Jaron Lanier on Silicon Valley

NY TIMES OPINION
GUEST ESSAY
I Am a Silicon Valley Pioneer.
We Are Sabotaging Ourselves.
Jaron Lanier

Silicon Valley has a special talent for offering amazing products and then screwing them up with ridiculous ideas about how those products should be used.

Few appreciate virtual reality more than I do. I came up with the term. There are simple pleasures in occasionally visiting alternate sensory worlds. It was only when virtual reality went mainstream around 2013 that I realized Americans would not embrace the technology for a generation. The reason: the awful ways key tech leaders talked about it. Recall the Meta chief Mark Zuckerberg proclaiming that we would primarily live our lives through virtual reality headsets. Or the venture capitalist Marc Andreessen suggesting that most people were doomed to live virtually, with only elites retaining the privilege of living in the physical world. Predictably, the public did not embrace this vision.

We in Silicon Valley are doing it again with artificial intelligence, except worse — and at a larger scale. In its filing for its upcoming trillion-plus-dollar initial public offering, the leading A.I. lab Anthropic warned that its models could present “catastrophic or existential risks.”

I work on A.I. and use it and like it. The latest large models are genuinely useful. But rather than focusing on how these tools could improve lives, many leaders at the biggest A.I. companies are instead asking Americans to embrace the belief that this technology may kill us and our children, or at the very least drain us of all potential for livelihood and meaning. It should not be surprising then that based on the results of this last election, many Americans have come to disapprove of A.I. more than almost anything…

...I am not saying Silicon Valley is terrible. Instead, I am saying we need to be honest with ourselves. There is nothing wrong with a new religion, but there is everything wrong with an imposed new religion. That is our problem. It is not the technology itself.

Quick reflection on the 2026 U.S. Midterms

The beginning of Trump’s second term saw summaries of [Carl] Schmitt’s views in The New York Times and several smaller publications. As the historian Jan Werner Mueller wrote in Foreign Policy, “It’s Carl Schmitt’s world, and we’re all just living in it.” Schmitt was a prolific writer well into his nineties. Though most of his books are short, I doubt most latter-day Schmittians have read them. Their ideas are so easy to summarize that they’ve passed into the psychic air we inhale every day. As Heather Cox Richardson put it:

The apparent plan of the Trump administration reflects the strategy of Nazi political theorist Carl Schmitt, whose writings seem lately to have captivated leaders on the American right, including billionaire Peter Thiel and the man who influenced him, Curtis Yarvin. ... As J. D. Vance described Schmitt’s ideas in 2024: “There’s no law, there’s just power.”

I’ve suggested we should learn how to recognize evil actions but beware of calling people evil. Calling someone evil expresses a finality that I’m loath to leave in human hands; condemning them to hell, or even death, should be left to others. Still few fit the judgment as well as the erudite legal theorist who defended the Nazis till his dying day. “The crimes against humanity are committed by Germans,” Schmitt wrote in an essay titled “The Tyranny of Values.” “The crimes for humanity are committed against Germans. That is the only difference.” Both his critics and his defenders argued over the question of whether Schmitt was a committed Nazi or just a craven fellow traveler. The critics won the argument with the discovery of private prewar writings full of hateful remarks about Jews.

The revelations of his antisemitism are not, however, the reason I’m tempted to ignore my own scruples and call him evil. Like any form of racism, antisemitism stems from the view that the world can be divided into friends and foes. Schmitt’s worst contribution to the contemporary world is that thought—combined with Hobbes’s conviction that this damns us to brutal anarchy without an absolute sovereign in control. Schmitt would have mocked Trump’s ignorance along with his devotion to gilt; even gold, he implied, was a value only liberal merchants prize. Though he had no objection to luxury, the real coin he treasured was power. The recent spate of U.S. Supreme Court shadow docket rulings supporting Trump is an ominous sign, for they are issued without legal reasoning or any other sort of justification. Like Schmitt, whose oracular pronouncements were seldom accompanied by argument, the rulings suggest that the Court is moving toward the view that power can supplant reason—if only you have enough of it. 

Days after the coup in Venezuela, White House deputy chief of staff Stephen Miller spelled this out precisely:

We live in a world in which you can talk all you want about international niceties and everything else, but we live in a world, in the real world, Jake, that is governed by strength, that is governed by force, that is governed by power. Those are the iron laws of the world since the beginning of time.

Schmitt’s influence is hardly confined to the U.S. There are large Schmitt revivals in Russia and elsewhere. As a twenty-three-year-old adviser to right-wing British politician Nigel Farage recently told The Guardian:

El Salvador is a lesson for those in Britain who wish to take back control of their country. Power works, and it’s all that matters. State power when used efficiently is basically omnipotent. The meritocracy will be established, criminals and corrupt officials will be jailed, immigration will drop to zero, houses will be built, and our citizens will once again feel proud of the country they call home.

Neiman, Susan. Call It Evil: Understanding the Trump Era (pp. 36-38). (Function). Kindle Edition. 

Quite a week, 'eh?

 

Below, a comment in The Atlantic.

Trump automatically provokes a very visceral vomit reflex in me because he's just absolutely repulsive in every possible way, but Miller sends shivers down my spine. 'There's nothing in those eyes but evil and hatred.'

Right...

NSFW: SORRY NOT SORRY 

Tania Lombrozo: We got some 'splainin' to do...

 

Among my numerous long-time print & digital periodicals subscriptions is Science Magazine (I'm an AAAS member). Digital editions of Science Magazine are posted a week prior to the print editions. 

 

 

Always a first-stop for me. In particular, I look at the latest book reviews. A great source of timely, relevant reading. One ongoing (sometimes a bit irritating) reviewer norm is the "Praise-Criticism-Praise Sandwich." (They are hardly unique in that regard.)

 

 

Ya tout the authors, then you find fault with them, after which you make-nice finish by again praising the reviewed work.

 

Impressively, Tania Lombrozo's new book's ScienceMag review was ALL effusive praise. It sold me. And, I've not been disappointed in the least.

A cognitive scientist turns the pursuit of explanation on itself

Explanations are among the most celebrated products of science, but rarely are they scientific subjects themselves. Few have done more to change that than cognitive scientist Tania Lombrozo, whose excellent new book, Why We Ask Why, holds a mirror up to explanatory inquiry. Why, she asks, do we explain at all? What makes an explanation satisfying, and are satisfying explanations more accurate? How do explanations support our goals as learners, teachers, and even political actors?

For Lombrozo, explanations are made, not found. One does not scoop an explanation off the ground the way a naturalist finds a beetle but rather constructs an explanation in one’s mind the way a cartographer sketches a map. (In one of the book’s memorable slogans, explanations are “mental acts, not just facts.”) The book draws on diverse conceptual and empirical resources to develop this view. Beyond psychology, insights come from computer science, history of medicine, theology, political science, primatology, and especially philosophy of science, which motivates much of Lombrozo’s own research.

The approach pays off early in an incisive treatment of Ockham’s razor—roughly, the principle that simpler explanations are preferable to complex ones. The preference for simplicity has been a North Star for generations of scientists, but what accounts for its seemingly productive track record?

Titanic figures from Isaac Newton to Richard Feynman held that simplicity is preferable because the world itself is simple. But Lombrozo is not so sure: Although physics sometimes delivers tidy equations, many phenomena, from a company’s success to a friend’s emotional response—to say nothing of protein folding, climate dynamics, or international relations—hardly seem simple. Moreover, research from Lombrozo’s lab shows that even when available evidence points to complexity (e.g., multiple clinical symptoms with distinct causes), people still favor the simpler story (a single cause of them all), often chasing structure that is not there. So is this scientific virtue just a cognitive vice?...

 

What of the future of explanation research? The all-human explanatory cast is not accidental; the book speculates that we are the only minds driven to explain, leaning on chimpanzee failures in crucial tests. But the roster may soon expand: Lombrozo describes work suggesting that prompting artificial intelligence (AI) systems to generate explanations can bend them toward humanlike performance, although it is admittedly unclear whether prompted behaviors meet the book’s high standard for explanations (“active, goal-directed constructions” that are “products of dynamic minds aiming for understanding”).

AI also looms as a threat to our own explaining. Children who explain their way to a story’s lesson can better apply it to new cases than children who are told the lesson directly, even if they can repeat it back. When we rely on chatbots or AI summaries to skip difficult explanatory work, Lombrozo warns, we risk similar consequences. If explanations were just facts, it would not matter how we got them. Because they are acts, it does.

She's now at Princeton. (Right quickly down 206 from where I grew up in Hillsborough TWP.) So is her husband Tom Griffiths. I've already had one of his books in my stash. Equally compelling.

 

I now call them

 

PRINCETON POWER COUPLE

 

 

TANIA'S BOOK

 

I was blessed to get to teach collegiate "critical thinking" and "argument analysis" for 5 years (1999—2004, evening school adjunct faculty; my day gig was that of a credit risk analyst in a bank). Were I chalk-talking today Tania Lombrozo's book would absolutely be an additional required text. I'd have to (and could) do better on "explanation." From my online syllabus:

CHAPTER 7: "Explanation" vs "argument"
 

In a nutshell: Explanations are used to clarify how or why something is or was, to give reasons describing [2] the physical attributes [2] the function, or [3] the behavior of something. Often, though, "explanation" is a thinly disguised argument for a conclusion that is still at issue. The same verbal and written structures are employed, the same "because this..." "therefore that..." premise-to-conclusion sequences are used. Explanation is only appropriate when then conclusion is agreed upon going in as factual. It gets confusing at times, because explanations are often used within larger arguments.

Just as there are good/bad, strong/weak arguments, so too are there good/bad, strong/weak explanations. Explanations should fully explain, and be testable, non-circular, appropriately precise and comprehensive, reliable, relevant, consistent with well-established knowledge, and so forth. These are covered in detail in your text.


• If I describe to you in precise detail how a missile works, that's explanation.
  
  
• If I describe to you in precise detail how a Missile Defense System "works,” that's an argument that we taxpayers should fund its construction. The "explanation" is inappropriate, given that we've yet to even build a system prototype.

The chapter also covers "justification," i.e., an argument posed to justify a position on an issue or act. All of the evaluative techniques apply when assessing justifications.

Many explanations take the form of "analogy." An analogy is an explanation (or argument) where a widely familiar example is posed in order to explain a more obscure object or concept. Lawyers use analogies all the time when pleading their cases, i.e., "this case" is like that/those "former case(s)", so we ought to decide in the same way as way done before.

Dr. Lombrozo is all over it. Below, a few random snips:

'eh?

TOM GRIFFITHS

Ch. 13: Universal Laws of Cognition 

Probability theory has a lot to offer to cognitive science. It is the best candidate we have for a theory of induction—a tool that we can use to explain both why people can learn from small amounts of data and why currently machines need large amounts of data to do the same. It also has the potential to allow us to combine two big ideas: the structured representations of the rules and symbols approach, and the statistical learning abilities of neural networks. Because Bayes’ rule can be applied to any kind of hypothesis—from logical formulas to connection weights—it allows us to explore the consequences of making different assumptions about how the world is represented and about the inductive biases that guide learning. 

But before cognitive scientists could explore that potential, we needed to overcome the belief that probability theory was incompatible with human minds. Daniel Kahneman and Amos Tversky had provided compelling examples of ways that people’s reasoning deviated from probability theory in general and from Bayes’ rule in particular. In order for accounts of human cognition based on probability theory to be taken seriously, these deviations would need to be explained. 

Doing so would require taking a new approach to using probability theory to understand thought. It turned out that the key was to stop focusing on human minds, and instead ask about principles of intelligence that might apply to any mind, anywhere in the universe. 

Psychology’s First Universal Law 

In 1687 Isaac Newton published his universal law of gravitation in the Principia Mathematica. The law asserted that the force of gravitation that we experience on Earth also applies to every object in the universe—that any two objects are attracted by a force proportional to their mass and inversely proportional to the square of the distance between them. Using this law, Newton was able to derive the motions of the celestial bodies that could be seen from Earth, providing a simple unifying principle for explaining astronomical observations. 

Exactly three hundred years later, Roger Shepard proposed psychology’s first universal law: the universal law of generalization. Like Newton’s law, Shepard’s was supposed to hold anywhere in the universe. By starting with an abstract problem that any intelligent organism must face and then deriving its solution, Shepard identified a principle that should apply not just to humans, and not just to animals, but to minds of all kinds…

Griffiths, Tom. The Laws of Thought: The Quest for a Mathematical Theory of the Mind (pp. 260-261). (Function). Kindle Edition. 

Like I said, Princeton Power Couple. I'm sure the breakfast nook, dinner table, and pillow talk in that household is routinely glorious.

 

Great reading. Highly recommended. 

 

ERRATA

 

Anyone recall "the 5 Whys?"In the wake of my initial baby-teeth-cutting Shewhart & Deming I was thereafter trained in Lean 6 Sigma—Root Cause Failure Analysis. "Why, why, why, why, why?" Shit happened. Why? 'Splain it, OK?

 

More to come...

Midterm Elections Day 2026

There have been three great crises in American history: the Civil War, perhaps the defining event in our history after the Revolution itself, the Great Depression and World War II. These events tested our republic and our resolve in fundamental ways, but the center always held — elections took place, there was a peaceful transfer of power and the judiciary was still independent. Our core democratic institutions remained fundamentally strong, respected by the public and our leaders alike. The guardrails of our democracy held and were even strengthened as we emerged from each.

As we go to the polls today in this most consequential of midterm elections, we face our country’s fourth great crisis. Because of misinformation, which the current administration encourages, age-old fears and conspiracies have created a sense of us versus them that is fundamentally at odds with a healthy democratic society. Elections are in doubt, the highest court seems compromised, history has been distorted, books have been banned, and dictators have been coddled while our closest allies have been ridiculed and dismissed. People are rightly concerned whether our institutions are at a breaking point…

NY Times.

#Blunami2026

My envervating decade of The Donald
   

My recurrent rant on "Regulation."

I find it to be an exasperatingly obvious given that human transactions get "regulated" one way or another. to wit,

If there were only one man in the world, he would have a lot of problems, but none of them would be legal ones. Add a second inhabitant, and we have the possibility of conflict. Both of us try to pick the same apple from the same branch. I track the deer I wounded only to find that you have killed it, butchered it, and are in the process of cooking and eating it. 

The obvious solution is violence. It is not a very good solution; if we employ it, our little world may shrink back down to one person, or perhaps none. A better solution, one that all known human societies have found, is a system of legal rules explicit or implicit, some reasonably peaceful way of determining, when desires conflict, who gets to do what and what happens if he doesn’t. 

The legal rules that we are most familiar with are laws created by legislatures and enforced by courts and police. But even in our society much of the law is the creation not of legislatures but of judges, embedded in past precedents that determine how future cases will be decided…

Friedman, David D.. Law's Order: What Economics Has to Do with Law and Why It Matters (p. 3). (Function). Kindle Edition. 

My longstanding riff:

Federal statutes set forth the “what” and (often optionally) the “why” of proposed bills that become enacted laws.

Subsequent subordinate regulations (published in the CFR) set forth the “who,” “how,” where,” and “when” the statutory “what” gets accomplished in furtherance of the legislative intent. “Rule writing” is delegated to appropriate executive agency officials (e.g., “as the Secretary shall determine…”), who subsequently compose and publish “NPRMs”—Notice of Proposed Rule-making, in the Federal Register. A public input review period then ensues for adequate, informed, material commentary and advice, after which the Final Rules (“FRs”) are appended to the CFR—Code of Federal Regulations. To the extent that a Final Rule fails to comport with the “what” specified in the parent legislation, it will be challenged judicially, and either modified or struck down.

I see nothing explicit nor implied in the Constitution prohibiting Congress (the Article I branch) from including The Who/How/Where/When operational procedures** within the statutes, but, that has not to date been the case. There are some (what ought be) obvious reasons. First of all, can you say “relatively apolitical SME career civil servants within Executive Branch agencies?”

      ** For those who’ve worked in Corporate, the apt analogy is those MEGO-inducing 2-3 inch “Policies & Procedures” binders we mostly ignored.

OK, so, IANAL, notwithstanding my fairly broad Administrative Law chops (mostly atrributable to my 1990s grad work). I was curious, so I went to Google Gemini "AI."
_____

A question I posed to Google Gemini:


“What proportion of ‘federal regulation’ is NOT subordinate to federal legislation? i.e., duly enacted statutes?”

"Virtually 0% of formal federal regulations are independent of or superior to federal legislation.

Under the United States legal hierarchy, federal administrative regulations—which are compiled in the Code of Federal Regulations (CFR)—are entirely subordinate to duly enacted federal statutes.

The Legal Hierarchy
For a federal agency to issue a legally binding regulation, it must possess an explicit grant of authority from Congress, known as an enabling statute. Because of this framework:


* Statutory Supremacy: If a federal regulation conflicts with a federal statute, the statute always wins, and courts will invalidate the regulation.


* No Inherent Power: Administrative agencies have no inherent constitutional power to write laws; they are entirely creatures of statute. If Congress repeals or restricts an agency's statutory authority, the underlying regulations lose their legal basis.

The Only Direct Executive Exceptions
The only executive actions that can bypass or match the authority of congressional legislation are those derived directly from the President's independent constitutional powers under Article II (such as acting as Commander-in-Chief or conducting foreign affairs).


However, these actions are typically issued as Executive Orders or Presidential Proclamations, not standard administrative regulations. Even then, if a President's independent executive directive directly conflicts with a validly enacted statute passed by Congress, courts frequently rule that the President's authority is at its lowest ebb and will strike the directive down unless it falls entirely within an exclusive presidential core power."

No further questions, Your Honor.

BTW: It's not "AI." It's just LLM-based improved search engine lookup.

Some KHIT "prior art"

 

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More shortly...

Boris will certainly NOT bore you.

   
We attended Boris Johnson's address at the Baltimore Symphony Hall last night. Enjoyed it way more than we'd expected. He is relentlessly mic-drop funny. Beyond the wit, he made some serious points, took some forthright stands. 100% support for Ukraine (all the way to NATO membership), called Putin, "creepy," unequivocally lauded Israeli "democracy" while not dismissing "Gazanocide." BREXIT? No apology.  Immigration? He's for it (adequately and rationally administered). His only waffling was with respect to Trump. 

 

He gave a rousing speech and Q&A.

 

That unfortunate hair...

 

An EPIC story

She is worth $7.8 billion.

She has never sold a single share to cash out. And she plans to give away 99 percent of it. When Judy Faulkner once asked her children what they needed most from her, they answered the way most kids do. Food. Money. Security. The things that make life feel safe. She shook her head.

“No,” she said. “You need roots and wings.” Roots to ground you. Wings to lift you. Everything else is just details. Decades later, at 82 years old, Judy Faulkner is quietly building those same two things for millions of people she will never meet. And she is willing to bet $7.7 billion that it matters.

Her story does not begin with wealth or power. It begins in a basement. In 1979, in Madison, Wisconsin, Judy started a tiny company called Human Services Computing. She had $70,000 borrowed from friends and family, two part-time employees who trusted her, and a massive computer that filled the room. She programmed it herself, line by line, hour by hour.

Her idea sounded simple. Make medical records follow the patient. She had seen what happened when they did not. Files locked in cabinets. Information trapped in incompatible systems. Doctors forced to guess. Patients lost in the gaps. But one moment made it personal.

Her husband Gordon, a pediatrician, had treated a young girl for years. When the family moved just 75 miles away to Milwaukee, the girl fell ill. At the new hospital, doctors could not access her records. They did not know her history. They did not know how fragile her condition was. By the time the pieces came together, it was too late. She died.

The next morning, Gordon was broken. Judy went back to her basement and made a decision. If she could prevent even one family from living through that kind of loss, she would dedicate her life to it.For nearly two years, her small team built software that could allow hospitals to share patient records across systems. It took two more years to convince skeptical administrators to trust it. She kept going anyway. That basement project became Epic Systems.

Today, Epic manages the medical records of more than 325 million patients. It supports roughly half of all hospital beds in the United States. The company brings in about $5.7 billion a year. And Judy Faulkner still runs it, showing up to work every day on Epic’s 1,670-acre campus in Wisconsin, a place filled with storybook architecture and playful design. One executive once described her as a mix of Bill Gates and Willy Wonka.

But here is what truly sets her apart. She never cashed out.She refused venture capital that would have pushed profit over patients. She refused to take Epic public and submit it to quarterly earnings pressure. She refused to sell to the highest bidder. “Why be owned by people whose main interest is return on equity?” she once asked. While other tech founders chased IPOs, yachts, and headlines, Judy kept writing software and solving healthcare problems. In 2015, she signed the Giving Pledge, promising to give away at least half her wealth. Then she went far beyond it. She pledged 99 percent.

In 2019, she and Gordon launched the Roots and Wings Foundation, named after that long-ago conversation with their children. The mission is simple. Give people roots like food, shelter, healthcare, and education. Give them wings like opportunity, stability, and hope. In 2020, the foundation gave $15 million to 115 organizations. By 2024, it had grown to $67 million across more than 300 nonprofits. Her goal is $100 million per year by 2027. She is doing it methodically, selling her Epic shares back to the company and directing nearly every dollar into giving. Out of hundreds of billionaires who have pledged to give, only a few truly do it while they are alive.

Judy Faulkner is one of them. She has never taken personal profit from her shares. Every dollar beyond her salary goes back into the world. Into healthcare access. Into education. Into families who need a chance to stand steady and rise. In an age where wealth often chases rockets, headlines, and ego, Judy chose something quieter and far more lasting. She built a company that helps hundreds of millions of people receive better medical care. She built it without surrendering her values. And she is ensuring that nearly all of her fortune continues that work long after she is gone. She could have walked away rich decades ago. Instead, she is still in Wisconsin. Still working. Still thinking about patients she will never meet.

This is not just a business success story.It is a blueprint. A reminder that wealth does not have to be about accumulation. It can be about impact. About service. About choosing roots and wings over yachts and applause. Her legacy will not be measured in billions kept.It will be measured in lives saved, children educated, families supported, and futures made possible. Her children asked for food and money. She taught them something better.

And now she is giving the world the same lesson. 

A friend re-posted the foregoing on Facebook today. I scraped it for re-post. Don't know who originally posted it.

 

I will fill in more of the story below.

 

… Epic is the dominant player in electronic health records. That’s because it kind of invented electronic health records. But the company requires more explanation, because writing about American health care without Epic is like performing Hamlet without Hamlet.

Epic was founded by Judith Faulkner in a Madison, Wisconsin, basement in 1979. Faulkner is now in her eighties and is still the CEO. She’s not a recluse, but she does very few interviews, so I’ll quote from a 2022 podcast she did with Bill Frist, the former US Senate Majority Leader and a heart and lung transplant surgeon. Frist gushes over Faulkner, as he should. She’s one of the most remarkable American women almost no one has ever heard of.

Faulkner was raised in Cherry Hill, New Jersey. Her father was a pharmacist and her mother was, for a time, the director of the Oregon affiliate of Physicians for Social Responsibility. Judy was a math major at Dickinson College when she took a summer job at the University of Rochester’s particle physics department, and her life’s work presented itself. “I had never seen a computer,” Faulkner told Frist. “They gave me a Fortran book and a week of access on the computer, and at the end of the week they said I was a good programmer. I’ve never figured out why anybody needs more than a book and a week.”

While she was getting her master’s in computer science at the University of Wisconsin, a professor asked Faulkner if she could help develop a system to track information over the course of a patient’s life. Everything at the time was written in Common Business-Oriented Language (COBOL), which meant a change to a patient’s record required a change to the source code of the whole database. Faulkner used a different language—MUMPS (Massachusetts General Hospital Utility Multi-Programming System)—to get around the problem. “I put the patient at the center and all the data around the patient.”

With seed money from friends and family, Faulkner started the company that would ultimately become Epic Systems. For its first twenty years, Epic expanded slowly but inexorably—into billing, scheduling, and almost everything else at the convergence of patients and the health-care system. In 2000, Epic rolled out MyChart, patient-facing software that’s now used by 200 million people. A few years later the company did a $1.5 billion deal to service all of Kaiser Permanente. When the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized hospitals to adopt digital health records and penalized those that didn’t, Epic exploded. Google, Amazon, and others have tried to grab a piece of its market share, and Judy Faulkner has left them all in tears.

Epic now generates about $5 billion in annual revenue and is used by twenty-one of the top twenty-two hospitals in US News’s 2023–24 Best Hospitals Honor Roll. “We have about 26 percent of the hospitals [total], but we have about 46 percent of the beds,” Faulkner says in a charming flex. “Because we tend to work at the larger places.”

The company has never gone public, never taken outside investment, never acquired another company, never advertised, and is structured to prevent an IPO or acquisition after Faulkner’s death. Its headquarters are on more than a thousand acres in Verona, Wisconsin; you can book a tour of the working farm and themed office buildings—including a wizard campus inspired by the Harry Potter series and a partially buried conference center called Deep Space with a lobby based on Lord of the Rings. But the most telling detail about Epic is buried in this exchange:

Faulkner: So if we have eleven thousand [employees], how many salespeople would you guess we have?
Frist: I don’t know. I’d say very few but go ahead, tell me.
Faulkner: We have seven worldwide.

Companies with $5 billion in revenue and seven salespeople are either really good or have achieved such dominance that they know customers have little choice but to buy their stuff. Epic is both.

Part of Epic’s secret is that it’s mostly a closed system, which makes it fantastically secure and reliable—essential qualities when dealing with patient data and life-or-death hospital operations. But closed systems also lock customers in, leaving them at the mercy of whoever holds the keys. Most Epic clients are fine muddling along with Judy Faulkner’s twenty-five-year-old taste in design and usability. The problem comes when a hospital’s priorities—like sepsis prediction—don’t align with Epic’s, or when an outside vendor proves undeniably better at something Epic already does.

No one doubts Faulkner’s motives. She famously doesn’t care about money—she lives modestly and signed the Giving Pledge to donate her personal billions—and considers herself a guardian against companies with more predatory ambitions. Over the years she’s gotten better at listening to clients and allowing outside vendors to sync with Epic. But Epic has the right to charge fees to integrate vendors it doesn’t like, or deny them access entirely. An executive at a different hospital system described the process as fraught, like telling your brilliant, wealthy, and very powerful mother that you loved her Thanksgiving dinner but you’re going to order out for dessert.

All of this helps to explain why changing health care with AI is so hard. It’s not just about getting advanced technology to work, without error, in clinical settings with life-or-death stakes. It’s about professional cultures, government policies, entrenched stakeholders, money, rivalries, emotions. Human stuff. The code may be willing, but the flesh is often weak …

AI for Good: How Real People Are Using Artificial Intelligence to Fix Things That Matter by Josh Tyrangiel: Ch 6: “Sepsis” pp 117-120

Highly recommend Josh's book. 

 

I first posted about Judy Faulkner and EPIC some 13 years ago when I was still working in Health IT in Las Vegas. My turf back then (workflow dude—YAWL— and HIPAA staff lead) was outpatient primary care (Familiy Med, Peds, OB/GYN, Internal Med, Geriatrics), so, beyond a bit of sandbox, I had little hands-on with inpatient—the bulk of which nationally was (and still remains) EPIC and Cerner (the latter now owned by Oracle). I am now retired, pushing 81, and a Kaiser patient—on EPIC, of course.

BUT. BUT, BUT, AI IS GONNA CURE EVERYTHING, RIGHT?

The goal in medicine is to make more out of more. In the context of the vast computational capabilities of a model, information overload ceases to be a meaningful constraint. If I input a medical record, a genetic profile, the latest research on a specific cancer treatment, and the patient’s own description of their symptoms, the model can curate a response that synthesizes all of it. No human could hold that much information in working memory simultaneously. 

The possibilities for healthcare are transformative. AI has the capability of synthesizing mountains of medical research and identifying potential treatment solutions that a busy clinician might never encounter. If we can relieve doctors of the burden of memorizing every new development, they would have more time to focus on the human side of medicine, including listening, comforting, explaining, and being present with a patient in their fear and uncertainty. 

In this scenario, the physician’s memory functions like a fixed map, limited in scope and inevitably outdated. The potential of AI is a dynamic web capable of curating and synthesizing information in real time, constantly updated, and infinitely patient. The human brings judgment, empathy, and the irreplaceable experience of looking another person in the eye. The machine brings everything else.

Nosta, John. The Borrowed Mind: Reclaiming Human Thought in the Age of AI (pp. 57-58). (Function). Kindle Edition.

I like a lot of my John Nosta reading thus far, but I do have a bit of discomfort.

 

UPDATE

 

Nice.

 

Below, the Faulkners' charitable Foundation.

 

RootsWings.org

CODA

Israeli election day

Bye Bye, Bibi, Bye Bye?

    

 Per Graeme Wood:

When the going gets tough, the tough don’t get subtle. Yesterday, with polls casting doubt on his continuing as Israel’s prime minister after Tuesday’s election, Benjamin Netanyahu posted a closing argument on Instagram: an AI-generated image of Tel Aviv destroyed by a nuclear blast, with accompanying text that asked, roughly, Would you prefer to reelect Netanyahu, or be incinerated along with your family? The text—written by the commentator Yuval Bloomberg and reproduced approvingly by Netanyahu—called all of the other campaign issues a “smokescreen,” and accused Netanyahu’s opponents of being so blinded by hatred that they would rather increase their chances of being burned alive than see their country’s political maestro win another election. If you support another candidate, the Instagram post cautioned, “your hand should tremble” as you vote...

This as we are 8 days anxiously out from our own U.S. midterm elections replete with similar endless thermonuke hyperbolic campaign rhetoric.

 

NY TIMES UPDATE

 

A fairly long read. Damning. Totally Trumpian.

In advance of Israel’s pivotal election on Tuesday, Prime Minister Benjamin Netanyahu sought for weeks to orchestrate a new airstrike on Iran but ran into resistance from the military’s chief of staff, according to three senior Israeli defense officials and three other people briefed on the matter.

Then, over the past few days, the chief of staff, Lt. Gen. Eyal Zamir, became concerned that Mr. Netanyahu had begun pushing for a separate action against Iran, short of an overt strike, according to an Israeli official and a person briefed on the matter, neither of whom described the nature of such an action. General Zamir believed that this would be a miscalculation that could provoke Iran into attacking Israel.

Spokesmen for Mr. Netanyahu did not respond immediately to requests for comment…

So, we move on from the Israeli gambit to the Nov 3rd Trump midterms gambit. Doomer-rumors are flying to & fro, nearly all mis/disinformed. We shall shortly see.

Sunday Sermon.

Faith-Based Technology in Silicon Valley.
  

 

A follow-on from this recent prior post.

"Two Cheers For Uncertainty" update

Riffing on the late Amos Tversky,

"When you worry, you may suffer twice."
  

By Rachel Feltman, for Scientific American

For Scientific American’s Science Quickly, I’m Rachel Feltman.

There’s a lot of uncertainty in the air right now, whether you’re trying to predict the outcome of an upcoming election or just trying to guess how much it will cost to gas up your car come next week. You don’t need a degree in neuroscience to know that all those unknowns are tough for the human brain to handle. But some experts think there’s actually a lot of nuance to explore about the cognitive burden of uncertainty—and that you might actually have the power to change how well you tackle it.

Our guest today is Maia Szalavitz, a contributing opinion writer for the New York Times and the author or co-author of eight books. She’s also the author of a feature in the latest issue of Scientific American that explores the emerging science of the human brain as a prediction engine. She’s here to tell us more about what that means in a world that feels increasingly unpredictable—and what we can do to make our minds more adaptable to chaos.

Thank you so much for coming on to chat with us.

Maia Szalavitz: Thanks for having me.

Feltman: So how did you first get interested in this topic?

Szalavitz: Sure. So our world seems to be becoming increasingly uncertain, and it’s not the kind of uncertainty that we’re used to dealing with in modern America because we’re used to the law being predictable. We’re used to the government’s actions being reasonably predictable. We’re used to all kinds of norms that are being violated. We’re used to being able to think of “What do I wanna be when I grow up?” and that be an actual thing that you can choose rather than perhaps losing all jobs to AI.

So I was in the midst of my own uncertainty, and I’ve been thinking a lot about this idea of how the brain works as a prediction engine, and I was really interested in hearing from people with that perspective about, like, how to manage in this really unusual situation—I mean, I didn’t even get to mention climate change. You’re used to, like, summer being summer and winter being winter—so it’s really unsettling and really, you know, because our brains do work, as far as we can tell, as prediction engines, and we’re constantly having to update prediction errors, when there’s uncertainty, it gives your brain a lot more work.

Feltman: What exactly do we mean when we say we’re modeling the brain as a prediction engine?

Szalavitz: So essentially, all of our experience of reality is a hallucination under this perspective, which is really weird to think about just in itself. But essentially, in order to solve the problem of avoiding entropy and avoiding death and ideally successfully reproducing, biological creatures need a way of managing risk and figuring out what to do next.

And so our brains sort of optimize on, okay, we get this general sense—and it’s based on experience, and there’s obviously some genetics—but you start out with this general, you know, way of perceiving the world, and then you update it when there’s an error. And so, you know, my example that I use in the piece is that, like, if you are in your room, and you have a cat, and you look, and you see something out of your corner of your eye, and it’s curled up, and it’s gray, you have a pretty full picture of that cat in your head when you, you know, do that. And then you look, and, oh, it’s actually the towel that you forgot to put in the laundry, right? But there’s no, like, glitch in it going from cat to towel, right? It’s, like, completely seamless, and this is the way our entire world works. And there’s all kinds of really interesting implications of it for things like pain and how you act psychologically.

But that is kind of the fundamental idea, that we are always making predictions, revising predictions, and, you know, with major prediction errors, it becomes seriously problematic because we may not be able to, you know, eat and survive and do the things we need to do.

Feltman: So what are some of the implications for, you know, what this means in terms of, like, how we think things through and how we process the world? I guess what I’m getting at is, like, “Why is it helpful to use this prediction engine idea?”

Szalavitz: If you think about it, if your entire life is based on predictions, there are certain things that you are going to be good at and certain things you are going to be bad at. Staying in the moment is going to be a very difficult thing if your entire world is predictions, right? And if you’re constantly predicting things, then what you’re predicting has a very big influence on what you will perceive.

And so if you are constantly seeing the world in a really negative way, that will skew it even further. Or if you are constantly just trying to avoid things, it’s really, if you think about it, it has implications for absolutely every aspect, which is why I’m sort of struggling of, like, narrowing it down here...

About 22 minutes. Very nice. I'm a SciAm subscriber. I check them out every day.

 

Check out Maia Szalavitz here.

Accomplished woman. Prolific author:

 

 
Will have to check it out. Long-time interest in the topic, given my grad work.

 "Two Cheers For Uncertainty?" What?
   

FROM BIGTHINK

 

My immediate reaction to seeing this graphic comprised a bit of mild net irritation—a bit of "Subjectivism Fallacy," i.e., there are no objective independent "truths," all perceptions are "subjective." (of course blithely ignore the logical paradox that for that assertion to be true, it must also be false).

And, yeah, I totally get the biological perceptual limitations of our sensory organs. See Other Senses, Other Worlds.

 

_____
 

I was blessed to do 5 years of collegiate adjunct faculty work teaching "Critical Thinking." From my online syllabus:

An attorney of my acquaintance once remarked that "we spend $100,000 to go to law school for three years to try to learn the meaning of the word 'reasonable'."

Indeed, what does it mean to reason well, i.e., what must we do to arrive at sound conclusions enabling us to make correct (or "best") decisions? In this course, we will learn the basic principles and acquire the intellectual tools that will leave us much better equipped to deal effectively with the endless onslaught of information we will have to evaluate throughout our lives. We will examine the sometimes sly techniques that partisans of every stripe employ to persuade us to their viewpoints. We will learn how to strip away the rhetorical clutter that often obscures the underlying intent and logic of arguments. We will examine the ways in which numerical data -- "statistics" -- are frequently misused or misinterpreted by those advocating one position or another on social, political, economic, or legal issues.

In short we will learn how to think, write, and speak more clearly in defense of our positions and decisions regarding important issues, and we will learn how to fully and honestly evaluate the claims of others. Our goals are to become honest and thoughtful communicators and skillful decisionmakers. They are most important goals.

Why?  There are several basic reasons. First, while perhaps as much as 80% of the technical knowledge you acquire during your college years may become obsolete with a decade, solid reasoning and communications skills will serve you well for a lifetime. Second, the world is a dangerous place. There is an endless supply of risks to be evaluated and dealt with, and society unfortunately remains full of people working tirelessly and deceptively to deprive you of both your resources and your liberty by getting you to buy into weak or false arguments shrewdly packaged with persuasive nonsense and/or irrelevance. Finally—and most immediately—, effective and efficient reasoning skills cannot but help you get better grades. A to-the-point, well-constructed, and well-stated argument is a breath of fresh air to your instructors.

My goal is to permanently sharpen the way you think and reason and make decisions.

Once you commit to a decision on a given issue (e.g., that x is good/bad, right/wrong, safe/harmful, etc), the psychological investment is difficult to discard. The tools you will acquire through active study and participation in a course such as this will pay life-long dividends by arming you with the means to get at the core truths and constructive resolutions of important issues you will face throughout your days...

I had my fill of tactfully shooting down the Subjectivism Fallacy students.

 

apropos of the topic

WHEN YOU THINK ABOUT the individual genetic and developmental differences that impact the sensory portions of our nervous systems, it’s remarkable that we can agree on a shared reality at all…

…Each of us operates from a different perception of the world and a different perception of ourselves. 

A portion of the individual variation in sensory systems is innate. But those innate effects are elaborated and magnified with time as we accumulate experiences, expectations, and memories, filtered through and in turn modifying those very same sensory systems. In this way, the interacting forces of heredity, experience, plasticity, and development resonate to make us unique.

Linden, David. Unique (pp. 253-254). Basic Books. Kindle Edition.

Yeah. 

 

A quick random note pertaining to the SciAm interview above before I crash.

I assume / take it as a given that our species' reach will continue to fall short of our cognitive grasp. "Equilibrium is death." The "Two Cheers" thing.

Also, a couple of relevant (?) priors, here, and here ("Orality Theory").

 

JOHN NOSTA IN PSYCHOLOGY TODAY

 

Raises a bunch of interesting speculations. Interesting guy. I have a bit of heartburn over this, though.