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Monday, February 20, 2017

#HIMSS17 in Orlando

I'm sure it will be interesting again, but I'm not attending this year. The uncertainty of my Jaco's looming demise was a major factor. Now that he's gone (sadly had to put him down Friday), I'm still heavy with mourning. He wasn't a "pet," he was a canine family member, a total delight. At 15 years old, he still had the rambunctious playfulness of a puppy. We were lucky to have found him in 2003 (on a freeway ramp in Las Vegas, about to be run over).

I'll just follow the HIMSS trade press reports like everyone else. Last time they held the show in Orlando was 2014. I was there. I first covered the HIMSS conferences in 2012, in Las Vegas (where I was living at the time, working for the Meaningful Use REC). The 2013 conference in NOLA was great fun. As was the 2016 conference, back in Las Vegas.

Next up for me on the conference front will be this year's "AARP Innovation 50+" event, which has expanded from a one-day conference to two days.

Will continue this week with my "STEM the Denialism" effort, and try to get caught up on my endless reading.

Also, visit the excellent new site "Calling Bullshit."

"What do we mean, exactly, by the term bullshit? As a first approximation, bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence.

While bullshit may reach its apogee in the political domain, this is not a course on political bullshit. Instead, we will focus on bullshit that comes clad in the trappings of scholarly discourse. Traditionally, such highbrow nonsense has come couched in big words and fancy rhetoric, but more and more we see it presented instead in the guise of big data and fancy algorithms — and these quantitative, statistical, and computational forms of bullshit are those that we will be addressing in the present course."





Interesting. She says that HIMSS18 will be again back in Las Vegas.

I searched the HIMSS17 news every day this week. Didn't see much beyond the usual corporate press release re-writes. The industry looks quite healthy (HIMSS, an $80+ million a year "non-profit" business, certainly is), but "transformational" IT innovations seem to be sparse at this point.

Uncertainties surrounding looming Trump administration / GOP "policy reforms seem to be key this year.

I'd have certainly attended this:

February 21, 2017 — 02:30PM EST - 03:30PM EST
Orange County Convention Center
W320, Chapin Theater
Session ID: 133

This session calls on two health policy experts for a discussion on the Affordable Care Act (ACA) and efforts underway to implement reforms to our healthcare system.  The current state of ACA implementation will be discussed as well as what issues need to be addressed in “repeal and replace” scenarios currently being considered in the US Congress as well as well as the Trump Administration.  Attendees can expect to gain knowledge on the critical health reform issues and outcomes being discussed by both Republicans and Democrats.

Jonathan Gruber, PhD
Yevgeniy Feyman
Gruber, 'eh? Press report of the session:
Policy Experts Explain the Trouble with Repeal and Replace
February 22, 2017 | Healthcare Reform
By Gabriel Perna

Repeal and replace is easier said than done.

present, and future of the Affordable Care Act (ACA) this week at the annual Healthcare Information and Management Systems Society (HIMSS) conference, held in Orlando.

Jonathan Gruber, Ph.D., professor of economics at Massachusetts Institute of Technology and ACA architect with the Obama administration, was joined by Yevgeniy Feyman, a fellow at the Manhattan Institute, a policy research organization, to give an overview of the challenges in repealing and replacing the health law. They also discussed the merits of the ACA, a collapse of the insurance market, and much more in an hour-plus session.

Gruber didn't mince words when asked to predict the road ahead for an ACA replacement. "It was a hard process to pass the Affordable Care Act. It was a year-plus process with a filibuster majority. I honestly don't see a replacement. I don't see how Republicans get enough Democrats to switch over, [and] not filibuster the law. You can't replace through direct reconciliation, you can repeal, but not replace. I honestly don't see it replaced," Gruber said.

Feyman was a little less skeptical, saying the plan proposed by Senators Susan Collins (R-Maine) and Bill Cassidy (R-La.), which allows states to go their own way with the ACA is potentially more "palatable." However, he also said he didn't think a repeal was going happen as enough Republicans will get on board.

The fact that every replacement plan proposed by Republican congressmen increases the uninsured is a significant roadblock, Gruber said, adding that repealing the law outright would cause 32 million to lose health coverage. There are 20 million who picked up insurance through the law and 12 million more through a collapse of the insurance market, he said. He also noted that insurance premiums would double.

"This is what the [Congressional Budget Office] said, this is not biased Jon Gruber," he said. The CBO predicted that the elimination of the Medicaid expansion and insurance subsidies would cause up to 32 million to lose coverage by 2026...
Interesting news coverage all week of numerous GOP "town hall" constituent meetings replete with angry people now flipping out over the realization that they may soon be without health insurance. But, hey, House Speaker Paul Ryan will "Put patients back in control of their health care." HSA's, vouchers, block grants, problem solved.

Meanwhile, Mr. Speaker will continue to avail himself of his 70% subsidy, generous FEHB program.


Interesting book review over at SBM:
Daniel and Tana Amen’s Book The Brain Warrior’s Way: Standard Health Advice Mixed with Misinformation and Fanciful Ideas
Daniel Amen, the media-savvy psychiatrist and promoter of SPECT scans, has teamed-up with his wife Tana to write a self-help book that hopelessly muddles good medical advice with misinformation and speculation
So much neurobabble, so little time. SBM is a great site.

@Health2con update
A Million Jobs in Healthcare’s Future

More to come...

Tuesday, February 14, 2017

Next up, STEM the Denialism

It has been a difficult week at my house. My terminally ailing elder dog Jaco may die or have to be put down at any time. I slept in fits and starts last night on the couch in the family room staying close by. We all know here that time is short. Keeping up with my reading, but I'm not getting much done at the keyboard.

In support of The March for Science effort and its important larger long-term purpose, I'm probably gonna start a new blog dedicated specifically to those issues. And will probably open it to co-contributors. Let me know if you're interested. bobby[dot]gladd[at]comcast[dot]net.


My precious Jaco is gone. Had to have him put down today. Crushingly sad.


Morose here today. Carlos (my other dog) is confused. Where's his Big Bro'? I am struggling to accept Jaco being gone. I shall miss him terribly.

Just in, a new academic effort I saw reported over at STATnews:

The world is awash in bullshit. Politicians are unconstrained by facts. Science is conducted by press release. Higher education rewards bullshit over analytic thought. Startup culture elevates bullshit to high art. Advertisers wink conspiratorially and invite us to join them in seeing through all the bullshit — and take advantage of our lowered guard to bombard us with bullshit of the second order. The majority of administrative activity, whether in private business or the public sphere, seems to be little more than a sophisticated exercise in the combinatorial reassembly of bullshit...
From the FAQ page:
Why are you doing this?
As we explain on our home page, we feel that the world has become over-saturated with bullshit and we're sick of it. However modest, this course is our attempt to fight back.

We have a civic motivation as well. It's not a matter of left- or right-wing ideology; both sides of the aisle have proven themselves facile at creating and spreading bullshit. Rather (and at the risk of grandiose language) adequate bullshit detection strikes us as essential to the survival of liberal democracy. Democracy has always relied on a critically-thinking electorate, but never has this been more important than in the current age of false news and international interference in the electoral process via propaganda disseminated over social media...
Their course syllabus page.

Cool. Yeah, See, e.g., Dr. Frankfurt's book "On Bullshit."

More to come...

Wednesday, February 8, 2017

Neurobabble update

I've had my sport here before with poseurs claiming to traffick beneficently in applied commercial "neuroscience." Recall these tweets.

Ahhh.... Jim Kwik, Mr. "I Build Better Brains." Then there's the jovial self-proclaimed neuro-musicology "scientist" Will Henshall.

Now comes "Neurocore Brain Centers" "Boost Your Brain Power in 2017."

Lordy. I've reached out to them repeatedly to no avail, asking for independent documentation of the underlying neuroscience upon which their "therapy" is ostensibly based. They're not gonna respond to some piss-ant ankle-biter like me. The temerity!
Their basic summary pitch:
The Neurocore Brain Performance Center Experience
At our Brain Performance Centers, we look past labels and assumptions to uncover the root cause of your symptoms. Based on your unique brain map, we create a personalized program to help you train your brain to its optimal performance. It’s safe and drug-free.

Brain Diagnostics
Rather than acting solely on observed behaviors, Neurocore takes a scientific approach to understand what’s wrong. Your comprehensive assessment includes brainwave analysis using qEEG technology, heart rate and breathing analysis and other diagnostic tests to paint a clear picture of what’s going on in your brain.

Customized Program
Once your brain shows us what is causing the problem, your unique brain map becomes our guide to designing a personalized treatment program. Through positive reinforcement and repetition, neurofeedback sessions train your brain to function better, more efficiently – so you feel better.

Lasting Results
Over time, your symptoms recede and in many cases disappear. This is unlike medication, which simply masks your symptoms until it wears off and it's time for the next dose. At Neurocore, we fix the problem, not just cover it up. Our drug-free solution lasts beyond each treatment session and can provide benefits to your brain and life for years to come.
Watch their "overview" video clip here.

That's a broad list of clinical conditions.

Turns out that Neurocore's principal investor is the controversial newly-confirmed Trump Administration Secretary of Education Betsy DeVos.
DeVos-Backed Company Questioned on ADHD, Autism
Neurocore touts its autism, ADHD treatment

By Benjamin Herold •February 7, 2017
President Donald Trump's nominee to head the U.S. Department of Education is a major backer of a company claiming its neurofeedback technology can "fix" problems such as attention deficit hyperactivity disorder and has "proven and long-lasting" positive effects on children with autism.

Current scientific evidence does not support such claims, according to the clinical guidelines of the American Academy of Pediatrics and three leading researchers Education Week consulted.

"It's misleading the public to say neurofeedback is effective in treating kids with ADHD and autism," said Nadine Gaab, an associate professor of pediatrics at Boston Children's Hospital and a faculty member at the Harvard Graduate School of Education. "It's still an experimental treatment that needs more rigorous research."

Launched in 2006, Neurocore is based in Grand Rapids, Mich. That's also the hometown of billionaire school choice advocate Betsy DeVos, Trump's pick to become U.S. secretary of education.

DeVos sat on Neurocore's board from 2009 until November, when she resigned the position to avoid potential conflicts of interest should she be confirmed. As part of her divestiture plan, which has been approved by the federal Office of Government Ethics, DeVos and her husband, Richard DeVos, Jr. , will maintain an indirect financial interest in the company. On her disclosure forms, DeVos valued that stake at between $5 million and $25 million.
...A spokesman for the DeVos family declined to respond to Education Week's inquiries about the investment in Neurocore. The Trump administration did not respond to Education Week's request for comment.

Neurocore CEO Mark Murrison defended his company's work and marketing. He pointed to an emerging body of research in which neurofeedback in general has shown promise, as well as information Neurocore collects from its clients.

"What we provide to our clients truly makes a difference, and our internal outcomes data and testimonials bear that out," Murrison said in an interview...
"Internal outcomes data and testimonials?"

...Murrison, Neurocore's CEO, acknowledged that there have to date not been any such high-quality studies conducted about Neurocore specifically. The first peer-reviewed study of the company's outcomes, for clients with anxiety and depression, "should be going to press in the next few months," he said. Another peer-reviewed study of Neurocore's impact on clients with ADHD is in the works, according to Murrison...
Yeah, I'll hold my breath.

The internet wags have wasted little time.
"Education Secretary Betsy DeVos Unveils Common NeuroCore Standards"
LOL. "Neurobabble." How about "NeuroPractic?" "NeuroQuackery?" (my irascible reactions)

I hope the good folks at Science Based Medicine will give this a go. Other media outlets are starting to chime in. See, e.g., "Betsy DeVos-Backed Doctor Says TV Can Remedy Attention Deficit Disorder."  

NY Times is also on it. "Betsy DeVos Invests in a Therapy Under Scrutiny."
“Is it time for a mind makeover?” the company asks in its advertising. “All it takes is science.”

But a review of Neurocore’s claims and interviews with medical experts suggest its conclusions are unproven and its methods questionable.

Neurocore has not published its results in peer-reviewed medical literature. Its techniques — including mapping brain waves to diagnose problems and using neurofeedback, a form of biofeedback, to treat them — are not considered standards of care for the majority of the disorders it treats, including autism. Social workers, not doctors, perform assessments, and low-paid technicians with little training apply the methods to patients, including children with complex problems...

Neurocore lists 40 "scientific papers" on their "learn more" page. Critics have countered that these window-dressing citations go to various aspects of neuroscience in general, but none go to the company's internal controlled trial studies.

Because, by the CEO's admission above, there aren't any to date. At this point, all we have is "neurobabble." Whether we get to "neuroquackery" remains to be seen.


Join the March for Science. See my prior post "Update on the March for Science"
and the antecedent "I am not a scientist."

Just in: Feb 9th War on Science update:
The Backpedaler-in-Chief
The Trump administration has retracted its most alarming anti-science moves. Is that heartening or a sign of more disturbing policies to come?

On science and "transparency." The Theranos VC lesson.

In this regard, see "Bill Maris: Here's why Google Ventures didn't invest in Theranos."


One of three new ones I have going at the moment, actually.

Gloriously written. Stay tuned. The other two are here and here.


About a month ago our precious 15 yr old rescue dog Jaco was diagnosed as "terminal" with a number of tumors in his liver. Absent "exploratory surgery" (which the vet said would be a coin-flip in any event), he's expected to die soon, or have to be put down should he get really bad.

It's been day-to-day, sometimes hour-by-hour ever since. Several times I though he was dying or already gone. Once I determine he's in significant pain, I will have him euthanized, but we're not there yet -- apparently. There's no good way to tell.

Trying to give him "A Good Death," but, well, you know...

Also, two days ago, my dear friend Kurt Kolstad finally succumbed, losing his 11-year struggle against mantle cell lymphoma. We are all distraught. As I posted on my Facebook page:
My dear friend of 43 years, Kurt Kolstad, has finally succumbed after an excruciating 11 year battle with mantle cell lymphoma. I am really heartbroken today. Kurt was one of the best drummers in the world. Period. He could've played for Sting. He also played guitar, and keyboard, and wrote great songs. Beyond all that, he was a wonderful human being. I was blessed to share a stage with him up in the Seattle area many years ago. While I am glad his suffering is finally over, I will miss him sorely.
He began his illness with pre-ACA health insurance,written through his wife's employer. He maxed out the policy and they lost coverage. Then they lost their home to foreclosure. THEN, not quite four years ago kurt's wife Cyndy died. I got there as soon as I could. I posted a YouTube clip:
My dear friend Kurt, who has been fighting off Mantle Cell Lymphoma for 8 years, lost his wife Cyndy 48 hours ago. I'm over at his place in Tacoma. I started singing "Lean on me," which spurred him. "Let me play for ya this tune I wrote 4 years ago. It's my "Lean on me'. It's on a CD out in the car."

This is off my iPhone. BobbyG's Left Hand Unsteady Cam Productions.

Self-explanatory. This glorious musician-writer (with whom I shared a stage 39 years ago) and his family have been reduced to crushing penury by nearly a decade of acute, life-threatening illness. Now with personal tragedy piled atop it.
Very sad time here of late.

More to come...

Thursday, February 2, 2017

Update on The March for Science

Recall my prior post "I am not a scientist." 

In my inbox this morning.


We are overwhelmed and grateful at the incredible support we've had in organizing this march. In the last week, almost 40,000 people have reached out to us eager to help.

We want to thank you so much for your support of the March for Science — and for you patience while we secured permits and coordinated with sister marches.

The March for Science is a celebration of our passion for science and a call to support and safeguard the scientific community. 

On April 22, 2017, scientists and science enthusiasts will take to the streets.

We will be reaching out to you for volunteer help in the coming weeks — we look forward to collaborating with you on outreach, planning events, fundraising, developing apps, brainstorming next steps, orchestrating satellite marches, and improving the world through science!

Satellite marches are being formed in countries across the globe from Canada to Australia. In Washington DC, our march will lead to a rally on the Washington Mall where scientists will hold teach-ins about their work and how science impacts our every day lives. Scientific discovery can be an arduous process, but it's also fun — it's time we share that excitement with the world!

The March for Science Team

I was beginning to wonder. I put in to volunteer straight away, but never heard anything in response.

They've now mounted a web page.

Twitter, Facebook, and Instagram links there. Hashtag #marchforscience.

Nice "diversity" statement:
In the past days, scientists have voiced concern over many issues - gag orders for government science agencies, funding freezes, and reversing science based policies. We recognize that these changes will differently and disproportionately affect minority scientists, science advocates, and the global communities impacted by these changes in American policies. Addressing these issues is imperative in understanding how recent developments will affect all people - not simply the most privileged among us. We take seriously your concerns that for this march to be meaningful, we must centralize diversity of the march's organizers at all levels of planning. Diversity must also be reflected in the march itself - both through the mission statement and those who participate.

At the March for Science, we are committed to highlighting, standing in solidarity with, and acting as allies with black, Latinx, Asian and Pacific Islander, indigenous, Muslim, non-Christian, non-religious, women, people with disabilities, poor, gay, lesbian, bisexual, queer, trans, non-binary, agender, and intersex scientists and science advocates. We must work to make science available to everyone and encouraging individuals of all backgrounds to pursue science careers, especially in advanced degrees and positions. A diverse group of scientists produces increasingly diverse research, which broadens, strengthens, and enriches scientific inquiry, and therefore, our understanding of the world.

I would gladly go and attend the DC march (I could see and stay with my son at his house in Baltimore), but I am also quite willing to help establish and participate in a Bay Area march. I will be making a donation as well.

See also the related

I again call attention to some excellent reading going to the central issues.

The first four comprise a compelling tour from the Big Bang to today's troubling Anthropocene era. The latter three go to issues of science denial and effective, potentially "disruptive" communication in a digital age. I've cited them before. All highly recommended.

Shawn Otto's book The War on Science dwells in particular on three areas of front-burner policy contention: [1] evolution, [2] climate change, and [3] human reproductive rights (long under attack, but increasingly so of late).

"Science Denialism" runs rampant on the first two. My position on the latter, politically radioactive topic has been set forth in some detail on one of my other blogs. See my 2008 post "Diploid Dave, Zelinda Zygote."

Shawn Otto:
When Does Life Begin? Another example of the thorny intersection of science with traditional ideas, law, and politics comes from the biosciences. Careful, reproducible observations and measurements have forced us to repeatedly refine our ideas about what life is and when it begins. Is a human being first a life when it emerges from the birth canal? Does it have any legal rights as a person before then? Or is it a life when it is able to survive independently outside of the womb even if it is removed early, as can happen naturally with premature birth or with a Caesarean section? Or is it perhaps a life at quickening (the moment a mother first feels a fetus move, at about four months), as was the legal standard for a life when America was formed? But wait! Perhaps it is really a life when a fertilized egg first implants in the uterine lining, which, based on observations, is the medical definition of when a pregnancy begins. A woman cannot be said to be pregnant until her body begins the chemical and biological changes that accompany a symbiotic hosting of the embryo, can she? If it does not implant, the egg, even if fertilized, is simply flushed. Here we get into a tricky area, because many religious conservatives say, “No, it is a life when egg and sperm meet,” whether or not the fertilized egg ever implants. 

But then, a scientist would ask the fundamentalist, is it still a life at the moment of fertilization, even if we know from careful observation that one-third to one-half of fertilized eggs never implant, and as many as three-quarters fail to lead to an ongoing pregnancy? And, of course, that brings up more questions: What are fertilized eggs that never implant? How should we define them, if life occurs at fertilization? As miscarriages? Abortions? Nonpregnancies? Suicides? Murders? Something else? What implications might that definition have— legally, ethically, morally— for the use of birth-control pills that inhibit implantation? Is that abortion, murder, or pregnancy prevention? 

As our careful observations of life continue, so does our power both to assist and prevent pregnancy. But as our skills improve, new, more troubling questions form. What if we remove the uterus from the process entirely? Is it a life when sperm and egg are joined in a test tube at a fertility clinic and allowed to divide into a group of, say, sixteen cells that are then frozen for future implantation in a woman desperate to have children? Can the woman be said to be “pregnant” as long as this microscopic clump of frozen cells exists? What does Burwell v. Hobby Lobby Stores say about that? What, if any, rights should these frozen cells possess? And is a child conceived in this way— a “test-tube baby,” as we once called them— without a soul, as was suggested by some religious conservatives in the 1970s? Once born, are the joy they bring and the contributions they make less valuable? If we make a special exception for them, by agreeing that in vitro fertilization is not interfering with God’s plan, or by acknowledging that they do appear to have souls, why? On what basis? And what does that make the dozens of frozen cells we discard after a successful pregnancy? 

While we’re pondering these linguistic, legal, and ethical quandaries, our observations lead us to yet another new understanding. We don’t need sperm to fertilize an egg; we can do it with the nucleus of another cell from the same being. We try this, and sure enough, we find we can create many identical genetic copies of a sheep or mouse. We call them clones. But then we have to ask: Is it a life if it is just an ovum that has had its nucleus removed and replaced by the nucleus of another cell, and has then been chemically or electrically shocked to induce the natural process of cell division, without fertilization by sperm? If egg and sperm have never met, is it a life? Or is that creature— possibly, one day, a human— damned or soulless as it was once argued “test tube babies” would be? 

Observations tell us that beings produced in nontraditional ways seem to be the same as any other creatures. We have to ask, then, is every one of the roughly 1.5 million eggs a woman has in her ovaries at birth a life with rights? When, exactly, does life begin? Is it true, as the comedy troupe Monty Python sang in The Meaning of Life, that “every sperm is sacred”? 

What happens if we transform adult skin cells into stem cells, and those into sperm and egg, and then fertilize one with the other? Is that a clone or something else? What if we take the troublesome term “fertilization” out of the picture? Is it a life if we design its genome on a computer (as scientists at the J. Craig Venter Institute have done), buy a high-quality DNA synthesizer on eBay for $ 8,000 or so, use it to make fragments of the genome we designed, chemically stitch the fragments together, inject the complete genome into a cell with an empty nucleus, and shock it into replicating? Here, we have made a living, reproducing thing starting with a computer design and a few common chemicals. What does that mean for our ideas about life and our definition about conception? Is it wrong to be doing this? To be asking these questions? Applying these observations? Gaining these powers? 

What is life? Is life an unbroken chain of genetic code, running down through the generations, endlessly recombining in new forms? Is it software? Does the software beget the hardware? When does it become an individual with rights? Where do we draw the legal line? The moral line? Can we draw a line at all? Is that the right way to be thinking about it? And if we do, how do we define the terms conception, fertilization, implantation, and pregnancy?
Otto, Shawn Lawrence (2016-06-07). The War on Science: Who's Waging It, Why It Matters, What We Can Do About It (Kindle Locations 1120-1164). Milkweed Editions. Kindle Edition.
"When does life begin?"

The (soon likely to be again pressing) Constitutional question is "when does personhood begin?"

I'm not sure "science" can answer that. It can help inform the answer, but the answer will necessarily come from serious, difficult moral deliberation. Serious deliberation, not the preening clean-hands moral dilettantism that seems to be at the anti-choice activist policy fore.

"Given the many urgent scientific and technological challenges facing America and the rest of the world, the increasing need for accurate scientific information in political decision making, and the vital role scientific innovation plays in spurring economic growth and competitiveness, we call for public debates in which the U.S. presidential and congressional candidates share their views on the issues of science and technology policy, health and medicine, and the environment."
I never sign online petitions, because you typically end up as a Mark, with your info sold to fundraising hucksters. I'm making an exception this time.


Rational reasoning and truth have been much on my mind as we enter a world of alternative facts and crypto-fascist edicts from the White House, less than two weeks into Donald Trump’s Administration. Last week, when “1984” rose toward the top of Amazon’s best-seller list, I dug out my dog-eared paperback copy and reread a quotation that I had underlined a decade and a half earlier: “For, after all, how do we know that two and two make four? Or that the force of gravity works? Or that the past is unchangeable? If both the past and the external world exist only in the mind, and if the mind itself is controllable—what then?”

In recent days, as Trump and his cohorts have peddled blatant falsehoods—that his Inauguration attracted the largest crowd in history, or that he lost the popular vote owing to millions of votes by illegal aliens—I have wondered about the extent to which minds can be controlled, or, rather, commandeered, by the relentless deluge of misinformation...

The muddling of fact and fiction is a tried-and-true tactic of totalitarian regimes. What’s more, when the two are confused for long enough, or when an indefatigable war on truth has been waged for a year, or two years, or perhaps eight, it will likely be harder and more tiresome to untangle them and remember a time when a firm line was drawn between the true and the false as a matter of course. If amnesia breeds normalization, fatigue has always served as the authoritarian’s great accomplice...

In the next four to eight years, American children will be born in a country led by a vainglorious man who wishes to fit facts—and their future—into the convenient shape of his ego. But democracy, freedom of expression, and, above all, the right to truth are not antiquated pieties. They belong to citizens who can still make their voices heard, before resignation metastasizes into complacency, exhaustion into self-doubt. The struggle will be to maintain openness and tolerance as the norm, the values that our children absorb into their identities naturally—to be defended rather than be defensive about...
- Jiayang Fan


Fear-mongering and otherwise pandering authoritarian irrationality extends to policy areas beyond explicit science topics such as climate change, evolution, and reproductive biology. Take, for example, the current dust-up over Trump's Executive Order immigration ban and his methodologically / operationally TBA promise of "extreme vetting." I'd call it "Total Information Awareness 2.0."

I've written on this topic elsewhere as well. After the GW Bush administration proposed a "Total Information Awareness" panoptic surveillance initiative in the wake of 9/11, I posted a web page entitled The Homeland Security Act and the proposed DARPA "Total Information Awareness" (TIA) program. (Probably a good bit of 'link rot' on that 15 yr old old thing. BTW, I had a bit of sport with the TIA Director here. Yes, I actually sent that via snailmail.)

I expanded on that riff in a more comprehensive 2008 blog post entitled Privacy and the 4th Amendment amid the "War on Terror."

Among other things, you're hemmed in by Bayes. Prevalence matters. Technologically, the gumshoe real world is not yet "The Bourne Ultimatum."

Just joined. Group link here. There's also a Twitter group. One of an increasing number, it would seem.


Via my now-daily email newsfeed from Scientific American:
Trump Immigration Ban Can Worsen U.S. Doctor Shortage, Hurt Hospitals
Thousands of U.S. physicians and medical students from banned countries may leave hospitals without staff 

The U.S. could face a shortfall of thousands of doctors, experts warn, because Pres. Donald Trump issued an executive order last week that banned citizens of seven majority-Muslim countries from entering the U.S. for 90 days. The order has created fears among foreign-born doctors and medical students—more than a quarter of the physician workforce in the U.S. comes from other countries, including Syria and Iran—that they will be persecuted in the U.S. or forced to leave. Medical school leaders say that sought-after applicants are likely to move their careers to other countries...
The Stupid. It burns.

UPDATE: Michael Specter nails it in The New Yorker, "The Deep Denialism of Donald Trump."

More to come...

Tuesday, January 31, 2017

The Price is not right. Indu Subaiya speaks out

apropos, see my prior post on Tom Price.

Indu Subaiya, to the Senate Finance Committee: Vote “No” on Tom Price: a perspective from the innovation community; January 30, 2017
Honorable members of the Senate Finance committee:

My name is Indu Subaiya, MD MBA and I am Co-Chairman and CEO of Health 2.0, the largest healthcare innovation conference and network in the world. I submit this letter to oppose Tom Price’s nomination for Secretary of Health and Human Services.

We know that the ACA reduces barriers to health care for millions of Americans, but what many don’t know is that it also fuels a vibrant segment of the private sector, the health technology innovation economy.

In a decade of working alongside thousands of healthcare innovators globally, and in chapters in over 40 US cities from Nashville to Boston, Dallas to Chicago, we have never seen our healthcare system adapt so beautifully to reward private enterprise while saving lives and taking care of our most vulnerable without the heavy hand of government.

Dr. Price appears to be a well-intentioned, educated man, but he has been out of both the practice of medicine and a transforming health care industry for too long to lead us in this dynamic market. Appointing him to architect a replacement plan for the ACA would be like hiring a dinosaur to build a space station.

What healthcare needs today is a pragmatic voice who can put pedal to metal on the progress that’s begun, who can work on reforming the ACA dispassionately with business leaders, entrepreneurs and patients represented in equal proportions, and who understands the healthcare innovation economy.

But Dr. Price is far too polarizing in his politics to be taken seriously by the diverse and moderate mainstream on both sides of the aisle. Those of us fixing healthcare on the ground have blasted silos, left partisanship at the door and figured out how to advance a common interest. Ask Republican Governor Charlie Baker, Republican former Head of the ONC, Dr. David Brailer, Chelsea Clinton of the Clinton Foundation, Mark Bertolini, CEO of Aetna, Bernard Tyson, CEO of Kaiser all of whom we’ve warmly welcomed on stage at Health 2.0 not just as speakers but as partners in the work of transforming health care.

Dr. Price on the other hand has never reached out to our community, and he’s had a decade to do so. Instead he has represented the Association of American Physicians and Surgeons, seen as a fringe group promoting self-interest, technophobia, and a “doctor knows best” philosophy. That era in medicine is over. The era of shared decision making, data transparency, evidence-based medicine and providers as partners in care and innovation is here. Our era needs a Secretary of HHS who will command the respect of the brightest lights in the healthcare innovation economy and Dr. Price is just not that person.

What do I mean by the innovation economy in health care? I am not referring to the old generation of electronic medical record companies (EMR) that indirectly received incentives under the HITECH act. I’m referring to the more than four thousand new companies and many more thousand jobs that were created in response to the ACA’s imperative to make health care more accountable for its outcomes. These companies have applied the best of American business and technological ingenuity to support doctors in their workflow and decision-making, to promote collaboration among caregivers, to avoid redundancy in testing, to improve patient safety and to allow patients to take more responsibility for their health and care.

As a sector, they’ve raised over 19.8 billion dollars in venture capital since 2011 because investors could bet on the momentum of a system aligning around the best interests of patients for the first time in history. What happens when you leave the doctor’s office or hospital has always mattered to individuals and families; but now it made business sense.

All this capital isn’t just lining the pockets of Silicon Valley startups. Economic development corporations in New York City, Massachusetts, Detroit, and Louisiana are making long-term, strategic investments in the health technology innovation economy to attract innovative companies to set up shop in their cities to provide badly needed solutions and to be powerful engines of job growth.
That’s great you say. We’ll keep this thriving and virtuous economy alive, we’re just going to get rid of the individual mandate, some nasty corporate penalties and poorly run exchanges that limit choice and raise premiums for patients and we’ll handle pre-existing conditions with hiving off those patients into separate pools. But that’s a fool’s errand.

It was precisely because the ACA widened the tent of coverage that new private sector markets were created. It was precisely because of exchanges that Americans woke up to the fact that you need to take responsibility for your health and spend your pre-deductible dollars wisely, and private sector businesses rose to the occasion to build tools to educate consumers on managing health care expenses and decision-making.

Overstretched health systems also see innovative technology as a way to do more for patients with less overhead, to reach people in rural areas and at home cheaply and effectively, to refer repeat visitors to the ER to a lower cost option in the community. Hospitals like Massachusetts General in Boston, Cedars Sinai in Los Angeles, Dell Medical Center in Texas, UPMC in Philadelphia and New York Presbyterian in New York City all have either started their own or participated in health technology innovation programs to test new models of care delivery in partnership with the entrepreneurial community in healthcare.

It was the ACA’s imperative to take care of a wider and more diverse population that created demand for new products to address the social determinants of health that are killing our small towns: caregiving burden, mental health, substance abuse, food insecurity, health literacy, social support for the elderly and so much more. These social ills normally depend on inefficient government programs. But thanks to the ACA, for the first time entrepreneurs have paying customers for solutions to these issues. Customers like public health departments, community clinics and hospitals. At the national conference we run on health innovation, the session on “Community Health” normally draws a handful of do-gooders. This past year you couldn’t get in the room if you tried; it was packed with entrepreneurs. The ACA had succeeded in creating a market for doing well by doing good.

The train of progress toward a healthier America and a more efficient health care system has left the station. If confirmed, Dr. Price would waste time trying to run after it only to get run over by it. We have better Republican candidates to choose from who have worked shoulder to shoulder with patients and innovators, who’ve been part of the transformation of American healthcare on the ground, not in DC and not in the ivory tower.

Don’t appoint him because you are comfortable with him as a congressman and a doctor. Neither role prepares him for this job. Don’t appoint him because the AMA endorsed him. The AMA is a friend to the innovation community but it speaks for a minority of physicians. You have already heard from thousands of doctors who aren’t involved in politics who oppose this nomination. Take your time and don’t rush this vote. Let’s fix what’s broken together without taking a wrecking ball to progress. On behalf of those of us with real experience making positive change in the trenches of health care, I ask you to vote “no” on Tom Price.

Thank you for your consideration.

Indu Subaiya, MD MBA
CEO, Health 2.0
Indu Subaiya, MD, MBA is the Co-Chairman and CEO of Health 2.0, a leading conference series and network for innovation in health care.

Indu is scary smart, and someone I've characterized as "the most cheerful person in all of health care." When she speaks, we do well to listen carefully.

Also relevant to health policy reform, my prior post "Put patients back in control of their health care."

BREAKING: Price confirmation for HHS Secretary advances without votes from Democrats
By Virgil Dickson  | February 1, 2017
The Senate Finance Committee has approved U.S. Rep. Tom Price as HHS Secretary in a vote that excluded committee Democrats.

Price's nomination still needs to be voted on by the full senate, which is likely to approve him along straight party lines. The vote took place during an executive session of the Senate Finance Committee called by Chairman Sen. Orrin Hatch (R-Utah)...
We are probably going to lose this fight, but we should press it forward in the full Senate nonetheless.

Monday, January 30, 2017

I am not a scientist

"Wherever the people are well informed they can be trusted with their own government; that whenever things get so far wrong as to attract their notice, they may be relied on to set them to rights." —Thomas Jefferson, January 8, 1789

Read it
Amid the acrimonious Celebrity Apprentice @POTUS distraction of the contentious "Muslim Ban," I reflect here on our early introduction to the reactionary Trump science denial/suppression era... 

I just joined AAAS (American Association for the Advancement of Science), and the Union of Concerned Scientists. I also gave them permanent links in my right-hand links column. Recall from my prior post:

Our Science Denier in Chief:
Is Anyone Actually a Scientist?
Forget the terrible “I’m not a scientist” schtick. Trump’s comments on climate change suggest no one is a scientist.

My favorite Trumpism is “nobody really knows.” He says it all the time. Did Russia interfere in the U.S. presidential election? “Nobody really knows.” How big is ISIS? “Nobody really knows.” Why did President George W. Bush invade Iraq? “Nobody really knows.” How can we identify potential terrorists? “Nobody really knows.” Most of the time, “nobody really knows” means Trump doesn’t want to, or isn’t prepared to, answer the question. (That’s why he says it so often.)

Climate change is different. “Nobody really knows” is simply Trump’s official position on global warming. It’s one of the rare times he uses his catchphrase offensively, rather than to get himself out of a jam. He doesn’t say it with a shrug and a casual toss of his hands. He leans in. To borrow a well-worn phrase from Trump supporter(ish) Donald Rumsfeld, Trump considers climate change a “known unknown“—the fact is that nobody knows about it...
I don't think we can overstate the risk here. Time to push back forcefully, particularly in light of reports of the Trump administration's attempts to suppress the public communications of federal departments and agencies such as the EPA, USDA, and National Park Service. Others whose legal charters are science-oriented rather than administrative are likely not far behind, e.g., FDA, NIH, CDC, NASA, NOAA and numerous others.

Unlike a couple of the entertaining, huckstering poseurs I've written up on this blog recently (e.g., Will Henshall, Jim Kwik*), I would never be so arrogant as to call myself a "scientist." Neither would I properly refer to myself as a "technologist," notwithstanding that I've spent my entire white collar career (which commenced in January 1986 at the age of 39 after finally getting my first degree) working in applied science and technology of one sort or another.
* In fairness, and to be precise, while young Mr. I-build-better-brains Kwik doesn't directly call himself a "scientist," he does repeatedly claim his methods to be "scientific" (neuroscience specifically). I have reached out multiple times since first encountering him asking him for credible, documentable verification. I don't expect to ever get any sort of reply.
From the Preface in a forthcoming book on "critical thinking / argument analysis / persuasion" I'm working on: initial job out of undergraduate school in January of 1986 was that of a quality control statistician and programmer [pdf] in an environmental radiation laboratory in Oak Ridge under the direction of acclaimed nuclear scientist John A. Auxier, PhD, CHP (so much for the anticipated corporate-industrial ad career). Much of our work was performed to a "forensic" standard, meaning that the laboratory's results would be used as evidence in litigation (e.g., contamination and dose/exposure cases) and regulatory enforcement actions. I spent more than five years there participating in excellent analytical science under the best of mentors, co-authoring several technical papers across my time there (see I learned a thing or two during my lab days about being extremely careful with computer coding and numerical results, lest I find myself sweating under Oath on a witness stand anxiously defending the accuracy of my work under intense cross-examination.

Fast forward a number of years. I started in graduate school in 1994 after working for a time as a Medicare hospitalization analyst [pdf], intending to pursue a Master's degree in Statistics, but soon switched over to an intriguing program known as "Ethics and Policy Studies" ("EPS," a unique interdisciplinary liberal arts course of study comprised of economics, political science, law, and applied philosophy). It played to my analytical writing strengths, as well as my long-standing interests in policy and political affairs.

It was there I absorbed the skills involved in honest and effective "argument analysis" (e.g., see my first grad school paper, an analytical, logic flow-charting deconstruction of the 1994 JAMA health care "Single Payer" argument [pdf] ). I also became steeped in the historical and contemporary literature of "applied ethics," — "doing the right things" beyond simply "doing things right."
Not long after completing graduate school, I was invited to join the part-time evening adjunct faculty at my local community college and university (my day job at the time was that of a risk analyst in a bank) to teach undergraduate courses in "critical thinking" as well as the EPS graduate seminar in "argument analysis." It was great fun. I would do it again in a heartbeat...

In recent years, I have worked again in the medical field, helping physicians and their staffs convert from the paper chart documentation method to electronic medical record systems. These software systems are extremely complex and controversial, with some clinicians arguing that they impede their work and decision-making processes. I've had to undertake deep study of the training, cognitive abilities, and diagnostic methods of physicians -- "How Doctors Think" (there's an excellent book by Jerome Groopman, MD with that title) -- as well as the thought processes of other "subject matter experts," in order to ferret out tactics that can help clients become better decisionmakers. I delve into a lot of these issues on my blog.

Effective, sustained "critical thinking" coupled with successful rational advocacy ("persuasiveness") are of particular importance in high-stakes fields such as medicine, various other applied sciences, and engineering (not to mention national and international governance, where misunderstandings can result in war or other tragedies). However, I argue also that it's equally important for all of us ordinary citizens to become better critical thinkers and constructively persuasive communicators to help each other get to truths large and small and put issues to rest. There will never be any shortage of disputes to resolve...

So, again, I am not a "scientist." I tout myself as a "quantitative analyst and writer," which I regard as more succinctly, reservedly appropriate. Nonetheless, I am thoroughly trained in and steeped in (and an enthusiastic advocate of) the methods of applied science and technology across a number of technical disciplines. I will put my operations science PDSA Process QI chops up against anyone's. My 1992 CQE exam was all about process improvement science. My 1994 IHC CQI cert was all about process improvement science in the clinical setting.

While the core founding topic of this blog was that of support for the national effort to extend the reach and efficacy of digital health information technology, I have taken the independent's pro bono liberty to extend my purview to encompass the gamut of topics and issues critical to the health care space.

Defense of science per se, it would seem obvious to me, sits atop that list. And, science is now more acutely under attack than during any time I can recall. We cannot afford a back-to-the-future return to "Soviet Science / Lysenkoism 2.0."


What is the Scientists' March on Washington
Welcome! We want to thank you all for your incredible outpouring of support for this march. We are working to schedule a March for Science on DC and across the United States. We have not settled on a date yet but will do so as quickly as possible and announce it here.

Although this will start with a march, we hope to use this as a starting point to take a stand for science in politics. Slashing funding and restricting scientists from communicating their findings (from tax-funded research!) with the public is absurd and cannot be allowed to stand as policy. This is a non-partisan issue that reaches far beyond people in the STEM fields and should concern anyone who values empirical research and science. 

 There are certain things that we accept as facts with no alternatives. The Earth is becoming warmer due to human action. The diversity of life arose by evolution. Politicians who devalue expertise risk making decisions that do not reflect reality and must be held accountable. An American government that ignores science to pursue ideological agendas endangers the world.

 Please bear with us as pull together our mission statement and further details. Many more updates to come on Monday. 
Twitter: @ScienceMarchDC
Reddit: /r/scientistsmarch
Get Email Updates
To help:
Count me in.

Democratic governments the world over are increasingly paralyzed, unable to act on many key issues that threaten the economic and environmental stability of their countries and the world. They often enact policies that seem to run against their own interests, quashing or directly contradicting well-known evidence. Ideology and rhetoric guide policy discussions, often with a brazenly willful denial of facts. Even elected officials seem willing to defy laws, often paying negligible prices. And the civil society we once knew now seems divided and angry, defiantly embracing unreason. Everyone, we are told, has his or her own experience of reality, and history is written by the victors. What could be happening?

At the same time, science and technology have come to affect every aspect of life on the planet. There is a phase change going on in the scientific revolution: a shifting from one state to another, as from a solid to a liquid. There is a sudden, quantitative expansion of the number of scientists and engineers around the globe, coupled with a sudden qualitative expansion of their ability to collaborate with each other over the Internet.

These two changes are dramatically speeding up the process of discovery and the convergence of knowledge across once-separate fields, a process Harvard entomologist Edward O. Wilson named consilience. We now have fields where economics merges with environmental science, electrical engineering with neuroscience and physics, computer science with biology and genetics, astronomy with biology, and many more. This consilience is shedding new light on long-held assumptions about the world we live in and the nature of life.

Over the course of the next forty years, science is poised to create more knowledge than humans have created in all of recorded history, completely redefining our concepts about— and power over— life and the physical and mental worlds as we assume editing control over the genetic code and mastery in our understanding of the brain. One only has to recall the political battles fought over past scientific advances to see that we are in for a rocky ride. How that rush of new knowledge will impact life, how it will be applied through technology and law, and whether our societies and governments will be able to withstand the immense social and economic upheavals it will bring depends upon whether we can update our political process to accommodate it. Can we manage the next phase of the scientific revolution to our advantage, or will we become its unwilling victims? 

If that were not enough, the explosion of information technology is creating a power struggle between individual privacy and the public good, and between the organizations— businesses, criminal enterprises, terrorist groups, and governments— who seek to use this new technology for influence and control. Sensing technology and robotics are threatening to replace millions of truck drivers and taxi drivers over the next decade, and to mechanize warfare with tiny autonomous robots that carry enough charge and intelligence to hunt and kill humans. These advancements have prompted many of the world’s leading scientists and engineers to warn that we must get ahead of artificial intelligence before it gets ahead of us. 

As we are being overwhelmed by new scientific and technological developments, we also are facing a host of legacy challenges caused by commercialization of the incomplete scientific knowledge of the past. Thanks to early science, humans have prospered, but at a cost: significant climate disruption, unprecedented environmental degradation, massive extinction of other species, vast economic and power inequities, and a world armed to the teeth with the products of a military-industrial complex, including weapons that could destroy nearly all life on the planet. 

Without a better way of incorporating science into our policymaking, democracy may ultimately fail its promise. We now have a population that we cannot support without destroying our environment— and the developing world is advancing by using the same model of unsustainable development. We are 100 percent dependent on science and technology to find a solution.

Otto, Shawn Lawrence (2016-06-07). The War on Science: Who's Waging It, Why It Matters, What We Can Do About It (Kindle Locations 159-193). Milkweed Editions. Kindle Edition.
A must-read, this book.

I will be cross-referencing it with this one (below), among others.

Otto takes some hard shots at the journalism field for its too-prevalent "subjectivist" 'just present all sides uncritically" ethos -- in particular when it comes to science reporting. To the extent that "investigative journalism" fails to hew to a scientific standard of reporting generally, well...

"Democracy's Detectives" is a fine, fine, thorough, analytical book, but I was disappointed to find just one reference to the scientific method in the body of the text.
[Pulitzer Prize-winning investigative reporter Pat] Stith’s experience made him a frequent speaker about CAR [Computer Assisted Reporting] techniques. In a 1996 talk to the Society of Professional Journalists, he laid out best practices in using data and software to develop investigative work. He stressed that CAR stories were similar in many ways to other articles in that “Computer assisted stories work best when the leads grow out of our reporting, out of our attempts to find answers to questions raised in our communities.”  CAR might often involve significant time and effort to gather and clean data, analyze patterns, and (sometimes) conduct statistical tests. But much of this would remain out of sight of the reader. Stith noted:
Numbers often are the essential element in a story— the “what” of the five “Ws.” They can tell us what happened.… But readers usually are more interested in the answers to questions raised by numbers.

Numbers may be the foundation, but it’s people, their experiences, their explanations, their feelings, that will bring the story to life, that make people want to read.

In the Internet era, “Nerd boxes” eventually became popular ways for online public affairs outlets such as ProPublica to show their work. Though Stith warned reporters not to load articles with too many figures, in the mid-1990s Stith was counseling reporters to be ready to share their results and methods when asked. His description of the importance of transparency, replication, and openness to revising hypotheses are all consistent with the scientific method [emphasis mine]. He noted:
We are glad to tell anyone exactly how we did a report. In a few cases, we have given the agency we’re writing about copies of key reports, and allowed them to study figures we intend to use, and those we don’t.

Our theory is, we’re not ashamed of our work, and the choices we’ve made. If we’ve made a mistake, by all means, find it, and bring it to our attention before we publish. Our work— and our results— can be duplicated. And we’ll show you how.

Hamilton, James T. (2016-10-10). Democracy’s Detectives (Kindle Locations 10092-10111). Harvard University Press. Kindle Edition. 
Dr. Hamilton devotes extensive attention to the work of IRE (Investigative Reporters and Editors):
Investigative Reporters and Editors, Inc. is a grassroots nonprofit organization dedicated to improving the quality of investigative reporting. IRE was formed in 1975 to create a forum in which journalists throughout the world could help each other by sharing story ideas, newsgathering techniques and news sources.
IRE provides members access to thousands of reporting tip sheets and other materials through its resource center and hosts conferences and specialized training throughout the country. Programs of IRE include the National Institute for Computer Assisted Reporting and DocumentCloud...
"Improving the quality of investigative reporting." Like, well, having it comport with science?

One of Shawn Otto's repeated critical shots at the journalism trade:
The clash between the science-literate and a science-illiterate society creates unique problems not just for hapless individuals who run afoul of ignorant or racist authorities, but for the mainstream media as well. Budget-strapped and increasingly unable to discern between knowledge and opinion, science-illiterate journalists too often aid the slide into unreason. Many journalists believe there is no such thing as objectivity, rendering otherwise brilliant minds unable to discern between objective knowledge developed from years of scientific investigation, on the one hand, and a well-argued opinion made by an impassioned and charismatic advocate on the other. This problem extends beyond journalists. Cumulatively, newspaper editors have allowed themselves to be heavily manipulated by antiscience public-relations campaigns. One cannot be certain exactly why an opinion editor chooses to run one piece and not another, for example, but in December, 2015, the nonprofit Media Matters did an analysis of opinion pieces that mentioned the recently concluded Paris climate talks and ran in the ten largest-circulation newspapers in the United States: USA Today, the Wall Street Journal, the New York Times, the Orange County Register, the Los Angeles Times, the San Jose Mercury News, the New York Post, the New York Daily News, Newsday, and the Washington Post. Nine of the pieces, or 17 percent, included climate-science denial. Just 3 percent of climate scientists in any way dispute human-caused disruption of the Earth’s climate system. This means that the major US papers expressed views that were more than five times as doubtful about climate change as the actual climate scientists publishing in the field. By engaging in this sort of misrepresentation, the media deprives the public of the reliable information necessary for self-governance. [Otto, op cit, Kindle Locations 292-305]
Keyword search "journalists" in The War on Science. 100 hits. "Journalism," 75 hits. Most of them linking to passages highly critical of the field (sometimes excessively so?) in the context of science reportage.

Stay tuned. For now, you might like my recent post "2017: Disruption ahead on all fronts, for good and ill."

"In our new era of fake news and post-truth gloom, the quest for objective truth and (non-alternative) facts has become more critical than ever before. Scientists and journalists must join forces in this common endeavor, and not hesitate to call out present and future falsehoods, whether due to innocent mistakes or to frank attempts to mislead. Whereas post-truth is an illusion—with no basis in reality—the actual truth is impervious to our wishes, emotions or beliefs. The scientific method teaches us that we will only ever attain truth by stubbornly stripping away every piece of misinformation that stands in its way. Investigative reporting and aggressive fact-checking will be crucial to get us there."
Glad I signed up for their email feeds.

Op-Ed: Trump is playing a dangerous game with these 'alternative facts'


See my follow-on post "Update on the March for Science."

More to come...