Happy accident fraud - Feds move on Aetna and other health insurers with deceptive provider listings

Happy accident frauds are emergent frauds — nobody needs to plan them. Don’t put your Disability Claims office on the fifth floor of a building with a faulty elevator to defraud anyone, just do it for the cheap rent. Then save costs by replacing your customer support staff with an automated call management system.

The insurance industry is great at emergent frauds enabled by complexity and powered by perverse incentives. It’s baked into their business model; any player who doesn’t cheat will go bankrupt.

So it’s not surprising that health insurers competing in public marketplaces have produced inaccurate physician directories. It’s not limited to public ACA style coverage, we get our Minnesota health care through an employer plan, and after we chose Aetna we discovered their oral surgery listings were fictional. They seemed to have many providers available in our area, but all the ones we called said the listing was wrong.

Why pay the costs to maintain an accurate listing when an inaccurate listing gets you customers who can’t actually make claims?

The good news is that the Obama administration is now starting to address the problem. Alas, the fines are likely to be pathetically small, we’ll need class action litigation to really change things or find ways to drive the worst offenders out of business by failure of ‘network adequacy’. (emphases mine, note the related problem of prince concealment in the industry, another part of a fundamentally murky business)

White House Moves to Fix 2 Key Consumer Complaints About Health Care Law - NYTimes.com

The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.

Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.

Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.

The new standards significantly strengthen an earlier rule, which required insurers to publish directories online and to make paper copies available on request. In the federal exchange, violations are subject to civil penalties of up to $100 a day [ed: 0.000001% of revenue?] for each person adversely affected.

Federal officials said that inaccurate provider directories could be a sign of larger problems. If doctors listed in a directory are not available or are not taking new patients, consumers may not have access to covered services, and the insurers may not meet federal standards for “network adequacy,” the officials said. Consumers must often pay extra when they use doctors outside the network of their health plan, so an inaccurate directory could also lead to higher costs for patients.

… Aetna says that data in its directory is “subject to change at any time.” UnitedHealth tells Medicare beneficiaries, “A doctor listed in the directory when you enroll in a plan may not be available when your benefits become effective.” …

See also:

• Emergence: how entropy and incentives create scams: 2009, Aetna’s FSA management - just make it hard to process a claim
• Mobile phone fraud - The accidental data charge and other scams: 11/2009. A lot of these scams have gone away during the Obama administration, thanks to more competition between carriers and a lot of regulatory action. Government can work.
• Emergence: how entropy and incentives create scams 2/2009.
• Emergent fraud: Anthem and automatic payment denials 9/2010
• Anthem - Putting the Hell in Health Insurance 8/2010
• Health insurance: we’re defeated by a complexity attack 11/2009
• Employment benefit complexity: we are sheep 11/2007
• The hidden insurance problem: they can play the game better than we can 11/2007

Alpha (the better twitter) on app.net 1 year post-death, is like this...

Alpha (the better twitter) on app.net, 1 year post-death, is like this (xkcd: Undocumented Feature  by Randall Munroe, used with permission):

I’ve read we have 1,200 active members now.

One day I’ll write a post about life in a highly transient technology environment and what this might mean. Maybe I’ll just quote Vernor Vinge.

The NYT web site is becoming unreadable on my iPhone

I subscribe to the NYT so I can go from a Feed rendered in Reeder 2.0 on my i6 to the articles rendered in mobile WedKit. I’ve gotten used to hitting an interstitial ad on initial page view, a quick back and forth clears that. (Don’t try to hit the close button, doesn’t work.) I’ve even gotten used to hitting the ‘continue’ button they’ve embedded to make things even more painful.

Today, however, articles are so infested with interlaced ads, and so slow to render, that I’m getting to the end of the road. I sent a message via the NYT subscriber web contact form:

It is increasingly hard to read the NYT on a mobile device. My iPhone is very slow to display pages, it may be related to changes made to embed more advertising.

The articles are also now broken up by ads and harder to read.

I'm really losing patience. The next step is to give up my subscription, maybe try The Economist instead.

Somebody there needs a slap on the head.

Tech bubble 2015: Billion dollar acquisitions financed by the "rent" we pay MegaCorp monopolies?

Stratchery claims retail investors are shielded from latest tech bubble because MegaCorp and Finance are buyers, not retail investors.

But why are MegaCorp (0.1 trillion and up publicly traded corporations) paying billions?

Largely, I suspect, to forestall competition and enable monopoly rent earnings. Incidentally sweeping up disruptive talent [1] as well as aborting potential corporate competitors.

We usually think of this acquisition bubble as driven by “paying you to borrow” interest rates, but it’s also being funded by the monopoly rents we pay oligopolies in the new gilded age.

When does it stop?

The ultimate limit is probably the ability of consumers to pay the rent(s)…

[1] Talent doesn’t have to be put to good use, just kept out of job market until threat expires. (*cough* secular stagnation *cough*). The corporate acquisition is intentional, the talent lock is partly an “invisible hand” class “happy accident”.

Pre-Diabetes and the Diabetes Risk Prediction Tool

Until recently the USPSTF did not recommend screening for diabetes in asymptomatic adults with BP of 135/80 or less. There’s now a draft recommendation, however, that basically recommends screening everyone over 45 plus lots of people under 45:

… 45 years or older, overweight or obesity, or a first-degree relative with diabetes. Women with a history of gestational diabetes or polycystic ovarian syndrome … African Americans, American Indians/Alaska Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders …

In other worlds, only skinny euros under 45 avoid screening.

Which makes me feel a bit better about our typically shotgun “workplace health” program. It’s been doing my fasting glucose for about 3 years. A glucose that’s consistently about 100-103 mg/dl (jumped from 82 in 2011 to 99 15 months later, which makes me wonder about something immune beating on beta cells). [2][3]

I should be under 100, typically under 90, so that’s not a good number. It’s in the “pre-diabetes” range, and the current enthusiasm is to start treatment with meds in the hope of delaying the onset of “true” diabetes. Of course there’s also the theoretical benefit of weight loss and exercise, but few people manage that. Unfortunately we know weight loss programs rarely work, and the reports of med efficacy smell dubious to me, so it’s not entirely clear how useful the “pre-diabetes” diagnosis really is. The diagnosis, of course, is likely to raise one’s health insurance costs, though ObamaCare helps somewhat.

Since I’m already a skinny fitness nut my family doc wanted to completely ignore this, presumably on the grounds that there’s nothing useful to do about it. A wise recommendation, but I’m not built that way. 

Poking around the net I found a BMJ article on a statistical model that tries to put some personalized precision medicine context around that fasting glucose. The researchers settled on 7 factors [1] that seemed to predict 3 year conversion to diabetes (yeah, only 3 year range). So I ran the Diabetes risk prediction tool on myself. 

I got 91 points; the instrument recommends consideration of preventive steps for scores of 146 and up. Which vindicates my FP’s intuition (maybe she does the instrument in her head?).

Figuring out what 91 points means for 3 year conversion to Diabetes is a lot harder. I didn’t find anything that mapped scores onto risk quartiles! The data on 3 y progression ti diabetes per quartile was, very roughly:

• 1st quarter: 10%
• 2nd quartile: 20%
• 3rd quartile: 30%
• 4th quartile: 60%

I’m guessing my odds are probably in the 25-30% range over 3 years. So pretty high over 10 years, but the bottom line is that there’s really not enough data to justify taking an (invariably) icky medicine.

So I’ll just keep playing with my glucometer [2]…

[1] The HbA1c (glycosylated Hb) value is weird in this study. Normal HbA1c is usually given as 4.0-5.9%, but in this study anything above 4 starts to pile on bad points. This could be either a sign that there’s something funky with their model, or a sign that we should redefine the normal range for HbA1c (I’m 5.2, “normal”, but on their chart it lines up with a fasting glucose of about 105).

Lastly, the paper text says “baseline fasting glucose was by far the most important predictor” which does make me wonder if the other 6 factors mean anything.

[2] Since I’m kind of curious about what’s going on I bought a glucometer on Amazon (I paid $28 or so, it’s $11 today. They make their money on the proprietary strips.) My 1-2h post-prandial glucose is identical to my fasting glucose — 103. “Normal” is less than 140. So that’s weird. Next time i’ll redo the standard sample test — maybe the glucometer is dead. Or maybe the FBG/PPG ratio is an interesting predictor  …

[3] I do idly wonder about getting a TSH (thyroid stimulating hormone).

See also

• Type 2 DM in young 5/2012: Makes me suspect something odd is going on.
• Medicine 2020: Integrative Personal Omics (iPOP) identifies RSV triggered onset of Type II Diabetes 3/2012. 
  “… The initial sequencing of his genome had also showed that he had an increased risk for type 2 diabetes … later became infected with respiratory syncytial virus, and his group saw that a sharp rise in glucose levels followed almost immediately... “. I wonder if I developed a similar infection between 2011 and 2012. 

I want a Zenith CruisePad for my iPhone

I finally realized what I want.

I don’t want an iPad.

I don’t want an aWatch.

I want a Zenith CruisePad for my iPhone …

Rather than a free-standing slate/tablet computer, the Zenith CruisePAD was a remote terminal to one's PC. It was designed to allow the user to interact with that PC's applications from a distance over a wireless network. What made it interesting to me was that it let one do so directly on the CruisePAD's screen, using either a stylus or finger.

This was an interesting approach given when it was released. In that year, 1995, neither Wi-Fi (which came into existence in 1999 with the formation of the Wi-Fi Alliance), nor the IEEE 802.11 protocols on which it was based, were available (the original version of the IEEE 802.11 standard was not released until 1997). Hence, it relied upon a proprietary 2.4 Ghz spread-spectrum radio protocol which they called CruiseLAN…

We played with tech like this at a 1990s Electronic Health Record/transaction processing startup called Abaton.com (no trace of it on the web btw, domain taken long ago). Ultimately impractical, but very cool. This was the era of the PalmPilot device, and we (ok, I) imagined walking up to a wall display and automatically switching from the itty-bitty Palm display to something real big.

That’s what I want for my iPhone. I don’t want the cost and hassle of another OS with all of the overhead of apps and licensing and bugs and DRM restrictions and updates and hacks. I just want a frigging wireless dumb display that can be shared between multiple devices. It would be nice to play video on it, but really I want to read. I’d be delighted if it used Digital Ink and cost $100 with a 1 week battery life.

That’s what I want. Google is much more likely to do this on Android than Apple on iOS; it’s the one thing that might tempt me to the Dark Side.

I wonder if Apple’s App Store rules prevent a 3rd party (Amazon?) from producing a reading app that would communicate with a Digital Ink display via Bluetooth….

The world needs a global heat map of nation-specific stress levels

I new Russia was stressed, but I didn’t know it was this bad …

G.M. Exiting Russia, for the Most Part - NYTimes.com

… Because of the collapse of the ruble in December, Russians’ incomes have plummeted: The average salary peaked in 2013 at $800 a month, and is projected this year to be about $400…

That line is buried halfway down in a NYT article on GM closing a Russian plant. I wasn’t able to confirm it in a quick search, and it’s likely ruble denominated salaries are roughly flat, but, still, that’s an amazing shift. Russia is a poor country, and given massive wealth inequality and corruption, most Russians are extremely poor by wealthy world standards. Russia remains a failed state and it’s getting worse.

Which reminds me, again, that we need a worldwide heat map of national distress levels to understand the planet we live on. Something we can glance at to see current stress levels, and click on a nation to get underlying information.

I can’t find anything like this today (maybe the CIA has one?). Instead I find World Stress Map is a “global compilation of information on the present-day stress field of the Earth’s crust”, while a search on “Distressed World Map”  finds simple maps rendered in a “distressed” style of aged paper.

That’s not what we need. We need an interactive “heat map” of nations that shows, at a glance, stress level indicators. I’m thinking of a 100 point linear scale of collapse probability, but probably it’s a non-linear “richter” type scale.

It’s not hard to come up with candidate metrics.  Economics, ecology, political science and history are full of possible indicators. Active civil war (Syria scores 100), changes in per capita income and income distribution, deterioration in air and water conditions (Egypt!), shifts in “tribal” (ex. white nationalist) power, instability in neighbors, military threats, deflation measures, employment churn, demographic transitions (birth rates, age skews), shifts in savings balances, rise of women in patriarchy — it’s basically the same list once used to model the rise of Al Qaeda.  

Someone like Randall Munroe could put up a first draft. Alas, he has a firm rule - “I don’t use submitted comic ideas”. Still, it’s the kind of thing that he does so well… 

Gordon's Laws of Acquisition updated: The Device Limit

It wasn’t the MacBook Air’s SSD problem confounded by encryption usability problems and the “Update Needed” ghost user. [2]

It wasn’t the cognitive gymnastics that connected inability to access iCloud video to Apple’s newly announced device limits. (Though once I connected this to weeks lost to iTunes sync bugs I was probably getting there.)

It wasn’t that our still warranteed AirPort Extreme Base Station acts like it has a failing power supply.

It was, finally, when the MacBook Air ran into a cyclic reboot problem. That’s when I did the math.

Our family owns 5 iPhones [1] and 3 Macs (and various iPods, but I’ll ignore those). Child #1 and #3 have school iPads. About ten devices across five users, and each user has iCloud and Google Accounts (more than 13 Chrome Profiles).  So maybe 20 or so things each of which has a 98% chance of being problem free in any particular week. How often should we have a trouble-free week?

That would be (0.98)^20, or about 67% of the time. So about 1 week in three I should run into one or more significant debugging problems. That’s pretty much what I see. I have other things I’d rather be doing.

This isn’t the first time I’ve run into this kind of complexity crunch. Until 2005 we were primarily a Windows XP household with a single lonely iBook. XP was emphatically not problem free 98% of the time. Maintenance was eating way too much of my life. I bought a G5 iMac, retired the XP machines, and, after I made it through some grim early days with the G5, life got a lot better.

So what can I do in 2015? XP was pretty bad by 2005 — I don’t have such an easy target today. I’ve already cut out a lot of services; we use a selective mix of Google Apps and iCloud with a handful of other high quality high reliability services (Pinboard, Feedbin) that only I use.

The answer, I think, is fewer devices. So instead of buying an iPhone and an iPad, buy an iPhone 6s+. If I want a new MacBook, I have to find something comparable to get rid of. If the WiFi is bad in a part of the house, I don’t buy a WiFi extender; I just don’t use the WiFi there. Over time, work towards fewer devices and services — sacrifice power for reliability.

Oh, yeah, and no (useless) Apple Watch.  Life is too short.

Fewer devices means it’s time to modify Gordon’s Laws of Acquisition (2008)…

1. Never acquire anything until you really, really, want it -- three separate times.
2. The real cost is the lifetime cost, from acquisition to disposal … think subscription — not ownership. In the modern world we don't own, we subscribe to something that's neither inert nor living. The purchase price is often the least of things.
3. Don't buy on promises or potential. Acquire for real value now. Anything in the future is a plus (or, sometimes, a minus).
4. Don't buy more than you can consume now. We all have fixed resources to acquire and adopt new things; acquisitions that sit on the shelf depreciate very quickly.
5. (new) Every purchase must reduce maintenance time and complexity, typically by replacing a less reliable device or by substituting one device for two devices.

 See also

• Why you will live in an iOS world 12/2010: “a hunch this opportunity cost is important to understanding what happened to the world economy between 1994 and 2010” foreshadowed a post from two weeks ago. Contrary to what i wrote then I think I’ll still be on OS X in 2018.
• Gordon’s Laws for software and service use 4/2010. i don’t pick up new services any more, not unless I can get rid of 1 or 2 old ones.

[1] I won’t pay for anything else. The thought of trying to maintain any other type of phone gives me hives.

[2] My blog post is still in draft. That was just 3 weeks ago.

Dinitrophenol and obesity: The NYT's curiously sparse coverage from 1933 to 1938

via Corante I came across Dinitrophenol and obesity: an early twentieth-century regulatory dilemma. - NCBI. It’s a modern article on a pre-FDA weight loss drug that worked very well.

Very, very well. Except for the death part.

Reminds me of 2015 herbal remedies, but at least most of those contain no active ingredients at all.

Since it’s from the 1930s, I thought I would be fun to look at what the NYT was writing about the drug at the time. I didn’t find as much as I expected, and at least two articles in the archive couldn’t be retrieved, but it’s interesting to look at what turned up…

TimesMachine: November 26, 1933  British Scientists Report Progress With a New Drug for Reducing Weight - NYTimes.com

Encouraging results … dinitro-ortho-cresol … five times more powerful than dinitrophenol which American physicians have been trying out clinically … speeding up rate of metabolism … Dinitrophenol is a very potent and dangerous substance … Dinitro-ortho-cresol is said to be safer …

and

TimesMachine: May 26, 1935 Drug Lowers Body Heath - NYTimes.com

Something rare in medicine, a drug that lowers temperature… dinitrosalicylic acid … attracted attention because of wide medical interest in dinitrophenol… has found wide use for reducing weight … It speeds  up metabolism … temperatures of animals dropped 7 degrees F

and

TimesMachine: October 13, 1935 Dangers in Diets (book review of Diet and Die) - NYTimes.com

.. better-known systems of reducing such as Salisbury system, fasting, vegetarianism, low protein diets, the banana and skimmed milk diet … Hollywood Eighteen Day diet, the Rocine, Hauser and Hay diets…

… thyroid and dinitrophenol preparations … fairly fast and sure methods of committing suicide …

and

TimesMachine: June 7, 1936 Deformities laid to reducing drug - NYTimes.com

… use of dinitrophenol, and the inhalation of naphthalene given off by ordinary moth balls, were described to the American Eugenics Association as causing congenital deformities…

… Women who used the reducing drug… may expect their children to be born with eye cataracts, atrophied livers or other defects…

The rest of the Eugenics Association meeting was about hereditary deformity and subnormality. A resolution to comment on the risks of dinitrophenol failed because the association dealt with heredity, not pharmacology.

and

TimesMachine: September 9, 1938 F. T. C. Attacks ‘Weight Reducer' in First Test of New Powers - NYTimes.com

The Federal Trade Commission, acting for the first time under a provision … gives … commission limited powers in stopping false advertising …order restraining Hartman chain … sales of … 281 … alleged to contain a drug which causes … blindness.

… contained a drug known as dinitrocresol …

… Senior surgeon .. stated physicians had “practically abandoned” the use of dinitrocresol or its milder congener, dinitrophenol, because of the risk that use of these drugs would tend to the formation of cataracts or even death …

Well. There’s just too much here. To unpack it all would take a rather long NYT Magazine. For example …

• Why doesn’t the NYT have more articles on dinitrophenol? It was being used in the US in 1933, but by 1938 it was already out of use because of widespread cataracts. In the course of that entire time there are less than 8 articles? (2-3 of which couldn’t be retrieved.) Did the NYT not cover medicine or health care in the 1930s? Who was writing about this stuff?
• WTF was dinitro-ortho-creso/ dinitrocresol? How could anyone think a drug that was 5x more powerful was “safer”? I assume that was mangled journalism, but what the heck did DOC do?
• Acetylsalicylic acid is better known as aspirin. First discovered in 1763 and widely used by the the 1900s. So what was the deal with dinitrosalicylic in 1935? Dropped temperatures 7F?! That’s one wicked poison.
• In 1935 vegetarianism was a considered a potentially lethal fad diet. The Rocine diet must be related to “Eating for Beauty” by Victor Rocine, 1929 including “How Iron Food Makes a Woman a Social Magnet”. (I couldn’t quite figure out what Racine was into, but he didn’t like fried foods).
• The Eugenics Association was just like you’d think.
• Why cataracts?! That’s intriguing. What was it about metabolic decoupling that led so remarkably to cataract formation? Do we understand this? Was there some kind of general accelerated aging of select tissues? Really, that’s quite fascinating.
• There’s no mention of the FDA, which FDR established in 1938. The Colman article says it took the early FDA to stop dinitrophenol, but the NYT 1938 article says use had been abandoned before the FDA was established. Instead (like today, thank you Senator Orrin @#&#$ Hatch) it was the FTC that blocked sale of a herbal remedy on the basis of false advertising. Interesting the false part wasn’t efficacy (it worked!), it was claims that the active ingredient was still popular with physicians.

Really, one could write a book. Incidentally, methamphetamine was a very popular diet drug around this time. American had fairly  effective diet drugs from 1930-1950. Maybe that’s why we seemed thinner then…

IT and productivity - two noteworthy posts from Equitable Growth

Brad DeLong, as best I can tell, does not lead the Washington Center for Equitable growth. Along with Nick Bunker he does, however, produce many of their best blog posts (RSS icon proudly displayed) - like two from a Hamilton Project Future of Work conference (intro PDF, Brynjolfsson and McAfee [1]) that I recently posted back-to-back in my app.net feed.

The first is by Brad, taken from a Larry Summers speech which explains why Summers matters (emphases mine) …

Morning Must-Watch: Larry Summers and Friends: The Future of Work - Washington Center for Equitable Growth

… we have enormous antidotal evidence and visual evidence of [modern IT/AI] technology having huge and pervasive effects … On the other hand, the productivity statistics over the last dozen years are dismal. Any fully-satisfactory synthetic view has to reconcile those two observations…

… I think it is a mistake to think of the economy as homogeneous–as producing something called “output”. As we approach these issues, an aspect that doesn’t get enough attention is that sectors through progress work themselves into economic irrelevance. … candle-making was a major industry in the 1800s, illumination is a trivial industry today…. 

We need to recognize that a sector that has rapid technological progress but of which the world can absorb only so much becomes ultimately unimportant in the economy….

…Consider two goods today: a television set, and a year at a university (or I could use a day in a hospital). The consumer price index for the latter two categories is in the neighborhood of 600. the consumer price index for the former category is 6. There has been a hundredfold change in the relative price of TV sets and the provision of basic education and health care services.

If anybody is wondering why governments can’t afford to do the things they used to do, I just gave you a big hint.

If anybody’s wondering where most people are growing to be working in the future, i just gave you a big hint.

If anybody’s completely confident we will have rapid productivity growth in the future, they should be giving pause–because no matter how much productivity we have in agriculture or illumination, it doesn’t really matter for the aggregate economy. Increasingly, that’s becoming true of a larger and larger fraction of what it is that we produce.

…  in the 1960s,= ,,,  about 6% of the men in the United States between the age of 25 and 54 were not working. Today, 16% of the men in the United States between the age of 25 and 54 are not working. It won’t be very different even when the economy is at full employment.

Something very serious has happened with respect to the general availability of quality jobs in our society.

… Whether you think it is due to technology or to globalization or to the maldistribution of political power, something very serious is happening in our society.

The second is by Nick Bunker …

What to worry about on the supply side - Washington Center for Equitable Growth

…  A new paper by economists Stephen G. Cecchetti of Brandeis International Business School and Enisse Kharroubi of the Bank of International Settlements argues that an over-bloated financial sector can reduce productivity. They contend that by drawing talented workers toward Wall Street, the finance sector lowers the total productivity rate….

From Summers we see that certain technologies have dramatically diminishing returns, so that they become a smaller part of a larger whole. Obvious, now that he’s pointed this out. There is only so much light that we can use. Is this also true of computing power? Is it true of energy?

Is Summers saying all employment will shift to expensive and inefficient health care and education? Isn’t that what Baumol said?

It’s a good exercise to consider how computational processing could follow the path of the lightbulb. There is, for me, no significant difference between a response time of milliseconds and picoseconds. Between modern processors and SSDs there seems no pressing need desktop performance increases. To some extent the human users is the rate limiting step. Only when one eliminates the human user does a millisecond vs. picosecond delay matter, as with high frequency stock “trading” (manipulation) — or the timescales of an AI.

Thinking of high frequency trading, we are reminded that vast amounts of modern economic activity transfer wealth without producing product. They have low to negative productivity, as found by Cecchetti and Kharroubi. Some of these are parasitic processes as would arise from any complex adaptive system, others are forms of more or less transparent fraud rooted in complexity exploitation. In our times information technology has been an essential enabler of both.

Considering failures of productivity enhancement, what do we make of Google Search? Ten years ago Google Search was miraculous, now it increasingly fails to produce much of value [2]. The web grew very quickly on an advertising based business model, but that model has failed and a new model is unborn. Progress is unpredictable in whitewater times.

Or consider email. We’ve been using it widely for almost 30 years, yet very few people use email well. Much time in routine corporate life is wasted by incompetent email [3]. Alas, email’s failures can’t compare to the disappointment of the “electronic health record” or “EHR”

Ahh, the EHR! What dreams we had in the 1980s. Dreams that took me from rural practice to another degree to a career in healthcare IT. It was so obvious how patients would benefit, and how all providers would become far more productive. 

The reality of the EHR has been a crushing disappointment. One day, perhaps, the dreams will come true — but nobody in 1990 would consider the state of clinical automation in 2015 anything but an appalling failure. A failure not of technology, but of business incentives, of markets, and of complex interlocking rigidities.

The list goes on. The same technology that enables location-based alerts also enables malware and adware.  Our economic landscape has been transformed; new technology causes vast wealth creation, but then wealth concentration drives the greater economy to a stagnant deflationary spiral.

Perhaps we’ve been here before. It took 60 years after the 1780 “start” of the industrial revolution for worker living standards to definitively rise. If our revolution started 70 years ago, maybe the rise will start any time now.

Or perhaps we’re headed in a different direction. An Economy is not a system for satisfying humans, or a system for producing goods or wealth or jobs. The “Complex Adaptive System” cliche truly applies. It is an immaterial ecosystem that produces things like wealth and jobs, but also emergent amoebacorp and brain sucking jobs in finance. The Economy is a beast of its own, slouching towards Bethlehem.

- fn -

[1] The PDF includes two killer graphs …

and

 

[2] While writing this post I often searched for prior posts in notes.kateva.org. Google did a poor job, Duck Duck Go constrained to “site:kateva.org” did much better.

[3] If you ever hear of a corporation that teaches employees to write effective email please let me know. I’d like to buy shares.

Related

• Global finance and parasites 9/2009
• Secular stagnation and the Beveridge curve - the role of frail boomer parents 6/2014
• Speculation: The corporate ecosystem and American stasis: corporations are players independent of their owners and managers, and they have changed our financial ecosystem the same way algae change a pond (Amaebocorp) 11/2010.
• The morality of markets - and a response to hunger 9/2010
• Baumol’s cost disease: medicine, education and post-AI disruption 10/2012
• Fraud, IT, Economics and the Depression: Galbraith is most impolite 8/2011
• Finance 2.0, Oil and Project Syndicate - entertainment 2012! 12/2011
• Fraud on Cyber: An annotated sample of Gordon’s Notes 8/2011
• Causes of the Great Recession: China, GPSII and RCIIIT. Now for Act III. 4/2010
• 21st century deception and the evolution of the emergent mind 6/2007
• The IQ of an ecosystem and other questions of emergence 5/2007 

Google and the Net 2015: The Quick, the Sick and the Dead - 7th edition

I first published a Google Quick, Sick and Dead list in January 2009, at the dawn of Dapocalypse. This was six months after the Battle of Latitude; we were well into the post-Android Google-Apple War I. By then the iPhone was big, but not as dominant as it would get.

Less than two years later, in July of 2011, Google Plus launched. Five months later Google Reader Shares vanished and Google 1.0 was declared dead. Looking back, a lot of software became ill in 2011.

Again with the damned interesting times! Since then many cloud services have been killed or abandoned. We’re growing accustomed to major regressions in software functionality with associated data loss (most recently with Apple’s Aperture). I am sure businesses struggle with the rate of change.

Looking back the 2009+ software turmoil probably arose from 2 factors, one technological and one external. The technological factor was, in a word, the iPhone. Mobile blew up the world we knew. The external factor was the Great Recession (which, in Europe, continues today as the Lesser Depression). 

Of course if you believe the Great Recession has its roots in globalization and IT (including IT enabled fraud and IT enabled globalization) [1] then it’s really all a post-WW II thing. I suppose that’s how it will look to the AIs.

Which brings me back to my Google Quick Sick and Dead series. It’s been more than four years since the 6th edition. I haven’t had the heart to update the list the way I once did — too many old friends have become ill. I’m doing an update today because I started a post on the Google Calendar iPad experience and it got out of control.

As with prior editions this is a review of the Google Services I use personally — so neither Android nor Chromebooks are on the list. It’s also written entirely from my personal perspective; I don’t care how the rest of the world sees Google Search, for me it’s dying.

With those caveats, here’s the list. Items that have effectively died since my last update are show with a strike-through but left in their 2011 categorization, old items have their 2011 category in parentheses. Items in italics are particularly noteworthy.

The Quick (Q) 

• Google Scholar (Q)
• Chrome browser (Q)
• Maps and Earth (Q)
• News (Q)
• Google Drive and core productivity apps - Docs, Sheets, Present (Q)
• YouTube (Q)
• Google Profile (Q)
• Google Translate (S)

The Sick (S)

• Google Parental Controls (D)
• Gmail (Q)
• Google Checkout (S)
• iGoogle (S)

The Walking Dead (D)

• Google Search (S)
• Google Custom Search (D)
• Google Contacts (Q)
• Google Hangout (S): on iOS
• Google Voice (D)
• Google Mobile Sync (S)
• Google’s Data Liberation Front (S)
• Google Calendar (Q)
• Google Tasks (Q)
• Picasa Web Albums (Q)
• Blogger (D)
• Google Books (S)
• Google Plus (Q)
• Buzz (D)
• Google Groups (D)
• Google Sites (D)
• Knol (D)
• Firefox/IE toolbars (D)
• Google Talk (D)
• Google Reader (S)
• Orkut (S)
• Google Video Chat (S) - replaced by G+ Hangout

A lot has happened in four years. I was surprised to see I’d rated Google Search as “sick” in 2011 — but that was the right call. In my personal experience Search has moved into the Dead zone since; I am often unable to locate items that I know exist. I have to find them by other means.

 

I haven’t adopted any new Google Services since 2011. On the other hand hand many services I thought would die have simply remained “Walking Dead”. Google Scholar’s persistence is quixotic; I figure Larry Page is personally fond of it.

 

Google Calendar is the Canary case. Four years ago Calendar was due for some updates, but it looked healthy. My immediate family members each have 1 Google Calendar; with various other family and school calendars and event feeds our total number of subscribed calendars is probably in the mid 20s. We use Google Calendar with Calendars 5.app on iOS and Safari or Chrome elsewhere. We’re Calendar power users.

 

Since 2011 though Calendars has stagnated. Google’s only “improvement” has been a partially reversed 2011 usability reduction. Today, thanks to our school district’s iPad program, I got to experience Google Calendar on the iPad without the benefit of Calendars 5 

[2]. It’s an awful experience; the “mobile” view is particularly abysmal. Suddenly four years of stagnation leapt into focus. Google Calendar is now an Android/Chrome only product.

 

Looking across the list there’s a pattern. Google is abandoning its standards based and internet services, focusing instead on Android and an increasingly closed Chrome-based ecosystem. Presumably those two will merge and Google and Apple will become mirror images. It’s unclear if anything will inherit the non-video streaming internet, or if it will simply pass into history. Maybe our best hope is that smaller standards-friendly ventures like Fastmail, Pinboard, WordPress, and Feedbin may prosper in an ecosystem Google has abandoned.

  

Damn, but it’s been one hell of a ride. The take away for me is that I need to get away from Google, but that’s easy to say and hard to do. Replacing my family’s grandfathered Google Apps services with the Fastmail equivalent would cost over $600 a year and the migration would take a non-trivial chunk of my lifespan. History is better to read than to experience, and we’re still early into the AI age.

 

- fn -

 

[1] It’s a different blog post, but widespread hacking (governments included) and ubiquitous identity theft may yet kill Internet 1.0. As of as Jon Robb predicted in 2007 the Internet itself is ailing.

[2] I haven’t been able to get my own iPad purchase past Gordon’s Laws of Acquisition. Those same laws have stopped my iPhone 6 purchase. Maybe I can justify the iPad by keeping my 5s.

See also:

• Google Quick, Sick and Dead #1 (1/09)
• Google Quick, Sick and Dead #2 (11/09)
• Google Quick, Sick and Dead #3 (6/10)
• Google Quick, Sick and Dead #4 (10/10)
• Google Quick, Sick and Dead #5 (5/11)
• Google Quick, Sick and Dead #6 (9/11)
• AvantGo RIP - memories of the roaring 90s 6/2009
• Software died three years ago. Why? 12/2014.
• Apple kills yet another photo sharing service - and generally screws up iOS photo management 9/2014
• How quickly can businesses adapt? 7/2014
• Apple and the 2013 tech world - in the doldrums 8/2012
• Project Ducky - why I’ve stopped using new Cloud services 3/2013
• Fraud and Globalization: Toy Story III 6/2007

Canopy Economics and Eco-Econ

I wrote my Canopy Economics post in 2004, and “eco-econ” in 2014 (see also). I haven’t seen these concepts filter into the mainstream, though wage stickiness in macroeconomics probably comes close. One day… (As much as Google’s zombified Blogger allows I’ve walked back and tagged old Canopy Econ posts as eco-econ)

Dynamic stability: struggle and balance in minds, brains, genomes, pregnancy, politics, ecosystems and economies

The minds we experience are based on multiple overlapping, redundant and competitive brain systems (I don’t get the term “degeneracy” btw) that can survive injury and genome bugs. Genome expression works the same way, which is why we’ve made so little progress with genomic medicine since 1994.

Human pregnancy works the same way — a dynamic struggle (war), a kind of tension control system.

American politics too — something to remember amidst the yammering and yelling and general madness - a reason for optimism.

So do ecosystems of course; and thus eco-econ says so do economies.

This is something we probably ought to think about a bit more.

Gene-environment interactions and the modesty of 2014 personalized medicine: Obesity, Reefer madness

Between 2007 and 2008 my work life got unusually exciting. Most of the time I work on software development in well understood aspects of medicine, but back then we were, once again, super-excited about genomics and “personalized medicine”. I made a couple of funded trips to meet with Stanford research teams maintaining genomic ontologies. I had a blast using exciting tools for navigating poorly maintained and unreliable massive web UI databases of gene-phenotype relationships.

At last we were going to realize the NIH predictions of 1994 — 10 years late, but better late then never.

Then the hammer fell. My 2008 post on schizophrenia [1] doesn’t talk about the work I was doing then, but it explains why we gave up. The disorders we cared about, schizophrenia, diabetes, lipid disorders, depression and so on, didn’t have a handful of generic recipes. Turns out there are hundreds, or thousands, or “recipes” for schizophrenia made up of environment (especially intra-uterine) and lots and lots of interacting genes. Even worse — lots of seemingly “normal” minds run on brains built with buggy genomics. Turned out “family” (genetic relative) history was a much more useful guide to predicting disease and treatment than genomic analysis — and that didn’t justify big investments.

Everything stopped, and then health care IT turned from the excitement of personalized medicine to the painful tedium of “meaningful use” and the more scientifically tractable domain of population health.

I still follow the field of course, and there has been slow but interesting progress …

Gene Linked to Obesity Hasn’t Always Been a Problem, Study Finds

… In 2007, researchers discovered that people with a common variant of FTO tend to be heavier than those without it. … Two copies of the gene bring 7 extra pounds — and increase a person’s risk of becoming obese by 50 percent.

… A new study shows that FTO became a risk only in people born after World War II.

… A variant of a gene called AKT1, for example, can raise the risk of psychosis — but only if the carrier smokes a lot of marijuana….

Small progress admittedly, but scientifically interesting. Exercise is good for most things — but we know that for most people moderate exercise [2] doesn’t add much to dietary control of weight. For people with the FTO gene though, exercise might indeed control weight. People with AKT1 are susceptible to persistent Reefer Madness — they really shouldn’t use marijuana [3]. In a related vein, there’s some evidence that the dementia protection of exercise is much stronger in the 14% of Americans with the APOE4 gene variant [4] than in APOE4 negative populations.

Progress — but darned slow. At this rate it will take decades to build what we expected before the year 2000.

- fn -

[1] Quite a good post, if I say so myself. I’d forgotten autism was once considered a variant of pediatric schizophrenia. We’re again merging both of those diagnostic categories.

[2] Extreme exercise is another matter, but one that’s rather hard to study. Though there is this recent NYT article on super-short higher intensity workouts that are to CrossFit as a snack is to a smorgasbord.

[3] Incidentally, marijuana legalization will be a boon to addiction medicine. Investors now include rehab clinics in the category of cannabis business opportunities.

[4] Why is a nasty gene so prevalent? The Wikipedia article mentions APOE4 helps with Vitamin D update — a particular problem in northern europeans. We presume it does have some survival advantage in some settings.

Software died three years ago. Why?

This is a weird time in software. Lots of things are going away, but few new things are appearing.

As best I can tell Windows software died around 2005. Based on what I’ve seen over the past year, particularly in the Mac App Store, OS X software died around 2011. The Chrome and Safari extensions I’ve looked for, like Pinboard extensions today, were often last updated in 2011 — around the time Google Reader died.

The iOS app store is such a well known mess that my fellow app.net (adn) geeks can’t find anything new to say, except that iTunes 12 is probably worse. Aperture died 6 months ago and yet is still being sold. Yosemite is still months away from release ready. My Google Custom Search Engines return fewer good results. Google Plus is moribund. Windows 8 might be fine but no-one I know uses it. 

I can’t speak to Android, except for second hand reports of increasing malware problems. If I strain to find a bright spot I’d say Google Maps is improving in some ways, but regressing in others. Ok, there’s the malware industry. It’s flourishing.

I seem to remember something like this in the 90s, both before and after Mosaic. Long time ago though, I may be confounding eras.

My best guess is that our software development is a lagging casualty of the Great Recession. Good software takes years to create, so the crash of 2009 probably played out in software around 2011. The effects were somewhat offset by involuntary entrepreneurs creating small but excellent products. The Great Recession’s effects started to fade in 2014, but that meant many Creatives were sucked back into profitable employment. The projects they’re working on now won’t bear fruit until 2015 and 2016.

The Great Recession is probably the main driver, but there are synergistic contributors. Apple was probably coming apart at the seams when Jobs fell ill, and it now behaves like a corporation riven by civil war. The stress of the mobile transition, and the related transformation of the software market from geek to mass user, hit everyone. I’ve little insight into how well ad-funded software development is working, but Google’s disastrous Plus effort suggests it’s not all that healthy.

The good news is that there’s hope. Google may turn away from Plus. Facebook is going to have to find new revenue streams. There’s a storm building among Apple’s customers that Cook can’t possibly ignore. Most of all, the Great Recession is fading.

Here’s to 2015. Hang in there.