Categories

Above the Fold

“Truth, Justice and The American Way” – Chris Reeve on Donald Trump.

By MIKE MAGEE

As we approach the 20th anniversary of the death of Christopher Reeve, I’m drawn back to the evening of September 25, 2002, and a private conversation in a back room off the ballroom of the Marriott Marquis Hotel. As we awaited the ceremonial beginnings of the Christopher Reeve Paralysis Foundation Benefit Gala that evening, he said, “What I didn’t expect was that in this country, home of ‘Truth, Justice and the American way,’ hope would be determined by politics.”

That sentiment was, no doubt, fresh in his mind, having just appeared in his book, “Nothing Is Impossible: Reflections On A New Life” (Random House), a week earlier. And it was top of mind last month while (with millions of other Americans) I awaited a verdict in the New York trial of Donald Trump.

A month earlier, Smithsonian Magazine had run a feature on the first issue of the Superman comic book. The original copy of the 1938 “Action Comics No. 1” had just sold for $6 million at auction. A large part of that value tracked back to Chris Reeves himself – the enduring image and voice of Superman – a genuine American hero.

The famous slogan, “Truth, Justice, and the American Way”, however did not appear in that first publication. It surfaced later, in the early 1940’s comic books, written by Jerry Siegel and Joe Shuster, “to cheer on American military efforts in World War II.” Its use waxed and waned over the next three decades until 1978. That’s when the Richard Donner film “Superman: The Movie” was released starring Christopher Reeve. As the Superman Homepage News acknowledges, it was thanks to Reeve’s performance that “the ‘Truth, Justice and The American Way’ motto was really cemented in popular culture for generations to come.”

In a controversial move, at the DC FanDome on October 21, 2021, DC Publisher Jim Lee announced that Superman’s motto “Truth, Justice and the American Way” would be “evolving.” “The American Way” would now be replaced by “a Better Tomorrow.” A press statement elaborated that the move was made “to better reflect the storylines that we are telling across DC and to honor Superman’s incredible legacy of over 80 years of building a better world.” Rolling Stone was given a slightly different spin by DC Comics which said, “Superman has long been a symbol of hope who inspires people from around the world, and it is that optimism and hope that powers him forward.”

Whether commercial, philosophical or political in motivation, now two years later, as Trump self declares his own “Superman-status” its worth contrasting two very different versions of “the American way.” As NewYork Magazine reported in 2012, “Among the many laughably unrealistic images in the Donald Trump NFT collection, one stood out: the illustration of the former president in the classic Superman pose, ripping open his dress shirt to reveal a superhero costume underneath. Trump used this image, which was animated to show lasers shooting out of his eyes, to tease a ‘major announcement’ on December 15, which turned out to be a collection of 45,000 digital trading cards. ‘America needs a superhero!’ Trump proclaimed.”

Continue reading…

Oh. Never Mind

By KIM BELLARD

You may have read the coverage of last week’s tar-and-feathering of Dr. Anthony Fauci in a hearing of the House Select Subcommittee on the Coronavirus Pandemic. You know, the one where Majorie Taylor Greene refused to call him “Dr.”, told him: “You belong in prison,” and accused him – I kid you not – of killing beagles. Yeah, that one.

Amidst all that drama, there were a few genuinely concerning findings. For example, some of Dr. Fauci’s aides appeared to sometimes use personal email accounts to avoid potential FOIA requests. It also turns out that Dr. Fauci and others did take the lab leak theory seriously, despite many public denunciations of that as a conspiracy theory. And, most breathtaking of all, Dr. Fauci admitted that the 6 feet distancing rule “sort of just appeared,” perhaps from the CDC and evidently not backed by any actual evidence.

I’m not intending to pick on Dr. Fauci, who I think has been a dedicated public servant and possibly a hero. But it does appear that we sort of fumbled our way through the pandemic, and that truth was often one of its victims.

In The New York Times,  Zeynep Tufekci minces no words:

I wish I could say these were all just examples of the science evolving in real time, but they actually demonstrate obstinacy, arrogance and cowardice. Instead of circling the wagons, these officials should have been responsibly and transparently informing the public to the best of their knowledge and abilities.

As she goes on to say: “If the government misled people about how Covid is transmitted, why would Americans believe what it says about vaccines or bird flu or H.I.V.? How should people distinguish between wild conspiracy theories and actual conspiracies?”

Indeed, we may now be facing a bird flu outbreak, and our COVID lessons, or lack thereof, could be crucial. There have already been three known cases that have crossed over from cows to humans, but, like the early days of COVID, we’re not actively testing or tracking cases (although we are doing some wastewater tracking). “No animal or public health expert thinks that we are doing enough surveillance,” Keith Poulsen, DVM, PhD, director of the Wisconsin Veterinary Diagnostic Laboratory at the University of Wisconsin-Madison, said in an email to Jennifer Abbasi of JAMA.

Echoing Professor Tufekci’s concerns about mistrust, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told Katherine Wu of The Atlantic his concerns about a potential bird flu outbreak: “without a doubt, I think we’re less prepared.” He specifically cited vaccine reluctance as an example.

Sara Gorman, Scott C. Ratzan, and Kenneth H. Rabin wondered, in StatNews, if the government has learned anything from COVID communications failures: in regards to a potential bird flu outbreak,  “…we think that the federal government is once again failing to follow best practices when it comes to communicating transparently about an uncertain, potentially high-risk situation.” They suggest full disclosure: “This means our federal agencies must communicate what they don’t know as clearly as what they do know.”

But that runs contrary to what Professor Tufekci says was her big takeaway from our COVID response: “High-level officials were afraid to tell the truth — or just to admit that they didn’t have all the answers — lest they spook the public.”

Continue reading…

Welldoc–Anand Iyer & Marina Dorotheo demo the latest!

Welldoc is a consumer facing tool that has been around a long, long time in the diabetes management space. It was the first company to be certified by the FDA as Software as a Medical Device, and it has moved into wide range of diseases as the consumer front-end for many organizations. Welldoc itself is hiding behind the scenes in most of these relationships but it has grown steadily and not had to raise money since 2016. A few weeks back I grabbed Anand Iyer, Chief Analytics Officer and & Marina Dorotheo, Chief Marketing Officer who also runs strategy. We had a long chat about the state of the market, the company and they showed me an extensive demo (9.40-32.00). If you haven’t caught up with this sector lately, this is well worth a detailed look.

Cost Containment Through Health Improvement

By BEN WHEATLEY

The U.S. is in the midst of an ongoing—and still expanding—health care cost crisis. Even among people with health insurance, medical debt has become a persistent problem. Top executives at nearly 90% of large employers believe the cost of providing health benefits to employees will become unsustainable in the next 5-10 years. And the nonpartisan Congressional Budget Office (CBO) is warning that expanding federal debt—driven largely by health expenditures and compounding interest payments—indicates that a major fiscal crisis is looming.

On this last point, it is true that reputable people have been predicting fiscal collapse for many years. In 1988, Benjamin Friedman wrote that we’re facing a Day of Reckoning. Pointing to the rising federal debt, he said: “we are living well by running up our debt and selling off our assets. America has thrown itself a party and billed the tab to the future.”

Peter G. Peterson wrote a book in 1993 called Facing Up: How to Rescue the Economy from Crushing Debt and Restore the American Dream. In it, he said that “runaway medical costs are the single most important reason that federal spending and federal deficits have now become ‘uncontrollable.’”

Not everyone agreed that deficits and debt were problematic. In 2003, as Republicans were pursuing further income tax cuts, Vice President Dick Cheney declared: “Reagan proved that deficits don’t matter.”

David Stockman was Ronald Reagan’s first budget director and one of the chief architects of the Reagan Revolution—a plan to cut taxes and reduce the size and scope of government. He wrote in The Triumph of Politics that the Reagan Revolution failed because the administration had not been able to control spending, leading to massive increases in the federal debt.

In 2013, Stockman wrote a book called The Great Deformation: The Corruption of Capitalism in America. He said that during the Great Recession, the Federal Reserve Bank had carried out “the greatest money-printing spree in world history.” Between 2004 and 2012, 70 percent of rising U.S. debt was absorbed by central banks. He said that “the world’s central banks have morphed into a global chain of monetary roach motels. The bonds went in, but they never came out.” He concluded that it was easy money, which the Federal Reserve System had supplied for decades, that was responsible for “deficits without tears.” “American politicians…had essentially died and gone to fiscal heaven.” They were able to spend money “without the inconvenience of taxing.” Both Democrats and Republicans have taken advantage of this changed reality.

In 2020, Stephanie Kelton wrote a book called The Deficit Myth: Modern Monetary Theory and the Birth of the People’s Economy. In it, she called for a paradigm shift: since the U.S. has the ability to print its own money, we should recognize that federal spending is not financed by tax revenue or borrowed funds. Whenever the need is pressing enough (e.g., warfare), we can and do supply whatever money is needed. The real deficit, she said, is not the fiscal deficit, but societal needs that are going unmet. Regarding health care, “our failure to provide proper insurance and care for every American is not because the government cannot ‘afford’ to cover the cost.” It’s just that we are operating under the wrong budget paradigm.

Importantly, though, Kelton wasn’t saying that there is a free lunch. She wrote, “It is possible for the government to spend too much. Deficits can be too big. But evidence of overspending is inflation, and most of the time deficits are too small, not too big.” This dovetails with David Stockman’s concerns about unsound money. And it mirrors the concerns of the CBO, which has said that a fiscal crisis would involve higher rates of inflation and an erosion of confidence in the U.S. dollar.

Containing Health Care Costs

If the CBO is to be believed, deficits and debt do matter. And although there have been “Cassandras” saying the sky is about to fall for many decades now, there may come a point in time when the need for cost containment becomes immediate and vital. (Some would argue that we’re already there.) Health care is a primary driver of fiscal deficits and, in an emergency, it would become a primary target for budget savings.

In this context, cuts to Medicare and Medicaid become a central focus.

Continue reading…

Who Needs Humans, Anyway?

By KIM BELLARD

Imagine my excitement when I saw the headline: “Robot doctors at world’s first AI hospital can treat 3,000 a day.” Finally, I thought – now we’re getting somewhere. I must admit that my enthusiasm was somewhat tempered to find that the patients were virtual. But, still.

The article was in Interesting Engineering, and it largely covered the source story in Global Times, which interviewed the research team leader Yang Liu, a professor at China’s Tsinghua University, where he is executive dean of Institute for AI Industry Research (AIR) and associate dean of the Department of Computer Science and Technology. The professor and his team just published a paper detailing their efforts.  

The paper describes what they did: “we introduce a simulacrum of hospital called Agent Hospital that simulates the entire process of treating illness. All patients, nurses, and doctors are autonomous agents powered by large language models (LLMs).” They modestly note: “To the best of our knowledge, this is the first simulacrum of hospital, which comprehensively reflects the entire medical process with excellent scalability, making it a valuable platform for the study of medical LLMs/agents.”

In essence, “Resident Agents” randomly contract a disease, seek care at the Agent Hospital, where they are triaged and treated by Medical Professional Agents, who include 14 doctors and 4 nurses (that’s how you can tell this is only a simulacrum; in the real world, you’d be lucky to have 4 doctors and 14 nurses). The goal “is to enable a doctor agent to learn how to treat illness within the simulacrum.”

The Agent Hospital has been compared to the AI town developed at Stanford last year, which had 25 virtual residents living and socializing with each other. “We’ve demonstrated the ability to create general computational agents that can behave like humans in an open setting,” said Joon Sung Park, one of the creators. The Tsinghua researchers have created a “hospital town.”

Gosh, a healthcare system with no humans involved. It can’t be any worse than the human one. Then, again, let me know when the researchers include AI insurance company agents in the simulacrum; I want to see what bickering ensues.

Continue reading…

Jody Tropeano, HLTH

Jody Tropeano is the head of content at HLTH which has become an extraordinarily large conference in digital health (12,000 attendees last year!). I met with her recently in New York to talk about this year’s conference and HLTH’s role in setting the agenda for digital health and the rest of health care. You can find out more about HLTH at www.hlth.com/2024eventMatthew Holt

Blue Shield CA, CVS Caremark & the mystery of the extra $116, with 2 UPDATES (at the end)

By MATTHEW HOLT

Today we’re going to have fun with show and tell. I’m going to show you how a little corner of American health care is making my life as a consumer worse and more expensive–hopefully someone can tell me why.

The cast members are: me, my MD, the (sort of) independent pharmacy that delivers, Alto, and my insurer Blue Shield of California and its PBM CVS Caremark, which also owns a mail order pharmacy.

The brief backstory: For some years my doctor has been whining about my high cholesterol, and a few years back I went on a statin called Rosuvastatin Calcium. Older readers may remember Jean Luc Picard himself advertising the branded version Crestor, but it’s been off patent for about a decade. About 50 million Americans now take a statin, almost all of them a generic, including many 60 year old males like me. My cholesterol has come down, but my MD told me it could come down more, so a few months ago we boosted the dose to 40mg from 20mg. 

Until recently I’d been insured by BCBS Massachusetts, and you might recall a little over a year ago I wrote a piece on THCB about the fun and games to be had trying to figure out what their PBM (CVS Caremark) was doing with the pricing of my kid’s ADHD medication. But they’d never messed with my medication as my statins are cheap. At least I thought they were. In fact as recently as April last year, they were free. You can see the price from the delivery from Alto Pharmacy below.

How BCBS Mass came up with $0.00 as the price I pay I don’t know, but presumably they think it’s a good thing to have me on statins in the hope I don’t have an (expensive) heart attack instead.

Then for some reason my price for the statin later the same year went up to $23. No longer $0 but at $8 a month not really worth making a fuss about.

At the end of the year, COBRA expired and I went to buy insurance on the California exchange. And in order to keep access to my family’s doctors at One Medical, I chose the only plan they were in, the Blue Shield of California HMO.

My next 90 day supply was the first one which went from 20mg to 40mg, but it’s still a common generic. Blue Shield of California also uses CVS Caremark (although it’s been talking a good game of ditching CVS Caremark and setting up its own PBM) and the cost at Alto barely budged. Now it was $28.

What happened next: So all was going normally until late last week when my next 90 supply was delivered. Except it wasn’t. Alto delivered me a 30 day supply and charged me $19.

Continue reading…

What We Can Learn From the Change Healthcare Hack

By ZACHARY AMOS

The health care sector is no stranger to cyberattacks. Still, large incidents like the February 2024 ransomware attack on Change Healthcare are enough to shake up the industry. In the wake of such a massive breach, medical organizations of all types and sizes should take the opportunity to review their security postures.

What Happened in the Change Healthcare Cyberattack

On February 21, Change Healthcare — the largest medical clearinghouse in the U.S. — suffered a ransomware attack, forcing it to take over 100 systems offline. Many of its electronic services remained down for weeks, with full restoration taking until early April.

A week after the attack, the infamous ransomware-as-a-service gang BlackCat claimed responsibility. BlackCat was also responsible for 2021’s Colonial Pipeline shutdown and several attacks on health care organizations throughout 2023. This latest act against Change Healthcare, however, stands as one of its most disruptive yet.

Because Change and its parent company — UnitedHealth Group (UHG) — are such central industry players, the hack had industry-wide ripple effects. A staggering 94% of U.S. hospitals suffered financial consequences from the incident and 74% experienced a direct impact on patient care. Change’s services affect one in every three patient records, so the massive outage created a snowball effect of disruptions, delays and losses.

Most of Change’s pharmacy and electronic payment services came back online by March 15. As of early April, nearly everything is running again, but the financial fallout continues for many enterprises reliant on UHG, thanks to substantial backlogs.

What It Means for the Broader Health Care Sector

Considering the Change Healthcare cyberattack affected almost the entire medical sector, it has significant implications. Even the few medical groups untouched by the hack should consider what it means for the future of health care security.

1. No Organization Is an Island

It’s difficult to ignore that an attack on a single entity impacted almost all hospitals in the U.S. This massive ripple effect highlights how no business in this industry is a self-contained unit. Third-party vulnerabilities affect everyone, so due diligence and thoughtful access restrictions are essential.

While the Change Healthcare hack is an extreme example, it’s not the first time the medical sector has seen large third-party breaches. In 2021, the Red Cross experienced a breach of over 515,000 patient records when attackers targeted its data storage partner.

Health care enterprises rely on multiple external services and each of these connections represents another vulnerability the company has little control over. In light of that risk, it must be more selective about who it does business with. Even with trusted partners like UHG, brands must restrict data access privileges as much as possible and demand high security standards.

2. Centralization Makes the Industry Vulnerable

Relatedly, this attack reveals how centralized the industry has become. Not only are third-party dependencies common, but many organizations depend on the same third parties. That centralization makes these vulnerabilities exponentially more dangerous, as one attack can affect the whole sector.

The health care industry must move past these single points of failure. Some external dependencies are inevitable, but medical groups should avoid them wherever possible. Splitting tasks between multiple vendors may be necessary to reduce the impact of a single breach.

Regulatory changes may support this shift. During a Congressional hearing on the incident, some lawmakers expressed concerns over consolidation in the health care industry and the cyber risks it poses. This growing sentiment could lead to a sector-wide reorganization, but in the meantime, private companies should take the initiative to move away from large centralized dependencies where they can.

Continue reading…

AI Cognition – The Next Nut To Crack

By MIKE MAGEE

OpenAI says its new GPT-4o is “a step towards much more natural human-computer interaction,” and is capable of responding to your inquiry “with an average 320 millisecond (delay) which is similar to a human response time.” So it can speak human, but can it think human?

The “concept of cognition” has been a scholarly football for the past two decades, centered primarily on “Darwin’s claim that other species share the same ‘mental powers’ as humans, but to different degrees.” But how about genAI powered machines? Do they think?

The first academician to attempt to define the word “cognition” was Ulric Neisser in the first ever textbook of cognitive psychology in 1967. He wrote that “the term ‘cognition’ refers to all the processes by which the sensory input is transformed, reduced, elaborated, stored, recovered, and used. It is concerned with these processes even when they operate in the absence of relevant stimulation…”

The word cognition is derived from “Latin cognoscere ‘to get to know, recognize,’ from assimilated form of com ‘together’ + gnoscere ‘to know’ …”

Knowledge and recognition would not seem to be highly charged terms. And yet, in the years following Neisser’s publication there has been a progressively intense, and sometimes heated debate between psychologists and neuroscientists over the definition of cognition.

The focal point of the disagreement has (until recently) revolved around whether the behaviors observed in non-human species are “cognitive” in the human sense of the word. The discourse in recent years had bled over into the fringes to include the belief by some that plants “think” even though they are not in possession of a nervous system, or the belief that ants communicating with each other in a colony are an example of “distributed cognition.”

What scholars in the field do seem to agree on is that no suitable definition for cognition exists that will satisfy all. But most agree that the term encompasses “thinking, reasoning, perceiving, imagining, and remembering.” Tim Bayne PhD, a Melbourne based professor of Philosophy adds to this that these various qualities must be able to be “systematically recombined with each other,” and not be simply triggered by some provocative stimulus.

Allen Newell PhD, a professor of computer science at Carnegie Mellon, sought to bridge the gap between human and machine when it came to cognition when he published a paper in 1958 that proposed “a description of a theory of problem-solving in terms of information processes amenable for use in a digital computer.”

Machines have a leg up in the company of some evolutionary biologists who believe that true cognition involves acquiring new information from various sources and combining it in new and unique ways.

Developmental psychologists carry their own unique insights from observing and studying the evolution of cognition in young children. What exactly is evolving in their young minds, and how does it differ, but eventually lead to adult cognition? And what about the explosion of screen time?

Pediatric researchers, confronted with AI obsessed youngsters and worried parents are coming at it from the opposite direction. With 95% of 13 to 17 year olds now using social media platforms, machines are a developmental force, according to the American Academy of Child and Adolescent Psychiatry. The machine has risen in status and influence from a side line assistant coach to an on-field teammate.

Scholars admit “It is unclear at what point a child may be developmentally ready to engage with these machines.” At the same time, they are forced to admit that the technological tidal waves leave few alternatives. “Conversely, it is likely that completely shielding children from these technologies may stunt their readiness for a technological world.”

Bence P Ölveczky, an evolutionary biologist from Harvard, is pretty certain what cognition is and is not. He says it “requires learning; isn’t a reflex; depends on internally generated brain dynamics; needs access to stored models and relationships; and relies on spatial maps.”

Thomas Suddendorf PhD, a research psychologist from New Zealand, who specializes in early childhood and animal cognition, takes a more fluid and nuanced approach. He says, “Cognitive psychology distinguishes intentional and unintentional, conscious and unconscious, effortful and automatic, slow and fast processes (for example), and humans deploy these in diverse domains from foresight to communication, and from theory-of-mind to morality.”

Perhaps the last word on this should go to Descartes. He believed that humans mastery of thoughts and feelings separated them from animals which he considered to be “mere machines.”

Were he with us today, and witnessing generative AI’s insatiable appetite for data, its’ hidden recesses of learning, the speed and power of its insurgency, and human uncertainty how to turn the thing off, perhaps his judgement of these machines would be less disparaging; more akin to Mira Murati, OpenAI’s chief technology officer, who announced with some degree of understatement this month, “We are looking at the future of the interaction between ourselves and machines.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside the Medical Industrial Complex (Grove/2020)

Your Water, or Your Life

By KIM BELLARD

Matthew Holt, publisher of The Health Care Blog, thinks I worry too much about too many things. He’s probably right. But here’s one worry I’d be remiss in not alerting people to: your water supply is not as safe – not nearly as safe – as you probably assume it is.

I’m not talking about the danger of lead pipes. I’m not even talking about the danger of microplastics in your water. I’ve warned about both of those before (and I’m still worried about them). No, I’m worried we’re not taking the danger of cyberattacks against our water systems seriously enough.

A week ago the EPA issued an enforcement alert about cybersecurity vulnerabilities and threats to community drinking water systems. This was a day after EPA head Michael Regan and National Security Advisor Jake Sullivan sent a letter to all U.S. governors warning them of “disabling cyberattacks” on water and wastewater systems and urging them to cooperate in safeguarding those infrastructures.

“Drinking water and wastewater systems are an attractive target for cyberattacks because they are a lifeline critical infrastructure sector but often lack the resources and technical capacity to adopt rigorous cybersecurity practices,” the letter warned. It specifically cited known state-sponsored attacks from Iran and China.

The enforcement alert elaborated:

Cyberattacks against CWSs are increasing in frequency and severity across the country. Based on actual incidents we know that a cyberattack on a vulnerable water system may allow an adversary to manipulate operational technology, which could cause significant adverse consequences for both the utility and drinking water consumers. Possible impacts include disrupting the treatment, distribution, and storage of water for the community, damaging pumps and valves, and altering the levels of chemicals to hazardous amounts.

Next Gov/FCW paints a grim picture of how vulnerable our water systems are:

Multiple nation-state adversaries have been able to breach water infrastructure around the country. China has been deploying its extensive and pervasive Volt Typhoon hacking collective, burrowing into vast critical infrastructure segments and positioning along compromised internet routing equipment to stage further attacks, national security officials have previously said.

In November, IRGC-backed cyber operatives broke into industrial water treatment controls and targeted programmable logic controllers made by Israeli firm Unitronics. Most recently, Russia-linked hackers were confirmed to have breached a slew of rural U.S. water systems, at times posing physical safety threats.

We shouldn’t be surprised by these attacks. We’ve come to learn that China, Iran, North Korea, and Russia have highly sophisticated cyber teams, but, when it comes to water systems, it turns out the attacks don’t have to be all that sophisticated. The EPA noted that over 70% of water systems it inspected did not fully comply with security standards, including such basic protections such as not allowing default passwords.

NextGov/FCW pointed out that last October the EPA was forced to rescind requirements that water agencies at least evaluate their cyber defenses, due to legal challenges from several (red) states and the American Water Works Association. Take that in. I’ll bet China, Iran, and others are evaluating them.

“In an ideal world … we would like everybody to have a baseline level of cybersecurity and be able to confirm that they have that,” Alan Roberson, executive director of the Association of State Drinking Water Administrators, told AP. “But that’s a long ways away.”

Tom Kellermann, SVP of Cyber Strategy at Contrast Security told Security Magazine: “The safety of the U.S. water supply is in jeopardy. Rogue nation states are frequently targetingthese critical infrastructures, and soon we will experience a life-threatening event.” That doesn’t sound like a long ways away.

Continue reading…
assetto corsa mods