Wednesday, September 10, 2014

Apple Watch - a bridge too far

There's a healthy business in in used 6th generation iPod Nanos. The kids lost ours recently and we all miss it; we might look for a used one.

I don't think the 1st generation Apple Watch will be nearly as successful in the US market, though it may have some success in its true target market of China. Unlike the much loved Nano-clip it doesn't solve anyone's problems well. An water-susceptible exercise device tied to an iPhone is far less useful than an inexpensive FitBit. An authentication device tied to an iPhone is redundant in today's world. The iWatch Apple Watch is a very limited music and video platform. It's too big, it's too expensive, it's too fragile (water), the battery is too small and the initial demo highlighted bumping hearts.

The Apple watch is less developed and less interesting than Google Glass -- and that's a very low threshold to clear. If Apple had innovated on the standalone Nano-clip they could have delivered an interesting product, but the technology isn't here for the product Cook decided to bring to market.

This isn't the usual Apple 1.0 product. The usual 1.0 Apple product is interesting and somewhat useful for early adopters with high pain tolerance and it comes with a clear path to a strong 2.0. This is version 0.5. It's far too ambitious for its time -- and it's 6 months behind schedule.

A waterproof $150 iOS 8 Nano-clip replacement in Sept 2015 will be interesting. Splitting the cellular phone into multiple components, for which iPad and Apple Watch are interaction elements will be interesting. Standalone Apple Watch 4 running on next-generation LTE will be interesting.

Apple Watch 1 is a mistake.

Tuesday, September 02, 2014

How can anyone compete with Amazon?

Two weeks ago I decided I needed proper running shoes for my aching Achilles — something other than my flat Crossfit shoes or my ancient clunky 911s. I’d have loved to go to a proper store and learn about pronation, but, really, I don’t have time.

So I ordered a B-width Asics that’s in Amazon’s free return program. The first pair was a bit big, so I returned them and ordered a half-size smaller.  They’re great. They were also tax free (very unfair) and probably 30% cheaper than a store purchase — but really, it wasn’t the price, it was the time.

A week ago I biked two miles to Petco to pick up a poop-scoop. Kateva ran on the way out, trailored on the way back. I found a good enough scoop for $30, but it’s so annoying when these break that I wanted a backup. Amazon had a much better one for $20.

#2 son needs an introductory electric guitar for school music — $99 at Amazon. We want a useable kitchen radio with aux-in [1] - Amazon. Clipless pedals for #1’s road bike. Madden NFL 15 for xbox. Ruby Redfort book. Welch Allyn batteries for 30 yo otoscope. Vittoria road tires to replace 30yo originals. Amazon for all of it, with donations to Minnesota Special Hockey on the side.

How can any retailer compete? It’s not the price — it’s the convenience, the speed, the inventory, the buying experience, the easy returns, the reviews [2].

The only option I can see is for stores like Walmart and Target to setup mini-stores. Customers pick what they want, items get delivered to store within 12-24 hours. Consumer can try on shoes, inspect guitar, decide if they want to complete the transaction. Maybe order three pairs of shoes to the mini-store, but buy one.

Is there any other model?

[1] Aux-in for AirPort Express AirPlay connection, because, as best I can tell, almost nobody can make Bluetooth audio work. While I’m at it, why is Tivoli the only company that makes a simple half-decent bloody radio? Can’t someone simply clone them?

[2] Which convinced me the Bluetooth Tivoli was a very bad idea.

Monday, September 01, 2014

Lessons from our "Simply Vibe" soundbar: sunk costs and the curse of the embedded processor

Years ago, based on the recommendation of a web site that might have been something like Wirecutter, we bought a low cost Amazon sound bar for kitchen use. In retrospect, we violated Gordon’s Laws of Acquisition [1] — a cheap purchase had a high cost of ownership. By way of penance, I present a warning to others.


We used the @$30 device it for 2 years before a failing battery brought us to our senses. Over those two years we endured hundreds of dollars worth of aggravation [2] - all because this simple device incorporated a chip with the capabilities of a 1970s mini-computer (more or less). A chip that allowed a Chinese engineer to inflict their personal version of usability Hell on the world. The volume behaviors were the inverse of the US standard, every button had two to three uses, you could plug in a peripheral with its own odd mechanical switch, attach a USB music source (mp3, no AAC - not a FairPlay issue, just no AAC support), and Darwin-forbid, it could even be a display-free radio. 

The sound was fine.

As has been noted often, there’s a lot to be said for limited choice technologies. The more choices technology affords, the more designer talent is needed to manage the choices. Which is probably why we have exactly one competent producer of embedded processor consumer electronics, and so much trash ware.

Now I’m looking for an alternative. We want a first class FM radio user interface, a simple audio in connector and … dare I say it … bluetooth.

[1] See also: Gordon’s Laws for buying software and services

[2] The amount someone would have had to pay us to use such a stupid device if it hadn’t been our idea in the first place.

Friday, August 29, 2014

Coming to terms with the multiverse

Like most people, my neurons were rebooted a few times between birth and adulthood. So I don’t remember that much about childhood, but I do remember sitting in a schoolyard, perhaps in grade one or two, trying to get my head around the end of the universe.

I’m not at all sure, but I believe at that time, around 1970, I thought of the universe as infinite. Later it became finite, a theoretically countable number of galaxies somewhere between 10-20 billion light years “across” with an estimated age that didn’t quite add up. Then came inflation and the height of a human defined the mid-point between Neutrino and the Universe. That was six or seven years ago.

Those were the good old days. Now we have the Multiverse, and Tegmark’s taxonomy of multiversi …

Level I: Beyond our cosmological horizon[edit]

… A generic prediction of chaotic inflation is an infinite ergodic universe, which, being infinite, must contain Hubble volumes realizing all initial conditions.

Accordingly, an infinite universe will contain an infinite number of Hubble volumes, all having the same physical laws and physical constants…. 

Level II: Universes with different physical constants…

… In the chaotic inflation theory, a variant of the cosmic inflation theory, the multiverse as a whole is stretching and will continue doing so forever, but some regions of space stop stretching and form distinct bubbles, like gas pockets in a loaf of rising bread….Different bubbles may experience different spontaneous symmetry breaking resulting in different properties such as different physical constants…

Level III: Many-worlds interpretation of quantum mechanics … 

Level IV: Ultimate ensemble …

I’m slowly reading Tegmark’s popular book of which some criticism might be made. That review, however, offers little solace to universe nostalgics (emphases mine)…

Level I [is] just lots of unobservable extensions of what we see, with the same physics, an uncontroversial notion. Level III is the “many-worlds” interpretation of quantum mechanics, which again sticks to our known laws of physics. Level II is where conventional notions of science get left behind, with different physics in other unobservable parts of the universe. This is what has become quite popular the past dozen years …

So an infinite number of universes like the one we observe is “uncontroversial” and the idea that our infinite multiverse is only one extreme instance of vastly larger number (mostly unsuitable for particles, much less life) is “quite popular”.  There are necessarily an infinite number of John Gordon’s typing versions of this post…

Yes, infinity is like that.

I prefer to think that nothing ever happened, and that we are merely granite dreaming, but I try to creep up on the multiverse by way of metaphor. One person standing on a barren planet is inexplicable; 8 billion people on a planet infested with life is relatively easy to understand.

Perhaps so it is with universes.

Sunday, August 17, 2014

Human pregnancy is a dynamic struggle - implications for eco-econ, corporate power and secular stagnation

At the “Spherical Cow” level of simplification, human pregnancy is a dynamic tension control system, a kind of brain and gene motivated cold war between fetus and host (emphases mine)

Pregnancy is a war between mother and child – Suzanne Sadedin – Aeon

As the pregnancy continues, the foetus escalates its hormone production, sending signals designed to increase the mother’s blood sugar and blood pressure and thus its own resource supply. In particular, the foetus increases its production of a hormone that prompts the mother’s brain to release cortisol, the primary stress hormone. Cortisol suppresses her immune system, stopping it from attacking the foetus. More importantly, it increases her blood pressure, so that more blood pumps past the placenta and consequently more nutrients are available to the foetus.

The mother … pre-emptively reduces her blood sugar levels. She also releases a protein that binds to the foetal hormone, rendering it ineffective. So then the foetus further increases its production. By eight months, the foetus spends an estimated 25 per cent of its daily protein intake on manufacturing these hormonal messages to its mother. And how does the mother reply? She increases her own hormonal production, countering the embryo’s hormones with her own that decrease her blood pressure and sugar. Through all this manipulation and mutual reprisal, most of the time the foetus ultimately gets about the right amount of blood, and about the right amount of sugar, allowing it to grow fat and healthy in time for birth.

Pre-eclampsia may represent a malfunction of these balancing factors — a malfunction that injures both fetus and mother (many wondered about this in the early 90s).

Eco-econ principles suggest we look for this kind of evolved dynamic tension in our economic and political systems. We might look at something like this…

Feb 2010.png

a three way struggle between powerful economic (voters are also customers) and political forces. 

By analogy our current situation of secular stagnation and extreme wealth concentration is the equivalent of pre-eclampsia — a dynamic control system disorder that ultimately injures even the dominant powers. Corporations  and powerful individuals have accumulated too much wealth and power, resulting in dysfunctional patent laws, increasingly oppressive non-compete contracts, and a corrupt political system.

We can either rebalance our control systems, or we can develop eclampsia.

Saturday, August 02, 2014

Exercise and 55 - still CrossFit

When I would lose weight at 35 friends might say I looked well. At 55 friends say nothing, but they look worried. Like they’re wondering who Emily will marry after the cancer gets me. It’s different.

I think the skinniness is the CrossFit though. I’m still doing it, 17 months now, still at CrossFit St Paul. I used to need 3 days to heal after the workouts, but I went to 3 times a week last January. When my bike season ends I’ll go to every other day until spring.

I’m not addicted. Ok, a bit.

Doing this has put an unexpected spin on aging. My hair gets whiter, my brain gets crappier [1], but my body gets stronger and faster. I ran my best lifetime mile a week ago. I finally started doing “double unders” - just took a year and a half of failure. (Ten year old girls do these routinely. I blame it on a 55yo cerebellum and my aspie genes.) I suck at snatchs and handstand pushups, but they don’t scare me any more. I’m doing the chin-ups with the smallest band assist - or none at all.

The pounding music and tattoos have become familiar. You see something every week and pretty soon it’s just background. (I told my daughter if she gets a tattoo I’ll get one too, but I’m bluffing.) Now I see all the levels at CrossFit — on-ramp, newbie, beginner, regular, “Rx”, specialty classes, competitive and beyond. I’m basically somewhere between newbie and regular. Rx, at least Rx for men, is beyond this life.

We have terrific coaches and classmates, times that work no matter my schedule, great location for my commute, no contracts, and great return on time spent exercising. I like the “risky crazy” reputation, though I am positive my bicycle commute is a higher risk for serious injury.

Yeah, it doesn’t go on forever. I know what 80 looks like. Long before that I’ll be doing something gentler, and if I’m lucky I’ll one day be pedaling a electric-assist trike for exercise. Until then, I pay a month at a time.

If you want to try CrossFit and your 40 year warranty has expired I can share what’s worked for me — so far. 

I’m careful. I keep my deadlift under 210 - which is ridiculously low for a guy. I’ve got some history with backs and I respect that. Deadlift aside I aim for 80-90% of “Women’s Rx” on the weight, where Women’s Rx is what a competitive CrossFit woman would do. (Men’s Rx for olympic weights is way beyond me.) When my technique gets poor I slow down — even when time is running out. I like to ride my bike to the gym to loosen up, and a few hours of bicycling on off days is balm for a sore body. In the winter XC skiing works the same way — but this winter I think I’m taking up skate skiing. It’s good for the squats.

There’s some etiquette with being old in a relatively young person’s activity. There’s always something on the body that’s trying to break — don’t whine. It’s just entropy at work.

That’s it. If you want to try I recommend starting twice a week, abandon any idea that you’re stronger or faster than the CrossFit women, respect the body (never push, it will break), be persistent and be patient.

[1] One of the reasons, maybe the main reason, that I started doing CrossFit was that the only damned thing we can do to slow our inevitable brain mushification is to do serious regular physical exercise. If it’s really working for that then I hate to think what my brain would be like otherwise.

Update: This 2012 review of CrossFit is well done.

Sunday, July 27, 2014

What if road laws treated bicycles as first class citizens?

Roads were not always the dominion of cars, and traffic laws were not always written only for cars. It took decades, and significant cultural transformation, for pedestrians to become 2nd class citizens.

There’s change in the air though. Sweden launched Vision Zero in the 90s. Dutch experiments showed the safety and health value of segregated bicycle travel. Manhattan launched a bicycle share system with far fewer fatalities than anybody expected. Over my 20 years in the Twin Cities I’ve seen amazing growth in our local bikeways.

States like Idaho (!) are thinking about what traffic laws would look like if they weren’t written only for automobiles. While we pray for autonomous vehicles, and while we build more segregated bicycle trails and better sidewalks, we can also think about what balanced laws would look like. For example… 

Current stateCarNon-car (bicycle, pedestrian, inline skater, etc)
Stop Sign Stop until clear Yield
Red Light Stop until green (no right turn on red) Stop until clear (Stop sign where cross-traffic doesn’t stop)

A car passing a non-car with less than 3 feet of clearance would be penalized as though it had run a red light. All cars would be required to have proximity detectors, and violation of the 3 foot rule would result in an automatic ticket…

See also:

Thursday, July 24, 2014

My home remedy for a volar (palmar) ganglion cyst

Age has many insults. Among the minor ones are lumps and bumps that come and go — like the Ganglion Cyst of the Wrist. These cysts are annoying, common, and weirdly mysterious.
I like the theory that at least some of them are due to a “a rent in the joint capsule … allow leakage of synovial fluid into the peri-articular tissue. Subsequent reaction between this fluid and local tissue results in the creation of the gelatinous cystic fluid and the formation of the cyst wall”. In plain language, some tear in the joint capsule causes joint fluid to leak and the tissue around the join tries to seal the leak with a thick fluid plug.
These usually happen on the back of the wrist, but I’ve had two on the palm (volar) side of my right wrist. One showed up in 2012 and another 2 years later. Oddly enough, I don’t recall seeing many of these during the five years I was a country GP. I’ve probably forgotten em.
When it first happened I researched the medical literature. I didn’t like any of the options - particularly for palm-side (volar) cysts. Surgery is expensive, prone to complication, and not terribly effective. Aspiration (puncture skin, try to suck out thick fluid) did no better — though it can work better on the dorsal side. It wasn’t clear splinting did anything, and smashing the cyst with “a bible” is problematic for dorsal cysts and ineffective for ventral. The best option seemed to be to do nothing and wait. Except that a volar cyst is a real pain when typing - which I do most of the day.
So I made up my own treatment. I taped a coin over the cyst and wrapped it with tape. Something like this:
Which work great for a day or two, until elastic tape and skin traction made for a nasty burn-like dermatitis. Good thing I was experimenting on myself. So then I went on to make a soft fabric strap out of “Get-A-Grip” multi-use velcro straps …
Ganglion Cyst Splint 3
and I taped a quarter to the strap:
Ganglion Cyst Splint 4
No more nasty skin traction (the transparent tape on the top right is tegaderm, treating my iatrogenic dermatitis/burn).
When I did this in 2012 the cyst had been established for a week. The micro-splint relieved typing discomfort and didn’t get in my way. After a few weeks of wearing it, and a regular splint when sleeping, the cyst abruptly flattened. I don’t know if it drained back into the joint, but it felt that way. I wore the micro-splint for a week or so and then forgot about it. I was careful to keep my wrist straight, though not terribly careful. Sometimes I did palmar pushups instead of straight wrist fist pushups.
Now I’ve got another one. I’ve recreated the splint, but perhaps because the cyst was new this time it flattened immediately. Maybe this time I’ll only need the velcro strap/coin for a week or two.
I doesn’t feel as though activity makes much difference — as long as I wear the splint and don’t extend the wrist (as in a palm-down pushup). So my CrossFit pushups are now fist down, and I’m putting my handstand pushups on hold for a few months (I’ll do wall-walk fist down, wrist straight instead — which should be more painful, hence better).
Caveat emptor. This isn’t science, it’s anecdote. If you try it, don’t blame me when your sarcoma metastasizes (not every lump is a benign cyst). 

Monday, July 07, 2014

Google shutdown policy - Orkut as a standard?

I played with Orkut briefly, so I received a shutdown notice for the 10 yo service around July 1.

Over the past decade, YouTube, Blogger and Google+ have taken off… We will shut down Orkut on September 30, 2014 …  You can export your profile data, community posts and photos using Google Takeout (available until September 2016). We are preserving an archive of all public communities, which will be available online starting September 30, 2014. If you don't want your posts or name to be included in the community archive, you can remove Orkut permanently from your Google account…

Bit of a comedown for G+ to be mentioned in the same phrase as Blogger, a service that’s always seemed one meeting from extinction.

I don’t remember how much notice we were given prior to the Google Shares/Reader shutdown, but I’m guessing Orkut’s 3 months will be a Google standard. Likewise the 2 years of Google Takeout. The public archive feature may be a case-by-case decision.

What’s next for shutdown? Google Voice is being merged into Hangouts, but I suspect many of the call routing features of GV will go away with a 3 month warning (or perhaps spun off into a business product?). Blogger has been next-in-line for so long it almost seems immortal. G+ Facebook-like features look doomed; seems there can be only ONE Facebook — but the end of Twitter might add a few years to G+ social. Otherwise I’m not sure what’s left to kill — more a matter of less pure ad-support and more a mixture of paying for services and ads.

Saturday, July 05, 2014

How quickly can businesses adapt?

iTunes Radio is at least partly funded by music purchases. But now people don't buy music, they stream it.

Similarly, we rent movies, we don’t buy them. I think people still some game add-ons for their phones, but I don’t think the current business model for game apps is all that healthy. Elite software, like Aperture and even iPhoto, is a dying business. There is now exactly one viable product for prosumer photo management on both OS X and Win 8. Those two platforms cost billions to produce, and they are arguably dying legacy products.
There are answers to all of these business issues, but the cycle times are very short. One obvious answer leads to a sort of death spiral; enter new markets quickly, ride the surge, then walk away with growth phase revenue. Then abandon the product. It’s a potential death spiral because with each cycle a certain percentage of customers drops out from churn fatigue. It’s the technological equivalent of slash and burn agriculture, a strategy that works until one hits a carrying capacity limit.
I wonder how something like this would show up in measures of economic productivity and GDP. It feels a bit “singular”.

Friday, July 04, 2014

Why Apple killed the most important applications on the Mac: Aperture and iPhoto

A bong smolders in the sanctum sanctorum of 1 Infinity Loop, Cupertino California. It’s early 2013 and Apple’s most powerful billionaires are looking ahead. Billions of dollars are overflowing Apple’s bank accounts…

“We’re screwed. Totally f*cked. Gimme that bong”.

“Yeah. I know. It’s bad. Google is gonna stomp us. Android owns the world. Schools are gonna do Google Apps on Chromebooks. We were wrong about phablets and now the iPad is gonna die. There’s no way we can catch up with Google Docs.”

“Yeah, we’ve all seen the numbers. We get a few good years … then boom - we’re Microsoft. Damn. Gimme that …”

“Sh*t. We gotta do something. Google’s got the numbers and the Net — how can we fight that?”

“We got something. We got the hardware. We gotta take a different angle and hope Samsung slits Google’s throat — because they hate Google even more than they hate us.”

“There’s plan B. Ditch everything where we ain’t making big money. That pro-software sh*t - we make more money in a day’s iPhone sales that we make on a year of Aperture. Nobody makes money on high end stuff any more. And look at our iPhoto sales — sucking wind for years. Ditch it, ditch it all. Hell, dump the Mac. We’ll be all “internet of things”…”


“No? Hey you sure you don’t want some of this T ..”


“No and Plan B is suicide. We can’t fight Google there. They’ll slaughter us. We gotta go with Plan A. We gotta make stuff that works for the low end and the geeks. We have to do the whole thing and we gotta stop screwing up the software. We screwed up iTunes. iCloud - everything on iCloud. iPhoto — oh, God, we screwed that one so many ways. - took  two years to fix that. iBook — you ever try using that piece of sh*t?. We got money — but we don’t have time. So we get better.”

“Plan A? That’s bad stuff man. We blow that, we’re done.”

“Plan A. And we’re gonna start with stuff we shoulda owned. We’re gonna start with photos. Nobody can manage their photos. People take thousands and lose ‘em all when they drop their phone in the toilet. Photo geeks have thousands in Aperture and they lose ‘em all - no backups.”

“Hah! You think we can do this? We had a great app with iPhoto, but we couldn’t add Library Management because that was an Aperture thing. Then we were five years late with a single iPhoto to Aperture library. We made iPhoto stupider, but we couldn’t make it easy to use. Sh*t we were idiots.”

“Aperture! Hah, that was joke. How many geeks every figured how to use our keyword tree? Even Brainiacs didn’t get that one. Where’d we buy that crap UI from anyway? Looks like something from NeXT.”

Screen Shot 2014 07 04 at 9 00 29 PM

Enough. We do Plan A. We’re gonna make a single application that works with a Phablet or an iMac, one app that scales from kids with phones to camera geeks. Elite and civilian — all of ‘em. We’re gonna burn our bridges — we’re gonna make it official. iPhoto and Aperture are dead.”

“Wow, we’re gonna have a lot of mad customers. But, hell, what are they gonna do? It’s easier to change gender than to move from Aperture to Lightroom — and Adobe ain’t gonna last much longer anyway. There’s no money in pro software, and they got nothing else.”

“So how do we do it? We should be classy. Let folks know we’ll keep the apps going until everything’s set. They’ll be bummed, but we know how to do this right.”


“No?! What do you mean no?!”

"We gotta make Google think we’re idiots. We’ll let it slip out through some blogger mac geeks read. We’ll give ‘em nothing. We’ll make it look like we’re pissing off our best customers. Google won’t suspect a thing. Hell, what are they gonna do? Go to Lightroom?!”

“Pass me that bong”.

Wednesday, July 02, 2014

Tax refund fraud targets health care workers, exploits big hole in IRS security

I missed this last year, but it’s worth knowing about. The usual suspects are exploiting weak security on tax returns; they steal identities, file returns, get refunds. Often targets physicians for obvious reasons — they tend to have large refunds and physician information is notoriously easy to steal from low security licensing databases.

If it were a corporation with this kinds of security weakness they’d be sued out of existence, but we can’t sue the Feds. 

The IRS is very slowly rolling out a PIN to include with returns to establish (relative) authenticity. There were arrests in late 2013 but this fraud is only going to grow over the next few years unless the security upgrade is accelerated. That would require serious bipartisan political pressure.

Sunday, June 29, 2014

Online textbooks are awful. It's time to kill the publishers.

My daughter and I are using “Holt” [1] Mathematics Course 3 for her summer math work. It’s quite a good printed textbook; a used 2007 edition cost about $10 on Amazon.

Her school doesn’t expect parents to buy the used textbook, however. They expect us to use the same material through Holt McDougal Online. Alas, unlike the printed text, the online textbook experience is miserable. Holt is serving up low to medium resolution bitmaps that are barely legible on screen or if printed. Our school district’s acceptance of this awful experience reinforces my fear of their iPad for all learning program. They are not ready for this.

It’s not just the schools that aren’t ready. The big publishers who control school textbooks have had decades to do computer based textbooks — and their products are still lousy.

We need alternatives to the traditional publishers. We need nations, states, provinces and startups to fund new textbooks that are digital from the start. This will kill Holt et al — but we have no choice. They can’t do this. They need to go away.

[1] Publisher names change constantly.

Saturday, June 28, 2014

Secular stagnation and the Beveridge curve - the role of frail boomer parents

American unemployment, as economist’s measure it, is back to our post-2000 “norm”. On the other hand economic growth is low; our last quarter would make a fine start to another recession. Krugman et al debate the cause of “secular stagnation” in general, and strangely low labor force participation and Beveridge Curve shift in particular.

The usual suspects are globalization and “IT” (increasingly “AI”, politely referred to as “robots”). I also suspect the dominance of the dysfunctionally powerful modern corporation plays an important role along with the related the rise of economic parasites.

Income inequality is inducing economic distortions that likely also contribute, though I think that effect is partly offset by corporate power. Slowdowns in scientific discovery and technological innovation aren’t helping.

That’s a long list - as one would expect in an eco-econ world where we have to treat economies as ecologies. It takes a lot to change a self-correcting system.

I think we can add more though - including the intersection of demographics and medicine.

Once upon a time, as “recently” (cough) as when I started medical school in 1982, parents died in their 60s and 70s. They weren’t as vigorous as today’s 70 yo’s but they weren’t particularly frail either. They ate poorly, smoked and exercised little — but that’s not enough to make someone frail. It just means that elders died relatively quickly of cancer, heart disease, and organ failure. Dementia was starting to become more common, but it wasn’t universal.

Today’s Boomer parents are different. They stopped smoking 20 or 30 years ago. They’ve had more education and they’ve benefitted from bypass surgery and far better medications for lipid and blood pressure control. Their diets are lousy and they never exercised much — but they’re not nearly as obese as we will be.

So they tend to last — into their 80s. Which is pretty much the end of the road for the human machine. So Boomer parents get to be frail - and demented. That’s an entirely different care burden than any previous generation has known - and it’s hitting the boomer peak of today’s demographic curve. As always, the burden falls largely on women.

The frailty burden is genuinely new. It’s not big enough to explain all of our economic transformation, but I think it plays a significant role.

Fortunately, there’s an obvious fix - and an investment opportunity.

I expect to see massive solar powered robotic dementia care facilities opening across the empty spaces of America — probably as extensions of Google’s data centers. With robotic caretakers, waste water recycling, soy lent green synthetic protein, and high bandwidth connections to companion AIs and VR-integrated remote children this should be quite pleasant.

I’m looking forward to my pod. (Oh, sh*t, I’m in it right no…..)

See also


Friday, June 27, 2014

A warning to family physicians doing educational modules - cultural competency isn't your worst option

The American Board of Family Medicine requires recertification every seven years. The standard modules are rigorous; perhaps absurdly so. They often require answers taken from the medical literature that have a reliability half-life of about 8 months. (That is, half these answers will be incorrect within 8 months of initial publication.)

I'm not warning family docs about those exams however. I'm warning docs who don't actively see patients about something far worse.

If you don't see patients, you need to do one of 3 "alternative modules". As of June 2014 the choices are:

  • cultural competency
  • hand hygiene
  • information management (MIMM)
Emily did hand hygiene. It was annoying and hard on the hands, but pleasantly mindless.

I'm a computer geek, so I thought information management might be interesting.

Oh, fool that I was. I am a broken man on a Halifax pier. Halfway through the exercise I fell sobbing to the floor, begging Emily to end my suffering. By the end, I thought of Winston Smith.  I have foresworn my career. Never again shall I speak of the role of software in medicine. I shall become an itinerant monk, clothed in rags, ranting before the doors of America's medical schools...

Do cultural competency.

You're welcome.