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, startup investing, and board service. My areas of focus include healthcare, Internet technology, blockchain mobile voting, climate change, and crypto. As you will see in the books I have written, I believe most big problems and big solutions involve Attitude. My latest book is
Reflection Attitude: Past, Current, and Future. Reflection 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, crypto, 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 about new developments in one of my areas of interest. The e-brief also includes highlights about Ukraine, crypto, Wall Street, and a summary of key stock and crypto markets. 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.
How Will AI Affect Healthcare?
Written: September 2022
A frequently discussed question in healthcare today is about the impact artificial intelligence (AI) will have on radiology. Robert Schier, MD, a radiologist in Orinda, CA with Radnet, a leader in outpatient imaging, wrote an article in the Journal of the American College of Radiology titled “Artificial Intelligence and the Practice of Radiology: An Alternative View.” He said,
What we will see in radiology eventually are diagnostic image interpretation systems that have read every textbook and journal article; know all of a patient’s history, records, and laboratory reports; and have memorized millions of imaging studies. It may help to imagine these systems not as a collection of circuits in a console, but as an army of fellowship-trained radiologists with photographic memories, IQs of 500, and no need for food or sleep.
Schier argues AI will eventually allow computers to surpass human intelligence and writes computers will eventually replace humans the same as steam and gasoline engines replaced donkeys, horses, and oxen. Schier is not as optimistic about preserving radiology jobs as some of his colleagues in the industry. He said further,
The advent of computers that can accurately interpret diagnostic imaging studies will upend the practice of radiology. The two currently unanswered questions are just how much upending there will be and how long it will take to happen. There are vastly differing opinions, from the apocalyptic claim that AI will make all radiologists extinct to the delusional assertion that computers will always merely assist—and never replace—radiologists. Both extremes are mistaken, but the truth is in the direction of the first.
Evidence is mounting to support Schier’s point of view. Research scientists at Stanford University have developed a new AI algorithm called CheXNeXt which can reliably screen a chest X-ray in seconds for more than a dozen types of disease. The results are equal to or more accurate than the readings of radiologists.
CheXNeXt is trained to predict diseases based on X-ray images and highlight parts of an image which is most indicative of each predicted disease. The algorithm is trained based on a database from the National Institutes of Health (NIH) containing more than 110,000 frontal-view digitized chest X-rays of more than 30,000 patients. The diagnosis given by a radiologist for each X-ray image was tagged by an automated procedure to extract the diagnosis from the corresponding radiology report.
To make a comparison between humans and AI, the researchers selected 420 X-rays which contained 14 different diseases. Three radiologists reviewed the X-rays one at a time. Their conclusions were designated as a ground truth (fact). This ground truth was used to test how well the algorithm had learned the telltale signs of the 14 diseases.
Matthew Lungren, MD, MPH, Assistant Professor of Radiology at Stanford, said,
We treated the algorithm like it was a student; the NIH data set was the material we used to teach the student, and the 420 images were like the final exam. To further evaluate the performance of the algorithm compared with human experts, the scientists asked an additional nine radiologists from multiple institutions to also take the same final exam.
Reading the 420 X-rays took the radiologists about three hours. The algorithm scanned the X-rays and diagnosed all pathologies in about 90 seconds. For 10 diseases, the algorithm performed just as well as radiologists; for three, it underperformed compared with radiologists; and for one, the algorithm outdid the experts. Lungren summed up the research as follows,
We should be building AI algorithms to be as good or better than the gold standard of human, expert physicians. Now, I’m not expecting AI to replace radiologists any time soon, but we are not truly pushing the limits of this technology if we’re just aiming to enhance existing radiologist workflows. Instead, we need to be thinking about how far we can push these AI models to improve the lives of patients anywhere in the world.
Lungren’s last point is important. In the United States we have a significant resource of radiologists in our healthcare system. In other parts of the world such is not the case. As for his statement about not expecting AI to replace radiologists any time soon, it is debatable. Schier said, “If computers can do something now, they will only get better at it. If computers cannot do something now, they will probably learn how to.” His editorial commented on two different opinions about the future of AI and radiology. One is the “apocalyptic” assertion AI will replace radiologists. The other, which he calls the “delusional assertion”, is computers will always assist radiologists, but never replace them. His bottom line in the editorial is,
Today there are 34,000 radiologists in the United States. Unless radiologists do things other than interpret imaging studies, there will be need for far fewer of them. This is a complex situation filled with unknowns, and events are moving fast. We need to figure how to deal with this coming change. And we need to do it in a hurry.
The Barrier
There are many Medical AI research projects underway, but widespread adoption in hospitals and medical centers has not grown substantially. The barrier is not the technology. Shinjini Kundu, a medical researcher and physician at the University of Pittsburgh School of Medicine said, “The barrier is the trust aspect. You may have a technology that works, but how do you get humans to use it and rely on it?” The way AI is being applied in medicine is to absorb a very large amount of data, analyze it, find relationships, and make a diagnosis based on the learning. In effect, a lot of data goes into a “black box” where algorithms are applied, and out comes the diagnosis. This is quite different from how physicians diagnose. If they can’t see inside the black box, they will not trust the accuracy of the diagnosis.
Summary
We are at the early stages of applying AI to various fields of medicine. The more diagnoses made, the better the accuracy gets because of the cumulative learning the AI achieves. The pace of AI learning is increasing. The other encouraging news is AI researchers are working on techniques to open up the black boxes and share the methodology with physicians. This will likely result in important feedback from the physicians on how the algorithms can be improved. I believe ultimately the diagnosis by medical AI will surpass the accuracy of human physicians. Next week I will write about AI in cardiology.
Reflection Attitude
Marketing campaigns are underway on Amazon and Facebook. I am featuring the “It’s All About Attitude” book series. Reflection Attitude is now selling on Amazon in both print and Kindle. The Kindle price is $9.99 and the printed version is now $11.99. I am working on making a hardcover version. You can see the entire series with information about each of the six books here.
Ukraine
According to an official post on Telegram, here are some things Putin said during his address on September 30.
• Ukraine has started a war, and it is necessary to sit down at the negotiating table;
• The choice of people in Crimea, Sevastopol, Donetsk, Luhansk, Zaporizhzhia, and Kherson causes wild anger in the West [the city of Zaporizhzhia is not under occupation and has not been seized – ed.];
• “Russia is a civilization country”;
• The West wants to colonize Russia, “exterminate ethnic groups” and start “manhunting”;
• Germany, Japan and Korea are under U.S. occupation;
• Ukraine is conducting experiments on people and pretending it is a noble goal;
• Bread is being taken out of Ukraine right now;
• The sabotage of the Nord Stream pipelines is the work of the “Anglo-Saxons”;
• “Anglo-Saxons” convince people in Europe to eat less and wash less;
• “The suppression of freedom in the West is outright Satanism.”
Space
The Hubble Space Telescope (HST) was launched into low Earth orbit by space shuttle Discovery in 1990. Named after Edwin Hubble, the astronomer who proved the universe is expanding, it is one of NASA’s Great Observatories, which includes the Compton Gamma Ray Observatory, Chandra X-ray Observatory, and Spitzer Space Telescope, but by far the most famous. Much in the same way James Webb Space Telescope’s discoveries and images will inspire a generation, Hubble has done the same to the generation before over its 32 years in orbit.– Aaron J. Patrick
Crypto
Bitcoin has been hovering around $20,000, bit above or a bit below. Stability is good but hoping it will become stable at a much higher level. Ethereun is a mystery. The long anticipated merge changed the technical details about the ethereum blockchain works. From an energy perspective it is great, with more than 90% reduction in energy use. I believe there are concerns the merge might create new security issues. If none emerge, I expect ETH will rise substantially. Wait and see.
Wall Street
Recession fears have clobbered the market big time. Who knows what is ahead? I sure don’t. The GAMMAT stocks are down to $7.7 trillion. Meta Platforms, Inc. (formerly Facebook) is losing users. The stock closed at $136. The 52-week high was $354. I remain bullish on tech otherwise.
What Can Biosensors Do for Us?
Written: September 2022
Dr. Vahram Mouradian holds an M.S. in Electronics Engineering and a Ph.D. in Computer Science. As a serial entrepreneur, he has created many breakthrough technologies. His latest focus is on wearable medical technology, one of the hottest areas in the industry. As founder and CEO of Sensogram Technologies, Dr. Mouradian’s vision is to enable people to take control of their own fitness and wellness using a new type of wearable technology. He is betting on Sensogram Technologies to be one of the most successful companies in this rapidly growing industry.
Based in Plano, Texas, Sensogram Technologies is a research and development company which designs, produces, and markets innovative biosensors integrated with easy-to-use mobile apps. Sensogram allows real-time and continuous monitoring of vital signs such as blood pressure, heart rate, respiration rate, oxygen saturation, and more. After many years of U.S. and International research, the company has transformed advanced medical technologies into affordable, lightweight devices suitable for everyday use.
Sensogram’s new wearable product is the SensoRING®. As the name implies, the product is a ring, available in five finger sizes. The ring can provide data through a mobile app which assesses personal activity and performance by tracking physiological parameters. The wearable device is made from medical grade plastic and is equipped with built-in biosensors, wireless connectivity, and a rechargeable lithium-ion battery. The battery has a life of four hours on a full charge in continuous working mode but in scheduled working mode it can last up to 24 hours. The ring recharges in 1.5 hours.
The SensoRING monitors seven physiological parameters as follows:
- Pulse Rate. Your pulse rate, also known as your heart rate, is the number of times your heart beats per minute. A resting heart rate is normally between 60 to 100 beats per minute based on age and condition, but it can vary from minute to minute.
- Respiration Rate. The respiratory rate is the number of breaths someone takes every minute. It is an important vital sign, along with blood pressure, pulse, and temperature. When a person inhales, oxygen enters their lungs and travels to the organs. When they exhale, carbon dioxide leaves the body. A normal respiratory rate plays a critical role in keeping the balance of oxygen and carbon dioxide in the body.
- Oxygen Saturation (SPO2). Oxygen saturation is the fraction of oxygen-saturated hemoglobin, a protein in red blood cells which carries oxygen, relative to total hemoglobin in the blood. The human body requires and regulates a very precise and specific balance of oxygen in the blood. Normal arterial, meaning related to your arteries, and the movement of blood through your body, blood oxygen saturation levels in humans are 97–100 percent.
- Blood Pressure. High blood pressure, also referred to as hypertension, is when your blood pressure, the force of blood flowing through your blood vessels, is consistently too high.
- Perfusion Index. The Perfusion Index, often abbreviated PI, is a measurement obtained from a pulse oximeter on your finger. It is calculated as the ratio of pulsatile, throbbing or beating, blood flow to the non-pulsatile blood in body tissues. Simply put, it is the ratio of pulsing blood to non-pulsing blood. This measurement can be acquired non-invasively and is a good indicator of a person’s pulse strength. Measurements generally range from 0.02% (very weak pulse) to 20% (very strong pulse). Physicians often use this measurement to gain a better understanding of the effects of a drug or treatment of a patient. It can also be used to gain insight into medicinal efficacy and track disease progression.
- Activity Index. Research has shown it’s important to get all four types of exercise: endurance, strength, balance, and flexibility. Each one has different benefits. Doing one kind also can improve your ability to do the others, and variety helps reduce boredom and risk of injury. Sensogram did not provide information on what the SensoRING activity index is and how it is calculated.
- An electrocardiogram (ECG) is a simple test which can be used to check your heart’s rhythm and electrical activity. Sensors attached to the skin are used to detect the electrical signals produced by your heart each time it beats, but the ECG can also be shown using biosensors which look beneath the skin.
Continuously monitoring seven physiological parameters and delivering accurate, credible, and understandable data to your smartphone is a tall order. You may be skeptical or at least have a lot of questions, especially if you are a doctor. I do too. Directionally, I see the SensoRING showing us the future and creating a lot of healthcare and fitness value. Will the FDA approve it? Will the measurements be accurate? There has been skepticism about accurate blood pressure readings using anything other than the traditional cuff. Is the mobile app which accompanies the ring accurate, and does it provide actionable data without causing unnecessary alarm? Many questions. I tried to reach Sensogram Technologies but had no luck.
Apple is putting a lot of money into its wearable device, the Apple Watch. It can perform an ECG, measure blood oxygen, temperature and menstrual cycle analysis, several activity measurements, cardio fitness (VO2Max), heart rate analysis, and support for a wide range of health and fitness apps. With its vast resources and commitment to this area, I would not bet against Apple as the market leader. Nevertheless, startups such as Sensogram will continue to attract venture capital and push the envelope of innovation.
Reflection Attitude
Ukraine
The price tag for Russia to continue to destroy cities and towns in Ukraine is staggering. Things are not going well for Russia. One of the highways departing out of Russia has a two-day backup. Words from the great communicator this week was about what the First Lady is doing.
“The First Lady has created a Foundation. She chose three areas: medicine, education and humanitarian aid. And these are colossal challenges: to restore what was destroyed, to help those who need protection, to give hope for the future and to give people the feeling that they are respected. I’ve emphasized this during the presentation of the Olena Zelenska Foundation. This is an extremely noble cause, and I encourage people, companies, foundations to join in. We defend freedom, we defend people, and we do everything so that as many friends of freedom as possible around the world can contribute to this struggle. Thank you to everyone who supports Ukraine!”
Space
After World War II the United States Army captured 200 German rocket scientists and 300 rail cars full of V-2 rocket parts, the latter of which were later reassembled and used as sounding rockets to test components and instruments and/or to collect engineering and scientific data at White Sands Proving Grounds in New Mexico from 1945 through 1952. During one such test on May 29, 1947, a modified V-2 veered off course and crashed near a populated area in Juarez, Mexico, just south of El Paso, TX. No one was hurt but a 50 foot by 24 foot crater was left by the impact of the four and a half ton rocket, which had no explosive warhead, hitting the ground at approximately 720 miles per hour.
This incident led to more strict range safety procedures, which can be overseen manually or automatically. For the last several decades every rocket flies with some form of flight termination system. This is an independently powered, usually by battery, explosive device that can be triggered remotely by the United States Space Force (USSF) in the event the launch vehicle departs from its intended trajectory. Historically, this capability required USSF resources to plan for and monitor any rocket launching from the eastern or western range. A newer system called the Automated Flight Safety System (AFSS) uses GPS and various tracking sensors to automatically terminate the vehicle if it goes off course. The benefits of this system are reduced resource requirements from USSF and dependency on ground stations, which are sometimes unavailable due to maintenance. Since less manpower is required when using AFSS the range is more flexible and nimble with companies like SpaceX who are launching at a rate of more than once a week while ensuring public safety.
– Aaron J. Patrick
Crypto
Crypto had another bad week but I continue to believe it will recover. Jamie Dimon, the high-profile chairman and CEO of JPMorgan, said “I’m a major skeptic on crypto tokens like Bitcoin”, speaking Wednesday at a House Financial Services Committee meeting with the leaders of other major banks. “They are decentralized Ponzi schemes, and the notion that it’s good for anybody is unbelievable. It’s dangerous.” I think the danger big bank CEOs are concerned about is protecting the tens of billions in fees the banks collect from our highly inefficient financial system. Yes, there are a lot of bad things happening in crypto land including fraud, Ponzi schemes, insider trading, etc. This was also true in the early days of the Internet. We have to look beyond the unregulated wild west we have today and consider the possibilities of a digital world. My belief in crypto is unwavering.
Wall Street
Rising recession fears have clobbered the market big time. Who knows what is ahead? I sure don’t. However, I believe the solutions to inflation and recession have their roots in tech. Gammat stocks are down to $8 trillion. I remain bullish on tech and bearish on abilities of Congress.
Is Apple Having a Supply Chain Problem?
Written: September 2022
Big Brown pulled up in front of my home at 12:15 p.m. on Friday. Our happy UPS driver, Russ, brought the box to my front door. I had pre-signed the Apple/UPS form and taped it to the door to authorize leaving the package in case I was indisposed when he rang the bell.
The shipping box is small because Apple no longer includes a charger. Like many people, I have a drawer full of chargers. I am looking forward to when Apple makes the transition to USB-C standardized chargers and cables for all of its devices. In June, the European Union announced a mandate that will require all new portable devices like smartphones, earbuds, and wireless keyboards to use USB-C by 2024. Apple has often been the first to adopt new technology but with more than a billion iPhones out there, they have built up a huge business around their Lightning cable. I suspect 2023 iPhones will have the new standard cable and charger. Amazon this week introduced a new $99 Kindle, and it will have USB-C.
The setup process seems to get easier every year. When the iPhone 14 Pro Max arrived, I placed it on my desk next to my old iPhone. The new iPhone copied all my apps, data, and settings from the old iPhone. I then put the old iPhone in a box Apple FedEx’ed to me, and it will be on its way back to Apple.
Skeptics have said people would not pay $1,000 for an iPhone. Turns out people are more than willing to do so and, in fact, many paid more than $1,000, helped by financing plans from Apple and carriers. I like the Apple Upgrade plan. I pay $58.25 per month and get a new iPhone every year. I order the newest iPhone when Apple opens its website orders. You set everything up the day before so placing the order takes just seconds. The site opened for orders at 5 a.m. Pacific Time so I placed my order at 8 a.m. In years past, the opening time was midnight Pacific Time. I had to get up at 3 a.m. to place the order.
Placing the monthly charge on my Apple Card, I get $1.75 (3%) rebated in Apple Cash which accumulates and can be spent from the iPhone Wallet. I don’t think of it as paying $1,000+ for the iPhone 14 Pro Max. I think of it as paying $58.25 per month for a personal supercomputer.
iPhone revenue for the second quarter was $50.57 billion. The numbers are staggering. The global count of iPhones is 1.2 billion. Even more astounding is the production rate. During the 90 days of the second quarter, Apple produced more than 44 million iPhones. That equates to 488,889 per day, 20,370 per hour, 340 per minute, and 5.7 per second.
Supply Chain has been a major problem around the world, but Apple has managed through it. Their secret weapon is Tim Cook, often referred to as a just-in-time inventory genius. After graduating from Auburn University as an industrial engineer, Cook spent 12 years in IBM’s personal computer business, ultimately serving as the director of North American fulfillment. A friend of mine was Tim’s boss and he once told me Tim was the best employee he ever managed.
As of the close on Friday, Apple was valued by investors at 2.5 trillion dollars, the largest valuation in the world. Skeptics have questioned whether the company can continue to grow rapidly, if at all, especially on such a huge base. Just to grow 5% requires $20 billion of new business. As written here many times, the skeptics have underestimated the potential of Apple’s services business which includes iCloud storage, Apple Music, Apple TV, Apple News, Apple Fitness, and the App Store. Services revenue was $19.6 billion for the quarter. Looks to me like the goal of a $50 billion a year business can happen. Total revenue for last quarter was a record $97.3 billion, up 9 percent year over year.
Behind everything Apple does is an incredible customer support process. Whoever is in second place for support is not even close. I agree no business can grow straight up forever, but I see no signs of things slowing down at Apple. As for the stock price, who knows? A wise friend once told me, “Never confuse a great company with a great stock.”
Disclosure: I am an investor in Apple. I am not making any recommendation about whether the stock will go up or down from where it is. I am simply sharing my views on what I see as a great company doing amazing things.
Reflection Attitude
Reflection Attitude published on August 22 and is now live on Amazon in both print and Kindle. The Kindle price remains at $9.99, but the printed version is now $11.99. Reflection Attitude is part of the “It’s All About Attitude” series. You can see the entire series with information about each of the six books here. I am running ads on Facebook and Amazon. Later, I will extend the ads to Twitter, LinkedIn, and YouTube. Too soon to say how the advertising is working. If you are in to Facebook, check out my new bookstore page here. I hope to get some discussion going in the Group.
Ukraine
The price tag for Russia to continue to destroy cities and towns in Ukraine continues to grow. Words from the great communicator this week about war crime were, “
The whole world should see this. A world in which there should be no cruelty and terrorism. But all this is there. And its name is Russia. More than 400 bodies were found at the mass burial site in Izyum. With signs of torture, children, those killed as a result of missile attacks, warriors of the Armed Forces of Ukraine. Russia leaves only death and suffering. Murderers. Torturers. Deprived of everything human. You won’t run away. You won’t hide. Retribution will be justly dreadful. For every Ukrainian, for every tortured soul.
Space
According to T-Mobile CEO Mike Sievert, there are more than 500,000 square miles (nearly twice the area of Texas) of dead zones, areas not covered by any cell phone network, across the country. Many of these dead zones are in topographically diverse landscapes where cell phone signals are obstructed or in remote areas of the country. Not places you’d want to be if there is an emergency. Without a terrestrial signal from a tower the only way to communicate electronically, provided you have a clear view of the sky, is via satellite. This has long been possible from providers like Iridium, which currently operates a constellation of satellites, but only with a specialized phone that has a bulky antenna.
In late August, T-Mobile announced they’ve partnered with SpaceX to provide satellite coverage to all T-Mobile subscribers starting next year using the Starlink v2 constellation, which will be launched into orbit on the yet to fly Starship currently in development. This is quite extraordinary as this capability will work with existing phones, no special antenna required, effectively eliminating the dead zone. Other satellite operators, cell phone manufacturers, and mobile carriers are working to provide the same type of capability. The recently announced iPhone 14 has a feature called “Emergency SOS via satellite”, which uses a similar service provided by Globalstar, which currently operates their own constellation. Initially, these services will only support brief text messages for emergency use, but maybe one day you’ll be able to send a selfie from the top of a mountain or in the remote wilderness.
– Aaron J. Patrick
Crypto
Crypto had a bad week but I believe it will recover. The ethereum merge demonstrated it is possible to operate blockchains in a highly energy-efficient manner. The price of ETH has gone down probably because of security uncertainly. Some experts believe it will be better than before while others think it will be worse.
Wall Street
What a nice rally underway before this week. Nice to see green pretty much across the board. Gammat stocks down to $8.3 trillion. Apple is at $2.5T after a great set of product announcements. My deep purple iPhone 14 Pro Max arrived and works great. With a few exceptions, all tech was down. I remain bullish on tech and bearish on abilities of Congress. The GAMMAT spreadsheet is not included this week due to a problem at GoogleFinance.
Is a Single Vaccine for Viruses Possible?
Written: September 2022
Humans have been very fortunate to have been protected by vaccines for more than two centuries. The path to get from the identification of an infectious disease to have an effective vaccine is complex, to put it mildly. The issues include research and development to get the right recipe, testing, regulatory approvals, procurement of dependable funding, scaleable manufacturing, equitable and efficient distribution, assured safety, management of public fears of inoculation, and global political considerations. Despite the complexity, what used to take years, now takes months. Politicians pushing to go faster may have helped, but it mostly has to do with bioinformatics, genomics, AI, machine learning, cloud computing, and synthetic biology. As I have written before, I believe the transition from years to months will continue to days and maybe even hours.
At one point, there were nearly 100 vaccines under development for COVID-19. About 20% of them are based on DNA or RNA. The RNA approach has shown to be best for speedy development. Efficacy of the two leading vaccines has shown to be more than 90%, compared to 60% for flu vaccine. Safety data has been very good.
The long-term implication of the RNA development and manufacturing platform is the potential to respond quickly to new variants and even new viruses. An antigen from a new virus or variant can be sequenced in hours, and the genetic code for a vaccine can be manufactured using a tested and pre-approved platform. If so, it would eliminate the traditional lengthy process for developing a new vaccine. The current pandemic became a testbed for the next generation of vaccine technologies.
But what is RNA? Let’s start with DNA to put things in perspective. DNA is material found in nearly every cell of every living organism. The structure of DNA is the famed double-stranded helix which some say looks like a twisted ladder. Our DNA contains genetic information which acts like a recipe enabling us to develop, grow, and reproduce. Although our environment, lifestyle, and nutrition have an influence, our DNA is primarily responsible for our development. The recipe informs our cells how to produce the tens of thousands of human proteins which form our cells, tissues, and organs.
Gregor Mendel has been called the “Father of Genetics”. Like Vint Cerf, who has been called one of the fathers of the Internet, there were several fathers of genetics. It started in 1866 when Mendel was the first to note human characteristics get passed down from generation to generation. He coined the terms of dominant and recessive. Numerous discoveries about DNA occurred over the next 87 years. In 1953, Watson and Crick published a detailed paper about DNA’s double helix structure which has become symbolic.
As early as 1939 scientists suspected there was something special which provided the recipe. The something was RNA. There are three types of RNA, but the one most relevant in the current vaccine development is messenger RNA, or mRNA. Using a process called transcription, mRNA copies genetic code to ribosomes, which act like a kitchen where the production of proteins take place.
Scientists have dreamed about the endless possibilities of synthetic mRNA. Researchers understood its role as a recipe book for the body’s trillions of cells, but their efforts to expand the menu have come in fits and starts. The concept: By making precise tweaks to synthetic mRNA and injecting people with it, any cell in the body could be transformed into an on-demand drug factory.
Moderna and Pfizer BioNTech are quite different companies but, in both cases, there were dedicated researchers with a passion and a vision about mRNA. The government pouring huge amounts of money into the research was no guarantee, but it certainly helped. The idea was to inject the synthetic mRNA into a patient, and the patient’s cells would create a protein which would fight the virus. The challenge was the patient’s body would treat the mRNA as a bad actor. The two companies, in different ways, devised a tailoring of the mRNA so it could get past the patient’s rejection. The results were 90% efficacy.
As of September 4, 2022, a total of 12.5 billion vaccine doses have been administered. This was no small feat. The ingredients list contains a lot of syllables and unpronounceable names. Unfortunately, there is a lot of misinformation on the Internet and some media outlets about what is in the vaccines. Following is a high-level summary of things which are not in the mRNA vaccines. No preservatives, no antibiotics, no medicines or therapeutics, no tissues like aborted fetal cells or any materials from any animal, no food proteins, no metals, no latex, and no manufactured products like microelectronics, electrodes, carbon nanotubes or other nanostructures, or nanowire semiconductors. The vaccines are not manufactured in facilities which produce food products. The vial stoppers used to hold the vaccine do not contain latex.
What are the ingredients? The various mRNA vaccines such as made by Pfizer BioNTech and Moderna contain about a dozen similar ingredients. Moderna ingredients fall in three categories. The mRNA provides instructions the body uses to build a harmless piece of a protein from the virus which causes COVID-19. This protein causes an immune response which helps protect the body from getting sick with COVID-19 in the future.
The second category is lipid nanoparticles. These are spherical vesicles, a thin-walled sac filled with a fluid, which help deliver the mRNA to the cells. This is a technology new to mass production and is incredibly complex. The vesicles must be small enough to enter our cells. When I say small, I mean on the order of 100 nanometers. There are 25,400,000 nanometers in one inch. A human hair is approximately 80,000- 100,000 nanometers wide.
The third category includes a half dozen salt, sugar, acid, and acid stabilizer ingredients. These ingredients work together to help keep the vaccine molecules stable while the vaccine is manufactured, frozen, shipped, and stored until it is ready to be given to a vaccine recipient. After the body produces an immune response, it discards all the vaccine ingredients, just as it would discard any substance that cells no longer need. This process is a part of normal body functioning.
The process to put all this together and make it safe and effective is mind boggling to me. Groups of scientists, doctors, researchers, and engineers made it happen for the 12.5 billion doses with many more to come. The best news is the manufacturing process has been tested, validated, and approved. When a new variant or virus comes along, and they will, the companies can do the genetic sequencing, tweak the recipe, and start manufacturing very quickly. I expect we will have one annual vaccination which will protect us from all known viruses and variants which can attack our respiratory system. Looks likely a year from now.
In the meantime, next week, I will get the new bivalent booster plus a quadrivalent flu shot. The bivalent booster protects against the original COVID virus plus Omicron and other variants. The quadrivalent flu vaccine protects against four different flu viruses, including two influenza A viruses and two influenza B viruses.
Epilogue: The more I read and learn about genetics, the amount I don’t know grows more rapidly. I plan to take an MIT biology course online at edX.org.
Reflection Attitude
Reflection Attitude published on August 22 and is now live on Amazon in both print and Kindle. Both versions have an introductory price of $9.99. Reflection Attitude is part of the “It’s All About Attitude” series. You can see the entire series with information about each of the seven books here. Now comes the hard part — marketing. I found a gentleman in North Carolina on the Upwork freelancer site. He is going to help me develop marketing materials and ads on Facebook, Twitter, LinkedIn, YouTube, and Amazon. I will share how that is going in the weeks ahead. One of the key elements of the marketing plan is the Attitude LLC page on Facebook. It will become my book store with links to Amazon for each of the books. If you use Facebook, please add a Like for my Attitude LLC page. It will start getting better every week.
Ukraine
The price tag for Russia to continue to destroy cities and towns in Ukraine is very large. The scorecard from the battlefields is probably not completely accurate but the numbers are staggering. If Russia was to have a scorecard of what they have destroyed in Ukraine, it would include kindergartens, high schools, universities, libraries, arts centers, clinics, psychiatric centers, hospitals, individual homes, grain elevators, apartment complexes, shopping centers, and civilian infrastructure. In addition, 383 children in Ukraine have died due to the Russian invasion, and these numbers are not final – because there is no data from a huge number of occupied territories. More than 750 children have been injured, many severely.
Space
According to T-Mobile CEO Mike Sievert, there are more than 500,000 square miles (nearly twice the area of Texas) of dead zones, areas not covered by any cell phone network, across the country. Many of these dead zones are in topographically diverse landscapes where cell phone signals are obstructed or in remote areas of the country. Not places you’d want to be if there is an emergency. Without a terrestrial signal from a tower the only way to communicate electronically, provided you have a clear view of the sky, is via satellite. This has long been possible from providers like Iridium, which currently operates a constellation of satellites, but only with a specialized phone that has a bulky antenna.
In late August, T-Mobile announced they’ve partnered with SpaceX to provide satellite coverage to all T-Mobile subscribers starting next year using the Starlink v2 constellation, which will be launched into orbit on the yet to fly Starship currently in development. This is quite extraordinary as this capability will work with existing phones, no special antenna required, effectively eliminating the dead zone. Other satellite operators, cell phone manufacturers, and mobile carriers are working to provide the same type of capability. The recently announced iPhone 14 has a feature called “Emergency SOS via satellite”, which uses a similar service provided by Globalstar, which currently operates their own constellation. Initially, these services will only support brief text messages for emergency use, but maybe one day you’ll be able to send a selfie from the top of a mountain or in the remote wilderness.
– Aaron J. Patrick
Crypto
Crypto had a nice rally on Friday. Innovation is alive and well but sorely needing some light regulation. Axios reported investments in blockchain and crypto companies from venture capital, private equity and mergers and acquisitions has totaled $14.2 billion through the end of June 30. This about half the pace of last year but still substantial.
Mid-term elections will have an impact on crypto. I hope we elect people who are knowledgeable about crypto. There are dozens of bills pending. Crypto is not going to go away. We need Congress to get its act together so the innovation ahead does not move to Europe and Asia.
Wall Street
What a nice rally. Nice to see green pretty much across the board. Gammat stocks approaching $9 trillion. Apple at $2.5T after a great set of product announcements. My deep purple iPhon 14 Pro Max will arrive on Friday. I remain bullish on tech and bearish on abilities of Congress.
Do We Need a National Health Database?
Written: September 2022
David Feinberg, M.D., former head of renowned Geisinger Health in Pennsylvania co-authored ProvenCare: How to Deliver Value-Based Healthcare the Geisinger Way. I found the book very interesting, and it gave me hope our healthcare system could be improved dramatically if it adopted the numerous principles Dr. Feinberg wrote about. In 2015, Dr. Feinberg announced a new app to guarantee patient satisfaction: the Geisinger ProvenExperience.
Once patients have completed their treatment, they can go to the app, enter a code for the condition they had treated, provide feedback, and then decide whether to request a refund. The refund page knows what patients paid and allows partial refund requests on a sliding scale. This was a bold move. The results have been surprising.
In the first year after the rollout of the app, ProvenExperience refunded $320,141. In 2020, Geisinger refunded about $84,000, and the program refunded $40,000 in 2021. This was a surprising trend, given a national drop in patient experience satisfaction measures throughout the pandemic. Rick Evans, Chief Experience Officer and Senior Vice President of NewYork-Presbyterian Hospital said, “For those who aren’t familiar with how patient experience data moves, this is a huge drop.”
Like most hospitals, Geisinger Health saw an increase in the number of complaints surrounding communication issues, access, and hospitality as the pandemic progressed. However, as complaints rose, refunds still decreased. Geisinger believes the commitment to the ProvenExperience program created an acute awareness among staff of the patient experience and drove the system toward constant improvement.
Dr. Feinberg has had an impressive career in healthcare. After being President & CEO at UCLA Health, he went on to be President & CEO at Geisinger. He then became VP of Google Health. In October 2021 he became CEO of Cerner. Cerner Corporation is an American supplier of health information technology services, devices, and hardware. As of February 2018, its products were in use at more than 27,000 facilities around the world. The company had more than 29,000 employees. Dr. Feinberg has been transformative in healthcare, but I believe his biggest challenge lies ahead.
In June 2022, Oracle Corporation completed its purchase of Cerner for approximately $28.3 billion. Oracle’s chairman, Larry Ellison, outlined a bold vision for the database giant to use the combined tech power of Oracle and Cerner to make access to medical records more seamless. Oracle plans to build a national health record database which could pull data from thousands of hospital electronic health records (EHRs).
Ellison was quoted as saying, “Your electronic health data is scattered across a dozen or more separate databases. One for every provider you’ve ever visited. This patient data fragmentation and EHR fragmentation causes tremendous problems.” Healthcare networks are adding more services but there are many providers who are not part of the networks. Examples at the network where I live include podiatry, urology, pain management, and dermatology. A patient may need to go “out of network” to see an expert not part of the network. All these examples have their own EHR, and none of them are interoperable. Getting information from these providers to your family doctor is by fax.
Oracle Cerner envisions all our health records in a unified national health records database. This is easier said than done. There are many technical, security, privacy, clinical, and organizational issues. I can guarantee it will become politicized. The concept is a good one. I believe if providers can have faster access to patient records and better coordinate among providers, they will be able to deliver better patient outcomes.
A national database can also be a huge boost to population health allowing public health officials to develop better public health policy. Over time this will lead to lower cost of healthcare. The key to population health is to have anonymized health data in the national database. An oncologist looking to make a cancer diagnosis can look at millions of cases where patient parameters match his or her patient. Artificial intelligence and machine learning can tailor the diagnosis to the patient. Anecdotal diagnosis is often good but not always.
I agree when Ellison said, “Better information is the key to transforming healthcare.” Dr. Feinberg said, “We’re bringing world-class technology coupled with a deep and long history of understanding how healthcare works. I don’t think anyone’s ever done that.” Feinberg has a good track record. I hope he can continue to deliver as President and CEO of Oracle Cerner.
Reflection Attitude
Reflection Attitude published on August 22 and is now live on Amazon in both print and Kindle. Both versions have an introductory priced of $9.99. Reflection Attitude is part of the “It’s All About Attitude” series. You can see the entire series with information about each of the seven books here. Now comes the hard part — marketing. I found a gentleman in North Carolina on the Upwork freelancer site. He is going to help me develop marketing materials and ads on Facebook, Twitter, LinkedIn, and Amazon. I will share how that is going in the weeks ahead. One of the key elements of the marketing plan is the Attitude LLC page on Facebook. It will become my book store with links to Amazon for each of the books. If you use Facebook, please add a Like for my Attitude LLC page. It will start getting better every week.
Ukraine
UNITED24 has now raised $177 million. It was launched by the President of Ukraine Volodymyr Zelensky as the main venue for collecting charitable donations in support of Ukraine. Zelensky is a TV star, comedian, and lawyer. I think of him as the modern day Ronald Regan. His daily speeches and countless meetings with world leaders has resulted in support for Ukraine by Europe and countries around the world. The website is really well done. Funds can be donated by credit card, PayPal, bank transfer, or crypto and will be transferred to the official accounts of the National Bank of Ukraine and allocated by assigned ministries to cover the most pressing needs. A weekly report shows exactly what the donations have been spent on. fyi, change.org has a petition to kick Russia out of the United Nations. If you agree with that, click here to sign the petition as I did. More than 35,000 had signed when I first mentioned this. The number as of Friday morning is more than 79 thousand.
Space
NASA this week announced James Webb Space Telescope has made its first direct image of an exoplanet. Discovered by the Very Large Telescope in Chile in 2017 and cataloged as HIP 65426 b, it is one of more than 5,000 known exoplanets, and although it is not the first exoplanet to be directly imaged, Webb’s position outside Earth’s distorting atmosphere along with its powerful instruments have enabled the most accurate measurements of this object yet. Webb’s Near-Infrared Camera (NIRCam) and Mid-Infrared Instrument (MIRI) are each equipped with a coronagraph, which can block out light from the host star to see the planet, which is about 10,000 times fainter, and 100 times further away than Earth is from our sun. Direct images of planets help scientists understand the physics, chemistry, and formation of these objects, and with so many targets out there more discoveries are sure to be made.
NASA’s first launch attempt of the Artemis I mission Monday was “scrubbed” due to technical issues with the giant Space Launch System (SLS) rocket. Specifically, a temperature sensor in one of four main engines in the core stage of the rocket was reading an unacceptable value. In a somewhat counterintuitive manner, the engines actually need to be cooled down rather than warmed up before igniting. In fact, the operating temperature for the RS-25 engines is -420 Fahrenheit as they consume cryogenic propellent to create thrust, which exits the nozzle at about 6,000 degrees. After studying the data, engineers believe all four engines were actually cooled to the correct temperature and the sensor is faulty, and as such will proceed with another launch attempt rather than replace the sensor. Launching a new rocket carries a significant amount of inherent risk and mission managers are taking the “We’ll launch when we’re ready” approach. The next launch attempt is Saturday at 2:17PM EDT.
– Aaron J. Patrick
Crypto
Crypto had a nice rally but is now falling and has a very long way to get back to recent highs. Bitcoin and Ethereum are leading the way. The two combined represent more than 60% of the total market cap of all cryptocurrencies. The other more than 20,000 cryptocurrencies are mostly junk. There are some exceptions. I dabble in Dogecoin and Shiba Inu but not significantly. They do have some appeal as memes. Creative people are trying to change how banking and insurance work and doing it without regulation. Fraud and failures are not surprising. When you see the promised high interest rate on crypto balances and low rates on borrowing, you know something is not copasetic. VCs continue to invest and governments around the world are studying crypto. It is not going to go away. We need Congress to get its act together so the innovation ahead does not move to Europe and Asia.
Wall Street
What a summer rally. Major averages tanked for 3rd week, and Nasdaq posted a 6-day losing streak. Rate hike fears seem to be driving it. Gammat stocks only $8.4 trillion. Regulators and politicians are after big tech but likely big tech will outsmart them or Congress will go on vacation. Nancy Pelosi nixed a bi-partisan privacy bill. I remain bullish on tech. I just have to wait.
