Dana Blankenhorn

Can IBM Succeed Where Obama Failed?

There was a lot of chuckling over WellPoint's  announcement that it will be partnering with IBM to use that company's Watson supercomputer for medical diagnoses.

The idea is that Watson will combine patient medical histories, tests, medical literature and (perhaps most important) clinical best practices to decide quickly what doctors should be doing.

It's not the only such deal in the market. Other tech companies have similar initiatives. AT&T calls its program ForHealth. 

The idea in all these cases is the same, to take some measure of decision making out of the hands of doctors, and give insurers a rationale for denying expensive treatments when less costly ones are available. 

Another term for this is comparative effectiveness. You look at what a lot of people have done in similar situations, what happened, then do what works best.

A Few Words About Google Health

Google Health was doomed from the start.

It was based on a legal fallacy and a technical one.

• The legal fallacy was that you own your health data, and can control it. That may be the law, but that's not the fact. The people who collect your data control it, and that control is important to them.
• The technical fallacy was that most people are versed on technical subjects, and either have the patience to input their own data or go through a complex download-transform process to get it.

Both these fallacies have been pushed for years by so-called privacy advocates, mostly shills of insurers, who use Fear, Uncertainty and Doubt (FUD) about technology to keep it out of doctors' offices. Through laws like HIPAA, and their continuing campaigns against reason, these "advocates" make it necessary for you to keep filling out the same damned forms -- over and over again -- whenever you see a new doctor.

AHLTA Connections Given Control of VistA Open Source Project

Fred Trotter writes about a very scary story out of Washington.

The custodian for the new VistA system, the open source software that's supposed to replace what the Veterans Administration is now using, will be a long-time Defense contractor with no ties to open source whatever.

This is important for two reasons:

1. DoD is not as enthusiastic about open source as the VA. 
2. The DoD's health care software system, called AHLTA, sucks. It sucks because it's built on a contractor model, with proprietary software companies holding their own intellectual property close to the chest, refusing to cooperate until they're paid by everyone else around the table.
3. Eventually, AHLTA and VistA are supposed to be merged, under the new open source process.

Obama's Vietnam

Vietnam isn't just Vietnam.

Vietnam is every generation's defining struggle, an effort of political will that defines a new Thesis and leaves the side which loses a spent and fading force.

For my generation that's just what Vietnam was, politically. It was the struggle that defined baby boomer politics. Some 40 years ago at this time the struggle was being lost.

It was the Nixon Thesis that would define how we got out of Vietnam, not the hippies and their cultural allies opposing him.

Just to recap it was 40 years ago this month that the My Lai charges came forward and Prince Sihanouk of Cambodia was overthrown. The following month the Cambodian incursion (invasion) would begin, followed in May by the killings at Kent State. 

There was no way to tell from the culture, or from the political temperature, that Nixon was winning, was going to win, was going to define American policy for a generation. To the right, from Coverbrowser (and available on eBay) is the March, 1970 cover of GQ. 

Fact is, culture and the media often run against politics, especially when a Thesis is new. Lincoln was hated in both the South and North in March, 1862. The Depression seemed to be bowing FDR in March, 1934.

That's where we are on the larger calendar.

The right's Achilles Heel

Science.

Science is not a belief system. It is a process, a method. Just like democracy is a process, and markets are a process. (To the right, vaccine scientist Paul Offit.)

No one believes in what scientists say. Even scientists don't. They accept what scientists say, when it is experimentally valid, because it answers good questions, because it can be engineered into things of use.

Over the last decades the political right in this country has forged a dangerous alliance with idiots who reject science, who call it a "belief" system and thus subject to political process.

It's not. Science has nothing to do with politics. Sure, scientists engage in little political games with one another. Good science is held down by authority figures all the time. Good scientists have their work questioned constantly. But in the end, science goes with what works.

Journalists have gone in for this game, because it's an easy "he said, she said" story. This is an incredibly dangerous stance to take.

A Long Walk

I turned 55 today.

The old double nickel. (Thanks.)

Aging is a bitch but it does beat the alternative, we assume. Even if it doesn't I can wait to find out.

So like a lot of people over many years I'm taking better care of myself. My cholesterol is down, my hypertension is under control, I get regular checkups and exercise. It's not so much about life extension so much as it is enjoying every day I have, seeing that the number is limited.

But there's a problem. It's cold. Real cold. Mitten cold.

How cold is it? So cold my YMCA was closed on Saturday, and opened late on Sunday. So cold I bought nine big old fire logs when my mom came to visit for a week and nearly used all of them. So cold the heater is on nearly all the time, and I live in Atlanta for chrissakes!

Fortunately my son, the teenager who drives me crazy, has a cure.

Walking.

Piece Work

Think of this as Volume 12, Number 46 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Here is the difference between a political campaign and running an American government.

In a campaign you have a platform. That platform includes many different parts. They are an integrated whole.

But once you start governing you have to separate the pieces. Anything requiring Congressional action must be passed separately. Thus Presidents are told to concentrate on doing just one big thing.

A great economic plan, jammed through Congress by a narrow majority, has been the instrument of choice for a generation now. Reagan used it, Clinton used it, Bush used it. This set the table for everything else they did, or tried to do.

This was not possible with President Obama. There were just too many things that have to be done. His stimulus plan, while massive, only turned the nose of the airplane up and kept it from crashing to the ground. It was not what he was about, not what we voted him in for.

The actual Obama program consists of two other pieces of legislation. Call them the labor bill and the jobs bill.

Setting Boundaries

Think of this as Volume 12, Number 37 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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The most important job of a President is to set boundaries for political debate.

No President can succeed unless they are able to do this. The President is our only nationally-elected political official. If he (or she) can't set boundaries they will be run over.

By that standard, George W. Bush began as a very successful President, undone only by events. The fact he set those events in motion -- Iraq, Katrina, the financial casino, the politicization of everything -- damns him before history. But at this first task, he succeeded.

Tonight, Barack Obama has to do this in the generations' old debate over health care. Success depends first on answering the question -- why did his predecessors fail?

Except for Lyndon Johnson, under whom we got Medicare and Medicaid, past Democratic Presidents were unable to turn their successful outside games -- their rhetoric and personal political success -- into a winning inside game in the form of legislation.

So two types of boundaries must be set.

• The outside boundaries define the ideas the media will hold to be legitimate, and those that will be illegitimate.
• The inside boundaries define the Congressional debate, and lead to a bill's passage.

The President's problem is that he has, so far, failed at defining outside boundaries. His opponents appear free to call him any names they wish, and those in Congress never pay a political price for repeating the slander.

Setting those boundaries is his primary task tonight.

A victory too late

My son graduated from high school.

The good news is the hell he went through, and the price he paid, won't be necessary for his children.

That's because theSupreme Court ruled this week, 6-3, that your kid has ADHD and the school refuses to deal with it, you can now send him or her to a private school and send the public system your bill. The case is FOREST GROVE SCHOOL DISTRICT v. T. A.

Torture

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Think of this as Volume 12, Number 19 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Everyone who has been a parent, or a child, knows something of torture.

As my son John prepares to graduate high school this month, my parenting career enters a new phase. I will try out this new role on a trip to China, Taiwan and Japan starting May 23rd. Posting will be sporadic.

It is not easier for someone with ADD to parent children who have it. It's harder. My son's ADD is much like mine, only sometimes it's on steroids, and our long-term efforts to treat it have left different scars on him than my own long-term denial left on me, coming up.

I must admit here that there were times when I hit him. Hard. He could be, can be, infuriating. He has the same buttons I have, and has known how to push them since he was a small child. Parenting him has helped me deal with my own ADD, for which I'm thankful. 

But there have been times when we tortured one another, both mentally and physically.