JohnPatrick.com
Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, investing, and board service. My areas of focus include healthcare, Internet and mobile voting, and technology. As you will see in the books I have written, I believe most big problems and big solutions involve Attitude. My latest book is Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better (2019). Robot Attitude and all the prior books are part of a Series called “It’s All About Attitude“. You can find all the details about each book here.
My blog below has more than 2,000 stories about technology, music, motorcycles, travel, business, Internet voting, robots, AI, healthcare, and more. Every Saturday morning, I publish an e-brief which contains an easy to read post or two about new developments in my areas of interest. Please sign up and give it a try. If you don’t like it, you can make one click and you will not receive it again. You can find me on social media on Facebook, LinkedIn, Twitter, and YouTube. You can also find my background in Wikipedia.
Ukraine
The EU Summit agreed on candidate status for Ukraine and Moldova. The President of the European Commission Ursula Gertrud von der Leyen congratulated the new candidates on joining the EU: “Today is a good day for Europe. Congratulations to President Zelensky, President Sandu, and Prime Minister Garibashvili. Your countries are part of our European family. And today’s historic decision of the Leaders confirms this.”
EU candidate status is a recognition that Ukraine has approached the EU at a basic level in economic and democratic terms. For negotiations on EU membership to begin, Ukraine may be presented with a number of preconditions. During the negotiation process, the candidate country brings its legislation into full compliance with EU law in almost all policy areas. The accession negotiation process is ongoing in 35 areas and can take years. Hopefully, there will be efforts to streamline and accelerate the process.
Space
NASA this week performed a fifth wet dress rehearsal (WDR) with its massive Space Launch System (SLS) ahead of its greatly anticipated maiden flight. The purpose of WDR is to simulate launch day operations through the countdown all the way to T-9 seconds to verify fueling procedures, ground and vehicle communications, and various actuators and sensors. The first several attempts at WDR earlier this year revealed several leaks at connections and valves used for loading propellant. There were a few minor issues remaining at the end of this week’s WDR but mission managers have determined these can be fixed with relative ease and no further WDR is required before launching an uncrewed flight around the moon later this year. This is a major milestone in the development of the largest rocket NASA has ever built.
From big to small, next week, Rocket Lab will be launching NASA’s CAPSTONE mission, which stands for Cislunar Autonomous Positioning System Technology Operations and Navigation Experiment. The primary payload is a “cubesat”, a 55 pound mini refrigerator-sized satellite that will evaluate the trajectory and orbit for future missions under NASA’s Artemis program to return humans to the moon, and as a staging area for missions to Mars.
– Aaron J. Patrick
Reflection Attitude
More progress on Reflection Attitude. A final cover is underway with assistance from Irina in Romania. She has done all but one of my book covers. Am still working on a third edit based on feedback. Based on travel schedule, I may have to push the publication to September.
Wall Street
Lots of green today and a strong week. The NASDAQ in particular is gaining ground. A long way to go. Many techs are at or close to their 52-week lows, but seem to be coming back. Gammat stocks up to $8 trillion and more than 20% of S&P 500.
Crypto
Very close to 20,000 cryptocurrencies. Most of them likely worthless. Crypto market cap just below $1 trillion. Half of what it had been. Bitcoin is 42% of the total. Ethereum is 16%. All the rest is 42%. Ethereum is going to have a major change in how it works sometime this year. It may potentially boost ETH value. Or, the change could crash the blockchain.
Are NFTs for Real?
Written: June 2022
The world of NFTs is emerging, and I think it is a big deal. CNBC reported on June 15 Microsoft co-founder Bill Gates said he thinks cryptocurrencies and NFTs are “100% based on greater fool theory.” Bill is one of the richest and smartest persons in the world so he may be right, but I do not think so. In Paris in 1996 he and I both gave keynote speeches at a technology conference. I presented a very bullish case where the Internet would be the next big thing. You can see a YouTube video of the speech here. Bill gave a great speech, but he played down the Internet. He said that the web was interesting, but it was slow, unreliable, insecure, and had no place in business. I give him credit however for, once he had made a 180 about Internet, turning around Microsoft on a dime and rapidly creating and adopting Internet technology. Before discussing NFTs further, let me offer a high-level view of what NFTs are and how they work.
NFT stands for non-fungible token. Non-fungible means an NFT is not like money as we know it. If I give you a $5 bill, you can give it to someone else or you can buy something with it. Whatever you do with the $5 bill, it is still $5. That is what is meant by the expression “funds are fungible”. Your buying power of the $5 may change based on inflation, but $5 is still $5. Suppose I create a digital piece of art using an Apple pencil and an iPad and I store it on an NFT blockchain. If I make the NFT for sale for $5, someone may be willing to buy it. The buyer might subsequently sell the $5 NFT for $10. Or maybe $100. According to market tracker NonFungible, the average sale price of an NFT is now below $2,000. The average had been over $6,800 in January.
Critics of NFTs are correct there are large amounts of junk being created, fraud taking place, and generally a lot of market chaos. I will be writing another post with my view of how this may sort out and why I am optimistic about the future of NFTs for artists and art collectors. First, I would like to share a point of view about another use and potentially much more significant case for NFTs.
In 1993, my wife and I purchased a lake home in the Pocono Mountains of Pennsylvania. We took out a mortgage with Prudential Home Mortgage, which I paid off four years later. We sold the home in May 2022. The attorney for the buyer of the home did a title search and could not find any record of the mortgage being paid off. The way it is supposed to work is when the bank receives final payment, they file a certificate of satisfaction with the local county where the property is located. Apparently, they did not, so the attorney withheld 100% of the original mortgage from nearly 30 years ago. The attorney said he would release the money when I show proof the mortgage had been satisfied.
The wild goose chase began with a web search to get a phone number for Prudential Home Mortgage. I found they had been acquired by Norwest Financial. A search for Norwest showed they had been acquired by Wells Fargo. The people at the Wells Fargo were very nice and were optimistic they could find the record. Apparently, this type of situation is very common. That is why they have a department just for that purpose. They required a written request for the record search. After three weeks, Wells sent me a fax saying the mortgage was acquired by Bank of America. BoA required a written request to initiate their search. After two weeks they sent me a fax saying the mortgage was held by Wells Fargo. Their response time was approximately 20 days. Wells Fargo and Bank of America have something in common. They both have a Lien Release Department and neither use email, only fax and USPS mail. When I eventually get a response from Wells Fargo, nothing will surprise me.
Imagine if the original mortgage had been converted to an NFT. Just like a piece of art, a PDF of the mortgage could be authenticated, encrypted, and “dropped” onto a blockchain. Once the drop is confirmed by the miners operating the blockchain, the mortgage would become a permanent immutable record. Immutable is a key word. It means the NFT cannot be modified or deleted. It is permanent and would live on the blockchain forever as a publicly accessible document just like at the county office except without the need for faxes or USPS.
Think of the mortgage NFT as an asset just like cryptocurrency. Then, think of other assets which could be stored on a blockchain: crypto, art collections, music collections, mortgages, titles of land, homes, cars, boats, motorcycles, deeds, birth certificates, marriage certificates, death certificates, investment ownership certificates, and votes. Today, these assets live mostly on paper and often get lost and require dedicated departments to search for them. When they can’t be found, which is possible for my mortgage, then the interested party must hire an attorney to sue the issuer and go to court to get satisfied.
All the assets I have mentioned could be handled by existing large, centralized organizations, in theory. In practice, they are too big, too slow, too bureaucratic, and intrinsically resistant to change. In the case of banks, they are impeded due to multiple acquisitions and mergers of companies which have incompatible information technology systems. In the case of state, local, and federal organizations, they are slow to move on anything. In my opinion, blockchain technology is emerging as the next phase of the evolution of the Internet. Billions of dollars of venture capital are flowing into blockchain startups. Most will fail, but some will change the world just like the Internet has.
Covid
I had been lucky for more than two years. Perhaps two vaxes plus two boosters and being cautious helped but maybe my immunosuppressed status was a factor. Seven days after returning from a week in Montreal, I tested positive. The symptoms were mostly mild and after three days I feel 90% normal. Seems the virus is everywhere. It is still worth being careful and vaxxed to the max.
Ukraine
A posting on Telegram says weapons Ukraine obtains as aid from international partners gets to the front lines almost instantly. A Ukraine Ministry of Defense spokesman said, “We see the results of the use of American 777 guns (M777 howitzers). The General Staff also reported on the success of using French CAESAR artillery systems; this is a very effective weapon that allows hitting the enemy at a distance with precise strikes”. As of today, the Ukrainians have converted 1,456 Russian tanks into scrap metal.
Space
SpaceX is racking up lots of records with the furious launch cadence of its workhorse Falcon 9 rocket, which is the only orbital class rocket with a reusable first stage, or booster. On Friday, SpaceX started a launch campaign with three Falcon 9 launches in three days, beginning with a another batch of Starlink satellites into orbit from Kennedy Space Center (KSC) in Florida. This launch has a number of notable milestones, such as the following:
– 1st booster to fly for a 13th time
– 100th re-flight of a booster
– 124th booster landing
– 50th consecutive landing (a record)
SpaceX has recently certified the Falcon 9 booster for 15 flights, up from 10. NASA has even flown crew on reused boosters, signaling a high level of confidence in the safety and performance of the vehicle.
SpaceX makes it look easy, but it is not. There are many things that can go wrong but everything has to go right to get off the pad, out of the atmosphere, and into orbit. Recently, Astra, a startup launch provider, had a launch attempt to send a pair of hurricane monitoring satellites for NASA into orbit from KSC. Astra’s rocket, called Rocket 3, has successfully taken payloads to orbit on previous attempts, but on this occasion the second stage shut down early and the payloads fell back to Earth. NASA has two additional pairs of these satellites it plans to launch with Astra. That is, of course once they identify and fix the issue leading to the second stage failure on this flight.
– Aaron J. Patrick
Reflection Attitude
More progress on Reflection Attitude. A final cover is underway with assistance from Irina in Romania. She has done all but one of my book covers. Am working on a third edit based on feedback.
Wall Street
The Dow was down again but the NASDAQ is regaining some ground. A long way to go. Many techs are at or close to their 52-week lows. Gammat stocks down to $7.6 trillion but still nearly 20% of S&P 500.
Crypto
Almost 20,000 cryptocurrencies. Crypto market cap just below $1 trillion. Half of what it had been. Bitcoin is 45% of the total. Ethereum is 15%. All the rest is 40%. Things are heating up about government regulation. I see this as a good thing. One of the provisions in a congressional bill exempts from capital gains tax any purchase with crypto of good or services at less than $200 . This is very important and I believe it will fuel growth of cryptocurrency payments. I believe as tech stocks come back, so will crypto. However, most of the 20,000 are jokes or schemes which will fall to the wayside. Too bad so many of been suckered into these. Same as 2000 when many websites had promised to make water run up hill.
Why Do We Need Trees?
Life on Earth depends on energy coming from the Sun. The greenhouse effect has protected life on Earth from unlivable cold conditions for as long as life has been here. To keep greenhouse gases in perspective, we need to remember greenhouse gases are a good thing, but only if there are not too much of them. The culprit of greenhouse gasses growing the fastest and upsetting the balance which nature has maintained is carbon dioxide (CO2).
The atmospheric concentration of carbon dioxide has been rising since the Industrial Revolution. Data collected by NASA’s orbiting satellites and other measurements indicate CO2 has reached a dangerous level not seen in the last 3 million years. Human sources of CO2 emissions are much smaller than natural emissions, but the growth of human created emissions has upset the natural balance which had existed for many thousands of years.
The natural sources of CO2 which add to the atmosphere include when organisms respire (exhale) or decompose, carbonate rocks, mostly limestone, which break down by weather, from forest fires, and eruption of volcanoes. The human sources of carbon dioxide emissions include the burning of oil, coal, and natural gas, cement production, and deforestation with up to 10 billion trees cut down per year. Almost 90% of all human-produced carbon dioxide emissions come from the burning of fossil fuels.
If you go along with the scientific consensus, the logical question is what can we do personally to reduce our own carbon emissions? The starting point is to calculate your personal carbon footprint. To get a footprint calculation which is actionable, you use a footprint calculator. There are many of them. I recommend using the one from carbonfootprint.com. It will ask you about how you heat and cool your home, what kind of car you have, what you eat, and several other factors. I view the calculation as a crude estimate. The footprint for my wife and I is somewhere between 5 and 10 metric tons of carbon per year.
I decided some years ago, I wanted to be carbon neutral. That means my net carbon footprint is zero. There are two ways you can reduce your footprint. There will be many new choices coming for electric cars. EVs are not zero emissions because you must use electricity which is made by an electric company which may burn coal to produce the power. However, the carbon emissions are much less than from internal combustion engine cars. The ideal offset is to get an EV plus a solar roof and charge your car from the sun.
In addition to using less fossil fuel for transportation, there are several things you can do including using only Light Emitting Diodes (LEDs) throughout your house, reduce your garbage, bring reusable bags to the grocery store, reduce your consumption of products with excess packaging and plastic, and buying water in plastic bottles and use filtered tap water. There are many ways to have an impact. One person can’t save the planet, but efforts of each individual person help, assuming enough individuals buy in to the idea.
Another way to help is to plant trees. Trees help remove carbon dioxide from the atmosphere by using it during the photosynthesis process which releases oxygen as a by-product. How many trees are there? It sounds like a question from an innocent child asking how many bugs or seashells are there? While it is virtually impossible to know how many trees are in the world, incredibly accurate satellite imaging has enabled scientists to make a rough estimate. A study in the journal Nature reported close to 3 trillion trees on Earth. That equates to 422 trees per person. It varies widely by country.
Scientists estimate, before the advent of humans, the earth hosted six trillion trees, double the current number of trees in the world. Our planet has half the trees it used to because of intensive agricultural practices and development of modern civilization infrastructure. Estimates vary but we continue to lose trees at a rate of up to 10 billion trees a year.
While it is quite possible to keep coal in the hole and oil in the soil, no government or company can ever ensure carbon will remain in trees. Forest fires, insect outbreaks, decay, logging, land use changes and the decline of forest ecosystems because of climate change are all hard or impossible to control. This doesn’t mean we shouldn’t try to protect and restore forests. We need to do it at the same time as reducing fossil fuel emissions to zero. Europe has just passed a law which will ban the sale of gas or diesel cars in Europe after 2035. In the short term it is obvious we need to increase the supply of natural gas and oil.
The above are just a few thoughts. There is much more to it. Just Google “carbon footprint” and you will find the resources. Even with aggressive actions on our part, we still will not get our footprint to zero. The other tool at our disposal is to invest in projects which provide offset. Many non-profits are focused on reducing carbon emissions. I guess you could say, to get to carbon neutral, you must buy your way out of it.
I donate to Arbor Day Foundation. They are laser focused on planting trees. Visit arborday.org to learn more. At about 10 years of age, trees are estimated to soak up about 48 pounds of CO2 per year. For example, if you have a 6-inch Fir tree on a property in Pennsylvania, that tree will reduce atmospheric carbon by 77 pounds per year. Yes, it would take a lot of trees to get to net zero, but the Arbor Day Foundation can calculate the size of a donation it would take to plant the required number of trees. I donate $750 annually to the Foundation to get me to neutral.
Ukraine
A posting on Telegram says almost every day, the Bureau of Investigation reveals new cases of the burning of Russian passports by citizens residing in Ukraine. Men and women, people of various professions and all ages are expressing their protest against the war.
A 64-year-old Russian citizen who has lived in the Lviv region since 1998, said, “In the 14 years that I have lived in Ukraine, I have not experienced any oppression from Ukrainians. I do not want to be a citizen of the country that arranged genocide against the Ukrainian people, so I am destroying my passport. Glory to Ukraine!
The number of people wishing to renounce Russian citizenship and obtain a Ukrainian passport is also growing.
Space
NASA’s Mars helicopter, Ingenuity, has exceeded everyone’s expectations for what this tiny vehicle is capable of doing. Originally designed for up to 90 seconds of flight over 5 flights, it has made 28 flights as of the end of April, with a total flying time of nearly one hour, covering over 4 miles of ground as high as 39 feet in altitude and as fast as 12.3 MPH. Its main mission was to demonstrate the first powered, controlled flight on another planetary body. Having swiftly accomplished that goal it received a new mission as a scout for the Perseverance rover’s science targets. Now in its second year of operation, it is nearing Martian winter, and daily sunlight levels are diminishing. The Ingenuity operations team never expected the copter to last this long but have adapted their approach to power management, letting it shut down each night when overnight temperatures drop below 100 degrees Fahrenheit, and wake up and reset itself each morning. All of these amazing accomplishments are a testament to the teams that built and operate this incredible machine.
In a recent flight, Ingenuity spotted the backshell and parachute that were discarded during Perseverance’s descent to the surface last February. This imagery is of particular interest to the Mars Sample Return team, who is keen to know how the structure and materials performed during entry. Perseverance, or Percy, is equipped with 43 collection tubes for rock and soil core samples to be left on the surface for return to Earth for analysis in a series of missions starting later this decade. In other Percy news, since February, the rover has had a rock lodged in one of its wheels that has been tagging along for over 5 miles of driving.
– Aaron J. Patrick
Reflection Attitude
Traveling in Canada and upstate NY this week so no progress on Reflection Attitude. I now have six very nice blurbs in hand. I have completed a second full edit and am working on a third based on feedback.
Wall Street
Stocks are trading at even more significant lows. Everything is red. Maybe techs will go down a lot more but there is also a chance for a lot of upside. I don’t think anybody knows. There are too many variables. I remain bullish on tech, large and small. It may be a long wait. Gammat stocks down to $7.9 trillion but still nearly 21% of S&P 500.
Crypto
Crypto.com now has 50 million users. Crypto market cap hanging in there at $1.2 trillion. Bitcoin is 46.3% of the total. One of the major knocks on crypto has been volatility. It is still an issue. However, BTC has been less volatile in the last 30 days than many stocks. Things are heating up about government regulation. I see this as a good thing.
Will Robocalls from Dealer Service Ever Stop?
Written: June 2022
I saw the following post on Twitter this morning, “Hello Amy from the dealer service center. I know you want me to know that my car warranty is about to expire, but Amy, I thought you knew that I don’t have a car, or a driver license to drive the car with the warranty that is about to expire. Thanks for calling though.” Twitter jokes aside, robocalls are a big pain for all of us. Fortunately, FCC and Congressional members get robocalls also. They are a huge waste of time for everyone, and the government is acting in a way I view as promising. First, an update on robocalls overall.
Consumers recognize robocalls and how to ignore them. Only 18% of unidentified calls and 9% of calls identified as spam get answered.[i] Spam calls typically last 45 seconds compared to legitimate calls from businesses which last almost three minutes on average.[ii] The math says spammers wasted a total of 651,176 minutes in 2020. October 2019 may be the peak with 190 million robocalls per day adding up to 5.7 billion calls for the year.[iii]
Since most consumers do not answer calls from unknown numbers, the scammers have developed spoofing technology which lets them show you an illegitimate calling number which looks like it is in your area code or local area. CNBC reported Americans lost nearly $13.4 million to coronavirus-related robocalls as of May 2020. Truecaller, a maker of a caller ID and spam blocking app, reported between mid-2019 and mid-2020, over 56 million Americans lost money to phone scams.[iv] The scammers are most successful when preying on seniors who may be technologically illiterate. AARP reported seniors lose an estimated $2.9 billion each year to financial scams.[v] More than half of seniors receive at least seven robocalls per week.[vi]
There are numerous apps available which claim to block spam calls. In the early days I found the Nomorobo app to be quite effective but not so lately. The FTC has a National Do Not Call Registry at www.donotcall.gov but it offers no immediate relief either. The problem has been spammers continue to innovate. The FCC voted to authorize carriers to block incoming calls. Some carriers, like AT&T, want to charge you a monthly fee to do the blocking. This turns off most consumers who don’t think they should have to pay for blocking and have the concern important legitimate calls may get blocked such as notice of a school closing due to weather.
Before I get to the impending government solution, let me explain the problem in a simplified manner. If you use AT&T, Sprint, T-Mobile, or Verizon and a friend or business uses the same carrier as you, calls go right through to the destination, or they get routed to you if the caller uses a different carrier. The problem is when the call originates from outside of the country or other unknown carrier, the call gets routed to the number the originator specifies, which may not be a legitimate caller. In other words, it is a number designed to look legitimate and trick you into answering the call. There is no way for the transferring carrier to know the call is not legitimate.
It has been a long time in the making, but our government may finally have a solution to the robocall/spam/scam/spoof calls. It is called STIR/SHAKEN or SHAKEN/STIR. At first blush, this may sound like the name was inspired by Ian Fleming’s character James Bond, who famously preferred his martinis “shaken, not stirred.” The STIR/SHAKEN or SHAKEN/STIR solution is a suite of technical protocols and procedures which are designed to combat the call spoofing.
The protocols are very technical. At a high level, what they do is require the originator of a call to register themselves through a set of steps which enable them to establish their legitimacy. If they do not follow the tedious steps outlined by the protocols, their calls will be blocked. All the steps need to be in place by the end of this month, June 30, 2022. There is no guarantee the new solution is going to work. So far, the bad guys have been able to work around blocking attempts like what some of the sanctioned countries in the world have been using to work around the sanctions. I may be proven wrong, but I believe the government’s technical solution will at a minimum provide a large decrease in robocalls.
For those readers anxious to know what the protocols stand for, here goes. STIR is short for Secure Telephony Identity Revisited. It consists of a series of technical standards developed by a Working Group of the Internet Engineering Task Force (IETF). The IETF is the group which developed the standards which make the Internet work the same all over the world. SHAKEN is short for Signature-based Handling of Asserted information using toKENs. This one contains a bit of a butchering of the English language. SHAKEN consists of a suite of guidelines for public switched telephone networks which do not comply with STIR.
Whether you call them robocallers, spammers, scammers, or spoofers, they are a major problem and the government, FCC and FTC, have been flooded with complaints. If STIR/SHAKEN work, noncompliance will become a big problem for the bad guys including big fines and likely lawsuits. Let’s root for the g
[i] Moshe Beauford, “The State of Robocalls in 2022,” GETVOiP (2022), https://getvoip.com/blog/2021/04/14/robocall-statistics/#:~:text=(RoboKiller),over%20190%20million%20per%20day.
[ii] Ibid.
[iii] Ibid.
[iv] “The World’s Best Caller Id and Spam Blocking App,” truecaller (2022), https://www.truecaller.com/
[v] Beauford, “The State of Robocalls in 2022”.
[vi] Ibid.
Ukraine
The Russians have made some gains this week but at a heavy cost. The following graphic is updated daily on Telegram.
Space
NASA on Wednesday announced two private companies have been selected to build the next generation of spacesuits for astronauts working outside the International Space Station (ISS) and soon on the Lunar surface. These two companies, Axiom Space and Collins Aerospace, will be competing for up to $3.5B in contracts to provide equipment, services, and maintenance through 2034. Each company is expected to demonstrate their respective suits by 2025, likely with a spacewalk outside ISS by a crew member.
The term “spacesuit” doesn’t really do it justice though. It is a tiny spacecraft built around a human. Since space is a vacuum it has to carry its own atmosphere and life support system for air pressure, oxygen, CO2 scrubbing, etc. It also has to have thermal protection to keep the astronaut comfortable when exposed to direct sunlight at 250 degrees Fahrenheit and also minus 250 degrees Fahrenheit in the shade of the Earth. Further, it needs video and communication systems as well as propulsion to return to safety in the event of a broken tether. For Lunar missions, the external material of the suit needs to be able to stand up to the abrasiveness of lunar dust, or regolith, and the suit also needs to provide the mobility required for surface activities. Indeed, a spacesuit is a complex and expensive piece of equipment.
– Aaron J. Patrick
Reflection Attitude
A lot more progress on Reflection Attitude this week. I have four very nice blurbs in hand and hoping for two more. I have completed a second full edit and am working on a third based on feedback.
Wall Street
Stocks are trading at significant lows. I have been snapping up some techs. Maybe they will go down a lot more but there is also a chance for a lot of upside. I don’t think anybody knows. There are too many variables. I remain bullish on tech, large and small. It may be a long wait.
Crypto
Crypto market cap hanging in there at $1.2 trillion. Bitcoin is 46.3% of the total. One of the major knocks on crypto has been volatility. It is still an issue. However, BTC has been less volatile in the last 30 days than many stocks. Things are heating up about government regulation. I see this as a good thing.
What Does Vitamin D Do for Us and Where Do We Get It?
Written: May 2022
Vitamin D consists of a group of fat-soluble secosteroids, a type of steroid. Vitamin D has several positive biological effects. It increases intestinal absorption of calcium, magnesium, and phosphate. Vitamin D also regulates numerous cellular functions in your body. Its anti-inflammatory, antioxidant, and neuroprotective properties support immune health, muscle function, and brain cell activity. A simpler view of Vitamin D is as a nutrient your body needs for building and maintaining healthy bones. Without vitamin D your bones cannot absorb enough calcium resulting in bones becoming brittle, soft, and thin leading to osteoporosis. Research on vitamin D has found it can have positive effects in a wide-ranging set of conditions including cancer, cognitive health, multiple sclerosis, osteomalacia, osteoporosis, psoriasis, and rickets.
The importance of the vitamin raises the question of where we get it. One source is our body. It can produce vitamin D when direct sunlight converts a chemical in our skin into calciferol which is an active form of vitamin D. The amount of vitamin D our skin produces depends on many factors, including the time of day, season, latitude, and our skin pigmentation. If you live in a place which does not get much sun or your lifestyle keeps you indoors, vitamin D production might decrease or even be completely absent. Dermatologists properly tell us to stay out of the sun to prevent skin cancer, but the result can be a decrease in vitamin D production.
How about what we eat? Vitamin D is not found naturally in many foods. Plants are generally poor sources of the vitamin. Most people rely on animal products such as dairy, eggs, and meat. Other sources include fatty fish such as mackerel, salmon, or sardines and from fortified milk or fortified cereal. A new source of vitamin D may be on the horizon.
Researchers are finding gene-edited tomato plants produce a precursor to vitamin D which may provide an animal-free source of the essential vitamin. When the gene-edited tomatoes are exposed to ultraviolet light in the laboratory, some of the precursor, called provitamin D3, is converted to real vitamin D3.[1] It may be quite a while before the discovery is commercialized. One big test is whether the modified plants will thrive when grown outside. Other obstacles include regulatory approvals and consumer acceptance. Both are iffy at this point.
A simple blood test can check your level of vitamin D. If you don’t have enough vitamin D from sunlight or dietary sources, a plan B, or D, would be vitamin D supplements. Taking a multivitamin with vitamin D may help improve bone health. Your doctor can recommend a daily amount of vitamin D ranging from 400 international units (IU) to 800 IU depending on your age. With as many as one billion people believed to be without enough vitamin D, we need all the sources we can find.
[1] Jie Li et al., “Biofortified Tomatoes Provide a New Route to Vitamin D Sufficiency,” Nature Plants (2022).
Survey
Thanks very much for your feedback. Surveymonkey only allows 40 responses unless you pay for a big subscription I would never use. We have exceeded the 40 responses and we have a statistically valid set of data. It was very positive. You can see the results at the following links:
- Overall analysis
- Comments about the weekly e-brief
- Comments about the feature stories
- Comments about which things you read
- Comments – general
Ukraine
I hope a lot of Russians are reading Telegram. President Zelensky, the great leader, said the following today as he addressed the people of Indonesian. Emphasized that the sooner our lands are liberated from the occupiers, the more reliably people everywhere in the world will be protected. Protected from the aggressive desires of those who want to pursue colonial policies, as in the old days. If the world is truly united and honest about this Russian aggression against our sovereign state, the speed of ending this war will be measured in weeks. Weeks, not even months.
Space
The National Oceanic and Atmospheric Administration has shared the first imagery from GOES-18 (Geostationary Operational Environment Satellite), it’s latest weather satellite, which sits on a perch in geostationary orbit observing the Western Hemisphere of Earth. It is the most advanced weather satellite ever sent into space and has a powerful array of instruments and sensors. Anytime you check the weather on your phone, tablet, or get it from any other source, you can thank GOES.– Aaron J. Patrick
Reflection Attitude
A lot more progress on Reflection Attitude this week. A first draft is in the hands of reviewers and blurbers. I am very grateful for the blurbs which have come in so far.
Wall Street
The market reflects investors concluded maybe thing are not so bad. Tech had beaten to a pulp. Techs were up across the board today. All GAMMAT stocks were up. The total is just above $8 trillion. I believe the high since I started reporting this was above $11 trillion. I still remain bullish on tech, large and small. Many of the world’s problems, like supply chain and labor shortages, will be solved by tech. It is going to be a long wait. They are still closer to 52-week lows than highs.
Crypto
As of Friday, there are 19,621 cryptocurrencies. Total market cap of all the crypto is $1.2 trillion. Bitcoin represents 46% of the total and Ethereum 18%. The rest are 36%. There are a lot of great ideas among the rest, but many are fraudulent or what I would call overly creative. The Fed is saying the idea of a stablecoin is not only a good idea but if the U.S. doesn’t create a digital coin then the dollar as the world standard may get weakened.
Written: November 2019
Amazon CEO Jeff Bezos, J.P. Morgan CEO Jamie Dimon and Berkshire Hathaway CEO Warren Buffett last January announced they were teaming up to tackle rising health-care costs. In the year the nonprofit company has been without a name, people have started calling it “ABC.” It’s now called Haven.
In August 2018, The Wall Street Journal reported major tech companies had signed a commitment to “share the common quest to unlock the potential in health care data, to deliver better outcomes at lower costs.” The companies, convened at a White House event focused on healthcare technology. The group included Amazon, Google, IBM, Microsoft, Oracle, and Salesforce. Apparently, Apple was not at the meeting, but is quite active in healthcare, much of it centered around its cardiac monitoring program with the Apple Watch and the Apple Health app.
The promise the companies made should help accelerate the emergence of a data-driven revolution in healthcare. Patients, providers, payers, and researchers all need easier and more compatible access to health records to enhance patient safety and lower the cost of healthcare. Unfortunately, healthcare data today is stored in silos at providers and payers. In large part, our healthcare data is locked up.
In theory, patients have access to their health data since the Obama administration distributed $30+ billion in incentives for the creation of patient portals and electronic health records (EHRs). The reality is quite different. Most people over 65 have multiple providers. Consolidation has occurred and many hospital networks have a range of services. However, some of the sub-specialty providers, such as urology and dermatology, remain outside of the networks. In addition, standalone practices in orthopedics and radiology have their own EHRs and portals. Another factor adding to the complexity is many people choose to get a second opinion or comparison shop on services such as radiology. The result of all this fragmentation is patients don’t have one patient portal, they have multiple. A friend of mine has 15. Nobody in the team of providers has a total view, including the patient.
Healthcare records are incompatible between providers. Even worse, you can look at test results at one provider, but you can’t easily download or email information from a record to another provider. You also cannot sort or search your health data. The bottom line is EHRs have become a train wreck. It is a tie between patients and providers as to who dislikes EHRs the most. EHRs are a failed promise. We can’t live without them, we can’t live with them.
- W. Bush hired a Chief Information Officer to fix this problem more than ten years ago. The CIO knew how to fix the problem but could not pierce the armor of special interest groups who wanted government to stay away from the issue. The CIO resigned in frustration. The current head of HHS, Alex Azar, is saying all the right things but is also having trouble getting past the special interest groups. The bottom line is government has been completely ineffective in solving the healthcare data and related cost problems. Now it is time to see what the tech giants can do.
I am optimistic the promise made by the companies mentioned above will be successful. There are a number of reasons for my optimism. First is healthcare cost has risen out of control to the point where it is nearly 20% of the economy. The tech companies are not startups. They have hundreds of billions in revenue and millions of employees which cost the companies billions of dollars for healthcare. They are motivated to solve the healthcare problem. The second reason for my optimism is technology. Cloud computing and AI have risen like a rocket ship. I believe they will be able to bridge the silos and make data access easier for all. Apple, for example, is making great strides to incorporate EHR data into its Health app.
Security technology has evolved to provide anonymity and protection of the data. Equifax and others have shown their incompetence in this regard, but the tech giants know how to do it. Lastly, mobile technology has advanced rapidly. With fingerprints and faceprints, they offer strong authentication. Mobile apps are easier to use. Banks, travel companies, food services, and many other segments have developed mobile apps which are easy to use and way better than their websites, except in healthcare. I expect Atul Gawande, CEO of the new Amazon/JP Morgan/Berkshire Hathaway healthcare company, Haven, to become a shining light to help rally all the tech companies to work together. They are fierce competitors, but the motivation to solve the healthcare cost problem is huge.
The Wall Street Journal said, “The Trump administration sees better use of health-care data as a key to unlocking savings and holding down costs while improving outcomes.” Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, said, “We want to lean into technology and use it as a potent force to create more efficiencies in our system.” I believe the tech giants will help make this happen.
Another reason for my optimism is Atul Gawande. I first met Atul in 2012 at an event in New York held by The New Yorker. He gave a brilliant and inspiring talk. I have read all his books and follow him on Twitter. He is an incredible physician with superb communications skills. The following are the guiding principles Dr. Gawande stated for Haven:
- We will be an advocate for the patient and an ally to anyone — clinicians, industry leaders, innovators, policymakers, and others — who makes patient care and costs better.
- We will create new solutions and work to change systems, technologies, contracts, policy, and whatever else is in the way of better health care.
- We will be relentless. We will ensure our work has high impact and is sustainable. And we are committed to doing this work for the long-term.
Most of the politicians talk about healthcare coverage, but few talk about healthcare quality and cost, which are the real problems, especially cost. Congress continues to stand in the way of addressing the cost problem. Haven has the right vision and I believe others will join the effort.
My reflections – 2022
I was dead wrong on this one. Haven was basically a tops down approach. It turned out the power of the healthcare lobbies for special interest groups was more than even Amazon and its two partners could break through. However, there are reasons to expect progress from new approaches now underway by Amazon and Apple. Both have developed bottoms up strategies built around the consumer. A few words about each follow.
Yesterday, I saw my family doctor for a routine checkup. He prescribed a new medication for me from his laptop to Amazon Pharmacy. When I got home, an email invited me to complete the order. I put the item in my Amazon Pharmacy cart and headed to checkout. The price for the medication using my Aetna prescription drug insurance was $6.90. The other option shown in the cart was an 80% Prime discount. I paid $1.40 for the medication with free shipping and delivery in two days. Congress has banned Medicare from negotiating the cost of drugs, but Congress cannot prevent Amazon from negotiating directly with drug manufacturers. The combination of consumer demand plus Amazon’s bargaining power will drive a wedge in the corrupt overpriced drug distribution system we have been living with and which has bankrupted families.
Amazon is going after the low hanging fruit of high cost healthcare in America and providing consumer oriented solutions. Amazon Pharmacy is just the beginning. There is much more to come. “Alexa, get me a telehealth appointment.” In a hospital room, “Alexa, tell the nurse I need a pillow.” Amazon is going to help healthcare providers improve healthcare patient satisfaction in ways the healthcare system has not been able to do.
The uniform dislike of EHRs is another issue which has struggled to be resolved on a tops down basis. Apple took a consumer approach. The Apple Health app is built into every iPhone. It is part of iOS, not something you have to the app store to get. In the app you can link your healthcare provider, not yet all of them, but many. If you can a blood test or have a surgery at any of the providers you have linked, you can browse the information on your iPhone. It is far easier than trying to navigate an EHR portal of a provider. The new medication I mentioned in the preceding paragraph has not arrived yet, but it already appears in the Medications section of the Health app.