Search the KHIT Blog

Wednesday, December 12, 2018

The Amazon Health IT play

Recall that I recently posted on Amazon's AWS machine learning open boot camp initiative.

OK, check this out:
Amazon will reportedly sell software that reads medical records
Electronic records are a famously contentious area

Amazon reportedly plans to start selling software that can read medical records and make suggestions for improving treatment or saving money, according to The Wall Street Journal.

The program scans medical files to pick out relevant information such as the medical condition and patient’s procedures and prescriptions. While other algorithms that try to do the same thing have been stymied by doctors’ abbreviations, Amazon claims to have trained its system to recognize the idiosyncrasies in how doctors take notes, sources told the WSJ. The company had already developed and sold this same software to other businesses, including ones focused on travel booking and customer service. For Amazon, this is another move into the health care market on the heels of the retailer buying the online pharmacy PillPack in June…

Given that Amazon already had the text-analysis technology, expanding into the health care market makes sense for the corporate giant. But the area of electronic health records is famously contentious. Though there has been a push to digitize medical records, the tangled evolution of e-health technology has, for many patients, led to a fragmented paper trail filled with gaps. In the recent, evocatively titled New Yorker article “Why Doctors Hate Their Computers,” physician Atul Gawande writes about how doctors are frustrated with the entire process, and observes that the various software systems for health records seem to have helped lead to burnout…
This certainly warrants watching. Could be good, providing de facto actual "interoperability." Could also present a host of vexing ethical conflict of interest problems. Think about it.
"The program scans medical files to pick out relevant information such as the medical condition and patient’s procedures and prescriptions..."
OK, any time electronic patient-identifiable information is created, viewed, edited/updated, deleted, or transmitted by a CE or BA (Covered Entity or its Business Associate), HIPAA (at 45.CFR.164.312 et al) requires that there be an audit trail log documenting date/time, which data, by whom, about whom. Will Amazon be a BA? Or will their software provide such functionality to licensees?

From CNBC:

BTW, also noteworthy here more broadly,
"In the recent, evocatively titled New Yorker article “Why Doctors Hate Their Computers,” physician Atul Gawande writes about how doctors are frustrated with the entire process, and observes that the various software systems for health records seem to have helped lead to burnout."
Yeah, already reported on that. See my post "Epic fail: Atul Gawande on the EHR."

A tangential note of caution for "Amazon HIT":
12 State AGs Sue Electronic Medical Records Company Under HIPAA for Data Breach, a First
A dozen state attorneys general have united to bring the first multistate lawsuit under federal health care privacy law, in connection with a medical records company data breach that put millions of patient records at risk. The lawsuit is part of a growing trend of state enforcement of consumer and data privacy laws, and the first such AG suit under HIPAA.

A dozen state attorneys general have united to bring the first multistate lawsuit under  federal health care privacy law, in connection with a medical records company data breach that put millions of patient records at risk.

The lawsuit is part of a growing trend of state enforcement of consumer and data privacy laws, and the first such AG suit under HIPAA—the federal Health Insurance Portability and Accountability Act of 1996, which requires companies to protect the privacy of patient information. The U.S. Department of Health and Human Services usually enforces HIPAA and the Federal Trade Commission usually enforces consumer data breach violations…
I was our HIPAA staff Lead at my last gig. This stuff still interests me.

How traditional pharmacies can survive the Amazon threat

Are traditional pharmacies doomed to the same fate as Borders, Blockbuster, and Sears? The threat is real.

Companies like Capsule and PillPack are redesigning the pharmacy for the digital age. In addition to making it effortless to get prescription medications, these disruptors are bent on cutting out the physical store. This summer, Amazon bought PillPack, bringing heft, customer-service expertise, and gargantuan corporate ambition to the fight…
Hmmm... Any correlation with the Amazon HIT play?


I "graduate" (discharged) early from cardiac rehab PT next Tuesday. I'm doing quite well, way better than I'd expected. No more need for my BP meds.

Major props to the entire Muir team. Grateful to be alive.

CrossFit is amassing an army of doctors trying to disrupt health care
CEO Greg Glassman believes his program could end chronic disease — and he wants doctors to help him.
By Julia Belluz @juliaoftoronto Dec 13, 2018
Oh, boy... More Disruption, Please...

Excellent article. Read it closely.

ERRATUM: MORE ON CLIMATE CHANGE (and other tech topics)

Nice podcast from Wired:

See my prior climate change posts.


More to come...

Thursday, December 6, 2018

More on climate change and health impacts

From Scientific American:

Also, nice piece at The Atlantic by Vann R. Newkirk II:

Climate change can seem almost too big to fathom. Reports such as the recent National Climate Assessment and the United Nations Intergovernmental Panel on Climate Change’s recent release have made waves by portraying the dire threats of a warming world, making the case that the fundamental fabric of humanity will be degraded without immediate action. But the scenarios—the biblical floods and droughts, the mass migrations of dispossessed people, the creeping seas and the retreating glaciers—have a way of short-circuiting the brain. It’s almost easier to despair or to will oneself into ignorance than to begin to grapple with the future. What are human lives when measured against the coming tempest?

Efforts to assess the exact human costs of climate change, however, have provided new tools for understanding the ways in which those lives will be impacted. A major report published November 28 in the public-health journal The Lancet provides predictions of how climate change is degrading human health, and how it will alter health-care systems in the future. The findings are reliably grim. But in focusing on the health-care implications and the potential damage done to people and their descendants, the report provides a firm backing to the call to climate action. The experts behind the report hope to marry the urgency of climate science with the muscle of America’s most successful and most trusted policy experiment—its public-health system…
Read all of it (including the linked resources therein). The Lancet work can be found here [pdf].
From page 21 of the Report:

Training the Next Generation and Educating the Public on the Health Impacts of Climate Change
Correlates with Lancet Working Group 5: Public and Political Engagement

Healthcare professionals need to be educated about the ways climate change is harming Americans’ health and well-being.These professionals include physicians, nurses, public health workers, and professionals in other health sciences. 

The International Federation of Medical Students Association (IFMSA) has created a 2020 Vision for Climate-Health in Medical Curricula as a call to action to include an element of climate-health in every medical school curriculum by 2020.67 The Global Consortium on Climate and Health Education (GCCHE), hosted at the Columbia University Mailman School of Public Health, has developed Climate and Health Core Competencies for health professional students which can act as an institutional guide.

Recent polls show that nearly half of Americans (49%) are “extremely or very sure” that climate change is happening versus only 7% who are “very sure” climate change is not occuring. Given that the bedrock of public health is education about threats to health, it is critical that health providers inform their patients, communities, and policy makers about the health harms of climate change. 

Evidence shows that primary care providers are among the most trusted voices to deliver this message (Figure 15), while nurses are the most trusted profession in the country across all sectors. It has been shown that educating Americans about the health impacts of climate change can increase public engagement and decrease political polarization.

I keep coming back to the climate change thing because if we don't get a handle on it soon, a lot of other tech topics in the health care space are going to be increasingly moot, as increasing financial resources diverted to exigent disaster relief and recovery crowd out funds for tech R&D and other economic needs.

See some of my prior climate related posts here. And, don't forget Mr. Best Words.

Look closely at the left side vertical descending bars of the Scientific American graphic above. The costs associated with adverse health impacts are projected to significantly outstrip other categories. Our time for continued denial is running out.
“The way I think about it is: Somebody was made sick yesterday from climate change, someone is being made sick today as we speak, and someone is going to be made sick from climate change tomorrow.” - Georges Benjamin, APHA


New post at Naked Capitalism:

The Inconvenient Truth about Climate Change and the Economy

Define the human right to science
Jessica M. Wyndham, Margaret Weigers Vitullo

The adoption of the Universal Declaration of Human Rights (UDHR) by the United Nations (UN) General Assembly will mark its 70th anniversary on 10 December. One right enshrined in the UDHR is the right of everyone to “share in scientific advancement and its benefits.” In 1966, this right was incorporated into the International Covenant on Economic, Social and Cultural Rights, a treaty to which 169 countries have voluntarily agreed to be bound. Unlike most other human rights, however, the right to science has never been legally defined and is often ignored in practice by the governments bound to implement it. An essential first step toward giving life to the right to science is for the UN to legally define it…

The scientific community has contributed three key insights to the ongoing UN process. One is that the right to science is not only a right to benefit from material products of science and technology. It is also a right to benefit from the scientific method and scientific knowledge, whether to empower personal decision-making or to inform evidence-based policy. In addition, access to science needs to be understood as nuanced and multifaceted. People must be able to access scientific information, translated and actionable by a nonspecialist audience. Scientists must have access to the materials necessary to conduct their research, and access to the global scientific community. Essential tools for ensuring access include science education for all, adequate funding, and an information technology infrastructure that serves as a tool of science and a conduit for the diffusion of scientific knowledge. Also, scientific freedom is not absolute but is linked to and must be exercised in a manner consistent with scientific responsibility…

In October 2018, the UN Committee on Economic, Social and Cultural Rights released a list of 29 questions related to defining the right to science [pdf]. Three of the most important questions were: What should be the relationship between the right to benefit from science and intellectual property rights? How should government obligations under the right differ based on the available national resources? What is scientific knowledge and how should it be differentiated, if at all, from traditional knowledge?…

The power and potential of the right to science for empowering individuals, strengthening communities, and improving the quality of life can hardly be overstated. It is time for the UN process to reach a responsible and productive end and for the right to science to be put into practice as was intended when it was first recognized by the United Nations in 1948.
Better late than never, I guess, when it comes to precisely pinning down core conceptual phrases.

Beyond international legal definitions, this goes to issues of "Ethics," no?

apropos of one specific science-technology area and ethics, "Artificial Intelligence," I call your attention here:

From their 2018 Report:
University AI programs should expand beyond computer science and engineering disciplines.
AI began as an interdisciplinary field, but over the decades has narrowed to become a technical discipline. With the increasing application of AI systems to social domains, it needs to expand its disciplinary orientation. That means centering forms of expertise from the social and humanistic disciplines. AI efforts that genuinely wish to address social implications cannot stay solely within computer science and engineering departments, where faculty and students are not trained to research the social world. Expanding the disciplinary orientation of AI research will ensure deeper attention to social contexts, and more focus on potential hazards when these systems are applied to human populations.
That's interesting. I am reminded of my cite of Dr. Rachel Pearson's book (MD, PhD) and her scholarship in the "Medical Humanities." Interdisciplinary synergy.


Saw an MSNBC Ali Velshi interview with this Jacob Ward fellow, and was rather impressed. Glad to now be aware of him.

Warrants following.
Could not agree more with that statement. Easier said than done. One of my favorite "Futurists," Ian Morrison, joked during a Health 2.0 Conference that "the benefit of being a Futurist is that you never have to change your slides."

Good writer, Jake Ward. Check this out:

In 1999, a trio of economists emerged from a conference at the University of California, Los Angeles, squinting without sunglasses in the unfamiliar sun, and began a slow walk through the hills overlooking the city. The three of them — a Harvard economist-in-training, Daniel Benjamin, and the Harvard economists Edward Glaeser and David Laibson — were reeling. They had just learned about a new field, neuroeconomics, which applies economic analysis to brain science in an effort to understand human choices. Now they were strolling through the taxonomy of midday joggers and dog-walkers in Los Angeles, talking all the while about how people become what they are. Benjamin recalls feeling very out of place. “Everyone was so beautiful,” he says.

The economists spent the walk discussing what else they could measure across such a wide variety of human beings. By the time the sun began to set, the conversation landed on the very building blocks of life. “If economists are studying the brain,” Laibson asked, “what about studying genes?”

At that time, the standard method for connecting genes to human outcomes was to look for connections between specific DNA clusters and specific conditions in the lives of people who share those genes. B.R.C.A., perhaps the best-known gene sequence in medical science, is associated with a high risk of breast cancer. The A.P.O.E. sequence seems to have a connection to your chances of developing Alzheimer’s. “We thought we were going to find a few candidate genes that were the critical genes for impulse control or risk taking or cognitive ability,” Benjamin says. But when Benjamin, Glaeser and Laibson began writing to the keepers of DNA databases, asking to partner up, they found the geneticists reluctant to join forces. And matching D.N.A. to social outcomes, like educational attainment or wealth, wasn’t just ethically questionable, it was practically impossible…

…researchers themselves acknowledge that it’s hard to think about oneself clearly when subjected to this new [DNA] tool. Benjamin, Conley and several others in the study went ahead and got their own polygenic scores measured. It was for fun, mostly, and no one was unhappy with their results. “But at the moment I did it, I regretted doing it,” Conley says. “It’s a cognitive trap. I immediately realized that at an individual level, it doesn’t predict anything, but it’s human nature to want to know more about yourself. I don’t know …” He pauses for several seconds. “People parse meaningless distinctions.

Benjamin is less conflicted. “I don’t regret doing it,” he says. “But I’m an economist, so I’m trained to always think more information is better.”
Ahhh... more "Omics" stuff. "Geno-economics?" "Neuroeconomics?" What could possibly go wrong with that kind of stuff? The hell with your GPA and GMAT. The hell with your FICO score (some people would end up in the "subprime DNA" demographic). The hell with your VC Startup Seed Round Pitch Deck. Just give us your whole genome assay result. GINA et al be damned.
I know: I should do a startup called™ 'eh? Get me some of that Silicon Valley money. Hmmm.. relatedly, how about™?
Read Jacob's entire NY Times Magazine article. Very thoughtful, analytical take on the issue. He's on Twitter here.
_____________ AnthropoceneDenial


Imagine my surprise.

More to come...

Tuesday, December 4, 2018

Health information, research biases

We are all prone to be afflicted by cognitive biases episodically -- even the "subject matter experts" among us. In health care, biasing ensues way before dx/px/tx efforts take place during patient encounters.

Nive Healthcare Triage video at The Incidental Economist:

Whether unintentional (bad methodology and/or sampling) or deliberate ("spin" to outright fraud), it's a significant problem.


More to come...

Sunday, December 2, 2018

Brief off-topic post on social and "spiritual" healing: the "One Voice" documentary

Our dear friend Mary Ford invited us to attend the Oakland Interfaith Gospel Choir Holiday Concert at the Paramount in Oakland last night. I'd only been dimly aware of them.

My Bad.

iPhone photo from my seat. I ended up lamenting not having brought my big Sony DSLR guns.

It was stunning, inspiring. As an old washed-up guitar player, I've been around a lot of A-list music and performers my whole adult life. This was every bit the equal. World-class. "Twenty Feet From Stardom?" "Muscle Shoals?" "3 Still Standing?" Add another.

And, the band -- sheesh.
I first came to the Bay Area in 1967. The lead singer in our North Beach bar band, Rick Stevens, went on to be the original lead singer for Oakland's eminent Tower of Power band. I still have friendships from those days. I have great affinity for Oakland.
They've produced a finely-crafted, compelling documentary, which has now begun film festival vetting. They sold a limited pre-release stash of DVDs. Of course, I bought one. Watched it today. Brought us to tears. Mostly tears of humbling joy.

"One Voice delves into the lives of four Oakland Interfaith Gospel Choir members and artistic director Terrance Kelly. This film illuminates a group of people from diverse faiths, races, genders, socioeconomic backgrounds, and lifestyles, all with a common goal: to bring joy and inspiration to the stage through black gospel music. By coming from a place of inclusion and acceptance, choir members are able to bridge their differences, embracing the celebrations and challenges that arise along the way.

Gospel music is a rich tradition born from the African-American spiritual during America's slavery period and the civil rights movement. Slaves used gospel to cope through the misery of bondage and civil rights activists sang gospel music to urge action and find courage. In the midst of a country that again finds itself grappling with issues of race, gender equality, and intolerance, a group in Oakland, California, continues the rich historical tradition of using music to promote peace, love, and acceptance.

With a rich history that spans three decades, OIGC has inspired audiences all over the world. The choir delivers its world-class music across the globe, thrilling concert attendees at renowned venues such as the Montreux Jazz Festival and the Molde International Jazz Festival. Yet it stays true to its Oakland roots, lifting the spirits of the homeless, elderly, and inmates throughout the San Francisco Bay Area. From its humble beginning to OIGC’s 30th anniversary celebration on the historic Paramount Theatre stage, this choir continues to circulate musical excellence through the manifestation of One Voice."
The tagline for my friends' band in Las Vegas is "Let the Healing Begin." I got some serious healing last night. Lordy, Mercy!

Tuesday, November 27, 2018

AWS to open its machine learning certification curriculum to all developers

Found this news item interesting:

Amazon’s own ‘Machine Learning University’ now available to all developers

by Dr. Matt Wood | on  | in Amazon Machine Learning, Artificial Intelligence | Permalink |  Comments |  Share
Today, I’m excited to share that, for the first time, the same machine learning courses used to train engineers at Amazon are now available to all developers through AWS.

We’ve been using machine learning across Amazon for more than 20 years. With thousands of engineers focused on machine learning across the company, there are very few Amazon retail pages, products, fulfillment technologies, stores which haven’t been improved through the use of machine learning in one way or another. Many AWS customers share this enthusiasm, and our mission has been to take machine learning from something which had previously been only available to the largest, most well-funded technology companies, and put it in the hands of every developer. Thanks to services such as Amazon SageMaker, Amazon Rekognition, Amazon Comprehend, Amazon Transcribe, Amazon Polly, Amazon Translate, and Amazon Lex, tens of thousands of developers are already on their way to building more intelligent applications through machine learning.

Regardless of where they are in their machine learning journey, one question I hear frequently from customers is: “how can we accelerate the growth of machine learning skills in our teams?” These courses, available as part of a new AWS Training and Certification Machine Learning offering, are now part of my answer.
There are more than 30 self-service, self-paced digital courses with more than 45 hours of courses, videos, and labs for four key groups: developers, data scientists, data platform engineers, and business professionals. Each course starts with the fundamentals, and builds on those through real-world examples and labs, allowing developers to explore machine learning through some fun problems we have had to solve at Amazon. These include predicting gift wrapping eligibility, optimizing delivery routes, or predicting entertainment award nominations using data from IMDb (an Amazon subsidiary). Coursework helps consolidate best practices, and demonstrates how to get started on a range of AWS machine learning services, including Amazon SageMaker, AWS DeepLens, Amazon Rekognition, Amazon Lex, Amazon Polly, and Amazon Comprehend.
New AWS Certification for Machine Learning
To help developers demonstrate their knowledge (and to help employers hire more efficiently), we are also announcing the new “AWS Certified Machine Learning – Specialty” certification. Customers can take the exam now (and at half price for a limited time). Customers at re:Invent can sit for the exam this week at our Training and Certification exam sessions.
The digital courses are now available at no charge at and you only pay for the services you use in labs and exams during your training.
Deserves a close look (notwithstanding the inappropriate marketing hype use of the word "University")..

Recall my prior post "Data Science?"

One AWS track, "Data Scientist":

A clip from a couple of the courses:

Curious omission of "finite / discrete math."

I bring most of that stuff to the table (though my calculus is by now a 3rd of a century old). AWS claims that the courses are available "at no charge," but I'm not seeing where you can get a deeper topical look (e.g., "syllabus") without "enrolling."

e.g., Linear and Logistical Regression:

Overview from enrollment page:
How do you make predictions in machine learning? Naumaan Nayyar, AWS Applied Scientist, will lead you through the key points—specifically, linear models for regression, least squares error, maximum likelihood estimate, regularization, logistic regression, empirical loss minimization, and gradient-based optimization methods.
As an experienced stats/regression modeling analyst (large pdf **), I'll just comment that that's a lot of material to cover to competency in 8.5 hours. "Lead you through the key points..."
** From my 2003 bank white paper: "This paper documents the Custom Risk Score (CRS 2003) development process undertaken by the Risk Management Acquisitions Group Model Development Team, a rigorous analytical and modeling effort leading to the derivation of a revised and improved FNBM CRS metric set with which to effectively evaluate and segment new account applicants for optimal profitability consistent with effective management of credit risk. The study was performed in a manner consistent with statistical and credit industry best practices, and was analytically comprised of a systematic application of Factor Analysis, Cluster Analysis, and Logistic Regression methods applied to a broad array of internal and external (bureau) credit history attributes pertaining to a suitable sample of FNBM accounts.The resulting tool consists of a stratified "suite" of scorecards more closely calibrated to empirically evident incoming applicant clusters, and thus represents a significant improvement over its predecessor CRS 2001, which, while effective and statistically valid in its own right, was based on a portfolio-wide single-score logistic regression underwriting model..."
You are not gonna get functionally up to speed on all of that kind of stuff in 8.5 hours.

Is this AWS offering basically a ML/"Data Science" "boot camp?" Will an AWS "certification" be of significant independent value?

The lense is over here, bro'.

More on "data science" and boot camps:

"Are Data Science Boot Camps Worth It?"
I came to this outfit by way of this author.


On the topic of tech talent, this book (along with several related other titles) is in my queue:

Nice podcast with the author:

50 minutes, well worth your time. Transcript here.I would imagine this would not be White House anti-immigration advisor Stephen Miller's favorite book. He breaks out in a rash upon hearing the word "global."

apropos of all of the foregoing, an interesting snip from the intriguing 2018 Annual Letter promulgated by
"Because of the lack of distribution of talent (most of the top AI experts and new PhD’s unfortunately join Big Tech due to their professional-athlete level compensation packages), deep learning has barely scratched the surface of its potential applications. Over the next few decades, as more engineers are trained in artificial intelligence and as developer tools and frameworks get easier to use, we should see artificial intelligence successfully applied to problems that were previously too difficult using traditional software methods, such as self-driving cars, robotics, and drug design and discovery. AI can truly transform how we work, how we live, and even how we think." -- Chamath Palihapitiya, CEO
'eh? In that regard, we'll have to keep considering Judea Pearl's pioneering AI work:

Some other books pending blog review:

There are more. Always.


From LinkedIn news updates.
Amazon says it’s marketing software that will allow doctors and hospitals to harvest patient medical records to enhance treatment and pare down costs. The move is the internet giant’s latest foray into medical care  and follows recent acquisitions in the healthcare and pharmaceutical industries. Amazon will also develop an app that's embedded in electronic medical records and provides doctors direct links to products to market to patients.  Here’s what people are saying.

Another "holy shit!" book. Another queue-jumper.

Twenty five leading lights of AI/ML etc. Fascinating. Hugely instructive.

UPDATE: I am a bit disappointed by the lack of any reference in the book to "computational biology." to wit,
Computational Biology
Computers, at the end of the day, are machines for turning information into processed information. This is obviously a very powerful and flexible capability, and our use cases for computers have expanded far beyond the “information processing” jobs they were initially tasked with. Yet, they can’t do everything. There are many different kinds of problems we can’t count on computers and software to solve. Many of them have one thing in common, which is that they aren’t problems about information. Instead, they’re problems about the physical world ("atoms vs. bits", as people like to say). Whether we need to build matter up (make materials, design drugs, process fuels), break things down (clean up pollution, treat disease) or identify and interact with things in the physical world (sense lead in water, sequester contaminants), there are a lot of hard problems in the world that computers cannot solve, but that biology can.

For many of these problems, the highest-potential path to fixing them lies in the overlap of computers and biology: computational biology. Computational biology is an emerging discipline that generally refers to two overlapping fields: 1) the practice of taking everything we’ve learned about how to build computers and applying that knowledge to building cells as a programmable, flexible, platform with which we can do useful work, and 2) productizing and automating the tools, processes, and methods we use in the lab to manipulate biology and build living systems. Although we’ve gone through a few waves of “biotech bubbles” over the past twenty years, this time may no longer only be about wildly speculative drug development, but instead about something more concrete and foundational. We'll be able to establish biological systems as engineered, all-purpose platforms that we can put to work the same way we do with computers.

Additionally, within a few years, we’ll reach a convergence point where our recent advances will start to overlap, and eventually blend, into our existing computing frameworks and infrastructure. This will have a profound and disruptive effect on many fields such as drug design and discovery, drug delivery, precision diagnostics and healthcare, engineered materials, ecology, agriculture, and much more. We’ll be able to work with biology in ways that increasingly resemble the way we work with software: as a platform for building tools, applications, and infrastructure. This time, however, we’ll be able to do it using living systems instead of code.
Chamath Palihapitiya, CEO, Social Capital, Oct. 2018 [pdf].
Think about the implications.

More to come...

Friday, November 23, 2018

An important climate change update

From the NY Times:

U.S. Climate Report Warns of Damaged Environment and Shrinking Economy

Recall my prior posts on climate change (and apropos of my recent immediate recent posts on our California wildfire disasters).
WASHINGTON — A major scientific report issued by 13 federal agencies on Friday presents the starkest warnings to date of the consequences of climate change for the United States, predicting that if significant steps are not taken to rein in global warming, the damage will knock as much as 10 percent off the size of the American economy by century’s end.

The report, which was mandated by Congress and made public by the White House, is notable not only for the precision of its calculations and bluntness of its conclusions, but also because its findings are directly at odds with President Trump’s agenda of environmental deregulation, which he asserts will spur economic growth.

Mr. Trump has taken aggressive steps to allow more planet-warming pollution from vehicle tailpipes and power plant smokestacks, and has vowed to pull the United States out of the Paris Agreement, under which nearly every country in the world pledged to cut carbon emissions. Just this week, he mocked the science of climate change because of a cold snap in the Northeast, tweeting, “Whatever happened to Global Warming?”

But in direct language, the 1,656-page assessment lays out the devastating effects of a changing climate on the economy, health and environment, including record wildfires in California, crop failures in the Midwest and crumbling infrastructure in the South. Going forward, American exports and supply chains could be disrupted, agricultural yields could fall to 1980s levels by midcentury and fire season could spread to the Southeast, the report finds…

 I've just started studying the report. Going to the "Human Health" section first.

From The Atlantic:
"It may seem like a funny report to dump on the public on Black Friday, when most Americans care more about recovering from Thanksgiving dinner than they do about adapting to the grave conclusions of climate science. Indeed, who ordered the report to come out today?"
Let me guess.


From the report "health" summary section:
Impacts from climate change on extreme weather and climate-related events, air quality, and the transmission of disease through insects and pests, food, and water increasingly threaten the health and well-being of the American people, particularly populations that are already vulnerable.

Changes in temperature and precipitation are increasing air quality and health risks from wildfire and ground-level ozone pollution. Rising air and water temperatures and more intense extreme events are expected to increase exposure to waterborne and foodborne diseases, affecting food and water safety. With continued warming, cold-related deaths are projected to decrease and heat-related deaths are projected to increase; in most regions, increases in heat-related deaths are expected to outpace reductions in cold-related deaths. The frequency and severity of allergic illnesses, including asthma and hay fever, are expected to increase as a result of a changing climate. Climate change is also projected to alter the geographic range and distribution of disease-carrying insects and pests, exposing more people to ticks that carry Lyme disease and mosquitoes that transmit viruses such as Zika, West Nile, and dengue, with varying impacts across regions. Communities in the Southeast, for example, are particularly vulnerable to the combined health impacts from vector-borne disease, heat, and flooding. Extreme weather and climate-related events can have lasting mental health consequences in affected communities, particularly if they result in degradation of livelihoods or community relocation. Populations including older adults, children, low-income communities, and some communities of color are often disproportionately affected by, and less resilient to, the health impacts of climate change. Adaptation and mitigation policies and programs that help individuals, communities, and states prepare for the risks of a changing climate reduce the number of injuries, illnesses, and deaths from climate-related health outcomes.
Trump's failure to fight climate change is a crime against humanity
By Jeffrey Sachs

(CNN) - President Donald Trump, Florida Gov. Rick Scott, Florida Sen. Marco Rubio, and others who oppose action to address human-induced climate change should be held accountable for climate crimes against humanity. They are the authors and agents of systematic policies that deny basic human rights to their own citizens and people around the world, including the rights to life, health, and property. These politicians have blood on their hands, and the death toll continues to rise…

As the Earth warms due to the continued burning of coal, oil, and gas, climate-related disasters that include high-intensity hurricanes, floods, droughts, extreme precipitation, forest fires, and heat waves, pose rising dangers to life and property. Hurricanes become more destructive as warmer ocean waters feed more energy to the storms. Warmer air also carries more moisture for devastating rainfalls, while rising sea levels lead to more flooding.

Yet Trump and his minions are the loyal servants of the fossil-fuel industry, which fill Republican party campaign coffers. Trump has also stalled the fight against climate change by pulling out of the Paris Agreement. The politicians thereby deprive the people of their lives and property out of profound cynicism, greed, and willful scientific ignorance…
Jeffrey Sachs is a professor and director of the Center for Sustainable Development at Columbia University. 
 Read all of it.

The World Needs to Quit Coal. Why Is It So Hard?
By Somini Sengupta

HANOI, Vietnam — Coal, the fuel that powered the industrial age, has led the planet to the brink of catastrophic climate change.

Scientists have repeatedly warned of its looming dangers, most recently on Friday, when a major scientific report issued by 13 United States government agencies warned that the damage from climate change could knock as much as 10 percent off the size of the American economy by century’s end if significant steps aren’t taken to rein in warming.

An October report from the United Nations’ scientific panel on global warming found that avoiding the worst devastation would require a radical transformation of the world economy in just a few years.

Central to that transformation: Getting out of coal, and fast.

And yet, three years after the Paris agreement, when world leaders promised action, coal shows no sign of disappearing. While coal use looks certain to eventually wane worldwide, according to the latest assessment by the International Energy Agency, it is not on track to happen anywhere fast enough to avert the worst effects of climate change. Last year, in fact, global production and consumption increased after two years of decline…
In the public imagination, the coal miner has long been a symbol of industrial virility, a throwback to an era when hard labor — particularly men’s labor, rather than robots — fueled economic growth.

That idea has been central to politics. German coal miners have lifted the fortunes of that country’s far-right party. Poland’s right-wing government has promised to open new coal mines. Australia’s prime minister, Scott Morrison, rose to power as a champion of coal.

President Trump has promised, unsuccessfully so far, to revive coal mining jobs and instructed his Environmental Protection Agency to roll back rules to reduce emissions from coal-fired power plants.
That message might be welcome in American coal country, but the industry’s future in the United States is not promising…
Again, read the entire article.


I cut my white collar teeth in a forensic-level environmental radiation / mixed waste lab in Oak Ridge in the 1980s (computer systems development and lab QC - pdf). I have known since those days about this (that hardly ever gets mentioned):
Coal is largely composed of organic matter, but it is the inorganic matter in coal—minerals and trace elements— that have been cited as possible causes of health, environmental, and technological problems associated with the use of coal. Some trace elements in coal are naturally radioactive. These radioactive elements include uranium (U), thorium (Th), and their numerous decay products, including radium (Ra) and radon (Rn). Although these elements are less chemically toxic than other coal constituents such as arsenic, selenium, or mercury, questions have been raised concerning possible risk from radiation. In order to accurately address these questions and to predict the mobility of radioactive elements during the coal fuel-cycle, it is important to determine the concentration, distribution, and form of radioactive elements in coal and fly ash... [USGS, 1997]
Radionuclides in the the coal seams. Lovely.


President Trump on the report he did not and will not read:

POTUS speaks eloquently to the Washington Post, Nov. 27th:
“One of the problems that a lot of people like myself, we have very high levels of intelligence but we’re not necessarily such believers. You look at our air and our water, and it’s right now at a record clean.”
Verbatim. SMH.


From Naked Capitalism:

How Economists Impede Addressing Climate Change

Posted on  by 
On a recent post, some readers recoiled at the idea of putting a monetary value on human life. Yet that happens all the time. Courts come up with damages for injuries and wrongful deaths. Younger people with high earnings are more “valuable” than other people. And remember the Pinto? Companies similarly put a value on how much it is worth to them to spend on safety to prevent deaths and dismemberment.
As this article indicates, this sort of thinking winds up playing a role any time companies or governments look at making financial outlays. And this situation is made worse by the fact that due to reasons of cognitive bias or bad incentives, people and institutions have a predisposition not to do difficult things now. People engage in procrastination and hyperbolic discounting. Politicians find “kick the can down the road” strategies to be the best approach most of the time...
Read it. Read the comments as well. NC rocks.

BTW, see also The Atlantic's "Why the U.S. Can't Solve Big Problems."
_____________ AnthropoceneDenial

More to come...