If you see me talking to myself, do not disturb, I'm having a staff meeting.

Some days are harder to show up for than others. Aren't we all on edge? If we truly are stardust--whipping up elements from the dawn of the universe on a cellular level--where does the sorrow, angst, or fear live? I would argue it is filtered through our brains.  Perhaps our creative selves can manifest these signals into meaningful or at the very least soothing tropes or missives. But today. I got nothing. I walked slowly to the gym hoping that my routine of "outsideness" would help to shake the funk. I listened to an uplifting conversation between Austin Kleon and Debbie Millman, Design Matters. And started to unclench a wee bit. Stories from the edges of how people define creativity or their work--Austin claims, a writer who draws. Also how to navigate the doubts and insecurities.

I am an ultra-runner so I have learned patience at the hand of "embracing the suck" but today I only checked the box of "showing up". Nothing slid into the groove but hey--I went through the motions.

While I am writing this I have a teenager losing his mind in the background. He is x-country captain and a rising senior in high school. He has spent 3 weeks at an academic program in Chicago and is heading for the beach for a week. He is mad because I won't let him miss practice for an overnight thing with his friends. I explain how when able--he needs to be there for his team. His argument? It sounds like that Charlie Brown teacher although less warm, fuzzy, and endearing. I just felt like checking in. I start most days running and writing. Those are the best days. Often we have to trust the ritual. Even if we feel like there is nothing to say. On a positive note I am left with more time to finish up the latest workshop classes for you, prepare for my month on an island, and work with large datasets. Not everything in our working lives is an instagramy perfect filter vibe. Case in point--drinking my tea on the run. The real deal.

You wanna fly, you got to give up the shit that weighs you down -- Toni Morrison

August brings into sharp focus and a furious boil everything I've been listening to in the late spring and summer--Henry Rollins 

This summer, faced with my youngest spending 3 weeks participating in an academic program at University of Chicago, Steve (husband) and I decided to take advantage of a long weekend in the lovely blue ridge mountains. The pace of summers vacillate between frenetic and this new normal--kids with new found independence and opportunities beyond the familiar. Fewer ferry rides to the beach and more sojourns with friends--pausing only to grab a set of keys and hoping for a little cash (just in case). I have observed an increased efficiency in my work as I evolved from a hired gun to simply write what I was asked to now being responsible for the data that informs the narrative. ​Don't get me wrong. I always did my due diligence with research and probing evidence-based medical articles but let me be frank. I only looked where the client was pointing.

Although my toolbox has expanded over the years to include Python, SQL, and R--I use them with intense focus and deliberation. When you evolve skills into exploring large data sets you innately comprehend why certain types of questions are higher value than others. For example, I sat through a Tableau session on how to analyze Likert data--data gathered from those ubiquitous uni- (one attribute) or multi (contrasting opposites)-polar scales. You are asked how likely you might be to exhibit a certain behavior.

We build too many walls and not enough bridges--Isaac Newton

...Since that time he has had no relationships with industry. Moreover, he now “sees” industry influence in almost all facets of patient care, medical education, clinical research, and even certification exams (in which the correct answers are based on pharmaceutical funded guidelines).--From the $80 hamburger to managing conflicts of interest with the pharmaceutical industry

In summary, we have found that modern RCTs in breast cancer, NSCLC, and CRC are substantially larger and more international in scope than those of earlier decades. Although methodology and quality of reporting seems to be improving over time, serious deficiencies persist, particularly in the identification of the primary end point and by not including all randomly assigned patients in ITT analyses. There has been a substantial shift toward industry sponsorship of oncology RCTs. Over the past 30 years, authors’ endorsement of novel therapies has increased while relative effect size has remained stable.

​A significant P value for the primary end point and industry sponsorship are independently associated with strong endorsement of the experimental therapy. Investigators and medical journals should continue to strive toward publication of high-quality studies and recognize the importance of adequate and unbiased reporting of study methodology and results. Finally, clinicians, investigators, and policy makers should maintain and refine perspective on what constitutes a meaningful benefit to patients beyond the P value associated with the result. Further research is needed to determine whether newly adopted therapies are truly worthwhile to patients.-- Evolution of the Randomized Controlled Trial in Oncology Over Three Decades

• Discrete choice experiments allow estimation of the relative importance of different aspects of care, the trade offs between these aspects, and the total satisfaction or benefit respondents derive from health care services. Monetary values of attributes may be indirectly estimated by including time-based attributes such as "waiting time"...Ryan et al. Use of discrete choice experiments to elicit preferences

Using discrete choice experiments to inform the design of complex interventions

Marketing books are awful. I have had an aversion to the self-help business genre since somebody stole someone's cheese and the Pharma company where I was working spun off a series of nauseating workshops with the same title. But as you likely know--Seth is different. I read his books and have been lucky enough to catch him on stage at a conference or two. I handed him a gift once and he stared at me momentarily with disbelief and teared up slightly. Oh. And he hugged me.  Full disclosure it was the On Being Gathering and we were all feeling about as good as you can possibly feel underneath beautiful redwoods being fed impossibly delicious food, drinking wine, and listening to some of the most influential purveyors of intention and goodness ever imagined. ​I needed to read this book. I think there is much you might enjoy as well.

People don't want what you make

If you can bring someone belonging, connection, peace of mind, status, or one of the other most desired emotions, you've done something worthwhile. The things you sell is simply a road to achieve those emotions, and we let everyone down when we focus on the tactics, not the outcomes. Who's it for and what's it for are the two questions that guide all of our decisions.--Seth Godin This is Marketing

“The sense of having walked from far inside yourself / out into the revelation, to have risked yourself / for something that seemed to stand both inside you / and far beyond you, that called you back”--David Whyte

A thought is harmless until we believe it. It's not our thoughts, but our attachment to our thoughts, that causes suffering.--Byron Katie

Since Charles Darwin published On the Origin of Species in 1859, scientists have repeatedly proposed that the laws of biological evolution apply not just to bird and beast but also to creatures of the mind.

Perhaps most famously, in his 1976 book The Selfish Gene, the En­glish evolutionary biologist Richard Dawkins coined the word meme to describe a “unit of cultural transmission” analogous to a biological gene.

Memes, he wrote, could be ideas, tunes, or styles of clothing—­essentially any product of human intellect. Moreover, they were not just metaphorically alive but technically living things.--The Story of Storytelling by Ferris Jabr

Unlike their predecessors in the nineteenth and early twentieth centuries, modern biologists no longer depend primarily on morphology and anatomy—on appearances—­to establish evolutionary relationships between organisms. They can also compare their DNA, which maintains a record of familial mergers and divisions over great spans of time.

As different species evolve, they accumulate genetic mutations at a more or less steady rate. In general, the more similar the genomes of two species—the more that certain key sequences of As, Ts, Cs, and Gs match—the more recently they split from a common ancestor. Using this general approach, Tehrani and a few other researchers pioneered a new kind of “phylogenetics” specifically for folktales and myths.

​The gist of their method is to reduce stories to their most fundamental structural elements—the narrative analogue to genes, sometimes called mythemes—and statistically analyze the number of discrepancies between those elements to determine ancestral relationships.The Story of Storytelling by Ferris Jabr

If we remove their layers of symbolism and subtext—which have been interpreted and reinterpreted for millennia—and focus on their narrative skeletons, we find that they are studded with practical and moral insights: people are not always what they seem; the mind is as much a weapon as the body; sometimes humility is the best path to victory.

The potential for guarantee-time bias (GTB), also known as immortal time bias, exists whenever an analysis that is timed from enrollment or random assignment, such as disease-free or overall survival, is compared across groups defined by a classifying event occurring sometime during follow-up.

​The types of events associated with GTB are varied and may include the occurrence of objective disease response, onset of toxicity, or seroconversion. However, comparative analyses using these types of events as predictors are different from analyses using baseline characteristics that are specified completely before the occurrence of any outcome event.--Challenges of guarantee-time bias. Giobbie-Hurder , Gelber RD, Regan MM.

Patients who undergo transplantation seem to have longer survival times. However, patients in the transplantation group must survive at least until donor is available (blue), and their survival reflects total time before and after transplantation (blue and gold).

More favorable survival does not result from the effect of transplantation but rather from the inclusion of extra waiting time (guarantee time). By contrast, the no-transplantation group includes all patients who died before a suitable donor could be found.

The Curse of Bigness by Christopher Ketcham

​THE NEXT TIME I HEAR a politico or banker or Detroit executive talk about institutions “too big to fail,” I’ll direct them to the 34 percent of Americans who are obese. ​Last I heard, these big Americans, themselves a kind of cultural institution, were failing en masse, racked by diabetes, asthma, heart trouble, and bound for early death. The human form can only grow so big. Or I could point them to Pig #6707. ​Conceived in the laboratories of the U.S. Department of Agriculture during the 1990s, Pig #6707’s embryo was genetically altered with a human growth gene to develop a super-pig, bigger and faster-growing and more productive of meat.

But the genetic alterations produced a monster, impotent and nearly blind, its legs arthritic, its body crippled, the creature able to stand up and be photographed only with the support of a plywood board.--Christopher Ketcham

The Lochnerized first amendment and the FDA: toward a more democratic political economy

“[T]he majority has chosen the winners by turning the First Amendment into a sword, and using it against workaday economic and regulatory policy. Today is not the first time the Court has wielded the First Amendment in such an aggressive way. And it threatens not to be the last. Speech is everywhere—a part of every human activity (employ­ment, health care, securities trading, you name it). For that reason, almost all economic and regulatory policy affects or touches speech. So the majority’s road runs long. And at every stop are black-robed rulers overriding citizens’ choices. The First Amendment was meant for better things.”--Janus v. AFSCME, Justice Kagan dissenting 

THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT

From the control of banks over financial stability as well as access to finance and credit, to the control of internet service providers (ISPs) and telecom companies over broadband infrastructure, the problem is the same: private actors possess the means to undermine the public value of essential goods and services upon which many businesses, communities, and individuals depend.--THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT--K. Sabeel Rahman

Definition of social infrastructure--” Where private actors accumulate outsized control over those goods and services that form the vital foundation or backbone of our political economy—social infrastructure—this control poses dangers. By defining social infrastructure as a concept, this article provides a way to diagnose essential goods and services and therefore potentially problematic accumulations of private power."--THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT--K. Sabeel Rahman

Drawing from these disparate debates over net neutrality and TBTF financial firms, I extract four key elements of a twenty-first century framework for public utility regulation: firewalling core necessities away from behaviors and practices that might contaminate the basic provision of these goods and services—including through structural limits on the corporate organization and form of firms that provide infrastructural goods; imposing public obligations on infrastructural firms, whether negative obligations to prevent discrimination or unfair disparities in prices or positive obligations to proactively provide equal, affordable, and accessible services to under-served constituencies; and creating public options, state-chartered, cheaper, basic versions of these services that would offer an alternative to exploitative private control in markets otherwise immune to competitive pressures.--THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT--K. Sabeel Rahman

Progressive reformers thus understood public utilities not just in terms of economies of scale and laws of nature, but in moral and social terms. Industries triggered public utility regulation when there was a combination of economies of scale limiting ordinary accountability through market competition and a moral or social importance that made the industries too vital to be left to the whims of the market or the control of a handful of private actors.

This combination of economic dominance and social necessity is what created the threat of not just exploitative prices but also discrimination and unequal access. The public utility model offered a way to check this particular form of private power. Public utility regulation thus did not apply to all forms of private power—but it did address the most vexing, powerful, and dangerous private actors. At the same time, this emphasis on social importance meant that industries could evolve into utilities over time, through changes in their production and distribution model and through social changes whereby one or another good became essential to more people. THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT--K. Sabeel Rahman

...firms and sectors that might warrant greater regulatory oversight by examining three overlapping conditions: the economics of production; the downstream uses of the good or service; and the degree to which the good or service is a necessity that makes its users particularly vulnerable to exploitation. The presence of all three features indicates a firm or sector that is “infrastructural,” where the concentration of private power over these services poses a unique potential threat to public welfare. THE NEW UTILITIES: PRIVATE POWER, SOCIAL INFRASTRUCTURE, AND THE REVIVAL OF THE PUBLIC UTILITY CONCEPT--K. Sabeel Rahman