Unsurprising news from physician payment experiments.

This week we learned:

  • If you pay physicians based on how patients do they avoid caring for high risk patients. Who then do worse.
  • Conversely physicians who care for wealthy healthy patients get more rewards, so health card dollars are flowing to wealthy patient care.

This surprised nobody with a brain.

Posted in t

Pinboard increasingly unreliable.

I pin a lot as part of my microblog posting. More and more authentication challenges. Maybe result of some bot attack/password reset?

I think I’m going to have to switch my flow around. Make it WordPress centric.

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How many calories does menstruation use?

I couldn’t find a scholarly article on this. Which is weird. Maybe research is old.

Women’s magazines estimate around 200-300 calories, they typically source a physician known to the journalist.

At the high end that is 3,600 calories a year, roughly a 1lb yearly weight gain if not menstruating and nothing else changes.

Posted in t

Neural networks 2018

The speed of neural network development feels faster than anything in my lifetime. Maybe early web was similar.

This is bigger potential impact though.

2018 is going to be too interesting.

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Consequences of bundling Photos.app with macOS.

The only sensible way to use macOS is to wait 8 months for bugs to be fixed and OS ecosystem to be updated.

That means waiting 8 months for bug fixes.

On the other hand, one gets a mature Photos.app update yearly with 3 months of tweaks.

Not all bad, but 8 months is a long time to wait for big bug to be fixed.

I’m still on Aperture, so still but abstract. Aperture looks better all the time.

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Apple metadatacide: iPhoto, Aperture, Photos

iPhoto allowed notes on albums and rolls. Aperture discarded the album notes but allowed notes on Projects. Photos discards the notes on Projects, it does not support them when translating to Albums.

Why I would like to see Apple broken up into five smaller companies.

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The science of bias and a roadmap for progress

A NYT piece on how bias works at law firms summarizes evidence-based research.

It is consistent with the hypothesis that the more a new employee resembles their superiors the more effective they will be.

I read this from the same NYT RSS stream that included an article about frustrated women staring more independent businesses.

That startup effort runs into obstacles to all business startups. We know startups have been in decline for over a decade. The suspects are burdensome regulations, lack of affordable health care outside of large corporations, effective use of financial and political weapons by large corporations, and increasing monopoly and monopsony powers of megacorps without antitrust responses.

There ought to be room for political compromise to support small business startups for all and particularly non-white-males. ObamaCare or single payor for health coverage. Regulatory rationalization. Startup support including packaged plans. Aggressive antitrust. Tax reform. Political and campaign contribution reform.

Of course all of these are far more likely to come from Dem than GOP — although the western GOP ( Utah, etc) would support some. I read several of these in Clinton’s policy proposals, though they didn’t get any media attention.

If America survives the Trump era, and a new party replaces the GOP, there is at least a roadmap. Now all we need is a miracle.

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Gaming of FDA adverse event database by anti-vaxxers

There is something especially horrible about this. From Politico health newsletter:

“In recent decades, lawyers alleging that their clients became autistic as a result of childhood vaccines were known to post reports in the related Vaccine Adverse Events Reporting System. Anti-vaccine activists then cited the reports as evidence that the vaccines were harmful.”

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Objectivism and eugenics

Recent events remind us the mass of humanity make sheep and frogs look pretty smart. (Frogs jump out of boiling water, humans seem to cook.)

Libertarian “market” solutions to things like Equifax require an informed and intelligent actor. Obviously humans don’t qualify.

So then how is this supposed to work? Only the elites survive?

I suppose that is how it worked out in Rand’s books.

So libertarianism is effectively a kind of eugenics program…

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Local: “Black man” with “afro” shoots unarmed security guard at local college

Helicopters, airplanes, K9 dogs, cordons. Not a good time to be a black man going for an evening run.

Security guard late admitted he shot himself with a gun he wasn’t supposed to have. Made up the black assailant in slightly misguided attempt to save his job.

Local Facebook commentary during the search had less overt racism than I’d expected. Maybe it was moderated? I didn’t hear of any black men running into scary trouble. St Paul police have a good reputation, that might have helped.

Apparently nobody hurt, so salutary lesson.

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Statins and global warming

Two years ago I was studying for my family medicine board exams. This was around the time the avant garde were ready to put statins in the water supply.

Fast forward 2017. Everyone hates on statins for primary prevention. Myalgias. Diabetes. Brain fog. Whatever. Now patients need to have a pretty good risk of 10y CVD death to take ’em.

This is kind of routine in medicine. Big swings usually amped by big money.

The swings have consequences beyond personal health and billions of dollars. They cost confidence. They are one reason it was so easy for big money to turn the GOP into an anti-science machine.

Statins have given us Scott Pruitt.

Thanks pharma.

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iOS is becoming less accessible for the cognitively disabled.

The original Mac was very easy to use. It became much less cognitively accessible after MultiFinder was introduced. Apple then added “SimpleFinder”, but that never truly made the transition to OS X (the name was preserved without the CamelCase, bit it is much less useful).

iOS is following a similar path, but without SimpleFinder. This impacts not only the legally disabled but also everyone who is less gifted – and the elderly.

iOS needs cognitive accessibility controls and considerations.

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Electoral strategy: Dems must drink the poison too.

So we now know 20% of Americans are proto-Nazi and another 20% lean that way.

I suspect that is a rule for human societies.

Today that 40% is concentrated in one political party that controls every aspect of Federal government. A ruling minority.

This is a historic disaster that we are all struggling to understand.

That poisonous 40% will be always with us. That is humanity.

We cannot eliminate it, but we cannot have it dominate one party. It has to be diluted.

So we Dems must drink some of the poison – without becoming the GOP. The deplorables must be shared.

I think Obama understood this. The key is policies that address the “great unwanted” across all genders and races and tribes. Policies for the 45% of Americans that are not going to college and have no future in a purely market driven post-labor economy.

If Dems address those policies we can take the salvageable half of the deplorables. The GOP will have to live with the 20% Proto-Nazis; but it may then be able to convert them to non-voters and reemerge as a democratic political party.

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Google and civilization’s fail

Google doesn’t find my stuff any more. Even when it holds answers Google can’t find.

Quality ad-supported media, available to all, is dying. Quality journalism requires subscription.

Donald Trump.

These are all part of the same thing.

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Apple two factor incompetence

“will verify your identity by entering your password plus a six-digit verification code sent to your other devices or a trusted phone number.”

There is no such thing now as a trustworthy phone number.

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PasswordWallet – bought it, deleted it.

PasswordWallet looked like a good alternative to 1Password. Michael Tsai likes it — and he has great taste.

Bought it on App Store and installed Mac and iOS versions. It wasn’t easy to get the sync working, but once it worked it seemed reliable. UI unpolished, but workable. I liked the ability to handle multiple vaults.

Looked good, until one day I searched for a record and got nothing. My jaw dropped.

Sure enough Selznick Scientific only implemented basic string search — the default SQL function. There’s no ‘word starts with’ search. A search for “green red” does not find a record with the title “green yellow red”. Search is basically one string at a time. That does not scale to my hundreds of passwords. It’s only good for numbers so small you could get away with an encrypted document.


This is why I prefer to download apps with In App purchasing. I can discover fatal flaws like this before I buy.

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Canon SL2 – handheld night scene and HDR

This is new since my T2i, I think maybe was T5i. The entry-level Canon dSLR includes some computational photography with HDR mode and 4 shot handheld low light photography. The 4 shot is marketed for night scenes, but there are interesting effects with indoor low light photography (just don’t blink).

Can’t compare to the wizardry of an iPhone 7, but there are some interesting effects there.

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Disentangling the 21st century crisis

Racism? Inequality? Productivity failure? Globalization? IT? AI? Rupert Murdoch? Capitalism crisis? Patriarchy collapse?

It is probably not one thing. It is probably interacting things.

So if we could change one or two components the result could change.

But which? Is there a critical vulnerability?

We do simulations of the evolution of the universe now. Could we simulate these kinds of interactions?

Seeking Psychohistory.

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NK: The T advantage

China and KN knew Obama was utterly sane. NK would become a nuclear power.

Trump not only acts crazy, he is genuinely irrational and he is stupid.

Jong Un and Xi want to live long and rule.

Trump has an advantage here.

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Curious silence on the death of the phone.

In my random sample only mothers answer unrecognized incoming calls. Because it might be about a child.

Everyone else lets them go to voice mail. Because every call is phone spam now.

I have not seen commentary on this — even though it happened fairly quickly.

That is odd.

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How I explore and find fun stuff

My work takes me across the Dakotas, Nebraska, Iowa, and Minnesota. Sometimes small to medium cities, sometimes small towns and byways. I usually have a night or two to look around.

I think I'm good at looking around. Wherever I am, I find something interesting. This is what I do.

If I have a long drive, which for me is more than 3 hours because I am a driving-wimp, I point Google Maps at a non-chain coffee shop in a town along the way. A town with a good coffee shop, especially with a bike path, is almost always interesting.

If I'm not flying I take my mountain bike (in winter I take skis). For much of the year I can get an hour or two of riding. In town I pick a spot in Google – usually a local attraction. Bike trails go by the good stuff. I put my phone with the volume turned high in the top compartment of my hydration pack; I can hear the voice pretty well. I orient myself by the sun, then I set out. I look for interesting streets and parks. With the mountain bike I can cross woods and grassy areas. I let the voice guide me but I don't follow it directly; I can usually find a more pleasant route than Google's default bicycle directions.

Lastly, during each trip I'll do at least one night as a drop-in at a local CrossFit gym. I email ahead to confirm the date is good. I meet local people with a shared interest — they often have good advice on places to go.

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Anker vs. Apple lightning cables

Apple lightning cables fray at the insertion end — where my kids pull on them.

Standard Anker cables don’t fray, but the contacts fail.

Anker PowerLine+ cables haven’t failed yet. Early days though.

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iPhones and the end of backup

Writing my Smarthones for All section on backup and suddenly realized it’s not all that important. The book’s target users just won’t have critical data that’s not in iCloud Photos or iCloud Calendar or streamed from an Apple source. Sure, games data will be lost, but that’s manageable. The big hit is to setup data; that can be pain to redo given all the work needed to make an iPhone special needs friendly. (Note to Apple – you should read the book.)

Weird moment. We old dudes are so used to backup being critical.

Turns out if you don’t own anything, you have nothing to backup. Just a password written on paper.

Duh. So obvious. Sucks to be old.

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Listening to ios podcasts without using cellular data

I had to create an iTunes playlist called “On Device” and drag from iTunes Library to Playlist, then set old school iTunes sync to include that playlist in podcasts. Then in Podcasts.app I could safely choose items that wouldn’t use data.

In several iOS apps there’s a (generally poorly implemented) way to restrict pick lists to on-device content, but I couldn’t figure that out for Podcasts.app.

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Apple DRM crisis coming — Apple ID for Store vs. iCloud

So does Apple want the Apple ID that owns all these purchases, or the Apple ID associated with my iCloud documents? [1]

I’ve been waiting for things like this to happen. For years Apple allowed us to have a separate Apple ID for purchases and iCloud service — but it’s clearly not their preference.

Meanwhile there is no way to merge Apple IDs (though it may be possible to do this with customer service).

This is going to go badly…

[1] In this case they wanted my iCloud Drive/Documents ID, not the Apple ID for DRMd content. I don’t have any DRMd eBooks fortunately — all purchased books are from Google Play store and any DRM is stripped.

Update: Via Twitter, @dfjdejulio suggested:

Partial workaround is to have iCloud account be head of family and store account be family member. Use iCloud account, access all content.

Clever! I may do this. Need to think it over a bit.

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Buying 2017 – the cost of too cheap

Amazon sells (direct listing) elegant slender simple "Casio" watches for $10 each. I bought a few.

After a few weeks one of them rattles.

So I lost out on that deal.

It might be counterfeit. Amazon is a shady place.

Or maybe it is just another race to the bottom. Maybe $10 is the only viable price, and that isn't enough to make a watch worth owning.

A "toaster problem" in other words.

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Canon Rebel SL2 dSLR quick impression.

Just got mine. Third Rebel I've bought, last was T2 I think.

Smallest and lightest Rebel, rivals EVIL. Battery door feels chintzy; overall feels less serious than prior models.

Video much better than T2 but doesn't seem truly more light sensitive. I prefer Nikon's choices there.

Has novice UI but can disable it.

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