Health

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I’m listening right now to On Point*, where the topic is Pushing E-Health Records. The only case against electronic health records (EHR, aka electronic medical recordsk, or EMR) is risk of compromised privacy. Exposure goes up. The friction involved in grabbing electronic medical records is lower than that involved in grabbing paper ones, especially with the Internet connecting damn near everything.

Here’s the problem with privacy in the Internet Age (which we are now in, with no hope of ever getting out, unless we live the connectionless life): the Net is a big copy machine. It’s amazing how a fact so simple escapes attention until a first-rate metaphorist such as Kevin Kelly comes along to expound on what ought to be obvious:

The internet is a copy machine. At its most foundational level, it copies every action, every character, every thought we make while we ride upon it. In order to send a message from one corner of the internet to another, the protocols of communication demand that the whole message be copied along the way several times. IT companies make a lot of money selling equipment that facilitates this ceaseless copying. Every bit of data ever produced on any computer is copied somewhere. The digital economy is thus run on a river of copies. Unlike the mass-produced reproductions of the machine age, these copies are not just cheap, they are free.

Our digital communication network has been engineered so that copies flow with as little friction as possible. Indeed, copies flow so freely we could think of the internet as a super-distribution system, where once a copy is introduced it will continue to flow through the network forever, much like electricity in a superconductive wire. We see evidence of this in real life. Once anything that can be copied is brought into contact with internet, it will be copied, and those copies never leave. Even a dog knows you can’t erase something once it’s flowed on the internet.

We’re not going to fix that. The copying nature of the Net is a feature, not a bug. We can fight some of it with crypto between trusting parties. But until we find ways to make that easy, the exposure is there. And, as long as it is, we’re going to have people who say risk of exposure overrides other concerns, such as the fact that dozens of thousands of people in the U.S. alone die every year of bad health care record keeping and communications — in other words, of bad data.

Still, if we want good medical care, we need EHR. That much is plain. The question is, How?

The answer will not be an information silo, or a set of silos. We have too many of those already. That’s the problem we have now — both on paper and in electronic formats (as I discovered last year in one of my own medical adventures).

The patient needs to be the point of integration for his or her own data, and the point of origination about what gets done with it. Even if the patient’s primary care physician serves as a trusted originator of medical decisions, the patient needs to anchor the vector of his or her own care, for the simple reason that the patient is the one constant as he or she moves through various medical specialties and systems.

The patient needs to be the platform. Not Google, or Microsoft, or your HMO, or the VA, or some kieretsu involving Big Pharma, Big Software Companies and Big Equipment Makers.

This requires classic VRM: tools of independence and engagement. That is, tools that enable the patient to be independent of any health care provider, yet better able to engage any provider.

In other words, while the answer needs to be systematic, it does not need to be A Big System (which I fear both BigCos and BigGovs whish to provide).

The answer needs to come from geeks who know how to eliminate big problems with simple solutions. For example,

  • Consider how the Internet Protocol solved the problem of multiple networks that didn’t get along.
  • Consider how email protocols such as SMTP, POP3 and IMAP solved the problem of multiple email systems that didn’t get along.
  • Consider how the XMPP protocol solves the problem of multiple instant messaging systems that don’t get along.

We need new ways of organizing our own health care data, and communicating that data selectively to trusted health care providers through open and standard protocols (that may or may not already exist… I don’t know).

I wanted to get those thoughts down because there’s a bunch of stuff going on around health care right now (including two conferences in Boston), detailed to some degree in Health Care Relationship Management, over at the ProjectVRM blog.

* On WBUR, a Boston station I pick up here in Santa Barbara over my Public Radio Tuner.

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Hanging in The Cities on (what wants to be) a Spring Day (a little snow still on the ground), talking deep blogging trash with Sharon Franquemont and Mary Jo Kreitzer. They’re both new to the practice (which isn’t quite a discipline, at least in my case). So bear with me as I show off some stuff.

For example, I just looked up personal health records on Google. As it happens, I already had Greasemonkey and the twitter search script installed. Thanks to that neat little hack, a pile of Twitter search results from the live web appears at the top of a Google search. Here’s a screen shot:

Note that among the Twitter results is one from adriana872, who is none other than my good friend Adriana Lukas, who I see also has a tweet that says “targetted advertising is visual spam”. Which resonates with me totally, of course. She links to her own post on the subject, which sources this post by Brian Micklethwait.

Which is all cool and conversation-inducing as well as expertise-spreading and authority-building and stuff like that. (Remember I’m showing how to blog here. Bear with me.)

I’ll also tag the shit out of all the above. Not sure if the tags appear here (I blog in too many places and I forget), but they exist.

I also just tweeted this post, with a #blogging hashtag, and instantly, we get this:

The Live Web indeed.

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From Chris Brogan via JP, a call to re-tweet: Sew hoping for a miracle.

Here is an earlier picture (and post about) Marielle, by her mom, the blogger Sue (aka Sew), of The Domestic Diva.

Marielle is dying, literally, for a kidney match.

Pass the word along. Somebody somewhere should be able to help.

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These are a few among the many salt ponds that ring the south end of San Francisco Bay. Once considered and agricultural innovation and an economic boom, the practice of “reclaiming” wild wetlands for industrial purposes is now considered ecologically awful by environmentalists, especially here on the West Coast of the U.S., which has precious few wetlands in any case. Many environmentalists have been working to get Cargill to close the ponds and return the Bay to its more natural state. Cargill hasn’t budged. In fact, <a href=”http://www.cargill.com/sf_bay/saltpond_ecosystem.htm”>Cargill has its own views</a> on the matter, plus some interesting facts about the ponds themselves.

It’s worth pointing out that the Bay is actually one of the youngest features on the California landscape, having flooded within only in the last couple thousand years, as sea levels rose. (Global warming has been happening, in fact, since the last ice age.)

I took this shot two days ago on approach to San Francisco on a flight from Boston. Here’s a set of all the photos I’ve taken of salt ponds, both here and in the desert. And here is the whole set of shots I took from coast to coast. Most were at the ends of the flight, since the sky was undercast most of the way.

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(This post began as a response to this comment by Julian Bond, in response to this post about Mad Men. When it got too long I decided to move it here.)

Smoking and drinking were standard back then. “Widespread” doesn’t cover it. They were nearly universal.

It’s easy to forget that Industry won WWII, and that the military-industrial complex crossed the whole society. All young men served in the military, either voluntarily or via the draft. Industry and its companion, Science, ruled. And — to an unhealthy degree — the former drove the latter.

Tobacco was an leading agricultural product, and cigarette manufacture was a leading industry that drove consumption through advertising so thick and ubiquitous — on TV and radio, in magazines, newspapers and on billboards — that for most people the only choice was which brand to smoke.

I remember thinking, as a child, that lighting sticks on fire and breathing the smoke was absurd and unhealthy on its face — and later being the only one of my high school friends who didn’t smoke. But I was weird. Common sense then was pro-smoking.

Drinking and driving was only a little harder to rationalize. I remember statistics that said one in twenty-five drivers at night in the U.S. were drunk.

Industry and Science also together decided, among other things, that —

  • Breast feeding was bad for babies, and “formula” was better. Thank you, Nestle.
  • Children at birth should be taken from their mothers and stored in nurseries.
  • All boys should all be circumcised at birth. So much for the Hippocratic oath: “First, do no harm.”
  • Tonsilitis” was a disease, and every severely sore throat should be treated surgically, involving removal of adenoids from the nose as well.
  • Intestinal infections were likely to be appendicitis, so the appendix had to go too.
  • Education is a manufacturing process, the purpose of which is to fill the empty vessels of childrens’ heads with curricula approved by the State.
  • Childrens’ intelligence — their most unique and human quality — was a fixed quantity (a “quotient”) that could be measured, as if by a dipstick,  with IQ tests, so herds of students  could be sorted into bell curves to better manage their progress through systems that regarded them — with the acquiescence of themselves and their parents — as “products” of their education.

I could go on. For what it’s worth, I have my appendix, but lack tonsils, adenoids, spleen and foreskin, all of which were considered “vestigial” or otherwise bad by the medical fashions at the times of their removal. My known IQ scores have a range of 80 points. If my parents hadn’t believed in me, my low IQ and standardized test scores in the 8th grade would have shunted me to a “vocational-technical” high school to learn wood shop, auto mechanics or some other “trade”. I shall always be grateful for that.

Mad Men is close to home for me in another way: I was long in the advertising business too, though a generation after Mad Men’s time, well after the “creative” revolution of the mid- to late 60s. It was one of the great periods in my life, but I’ve moved on. Similarly, I had a hard time watching the Sopranos, because I grew up in New Jersey, knew people like those, and was not entertained.

I think drugs and self-abuse are rituals of youth rationalized in their time by a sense of exemption from the due invoice we call aging. How long before fewer people are being tatooed than those having tattoos removed? I’m giving it 20 years.

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Steve Lewis writes, Obama’s “Homeostasis”: It must be the Roedjak! — a deep and wonderful detour from the usual punditry about a candidate’s temperament, informed by Steve’s years working in Indonesia, as well as his exposure to many countries and cultures unfamiliar to most Americans. I hope Steve doesn’t mind my lifting most of his post to repeat here. Dig:

So far, Obama’s seeming detachment has been exploited by his opponents as proof that “we don’t know who he his” or as a sign of his supposed smugness and intellectual superiority.  And, for, quite a number of Democrats Obama’s politeness and fixed smile are an unsettling suggestion of a lack of the politically requisite instinct to go for the jugular.  I would suggest something quite different and far more positive … namely, that Obama knows how to eat Roedjak.

Roedjak is an Indonesian fruit salad, slices of not yet fully ripened tropical fruits served with a sauce of sweet thick soy ketjap, tamarind paste, crushed chili papers, and a dash of dried dessicated shrimp.  Roedjak’s harmonic fusion of superficially contradictory tastes is more than culinary.  Roedjak restores equilibrium even while exciting the senses.  Preparing and eating Roedjak is a tonic during moments of personal emotional turmoil; domestic disagreements and work conflicts are calmed by sharing Roedjak when tensions to escalate. On the symbolic level, Roedjak embodies all that is positive of the values and social mores of southeast Asia.

Political commentators — other than those Republican cranks who have accused Obama of having attended fundementalist Muslim Koranic schools — have overlooked the “Indonesian” facet of the Democratic presidential candidate, his formative years on the island of Java, and his being a member of a family with Indonesian connections as well as Kansan and Kenyan ones.

In Java, outward emotional evenness and display of respect are inherent to the workings of families and of villages.  Frontal confrontations are avoided and adversaries are given room to retreat.  Such stances are central to the the stylized conventions of Java’s traditional complexly hierarchical society and to the realities of domestic, social, and political life on an overpopulated agrarian island and in crowded mega-cities such as Jakarta.

On the surface, Java is devoutly Muslim but Javanese Islam rests on older strata of Hindu and Buddhist culture.  The characters of the Buddha and of the heroes of the Bhagavad Gita still resonate as strongly as those of the Prophet Mohammed and Ali.  In Java, one learns that displays of restraint are incumbent on leaders and are signs of strength in people at all levels of society.

And so, for the sake of the US and the world, I’d rather see the American presidency in the hands of a Roedjak eater than a heart-beat away from the rule of an eater of mooseburgers.  Join me for a mango, anyone?

I dunno if Roedjak explains Obama, but I do like getting an interesting new angle on an exceptional man.

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Fall in New England is a visual cliché of the first order, and exactly as advertised. Only better this weekend, because it’s been unseasonably warm, as well as clear and perfectly gorgeous, complete with full moons each night.

We’ve been out at a church retreat at Otter Lake, New Hampshire. And it’s been a healthy break for me, coming as I am off one of the worst colds in a long time. The fever broke yesterday morning, and the cough ended last night. It was the first night in a week when I actually slept the whole night and it was blissful.

Meanwhile, I’ve loved walking along the lake and in the woods. The loud colors at a distance usually turn out to be comprised of leaves with blisters, chewed-out edges and other signs of wear & tear. What I love about the forest here is that it’s mostly evergreen with deciduous trim. You can see one felicitous effect of that in the shot above, where pine needles hang like ornaments from the stems of maple leaves.

I’m pretty sure the shot above is of a sugar maple, though it might be a Norway. Maybe one of ya’ll can help here.

Anyway, we’re home again tomorrow and back to work.

Oh, by the way, all the shots in this series were taken with a little pocket camera rather than my big (and somewhat broken) SLR. Still, does the job.

It’s hard to feel shitty when the Steve Miller Band is playing Jet Airliner in the middle of your head. Or smart, either — at least in my case.

Jeebus, all these decades I’ve been thinking the chorus was

  Big old jet had a light on
Don’t carry me too far away
Oh oh oh big old jet had a light on
‘Cuz it’s here that I’ve got to stay.

Turns out “had a light on” is “airliner”. Well, duh. Of course. That’s the freaking title. But phonetically, Steve is singing “biggo jed adda line oh”. I say this with confidence because I just replayed it about ten times to make sure. That’s the audible, as they say in football.

Who knows what the hell Steve’s saying, anyway? Well, some of us do, and to explain, we have the Internet. For example, The Joker begins,

  Some people call me the space cowboy, yeah
Some call me the gangster of love
Some people call me maurice
Cause I speak of the pompitous of love

Or is that pomitus? Hell, The Pompatus of Love is a whole movie devoted to the question. The Straight Dope sez that “pompatus” (that’s how it sounds) actually goes way back:

  Speculation about “pompatus” was a recurring motif in the script for The Pompatus of Love. While the movie was in postproduction Cryer heard about “The Letter.” During a TV interview he said that the song had been written and sung by a member of the Medallions named Vernon Green. Green, still very much alive, was dozing in front of the tube when the mention of his name caught his attention. He immediately contacted Cryer.
  Green had never heard “The Joker.” Cryer says that when he played it for Green “he laughed his ass off.” Green’s story:
  “You have to remember, I was a very lonely guy at the time. I was only 14 years old, I had just run away from home, and I walked with crutches,” Green told Cryer. He scraped by singing songs on the streets of Watts.
  One song was “The Letter,” Green’s attempt to conjure up his dream woman. The mystery words, J.K. ascertained after talking with Green, were “puppetutes” and “pizmotality.” (Green wasn’t much for writing things down, so the spellings are approximate.)
  “Pizmotality described words of such secrecy that they could only be spoken to the one you loved,” Green told Cryer. And puppetutes? “A term I coined to mean a secret paper-doll fantasy figure [thus puppet], who would be my everything and bear my children.” Not real PC, but look, it was 1954.

Anyway, I’ve had a bad cold the last few days, and right now I’m sitting on the couch with a fever, trying to think and write while a vacuum cleaner roars in the next room. But now I’ve also got these Etymotic ER6i earphones jacked deep into my head, muting the noise and substituting ol’ Steve, singing about getting on “that 707” — a plane nobody outside of Iran still flies. And it’s getting me high, just from the driving energy of the song.

Beats thinking about death, which comes easy when you’re 61 with a fever, a gut, and a history of exercise that consists mostly of getting dressed. But music helps. Music is the best evidence of immortality that we have.

Music is life. And vice versa. Listening to three-decade old Steve Miller on good earphones is life transfusion.

So is listening to an even older song: The Doors’ When the Music’s Over, from Strange Days, a brilliant, beautiful piece of work. To me Strange Days ranks among a handful of perfect albums, first song to last.

Which is When the Music’s Over, of course.

  When the music is your special friend,
dance on fire as it intends.
Music is your only friend,
until the end.

Strange Days came out in late ’67. I bought it in the summer of ’68 after Ken Rathyen, a guy on my ice cream route (he was a lifeguard at PV Beach in Pompton Plains, NJ) told me to get it. “Every song is a gem,” he said. He was right. (Kenny, if you’re out there, Yo!)

That fall I shared an apartment in an old house on Spring Garden Street in Greensboro, near Tate Street. Next door was a big Victorian, already boarded up. On Halloween night, a bunch of turned off all the lights and listened to Strange Days. After When the Music’s Over was over, we were deep in a creepy Halloween mood, and decided it would be fun to break into the “haunted house” next door. So we got a flashlight out, sneaked over, and found a way in.

There was no furniture, just empty rooms, with a coating of dust on everything… except for the footprints on the stairs. They were barefoot and small for an adult. We followed them up to the second floor, where they stopped. No other footprints went down.

Feeling creeped out, we pressed on, exploring this big old house. Still, other than the footprints, there was nothing.

Then we found the door to the attic. It was narrow, and opened to a narrow staircase. At the top was a camped room where there were a few items of furniture and some boxes. In one box was a diary by a girl who had lived there. She reported daily on what she saw out the window at the front of the attic, looking down on Spring Garden Street. She also gave weekly summaries of her favorite TV show, Whirlybirds, which last ran in 1960.

One name that appeared often in the diary was Jan Speas, who lived next door. I wondered if this was the same Jan Speas who taught creative writing at Guilford College, where I was a Senior at the time. (Jan, whose maiden name was Jan Cox and wrote as Jan Cox Speas, was best known as a writer of historical romances. More here.)

So we took the diary with us, and I brought it to Jan. Yes, Jan said, she remembered the girl well. They were good friends, and the diary was touching because the girl had later died.

Three years later Jan died too, of an unexpected heart attack. She was 46.

In August, 2004, ‘s Piedmont Bloggers Conference was held in the same exact spot as the condemned houses: the one I lived in, the haunted Victorian next door, and Jan Speas’ house on the other side of that one. I wrote about it here, and told the same creepy story here (but it doesn’t come up now, which is why I’m repeating myself).

But I’m still here. Dancing on fire. And getting back to real work, now that the vacuum cleaner is off.

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Since I lack a car here, I haven’t gotten out much, and not at all to any place that gave me a vantage on the fire. Until today, that is, when we went to Goleta and I had a chance to pause on Hollister Street by the airport where the Forest Service runs P3 Orion air tankers up to the fire sites to dump bright fire retardant on the landscape. (It’s not bad, by the way. Essentially, it’s fertilizer.) Here’s the photo set. (Also added more maps to this photo set.)

Tag: sbgapfire.

First, kudos again to Edhat‘s news list for not only gathering info from many sources, but for giving equal weight to both professional and amateur sources — and for hosting a great many comments on some of the postings. As an interactive local news service, “Ed” does a fine job. When surfing for the latest on the fire, it’s a good place to start. Others among these are good as well:

Second, I have been somewhat remiss by not including GeoMAC among sources for following the fire. You can follow maps from multiple sources, as I make screen shots and upload them, here. The latest from MODIS shows new fire activity (red dots, meaning in the last 0 to 12 hours) near highway 154 and on the uphill (north) and west sides of the fire perimeter. Highway 154 (San Marcos Pass) remains open.

The LA Times this morning has ‘Critical day’ dawns for Goleta fire, enlarged by overnight wind gusts, with a dramatic photo of an air tanker (see last paragraph below) dropping red fire retardant near a house. The summary:

The blaze, while 24% contained, grew to 8,357 acres. Firefighters plan to concentrate on protecting homes to the east before another night of ‘sundowners.’ At least 2,663 homes have been evacuated.

Note that there are 97 comments so far to that story.

KEYT has a summary of evacuation areas as of 5pm yesterday. That story also has a map.

Note that chapparal wildfires, especially in steep rocky country like this, do not only spread from their edges. They also spread by dropping burning material at distances from source flames, which can have powerful updrafts. This makes fighting these fires very hard on the ground.

Inciweb’s page for the Gap Fire currently gives its size as 54oo acres, with 1072 personnel working on the fire. Under Fire Behavior, it says,

Down canyon winds continued through the night pushing the fire front into the north side of Goleta and widening the flanks east and west. Fire also continued to the north into the wind overnight with limited movement.

Planned actions:

Structure protection, create safety zones and establish contingency lines In the Goleta foothills. Construct control lines when conditions permit. Damage assessment from last night will be conducted.

Remarks:

Firefighters are from several agencies including the United States Forest Service and Santa Barbara County Fire Department and several local cooperators including the San Marcos Volunteer Fire Department. The California Highway Patrol, Santa Barbara County Sheriff’s Office, and the American Red Cross are assisting. ICP has been established at Earl Warren Showgrounds. Dos Pueblos High School will remain a staging area.

Current wind is gusting at 30mph from the north (down the mountains, toward Goleta). The temperature is 75° and the humidity is 25%.

InciWeb has no maps for the fire, but does suggest visiting these sources:

It’s sad that InciWeb remains both slow (often overwhelmed) and behind its own curve. I’ve had a number of email exchanges with folks working on InciWeb, and have great respect for the hard work they do within what is essentially a bureaucratic morass. I think the lesson here is that we have to do our best with many sources, and the messiness that involves.

Somewhere among the sources above I read that an aggressive aerial attack was planned to start at dawn this morning. I’m too far east (~5 miles) of the fire to see that; but it helps that Santa Barbara’s airport is in Goleta itself, almost next to the fire, and is home to one of the main Air Attack Bases for the U.S. Forest Service. Here is a photoset I shot of that base, and the P3 Orions used for bombing fires with supressant. I am sure these are in use right now.

Finally (at least for now), I want to say that I’m optimistic about this fire, even though I must disclaim any qualifications for that other than as an amateur observer. I feel a need to do that because I’ve also shot photographs that could easily be seen as scary. These two sets, for example. Please note that I shot those with a long telephoto lens to maximize the apparent size of the sun — reducing the apparent distance between subjects in the photo (such as Mission Santa Barbara, the fire and the Sun). Also because, hey, I wanted to take good photos.

Speaking of which, I also shot the fireworks from up in the hills last night, where there was also a pretty rocking party. Life goes on.

Tag: sbgapfire.

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