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Friday, July 19, 2019

Baltimore: The Real News Network

Nice logo.

Last weekend Cheryl and I were traversing downtown Baltimore on our way to Pigtown when I saw a large sign on the side of a building. Turns out "The Real News Network (TRNN)" is located here (as well as in Toronto). That had escaped me.

I'd been aware of them online for quite a while, given my daily news surfing stops at the Naked Capitalism blog, which routinely features their videos, replete with interview transcripts.

I dig their Mission Statement:
The Real News Network (TRNN) produces independent, verifiable, fact-based journalism that engages ordinary people in solving the critical problems of our times. As legendary journalist Ida B. Wells said, “The people must know before they can act, and there is no educator to compare with the press.”
We examine the underlying causes of the chronic problems, and investigate and report on effective solutions and models for change. We don’t just cover people in high office or limit news to the partisan horse race for power. People who fight for human rights and work for solutions are newsmakers. We believe that real change will be driven by the people who need it most.
While we report on and investigate all important issues of social and economic concern, we consider the climate change crisis an existential threat. In all of our programming and journalism, the impact of environmental degradation and the climate crisis, especially on marginalized people, and the urgency of finding solutions will be front and center. 
Our motto is “The Future Depends on Knowing.”...
"We consider the climate change crisis an existential threat."
I am so with you on that call-out point. See, e.g., here, and here.

One of TRNN's numerous topical areas is that of health.

Yeah. I've been hip to Wendell Potter for a long time.

"Environment" topics?

More and more, I am going to focus on our accruing environmental crises (note plural)--from a pubic health perspective and more. Shaving another 30 seconds off a clinical EHR SOAP Note patient encounter workflow won't mean diddley if we allow our world to turn into a cheesy 'The Day After Tomorrow" disaster flick.
"We examine the underlying causes of the chronic problems, and investigate and report on effective solutions and models for change."
No small tasks. I'll certainly be watching.


Wendell Potter's initiative.
"Tarbell is pioneering journalism that informs, galvanizes and changes America.We take a unique approach to coverage of money in policy, not just politics.

We uncover how powerful people and companies use their influence to shape a system that works for them, not you. We highlight solutions to pressing problems. Our fiercely independent, unbiased news inspires our members in all 50 U.S. states to take action.We understand there are stories that matter to all Americans.

believe there’s journalism that can inspire people to see how much we agree. We know people want actionable, evidence-based solutions..."
The foregoing brings back to mind this cool book I reviewed in 2017:


The Tech Oligarchs Are Going to Destroy Democracy — Unless We Stop Them
Once, the big tech firms embodied American exceptionalism and aspiration. Today, they are strangling these ideals. Government: do something.
Joel Kotkin, for Daily Beast Inside

Congressional posturing about tech firms may have quieted for the moment, but the existential crisis that these firms are creating remains as now unchecked. Even faced with opposition on both sides of the aisle, the oligarchs—those five tech giants that now constitute the world’s five most wealthiest companies—continue to rapidly consolidate economic, cultural, and, inevitably, political power on a scale not seen for over a century.

This tiny sliver of humanity, with their relatively small cadre of engineers, data scientists, and marketers, represent a challenge to democracy, competitive capitalism, and the future of the middle class. Given their virtual monopoly status, a laissez faire approach will likely result in more consolidation; only government action of some kind can stop them now. Current concerns are large enough now that both the Trump administration and many Democrats oppose Facebook’s bid to issue its own currency. That’s a hopeful first step.

Historian Jeffrey Winters defines oligarchy as being based on “extreme concentrations” or power and wealth. Whether in ancient Athens or Rome, or contemporary New York or London, this overclass tends to be “unusually resistant to radical dispersions of power.” In our time, the ascendant tech oligarchy, as a recent World Bank Study suggests, have exploited “natural monopolies”—roughly 80- to 90-percent control of most key digital markets —that adhere to web-based business, and have served to further widen class divides not only in the United States but around the world.

The imperative for all oligarchies is to preserve their power. Once the media lights are off, and the posturing is done, the oligarchs can continue  playing a clever double game, making common cause with the defenders of capital and pouring money into the welcoming arms of the conservative think tanks…

 It might seem strange to think that the slick, urbane, and well-educated oligarchs as a greater threat to our future freedom than the blathering apostle of “fake news.” But despite his crude statements, it’s not Donald Trump curbing free speech and consigning even the mildly dissident into digital exile. If he loses next year, Trump will leave office as the bizarre leader of a peasant rebellion, but we could be living with the oligarchs information empire for decades…

…Long after Trump has retreated to his world of golf links and gold-plated faucets, an embarrassment at best, oligarchs like Jeff Bezos, Marc Benioff, and Lauren Jobs, widow of the late Steve Jobs, will have gained ownership over the nation’s fading traditional media.

But the main vehicle for oligarchical wealth comes from the exploitation of personal data, what Alibaba founder Jack Ma calls the “electricity of the 21st century.” These “super platforms,” as one analyst noted, “now operate as “digital gatekeepers” lording over “e-monopsonies” that aim to monitor our lives in ways even the snoop-crazy Chinese would admire. Firms like Facebook and Google seek to ferret out “psychographic” profiles as part of their core business.

We are already headed toward a world controlled by these super-snoopers. With their enormous financial resources and control of the key digital channels, they are positioned to dominate older industries like entertainment, education, and retail, as well as those of the future: autonomous cars, space-exploring drones, and most critically artificial intelligence…

In its earlier iteration, Silicon Valley was a uniquely egalitarian place where outsiders made success and working people had decent incomes. Today, Wired magazine's Antonio Garcia Martinez has labeled Silicon Valley as ‘feudalism with better marketing.” Despite enormous wealth, tech-driven cities like San Francisco and increasingly Seattle have become dysfunctional places, with massive homeless populations and a shrinking middle class. The urban website CityLab has described the Bay Area as “a region of segregated innovation,” where the rich wax, the middle class wanes, and the poor live in increasingly unshakeable poverty…

Once, the tech moguls legitimately could be sold as exemplars of American exceptionalism. But now, if unrestrained, the moguls are likely to be its assassins. Once, it was wise to let them work their magic unimpeded. But now, if we do this, we will create a society that is profoundly hierarchical, uncompetitive, and undemocratic. They need to be stopped, and now, or the world of tomorrow will not be a place we would like our children to inherit.

(Paywalled. Fairly long read. Subscribe. It's worth it.) 
AAAS proposes a "Science of Deliberation" as crucial for functional "democracy."

Assumes that we all want democracy. Enthusiasts of technocracy, "epistocracy," 'libertarianism" (please), aristocracy, autocracy, oligarchy, monarchy, etc., might well (and do) differ. And, in that regard in the wake of "Citizens United," "one person, one vote" is fast becoming "one dollar, one vote" in the U.S.

More to come...

Wednesday, July 17, 2019

Define "health"

Excellent article at STATnews:
It's time to change the definition of 'health'

The WHO defines health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Centers for Disease Control and Prevention, along with a range of WHO partners, endorses this definition...

A definition of “complete” health as the absence of disease leaves little space for people with chronic diseases and for managing them in new ways. Together, the increasing numbers of Americans over age 65 (currently 51 million) and even over age 85 (currently 6.5 million), with more than 617 million over age 65 worldwide, along with transformations in disease definitions and treatment, amplify the dissonance between the experience of living long and the definition of health...
Read all of it.

When I signed on to Kaiser-Permanente (Medicare Advantage) in June after our move to Baltimore, I self-rated my "health" as only "fair" on their intake form forced-choice Likert scale question. It's way more complicated than that. But, I do know one thing; were we still under pre-Obamacare "medical underwriting," people like me would be declared "uninsurable" irrespective of our rank-ordered self-assessments.
My "health," like that of many people close to my age (I would speculate) comprises a multidimensional distribution exuding highs and lows and averages along various axes. Given the stresses of the past few years (my 2015 prostate cancer dx and tx; losing a second daughter to cancer; my 2018 open heart SAVR px; our fractious April 2019 transcontinental move), I continue to ail a bit physically. But, I have never been more intellectually and socially engaged notwithstanding. Cognitively, I have to keep on being a (post-mid) "life-long unlearner." Socially, I have to give, give back.
I'll be adding this STATnews item to my list of "definitions" in need of closer scrutiny. 
Q: "What's the definition of a 'well person'?"
A: "A patient who has been inadequately worked up."

Recently at THCB: 
Landmark Results Achieved in Aging and Chronic Disease: Danish Group Extends Disease-free Life by 8 Years

New Scientific Breakthroughs Can Provide a Longer Healthier Life
Twenty-one years of follow-up comparing usual care with a protocol-driven team-based intervention in diabetes proved that healthy life in humans can be prolonged by 8 years. These results were achieved at a lower per patient per year cost. Aging researchers have been confident that we will soon be able to prolong healthy life. This landmark study shows this ambitious goal can be achieved now with lifestyle intervention and a few highly effective proven medications. These medications interfere with the core molecular biology that causes chronic disease and aging. These same medications will likely produce similar results in patients with congestive heart failure, chronic kidney disease, arterial disease, history of heart attack, hypertension, and angina. Simple medical interventions can extend healthy lifespan today.

Better Chronic Disease Management Can Improve Health and Lower Costs
90% of health care costs come from chronic diseases and aging which are both related. The same biochemistry that causes aging causes chronic disease. Eating processed food, gaining weight, smoking cigarettes, and sitting on the couch accelerate aging and chronic condition development. Those activities switch on genes that should be quiet. Eating real food, avoiding cigarettes, activity, lisinopril, losartan, atorvastatin, metformin, (and spironolactone) are now proven to extend healthy life by 8 years in patients who are at high risk of health catastrophes and early death! These medications all cost $4 a month except for atorvastatin which is $9 a month. The benefits continue even when best practice treatment stops probably because these treatments block signaling from dangerous genes that are inappropriately and persistently turned on…
 Nice. Again, read all of it.


On my iPhone...

Read this book.

Cited it here (scroll down).


It's hot in Baltimore this week.

apropos, see KHN's "Climate Grief."

I know it bums me out.

More to come...

Monday, July 15, 2019

Biden Cancer Initiative goes dark

In on my iPhone a bit ago,

Well, that didn't last long.

Cheryl and I went to one of their conferences in Concord, California last year. Given our painful personal cancer connection, I quickly put 'em in a links columns hard link here on the blog, wrote 'em up, and reached out to them multiple times asking how we might help.

Not one peep in reply.

Last year they had gross revenue of just under $4 million. No outrageous payroll. Paid their President Greg Simon about $225k. The Bidens took nothing. Nothing untoward that I can see lurking in their IRS 990. (pdf)

At the risk of sounding uncharitable, though, BCI came to seem to me a bit of a well-meaning hobnob-with-VIPs "vanity project." Endless talk-talk-talk "summits" empaneled by clinicians, policy people, celebs, and patients. We already have plenty of those.

I guess it's problematic now, with Joe running for President.

Biden proposes massive new Obamacare subsidies, public option in health care plan
Joe Biden is proposing massive new subsidies to make health coverage through Obamacare's exchanges cheaper -- as well as a new "public option" that would allow people to buy into a program his campaign says would be similar to Medicare.

The former vice president unveiled his health care plan Monday morning amid an escalating fight with his 2020 Democratic presidential foes as some more liberal candidates advocate enrolling all Americans in a national health plan, all but eliminating private health insurance.

Vermont Sen. Bernie Sanders is set to deliver a speech making his case for "Medicare for All" on Wednesday, according to his campaign. And California Sen. Kamala Harris, who has similarly backed a single-payer, government-run health program, teased the upcoming rollout of her plan in front of a crowd in New Hampshire on Sunday, too.

Biden, meanwhile, is pushing for a more moderate approach, built on former President Barack Obama's Affordable Care Act.

"We should not be starting from scratch. We should be building from what we have. There's no time to wait," Biden told an audience in Dover, New Hampshire, on Friday.

He said that under his plan, if "you like your employer-based insurance, you get to keep it." Under other leading Democrats' plans, he said, "you lose it, period.”…
Oh, boy... I wrote a post in 2009 titled "Public Optional."

I am reminded of a passage from a David Graeber book:

wherein he asks,
Does this mean that members of the political class might actually collude in the maintenance of useless employment? If that seems a daring claim, even conspiracy talk, consider the following quote, from an interview with then US president Barack Obama about some of the reasons why he bucked the preferences of the electorate and insisted on maintaining a private, for-profit health insurance system in America:
“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?”
I would encourage the reader to reflect on this passage because it might be considered a smoking gun. What is the president saying here? He acknowledges that millions of jobs in medical insurance companies like Kaiser or Blue Cross are unnecessary. He even acknowledges that a socialized health system would be more efficient than the current market-based system, since it would reduce unnecessary paperwork and reduplication of effort by dozens of competing private firms. But he’s also saying it would be undesirable for that very reason. One motive, he insists, for maintaining the existing market-based system is precisely its inefficiency, since it is better to maintain those millions of basically useless office jobs than to cast about trying to find something else for the paper pushers to do.

So here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs…

Graeber, David. Bullshit Jobs: A Theory (p. 157). Simon & Schuster. Kindle Edition.


BTW, we've now lived in Baltimore for 3 months, rolled in overland from California on Monday April 15th.

Likin' it. Interesting city. Lots of problems. Hot as Hades this week.

I subscribe to the Baltimore Sun "eNewspaper." It's a daily digital version of the print paper. It's very cool. Love it on my 27" iMac.

More to come...

Sunday, July 14, 2019


"Declining vaccination rates not only reflect a great forgetting; they also reveal a population that suffers from overconfidence in its own amateur knowledge. In her book Calling the Shots: Why Parents Reject Vaccines, the University of Colorado at Denver’s Jennifer Reich notes that starting in the 1970s, alternative-health movements “repositioned expertise as residing within the individual.” This ethos has grown dramatically in the internet age, so much so that “in arenas as diverse as medicine, mental health, law, education, business, and food, self-help or do-it-yourself movements encourage individuals to reject expert advice or follow it selectively.” Autodidacticism can be valuable. But it’s one thing to Google a food to see whether it’s healthy. It’s quite another to dismiss decades of studies on the benefits of vaccines because you’ve watched a couple of YouTube videos. In an interview, Reich told me that some anti-vaccine activists describe themselves as “researchers,” thus equating their scouring of the internet on behalf of their families with the work of scientists who publish in peer-reviewed journals..."
From "What the Measles Epidemic Really Says About America."

Good a time as any to bring this book back up.

Tom Nichols' The Death of Expertise shows how this rejection of experts has occurred: the openness of the internet, the emergence of a customer satisfaction model in higher education, and the transformation of the news industry into a 24-hour entertainment machine, among other reasons. Paradoxically, the increasingly democratic dissemination of information, rather than producing an educated public, has instead created an army of ill-informed and angry citizens who denounce intellectual achievement. When ordinary citizens believe that no one knows more than anyone else, democratic institutions themselves are in danger of falling either to populism or to technocracy or, in the worst case, a combination of both.
Because FreeDumb. We Don't Need No Steenkin' Science.


More to come...

Friday, July 12, 2019

Coming soon, the 2019 Health 2.0 Conference
My years covering Health 2.0 events were the most fun and educational times. So many smart, energetic people. I lament no longer covering the health tech space in person.

Loved doing my conference photography.
Where are we today? One critical eval over at TechCrunch:
Digital health is growing fast — but at what cost?
Chris Hogg @cwhogg

Silicon Valley is obsessed with growth. And for digital health startups, that obsession is not only misguided, but dangerous.
The prevailing idea in the tech industry is that to succeed, you have to be ready to sell your idea, no matter how far along your idea really is. You’re encouraged to believe in your product even when there is no product to believe in.

And if you’re disrupting the mattress industry or the eyewear sector, maybe that’s okay.

But digital health startups must be held to a different and higher standard. We touch people’s lives, often when they are at their most vulnerable.

The healthcare startups in the news recently — Theranos, uBiome, Nurx, eClinicalWorks, Practice Fusion — seem to have lost sight of that crucial standard. We’ll never know every detail of what happened in these organizations, but one thing seems clear: In the pursuit of growth, they have put the patient second, and suffered as a result…
"Money, money, money, money..."


Stay tuned. I'm never gonna get caught up.


Our "new home" in Baltimore (built in 1935) has a finished basement (where our dogs now hang). It's very quiet. I moved my 27" iMac and peripherals down there today.

Mucho podcasting soon to ensue. Done it before, when I lived in Las Vegas. That was all music stuff. Upcoming will be different. Science/tech policy related topics mostly.

More to come...

Thursday, July 11, 2019

Play Hard, Party Hard

Old medical joke:
Q: "How much alcohol is too much?"
A: "More than your doctor drinks."
Congratulations, U.S. Women's Soccer World Cup Champs.

Tuesday, July 9, 2019

Lisa Suennen at NCQA

Lisa rocks.

I've covered her at various health tech conferences (see here as well). She's one smart, perceptive, and funny woman. Put her onstage with Alexandra Drane and they're as good as any pro standup comics.

"NCQA?" "Disruption?"


Finished her book. Among other virtues, as fine a smackdown of "scientism" as anything I've encountered.
...The prestige of science derives from the assumption that it deals in truth, fact. This is its purpose and tendency, but at no point is the purpose assumed to be fully and finally achieved. Science is, after all, a strategy, a method, not a doctrine. This is the secret of its brilliance, its rigor, its general reliability. But reason is not strictly reason when it is leveraged against a faulty inference—that is, a bad guess. The list I made earlier of the various schools of thought, considered scientific in their time, that undertook to empty the heavens and enlighten humankind by, oddly enough, demonstrating to them that they had neither self nor soul, were a series of bad guesses, not one of them the foundation upon which truly rational or scientific thinking could be based. Some of them, notably racial science and eugenics, played out in atrocities. The question of the existence of God and all the rest is not affected in any way by the ineptitude of the case made against it. The prestige of science should not be affected by the fact that it is vulnerable to misuse. But certainly historical perspective permits us to say that neither science nor reason, properly so called, was implicated in these earlier campaigns against religion. And again, a largely consistent position was maintained through all these shifts in rationalization—no God, no self. Religion could make the humanist case if its defenders were humanists. It could also make a rational and scientific case against scientism, if it were not daunted by the old habit of deference, prejudice turned against itself. The selfish gene should have been laughed off the stage years ago, and it isn’t gone yet... [pp 62-63]

More to come...

Monday, July 8, 2019

Matthew Holt's 12 rules for health tech startups

12. Hope that you can disrupt health care, but remember that UnitedHealth Group’s revenue is $220 billion and CMS spends $900 billion a year and they both appear mostly powerless to make anything better.
LOL. Read rules 1 - 11 here at Matthew's THCB. They're awesome.

Speaking of "health tech startups,"
My niece's husband Jeff Nyquist is making good progress with his VC-funded company NeuroTrainer. They're expanding their move into the health care space.


I was unaware of Pulitzer-winning novelist, essayist, and writing professor Marilynne Robinson. Finally read her essay in my recent Harpers:
Is Poverty Necessary?
An idea that won’t go away
By Marilynne Robinson

…What really matters here is how people are valued. Democracy assumes that the generality of the population have the wisdom to govern a nation. They are not valued sufficiently to sustain democracy where, finally, the habitability of their place in the world can be sold as a commodity, or where their expectations and hopes can be lowered by fiat. Austerity policies are a collaboration of governments and financial interests. The luxuries we can’t afford under austerity are day care for working mothers and universal health coverage. At the same time, there is unprecedented flaunting of stupendous wealth. We have seen what the Russian in the street is also seeing, and has known for many years—that plutocrats and kleptocrats are the same crowd. What are the consequences for an ordinary Russian of the fact that the world has grown used to seeing hundreds of billions of dollars flow out of a country whose economy is small and whose standard of living must be modest indeed, considering its recent history? Granting that our old adversary must get a laugh out of watching us deal with the foolish and incompetent government it helped us install, it is fair to wonder if Russia finds it worth the investment, assuming this is real money, that is, that it represents a real transfer of wealth. We know that people on this side of the transaction are very happy to believe that it is real—and to sell another overpriced penthouse in Manhattan or a little bit of government influence. Whatever it is, it spends, as they say. I wait to hear from a Russian aluminum worker about the economic and psychological effects of watching oligarchs play with money. This under cover of resurgent nationalism, of course…
Indeed. Well, that led me to this:

This one has jumped my reading queue. I'm a pretty fair writer, but this woman blows me away. I'm about 40% in thus far.
...It is no accident that Marxism and social Darwinism arose together, two tellers of one tale. It is not surprising that they have disgraced themselves in very similar ways. Their survival more than one hundred fifty years on is probably owed to the symmetry of their supposed opposition. Based on a single paradigm, they reinforce each other as legitimate modes of thought. So it is with our contemporary Left and Right. Between them we circle in a maelstrom of utter fatuousness. 

I say this because I am too old to mince words. We have, in our supposed opposition, gone a long way toward making class real—that is, toward cheating people of opportunity. Historically, education has been the avenue by which Americans have had access to the range of possibilities that suit their gifts. We have put higher education farther out of reach of low-income people by cutting taxes and forcing tuitions to rise. And we attack public preparatory education. We make an issue about family background in terms of suitability for college, when in fact anyone who has paid a reasonable amount of attention in a decent high school will be fine in college. Unless he or she is working two jobs to pay for it, that is. I have taught for many years in a highly selective program that attracts students of every background. There is absolutely no evidence that those whose education would be called “elite” are at the slightest advantage. Our prejudices are impressing themselves on our institutions and therefore on the lives of all of us. The willingness to indulge in ideological thinking—that is, in thinking that by definition is not one’s own, which is blind to experience and to the contradictions that arise when broader fields of knowledge are consulted—is a capitulation no one should ever make. It is a betrayal of our magnificent minds and of all the splendid resources our culture has prepared for their use.

Robinson, Marilynne. What Are We Doing Here? . Farrar, Straus and Giroux. Kindle Edition.
 I'd started Arthur Brooks' new book (also excellent), but he'll just have to wait.

Meanwhile, he has an interesting article up at The Atlantic.

The article has an embedded audio of the text. I read through it at listened concomitantly.

More to come...

Thursday, July 4, 2019

My best to everyone on Independence Day 2019

Wishing everyone a safe and happy July 4th weekend.
Today is the Fourth of July. First, I want to say happy birthday to my two brothers, Bob and Joe, fraternal twins who were born on the 4th. But also happy birthday to America. The 4th is always a good time to reflect on what the American experiment in constitutional democracy really means.

I tend to look at it this way – process is more important than outcome. This is true in the same way it is true for science and critical thinking. Science is a system of valid methods used to build an empirical model of reality. In science, using proper methods is what counts, not the outcome of the experiment. When you put the outcome first, and then use whatever methods necessary to generate the desired outcome, that’s pseudoscience.

In the same way we have a system of government that puts the rule of law, with the Constitution being the highest law, above any particular outcome. It is supposed to be a peaceful and fair method of determining things like law, justice, rights, and the expenditure of common resources. It is valid in that it derives from the people with fair and even representation. Obviously the system is not perfect, partly because people are not perfect, but also because running a country with over 300 million people is horrifically complicated and must, by necessity, involve numerous trade-offs.

But the idea of the Constitution is that we have a system, and if everyone follows the system then at least there are checks and balances, there is a system for correction of error, people have a way to make their will felt, and the whole thing grinds messily on...

Tuesday, July 2, 2019

Jason in the news

No, not THAT Jason.

This one (via Science Magazine).

Jason—a secretive group of Cold War science advisers—is fighting to survive in the 21st century
By Ann FinkbeinerJun. 27, 2019

After 59 years of service, Jason, the famed science advisory group, was being fired, and it didn't know why. On 29 March, the exclusive and shadowy group of some 65 scientists received a letter from the Department of Defense (DOD) saying it had just over a month to pack up its files and wind down its affairs. "It was a total shock," said Ellen Williams, Jason's vice chair and a physicist at the University of Maryland in College Park. "I had no idea what the heck was going on."

The letter terminated Jason's contract with DOD's Office of the Under Secretary of Defense for Research and Engineering (USDR&E) in Arlington, Virginia, which was Jason's contractual home—the conduit through which it was paid for all of its government work. So, in effect, the letter killed off all of Jason's work for defense and nondefense agencies alike…

I posted about that Jason nearly five years ago, in the context of EHR "interoperability."

From the current Science Magazine article:
Expanding horizons
In the past 5 years, the range of studies Jason has done for nondefense agencies has broadened. HHS, for instance, has sponsored Jason only since 2013. The first of its three studies for the agency proposed an information systems architecture that would allow electronic health records to be operable across all health systems. In response, HHS formed a Jason Task Force that helped implement the report's recommendations through something called the Argonaut Project. "The health community has a unique sense of humor," says Teresa Zayas-Cabán, chief scientist at the Office of the National Coordinator for Health Information Technology at HHS in Washington, D.C.

The next HHS studies, in 2014 and 2017, were broader. One was about how data not in electronic health records—environmental data, data from health apps and fitness devices, social media data—could be used to improve personal health without threatening privacy. The other, Keller says, studied how to apply artificial intelligence (AI) to health, given the problems of uneven data quality and opaque, irreproducible AI models. Zayas-Cabán says one reason she likes Jason is the group's independence. The field of health care has "many powerful and entrenched interests," she says, "so independent and expert study of our issues can be extremely valuable."...

Yeah.Interesting article, fairly long read. Apparently not paywalled.

Not a lot of progress I can see on the interoperability front across the past five years. I'm not alone.
What Is Taking So Long For Meaningful Interoperability In Clinical Research?
By Alethea Wieland, founder and president, Clinical Research Strategies, LLC

Three decades ago when I entered the profession of clinical research, our workplace equipment extended to typewriters, white-out, mimeographs, hand-written documents, rubber erasers, pens, label makers, and fax and copy machines. Rows of massive, locked, fire-proof filing cabinets storing millions of papers for a nationally funded research program lined record rooms, hallways, and every spare corner of the offices. Most of us felt rewarded when we could use a typewriter with a correction key despite one’s typing skills being firmly judged by the illegible mistakes in the carbon copies.

Fast-forward to the present day, when countless digital technological advances, data warehouses, and hardware and software programs have made our jobs more repeatable, less erroneous, and faster. Yet, we still have not made significant progress on interoperability between disparate electronic systems such as routine, seamless, and secure data transfers from electronic health records (EHRs) to electronic data capture (EDC) systems…


More to come...

Monday, July 1, 2019

In Memoriam, July 1st 1998

Twenty one years ago my first-born succumbed to her long, arduous cancer illness in Los Angeles.

Last year we also lost her younger sister Danielle to a different, unrelated malignancy. Words to continue to largely fail me.

Saturday, June 29, 2019

In Memoriam

Former NYPD detective and heroic 9/11 First Responder Luis Alvaraz has succumbed to the cancer caused by his months of daily combing through the World Trade Center wreckage and its lethal hell of toxins.


Tuesday, June 25, 2019

Define "science"

OK, continuing my riffs begun by "define 'evidence'" and "define 'expert'"--do we all mean the same thing by the word "science?"

Physicians are usually quick to point out that the word "cancer" actually denotes a host of diseases that share not only core etiologic similarities but also significant clinical differences. Similarly, when we say "science" are we really alluding to many "sciences" that differ materially (and range from heuristically "soft" to algorithmically "hard")?

Dr. Rudolph's book has thus far got me off down a number of interesting rabbit holes.

...[W]hen I began studying to be a science teacher in college, I was surprised to learn that there was no such thing as the scientific method. That was certainly the message my science-teaching methods professor instilled in us. He taught that the focus of our teaching instead should be on something called “scientific inquiry,” the details and complexities of which we learned about from an early 1960s essay by a University of Chicago professor by the name of Joseph Schwab.

Rudolph, John L. (2019-05-31T23:58:59). How We Teach Science. Harvard University Press. Kindle Edition.
Schwab, 'eh?
...Joseph Schwab (1909–1988), a contributor to the innovative Biological Sciences Curriculum Study (BSCS) high school biology course materials, who advanced our understanding of inquiry-based instruc- tion. He enrolled in the university at age 15, earning undergraduate degrees in English and physics and later a doctorate in genetics (Westbury and Wilkof 1978). Schwab worked at the University of Chicago for over 50 years, where John Dewey had set up the Lab School and where educator Ralph Tyler (1902–1994) became well-known for his work in curriculum development. 

The phrase “teaching science as enquiry” is conspicuous in a 1962 lecture by Schwab at Harvard University titled “The Teaching of Science as Enquiry.” Schwab preferred the use of enquiry to inquiry, because he disagreed with the ideas surrounding inquiry then being promoted, especially by psycholo- gists. His idea of enquiry instruction was to teach students about the major paradigms of science, that is, the manner in which a certain community of scientists view a major idea and the way they investigate it. In his lecture, Schwab urged science educators to stress the conceptions of science and how they change over time. He placed a premium on how scientists view the ideas (content) they are developing and how these ideas shape what scientists do and say about the data they collect. Science should not be viewed as dogma, he said, but as revisionary and fluid. Teachers misrepresent science when they present it as a rhetoric of conclusion or as a finished product..
. "Historical development of teaching science as inquiry."
"Inquiry" vs "enquiry?" Any substantive connotative difference there, or just "you say 'tomato' I say 'tomahto?'
BTW, regarding "educate," my grad school program director and mentor, the late Dr. Craig Walton, was fond of asserting that the etymology of the term is "e-ducere,"--to elicit, draw out, which requires of the learner both persistent, wide-ranging curiosity and a "critical thinking" mindset. Differs fundamentally from "instruction" and training.
 Back to John Rudolph (apropos of my KHIT-related interests):
Discussions of scientific methodology typically erupt publicly when the authority or the legitimate scope of science is in conflict with other social or cultural norms, knowledge systems, or local claims. The sociologist Thomas Gieryn has referred to these moments as boundary disputes. In debates over what does and does not count as science, what gets ruled in (as science) is allowed the authority to decide what counts as true. While a boundary dispute centers on the question of where the line between science and non-science is drawn, the decision about where to make that demarcation almost always hinges on an interpretation of process or methodology...
"Climate change," anyone? We know what Donald Trump "thinks."


Dr. Rudolph also makes considerable note of this:

You can buy the Kindle version for $9.99 or read for free it online.


Over the course of human history, people have developed many interconnected and validated ideas about the physical, biological, psychological, and social worlds. Those ideas have enabled successive generations to achieve an increasingly comprehensive and reliable understanding of the human species and its environment. The means used to develop these ideas are particular ways of observing, thinking, experimenting, and validating. These ways represent a fundamental aspect of the nature of science and reflect how science tends to differ from other modes of knowing.

It is the union of science, mathematics, and technology that forms the scientific endeavor and that makes it so successful. Although each of these human enterprises has a character and history of its own, each is dependent on and reinforces the others. Accordingly, the first three chapters of recommendations draw portraits of science, mathematics, and technology that emphasize their roles in the scientific endeavor and reveal some of the similarities and connections among them...
OK, that publication is necessary and good, but 25 years old. What have we accomplished? Where are we of late in terms of "science cred?" From "Research!America"-
From natural disasters to an opioid epidemic that prompted a public health emergency declaration, science was at the forefront of events that shaped our nation in 2017. National public opinion surveys commissioned by Research!America throughout the year revealed that a majority of Americans agree that public and private sector research is critical to better health, economic growth, global competitiveness and more. While the perception of science and scientists is positive, based on survey findings, scientists and our nation’s scientific enterprise remain largely invisible to the public.
The public overwhelmingly (82%) considers scientists trustworthy spokespersons for science, far above elected officials and the media. This level of trust includes an expectation that scientists will be the primary messengers for scientific issues, even those with policy implications. More than half of Americans agree that scientists should play a major role in shaping public policy in many areas, not only in medical and health research, but also in education (58%), infrastructure (55%) and national defense (51%). Americans recognize that science plays a role in their well-being, where they live, work and play. Yet many are unaware of the science community and those responsible for scientific advances. A strong majority of Americans (81%) cannot name a living scientist, more than two-thirds (67%) cannot name an institution, company or organization where medical or health research is conducted, and less than a quarter (21%) know that medical research is conducted in all 50 states. The findings have been consistent over the past decade, indicating the need for stronger engagement between scientists and the public.
A strong majority of Americans (71%) say they have confidence in scientific institutions compared to only 31% for Congress and 46% for the Presidency. When asked if great strides in science and innovation will continue while Donald Trump is President, opinions were divided (46% agree, 33% disagree and 22% not sure), with more Republicans (74%) than Independents (44%) and Democrats (22%) agreeing. Furthermore, a significant number of Americans (79%), including strong majorities across the political spectrum, agree that it is important for President Trump to assign a high priority to putting health research and innovation to work to assure continued medical progress (85% of Democrats, 79% of Republicans and 72% of Independents). As we pivot towards midterm elections in 2018, it is important for scientists and science advocates to ask candidates about their level of commitment to research and innovation to ensure a healthier and more prosperous future for our nation.
OK, back to the top. Define "science." See "Our Definition of Science" by the UK Science Council.
Science is the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.
 Ahhh... "evidence." That which makes a true conclusion more likely (or "proves" it, best case).
I searched "Science for all Americans" from beginning to end. The word "evidence" appears 57 times. Not once is there any definition of what the word means. It is simply assumed that we all have the same understanding. Is that OK? No biggie? BTW, the word "evident" shows up eight times, again with the assumption that we all know what is meant.
Chapter 9: Project 2061 and the Nature of Science

If the period from the mid-1950s through the 1960s was the golden age of science education, with its unprecedented levels of federal funding and involvement of bill laureates and other top scientists, the decade of the 1970s into the first half of the 1980s represented an era of comparative neglect. Attention to academic subjects in schools declined with the new political emphasis on urban poverty and concerns about the regressive nature of formal education that arose in the late 1960s with the more liberal views of the rule of schooling in American society. At the same time, the image of science in public favor in these years as a result of his association with environmental degradation, on one hand, and with militarization and the Vietnam War, on the other. This shift in educational priorities along with the new critical views of science led to conditions of general decline in science education that raised alarms among the scientific elite.

Those worries were felt acutely by the leadership of the American Association for the advancement of science, prompting its executive director, William Carey, to recruit Jim Rutherford in 1981 to lead a new effort to rebuild science education across the nation. Rutherford came to the AAAS from his stint as assistant director for education at the National Science Foundation the position as assistant secretary for research and improvement at the newly established Department of Education. He was someone earlier with the levers of change, such as they were, in the American educational system Rutherford's immediate task was to move education to the top of the AAAS agenda, and specifically to enact elements of a January 1981 resolution passed by the Association's Board of Directors quote to reverse the damaging decline of science and engineering education in the United States."

The challenge Rutherford-based was profitable. Since the mid-1970s, science education had been pushed to the margins of public consciousness, and the crushing recession along with the education version of the newly installed Reagan administration made prospects for any federal initiatives bleak. "It is easy enough to say that business and industry, the scientific and engineering societies, and the foundations are to pick up the slack," Rutherford wrote to a friend. But it wasn't clear to him at the time what those institutions could do to really make a difference. What was obvious to Rutherford was that a long-term plan was needed rather than some fixed. As he saw it, his job was to develop something that quote the Association can stick with the decade or longer that it takes for anything to have a lasting impact on our complex educational system."

Rutherford told the possibilities in the summer of 1982. The scientists of the 1950s had had the shock of Sputnik and the military threat from the Soviet Union to help usher reforms into the schools. The biggest threat of the 1980s, however, was economic — from Japanese automobile imports, for example. Grasping for something bold and symbolic, Rutherford latched onto Halley's comet — a satellite of a different sort. It seemed to fit the bill. The famous comet, he noted, was due to appear that October, the same month as the 25th anniversary of the Sputnik launch, and it would be 75 years before it would return again. What sort of changes might take place in our civilization between those visits? Used Rutherford. Looking at the dramatic changes that had occurred between prior flybys, he concluded that "we cannot accurately describe the world as it will be when Halley's comet next returns." However, he asserted, we do know that "the changes that will be brought about in our culture, in our way of life, will have more to do with the utilization of science and technology than with anything else."
What was needed, and Rutherford's view, was an entirely new approach to science education, one that would prepare children born in 1986 — the year of the comet would make its closest pass by Earth — to live in the scientific and technological 2, when those students would grow up to work, have children, eventually retire, and live to see the comment return in the year 2061. The length of time between sightings gave Rutherford the Longview he and AAAS were looking for to avoid yet another crisis driven crash program that was unlikely to produce meaningful and enduring change. Project 2061, as he named it, was bold and imaginative, clearly something outside the typical educational reform box. Its central goal was to articulate "what understanding of science and technology will be important for everyone in tomorrow's world" and then to work towards realizing that goal in a systematic way... [How we teach science, pp 180-182]
I encourage everyone to read the entirety of Project 2061 material. And buy and read John Rudolph's book. And join AAAS.


I've previously cited this fine book:


Another important historical read. Lots of overlap with "How We Teach Science."

What's my point here? Go back to my "Is there a 'science of deliberation'?" What do we mean by "deliberation?"
When you encounter the word "deliberation," what typically comes right to mind? Jury service, yes? I'm looking into the psychology of that as well. (Excellent book.) Also, in my grad school program, deep and thorough "moral deliberation" was our constant focus ("Ethics & Policy Studies").
Finally for now, is there really such a thing as "Data Science?" Or that mostly another Bright Shiny Thing marketing hook for expensive, institutionally lucrative graduate school programs?

Stay tuned, Not done by any stretch. Juggling a lot of bowling pins this week.


Science Based Medicine rocks.
Media Literacy Is Key
Media literacy is an important component to teaching science and critical thinking. We’ll add that to our to-do list.

Educating the public about medical myths and misconceptions has various challenges. The psychological deck seems to be stacked against us. It’s easier to scare people with possible risks than to reassure them with facts. People tend to be more compelled by emotional anecdotes than dry data. There is something inherently compelling about conspiracy theories that attract many people. People are good at remembering dramatic details, but poor at remembering whether or not they are true and what the source of the information is.
But perhaps the most profound factor making our job difficult is that once an idea has taken root in someone’s mind, it is remarkably difficult to change. Humans are instinctively good at motivated reasoning and confirmation bias. We see what we want to see, remember the bits that support our narrative, and can rationalize away pesky things like logic and evidence. The result can be a powerful, even overwhelming, illusion of confident knowledge, even in notions that are patently absurd. We can then erect elaborate defenses around these beliefs to protect them from reality…

There are basically three types of preventive education that are likely to reduce susceptibility to pseudoscience. The first is scientific literacy. There is some controversy over how effective this is, however. A few decades ago the “knowledge deficit model” was dominant, and the prescription for belief in pseudoscience was to teach people science. However, recent research has not been kind to the knowledge deficit model. You cannot usually change someone’s mind about an emotionally held belief with just information…

…You can move the needle a bit with public education about certain topics. Sometimes beliefs are based more on misinformation than emotion or identity, and if you correct that misinformation you can change beliefs. This is very topic specific, and also is affected by the kind of information you give and how it is presented. For example, global warming denial is strongly predicted by political ideology, and not at all by scientific literacy. However, vaccine denial does correlate with low scientific literacy, which implies that science education can be a mitigating factor…

The second type of education is critical thinking. This relates more directly to the point about narratives. Critical thinking is about metacognition, knowing how to think with a valid process that is self-reflective and therefore potentially self-corrective. If someone understands exactly how conspiracy thinking is a cognitive trap, they are less likely to fall into that trap. Critical thinking and scientific literacy is a powerful combination – this is essentially what we mean by scientific skepticism, which is exactly what we are doing here (in the realm of medicine)…
'eh? Read all of it. This is why SBM is a requisite daily stop for me. As is The NeuroLogica Blog.

apropos, see my prior post "Selling science: effective communication with decision makers."


I continue to plumb "How we teach science" (while finishing up two Game Theory books).

My path here thus far has been cut-to-the-chase circuitous (an expedient MO I employ when I trust an author and the book lends itself to a non-linear read): Introduction, Chapter 1, Chapter 10, Conclusion, Chapter 4, Chapter 6, Chapter 7.

Final words:
The continued focus on students mastering scientific practice—doing science—in the hopes that some of these larger, contextual understandings will come along for free seems misguided. Perhaps the last word on this is best left to Schwab. During the Golden age of science curriculum reform, he warned that many science classrooms were "being converted into research microcosms in which every high school student, regardless of interest and competence, is supposed to act, on a small scale, like a scientist." This, unfortunately, seems to be where the current emphasis lies as well (when it isn't on the technical content of science itself). And Schwab noted to that such an approach was poorly suited to accomplishing if a understanding of the nature of scientific work. Given the choice between teaching about scientific inquiry and having students engage in the actual process of inquiry, "it is the former which should be given first priority," as Schwab said. Understanding what science is and how it works in the social context of our time is the necessary end for which we need to strive if, in Schwab's words, "we are to develop the informed public which our national need urgently demands." [How we teach science, pp. 230-231]


I forgot to cite my earlier post "Is there a science of success?"


All of the foregoing brings me back to my initial core KHIT concern--science-based, optimally effective health care, aided by technology where appropriate. Today I reflected on a book I bought in hardcopy back some time ago. It's now available in Apple iBook format, which I rarely use.

Well, lookeee who shows up right off.

Foreword by Harlan M. Krumholz, MD, MS 
Medicine is an information science. In an earlier era, medicine moved from religion to science via laboratory work on the mechanism of disease. Doctors improved their results by reflecting on the likely cause of disease and the likely response of an individual to a treatment based on that understanding of disease. Although many benefitted from that approach, others were harmed because assumptions were not sufficiently tested empirically. There was a recognition that advances in the lab needed to be supplemented with more rigorous studies in patients, especially when the benefit was modest and not easily demonstrated. Moreover, as these studies grew, the need for doctors to be able to manage the information, understand it, and apply it wisely also grew. 

Today, the expert clinician must have a command of information and know how to apply it. There is more attention than ever on the quality of treatment decisions and the assumptions that underlie them. The key to knowing how best to synthesize the available information and produce the best recommendations and decisions requires an appreciation of cognitive science...


Medical education tends to focus on medical content. We teach the facts and emphasize what is known. We often assume that if we apply the facts and rules, as an engineer applies principles and equations, we can solve most medical problems. But clinical medicine is not engineering—there are simply too many missing pieces, too much uncertainty. When faced with uncertainty, we inevitably use reasoning. But medical education gives the process of medical reasoning short shrift and rarely teaches it explicitly. We diligently teach the “what” but students often learn the “how” on their own...

This book does not present any great discoveries but, instead, synthesizes ideas that have been hiding in plain sight for years. During the past three decades, the field of cognitive psychology has developed a substantial literature on decision making but somehow hasn’t had much influence on doctors, who make tough, nuanced decisions every day. I am not a cognitive psychologist, but I have learned a great deal from Herbert Simon, Gerd Gigerenzer, Daniel Kahneman, Gary Klein, and others whose work on intuition and heuristics is directly relevant to medical decision making. Influenced by the work of Ian Hacking, I have included some introductory ideas about probability, logic, and statistical inference. I am also steeped in the literature on clinical reasoning by authors such as Alvin Feinstein, Larry Weed, Jerry Kassirer, Harold Sox, David Sackett, Pat Croskerry, Donald Redelmeier, Jerome Groopman, and Kathryn Montgomery. I continue to learn about medical reasoning from many colleagues, too numerous to list, and I hope that this book accurately reflects their teaching…
Pretty cool, I have to say. BTW: See my 2014 riff on "The Art of Medicine."

More to come...