Search the KHIT Blog

Saturday, August 31, 2019

"Seattle is dying"

In 1968, with the birth of my first child, Sissy, I moved from San Francisco to Seattle. Both of my girls were born there. I absolutely loved it there (the "Emerald City" indeed), staying until 1975, when we moved to Birmingham, Alabama. I still have numerous great friendships in the Seattle area.

Just watched a disturbing, sad KOMO News video documentary. Extremely well done.

It says "age-restricted video (based on community standards)."

My, how times have changed. The acute circular confluence of street drugs, crime, mental illness, and homelessness, amid the obscenely wealthy techietopia.

When I was volunteering at Muttville in SF, I used to traverse many blocks of homeless encampments on my way from the BART station. The scenes in this documentary look even worse, if that's possible.

More to come...

Thursday, August 29, 2019

EHRs and scribes

I've been a year+ overdue for an eye exam, so off I went yesterday. New patient at the Katzen Eye Group nearby in Lutherville. My wife used them recently and recommended them to me (they take our opto insurance we get through her employer--not using Kaiser for this benefit).

Excellent. They're on the NextGen EHR. And they use scribes, which I found rather effective. When I was with the REC/QIO, we served client clinics on NextGen. I found it a tad busy for my workflow taste. But, that was then, this is now.
They gave me login/setup info for their NextGen portal. Have yet to set it up. Most portals I've used are pretty feeble. We'll see.
Found out I have mild cataracts (no other pathologies). I'm probably about 5 years out from a mitigative eye surgery px. Ugh.

From AAFP:

Scribes Lessen FPs' Administrative Burden, Researchers Find

We used to have "coders." Those gigs are now kaput. Now, increasingly, we have mid-office scribe support staff. My last Primary at Muir in CA started using a scribe. I support this idea. They probably pay for themselves and then some (and I'd speculate are more accurate), net, across the board.


This quick review is in my Scientific American special edition "Truth, lies, and uncertainty." Bought and downloaded it. Just started. Stay tuned.

More to come...

Monday, August 26, 2019

"Human Nature"

From Science Magazine:
CRISPR comes to the silver screen
If you could cure a child suffering from sickle cell anemia, would you? This is the question at the center of Human Nature, a new documentary directed by Adam Bolt about the revolutionary gene-editing technology known as CRISPR. The documentary is visually stunning, thought-provoking, informative, and tightly focused on human health—which means that there are a few pieces missing from the overall picture.
"Omics" update stuff. Documentary website here.


NOTE: Some of this is not in English, you might want to click 'subtitles/CC."

More to come...

Sunday, August 25, 2019

dx for the planet: global COPD

The Amazon Basin rainforest, often called "the lungs of the planet" and reportedly the source of a disproportionate percentage of our atmospheric oxygen, is ablaze at an unprecedented pace.

The bulk of the Amazon Basin lies within the nation of Brazil. #

From The Real News Network:


Interview transcript at Naked Capitalism. Does not bode well.

The Horrifying Science of the Deforestation Fueling Amazon Fires

BEING A RAINFOREST, the Amazon isn’t supposed to burn out of control, unlike California’s drier landscape, which is built to burn and burn explosively. Yet here we are, watching swaths of the Amazon go up in flames. And we can easily nail down the cause: humans. Deforestation is what’s driving these blazes, and there is some horrifying science behind that.

Since the 1970s, 20 percent of the Amazon has been deforested, totaling about twice the area of California. But deforestation isn’t an organized shrinking of the rainforest, paring it down from the edges in. Humans carve out farmlands, sometimes leaving a neat edge where the forest meets the fields, or even creating islands of forest surrounded by crops or grazing fields for cattle. Indeed, agriculture is far and away the primary driver of deforestation in Brazil…
Global COPD coming?  More from WIRED:
"The destruction of the Amazon rainforest is methodical and self-perpetuating. When all those trees burn, they release CO2 into the atmosphere, cutting down on a critical carbon sink. In the Amazon, this is particularly problematic because it can turn into a net carbon emitter even when it’s not on fire. Rivers and lakes in the tropics are filled with algae and other life-forms that respire CO2 just like we humans do. Without trees, the Amazon loses its sequestering power and instead becomes a belcher of carbon.
It’s subtle ecological quirks like these that can turn a burning Amazon into a global catastrophe."
The Amazon Cannot Be Recovered Once It’s Gone
The fires blazing in Brazil are part of a larger deforestation crisis, accelerated by President Jair Bolsonaro.

The Amazon is burning. There have been more than 74,000 fires across Brazil this year, and nearly 40,000 fires across the Amazon, according to Brazil’s National Institute for Space Research. That’s the fastest rate of burning since record-keeping began, in 2013. Toxic smoke from the fires is so intense that darkness now falls hours before the sun sets in São Paulo, Brazil’s financial capital and the largest city in the Western Hemisphere.

…the Amazonian fires—which have been blazing for weeks and notoriously received less coverage than Notre Dame’s burning roof— seem like a potent symbol of humanity’s indifference to environmental disorder, including climate change.

But climate change is not the primary cause of the wildfires. Unlike, say, most California blazes—which are sparked by accident and then intensified by climate change—the Amazonian fires are not wildfires at all. These fires did not start by lightning strike or power line: They were ignited. And while they largely affect land already cleared for ranching and farming, they can and do spread into old-growth forest…

…The Amazon rainforest does, in some sense, belong to Brazilians and the indigenous people who live there. But as a store of carbon, it is fundamental to the survival of every person. If destroyed or degraded, the Amazon, as a system, is simply beyond humanity’s ability to get back: Even if people were to replant half a continent’s worth of trees, the diversity of creatures across Amazonia, once lost, will not be replenished for roughly 10 million years. And that is 33 times longer than Homo sapiens, as a species, has existed.

From Naked Capitalism again:
It’s Raining Plastic, From the Pyrenees to the Rockies to the Arctic
They mention this WHO report (pdf):

Fouling our nest at every turn. If it's in the air and in the water, it'll be in the food chain and in our bodies.



The harmful chemicals associated with plastics can be divided into three categories: ingredients of the plastic material, byproducts of manufacturing and chemicals adsorbed from the environment. The possible toxicological responses caused by plastic can thus be a combination of all of these chemicals. Some of these chemicals are defined as priority pollutants, which are regulated by governmental agencies because of their toxicity or persistence in organisms and food webs. These chemicals include heavy metals, pesticides, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs), which can disrupt important physiological processes of animals causing for example diseases and problems in reproduction. It has been found that at least 78 % of priority pollutants listed by EPA (US Environmental Protection Agency) and 61 % listed by EU are associated with plastic litter either deriving from the manufacturing or from the environment.
All plastic, from macro- to nanoscale are concerned to leach and adsorb hazardous substances. The loss of additives by leaching can have an effect on the polymers’ fragmentation behavior in the marine environment on a longer time scale, and this fragmentation might further facilitate the leaching or adsorption of hazardous substances from the environment. The size and surface area are important factors influencing the leaching and adsorption behavior: the smaller the particle the larger the surface-volume ratio is, and therefore also the capacity to release or bind compounds is higher for smaller particles compared to larger ones. It can sometimes be hard to determine whether a compound has been in the plastic since manufacturing or adsorbed from the environment. For example polycyclic aromatic hydrocarbons (PAHs) can be formed during polystyrene production or be adsorbed to the plastic from the environment.
Since different chemicals are present in the marine environment, such as in the sediments, water column, plastics and biota, in different concentrations, their interactions and possible synergic effects have to be taken into account when assessing the impacts to marine life. Up to date most of the studies have assessed the fate and impacts of plastics and their leachates or adsorbed contaminants as a whole without being able to separate the effects caused by individual substances, or on the contrary, examined only the influences of one specific substance without taking into account the chemical cocktail present in the material...

Will we need to expand the Labs sections of EHRs to include broad environmental toxins assay analytics? Complex chemical tox screens do not come cheap.


Donald Trump "responds" to a reporter's climate change policy question during his post-G7 Conference presser in France:
“I feel that the United States has tremendous wealth. The wealth is under its feet. I’ve made that wealth come alive. We are now the No. 1 energy producer in the world, and soon it will be by far. I’m not going to lose that wealth, I’m not going to lose it on dreams, on windmills, which frankly aren’t working too well.”
Is it too early to start drinking?

The Amazon Is Not Earth’s Lungs
Humans could burn every living thing on the planet and still not dent its oxygen supply.
As tongues of flame lapped the planet’s largest tract of rainforest over the past few weeks, it has rightfully inspired the world’s horror. The entire Amazon could be nearing the edge of a desiccating feedback loop, one that could end in catastrophic collapse. This collapse would threaten millions of species, from every branch of the tree of life, each of them—their idiosyncratic splendor, their subjective animal perception of the world—irretrievable once it’s gone. This arson has been tacitly encouraged by a Brazilian administration that is determined to develop the rainforest, over the objections of its indigenous inhabitants and the world at large. Losing the Amazon, beyond representing a planetary historic tragedy beyond measure, would also make meeting the ambitious climate goals of the Paris Agreement all but impossible. World leaders need to marshal all their political and diplomatic might to save it.

The Amazon is a vast ineffable, vital, living wonder. It does not, however, supply the planet with 20 percent of its oxygen.

As the biochemist Nick Lane wrote in his 2003 book Oxygen, “Even the most foolhardy destruction of world forests could hardly dint our oxygen supply, though in other respects such short-sighted idiocy is an unspeakable tragedy.”…
Interesting. Once "lungs of the planet" becomes a meme, complicated detail need not apply.
"Nevertheless, our geological bonfire illustrates just how unusual the project of humanity is. We are trying to retrieve, burn down, and metabolize all the forests and sea life ever buried, from alien worlds long past. We’re not merely lighting a match to the Amazon and imperiling everything that lives in it with extinction, but also summoning creatures long-dead to return to Earth’s surface and give up the ancient energy they took to the grave. This global industrial metabolism, this heedless combustion of the life at the planet’s surface and throughout its history, is a new phenomenon on the face of the Earth. It is a forest fire of the eons."

More to come... #AnthropoceneDenial

Friday, August 23, 2019

David Koch has died

Below: More reading on deck.

104 page pdf download (requires a subscription).
"The scientific process, as I have often said, is an engine of human prosperity. For centuries it has been a driving force behind the advances in knowledge and well-being that we’ve enjoyed as a species. But none of us can benefit from that evidence-based engine if we don’t first communicate well with one another. We need to be able to share new ideas and the products of research. The recipients need to be able to trust that the information is true and to understand an innovation’s possible advantages or drawbacks so that we can make sound decisions as a society about what to do with it. If we cannot impart what we are learning to one another in this foundational way, we simply won’t continue to progress…" - Mariette DiChristina, Editor in Chief, @mdichristina
Also, a TIME Magazine Special Edition I saw in the checkout line rack at Giant:

Ahhh... "science." Will have to get it.

More to come...

SAVR the moment, one year on

My cardiac surgeon snapped this pic of my failing aortic valve one year ago this morning prior to replacing it.

I sailed through post-op home care and then cardiac rehab. I'm since off my BP meds, down 20 lbs. Doing OK. Lucky to be alive. I never lose sight of that. Adjusting to life now in Baltimore, looking forward to a new grandson arriving soon.


The AI Now Institute is searching for an EDITORIAL LEAD for its NYC office.
The Editorial Lead will work closely with AI Now’s Research, Operations, and Communications staff to develop a range of editorial outputs based on original research and aimed at public audiences. The person in this role will have editorial responsibility for AI Now’s reports (including our annual report), white papers, blog posts, and other publications across a range of core research areas such as algorithmic accountability, bias and inclusion, rights and liberties, labor and automation, and safety and critical infrastructure...
Speaking of AI, interesting post up at The Neurologica Blog.

ERRATUM. Weather forecast: "It's Raining Microplastics."

More to come...

Tuesday, August 20, 2019

"Medical kidnapping?"

Is this necessary and ethical?

An Oregon court is ordering that a 13-year-old girl with a rare liver cancer have surgery and receive other medical treatment despite the objections of her mother.
The battle over Kylee Dixon's treatment began after her mother, Christina Dixon, halted a doctor-prescribed regimen to instead pursue alternative medicine such as CBD oil and vitamins, NBC affiliate KGW8 in Portland reported.
Dixon has said that after Kylee went through six months of chemotherapy, she could no longer watch her daughter suffer...

As the permanently heartbroken father of two girls lost to cancer, this story grabs me pretty acutely.

What do you think?

I assume the governing case law is pretty clear most everywhere. A minor is not the parents' "property," and has no independent legal "free will" to grant or withhold "informed consent." Broadly, it is uncontroversial that the state can intervene to prevent or mitigate "child neglect / abuse." Where that authority extends to mandating major surgery or other acute tx measures is something regarding which many people will disagree.

Tough situation, this one.


Carbon ion therapy. Like traditional radiation, carbon ion therapy damages the DNA of fast-growing cancer cells, ultimately destroying them. But unlike older forms of radiation, this technique causes minimal harm to normal tissue. It also works against tumors that are resistant to X-ray treatment, and studies suggest it triggers an immune response against cancer.

Globally, carbon ion therapy is viewed as the next horizon of cancer care. About 22,000 patients have received the treatment at 13 centers in Germany, Austria, Italy, Japan, and China. More locations are under development in South Korea, Taiwan, and France.

Yet the therapy has followed an odd trajectory in the US. Although it was developed in California in 1975 and early research pointed to its advantages, not a single carbon ion facility, not even a research-oriented one, exists in the US. Other countries invested public money in the technology, but so far, American proponents of carbon ions have been unable to garner federal construction money or sufficient private backing…
From WIRED. Good article.

ERRATUM: My latest read.

Totally fine. Just finished. Yes, "living" entities emerged from inert matter (albeit "CHNOPS" organic elements at root), and, while based in physics, organic life is evolving stochastically beyond it, in increasing complexity (to include "cultural evolution").
We cannot mathematize the specific evolution of the biosphere. We can, at best, seek statistical laws about distributions of aspects of this evolution. In short, I will claim that no law at all entails the becoming of the biosphere; and that therefore, we cannot reduce biology to physics. The world is not a machine.

Kauffman, Stuart A.. A World Beyond Physics (p. 112). Oxford University Press. Kindle Edition.

Are we trapped? Got onto the Robson book via a Science Magazine review, and the forthcoming Markovits book through an Atlantic article. These two will be of interest to me in regard to any additional light they might shed on my episodic riffs on cognition and "scientific thinking."

More to come...

Monday, August 19, 2019

The quantum computing revolution and China

Reporting from WaPo:

"Beijing is pouring billions into research and development and is offering Chinese scientists big perks to return home from Western labs."
Seriously recommend you read the entire article (a fairly long read).  Major props to my wife for the heads-up.
The quantum revolution is coming, and Chinese scientists are at the forefront
China’s drive to dominate a field with big economic and military applications outpaces some U.S. strides

SHANGHAI — More than a decade ago, Chinese physicist Pan Jian-Wei returned home from Europe to help oversee research into some of the most important technology of the 21st century.

At a conference in Shanghai this summer, Pan and his team offered a rare peek at the work he described as a “revolution.”

They spoke of the hacking-resistant communications networks they are building across China, the sensors they are designing to see through smog and around corners, and the prototype computers that may someday smash the computational power of any existing machine.

All the gear is based on quantum technology — an emerging field that could transform information processing and confer big economic and national-security advantages to countries that dominate it. To the dismay of some scientists and officials in the United States, China’s formidable investment is helping it catch up with Western research in the field and, in a few areas, pull ahead…
"A fully functioning quantum computer has the potential to be transformative. The exponentially greater calculation power could help identify new chemical compounds to treat intractable diseases, and eliminate traffic snarls by predicting and managing the flow of vehicles."
The confluence of AI / machine learning, fiber optics, and quantum computing, yeah. But,
"[T]he possibility that the machines could eventually crack all existing forms of encryption is a major worry for militaries, governments and businesses that handle sensitive data."
Meanwhile, Acting President Donald Trump seems content to brag about how he's made us all "rich."
We're doing tremendously well. Our consumers are rich. I gave a tremendous tax cut, and they're loaded up with money. And they're buying -- I saw the Walmart numbers, they were through the roof just two days ago. That's better than any poll. That's better than any economist.

And we're not going to have a recession. But the rest of the world is not doing well as we're doing. The rest of the world, if you look at Germany, if you look at the European Union, frankly, look at the U.K., you have a lot of countries that are not doing well.

China's doing poorly. Parts of Asia are doing poorly. We are doing better than any country or even area anywhere in the world. We're doing great. And our consumer is really, really strong. It looks like they're going to be for a long time…

Speaking of China, let us not forget "China Rx."

apropos of the economy, I'm about 2/3rds finished with this excellent book:

Got onto to this one by way of Naked Capitalism. Are we headed for a recession (or another related FIRE Sector Custerfluck)? Read Richard's book, and you tell me? Indicators may be mixed. But, this 73-yr-old ailing pensioner doesn't have time to recover from another one.

UPDATE: Finished the book. Simply excellent. Way worth your time and money.

More to come...

Friday, August 16, 2019

As football season draws nigh, a short take on being "data driven"

My latest Harpers Magazine just arrived in the mail.

Talk about "data-driven." A short snip from an excellent long-read (paywalled) entitled 'The Wood Chipper."
...One test at the [NFL evaluation] combine is more interesting [relative to all the obvious physical stuff] and says more about how we judge than all the others put together. It’s called the Wonderlic, and it was created by a Northwestern University graduate student in 1936. His name was E. F. Wonderlic. It was an I.Q. test meant to measure cognitive ability—math, language, basic reasoning. It consisted of fifty questions, with each correct answer yielding a point, fifty being a perfect score.

You can find sample Wonderlic questions on the internet:

  • Six cooks can boil 12 pots of water in four minutes. How many cooks are needed to boil 48 pots of water in four minutes?
  • A girl is 18 years old and her brother is a third her age. When the girl is 36, what will be the age of her brother?
  • What is the 18th letter of the English alphabet?
You have 12 minutes to take the test, 50 questions in 720 seconds. That was the innovation: the pressure of the ticking clock, the deadline looming. Wonderlic meant it to measure poise, not just how a person performs but how he performs under fire. It was designed for employers. He figured they’d use it to separate the execs from the mop pushers, but it was the armed forces that took it up first, especially the air forces—Army, Navy—­whose recruiters saw in it a way to find pilots. The ticking clock was thought to mimic the pressure a flier feels in combat, under the canopy when the ­MiGs close in. Fifty seconds till contact. Ten seconds. Three. Only around 2 percent of test takers even finished.
Tom Landry, the iconic leader of the Dallas Cowboys, was one of the first N.F.L. coaches to use the Wonderlic. Born in Mission, Texas, in 1924, Landry joined the Army Air Corps soon after his brother was killed in action over the North Atlantic in 1944. Landry flew thirty sorties in a B-­17 bomber and survived a crash landing. After the war, he played football at the University of Texas. A defensive back, he was elusive and fast and hit with the sort of force that wide receivers remembered years later.

Landry was taken by the Giants in the seventh round in the 1946 draft. He played seven professional seasons, the last two as a player/coach. He ran the defense opposite the offensive coordinator and future Hall of Famer Vince Lombardi. Most people remember Landry as the taciturn Texan who coached the Cowboys for 29 seasons, had 2 Super Bowl championships and 270 wins—­the face of the franchise. Though he looked as stolid as Clint Eastwood’s “Man with No Name,” Landry, in sport coat and fedora, was in fact an innovator. It was Landry who perfected the 4–­3 defense, which football fans will recognize as a standard alignment of the game: it starts with four “down” linemen, so-­called because these huge men begin each play in a three-­point stance (fingers in the turf, asses in the air), backed by three linebackers—­hence, 4–3. And Landry was one of the first N.F.L. coaches to realize the need for intelligence testing.

The game had become so complicated by the mid-­1970s—­so many formations, each requiring a read by the quarterback, which called for a series of adjustments made at the line of scrimmage, just the sort of improvisation known to combat pilots—­that Landry wanted a better way to scout for smarts. Not just speed and strength, but can a player think as he’s getting punched in the face, or concussed, or when Dick Butkus is biting his ankle at the bottom of the pile? That’s why he remembered the . . . wait . . . what’s that test they had us take during the war?

The Wonderlic had been in circulation long enough to generate a sea of data, the sort in which experts can read patterns. Via the test, they could tell you which professions attracted the smartest (and dumbest) people. ­Twenty was said to be the average score. Above forty, you’re a genius. Below ten . . . well. The highest average scores went first to systems analysts (32), then to chemists (31), and electrical engineers (30). These are your elites. Below that come the middle class, the multitude. Accountant (28). Copywriter (27). Bank teller (22). Firefighter (21), welder (17), janitor (14). Landry began giving the test to his players in the late 1970s. The rest of the league followed. It’s been a combine staple from the start, hated and feared.

Based on the Wonderlic, we know which positions are, on average, staffed by the smartest people on a football field, and which by the stupidest. You’d probably think that quarterbacks are the smartest players—­they have to run the offense, read defensive formations, and then make necessary changes—­but you’d be wrong. Offensive tackles have the top score, 26. Then centers (25), then quarterbacks (24). Running backs are said to be the dumbest, scoring an average of 16 on the Wonderlic. It would be interesting to give players the test before and after their careers; all those head blows must have an effect.

Of course, there are exceptions, outliers. Mario Manningham, a Michigan receiver, after failing multiple drug tests, lying about it, then admitting he’d lied, scored a 6 on the Wonderlic. (The scores are supposed to be confidential, but the numbers leak.) Running back Frank Gore, a probable Hall of Famer taken in the third round in 2005, scored a 6 as well. Jeff George, a physically gifted thrower who could never get it together, got a 10 on the Wonderlic, which is about as low as it gets for a quarterback. Aaron Rodgers, considered one of the smartest players because he looks brainy and played at U.C. Berkeley, scored a 35. Eli Manning, who took the Giants to two Super Bowls, scored a 39. Eric Decker, a receiver who did not compete at the combine because of an in­jury, scored an entirely unnecessary 43 on the Wonderlic (receivers average 17). Ryan Fitzpatrick, who played quarterback at Harvard, got a 48. He went to the Rams in the seventh round in 2005. Despite his nickname (Fitzmagic) and the length of his career (he’s played fourteen N.F.L. seasons), he’s been mostly mediocre, a fact that some use to discount the importance of the Wonderlic—­Fitzpatrick got a 48 and still sucks—­but that others use to prove its relevance—­If he weren’t a genius, the guy wouldn’t have lasted ten games in the N.F.L.

Linebacker Mike Mamula scored an amazing 49 on the Wonderlic (linebackers average 19). He broke or nearly broke several records at the 1995 combine, which bumped him way up in the draft. He went from a probable third rounder to a first rounder; he was taken seventh overall by the Eagles, just behind Steve ­McNair and just ahead of Warren Sapp, but lasted a mere handful of seasons and was never better than okay. Mamula is held up as an example of all that is wrong with the combine. Great in the weight room, great on the test, shitty on the field. The guy could do everything but play.

Only one prospect has ever gotten a perfect Wonderlic score: Pat ­­McInally, a Harvard wide receiver and punter who went in the fifth round in 1975 to Cincinnati, where he played ten seasons, which brings up an interesting question: Is it bad to overachieve on the Wonderlic?

General managers tend to steer clear of those who do poorly on the test and also of those who do well. Given a choice between too smart and too dumb, they’d choose too dumb every time. (Frank Gore, 6.) Anything over a 40 tends to be seen as a potential problem. Will too smart on the test mean too much thinking on the field and too much questioning in the locker room? If you’re looking at a 45, you’re looking at a guy who knows he’s smarter than the coach and who just might lead an insurrection. Some people speak of a Wonderlic sweet spot: 30 to 38, a range that would net most elite pro quarterbacks, including Andrew Luck, Tony Romo, and Colin Kaeper­nick. You want just enough intelligence to get up and down the field. Anything more is unnecessary or even a liability…
A great piece. Subscribe. Or, buy it off the stand.

The article concludes:
With all we know about the condition of retired players and the long-­term effects of concussions, maybe the real winners are those who didn’t get picked at all.
 Like, say, my grandson Keenan.

Preocious kid tennis player, USTA-ranked 43rd nationally by age 12. Four year varsity football starter in high school, subsequently recruited by more than 20 postsecondary schools, and (mercifully) opted to go Div III for his college ride (St. Olaf). We were so relieved when it was all over and he emerged unhurt.


 "SAM"--"Sentiment Analysis Moderation," that is. Artificial Intelligence-assisted censorship. From Naked Capitalism: "Advertisers blacklisting news and other stories containing 'controversial' words..."

Stay tuned.

More to come...

Thursday, August 15, 2019

Four months in Baltimore

In mid-afternoon April 15th Cheryl and I rolled in to our new home via our dogs-and-cats-in-tow convoy after an eight-day 2,790 mile transcontinental schlep from California.

Loving it thus far.

A few subsequent related posts, here, here, here, and here.

Wednesday, August 14, 2019

Healthcare Triage: Medicare coverage implications for the 2020 campaign

This is quite good. Timely, apropos of the 2020 campaign.




More to come...

Tuesday, August 13, 2019

Monday, August 12, 2019

China Rx

H/T to Naked Capitalism:

The Amazon blurb:
Millions of Americans are taking prescription drugs made in China and don't know it--and pharmaceutical companies are not eager to tell them. This is a disturbing, well-researched wake-up call for improving the current system of drug supply and manufacturing.Several decades ago, penicillin, vitamin C, and many other prescription and over-the-counter products were manufactured in the United States. But with the rise of globalization, antibiotics, antidepressants, birth control pills, blood pressure medicines, cancer drugs, among many others are made in China and sold in the United States. China's biggest impact on the US drug supply is making essential ingredients for thousands of medicines found in American homes and used in hospital intensive care units and operating rooms. The authors convincingly argue that there are at least two major problems with this scenario. First, it is inherently risky for the United States to become dependent on any one country as a source for vital medicines, especially given the uncertainties of geopolitics. For example, if an altercation in the South China Sea causes military personnel to be wounded, doctors may rely upon medicines with essential ingredients made by the adversary. Second, lapses in safety standards and quality control in Chinese manufacturing are a risk. Citing the concerns of FDA officials and insiders within the pharmaceutical industry, the authors document incidents of illness and death caused by contaminated medications that prompted reform. This probing book examines the implications of our reliance on China on the quality and availability of vital medicines.
Comforted to have Donald Trump in the White House? It's not limited to Rx, either. Consider the Chinese manufacturing origins of so many of the components of our military hardware alone.


Props to STATnews.
Canadians are hopping mad about Trump’s drug importation plan. Some of them are trying to stop it.

Canadians are furious about the Trump administration’s plan to import their prescription drugs. And some of them are determined to stop the proposal in its tracks.

Trump’s plan, which was announced late last month, would allow states, wholesalers, and pharmacies to import cheaper drugs from Canada. It’s a long way off from being implemented, but Canadians are baffled that America would look north to lower its own drug prices, and indignant that such a plan could exacerbate an already pressing drug shortage issue plaguing the country.

“You are coming as Americans to poach our drug supply, and I don’t have any polite words for that,” said Amir Attaran, a professor at the University of Ottawa, who calls the plan “deplorable” and “atrociously unethical.” “Our drugs are not for you, period.”…

More to come...

Thursday, August 8, 2019

The Technological Tail Wagging Humanity's Dog

Lots of hand-wringing these days with respect to the existing and potential malign attributes of digital technologies--social media in particular.

This is very interesting, very smart young man, Tristan Harris. Watch all of it. Time well spent.

Highly recommend you spend some time surfing their website once you've viewed the above video talk.

Dovetails in a number of areas with this book I'm close to finishing.

...The pandemic of contempt in political matters makes it impossible for people of opposing views to work together. Go to YouTube and watch the 2016 presidential debates: they are masterpieces of eye-rolling, sarcasm, and sneering derision. For that matter, listen as politicians at all levels talk about their election opponents, or members of the other party. Increasingly, they describe people unworthy of any kind of consideration, with no legitimate ideas or views. And social media? On any contentious subject, these platforms are contempt machines. 

Of course this is self-defeating in a nation in which political competitors must also be collaborators. How likely are you to want to work with someone who has told an audience that you are a fool or a criminal? Would you make a deal with someone who publicly said you are corrupt? How about becoming friends with someone who says your opinions are idiotic? Why would you be willing to compromise politically with such a person? You can resolve problems with someone with whom you disagree, even if you disagree angrily, but you can’t come to a solution with someone who holds you in contempt or for whom you have contempt. 

Contempt is impractical and bad for a country dependent on people working together in politics, communities, and the economy. Unless we hope to become a one-party state, we cannot afford contempt for our fellow Americans who simply disagree with us. 

Nor is contempt morally justified. The vast majority of Americans on the other side of the ideological divide are not terrorists or criminals. They are people like us who happen to see certain contentious issues differently. When we treat our fellow Americans as enemies, we lose friendships, and thus, love and happiness. That’s exactly what’s happening. I already cited a poll showing that a sixth of Americans have stopped talking to a family member or close friend because of the 2016 election. People have ended close relationships, the most important source of happiness, because of politics...

Brooks, Arthur C.. Love Your Enemies. Broadside e-books. Kindle Edition, location 352.
A lot to think about.

UPDATE: I finished Arthur's book. Also definitely "time well spent," though I have some picks.


How facial recognition became the most feared technology in the US
Two lawmakers are drafting a new bipartisan bill that could seriously limit the use of the technology across the US.

Facial recognition is having a moment.

Across the US, local politicians and national lawmakers on both sides of the aisle have started introducing rules that bar law enforcement agencies from using facial recognition technology to surveil everyday citizens.

In just the past few months, three cities — San Francisco, Oakland, and Somerville, Massachusetts — have passed laws to ban government use of the controversial technology, which analyzes pictures or live video of human faces in order to identify them. Cambridge, Massachusetts, is also moving toward a government ban. Congress recently held two oversight hearings on the topic and there are at least four pieces of current federal legislation to limit the technology in some way.

And now, Recode has learned that two top lawmakers, Rep. Elijah Cummings (D-MD) and Rep. Jim Jordan (R-OH), plan this fall to introduce a new bipartisan bill on facial recognition, according to representatives from both legislators’ offices. The specifics of the bill are still being hashed out, but it could include issuing a pause on the federal government’s acquisition of new facial recognition technology, according to a staffer from Jordan’s office.

Facial recognition is a rare case where regulators are working together — on a bipartisan level, no less — to try to get ahead of technology instead of catching up to it. That’s because this powerful new technology has the potential to infringe on Americans’ civil liberties — no matter their political persuasion — and to have a chilling effect on free speech…
For one thing, I am reminded of my 2008 post "Privacy and the 4th Amendment Amid the 'War on Terror'."

More to come...

Tuesday, August 6, 2019

A.I. for the masses?

What could possibly go wrong?

In my latest snailmail Science Magazine:
Bringing machine learning to the masses

Yang-Hui He, a mathematical physicist at the University of London, is an expert in string theory, one of the most abstruse areas of physics. But when it comes to artificial intelligence (AI) and machine learning, he was naïve. “What is this thing everyone is talking about?” he recalls thinking. Then his go-to software program, Mathematica, added machine learning tools that were ready to use, no expertise required. He began to play around, and realized AI might help him choose the plausible geometries for the countless multidimensional models of the universe that string theory proposes.

In a 2017 paper, He showed that, with just a few extra lines of code, he could enlist the off-the-shelf AI to greatly speed up his calculations. “I don't have to get down to the nitty gritty,” He says. Now, He says he is “on a crusade” to get mathematicians and physicists to use machine learning, and gives about 20 talks a year on the power of these new user-friendly versions.

AI used to be the specialized domain of data scientists and computer programmers. But companies such as Wolfram Research, which makes Mathematica, are trying to democratize the field, so scientists without AI skills can harness the technology for recognizing patterns in big data. In some cases, they don't need to code at all. Insights are just a drag-and-drop away. Computational power is no longer much of a limiting factor in science, says Juliana Freire, a computer scientist at New York University in New York City who is developing a ready-to-use AI tool with funding from the Defense Advanced Research Projects Agency (DARPA). “To a large extent, the bottleneck to scientific discoveries now lies with people.”…

The AI tools are more than mere toys for nonprogrammers, says Tim Kraska, a computer scientist at the Massachusetts Institute of Technology in Cambridge who leads Northstar, a machine learning tool supported by the $80 million DARPA program called Data-Driven Discovery of Models. Wade Shen, who leads the DARPA program, says the tools can outperform data scientists at building models, and they're even better with a subject matter expert in the loop.

In a demo for Science, Kraska showed how easy it was to use Northstar's drag-and-drop interface for a serious problem. He loaded a freely available database of 60,000 critical care patients that includes details on their demographics, lab tests, and medications. In a couple of clicks, Kraska created several heart failure prediction models, which quickly identified risk factors for the condition. One model fingered ischemia—a poor blood supply to the heart—which doctors know is often codiagnosed with heart failure. That was “almost like cheating,” Kraska said, so he dragged ischemia off the list of inputs and the models immediately began to retrain to look for other predictive factors.

Maciej Baranski, a physicist at the Singapore-MIT Alliance for Research & Technology Centre, says the group plans to use Northstar to explore cell therapies for fighting cancer or replacing damaged cartilage. The system will help biologists combine the optical, genetic, and chemical data they've collected from cells to predict their behavior…

The trend toward off-the-shelf AI has risks. Machine learning algorithms are often called black boxes, their inner workings shrouded in mystery, and the prepackaged versions can be even more opaque. Novices who don't bother to look under the hood might not recognize problems with their data sets or models, leading to overconfidence in biased or inaccurate results.
But Kraska says Northstar has a safeguard against misuse: more AI. It includes a module that anticipates and counteracts typical rookie mistakes, such as assuming any pattern an algorithm finds is statistically significant. “In the end it actually tries to mimic what a data scientist would do,” he says.
"The trend toward off-the-shelf AI has risks. Machine learning algorithms are often called black boxes, their inner workings shrouded in mystery...Novices who don't bother to look under the hood might not recognize problems with their data sets or models, leading to overconfidence in biased or inaccurate results."
I'll re-post something from last year:

Another "Holy Shit" book. Yikes.

ALMOST two decades ago, when I wrote the preface to my book Causality (2000), I made a rather daring remark that friends advised me to tone down. “Causality has undergone a major transformation,” I wrote, “from a concept shrouded in mystery into a mathematical object with well-defined semantics and well-founded logic. Paradoxes and controversies have been resolved, slippery concepts have been explicated, and practical problems relying on causal information that long were regarded as either metaphysical or unmanageable can now be solved using elementary mathematics. Put simply, causality has been mathematized.”

Reading this passage today, I feel I was somewhat shortsighted. What I described as a “transformation” turned out to be a “revolution” that has changed the thinking in many of the sciences. Many now call it “the Causal Revolution,” and the excitement that it has generated in research circles is spilling over to education and applications. I believe the time is ripe to share it with a broader audience.

This book strives to fulfill a three-pronged mission: first, to lay before you in nonmathematical language the intellectual content of the Causal Revolution and how it is affecting our lives as well as our future; second, to share with you some of the heroic journeys, both successful and failed, that scientists have embarked on when confronted by critical cause-effect questions.

Finally, returning the Causal Revolution to its womb in artificial intelligence, I aim to describe to you how robots can be constructed that learn to communicate in our mother tongue— the language of cause and effect. This new generation of robots should explain to us why things happened, why they responded the way they did, and why nature operates one way and not another. More ambitiously, they should also teach us about ourselves: why our mind clicks the way it does and what it means to think rationally about cause and effect, credit and regret, intent and responsibility…

Pearl, Judea; Mackenzie, Dana. The Book of Why: The New Science of Cause and Effect (Kindle Locations 47-61). Basic Books. Kindle Edition.
This one is gonna be fun. Stay tuned. From the Atlantic interview article: Pearl sees it, the field of AI got mired in probabilistic associations. These days, headlines tout the latest breakthroughs in machine learning and neural networks. We read about computers that can master ancient games and drive cars. Pearl is underwhelmed. As he sees it, the state of the art in artificial intelligence today is merely a souped-up version of what machines could already do a generation ago: find hidden regularities in a large set of data. “All the impressive achievements of deep learning amount to just curve fitting,” he said recently...
"If I could sum up the message of this book in one pithy phrase, it would be that you are smarter than your data. Data do not understand causes and effects; humans do."
In short, being unreflectively "data-driven" (that fashionable tech cliche) is a both naive and a cop-out. (Note: some of this will surely go -- at least tangentially --  to the "information ethics" topic of my prior post.)

See also my 2018 post "Data Science?"


This is a hoot:
Artificial intelligence is not intelligent enough or, more exactly, not imaginative enough or creative enough to make us resign thinking. Tests for artificial intelligence are not rigorous enough. It does not take intelligence to meet the Turing test – impersonating a human interlocutor – or win a game of chess or general knowledge. You will know that intelligence is artificial only when your sexbot says, ‘No.’

Fernández-Armesto, Felipe. Out of Our Minds. University of California Press. Kindle Edition, location 7720. 
This book, wow!
The speed and reach of the computer revolution raised the question of how much further it could go. Hopes and fears intensified of machines that might emulate human minds. Controversy grew over whether artificial intelligence was a threat or a promise. Smart robots excited boundless expectations. In 1950, Alan Turing, the master cryptographer whom artificial intelligence researchers revere, wrote, ‘I believe that at the end of the century the use of words and general educated opinion will have altered so much that one will be able to speak of machines thinking without expecting to be contradicted.’ The conditions Turing predicted have not yet been met, and may be unrealistic. Human intelligence is probably fundamentally unmechanical: there is a ghost in the human machine. But even without replacing human thought, computers can affect and infect it. Do they corrode memory, or extend its access? Do they erode knowledge when they multiply information? Do they expand networks or trap sociopaths? Do they subvert attention spans or enable multi-tasking? Do they encourage new arts or undermine old ones? Do they squeeze sympathies or broaden minds? If they do all these things, where does the balance lie? We have hardly begun to see how cyberspace can change the psyche. [Ibid, location 7441]

Amazon recommended this book to me:

Only $4.99 Kindle price. 5 star reviews. I precipitously did 1-Click.

My Bad. It's awful. Reads like it was written by A.I.

Machine learning is one in all the quickest growing areas of technology, with far-reaching applications. This textbook is intended to give a proper introduction of machine learning, and all the algorithmic paradigms that machine learning offers, in a principled way. The book provides an intensive hypothesis of the basic concepts underlying machine learning and also the mathematical derivations that remodel these principles into practical algorithms. After a presentation of the basics of the sector, the book covers a wide range of central topics that have never been addressed by previous textbooks. These embody a discussion of the process complexity of learning and also the ideas of convexity and stability; major algorithmic paradigms together with stochastic gradient descent, neural networks, and structured output learning; and rising theoretical ideas like the PAC-Bayes approach and compression-based bounds. Designed for a starting graduate or refined student course, the text makes the elemental and algorithms of machine learning accessible to non-expert readers and pupils of arithmetics, engineering, statistics and computer science.

Samelson, Steven. Machine Learning: The Absolute Complete Beginner’s Guide to Learn and Understand Machine Learning From Beginners, Intermediate, Advanced, To Expert Concepts (pp. 1-2). Kindle Edition.
Seriously? Need I really elaborate? Got played this time.


Reported at TechCrunch:
The UK’s National Health Service is launching an AI lab

The UK government has announced it’s rerouting £250M (~$300M) in public funds for the country’s National Health Service (NHS) to set up an artificial intelligence lab that will work to expand the use of AI technologies within the service.

The Lab, which will sit within a new NHS unit tasked with overseeing the digitisation of the health and care system (aka: NHSX), will act as an interface for academic and industry experts, including potentially startups, encouraging research and collaboration with NHS entities (and data) — to drive health-related AI innovation and the uptake of AI-driven healthcare within the NHS.

Last fall the then new in post health secretary, Matt Hancock, set out a tech-first vision of future healthcare provision — saying he wanted to transform NHS IT so it can accommodate “healthtech” to support “preventative, predictive and personalised care”.

In a press release announcing the AI lab, the Department of Health and Social Care suggested it would seek to tackle “some of the biggest challenges in health and care, including earlier cancer detection, new dementia treatments and more personalised care”.

Other suggested areas of focus include:

  • improving cancer screening by speeding up the results of tests, including mammograms, brain scans, eye scans and heart monitoring
  • using predictive models to better estimate future needs of beds, drugs, devices or surgeries
  • identifying which patients could be more easily treated in the community, reducing the pressure on the NHS and helping patients receive treatment closer to home
  • identifying patients most at risk of diseases such as heart disease or dementia, allowing for earlier diagnosis and cheaper, more focused, personalised prevention
  • building systems to detect people at risk of post-operative complications, infections or requiring follow-up from clinicians, improving patient safety and reducing readmission rates
  • upskilling the NHS workforce so they can use AI systems for day-to-day tasks
  • inspecting algorithms already used by the NHS to increase the standards of AI safety, making systems fairer, more robust and ensuring patient confidentiality is protected
  • automating routine admin tasks to free up clinicians so more time can be spent with patients...
Have to wonder what Seamus O'Mahony would say?

More to come...