Monday, November 02, 2015

Trump explained: Non-college white Americans now have higher middle-aged death rates than black Americans

From today’s NYT Health section:

Death Rates Rising for Middle-Aged White Americans. Gina Kolata Nov 2, 2015

… middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling…

… two Princeton economists, Angus Deaton… and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, they concluded that rising annual death rates among this group are being driven … by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids…

… the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans…

… The mortality rate for whites 45 to 54 years old with no more than a high school education increased by 134 deaths per 100,000 people from 1999 to 2014.

The article falls apart a bit here. What we want to know is how the absolute death rate for non-college middle-aged white Americans in 2013 and in 1999.  We want to know how the Long Stagnation has changed vulnerable Americans, but Kolata’s article mixes all white Americans with the no-college cohort.

Fortunately the PNAS article PDF is freely available, but unfortunately it explains Kolata’s problem — the data we want seems to be buried in an unlabeled parenthesis in Table 1. From that I think I can reconstruct the key information: [1]. 

YearWhite no collegeBlack (all)White some collegeWhite BA+White All
1999 601 797 291 235 381
2013 736 582 288 178 415

For the no-college White American 1999 was a pretty good year; probably the best ever. That was the era of NASCAR America and the candidacy of GWB, champion of the “regular” white guy. Employment demand was high and wages were rising. Yes, as a white guy without any college you had a shorter lifespan than the minority of white (Americans) with a college degree, but at least black Americans were even worse off. It’s always comforting to have someone to look down on.

After 16 years of the Great Stagnation though, things are different. Suicide and substance abuse have pushed no-college white mortality to the level of 1999 black Americans, yet during the same period black American middle-aged mortality has fallen substantially. White no-college Americans are now at the bottom of the heap [1].

This is why we have the inchoate white rage that thunders through the GOP. This is why we have Donald Trump.

A large and culturally powerful part of America is in crisis. A cohort with lots of guns and a history of violence. Maybe we should pay attention. Trump is a signal.

- fn - 

[1] There was no breakdown of black death rates by education; a 2012 census report said 29% of whites and 18% of blacks had a BA or higher. Since 80%+ of black Americans have no BA it’s likely no-college whites now have higher middle-aged mortality than no-college blacks.

See also

Update 11/4/2015

There’s been considerable coverage of this story, but it’s been disappointing. Both DeLong and Krugman missed the college vs. no-college white middle-age cohort, and I think that’s the important story. There’s also been some discussion of anger as a defining trait of the GOP base, but no connection to the extreme distress of their core voter.

I’ve seen speculation that this is all about narcotic overuse. I find that very hard to believe, but I admit the use of narcotics for pain relief in America has exceeded my expectations. I remember in the 90s when “pain is the new vital sign” and family docs were berated for inadequate use of narcotics. I guess my peers responded well to that feedback.

It has occurred to me that there’s a potential bias we’re missing. Over the past 40 years colleges have gone from predominantly male to predominantly female. The big story here is increasing mortality in the no-college white cohort. But if there’s been a gender shift in that cohort, say from 55% female in 1999 to 45% female in 2013, that will make the no-college numbers even more dramatic. Since mortality has increased even when college grads are included this isn’t the entire story, but it will make the no-college effect more dramatic.

Thursday, October 29, 2015

Capitalism, fraud and maximizing wantability

WaPo has a delightfully meta-subversive headline for an article about the failings of 21st century capitalism: This Kardashian headline shows why two Nobel winners say the economy is broken. Beneath the headline is a photograph of 3 reasonably attractive women and the hit enhancing text “Kourtney, Kim and Khloe — arrive at the Maxim Hot 100 party”.

Jeff Guo’s article proceeds to an interview with Akerloff and Shiller, reasonably well regarded academic economists, about their book Phishing for Phools. Unfortunately Guo does get around to the Kardashians, which blunts the beauty of the introduction. Still, it is a lovely bit of meta; boosting page hits for an article about how easily humans are manipulated in the interests of feeding their wants.

Shockingly, it seems capitalism does not optimize our better selves.

I’ll let that sink in a bit.

Sure, you think it’s obvious that capitalism is a system for finding local minima traps in a 3 dimensional field where demand is gravity and information technology enables complexity enables deception. If pressed to respond further you might say something like “tobacco”.

It’s not obvious to Americans though. Our culture equates wealth with virtue, and the “invisible hand” of capitalism with the “invisible hand” of a Calvinistic God. It’s an authoritian-dominance attractor in culture-space, and we’re not the only people to get stuck in it.

So this is an article worth scanning, if only as a marker for the fading glamor of the 1990s capitalist (emphases mine) …

… Economics predicts that wherever there is a profit, someone will be there to make it. To that, Akerlof and Shiller propose a corollary: Wherever there is an opportunity to profit off people’s weaknesses, someone will exploit it…

… The basic idea of this book is that there is a “phishing” equilibrium, in which if there’s a profit to be made by taking advantage of your weakness, then that will be there.

… The standard view of markets (which is subject to problems of income distribution and externalities) is that markets will deliver the best possible outcome.

… that’s what the standard graduate student is taught. It’s what you’re told to believe, and what I think most economists do believe. As long as the markets are competitive, and there are no problems of income distribution and there are no externalities, it’s going to lead to the best possible world…

… that then has acquired a moral tone, which is that whatever happens in the market is okay. And that translates, in turn, into people arguing and thinking that it’s okay to be selfish. That if I earn this income, then I in some sense deserve it.

So this view that whatever markets do is good becomes this idea that whatever markets do is right…

… Kirman tracing the origins of this idea back to the Enlightenment. He says, “laissez faire made a lot of sense against the background of monarchy and controlling church.” So this idea of freeing the markets really came through at a time when businesses were being particularly oppressed….

… Irving Fisher was a Yale economist who in 1918 wrote a book saying the free market system is maximizing something but it’s not what Jeremy Bentham, the philosopher, called utility. So he named it wantability.

I did a Google N-grams search [how often a word appears in books] for wantability. The term enjoyed some popularity in the 1920s and 1930s, then exponentially decayed. After the Reagan-Thatcher revolution the term was gone….

… the children’s candy bars were put at children’s eye level …You have professionals who are designing everything. They are designing it for wantability.

Reading this a part of me thinks I should get a Nobel just for my blog rants. Economists don’t think market solutions have local minima traps? It’s novel to think markets produce things that are bad for us? Stockholm, it’s not that hard to find my real identity. I would’t mind the money. You can give me another prize for canopy economics and eco-econ.

So this isn’t a book I’m likely to buy. It’s an interesting marker, however, of our changing attitudes towards market capitalism and for the intellectual history of our judgments from Adam Smith to Donald Trump. Twenty years of lousy economic growth (great for elite, awful for non-college) will do that. I’ll be looking for more signs of thoughtfulness …

See also

Learning from an Amazon "Newer Galaxy" fraud: I too am prey.

I’ve been digging into thunderbolt 2 lately. It’s an orphan technology — sure looks like Apple has given up on it. In retrospect either Apple or Intel needed to make their own hubs — in a low-trust world leaving this to dying 3rd party manufacturers was a mistake.

For now I’ve settled on the OWC Thunderbolt 2 dock. It’s not perfect, I still have suspicions about how it performs under load. I wouldn’t be surprised if I need to power cycle it every few days. Yeah, like I said, Apple needed to make this. I tested it next to an Elgato hub with similar USB 3 performance, the deciding feature was support for legacy firewire 800.

During the testing period I used a (too) short thunderbolt cable bundled with the Elgato, but that’s going back with the return. Due to a misunderstanding about Apple cable prices I decided to get a OWC 2m cable, but in a moment of weakness I ordered it from Amazon (Prime shipping, speed, etc).

That is, I ordered from an Amazon page that said OWC cable on it, via “Newer Galaxy Distribution Company”. The page looked like this:

OWC cable

Yeah, look closely, It says made by OWC and the image has OWC on it, but the page title doesn’t actually say OWC. On the other hand, the text says:

Utilizes the latest Thunderbolt chipset for high-speed 10Gb/s Thunderbolt and 20Gb/s Thunderbolt 2 devices
Enhance video workflows with support for faster 4K video transfers + 4K display capabilities via DisplayPort 1.2
1 Year OWC Limited Warranty

So I was stupid, yes, but I wasn’t completely misguided. I even inspected “Newer Galaxy”’s sales count and ratings — though I know ratings systems of this sort are almost completely fake.

Damn. I know better than this. Yes, it was Amazon Prime, but that only means the returns are easier. It doesn’t mean it’s legitimate.

This is what’s being shipped:

Shipped cable

A “2M” cable. It’s not actually a counterfeit cable at this point, it’s just not what I ordered.

There’s an upside to this experience. I can share it here for one, and every story like this is a small push for Amazon reform. Amazon returns are very easy, and for frauds like this there’s no return postage fee. (I’ll reference this blog post in the return comments.)

For another, I’ve also learned that I’m not as good at spotting fraud as I should be — I blame that on age. The data is clear that most of us become prey after age 55 or so. Prey have to learn fear, and I’m learning.

Best of all I learned that Apple has dropped its price on 2m thunderbolt cables from $60 to $40 (that price drop is probably why trustworthy alternatives have disappeared). So I’ll do that instead.

It would be good to have a trustworthy alternative to Amazon… 

Wednesday, October 28, 2015

Apple blogs: please stop confusing Apple shareholders with Apple customers

Apple made bazillions again. They won’t pay corporate tax on it. The share price has gone up.

That’s good for me in one way — I own index funds that hold Apple shares. On balance when those shares go up or Apple pays dividends I get more money. Yay for me, though I’d do just as well if the money went to, say, Microsoft or Google. My index funds own their shares too. So only a little Yay.

Whatever wealth I gain or lose from a change in Apple’s share price, however, is dwarfed by the money I spend on Apple products. Three laptops (one recently expired iMac), five iPhones, Airports, Apple TV, iTunes movies and TV shows and so on. That direct cost is exceeded by the life-time I spend managing Apple’s defects, quality issues, and nastily executed strategic killings. I think on balance I come out ahead — but some days I’m not so sure. The gap is smaller than it used to be.

As an Apple shareholder I’m mildly pleased with Apple. As an Apple customer though, I’m not so pleased. The Apple Watch leaves me cold. Using data lock customer retention while killing products (yeah, Aperture) without a replacement is just bad. The iPad should have been multi-user years ago. 3D Touch isn’t worth the cost, complexity and weight. The iBook mess. The nuttiness of putting a mechanical hard drive and a very expensive display in a non-serviceable iMac. Meanwhile Apple’s traditional 20% cost premium is turning into a 40% premium.

As an Apple customer I’d like to see Apple’s share price fall 20% - as long as one of my other funds gets the value instead. A falling share price might promote interest in existing customers.

So, Apple blogs, please stop paying so much attention to Apple’s share price. It’s just not that important to me.

Tuesday, October 27, 2015

Quicken spending spam - alert "feature"

In my mail this morning…

Screen Shot 2015 10 27 at 7 42 25 AM

During a machine transition I reinstalled Quicken 2015, so I at first thought we’d unwittingly enabled Quicken Mobile and put our finances into Intuit’s Cloud. We hadn’t, but there’s an alerting “feature” I didn’t know about that can be changed in preferences. I’ve now disabled all alerts. 

I’d prefer Intuit (current owner, but Quicken has been abandoned) not know anything about me at all. I suspect knowing about me is, unfortunately, a significant part of their failing business model.

If you don’t want this, then stay away from Intuit and Quicken.

Friday, October 23, 2015

Preventive care: what's new in the past 7 years

While studying for my 2009 American Family Medicine board exams I wrote up a summary of the American Academy of Family Practice’s preventive care recommendations. For this November’s exam I updated my old notes, so I got to see what’s changed with preventive care over the past 7 years.

There are more listings now, but most of the additions are recommendations not to do anything. HPV and cervical cancer screening recommendations still don’t consider immunization status. Screening for diabetes in pregnancy was removed in 2008 (though everyone would still do it) but it’s back in 2015. Hep C screening is recommended for at risk or born 1945-65; that’s because we have decent treatments now. I was a bit surprised that HIV screening is now recommended for everyone age 18-65 — though the screening interval is murky. Screening used to be limited to higher risk populations.

Lung cancer went from “don’t screen” to equivocal, but PSA (prostate specific antigen) went from equivocal to “don’t screen” (remember when every senior guy needed that?).

And … that’s about it. Based on the news this week mammogram screening will be further reduced but that’s not part of the official recommendations yet.

Not a lot of change.

Monday, October 19, 2015

London

This year has been a different year. By circumstance not of my choosing, but not displeasing, I’ve more personal time than usual, but also, for a time, income. So each of our children got to pick a trip with Dad. My 13yo daughter, #3, chose London. 

I was thinking Chicago, or perhaps Manhattan, but she was being mischievous, so London it was. We spent six days touring the city. By the city I don’t mean only “Zone 1”, the city of Old London and West London, but all the way out to Zone 3 and 4 — we stayed in an Airbnb in Mitcham, an utterly unremarkable bit of the megacity sprawl about 25 minutes of overground south of Blackfriars station. For my own reason I’m going to make a few notes about our experience, but these must be hasty notes. Life spins on. So they will be roughly sectioned, and made of bullets rather than paragraphs. There are two parts - impressions of the city and practicalities of modern travel.

Impressions of the City (mostly my surprises)

Emily and I spent a day or two in London about 30 years ago. That’s almost halfway to post-war London, though we didn’t think of it that way. I didn’t know much about the city, we basically visited a museum or two.

This time I was better prepared. I purchased a Great Courses (Teaching Company) audiobook course on the the History of London. It was superb; the device of replaying walks through London of various times guided our travel. My favorite travel book was Fromer’s London Free and Dirt Cheap, and my favorite map was an old map once published by London Transport, the “London Map”. It's now a secret but still available from Visit Britain. I had difficulty finding a good map of London, the era of paper maps is passing quickly. I think it is also true that the scope of London is a challenge to map makers.

It took me some time to grasp the scope of London. Guide books and most descriptions fail here. London is a mega-sprawl like Atlanta, but unlike Atlanta it has a central Core. The Core, better known as Zone 1, is morphing from a place where people live and work and visit to a place where people work and visit — but do not live. Zone 1 is a kind of urban singularity — bending light and threatening to fall out of the scope of normal human interaction. The expenses of operating there are pushing food and recreating prices out of the scope of most humans, but it still defies gravity. Last year was another record breaking visitor year. Older museums remain free — but that accessibility seems to be at risk. Newer museums, and even some older ones like the Monument (to the Great Fire) charge high fees. On the other hand perhaps part of London’s modern attraction is the opportunity to watch the wealthy at play, a kind of zoo for bankers and billionaires.

London has some attractive and charming areas — we visited many of those. I think it has less than many European cities though, probably less than Leeds. It is a city of power and commerce, thrusting and urgent. The 19th century swept away much of old London, rebuilding in a confusing array of faux-oldness that recalls the changes of modern Beijing. WW II destroyed a lot, and rebuilding was rough. A bit, as is often noted, like the rapid reconstruction after the Great Fire. For a city with a lot of history London has some of the ahistoric callousness of Los Angeles.

Happily, London is also a city of vanity and show. We only walked through the theater district, but we did visit most of the “great” museums. No irony in those quotes, they are everything they claim to be. (Note to British Museum — please get some local banker to cough up 50 million quid so you can affix an artist’s picture of what the artifacts would have looked like with paint and context. Also, London’s Chinatown rarely gets a mention, but it has great food in the midst of the theaters.)

I’d read that London real estate was emptying out — that empty rooms are traded by billionaire speculators who want a bolt hole or a spot to stay when doing business. That felt true, but also lazy. This is true of Zone 1, which is not so large, and, I suppose, bits of Zone 2. There’s a lot of London where billionaires don’t go. We stayed in one of those parts, and traveled far East to visit the Dr Who Shop in another. (Our itinerary was largely set by my daughter, with a focus on Dr Who and Harry Potter and a bit of Sherlock. And shops — especially museum shops.)

This wasn’t our original plan, but I wanted to stay in a quieter place where we could visit grocery stores and save money and sanity by making our own breakfast and dinner. That meant Airbnb, and thanks to a bit of a mixup of mine we ended up in an utterly generic and relatively distant part of the London of Ordinary People. A place of vast sprawls of narrow homes and many languages — our particular area seemed to specialize in blue collar English, Poles and other Slavs, and 3rd generation south Asian. A similar region out East was more Islamic. Learning our residential neighborhood was one of the more remarkable parts of the visit. I think by British standards these are somewhat scary neighborhoods, but we are urban Americans. They are benign by our standards.

Londoners smoke. This really surprised me. Americans don’t smoke, particularly after teenage years. I felt like I’d taken a Tardis back to my childhood — adults of all ages smoking in the streets, but at least not indoors. My daughter was shocked. I wondered if part of this came from migration from cultures were smoking is widely accepted, but I feel it’s also a part of local culture — much as cocaine use was part of 1970s America. The urban air quality is also poor by our standards. 

Other surprises — how car-centric London is. Capacity pricing works, so the cars do flow, but they flow at full capacity all the time. Which is, really, a triumph of the market. A market triumph with an unintended consequence; a city full of wealthy drivers who pay heavily to drive is a city that will be utterly dominated by the car. I’d gotten a hint of this from reading a London Bicycling blog, but it was still a surprise given London’s reputation as a walking city. We walked 8-12 miles every day, and the streets are very crowded with walkers even in the off-season, but all of us pedestrians are second class. There are no crosswalk laws (de jure or de facto) — one crosses if a car allows or between gaps in cars. The city is not friendly to the weak — walkers need to move quickly and be alert.

The transit system does it’s part to screen out the unfit — “mind the gap” is a serious warning. Getting on and off the tube is similar to boarding a bus or train — only a few places can handle a wheelchair. Many tube stations work on escalators or stairs alone. There is nothing like the American accommodations for disability, even the much weaker Canadian accommodations.

Despite all of this, there are many cyclists. They are, however, serious commuter cyclists. With the exception of a few suicidal tourists on Santander cycles they are fast and fit cyclists wearing high visibility clothing and moving, when possible, in coordinated packs. There is no room to pass, bicycle commuting in London is a blood sport. Aside from a dull path through Hyde Park we saw no protected bicycle lanes — nothing like our home town of St Paul, much less Minneapolis, much much less Munich. They ride, I presume, because there are many transit advantages to London bike commuting, and because traffic often moves at the speed of a fast and fit cyclist.

London is much less safety conscious than an American city (perhaps our safety fetish is a response to our violent culture?). We are used to doors that open outwards for fire exit, in London doors open in and out. Some tube stations would be death traps in an emergency. The cars move slowly but implacably. The infrastructure is a mix of expensive deluxe (Heathrow Express from Paddington is a touch of wealth) and less-expensive-but-still-not-affordable rickety. Google Maps was brilliant at rerouting around broken underground links — the London transit network needs its switching redundancy.

Incidentally, some of the core attractions in London are effectively unavailable to normal people. My daughter wanted to do High Tea at the Ritz — but those tickets appear to be entirely purchased 6 months out, presumably by hotels. Same thing with theater tickets — I think if you want do theater you need to queue at Leicester square for the last minute openings. We did our High Tea at Fortnum and Mason instead — which worked well. 

Practical and Geeky Things I learned (in bullet points, because geeky)

  • Google Maps for iOS and web are magical. I knew that, but in London, particular given our remote Airbnb residence, we depended very much on Google maps and ThamesLink.app. From ThamesLink we reviewed “overground” trains from Tooting station to Blackfriars, then used Google to evaluate transit options at various times or on the fly. When creating walking tours we could add point-to-point direction and have Google pick interesting routing and show us geographically related transit options. It’s not quite perfect — I’d like to be able to mix transit and foot connections when plotting routes — but it is a kind of magic only the old can appreciate.
    Screen Shot 2015 10 14 at 6 22 16 PM 
  • I thought we’d put in a SIM card and connect to London’s GSM network. Our hosts picked up a set of SIM cards for us to try, but I discovered that we couldn’t activate online them with an American credit card. We’d have had to visit something like a Carphone Warehouse and buy a GB there, or perhaps pick up a card at Heathrow. Instead we used AT&T’s Passport option. At roughly 0.25/mb it’s not cheap, but that’s nothing compared to London transit costs — and we didn’t feel like spending an hour getting kitted out. I locked down cellular use and turned on Data Roaming only when needed - usually for a Google Maps consult. The museums often have quite good WiFi, in the end our data costs were modest. London has some sort of citywide WiFi but it never worked for us, it’s just a source of interference. I found i was getting low speed 3G data until I allowed a Carrier Profile update; after that I had LTE. (There’s more complexity with GSM swaps than most of us imagine. I see why smart people don’t swap GSM cards but instead purchase a mobile hotspot device and swap cards in that.)
  • Google Drive kind of sucks if you don’t have a constant data connection. It’s very awkward to force documents to be locally stored on an iPhone. I’m migrating to Dropbox for a variety of reasons, but for this trip I’d plot out our walking plans on my laptop using our Airbnb host’s excellent data connection, then print with maps to PDF in Google Drive, then on my iPhone I’d migrate the PDF to iBooks. Awkward, but it worked.
  • I mentioned listening to the Great Course on London history (hint: much cheaper to buy via iTunes from Audible than from Teaching Company). I wish I’d created a short reference outline of English history in Simplenote that I could hang things off of. A list of key London events, related rulers, etc.
  • We traveled with my 2015 MacBook Air (non-Retina and I love it), two iPhones and one iPad. Instead of hassling with lots of chargers I brought a 5 device charger (Anker makes good ones), a single UK plug adapter, and a simple 3 outlet extension cord. Worked perfectly. (Of course voltage adapters are no longer needed, with a few exceptions modern devices switch between 110/200 automatically.)
  • I’ve had my issues in the past with Airbnb, but this time it seems to have worked out well. Airbnb encourages use of their system for communication between host and guest, but I wasn’t getting much in the way of responses that way. Once I started using direct SMS/iMessage instead the problem resolved. Young folk don’t do email.
  • London is a city of Apps. Apps for transit, Apps for museums, etc. Pick up a few. I wish I’d tried History Pin.app or Localscope.app (or the equivalent) but I more or less forgot I had them.

Sunday, October 18, 2015

Managing the TBs of videos and photos the kids produce

The kids generate a lot of images and video. Some of it I want to keep, other material is of temporary interest (instagram shares mostly), a lot of it is accumulated because, for them, storage is free. Meanwhile we’re overflowing our backup capacity — I just bought an 8TB Synology to replace a defective Time Capsule (4TB RAID 1)

The new policy is I put the media into dated folders on the server share. I quickly review my daughter’s images for things to add to our family archive (in Aperture, and, yes, I hate Apple). The kids have until the date on the folders to review the images for anything they want to keep. After that date I delete them.

I wonder what others do with this torrent of media. I suspect it just gets lost. There is a reason Apple gave up on Aperture — the entire market for amateur photo (much less video) management seems to be dying. Reminds me of the passing of personal finance software.

The "Paperless billing was requested" (minor) scam -- AT&T edition

I got this AT&T text message the other day...

Screen Shot 2015 10 18 at 7 21 02 AM

Except, of course, I never requested paperless billing. I suppose I should have for purely ecological reasons, but Emily prefers the paper copy. It’s her workflow — and modern email is unreliable for many people (flow control is the big issue).

I suspect this was a side-effect of some minor service agreement, like accepting AT&T’s recent (unexpected) increase in our mobile share data allowance. AT&T is showing a bit of its old dirty tricks here (they are generally much reformed), especially the requirement to correct this by (ugh) making an (ugh) phone call.

I will probably accept this one — it feels like a battle not worth fighting. AT&T isn’t alone in this sort of thing, corporations have become quite clever at tricking customers into accepting paperless billing — without, say, offering to share the savings.

Friday, October 09, 2015

The eBook is dying. I'm the only person on earth who blames the DRM.

My main workaround for eBook misery has been to buy from Google Play, strip the Adobe DRM, and store the ePub (really should be written EPUB but nobody does that) files in folders in Google Drive.

I do this because Apple is incompetent and, among other things, can’t produce a workable iOS eBook reader (Wait, audiobooks are now worse). A set of folders and descriptive file names is the most scalable solution we can manage across iOS and OS X. Yeah, I could leave Apple — if I cut off my right arm. Apple and Google live and breathe customer lock-in, and i’m well locked.

Since iOS 9 and some Google Drive update this no longer works. It still works for dropbox, so this is probably Google’s fault.

Nonetheless, it makes eBooks suck even more. 

Which brings me to those recent articles pointing out that people now buy paper books, not eBooks. I’ve read explanations ranging from mystical beauties of paper to the high cost of digital books. Nobody mentions the DRM (FairPlay, Adobe, etc) and the data lock, including proprietary file formats, that block development of decent cross-platform eBook solutions.

I feel like a raving loon. Or like the sighted man in the country of the blind ranting about the approaching lava flow.

Damnit Jim, it’s the DRM. 

How data lock destroys the customer experience - Apple edition.

But for FairPlay, I would not use iOS 9 audiobooks. I wouldn’t swear every time it loses its place. I wouldn’t be pissed at Apple.

But for proprietary data formats I would not use Apple Aperture. I wouldn’t be pissed at Apple.

And so on.

Thursday, October 08, 2015

Rheumatic syndromes remind me of pre-quark particle physics

This mornings board review included looking at the evolution of “inflammatory osteoarthritis” from 1970 to 2015. What was once described as an acute “inflammatory” (suddenly red and painful) form of osteoarthritis was later reformulated as “erosive osteoarthritis”, “psoriatic arthritis” and some vaguely described disorder that gradually morphs from osteoarthritis to rheumatoid arthritis — not to be confused with seronegative arthritis.

Bah. Humbug. It’s as bad as our mushy and obsolete classifications of neuropsychiatric disorders.

Unlike the neuropsychiatric disorders (autism, schizophrenia, etc) though, the rheumatic syndromes remind me of pre-quark partial physics. Lots and lots of fermions (neutrons, protons, etc etc) with mysterious distinctions; understanding the composing quarks brought a sort of sense to the world. Perhaps one day we’ll learn that seemingly distinct rheumatic syndromes are combinations of underlying simpler pathologies that in different contexts (microbiome, immune system etc) seem to make up different disorders...

Ok, not a great analogy. Just a thought. Classifications are powerful though, and that means they can be misleading — and harmful.

Update: On a quick literature scan it looks like psoriatic arthritis treatments (TNF inhibitors) haven’t worked that well for erosive osteoarthritis, which does suggest that inflammatory arthritis split is clinically meaningful...

Friday, October 02, 2015

Fixing a painful wrist with high frequency weightlifting and wrist hyperextension. WTF.

In the spirit of my medical anecdotes, I present my left wrist.

Late Monday afternoon, while typing, I developed sharp pains in my left wrist. It hurt! I couldn’t type, though changing wrist position with a gel pad helped. Maybe, I thought, it was something with some recent mountain biking. Or maybe it was the high intensity CrossFit cleans I was doing. Whatever, it was obnoxious.

So I sort of splinted it with my weightlifting wrist wraps and then I waited to see what it would do.

It kept hurting, but another mountain bike ride didn't make it worse.

Maybe, I think, it’s an inflammatory arthritis of some kind. I’ve a family history and some intermittent personal history to worry about. Who knows.

I go to my morning CrossFit anyway. (Hmm. I wrote that one at 54. Now I’m 56…) Today the workout is muscle cleans and push press — about 180 of em. Great. That’s gonna hurt. I do the first 80-90 with a straight wrist, which is extra work. Then, between sets, I realize my wrist isn’t hurting any more. I do the next 90 with the usual wrist extension.

There’s some mild aching as the endorphins fade, but then nothing. Twelve hours later it’s slightly sore with unusual motions. [1]

If a patient came into my office with wrist pain back in the 90s I might have recommended ice, a splint at night, and some gentle range of motion exercises. Today somebody smarter might suggest something like the Dynaflex Pro. I don’t think anyone would recommend high intensity high repetition wrist extension weightlifting.

That’s what helped though.

I do not understand my increasingly aged body, and I don’t think I’m the only mystery. I suspect nobody really understands joints and backs. Once upon a time we recommended bed rest for sore backs, then we recommended activity and exercise;  I personally did well with relatively intense weight and flexibility training. More recently, mountain biking made my anterior knee syndrome slightly worse, but deep squats seemed to have no effect and conventional rehab seems to have helped. Today there’s the wrist.

Pity the poor physician who has to make a recommendation for someone’s sore wrist. It doesn’t work to say “I really have no idea”. It would be nice to know what’s going on though.

[1] I can make up a theory. I have reason to suspect I’m prone to dumping calcium into sore tendons and tissues — a counter-productive response that promotes inflammation. Bad genes I guess. Maybe the vigorous activity promoted clearance of some local calcium deposits. Maybe a stuck tendon sheath loosened up. Maybe the gods had mercy...

Update 5/1/2023: Almost 8 years later I can see this was probably the start of wrist involvement in my mixed-type arthritis. It became an on and off problem over the next 8 years. I'm on HCQ to slow progression and the symptoms seem to be dose responsive. It's annoying but not bad. When it's more bothersome I do "true pushups" or ring pushups or more reps at lower weights.

Thursday, October 01, 2015

No, Apple News.app is not necessarily evil. Why do you ask?

[When first wrote this I chose an article, that, by chance, didn’t have a redirect to the original site. Which means I got things a wee bit wrong. Sirshannon gently corrected me. So now a bit of a rewrite …]

Viewing what I thought was a NYT article in News.app (turns out to be an Apple article that showed up on NYT page, which is kind of interesting) I can use Pinner.app 4.0 to create a Pinboard: Bookmark. That bookmark includes a URL like this:

https://apple.news/ABLDsKpUXSOafJmAr1FFtNg

From Pinboard app.net pourover and IFTTT (still around) share that link and my comment to app.net, twitter and my kateva.org/sh personal archive.

So far, so open. But what happens next?

If you access the particular link on an iOS device Apple launches News.app and you can view it there — both Safari.app and Chrome.app do the same thing.

If you access the link anywhere else you get this:

Screen Shot 2015 10 01 at 8 03 38 AM

However, that’s not the end of the story (thought I thought it was). This link, opened in a web browser, redirects to a web page:

https://alpha.app.net/sirshannon/post/65149315#65148990

Apple does not redirect to the web version of the article. With NYT and other sources I chose one can open the News page in Safari.

This isn’t is surprising for two reasons. The first is that, even more than Google, Apple is all about Roach Motel class lock-in. The second is that, unlike the RSS of old, News.app has a viable ad-funded business model. Links to the open (perennially dying) web don’t fit that model.

So, despite my dire expectations, Apple, for now, is providing redirects to the web source. This doesn’t mean Apple will never interfere with the distribution of information that would hurt Apple’s business or offend its executives, and my confusion between NYT and Apple content is a bit weird (user error?), but for now News.app isn’t necessarily evilI’ll be staying with Reeder and the lost mist-enshrouded all but forgotten Shangri La of RSS, Feedbin and Reeder until the last link dies  I’ll be experimenting with sharing News.app articles from it via RSS, Feedbin and Reeder ...

Wednesday, September 30, 2015

History: the printer has passed

First they came for the photo printer.

Then they came for the ink jet.

Now they’ve come for the rest.

Amazon return package label printing now includes ‘email to a friend’ and ‘request label by mail'

Screen Shot 2015 09 30 at 11 38 19 AM

Yes, mail. Handled by people.

End an era, yes, but which era? 

Thirty years back — when we all had dot matrix printers?

One hundred and fifty years back, when typewriters became common?

Or do we go back to when paper became common in homes ...