Alone Together

AloneTogether I just finished reading Sherry Turkle's new book, Alone Together: Why we expect more from technology and less from each other (book website, Amazon) and I can't recommend it highly enough. She reports on her research into how people experience social media and social robots, and asks many important questions about where we're headed. I found the second half of the book, on social media, more compelling than the first, on robots, though Turkle's analysis does bring the two topics together nicely.

Radiation Treatment Errors and Bad Design

The New York Times has an excellent investigative report into radiation treatment errors. They tell the story of two patients who died due to errors, and report on the frequency of these events. Sadly the errors usually look preventable in hindsight. And predictably, manufacturers of the machines blame the technicians who operate the machines, when in truth a main cause is bad software design without proper attention to safety and usability practices.

Link: Radiation Offers New Cures, and Ways to do Harm.

The article is the first in a series called The Radiation Boom. This kind of deep reporting is what makes the NYT and organizations like it so valuable.

The Complexities of Dying in a High-Tech Era

I thought this recent Fresh Air interview with Robert Martensen was very good: End of Life Care in America, A Doctor's Diagnosis. Martensen discusses the problem of medical intervention in the very final stages of life.

He has written a book called A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era.

From the book description:

Critical illness is a fact of
life. Even those of us who enjoy decades of good health are touched by
it eventually, either in our own lives or in those of our loved ones.
And when this happens, we grapple with serious and often confusing
choices about how best to live with our afflictions.
 
A Life Worth Living is
a book for people facing these difficult decisions. Robert Martensen, a
physician, historian, and ethicist, draws on decades of experience with
patients and friends to explore the life cycle of serious illness, from
diagnosis to end of life. He connects personal stories with reflections
upon mortality, human agency, and the value of “cutting-edge”
technology in caring for the critically ill. Timely questions emerge:
To what extent should efforts to extend human life be made? What is the
value of nontraditional medical treatment? How has the American
health-care system affected treatment of the critically ill? And
finally, what are our doctors’ responsibilities to us as patients, and
where do those responsibilities end? Using poignant case studies,
Martensen demonstrates how we and our loved ones can maintain dignity
and resilience in the face of life’s most daunting circumstances.

Novelist Jim Harrison's blurb gets to the heart of the matter:

A Life Worth Living is a deeply engaging book. It can be read
as a self-defense manual. In fact it should be read by, say, anyone
over forty-five because we are all destined to do battle with the
medical industrial complex which seems quite confused about helping us
out of life. Martensen, who is both an M.D. and an historian of
medicine, gracefully illumines the problems we all face.” – Jim
Harrison, author of Returning to Earth

ALifeWorthLiving

Convergence 08


I just learned about Convergence 08, a two-day event at the Computer History Museum in Mountain View, CA featuring a bunch of futurists and other thinkers on technology. From their buzzword-heavy blurb:

On November 15-16, 2008, the world's most dangerous ideas will collide in Mountain View, California. Convergence08 examines the world-changing possibilities of Nanotech and the life-changing promises of Biotech. It is the premier forum for debate and exploration of Cogtech ethics, and ground zero of the past and future Infotech revolution. Convergence08 is an innovative, lively unconference, the first and only forum dedicated to NBIC (Nano-Bio-Info-Cogno) technologies.

Link: Convergence08.org.

The speaker list includes some heavyweight futurists/technologists like Paul Saffo, Aubrey de Grey and Peter Norvig, and at least one critic, Denise Caruso.

I'm not sure I get the idea of an "unconference" as the main event, though. I thought those were typically free, alternative forums that took place outside big conferences.

Republican Wacky Math on Health Insurance

I apologize for going off-topic and getting all political but some things are more important than technology right now. And in this post I'm responding to another blog that's nominally related to technology and society: the Diagnosis blog at The New Atlantis. They don't have comments so I thought I'd rant here.

The New Atlantis publishes some good work occasionally, but at times they stray too far into (their right-wing) politics. In a post last week called Biden's Phony Health Care Argument, The New Atlantis's "health care policy expert" James Capretta tried to set the record straight on Joe Biden's statements about McCain's health insurance plan during the VP debate — the plan where McCain wants to give you $5000 to go buy your own health insurance (actually $5000 for families, $2500 for individuals). Biden pointed out that employers are paying $12000 per person on average, leaving a $7000 gap for you to make up on your own.

Here is the first part of Capretta's argument:

Where’s the additional $7,000 going to come from?

Here’s how it would really work.

Suppose a worker gets $50,000 in cash wages and $12,000 in health insurance.

Right
now, he pays federal income taxes on the wages but not the health
insurance. Let’s assume, for reasons of simplicity, that the tax rate
he is paying is a flat 25% on his wages. He therefore pays $12,500 in
federal income taxes. His after-tax, after-health-care income is
$37,500.

Now, under the McCain plan, his employer keeps paying
the premium, which is now counted as income to the worker. He therefore
pays federal income taxes on $62,000, or $15,500.

But he also
gets a tax credit of $5,000 for health insurance, which means that, all
in all, he owes $10,500 in federal taxes, or $2,000 less than he does
today. His after-tax, after-health-care income is $39,500.

Ignore the fancy tax math — it's irrelevant here. Capretta is figuring out the best case scenario — you get the tax credit and your employer still pays for your insurance. That's not very likely, given how employers will have every reason to drop health insurance coverage once McCain sets them free.

What about the other case then? Capretta:

If the worker decides to buy his insurance in the open market instead
of through the employer, the result will be the same. His employer is
indifferent to how he pays his worker as long as total costs are the
same. So instead of paying premiums, the employer pays his worker
$62,000 in cash wages and does not pay anything toward insurance. The
worker again owes $15,500 in taxes on this compensation, and he also
must buy health insurance costing $12,000. So, his pre-tax income is
$62,000, he owes $12,000 in health insurance premiums, and he owes
$10,500 in federal taxes (after claiming his credit). His after-tax,
after-health-care income is the same: $39,500 ($62,000 – $12,000 –
$10,500), or $2,000 more than today. 

First off, I love the illusion of choice — "if the worker decides" — as if everyone will have that luxury. Second, he's assuming your employer will give you a $12000 raise! Is he serious?

That second sentence is quite a howler: "His employer is indifferent to how he pays his worker as long as total costs are the same." Ha! Employers are struggling to pay health insurance costs. They want this plan because it will offload their costs to others.

Capretta also deceives by ignoring the rising cost of health insurance. For many companies it's increasing by double digits every year, I believe. Will McCain's tax rebate keep pace? How about those fantasy raises?

I'm not sure if The New Atlantis is just repeating Republican talking points on this or if this is their original analysis. My guess is the former, given how McCain and others are saying that "if you do the math," his plan will benefit you. This is some kind of math… more like nonsense and deception.

I'm no health policy analyst and I confess I don't know all the details of either candidate's plan. Nor do I think Obama's plan goes far enough, but it's clearly the better choice. More than that — it's the only choice that isn't insane.

In my fantasy world I envision a president Obama with an overpowering mandate to clean up the current messes and enact some truly rational, liberal, people-centered policies. One of which would be single-payer health care or something like it. I've been reading this new fantasy book: 10 Excellent Reasons for National Health Care (see also Physicians for a National Health Program). It's fantasy in the US, of course, but not in the rest of the civilized world.NationalHealthCare

Aging with Aubrey de Grey Event

Aubrey de Grey's Methuselah foundation is having an event in LA later this month called Aging 2008.  From the description:

Applying the new technologies of regenerative and genetic medicine, the engineering approach to aging promises to dramatically extend healthy human life within the next few decades.

How do you and your loved ones stand to benefit from the coming biomedical revolution? Are you prepared? Is society prepared?

At Aging 2008 you will engage with top scientists and advocates as they present their findings and advice, and learn what you can do to help accelerate progress towards a cure for the disease and suffering of aging.

It looks to be a fairly one-sided affair, with no ethicists or skeptics on the program, but nonetheless it's free and might be interesting if you want to hear more about what these people are up to.

You can win "VIP" entry to the event and free admission to a dinner with Aubrey et al. by going to a contest page and describing what you'd do if you lived to 150.

New Book: Enhancing Me – The hope and the hype of human enhancement

EnhancingMe
I just picked up a copy of Enhancing Me: The Hope and the Hype of Human Enhancement
by Pete Moore.  From the book description:

In Enhancing Me, Pete Moore examines the ways in which technology
can change our bodies, our brains, our emotions, and how long we live.
He talks to people who have actually been 'enhanced' to find out what
it's like and how beneficial it is; and to the experts to find out what
the future holds – including a look at some of the more controversial,
headline-grabbing claims.  He also looks at what drives us to want to
be 'superhuman', and the consequences for the individual and society
alike:I

  • If you could live forever, would you want to?
  • If you could download your mind onto a computer, would you still be you?
  • Should we insert chips into our children, so we can track where they are?
  • Should we force violent criminals to have mood-controlling brain implants?
  • Would you want technology to improve your memory… or help you forget?

I've only read a couple of chapters, but it seems quite good.  It's written for a popular audience but is not too terribly dumbed down.  The glossy full-color presentation makes it look a bit like a museum guide (which it sort of is — see below) or a Rough Guide.  That also makes it a bit pricey at $20 in the US.  My only other quibble is that it's missing a bibliography or further reading guide (though Pete Moore does have suggestions on his own website).

Enhancing Me is part of a book series called TechKnow, produced by the Dana Centre, which is affiliated with the London science museum. The Dana Centre is "a stylish, purpose-built venue in London (UK). It is a place for
adults to take part in exciting, informative and innovative debates
about contemporary science, technology and culture." They host multiple events every week on science and technology issues. It sounds like a fantastic project — I wish they had something like that here.

So far there are four other books planned for the series, covering computer games, human enhancement in sports, living online, and the consumer electronics industry.  The site has previews, blogs, and videos for each.

Liveblogging Your Vasectomy

On a related note… Medical science blogger "Abel Pharmboy" liveblogged his vasectomy last week.  You can relive the adventure here if you have the stomach: Liveblogging the Vasectomy Chronicles.  It’s yet another proud milestone for the web.  I don’t know who is creepier — the blogger who did this or the readers who tuned in live.

(Via io9.)

Google Health: Privacy Disaster Waiting to Happen?

Those aren’t my words.  That’s from the title to a post by John Paczkowski on the Wall Street Journal’s All Things Digital blog.  In regard to Google’s new pilot program with the Cleveland Clinic to store patients’ health records, he writes:

Of course, by making such records easier to share with medical providers,
Google may be making them easier to “share” with less well-intentioned
entities. Health insurance carriers. Potential employers. Online
marketers. The government.

Google, too.

As the World Privacy Forum pointed out yesterday, companies like
Google are not governed by the Health Insurance Portability and
Accountability Act or HIPAA. “Don’t assume your medical records are
protected no matter where they are: HIPAA privacy protections generally
do not follow the health-care files,” the WPF warned.
“HIPAA’s protections generally do not ‘travel’ with or follow a medical
record that is disclosed to a third party outside the health-care
treatment and payment system. … After you have disclosed your health
care information to a PHR (Personal Health Records) outside the privacy
protections of the health care system (HIPAA), your information can be
used or redisclosed by the PHR in ways that would not be permitted for
the same information if held by your doctor or health plan. Depending
on the applicable privacy policy, health records outside of HIPAA can
potentially be bought and sold, shared with merchants, and even
disclosed to employers.”

Link: New from Google: "Google Privacy Disaster Waiting to Happen"

Update: Lots of interesting discussion on this: see Michael Zimmer, Fred Stutzman.  Michael Zimmer has also been discussing privacy concerns with Microsoft about their similar efforts: More designing for privacy: Microsoft HealthVault.