Thoughts after two days of a primary care conference

I haven't seen a patient in 10 years, but I like to keep in some contact with my first career. So I've spent the last two days at the MAFP Spring Refresher. It's inexpensive and local and the lectures are comparable to most such conferences.

Mostly I enjoyed the presentations, but I'm not going to write about those. Instead of commenting on the "new" discoveries, I'll comment on the static and the transitory.

What's static is the manner of presentation. In the past 30 years we've gone from transparencies to (yech) PowerPoint, but the basic format of medical lecturing is unchanged. The most interesting material is only spoken, not written. We get lists of symptoms (near pointless) instead of typical and atypical presentations. We don't hear enough about common mistakes. We rarely get frequency or prevalence data or diagnostic sensitivity, specificity or positive predictive value. Even experienced clinicians don't describe natural history of the conditions they know. We see lists of moldy textbook treatments that the speaker would never actually lose herself. Specialists don't tell us what makes a good referral. We get nearly worthless PDFs (that we can't copy/paste), only one speaker (the best) provided a handout of key points.

Thirty years -- and we've made no real progress in something as fundamental as person-present education.  Since improvements are so obvious (see above) this is a curious form of market failure.

What's transitory is medical practice. Medical progress is almost as static as medical education, but I was struck today by the effervescence of medical fashion. Perhaps it's a side-effect of a field that now changes slowly, but several speakers spoke of national care guidelines that seem to reverse direction every two years. I think of daily and monthly changes to medical practice as being like the weather in Minnesota - frequent storms that rage and thunder -- then pass slowly away. Against that is the climate of slow change and true progress, but that now takes a decade to see ...

Text Spam: Phone company text messaging must die

I don't like paying $20/month for our AT&T unlimited texting family plan. After all, it costs AT&T next to nothing to provide SMS services.

I pay because the current IM alternatives don't work. That leaves texting as the polite alternative to the unscheduled phone call. I pay because what I get is worth more than the money I pay.

Or, rather, it was worth more. It's worth less all the time, because I'm getting more text spam like these 595-959 Welcome to Sears/Kmart Shop Your Way Rewards Text Alrts (yeah, "Alrts") ...

Unlike "full number" text spam, AT&T won't accept reports for these...

Instead, AT&T markets "short code" text message services. They charge spammers to spam us, and, I assume, they charge us to receive the spam. Talk about a win-win!

You could try completing the FTC's spam report form for wireless phones, but as of today it's not designed for text message reporting. It's as though the FTC got caught in a time warp @ 2002.

This is only going to get worse. There are now two phone companies in America, and they hate us almost as much as we hate them. They hate us so much they'll drive us to abandon their most profitable service.

We need an alternative to phone company controlled text messages. We need a messaging service that includes spam filtering -- and that doesn't make us sitting ducks for low grade spam. Blackberry did this years ago; maybe when RIM dies in 2013 either Apple or Google will buy their texting service -- and give us something worth paying for. Maybe California will ban text spam and end our spam as a side-effect. Maybe all of the above.

There's an opening here. Help me out Apple, Google, and California!

The debt ceiling: Can Goldman Sachs win if the US defaults?

The GOP is expected to blackmail the Democratic party by holding the American economy hostage. This isn't news; Bruce Bartlett has been talking about the debt ceiling and debt default since last June, and has been expecting this crisis since January.

Even so, I haven't worried. It's not that I think the GOP is reasonable or even rational. The GOP is certainly crazy enough to blow up the village in order to save it. I haven't worried about this because I have assumed that the GOP will obey its masters on the big things  ...

Gordon's Notes: Is the GOP truly a pawn of corporations and the wealthy? We'll find out soon. (Jan 2011)

... Charlie Stross says emergent corporate entities control America. Krugman says wealth alone is sufficient explanation, emergent entities are an unnecessary complication.

John Gordon says control (the bouncing yellow ball) of America is a dynamic balance between the emergent corporate entity (ECE) powerful (wealthy) individuals, and the voting masses [1]:

Of course I'm right, but it would be nice to have evidence.

Fortunately, there's a natural experiment coming up. The GOP is threatening to destroy the American, and world, economy. This is in the interests of neither powerful individuals nor ECEs. So if it happens, then Stross, Krugman and I are all wrong. The Voters have power after all, and it's just too bad so many Americans are detached from reality...

Recently, however, I realized there was a flaw in my logic.

I assumed destroying America was not in the interest of American "Corporate Entities". That's not necessarily so. I expect there's a way to make vast amounts of money off a US debt default, particularly for a company that has "insider" information. If Goldman Sachs were to bet on default, then they could combine with GOP whackiness to finish us all off.

Now I'm worried.

Epsilon breach: the iStealer and CyberGate mystery

A marketing (legal spam) firm was hacked and a bunch of our "private" (hah!) information was stolen. We can now expect more personalized phishing attacks (yawn). We might see more identity theft, but I've read that the identity reseller market has collapsed -- perhaps because there was too much cheating going on. (This is why civilization can win -- crooks can't trust each other).

Yawn. Another day, another semi-legal enterprise hacked. it's a boring story [1], not nearly as interesting as the far more sensitive, and far less discussed, RSA hack.

The story is boring, but there's a curious angle. The attack was prosaic ...

Epsilon breach used four-month-old attack - Security - Technology - News - iTnews.com.au

...The link in the body of the email took the user to a page that downloaded three malware programs – one that disables anti-virus software, another (iStealer) that is a Trojan keylogger to steal passwords, and a third (CyberGate) which offers hackers remote administration of the infected machine....

But the curious angle is how the attack trio are described: iStealer, CyberGate and an anonymous tool for disabling system defenses. I can't find out anything about them!

A google search on iStealer turns up lots of hits -- but they're obviously from shady sites I wouldn't visit without a VM constrained self-destructing browser. The only Wikipedia hits are on Russian language pages. In fact, as of today, this blog post is probably going to be the only legit result in many searches! (Sorry, I don't know anything.)

Why this curious silence?

[1] The firm is called Epsilon -- a silly name right out of a Bond flick. I think that's why this got so much attention.

Read the NYT on iPhone, iPad or desktop - for free with a Google Reader bundle

I was a happy Times Select subscriber. I liked paying for what I read, and I was disappointed that the NYT took down that paywall. The price was reasonable and access was convenient. True, I didn't get much value for my money (other than Krugman), but it was a way to contribute.

That's not how I feel about the NYT's $40 million paywall from Hell - $455 a year to view the NYT on 3 online devices. Unless, of course, I choose to mulch the newspaper, waste natural resources, and boost the earth's CO2. Then I pay less.

Multiply that by four family members, since there's no family plan. There's also no option to only get web access.

Happily, there's a practical alternative we can use until the NYT gets sane and offers web-only family access for @$150 a year. [3]

The practical, free, alternative to the NYT is ... the NYT. The NYT, you see, allows 'free' access from blogs. Since the NYT provides section feeds (Arts, Science, US, World) it is, in essence, its own blog [2]. If you add these feeds to Google's superb Reader, you can read the NYT from your web browser, iPhone or iPad for free. On the iPhone or iPad (or desktop) you can also use Reeder.app (my favorite iPhone app [1]).

It's a bit tedious to add these feeds, so you may want to start with using a Google Reader Bundle I prepared:  Gordon's Google Reader Bundle - New York Times. If you're a Google Reader user you'll get a button that lets you add all the feeds at once.

[1] Try the embedded readability function is excellent. Tap the little R in the top right of any page. The major limitation is that it only shows the 1st page of a multipage article, so sometimes I have to open the web view.
[2] If you browse the NYT web site with Safari you see either the RSS or "Reader" symbol by many articles. Since these are feed based, I wonder if they also dodge the paywall.
[3] We hate to encourage them, but to be fair Emily will pay the lowest cost subscription plan for the next few months.

Skimmer: The HTML 5 version of the NYT

The NYT is experimenting with HTML 5 at www.nytimes.com/skimmer/. I tested with Safari, the site stores 10MB locally to begin services.

I didn't like the way the fonts rendered on OS X Safari, but Windows users will probably do better (sadly, Windows' font technology is better than Apple's). The site is very responsive; it caches many page ingredients locally.

This is hardly revolutionary. In the days of 2,400 bps modems AOL was responsive because all the graphics elements ran off a 3.5" 720K diskette. It's taken a long time, but HTML 5 has brought us back the late 80s.

I had no trouble highlighting text and creating a blog post from the text. I suspected that might be blocked, but for now copy paste works.

The site is not glitch free. If a page doesn't render, don't wait. Hit refresh.

Worth a look.

Naked Emperors: where are all the connected people?

A NYT headline says half of all American adults have Facebook accounts [4]. Twitter-like valuations are leading to tech bubble denials. Social networks, we are told, led to the Egyptian revolution [1].

Except, I don't see it here among school parents, sports team families, tech company colleagues, and upper-middle-class neighbors.

True, I live in the midwest, but by all metrics Minneapolis is a snowier version of Seattle-Portland. If not here, then where?

I don't see feed readers in use outside our home [3]. Almost nobody subscribes to calendar feeds. Very few of my sample [5] use Twitter. Most of my friends who once used Facebook have stopped posting or even reading. Even texting isn't universal. Everyone has 1-2 email addresses and can use Google, but that's as far as it goes. Forget Foursquare.

I see more iPhones every day, but they're not used for location services, pub/sub (feeds) or even Facebook's user-friendly pub/sub. Around here iPhone communication change has been limited to faster email responses.

There is change of course, but it lags about 5-10 years behind the media memes. Dial-up connections are mostly gone, though I still see AOL addresses [2]. Texting is becoming common. Old school email is now universal, though many (unwisely) still use office email for personal messaging.

It's frustrating for me; all of the school, sport, community organization and even corporate collaboration projects I work with would go better with pub/sub in particular. I've learned the hard way to dial back my expectations, and to focus on 1990s tech.

So is Minneapolis - St. Paul strangely stuck in the dark ages? Or is there a gulf between the media portrayal of American tech use and reality --  a gulf that will lead to a big fleecing when Facebook goes public?

My money is on the fleecing - and a faint echo of the 90s .com bubble.

[1] The same nearly-free-to-all worldwide communication network that Al Qaeda used effectively in 1999-2000 is now celebrated by us for its benefits in Egypt. Technology has no values, only value.
[2] I assume about half those are dial-up. 
[3] Google Reader is astounding. Just astounding. Nobody mentions this, everyone talks about Twitter (not useless, but weak). Weird.
[4] Not actually using FB mind you, just have accounts.
[5] Ages 8-80.

Update: An hour after I posted this I thought of one remarkable exception: LinkedIn. Unlike Facebook, LinkedIn has a non-predatory business model. They have been relatively careful not to infuriate their users. LinkedIn continues to grow, and I don't see any true attrition. It will be interesting to compare their valuation to Facebook's.

21st century TV - preying upon the weak

Our kids love family road trips. They love that they can watch motel TV - cartoons and "reality" shows on logging and mining.

Their TV fest is my window to an alien world. As best I can tell, morning cartoons are funded by fleecing the weak. They don't sell to kids, they market adult good and services that are at best a waste of money. Their target market is the weak and uneducated; like lotteries they take money from those who need it most.

This is so 21st century America. We live in a nation where GE doesn't pay taxes (the best investments are Senatorial), Goldman Sachs uses the mafia's operations manual, the GOP has lost touch with Reason, and it's open season on the weak.

How did we end up here? Is it all the fault of aging boomers with rampant pre-dementia? I don't get it...

Update 3/26/11: The morning after I wrote this the NYT found that someone was imprisoned for his role in vast mortgage fraud enterprise of the past decade. A penniless guy who lied on his "liar loan". Is there a rehab program for a nation?

Update 3/27/11: After today's farewell NYT OpEd by Bob Herbert I'm tagging this post as "meme watch". Zeitgeist in action.

Quantized scent detection isn't quantum computing

Towards the end of my comments on a  BBC news article titled "quantum physics explanation for smell", I started to have second thoughts about how "quantum" these results were ...

Gordon's Notes: Quantum computing in the nose

... If these results are replicated, then Turin gets a Nobel.

If noses use these 'quantum' effects, then it's pretty much certain that neurons do as well.

Does that mean our brains are 'quantum computers'? I need help from Aaronson. This 'quantization' sites on the micro-macro boundary. Not all quantized vibrations are quantum physics....

I asked Scott Aaronson, MIT prof of computational physics [1] and famed blogger if he'd consider a comment on the original article. Instead he replied by email, and gave me permission to quote ...

These look like *really* interesting experiments!  And it's a priori plausible that smell would involve some quantum effect -- we already know that ... photosynthesis and bird navigation do.

If true, this doesn't IN ANY WAY imply that the brain is a "quantum computer" in the sense of using quantum coherence to speed up computation.  That's a separate question, and any such suggestion would still need to overcome the problem of how entanglement could survive in the brain for any appreciable length of time.

So while we do have evidence that natural selection has made use of some aspects of quantum physics, we have no evidence (yet), that it has made use of entanglement, the spooky action that motivates research into quantum computation. So the nose may be doing quantum physics, but we have no evidence that it's doing quantum computing. [2]

[1] Born in 1981, when I left college. Sob.
[2] Incidentally, if I read Aaronson correctly, he suspects quantum computing is possible, but it won't solve radically new problems (and thus won't destroy the world economy if it works).

Quantum computing in the nose

Smell, aka the application of algorithms for molecule classification, uses "quantum" effects ...

BBC News - Quantum physics explanation for smell gains traction

... in 1996, Luca Turin, now of the Massachusetts Institute of Technology in the US, suggested that the "vibrational modes" of an odorant were its signature.

Molecules can be viewed as a collection of atoms on springs, and energy of just the right frequency - a quantum - can cause the spring to vibrate.

Since different assemblages of molecules have different characteristic frequencies, Turin proposed, these vibrations could act as a molecular signature.

The idea has been debated in the scientific literature, but presentations at the American Physical Society meeting put the theory on firmer footing.

Most recently, Dr Turin published a paper showing that flies can distinguish between molecules that are chemically similar but in which a heavier version of hydrogen had been substituted...

If these results are replicated, then Turin gets a Nobel.

If noses use these "quantum" effects, then it's pretty much certain that neurons do as well.

Does that mean our brains are "quantum computers"? I need help from Aaronson. This "quantization' sites on the micro-macro boundary. Not all quantized vibrations are quantum physics.

Update 3/25/11: I forgot to change my title when doubts crept in. My mistake!

Japan

Only a few thoughts on Japan that have not been said better elsewhere.

1. Japan is a wealthy high tech manufacturing nation. Is the best way to help the Japanese people to buy something manufactured in the north of Japan? A Canon camera? An Apple iPad with expensive Japanese made components? A Subaru? If Yellowstone burped, and Minnesota somehow survived, I might prefer Japanese people buy our goods rather than send donations.
2. Our family offsite backup is located about five miles away. There's a nuclear reactor about 45 miles south of my home. I used to think our biggest regional risk was Yellowstone, and if that blew without warning I wouldn't need to worry about my backups. Fukushima makes me think the ideal offsite backup is in orbit.
3. Several bloggers I trust say the best place to follow the Fukushima nuclear plant story is Wikipedia.

I'm surprised Japan's most recent disaster has not brought more attention to New Orleans. Six years after Katrina the non-flooded areas of New Orleans are estimated to exceed their pre-Katrina population. I was unable to find any persuasive discussions of the current state of New Orleans, and how its recovery has evolved. I have read that the region of Japan hardest hit by the tsunami was, like pre-Katrina New Orleans, relatively poor and elderly (though far less prone to looting than New Orleans). The Northeast of Japan may recover more like New Orleans than like Kobe.

Canine companion culture and disability

Enjoyable article on cultural attitudes towards "companion animals" ("pet" is out of fashion. but is used throughout the article [1])

...

Emotional Power Broker of the Modern Family - NYTimes.com

... as a rule, people fall into one of three broad categories of beliefs concerning pets. Members of one group, which he labels “dominionists,” see pets as an appendage to the family, a useful helper ranking below humans that is beloved but, ultimately, replaceable. Many people from rural areas — like the immigrants Dr. Terrien interviewed — qualified.

Another group of owners, labeled by Dr. Blouin as “humanists,” are the type who cherish their dog as a favored child or primary companion, to be pampered, allowed into bed, and mourned like a dying child at the end. These include the people who cook special meals for a pet, take it to exercise classes, to therapy — or leave it stock options in their will.

The third, called “protectionists,” strive to be the animal’s advocate. These owners have strong views about animal welfare, but their views on how a pet should be treated — whether it sleeps inside or outside, when it should be put down — vary depending on what they think is “best” for the animal. Its members include people who will “save” a dog tied to tree outside a store, usually delivering it home with a lecture about how to care for an animal...

Obviously a simplistic distinction, most of us are somewhere in the midst of this triangle. Things get sensitive, and even more interesting, when you line up these cultural attitudes alongside cultural attitudes towards cognitively and/or physically (relatively) "impaired" humans. I think we could plot a 100 year migration of euro-American cultural attitudes towards both dogs and "the disabled" across this triangle and see some similar trends.

Personally I'm somewhere between 'humanist' and 'protectionist'. I don't treat Kateva (the canine) like a human child -- her needs, wants and interests are not the same as most humans. Besides, she's middle-aged.

On the other hand, I don't consider her as "inferior" to me, though, like me, her needs fall below those of Emily and the kids. She and I are happy servants of the pack with occasional opportunities for personal fulfillment. We are working animals.

[1] I don't like "pet", but "companion animal" is way too long. I'd go with comrade.

Isn't this what the GOP really thinks?

Martin Harty, a NH state rep tea partier, is 91 years old. If he were younger he'd be more discrete ...

New Hampshire Republican Won't Apologize For Saying 'Defective' People Should Die In Siberia | TPMDC

... A Republican in the New Hampshire House of Representatives regrets telling one of his constituents that the mentally challenged and other "defective" people should be sent to Siberia so they don't stand to inherit control of the world.

"The world population has gotten too big and the world is being inherited by too many defective people," Rep. Martin Harty told one of his constituents. "I mean all the defective people, the drug addicts, mentally ill, the retarded -- all of them."

Asked what should be done with those people, Harty said, "I believe if we had a Siberia we should send them to this and they would all freeze and die and we will be rid of them...

Ironically, Harty is obviously cognitively defective; almost all 91 year olds are. He'd be aboard his Siberian train. That's not just darkly amusing, it's important.

I've written recently about how attitudes towards "the defectives" defines America's cultural and political divide. The Right side of the divide includes ...

... The strong should not help the the weak because ...

* I am strong because I am of the strong tribe, non-tribe is non-person -> Weak person, in denial...

Harty is a weak person who dreams he is strong.

More importantly, he's saying aloud what many right wingers, including the respectable "school voucher" sort, whisper among themselves. Social Darwinism (forgive me Charles) is not dead, it's alive and well in today's GOP.

The Legless and the Lazy - a parable

There are two racers.

Jane is legless. Since the age of two she has excelled.

Jill is apathetic. She has trouble getting started. She gives up easily. Jill is lazy.

Each is invited to race one mile without devices. Jane rolls. She somersaults. She walks on her hands. She is relentless. The odds are invigorating.

Jill is disinterested. She starts slowly. She complains about her sore foot. She stops to rest. She doesn't like her shoes.

Jane finishes bruised, scraped, dirty and sore. Jill finishes first.

Who is the better person? Who do we praise?

Jane and Jill are identical twins. Jane lost her legs after a childhood infection. Jill's personality changed after a brain tumor was removed at age 17. Jill has spent years relearning speech and ambulation.

Who is the better person? Who do we praise?

Jane and Jill are not identical twins. Jill was born lazy.

Who is disabled?

Jack is a sociopath. He was born unable to form connections to other persons ...

See also ...

• A taxonomy of American politics - how attitudes to the weak define America (3/2011)
• Free Will RIP - The Economist on preemptive punishment (12/2006)
• Calvin, free will and me (3/2010)
• Addiction and disease: My comments on the TIME Science blog (7/2007)
• Lurching towards wisdom: neurodiversity and the morality of abnormality (5/2004)
• Bad genes, bad people and a crisis of punishment? (11/2009)
• Diminished responsibility: the next cultural battleground (9/2005)

Tools I use: iOS

When I write about software tools and services, I usually write about what's new or what's broken.

I don't write much about the tools I use all the time. Tools that work at least well enough.

I'm not alone in this. It's unfortunate, because Tools that Work are what I'm really interested in! There's an information-market failure going on.

In the spirit of lighting a single diode, I'm going to write periodically about the Tools I Use (see tag). I'll start with the tools I use on my iPhone. Most of these are on the start page of my iPhone, though a few there are still experimental. (On first posting I've no links here, I'll add those later.)

Calendar: I use iOS Calendar with my employer's Exchange Server and with Google's ActiveSync server. I currently use 13 distinct Google managed calendar feeds out of the @18 feeds registered with my Google Calendar.

Voice Memos: I've tried several alternatives, but Apple's version does what I need well enough. Most of all, on an iPhone 4, it loads quickly. Most competitors take too long to load. I like the integration with the iPhone earset controls.

Camera+: I like the speed of image acquisition, and especially the ability to quickly specify focus and exposure targets.

Todo.app: I sync it with ToodleDo. ToDo.app is very fine; ToodleDo is an odd mixture of excellent and inadequate.

Spotlight: I wish it searched more things, but I rely on it more and more.

iPod: Especially In Our Time podcasts. If only Apple would fix the 3 year old $!$#@ last listened bug.

Google Voice: I have used it about five times a week for years to call Canada from my cell phone. The quality is now, usually, excellent. It costs nothing. GV alone pays for my iPhone.

SimpleNote: I'm very glad I get to pay yearly for their sync service. I want the vendor to stay healthy. I sync it to Notational Velocity on OS X and ResophNotes on XP.

Contacts: My iOS Contacts app syncs to my employer's Exchange Server and to MobileMe Contacts. It's a long story. My Contact sync setup is complex and perhaps impossible to replicate, but it works across multiple OS X Mail.app instances, Gmail, and my iPhone.

TWC: The weather app that works well enough for me. I could see replacing it, but there are no ads in the one I own. I need to move this to my main screen.

Clock: I use the iOS Timer app very frequently. It's a kid thing.

LED Light: Replaced my venerable copy of Light.app.

Night Stand: Beside alarm clock when traveling and iPhone powered.

Latitude: My son likes to know where I am. I think Emily will start using this too.

Facebook: FB is more evil than most, but I like to see what my friends are up to. It's a vice.

Reeder: I used to use NYTimes.app, but I've switched to following NTY feeds via Reeder. Not perfect since they're partial feeds, but better than NYTimes.app. For every other feed source Reeder rules. Reeder generates the Google Share notes that also create my Twitter stream. I use this a lot.

Google News: The only web-app I regularly use. Works very well.

Maps: This iOS app is underrated. It's deep and subtle. It is strange, however, that Spotlight offers options to do searches via Google and Wikipedia, but not via Maps.

Mail: This iOS apps syncs via ActiveSync to Google Mail and to my corporate Exchange Server. Having corporate mail on my iPhone has been a dramatic help.

Messages: I resisted texting because I hated paying the super-high-margins fee to AT&T. We tried IM for quite a while, but it didn't fly. So now I text. Frequently.

Safari/Google.app: Inevitably. I find the voice search and search history on Google App marginally interesting, and it speeds access to Google Docs (though I very rarely use that).

1Password: I wish I had an encrypted database app that would painlessly sync to FileMaker. I don't, so this is the next best thing.

i41CX+: The HP41C that dare not speak its name. (Trademark.) The work of a madman who benefits all.

I have many more apps on my iPhone, but the above are 90% of what I use all the time. (Links coming later.)