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Sunday, December 31, 2017

Wishing everyone a happy and safe New Year's Eve and prosperous 2018

Lots to reflect upon regarding 2017. And, today is my wife's birthday. I hope everyone has a great 2018.

Be safe out there tonight.

And, don't forget this, coming up shortly.

Hope to see you there.


Saw this over on LinkedIn.


More to come...

Friday, December 29, 2017

On the ostensible inevitability and advanced efficacy of "Precision Medicine"

It's hard to overstate the aggregate effusiveness exuded by the digital health community these days. e.g., the recent 2017 Technology for Precision Health Summit I attended.

I heard this NPR All Things Considered segment yesterday while shlepping my daughter to BART.
Will Gathering Vast Troves of Information Really Lead To Better Health? 

The Mayo Clinic is building its future around high-tech approaches to research known as "precision medicine." This involves gathering huge amounts of information from genetic tests, medical records and other data sources to ferret out unexpected ideas to advance health. But one longtime scientist at the Mayo Clinic isn't playing along…

And it's not simply that he's an old-school devotee. He believes that the solution to our most pressing health problems lies in thinking about whole human beings, not breaking everything down to DNA sequences.

”The enthusiasm for this [precision medicine] is occurring in a country where life expectancy is actually falling," he says as he walks through the old linoleum-tiled halls of St. Mary's hospital.

That fact alone leads Joyner to ask whether the money being poured into high-tech medical research is really solving the nation's stark health problems, like obesity, heart disease, high blood pressure, diabetes, Alzheimer's disease and cancer...
"With the momentum now built up behind this enterprise, precision medicine will be judged like much of modern medicine: in hindsight, after it becomes entrenched in clinical practice."


Stay tuned. Teeing up shortly for a look at cryptocurrencies' underlying "blockchain" hype.

What could possibly go wrong?


Margalit Gur-Arie has posted another doozy:
...Funded with cash from sexist pigs and harassers, a startup, whose business model is to help other startups “hook” people on trashy little apps, is calling itself Dopamine Labs. “Dopamine makes your app addictive” is their promise. According to the website, they use AI and neuroscience to deliver jolts of dopamine that “don’t just feel good: they rewire the brain’s habit centers” of users to “boost usage, loyalty, and revenue”. “Your users will crave it. And they'll crave you”. At its rotten core, Silicon Valley is a drug cartel, a very clever and savvy cartel who managed to convince the world that its brand of drug addiction is actually good for you and either way, it’s inevitable...
From The Power of Silicon Valley.

More to come...

Monday, December 25, 2017

Booked up for the holidays

Trying to get back on pace with my reading tempo. Been hobbled most of the year with my daughter's illness.

Lots of great stuff.

In particular, the Rachel Pearson book has my rapt attention. Underachiever with MD (Peds) and PhD (Medical Humanities) degrees. Now in residence at UW Harborview Medical Center in Seattle.

Check this out, a summary of her UTMB Doctoral dissertation::

Objectivity is an epistemological virtue that physicians aspire to embody in our practice. Historians and philosophers have pointed out that objectivity is culturally specific: it varies with time, place, and profession. In pre-clinical training, physicians learn to honor a scientific version of objectivity, in which the self is understood primarily as a potential source of error and “scientific selves” seeks to eradicate the pernicious influence of the self from scientific data. In practice, however, this research identifies that medical objectivity is distinct from scientific objectivity. This dissertation examines memoirs of medical training to understand how physician trainees learn, experience, and use objectivity. Medical objectivity is defined herein as attitude within medical epistemology that serves physicians’ attempt to structure clinical knowledge as scientific knowledge. It is situated (within the bodies and selves of physicians and medical trainees), dynamically subjective (insofar as it both changes people and changes according to the people who embody it), structured by narratives (such as narratives of race and narratives of self), and learned. The objective/objectifying gaze is an epistemological technique that serves a limited but crucial role in medical objectivity. The devaluation and attempted eradication of the self that inheres in an idealized “scientific objectivity” persists in medical providers’ narratives of self, within the objective/objectifying gaze, and in the experiences of clinical detachment and aequanimitas. Medicine’s appeal to social authority relies in part on the perception that we are “scientific.” However, medical objectivity is best understood as a subjectively situated and narratively structured attitude that serves (and, in some cases, disserves) medicine: a science-using, moral practice. Truly embracing medical objectivity as a subjective and narrative practice can both alleviate trainee discomfort and improve care. Not only can our narratives be fruitfully examined and challenged, but also we can harness subjectivity (including our discomfort, our joy, and our narratives of self) as a tool to improve the quality of care we provide.
I really want to read her dissertation.

UPDATE: I finished Rachel's book. Utterly compelling. Five stars. I put it right up there with Ann Neumans's The Good Death.

I am always interested in books that shed light on "clinical cognition" and the lives of clinicians. e.g., see my prior post "Nurses and doctors in the trenches." Also a big fan of Dr. Danielle Ofri. See my "House calls, STAT!" See also my post on "Slow Medicine," "God's Hotel."

Below, I finished this book. Very good.

Dug it. Although, for a book claiming to have "launched the Lean Startup revolution," there is precisely nothing in it going explicitly to Lean methodology practices. Putting the "customer discovery / customer development" processes ahead of the "product development process," yeah, I get all that (and, charitably, it's foundational to a Lean philosophy, in many ways a direct descendant of Deming). But, no discussion of key topics such as "PDSA," "Value Stream," "Gemba," "Kaizen," "the 5 S's,", "A3," "Fishbone Diagram," etc.

I kept getting a recurrent feeling: "yeah, this is largely good old MBA (albeit PDSA-iterative) SWOT analysis stuff."  I'll have more to say about this one in a bit.

Other stuff in play:

And, off-topic, but intrinsically interesting to me (bought this in hardcover),

Below, not yet released, but coming in January:

Found out about this one via an article on its topic in The Atlantic.

I hope everyone has a happy and safe holiday season.


Update: I got two hardcover books for Christmas from my dear sister Carole.


Then there's this:

Ran across a reference to this book over at Naked Capitalism, "Cognitive Economics: How Self-Organization and Collective Intelligence Works."
Cognitive Economics
The more detailed study of apparently self-organizing groups points toward what could be called a cognitive economics: the view of thought as involving inputs and outputs, costs and trade-offs. This perspective is now familiar in the evolutionary analysis of the human brain that has studied how the advantages of an energy-hungry brain, which uses a quarter of all energy compared to a tenth in most other species, outweighed the costs (including the costs of a prolonged childhood, as children are born long before they’re ready to survive on their own, partly an effect of their large head size).

Within a group or organization, similar economic considerations play their part. Too much thought, or too much of the wrong kind of thought, can be costly. A tribe that sits around dreaming up ever more elaborate myths may be easy pickings for a neighboring one more focused on making spears. A city made up only of monks and theologians will be too. A company transfixed by endless strategy reviews will be beaten in the marketplace by another business focused on making a better product.

Every thought means another thought is unthought. So we need to understand intelligence as bounded by constraints. Cognition, memory, and imagination depend on scarce resources. They can be grown through use and exercise, and amplified by technologies. But they are never limitless...
Some of this is obviously going to point to "AI." Stay tuned.


More to come...

Thursday, December 21, 2017

January 10th in San Francisco, WinterTech 2018

Registration link
"WinterTech is up next, and we're extremely excited about the final agenda. The 2018 edition of WinterTech will be not only be focusing on the new investment treads in digital health, but will take a in-depth look into the revolution in choice within the consumer landscape and the rapid development of digital therapeutics.

Our jam-packed 1-day conference includes:

    •   Keynote presentation on how to create seamless health care experiences to meet the needs of consumers by Mark Ganz, CEO of Cambia Health.
    •   Panel discussion on the opportunities, roadblocks, and regulations within the field of digital therapeutics by Bakul Patel, Associate Director for Digital Health at the FDA.
    •   Investment Strategies Past and Present: a look into 2017 trends, surprises, and flops. plus predictions for 2018 by VC firms GE VenturesCanaan, Fifty Years, NEA, and B Capital Group.
    •   Fireside chat between 4 VCs and their CEOs on their relationship and investment models
    •   Access to the Investor Breakfast where start-ups and investors discuss business models and explore portfolios. Start-ups apply here.
    •   Live demos from some of the most innovative companies in the digital healthcare space.
Don't miss out the hottest digital healthcare event focusing on investment in the space. Register today to take advantage of the early bird rate before prices increase after Friday, December 22nd."

See you there. I'm bringing with me Jeff Nyquist, PhD, founder and CEO of


Just downloaded this:

The Amazon blurb:
A brutally frank memoir about doctors and patients in a health care system that puts the poor at risk.

In medical charts, the term “N.A.D.” (No Apparent Distress) is used for patients who appear stable. The phrase also aptly describes America’s medical system when it comes to treating the underprivileged. Medical students learn on the bodies of the poor—and the poor suffer from their mistakes.

Rachel Pearson confronted these harsh realities when she started medical school in Galveston, Texas. Pearson, herself from a working-class background, remains haunted by the suicide of a close friend, experiences firsthand the heartbreak of her own errors in a patient’s care, and witnesses the ruinous effects of a hurricane on a Texas town’s medical system. In a free clinic where the motto is “All Are Welcome Here,” she learns how to practice medicine with love and tenacity amidst the raging injustices of a system that favors the rich and the white. No Apparent Distress is at once an indictment of American health care and a deeply moving tale of one doctor’s coming-of-age.
"the raging injustices of a system that favors the rich and the white."

I've been reading through the final cut of the reconciled and enrolled GOP tax cut bill, H.R. 1, just signed into law by the President. Couple of cuties:
(1) IN GENERAL.—280F(a)(1)(A) is amended—
(A) in clause (i), by striking ‘‘$2,560’’ and inserting ‘‘$10,000’’,
(B) in clause (ii), by striking ‘‘$4,100’’ and inserting ‘‘$16,000’’,
(C) in clause (iii), by striking ‘‘$2,450’’ and inserting ‘‘$9,600’’, and
(D) in clause (iv), by striking ‘‘$1,475’’ and inserting ‘‘$5,760’’.
(A) Clause (ii) of section 280F(a)(1)(B) is amended by striking ‘‘$1,475’’ in the text and heading and inserting ‘‘$5,760’’.  (pp. 55-56)

‘‘(A) IN GENERAL.—No tax shall be imposed by this section or section 4271 on any amounts paid by an aircraft owner for aircraft management services related to—‘‘(i) maintenance and support of the aircraft owner’s aircraft, or ‘‘(ii) flights on the aircraft owner’s aircraft.
‘‘(B) AIRCRAFT MANAGEMENT SERVICES.—For purposes of subparagraph (A), the term ‘aircraft management services’ includes—‘‘(i) assisting an aircraft owner with administrative and support services, such as scheduling, flight planning, and weather forecasting, ‘‘(ii) obtaining insurance, ‘‘(iii) maintenance, storage and fueling of aircraft, ‘‘(iv) hiring, training, and provision of pilots and crew,‘‘(v) establishing and complying with safety standards, and‘‘(vi) such other services as are necessary to support flights operated by an aircraft owner.
‘‘(i) IN GENERAL.—For purposes of this paragraph, the term ‘aircraft owner’ includes a person who leases the aircraft… (pp.129-130)
OK, [1] quadrupling the depreciation limits on "luxury automobiles," etc, and [2] making all private air travel, including personal/pleasure flights tax-deductible (private business travel is already deductible).
There's more, including the 100% 1st year write-off for capital equipment investments (say, like, automation / robotics that replace human workers), but that's enough for now.
Note:The "Personhood at Conception / Unborn Child Tax Credit" provision in the House bill got removed -- “an unborn child means a child in utero, and the term child in utero means a member of the species homo sapiens, at any stage of development, who is carried in the womb.“

Below, here is the post that got me onto this doc, Rachel Pearson.
As a Doctor, I’m Sick of All The Health Care Freeloaders
I work in a clinic where the vast majority of my patients are on government-funded health care and have never worked a day in their lives.
The Ride of the Venture Valkyrie
From printed skin to augmented reality, Lisa Suennen channels her inner goddess to divine which health technologies people will actually use.
 Lisa will be onstage at WinterTech. I left a comment under this Medium article.

More to come...

Wednesday, December 13, 2017

Recapping the 2017 Health 2.0 Technology for Precision Health Summit

What a delight, the Julia Morgan Ballroom.

Matthew Holt kicked things off, and then remained offstage until the wrap at the end of the day. He roamed the ballroom all day shooting smartphone pics and uploading them, basically live-tweeting the entire day. Scooped the hell out of me and my ever-more obsolete Sony alpha DSLRs.

My friend, veteran health care journalist Scott Mace showed up. Way cool. We sat together for the day.

I have some 70 photos to consider for upload. Need to also review my notes for my impressions of the day.

A ton of intellect on that stage and in the audience. A great mix of Keynotes, panel discussions, slide presentations, and demos. And, really nice to see a lot of women onstage, many of them MD and PhD entrepreneurs.

Some jots from out of my little notebook:
Claudia Williams Keynote: “Innovation Can Now Come from Anywhere”

Defining “Precision Medicine, Precision Health, Personalized Medicine”

The “Omics”
Unsustainable Growth of Health Care % of GDP 
Big Data, a “Sea of Information”

Lagging Interoperability

CDOD, “Chronic Data Obstructive Disorder”

AI, Machine Learning

Blockchain/Distributed Ledger, Bitcoin

“We’re Still Building the Plumbing”

The Criticality of Patient Engagement

Longitudinal Patient Record from ALL Sources

Obama’s Precision Medicine Initiative

Real Time Analyses of Patient-Generated Data (e.g. wearables)

Data Transparency (Public Good) vs Proprietary “Silos” (BizIntel)

“Digital Dial Tone”

The “Unknown Unknowns” of Uncollected Data

Jared Kushner, “Interoperability Summit”

“Quantum Privacy”

David Ewing Duncan, “Precision Medicine is a 10-year Overnight Success”

The “Art of Medicine”

Q&A: Overdiagnosis, False Positives, Overtreatment

Abstracting Structured Data out of Free-Text EMR Records

UPSTREAM Issues, incl. Psychosocial Elements

Tech and Clinical Science “Convergence”

Genome vs Phenome

Gartner Hype Cycle

Carlos Bustamante Keynote, Biomedical Data Science at Stanford

Safety Net, Access Issues


“Precision Advertising (Facebook), Precision Shopping (Amazon), Precision Entertainment (Streaming), but NOT Precision Health?”

Ever-More Rapidly Shrinking Doubling Time of Medical Knowledge

VC and Business Models (e.g., WEF and California PMI initiatives)
Update note: I've had to be away from finishing this post for several days, helping move my daughter's things out of storage into a 26' U-Haul truck for my grandson to drive back to Las Vegas (he made it safely). He just moved back to Las Vegas from Baltimore where he'd been working and living with our son Nick.

I will get to more detailed thoughts on the foregoing list of #tph2017 topics ASAP. Some of this stuff is not exactly news, other topics indeed are. I can probably do a paragraph of impressions on each of the foregoing.

BTW: I found it curious that there was no mention of the FCC "net neutrality" issue, in light of the potential stakes for internet-based startups.

My summary takeaway tweet.

Conference Chair Linda K. Molnar, PhD

I have some family matters to engage before finishing out this post, but in the interim the Health 2.0 staff has already published an excellent recap.

This week a group of investors, entrepreneurs, precision health researchers, and data wonks all gathered at the opulent Julia Morgan Ballroom in San Francisco for a day of sharing, charged discussion, and live technology demos. The goal of the Technology for Precision Health Summit was to shine a spotlight on advancements and opportunities within an industry where the stakes are high and the imperative to innovate is often life or death.

Linda Molnar, Co-Chair of the summit, opened the day by offering some historical context and major milestones to illustrate how we got to where we currently stand…
Very cool.

Stay tuned.


Some random photos.

Opening Keynoter Claudia Williams! Been following her since her HIE days at ONC
The esteemed journalist David Ewing Duncan
Afternoon Keynoter Carlos Bustamante of Stanford. Yikes!

An absolutely fabulous day.

Up next, save the date (same SF location): January 10th, 2018, WinterTech!

Health 2.0 WinterTech is back in 2018 during the nation's leading investment summit, JP Morgan Week, in San Francisco. WinterTech is the place for insider insights on investing trends in health care technology. By bringing together top tech companies, VCs, entrepreneurs, policy makers, and more, the fourth annual event will highlight the new and unique opportunities available in the fast-rising digital health landscape. Join us for a day packed full of insights with top CEO and VC interviews, and an exploration of the consumer landscape and the rapid rise of digital therapeutics…
apropos of WinterTech, a personal note: two years ago I mentioned the Northern Michigan startup "NeuroTrainer" launched by Dr. Jeff Nyquist (PhD, NeuroPsych, Vanderbilt).

Jeff is the husband of my dear niece April. I was recently thrilled to learn that they have secured a VC Seed Round (totally reputable yet low-profile SF firm), have leased an apartment in San Francisco, and are enroute overland as I write this. They should be here by December 21st.

I've told Jeff about WinterTech. Would love to have him attend. I'm also gonna see if I can help get him a demo slot at the 2018 AARP Innovation 50+ event.

It'll be interesting to see how their effort plays out. They have a fairly short "runway." Really glad they're coming out here, both for their business prospects and for family reasons.


Finish one book, start right in on another.


Been speed-reading (mostly keyword/phrase search driven) through the 1,097 pages of the House/Senate reconciled GOP tax cut bill that is likely to pass into law before Christmas.

How comforting. Is it too early to start drinking?

And then there's this doozy.

The George Carlin jokes just write themselves.

More to come...