Unintended consequences and accidental death from polypharmacy

Patients are empowered, but lack knowledge.

Health care providers have knowledge, but are stressed, disintegrated, and "disintermediated". Primary care, in particular, is near death (or dead).

The pharmaceutical industry is in a lesser known crisis. Chinese generics drive ferocious price competition, the discovery pipeline is dry, patents are expiring, and the last cash cow, the US, is running out of money. So the advertisement is getting desperate.

The GOP has stripped regulatory agencies of mission and funding.

Add it all up, and you have a storm of unintended consequences brewing. Larry Zaroff tells the story very well (emphases mine)...

Heath Ledger death |By Larry Zaroff, M.D., Ph.D. | Salon Life

...According to the Centers for Disease Control and Prevention, motor-vehicle crashes rank first among unintentional deaths in America. But poisoning is second, most commonly from the abuse of prescription and illegal drugs. Unintentional deaths from accidental drug ingestion rose significantly from 1999 to 2004. This trend is primarily due to increasing use of prescription opioid analgesics, and not heroin, methamphetamines or other illegal drugs...

...After leaving the drugstore, the patient realizes the wise doctor has given her only 30 pills, not enough, since one pill no longer gives her what she requires: deep, worry-free sleep or relief of pain or anxiety. If she has all three problems, she will need more pills or other kinds. She goes to another doctor and gets a second supply. She is set for the moment. But her work requires travel, sometimes out of the country. She can locate other doctors in other places who will prescribe. Now she has a fine stash both in her medicine cabinet and in her suitcase.

She is young, smart, well regarded by her associates. She is the opposite of careless. But she has no understanding of physiology, how the body works, what controls vital functions -- breathing, heartbeat, circulation -- and how drugs can affect these functions. How drugs work, their rate of absorption, their peak level of activity, is of no interest to her. She only wants relief of her insomnia, her pain, her worries. She has no idea that drugs have an optimum dose, that combinations of drugs might be like taking too much of a single drug, that often dissimilar medicines can affect the same organs and stop their activities. Unknown to her, she may even have a genetic abnormality that makes her more susceptible to the synergistic effects of the drugs.

The patient is not an addict and suicide is the last thing she would consider. But she has a tough day ahead of her. She needs her sleep. She decides to take two sleeping pills since one did not work well enough the previous night. Because she strained her back yesterday and feared the pain might keep her awake, she takes a narcotic, a single dose. She feels edgy despite the sleeping pills and the narcotic, and so she takes a tranquilizer. The witches' brew works. She dozes off but awakes in two hours, her mind jumbled. She must sleep. She slips into the bathroom and repeats the doses. She lies down, sleeps soon, too deeply. An hour later she stops breathing. She is alone, no one to aid her...

I don't agree with Dr. Zaroff's recommended solutions (read the article). I think we need to go back to the list I started this post with, and work each one independently. I think we also need a national education program. The modern patient is going to "play doctor" anyway, so they might as well start in on medical skill. "Drugs Kill" might be a good ad slogan, though it might be confused with anti-cocaine ads.

Brad DeLong: Principles for enlightenment 2.0

DeLong responds to a post about the age of Milton Friedman with a statement of his own principles for our age.

Friedman's and his acolytes ascribed, perhaps unwittingly, wisdom and justice to the market itself. The religious right mixed this strange meme with their own traditions, creating a new golden calf that was one part Yahwism, one part Rand, one part Market, one part Calvin, one odd part Darwin, and one small part Christ.

DeLong's perspective is quite different, but it's very important to begin by recognizing that DeLong understands why the Market isn't the worst possible deity: (emphases mine)

Grasping Reality with Both Hands: Economist Brad DeLong's Fair, Balanced, and Reality-Based Semi-Daily Journal

...My principles would start from the observation that market economies and free and democratic societies are built on a very old foundation of human sociability, communication and interdependence. That foundation had a hard enough time functioning when human societies had 60 members -- eight orders of magnitude less than today's 6 billion.

So my principles would then be developed from Karl Polanyi's old observation that the logic of market exchange puts considerable pressure on that underlying foundation. The market for labor compels people to move to where they earn the most, at the price of potentially creating strangers in strange lands. The market for consumer goods makes human status rankings the result of market forces rather than social norms and views about justice.

This critique of the market is, of course, one-sided. After all, other arrangements for allocating labor appear to involve more domination and alienation than the labor market, which offers opportunities, not constraints.

Similarly, "social norms" and "views about distributive justice" usually turn out to favor whomever has the biggest spear or can convince others that obedience to the powerful is obedience to God. Market arrangements have a larger meritocratic component than the alternatives, and they encourage positive-sum entrepreneurship, making it easier to do well by doing good.

Nevertheless, the distribution of economic welfare produced by the market economy does not fit anyone's conception of the just or the best. Rightly or wrongly, we have more confidence in the correctness and appropriateness of political decisions made by democratically elected representatives than of decisions implicitly made as the unanticipated consequences of market processes.

We also believe that government should play a powerful role in managing the market to avoid large depressions, redistributing income to produce higher social welfare, and preventing pointless industrial structuring produced by the fads and fashions that sweep the minds of financiers.

Indeed, there is a conservative argument for social-democratic principles. Post-World War II social democracy produced the wealthiest and most just societies the world has ever seen. You can complain that redistribution and industrial policy were economically inefficient, but not that they were unpopular. It seems a safe bet that the stable politics of the post-war era owe a great deal to the coexistence of rapidly growing, dynamic market economies and social-democratic policies.

Friedman would say that, given the the world in 1975, a move in the direction of his principles was a big improvement. When I think of former US president Jimmy Carter's energy policy, Arthur Scargill at the head of the British mineworkers' union and Mao's Cultural Revolution, I have a hard time disagreeing with Friedman about the world in the mid-1970s.

But there I would draw the line: While movement in Friedman's direction was by and large positive over the past generation, the gains to be had from further movement in that direction are far less certain.

This is also what I believe. The Market is the best possible system we know of for "finding local minima" -- but it is not a Deity. Democracy is likewise imperfect. We seek a balance, something closer to Denmark and Canada than to old Hong Kong. Something that recognizes the problem of the weak, while admitting the limitations of human culture in 2008. This we can achieve, and this we must achieve.

Stories forgotten: Putin and the 1999 apartment bombings

Sometimes, when searching my blogs, I find fragments of stories even I've forgotten. I came across this one today:  Did the KGB blow up those Russian apartment buildings?.

In 2005 journalists at the Economists took seriously the possibility that Putin's KGB was involved in the "terrorist strike" that launched the Chechen war, and led, eventually, to Putin's current popular tyranny over all of Russia.

I wonder what would happen if evidence were to emerge that Putin was, in fact, involved.

If I were running the CIA, I'd be looking for that evidence. If I found it, I'd keep it for a rainy day ...

A bad day for Gastroenterologists

The (very high) income of the Gastroenterologist just took a significant hit.

The cause? We've now learned that half of all colon cancers arise from hard-to-see "flat lesions" in the colon:

Easily Overlooked Lesions Tied to Colon Cancer - New York Times

Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States.

The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise.

Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them...

...The study, of 1,819 military veterans, mostly men, found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to contain cancerous or precancerous tissue. Depressed or indented lesions were the least common but the most risky. Together, the flat or depressed lesions accounted for only 15 percent of the potentially cancerous growths found in the study, but were involved in half of the cancers. Once the doctors spotted the flat lesions, they sprayed a bluish dye on them to see their outlines better and remove them completely...

These suckers are hard to see. Looking for them may double the duration of a colonoscopy.

Problem is, Gastroenterologists are paid by the procedure, not by the minute. If a colonoscopy takes twice as long, then colonoscopy earnings fall by 50%. That probably translates to at least a 10-15% overall income cut.

Or, they could do what studies have shown many already do -- believe they're so incredibly skilled they can go really fast and still do a good job. Not true of course, but wishful thinking is strong when the money is right.

Either way, not a good day.

iPhone announcement - Fake Steve Jobs says it all

Love the Iron Man graphic ...

The Secret Diary of Steve Jobs: Happy now, bitches?

...29 June 2007 might be the day the world changed, but today it just changed again. BlackBerry is dead. Microsoft is dead. Windows Mobile is dead. Amazon is dead. Kindle is dead. Nokia is dead. Motorola was already dead but now they are even more dead...

... Seriously, folks, it's game over.... In Canada they declared a national day of mourning for RIM. It's that huge. Today, frankly, is a day that will live in the history of our industry...

Read the whole thing. It's funny, but might be true. I'm still waiting for the catch, but this announcement is way on the high end of what I'd expected.

One caveat: the June (31st*) SDK release is likely to come with iPhone 2.0, and my past experience with Apple is that new software releases never quite fly on hold hardware. So those of us considering buying an iPhone today have to recognize that we might be selling it four months from now.

* see comments

iPhone surprise: Microsoft is on board. Why?

About one week ago Michael Mace declared the mobile application marketplace dead.

Today Apple's developer web site was knocked off the net, completely obliterated, by people downloading the beta version of the iPhone SDK.

Sorry Michael.

Of course my critique of Mace's thesis wasn't perfect. I wrote:

... So now we have the iPhone. The browser experience leads people like Mace to predict that the browser is the new platform.

Maybe.

On the other hand, there are a lot of very, very smart developers who want to create the best possible native experiences for millions of iPhone users. Experiences that work on airplanes, cars, trains and lots of other places where the wireless experience sucks. Sure, you'll be able to create disconnected apps using Google Gears 2009 and Adobe AIR 2009, but they won't have the smooth elegance of native apps.

If Apple can prosper while staying clear of Microsoft's Exchange turf (don't go there Apple, it's a death trap) Mace may discover that he's declared the mobile platform dead at exactly the wrong time ...

Well, Apple didn't exactly steer clear of Exchange. They've embraced it, even licensing Microsoft's ActiveSync technology (current version supports sync with Exchange AND Outlook, but I didn't see the latter mentioned.)

Microsoft is playing along, helping Apple far more than they've helped RIM. Not to mention Microsoft's past use of Exchange to eviscerate Palm almost a decade ago.

So why is Microsoft playing nice? Are they just luring Apple into a pit of doom? Is this a clever way to bury RIM/BlackBerry without getting into antitrust problems? How the heck does Microsoft intend to protect their crappy corporate Mobile platform if the iPhone can sync with Exchange?

Those billion dollar EU fines have to be a part of the reason. Microsoft's (mis)use of Exchange protocols is cost money even they notice.

Even so, ActiveSync licensing?

I really don't think Microsoft is going to drop Windows Mobile and embrace the iPhone, but this is weird.

Physicians to go iPhone crazy

This is only the beginning, though it was neat to see Epocrates get Steve (Jobs) Note attention:

Epocrates Search Portal

...it was recently announced that Epocrates is one of a limited number of developers who have been working directly with the Apple team to make our applications available on the iPhone/iTouch.  We look forward to making the product available in the near future...

The iPhone SDK isn't officially out until June, so I don't necessarily expect Epocrates before then. On the other hand, they did demo it.

So much for Emily's BlackBerry Pearl -- ePocrates barely works on it and there's some memory leak besides. Anyone want a cheap Pearl?

Physicians loved the Palm when it worked, and the Newton before that. There are a surprising number of physicians who are perfectly happen to program (some did it professionally in prior lives), they'll be cranking out free iPhone and commercial iPhone apps at an amazing rate.

Toxic heparin was fraud, not accident

I realize I'm repeating myself, but this really would be a good time to panic.

A major medication, Heparin, was manufactured in very substandard conditions. The final product contained counterfeit chemicals designed to fool quality tests. It was then distributed widely in the US healthcare systems.

Up to 10% of the entire US supply of Heparin may consist of a counterfeit drug:

FDA says recalled heparin contained contaminant - USATODAY.com

In a finding eerily similar to the contamination of pet food last year, the Food and Drug Administration said Wednesday that a counterfeit chemical has been detected in recalled supplies of the blood thinner heparin.

From 5% to 20% of the active pharmaceutical ingredients in some heparin supplied by Chinese companies to Baxter (BAX) Healthcare is a similar, but different, chemical that mimics the blood thinner in commonly used tests.

Nineteen people have died since Jan. 1, 2007, from allergic reactions that appear to be associated with contaminated heparin, says Janet Woodcock, acting director of the FDA's Center for Drug Evaluation and Research. The death toll had been four.

Last year, thousands of pets fell ill after eating food made with adulterated wheat flour from China. The flour contained two industrial chemicals, melamine and cyanuric acid, added to make it appear to be the more expensive wheat gluten.

Baxter, which supplied half of the heparin used in U.S. clinical settings, first recalled some of its heparin products on Jan. 17. The company expanded the recall on Feb. 27 to include all of its multidose, single-dose and Hep-Lock products, used to flush intravenous lines to ensure that they aren't blocked by blood clots.

The USA's main other supplier of heparin, APP Pharmaceuticals, (APPX) has not had any reported allergic reactions associated with its products. It increased production after the Baxter recall.

Heparin is commonly used in many medical and surgical procedures. Initial analyses could find nothing wrong with the recalled product, says Woodcock.

"It reacts like heparin in some of the conventional tests used for heparin, which is why conventional acceptance tests of this ingredient might not detect this contaminant," she said.

But sophisticated tests by Baxter and the FDA, including nuclear magnetic resonance spectroscopy and capillary electrophoresis, showed slight differences. The counterfeit chemical is very like heparin in its molecular makeup and is also from an organic source, says Baxter's Peter Arduini. The raw ingredient in heparin comes from the lining of pig intestines.

Baxter Healthcare is based in Deerfield, Ill. Wisconsin-based Scientific Protein Laboratories (SPL) supplies Baxter's heparin from sources in China.

SPL has been a successful supplier of the active pharmaceutical ingredient in Baxter's heparin for almost 30 years with no problems, says Arduini.

Both the FDA and Baxter said they can't yet confirm that the heparin-like compound was the cause of the allergic reactions, but they are centering their investigation on them. They also don't know if it was introduced intentionally.

The news is good for Baxter as a company, says Aaron Vaughn at investment firm Edward Jones.

"Originally, it was a Baxter story. Now, it's become China supplying the U.S. market with goods that are not up to international standards," he says,

Good for Baxter? Maybe under current law.

We need to change the law.

Let me say that again.

We need to change the law.

Distributors must be held responsible -- only then will they be incented to move their supply chain away from unreliable sources. Congress should be considering vary large tariffs on medications coming from countries with known production and quality issues. The tariffs can help pay for the compensation claims that should be paid to injured persons.

This is why we need trial lawyers like John Edwards. It's also why we need to get the GOP out of the executive office, and resurrect America's regulatory infrastructure.

Update 3/20/2008: Yep, it sure looks like fraud.

The Democratic primaries vs. the general election: an enlightening comparison

This is funny, but so true.

Shtetl-Optimized » Blog Archive » Long-dreaded politics post

... The general election is so damn easy by comparison. There, the only questions I need to ask myself are, “do I prefer the Enlightenment or the Dark Ages that preceded it? Is the Earth 4.6 billion years old or 10,000? Do anti-gay laws spring from a less repugnant part of human nature than Jim Crow laws?” While I look forward to the day when my answers to such questions won’t determine my vote, so far they unfailingly have — thereby eliminating the need for me to adjudicate more complicated social and economic issues that I don’t really understand...

Everything is simple once the Democratic Primary is over. We ex-Edwardians slightly favor Obama, but if Hilary wins the same check is will be in the mail. We've not spent a cent on the primary battle, it's all for McCain. So to speak.

The iPhone software advantage: strong Digital Rights Management

This is sad.

But it must be said.

I am no friend of Digital Rights Management. I don't buy FairPlay'd music -- because I can't play DRMd music on my car stereo [1].

On the other hand, I remember when there was a large selection of games and children's software for the Apple II and the original Macintosh. There's almost nothing left like that today - on XP or OS X. The CDs we bought 5-8 years ago were the last of that wave, and they no longer work on XP or 10.4 Classic [2].

There are such games today of course. They're on the Nintendo platform [3].

Why is this software on Nintendo, and yet not on OS X?

It's the Digital Rights Management. You can't give a copy of your favorite Wii game to a friend. You can't even move the games you bought at work to your home. This 21st century version of "copy protection" cannot be broken as easily as as the 1980s version.

The iPhone, like the Nintendo Wii, has very robust DRM. It will not be possible to download an iPhone app via iTunes and install it on your wife and children's iPhones and iTouchs [4].

Unlike the Palm, the iPhone and iTouch will combine robust DRM with a single contact built-in delivery mechanism for software developers willing to push through the distribution hurdles.

Guaranteed distribution. Guaranteed copy protection/DRM.

The iPhone will have a very large software advantage over the Mac version of OS X, and over the Palm and Microsoft mobile devices that have preceded it.

Ringtones were once a billion dollar industry, though that's dying now. The iPhone software advantage will be bigger.

We'll have to pay for the apps though.

I'm happy to do that. It's just too bad we need the DRM to make this work.

--

[1] Most know this, but it's worth mentioning that AAC is a format and not a DRM mechanism. AAC encoded music plays on our SONY car stereo and our Nokia and Blackberry phones).

[2] 10.5, of course, doesn't support Classic on any platform, so when our G5 iMac dies so will all our old favorite children's apps. My son collects the old CDs in his desk drawer, hoping, perhaps, that they'll one day come to life again.

[3] It is odd that no other game platform seems to have realized that teen players come from children players, and yet they don't provide entry level game software. Maybe the execs don't have children?

[4] On OS X and Vista there is a strong tie between a hardware device and a user identity. Each device must sync to a single account on a single machine, though Apple has screwed up the software/hardware/multi-user integration (See also). Once you start going down the iPhone/iTouch route, you will discover a very interesting set of problems with sharing your music library.

PS. An exercise for the Reader: Consider an alternative path that Google's Android might take, and how that path resembles a future funding mechanism for the New York Times.

Wanted: an identity management service. Business model included.

I have many digital identities. Some are loosely connected (facets?), others are distinct personae. The varied identities each have their own managed reputations, with the facets sometimes sharing the same emergent Google-derived reputation. Even I have trouble keeping track of them. Personae are also susceptible to cloning; requiring either identity recovery or identity termination.

I'm not alone in this swamp.

We need more identity management tools that let us rapidly switch our personae (visible identities) and facets, while tracking our associated reputations and providing a visual cue as to our current identity. These tools can also remind us what each identity is designed for; it's not hard to forget the purpose or a persona, and thus to misuse it.

Obviously such a tool should have a biometric component, though it would need to be optional at first. One way to generate a revenue for such a service would be to provide the service free, but charge for the associated token*, biometric authentication component, or personal VPN add-on.

Needless to say, the service could not be hosted in the United States.

Denmark perhaps?

* Personally I'd like a token embedded in the well recognized geek watch.

PS. If you do create this business, I'd love a one-year free subscription :-).

Steve Jobs: brilliant, bizarre, not nice

Andy sent me the link to this Jobs profile. Brilliant yes. Bizarre, more than a bit. Nice, not so much. (BTW, abdominal CTs are not a routine procedure.)

The trouble with Steve - Mar. 4, 2008

... During a routine abdominal scan, doctors had discovered a tumor growing in his pancreas. While a diagnosis of pancreatic cancer is often tantamount to a swiftly executed death sentence, a biopsy revealed that Jobs had a rare - and treatable - form of the disease. If the tumor were surgically removed, Jobs' prognosis would be promising: The vast majority of those who underwent the operation survived at least ten years.

Yet to the horror of the tiny circle of intimates in whom he'd confided, Jobs was considering not having the surgery at all. A Buddhist and vegetarian, the Apple CEO was skeptical of mainstream medicine. Jobs decided to employ alternative methods to treat his pancreatic cancer, hoping to avoid the operation through a special diet...

...For nine months Jobs pursued this approach...

In the end, Jobs had the surgery, on Saturday, July 31, 2004, at Stanford University Medical Center in Palo Alto, near his home...

...Jobs' personal abuses are also legend: He parks his Mercedes in handicapped spaces, periodically reduces subordinates to tears, and fires employees in angry tantrums...

... He has listed himself as "co-inventor" on 103 separate Apple patents, everything from the user interface for the iPod to the support system for the glass staircase used in Apple's dazzling retail stores...

... Jobs' break-the-rules attitude extends to refusing to put a license plate on his Mercedes. "It's a little game I play," he explained to Fortune in 2001...

... Often Jobs would suddenly "flip," taking an idea that he'd mocked (maybe your idea) and embracing it passionately - and as his own - without ever acknowledging that his view had changed. "He has this ability to change his mind and completely forget his old opinion about something," says a former close colleague who asked not to be named. "It's weird. He can say, 'I love white; white is the best.' And then three months later say, 'Black is the best; white is not the best.' He doesn't live with his mistake. It evaporates." Jobs would rationalize it all by simply explaining, "We're doing what's right today."...

...In 2006, after the Wall Street Journal ran its Pulitzer Prize-winning series about backdated stock options, Apple (which hadn't been named in the coverage) scrambled to assess whether it had a problem. The company appointed a special board committee to investigate, which concluded that it did. The company discovered "irregularities" with 6,428 grants between 1997 and 2001 - roughly one in six that Apple issued during that period. (New disclosure requirements after that time caused backdating to dry up.) The company also found no instances of backdating before Jobs took over as CEO...

The article strongly implies Jobs knowingly backdated stock options -- then made two execs fall guys when he got caught. His family life has been reasonably tortured as well, though the article is mostly revisiting old sins in that domain.

I'd love to see him spend a week in prison the next time he parks his unlicensed Mercedes in a handicapped spot. A little bit of justice would be nice ...

The comparison to Gates is inevitable. Gates has a reputation of a similarly abusive temperament, but his charity and sense of duty are both respectable. There's nothing to respect about Steve Jobs -- except perhaps his passion for excellence.

3/5/2008: An interview in Fortune provides yet another perspective. It's not a contradictory perspective, but it illustrates how contradictory, inconsistent, complex, and brilliant, Jobs is.

John McCain is against Reason

McCain is not a rationalist.

Immune to the Facts - The Opinionator - Opinion - New York Times Blog

...“At a town hall meeting Friday in Texas, Sen. John McCain, R-Ariz., declared that ‘there’s strong evidence’ that thimerosal, a mercury-based preservative that was once in many childhood vaccines, is responsible for the increased diagnoses of autism in the U.S. — a position in stark contrast with the view of the medical establishment,” writes Tapper. “McCain was responding to a question from the mother of a boy with autism, who asked about a recent story that the U.S. Court of Federal Claims and the National Vaccine Injury Compensation Program had issued a judgment in favor of an unnamed child whose family claimed regressive encephalopathy and symptoms of autism were caused by thimerosal.”...

I recall McCain also favors teaching creationism in schools.

No big surprise. The GOP has a strong anti-science bias, McCain is their man.

Signs of the singularity: science fiction gives up

How do we know the rapture of the nerds is nigh upon us?

One clue is the state of "hard" science fiction. Not Star Trek stuff, but science fiction that tries to visit a real world 10 to 100 years from now (the masters, on occasion, make a stab far beyond that).

Someone writing this type of fiction wants it to be readable for at least 5-10 years. If they write in 2005 about the worldwide telescope's debut in 2015, then they're embarrassed when it debuts in 2008. Their work takes a hit, and might even seem silly.

Charlie Stross, one of the grandmasters, tells us how hard this game is getting after reading an Economist article about "High tech leapfrog". A World bank graph shows how quickly new technologies are disseminating around the world, in a fraction of the time it used to take.

Charlie's Diary: Blindsided by the future

...Here, in a nutshell, is why writing near-future SF has become so difficult. Say you want to set a story 30 years out, and as part of your world-building exercise you want to work out what technologies will be in widespread use by the time of the story. Back in 1900 to 1950 you could do so with a fair degree of accuracy; pick a couple of embryonic technologies and assume they'll be widespread (automobiles, aircraft, television): maybe throw in a couple of wildcards for good measure (wrist-watch telephones), and you're there. But today, that 30-year window is inaccessible. Even a 15-year horizon is pushing it. Something new could come along tomorrow and overrun the entire developed world before 2023.

Speed up this uptake curve a little bit by pushing it 20 years out, and you begin to see the outline of an onrushing singularity ... from the pages of The Economist.

(This post was prompted by the discovery that what I thought was a new and imaginative candidate for a not-here-today everywhere-by-2023 technology to stick in my next SF novel is, in fact, already here in concept form and will doubtless be around by 2013 and as unremarkable as wallpaper by 2023 ...)

This DeLong article on the Invention Transition is relevant; memes are propagating even faster than technologies -- indeed they probably enable the technologic dissemination.

The stunning collapse of television news

Even we aliens who live among humans have a hard time tracking their behaviors -- particularly since we are unable to watch television without major tranquilizers.

For example, this Zogby survey shows a rate of change faster than we imagined.

Print newspaper readership evidently collapsed completely some time ago. Only 10% of the adults surveyed get their news primarily from newspapers:

...10% newspaper figure is bolstered by the senior crowd, 17% of whom are still committed to the absurdly resource-intensive practice of consuming news on pulped, printed, and delivered dead trees. (... only 7% of the 18-29 crowd follows this example)...

Aliens, of course, stopped subscribing to print newspapers around 1998. I hadn't noticed the absence of newspaper delivery in our neighborhood until I read this however. It's been a long time since I've seen anyone delivering a newspaper to a neighboring home. In fact, it's been a while since I've seen a newspaper in a home, though I routinely read them at the cafe.

I suppose the newspaper delivery business, which I entered around age 8 or so, has gone the way of the telegram.

The really surprising story is the collapse of television as a news source:

... 48% said their primary source of news is the Internet (up 20% from only a year ago)....38% of 65+ year olds are clinging to TV as the primary source of news, but they're the only age group that favors a medium other than the Internet as the primary delivery vehicle...

That 20% shift is almost entirely from television news to the Internet. In one year.

Of course a good chunk of the news this alien reads on the net comes from the NYT, the BBC, and, via Google, by a range of traditional providers. My Feed portion, however, comes largely from non-traditional providers. (The Economist is on the list however).

I wonder what the humans are using for net news?

36% regard "blogs" as an important source of news.

Uh oh. The humans are turning into aliens ...

The real story, however, is the collapse of television news as a routine source of news. I've already mentioned that our children's generation don't seem to watch television much at all.

I don't think the sudden death of television is getting enough attention. The pending switch to digital broadcast will kill off our rabbit ears, I wonder if it will finish off traditional broadcast and cable television completely.