Dana Blankenhorn

The Health Internet

Think of this as Volume 11, Number 47 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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In looking at health care reform I am reminded of an old New Yorker cartoon by Stanley Harris (right).

A scientist stands before a blackboard filled with equations, but with a giant gap in the middle. "Then," he has written, "a miracle occurs."

We're very much in that position regarding health care reform. Advocates across the political spectrum insist that by automating the industry we can save tens of billions of dollars. Both John McCain and Barack Obama had this in their platforms.

Yet no one in the industry believes it possible.

Over the last 13 years many, many industries have succumbed under the World Wide Web. Where we once went to travel agents we now go to airlines' Web sites, or (for complex trips) a site like Expedia.com. Where we once went to book stores and record stores we routinely go to Amazon and similar sites. Instead of the library we ask The Google.

Almost as soon as the Web was spun, the rush was on to create special tags to deal with the problems of vertical industries. That's what XML is. It's an agreement between market participants as to what customized HTML-like tags will mean, in the context of their business. So we have special XML subsets for the advertising industry and for many others.

But not for medicine.

When I went to the annual HIMSS show in Orlando last spring I felt transported back in time. It looked like a 20-year old Comdex. Each major vendor - Cerner, McKesson, Microsoft -- had the equivalent of their own operating system. Each product vendor -- and an MRI machine in this case is just a fancy printer -- required multiple sets of drivers to move files into any one of these systems. And since you could not be certain that the equipment you bought would include drivers for the computer system you might want to buy, doctors and hospitals remained in statis. Because paper worked.

To break this bottleneck requires a set of standards as universal as paper, defining all sorts of medical conditions and procedures, across all vendor systems and equipment types, so that the whole can interoperate.

Easy to say. Very, very tough to do.

There are groups that are trying to create such standards. Health Level 7 is the most prominent. They require agreement on what to call procedures, on how to define medical processes, an enormous, ever-changing schema that is flexible enough to accommodate the change we know is coming to medicine as our knowledge advances.

It is an enormous undertaking.

Acceptance of this grand scheme is at the heart of Electronic Medical Record (EMR) systems (there are over 200 of them) sold to professionals and Personal Health Record (PHR) systems like Google Health and Microsoft Healthvault, which patients will control.

On top of the former are layered a host of regulations like the HIPAA law, which aims mainly to protect us from abuse by our "health vendors," and it's partly in implementing laws like this that EMR vendors have created the proprietary tweaks that make it so hard to create PHRs under patient control.

Note here that HIPAA does not really provide security, just bureaucratic control. And security, or the lack of it, is both the biggest fear and the biggest impediment to computerizing. The fear is real.

Now, having described the intractability of this problem, let me offer your Clue.

The problem can be solved.

Where the Next Boom Will Start

Think of this as Volume 11, Number 43 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Every economic recovery is different. What worked before may recover but it's never the same.

That said, note that every new boom starts slowly. Growth is never uniform, not between industries or within an economic cycle. Recovery will be slow. It will take years. But its pace will accelerate and at some point we'll forget again what hard times felt like. That's when we'll be ready for another bust.

Let me start by looking at previous booms I have lived through:

• The 1970s happened in the oil patch. I was in Houston then and it was a lot like Dubai has been the last few years. One bank put up what looked from the air like a huge green dollar sign. That's how things were. After the crash, which was hard, there was finally a recovery, but it was never the same as it had been.
• The 1980s happened on Wall Street. I was a business reporter then and I watched as supposedly brilliant people took apart companies, then put them back together to reveal value. Everything else went up in sympathy. After the crash the Wall Street game changed. You still read about the "heroes" of that era, like Carl Icahn, but it's not the same. Nor will it be.
• The 1990s  happened on the Internet. I was an Internet reporter. I started warning of the crash in 1997, but the boom happened despite me. The bust took down a ton of companies, and I was out of work completely for over two years. But it did come back. Amazon and eBay came back. Other sites came back. Google barely existed at that time. But, again, this decade, online, has been mainly about consolidation and steady change, not revolution.
• The 2000s were all about housing. Whether the boom was real or artificial, the product of lax regulation or an attempt to cover up for the Iraq War's costs, is irrelevant right now. We created enough Confederate Money to paper the world, backed by houses that were only worth a fraction of what we paid for them, and it will take years to unwind that. When housing does "come back" it won't be the same. It can't be. But, in time, it will come back.

Where I Am To Obama's Left

It's the War Against Oil.

Sen. Obama has couched his energy policy solely in terms of energy independence, specifically "independence from MidEast oil."  Since a lot of our oil comes from outside the Middle East (Nigeria, Venezuela and Mexico are all major suppliers) this makes his10 year  goals truly modest.

More important, Obama is not committed in his rhetoric to really fighting hydrocarbons. He and his running mate, Joe Biden, talk at length about "clean coal," which is a sop to Appalachian coal producers, not a working reality. They talk about "clean ethanol," but ethanol is not clean, nor is it really green. Even cellulosic ethanol systems, using non-food crops as feedstocks, are years away from coming onstream. Heck they're blind enough to support natural gas and offshore drilling, which is a sucker's game because it maintains our dependence on foreign suppliers, keeping their game going longer.

Then there is nuclear. Forget about the arguments over its efficacy. It is undisputed fact that a nuclear plant is most dangerous in its early years of service and its later years of service. Nuclear plants take years to permit and build, even in the best circumstances. You can't get much lift from this in the near term, and the danger from these new plants will be at a maximum just as existing plants enter their most dangerous phase of life.

When it comes to The War Against Oil, Sen. Obama is very much a conservative.

The Key To The War Against Oil

The key to winning the War Against Oil will lie in the appointment of a new Energy Secretary.

The Department of Energy has been moribund practically since the day it was born, in part because the President who created it, Jimmy Carter, became so discredited he wasn't even asked to speak at his party's convention this week, despite two Nobel Peace Prizes.

It was designed to implement an industrial policy, but instead it became a political dumping ground, staffed by businessmen under Republicans and party hacks under Democrats.

We can't afford that now.

The Department of Energy must deliver research and policy to guide public and private investment toward a hydrogen economy. Since people really began recognizing the priority we have seen scam-after-scam-after-scam get funding, get publicity, and get power.

1. Ethanol is a scam. It raises food prices, and costs more in energy to produce than it delivers.
2. Clean coal is a lie. The technology does not exist, yet. It might one day, but until it does new coal investments are counter-productive.
3. T. Boone Pickens is a fraud. He wants government power, and subsidies, to turn West Texas into his own fiefdom, stealing and selling its water, running roughshod over property rights with special eminent domain laws.
4. Wind efforts are being wasted. Power lines lose half the power getting it to market. There is, as yet, no infrastructure to turn that power into hydrogen and get it to market.

That's not all. Nuclear power is making a comeback, even though we still don't know what to do with the waste, or even how to protect it against dirty bomb makers. Drill here, drill now advocates threaten to seize the capital we need to make the future and re-enslave us to the past.

I have a very simple plan for the next Energy Secretary:

Google Steps Wisely in The War Against Oil

Google has announced its first announcements in its RE<C (renewables costing less than coal) initiative and they look pretty cagey.

Google is looking at long-term technologies in niches others don't consider obvious. It's also not splashing the cash around. There's just $10 million in this announcement for:

• Altarock Energy, which is getting $6.25 million, and
• Potter Drilling, which is getting $4 million.

There's also a research grant of just under $500,000 to SMU's Geothermal Lab.

All these investments have a theme, specifically Enhanced Geothermal Systems  (EGS). Current geothermal plants drill a hole in the Earth to find a source of heat, then pump in water to create steam, and generate electricity from the heat.

This is fine in parts of the West, where there are ample quantities of hot rocks relatively near the surface. Assuming there's water nearby. It doesn't work in the East, where rock formations are more stable, meaning you have to drill further to reach the heat source.

The idea of EGS is to solve these problems, pulling heat economically either from deep inside the Earth or from areas where there is no ready supply of water to produce steam.

Altarock, which is based in Seattle and was called "secretive" in a 2007 news story, when it was seeking $4 million, plans to pump water into hot rock formations, then pump the water back up separately. As it rises and its pressure decreases the hot water produces steam for turbines.

Altarock's "big name" is Susan Petty (above), a geothermal consultant with three decades' experience at Black Mountain Technologies. It's as important to get good people in these start-ups as it is good ideas, and Susan is said to be one of the best.

What Does MIT Have?

I drew nastygrams for noting that ITM Power of England only has a membrane, not a solution to the problems of solar power.

I'm all for solar, and I'm all for hydrogen, but we need to hold ourselves in check, I wrote then. Extraordinary claims demand extraordinary proof.

Now MIT has its own claims, namely a catalyst for splitting hydrogen from oxygen in water, described as an "indium tin oxide electrode in phosphate-buffered water" containing carbon dioxide.

Major discovery? Yes. Certainly worth the $20 million the team has won to move on to the next phase of its work.

But a solution? A revolution?

No.

Al Gore and The War Against Oil

I disagree with some of what Al Gore said today, but I welcome it nonetheless.

Let me start with my points of disagreement:

• The Apollo Program is not the model. The Manhattan Project is the model. Apollo implies a win-win-win we can watch on TV. In World War II we gladly taxed ourselves and lent the rest to the government knowing our lives were at stake -- as they were.
• A carbon tax, used to cut payroll taxes, won't pass. Businesses won't wear it. A price floor, which can be adjusted downward for alternative fuels as they come on-stream (and their costs decline), is a better way of getting where we need to go. What solar, wind, and geothermal companies need most is the assurance of a market for long-term investment.
• Government intervention must be minimized, not expanded. Set the rules and let the best technology win. We can't afford to let goobers like Boone Pickens hijack this thing and use it as an excuse for subsidies.

My main problem with Gore for a long time has been his making global warming into a partisan divide, and despite his talk about national security this speech maintains that trend. Getting an introduction from Bernie Sanders is nice, but it's partisan.

It's counter-productive.  The War Against Oil must be non-partisan in fact, not just rhetorically.

Defining the Crisis of 2008

Think of this as Volume 11, Number 27 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Waste.

At the heart of our current crisis is one word, waste.

We have been wasting the energy of the world, and wasting our own energy. We have wasted too much time on nothing but our own comfort. We have piled mountains of waste around our big cities, dumped mountains more into our seas and rivers, and given no thought to getting more from it. We have wasted our power in the world, and even our ideals have been wasted away, tossed aside as mere words when deeds are all that matter.

These are hard words to hear. They are not natural applause lines. So we're not given them. Instead we're given a vague mantra of change and hope which becomes easy to ridicule if it's repeated often enough. Which allows the media to define this race as no different from a half-dozen others over the last few decades, all about personality, tactics and money.

That distraction will kill our nation, if we let it, as we have let it for a generation now.

Because we have not been given the truth the 2008 campaign has devolved into ennui. Our nation is like a man drowning in quicksand who has accepted his own doom and is thus reluctant to grab the rope which might save him. He's filled with excuses, that the rope won't hold, that he might pull in others. He remembers the advice that if you don't fight you'll float, yet his heart is racing.

Thus we as a nation face the risk, and the opportunity, which all great crises engender.

We are where our forefathers were, 76 years ago, fearing fear itself.

We are where their forefathers were, 72 years before that, unaware of the better angels of our nature.

And again, four score and four more back, at the dawn of our nation, facing a King's wrath and our own worst fears.

Will we pledge our lives, our fortunes, and our sacred honor again? And if so, to what?

To dealing with waste, and in so doing erase all limits to what our children can accomplish.

The 1896 Game

Think of this as Volume 11, Number 24 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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Thanks in part to best-sellers like Rick Perlstein's Nixonland, and in part to their own self-referential nature, TeeVee blowhards are  falling all over one another to compare this year with 1968, the year of the last American crisis.

I started playing around with this two years ago as The 1966 Game, and while it's fun it's really very bad historical analysis. It does nothing but look backward. It teaches us nothing about what's coming.

While it's true we're in a crisis period, the nature of today's crisis is quite different from that of 40 years ago. The 1960s were a social crisis, in which the previous era's foreign policy assumptions were validated and became the new political divide.

The current crisis is economic. Those old assumptions have fallen apart. They led us into Iraq. We the People no longer believe them. All this constant harping on 1968 does is justify those assumptions anew, trying to make John McCain the New Nixon, Barack Obama the late Bobby Kennedy.

It's stupid. It's brain dead.

Every generational crisis in American history has been different. Every emerging Thesis has been different. But there is one such crisis to which valid analogies can be made.

1896.

The 1896 Crisis was the only one in which the majority party going in was the majority party coming out (maybe that will get the bloviators interested). But more important it was about economic organization and America's place in the world.

The 1890s created America as a single national market, with national brands, an industrial organization, and an imperialistic sense of itself. At the heart of solving the crisis was the Spanish-American War of 1898, which not only gave us Teddy Roosevelt (the crisis' central figure) but also gave us our first true foreign possessions. We even fought a colonial war, in the Philippines, to keep that empire alive, and created Panama out of Columbia to extend that empire.

The current crisis is in some ways a mirror image of the 1890s.  In others it is its polar opposite. The trends, thanks to technology (which also drove the 1890s) are leading us in a new direction:

• The Internet is the new railroad.
• Knowledge is the new resource.
• Sustainability is the new industry.
• Consensus is the new imperative.

Let's take a look at these trends, one at a time, and see what they portend:

Rice Science Tuesday: It's Alive!

A lot has been written in the last week about the Rice Mech E's success in using nanoparticles to trap oil.

A team under Prof. Pulickel Ajayan hung gold nanowire on carbon nanotubes. These structures, which the team called nanobatons, then spontaneously surrounded oil droplets.

But the reporters ignored a key part of Dr. Ajayan's quote, the goal of his research, to create "self-assembling, functional nanomaterials."

Translation: It's Alive!

Well, not really. These are structures consisting almost entirely of carbon and other metals. There's no hydrogen, no oxygen inside these structures. But the structures can spontaneously self assemble and function, which is how the original amino acids, deep in the sea, spawned the first primitive life forms billions of years ago.

There is no intelligence in these structures. They are not really "alive." Individual amino acids aren't "alive" either. But when amino acids spontaneously self assemble and function to reproduce their own structures, they are taking the first steps down the road of life.

What we're really talking about here, after you get rid of the scary imagery of science fiction, is something Rice scientists have been working on for decades, namely tearing down the walls separating organic and inorganic chemistry. Organic compounds combine into larger structures for reasons, scientific reasons, in response to stimulus from the environment. By creating nano-structures on an atom-by-atom which can mimic self assembly, and then then providing a specific stimulus, you get the result you seek.

Now here's how the wall really gets breached.