I hope this is a meme that sticks.

The American Center of Medicare and Medicaid Services (CMS) is not your friend any more than the American Internal Revenue Service (IRS).

CMS, like IRS, is charged with the grim duties of its office. They are not magic or Gods or evil or friendly. They are people with jobs. Jobs that they do. But know this: there is no civilian interaction with either CMS or IRS after which you’ll come home smiling.

Remember the movie “Meet Joe Black?” How did the screenplay writers depict Death himself? A noisy bully? A pedantic bureaucrat?

No. Death is already everywhere. He already knows everything. He has all the time and all the power in the universe, and he amuses himself by drifting about the highest pinacles of power in effortless bemusement punctuated by an occasional gesture of utter domination. (Except, arguably, over “the power of the human spirit,” —not that that’s going to make you any less dead or any less liable. Anthony Hopkins still died in that movie.)

CMS: The Death Office. Boring, boring, boring… BOOM! By the time you’re warned, it is too late, and in the meantime, Death had been watching you the entire time. You had simply chose to ignore Death because you had simply chose not to think about Death. Too scary. Yah, well now you’re too audited and too broke to do anything about it (or too dying and too broke to do anything about it, depending on your perspective).

Now, certain idiots in Silicon Valley think that 4chan “Internet is Serious Business” is a great big joke and that they can be invincible so long as they run around with their impossible powers like obnoxious children. Free! Free $44,000 from CMS! Just Sign Here!

Hey, this worked for Google, right? (no, but that’s what everybody thinks, so that’s what’s relevant)

The problem is that it’s not going to be the software vendors who will suffer the wrath of CMS. Or, they will, but the best nerds already expect to be kicked around —they basically build that into their business plans –you aren’t even a real Silicon Valley player until you can prove your creds by goading dumb jock powerful enough to kick at you. Meanwhile, the alpha nerds made their money, the bagmen kick down a few paper companies, and poof! Nerdswarm spores explode into the breeze —drift about, puff puff puff— until enough land in whatever new domain seems ripe enough for a whole new nerdswarm raiding party. These few hire their friends… The Great Nerd Cycle of Life begins anew. (that’s basically how I got to where I am, so yah, that’s basically how the technology industry works)

No, it’s not the guilty nerds who will suffer, its the most vulnerable doctors —and their patients— who don’t know yet not to blindly trust the alpha nerds and their blueshirt lackeys because, to doctors, they all look like harmless Best Buy kids with free cool toys and —oh hey! Free money from the government! Doctors can get behind “free money from the government” (especially when their own medical practice businesses are failing and their embarrassed to admit it)

Meanwhile, the real “muhaha’s” are left for the financier politocrats who don’t do the work and don’t care about the science but now have all the power because you idiots all bankrupted each other in a big “Who Is Most T Shirt Che Guevara” competition funded by increasingly “creative” loans and contracts gleefully doled out by Ambitious Young Men who also love to par-tay! and truly believe everything you do but who, regrettably *sad face*, had to include all that “boring legal boilerplate stuff” because otherwise their bosses would get all mad and, like, “Whatever, dude. Eat or be eaten… but not you. You’re a champ. A real go-getter.”

From KevinMD:

But – after I talked to an Apple employee, they informed me the 2009 American Recovery and Reinvestment Act of 2009 is one of the main reasons why Apple is trying to promote its platform for electronic medical record use – and one of the main reasons for the workshops.

Really? The best feature of the iPhone is that CMS is going to pay you to use it? That’s your pitch to doctors?

“Hey! Go Fuck with The Death Office! They’re giving out FREE MONEY! (sign here)”

Listen: most people already know that you can’t trust all doctors all the time. Why? Because you can’t trust all people all the time, and all doctors are people; therefore, you don’t double down any drug Whatever Clinic dumped into your purse to get you out the door because you saw it on television.

The same is true with technology. Use common sense! You are trusting these companies about which you know nothing with your most private and valuable information on the premise of what we already know to be a lie: Free $44k From CMS. Does it matter that from this lie that it doesn’t necessarily follow that the software vendor is untrustworthy? No, it does not follow necessarily, but then, neither does it necessarily follow that your ruin will be of Management Team Bagman at frothy Software Vendor Yesterday, or, much more likely but much less interesting, the simple bad business of giving away your only means of economically supporting your business to people you don’t know for free while meanwhile you refuse to address the most obvious flaws of your business including 1) you don’t understand technology 2) your business is utterly dependent on that technology 3) medical insurance stopped paying you and there’s nothing you can do about it (now).

Listen: if you make medical software, can’t you just made a reasonable product and sell it for regular money without all the gimmicks and stupid tricks? Is it really so hard to charge a fair price for a fair value? Come on. The iPhone itself is a great tool for a steal price because —with no additional “Applications”— it is already a cell phone and a pager that browses the web and downloads your email for a few hundred. Come on! That’s crazy voodoo magic. It’s wonderful! So, do you really have to also entertain these venture-funded campaigns to steal All The Medical Data in the World! (muhahaha) and then shuffle around all-bashful-like confused while they concoct troll-face excuses and Lawyer-To-The-Letter defenses to cover their own guilty-as-hell-but-too-smart-to-get-caught asses? Then what? Play or be played? Nerd rage on Twitter?

Go to hell.

There’s plenty of potential for great work in medicine without resorting to tricks. For example: you are going to die. So are all your friends! That sounds like a problem to me. Wouldn’t you like to credibly try and solve that problem rather than just blow about until you’re hired to push whatever stupid blueshirt tech fad you saw at the last bubblecon? I would. Hell, you can start all the back with “billing software” in medicine (yes, addition and subtraction) because —I can assure you from personal experience running an actual medical practice —doctors are not getting paid, and that’s bad —assuming you want anybody around in your country still in business who has dedicated their lives to understanding and healing the human body in a credible and responsible way? (Yes, you do.)

Yes, I think that DMV medicine is basically a given, but you people don’t have to exasperate it, and hey, maybe DMV medicine is not inevitable. Maybe I’m wrong, and the whole world will be singing koom-ba-yah because this “Free Universal Healthcare! (insurance)” thing actually worked out. Maybe Jesus will return to Earth and fix up the math of it with super Jew Plus Team America GO! chacha magic or whatever. And if I’m right and we (you) are all screwed, well, maybe now is the time to make friends with some private jet pilots (doctors) to discuss that other Plan B (your escape to the good private healthcare that’s going to be technically unlawful in a decade) because you’re not going to be able to do that so easily in twenty years standing in line to register your car and update your pharmacogenomic profile —especially if you’re already dead from hypertension complications or whatever because you thought this New Age stuff was the real deal and the DMV Clinic line was pretty long and it’s so boring and yah whatever smoking and drinking and fast food and soda really wasn’t that bad after all or at least you don’t care anymore so whatever.

(in response to “Lost” by Steven Murphy)

I claim that you can’t expect results better than the ideal model by using that model.

I claim that it’s not enough to choose another ideal model that gives you answers that you like irrespective of reality. That method already exists; it’s called religion. Go to church.

I say that genomics is the best opportunity of which I’m aware to design and implement a better model of human medicine, but that the gravity and magnitude of this potential as it can be applied to each human individual to themselves has been so far squandered by people who —by all external appearances— had just wanted to throw parties for themselves.

My frustration is that the leaders of “genomics medicine” were unworthy —which I claim by evidence including:

• their lack of quantitative results as measured in unhealthy people made healthy
• their failure to lead their teams and companies over even a few years
• sometimes even outright abandonment or exile which I can only interpret as shear cowardice or perhaps weakness but nonetheless was at the expense of the domain and those invested in it
• demonstrable commercial gluttony of pricing the market for genomic tests and services far below the sustainable cost to provide them
• demonstrable civil gluttony of abusing permissive public health regulations and academic endorsement until law enforcement is forced to interviene (e.g. FDA)
• demonstrable intellectual gluttony of abusing academic endorsements including those by Stanford, Harvard, Yale, Oxford, and Google which were justified as “experimental” until the community was forced to publish work which has humiliated even the endorsement of the theoretical substance of these “experiments”
• demonstrable publicity gluttony of abusing the trust of media institutions including the New York Times and Time magazine to broadcast bombastic declarations of the future which were then held against them when they were found to be absurd which has substantially damaged both the credibility and the morale of these institutions —particularly regarding their participation in this domain

I claim that the continued entertainment of the residual sophistry propping the myth failed leader’s success and their obnoxious superstitions is an obstruction, a distraction, and an insult, and I think that the people at fault are not the majority of the domain leaders themselves who are probably all too acutely aware of their own failures, but the crowds of teaming enthusiastic groupies who had believed the original mythology on the cheap but now will not be constructively disabused otherwise for a reasonable expense because it is more difficult to unlearn an identity than it is to adopt a new identity and because of a residual interest by this leadership to not publicly flagellate itself at its own expense and pride. These people are largely worthless excluding their unconditional support or cooperation which will no longer be readily available due to the abuses I described. It is my advice that this mess be labeled “DTC Genomics,” publicly mocked, cast away, and then relaunched under some other label which actually is the same people in the same domain doing the same work but without the negative connotation of “whatever was bad about the last time” which will be labeled as “DTC.”

People fail, but fail honestly, accept responsibility, and learn from your mistakes. No yoga happy fun time go team A for Æffort bullshit is going to get code written or diseases cured. This isn’t China; but it’s not the Special Olympics either.

Dr. Steven Murphy expresses another frustration which is that he knows that the best of what is already available in medicine has not been already widely applied before new methods are being explored. I agree, but I don’t think that is relevant to exploratory genomic medical application like as in the Lancet paper because that was not the intent of the paper and that would not have changed its conclusions or relevance. I also think that Steve conflates his general frustration with the politics of the domain with his frustration of its substance, and that this weakness (ie he’s a shitty writer and a sloppy debater) makes his arguments read like incoherent rants when in demonstrable reality he knows more about the successful application of genomic medicine at an individual patient level appropriate to expect in common practice because he actually regularly achieves this in his daily work as opposed to merely publishing theories about such application with experience limited to practice within City Of God like enclaves of a world class medicine institution. Being a shitty writer and a sloppy debater is irrelevant to Steve’s excellence as a medical doctor and is unlikely to necessarily prevent him from improving these skills given practice and relevant corrective exposure.