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Thursday, February 28, 2019

The scourge of medical billing

I know this stuff all too well. As I'm sure do many of you.

From NPR:
This is what having cancer in the U.S. these days entails - grueling treatment, yes, but also surprising medical expenses, insurance denials, depleted savings accounts, even bankruptcy. Anna Gorman reports from Texas on one family coping with the financial fallout of cancer.


Carol Marley is 50 years old. She has pancreatic cancer. Every day counts. And every day brings a frustrating phone call with an insurer or medical provider.


This is Carol Marley calling. I'm getting ready to be going out of town for a treatment for my cancer, so I really - I need some help. If you could please call me today, I would appreciate it.


Even though pancreatic cancer is one of the deadliest cancers, Carol's doctors caught it earlier than most.


I have faith in God that my cancer is not going to kill me. I have a harder time believing that this is going to get straightened out and isn't going to harm us financially.


Carol is a nurse near Austin, Texas. She was diagnosed in July, and the cancer hasn't spread beyond her pancreas. Her health and the finances weigh on her.


It's incredibly stressful. I mean, I don't sleep at night. I take anxiety medication, you know, more often than I want to...

Just what you need when you're fighting serious, life-threatening illness.

This is a particularly pernicious area exacerbated by chronic data opacity / siloing, and what I irascibly call health IT "interoperabble."

My own 2015 experience with prostate cancer consumed most of that year. My head-scratching hassles with the medical billing industry were mostly a recurrently eye-rolling annoyance. See my prior post "The U.S. healthcare 'system' in one word: 'shards'."

Ten months after losing my younger daughter to pancreatic cancer on April 27th 2017, I continue on her late behalf to foist off aggressive attempts to collect absurd amounts of money (though by now it is abating). Twenty years prior to her death, we lost her elder sister to (unrelated) cancer. Similar postmortem bureaucratic hassles ensued.

Both of my girls died beyond flat broke as a result of their illnesses. Not that any of that mattered to medical bill collectors. But, the money gumshoes all eventually came to learn that they were messin' with the Wrong Irishman.
Danielle is survived only by her son, my grandson Keenan. Notwithstanding that I am not legally on the hook from any of her residual debts, I try to shield him from most of this crap so he doesn't get gamed into assuming liabilities for which he is not responsible. The Wrong Irishman knows the ropes. I used to work in subprime risk management. I know all about delinquency, collections, and charge-offs.
Listen to the entire NPR episode. Read the transcript. I so wish this woman well.
"Every misspent dollar in our health care system is part of someone's paycheck" -- Brent James, MD, M.Stat
Yeah. An observation in passing:
“I don’t think in ideological terms. I never have,” Obama said, continuing on the health care theme. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”

Graeber, David. Bullshit Jobs: A Theory (p. 157). Simon & Schuster. Kindle Edition.
Stay tuned. Once again, political talk of "Medicare for All" and "Single Payer" (my 1994 Argument Analysis pdf) are in the air as the 2020 presidential race heats up. It will no doubt be as contentious as the "Obamacare" reform, if not more so.

apropos, see my post on the CATO Institute book "Overcharged" (a post which cites other relevant reads as well).


Reviewed at Science Magazine:

A science writer probes the one risk factor shared by a bevy of devastating diseases

Chronic disease states—including diabetes, most cancers, and cardiovascular and neurodegenerative syndromes—have become the leading drivers of morbidity and mortality. Medicine has set out to develop therapies for each condition separately, and yet they share a common denominator: aging. This has led to the revolutionary idea that interventions that slow aging will have the biggest impact on our collective health: not just extending life span but also delaying or preventing the onset of many diseases and improving functional parameters later in life.

But what causes aging, and how do we intervene? In Borrowed Time, Sue Armstrong describes proposed hallmarks of aging—which include accumulation of cellular damage, loss of stem cell function, cellular senescence, and others—and makes a cogent case for the role of each in driving age-associated dysfunction. Along the way, she describes the origins and development of the aging research field…
 Looks interesting. Only $9.99 Kindle price. In the wake of the stresses of the past couple of years here, I'm certainly feeling and seeing the effects of aging, at 73 now. 

More to come...

Monday, February 25, 2019

Selling pseudoscience to the gullible

Trump Wants To Set Up ‘Ad Hoc’ Panel To Fight Conclusions About Climate Change: Report
The group of scientists would be tasked with countering a sweeping federal report released last November that warned of a dire future.
Using the Best Words, President Trump dismisses the 2018 U.S. and IPCC climate change reports
Evidence for man-made global warming hits 'gold standard': scientists
OSLO (Reuters) - Evidence for man-made global warming has reached a “gold standard” level of certainty, adding pressure for cuts in greenhouse gases to limit rising temperatures, scientists said on Monday...

More to come...

Monday, February 18, 2019

Selling science: effective communication with decision makers

Finished this excellent, important book across the weekend, and spoke by phone with co-author Amy Aines today.

Highly recommended. Five stars. Not about communicating science to the public, but to decision makers, e.g., philanthropists, grant-making institutions, corporate entities, politicians and government agencies, venture capitalists, etc.
"Selling" is the grubbier, lesser synonym of "championing," yeah, I know. The latter connotes educated, credible sincerity.
Let's cut right to the chase, shall we?


…Executed well, these eleven actions can help every scientist communicate ideas to change the world. Throughout the book, we develop these concepts in detail, but if you get no further than absorbing this list, you will be on your way to becoming a more effective communicator and science champion.

  1. Be passionate. Palpable enthusiasm is contagious. It will carry people along for the great ride of science. Sharing what inspires you about your work will help others see its potential.
  2. Build the big picture first. Resist the temptation to dive into the details. Frame what you say by succinctly explaining what exists today, the future possibilities, and how your work will fill the gap.
  3. Know who’s listening. Think carefully about what your audience knows and their prevailing sentiment. Determine what you want them to think, do, and feel after they hear from you. Find out how they like to receive information and adapt accordingly.
  4. Spend more time on why it matters and less time on how you do it. Never promote science for the mere sake of science. Always demonstrate the value to people and the planet we inhabit.
  5. Extract the essence. Formulate your overarching messages and support points. Tell that story. Never dumb it down.
  6. Be understandable. Use plain, common language. Avoid or translate acronyms. Start from where your audience is, not from where you are. Use iconic references to anchor scientific concepts to everyday, familiar experiences.
  7. Balance precision with impact. Choose language carefully to be clear and directionally accurate. Long phrases bog down the listener. Think and speak in short sentences. There is no need for hype. Learn to deliver a compelling narrative.
  8. Be human and credible. The integrity of your word must be unquestionable. Verify your facts. Evaluate your sources. Be yourself. Make an emotional connection by showing up as a person first and a scientist second.
  9. Influence patiently. Convincing decision makers is a process, not a single act of persuasion. Use information as a gift. Engage often to build understanding and show the value of supporting your science. Learn what matters to your audience.
  10. Collaborate thoughtfully. Advancing your ideas doesn’t mean you have to go it alone. Seek out advisors, influencers, and partners who can help carry your science further.
  11. Enable your listeners to act. Know the purpose of your communication. Make the ask every time. Leverage each conversation and presentation to build support for advancing your work. Remember that you are ultimately building relationships for the long run.
Aines, Amy L., Roger D., Championing Science, University of California Press. Kindle Edition locations 280- 295.
My advice? Commit these 11 tenets to memory. Repeat them to yourself aloud multiple times.

I read the book with intense interest and enjoyment, and can attest that they made the case thoroughly. I would make this required reading in scientific curricula.
Scientists are great communicators—with other scientists. We are schooled in the exacting art of talking to our professors and colleagues, people deeply steeped in both the importance and the nuance of our topic. We can talk about the incredible details of modern science in an efficient way, condensing complex arguments into short discourses. But once we go out beyond the academic world to make an impact, scientists from every discipline face a brand new challenge—communicating science to decision makers.

Decisions about which scientific endeavors are advanced and how they are pursued usually get made by people who are not experts in the field. Corporate chief technology officers, elected officials, government program managers, venture capitalists, heads of nongovernmental agencies, and, often, senior management have the power to award funding and support new discoveries. These decision makers are well educated, hardworking, sincere, and extremely busy. Over the course of a day, they may be expected to make important decisions on topics spanning a myriad of unrelated fields. It is incumbent on us as scientists to quickly and effectively make our case. We must learn to talk about our work in succinct and compelling ways that convince the people who are pivotal to our success to take action…
[ibid, Kindle location 106]
Indeed, indeed. I am pretty well up to speed on the persuasion psych and "critical thinking" literature (with a particular focus on clinical reasoning), but after reading Amy and Roger's book I feel significantly better informed.

Below, from Amy's website:


A lot to reflect on here. I jotted down an entire page of notes for my call with Amy. She had spot-on answers for all of my questions.


Of direct relevance to Championing Science, recent OpEd in Science Magazine:
Scientists work with a deep sense that their quest for reliable knowledge leads somewhere—that following the evidence and excluding bias help to make sense of the world. It may be a slow process, and interactions in the scientific community are not without friction and false steps, yet scientists are devoted to the quest because they observe that it works. One can make sense of the world. Einstein famously said, “the eternal mystery of the world is its comprehensibility,” and scientists understand that evidence-based scientific thinking leads to this comprehension. Scientists could do a better job of sharing this powerful insight.

As I fret over recent challenges to democracy, it seems that a cure for what ails democracy may lie, in part, in science. Citizens are increasingly asserting their values, hopes, and opinions without apparent interest in finding a shared understanding of the actual state of things. Without such a shared understanding, those values and hopes cannot rationally be expressed and realized. Observers speak of “truth decay,” dismissal of expertise, and neglect of evidence. Collectively, these are problems of enormous importance because they threaten democracy itself. Democracy is at risk when it becomes simply a contest of fervently held opinions or values not grounded in evidence…
Amy and I had a cool discussion concerning the word "evidence" (I asked what it meant to her). We use it all the time, but do we all mean the same thing? "Evidence," in my view, is simply that which makes a true conclusion more likely -- or, in rare cases proves it outright. Everything else is just noise -- language and data clutter. As such, evidence ranges from "nil" to "dispositive." Envision a bell curve distribution (or a skewed or flat distribution) of "evidence." In popular language we typically refer to evidence in qualitative terms, i.e., nil-to-weak-to-moderate-to-strong-to-incontrovertible. In science, they love their "p-values" (going to probability estimates). 
Another tangential point: evidence must not only have "truth value" but also "materiality," topical relevance. Ask any trial lawyer.
For now, speaking of "Science," recall my prior post "The Science of Success?"

I was dubious when I first saw that title, but, again, case made. Also highly recommended. As is this one below:

If you hope to initiate or change beliefs, it behooves you to understand the salient aspects of them.


Amy sent me this YouTube link:
An Evidence-Based Approach to Science Communication — Webinar

Alan Alda Center for Communicating Science

For all our careful work, scientists can still succumb to biases and assumptions that sabotage our efforts to engage with the public. Valuable new insights into public attitudes towards science are replacing conventional opinion with solid data. Learn how to avoid falling into the traps that still plague many in the scientific community...
BTW, You may have noticed that I'd accorded the Alan Alda Center a permanent right-hand column link on this blog.
Everything is "branding" these days.
Interesting, from the above webinar:
Christopher Volpe, PhD, @4:13 “...For the last 20 years, I’ve really been more of a professional marketer then I’ve been a scientist, and that makes some science folks cringe, but, believe it or not, the scientific method and the marketing method are remarkably similar, they just use different languages...”
Hmmm... how about "The Presentation Secrets of Steve Jobs?"

Recommend you visit also the "Science Counts" website:

"ScienceCounts is deciphering Americans’ complex views about science to develop more effective ways to foster grassroot support for scientific research and exploration."

Championing Science cites Robert Cialdini's "Six Principles of Influence": reciprocity, commitment/consistency, social proof, authority, liking and scarcity.
I am also reminded of Howard Gardner's book Changing Minds and his "7 Re's": seven levers for persuading others to embrace new ideas:
  1. Reason: You present all relevant considerations of an idea, including its pros and cons.
  2. Research: You provide numerical and other information about your idea’s ramifications, or data relevant to your idea.
  3. Resonance: You and your ideas are convincing to your listener because of your track record, effective presentation, and sense of your audience.
  4. Representational redescriptions: You deliver your message in a variety of formats, including stories, statistics, and graphics.
  5. Resources and rewards: You draw on resources to demonstrate the value of your idea and provide incentives to adopt your idea.
  6. Real-world events: You monitor events in the world on a daily basis and, whenever possible, draw on them to support your idea.
  7. Resistances: You devote considerable energy to identifying the principal resistances to your ideas (both conscious and unconscious resistances) and try to defuse them directly and implicitly.
As I reflect on all of the foregoing, I should again note that I am not a scientist. Just an aware, concerned citizen. We have serious pressing issues that will be in ongoing need of science and public support for it. I would put climate control science at the top of the list. Failure there will exacerbate of host of other serious global social, public health, political, and economic problems, perhaps irremediably so.

I have no illusions regarding the difficulties involved in "selling science" where it butts up against powerful economic interests with huge stakes in an unsustainable status quo. We gotta Bring Our A-Game.


I've been pondering science issues for a long time, particularly in the medical space. From my "One in Three" essay in the late 1980s concerning my late elder daughter's cancer illness:
Is science the enemy? To the extremist "alternative healing" advocate, the answer is a resounding 'yes'! A disturbing refrain common to much of the radical "alternative" camp is that medical science is "just another belief system," one beholden to the economic and political powers of establishment institutions that dole out the research grants and control careers, one that actively suppresses simpler healing truths in the pursuit of profit, one committed to the belittlement and ostracism of any discerning practitioner willing to venture "outside the box" of orthodox medical and scientific paradigms.

One e-mail correspondent, a participant in the internet newsgroup, vented splenetic at length recently regarding U.S. authorities' alleged hounding, arrest, and imprisonment of alternative healers. He railed that law enforcement, at the behest of the AMA/FDA Conspiracy (a.k.a. the "corrupt AMA/FDA/NCI/ACS cartel"), had made the practice of alternative medicine illegal in the U.S. Moreover, he considered the fact that medical science can only claim "cures" for approximately 10% of the roughly 10,000 classified human diseases an a priori indictment of the mainstream profession.

I know: this is akin to the U.N. Black Helicopters/One-World-Government Conspiracy stuff of the not-too-tightly-wrapped…
Those anti-science attitudes have hardly gone away.


Just came across this book via a MSNBC interview segment. Downloaded it and started my study.

…Perversely, decades of climate denial and disinformation have made global warming not merely an ecological crisis but an incredibly high-stakes wager on the legitimacy and validity of science and the scientific method itself. It is a bet that science can win only by losing. And in this test of the climate we have a sample size of just one.

No one wants to see disaster coming, but those who look, do… all told, the question of how bad things will get is not actually a test of the science; it is a bet on human activity. How much will we do to stall disaster, and how quickly?

Those are the only questions that matter…

Wallace-Wells, David. The Uninhabitable Earth (p. 219). Crown/Archetype. Kindle Edition.
Again, I refer you to my "Anthropocene Denial" series of posts.

From the foregoing page 219 near the conclusion of David's book, let us return to his onset, page 3.
It is worse, much worse, than you think. The slowness of climate change is a fairy tale, perhaps as pernicious as the one that says it isn’t happening at all, and comes to us bundled with several others in an anthology of comforting delusions: that global warming is an Arctic saga, unfolding remotely; that it is strictly a matter of sea level and coastlines, not an enveloping crisis sparing no place and leaving no life undeformed; that it is a crisis of the “natural” world, not the human one; that those two are distinct, and that we live today somehow outside or beyond or at the very least defended against nature, not inescapably within and literally overwhelmed by it; that wealth can be a shield against the ravages of warming; that the burning of fossil fuels is the price of continued economic growth; that growth, and the technology it produces, will allow us to engineer our way out of environmental disaster; that there is any analogue to the scale or scope of this threat, in the long span of human history, that might give us confidence in staring it down.

None of this is true...
[ibid, pg 3]
David expresses a bit of qualified caution at the beginning of his end notes section (which comprises roughly 30% of the book's volume).

All science is speculative to some degree, subject to some future reconsideration or revision. But just how speculative varies from science to science, from specialty to specialty, indeed from study to s

Within climate change research, both the fact of global warming (about 1.1 degrees Celsius since humans first began burning fossil fuels) and its mechanism (the greenhouse gases produced by that burning trap heat radiating upward into the planet’s atmosphere) are, at this point, established beyond any shadow of a doubt. Exactly how that warming will play out, over the next decades and then the next centuries, is less certain, both because we don’t know how quickly humans will drop their addiction to fossil fuels, and because we don’t know precisely how the climate system will recalibrate in response to human perturbation. But the notes that follow are, I hope, a road map to the state of that science, in addition to being a bibliography for this book.
  [ibid, pg 233]
Since I posted the foregoing, I've run into some pushback from noted climate scientist Michael E. Mann (whom I've cited before).
"The evidence that climate change is a serious problem that we must contend with now, is overwhelming on its own. There is no need to overstate the evidence, particularly when it feeds a paralyzing narrative of doom and hopelessness."
More on all that in a bit. Are we to be continually stymied by "analysis paralysis" / credibility contention going to complex issues of science having significant economic and ethical policy implications?

UPDATE: I finished The Uninhabitable Earth. Riveting. Sobering. It will have to have its own review post. Highly recommended. 


Trump’s pick to lead climate security panel calls climate science ‘a cult’
Rear admiral slams "extreme, fringe" pick to head White House climate and security panel.

In his ongoing war with U.S. intelligence agencies, President Donald Trump is now challenging the military’s longstanding conclusion that climate change poses a serious national security threat to America, appointing a fringe climate science denier to lead the effort…

apropos of the climate issue, ran into what looks to be another interesting book (available on Feb 26th).

The Amazon preview looks very intriguing.
For the entire globe, the era of plentiful water appears to be over.
Forget energy price shocks, mass unemployment, fiscal crises and financial failures. Even biodiversity loss, ecosystem collapse, human-made environmental catastrophes or the spread of infectious diseases pale in comparison…

Water problems are also strongly linked to two other prominent global risks—climate change and food insecurity. By 2050 more than 40 percent of the world’s population will be living in water-stressed regions, which is around 1 billion more people than live in such areas today. Around 2.7 billion people are also affected by water shortages each year. Meanwhile, 663 million people—one in ten of the world’s population—lack access to safe water and 2.4 billion—one in three—do not have use of a toilet. These water stresses and shortages will only worsen with the rising temperatures, more frequent droughts and variable rainfall that will accompany global warming. Growing water scarcity will, in turn, magnify the economic and environmental impacts of climate change.

Barbier, Ed (2019-02-25T22:58:59). The Water Paradox. Yale University Press. Kindle Edition.
You might like my 2015 rumination on "The Western US Drought."

More to come...

Sunday, February 10, 2019


The Big Show, the "Comdex of Health IT" (remember Comdex?) Not going this year. My last HIMSS Conference trip was HIMSS16 in Las Vegas. I appreciate them first comping me a press pass back in 2012. I've met a lot of cool people across my HIMSS Conference years.

I'm sure it'll be great. I'll just follow the tweets and news like lots of others. Expect the usual overload of grand, Gartner-hyperenthused rhetoric amid the keynotes and topical sessions. It's first and foremost a trade show. HIMSS is an $80+ million a year "non-profit" business. Look at their IRS 990s.
The average primary care doc makes about $200k a year. The CEO of HIMSS is paid about $1 million annually. Jus' sayin'.
Wonder if there will be any chatter about this (below) at HIMSS?

As Democrats mount 2020 Presidential campaigns, this is already a front-burner topic.

UPDATE: HIMSS 2019 News, Trends, and Analysis from TechTarget. Succinct coverage.

Also, apropos of "health information,"

I'd notice this title before. It's not yet released (according to Amazon), but THCB has a good post reviewing it today, "Obsessive Measurement Disorder: Etiology of an Epidemic." Kip Sullivan rocks. I can't top that review.

Loved this:
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”

More to come...

Wednesday, February 6, 2019


Earth's long-term warming trend can be seen in this visualization of NASA's global temperature record, which shows how the planet's temperatures are changing over time, compared to a baseline average from 1951 to 1980.

UPDATES: "Can We All Agree the Earth Is Warming Yet?" and "Climate Change, or 'just the weather'?"


Let a million renderings of hip clip art ensue. I've not yet seen any details regarding what draft legislation has been offered up, but, suffice it to say, nothing will get through the still- GOP-controlled Senate (much less get Trump's signature). UPDATE. Legislative news from Naked Capitalism.

UPDATE: more Green New Deal news. All "sound and fury?" Or even more diabolical? Hmmm... Comrades?

LOL. SMH. Yeah, I know.

More to come...

Saturday, February 2, 2019

Americans don't get enough fiber

Last mile optical fiber, in addition to diet.

Got onto this via a Science Magazine book review (may be firewalled).
In her latest book, Fiber, legal scholar Susan Crawford writes about the role of fiber optic cables as the enormously capable conduits of digital data flows. According to Crawford, fiber is the technological enabler that affords true high-speed internet connectivity. But even though the technology is well understood, incumbent telecommunications providers in the United States have so far failed to bring fiber to most homes.

This has locked the American people into slow and outdated internet connections that are grossly overpriced, especially outside major urban areas, stifling innovation and economic growth and perpetuating social, economic, and geographic inequalities. And whereas in other nations, from Singapore to Sweden, regulators have worked to make fiber available and affordable for many, in the United States, federal and state policies have acted as impediments to widespread fiber availability...
A very interesting read. We should be pushing massless pure energy photons around in lieu of electrons. The enormous differential bandwidth capacity implications are mind-boggling.

 From the Amazon blurb:
The world of fiber optic connections reaching neighborhoods, homes, and businesses will represent as great a change from what came before as the advent of electricity. The virtually unlimited amounts of data we’ll be able to send and receive through fiber optic connections will enable a degree of virtual presence that will radically transform health care, education, urban administration and services, agriculture, retail sales, and offices. Yet all of those transformations will pale compared with the innovations and new industries that we can’t even imagine today. In a fascinating account combining policy expertise and compelling on-the-ground reporting, Susan Crawford reveals how the giant corporations that control cable and internet access in the United States use their tremendous lobbying power to tilt the playing field against competition, holding back the infrastructure improvements necessary for the country to move forward. And she shows how a few cities and towns are fighting monopoly power to bring the next technological revolution to their communities.
The history of fiber optics goes back to the 1960s, with the invention of the laser. Lasers apply energy to billions of atoms, exciting their electrons and making them emit photons that then turn around and make already-excited atoms give off even more photons. When some of the photons are allowed to escape, the result is an amplified, concentrated beam of light—Light Amplification by Stimulated Emission of Radiation, or LASER. That light has a frequency; it is wobbling at a rate of millions of millions of times a second, and each of those wobbles can be modulated to carry data. That [sic] data then travels at the speed of light.

The trouble was how to transmit that focused data reliably from point A to point B. Light can be carried by water—just imagine a nighttime fountain lit by purple light from below—but light can’t carry information through water very far. You need the waves to maintain their strength and definition in order for the information they carry, encoded in the height or frequency of these waves, to be understood. Back in the late nineteenth century, a Viennese medical team identified only as “Dr. Roth and Prof. Reuss” experimented with guiding light through bent glass rods to illuminate body parts during surgery.4 With the arrival of the laser, scientists saw the possibility of guiding information across many miles with very little loss of accuracy.

Enter “optical fiber.”…
Crawford, Susan. Fiber. Yale University Press. Kindle Edition [Location 382]

Very good, though mostly about "telemedicine" applications for optical fiber.
Most U.S. states already require private insurers and Medicaid to reimburse for a wide range of telemedicine-provided services without discrimination. But the field is still in its infancy: often, “telemedicine” means either very-low-bandwidth remote patient monitoring (of blood pressure, for example), or simply a phone call with a provider. It’s hard to imagine a doctor-patient relationship forming through just phone calls, emails, text messages, and online questionnaires. Several states have restricted or banned reimbursement for telemedicine services that fall short of full-bandwidth communications. That makes sense: the game-changing, cost-reducing developments will require the real-time, reliable, visible presence of health professionals in patients’ actual lives; a human, two-way connection that can convey empathy and compassion as well as two-figure data updates. Those are the connections that can vastly reduce the country’s spending on hospital and in-office care.

The problem is that the vast majority of Americans—upward of 84 percent of us—don’t live in a house that has a fiber connection to the outside world. And unless we upgrade to fiber as a country, we will never be the nation with the world’s most advanced health care system. Instead, we will make more people unsafe and sicker, keep people waiting unnecessarily at medical offices and hospitals all over the country, and spend untold billions on services that are inadequately tailored to people’s individual needs…
Fiber, location 2108
OK, that's all good, as far as it goes. Add to that perhaps some advances in portable dx technologies like, say, a football helmet size "brain MRI" unit delivered to your door. Strap it on, hook it up to your fiber optic internet interface, and let your clinicians get an MRI remotely in real time? More mundanely, I might get my next follow-up Cardiac Echo done here at the house. Labs, vitals, etc?

Lots of apps potential (beyond trendy wi-fi'd "wearables").
apropos of my prior post on updates regarding Jeff andApril's NeuroTrainer, perhaps they could develop a wrap-around VR "helmet" for real-time neurological monitoring while engaging with core the NeuroTrainer technology?

Often, when I begin a new read, I first do some keyword/phrase searches, to cut to a chase of interest. In this case, "crypto," "blockchain," distributed ledger," "bitcoin," "datamining, "data mining..."
"0 matches found."
Need I elaborate? I usually reach for my Photoshop...

Will variants on the word "photon" become the "cool" new shiny thing to add to your start-up's name to bump up your VC market cap? One dude in Pennsylvania has already been squatting "" for some time. No website, no business activity, just a domain name registration going back a number of years, LOL.

Seriously, read up on the breathtaking, unsustainable energy consumption of crypto data mining (all of which results in heat). Now, I couldn't give a flip about "Bitcoin" et al. I call that stuff "digital tulips." But "blockchain" is a current (Gartner Hype Cycle?) darling in the health care space (along with other commerce domains).

Transmit and compute with photons.
Of course, that assumes not only practically infinite fiber optic data transmission, but also optical-based integrated circuit boards in the computers doing the end-point processing. There's a reason why your laptop heats up in your -- well -- lap while you use it. There's a reason why Microsoft recently moved a huge server farm under the ocean.
See, e.g., "Photonic Integrated Circuit." See also stuff like
Fiber optic biosensor-integrated microfluidic chip to detect glucose levels
By integrating microfluidic chips with fiber optic biosensors, researchers are creating ultrasensitive lab-on-a-chip devices to detect glucose levels

Taking it back to the top. In sum, Susan Crawford's Fiber is a great read. Notwithstanding that her policy recommendations -- with which I agree -- are swimming against a serious anti-regulatory Trumpian mega-corporate Rentier tide.
We’re missing a leader who has had the experience of connectivity over fiber—or at least understands that it is possible and necessary—and, like Lincoln, understands the connection between this upgrade and economic growth and social justice. That person needs to be a first-rate communicator, able to convey with color and verve why Americans should not have to settle for expensive, second-class data services, and why we cannot remain the world’s leading economy without first-class connectivity.

The second key step, one only a leader backed by federal agencies and Congress can take, is to declare (enforceably) that the standard connection for a thriving life in America requires a reasonably priced, open fiber network running to homes and businesses. Such a declaration could itself drive the upgrade: ancient last-mile copper networks could be forced into retirement through tax policy and other incentives; poles and conduit could be subjected to basic openness requirements as a matter of regulation and local ordinance; new housing could be approved for habitability and federal support only with fiber-readiness or actual fiber attached. By saying that anything that wasn’t fiber-ready, or actually connected to open fiber, wouldn’t be supported by federal funding, the federal government could push the entire process forward. There are limits to this power: state tax rules and state constraints on local authority can get in the way, and the details are difficult. But the federal government can do a great deal in the vast portion of the marketplace that is touched, directly or indirectly, by federal funding…
[Fiber, location 3596]
Lordy. "...convey with color and verve..." Is it too early to start drinking yet?


I cited this excellent Michael Lewis book last year.

FinTech applications of optical fiber, where milli- to microseconds of time burden ("latency") equate to big money.


To the broader point of this post (as pertining to the medical space), from the always excellent Neurologica Blog:

Powering Implantable Devices

...[O]nce we have the ability to self-power implantable devices, with small enough electronics that they can fit in tight biological spaces, and produce enough energy to work with, people will find many applications. Researchers are also working on developing more “squishy” electronics, that are flexible and will move with the body and are biologically compatible. More efficient electronics (for example, using carbon nanotubes) allow for using less energy and producing less waste heat.

Multiple features are progressing steadily and moving in the direction of better powered biological devices. We are probably rapidly moving in the direction of the human cyborg, developing technology that we can comfortably merge with. And as I often speculate – at first such technology will be used to mitigate and treat medical problems, but eventually may be used for routine monitoring and disease prevention, and then for augmentation.
Indeed. The Neurologica Blog should be on your daily surfing list.


Yet another one on deck:

Book reviews at Science Magazine and Science Based Medicine plus the Amazon "Buy now with 1-click" are gonna put me in Chapter 11, lol. "Communicating your ideas to decision makers?" Say, well, like patients? Hmmm... that whole messy "Art of Medicine" thingy?

More to come...