In this new world, intellectual property is intellectual monopoly. Monopolies are unjustified and unjust, dangerous both to our economies and our societies. We need new rules for this new, digital world: rules appropriate to the information economy; rules that provide ways to reward innovators and creators whilst preserving fairness and freedom, and which give everyone a stake in our digital future.--The Open Revolution: New rules for a New World by Rufus Pollock

The Economist: Babbage podcast is a nice visit with science and technology and an easily assimilated brief audio snap. The namesake of Charles Babbage the "19th-century polymath and grandfather of computing" presents a potential seed of a solution for drug pricing. ​In continuing the Rufus Pollock theme--he appears momentarily but discusses the tensions around drug price transparency and monopolies. ​A firm supporter of innovation, he recognizes that the big player in tech isn't necessarily the associated gadgetry but the basic rules around ownership. Enterprise, free markets, innovations and inequality depend on rules we combine. We are operating as if monopolies and patent rights are a single tool and the only solution to  rewarding creators for their investments in R&D. I admire the "out of the box" thinking around better solutions to improve access to life-saving drugs.

The book and podcast distinguish patent rights from property rights.  The problem arises when patients will die without access to drugs. If they are priced prohibitively to cover R&D and the marginal cost of manufacturing with one price--fewer drugs are sold and patient outcomes may be quite draconian. But what if, as Rufus suggests, there is a two part payment model--cost of goods has the fixed cost of R&D and cheap marginal cost for medicines relative to R&D. Innovators can invest or pay for two things separately. Subscription fees pay for fixed cost and manufacturing costs are calculated separately. An enumeration model provides access through a fixed fee to cover R&D and money is allocated to a fund to pay for which drugs get used and how effective they are. No need for government to distribute--only to make sure money is collected. An actual plausible model not trying to be crammed into an outdated framework like US healthcare ecosystem.

“The best thing to do with your data will be thought of by someone else”-Rufus Pollock

I hope you will take the few moments to read the poem. If you work with patients in any capacity or are tasked with research methodology in questionnaire design or work with healthcare providers--you will appreciate how a simple pain scale serves no one. I was fortunate to hear David read his poems live at the first ever On Being retreat held beneath the beautiful redwoods in California. He has a hauntingly beautiful tone and cadence. Listen to him from the TED stage. David Whyte has many beautiful books of poetry but one of my favorites is Consolations: The Solace, Nourishment and Underlying Meaning go Everyday Words. The poem Pain is one of the 52 words selected as a "doorway into the underlying currents of human life"... I for one don't think we live enough in the space of what a word actually means. I recall robust debates between stakeholders when collaborative efforts were stalled as we intently tried to define such familiar terms such as "middle-class" or "value" in a way that allowed merging of large datasets. Pain is a big one. When we examine addiction culture, rising suicide rates, and patient outcomes across a wide variety of chronic conditions are we certain we are measuring the same thing?

Experiencing real pain ourselves, our moral superiority comes to an end; we stop urging others to get with the program, to get their act together or to sharpen up, and start to look for the particular form of debilitation, visible or invisible that every person struggles to overcome. In pain, we suddenly find our understanding and compassion engaged as to why others may find it hard to fully participate.--David Whyte

Many recent studies, however, have under-scored the importance of considering the heterogeneity among LDL and HDL particles, e.g., their quality and number, and their variable association with CVD risk.

I don’t have an agenda, but I do have a point of view, and it might change from minute to minute--Anthony Bourdain

The Longform is one of my favorite writerly podcasts. No insta-author or ill-fated recipes for success--just heart to heart granular discussions with interesting writers and editors. The recent interview with Elif Batumen is an example of a writer culling from an extensive love of reading and critical thought. A fan of Roland Barthes has my ear for eternity. A recent critique by @filmsie pulled the thread from an obscure essay, The Death of the Author. I recently shared the quote on LinkedIn when asked to recommend a business book.

Common culture seems to oppose the idea of multiple discovery very vehemently and prefers the “heroic theory” of invention, which gives all the credit to a single person. Good examples are patents, copyright laws, and other measures that promote singular contribution to discoveries."

“The greatest hazard of all, losing one’s self, can occur very quietly in the world, as if it were nothing at all. No other loss can occur so quietly; any other loss - an arm, a leg, five dollars, a wife, etc. - is sure to be noticed.”

An old Cherokee chief was teaching his grandson about life...

"A fight is going on inside me," he said to the boy. 
"It is a terrible fight and it is between two wolves.

"One is evil - he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, self-doubt, and ego.

"The other is good - he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. 

"This same fight is going on inside you - and inside every other person, too."

The grandson thought about it for a minute and then asked his grandfather, 
"Which wolf will win?"

The old chief simply replied, 
"The one you feed."

It was unthinkable not long ago that a biologist or paleontologist would be at the same conference as an astrophysicist. 
Now we have accumulated so much data in each of these branches of science as it relates to origins that we have learned that no one discipline can answer questions of origins alone—Neil deGrasse Tyson
​

Dean Baker, Senior Economist at Center for Economic and Policy Research, pointed out that we need significant changes in our insurance providers before handing them the reins to a “Medicare Advantage For All” system – at the least changing them to non-profit insurers like in other countries. He also proposed more radical changes to bring down prices, like abolishing patent monopolies for new drugs.
“The way we pay for drugs now, it’s like paying firefighters to come to your house when your house is on fire,” said Baker.--Lown Institute A think tank advocating a radically better and uniquely American health system that overturns high-cost, low-value care

The delivery of medical education relies on the traditional methods for didactic learning such as lectures and seminars in customary settings such as auditoriums or classrooms. The content is largely driven by the educator without any assessment of the true educational needs of the learner. Using these traditional delivery methods, there are few opportunities to assess whether the educational program actually changed physician behavior or resulted in improvement in patient outcomes.--Steven E. Nissen, MD

Across two experiments, people showed evidence of poor metacognitive awareness of belief change about a social science topic. Following belief change, recollections of initial beliefs were generally inaccurate and biased toward current beliefs. In mediation analyses in both experiments, results showed that the relationship between the belief consistency of the text read by a person and their accuracy at recollecting their initial belief was mediated by their level of belief change.

These results suggest that recollections of previous beliefs are constructive, and influenced by the beliefs of the person at the time of the recollection. We propose that changes in beliefs do not tend to be moni- tored as they happen. Rather, we propose that people sim- ply use salient information at the moment of recollection to try to reconstruct their previous beliefs. 

Awareness of belief change is an under studied issue, but may be an important factor in people’s metacognitive understanding of their own comprehension. If people show little awareness of changes in their own beliefs, they may erroneously conclude that their beliefs are more fixed than they actually are, and consequently may be less willing to engage with information that is contrary to their beliefs. 

In the show, psychologists Michael Wolfe and Todd Williams, take us though their new research which suggests that because brains so value consistency, and are so determined to avoid the threat of decoherence, we hide the evidence of our belief change. That way, the story we tell ourselves about who we are can remain more or less heroic, with a stable, steadfast protagonist whose convictions rarely waver ...

This can lead to a skewed perception of the world, one that leads to the assumption that mind change is rare and difficult-to-come-by. And that can lead to our avoiding information that might expand our understanding of the world, because we assume it will have no impact.

​Fortunately, Ned was invited to a surprise party.
Unfortunately, the party was a thousand miles away.
Fortunately, a friend loaned Ned an airplane.
Unfortunately, the motor exploded.
Fortunately, there was a parachute in the airplane.
Unfortunately, there was a hole in the parachute.
Fortunately there was a haystack on the ground
Unfortunately, there is a pitchfork in the haystack 
Fortunately, he misses the pitchfork. 
Unfortunately, he misses the haystack. 
Fortunately, he falls in the ocean. 
Unfortunately, there are sharks in the ocean.

(and it goes on from here...)

Do we mean unknown through lack of skill in arguing from evidence, or unknown through lack of evidence? The first alone is admissible, for new evidence would give us a new probability, not a fuller knowledge of the old one; we have not discovered the probability of a statement on given evidence, by determining its probability in relation to quite different evidence...For it is not this probability that we have discovered, when the accession of new evidence makes it possible to frame a numerical estimate-- John Maynard Keynes, 1921, A Treatise on Probability

Probability entails a delicate balancing act. On the one hand, we must recognize the infinite complexity of the individual case. On the other, we must simplify to achieve useful generalizations by ignoring much individual detail. To selectively view only the subset of information we deem relevant, out of all potential information, is to maintain a posture of willful ignorance. This is absolutely necessary in order to generate a mathematical probability statement, but is usually done implicitly and unconsciously. The challenges and opportunities of the future demand that it be done more explicitly and mindfully--Herbert I. Weisberg, Willful Ignorance The Mismeasure of Uncertainty.

More a fan of James Gandolfini than anything else (he was a bouncer at a neighborhood bar when I was at Rutgers) I still chuckle at the discussion of alteration--Instead of altercation from the extensive list of character malapropisms during the long run of the Sopranos. Even more amusing when thinking about my current crossroads. Tony Soprano is told he is at a precipice of an enormous crossroads--I think you can see the absurdity recognized briefly on his face.

Krista Tippett, CEO, founder On Being Studios

The weekend was titled, The On Being Gathering--Becoming Wise: A Calling for the Age. I have been a fan for a long time. Science Advances One Funeral at a Time featured a discussion about the difference between healing and curing. There comes a time while running a business you are required to make a decision. ​What do you stand for?  As a data scientist I prefer to have expansive dialogue. Examining disease state knowledge in the absence of pharma SEC filings, FDA adverse event reporting system (FAERS) data, and disease epidemiology tells a different story if we don't add insights from different databases--such as health policy and economics. My question for the weekend at On Being Gathering? What is the way forward?

Clients often have the solution before they ask the question in a meaningful way. You can repeat good data governance, process, and analysis but even if you say the right thing--it matters WHERE you say it. ​Listening and understanding are not the same thing.  Seth Godin says "now that you have the ducks in a row, what are you going to do with the duck? Maybe your duck isn't for everyone. You can offer it, here I made this. But you can't please everyone. Don't diminish your vulnerability for the easy win. Seth Godin generously included Footprints on the Moon for attendees. Quietly, sincerely, and without fuss. I pulled it out on the airplane not sure what was inside. A few sentences and I recognized the voice. The words were a ladder back down from the precipice...

Ways we sacrifice our work to our fear...(a few from Footprints on the Moon)