Tuesday, July 15, 2008
Franklin quote: new to me
Emily laughed, so maybe it's safe to post.
Unintended consequences: medication co-pays and combination therapy
In the course of a board review program I've been reviewing ten years of medication development ...
Gordon's Notes: Family Medicine Board Review from the AAFP, ABFM and free - with podcasts
... I've long had an information-geek's admiration for the printed version of Monthly Prescribing Reference. Despite its evil ad-funded roots, there's a real genius to the density and layout of the content, refined by generations of customer feedback. It also has the virtue (and sin) of being always topical and exceedingly brief.
So I started my review by reading this cover to cover. Each time I come across a medication that's new to me, or a familiar one that unlocks a domain of forgotten knowledge, I add it to my core med review sheet. This sheet is also an interesting overview of what's changed in medicine over the past decade. There was more activity in the treatment of Parkinson's Disease, for example, than I would have guessed...
Other than observing the desperate attempts to find something Tumor Necrosis Factor inhibitors are good for, I was struck by the explosion of combination meds.
What explains this? Is it patient demand? Is it pharma desperation due to a shrinking development pipeline?
It was Emily who suggested a motivation that could explain the development all by itself.
Medication co-pays.
The most common co-pay schemes strongly incent patients to minimize the number of their chronic prescriptions, with much less incentive to minimize the cost of prescriptions. On the other hand, combination meds are very profitable for pharmaceutical companies.
I suspect the payors who designed co-pay schemes didn't have have these outcomes in mind.
Delaying the inevitable onset of Alzheimer's: exercise is the new best hope
I assumed it was a spurious correlation. Maybe rapidly progressive Alzheimer's has a very early effect on the enjoyment of exercise, for example.
The studies keep coming though. This one, for example:
BBC NEWS | Health | Exercise 'slows down Alzheimer's'Hmmphh. Still not a randomized study, so it's not very persuasive. These associative studies are more wrong than right.
... While there was no relationship between brain size and exercise in people tested who did not have Alzheimer's, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.
He said: 'People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.
'Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance.'...
What gives me more hope, are the animal model studies (emphasis mine):
Still voluntary exercise. I'd have preferred they forced the mice to exercise, say a treadmill that dumps the non-runners into water.... To directly test the possibility that exercise (in the form of voluntary running) may reduce the cognitive decline and brain pathology that characterizes AD, the study utilized a transgenic mouse model of AD rather than normal mice. The transgenic mice begin to develop AD-like amyloid plaques at around 3 months of age. Initially, young mice (6 weeks or 1 month of age) were placed in cages with or without running wheels for periods of either 1 month or 5 months, respectively. Mice with access to running wheels had the opportunity to exercise any time, while those without the wheels were classified as “sedentary.”
On 6 consecutive days after the exercise phase, the researchers placed each mouse in a Morris water maze to examine how fast it could learn the location of a hidden platform and how long it retained this information ... the mice that used the running wheels for 5 months took less time than the sedentary animals to find the escape platform. The exercised mice acquired maximal performance after only 2 days on the task, while it took more than 4 days for the sedentary mice to reach that same level of performance...
So mark me down as cautiously optimistic, though very puzzled about mechanism.
At present I'll grant a 40% probability that exercise will really slow the inevitable [1] onset of Alzheimer's -- presuming the exercise isn't associated with head injury risk. (So my inline skating hobby is not a preventive measure.)
Even at a 40% 'might help' that's a much higher protective probability than anything else I've heard of other than avoiding head injury [2].
Since we really do need to work until 70, we can't be cognitively impaired before then. That means we need to delay the normal dementing process by at least ten years. It's time to dust off that old Nordic Track ...
[1] Live long enough, you get Alzheimer's -- along with vascular dementia. Genetics, head injury and (perhaps) exercise only determine the speed of decline.
[2] I classify the modern enthusiasm for live combat right up there with the 1970s enthusiasm for snorting coke.
iPhone 2.0 development: looks like a death march ...
We can gather that from the things that were left out:
- cut, copy, paste: Apple has now admitted they wanted to put this in, so the omission must have been a desperate decision
- tasks: If they couldn't add tasks, then they were beyond cutting features and deep into slashing organs.
Entirely Random Notes On iPhone 2.0 - Inside iPhone Blog: "Search only looks at contact names. Wow. It must have been really, really, ugly in Cupertino over the past few months.
... There appear to be crashing bugs with both many third party applications themselves, as well as the OS itself. Prior to updating to 2.0, I can't recall the last time my iPhone reset. I've seen it a half dozen times already so far, however.
Searching in Contacts is nice. However, I find I still generally just scroll for the contact, and the search doesn't look inside each contact, just at the name...
I'm feeling sympathy for the iPhone development team. They must be toast.
It's going to take more than a few months to get things patched up. Corporate customers are going to want to hold off on significant deployments until next year.
Britain leads on the post-oil economy - and positive feedback loop on corn prices
The Oil Drum includes his speech and a summary of key points:
The Oil Drum | The post-oil energy economies of the future - by Gordon Brown:There's no reference, however, to a Carbon Tax or Carbon permit trading; this is speech about energy, not global climate change.
* Expansion of nuclear
* Expansion of renewables, possibly including Severn barrage
* Discussion of solar energy with Mediterranean states
* Tax breaks for energy efficiency measures
* Electric vehicles are placed on the agenda
That's one heck of an omission. We have vast reserves of coal and tar sands to burn; if we switch to electric cars without a massive carbon tax on coal we're slitting our throats.
So this is impressive because of what it says about our energy future, but it's only the easy part of the policy debate.
In a related vein, isn't there a positive feedback loop emerging from the use of corn to produce energy? Biofuel corn is an energy intensive crop with a minimally positive return on energy inputs, so, after other costs are accounted, isn't it as though we're burning 10 barrels or oil to create nine barrels of oil? This can only happen because of twisted bipartisan governmental subsidies, but it means the price of corn will keep spiraling upwards as long as the subsidies last.
At some point the corn biofuel program will then consume the entire economic output of the US. Hmm. Maybe China will support it?
Since we get the government we deserve, what does that say about how bad we Americans have been?
Update 7/16/08: Great comment pointing out that Gordon Brown doesn't need to speak about Carbon credit trading since his listeners know the UK and EU have a fully operational program. I knew that, so this reminds me how tricky it is to interpret international statements -- there's always context I might know but haven't really integrated.
In the Twins, the cops are bike savvy
Maybe it's the time on bike patrol, but Twin City police are pretty savvy about bicycles. This is from a press release aimed largely at drivers -- who are recently seeing a lot more bikes on the street.
For example:
Roadguy -- Bikes vs. cars: Here’s what the police say:I didn't realize it was legal in the Twins to ride on the sidewalk. As an adult bicyclist I personally don't do that, but I do prefer that my younger children use the sidewalk. They've learned to stop their bikes and let pedestrians pass, and to be very careful about passing. It's definitely a crowded world compromise.
....MYTH: Bikes must use the street.
FACT: Cyclists may ride on sidewalks except in business districts or where posted. Studies have shown that it is often safer to ride on the street.
MYTH: Bikes and pedestrians don’t mix.
FACT: It’s easy for cyclists and pedestrians to share trails and sidewalks when everyone is respectful. Cyclists should slow down when passing pedestrians. Bicyclists, be sure to give a polite warning and pass on the left with as much clearance as possible. Pedestrians should stay or move to the right when being passed or use a designated pedestrian path when available...
In terms of "polite warnings" I found, years ago on mixed use trails, that the best option is a soft tinkling bell from about 50 feet away. Go slow, ring a few times, and it seems almost peaceful. Spoken announcements, especially from a male voice, are disturbing to most pedestrians.
The Twins are a great place to live.
Investments: 1999 to 2008. Not quite what we expected.
We didn't buy that NASDAQ blarney, when prices went crazy we bought less but held our index funds. We figured we'd earn 7% or so a year over a twenty year period, and maybe we might even retire.
One day. Maybe.
Fidelity still talks about that 7% a year number in their marketing materials. It's good for a bitter laugh, but really the humor is wearing thin.
Here's what the S&P looks like from 1999 to 2008 - an era largely controlled by the GOP.
This Yahoo! Finance Charts graph doesn't show losses due to fees and taxes and gains due to dividends, but it gives the general sense of how the market has done:

The trend is likely to continue downwards for a while, so we'll be looking at a flatline decade.
It used to be assumed that index funds held for at least 10 years were a pretty safe investment, but let's take a look at the longer view, again you can click for a magnified view. (Yahoo Charts are a real gem):

Now let's drill down a bit at 1968 to 1978 -- including a gap in Yahoo's data. On this scale it's almost as volatile as 2000-2008, but over that decade things are flat to negative. Since inflation in those days ran at 8-12% the real returns were probably much worse than what we see here even after adjusting for higher dividend payments.
Stocks sucked in the 70s.

So we see that the "stocks are the safest investment" over a decade all depends on which decade you're talking about. Really, the long term safe return period is more over fifty years than ten years. So that means by the time a physician gets real income at age 30, they're already too old to bet on a 50 year outcome.
Our current retirement plans are to take up smoking, hang gliding, base jumping and heroin at age 65.
Thank you GOP. You've sure done wonders for us.
Monday, July 14, 2008
Businesses can advertise on Google Maps (hint: iPhone, GPS)
Now consider Google's new program to allow businesses to associate data with Google Maps:
Google Local Business CenterIf I were a small business, say a Cafe owners, I'd sign up tonight.
Enter your business information below. Your listing will appear to the right. This is just a first step. After this has been completed, you will be able to upload photos and videos, specify categories, payment options and business hours and much more.
This will be very cool when Mobile Map users are able to specify alert criteria, so we get pinged when we pass near retailers who match our criteria ...
iPhone 2.0 not really ready for release?
The one exception, intriguingly, was iPhone 1.0. It was way more stable than I expected.
iPhone 2.0 may represent a return to form:
Did Apple set developers up for failure? - The Unofficial Apple Weblog (TUAW)If you're not in a real rush, it would be good to wait until at least the next major firmware update before buying.
... Anonymous developer sources are reporting that they've been poring over crash logs and discovering that the reported crash has nothing to do with their application. There's a growing consensus that Apple has released a highly unstable 'final' version of the 2.0 firmware...
I'll be buying anyway, but I've already decided I won't be able to abandon my Palm for another 6-12 months due to other iPhone limitations. So I'll be ok with a crashy device.
They'll fix it, probably faster than Apple fixed 10.5 (that took over a year).
The law of unintended consequences: iTunes, the Nordic Track, NBC, and Babylon 5
It began with my back.
An annoying lifelong back problem finally got serious enough that I had to do something about it. This is good. I like exercise, and exercise is what I need. Now I can make a business case for it; I can show it's necessary to keep me functional for the next twenty years. (In our family, this is all that's needed.)
So we moved the kids toys to the dining room (this was recognizing reality) and turned the toy room into a gym. We dragged the thirteen year old Nordic Track out of the attic and hauled the weights out of the garage. (Emily and I spent five years on the Nordic Rack -- we like it and used it. It's the closest I'm going to get to my once favorite sport in our new, warmer, world.)
Now, I had to figure out exercise entertainment. We had a 12" CRT my son uses to watch sports in his 3/week TV slot, that would do fine -- it even has a headphone jack. The question was inputs.
We could add an exercise Netflix, but then I'd have to replace the broken VCR/DVD player with another one that would last 3 months. Too much hassle there. Also, DVDs aren't as good as VCRs at "remembering" where one stopped watching.
I can't deal with the thought of cable TV, DVRs, etc. AppleTV rentals are too restrictive.
So the best option is to start watching a good, exciting, TV series. I don't watch TV, so it's not hard to find one. This can work now that I've finally figured out how to get video out of my old iPod.
Unintentend consequence #1: Battlestar Galactica, my first choice, is an NBC show. NBC and Apple couldn't agree on price, so it's not on iTunes. So long Battlestar, I'll do Babylon 5 instead. I wonder how their decision to forego iTunes distribution is working out for NBC. I'm sure they didn't intend this consequence. It will take years for me to work through B5.
I download a season of Babylon 5.
That's when I notice each episode is a GB or so.
I wonder what my bandwidth cap is. I wonder how much drive space I have left on my backup drives.
I think I need to accelerate my transition to a rotating pair of 1TB external backup drives (for example). I needed to do that this fall, but now I'll need to do it this summer.
Maybe I need to move forward on a bigger internal drive for the iTunes library server. The iMac is an aging PPC machine, so maybe I should accelerate my purchase of its successor machine.
This is getting kind of expensive for me, and kind of profitable for Apple. Funny how that works.
Life in the modern world is like that.
Well, now I'm really motivated to get my money's worth out of the gym.
Update: My iTunes library is now 40GB. Ouch.
Apple after Jobs: give reliability a chance
They could do better though.
In particular, they could work on reliability. Their dotMac service (.Mac) has a long record of poor quality and unreliable service.
Even their retail service has been flaky. Today the iTunes store told me:
We could not complete ... An unknown error occurred (5002) ... There was an error ...Apple's hardware quality is industry average at best. Their software quality has been nothing to boast about (design is good, execution is average).
After the iPhone 2.0 launch debacle I wrote:
Even Apple’s discussion servers are crushed …Jobs is a genius, but he loves innovation, elegance, grace and aesthetics -- not reliability. In time, perhaps sooner than later, Jobs will retire. The media will treat this as a disaster for Apple.
...In an ideal world, Apple would do some post-mortem analysis of their culture and commit themselves to being a high-reliability organization.
In the real world, we shouldn’t expect Apple to deliver mission-critical services. It’s not what they do.
I'm not so sure. The transition will be very hard, but in the world of Software as Service, Data in the Cloud, and distributed memory, reliability matters even more than in the old days of local drives and static files.
If a new Apple can shift their premium price points towards quality and reliability, while preserving a love for elegance and innovation, they'll deliver even better value for my money.
Whether that will translate into continued wealth and growth is another question -- one I can't answer. If I could answer those kinds of questions, I've have way too much money.
Sunday, July 13, 2008
Google is done talking with librarians
They've decided the best remedy for misunderstanding is to stop talking ...
Google Librarian CentralReading on, it appears that sooner or later they might send a newsletter. Maybe.
...As you may have noticed, we've taken a somewhat leisurely summer break here at Librarian Central. We've been thinking about how to best communicate with you, our audience, and as a result, we've decided to close this blog in order to focus on our newsletter...
I don't know why Google has such poor relations with librarians, but Bethany Poole has written one cold "Dear John" post.
Dapocalypse Now
It goes something like this.
Some evildoer plants a data bomb deep into a compiler language. One day they pull the trigger, and Google's data stores are irreparably corrupted. It will take months of labor to restore from deliberately isolated time-delayed offline archives (Google does have these, right?).
By this time Google holds a large part of the world's knowledge, and it accounts for 40% of the metamind's IQ. The lobotomized metamind can't keep a lean mean non-redundant economy running; the economy crashes hard. Google dies in the carnage, so there's nobody to do the restore. An interconnected world crashes, war breaks out, billions die, we return to the 19th century.
Makes for an uplifting story (no Singularity extinction!), but maybe it's not so far-fetched.
I used to control my corporate data. It lived on my drive in thousands of dead-bit documents. Write once, re-read never, though nowadays full-text search brings some of 'em back.
Today, instead of a single document, I may use a loosely-coupled dynamic and shareable collection of smaller documents, linkable blog posts, and long-lived database list views and wikis. It's early going, but I think this distributed approach will win the day.
There's a catch though.
I can't back up the data distributed across the corporate LAN. Can even the very best IT department be relied on to restore a relative handful of critical rows and joins across a petabyte data store?
Restoring a document is trivial. Restoring a distributed data engram across multiple Sharepoint lists is very, very hard. Perhaps prohibitively hard. Entanglement gives meaning, but now data is becoming as fleeting and transient as thought and memory.
I'm good at backup. In perhaps 15 disk crashes I've lost maybe a few hours work. Now though, my personal Dapocalypse feels inevitable. It feels like I'm waiting for a stroke.
I really don't know what to do about this.
Update 11/25/08: Changed my mis-spelled dacopalypse to Dapocalypse when, what do you know, it happened.
Update 1/3/09: Slashdot uses the term "datapocalypse" , but not, alas, Dapocalypse.
Software as service: watch out for Data Lock
Microsoft's traditional model favored proprietary data formats (Data Lock), feature mania until competition died, then forced obsolescence every 2-3 years.
Ad-supported software has to get us to look at the ads. If we stop looking, it will get more and more obnoxious. Data Lock helps ensure we can't escape, even as the pain level rises.
Software as a service has technical issues (Gmail was down a few days ago - again), but, above all, Data Lock is a terribly strong temptation. At least on the desktop there are local files that conversion software might run against.
Please note that while all three models suffer the Data Lock temptation, it's strongest in the "Software as Service" model.
So the Evernote example is worth remembering ...
Gordon's Tech: Evernote fails the critical software as service import/export test:In an important sense, this is not Evernote's fault. The startup has a large mission and limited resources. Their investors are not going to favor a single penny spent on Data Freedom, even if Evernote developers dislike Data Lock. The only way export will be developed is if customers make it an absolute requirement.
...So Evernote is not an option for my Palm to iPhone conversion, and I'd say it's not an option for anyone on any platform until they demonstrate Data Freedom...
Customers don't do that.
In commerce as in politics, the fault lies within us.
Update 2: A few hours later the CEO of Evernote responded, on a Sunday, with a comment to the Gordon's Tech post. They pledge serious commitment to Data Freedom, with APIs coming this summer.
I want to point out that these two things, the ultra-rapid indexing and the CEO response within hours, would be very hard to explain to a primitive from, say, 1993.
I'm also feeling chuffed now that Data Lock is no longer a novel concept. People are learning to worry, that's wonderful news.
Update 7/27/08: I warm to Evernote -- because it works now as a cache.
Update 10/3/08: Evernote has reformed, and Phil Libin has credibility again. They have an API and XML import/export. It's not the simple tab delimited format anyone can use, but that format is a poor match for Evernote's data complexity. Full credit for turning the corner!
Obama is the anti-Christ. Of course.
Aetiology: Smallmindedness in small townsThere were no Muslims when Revelation was written.
...According to the Book of Revelations the anti-christ is: The anti-christ will be a man, in his 40s, of MUSLIM descent, who will deceive the nations with persuassive language, and have a MASSIVE Christ-like appeal.... the prophecy says that people will flock to him and he will promise false hope and world peace, and when he is in power, will destory everything. Is it OBAMA??...