Tuesday, February 26, 2019

Primary care 2019 vs. 1989

There’s been at least a 200-300% increase in care complexity between when I started medical practice and today. Many new classes of medications for fairly common disorders, many more specialty interventions that may be considered.

At the same time computer based clinical decision support systems have been a surprising failure. (Emily uses Epic, I use VistA/CPRS). In the 90s we expected far more than we actually got.

We are asking a lot of the modern primary care physician.

Monday, February 18, 2019

Greenlight card for "kids" - early impressions

I ordered the Greenlight cards for our children. Only one is a minor (and she uses a regular debit card) but two are special needs adults who are more vulnerable to financial scams or misjudgments. I also got one for a sibling with some similar issues though that is certainly not the Greenlight market.

So far it’s been a mixed experience. The Greenlight site has suprisingly poor documentation — basically some simplistic FAQs. They don’t document where the cards don’t work but from customer support I got:

Since our cards are meant for children, there are certain places that our cards will not work. Liquor stores, gambling websites or establishments, money orders, MoneySend and wire transfers are some examples of things that our cards will not work for. Since we are a prepaid debit card, we have also had families experience some trouble when attempting to use our cards to pay bills. We recommend not transferring funds to the Greenlight card that need to be used for utilities or other bills.

That seems reasonably, but it’s not the complete list. They don’t work for Patreon for example — my son wanted to donate there. Greenlight won’t provide a full list.

There’s also a problem with Greenlight.app behavior on one child’s phone. Again, this is undocumented, but I think there are two paths it should follow on launch. One path should enable access to card balance, the other is for requesting a card. On his phone it goes down the wrong path. Hard to sort out since, again, there’s no documentation.

The vibe I get from Greenlight is that is a venture funded effort that didn’t scale quickly enough …

Saturday, February 16, 2019

CrossFit for Olds - years to build ligaments and tendons

My son bought me a slim book on rock climbing techniques. Rock climbing was my brother Brian’s gig, but I could see doing it when my knees knock me out of CrossFit. It’s something I did in college back when we belayed using ropes wrapped around our body (no belay hardware).

The book talks about single finger pinch holds. Specifically, it says not to try them until at least two years of building up tendons and ligaments.

Two years is a fair amount of time. I’ve not seen that mentioned in any clinical references I read. I suspect it’s right though; it’s obvious muscles can develop much faster than tendons.

I think we should be more aware of this in CrossFit training. Young muscles develop fast, but ligaments and tendons take time. To lift heavy things safely we need connective tissue to be at least as strong as muscles (ideally stronger).

In my 60th year I lift significantly heavier things than I did when I was younger-Old. Probably heavier than I could have done in my mid 30s. My muscles are somewhat stronger, but I think a lot of that is connective tissue development, and that took years. More than two years for Olds I think.

Saturday, February 09, 2019

The curious psychiatric state of Robert F Kennedy Jr

Robert F Kennedy Jr showed up in a scrum of pro-measles whackos recently. It  me wonder how he got so nuts.

There’s an extensive wikipedia page for him, starting with a time I remember:

He was 9 years old when his uncle, President John F. Kennedy, was assassinated during a political trip to Dallas, and 14 years old when his father was assassinated…

Despite childhood tragedy he was a successful academic and he’s done some decent work legally and for the environment. He seems to have started off the rails in the 80s:

In 1983, at age 29, Kennedy was arrested in a Rapid City, South Dakota airport for heroin possession after a search of his carry-on bag uncovered the drug, following a near overdose in flight.

By 1989 he’d started on vaccines — but not with autism … 

His son Conor suffers from anaphylaxis peanut allergies. Kennedy wrote the foreword to The Peanut Allergy Epidemic, in which he and the authors link increasing food allergies in children to certain vaccines that were approved beginning in 1989

By 2000s he’d jumped from immunizations causing his son’s anaphylactic disorder to immunization causing autism. He became "chairman of “World Mercury Project” (WMP), an advocacy group that focuses on the perceived issue of mercury, in industry and medicine, especially the ethylmercury compound thimerosal in vaccines”. It was a downward spiral from there.

Despite his vaccine delusions and troubled marriages he seems to have maintained a fairly active wealthy person life. He’s said to be a good whitewater kayaker.

Psychiatrically it’s curious. He combines fixed irrational beliefs (the definition of delusions) with relatively high functioning in other domains. He reminds me of L Ron Hubbard, founder of Scientology

We need to keep him far from the political world.

Saturday, February 02, 2019

Against superhuman AI

I am a strong-AI pessimist. I think by 2100 we’ll be in range of sentient AIs that vastly exceed human cognitive abilities (“skynet”). Superhuman-AI has long been my favorite answer to the Fermi Paradox (see also); an inevitable product of all technological civilizations that ends interest in touring the galaxy.

I periodically read essays claiming superhuman-AI is silly, but the justifications are typically nonsensical or theological (soul-equivalents needed).

So I tried to come up with some valid reasons to be reassured. Here’s my list:

  1. We’ve hit the physical limits of our processing architecture. The “Moore-era” is over — no more doubling every 12-18 months. Now we slowly add cores and tweak hardware. The new MacBook Air isn’t much faster than my 2015 Air. So the raw power driver isn’t there.
  2. Our processing architecture is energy inefficient. Human brains vastly exceed our computing capabilities and they run on a meager supply of glucose and oxygen. Our energy-output curve is wrong.
  3. Autonomous vehicles are stuck. They aren’t even as good as the average human driver, and the average human driver is obviously incompetent. They can’t handle bicycles, pedestrians, weather, or map variations. They could be 20 years away, they could be 100 years away. They aren’t 5 years away. Our algorithms are limited.
  4. Quantum computers aren’t that exciting. They are wonderful physics platforms, but quantum supremacy may be quite narrow.
  5. Remember when organic neural networks were going to be fused into silicon platforms? Obviously that went nowhere since we no longer hear about it. (I checked, it appears Thomas DeMarse is still with us. Apparently.)

My list doesn’t make superhuman-AI impossible of course, it just means we might be a bit further away, closer to 300 years than 80 years. Long enough that my children might escape.