Atul Gawande has a terrific article in the New Yorker about how the way doctors organize themselves into social groups affects the effectiveness and cost of the medical care. (I first got turned on to Gawande by my daughter Karen, who gave me two of his books to read. He's very thoughtful and very smart about the problems of medical care -- and a terrific writer as well.)
There are tons of interesting thoughts in the article, which is a great read, as well as insightful. Here I'll just piece together the high-level flow of the argument around the structure of doctor's organizations within a locale.
1) The most expensive areas of the country for Medicare are 2-3 times the cost of the least expensive. If these most expensive areas could be changed to cost the same as the average areas, most of the expense problems of Medicare could be solved.
2) The most expensive areas of the country do NOT get better health outcomes than the less expensive areas. They do provide substantially more "services" -- hospitalizations, tests, surgeries, etc. -- but patients don't have live longer, aren't healthier, and aren't happier with the results.
3) By comparing expensive locales with less expensive locales, we can rule out most of the obvious causes of the difference. The expensive locales are very similar in types of patients, the problems those patients have, the training their doctors received, etc.
4) One key difference is that in the LESS expensive locales the doctors have organized themselves to create a medical system that changes substantially the motivations. Doctors are evaluated on long-term patient outcomes, and cannot make themselves richer by performing additional procedures on patients. The doctors work together collaboratively to learn how to better serve patients.
Fascinating article. Check it out! (Yes, it is a stretch for this blog. Perhaps we could argue that the connection is in understanding how big a difference social structure makes in the performance of an organization. In our work we're building computer tools to support those social structures; in this article, the doctors are inventing the structures themselves.)
John
Interesting article about pay-per-tweet technology from izea, the company that already leads in pay-per-blog. Seems like an awkward way to fund a social medium, having people pretend to like stuff because they're getting paid to pretend. Of course, we're used to that from our funding for radio and television and publishing and ... Interesting that books, for instance, work on a completely different model, and that most movie revenue still comes from direct pay. What's different about the media we refuse to directly pay for, and the media we are willing to directly pay for? Is it possible to change one into the other?
If the hidden price model is the only choice, we should seek a set of ethical rules for it. Perhaps the adverts could just be clearly marked as being for-pay.
John
Very fun article about apportioning credit among multiple authors of academic papers. Read the article for the details, but the author's basic argument is that at equilibrium the total value per paper had better be constant with number of authors, or economists will start putting in tons of extra authors on their papers to boost their total credit. (Assuming quality is held constant.)
I see the economic argument. OTOH, it is also true that doing joint work takes more interaction and negotiation (and hence is more difficult) but often seems to me to lead to work that has a bigger impact. Hence, an organization might prefer the joint work even if it is slower per person hour, if they believe the style leads to more impact. (I suppose this is a cheap way of saying I don't think you can really hold quality constant.)
John
It's a sad day for use rights folk, as Amazon caves to the authors' group that had insisted that having a computer "read" their work out loud was a protected use ("copy") that they could prevent. The legal issues here are somewhat murky, since a public performance of a play is preventable (you have to pay the author each time) while just reading the book (what if you move your lips?) is presumably not preventable by the author. However, it's a sad day for creativity when a person who purchases a media item for his or her own use can be prevented with using it by himself or herself in a novel way by the people who created it. This attempt by the authors' group to prevent novel uses -- of the novel! -- is unlikely to create additional value for their members over the long term. (Or the short term: those who have listened to the voice reading books report that that quality is nothing like a real human reader.)
For those who like to think about the far-out implications: it's fun to imagine the day in the future when robots can actually read well enough that a feature like this might be useful. Imagine a software reader that is good enough that some people prefer it to a human reading the same text. Or: a program that reads a book and then stages a visual version of it as a "play" for the person who wants to "read" the book. These cases get closer to "performance", and more interesting as tests for copyright law, I think.
John
Very nice article at Read/Write Web about eBay and its business model. The theme of the article is that eBay as an auction site is going to continue to face tough competition, which it may or may not overcome ... but that some of the other businesses of eBay are doing extremely well, and seem positioned for the end-game. The author particularly calls out PayPal, which has been solving the problem of doing safe banking on the Internet one country at a time, and Skype, which has been growing 30-40% per year, as great businesses that are undervalued as part of eBay.
The PayPal argument is compelling to me: it's a great business, and being part of eBay creates complicated relationship issues for eBay competitors who otherwise would be great supporters of PayPay.
Skype I'm less convinced about. While I love Skype, and use it regularly, its present business model has two serious problems. First, Skype is bizarre in that it is one of the few communications business to have an inverse Metcalfe's law effect: the more people who use Skype, the less money the company will eventually earn -- because Skype calls are free if both ends use Skype. Of course, this is only a problem at the end-game, which is likely many years away, but it may be a fundamental problem eventually.
Second, Skype is in a business with relatively low barriers to entry. They have the lead in the audio and video encoding right now, and have by far the best interface ... but the telcos should be well-positioned to compete for the business if they decide to tackle VOIP in a big way. It would be scary to be Skype and to face several of the baby bells coming fast for your business.
What do you think? Do you want a chance to buy Skype of PayPal stock, or would you rather they stay safe in the eBay cocoon?
John
An article in Information Week discusses a call from the DoD for proposals to create "virtual parents" to talk to the young children of service men and women while they are deployed, and unable to talk in person. Though I enjoyed Diamond Age as much as the next person, this idea seems completely bonkers. Given the limitations on our understanding of AI and child psychology, it seems more likely we'll do real damage than that we'll create a positive experience for the child. This seems to me a great example of the type of research that professionals should just refuse to do.
For the most part I'm a supporter of the view that knowledge for it's own sake is valuable and should be pursued. Further, it's not implausible that eventually we'll be ready to build applications such as the proposed one. However, as Catherine Caldwell-Harris, the thoughtful critic quoted in the article, points out, there are plenty of other directions for researchers interested in this problem to pursue in the short-term, many of which are likely to bring short-term benefits, while moving the science forward. For instance, a researcher might develop a system for teaching a foreign language to a young child. Simulating a parent seems flat-out dangerous, though!
What do you think?
John
My friend Jamie Thingelstad has a blog about a new technology for RFID in the home, from a company called Violet. The basic idea is that you get a small USB device for your computer and a collection of RFID tags. You can then associate RFID tags with actions on the Violet web site. The hope is that eventually people will come up with cool uses for this technology in the home.
The video is mostly underwhelming: very few of the apps are things that I can imagine using, mostly because they are no more useful or fun that existing alternatives. One that might have some legs is the ability to put RFID stamps on postcards, so the recipient gets taken to a page with related content (e.g., pictures from your trip). This app, however, suffers from a network effect: it's only useful once lots of people have the readers, which will only happen once there are lots of useful apps.
It will be interesting to see where RFID technology for the home goes. Nice to see the tools getting delivered ... now it's time to come up with the apps.
Any app ideas?
John
The Times Online has a terrific article about Nicholas Taleb's reaction to the market crash. Taleb is the author of The Black Swan, a very fun read about his theories of unpredictable events. (It's interesting that the ideas in the book come across as much more attractive than their author, who presents himself as unconscionably arrogant for someone whose strongest arguments are about the limitations of human knowledge!)
I found several things enchanting about the article. First, it's amazing to an American that a professional athlete in Britain writes and thinks like Ed Smith does. Our athletes mostly get in fights with their bodyguards in bars; they certainly don't write with insight about major economic events. Second, there are a number of wonderful quotes that strike at the heart of Taleb's arguments. We'll go through those individually.
So is Taleb really against expertise, or is he simply pitting his own against that of the experts? He got this call right. The fall was forecast-able and he forecast it. It was not really a black swan.
This problem grabbed my attention while reading the book. Taleb keeps attacking the ability of "experts" to know what they're doing, all the while arguing that he himself knows exactly what he's doing, because of his analysis of the limits of knowledge ... but how can he -- or we -- know that he knows what he's doing? What evidence can be trusted, given the limits of all evidence to predict the future. Taleb comes back to this point when he says:
But Taleb's victory today is a pyrrhic one. “I wake up every morning at 2am, scared. I have made money on my bet that the financial world will go under. But now, if the banks go under, I can't cash my money. If I follow my logic all the way through, I get scared.”
This point is the critical one for his reader: how far ought we to follow the chain of logic in predicting that astonishing disasters will occur with (unpredictable) regularity? Ultimately some of the disasters will be ones we can't recover from. What about those? It's impressive that Taleb made lots of money by betting the economy would crash, but how does one short sell an ecological disaster, for instance?
A phoney meritocracy of people who got massively lucky and think they did it all themselves is a recipe for social disaster.
[later]
There is surely, for Taleb, an uncomfortable irony. Much of his present notability is due to his having made one devastatingly accurate prediction. Had he got his forecasts for the fall of banking wrong, the error would only have strengthened his general theory of black swans. But it would have undermined his popular reputation, which has never been higher. Now that really is luck. I leave him hoping that it may prove contagious.
Lovely writing about lovelier thinking. Taleb is powerfully convincing about the limitations of human knowledge to predict outside of their sphere of understanding. However, his theories aren't powerful ones, like, say, chaos theory, that give us rich meta-theories from which to predict the overall structure of likely events. Instead, they just tell us that very, very bad things are going to happen, and that their happening is completely unpredictable. Fascinating ideas ... but what should we do about them?
John
Cute cartoon that reminds me of Nathan Good's paper with Joe Konstan (and others) on the timing of software license agreements. It would be very nice if we could reliably change our mind, perhaps after the monster shows up.
John
