Saturday, December 15, 2018

Old doctor pet peeve - disease descriptions were better in Osler's day.

I didn’t know Sir William personally, but I think he’d be appalled by the descriptions of patient-disorders in our medical textbooks.

We typically present a collection of findings, sometimes organized by ‘history’ or ‘physical’ or ‘lab’, but the sequencing and relationships are all lost.

We should have textbooks that describe a disease or disorder with 3-8 case histories that span a reasonable spectrum of presentations. So not x% have red eyes and y% have chest ache, but a case called “common” that might be “8 yo both with cough, then red eyes for day and a swollen lymph node, then a day later some red palms …” and another case called “often”, and 2-3 called “unusual1”, “unusual2”, and so on.

Ok, it’s not just my Oldness. I’ve been grumpy about this for roughly 25 years, even when I was only old in spirit. It annoys me a great deal.

Now I’ve said it.

Saturday, December 01, 2018

Quicken for Mac -- why vendors are going to screw-up subscription pricing for software services

We’ve been using Quicken for Mac for the past year. I’m satisfied with the software, but I no longer trust their pricing and renewal.

We paid $60 for Quicken for Mac 2015 on 7/31/2015.  On 1/8/2017 we paid $48.41, presumably for 1 year of subscription service. On 12/31/2017 we paid $32.35; we probably switched from a “deluxe” plan to a basic plan.

Today I received an email requesting renewal:

Your Quicken membership will expire on 12/31/2018. In order to continue enjoying all of the benefits of Quicken, including connected services such as bank downloads, stock price updates, account sync, and free phone support, please click here to renew your plan.

The link goes, however, to Quicken for Windows where we are shown as “deluxe” plan for $50.

Ok, so that’s presumably a mistake — albeit a bad mistake. When I go to I can see the Mac plans - Starter at $35 (so probably a 15% price hike from last year) and “most popular” Deluxe for $50. I can’t compare to last year but it looks like most of the features added in the past year or so require the “deluxe” option now.

Which leads me to reconsider my previously relatively positive attitude towards software subscriptions.

I’ve been generally in favor of subscription pricing for software. I think Microsoft has done a great job with Office 365. It does, however, come with temptations for vendors. Subscription pricing makes it too easy to hide price increases and game features. It promotes “information asymmetry”.

I think Quicken has fallen for that trap.

I don’t trust them now.

We are evaluating options.



Saturday, November 03, 2018

Amazon reviews now unreliable - negative reviews filtered (Anker example)

Amazon reviews have long been helpful to me, and were once a big part of Amazon’s value proposition.

That is no longer true. Amazon is filtering out negative reviews.

I learned this after attempting to review Anker bluetooth earbuds I bought for Emily’s birthday. The power switch was defective. That wasn’t a complete surprise, I have a similar pair and I often have to push 2 or 3 times. Anker should have spent another 10 cents on that part.

Amazon made the return easy, but when I tried to write a review I got this notice:

Screen Shot 2018 11 02 at 10 12 04 PM

“Sorry we are unable to accept reviews for this product …”

I then switched to Emily’s account. There I was at able to start a review, and even able to give in a two star overall rating. When I clicked 1 star for material quality however the “unable to accept reviews” notification appeared:

Screen Shot 2018 11 03 at 12 18 40 PM

This is, of course, worse than if Amazon removed all product reviews. They are promoting systemic bias in their closed world. The Fox model is catching on elsewhere, Apple is doing something similar with the Mac App store.

On certainty

A week ago, in a Facebook group for CrossFit physicians, I read a post blaming poor parenting (i.e., poor mothering) for childhood obesity.

There and elsewhere I read confident statements on nutrition. I read confident statements about market movements (usually retrospective) and white men.

I always imagine these confident people are young, but I believe that is not always true.

There are likely things. There is entropy and death (but also the inexplicably low entropy of the early universe, and it is possible for an Old person to be stronger than they were in middle age).

Most things though, they are … complicated. They are some of this and some of that.  If you cannot imagine a worse outcome than an obese child you have not opened your eyes enough, or lived long enough for the world to pin your eyelids back and burn reality into your retina.

Look for the Old of any age. Some have something that might be wisdom. Ask them about certainty.

Sunday, October 21, 2018

Nasty flaw in Minnesota mail ballot process

There’s a nasty flaw in Minnesota’s vote by mail process.

When you apply for a mail ballot you are asked to provider either a SSN last 4 or License number or State ID number.

When you complete the ballot you are asked to provider either a SSN last 4 or License number or State ID number.

The two numbers have to match or the ballot will be rejected.

Hope you remember if you used your MN License number or your SSN Last 4 on the ballot application.

I tried testing for the identifier I used by querying my absentee ballot status, but it found the same status regardless of which identifier I used.

Saturday, October 20, 2018

Attack of the Clones - New disease mechanism identified

First came CHIP - Clonal hematopoiesis of indeterminate potential (Jan 2018)

… a bizarre accumulation of mutated stem cells in bone marrow increases a person’s risk of dying within a decade, usually from a heart attack or stroke, by 40 or 50 percent. They named the condition with medical jargon: clonal hematopoiesis of indeterminate potential…

… Up to 20 percent of people in their 60s have it, and perhaps 50 percent of those in their 80s …

… large numbers of study participants had blood cells with mutations linked to leukemia — but they did not have the cancer. Instead, they had just one or two of the cluster of mutations…

… [mutations], especially those linked to leukemia, seem to give stem cells a new ability to accumulate in the marrow. The result is a sort of survival of the fittest, or fastest growing, stem cells in the marrow…

… researchers described a 115-year-old woman. Nearly her entire supply of white blood cells was generated by mutated stem cells in her bone marrow.

At the first she had developed just two mutated stem cells. But over time their progeny came to dominate her bone marrow. She lived about as long as a human can, nonetheless, and died of a tumor.

… Mutated blood cells began proliferating in the mice, and they developed rapidly growing plaques that were burning with inflammation.

“For decades people have worked on inflammation as a cause of atherosclerosis,” Dr. Ebert said. “But it was not clear what initiated the inflammation.”

Now there is a possible explanation — and, Dr. Ebert said, it raises the possibility that CHIP may be involved in other inflammatory diseases, like arthritis.

That was mindboggling. An entirely new mechanism of disease! It’s easy to speculate on relationships to unexplained disorders like osteoarthritis.

This week the clones are everywhere …

Researchers Explore a Cancer Paradox Oct 2018

… a large portion of the cells in healthy people carry far more mutations than expected, including some mutations thought to be the prime drivers of cancer…

… rogue cells spread out across the esophagus, forming colonies of mutant cells, known as clones. Although these clones aren’t cancer, they do exhibit one of cancer’s hallmarks: rapid growth.

These mutant clones colonize more than half of your esophagus by middle age” …

… By examining the mutations, the researchers were able to rule out external causes for them, like tobacco smoke or alcohol. Instead, the mutations seem to have arisen through ordinary aging. As the cells divided over and over again, their DNA sometimes was damaged. In other words, the rise of these mutations may just be an intrinsic part of getting older…

It’s been a long time since we’ve had an entirely new class of pathophysiology. We may be entering a new and exciting era of medical research with near term clinical implications. Nobel prizes have been awarded for less.

We still need a way to explore and resurface old blog posts

Six years ago I wrote about browsing the blog blacklist and the need to resurface content from old blog postings. Today, even in the supposed twilight of blogs [1], I was again reminded how much we need a tool for excavation of old posts. I can think of at least one way do it (standard metadata for blog history, random selection of past posts based on internal and external inbound links) but there are probably several.

Maybe something for a future blog renaissance to tackle. Or if Feedbin is looking for a new feature set …

- fn -

[1] On the one hand I accept that RSS and blogs are vanishing, on the other my Feedbin stream is a rich and engrossing as ever, covering hundreds of sources.

Why is the hamstring connected to the paraspinal muscles?

The hamstrings (biceps fermoris, semitendonosis, semimembranosus, some include adductor magnus) flex the knee and extend the hip. The erector spinae and latissimus dorsi flex, extend and rotate the spine [1].

These muscles don’t directly connect with one another. They are innervated by different nerve roots. As far as we know [2] they only connect in the brain.

So it’s curious to observe the connection between the minor back strains I get [3] and my hamstrings. I normally have a good hamstring stretch for my age, but even a minor erector spinae strain will immediately tighten the ipsilateral (same side) hamstring. Improving the back strain is likewise intimately related to stretching the hamstring.

I presume it’s some kind of injury reflex, but I can’t figure out why it’s adaptive.

[1] Kudos to my all-time favorite medical app, Visible Body’s Human Anatomy, for helping me visualize these areas. It takes a while to learn this powerful app, but it’s worth the time.
[2] Decades after we thought we understood anatomy we keep learning new things. So who knows :-)?
[3] There’s a personal history here. I have been mildly surprised how little this history interests other people — including people with disabling back pain. The back strains I get now are more annoying than painful; they are usually related to heavy weights and intense exercise.

Saturday, October 13, 2018

Bostromism rediscovered

While recently rereading Banks’ marvelous book The Algebraist I decide I ought to write a post about “The Truth”, which is basically Bostrom’s simulation hypothesis made theology.

An initial topic search lead me to a 2013 pinboard post, where I learned I’d started to write that post 5 years ago - in 2013. I didn’t finish then, because at that time a topic search uncovered a post from 5 years before that. In 2008, 10 years ago now.

My 2008 post includes an excerpt from The Algebraist — it’s worth a read. Banks begins with the consensus response to the simulation hypothesis — “a difference that made no difference wasn’t a difference to be much bothered about, and one might as well get on with (what appeared to be) life.”  I’m not sure the hypothesis is totally irrelevant though; it is one answer to the Fermi Paradox.

Now I’m looking forward to doing this again in 2023.

PS. deGrasse in 2016.

PPS. I’ve been lately thinking about the other odd aspects of Oldness. Such as realizing I’m supposed to be the sober and silent sage in meetings whose primary duty is to do introductions and conclude with expressions of appreciation. Most unfairly, for someone who never missed a nap during meetings and classes, I’m not allowed to fall asleep any more.

Thursday, September 20, 2018

CrossFit 59 and so on

I used to write a birthday blog post each year about doing CrossFit. I missed this year; probably because its kind of a regular thing now. I had several personal best lifts this year, but none in the past couple of months. Still not bad for almost 60. Stronger than I was at 55, much stronger than I was at 40. I finally did more than 10 consecutive dubs (14!) … and then I dropped back to doing a few at a time. I still haven’t done a bar muscle-up, but I haven’t given up. I think I’m more impacted by heat than I used to be. My cardio isn’t improving much but it’s probably no worse when the temperature is good.

There is one new thing. My 16yo daughter started doing CF with me this summer. She’s progressing quickly; she’ll be doing sets of 50 dubs within a year. She’s good at CrossFit and it makes her happy. She hangs with very healthy, very fun, women from ages 20s to (maybe?) 50s. Pretty great role models.

I have no currently active wear and tear injuries, despite my familial arthritis. Shoulders, knees, wrists, back, hands, ankles — all behaving for a change. I don’t know why. Bodies are weird. I can do CF four or five times a week rather than just three times. Maybe I’m just better at scaling.

PS. For my birthday this year I got a mountain bike tire and some mountain bike shorts.

Saturday, August 18, 2018

Random thoughts on replacing Twitter

  1. Twitter will become a blend of home shopping network, daytime TV, and tabloid news. That might be quite profitable.
  2. There is money in sane social communication, but there isn’t big money. In particular there isn’t publicly traded corporation money.
  3. With current software and hardware stacks a base social network doesn’t have to be very expensive. I suspect without video storage and without advertising it could be done for $20/user a year and perhaps less.
  4. A consortium of newspapers, foundations, and universities with some grant money is enough to develop and support a standards based solution. Remember USENET* was basically supported by universities. USENET was also an open standard.
  5. USENET didn’t have to support a billion users though. A sane social communication network will require either an ad model similar to 1980s newspapers or user fees. I like the idea of free read access for all, contribution requires subscription ($20/year), people can donate subscriptions (free pool).

And that’s all the time I have to think about this for now …

* Still around, by the way. Searchable too.

Friday, June 29, 2018


Ten. Consecutive. Dubs.

It’s not too much to ask, is it?

Oh, and one muscle-up. Or bar muscle-up. I’m not picky.

Dubs aren’t that hard. Most CrossFit newcomers figure it out in a few months, maybe a year. I don’t know anyone who has failed as persistently as I have.

A few months ago I got 8. It was a bit of a fluke. I’ve gotten 5 or more several times. I looked like a meth-addled feeding frenzy but, like I said, not picky.

Then I started to get worse. Finally I couldn’t get any at all.

I think I’ve figured out what happened. My technique got better. Instead of swinging my forearms I learned to do singles with my wrists — like you’re supposed to. Turns out my wrists can’t move the rope fast enough. I don’t have anywhere near the coordination. This isn’t only being Old, I’ve had horrible coordination all my life. Old isn’t helpful though.

Once I thought of this I went back to the arm swinging feeding frenzy and I can do a few again. So I’ll practice that for a while. Preferably somewhere nobody can see me. Which means not my gym, where sympathetic looks of sorrow and helpless frustration are hard to bear.

Meanwhile, I can work on those lat pulldowns.

8/6/2018: I0. Also, in that set, some 7s, 8s and a 9. #lifegoal

8/12/108: 14

Saturday, June 09, 2018

My iOS medical references

My iOS medical references for my small adult primary care practice (mostly I’m an admin)

  • FP (I subscribe, one of my favorite references)
  • MPR: Monthly Prescribing Reference
  • ePocrates: not as great as it was. Truly annoying that they block paste in password.
  • Washington Manual in inkling eBooks - for nostalgia mostly
  • Sanford Guide (antimicrobials)
  • Atlas (anatomy - fabulous app)
  • MDCalc
  • AccessMedicine: a few texts which I should use more often.

My top 3 are FP Notebook, MPR, and Atlas these days.

Saturday, June 02, 2018

Are Trump-era Evangelicals closer to ancient Judaism than to Christianity?

It takes a lot of mental gymnastics to worship both Christ and Trump. But if you demote Christ and elevate Trump, both can have similar Prophet status. Prophets of a Chosen people can disagree and refine one another; they don’t have to be omniscient.

Culturally and theologically, the Trumpian Evangelical seems closer to ancient Judaism than to historic Christianity — but with an added emphasis on the ancient theology that wealth is a sign of divine approval and thus of virtue.

I wrote these in 2004 …

Georgia Takes on ’Evolution’ - The Decline and Fall of American Education

… If the evangelicals continued their steady victories, there will eventually be a public evangelical educational system and a private secular/other system. The private secular system would attract the educated elite, and they in turn would attract parents seeking social networks. The evangelical school system of 2010 could become a stigmatized backwater of ever growing ignorance (ok, so it might produce an incompetent President or two ...). 

The evangelical right can indeed win this war, but they may not like what they get. Perhaps they should reconsider ...

and (from an email to Nicholas Kristof back when we did things like that)…

Nicholas Kristof (NYT): The God Gulf - comment - The Yahwites and the Jesites

… I think you’ve skirted, however, a second great schism, between the "Yahwites" and the "Jesites". Both call themselves Christian, but they are as different as the Old and New Testaments -- and equally irreconcilable.

The Yahwites worship Yahweh, and draw their theology from the Old Testament -- a quintessentially Republican document. The Jesites follow a blend of the teachings of Paul and Christ, a doctrine that is more comfortably Democrat or even secular humanist. Mainstream Prostestant and Catholic churches, now in decline, lean towards Jesism; the evangelicals tend to Yahwism.

The Yahwites are in ascendance. In their doctrine God rewards virtue with wealth, and punishes his enemies with brutal power -- sowing salt upon the fields of the dead. The Jesites, always a minority, are in retreat. In particular the teachings of Jesus are so peculiar and demanding as to be almost unattainable for most humans. Jesites are always falling short of their ideal. Frustrating and not so marketable as Yahwism.

There is only a small theological gap between the Yahwites and the Wahaabi, so it is ironic that fundamentalist Islam should see Bush as their virulent enemy. Not the first irony in history.

American Evangelicism has been in free fall for years. One positive feature of Trumpism is that Evangelicals don’t talk about “family values” any longer. The laughter is deafening.

Sunday, May 20, 2018

Snapshot of a changing world - electric fat bikes

This “out of stock” direct sale electric fat bike is a sign of the times…

Screen Shot 2018 05 20 at 8 26 12 AM

I remember when, just before the great .com crash, a mysterious ‘product x’ was going to revolutionize the world:

John Doerr speculated that it would be more important than the Internet.[6] South Park devoted an episode to making fun of the hype before the product was released. Steve Jobs was quoted as saying that it was "as big a deal as the PC",[6] 

That product turned out to be the Segway. Which was, and is, a pretty neat product — but perhaps a few decades ahead of its time.

Meanwhile, as a quiet consequence of LiOn battery evolution and China, eBikes are growing exponentially. A fusion between traditional bicycle and scooter.

Like most cyclists I have mixed feelings about eBikes. On balance I think they are a good thing, but they will certainly have bad consequences — especially when collisions happen. A 250 lb adult on a 50 lb eBike moving at 25 mph is a lot of kinetic energy.

Mostly though, this is a marker of a changing world.