iPhone effect: cell phones do really suck

An investor web site shows the pre-launch effect of the iPhone on cellphone sales and carrier subscriptions. It's an unprecendented effect for an unavailable product that is going to take 1-2 iterations to truly succeed.

The only possible explanation is that today's cell phones suck. It's not just the RAZR, they're all bad. The good ones are gone, and the Treo carries the curse of a dead OS (Vista support in 2008?).

Consumers may not be able to articulate what's wrong with their phones, but they know they're bad. Apple is our only hope.

My Sprint contract expires in October, so I'll have a few months to see how bad iPhone 1.0 will be. I expect it will be pretty flaky, but Apple flaky may be good enough ...

Innovations in back pain management: cold and colder packs

[Update: I had a more extensive post on the same topic in 2005, that one's more complete.]

Every bad back is bad in a different way. Mine puts me down fast, but recovers fast. The key for me is cold [1], cane, and motion. Slap the cold pack on within a minute of an outage, whip out the cane, slug back the ibuprofen, and get moving. (I swear by therapeutic inline skating on day 2, but that's a bit extreme.)

My fundamental accessory is the brilliant Tru-Fit neoprene/velcro wrap that holds one of the four cold packs we keep in the freezer. That patent was well deserved.

There's only one problem. Therapeutic cold packs aren't all that cold, and they're only good for about 20 minutes at a time. They're designed to be relatively safe for persons with impaired vasculature and sensation, particularly diabetics. On the other hand, picnic packs are uncomfortably hard and too cold, not to mention absolutely contraindicated for just about everyone.

So my latest innovation is to double 'em up. A small picnic pack goes on the outside of the pocket, a large therapeutic pack goes on the inside (against my back). The results is just right, and it lasts for over an hour (yeah, I know, you're supposed to use cold for 20 minutes -- I have a lot of experience with this).

Use at your own risk. I guarantee you will develop deep tissue freezing, secondary necrosis, massive muscle loss, disseminated infection, toxic shock, and massive stroke due to multisystem organ failure. You will fester in misery for 20 years draining your family's resources. Don't say you weren't warned.

[1]. I suspect cold therapy doesn't work nearly as well when there's a thick lipid layer involved.

Climate change: the optimist's case

Der Spiegel presents the optimists case for global warming. There's a great deal of spin in the dramatic presentation, the underlying data they reference is pretty conventional. Faster than expected arctic melting, considerable Greenland melting, sea level rise @ 20 inches. The primary difference is they claim current models show less African drought and more American drought, and they discount any diversion of major Atlantic temperature flows.

They seem to be arguing against 'An Inconvenient Truth', which was a dramatization of a worst case scenario, but was based on models of several years old. The worst of the Spiegel article is a muddled implication that warming is good for all existing animal species, which is simply whacko.

I think they're arguing that we don't need to slow CO2 production, but I think the models they reference are based on limiting CO2 output ...

Happy 50th, your brain's myelin is toasty

As if 50 wasn't enough fun already, Future Pundit review current research on demyelination in the aging brain. I don't think this is new, but I've of course forgotten about it. After age 50 or so the brain is increasingly crummy at synthesizing myelin and neurons work less well. The Alzheimer's process may be related, but even if we could prevent that we'll still have flaky myelin.

Oh well.

Product excellence: protect the genius

A former apple executive pays slightly reluctant homage to the gifts of Steve Jobs (emphases mine):

Mobile Opportunity: Apple's industrial design: The value of a decisive bastard with good taste: "

... But the issue's more than just decisiveness vs. bureaucracy. I think Steve Jobs also has very good taste in hardware. I watched the Apple industrial design folks up close for almost ten years, under both Brunner and Jonathan Ive. The groups produced a huge variety of product concepts, ranging from sublime to downright ugly. The bureaucracy pre-Jobs (including, alas, myself) generally picked designs that were nice but prudent -- easy to produce, low risk, not too expensive.

Steve Jobs picks the pretty ones. The ones your average risk-averse business manager would look at and say, "gee, that's nice, but..."

Steve sometimes goes overboard (remember the G4 Cube, a triumph of gorgeous shape over practicality; or the magnesium fetish of the NeXT computer?). And I think his taste in software interfaces isn't as good as his taste in hardware, which is why the current Mac interface is (in my opinion) tarted up like a teenage girl just learning to apply makeup...

Jobs has a very strong aesthetic sense (which is far more than merely "pretty", there's a bit of malice in that word). That's credible, but not useful. CEOs are not selected for that ability. Mace translates this into a very challenging recommendation:

...There is another alternative. Hire someone with good taste, and then back their choices vigorously when everyone else tries to compromise them. Go watch the movie Amadeus. If you can't be a Mozart, be a Salieri -- recognize and use the genius in others...

Ahh, now that's really hard. There are so many reasons this doesn't work. Remember -- Mozart died a miserable death and was buried in a pauper's grave...

This is why great products almost always come from startups, usually reflecting the vision of a handful of creative and committed individuals. The products rarely, if ever, survive long in a public company. (Microsoft Excel being the notable exception.)

Apple's continued ability to create great, innovative products on a semi-regular basis, is almost unprecedented. SONY used to be able to do something similar, but they died 10 years ago. 3M used to have the knack, but they seem to have lost it.

It's extremely hard to keep creative types happy and functional in a corporate setting, reward them for being creative, and keep their vision moving forward. I'd like to read Jobs thoughts on that ...

How to buy a physician - first find someone who agrees with you

I dug this post out of the archives of unpublished posts. I wrote it in 3/07, but the NYT has followed up with a 2nd article today. So I've put them together.
--
In the old days, when you wanted to buy a Senator you slipped them a bag full of money. That still happens I'm sure, but we're more sophisticated now. If Philip Morris wants to buy a Senator, they find who agrees with them (preferably someone stupid, but a smart libertarian will do) and they fund their political career. Chances are they'll still be an idiot even if they're elected, and Philip Morris will have purchased a senator.

Not surprisingly, physicians are just as easy to purchase as Senators -- and cheaper. They're equally likely to deny that they've been bought. This is not new, but now, thanks to my home state, we have numbers (emphases mine). Much of this money will come from small CME programs sponsored by drug companies rather than direct payments. I've done those CME programs, though I probably wasn't speaking about meds. So the money trail is probably less precise than the NYT article implies ...

Doctors’ Ties to Drug Makers Are Put on Close View - New York Times
The New York Times
March 21, 2007
By GARDINER HARRIS and JANET ROBERTS

... payments ... appear in an unusual set of records. They come from Minnesota, the first of a handful of states to pass a law requiring drug makers to disclose payments to doctors. The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products.

The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million [jf: over 8 years] Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

Doctors receive money typically in return for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines. Dr. Collins, who received more money than anyone else in the state, is among a limited number whose payments financed research.

In dozens of interviews, most doctors said that these payments had no effect on their care of patients...

...There is nothing illegal about doctors’ accepting money for marketing talks, and professional organizations have largely ignored the issue.

But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs — whether or not they are in the best interests of patients.

“When honest human beings have a vested stake in seeing the world in a particular way, they’re incapable of objectivity and independence,” said Max H. Bazerman, a professor at Harvard Business School. “A doctor who represents a pharmaceutical company will tend to see the data in a slightly more positive light and as a result will overprescribe that company’s drugs.”

In an e-mail message, Dr. Collins said he personally received in 2004 less than $10,000 from Amgen for educational presentations. “The contract amount of $1.9 million from Amgen was paid to the Minneapolis Medical Research Foundation (MMRF) for the research contract, on which I am the designated senior researcher,” Dr. Collins wrote. He wrote that he did not work for or serve on the board of directors of the foundation. Dr. Collins discloses on his Web site and research papers that he is a consultant to Amgen, among other companies.

Dan Whelan, an Amgen spokesman, said the company paid the Minneapolis Medical Research Foundation “to conduct sophisticated research and data analyses that have enhanced the understanding of health care delivery” for kidney patients.

But Dr. Daniel Coyne, a kidney specialist at Washington University, said he was troubled by the payments.

“Amgen’s funding for Dr. Collins’s MMRF is another huge financial connection to individuals at the National Kidney Foundation,” Dr. Coyne said. “The foundation’s recent pro-industry anemia guidelines — and the revisions due next month — have to be viewed with great skepticism.”

... More than 250 Minnesota psychiatrists together earned $6.7 million in drug company money — more than any other specialty. Seven of the last eight presidents of the Minnesota Psychiatric Society have served as consultants to drug makers, according to the Times examination.

After psychiatrists, doctors who specialized in internal medicine garnered the most money, followed by cardiologists, endocrinologists and neurologists...

... In addition to Minnesota, legislators in Vermont, Maine, West Virginia, California and the District of Columbia have passed laws requiring some level of disclosure of drug company marketing efforts. In Vermont, the state has collected three years of data on payments to doctors, but drug makers are allowed to keep the records private by declaring them trade secrets....

...Dr. George Realmuto, a psychiatrist from the University of Minnesota, said most of the marketing associated with his lectures was packaged around his talks.

“It’s at a wonderful restaurant, the atmosphere is very conducive to a positive attitude toward the drug, and everyone is having a good time,” said Dr. Realmuto, who compared the experience to that of buying a car in a glitzy showroom. He earned at least $20,000 between 2002 and 2004 from drug makers.

... Jamie Reidy, a drug sales representative for Pfizer Inc. and Eli Lilly & Company who was fired in 2005 after writing a humorous book about his experiences, said drug makers seduced doctors with escalating financial inducements that often start with paid trips to learn about a drug.

... “You’re making him money in several ways,” said Gene Carbona, who left Merck as a regional sales manager in 2001. “You’re paying him for the talk. You’re increasing his referral base so he’s getting more patients. And you’re helping to develop his name. The hope in all this is that a silent quid quo pro is created. I’ve done so much for you, the only thing I need from you is that you write more of my products.”

...The number of drug marketing presentations delivered by doctors across the United States rose nearly threefold between 1998 and 2006, according to Verispan, a company that tracks drug marketing efforts.

In some cases, consulting doctors are so well recognized that they offer drug makers far more than the chance to influence their own prescriptions. For drug makers, among the most prized consultants are those who write guidelines instructing their peers about how to use drugs...

A prior (harshly titled) post of mine has links to an article that details just how an individual is, slowly, corrupted. The great disappointment for me is how completely the drug companies have infiltrated the standards groups.

The NYT followed up in 5/07 with another article using the same data source, this time focusing on pyschiatrists and their prescription patterns:

... A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.

From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.

Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money...

... Ten years ago, Dr. Realmuto helped conduct a study of Concerta, an attention deficit hyperactivity disorder drug marketed by Johnson & Johnson, which also makes Risperdal. When Concerta was approved, the company hired him to lecture about it.

He said he gives marketing lectures for several reasons.

“To the extent that a drug is useful, I want to be seen as a leader in my specialty and that I was involved in a scientific study,” he said.

The money is nice, too, he said. Dr. Realmuto’s university salary is $196,310.

“Academics don’t get paid very much,” he said. “If I was an entertainer, I think I would certainly do a lot better.”...

I wonder if Dr. Realmuto has any idea how bad that sounds? There is, finally, one hero in the entire series ...

Other psychiatrists renewed Anya’s prescriptions for Risperdal until Ms. Bailey took Anya last year to the Mayo Clinic, where a doctor insisted that Ms. Bailey stop the drug. Unlike most universities and hospitals, the Mayo Clinic restricts doctors from giving drug marketing lectures...

Praise be to the Mayo.

Great series NYT, but lord its bad news for physicians. Psychiatrists, in particular, are supposed to know a bit about how the mind works. Be ashamed, be very ashamed.

Health care reform 2007 - the Massachusetts plan

The discussion begins again. Gawande begins with the assumption that we introduce a new plan without removing the existing system. It's a practical approach.

Curing the System - New York Times
By ATUL GAWANDE
Published: May 10, 2007

....Experts have offered half a dozen more rational ways to finance all this than the wretched one we have. But we cannot change everything at once without causing harm....

...Option 1 is a Massachusetts-style reform.... Enacted statewide last year, the law has four key components. It defines a guaranteed health plan that is now open to all legal residents without penalty for pre-existing conditions. Using public dollars, it has made the plan free to the poor and limited the cost to about 6 percent of income for families earning up to $52,000 a year. It requires all individuals to obtain insurance by year end. And it requires businesses with more than 10 employees to help cover insurance or pay into a state fund.

The reform gives everyone a responsibility. But it leaves untouched the majority with secure insurance while getting the rest covered. As a result, it has had strong public approval. Experience with delivering the new plan is accumulating. And best of all, it offers a mechanism that can absorb change. The guaranteed health plan may cover 5 percent of the state at first, but as job-based health care disintegrates, the plan can take in however many necessary...

The Massachusetts plan seems very much like the Clinton plan, or at least something that would evolve to it. The employer burden is interesting, I assume it's there so employers don't ditch health care coverage en masse.

The "shared responsibility" part sounds like a political slogan. In any event this is consistent with my prediction of how it will all turn out.

Slouching towards world government: the police force

Phil Carter joins a call for an international policing mission...

INTEL DUMP - New articles of interest

... The time has come to develop standing constabulary forces at several levels: U.S., NATO, and U.N. Such a building block approach would allow national and regional operations, as well as global U.N. efforts....

...Policing and crime control skills must be integrated into strategic and operational responses to peace operations and related conflicts that challenge transnational stability. A global framework of standing or composite constabulary forces could fill this need...

Global warming management, global standards for food and drug safety, global police forces, a recent 'parliament of the united nations' meeting... world government is in the air again.

Age of wonders: A North Korean Bush joke

The author of a post on a Hong Kong journalism student site seemed mostly concerned with the affront to American dignity, but I found this story both marvelous and encouraging ...

International News (JMSC 0042): North Korea general tells Bush joke

When military chiefs from the two Koreas met on Tuesday for talks, a general from the North, Kim Yong-chol, started off by telling a joke about Bush on the internet.

He then retold the joke about Bush who goes out jogging one morning and as Bush is preoccupied with international affairs, fails to notice that a car is heading straight at him.

A group of schoolchildren pull the president away just in time, saving his life, and a grateful Bush offers them anything they want in the world as a reward. However, the children ask for a reserved place for them in the Arlington Memorial Cemetery. Bush asks them why.

“Because our parents will kill us if they find out what we’ve done.”

Incidentally, it's funny, albeit a bit politically improper. Bush isn't run over, the children are fine, and it's a variation on a very old and well established joke.

Much more importantly, we see that Kim Yong-chol is rather well connected. He (or one of his intelligence people) reads jokes off the internet, knows Bush is very unpopular in the US, and he tells a joke that's a bit chancy but is quite topical.

Why is this good news? Remember the common American perception that North Korea is full of delusional madmen cut-off from reality. That's clearly not true at a fairly senior level. The more they know about the world, the less likely they are to do something that will work against their own best interests. And if North Korean knows its own best interests, then there's a lot that can be done ...

Pet poison chemistry: more on cyanuric acid

So cyanuric acid was not merely a byproduct of melamine production, it was a fraudulent ingredient in its own right ...

Another Chemical Emerges in Pet Food Case - New York Times

... Two of the Chinese chemical makers say that cyanuric acid is used because it is even cheaper than melamine and high in nitrogen, enabling feed producers to artificially increase protein readings which are often measured by nitrogen levels of the feed. The chemical makers say they also produce a chemical which is a combination of melamine and cyanuric acid, and that feed producers have often sought to purchase scrap material from this product.

Competition among animal feed producers here is intense. But the practice of using cyanuric acid may now provide clues as to why the pet food in the United States became poisonous.

Scientists had difficulty pinpointing the precise cause of the deaths, for neither melamine nor cyanuric acid are thought to be particularly toxic by themselves. But scientists studying the pet food deaths say the combination of the two chemicals, mixed together with perhaps some other related compounds, may have created a toxic punch that formed crystals in the kidneys of pets and led to kidney failure.

“I’m convinced melamine can’t do it by itself,” said Richard Goldstein, an assistant professor at the Cornell University College of Veterinary Medicine. “I think it’s this melamine with other compounds that is toxic.”

On May 1, scientists at the University of Guelph in Canada said they had made a chemical discovery that may explain the pet deaths.

In a laboratory, they found that melamine and cyanuric acid may react with one another to form crystals that could impair kidney function. The crystals they formed in the lab were similar to those discovered in afflicted pets, they said...

Another quote in the article says cyanuric acid is allowed in food in China, even though it's only known use is to produce deceptive protein measurement.

On the brighter side, there are hints in other articles today that China may start taking food safety very seriously, basically requiring exporters to support the standards of the importing country. That is potentially politically explosive, however, given the poverty of the rural areas where the fraud is rampant ...

The end of Down syndrome and the rise of the modern eugenics movement

Down syndrome will become very rare within US schools by 2020.

Prenatal Test Puts Down Syndrome in Hard Focus - New York Times

...About 90 percent of pregnant women who are given a Down syndrome diagnosis have chosen to have an abortion...

90%. We may be sure that abortion will not go away in the US, though it may lose public funding.

Since Trisomy 21 is not a rare cause of cognitive disability, this will slightly reduce special education costs in the US starting 6 years from today.

The Times article describes people with Down syndrome advocating against the diagnostic test. This is similar to deaf persons arguing against the use of acoustic nerve prostheses. Whatever social noises we may make, abortion is a pretty clear statement of honest perception. I don't think the advocacy will change the numbers, and I don't think our modern eugenics movement will stop with Downs syndrome. Many less disabling disorders will be also aborted. If we devise gene testing for dyslexia or Asperger's ...

I have personal reasons to both understand and empathize with those who campaign against the abortion of children of Down syndrome. Much that is good and joyful will be lost to parents and to society. The neurotypicals who will instead be born will, I suspect, produce greater harm than the Down children who will never be.

Remember, it won't stop with Down syndrome. We will have our eugenics movement, for better and for worse.

Update 5/11/07: Steven Levitt, the well known economist and writer (Freakonomics), has a poignant comment on this topic. He's not asserting a position, he is speaking a truth. I would not have chosen the life I now live, but I would not undo it either.

Bismarck and Mother's Day

If Bismarck's mother had not sent him to a boarding school at age 6, would we have avoided WW II and possibly even WW I?

In Our Time reviewed the Iron Chancellor a few months back. I was left with the impression of a very talented and not particularly evil man who set up Germany and the world for colossal tragedy. If he'd had more mental flexibility, fewer internal demons he couldn't shake, less insecurity at the core of his massive confidence, could Germany have taken a far healthier route to modernity?

Boarding school at age 6 is not a good idea. Thus does one mother's personal error have non-trivial consequences. A thought my wife will doubtless treasure come Mother's Day ...

PS. Liberate In Our Time!

Experiments in employment: DoMyStuff

This will be most interesting when you're able to hire a very smart person from a nation where a good wage is $5/day.

Website Does Your Stuff

... DoMyStuff.com is as entertaining as it is easy to use. Unlike the other legitimate Work-at-Home web sites, DoMyStuff.com allows posting of the old-fashioned, “gal-Friday” type of jobs. From grocery shopping to laundry, babysitting to mowing the lawn, changing the oil to arranging a party, you’ll see it on DoMyStuff.com...

The fallacy of delayed retirement

This data is consistent with they hypothesis that, for the average American, functional decision making deteriorates after about age 53:

Marginal Revolution: Eight more years to go

....The sophistication of financial decisions varies with age: middle-aged adults borrow at lower interest rates and pay fewer fees compared to both younger and older adults. We document this pattern in ten financial markets. The measured effects can not be explained by observed risk characteristics. The sophistication of financial choices peaks at about age 53 in our cross-sectional data. Our results are consistent with the hypothesis that financial sophistication rises and then falls with age, although the patterns that we observe represent a mix of age effects and cohort effects....

It's a long downhill ride to age 68.

Unless we can find a way to slow the natural Alzheimer's process, we should expect the employment situation and income of the average non-"tenured" workers [1] to deteriorate after age 55. Remember that the next time you read about how baby boomers will work so much longer than their parents ...

On the upside, I'm betting that today's 30 yo will be on preventive meds by the time they're 45 -- they may well be able to work into their 70s.

[1] Tenure as in academia, but also the "tenure" of senior executives who are no longer "at will" employees.

Geeks crush DMCA

The aggregate geek mind is on the war path. Yesterday tatoos and color coded t-shirts were used to protest the ownership of a 128 bit integer, now geeks are using the DMCA to seize personal control of other digits.

Slashdot | Own Your Own 128-Bit Integer

.... the folks at Freedom to Tinker would like to point out that you too can own your own integer. They've set up a script that will generate a random number, encrypt a copyrighted haiku with it, and then deed the number back to you. You won't get a copyright on the number or the haiku, but your number has become an illegal circumvention device under the DMCA, such that anyone subject to US law caught distributing it can be punished under the DMCA's anti-trafficking section, for which the DMCA's Safe Harbor provisions do not apply.

Alas the server is a cooling puddle of liquid metal. Try it in a few days ...