when government’s share of U.S. health spending is expected to rise to 67.3 percent.

At $5,960 per capita, government spending on health care costs in the U.S. was the highest of any nation in 2013, including countries with universal health programs such as Canada, Sweden and the United Kingdom. (Estimated total U.S. health spending for 2013 was $9,267 per capita, with government’s share being $5,960.) Indeed, government health spending in the United States exceeded total health spending (government plus private) in every other country except Switzerland.

The finding that Americans pay the world’s highest health-related taxes conflicts with popular perceptions that the U.S. health care financing system is predominantly private, write Drs. David U. Himmelstein and Steffie Woolhandler, the authors of the study. Himmelstein and Woolhandler are professors at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School.

Direct government payments for such programs as Medicare, Medicaid and the Veterans Administration accounted for 47.8 percent of overall health spending. The analysis also identified two commonly overlooked tax-funded health expenditures – government outlays for public employees’ private health insurance coverage ($188 billion, or 6.4 percent of total spending) and tax subsidies to health care ($294.9 billion, or 10.1 percent of the total). Together, these public expenditures put the U.S. in first place for health care taxes.

Using another yardstick, the researchers note that tax-funded health expenditures in the U.S. accounted for a larger share of the gross domestic product (11.2 percent in 2013) than did the total health expenditures of any other nation...
Nearly 20% of GDP, more than half of it already publicly financed. And -- going all too frequently unreported -- the vast bulk of that publicly-funded expenditure going to private sector entities.

But, hey, the future of health care?
The future of health care? "Flawlessly run by AI-enabled robots, and 'essentially' free?"

A physician and a well-known "liberal" health care consultant argue their cases for electing Donald Trump.


Interesting series up at the excellent STATnews. All three "seasons" now posted.

Season 1
Episode 1: Man inside the hard drive
Episode 2: A code is broken
Episode 3: BAM reveals all
Episode 4: Rosetta Stones
Episode 5: Individual Z dissected
Season 2
Episode 6: A Jedi in the wastelands
Episode 7: Duplicate and delete
Episode 8: The variants of protection
Season 3
Episode 9: Ancient paths of Y and X
Episode 10: Echoes of pre-human ancestors
Episode 11: The Neanderthal inside
Episode 12: Host to viruses and selfish genes
Episode 13: Answers and questions

I was particularly interested given my most recent books on the "omics" topics.

I continue to closely (and guardedly) study "omics" issues.

UPDATE: Just in from the National Academies of Science, Engineering, and Medicine.

Research on gene drive systems is rapidly advancing. Many proposed applications of gene drive research aim to solve environmental and public health challenges, including the reduction of poverty and the burden of vector-borne diseases, such as malaria and dengue, which disproportionately impact low and middle income countries. However, due to their intrinsic qualities of rapid spread and irreversibility, gene drive systems raise many questions with respect to their safety relative to public and environmental health. Because gene drive systems are designed to alter the environments we share in ways that will be hard to anticipate and impossible to completely roll back, questions about the ethics surrounding use of this research are complex and will require very careful exploration...
Free PDF download, if you don't want ot spend $79 for a bound copy.


I've been covering Health 2.0 events for years (including WinterTech).

Mercifully, this year I won't be in the middle of radiation tx for prostate cancer. See here, here, here, and here as well.


Friday update: As the GOP and DNC conventions enter the history books, one utterly true headline this morning.


More to come...

Saturday, July 23, 2016

The Health Care Productivity Treadmill

Recently at THCB:
How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind the clock while they examine you.

That’s not to say that your physician “clocks out” as soon as your 1 p.m. appointment hits 1:15, or that all appointments last that long. What it does mean is that patients and doctors may be deprived of the opportunity for more meaningful discussions about the underlying causes of their problems and plans to improve them. A woman in her 50s who presents with high blood pressure and obesity might need medicine. But a longer conversation about the stresses of being the primary caregiver to her father, who has Alzheimer’s, could help provide strategies to help her look after herself.

When you see a new patient every quarter hour, there is often scant time to get to these root causes, to make accurate diagnoses, and develop the best treatment plans. And there is the danger that you miss a major diagnosis altogether.

The 15-minute appointment arose not out of evidence that it improves patient outcomes but out of production pressures — both the need to meet patient demand and to see enough patients to stay profitable...
By Peter Provonost, MD, "A Novel Proposal: Let’s Trust Our Doctors."
"See enough patients to stay profitable."
So, roughly 30 patients a day, give or take, say, 5 days a week, 48 weeks of the year (assuming closed days for holidays and other time out of the office). Take some current Medicare Fee Schedule data ("992xx") and do some math.

(Click to enlarge. The rightmost yellow column are 2016 payment data, vs the 2015 dollars to their right. I, for example, am a "99213," a Moderately Complex Established Pt.)
Then, consider some workflow throughput numbers, those simply pertaining to patient visit data acquisition, entry, update, review, and assessment (spanning the administrative to the clinical).
  • Admin/Insurance/Demographic
  • Chief Complaint(s)
  • Active Problem List
  • Active Rx List
  • Family Hx
  • Social Hx
  • Past Medical Hx
  • Past Surgical Hx
  • Vitals
  • HPI
  • ROS
  • Labs/Imaging
All the stuff that goes into the SOAP. Just to cite the two most common lab orders, a blood panel alone can have up to 80 or so parameters (my last one listed 31). A "UA" (urinalysis panel) may have as many or more. The "data" comprising each result will have an alphanumeric text name, numerical (or qualitative) finding, and a reference range (four actual data elements per "datum"). ROS ("Review of Systems") can contain up to about 122 data elements.

Then you might have to review priors as well, to estimate trends/progress ("flow sheet" stuff, "progress note" narratives).

Also, don't forget specialist consulting "impression" reports (e.g., imaging, or specialty things like my prostate tumor "OncoType dx" assay last year).

So, assuming all of the foregoing, and further assuming that your patient complexity distribution and "payor mix" gets you an average, say, $90 a visit, you might work you tail off to gross $650k a year -- before the myriad expenses (you can readily spreadsheet all of this; I've done it many times).
I might note as well that I've never gotten 15 minutes per visit with my doc. Back when I was with the Meaningful Use REC I'd stopwatch my personal visits, trying to gauge the overall workflow (my doc was also one of my MU clients). My face time with my PCP was typically 5-10 minutes of the entire encounter span.
(Click to enlarge)

I did have one PCP encounter wherein I got 13 minutes of face time with my doc. It was back in June, 2010, a month after I launched this blog.

Not being privy to their EHR scheduling module, I have no idea what time span was allotted for my appointment. Nonetheless, I spent 31 of the 50 minutes I was there (62%) twiddling my thumbs. I quickly learned to schedule my visits for early in the mornings, because my doc would always quickly fall behind schedule.

No wonder solo doc PCPs are becoming a thing of the past. See my prior post "Clinician burnout."

Interesting comment beneath the THCB post:
The rapid fire care that patients and physicians despise alike has been generated and reinforced by the corrupt, AMA endorsed Relative Value system. Regardless of if I treat 1 problem or 10 problems, the cognitive effort of physicians is reduced to “office visit”. Hence the inability to adequately dedicate time appropriately for patient care. Fee for service is not a bad idea when you actually recognize services as problems addressed or solved, rather that those procedures that are exalted by some chosen few. No one wants their surgeon rushing through their surgery. Why is rushing through office visits tolerated by anyone? This question needs to be directly addressed by those doing the price fixing in medicine. Then explain why Primary Care should not exit the system and actually serve patients they way they deserve for an appropriate price. - Leo Holm, MD
None of this is actually news. I've been hearing these criticisms and complaints since I started with the "DOQ-IT" initiative in 2005. The irreducibly high cognitive burden patient visit environment remains. It is simply not reasonable to expect clinicians to perform recurrent daily data-heavy glancing process "drive-bys" within highly complex health IT systems (too frequently addled by poor UX) in compressed time frames and routinely arrive at accurate dx's.

There's also Margalit's nagging question: Are structured data the enemy of health care quality?

Will any of these concerns get any Presidential campaign attention?

Asked and answered, 'eh? It'll all just be about the money, and access to the system (not to imply that those are not fundamental issues; the best clinical infrastructure in the world is irrelevant if a huge proportion of patients are locked out or bankrupted owing to cost).


apropos of the foregoing, a new book has come to my attention.

...As a complexity scientist, I spend a lot of time being preoccupied with the rapidly increasing complexity of our world. I’ve noticed that when faced with such massive complexity, we tend to respond at one of two extremes: either with fear in the face of the unknown, or with a reverential and unquestioning approach to technology.

Fear is a natural response, given how often we are confronted with articles on such topics as the threat of killer machines, the dawn of superintelligent computers with powers far beyond our ken, or the question of whether we can program self-driving cars to avoid hitting jaywalkers.

Even if we aren’t afraid of our technological systems, many of us still maintain an attitude of distaste toward technology. We see this in our responses to the inscrutable recommendations of an Amazon or a Netflix. Many of us even rail at the choices an application makes when it tells us the “best” route from one location to another.

On the other hand, some of us veer to the opposite extreme: an undue veneration of our technology. When something is so complicated that its behavior feels magical, we end up resorting to the terminology and solemnity of religion. When we delight at Google’s brain and its anticipation of our needs and queries, when we delicately caress the newest Apple gadget, or when we visit a massive data center and it stirs something in the heart similar to stepping into a cathedral, we are tending toward this reverence.

However, neither of these responses—whether from experts or laypeople—is good or productive. One leaves us with a crippling fear and the other with a worshipful awe of systems that are far from meriting unquestioning wonder. Both prevent us from confronting our technological systems as they actually are. Next time, the results of our failure to understand might not be as trivial as a frustrated Wall Street Journal reader being unable to access an article at the time of her choosing. The glitches could be in the power grid, in banking systems, or even in our medical technologies, and they will not go away on their own. We ignore them at our peril...
I was alerted to this over at The Daily Beast, "Tech's Not Our God. Or Our Devil." The foregoing is verbatim to that found in the Amazon "Look Inside" larger excerpt.

Resonates with stuff in my prior posts such as "Evolution, science, technology (including Health IT), and the future of cognition," "Convergence: the future of health," and "Technology, particularly the technology of knowledge, shapes our thought," to cite just a few.

See also "The future of health care? "Flawlessly run by AI-enabled robots, and 'essentially' free?"

More to come...

Wednesday, July 20, 2016

The Trump campaign health care policy position

Well, as of July 19th, he's no longer "the presumptive nominee," he's now the official GOP candidate.

Count me among the millions of people continually aghast at the prospect of the vulgar, belligerent, policy-detail-dementia'd, make-shit-up-on-the-fly, unabashed war crimes proponent Donald J. Trump as U.S. President in 2017. Nonetheless, he could very well win the election, given Hillary Clinton's ineradicably high "trustworthiness" negatives.

Can we tell what he might actually try to do in the health care space were he to win the White House?

Probably not. But, here's what's on his campaign website.
We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans...

Congress must act. Our elected representatives in the House and Senate must:
  1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
  2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
  3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
  5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
  7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
That's pretty much it. A "Seven Point Plan" at this stage. Oh, and, of course, this:

Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.
We'll take these up point-by-point shortly (nothing in the foregoing about InfoTech, we can note). But first...

Also, for now, see "Donald Trump’s Health Care Ideas Bewilder Republican Experts."

And, from Politico a few months back:
“It’s kind of warmed-over Republican mush,” said Tom Scully, who was a top health official in George W. Bush’s administration. “I just don’t think there’s a whole lot to shoot at.”
“I’m not sure health care issues matter much to the Trump candidacy,” added Doug McAuliffe, a GOP consultant who worked on Chris Christie’s super PAC before the New Jersey governor dropped out of the race. “The Trump candidacy is based on his vainglorious message. When it comes to issues, he ranges from uninformed to helter skelter.”
Critics say there’s no way to predict where Trump might come out on these issues if he secures the party’s nomination for president. His evolution — from professed admiration of Scotland and Canada’s single-payer health systems to denunciations of health insurers’ profits — suggests a willingness to tout different, in some cases even contradictory positions, based on political expediency.
I'll eventually get around to the health policy proffers of both the Clinton and Libertarian campaigns as well.

Tangentially, see my prior post "145 Tech Leaders on the 2016 election."


The Libertarian candidates (Johnson-Weld) have nothing directly on health care as of today. From their website "Issues" page.

The Hillary Clinton "Issues" page is fairly overflowing with topical detail across a breadth of policy areas. "Health Care" specifically is here.


A young writer reached out to me this morning, offering to comp me his new book in return for a review. He'd seen a comment I'd left on Amazon concerning another book on the topic.

I opted to just buy it and add it to my never-ending reading pile. Looks interesting. Stay tuned.
This book will help anyone who is interested in learning more about death, coping with a loss, approaching death, or explaining death to a child. It is an exploratory journey that includes multiple viewpoints, including Steve Jobs’s embrace of his death, Ray Kurzweil’s striving for immortality, and Joseph Campbell’s view of death as the “ornament of life.” The book looks at death from the perspectives of atheists, Christians, and Tibetan Buddhists, among many others. Interestingly, it considers the often unexplored aspects such as the curious relationship between death and ayahuasca. It is a guidebook, offering insights and comfort on a topic that many find frightening or macabre...
Maybe it's again a good time to contemplate death.
“I genuinely believe that if Trump wins and gets the nuclear codes there is an excellent possibility it will lead to the end of civilization.”
LOL. The guy who ghostwrote "The Art of the Deal." See "DONALD TRUMP’S GHOSTWRITER TELLS ALL."


Speaking of "death."

Okeee Dokeee, then. Never mind any due process quibbles and the precise, narrow Constitutional and statutory definitions of "Treason."

RNC: And Now for a Different Take on Obamacare ACA
m, not repeal, urged by former HHS Secretary

by Shannon Firth
Washington Correspondent, MedPage Today

CLEVELAND -- Could a Republican administration repeal Obamacare? That was the topic up for discussion at a briefing Tuesday, held outside the Republican National Convention.

"I do not believe ... that my political party is going to be able to put together a complete repeal, and I don't think it should," said Tommy Thompson, JD, a fellow of the Council on Foreign Relations, who served as Secretary of Health and Human Services under President George W. Bush, and four terms as governor of Wisconsin...
Maybe they'll want to shoot him as well.


I just learned from my sister that my niece April and her brainiac husband Jeff Nyquist, PhD, co-founders of NeuroTrainer, are taking the Silicon Valley startup VC plunge at the end of this month. Way cool. I first mentioned this project back during WinterTech: "#WinterTech 2016: Venture Capital in #HealthIT."

More on my beloved April here.

The NeuroTrainer Facebook page is here.

New at THCB: "Is the Public Option an Option?" apropos, see my 2009 post "Public Optional."


The principal elevator speech on national health policy in two words (irrespective of party)? "Payment Reform." The finest clinical infrastructure in the world is of no use if people can't access it when in need because of crushing costs.

The 2016 partisan span runs from "Single Payer" (which I took a first run at in 1994) to (the mythical) "Free Market" (via which -- all together now -- to "Repeal and Replace ObamaCare").

This just in from Health Affairs:

Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.

What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.

Covered California, that state’s marketplace, just announced premium increases averaging 13.2 percent. But even if premiums increase by the 10 or 15 percent overall that some are predicting for 2017, they will still be far lower than premiums otherwise would have been in the absence of the law. Moreover, this analysis does not include the effects of premium and cost-sharing subsidies that serve to make ACA marketplace plans more affordable for many people...
Of course, the GOP side is not gonna buy any of this. It's an enduring article of faith for them that if we simply permit the (mythical) "free market" to work its wonders, MRIs will soon cost only $29.99 at Jiffy-Scan in the strip mall, and the CABG px will be a mere $149.99 at the Walmart walk-in AcuteCardioCare Clinic near you.


OK, this is funny. H/T to one of my FB pals.


More to come...

Sunday, July 17, 2016

The future of science

This blog has long delved primarily into issues in information technology in the health care delivery space (the legacy of my recent REC tenure in the federal Meaningful Use initiative). But I recurrently range far afield into significant overlapping (and frequently n-dimensionally mutually confounding) related issues such as economics (including public funding and private capital markets), "socioeconomics/demographics" (e.g. the "upstream")," organizational culture, workflow/process QI, leadership, law/policy/intellectual property, and clinical pedagogy, as well as scientific methodology  per se.

Good article up at Vox.com:
The 7 biggest problems facing science, according to 270 scientists
  1. Academia has a huge money problem
  2. Too many studies are poorly designed
  3. Replicating results is crucial — and rare
  4. Peer review is broken
  5. Too much science is locked behind paywalls
  6. Science is poorly communicated
  7. Life as a young academic is incredibly stressful

To that end, here are some broad suggestions:

One: Science has to acknowledge and address its money problem. Science is enormously valuable and deserves ample funding. But the way incentives are set up can distort research.

Right now, small studies with bold results that can be quickly turned around and published in journals are disproportionately rewarded. By contrast, there are fewer incentives to conduct research that tackles important questions with robustly designed studies over long periods of time. Solving this won’t be easy, but it is at the root of many of the issues discussed above.

Two: Science needs to celebrate and reward failure. Accepting that we can learn more from dead ends in research and studies that failed would alleviate the "publish or perish" cycle. It would make scientists more confident in designing robust tests and not just convenient ones, in sharing their data and explaining their failed tests to peers, and in using those null results to form the basis of a career (instead of chasing those all-too-rare breakthroughs).

Three: Science has to be more transparent. Scientists need to publish the methods and findings more fully, and share their raw data in ways that are easily accessible and digestible for those who may want to reanalyze or replicate their findings...
apropos, two current reads I will soon be reporting on, triangulating with numerous earlier reads.


See, e.g., some prior posts of mine,
to cite just a few. See also the intriguing essay "Four Futures."


Interesting quote from Dr. Hadler:
“Disease” is no longer an elusive monster in the swamp of ignorance; “disease” is prey. It can be defined, parsed, deduced, and sometimes defeated.

Little of this pertains to “health.” Health does not objectify itself. Nor is it simply the absence of disease. Health has temporal and geographic dimensions. Health is inseparable from the context in which it is experienced. Health has a narrative laced with peculiar, often idiosyncratic idioms.  Furthermore, there is a crucial difference between the health of a person and the health of the people.

Science has limitations when it comes to studying health. For one, the studying becomes a component of the experience of health... 
See my post on Dr. Hadler's new book in Fixing U.S. health care by "monetizing altruism"?

More to come...

Thursday, July 14, 2016

145 Tech Leaders on the 2016 election

What do these 145 tech leaders have in common?
  1. Marvin Ammori, General Counsel, Hyperloop One
  2. Adrian Aoun, Founder/CEO, Forward
  3. Greg Badros, Founder, Prepared Mind Innovations; Former Engineering VP, Facebook
  4. Clayton Banks, Co-Founder, Silicon Harlem
  5. Phin Barnes, Partner, First Round Capital
  6. Niti Bashambu, Chief Analytics Officer, IAC Applications
  7. John Battelle, Founder/CEO, NewCo, Inc.
  8. Ayah Bdeir, Founder/CEO, Little Bits
  9. Piraye Beim, Founder/CEO, Celmatix
  10. Marc Bodnick, Co-Founder, Elevation Partners
  11. John Borthwick, Founder/CEO, Betaworks
  12. Matt Brezina, Co-Founder, Sincerely and Xobni
  13. Stacy Brown-Philpot, CEO, TaskRabbit
  14. Brad Burnham, Managing Partner, Union Square Ventures
  15. Stewart Butterfield, Co-Founder/CEO, Slack
  16. Troy Carter, Founder/CEO, Atom Factory
  17. Sukhinder Singh Cassidy, Founder/CEO, Joyus
  18. Vint Cerf, Internet Pioneer
  19. Amy Chang, Founder/CEO, Accompany
  20. Aneesh Chopra, President, NavHealth; Former US CTO
  21. Patrick Chung, General Partner, Xfund
  22. Tod Cohen, General Counsel, StubHub
  23. Stephen DeBerry, Founder/Managing Partner, Bronze Investments
  24. Peter Diamandis, Entrepreneur; Author, Abundance and BOLD
  25. Barry Diller, Chairman, Expedia and IAC
  26. Esther Dyson, Executive Founder, Way to Wellville; Investor
  27. Amy Errett, Founder/CEO, Madison Reed
  28. Caterina Fake, Founder/CEO, Findery; Co-Founder, Flickr
  29. Christopher Farmer, Founder/CEO, SignalFire
  30. Brad Feld, Managing Director, Foundry Group; Co-Founder, Techstars
  31. Josh Felser, Co-Founder, Freestyle Capital & ClimateX
  32. Hajj Flemings, Founder/CEO, Brand Camp University
  33. Natalie Foster, Co-Founder, Peers
  34. David Grain, Founder/Managing Partner, Grain Management, LLC
  35. Brad Hargreaves, Founder/CEO, Common
  36. Donna Harris, Co-Founder/Co-CEO, 1776
  37. Scott Heiferman, Co-Founder/CEO, Meetup
  38. David Hornik, General Partner, August Capital
  39. Terry Howerton, CEO, TechNexus
  40. Reed Hundt, Former Chair, FCC
  41. Minnie Ingersoll, COO, Shift Technologies
  42. Sami Inkinen, Founder/CEO, Virta Health; Co-Founder, Trulia
  43. Craig Isakow, Head of Revenue, Shift Technologies
  44. Rev. Jesse L. Jackson Sr., President and Founder, Rainbow PUSH Coalition
  45. Irwin Jacobs, Founding Chairman/CEO Emeritus, Qualcomm Inc
  46. Paul Jacobs, Executive Chairman, Qualcomm Inc
  47. Leila Janah, Founder/CEO, Sama & Laxmi
  48. Sujay Jaswa, Former CFO, Dropbox; Founder, Witt Capital Partners
  49. Mark Josephson, CEO, Bitly
  50. Sep Kamvar, Professor, MIT
  51. David Karp, Founder/CEO, Tumblr
  52. Jed Katz, Managing Director, Javelin Venture Partners
  53. Kim Keenan, President/CEO, Multicultural Media, Telecom & Internet Council
  54. Ben Keighran, Entrepreneur; Former Design Lead, Apple
  55. William Kennard, Former Chair, FCC
  56. Vinod Khosla, Founder, Khosla Ventures; Co-Founder, SUN Microsystems
  57. Ron Klain, Executive Vice President, Revolution LLC
  58. Walter Kortschak, Former Managing Partner and Senior Advisor, Summit Partners
  59. Jared Kopf, Founder AdRoll, HomeRun, Worldly
  60. Joseph Kopser, Co-Founder, Ridescout
  61. Karen Kornbluh, Former US Ambassador, OECD
  62. Othman Laraki, Co-Founder/President, Color Genomics
  63. Miles Lasater, Serial Entrepreneur
  64. Jeff Lawson, CEO, Twilio
  65. Aileen Lee, Founder/Managing Partner, Cowboy Ventures
  66. Bobby Lent, Managing Partner, Hillsven Capital
  67. Aaron Levie, Co-Founder/CEO, Box
  68. John Lilly, Partner, Greylock Partners
  69. Bruce Lincoln, Co-Founder, Silicon Harlem
  70. Ruth Livier, President, Livier Productions, Inc.
  71. Mark Lloyd, Professor of Communication, University of Southern California - Annenberg School
  72. Luther Lowe, VP of Public Policy, Yelp
  73. Nancy Lublin, Founder/CEO, Crisis Text Line
  74. Kanyi Maqubela, Partner, Collaborative Fund
  75. Jonathan Matus, Founder/CEO, Zendrive
  76. Josh McFarland, Vice President of Product, Twitter
  77. Andrew McLaughlin, Head of New Business, Medium; Venture Partner, betaworks
  78. Shishir Mehrotra, Entrepreneur & former VP of Product & Engineering, YouTube
  79. Apoorva Mehta, Founder/CEO, Instacart
  80. Doug Merritt, CEO, Splunk
  81. Dinesh Moorjani, Founder/CEO, Hatch Labs; Co-Founder, Tinder
  82. Brit Morin, Founder/CEO, Brit + Co
  83. Dave Morin, Entrepreneur; Partner, Slow Ventures
  84. Dustin Moskovitz, Co-Founder, Asana; Co-Founder, Facebook
  85. Amanda Moskowitz, Founder/CEO, Stacklist
  86. Alex Nogales, President/CEO, National Hispanic Media Coalition
  87. Alexis Ohanian, Co-Founder, Reddit
  88. Mike Olson, Founder/Chairman/CSO, Cloudera
  89. Pierre Omidyar, Founder, eBay
  90. Felix W. Ortiz III, Founder/Chairman/CEO, Viridis; Board Member of The NYC Technology Development Corporation
  91. Jen Pahlka, Founder/Executive Director, Code for America
  92. Barney Pell, Founder Powerset, MoonExpress, Locomobi; Founding Trustee, Singularity University
  93. Mark Pincus, Executive Chairman and Founder, Zynga
  94. Shervin Pishevar, Co-Founder/Managing Director, Sherpa Capital and Co-Founder/Executive Chairman of Hyperloop O
  95. Brandon Pollack, Director of Global Affairs, 1776
  96. Amy Rao, Founder/CEO, Integrated Archive Systems, Inc.
  97. Eric Ries, Entrepreneur & Author, The Lean Startup
  98. Justin Rosenstein, Co-Founder, Asana
  99. Alec Ross, Author, The Industries of the Future
  100. Javier Saade, Venture Capitalist; Former Associate Administrator, SBA
  101. Chris Sacca, Founder/Chairman, Lowercase Capital
  102. Dave Samuel, Co-Founder, Freestyle Capital
  103. Julie Samuels, Executive Director, Tech:NYC
  104. Reshma Saujani, Founder, Girls Who Code
  105. Chris Schroeder, Venture Investor; Author, Startup Rising
  106. Jake Schwartz, Co-Founder/CEO, General Assembly
  107. Robert Scoble, Entrepreneur in Residence and Futurist, Upload VR
  108. Kim Malone Scott, CEO, Candor, Inc; Former Director, Google
  109. Tina Sharkey, Partner, Sherpa Foundry & Sherpa Capital
  110. Clara Shih, Co-Founder/CEO, Hearsay Social
  111. Shivani Siroya, Founder/CEO, InVenture
  112. Steve Smith, Executive Director, Public Policy Institute, Government Relations & Telecommunications Project, Rainbow P
  113. Jonathan Spalter, Chair, Mobile Future
  114. DeShuna Spencer, CEO, kweliTV
  115. Katie Stanton, CMO, Color Genomics; Former VP of Global Media, Twitter
  116. Jenny Stefanotti, Co-Founder, OneProject; Board of Directors, Ushahidi
  117. Debby Sterling, Founder/CEO, Goldiblox
  118. Seth Sternberg, Co-Founder/CEO, Honor
  119. Margaret Stewart, Vice President of Product Design, Facebook
  120. Jeremy Stoppelman, CEO, Yelp
  121. Michael Stoppelman, SVP, Engineering, Yelp
  122. Baratunde Thurston, Former supervising producer, The Daily Show with Trevor Noah; Co-Founder, Cultivated Wit
  123. Stephanie Tilenius, Founder/CEO, Vida Health; Board of Directors, Seagate Technology
  124. Richard D. Titus, Entrepreneur; SVP, Samsung
  125. Anne Toth, VP of Policy & Compliance, Slack
  126. Bill Trenchard, Partner, First Round Capital
  127. April Underwood, VP of Product, Slack
  128. Max Ventilla, Founder/CEO, AltSchool
  129. Tabreez Verjee, Co-Founder/Partner Uprising; Board Director Kiva.org
  130. Jimmy Wales, Founder of Wikipedia
  131. Hunter Walk, Partner, Homebrew VC; Former Director of Product Management, Google
  132. Tristan Walker, Founder/CEO, Walker & Company Brands, Inc.; Founder/Chairman, Code 2040
  133. Ari Wallach, CEO, Synthesis Corp.
  134. Padmasree Warrior, CEO, NextEV USA; Former CTSO, Cisco
  135. Laura Weidman Powers, Co-Founder/CEO, Code2040
  136. Kevin Weil, Head of Product, Instagram
  137. Phil Weiser, Hatfield Professor of Law, University of Colorado and Executive Director of the Silicon Flatirons Center
  138. Daniel J. Weitzner, Principal Research Scientist, Computer Science and Artificial Intelligence Lab, Massachusetts Institut
  139. Emily White, Entrepreneur; Former COO, Snapchat
  140. Ev Williams, Founder/CEO, Medium; Co-Founder Twitter, Blogger
  141. Monique Woodward, Venture Partner, 500 Startups
  142. Steve Wozniak, Co-Founder, Apple
  143. Tim Wu, Professor of Law, Columbia University
  144. Andrew Yang, Founder/CEO, Venture for America
  145. Arielle Zuckerberg, Partner, Kleiner Perkins Caufield & Byers
"We are inventors, entrepreneurs, engineers, investors, researchers, and business leaders working in the technology sector. We are proud that American innovation is the envy of the world, a source of widely-shared prosperity, and a hallmark of our global leadership.

We believe in an inclusive country that fosters opportunity, creativity and a level playing field. Donald Trump does not. He campaigns on anger, bigotry, fear of new ideas and new people, and a fundamental belief that America is weak and in decline.  We have listened to Donald Trump over the past year and we have concluded: Trump would be a disaster for innovation.  His vision stands against the open exchange of ideas, free movement of people, and productive engagement with the outside world that is critical to our economy—and that provide the foundation for innovation and growth..."

Well, uhhh... make that 144 tech leaders and the Reverend Jesse Jackson? What's up with that?

Link: An Open Letter From Technology Sector Leaders On Donald Trump’s Candidacy For President

My views on Donald Trump are no secret. Click here. And here.

Silicon Valley's Hyper-Partisan Future
A major venture capitalist will speak in support of Trump, as dozens more decry him.

Most years, the power players of Silicon Valley regard their counterparts in Washington, D.C., with some mix of detached affection and amused pity—the way an EDM-inclined son might feel about his father’s love of The Eagles. (Sure, they might have mattered once, but that harmony’s never gonna sound as sweet again.) More than one venture capitalist has told me that when he visits Capitol Hill, he mostly wants to make sure Congress isn’t about to screw up his work, which is, it’s left unsaid, more important. Software is, after all, eating the world.

So it has been odd this week to see some of the highest-profile leaders of the technology industry speak clearly and publicly about political issues—and American partisan politics, in particular.

First, the venture capitalist Peter Thiel announced he will speak at the Republican National Convention next week in Cleveland. Thiel made his fortune by co-founding Paypal and investing early in Facebook; since then he has run venture funds with varying levels of success and created anti-college fellowships. He remains on Facebook’s board of directors...
I reported on Thiel's book "Zero to One" back in October 2014. It's a bit difficult to square what I wrote back then with this latest news.



More to come...