Maybe more of a theory than a law, but still:
Any eLearning tool, no matter how openly designed, will eventually become indistinguishable from a Learning Management System once a threshold of supported use-cases has been reached.
They start out small and open. Then, as more people adopt them and the tool is extended to meet the additional requirements of the growing community of users, eventually things like access management and digital rights start getting integrated. Boil the frog. Boom. LMS.
It is easy to make facile comparisons between universities, publishing, and the internet. But it is useful to explore the differences and similarities, even down to the mundane production of ‘content’.
This is from Frederic Filloux form the ever wonderful Monday Note
The biggest mistake of news publishers is their belief that the presumed uniqueness of their content is sufficient to warrant a lifetime of customer loyalty.
The cost of news production is a justification for the price of the service; in-depth, value-added journalism is hugely expensive. I’m currently reading Bad Blood, John Carreyrou’s book about the Theranos scandal (also see Jean-Louis last week’s column about it). This investigation cost the Wall Street Journal well over a million dollars. Another example is The New York Times, which spends about $200 m a year for its newsroom. The cost structure of news operations is the may reason why tech giants will never invest in this business: the economics of producing quality journalism are incompatible with the quantitative approach used in tech which relies Key Performance Indicators or Objectives and Key Results. (
In France, marketers from the French paid-TV network Canal+ prided themselves of their subscription management: “Even death isn’t sufficient to cancel a subscription,” as one of them told me once.
Facebook accounts hacked? I thought that was the feature not the bug.
Carrot weather — the weather app with attitude.
Two quotes from Bad Blood: Secrets and lies in a Silicon Valley Startup, by John Carreyrou. Only without much silicon.
“Henry, you’re not a team player,” she said in an icy tone. “I think you should leave right now.” There was no mistaking what had just happened. Elizabeth wasn’t merely asking him to get out of her office. She was telling him to leave the company—immediately. Mosley had just been fired.
He also maintained that Holmes was a once-in-a-generation genius, comparing her to Newton, Einstein, Mozart, and Leonardo da Vinci.
The reality distortion field lived on. Medicine is indeed tricky.
This is a scary story. But the lesson is (yet again) our inability to understand what makes humans tick.
How Maersk was taken down by Russian malware, and how it recovered. The passage that got the attention is the bit about flying a domain controller backup in from Ghana (the only one that survived). The one that matters is that they were still running Windows 2000 on some servers and hadn’t carried out a proposed security revamp because it wasn’t in the IT managers’ KPIs and so wouldn’t help their bonuses. Link
Via Ben Evans
It is not only taxi drivers that are being “uberised” but radiologists, lawyers, contractors and accountants. All these services can now be accessed at cut rates via platforms.
The NHS became such a platform, for good and bad. That is the real lesson here. The tech is an amplifier, but the fundamentals were always about power.
One selling point of MOOCs (massive online open courses) has been that students can access courses from the world’s most famous universities. The assumption—especially in the marketing messages from major providers like Coursera and edX—is that the winners of traditional higher education will also end up the winners in the world of online courses.
But that isn’t always happening.
In fact, three of the 10 most popular courses on Coursera aren’t produced by a college or university at all, but by a company. That company—called Deeplearning.ai—is a unique provider of higher education. It is essentially built on the reputation of its founder, Andrew Ng, who teaches all five of the courses it offers so far. Link
The MOOC story is like so much of tech — or drug discovery for that matter. Finding a use for a drug invented for another reason often offers the biggest payback. This story has barely begun.
Hype is not fading, it is cracking.
I like the turn of phrase. It is from a post on the coming AI winter. Invest wisely.
A Magic Shield That Lets You Be An Assh*le? – NewCo Shift
The Internet of the 1990s was about choosing your own adventure. The Internet of right now over the last 10 years is about somebody else choosing your adventure for you.
“They took all the trees, put ’em in a tree museum, and they charged the people., a dollar and a half just to see ’em…”
“It’s quite obvious that we should stop training radiologists,” said Geoffrey Hinton, an AI luminary, in 2016. In November Andrew Ng, another superstar researcher, when discussing AI’s ability to diagnose pneumonia from chest X-rays, wondered whether “radiologists should be worried about their jobs”. Given how widely applicable machine learning seems to be, such pronouncements are bound to alarm white-collar workers, from engineers to lawyers.
The Economist’s view is (rightly) more nuanced than Hinton’s statement on this topic might suggest, but this is real. For my own branch of clinical medicine, too. The interesting thing for those concerned with medical education is whether we will see the equivalent of the Osborne effect (and I don’t mean that Osborne effect).
This is some text I recognise, but I had forgotten its source: Bruce Schneier.
Technology magnifies power in general, but the rates of adoption are different. Criminals, dissidents, the unorganized—all outliers—are more agile. They can make use of new technologies faster, and can magnify their collective power because of it. But when the already-powerful big institutions finally figured out how to use the Internet, they had more raw power to magnify.
This is true for both governments and corporations. We now know that governments all over the world are militarizing the Internet, using it for surveillance, censorship, and propaganda. Large corporations are using it to control what we can do and see, and the rise of winner-take-all distribution systems only exacerbates this.
This is the fundamental tension at the heart of the Internet, and information-based technology in general. The unempowered are more efficient at leveraging new technology, while the powerful have more raw power to leverage. These two trends lead to a battle between the quick and the strong: the quick who can make use of new power faster, and the strong who can make use of that same power more effectively.
Well, this was the modest description of a ‘new’ way to test blood. Except it wasn’t. The reality distortion field in hyperspace. If you don’t know the Theranos story — or doubt the importance of real journalism — have a look.
In this week’s privacy nightmare, an Oregon couple discovered their Amazon Echo smart speaker recorded their conversation and sent the audio to an acquaintance — without their knowledge.
The claim seemed improbable, until the company confirmed it really happened. Amazon said it was reviewing how its smart speakers work to avoid similar situations.
Exactly in the same way that Big Tobacco has been free to fill the lungs of Asian of African populations, with little interference from local health administrations, Facebook will have a free hand to lock up these markets. (If you find my comparison with the tobacco industry exaggerated, just ask the Rohingyas or people in the Philippines about the toxicity of Facebook to democracy — or read this Bloomberg Business Week piece, “What happens when the government uses Facebook as a weapon?”)
I used to think this whole topic was overblown. But then again, I once thought those who foresaw the obesity epidermic were selling something. Wrong on both counts.
Former Google Design Ethicist: Relying on Big Tech in Schools Is a ‘Race to the Bottom’ | EdSurge News
I see this as game over unless we change course,” says Tristan Harris, a former ethicist at Google who founded the Center for Humane Technology. “Supercomputers play chess against your mind to extract the attention out of you. The stock price has to keep going up, so they point it at your kid and start extracting the attention out of them. You don’t want an extraction-based economy powered by AI, playing chess against people’s minds. We cannot win in that world.”
In an interview with EdSurge, Harris noted that the focus of their campaign started with children because they were the most vulnerable population. He says that particularly children in schools had little agency over whether they opted into or out of a technology platform because of pressure from both peers and educators handing out assignments.
Some nice turns of phrase and perspective from this article in the FT
In 1829, the great Scottish historian and essayist Thomas Carlyle wrote: “Were we required to characterise this age of ours by any single epithet, we should be tempted to call it . . . the Mechanical Age. It is the Age of Machinery . . . the age which, with its whole undivided might, forwards, teaches, and practices the greater art of adapting means to ends.”
He continued with a lament for older ways of doing and being: “On every hand, the artisan is driven from his workshop, to make room for a speedier, inanimate one. The shuttle drops from the fingers of the weaver and falls into iron fingers that ply it faster. The sailor furls his sail, and lays down his oar, and bids a strong unwearied servant . . . bear him through the waters.”
It is a measure of just how much speedier our age is that no one today will take the time to write or read such comparatively languorous prose. What is striking about Carlyle’s writing from today’s vantage point is how early in the industrial revolution he mounted a protest against it. By 1829, the steam engine was entering its heyday, but the explosion of iron, steel, coal and oil that we associate with the industrial age was visible only on the horizon.
Universities are certainly putting their courses online. The question is “why?” I talked last week with a University President whom I have known for many years and asked him why he was building online courses. His answer, unsurprisingly, was “fear.”
This is an old quote, but still redolent.
Well, just as I approached utter despair, it seems the authors of this Editorial in the Annals of Internal Medicine, say no. Whew! Gee, they will soon wonder if texting patients appointment times might occasionally be a good idea.
It is a truism that you never understand anything unless you can understand it more than one way. I like this one:
When he and his colleagues spun ClearMotion out of the Massachusetts Institute of Technology in 2008, their intention was to use bumps in the road to generate electricity. They had developed a device designed to be attached to the side of a standard shock absorber. As the suspension moved up and down, hydraulic fluid from the absorber would be forced through their device, turning a rotor that generated electricity. But, just as a generator and an electric motor are essentially the same, except that they run in opposite directions, so ClearMotion’s engineers realised that running their bump-powered generator backwards would turn it into an ideal form of suspension. And that seemed a much better line of business. They therefore designed a version in which the rotor is electrically powered and pumps hydraulic fluid rapidly into and out of the shock absorber. The effect is to level out a rough road by pushing the wheels down into dips and pulling them up over bumps.
“People worry that computers will get too smart and take over the world, but the real problem is that they’re too stupid and they’ve already taken over the world.”
Pedro Domingos, The Master Algorithm1, (2015)
via John Naughton
Frederik Filloux in the ever readable Monday note. And just as big T went for the developing world, so with FB
Mark Zuckerberg talking: “ There was this Deloitte study that came out the other day, that said if you could connect everyone in emerging markets, you could create more than 100 million jobs and bring a lot of people out of poverty.”
The Deloitte study, which did indeed say this, was commissioned by Facebook, based on data provided by Facebook, and was about Facebook.
I had just wanted one, but now….
The Osborne effect is described in Wikipedia as follows:
The Osborne effect is a term referring to the unintended consequences of a company announcing a future product, unaware of the risks involved or when the timing is misjudged, which ends up having a negative impact on the sales of the current product. This is often the case when a product is announced too long before its actual availability. This has the immediate effect of customers canceling or deferring orders for the current product, knowing that it will soon be obsolete, and any unexpected delays often means the new product comes to be perceived as vaporware, damaging the company’s credibility and profitability.
AI and associated technologies will have major effects in some areas of medicine. Think skin cancer diagnosis, for certain; or this weekend story in the FT on eye disease; and radiology and pathology. This then begs the question, whether these skills are so central to expertise within a clinical domain, that students should think hard about these areas as a career. Of course, diagnosis of skin lesions is not all a clinical expert in this domain does. Ditto, ophthalmologists do more than look at retinas. Automated ECG readers have not put cardiologists out of work, after all. And many technical advances increase — not reduce — workloads.
But at some stage, people might want to start wondering if some areas of medicine are (not) going to be secure as long term careers. The Osborne metaphor should be a warning about how messy all this could be. Hype, has costs.
The value of your mountains of data is becoming obvious, especially as you continue to push into new areas that collect more information about consumers while binding them closer to you, such as the home microphones you are careful to call home speakers. Link
Remember your physics 101: when is a speaker a microphone? And of course this is not all new — see the Intercept article (with great graphics) here
The internet, as digital journalist and commentator Cory Doctorow has remarked, is “an ecosystem of interruption technologies”. Always imagine that your readers are looking for a reason to — in Tinder terms — swipe left on your prose
In my professional area of medical education there is clear market failure. Publishers are simply unable or choose not to, to develop what we need. And the institutions — universities — despite their origins have simply looked the other way, ignoring the needs (and wants) of their students. And do not get me started on “lecture recording”.
The quote below is a great article on some of the economics of book publishing: it is about a cookbook. And why not?
One of the most opaque industries around is publishing, not here online, but good old-fashioned print-books and their digital and audio spin-offs. Poke around and try to find some hard sales numbers and you’ll quickly find that it’s near impossible to do so. You can find bestseller lists from reputable sources like the NYTimes, Amazon and others but tying those rankings to an actual number of books sold at retail is simply not doable. Publishing costs, deals, and profit lines are even harder to shake loose.
“Why We Are Self Publishing the Aviary Cookbook – Lessons From the Alinea Book”. Real numbers from the opaque world of cookbook publishing. [Link]
And if you want insights into the research publishing business, here is a link to a great article that appeared in 2017 on this topic by Stephen Buranyi. Mind you, I almost have a sneaking admiration for some of the crooks: foxes in the henhouse.
I like computers (see previous post), but despair of them in the clinical context of keeping medical records. By contrast nobody sane doubts that computers are advantageous in other medical contexts: imaging, radiotherapy, or even using an insulin pump. We don’t have problems with the latter instances, because self-evidently computers work, and they are the result of a culture of improvement. Not so with electronic medical records, where a neutral observer might thing that the purpose is to save money in one budget at the expense of diminishing clinical care in another. The economists might talk about externalities, but essentially many electronic record keeping systems are a form of pollution of the clinical workspace.
The following quote caught my eye because, whilst in Scandinavia recently, a dermatologist from Denmark was expressing frustration with how bad their computer systems are; and how older physicians choose to ignore them by retiring early. I heard a similar tale from the US in the summer, from a dermatologist who takes a financial hit because he has not implemented electronic records. He says he can either manage patients or do IT (and yes, he is planning to get out early).
Electronic medical records (EMRs) have resulted in increased documentation burden, with physicians spending up to 2 hours on EMR-related tasks for every 1 patient-care hour. Although EMRs offer care delivery integration, they have decreased physician job satisfaction and increased physician burnout across multiple fields, including dermatology.
I would add, that I have read that the average ER doc on a shift in the US presses his mouse 4000 times.
A long time ago, Richard Doll wrote an article pointing out that hospital record systems such as hospital activity analysis were perhaps useful to managers, but not much use for doctors or researchers. He was right, and I even published a paper saying similar things. My experience of electronic records in hospitals is that they are designed for the purpose of ‘management’ not clinical care. Contrary to what many say, these two activities have little in common, and share few goals. Our care system is not designed for care or caring, and our software is not designed for clinicians or patients. As for EMR, we are still waiting for our VisiCalc or Photoshop. If somebody can pull it off, it would be worth a Nobel.
Today (Oct. 17) was International Spreadsheet Day, marking the day back in 1979 that VisiCalc first shipped for the Apple II. Creator Dan Bricklin devised the program originally to help him crunch numbers for an assignment at Harvard Business School. [Link]
I dislike spreadsheets, and think the world will end not in fire, but in one giant bloody spreadsheet (or as a result of one). I also think they are a great metaphor for what is often wrong in medicine: an Excel spreadsheet can calculate a PASI (pissing awful psoriasis index, in lay terms) but it cannot tell you when somebody has bad psoriasis. People get confused about the epistemology here.
But these comments are a little sour. I have never really had to use spreadsheets, instead preferring to use something like R for when I have need of matrices, or when I was really young, FORTRAN. And to be fair even then, I would (now) need to go via a spreadsheet / csv file to enter the data. And this ignores the fact that mostly spreadsheets are used as static tools to present multicoloured tables rather than do calculations. But spreadsheets were, and are, revolutionary. I knew of Dan Bricklin, their inventor, but not all of the following story about how he invented then because he needed them to carry out a set assignment at Harvard Business School
Bricklin knew all this, but he also knew that spreadsheets were needed for the exercise; he wanted an easier way to do them. It occurred to him: why not create the spreadsheets on a microcomputer? Why not design a program that would produce on a computer screen a green, glowing ledger, so that the calculations, as well as the final tabulations, would be visible to the person “crunching” the numbers?
Why not make an electronic spreadsheet, a word processor for figures?
Bricklin’s teachers at Harvard thought he was wasting his time: why would a manager want to do a spreadsheet on one of those “toy” computers? What were secretaries and accountants and the people down in DP for? But Bricklin could not be dissuaded. With a computer programmer friend from MIT named Bob Frankston, he set to work developing the first electronic spreadsheet program. It would be contained on a floppy disk and run on the then brand-new Apple personal computer. Bricklin and Frankson released VisiCalc (the name was derived from Visible Calculation) in late 1979.
There are some general points. Advances are often made by tool makers; and the best fillip for great software is a problem you personally need to solve (a point Paul Graham makes repeatedly). And of course, people who know better, will not think your efforts worthwhile. Little of this is true of hospital information systems.