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Thursday, April 28, 2016

5th Annual AARP Health Innovation@50+ LivePitch™

Well, it took me 2 hours and 12 minutes to drive the 70 miles to the Sunnyvale Plug and Play Center from my house in Antioch. I should have left the house at 5:30 instead of 6. I briefly thought about going the back way over to Livermore and then down (a lot shorter as the crow flies), but I'm glad I didn't, even though it took me an hour just to get to Walnut Creek alone on the 4 and the 242. I had KQED on the radio (as always), and they reported a major fatal crash on the 580 at Hopyard Road in Pleasanton that had westbound 4 lanes closed, with traffic backed up all the way to Altamont Pass.

Ugh. Then, I didn't get back to the house 'til about 7:45 pm after the event.

I'm glad I resisted the (coffee bladder exacerbated) episodically transient traffic gridlock urge to bail and just go back home and crawl back in the sack. The day was well worth it. Particularly in the contextual light of this book I'm close to finishing.

See also, in particular, my recent take on Dan Lyons' book "Disrupted." And, my April 25th post Digital Health IT = "Better Care at Lower Cost." Right? -- wherein I review evolutionary biologist Dan Lieberman's important book "The Story of the Human Body." As I posted over on Medium,
I could not recommend this book more highly. I would make it required reading in medical school. The genus homo has been around on earth for more than 7 million years, after branching off from its primate forbears. Roughly 99% of that time has been spent in pre-agrarian hunter-gather mode, and it is that long, ancient period to which we remain biologically adapted. To the extent we fail to take this into account, we will stymie to a significant degree everything else we try to do to improve health care and human health...

So, this year's theme was all about "caregiving" and caregivers. Yeah, been there, done that. Between my late daughter and then my now-late parents I put in 15 years of next-of-kin caregiver duty.

Nice PDF link here.
"As of late 2014, approximately 40 million Americans provided unpaid care to an adult. This population of caregivers is estimated to reach 45 million by 2020, caring for 117 million people."
My time wearing the Driving-Miss-Sissy/POA/Legal Guardian/ADL scutwork hats was pretty much bereft of any digital apps assistance.

It looks like a lot of help is on the way. One hopes. Definitely a huge and ever-growing market. BTW, the UK's Paul Mason notes in his fine book "Postcapitalism" that there are three overlapping drivers bearing on the future of markets: [1] aging population, [2] climate change, and [3] migration. Another important read, this book.

So, this Innovation@50+ event featured, beyond the great panel discussions, short presentations by ten Pitch Competition finalists, each of whom had to then take questions from a panel of Venture Capital representatives. The audience subsequently got to vote on three (ordinal ranked) criteria as well via little hand-held remotes.
  1. "Does this product or service fill a significant need?"
  2. "Is this product or service unique?"
  3. "Would you use this product or service yourself or recommend it to family?"
The offerings spanned a wide products and services array, as did the panel and audience reactions.

At the conclusion two winners emerged, one chosen by the VC panel, one on the basis of audience vote tallies.

A few random pics from the day.

Alexandra Drane and Lisa Suennen!

Robin Farmanfarmaian.

What a story she has... I found her passing negative allusion to Theranos interesting. BTW, she has a book out.

"We are on the cusp of a healthcare revolution.

From wearable sensors, to improved point-of-care diagnostics to artificial intelligence and robotics, there are breakthroughs in biomedical technology on an almost daily basis which are set to fundamentally change the way that patients interact with their healthcare providers.

Author Robin Farmanfarmaian has seen this change first-hand. Misdiagnosed at age 16, she endured multiple surgeries and countless hospitalizations over the course of a decade before deciding to take charge of her own healthcare and changing her life overnight..."
Mo' pics...

Gonna take me a while to name all of these peeps. Difficult to take notes while shooting on the fly. I'd seen some of them at #WinterTech. Lotta smarts on the stage.

The absurdly smart 17 yr old CEO of SafeWander!
Wonder if they carded him at the 4 pm open bar reception ;)
Alex's keynote interview with AARP's Nancy LeaMond

Yeah, BobbyG loves to photograph the ladies in particular. Like, duhhh...

Competition winners Penrose (two on the L) and SingFit (two on the R)

Plug and Play is a cool place. Stage lighting sucked, though. Insufficient spots, mis-aimed, no parcan floods with gels, and no backlighting. Yeah, I'm spoiled.

I'll have further reflections shortly, but for now I'll just post the foregoing.

AARP Health Innovation@50+ Announces Winners of LivePitch: Penrose Senior Care Auditors as Judges’ Choice and SingFit as Consumers’ Choice
Sunnyvale, CA (PRWEB) April 28, 2016

AARP today announced the winners of its fifth Health Innovation@50+ LivePitch event held yesterday, Wednesday, April 27 at Plug and Play Tech Center in Sunnyvale, CA. Ten startup health tech companies focused on caregiving pitched their businesses and Penrose Senior Care Auditors was chosen as Judges’ Choice. SingFit was voted as Consumers’ Choice by the 400+ audience. The full event streaming video, as well as highlights, will be posted on the website which also includes more information on companies and content, at

“We were very impressed with our finalists this year, and how their businesses will improve the lives of caregivers and those they care for,” said Jody Holtzman, senior vice president, Enterprise Strategy and Innovation, AARP. “Of a great set of companies, Penrose Senior Care Auditors stood out and was recognized by our industry expert judges. SingFit resonated the most with the 400+ people who joined us yesterday. We are now excited to work with all the finalists to support their businesses as they make critical impacts in the “50 and over” health technology sector.”

Judges’ Choice Penrose Senior Care Auditors of Dallas, TX provides the first and only tech/app-enabled senior care auditing solution, called Penrose Check-Ins, to ensure seniors are okay while providing families peace-of-mind. During the Penrose Care-Check, an auditor visits the senior and using the app, assesses 150 items related to their well being and reports back to the family. @penrosecheckin

Consumers’ Choice SingFit of Los Angeles, CA combines a growing body of scientific research on the health benefits of prescribed singing with a proprietary music platform in order to mass distribute the benefits of music as medicine. Focused on dementia care and healthy aging, its debut product SingFit PRIME is the winner of the USC Keck School of Medicine Body Computing Prize. @MusicalHealthT...
I dug the SingFit thing in particular, given that I'm an ex-working musician.

So, just prior to the conclusion of the event, Alexandra and Lisa riffed together on some really funny standup-worthy stuff about starting and VC-pitching a fake "caregiver startup" simply to prove to their loved ones that they truly cared about them.

I immediately recalled a passage in Douglas Rushkoff's book (update: which I've now finished; he saved the best for last).


When investing gets so separated from real economic activity, finding funding for a company— without falling into the growth trap— is hard. Entrepreneurs must play the same abstracted game as investors but from the other side of the board. 

One of the smartest technologists I know, a young woman from the West Coast I’ll call Ruby, decided to launch a company on a whim. She was not interested in making money or even promoting a new technology; she wanted to test her theories about how the ebbs and flows of the startup market worked and whether she could win at the game by getting herself acquired. 

So Ruby did exhaustive research on emerging interests and keywords in the technology and business press, as well as conference topics and TED subjects. What were venture capitalists getting interested in? Moreover, what sorts of technical skills would be valuable to those industries? For instance, if she concluded that big data was in ascendance, then she would not only launch a startup related to big data but also make sure she created competencies that big data firms required, such as data visualization or factor analysis. This way, even if her company’s primary offering failed, it would still be valuable as an acquisition— for either its skills or its talent, which would be in high demand if her bet on the growing sector proved correct. 

She ultimately chose geolocation services as the growing field. She assembled teams to build a few apps that depended on geolocation— less because the apps themselves were so terrific (though she wouldn’t complain if one became a hit) than because of the capabilities those apps could offer to potential acquirers. Working on them also forced her team to develop marketable competencies as well as a handful of patentable solutions in a growing field with many problems to solve. The company was purchased, for a whole lot, by a much larger technology player looking to incorporate geolocation into its software and platforms. The employees, founder, and investors who believed in her are now all wealthy people. 

Ruby is not cynical; she is a hacker by nature, and merely gamed a system that she knows is already a game. She reverse engineered a startup based on market conditions, industry trends, and nascent investor fads...
The smartest hackers understand that their skill at hacking technology may be less important than their skill at hacking the digital marketplace. To them, it’s all just code— and even if it’s not, it’s more like code every day. The economy is less a place to create value than a system to game. Hell, everyone in finance and banking is already gaming the system, extracting money from what used to be the simple capitalization of business ventures. Why not create business ventures that game the gamers at their own game?...
Rushkoff, Douglas (2016-03-01). Throwing Rocks at the Google Bus: How Growth Became the Enemy of Prosperity (pp. 184-186). Penguin Publishing Group. Kindle Edition. 
LOL. Seriously, you really need to read this one.


With apologies to Ted Cruz.

More to come...

Tuesday, April 26, 2016

Up next, AARP Health Innovation@50+ Pitch Competition

Innovation@50+ is a one day pitch competition for emerging startups in the healthy living space with a focus on caregiving. At the pitch competition, 10 finalist companies will present their business focus on stage in a rapid 3 minute presentation to a panel of industry expert judges, most of whom are venture capitalists and angel investors focused on the aging health tech space.

Representing 38 million members, the power of AARP takes this pitch event up a notch. Only Innovation@50+ creates a dual-pitch event that also provides an audience of 100+ actual intended end user consumers who listen to the pitches and share feedback in real time, providing the companies absolutely invaluable market data on the spot.

This year’s event will be held at:
Plug and Play Tech Center
440 N. Wolfe Road
Sunnyvale, CA 94085
Should be interesting. More "VC" stuff. They've invited me to attend on a press pass. And, I'm an AARP member, Geezer-in-Training that I am, so it's of intrinsic interest.

BTW, my current book.

Yikes. Stay tuned for the review on this one. Another great read, as were my last two, cited here, and here.

For now, a little taste of Rushkoff:
...Amanda Palmer is not some monopoly company, or even a superstar performer exploiting her fans; she’s one midlist singer trying to make a living in a winner-takes-all landscape intentionally designed to prevent her from forging real relationships or exchanging value with her listeners. Her mix of barter, money, and gift is actually much more compatible with the tangled, ambiguous nature of real human relationships and hearkens back to the best qualities of the preindustrial economy.

Digital platforms from social media to crowdfunding allow us to reclaim some of these community dynamics and apply them to our own business pursuits. Those of us who have become aware of the way some corporations exploit or hide their tactics may have a knee-jerk reaction against people who appear, at least on the surface, to be doing the same thing. But the relationships that small-business people are forging with their constituencies online are direct, transparent, and peer-to-peer; they are explicit, fee-for-service, and social.

They are relationships between real people.


The value exchange between users and social networks, or fans and giant media properties, is entirely less direct and most intentionally covert. Digital networks simulate the very same human social dynamics fueling the communities of artists like Palmer in order to generate goodwill and mass excitement for their corporate clients.

It’s a one-sided, highly controlled relationship in which, invariably, the platforms and companies with which we engage learn more about us than we ever learn about them. Social marketing creates the illusion of a natural, nonmarketed groundswell of interest and, more importantly, provides marketers with a map of social connections and influences. These social graphs, as they’re called in the industry, are the fundamental building blocks of big data companies’ analyses.

Big data is worth more than the sum of its parts. It is the technology for solving everything from terrorism to tuberculosis, as well as the purported payoff for otherwise unprofitable tech businesses, from smartphones to video games. Like pop stars, these health, entertainment, and content “plays” will make no money on their own— but the data they can glean from their users will be gold to marketers. So they hope.

Indeed, it seems as if every startup is a “big data play.” Yet when we take into account the fact that the revenue supporting big data apps must presumably come out of that same constant 5 percent of the GDP associated with marketing and advertising, it becomes clear that such a payout can’t possibly come to pass. In fact, our increasing dependence on big data solutions may actually limit the growth it’s supposed to be stoking.

Reducing people to manageable sets of numbers is nothing new to digital technology. It began long before digital spam, when the high cost of printing and mailing physical pieces of paper motivated marketers to limit their offerings to those homes that might actually be interested. They gathered publicly available data, such as tax records and mortgage information. They stored this information on physical notecards— one for each household— and then manually selected a range of cards to include in a mailing.

With the advent of computers, statisticians began categorizing people into increasingly sophisticated demographic and psychographic groups, giving rise to the first data-driven market research firms. With upwards of seventy different categories in which to put us, researchers at Acxiom, for example, could arm marketers with psychological profiles of their target audiences, helping them to match their pitches to the particular social aspirations of their customers. 32

But they soon realized that their data offered more possibilities than this: it could predict our future choices. Using more sophisticated computers and methodology, researchers began connecting seemingly unrelated data points and became capable of determining who among us was about to go to college, who was probably trying to get pregnant, and who was likely to have a particular health problem. More than merely knowing our likely receptiveness to a pitch, they became capable of calculating, with alarming accuracy, what we human beings were going to do next. They had no idea why such a prediction might be true, and didn’t really care. This was the beginning of what we now call big data.

What makes big data different from traditional market research is that it depends on correlations that make no outward human sense. That’s the truly creepy part. Privacy is the red herring. Most people are still concerned about surveillance on the actual, specific things they are doing. That’s understandable enough. So when both the NSA and corporations assure consumers that “no one is listening to your conversations” and “no one is reading your e-mail,” at least we know that our content is supposedly private. But content is the least of it. As anyone working with big data knows, the content of our phone calls and e-mails means nothing in comparison with the metadata around it. What time you make a phone call, its duration, the location from which you initiated it, the places you went while you talked, and so on, all mean much more to the computers attempting to understand who you are and what you are about to do next. Facebook can derive data from how long your cursor hovers over a particular part of a Web page. Think of how many more data points there are in that single act than there are in the price of your car or the subject of your phone call.

The more data points statisticians have about you, the more data points they have to compare with those of all the other people out there: hundreds of millions of people, each with tens of thousands of data points. Researchers don’t care what any particular data point says about you— only what it reveals when compared to the corresponding data point in everyone else’s profiles.

Combine this with the ability of the Web to keep track of individual users and you get a true one-to-one marketing solution. Instead of buying ads that every visitor to a Web site sees, advertisers can limit their ad spend to the browsers of their target consumers. It’s the same technology that lets marketers hit us with ads for products we may have recently browsed on e-commerce sites— only now, instead of using our browsing histories, they use our big data profiles.

The same sorts of data can be used to predict the probability of almost anything— from whether a voter is likely to change political parties to whether an adolescent is likely to change sexual orientation. It has nothing to do with what they say in their e-mails about politics or sex and everything to do with the seemingly innocuous data. Big data has been shown capable of predicting when a person is about to get the flu based on their changes in messaging frequency, spelling autocorrections, and movement as tracked by GPS. 33

For marketers looking for an edge, however, mere prediction isn’t enough, and this is where they tend to get in the most trouble. Big data is simply a set of probabilities. Usually, it’s hard for analysts to get more than about 80 percent certainty about a future human choice. So, for example, big data analysis may reveal that 80 percent of the people who share three particular data points are about to go on a diet. That’s a pretty good indication of where to direct their ads for diet products.

But what about the other 20 percent, who may have chosen to do something other than go on a diet? They get sent messages along with everyone else, aimed at convincing them that they need to think about their weight. Feeling fat today? If they weren’t already on the path to considering a diet, now they will be. And it’s not even human beings making the decisions about who to send which ads— it’s algorithms programmed to extract the most purchases out of consumers by exploiting their data sets. The algorithms use trial and error to see what works, iterating again and again until that 80 percent probability goes up to 90 percent. Fewer people find alternative paths as they are corralled toward the limited outcomes of their statistical profiles. Companies depending on big data must necessarily reduce the spontaneity of their customers, so that they are satisfied with what amounts to fewer available choices.

It’s a digitally complexified version of the one-size-fits-all values of industrialism.

On the surface, the increase in customers for a product looks like growth. But it’s a limited, zero-sum game, in which the reduction in new possibilities cuts both ways. Many of the companies I’ve visited have been cutting back on expensive, unpredictable research and development (R & D) and spending resources instead on big data analysis. Why ideate in an open-ended fashion, they argue, when they’ve already got the data on what consumers are going to want next quarter? It’s virtually risk free. What they don’t get is that using big data to develop new products is like looking in the rearview mirror to drive forward. All data is necessarily history. Big data doesn’t tell us what a person could do. It tells us what a person will likely do, based on the past actions of other people.

The big rub is that invention of genuinely new products, of game changers, never comes from refining our analysis of existing consumer trends but from stoking the human ingenuity of our innovators. Without an internal source of innovation, a company loses any competitive advantage over its peers. It is only as good as the data science firm it has hired— which may be the very same one that its competitors are using. In any event, everyone’s buying data from the same brokers and using essentially the same analytics techniques. The only long-term winners in this scheme are the big data firms themselves.

Paranoia just feeds the system. Becoming more suspicious of the data miners— as we do with each new leak about government spying or social media manipulation— only increases the value of data already being sold. The more restrictive we are with what we share, the more valuable it becomes and the bigger the market that can be made. We might just as easily go the other way— give away so much data that the data brokers have nothing left to sell. At least that would put them all in the same boat as the rest of us.

Rushkoff, Douglas (2016-03-01). Throwing Rocks at the Google Bus: How Growth Became the Enemy of Prosperity (pp. 39-44). Penguin Publishing Group. Kindle Edition.
You need to read this book as well.

More to come...

Monday, April 25, 2016

Digital Health IT = "Better Care at Lower Cost." Right?

That was the promise, recall?

Below, I shot this off a slide deck screen at the HIMSS Conference in 2012.

Last Friday while on my way home from my weekly volunteer day in San Francisco, I heard an interesting NPR "Intelligence Squared" debate on the question "should corporate subsidies be eliminated?"
The auto industry, agriculture, the energy sector. What do they have in common? These industries benefit from government subsidies in the form of loans, tax breaks, regulation, and other preferences. Critics from the left and right say that not only do these subsidies transfer wealth from taxpayers to corporations, they distort the markets and our economy. Proponents say that government has an important role to play in launching innovation via strategic investment, and its support helps American companies thrive. Do we need subsidies, or is this corporate welfare?
From the transcript:

And that motion is Eliminate Corporate Subsidies and here to make his closing statement against the motion, Michael Lind, policy director of the economic growth program at New America and author of "Land of Promise."

Michael Lind:
Medical errors are the third leading cause of death in the United States. Up to 440,000 Americans die each year from preventable medical errors. A lot of it because the lag with doctor's offices using paper records. As part of the stimulus act in 2009, the federal government has spent to date more than $35 billion in incentives to individual doctors, hospitals, and other health care providers. What's the result? In 2009, those using -- the physicians using electronic health records were only 21.8 percent. Today, a few years later, they are 78 percent. The subsidy worked. In 2009, only 12.2 percent of non-federal acute care hospitals were using a basic computer electronic health record system. By 2014, after this $30 billion had been spent, more than 76 percent were. This is a tremendous unsung success of federal policy. Now, there are problems with the next stage.

There are problems with interoperability, with monopolistic corporations engaged in so- called data blocking. So there are problems with it. But, you know, this sort of really brings it home. As a result of this particular highly successful federal subsidy, your loved ones or your own life may be saved and as long as there are a few programs like this that are successes, you need to vote against the motion.

John Donvan:
Thank you, Michael Lind.

Well, myriad critics would dispute the assertion that the HITECH "Meaningful Use" initiative has turned out to be a "highly successful federal subsidy." Mr. Lind's citing of post-MU accelerated HIT uptake does nothing to answer the "better care at lower cost" question. Many critics argue that MU has in fact stifled innovation, and has largely served to line the pockets the large incumbent EHR vendors, while perhaps even having an adverse effect on care delivery, via clinically irrelevant "productivity treadmill" compliance imperatives.

Beyond issues of uniform, appropriate operational definitions of "better" and "lower cost," I continue to regard it as premature to declare either "failure" or "victory" in this area. As I observed a year ago in my March 2015 HITECH Interoperababble Update post:

I have noted before what I call "Health IT Policy ADHD." Major legislation gets passed and funded, and when we don't get immediate, dazzling results, we go sour on it, lamenting its "failure," and calling for its demise. HITECH is not that old. There have really only been four years of full-bore boots-on-the-ground operation. REC contracts were let in 2010, and the RECs spent most of their first year getting their sea legs under them and scurrying about hustling skeptical clinical participants...

We never tire of citing the "information superhighway" analogy. Fine. The U.S. Interstate Highway system took more than 35 years to complete. Significantly and sustainably transforming the incredibly complex, heterogeneous U.S. healthcare delivery and information infrastructure easily rivals it in scale and exceeds it in complexity by orders of magnitude. Moreover, this $35 billion outlay comes to about $22 per capita per year since the deployment of the HITECH program five years ago. The latest NHE per capita expenditure is about $10k. $22 is about 0.2% of that (0.0022). Close to being a rounding error...
Some other vexingly inhibitory factors go to the byzantine, dysfunctional economic imperatives of organizational structures and cultures in the health care space. See my accruing rant The U.S. healthcare "system" in one word: "shards."

On healthcare workforce cultural dysfunction specifically, recall my post The "Talking Stick" and the three-legged stool of sustained, transformative healthcare QI.

Socioeconomic issues: “When it comes to health, your zip code matters more than your genetic code.”

Relatedly, The future of health care, continued. Where will economics come in?

Then, there are more fundamental concerns, going to the effects of digitization on clinical cognition per se. See Are structured data now the enemy of health care quality?

I've also set forth my concerns regarding "personalized medicine," which necessarily include the various "omics" scientific disciplines. See, e.g., Omics update: National Human Genome Research Institute Health IT news.

So many contending, frequently mutually-negating moving parts, so little time.

Now comes a very big new wrinkle.

This book has been an utter delight to read, at once scholarly, scientific, accessible, and conversationally genial. The implications for health and health care delivery could not be more important, IMO. Seems like I spent half of the weekend reading parts of it aloud to my wife. I bought the Kindle edition, and have also just ordered a hardcopy for her and my daughter.
...I have made the human body the focus of my career. In fact, I am extremely lucky to be a professor at Harvard University, where I teach and study how and why the human body is the way it is ... I study fossils, I travel to interesting corners of the earth to see how people use their bodies, and I do experiments in the lab on how human and animal bodies work...

...of all the questions I am commonly asked, the one I used to dread the most was “What will human beings look like in the future?” ... My reflexive answer was always something along the lines of: “Human beings aren’t evolving very much because of culture.” This response is a variant of the standard answer that many of my colleagues give when asked the same question.

I have since changed my mind about this question and now consider the human body’s future to be one of the most important issues we can think about. We live in paradoxical times for our bodies. On the one hand, this era is probably the healthiest in human history. If you live in a developed country, you can reasonably expect all your offspring to survive childhood, to live to their dotage, and to become parents and grandparents. We have conquered or quelled many diseases that used to kill people in droves: smallpox, measles, polio, and the plague. People are taller, and formerly life-threatening conditions like appendicitis, dysentery, a broken leg, or anemia are easily remedied. To be sure, there is still too much malnutrition and disease in some countries, but these evils are often the result of bad government and social inequality, not a lack of food or medical know-how.

On the other hand, we could be doing better, much better. A wave of obesity and chronic, preventable illnesses and disabilities is sweeping across the globe. These preventable diseases include certain cancers, type 2 On the other hand, we could be doing better, much better. A wave of obesity and chronic, preventable illnesses and disabilities is sweeping across the globe. These preventable diseases include certain cancers, type 2 diabetes, osteoporosis, heart disease, strokes, kidney disease, some allergies, dementia, depression, anxiety, insomnia, and other illnesses. Billions of people are also suffering from ailments like lower back pain, fallen arches, plantar fasciitis, myopia, arthritis, constipation, acid reflux, and irritable bowel syndrome. Some of these troubles are ancient, but many are novel or have recently exploded in prevalence and intensity. To some extent, these diseases are on the rise because people are living longer, but most of them are showing up in middle-aged people. This epidemiological transition is causing not just misery but also economic woe. As baby boomers retire, their chronic illnesses are straining health-care systems and stifling economies. Moreover, the image in the crystal ball looks bad because these diseases are also growing in prevalence as development spreads across the planet.

The health challenges we face are causing an intense worldwide conversation among parents, doctors, patients, politicians, journalists, researchers, and others. Much of the focus has been on obesity. Why are people getting fatter? How do we lose weight and change our diets? How do we prevent our children from becoming overweight? How can we encourage them to exercise? Because of the urgent necessity to help people who are sick, there is also an intense focus on devising new cures for increasingly common noninfectious diseases. How do we treat and cure cancer, heart disease, diabetes, osteoporosis, and the other illnesses most likely to kill us and the people we love?

As doctors, patients, researchers, and parents debate and investigate these questions, I suspect that few of them cast their thoughts back to the ancient forests of Africa, where our ancestors diverged from the apes and stood upright. They rarely think about Lucy or Neanderthals, and if they do consider evolution it is usually to acknowledge the obvious fact that we used to be cavemen (whatever that means), which perhaps implies that our bodies are not well adapted to modern lifestyles. A patient with a heart attack needs immediate medical care, not a lesson in human evolution.

If I ever suffer a heart attack, I too want my doctor to focus on the exigencies of my care rather than on human evolution. This book, however, argues that our society’s general failure to think about human evolution is a major reason we fail to prevent preventable diseases. Our bodies have a story— an evolutionary story— that matters intensely. For one, evolution explains why our bodies are the way they are, and thus yields clues on how to avoid getting sick. Why are we so liable to become fat? Why do we sometimes choke on our food? Why do we have arches in our feet that flatten? Why do we have backs that ache? A related reason to consider the human body’s evolutionary story is to help understand what our bodies are and are not adapted for. The answers to this question are tricky and unintuitive but have profound implications for making sense of what promotes health and disease and for comprehending why our bodies sometimes naturally make us sick. Finally, I think the most pressing reason to study the human body’s story is that it isn’t over. We are still evolving. Right now, however, the most potent form of evolution is not biological evolution of the sort described by Darwin, but cultural evolution, in which we develop and pass on new ideas and behaviors to our children, friends, and others. Some of these novel behaviors, especially the foods we eat and the activities we do (or don’t do), make us sick...

The core subjects of this book— human evolution, health, and disease— are enormous and complex. I have done my best to try to keep the facts, explanations, and arguments simple and clear without dumbing them down or avoiding essential issues, especially for serious diseases such as breast cancer and diabetes...

...I have rashly concluded the book with my thoughts about how to apply the lessons of the human body’s past story to its future. I’ll spill the beans right now and summarize the core of my argument. We didn’t evolve to be healthy, but instead we were selected to have as many offspring as possible under diverse, challenging conditions. As a consequence, we never evolved to make rational choices about what to eat or how to exercise in conditions of abundance and comfort. What’s more, interactions between the bodies we inherited, the environments we create, and the decisions we sometimes make have set in motion an insidious feedback loop. We get sick from chronic diseases by doing what we evolved to do but under conditions for which our bodies are poorly adapted, and we then pass on those same conditions to our children, who also then get sick. If we wish to halt this vicious circle then we need to figure out how to respectfully and sensibly nudge, push, and sometimes oblige ourselves to eat foods that promote health and to be more physically active. That, too, is what we evolved to do.

Lieberman, Daniel (2013-10-01). The Story of the Human Body: Evolution, Health, and Disease. Knopf Doubleday Publishing Group. Kindle Edition, locations 41-99.
Boy, does he ever deliver across the full span of the book. A must-read, in my view.

Some triangulation.

I came to this book by way of, one of my requisite daily stops.
Human life has changed immensely over the millennia, but never so much or so quickly as in the past century. For almost the entire 200,000-year existence of our species, Homo sapiens, biology controlled us. We gathered fruits, nuts, and plants; hunted and fished for the animals that were available; and like the wildebeest or zebra, we moved on when resources ran low. Even after the advent of farming and civilization, and the development of cities, we were still very vulnerable to the whims of the weather, and to famine and epidemics. 

But in just the past hundred years or so, we have turned the tables and taken control of biology. Smallpox, a virus that killed as many as 300 million people in the first part of the twentieth century (far more than in all wars combined) has not merely been tamed but has been eradicated from the planet. Tuberculosis, caused by a bacterium that infected 70– 90 percent of all urban residents in the nineteenth century and killed perhaps one in seven Americans, has nearly vanished from the developed world. More than two dozen other vaccines now prevent diseases that once infected, crippled, or killed millions, including polio, measles, and pertussis. Deadly diseases that did not exist in the nineteenth century, such as HIV/ AIDS, have been stopped in their tracks by designer drugs. 

Food production has been as radically transformed as medicine. While a Roman farmer would have recognized the implements on an American farm in 1900— the plow, hoe, harrow, and rake— he would not be able to fathom the revolution that subsequently transpired. In the course of just one hundred years, an average yield of corn more than quadrupled from about 32 to 145 bushels per acre. Similar gains occurred for wheat, rice, peanuts, potatoes, and other crops. Driven by biology, with the advent of new crop varieties, new livestock breeds, insecticides, herbicides, antibiotics, hormones, fertilizers, and mechanization, the same amount of farmland now feeds a population that is four times larger, but that is accomplished by less than 2 percent of the national labor force compared to more than 40 percent a century ago. 

The combined effects of the past century’s advances in medicine and agriculture on human biology are enormous: the human population exploded from fewer than 2 billion to more than 7 billion people today. While it took 200,000 years for the human population to reach 1 billion (in 1804), we are now adding another billion people every twelve to fourteen years. And, whereas American men and women born in 1900 had a life expectancy of about forty-six and forty-eight years, respectively, those born in 2000 have expectancies of about seventy-four and eighty years. Compared to rates of change in nature, those greater than 50 percent increases in such a short timespan are astounding...

Diseases, it turns out, are mostly abnormalities of regulation, where too little or too much of something is made. For example, when the pancreas produces too little insulin, the result is diabetes, or when the bloodstream contains too much “bad” cholesterol, the result can be atherosclerosis and heart attacks. And when cells escape the controls that normally limit their multiplication and number, cancer may form. 
To intervene in a disease, we need to know the “rules” of regulation...

Carroll, Sean B. (2016-02-16). The Serengeti Rules: The Quest to Discover How Life Works and Why It Matters (Kindle Locations 96-130). Princeton University Press. Kindle Edition.
"To intervene in a disease, we need to know the “rules” of regulation."

Yeah, and Dr. Lieberman would say that we need to look more closely at the implications of the broad span of human evolution in order to effectively manage, mitigate, and/or cure what he calls today's "diseases of evolutionary mismatch." Absent that contextual grounding, we may well do everything else (including HIT deployment and process QI) as efficaciously as possible and still come up short.

BTW, tangentially, a bit more "evolution" triangulation.

Michael Tomasello sets forth a pretty compelling case for the evolutionary adaptive utility of prosocial, empathic, and altruistic inclinations and behaviors. My summary excerpts here.

Ayn Randians will have a cow.

Dr. Lieberman:
...For millions of years, our ancestors relied on innovation and cooperation to get enough food, to help care for one another’s children, and to survive in hostile environments, such as deserts, tundras, and jungles. Today we need to innovate and cooperate in new ways to avoid eating too much food, especially excess sugar and processed industrial foods, and to survive in cities, suburbs, and other unnatural environments. We therefore need government and other social institutions on our side, because we never evolved to choose healthy lifestyles. Most people don’t get sick through any fault of their own, but instead they acquire chronic illnesses as they age because they grew up in an environment that encourages, entices, and sometimes even forces them to become sick. For many of these diseases, we can then only treat the symptoms. Unless we want to end up as a species ever more dependent on medicines and expensive technologies to cope with the symptoms of preventable diseases, we need to change our environments. In fact, it is questionable whether we can continue to afford the cost of our current trajectory of increased longevity and population sizes combined with increased chronic morbidity. 

I think it is reasonable to conclude that cultural evolutionary processes today are gradually replacing one form of coercion with another. For millions of years, our ancestors were required to consume a naturally healthy diet and to be physically active. Cultural evolution, especially since humans began farming, has transformed how our bodies interact with the environment. Many people today still live in poverty and suffer from diseases caused by poor sanitation, contagion, and malnutrition that were much less common in the Paleolithic. Those of us fortunate enough to live in the developed world have escaped those miseries, and we can now choose to be inactive as much as we want and eat whatever we crave. In fact, for some, such habits are the default setting. Those choices or urges, however, often make us sick in other ways, which then compel us to treat our symptoms. Right now, we are generally satisfied with the system we have created, thanks to long life spans and overall decent health. But we could do better. And as the mismatch environments we have created and pass on to our children through the pernicious feedback loop of dysevolution intensify, we increase our risk of suffering from needless, preventable diseases. [Lieberman, op cit, pp. 364-365].
I would make Daniel Lieberman's book required reading in Med School. Buy it and study it ASAP.

BTW, I came to the book here, at The Daily Beast.


Count me a fan of Gould's "Drunkard's Walk" theory of evolution.
Before the advent of rapid, accurate, and inexpensive DNA sequencing technology in the early 2000s, biologists guessed that genes would provide more evidence for increasing complexity in evolution. Simple, early organisms would have fewer genes than complex ones, they predicted, just as a blueprint of Dorothy’s cottage in Kansas would be less complicated than one for the Emerald City. Instead, their assumptions of increasing complexity began to fall apart. First to go was an easy definition of how complexity manifested itself. After all, amoebas had huge genomes. Now, DNA analyses are rearranging evolutionary trees, suggesting that the arrow scientists envisioned between simplicity and complexity actually spins like a weather vane caught in a tornado...

With comb jellies at the base of the tree, evolution suddenly seems less like a march towards complexity and more like a meandering stroll. This isn’t a new idea. Back in 1996, evolutionary biologist Stephen Jay Gould posited that evolution progresses like a drunkard’s walk. Organisms, he said, stand an equal chance of becoming simpler or more complex over millions of years—although sometimes there’s a lower limit on how simple they can possibly be, just as a drunk may fall into a gutter at the far left side of the road. An Internet meme even celebrates oddities that result from evolution’s stumble: “ Go Home Evolution, You’re Drunk,” features organisms with sub-optimal traits that have managed to survive just fine...

Perhaps the fact that people are stunned whenever organisms become simpler says more about how the human mind organizes the world than about evolutionary processes. People are more comfortable envisioning increasing complexity through time instead of reversals or stasis. Physicist Sean Carroll calls humans “ terrible temporal chauvinists” for this reason, because they desperately want the street from the past to the future to run in one direction. The textbook scenarios on early animal evolution might be correct, but they should be treated as hypotheses built by temporal chauvinists. When new data suggests a rearrangement, it must be considered no matter how perplexing the conclusion seems.

Casey Dunn, an evolutionary biologist at Brown University in Providence, R.I. who took part in the still-contentious comb jelly project, now doubts all notions of increasing complexity. Instead, he says the environment selects whatever form handles the challenges at hand, be it simple, complex, or plain ugly.  Mother Nature, with her 4 billion years of experience, does not work like Steve Jobs, continuously designing sleeker versions. When asked whether de-evolution, a reversal from the complex to the simple, happens frequently, Dunn replies, sure. “But,” he adds, “I wouldn’t call that de-evolution, I’d call it evolution.”
The "bush of life" rather than "the tree of life" metaphor. I just like the "Occam's Razor" simplicity as it applies to evolution. You need assume only three things, all of which exist: [1] simple carbon-based organisms capable of reproducing, [2] a relatively stable environment with a reliable source of energy input, and [3] a lot of time. You need not anthropomorphically assume "purpose," "intentionality," an evolutionary "drive toward complexity."

Pop the clutch, and 4.7 billion years later you might end up with us (along with the enormous volume of single-celled microbial life that still accounts for the bulk of planetary biota). Re-run the experiment and you probably get something unrecognizably different (Dr. Lieberman even generally alludes to this likelihood).

All the more reason to treat life with reverence.


Put up a short post, one pointing back here, over at the new publishing platform. See The underappreciated evolutionary factors that bear on human health and impede effective modern health care

Just trying out the platform. It's OK. I have my doubts as to their business model.

More to come...

Thursday, April 21, 2016

On Disruption: "OMG! Awesome!! Dan Lyons for President!!!


Yeah. Utterly fashionable, overwhelmingly euphoric term of late, particularly in the health care and Health IT space. Recall my recent post "Disruptive" solid tumor tx?" Recall athenahealth CEO Jonathan Bush's repeated calls for "More Disruption, Please"? Recall how the now-relentlessly-beleaguered  Elizabeth Holmes' Theranos was gonna lethally "disrupt" the entire incumbent clinical blood testing industry?

Well, there has in fact been some farting-aloud-at-the-party dissent, e.g., Leon Weiseltier at the NY Times last year:
Amid the bacchanal of disruption, let us pause to honor the disrupted. The streets of American cities are haunted by the ghosts of bookstores and record stores, which have been destroyed by the greatest thugs in the history of the culture industry. Writers hover between a decent poverty and an indecent one; they are expected to render the fruits of their labors for little and even for nothing, and all the miracles of electronic dissemination somehow do not suffice for compensation, either of the fiscal or the spiritual kind. Everybody talks frantically about media, a second-order subject if ever there was one, as content disappears into “content.” What does the understanding of media contribute to the understanding of life? Journalistic institutions slowly transform themselves into silent sweatshops in which words cannot wait for thoughts, and first responses are promoted into best responses, and patience is a professional liability. As the frequency of expression grows, the force of expression diminishes: Digital expectations of alacrity and terseness confer the highest prestige upon the twittering cacophony of one-liners and promotional announcements. It was always the case that all things must pass, but this is ridiculous.

Meanwhile the discussion of culture is being steadily absorbed into the discussion of business. There are “metrics” for phenomena that cannot be metrically measured. Numerical values are assigned to things that cannot be captured by numbers. Economic concepts go rampaging through noneconomic realms: Economists are our experts on happiness! Where wisdom once was, quantification will now be. Quantification is the most overwhelming influence upon the contemporary American understanding of, well, everything. It is enabled by the idolatry of data, which has itself been enabled by the almost unimaginable data-generating capabilities of the new technology. The distinction between knowledge and information is a thing of the past, and there is no greater disgrace than to be a thing of the past...
"There is no greater disgrace than to be a thing of the past."

Tell me about it.

My latest read. By iterative turns, howlingly hilarious, deadly serious, and infuriating. Early on, I could not help thinking of the early episodes of Season 5 of "The Wire," where seasoned journalists at the Baltimore Sun were losing their jobs in droves in the face of internet-"disrupted" seismic, irreversible economic shifts.

Beyond the personal, self-deprecating, eye-rolling "memoir" aspect, "Disrupted" is a fine and necessary piece of reportage.  Definitely 5-stars for me.

If you made a movie about a laid-off, sad-sack, fifty-something guy who is given one big chance to start his career over, the opening scene might begin like this: a Monday morning in April, sunny and cool, with a brisk wind blowing off the Charles River in Cambridge, Massachusetts. The man— gray hair, unstylishly cut; horn-rimmed glasses; button-down shirt— pulls his Subaru Outback into a parking garage and, palms a little sweaty, grabs his sensible laptop backpack, and heads to the front door of a gleaming, renovated historic redbrick building. It is April 15, 2013, and that man is me. I’m heading for my first day of work at HubSpot, the first job I’ve ever had that wasn’t in a newsroom. 

HubSpot’s offices occupy several floors of a nineteenth-century furniture factory that has been transformed into the cliché of what the home of a tech start-up should look like: exposed beams, frosted glass, a big atrium, modern art hanging in the lobby. Riding the elevator to the third floor, I feel both nerves and adrenaline. Part of me still can’t believe that I’ve pulled this off. Nine months ago I was unceremoniously dumped from my job at Newsweek magazine in New York. I was terrified that I might never work again. Now I’m about to become a marketing guy at one of the hottest tech start-ups on the East Coast. There is one slight problem: I know nothing about marketing. This didn’t seem like such a big deal when I was going through the interviews and talking these people into hiring me. 

Now I’m not so sure. I reassure myself by remembering that HubSpot seems pretty excited about having me come aboard. Cranium, the chief marketing officer or CMO, wrote an article on the HubSpot blog announcing that he had hired me. Tech blogs wrote up the story of the fifty-two-year-old Newsweek journalist leaving the media business to go work for a software company...

Lyons, Dan (2016-04-05). Disrupted: My Misadventure in the Start-Up Bubble (pp. 1-2). Hachette Books. Kindle Edition.
I came to this book by way of a review at THCB, "Beyond the Valley of Hype and the Plateau of Despair" by David Shaywitz, MD.

Intrigued, I read the Amazon "Look Inside" preview. Further intrigued by that, I started reading the Amazon reader comments. I typically begin with any 1-star negative reviews. More than one or two of those is often a deal-breaker for me. There are just too many dad-gumbed books to buy and read (along with all of my periodicals), and I'm not getting paid to do so.

The negatives in this case, though, evinced a bit of trollish suspect quality (pissed-off sock puppet HubSpot employees?). So, I turned to the 5-star commentaries. After a good number of those, I thought "yeah, OK, I get it."

I clicked the Kindle edition "Buy Now With 1-Click" bar.

Really glad I did. A compelling read. Finished it in a day. The joke "I spewed my coffee all over my screen" is apt. After I finished, I thought "Dr. Shaywitz, Methinks Thou Dost Protest Too Much."


I now serve as a volunteer one day a week at San Francisco's "" senior dog rescue/foster/adoption service in the Mission District.

I knew my Master's would one day come in handy for something. When not walking dogs or mopping up pee, I spend most of my Fridays down in the basement doing the endless onslaught of laundry they generate. I may shlep one of my 12-strings one of these Fridays and 'shed some tunes while doing the wash. Lord knows I still need the practice.

One of my fellow volunteers is a nice young guy who works in marketing at Salesforce (everyone is starting to look really young to this Geezer-in-Training), the company that has pretty much taken over a good bit of downtown San Francisco. I mentioned that I'd seen that Salesforce was getting into the Health IT space, and that I'd posted about that on my blog last fall.

I also told him "yeah, ONC made us use Salesforce while I was in the Meaningful Use program with the Nevada/Utah REC. I didn't dig it that much; it was not a great fit for what we did. And, we actually resorted to mirroring it by using Microsoft Access and Microsoft CRM to capture, via screen-scrapes and double-entry, the accruing business intelligence for post-REC HealthInsight purposes, since ONC would own the Salesforce REC cloud database (though not the taxpayer-acquired data themselves) once the HITECH contract ended."

Dan Lyons:
Thirteen: The Ron Burgundy of Tech.
Imagine Joel Osteen pumped up on human growth hormone. Imagine there’s a secret government lab where scientists have blended the DNA of Tony Robbins with the DNA of Harold Hill, the aw-shucks shifty salesman from The Music Man. Imagine a grizzly bear in a pinstriped suit, standing on his hind legs and talking about changing the world through disruptive innovation and transformation. 

If you can imagine those things then you can almost imagine the horror of seeing Marc Benioff, the billionaire founder and CEO of, on stage at his company’s annual conference, Dreamforce. It’s November 2013, and that’s where I am, along with Cranium and Spinner and a bunch of other HubSpotters, sitting through Benioff’s three-hour keynote speech on the opening day of the conference. I was psyched when Cranium asked me to go to Dreamforce, if only for the chance to spend a few days in San Francisco. I haven’t been back here since I left my job at ReadWrite. I have a list of people I want to see, restaurants I want to visit. 

But San Francisco is a shitshow. One hundred forty thousand people have descended on a one-square-mile area of downtown. Dreamforce takes place over four days, with concerts and comedians and inspirational speakers. It’s basically Woodstock for people who work in sales and marketing. Or, as Benioff has declared, “the largest and most transformational event in the history of enterprise technology.” 

Entire blocks have been shut down to traffic. All of downtown is gridlocked. Restaurants and hotels are booked solid. I’m staying at the Courtyard Marriott, which was my home away from home during my stint as editor of ReadWrite. Last year I spent so many months living in this hotel that when I walk into the lobby the woman at the front desk recognizes me and remembers my name. Last year I paid $ 129 a night. This week, because of Dreamforce, I’m paying close to $ 700 a night. As for getting around town, forget about finding a taxi. They’re all booked. Oh, and the forecast calls for rain. It’s a nightmare. 

None of this is as awful as Benioff himself. He stands six-feet-five-inches tall and weighs three hundred pounds, with gleaming white teeth and curly black hair that glistens with hair gel. He is a former salesperson who now sells software that lets other salespeople sell more stuff. It’s called customer relationship management, or CRM, software. Benioff is also one of the wealthiest people in the world, a member of the Forbes billionaire list. Here in the main auditorium of the Moscone Center, thousands of people who sell things over the Internet are standing up and cheering for him as if he’s some kind of superhero. 

The whole thing makes me depressed, in part because Benioff is a buffoon, a bullshit artist, and such an out-of-control egomaniac that it is painful to listen to him talk. He lives in Hawaii and signs his emails “Aloha.” He’s a Buddhist and hangs out with Zen monks from Japan, and he gave his golden retriever the title “chief love officer” at his company. He is the Ron Burgundy of tech. He and this conference are the essence of everything that has gone wrong in the industry. “Have you transformed the way you innovate?” was Benioff’s big line at the 2012 Dreamforce show. Note that you can switch the two buzzwords in the sentence and it still sounds good and still means nothing. Meaningfullessness is not a word, but should be. There’s an art to this kind of horseshit, and Benioff is its Michelangelo...

We’re here in part to steal ideas— we’ll see what these guys do to create a spectacle and copy that for our Inbound conference in Boston. We’re also here to gather competitive intelligence, to see how Benioff talks about his new marketing software and what the audience makes of his pitch. We want to find out what we’re up against. 

Based on what I’m seeing, we’re in trouble. Sure, Benioff is full of shit, but so are we, and Benioff is way better at being full of shit than we are. Also,’s sales are about fifty times what ours are. In terms of hype, the disparity is even greater. Just two months before this, HubSpot’s Inbound drew five thousand people, a tiny fraction of the Dreamforce audience— even after giving away or selling a lot of our tickets at a discount. 

We’re screwed, I keep thinking. We’re totally, absolutely screwed. Not because the ExactTarget product is better than ours, because who even knows, and who even cares? Having the best product has nothing to do with who wins. What matters is who can put on a great show, who can create the biggest spectacle, who can look huge and unstoppable and invincible, and who is the best at bluster and hype. 

When it comes to these things, nobody comes close to Benioff. Nobody has cashed in on the bubble as well as he has. In 2012, lost more than a quarter of a billion dollars, and in 2013 it will lose almost as much. In 2013 the company is fourteen years old and not making a profit. But its revenues are growing more than 30 percent each year, and growth is what investors are looking for, so even though is bleeding red ink, its stock has doubled over the past two years, and Benioff’s personal net worth has soared to $ 2.6 billion. 

Now, here in the Moscone Center, the P. T. Barnum of the tech industry is giving a master class in how the game is played. It’s the Marc Benioff show, brought to you by Marc Benioff, with special guest Marc Benioff. Fifteen thousand people are packed into this hall. Thousands more are packed into spillover rooms. It feels like a rock concert. In fact it is a rock concert. Before Benioff appears, the lights go down and suddenly Huey Lewis and the News are performing “The Power of Love.” It is nine in the morning. From our seats, way in back, we can barely see the band, but we watch on huge screens, the kind used at football stadiums. 

Next comes Benioff, making a big high-energy entrance, like some kind of cheesy talk-show host, roaming up and down the aisles, a man of the people. He wears a blue suit and a pair of multitoned shoes, called Cloud Walkers, custom made by Christian Louboutin. He says he chose that Huey Lewis song because the power of love is what is all about. He doesn’t want to talk about business. He wants to talk about the hundreds of millions of dollars that he and have donated to worthy causes. “The best drug I ever took,” he says, “was philanthropy.” 

I suspect that opening with a big-name band is also a form of dick measuring. It’s Benioff’s way of saying, “I just spent three hundred thousand dollars to have a band play one song. You know why? Because I can.” The same goes for his philanthropy. Benioff says he’s challenging other tech billionaires to give away as much money as he does. The thing is, a lot of rich tech people do give away a lot of money; they just don’t go around bragging about it. Benioff’s challenge is a form of self-aggrandizement, his way of saying that while others might give away money, Mine is bigger. He wields his philanthropy like a four-foot cock, slapping us all in the face with it...

Dreamforce rolls on. Over the next few days the show features some of the biggest names in tech, like Dropbox CEO Drew Houston, HP CEO Meg Whitman, Yahoo CEO Marissa Mayer, and Facebook COO Sheryl Sandberg. Benioff has latched on to the “Women in Tech” crusade and made it his cause célèbre. “Powerful women” is a theme of the conference— yet oddly enough only four members of Benioff’s twenty-two member management team and only one member of his board of directors are female. is run almost entirely by white men. But look— over there! It’s the prime minister of Haiti! And wait, hold on— is that thunder and lightning? Indoors? Is that a Tesla? From the future? On stage? 

Green Day plays a concert in AT& T Park, home of the San Francisco Giants. Alec Baldwin gives a talk. Tony Bennett and Jerry Seinfeld make appearances. It’s all part of what describes as “dynamic programming to exhilarate the Dreamforce community.” Cavernous halls are lined with countless booths rented out by software makers hawking programs that work with Salesforce: add-ons, plug-ins, mobile apps. There’s a “connected devices playground” and a “Dreamforce hackathon.” There are more than a thousand breakout sessions and “success clinics,” where people can learn how to sell stuff. Two people dressed up in foam balls— the mascots, SaaSy and Chatty— bounce around the conference, dancing awkwardly with legions of mostly white people...

I stay in my hotel and gaze out my window at the rain-blurred lights down below, marveling at all the money and evil sloshing around down there. One hundred and forty thousand salespeople have hit San Francisco, armed with expense accounts and determined to have the time of their lives. They will sleep with their clients. They will sleep with their colleagues. Hookers have flown in from all over the country for this. Tinder and Grindr and the Craigslist “casual encounters” listings are packed with out-of-towners looking to hook up. The strip bars and S& M clubs are booming. Dreamforce turns out to be a four-day orgy worthy of Caligula, a triumph of vulgarity and wasteful spending, with free booze and endless shrimp cocktail and a rate of STD transmission that probably rivals Fleet Week. 

Gazing down on this mess is like looking into the pit of Mordor. So many lost souls! These glorified car salesmen, these people whose jobs involve coercion and manipulation, whose lives revolve around making their numbers. Every month, every quarter, every year: sell, sell, sell! These are the people who took the Internet, one of the most wonderful and profound inventions of all time, and polluted it with advertising and turned it into a way to sell stuff. No wonder these zombies need to take a week off in San Francisco once a year, with some Deepak Chopra and maybe an eight ball of coke and a Canadian hooker to make the whole thing seem worthwhile. 

Dreamforce is only part of Benioff’s mad campaign of megalomaniacal self-aggrandizement. Five months from now, in April 2014, Benioff will announce plans to make the anchor tenant for a new skyscraper that is already under construction in San Francisco. will commit $ 560 million to help finish work on the one-thousand-foot glass-and-steel skyscraper, which will become the company’s headquarters and be named the Salesforce Tower. When it opens in 2018, it will be the tallest building in the city, dwarfing everything around it. Maybe Benioff is oblivious to the phallic symbolism, or maybe he doesn’t care, or maybe— and this is my theory— he knows exactly what he’s doing and he loves it. Mine’s bigger! It’s the biggest! 

For P. T. Benioff there is no end to the extravagant spending. At the 2015 Dreamforce he docks a one-thousand-foot-long luxury ocean liner at pier 27 to serve as a hotel and party space— the Dreamboat, he calls it. still isn’t turning a profit, but thanks to Benioff’s huffing and puffing’s market value has topped $ 50 billion and Benioff’s own net worth has swollen to $ 4 billion. Benioff has invented a form of financial alchemy, one where he makes money by losing money. The more Benioff squanders on parties, the richer he gets. 

Looking down from my hotel window in November 2013, I realize that things are playing out exactly the way Tad, my investment banker friend, told me they would when I met him for a drink just one year ago at Anchor & Hope. This is what a trillion-dollar wealth transfer looks like. Across the country, in New York, bonuses on Wall Street are going to be the highest they’ve been since 2007, before the crash. In 2013, there will be more IPOs than in any year since the dotcom bubble peaked in 2000, and in 2014 there will be even more, according to Renaissance Capital, a company that tracks the IPO market. 

Surely it cannot end well when a bunch of money-losing companies go racing into the public markets, and when risk that previously was confined to private investors gets shifted onto the public. Nevertheless, the Fed keeps printing money, and the stock market keeps going up. The ducks are quacking, and the VCs are racing for the exits, launching IPOs as fast as they can... [Dan Lyons, pp. 128-137].
Ouch. That, while a bit lengthy, is just an "Amazon Preview"-ish chapter excerpt.

Five stars. Again, by turns hilarious, deadly serious, and infuriating. An important piece of cautionary journalism overall, IMO. Buy it. Enjoy.

Since I started covering Health 2.0 events several years ago, I've had repeated looks at all this irrepressively exuberant Health IT VC stuff. Dan's book has provided additional heft to my "Free Beer Tomorrow" dubiety.

Inclusive of its darker socioeconomic implications.

During the last Health 2.0 WinterTech Conference I watched a presentation by a guy representing a startup company pitching an AI-assisted "app" that recursively calculates your "Health Score" -- akin to a FICO credit score. You enter in some basic data and get a baseline score. Then, as the app reaches out to mine various elements of your social media accounts (once you've clicked the ever-handy "I agree" auth), the "score" gets refined and re-refined over time.

What could possibly go wrong there?

Lordy. See my post from about a year ago "The old internet of data, the new internet of things and "Big Data," and the evolving internet of YOU."

I used to work in subprime credit risk modeling. I could give you chapter and verse of what can (and will) go wrong.

A Final Dan Lyons cite:
We share our information with companies all the time. We send email through Google or Microsoft. We store files on Dropbox. We shop on Amazon. We buy apps and music from Apple. We hire drivers through Uber, and rent apartments through Airbnb. Companies use Workday for HR, Zendesk for customer service, for customer tracking, Slack for messaging, and on and on. Most of these companies don’t operate their own data centers. Instead, they rent server and storage space from a hosting company like Amazon. Our information gets distributed around the globe, zipped between data centers at the speed of light, stashed on hard drives, backed up, duplicated, replicated, sliced and diced, sold and shared. Even the people who supposedly manage our data have no idea where all of it resides or who has access to it. 

Yet we go along. We convince ourselves that nothing bad will happen. We tell ourselves that we’re not important enough for anyone to spy on us, or that even if someone did want to spy us, there must be safeguards in place that prevent bad people from snooping. We hear the people who run these online services present themselves as idealistic do-gooders who want make the world a better place. 

Even if we don’t believe them, we understand that they have a financial incentive not to spy on us. They don’t have to be good people, or honest people, or law-abiding citizens. They just have to want to make money. They can’t do that unless people trust them. Their own greed will keep them honest— that’s the theory, anyway. 

So we figure we’re safe. We figure we can trust the people who run online services not to snoop on us. I used to believe that. I don’t anymore. Halligan, Volpe, and Chernov were not random nerds going rogue in some data center. They were top executives of a publicly traded company. They’re the ones who were supposed to be keeping an eye on the others. During my time at HubSpot, I was shocked to see how badly managed the company was and how packs of inexperienced twenty-something employees were being turned loose and given huge responsibility with little or no oversight. In the world of start-ups that is now the norm, not the exception. 

The consequences are just what you would expect. Employees at Uber, the ride-sharing company, have used a “God View” feature to stalk people using the service, including a BuzzFeed journalist. Re/ code, a tech blog, claims other companies have done the same, including Lyft, a rival to Uber; Swipe, a photo-sharing app; and Basis, which makes a “health watch” that tracks people’s heart rates, sleep patterns, and other personal information. In the early days at Facebook, the young employees had a master password to gain access to anyone’s account, according to a book by a former Facebook employee. Dirty tricks have become par for the course at these places. In 2011 Facebook was caught running a sneaky smear campaign, hiring a PR firm to spread negative stories about Google— I know because I’m the reporter who caught them and broke the story for Newsweek. Facebook’s entire business model is based on mining personal data in order to deliver targeted advertising. The same goes for Google and countless other online companies. We have no idea who has access to what. 

We also have no choice but to go along. None of us is going to opt out of using the Internet. Nor can we expect that the companies will do any better when it comes to oversight. They’re funded by venture capitalists who seek only the biggest and quickest return on their investment. That means hiring kids, cutting corners, breaking rules. It does not mean investing loads of money in order to build safeguards and protect users. There’s an adage in Silicon Valley that people who use online services are not the customers. We’re the product. As far as companies in Silicon Valley are concerned, we exist solely to be packaged up and sold to advertisers. We should not expect these companies to look out for us... [Dan Lyons, pp. 255-257].
All the raucous hilarity of "an old guy" struggling to fit in with the organizationally random MEGO 20-somethings' culture of an internet marketing company aside, this is a serious and valuable piece of work. All the more entertaining for its chortle-inducing Michael Lewis-esqe snarkiness.

We don't need another "built-to-flip" tech bubble burst. That one may well happen, though, would not surprise me one bit.


Wow. That is very sad. The news broke just as I was finishing this post. One of my friends, Paul Peterson, (who once got Kenny Loggins to come to the Santa Fe gig for us) was his keyboard player during the whole "Purple Rain" thing. He's inconsolably stunned at the news.

Undisrupted: HubSpot's Reflections on "Disrupted"
Dharmesh Shah, Founder and CTO at HubSpot

It has been almost 10 years since the two of us founded HubSpot. If someone had told us then that someday, the company would grow up to be publicly-traded and have over a thousand employees, we would have been cautiously hopeful. After all, the plan from the beginning has always been to build a successful, enduring company. But, if someone had also said that we’d have a satirical author write a scathing book about us, we would have never believed that. That was definitely not the plan. Besides, who’s going to want to read a book about HubSpot? 

Last week, Dan Lyons, a former employee of HubSpot released just such a book: “Disrupted: My Misadventure In The Start-Up Bubble.” And as it turns out, a lot of people are reading the book. We have now had a chance to read it ourselves and reflect on it a bit...
I would say buy and read Dan Lyons' book. Decide for yourselves. I see they're thus far not suing him for libel.

More to come...