Thursday, December 31, 2009

Healthcare standards: how you know they blew it

You only need to know one thing to know that the frenetic healthcare standards efforts failed ...
Life as a Healthcare CIO: The Interim Final Rule on Standards
... The adopted vocabulary standards for procedures are the applicable HIPAA code set required by law (i.e.,ICD-9-CM) or CPT-4. The candidate standards are the applicable HIPAA code set required by law (e.g.,ICD-10-CM) or CPT-4...
CPT. Fully owned by the AMA, CPT is a rough collection of work descriptions sometimes loosely related to procedures. It's not a vocabulary, it's not a classification, and it has no stable semantics.

The adoption of CPT as a healthcare "standard" is not the only sign of failure, but it is the most telling sign.

Thank you Mr President.

John Scalzi and Andrew Sullivan agree. President Obama has been a giant.

I say he's much more than American deserves. The roots of GOP rage are many, but one of them is that this man is so much better than they are.
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Wednesday, December 30, 2009

CARE.ORG for charity: four stars, never bugs us

We were very late with our 2009 donation to CARE.ORG. I just got it done.

We donate to CARE, and very little to anywhere else, for four main reasons:
  1. Since they work with the most impoverished populations the reduction of human suffering per dollar donated is immense.
  2. They have a four star Charity Navigator Rating - CARE.
  3. Consolidating our donations to one organizations means less tax hassles and paper work.
  4. CARE doesn't bother us.
The last is critical. Most of the places we've donated to in the past plagued us with spam, mailings, unwanted calendars, stickers, etc. With a very few exceptions, CARE does not. Once a year or so, often after our major annual donation, we may get an email. I respond by saying our annual donation is contingent on never hearing from them. That's been the end of it.

Strongly recommended.

Monday, December 28, 2009

Cloud Lesson #72: The risk of letting Google own your web site

Google finally migrated our Page Creator site to Google Sites - six months late.

It's a train wreck.

Remind me again why we're supposed to trust the Cloud?

America, please grow a spine

Another mentally ill al Qaeda cannon fodder has tried to blow up an airplane. It's encouraging that they're still scraping the barrel to recruit suicide bombers.

Meanwhile, in America, there are rumors that we'll have to forsake electronics and all motion or access to personal goods for the last hour of flight. At one point it was rumored that we'd have to go without a book for the "last hour". We might as well scratch all children and many adults with medical, cognitive or psychiatric disorders from flying.

Oh, and I love they way they say "last hour" as though planes never spend 1-2 hours circling the airport or waiting for a gate.

Meanwhile anyone who's seen a movie or read a book about smuggling or prisons is waiting for the first bomb smuggled in by body cavity - or surgically embedded into the abdomen. The next generation of scanners will have to incorporate a rectal probe.

The TSA administrators can't be as stupid as they look. They must know there's really no practical way to secure an airplane (train, bus, public space) against a truly competent and determined attacker. The best we can do is balanced risk mitigation. As Schneier has told us so many times, the big changes post 9/11 were to secure the cockpit door and look to the courage of passengers.

So if the TSA administrators aren't stupid, where do these regs come from? They come from legislative pressure. Now, many of our legislators are stupid, but not all of them. So why do they do this?

Because they know if a plane blows up and they didn't max out on security theater they'll be out of office - because we American voters are who we are.

We gotta stop this. Voters and legislators alike need to grow an American spine -- before our fear and stupidity drives us off the deep end of history.

Update 12/29/09: Signs of vertebral development. The absurd early responses have been dropped. Also, rectal bombs have already been used in Saudi Arabia.

Sunday, December 27, 2009

In praise of cardiac risk calculators

I've always had annoyingly high cholesterol levels, but I recently hit both age 50 and a new high cholesterol (though also a new high HDL). I figured it was time to bite the Statins.

First, though, I made the rounds of the risk calculators. I stuck with those on US and Canadian government and educational sites. The results varied depending on where the modeling data was taken from, but I generally fell between a 5% and 7% 10 year risk of a cardiac event (Said even is not necessarily fatal, but certainly unpleasant).

Even more significantly the only thing that really shifted my risk was to change gender. Even a fantastic statin effect, such as taking my cholesterol below 190, didn't change my risk much (from 6% to 4%, for a 33% relative risk reduction but a mediocre absolute risk reduction).

Considering that the statins are unlikely to be risk free [1] I decided to wait until my personal risk tops an arbitrary 10% threshold. In the meantime I'll continue to focus on diet and (especially) exercise.

The key lesson here is the value of these dynamic, personalized, risk calculators. They drive home the lessons we were taught in the 90s about the difference between statistical and clinical significance and they are an early and practical application of the principals of "personalized medicine".

Now if we could only apply these basic principles to airplane security planning...

See also:
[1] We have good reason to believe that the published literature has a systematic bias understating the risks of high value medications. We also know these are powerful medications that act on a wide variety of lipid receptors. On the other hand studies of absolute mortality risk in the last decade have been encouraging -- but those studies were done on persons with much higher risks of cardiac disease than mine.
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Google Health and my Google password

Google is infamous for not providing direct customer service. If you lose control of your Google Account you can be in deep trouble very quickly.

I thought of that as I experimented with entering my recent (yechy) lipid results into Google Health. Google Health is a part of my suite of Google services; if I lose control of my Google Account I also lose control of my personal health record (PHR).

How long will Google be able to provide a "PHR" without support services? Will they run into regulatory issues now that legislators threaten to extend HIPAA rules into the PHR domain?
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Saturday, December 26, 2009

Tech Churn: OS X Server, MobileMe and the Cloud

I've been gradually working through all the expected and unexpected* consequences of moving in a new machine and sunsetting my 6+ year old XP box.

Along the way I've run into another example of technology churn.

In our home we have 5 users and a guest account that are distributed across four Macs - an iMac i5, MacBook dual core, iMac G5, and a surprisingly functional though immobile iBook G3 running Camino. Each machine has its own uses, and most have six accounts.

It's a furball. It doesn't work well, for example, to put all personal files on an AFP share (Spotlight doesn't readily index shares, Mail and Aperture have issues with shares, there's no trash recovery post delete, etc). It's a pain to distribute passwords (keychain), credentials, desktops, etc. Let's not discuss our modern backup mess, shall we?

Once upon a time the answer would have been reasonably straightforward. I'd buy a used Mac Mini, stick OS X server and two 2TB firewire drives (one backup and one local) and do manage desktops.

Except Apple's iCal server fiasco tells me their server team is in disarray. There's also a relatively modern alternative to consider; at one time this is what MobileMe was marketed for. It was have been kind of OS X server in the Cloud, accessible both from the home firewall and from remote clients. (As of 10.6, incidentally, I think a MobileMe user name/pw associated with a user account in the Accounts Preference Pane acts like a kind of (undocumented) alternative global user identifier.)

So should I make good user of our family MobileMe account? Well, I'm kind of doing that, but there's churn there too. MobileMe has been caught in the iPhone, photo sharing, Google Apps and Facebook swhirlpool. Nobody, not even Steve Jobs, seems to know what the heck to do with it.

Or maybe we could extend what we've been doing for 3 years, and move more of our family functions into the gCloud? If Google does deliver a $150 Chrome OS netbook then each child will have one. Maybe we should start now.

Or maybe, because there's so much technological uncertainty, we should stall for time.

I think we're going to stall for time -- which means some combination of an AFP share, a backup server, MobileMe synchronization and continued use of our successful family Google Apps domain. That means OS X Server stays on the shelf for at least another six months.

Tech churn is a pain.

See also:
Update 10/4/09: A positive review of OS X 10.6 server convinced me that I really don't want to go that route! If Apple does make MobileMe a sort of "OS X Server Lite" for that masses, however, I'd find value there.
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Amazon holiday

It's getting hard for me to remember pre-Amazon. I know I bought books in the first few months of operation, when that was all they sold.

For our children, Amazon is eternal.

This holiday the Amazon boxes made one heck of a pile. Between the things we bought and Amazon gift certs from aunts and uncles the store in the cloud provided over 80% of the kid stuff (including things like the scope that came from Orion via the Amazon storefront).

We're clearly not typical of anything, but I'm looking forward to seeing how they did against the competition (though I expect nobody did great this year).

Incidentally, one fringe benefit of Amazon is that the gifts are concealed. Prying eyes are much less of a problem.

PS. Not that Amazon is perfect. In theory you can cancel mistaken orders even after they've been placed. In practice that doesn't work for affiliates, the orders still get processed. I didn't say I loved Amazon.
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Thursday, December 24, 2009

The health care bill

Odds are something like the Senate bill passed today will become law.

I didn't hope for much, but I did have one selfish desire. I hoped we'd get alternatives to employment based healthcare. I hoped individuals would be able to purchase insurance with large group pricing. It looks like we won't even get that. Instead the cost of open market insurance is expected to increase. Subsidies will offset those costs, but they will have an income cap.

Oh, and we'll be paying for the benefit expansion too - since costs won't be significantly contained.

Sigh.

On the other hand the current debauched system will be shaken up. I think, on balance, we'll move closer to what we need, even though that won't be the fantasy most Americans expect. We'll take two steps backward, 3 steps laterally, and 2 steps forward and we'll make progress. Given how stunned and confused Americans are and the state of the GOP this is probably the best we can do.

We need a better American citizen.

Update: Joe Paduda is even bleaker than I, but still thinks this bill is worth doing.
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Coldest major cities?

A biking book I was reading claimed Minneapolis (meaning St Paul) was the coldest major city on earth. That might be true of the US if you exclude cities with metro areas under 1 million ...
USATODAY.com

... The coldest major city in the USA is Minneapolis, which has an annual average temperature of 45.2 F. However, several other smaller cities are much colder, including Fairbanks, Alaska (26.7 F), Anchorage (36.2 F), International Falls, Minn. (37.4 F), Duluth, Minn., (39.1 F), and Caribou, Maine (39.2 F)...
There's no way it's true of the world however. Edmonton is insanely colder, and their metro population is now over 1 million very tough people. Montreal is slightly warmer than us -- though the weather there is far more miserable (gloomy, slushy, thaw, freeze - yech). Winnipeg is colder than Minneapolis, but it doesn't make the 1 million cut (they claim to the coldest western hemisphere city over 600,000 people).

Google has only one list and it omits Edmonton (but includes Minneapolis) ...
harbin: -13 C/ 8 F (the 10th largest city in China with 9.8 million residents)
qiqihar: -13 C/9 F
urumqi: -8 C/18 F
changchun: -10 C/14 F
minneapolis: -6 C/22 F
montreal: -6 C/22 F
moscow: -6 C/22 F
shenyang: -6 C/22 F
So even on this list, we tie for 5th place with 3 others -- and this informal list omits Edmonton. I suspect if we use St Paul's post global warming temperatures (1990 on) we might fall out of the top 10.

We're definitely not the coldest "major" city on earth -- though we might make the top 3 of coldest wealthy city.

Incidentally, Harbin once had a Jewish population of 20,000 - in the 1920s.

Wednesday, December 23, 2009

Alzheimer's, cancer and aging

Alzheimer's syndrome is associated with reduced risk of cancer. I'm not surprised, I wrote about this sort of thing back in 2006.

What we call "Alzheimer's" is probably a variety of disparate processes that lead, over time, to brain failure. The most common of these processes is probably above average aging of the brain. In other words, "Alzheimer's" is what you find in aged brains, it's where we're all going. Some get it sooner, others later.

Those whose brains age faster, or who start with less capacity, get demented sooner. Since accelerated aging seems to be inversely associated with malignancy risk, those who get demented earlier are less likely to get cancer.

Tuesday, December 22, 2009

Scylla and Charybdis: Corruption, health care reform and climate change.

A combination of flawed institutional practices, the nihilistic devastation of the Party of Beck and Limbaugh, and the political, economic and social importance of health care reform have made corrupt Democratic party senators immensely powerful.

Since these people care about nothing but their own power and privilege, and because they hold millions of Americans hostage, they can extort a heavy price from far more honorable people. They make the Beckians seem almost respectable.

It’s a tooth grinding time for compassionate rationalists. We know the historic price of failure. We know the GOP is ever more the party of unreason. We know too, the deep cost of social and institutional corruption.

Knowing all this, for the sake of health care “reform” we’ve eroded our enamel. Do we go to dentures for the sake of senate action on climate change?

I don’t think we can afford it, and I don’t think it will work. American support for climate policy is as fickle as the weather – by comparison support for health care action is relatively strong. Even if we continue to feed the leeches we still won’t get meaningful senatorial action.

We’re going to have to find ways to act on climate change through a combination of Presidential powers, EPA regulatory authority, and state policy (California still matters – just as in the days of Silent Spring). Perhaps international CO2-based trade tariffs will cause enough American corporate pressure to bring pet Senators into line.

No, it’s time to stop feeding the leeches. We’ve given up a lot, and the price continues to rise.

This is the time to change course. The midterm elections are ahead, and the party of relative reason is almost certain to lose its Senatorial supermajority. Even if nothing else happens, Robert Byrd will expire.

Losing the supermajority means we can now open yet another front against political corruption in America. No, not against Lieberman – that corrupt sod is safe until 2012 and will be well rewarded thereafter. Forget mere justice, this is about survival.

We need to resurrect old ideas about campaign finance reform and start the long, hard fight against a culture of corruption that has grown up in so many aspects of American life – in politics, professional societies, physicians, the judiciary, corporate governance, the media, and in finance and regulatory authorities.

Personally, I’ll be writing more on this topic in the months to come under a new tag of “corruption”. To start with I’ve asked the Center for Public Integrity to make it easier to find the feed for their latest from the center page. I’ve also become a Facebook fan of the CPI (yeah, there’s irony in using FB to fight corruption).

I’ll be pointing to similar organizations and making some donations*. I’ll even be consorting with the enemy; although the GOP is merely seeking to advance their own immense corruption their attacks on corrupt Dems do provide valuable intelligence we can use.

We’ve given a lot of ground for the millions of Americans held hostage to health care reform. We’re at the cliff’s edge now, we’ve got no more ground to give. We need to push back.

Take your anger against Lieberman, Nelson, and the like – and use it. Not against them – forget ‘em. They’re history. Use your anger against their kin everywhere.

Fight.

* If you donate to any of these groups, you will be spammed mercilessly. Yeah, that’s kind of corrupt too. It ain’t a sweet world out there. Don’t give them a phone number, do give them your spam-only Yahoo email account.

Saturday, December 19, 2009

Google vs. Apple - Stross on the phone wars

Charlie Stross is a literate geek who makes a living inventing plausible worlds. That's why he can write one of the best tech posts of 2009 ...
Charlie's Diary: Gadget Patrol: 21st century phone

... I think Google is pursuing a grand strategic vision of destroying the cellco's entire business model — of positioning themselves as value-added gatekeepers providing metered access to content — and their second-string model of locking users in by selling them premium handsets (such as the iPhone) on a rolling contract.

They intend to turn 3G data service (and subsequently, LTE) into a commodity, like wifi hotspot service only more widespread and cheaper to get at. They want to get consumers to buy unlocked SIM-free handsets and pick cheap data SIMs. They'd love to move everyone to cheap data SIMs rather than the hideously convoluted legacy voice stacks maintained by the telcos; then they could piggyback Google Voice on it, and ultimately do the Google thing to all your voice messages as well as your email and web access...
Please go now and read the entire essay ...

... Fun, isn't it? Charlie can write.

Charlie compares Apple to high end and luxury auto companies. It's an old metaphor, but it works. Extending that metaphor, what Google wants to do is deliver the Model T platform -- a super-cheap internet-connected phone and netbook for use in Detroit, Seoul, Kabul and Kampala.

2010 will be a very interesting tech year.
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Copenhagen - Better than I'd expected

If the UN's 2009 Climate Change Conference (Copenhagen) had reaffirmed the Kyoto Accord, or committed the world to saving Tuvalu, or promised to limit temperature rises to 1-2 degrees C, it would have been a disaster for humanity.

Instead we saw desperate back stabbing, dodging and weaving. That's a good thing.

No, I haven't turned into a Republican. The rise of China made the Kyoto accord absurd; affirming it would have a been a form of mockery. Similarly saving Tuvalu would require Americans to make radical lifestyle changes this month, and China to shut down its development. Not going to happen, so that kind of commitment would be a promise to do nothing.

We can't save Tuvalu.

A trillion dollars to offset the harm global warming causes developing nations? From the country that reelected George Bush? Puh-lease.

We've gotten about as much as humanity can produce. Colin Blakemore, a neuroscientist writing for The Guardian, put it well (emphases mine) ...
Copenhagen summit: This marked a turning point in human nature | Colin Blakemore | The Observer
.... Copenhagen may mark a turning point in human nature, when the global village acquired a global mind.

What we have just witnessed is delegates from 192 countries talking about making sacrifices, slowing their development, constraining their industry, taxing their citizens, in a collective bid to stifle climate change. Those nations included virtually every race, every religion, every style of government – from monarchy to dictatorship, from constitutional democracy to communism.

For the past 5,000 years, agreements between nations have been determined by military or economic power, by political ideology or religious dogma. What Copenhagen has established, even if the final agreement fudges and procrastinates, is that a new force is at work in international diplomacy. A force that does not speak in terms of faith and conviction, that is not even absolutely certain about what it has to say. That force is science....

... In his first major speech after winning the presidential election, Barack Obama said of the value of science: "It's about listening to what our scientists have to say, even when it's inconvenient – especially when it's inconvenient." And in his inaugural address, he promised "to restore science to its rightful place". Even with its flaws, what Copenhagen suggests is that the rightful place of science is at the heart of policy for a threatened world. The oceans are already rising. Either we sink, separately, or swim, together.
The leaders at Copenhagen, by and large, took the science of climate change seriously -- even though it's saying things they don't want to hear, and that their citizens often disbelieve.

That won't be enough to save Tuvalu, but it's more than I expected. The game is far from done.


Update 12/22/09: A relatively neutral observer tells us that China's goal was to sabotage the meeting and that Obama did yeoman's work: "I saw Obama fighting desperately to salvage a deal, and the Chinese delegate saying "no", over and over again..."