Siddhartha Mukherjee

“The promise of bringing medical recordkeeping into the digital age was to maintain a live record of a live patient, enabling clinicians to track patient care across hospital systems and over time. Instead, we’ve been saddled with systems that cut into patient care (clinicians typically spend an hour feeding documentation into a computer for every hour they spend with patients) and, often, are too fragmented to allow a patient’s file to follow her from one medical center to another. The E.M.R., as a colleague of mine put it, is “electronic in the same sense that your grandfather’s radio is electronic.” The energized, improvisatory role of medical Twitter inevitably draws attention to what our balky, billion-dollar systems should have been providing—to the cost, in dollars and lives, of the rapid clinical learning that we’ve forgone.

It’s hardly news that our E.M.R. systems have failed medicine, and yet an executive order from New York State, issued at the end of March by Governor Andrew Cuomo, amounted to a grim epitaph: “Health care providers are relieved of recordkeeping requirements to the extent necessary for health care providers to perform tasks as may be necessary to respond to the covid-19 outbreak. . . . Any person acting reasonably and in good faith under this provision shall be afforded absolute immunity from liability.” A system designed to expedite and improve the delivery of health care was officially recognized as an obstacle.

“When the tide goes out,” Warren Buffett once said, “you discover who has been swimming naked.” The pandemic has been merciless in what it has exposed. In many cases, the weaknesses in our medical system were ones that had already been the subject of widespread attention, such as the national scandal of health-care coverage that leaves millions of Americans uninsured. In others, they shouldhave been the subject of widespread attention, because we had plenty of warning. Again and again, in the past several weeks, we’ve heard of shortages—shortages of protective gear, of ventilators, of pharmaceuticals. Yet, even before the crisis, medicine was dealing with troubling scarcities of needed drugs and support systems. Last summer, long before the pandemic, pulmonologists were raising concerns about a lack of oxygen supplies—the result of cost-cutting measures by suppliers of durable medical equipment. Competitive-bidding programs drove margins down so low that more than forty per cent of such companies—responsible for the supply of portable oxygen tanks and concentrators—went out of business. Inventory diminished; delivery times increased. Patients suffered. Neeta Thakur, a pulmonologist and researcher at the University of California in San Francisco, told me about the byzantine process (involving “ten to fifteen disconnected steps”) that was required in order for a patient to receive oxygen at home—a patient who is then at the mercy of the intermittent delivery schedules of understocked venders. The problem builds into a failure cascade: if patients cannot be discharged from the hospital because they cannot have oxygen at home, the resultant logjam delays the treatment of other patients who need those beds for acute care.”

Yet, taxpayers have spent $38B+ (!) on back door electronic medical record subsidies since 2011…..

Bruce Schneier:

“My problem with contact tracing apps is that they have absolutely no value,” Bruce Schneier, a privacy expert and fellow at the Berkman Klein Center for Internet & Society at Harvard University, told BuzzFeed News. “I’m not even talking about the privacy concerns, I mean the efficacy. Does anybody think this will do something useful? … This is just something governments want to do for the hell of it. To me, it’s just techies doing techie things because they don’t know what else to do.”

I haven’t blogged about this because I thought it was obvious. But from the tweets and emails I have received, it seems not.

This is a classic identification problem, and efficacy depends on two things: false positives and false negatives.

• False positives: Any app will have a precise definition of a contact: let’s say it’s less than six feet for more than ten minutes. The false positive rate is the percentage of contacts that don’t result in transmissions. This will be because of several reasons. One, the app’s location and proximity systems — based on GPS and Bluetooth — just aren’t accurate enough to capture every contact. Two, the app won’t be aware of any extenuating circumstances, like walls or partitions. And three, not every contact results in transmission; the disease has some transmission rate that’s less than 100% (and I don’t know what that is).
• False negatives: This is the rate the app fails to register a contact when an infection occurs. This also will be because of several reasons. One, errors in the app’s location and proximity systems. Two, transmissions that occur from people who don’t have the app (even Singapore didn’t get above a 20% adoption rate for the app). And three, not every transmission is a result of that precisely defined contact — the virus sometimes travels further.

Assume you take the app out grocery shopping with you and it subsequently alerts you of a contact. What should you do? It’s not accurate enough for you to quarantine yourself for two weeks. And without ubiquitous, cheap, fast, and accurate testing, you can’t confirm the app’s diagnosis. So the alert is useless.

Similarly, assume you take the app out grocery shopping and it doesn’t alert you of any contact. Are you in the clear? No, you’re not. You actually have no idea if you’ve been infected.

Catherine Nixey:

In the spring of 1822 an employee in one of the world’s first offices – that of the East India Company in London – sat down to write a letter to a friend. If the man was excited to be working in a building that was revolutionary, or thrilled to be part of a novel institution which would transform the world in the centuries that followed, he showed little sign of it. “You don’t know how wearisome it is”, wrote Charles Lamb, “to breathe the air of four pent walls, without relief, day after day, all the golden hours of the day between ten and four.” His letter grew ever-less enthusiastic, as he wished for “a few years between the grave and the desk”. No matter, he concluded, “they are the same.”

The world that Lamb wrote from is now long gone. The infamous East India Company collapsed in ignominy in the 1850s. Its most famous legacy, British colonial rule in India, disintegrated a century later. But his letter resonates today, because, while other empires have fallen, the empire of the office has triumphed over modern professional life.

The dimensions of this empire are awesome. Its population runs into hundreds of millions, drawn from every nation on Earth. It dominates the skylines of our cities – their tallest buildings are no longer cathedrals or temples but multi-storey vats filled with workers. It delineates much of our lives. If you are a hardworking citizen of this empire you will spend more waking hours with the irritating colleague to your left whose spare shoes invade your footwell than with your husband or wife, lover or children.

Or rather you used to. This spring, almost overnight, the world’s offices emptied. In New York and Paris, in Madrid and Milan, they ready themselves for commuters who never come. Empty lifts slide up and down announcing floor numbers to empty vestibules; water coolers hum and gurgle, cooling water that no one will drink. For the moment, office life is over.

Even before coronavirus struck, the reign of the office had started to look a little shaky. A combination of rising rents, the digital revolution and increased demands for flexible working meant its population was slowly emigrating to different milieux. More than half of the Ameri­can workforce already worked remotely, at least some of the time. Across the world, home working had been rising steadily for a decade. Pundits predicted that it would increase further. No one imagined that a dramatic spike would come so soon.

Tony Perez:

You can argue that the openness of the web has been dying for the past decade. For the web, death comes in the form of a centralization of control and power, and arbitrary authoritarian changes made for the “greater good.” 

The current state of our fear for the safety of public health has created the perfect event to push the pendulum out of balance. 

Let there be no mistake in our minds, the actions that my fellow technologists, and associated companies, are taking, and pushing, are things that society as a whole will feel in the not so distant future. 

The scariest part for me is that as a technologists, I have seen first hand what an organization can do with unfettered access to data, when the checks and balances are lost, when we believe we are the ones capable of dictating what is good for society, on their behalf, without choice, and what a little power can do to any person. 

What further amplifies the concern is that it is not government that is driving this “big brother” state of affairs, its big tech. These are entities that are not elected officials, but corporations that transcend physical and logical boundaries. They have the ability to influence what you see, what you think, and they have the ability to choose sides. 

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This was not a case of individuals selling snake oil. They were sharing their observations, and opinions. Right or wrong, is not the point. It’s the process of normal debate and discourse. They were also seasoned medical professionals.

Shortly after its release, it was removed from the platform. Because it didn’t conform to the guidance from the World Health Organization (WHO). Say what?

It seems a far stretch to remove their content simply because it doesn’t conform to WHO, and goes contrary to spirt of the examples Susan provided. In essence, YouTube is saying you are not allowed to disagree with WHO, at all; do so, and your content will be removed. But what if they are wrong? Are we not allowed to question that?

Once it’s demonstrated that a company has this level of power, how, who, draws the distinction between what government policies they conform with, and which you don’t? What happens when society as a whole disagrees? How do you say yes to state government, but not Federal? How do you tell China, Cuba, North Korea they are wrong for their censorship when we do the same thing?

Craig Timberg,  Drew Harwell and Alauna Safarpour:

A major source of skepticism about the infection-tracing apps is distrust of Google, Apple and tech companies generally, with a majority expressing doubts about whether they would protect the privacy of health data. A 57 percent majority of smartphone users report having a “great deal” or a “good amount” of trust in public health agencies, and 56 percent trust universities. That compares with 47 percent who trust health insurance companies and 43 percent who trust tech companies like Google and Apple.

“I don’t feel like they have a good track record of taking care of people’s privacy and data. And I don’t want to give them more if I don’t trust them,” said Brent Weight, 43, a Republican-leaning independent voter who runs a small trucking company in Rigby, Idaho. “Seems like every other day you’re hearing of a data breach in a big company, and they’re losing credit card information and everything else. For them to just tell us it’s going to be safe and anonymized, I’m not going to take them at face value.”

Among Americans overall, 41 percent say they both have a smartphone and are willing to use an infection-tracking app, the poll finds. Oxford University researchers have suggested that 60 percent of a country’s population would need to use a coronavirus-tracking app like this to stop the viral spread. Reduced adoption could limit its effectiveness in slowing new infections and deaths.

J Cavanaugh Simpson:

Twenty biomedical companies. Seventy nations. An aggressive search for COVID-19 treatments and vaccines is underway worldwide. Yet even 21st-century technology can’t match one man who curbed a major influenza pandemic spreading across the United States in 1957. 

Pioneering virologist Maurice Hilleman, now oft-forgotten, detected that pandemic from across the globe, convinced reluctant U.S. health officials to take notice, and single-handedly fostered a vaccine that became publicly available. All in just four months.

An irascible, no-holds-barred Montana farm boy born in the midst of the 1918-19 influenza pandemic, Hilleman survived diphtheria and Great Depression-era poverty to earn a PhD in microbiology and chemistry at the University of Chicago. Practical and impatient, he turned down the prestige of academia and primarily worked in industry, at the pharmaceutical company E. R. Squibb & Sons and later Merck & Co, where he led vaccine research for 25 years.

An iconoclast who slung swear words like the proverbial sailor, Hilleman helped develop an astounding 40 vaccines: to prevent measles, mumps, rubella, pneumonia, meningitis, hepatitis A and B, and other infectious diseases. The measles vaccine alone has saved an estimated one million lives a year. “Maurice’s genius was in developing vaccines, reliably reproducing them, and [taking charge] of all pharmaceutical facets, from research to marketplace,” biographer Paul A. Offit, MD, told the British Medical Journal for Hilleman’s obituary in 2005. The New York Times later noted that researchers credit him with “saving more lives than any other scientist in the 20th century.”