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.

John R. Patrick

A handful of us joined with Tim Berners-Lee to start the World Wide Web Consortium at MIT in December 1994. None of us at the time saw the potential for eCommerce. Most of the focus was on techniques for formatting web pages and on various other content related issues. Jim Clark, founder of Netscape, did see the eCommerce potential and he also realized one of the biggest inhibitors was the U.S. Government regulation of encryption, a key tool for making eCommerce secure. Jim and a handful of us started the Global Internet Project as a public policy group to gain more awareness about encryption and urge governments around the world to resist the temptation to regulate the Internet. I was the Chairman of the GIP for about five years.

There were many other complexities looming under the surface which could have dramatically stalled the growth of eCommerce. Collectively it was a hodgepodge of sticky issues — like non-U.S. countries who objected to the U.S. control over key elements of the Internet infrastructure — but the biggest issue was a lack of vision. There was no consistent framework for eCommerce which could enable businesses to move forward with it. One of the first of the Fortune 500 to put a stake in the ground was IBM Corporation where Lou Gerstner said in 1997 the web is not for surfing, it is for business transactions. IBM later introduced the term e-Business. The gamble being taken by IBM and many others was the Internet would become internationally politicized and potentially regulated to a standstill.

Fortunately, there was a person in a high place in the U.S. government who would help solve many of the tough issues and enable President Clinton to announce a “Framework for Global Electronic Commerce” in the summer of 1997. It was a huge accomplishment for which we should all be eternally grateful. The person who lead the effort was Ira Magaziner, a top aide at the White House. Ira is best known for his efforts to create a major American healthcare program. His effort got attacked from every political direction and eventually fell. Unlike healthcare, the Internet was not well understood by politicians and they stayed out of the way as Ira solved many of the key issues. He then traveled around the world enlightening key government leaders. The rest is history.

At the 10-year anniversary conference in 2007, Ira modestly said the event was “a good reminder of how far we have come and of how much opportunity still remains”. Ken Wasch, then head of the Software and Information Industry Association, said “Electronic commerce has provided a significant engine for the growth of the global economy and has sparked the delivery of a multitude of innovative products and services.”

It was my privilege at the conference to serve on a panel moderated by Michael Mandel, chief economist of BusinessWeek. The panelists were Stewart Baker, Assistant Secretary, Department of Homeland Security; Dan Burton, Senior Vice President, at Salesforce.com and former President of the Council on Competitiveness; Jamie Estrada, Assistant Secretary (Acting) at the U.S. Department of Commerce, Ira Magaziner, who is now Chairman of the Clinton Foundation, and myself.

I delivered the closing keynote, which I called “The Future of the Internet“. I asserted the Internet has grown to it’s infancy and we have so far only seen five percent of what the Internet has in store for our business and personal lives. Keep in mind this speech was 12 years ago, and the iPhone had just started shipping the week of the conference. I may have been the only there who had one. A video of Ira Magaziner’s talk is here and a video of my closing speech is here. When you hear my remarks about the future, please remember the speech was in 2007. Amazon’s stock was $30 and its profit was 2% of sales.

The picture above was at Grand Central Station in 2011 when a throng of people (including me) were waiting to visit the new Apple Store. People love Apple products. It remains to be seen if people will love Apple services as much. I suspect they will, but it will take time. However, the products remain the heart of the company for now. The June 3 Apple Keynote to introduce the upcoming software updates to the Apple platform lineup including tvOS, watchOS, iOS, MacOS, and the new iPadOS was done with great marketing aplomb. Apple has it down pat. Tell them what you are going to tell them, tell them, and then tell them what you told them works every time. What has changed in very recent years is Tim Cook has shared the stage with a diverse team of senior and upcoming executives from Apple’s team of 132,000 full time employees. The bench is impressive.

There are many skeptics who worry about profit margins, China, market saturation, tariffs, and other potential problems. If you watch the keynote, which I highly recommend, or visit an Apple store, you can feel the enthusiasm. I do not know when or if the the stock will go up or down, but I see a very bright future for Apple.

A number of reasons make me feel so positive about Apple. First, their products are really powerful and easy to use. The Apple support structure and approach is second to none. Third, and equally important, is the ecosystem. With Apple TVs, Watches, iPhone, iPad, iMacs, AirPods, etc., I have 13 Apple devices. If I take a picture with one device, it appears on all the devices (except the AirPods). If I receive a phone call, I can answer it on an iPad or my Watch. I can start a task on one device and finish it on another. The platform integration got even stronger with this week’s dozens of announcements. The platforms and services create an ecosystem which keeps users locked in and loyal.

Another reason is privacy. Amazon, Google, Facebook, and others are defending their strategy to collect and use personal information from its users. Ultimately, I believe this will become highly regulated, as it should. Meanwhile, Apple makes your private information private. The devices are incredibly powerful. Artificial intelligence is not dependent on the cloud like the others, Apple’s AI runs on the devices and your data stays on your devices. If you want your data in iCloud for whatever reason, the data is encrypted and nobody, not even Apple, can read your information. This is particularly important when it comes to the increasingly abundant amounts of personal health data. In my opinion, the government scrutiny unfolding on Apple, Amazon, Google, and Facebook will be a slam dunk on the latter three. Scrutiny of Apple will run counter to how much hundreds of millions of users love their Apple ecosystem.

American consumers have a strong demand for unblemished fruits and vegetables. Satisfying that demand requires hundreds of thousands of workers who have the skills to plant the fields, tend the crops, harvest the produce, and pack it and prepare it for shipment to markets in the U.S. and abroad. Unfortunately, we have a huge shortage of workers with these skills.[i]

The problem is even bigger in Japan where the number of people working in farms dropped from 2.2 million in 2004 to 1.7 million in 2014.[ii] Small farmers are retiring and, in many cases, not being replaced. To improve productivity, the government has encouraged consolidation of farms by larger companies which can apply more business skills to the industry. The consolidation is happening but is limited by the availability of farm workers. The current labor shortage is more than 70,000 full-time employees but experts predict the unmet demand will rise to 130,000 over the next five years.[iii] The European agriculture sector is experiencing similar labor shortages. The root cause of the labor shortages around the world is older farmers are retiring and young people are not finding farming an attractive career opportunity.

Compounding the problem of labor shortages is the increased demand for food. The UN estimates the world population will rise from 7.3 billion today to 9.7 billion in 2050.[iv] A third factor is the need to increase yields for farmers to meet the demand.

Agricultural robots can help increase production yields and fill the labor gap. Robotic solutions range from autonomous tractors to robotic arms. Agricultural robots can automate boring and repetitive tasks, and enable farmers to focus more on managing and improving the overall production yields. Some of the specific tasks robots can fulfill include:

  • Harvesting and picking
  • Controlling weeds
  • Autonomous mowing, pruning, seeding, spraying and thinning
  • Sampling and categorizing genetic characteristics
  • Sorting and packing

Harvesting and picking is one of the most widely adopted robotic applications in agriculture because of the precision and speed robots can deliver. The results are improved yields and reduced waste from crops left in the field. However, these applications can be difficult to automate. The RIA Robotics Online Marketing Team explained,

A robotic system designed to pick sweet peppers encounters many obstacles. Vision systems have to determine the location and ripeness of the pepper in harsh conditions, including the presence of dust, varying light intensity, temperature swings and movement created by the wind. It still takes more than advanced vision systems to pick a pepper. A robotic arm has to navigate environments with just as many obstacles to delicately grasp and place a pepper. This process is very different from picking and placing a metal part on an assembly line. The agricultural robotic arm must be flexible in a dynamic environment and accurate enough not to damage the peppers as they’re being picked.[v]

Farming is not limited to outdoor fields. Next week, I will discuss robotics for indoor farms.


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[i] Zippy Duvall, “America Has a Farm Labor Shortage. We Need a Better Guest Worker Program,”  Los Angeles Times (2019), https://www.latimes.com/opinion/op-ed/la-oe-duvall-farm-labor-shortage-20190212-story.html
[ii] “Global Agricultural Robots Market (2018-2023): Set to Expand at a Cagr of 21.1% “,  Associated Press (2018), https://www.apnews.com/f204e2f3f54f4f378399d549ab6aa25e
[iii] “Japan in Dire Need of Foreign Farm Workers,”  Fresh Plaza (2018), https://www.freshplaza.com/article/9046466/japan-in-dire-need-of-foreign-farm-workers/
[iv] “World Population Projected to Reach 9.7 Billion by 2050,”  United Nations (2015), https://www.un.org/en/development/desa/news/population/2015-report.html
[v] “Robotics in Agriculture: Types and Applications,”  Robotics Industries Association (2017), https://www.robotics.org/blog-article.cfm/Robotics-in-Agriculture-Types-and-Applications/74

Apollo 11 was the spaceflight which landed the first two humans on the Moon. Commander Neil Armstrong and lunar module pilot Buzz Aldrin landed the Apollo Lunar Module, Eagle, on July 20, 1969. Armstrong became the first person to step onto the lunar surface six hours later, and Aldrin joined him 19 minutes later. The two astronauts spent about two and a quarter hours outside the spacecraft, and they collected 47.5 pounds of lunar material to bring back. Command module pilot Michael Collins flew the command module, Columbia, alone in lunar orbit while Armstrong and Aldrin were on the Moon’s surface. Armstrong and Aldrin spent 21.5 hours on the lunar surface before rejoining Columbia in lunar orbit, and then returning to Earth. The documentary movie was fantastic, and included never before seen footage.

I was two years out of engineering school at the time of the historic flight. Although I was not involved in any way, my employer, IBM, was one of the lead contractors. I was proud of that but I remember being on the edge of my chair in fear. There were so many things which could go wrong. Imagine being strapped in on top of a three-stage rocket. The first stage was 138 feet tall, 33 feet in diameter, and full of liquid oxygen. The first stage provided over 7,600,000 pounds of thrust. While I was in fear, the three astronauts were fearless. They believed in the technology.

Speaking of fear, this week, the Los Angeles Times published “The vote-by-phone tech trend is scaring the life out of security experts”. Vote-by-phone (and Internet voting) has been tested successfully by West Virginia and others. Estonia has been using it for more than a decade without issues. Vint Cerf, one of the fathers of the Internet properly said, “We can do this”. But the security experts are afraid, like I was about Apollo 11 in 1969. It almost seems they enjoy being quoted in the press about all the things which could go wrong. We could put men on the moon 50 years ago and a robot on Mars more recently, but we can’t figure out how to vote electronically with security, privacy, and verifiability? Why aren’t the “experts” willing to say we could do it if we planned carefully and took precautions A, B, and C?

The bottom line reason, in my view, is the experts compare Internet voting to a perfect online system which we will never ever have, and they are unwilling to compare it to the 150 year-old paper based system of today which disenfranchises millions of voters. This morning, Axios reported the 2020 election turnout may be the biggest of all times. I am afraid. What I am afraid of is hours-long lines, broken 15-year-old voting machines, elderly people standing in line in inclement weather and damaging their health, ballots from overseas getting lost in the mail or arriving late and not counted, paper ballots in the U.S. not getting counted because something was wrong with the signature on the outer envelope, and thousands (or millions) of others who were unable to get to the polls due to last minute issues with work or family. When it comes to voting, we should worry about Russian attempts to influence us, but we should also worry about a repeat of 2016 when 100 million eligible voters did not vote because they could not get to the polls. Congressmen, afraid of technology, want to go to all paper rather than fund investments in technology, like we do for NASA, to strengthen our democracy in a way which makes it safe and convenient for American citizens.

Silicon Valley is having some success in a crusade for voting by phone. Computer security experts are aghast to see election officials signing on.

Source: The vote-by-phone tech trend is scaring the life out of security experts – Los Angeles Times

JRP on roof of an I.M. Pei building in Somers, NY

Thanks to Mike Maney, Founder of ManeyDigital, for posting the picture on Instagram. The picture also appears on Instagram at #johnrpatrick. Mike was Public Relations Manager for our Internet Technology group at IBM back in 2000. There was an upcoming story (below) which was to appear in the Los Angeles Times and they wanted a picture. Mike did not want to give them any picture, he wanted it to be special. He convinced the facilities manager to let a professional photographer on the roof of one of five beautiful I. M. Pei designed buildings of IBM in Somers, New York. The picture shoot day was just under 20 years ago, and I remember it well. Tributes should go to Mr. Pei who died yesterday at age 102.

As important as Mike’s picture was the story about the future of the Internet. It is hard to describe how much skepticism about the Internet still existed at the beginning of the 21st century. I had no doubts. Exactly 18 months later, Net Attitude: What It Is, How to Get It, and Why Your Company Can’t Survive Without It was published by Perseus of Cambridge, MA. I wrote an updated version called Net Attitude: What it is, How to Get it, and Why it is More Important Than Ever which published 15 years later in 2016. As you read the article, keep in mind the iPhone was not introduced until seven years later.

Internet Guru’s Theory of Evolution Monday, April 3, 2000 Q&A: IBM’s chief Web evangelist foresees a fundamental change in the way we live. Increased connectivity, he says, seems inevitable. April 03, 2000 | CHARLES PILLER | TIMES STAFF WRITER

SAN FRANCISCO–IBM is one of the principal advocates of ubiquitous networked computing. The concept holds that a multitude of always-on, always-connected devices–from PCs to refrigerators, cell phones to garage door openers–will gradually make the Internet not just a part of everyday life, but the connection that links together most human activities.

The company’s top researchers suggest that Internet appliances will soon eclipse the PC as the focus of most people’s computing experience.

John Patrick, vice president for Internet technology at IBM’s Somers, N.Y., campus, is the company’s chief evangelist for the “next-generation Internet.”

Patrick, who will lay out those views in his keynote speech Wednesday at the Internet World trade show in Los Angeles, talked with The Times about how the Internet will expand its role and further alter society in coming years.

* * *

Question: How will the Internet evolve in the next few years? Will it contrast sharply with today’s reality?
Answer: Most people think about [changes in the Internet] as speed alone. Speed is important and we all need more of it. . . . But as I think about the evolution of the Internet, I think about seven characteristics: fast, always on, everywhere, natural, intelligent, easy and trusted. . . .
Something north of 90% of Web access is via a browser and a PC. Within two years that is going to be 50%–and not because of any decline in the PC. It is because of a whole series of new kinds of devices. The biggest factor of course being the cell phone, the PDA [personal digital assistant, such as a hand-held computer], things like Palm VII. It is a whole new class of devices that we could think of as information appliances. . . . Turn them on and there’s the Web.

* * *

Q: Does this suggest that the PC will no longer form the center of most people’s computing experience?
A: Getting the first 100 million or 200 million users of people on the Web is relatively easy because there are people that want to do it. Getting from 200 million to 2 billion is going to involve a lot of people who don’t necessarily want to do it [if] . . . that require[s] them to learn about computers. When they realize that they can sit on a train and read the news on their phone or pay their bills or send instant messages, that is pretty neat [and they will be hooked on the Net].

* * *

Q: I hope they know a good optometrist. After all that squinting into a cell phone, they’ll need one.
A: I was just out at the PC Forum [trade show] and I saw all kinds of [impressive optical] devices there. . . . One device that looked like a cell phone and you literally put it up to your eye and looked in it like you would a telescope. . . . The clarity was amazing. It was like looking at a full-screen PC.

* * *

Q: Presumably, that kind of technology will be extended to eyeglasses.
A: They had a pair there. They were amazing. Like a lot things about the Internet, the answer is yes. People say, “Is it the PC or is it the network computer?” The answer is yes. “The mobile phone or the PDA?” Yes. “Eyeglasses for the optics or is it something you hold up to your eye?” Yes.

* * *

Q: Can you give an example of the Internet becoming a more “natural” experience?
A: I am excited about language translations. [Today, instant online translation] is not good enough for contracts but it is good enough for conversation. It is good enough for customer service and support. So, for example, a Spanish-speaking person can ask a question of customer service and a Chinese person can answer it in Chinese and the Spanish person hears it in Spanish. [As such services become broadly available, they will] make the Internet a lot more natural for large numbers of people.

* * *

Q: The future home is often seen as having refrigerators and dishwashers and other appliances connected to the Internet. Aside from a few people who are interested in technical novelties, most people seem to view such devices as adding a layer of unwanted complexity.
A: I am not sure I really want my refrigerator on the Internet either. . . . The innovators had a vision. It takes the businesspeople to come behind them and turn that innovation and that vision into something practical.

* * *

Q: My current PC crashes as often as the one I used in 1982. And networks are notoriously insecure and unstable. What happens if I’ve grown dependent on Internet-connected devices everywhere, then the network crashes?
A: In 1982, that computer was doing one thing at a time and not 50 things at a time. It is like two totally different worlds. On the point of crashes, I think you have to separate this into three buckets: the pervasive devices; the PC; and the server.

With the pervasive devices–your cell phone or your smart pager or your PDA or your Palm–you turn it on, it works. When you are finished, you turn it off. There is no concept of rebooting. That proves that in a relatively fixed set of functions you can achieve a noncrash environment. My Palm has never crashed. My cell phone has never crashed.

The PC is harder to achieve that with because . . . the user is constantly reconfiguring the functionality of machines. . . . So it is a trade-off between the flexibility to be able to do whatever you want to do that conflicts with complete stability. I would argue that it is getting better. It is not perfect.

I don’t want to get into a Microsoft discussion, but with Windows 2000 on my ThinkPad, I almost never reboot anymore. With Windows 98, I would reboot multiple times per day.

And Linux [a rival computer operating system] changes the game here also. With Linux you have hundreds of thousands of people contributing into the open source community [volunteer programmers who rapidly improve the product]. . . . Apache [a Web server product produced by the open-source community] is still gaining market share, and why is that? It doesn’t crash. . . . The other part of the answer is that, as we become more of a network society, it is incumbent upon the service deliverers, the corporate intranets, to make sure that they are investing in the technology and the training and the discipline and procedures to assure five nines–99.999% availability.

* * *

Times staff writer Charles Piller can be reached at [email protected]
Original article: http://articles.latimes.com/2000/apr/03/business/fi-15428

Pills and Money

I believe Alex Azar, Secretary of Health and Human Services, is doing a good job of trying to improve our broken healthcare system. The move to allow states to seek a Federal waiver to implement Medicaid in ways tailored to their needs has a lot of potential. Some states have already shown they can reduce cost and improve patient safety and quality. Azar is also trying to make drug pricing more transparent. Manufacturers make deals with middlemen who extract significant revenue which translates directly into higher prices for consumers. His latest move is to require drug companies to show the retail price of the drugs they advertise on TV.

Given the incredible lock the drug companies have on Congress, perhaps this is the best he could do. It may help, but I would prefer to have the TV advertising banned completely. All but one developed country in the world do not allow drug advertising on TV. Consumers know how to get answers. If someone has toe fungus, they can Google toe fungus and see all available information about diagnoses and cures.

The main problem with the TV ads is they use professional actors to look and act like people who have the particular health condition for which they are advertising expensive drugs. I have no doubt, nor do the advertisers, that TV watchers may say to themselves, “Oh, maybe that is what I have”, and they call their doctor to prescribe the expensive drug and then Medicare ends up paying for it, even though a generic drug or non-drug alternative may be equal or better than the expensive advertised drug.

I have written a number of articles for various publications about TV advertising of prescription drugs. I have also talked about healthcare on Fox BusinessTV. The TV news programs are unlikely to invite me in to talk about the subject of drugs since the pharmaceutical industry spends $5 billion per year on TV advertising. My latest article was published in Pharmaceutical Processing. You can read it here. The six reasons why the ads should be banned are highlighted below. Read the complete article here.

1. Direct to consumer advertising creates artificial demand.
2. The ads do not improve American health.
3. The TV ads are inappropriate for young people
4. The ads urge people to get expensive drugs no better than cheaper alternatives.
5. The TV ads are subsidized by taxpayers through tax deductions.
6. European countries with excellent healthcare do not allow TV ads for drugs.

Investigating crime. Magnifying glass and handcuffs

Robot Attitude is coming this summer! Click here to get an alert when it publishes.

This is the final post about the use of voices and AI. As we have seen in the prior posts, voice analytics can play a role in numerous areas. In the case of criminal investigations, it can do much more. One of the leading scientists in the field of voice recognition is Rita Singh at Carnegie Mellon University’s Language Technologies Institute. Over the period of more than 20 years she and her team have developed techniques to extract a lot of intelligence from a small sample of our voices. Simon Brandon, reporting from the World Economic Forum in 2018, explained,

The techniques developed by Singh and her colleagues at Carnegie Mellon analyse and compare tiny differences, imperceptible to the human ear, in how individuals articulate speech. They then break recorded speech down into tiny snippets of audio, milliseconds in duration, and use AI techniques to comb through these snippets looking for unique identifiers. Your voice can give away plenty of environmental information, too. For example, the technology can guess the size of the room in which someone is speaking, whether it has windows and even what its walls are made of. Even more impressively, perhaps, the AI can detect signatures left in the recording by fluctuations in the local electrical grid and can then match these to specific databases to give a very good idea of the caller’s physical location and the exact time of day they picked up the phone.[i]

In 2014, the U.S. Coast Guard was working on a case where an unknown person had made 28 false distress telephone calls. The emergency responses to the calls cost an estimated $500,000.[ii] The investigators had little to go on other than the recordings of the emergency calls. They reached out to Ms. Singh at Carnegie Mellon. Using nothing more than the voice recordings, she was able to determine the hoax caller’s age, height, and weight.[iii] The case is ongoing, but having this information provided valuable clues for the investigation.

Ms. Singh, through years of research, has learned the voice carries information which predicts demographic, environmental, medical, physical, physiological and other characteristics of the speaker. The tiny snippets of human voice patterns are called microsignatures and they can be used to create profiles of people. Ms. Singh acknowledges the technology is not perfect. For example, age can only predict within a three-year range. However, research is improving the predictive capability and opening up new areas. McCormick said,

Ms. Singh and her team recently demonstrated a system that could reconstruct 60% to 70% of a person’s face just from their voice, she says. Ms. Singh says voice-analysis technology still has a long way to go, but its potential is enormous. “It would enable machines to understand humans a lot better than perhaps even humans can,” she says.[iv]

Summary AI and related technologies have awesome power to uncover a lot from human voices including the ability to determine who we are, and what our emotions of the moment are. The tools can empower others to identify and profile us. The concerns about privacy are obvious. On the other hand, we have seen in the posts how voices can enhance mental health treatment, keep drivers awake, fight heart disease, enhance call center experience, improve job recruiting, combat fraud, and investigate crimes. The challenge facing technologists and policymakers will be to achieve a balance which can be tolerated.


[i] Simon Brandon, “How to Catch a Criminal Using Only Milliseconds of Audio,”  World Economic Forum (2018), https://www.weforum.org/agenda/2018/01/catch-criminal-milliseconds-audio-rita-singh-carnegie/
[ii] McCormick, “What Ai Can Tell from Listening to You”.
[iii] Brandon, “How to Catch a Criminal Using Only Milliseconds of Audio”.
[iv] McCormick, “What Ai Can Tell from Listening to You”.

About 10 percent of the property and casualty insurance industry’s incurred losses and loss adjustment expenses each year are fraudulent[i] During the five-year period from 2013 to 2017, the fraud amounted to approximately $30 billion each year.[ii] The most common fraud is when an insured pads or inflates actual claims, misrepresents facts on an insurance application, or submitting claims for damage or injuries which never occurred. Most insurers use software technology to detect and combat the fraud.

One of the most common technologies used today are automated red flags, which automatically highlights suspected fraudulent activity. The software can look at the claim and compare it to similar situations or find patterns of claims which do not look normal. Sophisticated data analysis can sometimes uncover relationships between groups across multiple claims which might represent organized fraud rings. Insurers realize no single technology is sufficient to combat opportunistic or organized fraud. A relatively new technology they are evaluating is voice AI.

Nemesysco Ltd., a privately held company founded in 2000 with headquarters in Israel, has developed technology which uses voice analysis for emotion detection, personality, and risk assessment.[iii] McCormick explains how a Slovakian insurer is using the technology,

Insurer Allianz-SP Slovakia, a subsidiary of Allianz ALIZF +2.66% group, handles claims using Nemesysco’s voice-stress analysis technology. The tool picks up people’s reactions to a set of scripted questions asked by the claims handler. The system looks for a combination of markers, such as tiny pauses when a person is speaking, that may indicate the speaker is providing false information, according to Allianz-SP Slovakia. “The aim is to pay a claim without any problems immediately and to prevent any fraud-like exaggeration of a claim,” says Jaroslava Zemanová, head of control and special activities at Allianz-SP Slovakia.[iv]

Allianz-SP Slovakia emphasizes the voice analysis is not proof of wrongdoing. The company views the analysis as a first stage in detecting the possibility of fraud. An investigation would determine if there is more evidence which may justify rejecting a claim. The company says the technology is saving it time and money so far. [v]



[i] “Background On: Insurance Fraud,”  Insurance Information Institute (2018), https://www.iii.org/article/background-on-insurance-fraud
[ii] Ibid.
[iii] “Investigation Focus Tool,”  Nemesysco (2019), http://nemesysco.com/
[iv] McCormick, “What Ai Can Tell from Listening to You”.
[v] Ibid.

Glassdoor, one of the world’s largest job and recruiting sites, commissioned a research study which concluded 95 percent of employers have made hiring mistakes by recruiting the wrong people.  each year.[i] According to the Harvard Business Review, 80% of employee turnover occurs because of bad hiring decisions, often because the new hire did not fit the corporate culture into which he or she was hired.[ii]

Voicesense, a predictive speech and analytics company based in Herzliya, Israel, may have an AI solution to the problem. The company believes voice is everywhere, and by recording the voice and analyzing speech patterns, they can learn more about a person’s core characteristics than words spoken in an interview can convey. John McCormick explained,

Employers upload video or audio interviews to Voicesense’s cloud and the company’s system analyzes 200 speech parameters, such as intonation and pace, says Yoav Degani, Voicesense’s chief executive officer. The system builds a behavioral model of the applicant’s temperament, ambition, dependability and creativity, among other characteristics. An employer can then use the scores the system generates to tell if an applicant is a good match for a job. For instance, if an organization was looking to hire a salesperson, the system would identify as a possible match someone who was highly active and engaged in the conversation, says Mr. Degani.[iii]

The company may have challenges in convincing customers the technology is accurate enough. Mr. Degani acknowledges the analysis of voices results in probabilities rather than certainty. The company must also convince customers privacy safeguards are in place. Mr. Degani says Voicesense doesn’t store any of the data and its tools do not make judgements on the content of a conversation. The company’s AI tools only look at the patterns of speech.

Another AI company focused on voice analysis is HireVue, based in South Jordan, Utah. They claim to have more than 700 customers. One of them looking for help with its recruitment efforts is AdventHealth Orlando, a unit of the AdventHealth healthcare system, which more than 80,000 skilled caregivers in physician practices, hospitals, outpatient clinics, skilled nursing facilities, home health agencies and hospice centers. John McCormick explained,

The organization, which operates eight hospitals across central Florida and employs more than 25,000 people, hires 8,000 people each year. That means reviewing more than 350,000 applications, according to Karla Muniz, AdventHealth’s human-resources director. Candidates who meet basic job requirements are invited to take an online interview using HireVue. Its algorithm evaluates applicants’ responses to interview questions, such as tone of voice and word clusters. It also incorporates visual analysis, examining very quick facial movements called microexpressions. The information from these assessments is then matched against data points that correspond with each job. Applicants who score high for a position are called in for interviews.[iv]

Due to an aging population and greater demand for healthcare services, jobs in healthcare are projected to grow 18 percent from 2016 to 2026, adding about 2.4 million new jobs, more than any other occupational group.[v] The industry growth means healthcare organizations need to be as efficient as possible in finding the right people for the right jobs. McCormick reported AdventHealth, since using HireVue, has decreased the time it takes to fill a job from 42 to 36 days.[vi]


[i] Suzanna Colberg, “Why 95% of Companies Make Bad Hires,”  FurstPerson (2019), https://www.furstperson.com/blog/why-95-percent-of-companies-make-bad-hires
[ii] Ibid.
[iii] McCormick, “What Ai Can Tell from Listening to You”.
[iv] Ibid.
[v] “Healthcare Occupations,”  Department of Labor Bureau of Labor Statistics (2019), https://www.bls.gov/ooh/healthcare/home.htm
[vi] McCormick, “What Ai Can Tell from Listening to You”.

View Of Staff In Busy Customer Service Department

In 2001, I wrote Net Attitude: What It Is, How to Get It, and Why Your Company Can’t Survive Without It. The focus was to share with organizational leaders how they could use a “net attitude” to make their organization more successful by using the web to be more responsive to customers and constituents. The classic example of a poor net attitude is often one of the many call centers, which I wrote about almost 20 years ago, and many have still not improved. The pre-recorded voice greeting begins with, “Please pay attention because our menus have recently changed.” How is it the menus of all call centers have recently changed. If you press “0”, you often get a response saying, “You have pressed an invalid key”. “Please enter your 16-digit account number” is often followed by a person in the call center, right after you entered the 16-digit number, asking, “What is your account number?” These annoying, often repetitive responses are not due to a technical problem. They are due to a lack of net attitude.

Smartphone vendors and online retailers strive to outdo each other. The top tier of them have customer satisfaction percentages in the range of 75 to 90. On the other hand, the leading cable companies hover in the range of 55 to 60.[i]  One of the key elements in the difference is the call centers.

In early 2019, I had a question to ask Comcast technical support. I tried my best but eventually gave up trying to reach them. It wasn’t the hold time; it was the attitude they deploy. I called the main number. The first prompt said to press 1 if the call was about USC. I have no idea what USC means. University of Southern California? I was next prompted for my reason in calling. I said “technical support”. I then listened to 15 seconds of clicking sounds which I was supposed to think was an agent typing my request on a keyboard. Do they think anyone would believe that? Next, I was asked to press 1 for Slow Internet, 2 for Connection Problems, 3 for Wi-Fi Password, or 4 for Email trouble. There was no other choice. If I did not select one of those four choices, I could not proceed. I pressed “0” hoping to get to a person, and the call center hung up. Cable companies face a number of issues related to pricing and contractual terms but I belive annoying call centers contribute to the frustration and poor ratings.

According to Site Selection Group, a Dallas, TX, and Greenville, SC provider of global location advice, there are 7,400 call centers in the U.S. employing more than three million people.[ii] John McCormick at the Wall Street Journal, described how Cogito, a Boston based augmented intelligence company, is using voice AI to make call centers more effective. McCormick explained,  

As calls come into a center, they are streamed to Cogito’s system, which evaluates hundreds of data points including speech rate, tone and more. If agents are pausing before answering questions, it could indicate they’re distracted. If customers raise their voices, it could be a sign of frustration. When the Cogito system detects a possible issue with a call, it sends a notification in the form of an icon or short message to the staffer’s screen. It is a suggestion that the agent recognize and acknowledge the caller’s feelings.[iii]

The Cogito system in effect coaches the call center agents to help them become more confident, engaged, and empathetic. McCormick quoted the Cogito CEO as saying, “Learning to speak to different customers is a real skill. You’re not born with it. You have to learn it.”[iv]

Some insurance companies have found the Cogito AI helpful in improving first call problem resolution as much as 10% and customer satisfaction, but it clearly has a long way to go. I believe, over the next few years, we will find an AI will be able to learn how to satisfy customers better and faster than human agents. By applying machine learning to a very large number of customer calls and matching the nature of the problems with solutions which solved problems in the past will enable much higher accuracy than a human can achieve. We can look forward to AI-created voices which sound like a human and an AI which can understand the questions we ask without asking us to press 1 for this and 2 for that. 


[i] “Benchmarks by Company,”  American Customer Satisfaction Index (2018), https://www.theacsi.org/index.php?option=com_content&view=article&id=149&catid=&Itemid=214&c=Comcast&i=Subscription+Television+Service

[ii] “Strategic Locations Solutions,”  Site Selection Group (2019), https://www.siteselectiongroup.com/site-selection-group-about

[iii] McCormick, “What Ai Can Tell from Listening to You”.

[iv] Ibid.

Robot Attitude in Sun and Surf Magazine

Get a small glimpse of my upcoming book, Robot Attitude: How Robots and AI Will Make Our Lives Better in the April issue of Sun and Surf Magazine. This is my third article in an issue of Sun and Surf. Click here to enjoy the entire magazine, and flip to page 18 to see my article in a larger size. I hope you like it. If you would like an email when the book is published, just enter your email below and click “Let Me Know”. Your email will not be used for any other purpose.

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In the United States, about 610,000 people die of heart disease every year, accounting for one in every four deaths.[i] Heart disease is the leading cause of death for both men and women.[ii] Dr. Amir Lerman, director of the Cardiovascular Research Center at Mayo has focused his research on coronary physiology. He conducted a two-year study ending in February 2017 to see if voice analysis was capable of detecting coronary-artery disease. Dr. Lerman said, “Every person’s voice has different frequencies that can be analysed.”[iii]  

Mayo has been collaborating with Beyond Verbal, a Tel Aviv, Israel, and Newton, MA based company which is developing voice-enabled AI to create voice biomarkers. Biomarkers are normally thought of as biological molecules found in tissues, blood, or other body fluids which indicate a normal or abnormal bodily process or the presence of a specific condition or disease. Researchers at Beyond Verbal have discovered the human voice can also be a biomarker, specifically for coronary artery disease. The company believes the voice biomarkers can be used for personalized healthcare screening and continuous remote monitoring of heart health.[iv] In collaboration with Mayo, Beyond Verbal, used machine learning to identify specific voice biomarkers, and then tested groups of people who were scheduled to get angiograms.

Participants in the study recorded their voices using a smartphone app provided by Beyond Verbal. An analysis of the voices showed patients who had evidence of coronary-artery disease based on their angiograms also displayed voice biomarkers which could show presence of the disease.[v] The implication of the study is heart disease can be detected without intrusive and expensive tests. The combination of a patient’s voice plus AI will be able to do the job.


[i] “Heart Disease Facts,”  Centers for Disease Control and Prevention (2019), https://www.cdc.gov/heartdisease/facts.htm

[ii] Ibid.

[iii] “Amir Lerman, M.D.,”  Mayo Clinic (2019), https://www.mayo.edu/research/faculty/lerman-amir-m-d/bio-00078051

[iv] “Beyond Verbal,”  Beyond Verbal (2019), https://beyondverbal.com/

[v] McCormick, “What Ai Can Tell from Listening to You”.

If a friend or relative calls you on the phone, and something is wrong in his or her life, you can tell immediately. Could an AI tell also? Yes, and a whole lot more. Using the same machine learning technology an AI can use to tell a cat from a dog or recognize a person’s face, an AI could recognize your voice. An AI with access to a database containing a large number of your voice samples along with a description of whose voice each sample is associated with, the AI can recognize you. Based on characteristics of the voice and what state of mind those characteristics are associated with, it can also know if you are not feeling well, are upset about something, or in a big hurry. Some of the characteristics of voice data which can be detected include tone, tempo, volume, language and dialect used, and other voice characteristics.

John McCormick, deputy editor of WSJ Pro Artificial Intelligence, wrote an excellent article about voice recognition called, “What AI Can Tell From Listening to You”.[i] McCormick said that by analyzing voice data, an AI can determine a person’s emotions, mental and physical health, height and weight, and detect if you are depressed, in danger of a heart attack, or dozing at the wheel of your car. The AI voice technology is already in use in a number of application areas. The following paragraphs contain some examples.

A major area of opportunity is in mental health. McCormick said,

In the U.S., mental illnesses affect one in five adults, or 46.6 million people in 2017, according to the National Institute of Mental Health, which estimates only half of those needing treatment receive it. Emerging voice technology may be able to make problems easier to spot.[ii]

CompanionMx Inc., a digital health technology company spawned out of the Massachusetts Institute of Technology, has introduced a mobile app, called Companion. Patients are encouraged to talk to the app describing how they are feeling. The app securely records the voice and extracts features which are indicative of digital biomarkers correlated with symptoms of mental health.[iii] Using AI, the relevant data and trends are available to a clinician who can make better clinical decisions to improve the mental health of the patient. Researchers who have studied the Companion system have found it very encouraging.[iv]

Another interesting area of opportunity is keeping drivers awake. McCormick said,

More than 800 Americans died falling asleep behind the wheel in 2015, according to October 2017 statistics from the National Highway Traffic Safety Administration, and more than 30,000 people were injured in crashes involving drowsy drivers.

Many cars already have voice recognition for making phone calls or telling the car GPS system where you want to go. Some cars have external cameras to help avoid collisions. Cars could also have a camera on the dashboard watching you. McCormick said,

Now, many major car companies and artificial-intelligence companies are designing AI that uses voice analysis, along with facial recognition, to assess the alertness and emotional state of a driver.

Toyota Motor Corporation displayed a demonstration vehicle at last year’s Consumer Electronics Show which can read facial expressions and voice tones. If onboard AI detects you are exhibiting signs of being tired, the car’s voice assistant could alert you and suggest you pull over to take a break. McCormick said that the AI in the car could engage you in a conversation and, over time, learn what topics of discussion are most likely to keep you alert.[v] It could also blast you with loud music to help keep you awake.

Other areas where McCormick reported AI and voice analysis will eventually have a large impact include:

Humanizing the call center

Hiring the Right Candidates

Fighting fraud

Investigating crimes[vi]


Stay tuned for more on these areas next week.

[i] John McCormick, “What AI Can Tell from Listening to You,”  Wall Street Journal (2019), https://www.wsj.com/articles/what-ai-can-tell-from-listening-to-you-11554169408

[ii] Ibid.

[iii] “The Companion System Has Three Key Components,”  CompanionMx (2019), https://companionmx.com/product/

[iv] McCormick, “What AI Can Tell from Listening to You”.

[v] Ibid.

[vi] Ibid.

When I first started having knee pain many years ago, an orthopedic surgeon told me he thought the problem may have arisen because one of my legs is a fraction of an inch shorter than the other. Such a condition may exist with many people who never notice the difference. However, if you are running marathons, which I was back then, the slight difference in leg length can become noticeable and lead to skeletal pain somewhere.

​When someone gets a hip replaced, a similar problem may arise. After the replacement, it is not uncommon for the leg attached to the replaced hip to end up a little longer or shorter than it was before. If the leg-length changes by less than 3/8 of an inch, the body is able to adapt and compensate. However, if the length change is more, posture changes can develop, which can lead to back pain. A team of scientists at the Fraunhofer Institute for Machine Tools and Forming Technology based out of Chemnitz, Germany, may have a solution to the problem.

The artificial hip developed by the scientists is adjustable. After the hip is surgically inserted into the patient, the surgical team uses a computerized camera system to measure the exact length of the leg. If the length needs to be adjusted, the surgeon can turn a screw which connects the artificial hip’s femoral stem and the ball and socket. Once the length measurement matches the proper length, the implant can be secured and the surgery completed. The adjustable system is in the testing phase, but the scientists are hopeful it will be ready for clinical adoption within two years. In the future, I envision a procedure involving very precise measurements being taken from MRI or CAT scans and then a precision hip replacement will be created using a 3-D printer.

As usual, the Apple Keynote to introduce the new Apple services lineup including TV, news and magazines, games, and a new kind of credit card was done with great marketing aplomb. Apple has it down pat. Tell them what you are going to tell them, tell them, and then tell them what you told them works every time. There are many skeptics about the new services, but it looks to me like a home run. Over the next few years, Apple services revenue may surpass that of the iPhone. There are than a billion Apple devices out there capable of taking advantage of Apple services, and none of them are free. The highlight of the keynote was the hug at the end between Oprah and Tim Cook, Apple’s CEO. It is hard to get the full story from the news, so I recommend, if you have not seen it, watching the entire keynote. You can see it here.

In case you did not see it, the week before the services announcements, Apple introduced new AirPods with wireless charging, iPads, plus a new lineup of Macs.

Swiss law guarantees that every Swiss citizen has the right to vote, whether or not they currently live in the country. Overseas citizens have previously pushed for e-voting, arguing that postal methods are frequently delayed, making them unreliable. Votes are also a much more common occurrence in Switzerland, whose system of direct democracy calls for as many as a dozen national votes every two years.

Switzerland is not the only country to have consider online voting, but the threat of security scares or privacy problems, fueled by anti-Internet voting activists, have caused election officials to drop their plans. For example France and the U.K. dropped their Internet voting plans. In the United States, an email voting method, which they call Internet voting, is available to overseas service personnel in 25 states. However, in most of these states they must submit their ballots via email, which is more insecure than Internet voting. In some, they are actually required to sign a waiver giving up their privacy in order to vote by email. The one exception is the state of West Virginia, which engaged an Internet voting technology company, Voatz, to enable overseas Internet voting for military personnel. The implementation worked quite well, with dozens of military voters voting from dozens of countries, yes countries, not counties. Despite criticisms from the anti-Internet voting activists warning it was unsafe, the voting was secure, private, and verifiable.

The Swiss government is taking an innovative approach to Internet voting. Rather than wait for the normal criticisms from the anti-Internet voting activists, the country offered “bug bounties” of around $50,000 to any registered “white hat” hacker who could find vulnerabilities in its Internet-based e-voting system. The Swiss Post system for Internet voting was open for a dummy election between February 24th and March 24th, the length of a typical Swiss federal vote, during which time any registered “white hat” hackers were free to discover and report vulnerabilities. Thousands signed up to do so.

A top security expert last week published an article titled, “Critical Flaw in Swiss Internet Voting System”. I consider the “bug bounty” to be a great success. The flaw which was discovered was real, but one which some (including me) would consider a hypothetical flaw. It was real but not easily exploited. Few if any have the knowledge to challenge the expert’s logic for why the newly proposed Internet voting system should not be implemented in Switzerland. However, my view is the election should go on and be carefully monitored with regard to the flaw.

The basic problem I see is the anti-Internet voting activists are comparing the Swiss Internet voting system to a perfect system, which Switzerland (or any country) will never have. The Internet voting system should be compared to the old-fashioned paper-based error-prone system we use today. It is very far from perfect, and many millions of people do not get to vote because of it.

Security, privacy, and verifiability should not be ignored and finding and fixing vulnerabilities should be a top priority. Security experts should be listened to. Few, if any, persons have the knowledge to challenge the expert’s logic. However, we should all expect more than the sky is falling fears offered. In addition, security experts should offer suggestions on how to proceed with the least possible risk, but not necessarily zero risk. Otherwise, we continue to disenfranchise the millions who cannot vote because they can’t get to the polls or who believe a paper ballot may not get to the polling place on time or even be counted unless there is a tie. West Virginia and other trials have shown what is possible.

I had been following the Internet with great interest and enthusiasm beginning in 1992, and in 1994 became a co-founder of the World Wide Web Consortium at MIT. There were not many people familiar with the Internet or the fast-growing application called the Web, which many people at the time called the information superhighway. It was big news that year when the first known Web purchase took place: a pepperoni pizza with mushrooms and extra cheese from Pizza Hut. Also that year, the Clinton White House came online, and Yahoo! was created by Stanford University graduate students Jerry Yang and David Filo. At the time, they named the site “Jerry and David’s Guide to the World Wide Web.” The estimated number of Internet users in 1994 was 11 million.

In 2000, just 43% of internet users said they would miss going online “a lot,” if they lost access, 78% of internet users said they didn’t think it was stealing to download music from the Internet, and 40 million of the 83 million American Internet users had purchased a product online.

In 2004, 11% of American internet users followed the returns on election night online. The same year, Harvard student Mark Zuckerberg launched thefacebook.com (not a typo; that is what it was called back then). 1,200 Harvard students signed up within the first 24 hours, and Facebook went on to become the world’s biggest social networking site, with more than two billion users worldwide. Google started trading on the NASDAQ at $85 a share.

In 2008, 74% of internet users, which was then 55% of the entire U.S. adult population, said they went online during the presidential election to take part in or get news and information about the campaign. Just 19% of cellphone owners say they had gone online with their phones. Apple launched its App Store with 552 applications. Microsoft offered to buy Yahoo! for $44.6 billion, but the two companies could not agree on the purchase price. I was glad the purchase did not happen because the cultures were night and day different.

By 2013, the number of internet users had increased tenfold from 1999. The first billion was reached in 2005. The second billion in 2010. The third billion in 2014. The current number of users is 4.2 billion. Perhaps the most astonishing statistic is the number of Internet users in China. I remember when there were almost none. As of the end of 2018, the number had reached 829 million, more than double the entire population of the United States. Even more astounding is 817 million of the Chinese used a smartphone to access the internet, accounting for 98.6 percent of the total netizens.

According to Global Times, “There are still 562 million people in China isolated from the online world, with most living in rural regions. A low education level and insufficient internet surfing skills are the main obstacles blocking them from accessing the internet.” I have no doubt this will change. The dramatic increase in Internet use by the Chinese relates to the huge advances they are making in scientific research including robotics and artificial intelligence.

OCLC Library 100

One of my affiliations is as a board member at OCLC Inc. in Dublin, OH. I am very proud of the work OCLC does as a global library cooperative. The organization supports thousands of libraries in making information more accessible and more useful to people around the world. OCLC provides shared technology services, original research, and community programs which help libraries meet the ever-evolving needs of their users, institutions, and communities. OCLC’s trademarked slogan is Because what is known must be shared.®

One of the many strengths of OCLC is its Research arm. It is one of the world’s leading centers devoted exclusively to the challenges facing libraries and archives. In a rapidly changing information technology environment, OCLC Research proves quite valuable to these organizations. One of the many tools OCLC Research uses and makes available to libraries is WorldCat. WorldCat is a bibliographic database which includes everything that’s available to users in libraries. It contains bibliographic information about books and journals, DVDs, historic photos, video games, musical scores, newspapers, webpages and many other items. It also includes unique items such as 2,700-year-old jewelry and 18th century soup bowls. I use WorldCat personally when I am writing a book and want to include a citation in the Notes section at the end of the book. (My Attitude series of books contains almost 900 bibliographic citations.) WorldCat will also show you where the nearest library is which holds a book you are interested in borrowing. Take a look at worldcat.org and you will get an idea of what it has. In total, WorldCat has approximately 445,000 bibliographic records and 2.75 billion holdings.

A recent project of OCLC Research was to use WorldCat to determine what makes a novel “great”. OCLC believes greatness can be measured by how many libraries have a copy on their shelves. Libraries offer access to trendy and popular books, but, they don’t keep them on the shelf if they’re not repeatedly requested over time. In order to find the top 100 novels of all time, OCLC Research looked at the holdings in thousands of libraries around the world using WorldCat. The result of the research is The Library 100. Check it out here. You may be surprised, as I was, about how many names you recognize and how many you have yet to read. I doubt if I will ever be able to read them all, but I just put the #1 novel on my Kindle. I will read Don Quixote as soon as I finish Zucked.

IBM research publishes an annual five year look at key trends it sees around the corner. There are many of them, but this year its report focused on related to innovations in the food supply chain – “from seed to shelf”. At a recent conference, IBM researchers made presentations about a variety of food-oriented initiatives including the future of farming, streamlining the transport and distribution of crops, improving food safety, reducing food waste, and ridding the sea of plastic waste.

Jeanette Garcia, a Master Inventor at IBM Research, discussed the need to improve the recycling of plastics. She said, “In the U.S., less than 10% of plastic waste is recycled.” “Plastics are everywhere, and it’s becoming an environmental disaster.”

Garcia noted that half of all plastic products become trash within a year. She cited a study which predicted by 2050 there will be more plastic in the ocean than fish. Currently, more than 272 million metric tons of plastic are produced each year around the world. Twenty-five percent of the plastic contains PET (polyethylene terephthalate), a type of plastic commonly used in food packaging.

IBM researchers have created a catalytic chemical process called VolCat. This new technology can turn PET into a renewable resource. VolCat uses a combination of chemicals, heat, and pressure to reduce the amount of plastic, and ultimately the amount of waste. This new research is capable of breathing new life into old plastic. Over the next five years, Garcia predicted the new research could completely transform the way plastic is manufactured and, more importantly, how plastic is discarded.

Sony has been making robotic pets for more than 20 years. As technology has evolved, so has the robo-pup. The latest version of Sony’s Aibo, pronounced eye bo, became available in the United States at the beginning of 2019. Aibo could be perceived as a home automation device when you consider all of its sensors and cameras. In reality, it is nothing at all like a smart home device. The giveaway is the wagging tail and the way Aibo trots around your home. Aibo’s goal is not home security or automating your lights. In Japanese, Aibo means “pal” or “partner”, and its sole mission is companionship. A two year-old child will likely find Aibo a delightful addition to the family. Aibo may cause chronically ill seniors to think less about their aches, pains, and loneliness. Reports from reviewers of the robo-pup say a real dog or cat may not find Aibo at all interesting.

A companion Apple or Android mobile app enables you to set Aibo’s gender to male or female. This affects the pitch of Aibo’s voice and how he or she walks. You can also set the color of Aibo’s eyes, teach it new tricks, and even take photos with the camera in its nose. He or she can understand more than 50 voice commands. All of this and more is made possible by a plethora of technology components inside of the 12 inches tall, 12 inches long, 7 inches wide, 5 pound robot including a super-fast computer chip, OLED displays (eyes), sound speaker, four microphones, two cameras, a dozen sensors, and Wi-Fi. 

In terms of movement, Aibo has 22 degrees of freedom (DOF). The human body has 244. For example, our hands have 27 DOF. Each of our four fingers can move in four different ways. The thumb has five DOF, and the wrist has six. Aibo stands out versus any toy or consumer robot with its 22 DOF. Its head can move along three axes, one for the mouth, neck, and waist. Each leg (front and back paws) has three axes. Each ear has one DOF and the tail has two. 

The purpose of all the technology is to make Aibo seem like a real puppy. Reviewers all say that mission was accomplished. A review in TechCrunch said,

A long press of the power button on the collar wakes him up. He stirs slowly, from a near fetal position, his paws extending outward with a stretch. He acknowledges his limbs with a yawn and slowly stands, shaking himself out as though he’d just run through the sprinklers in the yard.

Aibo uses artificial intelligence and deep learning technology to remember 100 friends and family. He remembers what makes different people happy based on their reactions. As Aibo learns its environment and develops relationships, its personality becomes unique. As an owner, Aibo becomes uniquely your Aibo. A reviewer at c|net spent a week with Aibo at home. She said,

Aibo loves praise with a nice rub on the head, chin and back — or give him some positive verbal feedback. (“Good boy!”) Teach him tricks and watch him respond to voice commands. Cameras and sensors on his front side help the dog sense nearby people, as well as find his signature pink toy ball, bone and charging station. A camera near his bum points to the ceiling to map the layout of your home, so over time he learns how to get around.

Aibo connects to the Sony cloud which uses artificial intelligence to help Aibo become more and more real. The nice thing is you don’t have to take him for a walk several times a day. The only downside is the cost – Aibo sells for $2,900.

Russian National Orchestra

It was a great evening at the Lewis Auditorium at Flagler College in St. Augustine, Florida. The Russian National Orchestra was founded in 1990 and has been described as “a living symbol of the best in Russian art” (Miami Herald) and “as close to perfect as one could hope for” (Trinity Mirror). The orchestra maintains an active international schedule with appearances throughout the music capitals of Europe, Asia and the Americas.

Conductor Kirill Karabits started the concert with a great performance of Sergei Rachmaninoff’s Vocalise. The star of the evening was next as violinist Alexey Bruni delivered a brilliant performance of Ilyich Tchaikovsky’s Violin Concerto in D Major, Op. 35. The three part concerto is incredibly complex. A friend told me it is not performed often because the piece is too difficult to play for most concert violinists. I believe it.

After the intermission, Karabits conducted Alexander Glazunov’s four part Symphony No 8 in E-flat Major, Op. 83. The symphony brought out the full diversity and expertise of the orchestra’s outstanding string, brass, woodwind, and percussion sections. After a sustained standing ovation, the orchestra played an encore. The name of it was not announced, but I recognized it from the sound track of my favorite movie: The Hunt for Red October.

Mobile Internet Voting

AlterNet, this week, published “2020 will be the year that online voting really takes hold in the U.S.— here are some of its biggest challenges“. Steven Rosenfeld did an excellent job of outlining the issues surrounding the lack of political and technological will to enfranchise the 100 million people who could not get to the polls for various reasons in 2012, 2016, and 2018.

Steven described three scenarios which I had written about in Election Attitude – How Internet Voting Leads to a Stronger Democracy,

A. A perfect Internet system. All Windows 95 and other older systems have been eliminated. There are no hackers, no viruses, and no malfunctions. 100% of the population has a perfect device with flawless authentication and they are well versed in how to use them.

B. The voting system using blockchain technology, smart phones, and the Internet. The system would support finger or face identification for authentication. All voting data would be encrypted. Choices on the screen would be clear, expanded text sizes would be available, and audio provided for those who are hearing impaired. Links would provide details about a candidate or an issue being voted on. Not everyone would be required to use the Internet voting systems. For those without a computer or who don’t want to use a computer, they will be able to go to a local polling place or public library to use the computer there. For those who do not want to use one of these computers, they will be able to vote with a paper ballot. Voters using a smart phone or computer can vote multiple times with only their last vote counting. Votes remain private and voters will be able to confirm their vote was counted.

C. Today’s system which is full of problems such as the few listed above. Tens of millions of Americans who are eligible to vote, will not vote for a long list of reasons. Some will be sick on election day, be called away on assignment at the last minute by their employer, not be able to get off of work, intimidated by weather or ours-long lines, and many other reasons. In 2016, 100,000,000 people fell into these categories and were therefore disenfranchised.

Now, consider A, B, and C. The anti-Internet voting activists want to compare scenario B to scenario A, which we will never have. They refuse to compare it to scenario C which is the flawed system we have today which disenfranchises huge numbers of voters. I hope Steven is right when he says, “2020 will be the year that online voting really takes hold in the U.S”. There are encouraging signs, such as the West Virginia trial using Voatz blockchain technology. What we need now is a grass roots movement, state by state, where voting officials develop requests for proposals for Voatz and numerous other voting technology companies. Competition among tech companies is exactly what we need to bring out the potential for safe, secure, private, and verifiable Internet voting.

AI

There is no doubt millions of jobs will be absorbed by impending robotic and AI technologies. It is already beginning in the financial and services industries where there is a major push to improve efficiency and replace the decades old infrastructure which handles mundane transaction processing. Millions of new jobs will be created for data scientists, systems architects, machine learning experts, robot designers who can teach robots how to design robots, manufacturing systems engineers who can design the factories of the future, bioinformatics experts, and many others with advanced skills. The key question we need to focus on is how we can transform our educational system to create these new skills. The demand will be there. The supply may not be.

There is hope the administration is finally getting on board and providing some leadership in AI, and equally important with the educational system needs. This week, the U.S. Department of Commerce announced Apple CEO Tim Cook and IBM CEO Ginni Rometty were among 25 members appointed to the Administration’s American Workforce Policy Advisory Board. The board will make recommendations on policies to help bridge the skills gaps between American students and workers and jobs needed in the modern economy. This is an overdue, but really important, action. 

CNBC reported the story and titled the article as “Apple and IBM CEOs join Trump’s advisory board to make sure AI doesn’t kill jobs”. There is no possibility of prevented the killing of jobs, but as noted in my prior post, many new jobs will be created, and we need a newly energized educational system to ensure the new jobs do not all go to China where huge investments in AI are being made. The Advisory Board has a good mix of leaders from community colleges, universities, and technology companies. The creation of this Board follows another Administration move to create an executive order to foster AI technology. Seems the alarm bells have gone off in Washington. There are reasons to be hopeful. If you want to see the full list of the 25 members of Advisory Board, click here.

AI

In a 2017 e-brief, I suggested artificial intelligence (AI) will change everything. One of the things is employment. Some embrace doom and gloom scenarios where millions of jobs are lost to robots and algorithms, creating a major burden for society. A cabinet member at the time said the impact is 50-100 years down the road. I hope his comment is just a reflection of him not yet being informed of what is happening.

There is no doubt millions of jobs will be absorbed by impending technology. It is already beginning in the financial and services industries where there is a major push to improve efficiency and replace the decades old infrastructure which handles mundane transaction processing. AI will enable transactions to be handled smarter and faster. Customer service agents in all industries will be supplemented and mostly replaced with AI based capabilities. These AI will gain intelligence from absorbing millions of calls, problems, resolutions, and suggestions from humans, and learning from them. After each interaction, the AI will get smarter.

There is also a dark side to AI. Bill Gates has been quoted as saying AI is potentially more dangerous than a nuclear catastrophe. Other pundits believe, in the next few decades, we are either going to head toward self-destruction, or  humans will eventually leave Earth and colonize the universe. Maureen Doud interviewed Elon Musk and other pundits and wrote a comprehensive article about the dark side of AI. It was published in Vanity Fair. Click here to read it.

While I do not reject the dark side out of hand, I believe there are a lot of positive things to come from AI. Nurses and physician assistants will be able to make more accurate diagnoses than doctors can make today. Customer service will be extraordinary. Needless delays in financial transactions involving money transfers will be eliminated. Productivity of enterprise knowledge workers will be greatly enhanced. Getting millions of hits when we search online will be replaced by discovery of the information we want, even when we don’t know what key words to search for. Knowledge workers in large organizations will be able to find answers to a lot of questions and research which are hidden in silos within their own company or even down the hall.

Millions of new jobs will be created for data scientists, systems architects, machine learning experts, robot designers who can teach robots how to design robots, manufacturing systems engineers who can design the factories of the future, bioinformatics experts, and many others with advanced skills. The key question we need to focus on is how we can transform our educational system to create these new skills. The demand will be there. The supply may not be.

Robotic vacuum cleaner

An emerging part of home automation includes the use of robots at home. Bilal Athar, CEO at Wifigen LLC and a home automation enthusiast, believes robots will be central to having a smart home. “A smart home should also be a clean home.”, said Athar. ECOVACS ROBOTICS is a company specializing in research and development, design, manufacture, and sales of robotic home appliances. Their mantra is “Live Smart. Enjoy Life.”]  The company makes robots which add a lot of convenience for cleaning floors and even windows. One product, the DEEBOT M81, is designed to clean different kinds of messes in the home.

The M81 vacuum and mop combo can sweep, vacuum, and mop in one pass. The company says the robot can “give your home a thorough and deep clean.”] You can choose the cleaning mode to auto mode for general cleaning, edge mode for cleaning specific edges, or spot cleaning when intensive cleaning is required. Everything is controllable from your smartphone. When battery power gets low, the DEEBOT automatically returns to its charging dock. No human intervention is required. You may add some integration with voice assistants like Alexa. A use case could be a child spilled something, and you say “Alexa, ask DEEBOT to clean the kitchen floor”.

While robots clean the inside of homes and apartments, a new field of home robots is emerging. Robots at home doesn’t mean they need to be in the home. They could also be outside moving the lawn. iRobot, the company which developed and markets the Roomba vacuumbot, has been working on robotic lawn mowers for more than ten years. In January 2019, iRobot announced Terra, a flat, square, autonomous, grass-cutting lawnbot.[iv] The company faced many engineering challenges along the way. GPS technology works nicely on a tractor out in an open field. At a residential property with trees and neighboring homes, there is too much signal interference to make GPS a reliable way to safely navigate the property. Sensors had to be developed which could keep the lawnbot out of garden beds, and avoid hitting picnic tables, toys, or other obstacles which may be on the lawn.

iRobot believes it has solved the engineering problems and plans to begin beta testing in 2019 with sales to begin in 2020. Terra has a quiet electric motor and a pair of tri-blade mulchers. The idea behind the mulchers is to allow the lawnbot to operate slowly and achieve a manicured look. Rather than mowing the lawn once a week, consumers might choose to have Terra work several days per week. When the battery gets low, Terra heads for the outdoor charging station to charge up and then return to where it left off.

Robotic lawn mowers are successful in Europe. Analysts say European lawns tend to be small and square, which makes the lawnbots simpler and more affordable. The analysts also question whether there is enough demand in the U.S. to have a successful product. The price is likely going to be $1,000 or more.

Cleaning floors and windows and mowing the lawn are just the beginning of what robots will be able to do at home. At the Consumer Electronics Show in Las Vegas in 2018, I saw a robot which could fold shirts. In the future we can expect to see robots which can do the laundry, make the beds, prepare cocktails, cook and serve dinner, and then go get a recharge. For those of us who like to cook in the kitchen, a robot may be our assistant to chop the onions or shuck the oysters. As robots gain AI, they will be able to anticipate our needs and operate autonomously to give us more time to spend on the things we want to do.

Robot Attitude: Robot Attitude: How Robots and AI Will Make Our Lives Better will be published later this year. I hope during the summer. If you would like me to let you know when the book becomes available, enter your name and email below, and click the Let Me Know button.

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References
A Robot for Every Family,”  ECOVACS ROBOTICS (2018)
Where’s My Robot Lawn Mower? Roomba-Maker Now Has an Answer,”  AP (2019),

Exceptional Parent Magazine provides practical advice, emotional support, and up-to-date educational information for families of children and adults with disabilities and special healthcare needs. One of my readers follows EP and introduced me to Vanessa Ira, Managing Editor. Vanessa told me about EP’s Annual Resource Guide for their readers, and asked if I would write an article for it. I happily agreed. Just click on the image above or here to see the full article, “How mHealth, 3-D Printing & Robots Will Change The World For People With Special Needs“.

Thyroid

A number of articles appear here about regenerative medicine. The reason I think the topic is so important is 115,000 people are waiting for a lifesaving transplant. Another person is added to the waiting list every 10 minutes. Twenty-two people die each day because the organ they need was not donated in time. A single organ, eye, and tissue donor can save and heal up to 75 lives. The argument to be a donor is compelling, but only 52% of us have registered to become one.The Apple Health app provides a simple registration form you can submit directly from the iPhone app to the National Donate Life Registry. If you sign up, first responders will have access to the decision to be a donor right from the iPhone emergency screen. It took just seconds to register from my iPhone. Perhaps organs from someone my age would not be useful, but it costs nothing to sign up, and you never know.

I believe the ultimate solution to the shortage of donated organs is regenerative medicine using 3-D printing and pluripotent stem cells. There have been many breakthroughs. Scientists have successfully produced human kidney tissue within a living organism which is able to filter blood and produce urine, a first for medical science. The study signifies a significant milestone in the development of treatment for kidney disease. Researchers have also created human heart and liver tissue.

The latest breakthrough came from Russia. The Russians developed a magnetic bioprinter, and transported it to the International Space Station. Printing in a zero-gravity environment in space enables printed organs and tissues to mature at faster rates. The Russian scientists were able to print a mouse thyroid. The bioprinted thyroid is an important breakthrough for printing living tissues and microorganisms beyond the stratosphere. The thyroid will be implanted in a mouse back on Earth.

I find this research remarkable. It will take more time, but it seems clear the day of people dying because of a lack of a replacement organ will come to an end. Read more about regenerative medicine in Health Attitude: Unraveling and Solving the Complexities of Healthcare.

The Republic of Estonia is a country in the Baltic region of Northern Europe. It is bordered on the north by the Gulf of Finland, on the west by the Baltic Sea, on the south by Latvia, and on the east by Russia. Some years ago, I was on a Baltic cruise which made a stop in Tallinn, the capital and largest city of Estonia. I was quite impressed with the ancient narrow streets lined with cars from BMW, Maserati, Mercedes, and Porsche. I later learned Tallinn was a high tech center of innovation. Skype was created by Estonian software developers.

Estonia has a vision to empower all of its citizens by making the government highly efficient with all of its services accessible electronically. In 2005, it introduced what it calls ‘i-Voting’, or internet voting. All citizens have an electronic ID card to assure their identity. They are now given at birth. For eligible voters, they can cast their ballots from any internet-connected computer from anywhere in the world. (Wouldn’t it be nice if our millions of military and overseas citizens could do that?) During a designated pre-voting period, the voter logs onto the system using their ID and casts a ballot. The voter’s identity is removed from the ballot before it reaches the electoral officials for counting to ensure anonymity. An argument against Internet voting is the possibility of coercion. Estonia has a simple and elegant solution to this problem. They allow voters to vote as many times as they want up until the voting period ends. The last vote counts and any prior vote is canceled.

I am quite impressed with Estonia’s digital leadership. They have conducted national elections using the Internet for more than a decade with no security or privacy problems. Strong leadership and vision from the President of the country helped make this possible, but an important factor is Estonia’s digital ID card for all citizens. The chip card enables Estonians to sign contracts, start businesses, retrieve health records, and vote. The country has recently extended its digital leadership outside of its borders.

Estonia has created a new digital nation for global citizens called an e-Residency. Estonia is the first country to offer an e-Residency, a government-issued digital ID available to anyone in the world who can fully authenticate themself. E-Residency offers the ability to easily start and run a global business in a trusted EU environment. An e-Resident anywhere in the world can register an EU based company entirely online. He or she can then access business banking, and online payment providers to accept payments from customers and clients worldwide. They can also digitally sign contracts and other documents.

Kersti Kaljulaid, President of Estonia, said,

Even though there are only a little over a million of us, thanks to Estonia’s capabilities, we can make ten million payments, perform ten million requests and sign ten million contracts in just ten minutes. Even ten times larger states cannot beat us. But the good news is that it is possible to join our exclusive club of digitally empowered citizens.

I decided to take her up on the idea, and applied for an e-Residency in 2017. After submitting passport and other identifying information online, I received approval. I then visited the Estonian Embassy in New York, presented my passport, and got finger-printed. I was handed my e-Residency chip card. A subsequent email from the Estonian Police and Border Guard Board confirmed they had “granted e-Residency to JOHN RUSSELL PATRICK”. See my chip card above.

You may be wondering what in the world I am going to do with my e-Residency. Not sure just yet. I may create an EU sister company to Attitude LLC. Not sure what that company would do. Anyway, I feel good I am walking the talk. We really should have national digital IDs in America. This would simplify e-commerce and healthcare records, and enable most of the 100 million people who did not vote in 2016 because they could not get to the polls to use Internet voting. There is a path to create a national digital ID, but that will have to wait until another posting.

Thanks to my friend Dan in California for posing a question about my Tesla Supercharger story last week. He asked, “So how do youn calculate mpg when there is no G?” Good question. The following is from the window sticker of my Model S.

The government calls it MPGe, with the e standing for equivalent. I don’t know how they calculated the 102 mpg, but I will share with you how I would calculate it. Somewhere along the line, probably in engineering school 50 years ago, I learned a technique called Dimensional Analysis. It has been a handy tool for me all these years. The purpose of the tool is to convert one unit of measure to another. The method is simple. You multiply fractional representations together. Below is what I scratched out on a piece of paper.

When you multiply miles per kWh times kWh per $ times $ per gallon, you get miles per gallon. Voila. Now lets add some numbers. The first fraction is miles per kWh. The Model S has a range of 335 miles with a full charge, which is 100 kWh, so that fraction is 3.35. The second fraction reflects the cost of one kWh. The cost varies greatly from state to state. The Choose Energy website shows the average price by state. It ranges from $.093 per kWh in Louisiana to $.223 per kWh in Rhode Island. (I excluded Hawaii and Alaska as they are off the charts). The third fraction reflects the cost per gallon of premium gasoline. This cost, as shown on the AAA website, varies greatly also, from $2.37 in Missouri to $3.64 in California.

Now, just multiply the three factors together to get the miles per gallon equivalent. For the high side, lets use Louisiana electricity and California gasoline. The result is 132 miles per gallon. At the other extreme, lets use Rhode Island electricity and Missouri gasoline. The result is 36 miles per gallon. Reality is somewhere in between. If half of the electricity you use for charging is from a free Tesla Supercharger, the results easily go above 200 miles per gallon.

Thanks, Dan!

For the first time in 3 1/2 years, I encountered “No Room at the Inn” for Tesla Superchargers. I stopped at the Danbury Fair Mall in Danbury, CT to get my glasses repaired, have a sandwich, visit the four PokéStops, and catch some wild Pokémon. Tesla recently installed ten Supercharger stalls at the Mall, and today was the first time I saw all of them occupied at once. I did not need a charge, but why not have “filled it up” if possible.

With the anticipated flood of new Tesla Model 3s on the road, Superchargers will become very busy. As a result, the company has adopted a new “Fair Use” policy which will exclude Supercharger use for taxis, ridesourcing such as Uber or Lyft, commercial delivery, government purposes, or other commercial ventures. The purpose of the free (for now, for many) worldwide Supercharger network is to facilitate long distance personal travel, a significant advantage Tesla has over other EVs at this stage. For local use, it is expected owners will normally charge at their home or business location overnight.

Another part of Tesla’s evolving policy addresses people who abuse the Supercharger parking. For example, a CT resident might decide to drive to the Mall, plug in, and spend the following few hours shopping when they may need only a half-hour or less to charge. Meanwhile others may have no access to charging because the “Inn is full”. The new Tesla policy will implement a charge once your car is charged. You will be notified on your smartphone if half or more of the total stalls are occupied and your charge has completed. After reasonable notice, you will be charged a fee per minute while your car is fully charged and occupying (hogging) a stall.

Overall, the charging cost can be a bit confusing. There are special credits, deals, and promotions out there. My first Tesla Model S had lifetime free charging. At the end of my three-year lease, I got a second Model S on another three-year lease. In return for acquiring another new Tesla, I was given lifetime free charging once again. All things considered for everyone, charging is not expensive. When the cost is converted to what gasoline would cost, the Tesla gets the equivalent of more than 100 miles per gallon.

While enjoying the fact your car is not burning fossil fuel, you can also enjoy the fact the Mall itself is quite energy efficient. One day when I was catching Pokemon, near the back of the Mall, I discovered there are a number of tractor trailer sized BloomEnergy Servers. They are not really servers, that is just PR, they are fuel cells. The cells are made from oxide (sand) which is heated to 1,800 degrees. Fuel (probably natural gas) flows into the fuel cells and a chemical reaction causes electricity to be created without any combustion. The by-product of the process is water. Danbury Fair Mall’s fuel cells produce 750,000 kW of clean, reliable energy while reducing the carbon emissions of the facility by nearly 3 million pounds each year and meeting more than a third of the Mall’s energy needs.

Biometric verification. Face recognition on polygonal grid is constructed by the points

Apple announced Face ID during the unveiling of the iPhone X in September 2017. The feature was presented as the successor to Touch ID, Apple’s previous fingerprint-based authentication technology. With a simple glance, Face ID securely unlocks your iPhone X. Also with Face ID, you can make purchases from Apple and make payments with Apple Pay. Apple opened up the interface to Face ID and now many apps take advantage of the feature.

The technology behind Face ID is quite impressive. The camera captures and analyzes more than 30,000 invisible dots projected onto your face plus an infrared image of your face. The data is compared to the data from when you enrolled yourself on the iPhone. Face ID works in the dark and can adapt to shaving a beard, and wearing a hat, scarf, or sunglasses. While the odds of someone stealing your iPhone and having a fingerprint just like yours is 1 in 50,000, with Face ID, the odds of a thief having a face the same as yours is 1 in a million.

Face recognition is here to stay. What Apple has done to recognize your face is benign. The data about your face is stored on your iPhone in a special area inside the phone called  the Secure Enclave. The data is not stored in iCloud. If you get a new phone, you have to scan your face again. Delta Airlines has announced they will be using face recognition to help you check in faster. The TSA has laid out plans to use facial recognition for domestic flights. Banks and hotels are planning to use face recognition. And then there is Government. Face recognition will be ubiquitous. Where will Marriott store data about our faces? In their cloud? Will they use the same protocols to protect that data as was used to protect Starwood’s data which was breached for 500 million guests?

And, how will government use face recognition? Cameras on every street corner will not just show someone in a monitoring center video of who is walking by. They will know WHO is walking by. Will we be tracked? Or will just certain people be tracked? The policy questions abound. The need for regulation here is obvious. Will it be left up to our tech savvy Congress?

The issues surrounding face recognition are going to be much broader and deeper than what I have outlined so far. A team of researchers funded by the German Research Foundation has published a paper called, “Face2Face: Real-Time Face Capture and Reenactment of RGB Videos“. What they have done is mind boggling. They call it facial reenactment in real-time. Five examples appear in the images below. I made a few highlights to help you see what is going on. Look at the person with the red box around his face. He is the “target”. The person whose face is outlined in green is one of the researchers, he is the “source”. While the video of the target is playing, video of the source is captures and used to “reenact” the video of the target. Notice in the original video the target had his mouth closed. But, using the research technology, the video was modified from video of the source and, voilà, the target has his mouth opened.

The German research is incredibly profound. The researchers said, “Our approach is a game changer.” The technology will enable editing of videos in real time on a home PC by non-experts. In 1994, the cover of Scientific American showed a picture of Marilyn Monroe with Abraham Lincoln. It demonstrated what was possible with computer graphics, and it was stunning at the time. The technology demonstrated by the German researchers could be called face manipulation. It can bring “Fake News” to a whole new level. The researchers said, “We hope that the numerous demonstrations of our reenactment systems will teach people to think more critical about the video content they consume every day, especially if there is no proof of origin.” And where will we get the proof of origin? From Facebook?


Picture from Apple

In the 1860s, a proverb originated in the country of Wales; “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread.” By the end of the 19th century, the phrase morphed into “An apple a day keeps the doctor away”. There is actually some scientific backing to the proverb. 

A 2011 study found consumption of apples and pears might prevent strokes. A 2012 study found apple consumption significantly lowered bad cholesterol levels in middle-aged adults. In 2013, leading general medical journal BMJ published a study as part of its humorous Christmas issue comparing the effects of prescribing everyone in the UK over age 50 either an apple or a lipid-lowering statin a day. The study concluded that both interventions had the same effect. A 2015 study looked directly at the relationship between apple consumption and physician visits and found no evidence that the proverb was true. The study did, however, find that people who ate an apple a day did use fewer prescription medications. A Cupertino, California based company hopes the phrase means everyday more people buy an Apple Watch to monitor their health.

As promised to happen before end of the month, Apple released an Apple Watch update which adds a new capability, the addition of an algorithm which can detect arrhythmia of the heart. It was not obvious from the announcement, but the new capability is available for existing Apple Watches, not just the new Series 4 Watch.

The pre-Series 4 watches will have a new capability in the Heart app. In addition to measuring heart rate, the app will apply an FDA approved algorithm which can detect irregularities in the heart rate and correlate what it finds to atrial fibrillation (AFib). It is believed 6 million people may have AFib and the number is expected to double over the decade ahead. AFib is not in itself life threatening, but it can lead to stroke or heart failure.  You can set preferences for the Heart app to alert you if one of three things happen. First is your heart rate is above a number you select, such as 120. Second is your heart rate is below a rate you set, such as 50. Third, is an alert if the Watch algorithm detects an irregularity in your heart rate. 

Picture from Apple

The new Series 4 Watch takes things further and enables a 30-second ECG by simply placing your finger on the watch crown. Apple has added new sensors behind the crown to pick up additional information. As a result it can display your heart rate pattern, save it as a PDF, and enable you to send it to a doctor. The new ECG app is not equivalent to the gold-standard 12-lead ECG you would get from a doctor. It is equivalent to Lead 1, and the FDA has approved it as capable to reliably detect AFib.

In my opinion, Apple approached this new strategic area for them in exactly the right way. They collaborated with Stanford University and designed a study meeting all the standards of a clinical study including clearance by an Institutional Review Board to ensure there would be no harm to study participants. I can attest this is a rigorous process, as I went through the same thing as part of my research and doctoral dissertation in 2014. The Apple study The study was able to identify with 98% accuracy the patients who had AFib, and with 99% accuracy the patients who had healthy heart rates. This is the beginning of Apple’s understanding, not the end. With millions of Apple Watch users, the potential for learning is unprecedented to say the least. 

Picture from Apple

I view the new features in the Series 4 Watch as important healthcare breakthroughs, but not without controversy. Some doctors are skeptical. An electrophysiologist at a leading university said the new Apple capability puts tech ahead of medicine. I agree, but don’t feel the progress should be slowed down to allow medicine to catch up. The biggest concern of the medical community is the Watch will produce false positives among the millions of people who have not been diagnosed with AFib. The concern is undue anxiety will be created, people will seek unneeded medical care, and in some cases medication will be prescribed which can have negative effects. I agree with this concern also, but how about the people who may have afib, not be aware of it, and have even more serious consequences. Apple has received multiple communications from people who believe the Watch saved their life because of previously unknown rapid heart rate or arrhythmias.

I view the new monitoring capability as release 1.0 of a new generation of mHealth. (See my peer-reviewed journal article about mHealth here.) Our healthcare system is under great pressure. It is short on resources and under attack for being so expensive. Every day, 10,000 people turn 65 and join Medicare at a cost of $10,000 per year. Something has to give. Consumer led healthcare monitoring is part of the solution. People who track their health will be healthier. If you are interested in this topic, please read Health Attitude: Unraveling and Solving the Complexities of Healthcare.  

Source: Apple’s Newest Watch Features Will Transform Heart Health | WIRED

Solar Pacemaker

A pacemaker device implanted in the abdomen or chest can control abnormal heart rhythms. Millions of people have a pacemaker and more than one million additional ones are implanted every year. Pacemakers utilize electrical impulses to assist the heart in maintaining a proper rhythm and heart rate. The small but sophisticated pacemaker devices get their power from a battery which, like all batteries, eventually loses its charge. The depletion phase of the battery life usually begins at about seven years. Although the battery replacement is not complicated and can be done in an outpatient setting, there is the risk of complications. For some, it can be a stressful experience.

Power Electronics magazine reported there have been a number of battery alternatives considered over the years.

Various power sources have been used for pacemakers—among them a radioactive material power source using plutonium-238. Another approach involved inductive transfer in a manner similar to charging a smartphone battery. Several other techniques have utilized the movement of the heart to harvest energy for powering the pacemaker. These approaches all had problems that limited their commercial use. In addition, some of these solutions are affected by cell phone signals or an MRI procedure.

A group of Swiss researchers believes they may have a better idea: power the pacemaker with solar cells implanted under the skin. The researchers found a solar cell less than 1.5 square inches is adequate to generate enough electricity to power a typical pacemaker. The lead research author, Lukas Bereuter of Bern University Hospital and the University of Bern in Switzerland, said that wearing power-generating solar cells under the skin will one day save patients the discomfort of having to undergo a surgical procedure to change the batteries of life-saving devices. More research is needed but the initial research is very promising.

Source: Subcutaneous Solar Cells Could Power Pacemakers

This was a big week for NASA. The InSight spacecraft traveled 300 million miles to the red planet, slowed down from 13,000 mph to 5 mph and then gently landed on the dusty surface of Mars. Less celebrated but also technologically amazing  was the MarCO project. Two CubeSats, made up of 4 inch square cubes containing communications and other technology. When the Insight craft landed, a briefcase sized craft made from four CubeSats took a picture and then one of the CubeSats relayed the digital picture to Earth in real time. Quite amazing.

The $800 million dollar project has been in planning for eight years, and in the mind of some NASA researchers for several decades. The expected valuable results will take months to arrive. A seismometer will be placed on the surface by a seven-foot robot arm on the InSight spacecraft. It will measure seismic disturbances below the surface. Another instrument placed by the robot will drill 16 feet into the surface. Not only will the scientific discoveries made benefit the understanding of Mars, where some of our grandchildren may live in the future, they will also help scientists better understand the mysteries of the evolution of Earth and other planets.

I can’t resist a simple comparison. We can launch a spacecraft from California, adjust the course over a 300 million mile seven month journey, and land on Mars after flawlessly executing millions of precise instructions. Here on Earth anti-Internet voting activists don’t believe we can conduct secure, private, and verifiable elections with the Internet. The problem is not technical. It is lack of technological and political will.

In March 2015, Health Attitude: Unraveling and Solving the Complexities of Healthcare was published. One of the recommendations made in the book, to address the spiraling healthcare cost for Americans, was to allow Medicare to negotiate the price of drugs. It was a lone voice at the time, but since then more and more people, including the President, have echoed the point. It is so obvious to anyone who looks into the double digit rises in the cost of medications. A friend of mine was at a cocktail party attended by a pharmaceutical company CEO. My friend asked the CEO why he kept raising drug prices. The answer was, “Because we can.” We need someone to stand up to big pharma. The new head of HHS is the one.

To put our healthcare cost in perspective, consider two astounding points:

  • The InSight Spacecraft mission to Mars cost roughly $800 million. Many have said Wow that is a lot!  In America, we spend $10 billion PER DAY on healthcare.
  • Every day, 10,000 Americans turn 65 and join Medicare. Each of them will cost taxpayers roughly $10,000 per year. In other words, each day, we add $100 million dollars to the healthcare bill for Medicare. 

Needless to say, the cost of healthcare is out of control. By 2026, the current estimate is the healthcare bill will be $5.5 Trillion per year and continuing to grow. Something has to give. There is a long list of reasons for the extraordinary cost of American healthcare. One of the culprits is the double digit rise in the cost of prescription drugs. 

Health and Human Services (HHS) head Alex Azar is saying all the right things. In a March post, “Big Changes Coming to Healthcare“, I quoted from Mr. Azar’s first major speech after taking on the HHS role. He said, “Change is possible, change is necessary, and change is coming.” An October post, “Drug Pricing Transparency“, was about Mr. Azar’s view of TV prescription drug advertising where he said the list price of the drugs big pharma is pushing should be shown clearly in the ad. The industry has pleaded that would be a violation of their first amendment rights. Huh? My view, shown in a number of articles and media interviews has been we don’t need TV advertising at all. We are the only country (except New Zealand) which allows it. Forcing the industry to show the price of the drugs is a good compromise.

The biggie is letting Medicare negotiate the price of drugs. Azar knows the industry and has gained bipartisan support for big changes. On Tuesday, HHS announced a major revamp of how Medicare drug pricing will change. The CNBC interview above makes it clear what Mr. Azar thinks and how he is approaching the problem. I found it refreshing. Take a look above or here.

Wearable Patch
IMAGE CREDIT: CHONGHE WANG/NATURE BIOMEDICAL ENGINEERING AND UCSD

The trend is clear. More and more medical tests and procedures will be less invasive than in the past. Smart devices of various types will be able to look into our bodies and measure what is going on. One of the areas where great progress is being made is the measurement of our central blood pressure. The blood pressure we are most familiar with is our peripheral blood pressure, measured with an inflatable cuff strapped around the upper arm. Central blood pressure is the pressure in the central blood vessels, which send blood directly from the heart to the major organs throughout our bodies. Experts say central blood pressure is more accurate than peripheral blood pressure and, in particular, is better at predicting heart disease. The question is how is central blood pressure measured?

The state-of-the-art clinical method requires inserting a catheter into a blood vessel in a patient’s arm, groin or neck and guiding it to the heart. There is a non-invasive alternative using a device called a tonometer, but it is not accurate or consistent. The breakthrough, developed by nanoengineering researchers at the University of California San Diego Jacobs School of Engineering, is a wearable ultrasound patch which can non-invasively monitor blood pressure in arteries as much as 1.6 inches deep beneath the skin. Electronic Component News (ECN) Magazine, around since 1956, reports on electronic design, emerging technologies, and new products. See Wearable Ultrasound Patch Monitors Blood Pressure Inside Body for the full story on the new wearable.

The patch is not ready for clinics just yet, but the research is very promising. ECN quoted Dr. Brady Huang, a co-author on the paper and a radiologist at UC San Diego Health, as saying, “This has the potential to be a great addition to cardiovascular medicine. In the operating room, especially in complex cardiopulmonary procedures, accurate real-time assessment of central blood pressure is needed–this is where this device has the potential to supplant traditional methods.”

The patch has some shortcomings, which the next wave of research will address. Needed improvements include integrating a power source, data processing capability, and wireless communication into the patch. As the wearable patch technology evolves, the potential will extend beyond measuring central blood pressure. Dr. Sheng Xu, a professor of nanoengineering at the Jacobs School of Engineering, said, “Wearable devices have so far been limited to sensing signals either on the surface of the skin or right beneath it. But this is like seeing just the tip of the iceberg. By integrating ultrasound technology into wearables, we can start to capture a whole lot of other signals, biological events and activities going on way below the surface in a non-invasive manner.”

Technology

There is a lot going on in the world of technology. I look forward to sharing new stories on things I learn about in the fields of artificial intelligence, robotics, scientific discovery, medical research, healthcare, and much more. However, it is still November, and I cannot resist making some further commentary about the American election system. I’ll then take a breather on that topic for awhile.

Our election system is badly broken. I am a registered voter in Florida and embarrassed how, once again, the state has become a global laughing stock for not being able to count votes. It is actually worse than that. Thousands did not vote for a senator because the ballot design was so confusing, putting the senator selection in lower left of ballot below the ballot instructions. Regardless of the outcomes, the final count will not be totally representative of the voice of the people. The military overseas has learned over the years to not bother voting because they have no confidence their ballots would get to the polls on time and if they do may not be counted. To add insult to injury, the law is requiring some elections to ignore the machine counts and do it over again — by hand. 

The news media loves to make “the call” on winners and losers as early as possible, sometimes hours before the polls have closed. Wouldn’t it be better if we could just wait until the polls closed in all time zones and then, a few minutes later, make all the results available. Is this possible? If we can put a robot on Mars, we can surely count votes nearly instantly, securely, verifiably, and accurately. Need a recount, although it would be unlikely, no problem, it could be done in a few minutes also. All of this, of course, would presume we have a modern, highly secure Internet-based voting system. As Vint Cerf, often referred to as the “Father of the Internet” said on the back cover of Election Attitude – How Internet Voting Leads to a Stronger Democracy, “We can do this.” I would add all we need is the political and technological will.

There is one bright spot on the election scene. West Virginia made the bold move to enable overseas military and ex-pat citizens to vote using mobile devices with finger or face recognition, blockchain technology, and the Internet. The initial trial was in the May primary election for a handful of overseas voters. The proof of concept came out with thumbs up. In the November general election, an expanded trial enabled 144 overseas voters to cast their vote over the Internet from wherever they might be. Secure, private, and verifiable votes came in from 29 countries. Two voters had a problem with the app. This is nothing compared to the thousands who could not get to the polls, did not understand the paper ballot, or signed an early or absentee ballot envelope with a signature which did not exactly match the DMV database. Some people do not like to craft a perfect signature on the outside of a ballot envelope for fear someone could copy it and sign credit card charges or other identity theft acts. This is not voter fraud. It is grappling with a 150-year-old system.


My friend, Bob Fornshell, shared a great video called the Pale Blue Dot with me this week. Watch it below. The short video is narrated by the late Carl Sagan, American astronomer, cosmologist, astrophysicist, astrobiologist, author, and science popularizer. The video starts in outer space at a distance of nearly four billion miles away on Feb. 14,1990. At the time, Voyager 1, had just completed its primary mission and was leaving the Solar System. At the request of Carl Sagan, NASA commanded the spacecraft to turn its camera around and take one last look at Earth across the great expanse of space. The narration you will hear was written by Sagan 27 years ago. Bob’s friend said, “The words are still, and even more, relevant today. If only all on this earth could hear them.” I hope you enjoy the video. YouTube put an advertisement on the front end. You can skip it after a few seconds.

Mobile Internet Voting

There have already been multiple reports of voters being turned away at polling places due to lack of polling place preparation and other logistical failures. For example, the ABC affiliate in Detroit reported people who arrived at the polling place at Martin Luther King Jr. High School this morning were unable to vote because the voting machines were missing. “Due to miscommunication, the machines had been locked in a closet on the opposite end of the campus that election workers were unable to access.” Lines formed because of broken machines in Atlanta, North Carolina said humidity was preventing its machines from working. The Houston Chronicle reported that multiple polling places across the city are “experiencing technical difficulties with machines, leading to long lines.” One polling place had a line of around 70 people as of 8:00 AM. Florida often makes the headlines but temperatures in some states are near freezing and unbearable for some senior and ill voters. In past elections, leaders have shown up on time but the ballots came hours later because a truck got lost. In some cases fights broke out in the voter line, scaring many away. This is just a small sample of many failures of our 150-year-old system. The list of problems at the polling places is very long as I detailed in my research for Election Attitude – How Internet Voting Leads to a Stronger Democracy.

Mobile Internet voting with blockchain technology can solve this problem. The inhibitor is election officials and politicians who are afraid of the Internet. Their fear is fueled by anti-Internet voting activists. The root of the problem can be understood by considering the following three scenarios:

A. A perfect Internet system. All Windows 95 and other older systems have been eliminated. There are no hackers, no viruses, and no malfunctions. 100% of the population has a perfect device with flawless authentication and they are well versed in how to use them.

B. The voting system using blockchain technology, smart phones, and the Internet. The system would support finger or face identification for authentication. All voting data would be encrypted. Choices on the screen would be clear, expanded text sizes would be available, and audio provided for those who are hearing impaired. Links would provide details about a candidate or an issue being voted on. Not everyone would be required to use the Internet voting systems. For those without a computer or who don’t want to use a computer, they will be able to go to a local polling place or public library to use the computer there. For those who do not want to use one of these computers, they will be able to vote with a paper ballot. Voters using a smart phone or computer can vote multiple times with only their last vote counting. Votes remain private and voters will be able to confirm their vote was counted.

C. Today’s system which is full of problems such as the few listed above. Tens of millions of Americans who are eligible to vote, will not vote for a long list of reasons. Some will be sick on election day, be called away on assignment at the last minute by their employer, not be able to get off of work, intimidated by weather or ours-long lines, and many other reasons. In 2016, 100,000,000 people fell into these categories and were therefore disenfranchised.

Now, consider A, B, and C. The anti-Internet voting activists want to compare scenario B to scenario A, which we will never have. They refuse to compare it to scenario C which disenfranchises huge numbers of voters.


With my right arm in a sling, this blog post was dictated using an iPhone XS Max. I apologize for any typos it made on my behalf.

The Internet

There has been plenty of bad news about the Internet lately. Big tech spying on us, fake news, etc. I am optimistic these issues will get resolved, although it will take time. Meanwhile, there are a lot of good things happening in the world of the Internet and big tech. On election day we had a lot of disasters from the ancient voting machines, broken procedures, long lines, and a 150-year-old approach to counting the votes. 

Meanwhile the northern European country of Estonia has been using Internet voting for more than ten years. They have shown how an Internet attitude can make voting fast, convenient, private, secure, and verifiable. While the U.S. has pioneered Internet search and social media, Estonia has focused on creating a digital economy with strong digital governance, including voting and most any interaction needed with the government. While we continue to argue about Internet voting, Estonia has been doing it for years without issues. Instead of waiting for hours in a line, Estonian citizens can vote from home or while traveling anywhere in the world. While we wait for weeks to get final voting tabulation, Estonia gets the results almost immediately after the polls close. (Yes, they still have polls and people can vote with a paper ballot if they choose).

Just imagine what the American government of the future might look like if the engineers that brought us the modern web spent a little less time creating web-connected organic juicers and a bit more time redesigning our obsolete paper-obsessed bureaucracy. Estonia offers us a vision of this incredible future.


There is much more coming about how the Internet can streamline our antiquated healthcare system. Amazon, along with JP Morgan and Berkshire Hathaway, has launched a new healthcare company headed by CEO Atul Gawande, one of the top thought leaders in healthcare. Yesterday, Google has stepped into the ring (again) with the hiring of David Feinberg, head of renowned Geisinger Health in Pennsylvania. Feinberg co-authored ProvenCare: How to Deliver Value-Based Healthcare the Geisinger Way, which I also highly recommend. Details are not out yet but, like the Amazon group, Google has a lot of employees, currently about 85,000. The cost and productivity hit from our inefficient and not always effective healthcare system gets the attention of management, financially and morally. If big tech can give us answers and products coordinated among millions of servers on the Internet, can they make a dent in healthcare? I have no doubt. Stay tuned. 

Right Shoulder Prosthesis

Here is the proof of my new shoulder. The new titanium ball is nicely fitted into my humerus, the long bone in the upper arm between the elbow joint and the shoulder. It took a highly skilled surgeon with hammer, saw, and drill to get it there, which explains the pain and long recovery time to get back to normal. You can’t see the socket of the prosthetic ball and socket pair. The socket is plastic and does not show up in the x-ray. The short white line to the right is the screw in the center of socket fastening it to the glenoid. One thing I am sure about: the new ball and socket will be there for the duration. If you want to see the toolkit and parts used to create the new shoulder joint, look here.

Shoulder Joint

All of us are familiar with arthritis, but we may not realize there are more than 100 different types of arthritis and related conditions. Arthritis is the leading cause of disability in America, and more than 50 million adults and 300,000 children have it. The most common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms can come and go, and they can be mild, moderate or severe. That was the case with my knee, but I finally reached the point where the pain and lack of mobility led me to have it replaced. There are a number of stories about my 2008 knee replacement experience here on the site. One that has the details is here.

Now, ten years later, my shoulders have reached that same stage. After evaluating a number of alternative treatments, I decided to get my right shoulder replaced on October 25 and the left one in April. Rotator cuff repairs and other shoulder surgeries are common, but a total replacement of the shoulder joint is much more complex. A top hip and knee surgeon might do 400 replacements per year. A top shoulder replacement surgeon might do 75 per year. There are not as many cases requiring a total shoulder replacement. I elected to have my replacement done at Danbury Hospital in Connecticut by Dr. Ross Henshaw. Dr. Henshaw went to medical school at Columbia University College of Physicians & Surgeons, his residency and internship at New York Presbyterian Hospital, and a Fellowship in Sports Medicine at New York’s Hospital for Special Surgery. I have known Dr. Henshaw for many years and entered the OR with complete confidence that when the propofol wore off I would wake up in the recovery room with a new and perfectly installed shoulder joint.

For my new shoulder, Dr. Henshaw selected the Tonier Aequalis Ascend Flex shoulder joint made by Wright Medical Group N.V., a Netherlands based global medical device company. I suppose many people would not want to know the details but, as I move along toward becoming a bionic person, I want to know what is going into my body. The video here shows an excellent animation of all the titanium components which become part of the new shoulder. When you see the precision engineered components, and considering that the tool boxes and all contents must be sterile, you can see why a joint replacement is so expensive. If you have the stomach for it, you can watch an actual shoulder replacement surgery performed at Stanford University here.

The surgery is incredibly impressive, but an equal part of the total solution is physical therapy. I have known Valory Ramsdell, PT, for 15 years. She is a graduate of the University of Connecticut School Of Medicine, and has more than 40 years of experience in physical therapy. Valory is a hands-on therapist. This is really important, especially at the beginning of the therapy program. A final part of the total solution is me, the patient. I have been preparing mentally for months and am dedicated to following the physical therapy program fully. It is no fun and much of it is painful, but I know it is critical to the most effective recovery.

Today is Day 1 of Week 2. Life in an awkward sling and bolster will be no picnic during the weeks ahead. Performing matutinal duties without my dominant right hand is challenging. The pain can be debilitating, but I don’t want to take too much pain medication and be a vegetable in my office chair. We all know interactions with the Mac, iPhone, and iPad can be done via voice. Ultimately, we probably will have no keyboards, but at this stage, I am finding voice recognition to have some shortcomings. It is getting better, but until AI takes a larger role, we will still have to do a lot of editing of what we dictate. 

 

Eye Scan

An AI becomes intelligent after it has learned a lot. For example, let’s consider the weather. If a meteorologist considers a number of factors including the size and shape of clouds, temperature, dew point, wind direction and speed, and barometric pressure, he or she can forecast the weather for the next hour will be X. With a different set of conditions, the forecasted weather would be Y. If you applied machine learning software to thousands of conditions and resulting forecasts, an AI could be trained to forecast the weather. As more and more data with sets of conditions and actual weather are accumulated and submitted to machine learning, the accuracy of the forecasts would get better. With enough data and machine learning, the weather AI may produce better forecasts than meteorologists.

Similarly, machine learning can be applied to medical data and enable an AI to learn how to diagnose a medical condition. AI systems are learning to diagnose disease across a wide range of medical conditions, and gradually they are becoming as accurate as human doctors. A good example of AI diagnosing is occurring in London. A collaboration is underway there between researchers from Google’s DeepMind subsidiary, University College London, and Moorfields Private, the private patient division of Moorfields Eye Hospital NHS Foundation Trust.[i] The researchers are using deep learning to create an AI which can identify more than 50 common eye diseases based on thousands of 3D scans. With a single scan of a patient’s eye, the AI can recommend a specific treatment. While the research is still in the early stage, not ready for clinical use, the results to date are very promising. The Verge quoted Dr. Pearse Keane, a consultant ophthalmologist at Moorfields who was involved in the research, saying,

The number of eye scans we’re performing is growing at a pace much faster than human experts are able to interpret them. There is a risk that this may cause delays in the diagnosis and treatment of sight-threatening diseases. If we can diagnose and treat eye conditions early, it gives us the best chance of saving people’s sight. With further research it could lead to greater consistency and quality of care for patients with eye problems in the future.[i]

The software the researchers developed uses algorithms which can identify common patterns in data from 3D scans of patients’ eyes. The scans are made using a technology called optical coherence tomography (OCT). The researchers submitted data from nearly 15,000 OCT scans from 7,500 patients. In addition to the data from the scans, the researchers fed the software diagnoses made by Moorfields doctors. Based on what the AI software learned from the data, it is able to develop a diagnosis a new scan. The Verge reported the AI’s diagnoses were 94% accurate when compared to the diagnoses made by a panel of eight doctors.[ii]

[i] James Vincent, “Deepmind’s AI Can Detect over 50 Eye Diseases as Accurately as a Doctor,”  The Verge (2018), https://www.theverge.com/2018/8/13/17670156/deepmind-ai-eye-disease-doctor-moorfields
[ii] Ibid.

Healthcare Cost

Last March, I quoted the new Health and Human Services (HHS) Secretary, Alex Azar, as saying, “Change is possible, change is necessary, and change is coming.” I hope so. Change is desperately needed. It remains to be seen if the federal government can make the changes needed and make them fast enough. The biggest barrier is Congress. HHS tried to simplify drug insurance last year, and Congress blocked the simplification because it would have been negative for the health insurance industry, one of the powerful lobbies that fuels Congress with donations. The most important thing Azar said as part of the recent address was, “We’re unafraid of disrupting existing arrangements just because they are [controlled by] powerful special interests.”

Medical science has advanced rapidly, but innovation in healthcare payment and delivery systems has been slow. While Blockbuster put local video shops out of business and then Netflix put Blockbuster out of business, the healthcare system of care delivery and administration changed very little. The cost of Medicare has grown from $400 billion in 2001 to trillions, but quality has not grown at the same rate.

One of the priorities Azar outlined for HHS was making healthcare drug pricing more transparent, and this week he took steps to make the promise a reality. While USDA regulations require companies to disclose possible side-effects in TV advertisements, the administration has now stipulated pharmaceutical manufacturers must disclose their list prices in the ad copy as well. The pharmaceutical lobby will argue vehemently against such disclosure, even claiming first amendment rights. In other words, they will argue their right to hide prices should supersede consumer rights to understand the pricing. Pharma would like to keep the pricing impossible to understand. Today, patients and purchasers pay very different amounts for the same medications. They use coupons and rebates to lower the advertised price for patients while simultaneously raising what they charge insurers. The insurers then pass those costs back to consumers through higher premiums. While Congress allows U.S. consumers to pay top dollar prices, pharmaceutical companies offer the same drugs to wealthy European countries at much lower prices. Those countries negotiate aggressively. The U.S. Medicare system is forbidden by Congress from negotiating.

Azar has a list of other actions he plans to take to lower drug prices. The president has said drug prices will drop “Really, Really Substantially”.  People go bankrupt or even die because they can’t afford the price of needed drugs. To date, no politician has been willing to stand up to the pharmaceutical lobby. I hope the Secretary and the President have the courage to continue the fight.

Read much more about healthcare and the pharmaceutical industry in Health Attitude: Unraveling and Solving the Complexities of Healthcare.

Reflecting on the future of healthcare during my two weeks out of the country, I conclude two things. Electronic health records, the ability to get speedy access to your health information, the ancient processes for getting medications, the frustrations of getting and paying for medications, and the backward methods of communications are all a train wreck. I continue to believe Amazon, Apple, and others are going to shake up this side of healthcare soon. The other thing I conclude is medical research and development of new surgical and pharmacological treatments are moving forward at a breakneck pace. In ten years, healthcare will be quite different than today.

On a lighter note, a company called Chiiz has developed a sonic-powered automatic toothbrush it claims to clean all your teeth in just 30 seconds. The mouthpiece-styled automatic toothbrush may make the twice daily teeth-cleaning routine a quick and effortless job. The device is basically a mouthguard fitted with an assortment of bristles designed to come into contact with every part of all 28 of your teeth. A small motor using sonic technology is inserted in the middle of the device. The motor generates sonic vibrations which Chiiz claims are equivalent to 25,000 strokes per minute. Before use, you add some toothpaste mousse which cleans plaque stuck between teeth. Simply rinse the device after the 30-second cleaning.

The startup company is raising money through Kickstarter.com and hopes to be ready to ship product before end of the year. You can read the full story and scroll down to a video of the Chiiz device in action by clicking here.

I look forward to getting home and writing about healthcare, technology, Internet voting, robots and artificial intelligence. For now, we are off the coast of Santorini in the Greek Islands. I have heard about the islands over the years, but never had much interest in them. Being here now, I can see why so many like to go there. The topography and beauty are amazing. The bay where we are floating was formerly the center of a huge volcano. The water is a beautiful deep blue, and the depth of the bay is 1,300 feet. Being so deep, the ship is unable to anchor and, as a result, it must continuously engage the forward and reverse propulsion of the engines supplemented by the port and starboard side thrusters. Otherwise, we would smash into the shore or one of the other ships in the bay. The view is amazing, and I wanted to share a picture, but the bandwidth is so slow, I have been unable to upload the picture. When I get back, I will share some albums from the trip. We started with a couple of days in Venice and then cruised to Rovinj and Dubrovnik in Croatia. Then, on to Greece: Corfu, Katakolon (Olympia), Nafplion, and Santorini. Tomorrow we will be in Rhodes and then end up in Athens. Be back soon.

Nano Robot

I have no scientific basis to substantiate this, but it seems that advances in healthcare during the next 10 years will surpass what has occurred during the past 100 years. Consumer devices such as the Fitbit are the tip of the iceberg that will lead to massive amounts of epidemiologic data being collected by consumers that will benefit them individually and the population at large. One of the many areas of technological advancement is occurring with nanotechnology.

I remember attending a conference 15 or so years ago where a presenter said the day would come when we would be able to drink a “nanobot cocktail”. The nano robots would then traverse our bodies and make “corrections or replacements” to cells they found to be defective. To most, it seemed unbelievable. Fast-forward to 2013 when engineers at the University of California, San Diego had invented a “nanosponge” capable of safely removing dangerous toxins from the bloodstream – including toxins produced by MRSA, E coli, and even poisonous snakes and bees. The nanosponges have already been studied in mice and have been found able to neutralize poor-forming toxins that destroy cells by poking holes in their cell membranes. The nanosponges look like red blood cells, and therefore serve as red blood cell decoys which can collect the toxins. The nanosponges absorb damaging toxins and divert them away from their cellular targets. After a half-life of 40 hours in the researchers’ experiments in mice, the liver safely metabolized both the nanosponges and the sequestered toxins. The liver incurred no discernible damage. This is not science fiction. In fact the researchers have a goal to translate their work into approved therapies. This would be a welcomed breakthrough in the treatment of MRSA, a dangerous and antibiotic-resistant bacteria which has become prevalent in hospitals.

Before continuing, lets reflect for a moment on the word nano. Simply put, nano means “one billionth”. Nano is normally used in connection with with the metric system. For example, the nano prefix denotes a factor of 0.000000001 meters. A typical nano robot ranges in size from 1,000 to 10,000 nano meters. To put this in perspective, a human hair is approximately 80,000- 100,000 nanometers wide.

The latest nano invention goes a step further. A team of researchers at Ecole Polytechnique Federale de Lausanne in the French-speaking part of Switzerland are proposing a nano cocktail. Patients may soon be able to track their illness simply by drinking a solution containing millions of tiny electronic sensors disguised as bacteria. After the microscopic sensors have been ingested and enter the blood stream, they would locate and attach themselves to diseased tissue in the patient’s body and send out a continuous stream of diagnostic data via telemetry. A potential use is to track cancer cell metabolism which could be valuable information for oncologists. The researchers do not believe there would be any side effects. The nano bots would be removed from the body either when a tumor is removed or, if therethere is no diseased tissue, through the patient’s method of passing things out of their bodies. 

Source: Tracking Cancer Cells With ‘Drinkable’ Electronic Sensors

Masterminds

I was fortunate on Friday to attend Masterminds at the Ohio Union in the center of The Ohio State University campus. I was the guest of Cindy Hilsheimer, founder and managing principal of BeecherHill, a retained executive search firm in Columbus. Cindy and I are board colleagues at at OCLC, Inc. in nearby Dublin, Ohio. Masterminds is a series of short, engaging talks made by brilliant faculty who hold endowed positions at Ohio State. The event is related to the philanthropic development program of the university. Four speakers presented cutting-edge research, discoveries, and innovative ideas.

Casey W. Hoy, PhD is a professor in the College of Food, Agricultural, and Environmental Sciences. He is the W.K. Kellogg Foundation Endowed Chair in Agricultural Ecosystems Management, and Faculty Director of the Initiative for Food and AgriCultural Transformation. He pointed out the world can produce enough food to provide a healthy diet to the entire world’s population, but one out of nine are seriously underfed. His talk, “A Systems Approach to Food Security” described a large collaboration across multiple disciplines at the university to develop models to produce food nearer the source of the need. 

Timothy M. Pawlik, MD, PhD, MPH is a professor in the College of Medicine, Urban Meyer III and Shelley Meyer Chair for Cancer Research, and Chair of the Department of Surgery in the College of Medicine. His talk was about treating the sick as people, not as patients. He described the gap between what a provider things is realistic relative to curing a person and the perception and expectation of the person. “Reframing Hope for Patient Centered Outcomes” was an enlightening vision of a very complex and difficult topic.

Caroline S. Wagner, PhD is a professor in the John Glenn College of Public AffairsAmbassador Milton A. and Roslyn Z. Wolf Chair in International Affairs. The focus of “The Global Network of Science” was how basic science research often begins by a researcher who immigrated from another country, and then the researcher reached back into their country of origin to collaborate. The result is a massive global network of communications. The alarming statistic she showed is the rate at which China is gaining a strong foothold on research with nearly 30% of scientific papers being published there. They are about to surpass the amount of research published by the United States.

Jianjie Ma, PhD is a professor and researcher in the College of Medicine and is the Karl P. Klassen Chair of Thoracic Surgery. His talk was “Regenerative Medicine”, a topic I have written a number of stories about the topic here. Dr. Ma talked about MG53, also known as tripartite motif or TRIM. The newly discovered protein can be injected into a cell and it then grows. After cell growth, the result is sliced and diced into a powder and then a salve, which has shown it can repair heart, skeletal muscle, and, other tissues. He showed some incredible before and after pictures after MG53 was applied. He referred to MG53 as pixie dust with amazing healing power. More research is underway but the potential looks very promising.

The tag line for Masterminds is Short talks, Big ideas. That was certainly the case for all four talks. I feel lucky to have been able to learn a lot on Friday. I was hoping to report on first reactions with the iPhone Xs Max and the Series 4 Watch. Unfortunately, the iPhone arrived at home in Connecticut while I am in Ohio. The Watch was erroneously shipped to my Florida address. Stay tuned.

 

  
  
  
  
 

Tesla 100D

Hard to believe, but the lease on my Tesla Model S 90D ended today. The 30,000 mile lease finished with 25,774 miles. I chose the lease option because of likely updates to the technology, which turned out to be true. The new lease started today and will also go for three years for the same reason. A Model S redesign is anticipated in about three years. In addition to the switch from Metallic Blue to Midnight Silver, there is a large number of changes. I will describe what I consider some of the more important ones. A few pictures of the S are here.

The biggest changes are the “eyes and ears” and the onboard computer processing power. The upgraded model has forward radar, eight cameras, and twelve ultrasonic sensors. The Tesla Model S was the first car to use ultrasound for long range sensing. Elon Musk, South African-born Canadian-American business magnate, investor, engineer, and inventor, said the Tesla ultrasound system is, “long-range, offers 360-degree coverage, and establishes a protective cocoon around the car. It can see anything: a small child, a dog. And, it can operate at any speed.” 

The surround cameras provide 360 degrees of visibility around the car at up to 750 feet of range. The twelve updated ultrasonic sensors complement this vision, allowing for detection of both hard and soft objects at nearly twice the distance of the prior system. A forward-facing radar with enhanced processing provides additional data about what it is able to see, through heavy rain, fog, dust and even the car ahead.

To make sense of all of this data, a new onboard computer with more than 40 times the computing power of the previous Model S runs the new Tesla-developed artificial intelligence neural net for vision, sonar and radar processing. The combination of all these enhanced features gives the new Model S a view of the world that a driver alone cannot access, seeing in every direction simultaneously, and on wavelengths that go far beyond the human senses.

All Tesla vehicles, including the new Model 3, have the hardware needed for full self-driving capability at a safety level at least double that of a human driver. Although the hardware is now in place, the software validation and regulatory approvals are not. The auto-pilot feature is available and is great for driving on highways. You have to keep your hand on the wheel, but the Tesla does the steering. The updated and enhanced Autopilot adds new capabilities to the driving experience. With the new Tesla Vision cameras, sensors and computing power, the Tesla navigates tighter turns and more complex roads. I can tell the difference already. The Tesla will match speed to traffic conditions, keep within a lane, automatically change lanes without requiring driver input, transition from one freeway to another, exit the freeway when your destination is near, self-park when near a parking spot, and be summoned to and from your garage. Once the regulatory approvals are in place, you will be able to get in the Tesla and tell it where to go. If you don’t say anything, the car will look at your calendar and take you there as the assumed destination. The Tesla will figure out the optimal route, navigating urban streets, complex intersections and freeways. But not yet.

The other big change is moving from 90D to 100D. The D means dual AC induction motors, which provide all-wheel drive. The 100 means the battery cells provide 100,000 watts of microprocessor-controlled power. The rated distance on one charge is 335 miles compared to 290 on the prior Model S 90D. I drove to the Danbury Fair Mall today and backed into one of the ten Superchargers. In 50 minutes it charged up from about 250 miles to 335 miles. See pictures. My old Model S never charged beyond 274 miles. The 335 is enough to get you anywhere you want to go and with more flexibility in where to stop for a charge. The EPA rates the equivalent fuel economy at 102 miles per gallon. The upgrade to the new Model S entitles me to lifetime free charging on the road at Tesla Superchargers. Tesla Says 99% of the U.S. population lives within 150 Miles of a Supercharger.

Another innovative feature of the new Model S is the Smart Air Suspension. When the car has the body in a low position, it looks more sleek and is more aerodynamic. However, if you have a steep driveway or a garage with a drop or encounter a road with a lot of potholes or rough terrain, you want the suspension to raise the car much higher. I have encountered situations like these and it is no fun to feel the bottom of the car scraping the ground. The Model S has four positions for the suspension: low, standard, high, very high. If you encounter one of the bad situations I mentioned, you can stop and select high or very high. The car will remember your exact location where you did that and, in the future it will automatically adjust the suspension when you get near there. Once you then reach higher speed, the suspension will automatically adjust to standard.

The press has continuously criticized Tesla for its Model 3 production numbers. If you have any doubts about how real Tesla production is, just visit one of its 250 service centers. Connecticut, where I live this time of year, has no delivery centers because the politicians are protecting the traditional dealerships who don’t want to see more efficient dealerships owned by the manufacturer. They listen to the lobbyists, not to the consumers. I arrived at Mt. Kisco, NY, about 20 miles away, on Saturday morning at 10 AM. The showroom was packed like an Apple store. The Tesla employees are enthusiastic. There is nothing traditional about the delivery process. A young man removed the license plate from the old Model S, I signed the paperwork (yes, it will eventually all be done through paperless blockchain technology), I was escorted to a Model X, and driven five miles to a huge parking lot full of Teslas, models S, X, and 3. Employees there briefed new owners on how to use the car, and they wiped off any smudges the cars might have. The schedule for Saturday was to deliver five Model S and twenty Model 3 cars. You got the feeling the employees were as happy as the new owners.

My first step was to pair the iPhone to the Model S. The 17-inch touchscreen almost immediately displayed my calendar, contacts, and calling history. When I got home I found an enthusiastic email with a PDF attached containing all the documents I had signed. The next step was to remove the front license plate bracket since Florida does not require a front plate. I then installed the E-Z Pass transponder under the front nose. I am looking forward to the end of the lease and getting an even more amazing model S.

 

AppleAs usual, the Apple Keynote to introduce the new Apple Watch and three new iPhones, was done with great marketing aplomb. Apple has it down pat. Tell them what you are going to tell them, tell them, and then tell them what you told them works every time. The new Watch will enable millions of people to monitor their heart rate and rhythm, which can lead to enhanced conversations with cardiologists. The three new phones with FaceID and the amazing A12 Bionic chip will set a new standard for smartphones and their use of artificial intelligence. The only thing Apple can’t seem to do is switch my timezone so I don’t have to get up at 3 AM EDT to place my orders. I’ll have more to say in a couple of weeks about how the new products work.

Meanwhile, healthcare continues to be behind. I visited a very busy imaging center last week for a routine X-Ray. The waiting room was huge and full of people. No WiFi.  I still encounter restaurants who don’t offer WiFi, and when I talk to owners, they say they don’t want people lingering and tying up a table. This is a really benighted rationale, but at least it is somewhat understandable. The radiology center has people lingering, not by choice, and they get to read outdated paper magazines. 

This week, I visited a new imaging center for an MRI needed for my upcoming Total Shoulder Replacement. The new center was beautiful, the receptionist and technician were very polite and professional. The waiting area had WiFi and a WiFi placard to tell people how to use it. Hooray.The total experience could have been better. The classical music in the headphones was weak and not very good. Worse yet, it was interspersed with loud advertisements. I never expected to be bombarded with ads inside of an MRI machine. I asked how I could get the radiologist’s report on my shoulder, and was offered two choices. They can mail it via USPS regular mail or I can drive back and pick it up. After the MRI, I was presented with a CD. I have a lot of computers around my house, and none of them has a CD drive. CD = Completely Dinosaur. This is one of the many reasons healthcare is so expensive. Information is locked up on paper, CDs, departmental silos, Post-Its, and patient portals which you can’t search, sort, or export. The lingua franca in healthcare is the fax machine.

Last night after the Apple Keynote, I opened the Apple Store app on my iPhone, and pre-ordered the new iPhone Xs Max. After gliding through the configuration choices, I was offered the opportunity to get pre-approval for monthly payments for the Annual Upgrade plan. The confirmation screen showed the details of what I had ordered and the phone number and serial number of the iPhone I will be replacing. Everything in one place. Smooth as silk. I dream of the day healthcare will be that way. It can be done. There are some encouraging signs, but the rate of progress is glacial.

3-D Printer in shop

The LulzBot TAZ 5 3-D printer in my shop (in photo above) prints using a roll of filament which feeds into a heated nozzle. The nozzle moves back and forth and up and down to print objects such as the blue ball bearing race on the printer table. (When it was finished printing, the newly printed ball bearings were able to move inside the race). The “ink” the LulzBot uses to print can be any of numerous 3mm filament materials. PLA and ABS are the two most common materials. Both are thermoplastics, meaning they become soft and moldable when heated, and then become solid when cooled. There are numerous other filaments which can be used for 3-D printing including polycarbonate, nylon, wood-filled PLA, and metal-filled PLA,

In healthcare, there are other kinds of “ink”. For example, one newly developed material can be used by dentists to 3-D print teeth. Independent surgical centers will soon begin printing bone implants, including large pieces of the skull. As described in Health Attitude: Unraveling and Solving the Complexities of Healthcare, researchers are printing organ tissues using pluripotent stem cells.

The missing ingredient in 3-D printing has been steel. Until now. HP has just introduced its Metal Jet printers, which will ultimately be able to print airplane and car parts, healthcare devices, and much more.

3-D printing is great for creating prototypes, but has been slow and expensive to mass produce. The other limitation has been the lack of steel, which is required for many items which need industrial strength. HP aims to change all those limitations with its new large-cabinet $400,000 Metal Jet printer. Watch the short video to see it in action.

Wired quoted Tim Weber, HP’s head of 3-D metals, says 3-D printing will save manufacturing costs for certain product parts and enable companies to create new products faster. Companies will be able to create a prototype and then use the same design for mass production. Weber said, “A lot of parts take months to prototype. We can now do in days what it took months or years to do. It will increase the pace of innovation.”

The HP Metal Jet printers use a process called binder-jet printing. The printer spreads layers of metal powder and then sprays the printed object with a binding agent to solidify it. The initial pieces are then placed in a furnace which solidifies the powder. Wired described the process as being analogous to putting a tin of cookies in the oven. The result will be many new objects which are innovative, solid, smooth, and affordable.

Source: HP’s New 3-D Printers Build Items Not of Plastic but of Steel | WIRED

 
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