You're 50 now. It's time to start plan 0.

Ken Murray hit a nerve when he wrote "how doctors die" last November. Now he's back with Doctors Really Do Die Differently.

Briefly, physicians are relatively good at dying. Maybe we just think about it more. Certainly we have a better idea than most civilians of what medicine can do (heart transplants) and what it can't do (run an effective code after respiratory arrest, prevent dementia, etc).

So I'm thinking now about plan 0.

No, not wills and living wills and the like -- Emily and I took care of that stuff decades ago and we've redone them several times. There's still work I need to do on digital archive plans and transferring domain names, but it's manageable.

No, not contingency plans for password and account information access. (Though, come to think of it, I do need to update the danged password archive. That's getting harder these days.)

Plan 0 isn't about those things. It's about emulating Molly Thunderpaws Squirrelbane. She lived to be an old dog, maybe a bit forgetful but good company. One day she's sick with some abdominal cancer. Heartbroken we feed her high cost lamb for her last few days. Which turned out to be 340 last days. It got quite expensive, since we obviously couldn't stop the therapeutic lamb. Cheaper than vincristine though, and tastier. Finally, her legs give out, friends gathered, and the vet made a house call. Perfect.

I have a bit of time to figure out plan 0, probably 30 years or so assuming a good morbidity compression strategy [1]. First I need to get euthenasia legalized, then I need to give the kids a financial incentive to bump me off, but not too much of an incentive ...

[1] Based on family history, health habits, current health, mortality curves and assuming medical progress continues to be very slow.

A shot in the dark - Am I my brother's keeper?

Roger Ebert wrote a column on gun control and received 650 comments.

He read them all.

Then he responded, with one of his best columns ever. Some of the lines are so well said I've excerpted them below. I've written about this many times, but, of course, not with his eloquence.

A shot in the dark - Roger Ebert's Journal

Catie and Caleb Medley went to the doomed midnight screening of "The Dark Knight Rises." It was a movie they'd been looking forward to for a year, her father said. Gunfire rang out. The bullets missed Catie, who was pregnant. Caleb was shot in the eye. On Tuesday, their son Hugo was born. Caleb is listed in critical condition, and the cost of emergency treatment for his head wound has already reached $2 million. The Medleys were uninsured.

... Many of the comments were about health care, and one of the arguments frequently heard was: "I don't want the federal government taxing me to pay for the medical costs of people who don't care enough to provide for their own costs."...

... In our imagination it's always other people who get sick. I have a reader who tells me he's never been sick a day in his life. I tell him that's interesting from an autobiographical point of view, but otherwise not relevant. I can assure him that unless he's killed in an accident, sooner or later he will most surely get sick, and sooner or later he will most surely die.

Are we our brothers' keepers? Many people who resort to scripture are under the impression that we are not. They forget that it was Cain who said he was not his brother's keeper, after murdering Abel. In a similar sense, if our fellow citizens die because they have no access to competent medical care, they argue that we are not their keepers...

... I quote from the Bible for a particular reason. Many of the opponents of Universal Health Care identify themselves as Christians, yet when you get to the bottom of their arguments, you'll find them based not on Christianity but on Ayn Rand capitalism...

Ebert is talking about prosperity theology (wikipedia, see also Prosperity Theology | Christian Bible Studies [1]), a belief that wealth is a sign of god's approval, and poverty of god's disapproval. Since sin earns god's disapproval, the poor are sinners.

Although American Christians have brought prosperity theology to new heights, it's not unique to Christianity or to Mormonism. Hinduism's justification of caste maps well to the idea that poverty goes with sin, and wealth with grace.

In 2012 the fundamental difference between the right and the liberal is how we answer the question: "Am I my brother's keeper". Ironically, avowed Christians often give the answer of Cain and Ayn, while secular humanists often give the answer of Abel.

Cain and Abel. Romney and Obama. Some things never change ...

[1] Probably the only time I've ever linked to Christian Bible site.

Zenith CruisePad 1996

I found this in some archives.

A little bit of history from 1996. An antecedent to the iPad, the CruisePad was a wireless thin client sold into healthcare verticals ...

Zenith just announced its MultiCruise system that supports 5-60 simultaneous users of its mobile CruisePAD (640x480 VGA LCD 3.2 lb with integrated touch- or stylus-activated dignitzer panel). The system works with standard DOS, WIndows 3.x, Windows 95, and Windows NT applications. The wireless communication uses Integrated Spread Spectrum Frequency Hopping radio that supports a standard range of up to 500 feet in office environments, unlimited range if a network of CruiseLAN/Access Point nodes is installed. Thus, a clinic could implement an interactive EMR system enabling clinicians with CruisePADs to access the system anywhere in the clinic without hard wiring PC's in every room. A complete 5-user system, including single Pentium (upgradable to 4 processors) server with 36MB RAM (upgradable to 768MB), 850MB HD (upgradable to 24GB), keyboard, montor, 5 CruisePADs, and an extended version of Windows NT Server lists for "about $15,000."

Apple's profits disappoint. So what has Apple done for me lately?

Apple's margins disappointed today, and the stock dropped.

Coincidentally, I just ordered a Nexus 7 for $200.

 

Or maybe that's not entirely coincidental. What, after all, has Apple done for me lately?

 

Apple forced me to migrate from MobileMe/OS X to iCloud/Lion - causing significant pain for my family and me with zero perceived benefits. Actually, less than zero benefits. Lion is a slug on our previously lively MacBook, and iCloud has added nothing but severe pain while eliminating iWeb and Gallery.

 

Apple botched the MobileMe Gallery to iPhoto transition, destroying some user's iPhoto Libraries (I was spared that one).

 

Ten years late Apple enabled iPhoto Library integration -- but incompletely and only with Aperture and Lion (this is actually the least of their sins).

 

Apple is changing the iPhone Dock Connector. That would be tolerable if they were going to something that was USB standard compatible, but rumor expects another proprietary connector.

 

Apple screwed up my Apple ID to Apple product records.

 

Apple doesn't yet have repair support for unlocked AT&T iPhones.

 

iOS Parental Controls are still broken.

 

I could go on. Bottom line - Apple has done a lot for me over the past decade, but not so much over the past two years.

 

That's part of why I ordered a Nexus 7 today rather than wait for an iPad 8". If the Nexus works I'll wait until next spring to look at the iPad. Maybe. Google is definitely evil, but lately they've been less incompetent than Apple.

 

Evil is bad, but incompetence is worse.

Usenet: it's time to put a stake in it

Google has rebooted Google Groups for Business. I'd was surprised by the reboot, so the announcement brought me back to my old Groups account.

I found Google had me listed as a member of rec.sport.skating.inline. Yes, a usenet group. Google inherited them when it rescued the DejaNews usenet archive from oblivion [1].

There are still posts to the group that pass Google's spam filters -- one every few weeks. Alas, even they look like spam. I saw some older posts from a year before.

Wikipedia tells us that most of the usenet traffic now is spam and "binaries" newsgroups. The article gives the impression that those binaries range from illegal software to child porn. Most ISPs don't carry usenet any more; I'm sure Google doesn't index the binaries and I suspect it filters most of the spam.

It's time to put a stake in usenet. At the funeral, we should consider the lessons it taught us.

[1] I was a keen DejaNews user. I used to 'tag' my usenet posts with a unique string to enable retrieval and review (for example). I'm tempted to add this search string to my Google Custom Search engine, but I'm a bit leary of breaking the engine.

Facebook changing: it's not about friends or games any more ...

My slice of Facebook is changing in ways that are interesting, but not necessarily profitable for Facebook.

Consider this "Likes" list from the Minneapolis Park and Recreation Board's Facebook Page:

Many of the items on this page are of interest to me. Likewise for the items on the St. Paul pages. Not to mention the Pages I maintain for Minnesota Special Hockey Eagles and the Minnesota Inline Skate Club.

I "liked" quite a few of these Minneapolis Parks related pages. When I browse my list of Likes (painful term), many, if not most, are local organizations and businesses rather than people. These organizations used to try to reach me through newspapers or the US Mail, now I read them on Facebook.

I don't seem game invitations any more (mercifully); they're tucked away on the right upper page. Periodically I decline them all.

I don't see that much activity from friends and family. Some are quite active (thanks MC!) but most don't post at all. Many stopped using Facebook.

So my slice of Facebook isn't about games or celebrities (never was). It's still a bit about friends and family. Most of all though, it's about organizations and businesses I want to hear from, including local government.

How does Facebook make any money from this? They're going to have to start charging for Pages at some point ...

Aurora - the rational response is better schizophrenia management

Robert Ebert:  "Here is a record of mass shootings in the United States since 2005. It is 62 pages long ... The hell with it. I'm tired of repeating the obvious."

Gail Collins: "Did you catch the one last week in Tuscaloosa? Seventeen people at a bar, hit by a gunman with an assault weapon."

Well said, but both Collins and Ebert know we're not going to get meaningful gun control in the United States any time in the next twenty years. We'll get a Carbon Tax long before we'll get weapon management.

American gun control died when the NRA pushed Bush to a statistical tie with Gore, and brought us the torture presidency.

In any case, it's not clear even strict gun control would be more successful than the American War on Drugs. There are vast numbers of inexpensive and effective weapons of mass murder in the US. The cost of havoc is low.

As a nation, we've gone a long way down a rough road.

That doesn't mean we can't do anything. It's almost certain that the latest killer is mentally ill, probably paranoid schizophrenic. As a nation, our care of the mentally ill is abysmal in blue and red states alike. Physicians have fled the specialty of psychiatry and we're dramatically short of the family physicians who might fill the gap.

If we're going to get anything of value from this soon-to-be forgotten nightmare, it won't be from some incremental and soon eroded change to Colorado's gun control laws. It will come from leveraging Obamney Care's new financing for mental illness. We need to make it much easier for friends, family, and teachers to get help for paranoid schizophrenics, and we need to provide support for treated schizophrenics to stay well.

Update 7/22/2012: A slightly different take from a Columbine book author:

The Unknown Why in the Aurora Killings - David Cullen - NYTimes.com

... Dylan Klebold was an extreme and rare case. A vast majority of depressives are a danger only to themselves. But it is equally true that of the tiny fraction of people who commit mass murder, most are not psychopaths like Eric Harris or deeply mentally ill like Seung-Hui Cho at Virginia Tech. Far more often, they are suicidal and deeply depressed. The Secret Service’s landmark study of school shooters in 2002 determined that 78 percent of those shooters had experienced suicidal thoughts or attempts before mass murder...

It's a bit odd to say that someone who is suicidal and has delusional symptoms of major depression is not "deeply mentally ill", but Cullen is not a physician.

I think what he's trying to say is that most shooters are mentally ill, but that psychotic or severe depression is more common than schizophrenia.

I haven't been able to find any public health literature, but it's important to note that many shooters don't survive to get to a full psychiatric evaluation. One of the best responses to the Aurora shooting would be to fund a review of psychiatric issues in shooters and identify intervention opportunities.

Google World Wonders Project

Google World Wonders Project. Wonders, world, pretty much what is says on the can.

As of today not all of the new antarctic street view image have been added to the site.

Google's evil level falls a bit when I browse this.

Why Montreal is the #1 bicycle city in North America.

Portland and Minneapolis have been fighting for bicycle glory over the past few years. We usually trade #1 and #2 spots with the hilly city in American rankings.

It's harder to find comparable rankings that include Montreal; I've seen it ranked #1 in NA but I can't find the reference. Looking at this picture though, I suspect it deserves the #1 slot ...

This dull looking landscape is Rue Berri, a major North-South urban artery that parallels the much more fashionable rue St Denis. What you're looking at is not a car lane, it's a two way bicycle avenue carved out of an urban street sometime in the past decade. Alongside is one of Montreal's extensive bixi bike stations (they were first in NA to have 'em, I think Minneapolis was 2nd.)

These separate bike avenues have their own lights and signals; Minneapolis has approximately 1 bike light in the entire city (more are coming). It's comparable to what I saw in Munich 20 years ago.

I'd love to know how Montreal managed this transformation. Maybe a group of Minnesota cycling advocates should make a fact-finding trip to Montreal. I recommend grabbing a Bixi bike at the Berri/UQAM stop, riding north to dinner on Prince Arthur, then down St Denis to Brioche Lyonnaise for desert and then a five minute drop to the river and Vieux Montreal for a beverage on the pier.

See also:

Montreal and Minneapolis: Unremarked differences 4/2011

Why does Thrifty Rental provide car key sets bigger than my iPhone?

When I rented from Thrifty recently I got this set of keys:

There were two keys with batteries, each 1cm thick at the head. A third valet key, designed to provide ignition access without trunk access, is securely bound to the other two with a fixed cable.

Yes, the "valet key" cannot be distributed without the full access key.

Two full access keys.

Taken together, they dwarf my iPhone. With a wallet in one front pocket and an iPhone in the other, there's no way to comfortably carry them in conventional pants -- even if these are the only keys you carry.

Why does Thrifty do this?

A manager told me that the extra remote reduces customers complaints about dead remote batteries. More importantly, he said, they lose fewer keys now that they've moved to this massive set. I assume he meant it's much harder to dash for a plane with a key in the pocket -- these suckers are impossible to forget.

Of course they could achieve the same effect by putting a 3 inch wood cylinder together with a single key. If you lost that one though you'd only pay a huge markup on a single key, instead of a huge markup on 3 keys. Maybe Thrifty's rental business is sustained by lost key fees.

Does anyone know a rental business that has a sane key chain?

I hadn't paid much attention to car-sharing alternatives to the traditional rental business. After carrying these things for four days though, I'm keenly interested.

How Google can save itself - sell privacy.

It's been 3 years since the Google-Apple divorce, eight months since Google 1.0 died, and six months since I tried divorcing Google.

Divorcing Google, but planning to go out with something else. That hasn't worked out so well; Apple in particular is exploring new domains of pain.

Meanwhile, the less-facebooky parts of Google+  are improving, even as Twitter enlists with the Sith (don't they know there can only be two?).

So I'm thinking about trying to reconcile with Google - assuming she's still into geeks. How could Google win us/me back?

Google could sell privacy.

Let me explain. In the modern world two populations have privacy. One is poor, lives on cash and checks, and doesn't have a cell phone. The other is Romney-class wealthy. The rest of us are the Transparent Society. We can't buy privacy.

That is, we can't buy it now, but Google could sell it.

Google could sell a yearly G+ privacy subscription for something like $200 year per person or $400 year per family (wild ass guesstimates). For that amount we'd have full control over what we share, and we'd opt out of all advertising and marketing. We'd still be able to opt in to ads if we wanted, and of course there'd be no shield from subpoena. We'd be able to turn on the parts of G+ we want, and disable those we don't want. We might even have the optional use of disposable avatars or identities.

It sounds like a lot of infrastructure to build for a few users, but Google needs to sell into the German and EU market. Their privacy laws are much stricter than America's privacy "suggestions". Google would also like to provide services for the under 13 group, and even in the US that requires enhanced privacy protection. So they have to build this infrastructure anyway.

At a stroke, this would rebuild Google's geek appeal. Most would decide not to pay the price, but there would be no grounds for objections -- because Google's contract with its users would be transparent.

Some of us would pay.

You can do it Google. Save yourself and we'll be happy again.

Is labor lumpish in whitewater times?

Krugman is famously dismissive about claims of structural aspects to underemployment (though years ago he wasn't as sure). DeLong, I think, is less sure.

Krugman points to the uniformity of underemployment. If there were structural causes, wouldn't we see areas of relative strength? It seems a bit much to claim that multiple broad-coverage structural shocks would produce such a homogeneous picture.

Fortunately, I fly under the radar (esp. under Paul's), so I am free to wonder about labor in the post-AI era complicated by the the rise of China and India and the enabling effect of IT on financial fraud. Stories like this catch my attention ...

Fix Law Schools - Atlantic Vincent Rougeau  Mobile

... the jobs and high pay that used to greet new attorneys at large firms are gone, wiped away by innovations such as software that takes seconds to do the document discovery that once occupied junior attorneys for scores of (billable) hours while they learned their profession..

Enhanced search and discovery is only one small piece of the post-AI world, but there's a case to be made that it wiped out large portions of a profession. Brynjolfsson and McAfee expand that case in Race Against the Machine [1], though almost all of their fixes [1] increase economic output rather than addressing the core issue of mass disability. The exception, perhaps deliberately numbered 13 of 19, is easy to miss ...

13. Make it comparatively more attractive to hire a person than to buy more technology through incentives, rather than regulation. This can be done by, among other things, decreasing employer payroll taxes and providing subsidies or tax breaks for employing people who have been out of work for a long time. Taxes on congestion and pollution can more than make up for the reduced labor taxes.

Of course by "pollution ... tax" they mean "Carbon Tax" [1]. The fix here is the same fix that has been applied to provide employment for persons with cognitive disabilities such as low IQ and/or autism. In the modern world disability is a relative term that applies to a larger population.

If our whitewater times continue, we will either go there or go nowhere.

[1] They're popular at the "Singularity University" and their fixes are published in "World Future Society". Outcasts they are. Their fan base probably explains why the can't use the "Carbon" word, WFS/SU people have a weird problem with letter C. 

See also:

• Slavery, technology, and the future of the weak 2/2012. What do you do with a labor surplus?
• DeLong, Mankiw and the Problem of the Weak 10/2006. When Mankiw was almost readable.
• Mass disability and the middle class 9/2011

Health care: We don't want more stuff, we want more years.

Stanford's Chad Jones and Robert Hall tell us health care spending really is different ...

Why Americans want to spend more on health care (Louis Johnston, MinnPost, 7/6/12)

... Income elasticity measures how much more of a good or service a person will buy if their income goes up by 1 percent. For most goods and services this number is less than 1; that is, if income rises then people will buy more of most goods but they will increase their purchases by less than 1 percent. 

Years of life are different. If you have a medical procedure that extends your life, then the first, second, third and however many extra years you receive are all equally valuable. So if your income rises by 1 percent, you will increase your spending on medical care by at least 1 percent, and possibly more.

Jones, along with Robert E. Hall (also of Stanford) embedded this idea in an economic model and found that it does a good job predicting the path of health care expenditures from 1950 to 2000. Further, they show that if this is true, then the share of GDP we devote to health care could easily rise to 30 percent or more over the next 50 years as people choose to spend more on health care to obtain more years of life.

Thinking about the rise in medical spending this way puts health care policy in a different light. People want to live longer, better lives, and they are willing to pay for it. They don’t want more stuff, they want more life...

Life extending [1] health care is an inexhaustible good. That's what simplistic happiness studies, like a pseudo-science [2] article claiming that $75,000 is "enough", usually miss. They implicitly assume, or indirectly measure, good health [3].

Years ago, when health care spending was a mere 12% of GDP (we're about 15% now), my partner, Dr. John H, saw no reason why it wouldn't, and shouldn't rise to a then unthinkable 15% or more. His point was that people like being healthy, and to the extent that health care works, they will want more of it.

Health care that is perceived to be effective is the ultimate growth industry.

That's why this is where we'll end up. We could do much worse.

[1] A shorthand for extending life that we care about, particularly life-years of loved ones. More years of dementia don't count, though significant disability has less impact that many imagine. I assume there's some amount of quality lifespan that would, depending on one's memory, have an income elasticity of less than one. Science fiction writers often put that at somewhere between 300 and 30,000 years.
[2] I read the published study; "Participants answered our questions as part of a larger online survey, in return for points that could be redeemed for prizes." Can you image a less representative population? Needless to say they didn't define what household income meant, yet they turned this into a NYT article.
[3] The Jimmy Johns' insultingly stupid parable of the mexican banker is a particularly egregious example. 

Where would I hide a military AI project?

If I were a somewhat different person, and life played out quite differently, I can imagine being a senior NSA bureaucrat.

I'd read about Google's cat-recognition engine, and the likelihood of a mouse-level AI within the decade, and I'd be thinking that the NSA needs to get there first.

Not because there's an obvious military application, but because there could be a weapon in there somewhere and because someone in China is thinking the same thing.

So I'd add a few hundred million a year to my off-budget budget; just  pocket change really. Then I'd build a data center for my testing and I'd get to a mouse level AI in six years. If I needed to I could pry the secret sauce out of Google's hands; I'm sure there a ways to do that but it's probably not necessary. Google publishes much of its AI research.

I'd build it just to see what it was like, and so I could assess the military potential.

Problem is, modern AI experiments take a lot of power and produce a lot of heat. I wonder how I'd disguise it...

How China might play the Koreas

Even by China's standards, North Korea is a hideous place.

Why does China keep it going then? Is it merely for cheap labor? A way to keep America busy? Fear that a free North Korea would inspire the Chinese people?

Or do China's rulers have another game in mind ...

Top South Korean Aide Steps Down Over Pact With Japan

... It quickly became apparent, however, that the government had underestimated South Koreans’ misgivings about cooperating militarily with Japan. Mr. Lee’s political opponents quickly seized on that disquiet to begin an election-year offensive, accusing Mr. Lee of kowtowing to Washington and, with various civic groups, likening the conservative governing camp to the past Korean “traitors” who secretly cooperated with Japan’s annexation of the Korean Peninsula in 1910...

...  he could not withstand the furor over reports that he played an important role in negotiating the pact with Japan, a country most South Koreans still view with animosity because of its often-brutal colonial rule in the early 20th century and its territorial claim to a set of islets administered by South Korea.

After the Lee government announced the deal last Thursday, accusations flew that the government was “pro-Japanese,” a far worse charge in South Korea than being “pro-North Korean.” ...

Hmm. Sounds like a country that could be turned.

Perhaps the prize in this game is separating South Korea from the West, either as a democracy or as an authoritarian oligarchy. Preferably the latter.

The prize for neutrality, or for alliance, would be unification on South Korean terms.

I wonder if NK's military leaders think this too.  I doubt they like the idea. They should be working hard to keep South Korea allied with the US.