Don’t Insult Me with your “AOL Keyword” Strategy, Google Health

Yes, I get it. You want to “free” the “masses” from the “evils” of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT).

Yeah, just like how AOL wanted to “free” the “masses” from the “evils” of Universal Remote Location (URL).

Yes, I agree that the American Medical Association is obnoxiously aggressive about CPT copyright… but ICD? You have a problem with the World Health Organization (WHO)?

I was in elementary school during the first dot-com boom, but even I know the “redefine words” game from way way back when AOL and every other obnoxious portal site tried to redefine reality in the vocabulary of their own private text box.

ICD-9 is moving to ICD-10, and Google Health, you could have done the world good by easing the transition by understanding ICD as a domain addressing system for medicine like its intent. But no. Google Health, you wanted to play the greedy “newspeak key word game” with the entire Google search engine. Never mind that medical vocabulary is spread over multiple millennia, languages, and cultures and can’t be trusted for credible medical documentation for any purpose including billing. Right? So you’re just going to “help” “simply” the “vocabulary.”

Assholes.

Thank God for Wikipedia.

World’s Best “EMR” for $1000: Google Spreadsheets + iPad

Apple + Google* runs my primary care medical practice. Patients enter their information in Google Form on an Apple iPad in the waiting room or at home on their computer. A Google Calendar displays the patient appointments on a big screen in the waiting room on the web alerts the patient when an appointment is ready. The patient records, plus any paper or insurance cards scanned into Dropbox using Fujitsu Scansnap, are wirelessly available to Dr. Steven Murphy’s iPhone, iPad, and HP Touchsmart office desktop for his reference during examination while moving about the examination rooms. After medical service, Steve enters the CPT and ICD (medical service and diagnosis codes, respectively) into a Google Spreadsheet for billing. In the background, software using Gdata uses these records to bill insurance and the patient’s credit card via Authorize.net and MDonline. Later, Steve dictates his complete medical note using Dragon into a Google Docs template. In the afternoon, Steve makes rounds on patients at Greenwich Hospital and Greenwich Woods nursing home using his iPad and a Google Spreadsheet to keep logs while always on call via Gmail on his iPhone.

In the meantime, calls, faxes, and emails to the Office are routed through RingCentral and Google Voice, MyFax, and Gmail respectively to Gmail accounts which process, filter, and route messages to my sister and her roommate at University of Toledo for reception. Spam is filtered, and patients are scheduled by phone or email using Google Calendar, and clinical messages are forwarded to the doctor’s or patient’s attention. Because Gmail automatically archives all messages, the computer automatically and securely files, sorts, and stores all communications for easy future reference, transmission, and processing. (Are you an insane backcountry Greenwich narco addict with delusions of aristocracy who soaps up my little sister for hours over the phone because we don’t jump around like dogs to get you drugs because “somehow” you “lost” them and you simply “cannot” schedule an appointment? One button, poof! You are spam. Good bye. Tell it to your horses.)

Medical inventory is managed by rolling “drawer carts” assembled from clear plastic drawers and metal shelving purchased at Home Depot. Each transparent drawer is labeled with a QR code of a URL to be scanned by your iPhone to go to the McKesson or Amazon webpage for that drawer’s restock. (Actually, I’ve paused the QR scanning project because inventory projects cost money and I’ve been busy with collections. I can’t program websites when I’m busy telling old ladies with uncontrolled diabetes that their medical insurance doesn’t cover $100 in copays and that I’ve dropped them from the practice when they threaten me about it to me over the phone.)

For medical reference, why, we use Google.com Search of course! Why go to “school” to be a “medical biller” when Wikipedia has the world’s best diagnostic reference online for free?

Of course, we never use Google Health which is Silicon Valley’s second** most embarrassing politico boondoggle of worthless garbage —even though Google pushes Google Health to the top of search results. Where are the ICD codes? Oh, you mean the magical language that standardizes pages of indecipherable handwritten notes and legacy medical terminology into an easy-to-type-and-process tokens understood worldwide which are required for all medical billing? Oh no, Google Health is more about FACETIME for flawless resumes. (Where are the faces of the people who made Gmail, Search, and Docs?)

All of this is for you —any person, patient, or doctor— to purchase and assemble yourself with no evil bizdev blueshirts and their stupid websites at consumer prices. Need something really fancy not mentioned here? Google Shopping or Amazon.com. Hell, go visit Best Buy in person if you want that procrastinaty retro consumertime vibe for the day.

You can see this for yourself if you are in the Fairfield County, CT area. Schedule an ordinary, boring physical or sick visit by email at 9hh@hhdocs.com. We accept most medical insurances.

Currently, I’m working on patient accounts for billing and medical records in Python Google Apps and networking and billing tools for the independent Greenwich Physician Association which is headquartered in the office adjacent to mine. Also, I ordered a Counsyl genetic test for myself and am waiting for the results. If the results are good, then I’m unilaterally applying Counsyl to our regular medical physical procedure for all patients of childbearing age. SO: HA! Genetics as standard primary care! Eat me, 23andMe! (but… do need to wait for results before applying…)

PS: My sister and I will be at Google I/O this May. Ideally, I can get the hell out of this horrible, horrible town and do some real engineering remotely where I don’t have to deal with detachments of worthless, decaying dependents to retired millionaires who tattle to Grandpa, fucking President of Whatever, about every $76 bill for coinsurance.

*Enterprise edition with no advertisements: selling patient data for marketing is evil, dishonest, and unlawful in medicine)
** #1 is 23andMe. Special recognition is in order for a medical genetics test which not only is hostile to medical use by design, but EXPLICITLY FORBIDS medical use in its Terms of Service.

"The Silken Web: The Erotic World of Paris, 1920-1946," Mel Gordon Lecture at Observatory, Tomorrow April 20th


Tomorrow night! At Observatory!

The Silken Web: The Erotic World of Paris, 1920-1946
An illustrated lecture by Professor Mel Gordon, author of Voluptuous Panic: The Erotic World of Wiemar Berlin

Date: Tuesday, April 20

Time: 8:00 PM

Admission: $5

Presented by Morbid Anatomy

In tonight’s illustrated lecture, Professor Mel Gordon–author of Voluptious Panic: The Erotic World of Weimar Berlin and Grand Guiginol: Theatre of Fear and Terror–will present a graphic look at the brothel worlds of interwar Paris. Each of the 221 registered maisons closes–French for “closed house”–had its own unique attractions for its specialized clientele: theatricalized sex, live music, pornographic entertainments, aphrodisiac restaurants, even American-style playrooms and wife-friendly lounges for the customers’ families and bored mistresses. Tonight, have some wine and partake in authentic French culture and their Greatest Generation, complements of Mel Gordon and Observatory.

Mel Gordon is the author of Voluptious Panic: The Erotic World of Weimar Berlin, Grand Guiginol: Theatre of Fear and Terror, and many other books. Voluptuous Panic was the first in-depth and illustrated book on the topic of erotic Weimar; The lavish tome was praised by academics and inspired the establishment of eight neo-Weimar nightclubs as well as the Dresden Dolls and a Marilyn Manson album. Now, Mel Gordon is completing a companion volume for Feral House Press, entitled The Silken Web: The Erotic World of Paris, 1920-1946. He also teaches directing, acting, and history of theater at University of California at Berkeley.

You can find out more about this presentation here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here. To find out more about Gordon's books, click here and here.

"Stuffed Animals and Pickled Heads" Book and Lecture by Stephen Asma, Thursday April 22, Observatory


People often ask me how I first became interested in the topics that would lead me to launch the Morbid Anatomy blog and related projects, such as The Secret Museum and Anatomical Theatre exhibitions. When I am asked this question, I usually rattle off a few of my major serendipitous inspirations: my first trip to Europe and the death-symbolism-packed churches and osteo-architecture I was surprised to find there; The gift of a Mütter Museum Calendar for my birthday one year from a well-meaning friend; And, last but never least, the discovery of Stephen Asma's wonderful, incredible, perfect book Stuffed Animals and Pickled Heads: the Culture and History of Natural History Museums.

Asma's book has had such a profound impact on my work that it is difficult to exaggerate its importance. The book is a conversationally toned yet extremely scholarly "natural history of natural history museums," covering, with wit and intelligence, the history of specimens preparation and the artists and pioneers of the medium, the evolution of the museum from Cabinet to comparative anatomy collection to today's science museum, the history and follies of taxonomy, and what the drive to order the world reveals about human nature. Over the course of the book, Asma introduces us to a number of incredible museums I have now--inspired largely by this book!--visited and photographed many times, such as London's Hunterian Museum and Paris' Hall of Comparative Anatomy, and all this in an accessible, enthralling, humorous, and fascinating way.

This is why I am so extremely delighted that Stephen Asma will be visiting Observatory this Thursday, April 22, to deliver his much-anticipated lecture "Museums, Monsters and the Moral Imagination." This heavily-illustrated lecture will draw on the scholarship of both Stuffed Animals and Pickled Heads and new book, On Monsters, to examine how science museums and monsters both illustrate the essential yet problematic human "urge to classify, set boundaries, and draw lines between the natural and the unnatural the human" and to "try to excavate some of the moral uses and abuses of this impulse."

Both of Dr. Asma's books will be available for sale and signing at the event. Full details follow; hope very much to see you there!

Museums, Monsters and the Moral Imagination
An Illustrated lecture with Professor Stephen Asma, author of Stuffed Animals and Pickled Heads: the Culture and History of Natural History Museums and On Monsters.
Date: Thursday, April 22
Time: 8:00 PM
Admission: $5
Presented by Morbid Anatomy

In this illustrated lecture, professor Stephen Asma–author of the the definitive study of the natural history museum Stuffed Animals and Pickled Heads: the Culture and History of Natural History Museums–will draw upon his studies of science museums and monsters to reflect on their often hidden moral aspects. Museums are saying more about values than many people notice, and the same can be said about our cultural fascinations with monsters. The urge to classify, set boundaries, and draw lines between the natural and the unnatural are age-old impulses. In this lecture, Dr. Asma will try to excavate some of the moral uses and abuses of this impulse.

Stephen T. Asma is the author of Stuffed Animals and Pickled Heads: the Culture and History of Natural History Museums (Oxford) and more recently On Monsters: an Unnatural History of Our Worst Fears (Oxford). He is Professor of Philosophy at Columbia College Chicago and Fellow of the LAS Research Group in Mind, Science and Culture at Columbia. You can find out more about him at his website, http://www.stephenasma.com.

You can find out more about this presentation here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here. To find out more about Asma's fantastic books, click here and here.

Image: From The Secret Museum; Pathological Cabinet, the Museum of the Faculty of Medicine at the Jagiellonian University, Krakow. © Joanna Ebenstein

Antigua: Movin on up

jumby-bayAlthough well-known in the island world , Antigua has largely gone unnoticed in the mainstream. This is changing with a  growing number of Europeans  scouting real estate on the Caribbean island of Antigua, lured by its legendary 365 beaches and the explosion of upscale properties that have come on the market in recent years.

Jumby Bay a exclusive private island resort is leading Anituga’s reimaging with the recent completion of a 28$ renovation.  In addition to the hotel, where rooms are furnished with mahogany four-poster beds and marble baths, there are 49 privately owned homes. Prices generally start at about $4.25 million but can be more than $30 million.

Accessible only by private ferry, the island is owned and operated by Jumby Bay Island Co., and individual homeowners are shareholders. The hotel is managed by Rosewood Hotels & Resorts, the luxury company that also runs The Mansion on Turtle Creek in Dallas.

Cadillac's OHC V-12 Engine

When Richard Langworth went looking for photos of the 1960s Cadillac V-12 to prove its existence for a story he wrote, he came up empty-handed. But after a few well-placed e-mails, GM's Heritage Center (which now has one of the engines on display) sent along these three photos of what it called

CALL FOR ABSTRACTS: Medicine 2.0’10: 3rd World Congress on Social Media and Web 2.0 in Health, Medicine, and Biomedical Research on November 29-30, 2010 in Maastricht, The Netherlands.

CALL FOR ABSTRACTS:
http://bit.ly/dCOIeT

DEADLINE: May 31st, 2010

As announced earlier this year, the Medicine 2.0® conference – in 2008 and 2009 hosted in Toronto – goes global and will in 2010 be organized in Europe. The University of Twente (UT), the Radboud University Nijmegen Medical Centre (UMNC) and the National Institute for Public Health and the
Environment (RIVM) will host Medicine 2.0 Congress (Medicine 2.0’10: 3rd World Congress on Social Media and Web 2.0 in Health, Medicine, and Biomedical Research) on November 29-30, 2010 in Maastricht, The Netherlands.

Medicine 2.0® 2010 will be supported by the core Medicine 2.0® team in cooperation with scientists from UT, UMNC and RIVM; the website will remain at http://www.medicine20congress.com, and the submission and dissemination process will remain centralized. Medicine 2.0'10 will serve as an umbrella for REshape (Fall edition, UMNC) and the ‘Supporting health by technology’ (IIIrd edition) symposium
series (University of Twente, RIVM).

Abstract submissions for the Medicine 2.0'10 congress in Masstricht are open.

Medicine 2.0'10 will contain a mix of traditional academic/research, practice and business presentations, keynote presentations, and panel discussions to discuss emerging issues. We strive for an interdisciplinary mix of presenters from different countries and disciplines (e.g. health
care, social sciences, computer sciences, engineering, business) and with a different angle (research, practice, and business).

Participants are invited to either submit a 500 word abstract to propose a 15 minute single-presenter talk, or can submit a a 500 word panel proposal to present or discuss a topic in a 45-60 min session with 3-4 colleagues from other organizations/institutions (panel proposals with all authors from
the same institution or organization are not permitted).

All submissions will be considered for one of the Medicine 2.0 Awards, if eligible. To nominate your work for one of the awards, read the award criteria and prepare the abstract as outlined below. Note that in order to be considered for the IMIA Medicine 2.0 Award, a checkbox must be checked on the submission form (consideration for all other awards is automatic).

Track what is being submitted in real time through RSS feed at http://feeds2.feedburner.com/med2submit.

Follow on Twitter (http://twitter.com/medicine20)

Only requirement issubmission of a short abstract, no full papers. However, the meeting is working towards (optional) publication of full papers in PubMed-indexed publications, either in form of a full paper submitted to a special issue of the Journal of Medical Internet Research, or publication of the presentation transcript including the audio/video podcast in a new, electronic forthcoming serial called "Medicine 2.0", indexed in PubMed.

If you are interested in either of these options, please check the respective checkboxes in the abstract submission form (subject to additional publication charges).

For general questions please contact the conference secretariat at congres@key-cs.nl

Admixture between humans and the Others | Gene Expression

neanderthal-615Mr. Carl Zimmer points me to a new article in Nature, Neanderthals may have interbred with humans. The details within the article are more tantalizing, it seems to me, than the headline would imply.

The topline is this, researchers presented the following at the recent meeting of the American Association of Physical Anthropologists:

* An analysis of 614 highly variant loci, microsatellites, in ~2,000 people from diverse populations imply some variants which seem to be derived from human lineages outside of the mainline which led to the anatomically modern humans who left Africa 50-100,000 years before the present to settle the world. I assume there were “long branches” on the phylogenies of some loci, indicating that some of the alleles were “separated” from others for long periods of time so that recombination wasn’t able to dissolve the differences between distinctive haplotypes (if we’re all descended from a small African populations which expanded demographically less than 100,000 years ago the common ancestor of the variants should have a shallow time depth).

* The data imply two admixture events, one 60,000 years ago in the eastern Mediterranean, the other 45,000 years ago in East Asia. I think of this as a floor to the number of events. The latter one seems particularly clear in Oceanic populations from the reporting.

* African populations do not have the variants for these two admixture events (there hasn’t been that much back migration to Africa aside from north of the Sahara and the Horn of Africa. I assume that’s because Africans are well adapted to their environment, and outsiders are not).

In light of the recent discovery of a Siberian hominin which lived ~30,000 years ago, and was not a H. sapiens sapiens or H. sapiens neanderthalis, as well as the confusing but intriguing Hobbits of Flores, I think we can conclude that the the evolutionary genetic past was much more complicated than we’d assumed 10 years ago. Remember three years ago when there was a spate of research on a few genes which were suggestive of introgression into the human genome from Neandertals? There are other hints here and there which pop up in the literature over the years, some in Asia. But the methods being imperfect, and interpretation being somewhat an art, a consensus of Out-of-Africa + total replacement has been assumed to be a null. So we look at isolated results with some skepticism (I think this is justified).

So is this going to be met with skepticism due to reliance on the orthodox model? This section of the article is intriguing:

A test of the New Mexico team’s proposals may come soon. Svante Pääbo and colleagues at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, announced early last year that they had finished sequencing a first draft of the Neanderthal genome, and they are expected to publish their work in the near future. Pääbo’s earlier studies on components of Neanderthal genomes largely ruled out interbreeding, but they were not based on more comprehensive analyses of the complete genome.

Linda Vigilant, an anthropologist at the Planck Institute, found Joyce’s talk a convincing answer to “subtle deviations” noticed in genetic variation in the Pacific region.

“This information is really helpful,” says Vigilant. “And it’s cool.”

Trying to glean what results Paabo is going to come out with is like reading tea leaves, but it is notable that a colleague at Max Planck seems to be excited about the results of this study. I do not get the sense that any of these results would reject the model that the overwhelming signal of ancestry in non-African humans is African. There’s a reason that mtDNA, later analysis of classical markers, and finally modern genomics (as well as cladistic analysis of skeletal features) imply that there was an Out of Africa event, whereby anatomically modern humans entered into a period of massive demographic and range expansion from a small ancestral group. But that does not preclude the assimilation of other groups along the way, and there is circumstantial evidence of sex between the Others and modern humans (the time of separation between various hominin lineages is on the low side in relation to various other taxa which can still produce fertile hybrid young).

A final point is that if these results hold up, one might look to Africa itself for other hybridization events. It may be that ancient hominin genetic variation is preserved in modern Africans as H. sapiens sapiens entered its period of expansion within that continent. Those signals may be currently obscured because the archaics in Africa were genetically more similar than those outside of Africa, and the African genome hasn’t been as well characterized as that of other populations in relation to its great diversity (remember the finding of new SNPs in the recent paper on Bushmen).

Image credit: National Geographic

Some signs Cuba may be about to burst

"Stalinist-style bureaucracy"

The Catholic Cardinal is now openly criticizing the Cuban government of Raul Castro. According to the BBC Cardinal Jaime Ortega is saying that the Communist State is suffering from the worst crisis in decades due in part to the US Embargo, the decline in the World economy, and the fall of the Soviet Union.

From the BBC:

The 73-year-old prelate said that people were openly talking about the deficiencies in Cuba's socialist system, calling it a Stalinist-style bureaucracy producing apathetic workers and low productivity.

"Our country is in a very difficult situation," he warned. "Certainly the most difficult we have lived in this 21st Century."

Other reports that "Damas de Blanco" (Ladies in White), a protest group against human rights abuses, made up mostly of wives of victims of the regime, has become emboldened. They are increasing the number of protests, and their intensity.

Good polling news for Republicans out of Pennsylvania

From the liberal-leaning North Carolina-based Public Policy Polling (PPP):

PPP (D) PA-12 Congressional Survey

•Tim Burns (R) 44%
•Mark Critz (D) 41%
•Undecided 15%

This is a special election for the congressional seat of the deceased Rep. John Murtha, Central Pennsylvania, Johnstown area. The election will take place on May 18.

The Democrat lean for this District is 55%.

Science Blogs and the Public Sphere: A Teaser | The Intersection

So, I've been working very hard over the past month to organize an event with Sheila Jasanoff of the Harvard Kennedy School about the state of science blogging. The event is cosponsored by Jasanoff's Science, Technology, and Society Program and the MIT Knight Fellowship in Science Journalism. I'll be putting up much more information about it very soon, but for now, just a teaser....the truly rockin' poster: C'mon, you know you want to attend....


The strange land of atheist politicians | Gene Expression

There is some interest in the upcoming British election, and the renaissance of the Liberal Democrats under Nick Clegg. See this article in The New York Times about the rise of the Liberal Democrats at the expense of the two traditional parties of power, Labour and the Tories. One interesting fact from an American perspective is that Nick Clegg is an admitted atheist, though his children are being raised Roman Catholic by his wife. Of course the lack of faith of British politicians isn’t that new, two Prime Ministers were not even nominal believers, Clement Attlee was an agnostic and James Callaghan was an atheist.

This is of course in sharp contrast with the United States where all politicians operationally have to avow a religious affiliation, and the higher that a politician ascends up the ladder of achievement the more vocal and thorough the assertions of sincere faith have to become. And yet it is Britain which has an established church, where the head of state is the head of the church, and, religiously oriented schools receive public funding.

There are many models rooted in history one could propose, but the facts as they are would probably be unlikely to be inferred from prior axioms. It’s a reminder that human social affairs are the outcome of messy dynamics, and observation is often far easier than deep analysis. In 1800 one would reasonably have expected that it was in the United States where “infidel” politicians would flourish, and yet that has not been so.