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Monday, May 20, 2019

Define "evidence"

Ahhh... "Just the facts." 

My (non-dictionary) definition:
EVIDENCE: Information which renders a true conclusion more likely, or (much more rarely), constitutes proof of a true conclusion (a.k.a. "dispositive evidence").
Anyone see anything at least episodically problematic there? Say tuned. Lots to unpack in this upcoming post. Let's just say for openers I'm a bit of a pedantic stickler for precise definitions as a starting point for rational and productive discourse (e.g., "Deliberation Science," anyone?).

It behooves us to all be singing from the same sheet of music.

1. The available body of facts or information indicating whether a belief or proposition is true or valid. ‘the study finds little evidence of overt discrimination’

1.1 (Law) Information drawn from personal testimony, a document, or a material object, used to establish facts in a legal investigation or admissible as testimony in a law court. ‘without evidence, they can't bring a charge’

1.2 Signs or indications of something. ‘there was no obvious evidence of a break-in’
BTW, apropos of 1.1, my trusty Black's Law Dictionary (10th ed.) devotes five pages [pp 576-581] to the word "evidence" and its related phrases and usages (most of them obviously pertaining to the legal domain).
"Information which renders a true conclusion more likely..." The briefest reflection extends that definition to sensory organ-initiated perceptions. Is that rustling in the bushes outside your tent that of a bear? Does that acute smell of gas portend an incipient explosion? Is that "sound of 100 approaching freight trains" evidence of a tornado headed your way? Is that mole cancerous? etc.
In terms of human "arguments," any assertive premise statement ("truth claim") that fails to improve the likelihood of a true conclusion is at best simply rhetorical noise, and at worst a rhetorical fallacy. We have too much of it in our discourse.

A recent article in my AAAS Science Magazine made me aware of this:
H. R. 4174, ‘‘Foundations for Evidence-Based Policymaking Act of 2018’’—01/14/2019, Public Law No: 115-435.
"There is no natural constituency for evidence-based policy. It should, by rights, be the public who wants the most from their government (and their public funds). But the public, like most politicians, is often not aware of the ins and outs of evaluation methods and evidence. Think tanks and academics have long filled this gap and will likely continue to play key roles. But legislation signed into law in early 2019 could transform the way U.S. government officials design programs by introducing more scientific evidence into the process…"
Really? Under a Donald Trump administration? How did that happen? He signed the final bill. We can rest assured he carefully read every word of its 29 pages.

‘‘§ 311. Definitions
‘‘In this subchapter:

‘‘(3) EVALUATION.—The term ‘evaluation’ means an assessment using systematic data collection and analysis of one or more programs, policies, and organizations intended to assess their effectiveness and efficiency.
‘‘(4) EVIDENCE.—The term ‘evidence’ has the meaning given that term in section 3561 of title 44.

The term “evidence” means information produced as a result of statistical activities conducted for a statistical purpose.

(10)Statistical activities.—The term “statistical activities”—
(A) means the collection, compilation, processing, or analysis of data for the purpose of describing or making estimates concerning the whole, or relevant groups or components within, the economy, society, or the natural environment; and
(B) includes the development of methods or resources that support those activities, such as measurement methods, models, statistical classifications, or sampling frames.

(12)Statistical purpose.—The term “statistical purpose”—
(A) means the description, estimation, or analysis of the characteristics of groups, without identifying the individuals or organizations that comprise such groups; and
(B) includes the development, implementation, or maintenance of methods, technical or administrative procedures, or information resources that support the purposes described in subparagraph (A)...
Well, isn't that interesting? Enter "Data Science," anyone?
A couple of passing thoughts on evaluative classification of empirical "evidence." In conventional usage, we often resort to qualitative ordinal ranking, with evidence strength thought of as ranging from "dispositive" to "nll," with (descendingly) "extremely strong," "strong," "moderate," "weak," "extremely weak" designations in between. Sometimes we gussy things up by stating nominally "quantitative" evidentiary "probabilities" when, properly, we should be proffering what are really "probability estimates."
UPDATE: just in, of relevance,
EPA Changes Math to Allow Burning of More Coal


"Evidence-Based Medicine." Not universally loved, historically. Still often dissed as anti-innovation "cookbook medicine" by apologists for "Eminence-Based Medicine."
"[S]ince antiquity, the mark of distinction of a learned man had been the certainty of his knowledge. A doctor knew—he did not need to test his kind of knowledge empirically because this would imply acknowledgement of uncertainty."—Ulrich Tröhler

More to come...

Thursday, May 16, 2019

On Sorcery

...Thank goodness we have you to turn to, Representative Stickland, for homespun wisdom that isn’t tainted by either higher education or the sulfurous fumes of Beelzebub. As a licensed pest control technician, you are well-positioned to critique the instruments of the occult.

I mean, of course, vaccines. Vaccines are powerful dark magic that have eliminated child-killing diseases such as polio, smallpox and — until recently, in this country — measles. If left unchecked, necromancers such as Dr. Hotez and myself would gladly vaccinate every child in Texas who doesn’t have a medical condition affecting their immune system. Our sorcery already prevents 2 to 3 million unnecessary deaths every year, and we would gladly prevent even more.

We would cackle over our big steaming cauldrons as we prevent children from contracting tetanus and experiencing such intense muscle spasms that they break the bones in their spines!

We would interpret diabolical messages from the blood of salamanders as we vaccinate kids against whooping cough, which can kill babies by driving their oxygen levels so low that their hearts slow and they experience cardiac arrest!

The demons lurking among us would howl in ecstasy as we prevent mumps, which can sterilize boys, and measles, which can cause a slow, incurable inflammation of the brain. Nothing would spark more joy in the evil heart of Satan than seeing Texas kids fully protected against vaccine-preventable disease!...

Rachel, I still want to read your doctoral dissertation.

More to come...

Wednesday, May 15, 2019

On data dashboards

Click either above to enlarge.

Interesting, iconoclastic post at THCB:
We Are Not A Dashboard: Contesting The Tyranny Of Metrics, Measurement, And Managerialism

The dashboard is the potent symbol of our age. It offers the elegant visualization of data, and is intended to capture and represent the performance of a system, revealing at a glance current status, and pointing out potential emerging concerns. Dashboards are a prominent feature of most every “big data” project I can think of, offered by every vendor, and constructed to provide a powerful sense of control to the viewer. It seemed fitting that Novartis CEO Dr. Vas Narasimhan, a former McKinsey consultant, would build (then tweet enthusiastically about) “our new ‘control tower’” – essentially a multi-screen super dashboard – “to track, analyse and predict the status of all our clinical studies. 500+ active trials, 70+ countries, 80 000+ patients – transformative for how we develop medicines.” Dashboards are the physical manifestation of the ideology of big data, the idea that if you can measure it you can manage it.

I am increasingly concerned, however, that the ideology of big data has taken on a life of it’s own, assuming a sense of both inevitability and self-justification. From measurement in service of people, we increasingly seem to be measuring in service of data, setting up systems and organizations where constant measurement often appears to be an end in itself…
Good post. Read all of it. What do you think?
...Data sciences and technology could, and must, play a vital role. But they haven’t earned the right to be considered an end in themselves. They represent potentially valuable tools, ideally in the hands of experienced and inquisitive practitioners, who uniquely appreciate the subtleties of their domain – McClintock’s phrase “feeling for the organism” comes to mind; who have the humility to recognize the limits of knowledge; and who will actively seek to leverage the benefits potentially offered by data, analytics, and measurement, thoughtfully applied.

More to come...

Sunday, May 12, 2019

"This doctor posted online in favor of immunization."

An infuriating article in The Boston Globe.
This doctor posted online in favor of immunization. Then vaccine opponents targeted her
By Liz Kowalczyk

Dr. Monique Tello was attending a medical conference last fall when a speaker on social media suggested the physicians search themselves on Google. Why not, thought Tello, an internist at Massachusetts General Hospital.

She was stunned by what she found.

More than 100 negative one-star reviews and derogatory comments had been posted about her on popular physician rating websites.

“Ignorant, and could care less about her patients,’’ she recalled one poster writing.

“Danger,’’ another warned.

Tello soon discovered these comments were not from people who had been her patients, she said, but instead from anti-vaccine activists. The reviews on the websites Vitals and Healthgrades began pouring in last August, soon after Tello wrote pro-vaccine commentary on another doctor’s Instagram account…
Read all of it. Simply infuriating. See @ScienceBasedMed's voluminous postings on the vaccination issues.

Dr. Tello is fighting back. e.g., on Facebook:

Bullying and cyberbullying of physicians is becoming an enormous issue, especially now that so many of us are trying to have more of an online presence. Many of us have experienced being bullied online through comments on out pages, fake bad reviews, and more. Sometimes if can be massive groups that decide to attck like the antivaxxers or fans of a particular person or group. We need better education and support when this happens. I hope this can be that place. Please share your stories so we can learn from you. Please ask your questions so you can learn from others. Please post anything you think might be valuable to fellow physicians this may be happening to.
I'm not an MD, so I can't join (it's a closed group). If you're a doc, join up and fight back. What's next with these lunatic people? Actual assaults? Death threats? Attempted (or successful) murders of vaccination proponents (like have happened over the abortion issue)?

Enough of this Idiocracy stuff.



Saw a book review on STATnews by Dr. Gerard Anderson. Bought the book immediately.

From the Amazon blurb:
From a giant of health care policy, an engaging and enlightening account of why American health care is so expensive—and why it doesn't have to be
Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of today's U.S. health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it.
The problem, Reinhardt says, is not one of economics but of social ethics. There is no American political consensus on a fundamental question other countries settled long ago: to what extent should we be our brothers' and sisters' keepers when it comes to health care? Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America finances health care, and he offers a penetrating ethical analysis of recent reform proposals. At this point, he argues, the United States appears to have three stark choices: the government can make the rich help pay for the health care of the poor, ration care by income, or control costs. Reinhardt proposes an alternative path: that by age 26 all Americans must choose either to join an insurance arrangement with community-rated premiums, or take a chance on being uninsured or relying on a health insurance market that charges premiums based on health status.
An incisive look at the American health care system, Priced Out dispels the confusion, ignorance, myths, and misinformation that hinder effective reform.
Stay tuned. Relatedly, see my posts going to "An American Sickness" and "Are we overcharged for health care?"


My latest Science Magazine hardcopy arrived today. Loaded with cool stuff, including this (firewalled, alas):
Building upon foundations for evidence-based policy
There is no natural constituency for evidence-based policy. It should, by rights, be the public who wants the most from their government (and their public funds). But the public, like most politicians, is often not aware of the ins and outs of evaluation methods and evidence. Think tanks and academics have long filled this gap and will likely continue to play key roles. But legislation signed into law in early 2019 could transform the way U.S. government officials design programs by introducing more scientific evidence into the process…
Very interesting. I will be all over this stuff. I'm already dissecting the legislation it cites.


We need "evidence-based" deliberation more than ever.

More to come...

Friday, May 10, 2019, Day One of Year Eleven

OK, where do I go from here?

Monday, May 10th, 2010 I launched this solo pro bono effort as our QIO/REC work commenced on the (now widely mocked) ONC Meaningful Use initiative. While it began as sort of an online "diary" of my work, I've taken it topically wherever I thought broadly useful and relevant. I will likely continue with that M.O. going forward. I have some specific ideas I'm not yet ready to reveal as we continue to try to fully settle in from our crazy move to Baltimore. Stay tuned.

Ten years. Eligible to be tried as an adult.


Researchers Now Have Even More Proof That Air Pollution Can Cause Dementia

A few years ago I stood in a cramped trailer beside the busy 110 freeway in Los Angeles as researchers at the University of Southern California gathered soot thrown off by vehicles pounding by just a few yards from their instruments, which rattled whenever a heavy truck passed. I was there to learn about how scientists were beginning to link air pollution—from power plants, motor vehicles, forest fires, you name it—to one of the least understood and most frightening of illnesses: dementia.

At that time, as I reported in Mother Jones, the research implicating air pollution as one factor that can contribute to dementia was alarming, consistent, and, ultimately, “suggestive.” Since then scientists have published a wave of studies that reveal that air pollution is much worse for us than we had previously imagined.  The evidence is so compelling, in fact, that many leading researchers now believe it’s conclusive. “I have no hesitation whatsoever to say that air pollution causes dementia,” says Caleb Finch, gerontologist and the leader of USC’s Air Pollution and Brain Disease research network, which has completed many of these new studies. In terms of its effects on our health and welfare, Finch says, “air pollution is just as bad as cigarette smoke.” This evidence arrives alongside the alarming news that air quality is actually worsening for many cities in the United States, while the Trump Administration continues its effort to delay or roll-back environmental safeguards…
But, hey,

My late Dad spent the last seven years of his 92 in dementia-addled befuddlement in VA long-term care. It was not fun.


More to come...

Thursday, May 9, 2019

Health Information Technology news items


LAST MONTH, IN a Safeway supermarket in Casa Grande, Arizona, Akos Med Clinics opened the “medical clinic of the future,” which uses augmented reality, artificial intelligence, and telemedicine to treat patients who walk in. It was the 11th Akos clinic in the state, each one tucked inside of a Safeway.

The pairing of clinic chain and supermarket chain has been fortuitous, Akos executives say. To start, there is the natural parallel between the speed and efficiency of self-checkout at the supermarket and the speed and efficiency of the Akos clinics. Just as there is no cashier at self-checkout at Safeway, there is no doctor or nurse at an Akos clinic. Instead patients are guided by AR-enabled computers to record basic measurements of themselves—weight, temperature, blood pressure, and blood oxygen content—as well as images of their ear, nose, and throat, and sounds made by their chest, lung, and abdomen.

The results are relayed to the company’s headquarters, where a medical professional speaks to the patient via video linkup, so-called telemedicine, and is aided in diagnosis by artificial intelligence. There is an assistant at the clinic who can perform blood tests as a follow-up or call 911, if needed; prescriptions can be emailed to a pharmacy.

Akos has found Safeway super­markets a good fit in another way too—the markets had plenty of clinic space available, recently built. A different company had abruptly abandoned its dream of using supermarkets and pharmacies to host its new medical technology. You may have heard of the outfit. It’s called Theranos…
Ahhh... Theranos.

Good article. Read all of it.
...These innovations assume that the problems with the medical system—the unaffordability, the lack of doctors in some areas—cannot be fixed through collective action (Medicare for all comes to mind), but must be cleverly managed.
In other words, medical hacks, masquerading as medical solutions.

Consolidated Healthcare institutions, Insurance companies, Pharmaceutical companies and Health Information Technology companies (CHIPHIT complex)
From The Health Care Blog.
"...If we hope to have the healthcare system we need, society must redirect resources away from the CHIPHIT complex and into the hands of those who unambiguously prioritize a holistic, high quality, low cost and egalitarian healthcare system."
Assumes facts not in evidence, Your Honor (not that I disagree with the sentiment).


I launched this blog 10 years ago tomorrow (that's 332.045 Scaramuccis). Thanks for reading it. I've tried to effectively address the gamut of issues. And I will continue, on a broader scale. Stay tuned.

The latest on our stressful transcontinental move, btw.

More to come...

Monday, May 6, 2019

“We are eroding the very foundations of our economies, livelihoods, food security, health and quality of life worldwide”

- atmospheric chemist and IPBES chair Robert Watson

Read the report. We are running out of time. Prior related topical posts here.


New book coming out soon.

Read The Atlantic article adapted from it, "The Peculiar Blindness of Experts." Very important stuff.
...[T]he track record of expert forecasters—in science, in economics, in politics—is as dismal as ever. In business, esteemed (and lavishly compensated) forecasters routinely are wildly wrong in their predictions of everything from the next stock-market correction to the next housing boom. Reliable insight into the future is possible, however. It just requires a style of thinking that’s uncommon among experts who are certain that their deep knowledge has granted them a special grasp of what is to come...
Among others, I am reminded of those who call themselves "futurists." They even have their own Professional Association.
People like "Nobody knows more about ________ than me" Donald Trump never pass up an opportunity to assert that experts are always wrong about everything. Consequently, we must do our best to get substantive things right, notwithstanding that the possibility of error is always with all of us.
I ask again; is there a "science of deliberation?" We certainly need it.

More to come...

Margalit Gur-Arie is at it again


The Medicare For All Heptagon

I am going to make a prediction here. No matter who we elect in 2020, Bernie or Trump or anything in between, Medicare For All is not going to happen in America. One can run an electrifying campaign on the promise of Medicare For All, or indignantly against it, but this is pure theater on both sides. I don’t know if God can make a rock so big and heavy that even He can’t lift it, but I do know that government can make corporations so big and powerful that even government itself can’t break them.

For decades our government encouraged the health care industry to consolidate vertically, horizontally and obliquely so it can achieve “economies of scale” and therefore lower consumer prices. In the last couple of decades, the government also compelled the industry to computerize its operations, because technology makes everything better and cheaper. Once the resulting monopolistic behemoths were summoned into existence, it was time to nationalize the whole lot, into one super monopoly, with super technology and super economies of scale. The only other example of such government monopoly in America is the Military.

Obviously, our standing armies must be, by definition, a national monopoly, but note that the Navy is not building its own ships and the Air Force is not building its own planes and the Army is not manufacturing tanks. The government is contracting with private suppliers for pretty much everything, from butter to bullets. The Military Industrial Complex is a network of very large and utterly corrupt contractors for the government, yielding more power over foreign and fiscal policy than Congress, the President, and all citizens put together, while delivering practically nothing either on budget or on time. A powerful Military is essential to America’s safety and global success, so we grind our teeth and keep paying. And medical care for hundreds of millions of people is at least as important.

I am not entirely sure how people think Medicare For All is going to work. Are you folks envisioning an angry President Bernie dragging Samuel Hazen into the Oval, wagging his finger at him and making an offer Mr. Hazen cannot refuse? Something like, “I will pay $50 per head and not a penny more, because health care is a human right, and if you want to be a disgusting millionaire or billionaire, go write a bestselling book, like I did…”, at which point Mr. Hazen will be hanging his head down in shame and gratefully take the $50 deal. Upon his return to Nashville, Mr. Hazen will immediately schedule book writing workshops for all HCA department chiefs to compensate for cutting all salaries in half. Yeah… no, that’s not how this works.

Go ask Northrup Grumman or Lockheed Martin or General Dynamics or even Boeing or Booz Allen or any other “beltway bandit” how getting money from the Feds really works. There are well-greased revolving doors between the Pentagon and its contractors. There are stock options and executive positions for high ranking Federal employees. There are 535 people in Congress responsible for allocating budgets, and all 535 are for sale. Most of this infrastructure is already in place for health care too and building the HHS Heptagon shouldn’t take very long. The American President has little to no power over Federal spending, and even less so when it comes to large procurement contracts, as the current occupant of the White House discovered the hard way, during the Lockheed F-35 kerfuffle.

Clearly large health systems will survive and thrive under a Medicare For All law, but how about private health insurance? Future President Bernie says they will all be banned. Is that so? Currently a full third of Medicare beneficiaries are insured and “managed” by a handful of large private health insurers. Medicare is paying those private contractors fixed amounts of money per head for their services. Medicaid is doing the same for most of its beneficiaries, and all military health insurance (TRICARE) is contracted out to the usual suspects. Basically, the vast majority of people covered by public insurance, are really insured by gigantic insurance corporations. Fact: under the hood, taxpayer funded health care is the bread and butter of private health insurance companies.

When future President Bernie and the hordes of uninformed supporting characters in the 2020 elections festival say that private health insurance will be banned, they are lying to you. What will be banned under a Medicare For All law, is your ability or your employer’s ability, to purchase health insurance directly from a private company. Instead, the government will procure contracts in bulk as it sees fit, assign people to them as it sees fit, and pay for these contracts with tax revenue as it sees fit. Just like they pay for battleships, fighter planes, bombs, tanks and such.  The United States Military is known for lots of great things. Value-based purchasing, and cost-effectiveness in general, are not among those things.

Depending on who you ask and what is included in the definition of health care, Medicare For All is projected to cost between three and four trillion dollars per year, which is five times the amount we spend on the Military. This number is calculated based on costs under current law, minus the waste generated by the cacophony of hundreds and thousands of different insurance plans, different health care facilities and their too many to count service and product vendors. The projections do not include the effects of the inevitable massive consolidation of everything health care into a dozen or so Federal contractors, able and willing to demand multi-billion dollars contracts for services worth a few million dollars at most on the open market. Remember the Obamacare marketplace website? Multiply that by orders of magnitude and you have Medicare For All.

Medicare For All is as egregious a misnomer for this plan as the Affordable Care Act was. When they say Medicare For All, they mean Federal government procured health insurance for all. When they say everything soup to nuts will be covered, they mean everything the heavily indebted Federal government thinks should be covered, and can afford to cover, will be covered. When they say health care will be better, more plentiful and much more affordable, they mean please vote for me in 2020. Medicare For All will be built on the largely immovable foundation our government chartered and nurtured for half a century. If you want a glimpse into a Medicare For All future, go look at any Medicaid Managed Care plan in any impoverished southern State, and look at the balance sheets of the associated contractors and sub-contractors.

It doesn’t have to be this way. We don’t need to bulldozer everything we have, and we certainly don’t need to pretend that we can, or that we must. And we need to remember that the proper role of government in a free country is not to manage the health or the care of all its citizens. Free people are not the wards of a State responsible for keeping them healthy, productive and happy. The role of a democratic government is to keep predators, foreign and domestic, including corporate ones, at bay, while providing a sturdy safety net for the few who cannot care for themselves. Let’s do that instead. It will be better, faster and cheaper than the fictional construct called Medicare For All.
I don't agree with Margalit on everything, but I have to seriously respect her views.

This stuff will be a dominant concern in the 2020 campaign, as it was in the recent mid-term.

More to come...

Saturday, May 4, 2019

Another "Omics" in the health care space

My wife just passed along this Washington Post article to me.
"Doctors who are kind have healthier patients who heal faster, according to new book"
I bought and downloaded the book. Thanks, Cheryl. Add another branch to the "Omics," 'eh?

Stay tuned.

From the Amazon blurb:
A 34-year-old man fighting for his life in the Intensive Care Unit is on an artificial respirator for over a month. Could it be that his chance of getting off the respirator is not how much his nurses know, but rather how much they care?

A 75-year-old woman is heroically saved by a major trauma center only to be discharged and fatally struck by a car while walking home from the hospital. Could a lack of compassion from the hospital staff have been a factor in her death?

Compelling new research shows that health care is in the midst of a compassion crisis.
But the pivotal question is this: Does compassion really matter?

In Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, physician scientists Stephen Trzeciak and Anthony Mazzarelli uncover the eye-opening data that compassion could be a wonder drug for the 21st century.

Now, for the first time ever, a rigorous review of the science - coupled with captivating stories from the front lines of medicine - demonstrates that human connection in health care matters in astonishing ways. Never before has all the evidence been synthesized together in one place.

You will see compelling evidence that:

  • Compassion has vast benefits for patients across a wide variety of conditions
  • Missed opportunities for compassion can have devastating health effects
  • Compassion can help reverse the cost crisis in health care
  • Compassion can be an antidote for burnout among health care providers
  • 40 seconds of compassion can save a life
After seeing all the evidence, the answer is crystal clear: Compassion not only meaningful but measurable ways.
We shall see. From the Foreword by Senator Cory Booker:
We are often led to believe that sentiments like compassion, love and kindness are expressions of weakness rather than signs of strength. And we are often all too ready to give in to the false belief that meanness somehow equates to toughness and that empathy is empty of power... [Kindle location 168]
"...meanness somehow equates to toughness..." Remind you of anyone of late? Hmmm...

I look forward to studying this book. I have to think that one reason I sailed through my SAVR px last August was the empathic, compassionate care of my cardiac surgeon and his team.

I left a comment under the WaPo article.
There is good scientific evidence that prosocial behaviors--up to and including the altruistic (sorry, Ayn Rand)--have evolutionary "adaptive utility." See, e.g., Tomasello's "A Natural History of Human Morality." Which simply makes sense when you fully reflect on it. "Nature may be red in tooth and claw, but it is not merely so." - Sam Harris. 

I just bought the book and will report on it at ASAP.

The author of the WaPo article has a heavy duty Sheet and a new book out.

"The science of happiness?" There's that word "science" again. More stuff to study and evaluate.


"Physicists, philosophers debate whether research can ever solve certain mysteries of the universe—and the human mind"
Well, duhhh.. Seriously? Scientific American, no less. My favorite Hastie & Dawes quote: "Two Cheers for Uncertainty."

C'mon, think about it.

More to come...

Wednesday, May 1, 2019

AAAS goes "social"

As a member, I just signed up for this. We shall see.
All individual members of AAAS can join up to three Sections. Sections are a great way to network with other members while participating in the AAAS Annual Meeting, and providing our leadership with expertise on issues of importance within the scientific community.
There are 28 "Sections," roughly equivalent to my ASQ "Divisions."
My principal Section, I guess, will be "Social, Economic, and Political Sciences," followed by "Societal Impacts of Science and Engineering," and a 3rd one TBD (a lot to choose from).

apropos of a prior post, is there really a "science of deliberation?" Also, "I am not a scientist."

Unlike some eminent others.


These folks are unhappily going to come to know Bad Bobby--and his attorney. More on that at another time on another blog. Suffice it to say we had a very bad experience with these people, expensively so. My Yelp review rating will start with a decimal point.


Once we get functionally settled in Baltimore in the wake of this CusterFluck transcontinental move, my thrust going forward (as might be inferentially evident from recent topics) will increasingly focus on larger issues, climate change policy and tech (and human health impacts) chiefly among them. If we continue our anti-science global warming remediation denial much longer, advocating "Lean process QI" ways of perhaps shaving another 30 seconds off patient encounter EHR SOAP note workflows is not going to matter materially.

Props to The Neurologica Blog

Just ran across this on Linkedin:

The healthcare industry encompasses a large and diverse workforce with many skills, roles, and practice settings. As our effort builds, we are mindful of supporting all those who are vulnerable to bias, harassment, and discrimination, whether due to gender, gender identity, sexual orientation, race, ethnicity, country of origin, disability, or any other factor.

When TIME'S UP was established in response to the common experience of power inequity and unsafe workplaces for women and other underrepresented groups everywhere, women in healthcare took notice.
We had been having the same conversations about the profound problems in our industry. While women make up over 80% of the healthcare workforce, the decision makers, including hospital leadership, executives and association presidents, are largely men. We continue to work in environments highly tolerant of sexual harassment. We had been gathering in women's groups and social media platforms and saying to each other, “It's time for change!”
We reached out to the TIME’S UP organization and decided to join them and their affiliates in the work of supporting safe, fair, and dignified workplaces, with a focus on the issues and solutions specific to health care. 
In healthcare, we know that lives are saved by working together and improving collective intelligence through teams that are not only diverse, but are respectful, inclusive, and equitable.
Starting from an initial core network of founders, our plan is to grow our team to span a wide variety of roles, types of practice, settings, and locations, until we are a unified and powerful voice for change.
Together, we can create a better future for ourselves, our patients, and future generations of healthcare workers.


More to come...

Friday, April 26, 2019

Telomeres don't fail me now

Thinking about writing a new song (w/ apologies to Little Feat), as I sit here in Baltimore still awaiting the egregiously late arrival of our moving van. Pondering the increasingly noticeable effects of the relentless stressors of the past few years (including this one).

I only think I'm still 18. 73 yr old Coot in Training. Who is this declining-muscle-tone, achy-breaky-back nascent geriatric staring back at me from the mirror? He looks like my late Pop.

Loving our new neighborhood, btw (the Baltimore city "Homeland" district). Everyone is so friendly.

More to come...

Monday, April 22, 2019

An #EarthDay reflection from Baltimore

Still waiting on our (late now on this end) moving truck, sleeping on an air mattress, hotspotting, sitting in fold-up camping chairs, and eating with plastic utensils. A laudatory Yelp review is increasingly unlikely.

I tweeted:

It's now up.

Read all of it carefully. Fine writing, astute, sobering reflections. Eventually none of us will escape the wrath of the unleashed Anthropocene, intractable dilettante denialisms notwithstanding.

See also Ron's excellent 2015 piece "The Sea Also Rises."

Relatedly, I'm well into Bill McKibbin's new book.

Thirty years ago Bill McKibben offered one of the earliest warnings about climate change. Now he broadens the warning: the entire human game, he suggests, has begun to play itself out.
Bill McKibben’s groundbreaking book The End of Nature -- issued in dozens of languages and long regarded as a classic -- was the first book to alert us to global warming. But the danger is broader than that: even as climate change shrinks the space where our civilization can exist, new technologies like artificial intelligence and robotics threaten to bleach away the variety of human experience. 
Falter tells the story of these converging trends and of the ideological fervor that keeps us from bringing them under control. And then, drawing on McKibben’s experience in building, the first truly global citizens movement to combat climate change, it offers some possible ways out of the trap. We’re at a bleak moment in human history -- and we’ll either confront that bleakness or watch the civilization our forebears built slip away.

Falter is a powerful and sobering call to arms, to save not only our planet but also our humanity.
Is it too early to start drinking? (He asks, Samuel Adams Summer Ale already in hand.)


Still no moving van. Unreal. But, yesterday I at least got WiFi hooked up so we can quit piling up those exorbitant Verizon hotspotting bandwidth overage charges.

Eyeball deep into Bill McKibbin's book. This gentle man and astute analytical writer (my analogy is "the James Taylor of environmental journalism") has had death threats over his findings and views? Shameful.

Remediation time is seriously abating, at an accelerating pace. None of us may survive the worst of what looms, should our rigid aggregate denialism continue. McKibben concludes,
…So, yes, we can wreck the Earth as we’ve known it, killing vast numbers of ourselves and wiping out entire swaths of other life—in fact, as we’ve seen, we’re doing that right now. But we can also not do that. We could instead put a solar panel on the top of every last one of those roofs that I described at the opening of this book, and if we do, then we will have started in a different direction. We can engineer our children, at least a little now and doubtless more in the future—or we can decide not to. We can build our replacements in the form of ever-smarter robots, and we can try to keep ourselves alive as digitally preserved consciousnesses—or we can accept with grace that each of us has a moment and a place.

I do not know that we will make these choices. I rather suspect we won’t—we are faltering now, and the human game has indeed begun to play itself out. That’s what the relentless rise in temperature tells us, and the fact that we increasingly spend our days staring glumly at the rectangle in our palm. But we could make those choices. We have the tools (nonviolence chief among them) to allow us to stand up to the powerful and the reckless, and we have the fundamental idea of human solidarity that we could take as our guide.

We are messy creatures, often selfish, prone to short-sightedness, susceptible to greed. In a Trumpian moment with racism and nationalism resurgent, you could argue that our disappearance would be no great loss. And yet, most of us, most of the time, are pretty wonderful: funny, kind. Another name for human solidarity is love, and when I think about our world in its present form, that is what overwhelms me. The human love that works to feed the hungry and clothe the naked, the love that comes together in defense of sea turtles and sea ice and of all else around us that is good.

The love that lets each of us see we’re not the most important thing on earth, and makes us okay with that. The love that welcomes us, imperfect, into the world and surrounds us when we die.

Even—especially—in its twilight, the human game is graceful and compelling.

McKibben, Bill. Falter (pp. 255-256). Henry Holt and Co.. Kindle Edition.
Taking it back to the top,
Thirty years ago, in 1989, I wrote the first book for a wide audience on climate change—or, as we called it then, the greenhouse effect. As the title indicates, The End of Nature was not a cheerful book, and sadly its gloom has been vindicated. My basic point was that humans had so altered the planet that not an inch was beyond our reach, an idea that scientists underlined a decade later when they began referring to our era as the Anthropocene

This volume is bleak as well—in some ways bleaker, because more time has passed and we are deeper in the hole. It offers an account of how the climate crisis has progressed and of the new technological developments in fields such as artificial intelligence that also seem to me to threaten a human future. Put simply, between ecological destruction and technological hubris, the human experiment is now in question. The stakes feel very high, and the odds very long, and the trends very ominous. So, I have no doubt that there are other books that would offer readers a merrier literary experience. [ibid, pg. 1]
 The span between these excerpts is depressingly compelling. See also

Another scary read.

More to come...