I spent most of my career in cancer diagnostics. Yes, there are other types of biopsies and surgical specimens looking for a variety of infectious or inflammatory diseases, but the bulk of the focus of surgical pathology is ruling out, screening for, or helping to direct the therapy of cancer.
Cancer is a scary disease. My mom was terrified of it. I am sure it didn’t help that it took both her parents. Back then, chemotherapy was not too good. At the beginning of my career, I quickly adopted the mindset that no one was ever going to give me chemotherapy. Feeling really shitty for weeks or months before dying anyway was just an ordeal I would gladly skip out on. But that’s just me, and different people have different ideas.
I use my wife and I as examples of different polar-opposite philosophies: my wife’s life revolves around her girls (so I constantly compete with the dog and the cat for the third wrung on her ladder). If faced with a terminal diagnosis, her primary goal would be time. She would want to watch the events in the life of her children unfold, and she would fight like nobody’s business for every precious second.
I would go with the squirrel suit.
My goals are different, and I want to face life on my own terms. I want to teach my kids by example, to encourage them to look where they want to go and reach for that goal with fierce tenacity. And that’s how I want them to remember me. Hence the squirrel suit. I’d really like one of those jet wings, but I hear they are tricky to fly and I have no experience so the tumble followed by vomit followed by my death and the destruction of some contraption that can’t be cheap…a man’s got to know his limitations. The wingsuit is a pretty binary trip that either ends well (in which case it was awesome and you get to go again) or it just ends.
I never really thought about dementia until it hit my mom. How ironic that she was stricken young with the one disease that is arguably worse than the cancer she feared. And now as my dad suffers with a different flavor of the same shit sandwich, I find I fear cancer very little now. Diseases like cancer are terrible and cause tremendous suffering and death. But there is one crucial difference: control.
The horrifying reality of dementia is that the victim is powerless. By the time you have any idea what is happening, the ability to decide your own fate is passed. I would prefer to avoid both suffering and death, but I would accept either or both in order to maintain control.
My hypothesis on poverty can be over-simplified as a lack of connections, but I find myself wondering if lack of control is another component. For sure, no one wants to lose control of their own fate.
And maybe a little of that is happening to us all right now.
We have been at this for weeks, trying to assess this new threat, how bad is it really, who is at risk, what will it do to me, how do I keep from getting sick. People deal with these things differently and for a variety of reasons. Some want to take shelter and wait it out, suffering now in the hopes that the storm will pass, biding for time. Others want to stare it in the face, and if it doesn’t go well, at least they go out on their own terms. And the more the stakes rise, the more polarized we become. Unlike some theoretical discussion about an issue that doesn’t genuinely impact our lives, this shit is very, very real.
Many have prioritized keeping people safe, but maybe what people really want is a bit of control. Is that too much to ask?
When you have lost almost all your control, sometimes it’s the little things that help you keep some semblance of self. Maybe what your neighbor needs right about now is to feel like they still have some say in their own destiny. Maybe sheltering at home is not the way they want to face a crisis. Maybe what’s best for some is simply allowing them some shred of independence. But it’s not about you, it’s about protecting others, right?
My dad has lost every spec of control. For two months he has been locked up in assisted living, suffering in isolation. He had already been having difficulty expressing himself, of finding the words he wanted to say, but now he can barely complete a sentence. Still, I don’t need the words to know what he is thinking: this isn’t what I want, this isn’t how I want to go out. And he is not alone, as many of our most vulnerable would choose to face life on their own terms, even now. I know I am really struggling with this strategy of sacrificing our kids to save our elderly.
It all reminds me of a bit by George Carlin: “Live and let live, that’s my motto. Anyone doesn’t agree with that, take ‘em, out back and shoot the MF.” Isn’t that what I am hearing?
I’ll put it in print now – like an advance directive – so when the time comes it’s all recorded: don’t even think about doing this for me, because if I had control, this is not the choice I would make.
A wise friend recently pointed out that my blog is linked to the MoveUP’s Facebook page and suggested that mixing politics and business may not be a good plan. This is not the first excellent advice that I have chosen to ignore, however the intention of all of this writing is to be the mission statement for the company we are building. The hope is that we will look back and see the philosophy that shaped our work as opposed to a marketing statement crafted post-production to try to instill faith in a customer base. Everything that has influenced how we got where we are today and our path to the end goal is here.
MoveUP didn’t actually start as a transportation solution, it started as an individualized solution for connections. Connections are valuable. They are powerful. Enabling people to make connections on their own terms for their own benefit, that’s MoveUP. It just so happens that the value of connections extends to transportation, where a person might connect with someone who is able to get that someone – or someone else or even something – someplace else.
The name MoveUP doesn’t refer to moving people or even stuff, it refers to this idea that we might evolve as a society by improving how we connect. We believe that intelligently designing and implementing a platform that allows us to live together cooperatively could facilitate reaching our maximum unified potential.
To illustrate this, I want to introduce the next phase of MoveUP’s development: PHISion.
PHISion is a Personal Health Information Solution. It is a way for you to collect and manage various data that might be important to your health, all completely controlled by you. It also allows you to connect this data to whomever you wish- family, friends, or maybe a doctor – on your terms, and with the utmost in security.
This is far from the first health app, but it is completely different because it was designed from the beginning to enable you to live better on your terms. Every other system was designed from the beginning to have some control over your data, because that data – and the ability to connect it to other things or share it with other people – that has value. We will let you be the one to realize that value.
Like every component in MoveUP, PHISion’s functionality will expand over time, but its core components are: weight, resting heart rate, and gps location history.
Today, the discussion of weight is consumed with obesity, but the untapped potential is monitoring for unintended weight loss. Most lung cancer patients present with unintended weight loss, and other types of cancer may do the same. No, unintended weight loss does not mean someone has cancer, but in today’s society, losing weight without trying raises a red flag. PHISion will allow you to easily store your weight securely where only you can access it. Meanwhile, an algorithm steadily monitors how you are doing and can alert you if it appears there could be a problem. How that works – an alert just for you, or maybe a simple message to a loved one or your doctor, or maybe a combination depending on the level of concern – that’s completely up to you. Note that the actual data – how much you weigh – is not important (nor is data like your address or SSN). It’s just a screen to safely and easily help catch potentially serious diseases a bit earlier.
Resting heart rate has similar potential, because unexplained increases can indicate an underlying health problem like evolving anemia or poor management of a chronic disease like diabetes. Resting heart rate is like an engine at idle and can be measured by most health trackers. The data can be stored securely, and a similar algorithm can initiate a very similar alert with the same flexibility, security, and individual control.
Though a potentially powerful tool, storing historical gps data – tracking your location – is a very sensitive discussion that raises numerous ethical issues concerning privacy. PHISion eliminates those worries by giving you complete control over your data in such a way that no one can access it without your consent. Furthermore, it allows you to share that data in a deidentified form on your terms. For example, allowing researchers to see if there is overlap in location between one person with a disease as compared to other people with the same disease can unlock patterns of spread or contributing factors that can to effective strategies of prevention or even management. Notice that it doesn’t matter who the people are – the data can be stripped of names and other sensitive information – it is simply a matter of connecting the dots to the diagnosis.
There are important considerations for all of this, and PHISion will walk you through things you may not have thought about, like how to read a consent form for a research study before turning over your potentially sensitive information. A gps data file can never be truly de-identified because it will include information like your home and work that someone could use to figure out who you are. That means you want to be careful about who you share this information with, what they intend to do with it, and what assurances they can provide you that you and your information will stay safe. These are the types of issues a medical research team is required to manage, but industry often lacks this level of oversight. PHISion and MoveUP were envisioned to help you understand how to get the most out of what you have with unmatched safety.
As usual, I made myself the test subject and have been tracking my own weight and resting heart rate for several years. I wanted to evaluate the overall cost and difficulty, because it doesn’t matter how powerful a tool is if no one will use it or many can’t afford it. And these three metrics are just the beginning: the underlying architecture will allow for you to manage anything related to your health, from medical records to laboratory data, even social history that updates in real time using secure connections to other family members.
Because all of this was integral to the fundamental intent, it all comes down to connections: connections to what is important to you, to who is important to you, to the what’s and where’s and when’s that are important to you. It’s all designed so that we can MoveUP.
There are a lot of diagrams out there trying to make complex stuff easier to digest. It’s got benefits, but one of our biggest problems is this need to have everything explained in a headline or fit on a single slide, and the world just doesn’t work like that. To explain, I made my own diagram.
Actually, I stole someone else’s and modded it. (Maybe that Fast and Furious marathon wasn’t such a good idea).
This is intending to explain the complexities of public health. The most important lesson: it’s complicated.
On the left you will see a wonderful rendering of blue and green peeps participating in increasing restrictions to prevent the spread of COVID. The first modification I made was to remove the numbers as the original diagram had percentages that were supposed to be the exact risk of transmission in each of these scenarios. I did this because these numbers were not what we would call in the scientific world “significant figures.” I am taking a lot of license with that term here, but let’s just say there is no way anyone should regard the reported figures as factual for a couple dozen different reasons. But don’t worry, because no one will deny that we have ranked our blue and green citizens in decreasing order of risk of transmission, starting at no-holds-barred rock concerts ad nauseum and ending with our unfortunate neighbors hermetically sealed in their homes.
The original document also attempted to discriminate between uninfected and asymptomatic carriers, a distinction which is theoretical at best in the real world. On this, let’s just agree to disagree and instead recognize that one cloth mask between our subjects is better than none, and not as good as two. And with a few quick clicks in Microsoft’s ubiquitous Paint, we have arrived at a universal consensus, at least as it applies to the transmission of virus.
But, as I stated, it’s complicated.
The next column refers to the social mandates required in a free society to achieve these scenarios, and then a list of major categories of repercussions: public fear, the public impression of the government, the economic impact, the psychosocial impact, the impact on education within the community, and the impact on the management of all of the other disease processes like cancer, heart disease, and diabetes.
The goal with our decisions is supposed to be the best overall outcome. The problem we often face with a complicated chart like this is that you can’t just look at one column and select the best answer, because you have to balance the real-world repercussions of that choice. Furthermore, we have to let go of the ideal: regardless of what anyone thinks should happen, it’s what does happen that matters. So even if you believe that everyone should get on board with a particular idea, if that’s not going to happen, then it doesn’t matter why, it’s just not going to happen.
There has been a lot of discussion of public fear. I want to point out something on this little chart: note that I estimated fear higher in the situation where we do nothing. That’s because the scary ship has sailed. People are already afraid, so if we just shrugged and said, “Move along, please, nothing to see here!” That would actually make things worse. People want guidance and reassurance, and things like masks make some people feel more comfortable. That’s real, and we shouldn’t pretend there is no risk when there is risk.
Well then, what is our leadership to do? We are now slipping below the murky surface in the turbulent sea of politics. I often say that we need to stop looking to our government as a source of solutions. That doesn’t mean that no one in government is a good person or wants to do good things or has great ideas, it’s that politics is truly two big parties that are entities in their own right, and individuals are no more capable of controlling those entities than an individual cell in your body. Which means these parties are going to act in their own collective self-interest regardless, which is extremely unfortunate, because it’s times like these when we need to have truly effective leaders.
If you really want good outcomes, then you want everyone (or as many people as you can) united, and that’s the problem with our current system. When the pollical party’s primary objective is to win an election, then the outcome only matters as it relates to that election. We all know that a massive disaster can be a huge boon for a pollical party so long as the public blames the devastation on the opposition. Our current situation has become political, so what our leaders do has an effect, not just because of the policy itself, but because of the public reaction. That reaction is real and it has to be considered in the equation. And no, you don’t get to say, “but this way is the right way!” Because it doesn’t matter. If a policy is going to result in rioting in the streets, then the rioting and the resulting destruction has to be included in the discussion. If locking people in their houses slows the spread of disease but results in a violent divide of the people, then these factors have to be weighed.
I am not going to spend much time on the economic component in this, except to say that if you are reading this from the comfort of your own secure home, you are probably going to need some empathy to contribute in a meaningful way.
The social – or really psychosocial – impact is one that is hard to quantify but may be the most important of all. If you look at societal issues like poverty, you come to the realization that a lot of measurables – incomes, cost of living, resources, employment rates – these don’t necessarily correlate with happiness. But if you think on the goals of the founding fathers, it was prominently featured: life, liberty and the pursuit of – you guessed it – happiness. This is so hard to achieve in the real world, where people’s views and perspectives differ, and it’s all been muddled by the insertion of for-profit social media platforms that capitalize on our innate attraction to issues that resonate with our fundamental beliefs, profiting from our texted, emoji-laden conflict.
Public schools and small businesses have a lot in common: both are major cogs in the machinery of society, and they both struggle in the best of times. Neither is capable of successfully adapting to the pressures we have placed on them. If you don’t understand what I mean, go to your favorite establishment and watch them try to modify their business model from one of multiple servers waiting on a variety of customer tables to a single input of a phone line while attempting to manage curb-side or delivery service as a primary mode of business when it represented a sliver of what they did in their prior life. I am going to vehemently disagree with the people who think the failure of restaurants is just part of the circle of life, but when it comes to schools, a lack of appreciation of the importance of having an educated society marks you as a irrecoverable dullard. Schools already have an impossible task, but forcing measures like a continuous maintenance of six feet between students at all times will render them completely ineffective, and the most severely impacted will be those already at the bottom of the pile. The repercussion of this will be almost irrecoverable.
The other health concern column is intended to include things like cancer screening and care, which has been supplemented by our focus on the care of patients with COVID. If we keep you safe from this virus only to have you die of some other (potentially preventable) disease like suicide, what do we put on the scoreboard?
When you put it all together, you start to see why a little compromise goes a long way. Again, if you just focus on one issue and demand an extreme – everyone should wear a mask all the time and I just don’t give a damn if you don’t like it – there are very real and devastating repercussions that come when you force the issue. It all depends on whether the best public health outcome is your goal, or whether you absolutely have to win this particular issue, no exceptions.
So, what’s it gonna be?
By the way, there are times when you don’t really want to be right, and this would be one of those times. In the 36 hours since the completion of my last blog where I discuss at length the risks of ineffective facsimiles, my father had a routine screen prior to being transferred from his current spot in an assisted living center to a true memory care center where his dementia – markedly exacerbated by isolation – can be better managed. And he tested positive for COVID-19. Which landed him immediately in the lock-down ward in the hospital, which will turn this isolation thing up to eleven. Though it might be that his condition, his rapid decline, and the lost social interactions – like my being able to explain to him that I published the app I envisioned to help him have a better life – these were insignificant loses next to the need to protect his vulnerable neighbors. Perhaps, but these are very real to me and I want them to be reflected on that hypothetical scoreboard.
Whereupon you scream: How is this even possible, his facility was locked down!
No, it just looked like it was locked down – an ineffective facsimile – because we don’t do real lock-downs here, it’s just not possible.
Well, you say, who is to blame?
Who the actual-F cares? Policies were put in place – relative isolation – in an attempt to protect the very vulnerable inhabitants, but these only delayed the inevitable. To truly stop the spread of a virus in society, we have to literally stop society – see the bottom row on the chart – and that’s not compatible with life. If you fixate only on one column and ignore the rest, you lose sight of all of the devastation that happens as you fail to achieve your goal.
But someone must have violated a policy!
Yeah, I imagine they did, but only because the plan wasn’t realistic. At the end of the day, it doesn’t matter what you are trying to achieve, the only thing that matters is what actually happens.
The better plan is to accept the realities of the risks and dangers inherent in life and try to establish practices that do the most good while causing the least amount of damage.
There are no guarantees in life, but letting people live as they want to live is generally the safe bet.
This is literally blog #7, and I am going to actually put this one out there. I haven’t published the past half dozen because right now it is politically incorrect to offer a different perspective, and I have been afraid of the backlash. That right there should say something. I am now going to be brave enough to stand up for what I believe and overcome the fear of the inevitable misunderstanding and hatred. Also, my frustrations are going to clearly come through in this. They are not directed at any person but emanate from the way our interactions over social media have destroyed our ability to work together.
I am a doctor and I do not support the widespread use of cloth masks in public, and strongly oppose a government mandate to this effect.
Many of you are already looking for the biggest thing you can pick up, so before the rocks and chairs are in the air, I will try to go through this logically.
From the very beginning, I have not supported the disruption of normal life to fight a virus. I still do not. That does not mean I believe it’s a hoax or a bioweapon. It doesn’t mean I don’t care about other people, or that I refuse even the slightest inconvenience to myself for the betterment of others. It is because I believe that more harm will come from the disruption – even temporary – of normal life than from the virus itself, and that we could have implemented more effective practices and policies that allow better mitigation of the threat with far fewer iatrogenic consequences. And we have got to do a better job with both the restarting and subsequent continuation of society as we know it.
We actually have an opportunity here to make things better instead of worse. Mandating the ubiquitous wearing of masks will make it worse, not better. Intelligent application of the tools at our disposal based on genuine science (not mathematical models) with an understanding of the of real-world application is a much better tactic. I suggest we try out this novel concept.
Our approach to the wearing of masks is looking to be identical to our approach to the use of quarantines, testing, and contact tracing: ubiquitous application of a facsimile.
We saw evidence suggesting that quarantines worked to mitigate this virus, so we decided we would put everyone in quarantine. Hey if a little works a little, let’s try a lot! We didn’t really think about the fact that there are important details about quarantines that are required to make them effective and that we couldn’t actually do these things. It still looked and felt the same, so we ignored the realities and went all-in. Furthermore, we didn’t take the time to effectively quarantine our most vulnerable, and we didn’t do a whole lot to mitigate the irreparable harm that all of this was doing to the vast majority of people, instead lashing out at anyone who complained and accusing them of thinking only about themselves.
Now we are looking back at the way the virus got on and – despite the fact that we have no control group to compare it to and the natural history is shaped just like every prior respiratory virus pattern – we are congratulating ourselves on curbing the spread and using that as rationalization to kinda ignore the damage we did. And we are afraid to go back to normal life, with some even suggesting this should become the new norm.
And then there is testing. This whole subject sticks in my craw because there is constant insistence that we listen to experts and for the love of all that is holy I am an expert here. And when I tell you that there are limitations to testing you should at least offer up a few brain cells and hear me out. There are times when testing is very helpful, but there are important details that are required to make it effective and we shouldn’t ignore the realities again and just go all-in, especially when – like quarantines – you can do a lot of harm if you do it wrong.
There is an unfortunate reality of testing for this disease which includes what we can actually do about it – or more specifically what we can’t – that severely limits the real-world utilization. The first rule of laboratory medicine: don’t order a test unless you are going to do something different because of the results. We have no specific COVID19 treatments of any kind, so testing has a very limited role. I am very sorry this fact doesn’t make you comfortable, but it is what it is.
Before you belt out the battle cries “asymptomatic carriers!” and “contact tracing!” let me finish with testing:
The test we should be doing widely but stopped – one of our biggest scientific mistakes in all of this – is the test for influenza. We should be doing that test because (1) we actually have treatments, so we can do something different based on the results, and (2) we could be scientifically measuring the actual impact of all of our attempts at pseudo-quarantines on the spread of a virus where we have tremendous past data and the two diseases spread in exactly the same way. In short, we blew our chance to have a near-perfect control and a real scientific study instead of more facsimiles (mathematical models).
So now people want to screen asymptomatic carriers to eliminate what is widely regarded as the major source of transmission (and I am going to leave out all of the arguments against this concept, because I don’t think you will accept this no matter what). When I tell you that’s just not possible, the reaction seems to be to somehow make it possible. Well here is the reality we face: It’s not possible. (And yes, on this, I am an expert). But… you are going to cry… this is precisely the scenario where we would do something different! So we have to have it! And others did it!
Nope, they didn’t. And furthermore, you aren’t going to do the other stuff like contact tracing without consent and forced quarantines, so once again, there are important details required to make this process effective, so don’t implement yet another ineffective facsimile.
It’s not possible because what we wish we had – an instantaneous, inexpensive, perfectly performing test to detect dangerous asymptomatic carriers – it doesn’t exist. The test for asymptomatic people is the one where you ram the swab up into your sinus (which is not comfortable, by the way) and it is not easy to perform, easy to tolerate, rapid, inexpensive, nor perfect. The idea that we would test everyone on some regular basis is completely ludicrous. The fact that it is impossible to test every school kid in our little city even once – that’s 15,000 kids (and 1.5 million dollars) – should be obvious. On a weekly basis? Seriously?
Thermometers have been the first line and most effective testing method in every successful model. A change in our society where we are expected to stay home when we have a fever or just don’t feel well would be more effective in mitigating the spread of diseases than anything we have implemented over the past few months. (Resting heart rate remains a powerful tool we continue to ignore, but I hope to do something about that…)
There is a place for laboratory testing, such as where my father was just tested as a screen before being moved from his current home in assisted living to a memory care unit for dementia. By the way, the move was precipitated by the stress of isolation; I am not suggesting there was anything that could have been done differently, but damage is damage.
The only thing I am going to say about contact tracing is that you are getting ready to see industry try to position themselves to be able profit on the ability to track your movements, and the government is going to try to make legislation about technology that they don’t really understand. (We are working on a better solution and it’s tied to that resting heart-rate thing… stay tuned).
And now we arrive at masks. This one seems obvious, right? It’s not a big deal, just put on a damn mask and keep everyone else safe. If this is a problem, then you really don’t care about others.
Once again, it seems obvious, but it’s not.
Masks are just like quarantines: an ineffective one is worse than none at all. Now I am having enough trouble explaining to some people how big a mess we made when we shut down the world, so explaining the negatives of mandating the ubiquitous wearing of masks is a tall order. But like everything else in life, these things are intertwined.
Frist, these cloth masks are ineffective. We know they are ineffective, and that’s why we have never mandated them for influenza and other respiratory viruses – even in doctor’s offices and hospitals – when these viruses kill tens of thousands of people every year. Believing they are more effective than they are leads to a very-real false sense of security, especially in vulnerable people. Am I saying that wearing a cloth mask will not in some way reduce the spread of respiratory viruses? No, what I am saying is that wearing willy-nilly cloth masks is not effective – you need a properly designed and fitted mask to actually be effective – and vulnerable people need to be effectively protected. Instead of having the entire world adapt to an ineffective practice that can make vulnerable people feel unrealistically comfortable and potentially lead to their getting sick and dying, I suggest we better protect the folks who need it.
People like cancer patients and others who are immunocompromised need to be protected no matter what. They need effective (N95) masks that work regardless of whatever the people around them are doing, because someone could have a raging fever from influenza and wear an ineffective cloth mask and wander about spreading that shit to everyone. It boggles my mind that the use of bandanas or home-made – even industry made – untested cloth masks is reassuring. And we are resisting the use of thermometers…
Now, if you are otherwise healthy but it makes you feel better wearing a mask, have at it, but I still don’t like it. (That, by the way, is me allowing you to do what you want to do, even though I don’t think it’s a good idea). Whether anyone cares to admit it or not, the routine wearing of (ineffective) masks in day-to-day life perpetuates fear over logic. If an uncovered face elicits a reaction in you, that’s a real thing. That’s fear. It’s also anger and resentment, and all of this is misplaced, but masks have been turned into a symbol. The wearing of a mask – despite the real-world dangers that I have tried to explain – is now equated with caring about your fellow man, and not wearing one clearly demonstrates you don’t give a happy crap about anyone but yourself.
This mentality has got to stop. Life has to go on. Shutting down society was never the right plan, we didn’t really change the natural course of this virus, and we will be a long time digging out. We have to stop applying ineffective measures to the whole world and instead cooperatively apply effective measures in the places where they will do the most good. Like reopening schools but with systems that allow our older and immunocompromised folks to effectively participate from the security of home, while kids – who we have harmed far more than we have helped – get to be kids with a genuine future.
I refuse to sit quietly and watch as we continue to try to force each other to do ineffective stuff instead of doing the right things for the right people at the right times. If we are going to create a new normal, then it needs to be one where logic reigns over fear.
It’s here. 4 years of planning, 2 years of software development, countless hours devoted to fixing a ubiquitous problem. We have changed laws, challenged convention, grown in scope and support, and now a pandemic is forcing the issue. Like everyone else, I have had to adapt to this new virtual reality, so I made a video to summarize where we started, where we are, and where we are going:
The generation that is shaping our future economy doesn’t understand the importance of product compatibility quite like my generation. They didn’t live through the VCR vs. Betamax era, where you had to pick a side of the movie rental store and cross your fingers. The iPhone vs. Android battle remains a nuisance, but software advances have helped to force cross-compatibility. In day to day life, these are annoyances, but it is the behind-the-scenes incompatibilities in our businesses – including healthcare – that is really costing us time and money. We will see incredible benefits as a community by standardizing our digital infrastructure. MoveUP will be an example of that, allowing us to share a single transportation platform.
Over the past few weeks, I have been interacting with as many business and people as I can (mind, while maintaining a safe, virus-free distance). The goal is to choose a platform for electronic fund transfer, which is why we haven’t embedded this function yet. It’s an important choice, because we will see far and away the greatest benefit if we all adopt a single platform.
Let me ‘splain:
A bank is where you keep your money, and this is a personal decision. You may have a nearby branch or ATM, you may be a credit union member, you may have a mortgage with a particular company, whatever. We have been moving from cash to plastic for a long time, and most are aware that using a credit card costs money – the merchant pays fees for its customer’s convenience. You may not think about it, but we all pay those fees, it’s just they are worth it. Progressively, ways of moving money electronically have emerged, like PayPal. These companies allow electronic fund transfer, and we are doing this more and more.
Unlike a personal bank, electronic fund transfer is all
behind the scenes. It doesn’t matter how
it happens so long as it is easy, secure, and inexpensive.
Because these companies make money on transactions, the more transactions, the more money they make, and the more it all costs us. Transactions between systems such as from PayPal to a bank are more difficult, less secure, and more expensive. Internal transactions – PayPal account to PayPal account – are easy and flexible, more secure, and much less expensive or even free. Because we don’t see any of this, if we all adopt a unified system, we will all get a lot more for our money.
But boy is it hard to get people to agree on anything!
As they grow and fight for market share, many of these company’s offerings are beginning to overlap, like PayPal, Stripe, and Square. PayPal started as a way for online vendors such as people selling on Ebay to accept electronic payment without having a contract with a credit card company. Stripe is another electronic fund transfer company primarily for online transactions. Both companies are now expanding into the small business market with systems allowing in-person payments, because there are different needs for each.
Square began as a company that allowed in-person transactions from people on-the-go such as a plumber or a food truck to accept credit card payments anywhere and without a fixed cash register. Because of its roots, it has led the way in products designed for small business owners, and is now expanding its own offerings to include things like accounting and payroll. And electronic fund transfer.
As we try to find a path that is best for us, easing the transitions of the long-establish small business into the digital world is a top priority. I am seeing the real-world challenges of connecting a very analog restaurant with a digital delivery network, and many of these businesses will not survive if we don’t do something to help. The ability to work on a massive scale is the sledgehammer that Walmarts and Dollar Generals use to smash small local competitors out of existence. This is why I am leaning toward integrating square into MoveUP. I believe this will not only give us an electronic fund transfer platform that is essentially equal the its competitors, it can be more easily integrated into small businesses that currently lack these capabilities giving us greater flexibility, increased security, fewer transaction fees, and minimizing costs for everyone.
This doesn’t mean that if you currently operate a restaurant or small business using another vendor that you will have to switch – if it ain’t broke, don’t fix it. We already have a connection to the online e-commerce platform Ecwid, and this is a flexible and inexpensive way to move into the digital world if you remain a hold-out, like many of our iconic watering holes. This is not about forcing personal preferences like banks, this is about the shared network that connects it all together. That’s where the real money is.
If there is anything good that is going to come out of all
of this, it is the fact that we are going to be forced to take care of each
other. I really like this, because it
may be the first time in history that we actually have the full capacity, and I
have been looking for a way to prove it.
I didn’t ask for this plague, but I am going to make the best of it.
(You locked me in my house, so get ready for some philosophical
rambling… I encourage you to push on through this one…what else have you got to
There are three main forces that shape our lives, that hold
together the framework of our modern society, listed here in the order in which
they were created: government, industry, and healthcare.
For a really long time, government was the only significant player,
and it was what pulled us out of primitive anarchy. For thousands of years, government was
authoritarian: you did what you were told to do. Over time – and these United States led the
way – societies have shifted to governments that allow personal freedom for the
vast majority and mostly serve to keep the jack-o-napes in line. This works pretty well, but there is a major
problem: modern governments in free societies can’t make people ethical. They can stop people from being shitty, but
they can’t force you to be good. And
like it or not, we are all driven to do what we need to do in our own best
In more recent times, industry has taken on a greater and
greater role. This has truly brought a
revolution of products that have changed our world to the point that it would
be unrecognizable and almost unnavigable to someone who lived some two hundred
years ago. Water and electricity, boats
and trains and cars and planes, and now computers. Those computers – for better or worse – have
reshaped literally everything. But industry
has a deep-seated problem that’s not unlike our own: we can’t force companies
to be ethical. We can pass laws to try
to keep them from being too shitty, but we can’t force them to be good. Just like people, businesses are going to act
in their own best interest, and that interest is first and foremost money.
Healthcare wasn’t even a factor until recently, and that’s
because we didn’t have anything that could meaningfully affect your life. In
the not-too-distant past, if you got sick, you died. We are in the middle of a pandemic, but even
the worst-case scenario isn’t going to be a fraction of the toll of something
like the bubonic plague that killed near on half the people in the world and
resonated for a couple of centuries. The
life expectancy then was about half what it is today, and now the pace of
medicine is so rapid that it is impossible for a physician to be current in
anything but a narrow specialty. In
addition, we apply what we know to everyone, and we still haven’t adapted to
that massive change. So as the cost of these
advances continues to climb, the growth of this societal expense is
exponential. Cherry on top: how we
live is more important to health than treating things when it goes wrong,
so the astronomical spending in healthcare isn’t making us any healthier.
None of these things can save us. The government can’t make us be good people or
force businesses to become benevolent. The
businesses that are our industry, no matter what they make or do, were designed
around a profit motive, and so it is a requirement for their continued
existence. Healthcare is focused on
fixing things that go wrong despite the fact that our health is determined by
how we live, not how we are treated. So
what are we to do?
I suggest we create our own solutions, and for the first
time in history, we can.
Remember those computers?
They have changed the single most important aspect of our society: how
we connect. Throughout history, all those
thousands of years, societies are based on how people interact, how we
connect. Until the last few years,
those connections have been primarily personal, face to face. For a long, long time, we had no other
choice. We invented writing and mail, then
things like telephones, and now we have these hand-held computers that let us
connect in new ways and almost continually.
Some want this to stop, because it is not how they learned to interact,
and it’s just not natural. But these
thoughts are folly, these things are here to stay, and so the way we connect
has changed forever. Whether we want to
admit it or not, people like to connect, and industry is going to feed that
desire: it is going to sell us new and better stuff that we want. In a free society, the government is not
going to limit this, and even the healthcare system is trying to figure out how
to use this to advantage.
The one thing we haven’t done is the one thing that we can
now do: decide how we want to connect.
We can now build systems that let us connect on our own terms, the way
we want, as much as we want. The secret –
the magic ingredient – is called software. These new languages that tell these computers
what to do has advanced just as rapidly as everything else. Software is actually what makes computers
powerful, and we can now make – write – almost anything we want, easily,
inexpensively, and reproduce it over and over again, for free.
About ten years ago, a company called Uber brought us a new
way to connect. Transportation is
essential for modern life, and this software – this app – allows someone to connect
to a ride. This connection has
value, and the company was built on the idea that it could capitalize on that
need, it could profit from our desire to have a ready means of getting around. This is time-honored economics: supply and
demand. You want it, they have it. But the company was created to make money,
and the design of their app allows them to control that connection; without
that control, there is no way to profit.
OK, what if we write our own app? What if we make a system that is even more
powerful, one that can be used by even more people, one that lets anyone connect
on their own terms, the way they want, as much as they want? And what if we can reproduce this system, and
make it safer, and make it more flexible, and make it available to anyone? Well this is no way to run a business, but
that doesn’t mean it can’t be done. So
what would happen?
We are getting ready to find out. We have this tremendous need to connect, and we
now have the capability to do that on our own terms. Connections are extremely valuable, and we
can now distribute them to everyone the way they want them, as much as they
want. This is going to change society
again, but this time in a good way. Connections
are the asset that we can now provide to others without cost to anyone, where
the more you take of that asset, the stronger you are as an individual, and the
stronger the community becomes as a whole.
We will be enabled to meaningfully connect with whatever and whoever we
want to, to live better, to live healthier.
We will be able to take care of each other, not just in this time of
crisis, but into the future.
What we demonstrate over the next few months will become a template
for creating solutions that we will never get from government, industry, or
healthcare, because it’s not what they were designed to do. But that doesn’t matter anymore, because we no
longer need to rely on someone else fixing our problems for us. Instead, we can finally come together and do
We are facing a crisis of a magnitude that few of us alive
have ever seen. If we want to avert disaster and minimize the damage, we are
going to have to do it ourselves. Think
The crisis I am talking about is not viral, it’s societal, and we must act now to save it.
There are a lot of statistics being thrown about, and we use the credentials of whoever is stating their opinion to judge how much stake we should put in their prediction. I don’t have a background in economics, so I’ll mitigate my lack of training by sticking to things that are either indisputable facts or stuff I do know about.
Here is a fact that falls into both categories: Doctors are terrible
at business. I am not going to argue with
anyone about pandemic predictions, but the economic impact of what we are doing
is going to be absolutely devastating, and the people hardest hit will be those
who were already at or near the point of breaking.
More facts: money is a proxy for goods and services. I think we have collectively forgotten that.
Thousands of years ago, the concept of eat what you kill
had a literal meaning. In the healthcare
world, it refers to a reimbursement structure based on productivity, but I can
think of maybe one doctor who could hack out an existence without the protective
veneer of society. Perhaps a refresher
course in the most basic sociology will be a wake-up call.
All those years ago, we started moving away from the nomadic
hunter-gatherer life and started settling down in groups. We began to specialize, with different people
taking on different tasks. As we continued
that specialization, we introduced money as a way of exchanging different
stuff or tasks, so we could compare things like hunting with cleaning the hut. That way, we could all eat, even though only
a small number did the actual killing.
As we improved on all of this – as we got more and more efficient at the
necessities of life – we have been able to spend more and more time doing fun
stuff, like sports and recreation.
Today, the more money you have, the less time you have to spend on the
necessities, the more time you have to recreate. For some, there is not enough money to make
One of our problems is that we focus on the money, and we
forget that money is nothing but a proxy.
It’s the goods and services that have the real value, and if they go
away, bad things happen. To all of us. When we decided to set up this thing we call
society, we kinda left behind any backup plan.
This machine we built is literally life-sustaining for all of us, and
each cog is interconnected with the others to make it work.
I am going to run with this machine analogy, because I know more about these things than most of my doctor colleagues. Think of money as gas: it powers the whole shebang. If you run out of gas, the engine stops. Put gas back in the tank and you can start it back up. That’s like a recession. Now, if you tear up the crankshaft and punch a hole in the side of the engine block, the engine also stops running. Except now it doesn’t matter how much gas is in the tank, and it’s quite possible the whole thing will catch fire and burn to the ground.
And that’s exactly what we have done. There is still gas in the tank, but we just ripped out two of the most important gears of the machine that is our life-sustaining society: schools and restaurants. You may think we can go on without these things, but all of the gears of the machine interconnect, and you can’t just shove a wrench into the works and expect the rest of it to keep turning. But we had to you say; it doesn’t matter why, it’s done, and the effects will be the same regardless.
So think Dunkirk, where thousands of regular folks did what needed to be done to mitigate disaster. We need to save our restaurants and small businesses, and no one else is even capable of doing it for us. If you think the government throwing money at us will help, think again: the machine must start turning. Remember that money is just a proxy, and we are the ones that will have to do the work. This morning’s estimate (from people that actually did train in economics) was that more than 75% of restaurants will go bankrupt. And that’s today’s prediction. The longer this goes, the worse it will get.
To save these essential components of our society, we need a delivery system. If we are all stuck in our homes, we need a new way to move stuff around. We have to keep the specialized tasks that are the inner workings of this engine connected together and turning in some sort of harmony, or our entire society is going to come to a screeching, smoking, potentially blazing halt. These businesses need customers and people need jobs. We have to be able to get stuff to people that need it, whatever the reason. Rebuilding this machine is going to take time, so there is none to lose.
Safety. A valid concern,
but the alternative – inaction – ends in chaos, so let’s focus on doing this
the best we can. Young people are
probably our best source of delivery people, since they are at lower risk of
adverse outcomes. Plus, they aren’t in
school, so this will give them something to do.
Money. This is not
the time to focus on money, focus on the task at hand. Drivers need to be paid, restaurants and businesses need to be paid,
the flow of goods and services needs to be sustained. Your retirement account is not going to be of
value if the world around you is in shambles.
Unemployment in the Great Depression topped out at something like 25%, and
it took us a decade and a big war to dig out.
Connections. This is
where we have an advantage. We can use
new methods for connecting that allow us to coordinate and collaborate in ways
impossible even ten years ago. Smartphones
and social media have changed the way we connect, it’s time we begin using them
to advantage. Thus far, the systems
introduced have been designed to profit on our needs and wants. We will need to move past that and focus on
Think Dunkirk. In that miraculous evacuation, no one thought about money. No one consulted a tax attorney, no one re-read their liability policy. The government cannot save us, as it has no capability to keep our small businesses – the core of our society – running. Money will not get food and supplies to people that need them, we will have to physically go and do it ourselves. No amount of money could have extracted the trapped soldiers from the northern coast of France. The corporate world is only designed to capitalize on problems, not find solutions. Healthcare systems treat the diseases of individuals and have no assets to support the health of a community.
Right now, we are developing and implementing systems in our town to facilitate deliveries. I believe this is going to be absolutely imperative to save our communities, and what we do here can be done anywhere else. If you are thinking I am just trying to sell my widget, keep in mind that I have been trying (using lots of data) to illuminate our desperate need for these things long before Corona was anything more than a mass-produced beer. Nor do I support this whole fiasco, but it’s not about who is right or wrong, it’s about saving our people, our communities, our society.
So we are building a tool that will help people connect and hopefully facilitate doing what needs to be done. Forget politics, forget blame, forget predictions, focus on the problem at hand. Think Dunkirk, and let’s try to avert this disaster together.
Social distancing? Sorry,
but I don’t agree. I think life is more
important, and life comes with risks. (I
apologize for the exponential infusion of cynicism in this angry ramble,
It has become virtually impossible to even know who to listen to, as there are thousands of experts talking about everything from molecular biology to statistics to epidemiology and who is right? One thing is for sure, we have collectively become Egon Spengler: we are terrified beyond the capacity for rational thought.
As I type this, the current stats for influenza in Virginia are here, but we all know you aren’t going to read through it, so I will summarize: 10,234 cases, 782 deaths. At the risk of making this argument overly data intensive, I’m going to convert that to a mortality rate: 7.64%. And that’s the disease we aren’t really worried about, because we have these treatments and vaccines, so hey, no biggie. Don’t worry about that, because the real big one is coming, so we must stay away from each other, we have to stop living, to prevent this (inevitable) infestation from wreaking havoc upon our society.
Wait, we kinda just did that ourselves.
An incredibly intelligent friend shared a bit from the NY Times about our perception of risk. He’s a pulmonologist, which is the type of doctor that takes care of people with influenza in the ICU. I’d share the link, but the Times wants you to have a subscription or give them a kidney to have access, and precious few would read through it either so I will again summarize: when it comes to assessing risk, we suck at it.
There is another bit that I read a long time ago which has proven out like the prophecy in an epic fantasy about how we form and maintain our opinions. Summary: I am not going to change your preconceived beliefs. No matter what logic I use, no matter the data I show you, your mind will simply continue to believe whatever it is that you want to believe. If my argument is in lockstep with your own opinion, well… exactly! But if I present evidence that goes against what you believe, something funny happens: it still strengthens your convictions. It also proves that nagging insight that’s been lurking for a while: I am a babbling idiot and anything I say from now on can and will be used against me in the court of public opinion.
So we are supposed to all adhere to “social distancing” for the
betterment of society, to protect our loved ones, our young, our old, our vulnerable. To even suggest otherwise clearly
demonstrates a wonton disregard for our disadvantaged. Um, what about smoking and alcohol and (gasp)
driving? Why do we continue to be
allow these horrid activities? And
stairs. Every year, 1000 people die
falling down stairs. Don’t get me
started on concussive injury in sports, because a life without football – or the
ability to use your head in football, I mean soccer, wait – well it is no life at
So we are shutting down the world. Being together is too dangerous. We are locking down nursing homes, not allowing people in to see their family members, for their safety, to protect them against a virus that isn’t here (yet!), while ignoring a dozen other viruses that spread exactly the same way and kill them just as dead. Because the other stuff was just part of life; but not this, it is new!
Everything we do in life has risks and consequences. The wise thing to do is assess the risks, try to mitigate them within reason, and then live life to the fullest, understanding that, sometimes, things aren’t going to go as planned. Right now, we have lost our collective minds, terrified beyond the capacity for rational thought. We are not even considering the damage we are going to unleash. Like this virus, the deleterious effects of our hysterical reactions are going to expand exponentially. Our calculated actions will be worse than the damage from the virus had we just gone on with life, happily unaware.
In case you made it this far and agree with me, here are two
things I recommend you do, every day, even when there is no deadly
pandemic. These are simple things that
will let us all live our lives to the fullest while mitigating risks within
reason. I’d tell you that I am a
pathologist (which is still true, even if I am now unemployed) to support the
validity of my arguments, but it doesn’t matter. If you don’t agree with what I said here, I am
not going to change your mind, and you now think I am an even bigger threat to
society. Fine. You do your thing, I’ll do mine, and life will sort it out:
Rule 1: stay home when you are sick, and encourage others to do the same. If you have a fever, you are sick. Stay home. Stay in your own damn bed, don’t bring your plague to work and get everyone else sick. I don’t care what orifice is affected, keep it away from me until it stops oozing. If you are an employer, don’t be part of the problem. You know what I mean. This is how you mitigate flu-like illnesses that are spread by coughing. And don’t give me the crap about asymptomatic carriers, because it’s symptomatic people who break this rule (and employers who make them) that are the real problem.
Rule 2: Don’t put stuff in your mouth if you don’t know where it’s been. Other than some truly scary parasites that can burrow through your skin, things that make you sick have to get in through an opening, and we are usually the ones that do the work. If you shake someone’s hand – an act that now ranks with squirrel-suit base jumping in absolute risks – don’t put your hand in your mouth. Or up your nose. If you are a healthcare worker going from sick patient to sick patient, hand-washing is an important part of preventing the spread of disease from one person to the next. For everyone else, you wash your hands for your own safety – to make them safe to put in your mouth. If you feel the need to do this 1000 times a day to reduce your risk, that’s your choice. I like to live on the edge. But you don’t have anything to fear from me, because I always follow rule #1.
From my new office I can look at my time trial bike hanging on my wall like an exhibit from a past era. In those bygone days, I was a force to be reckoned with, provided you were over the age of 40 and lived within the city limits of Lynchburg and preferred long-course to sprint triathlons. Ah, those were the days. Now I gaze at that outlandish bike with its three-spoke carbon wheels and blade-like frame and can’t help but see the cosmic irony: time trial bikes are analogous to healthcare.
I was never much of an athlete, but I have always liked biking, and there have been moments in time where I managed some success in competition against my peers. I hold to the belief that some of this hard-earned success was due to science. I like to research stuff and use it to advantage, and that is exactly what I did when I wanted to get a proverbial leg up in triathlon-ing.
Cyclist are a funny breed. The hardcore will sell a loved-one or spare organ to save weight on a bike, or shamelessly leverage the house to buy components they believe will make them go faster. I am not immune; there was a time when I made spreadsheets comparing dollars spent to increments of 100 grams of saved weight – roughly ¼ pound. As in a burger. I am not going to tell you what comes next. I recommend against pointing out the fact that the water in 2 large bottles weighs 1360 grams – over 3 pounds – if you happen to be riding in a group of men who routinely shave their legs.
When I wanted to go faster on a time trial bike – a bike designed for a solo rider’s absolute speed, ignoring comfort or handling or safety or potential impotence – I looked at the data. And that data is related to the wind, because wind resistance is the main thing holding you back. Right away I found an interesting stat: 85% of the modifiable drag of a human on a bike is due to the position of the rider’s torso. In other words, by far the most important factor is how the rider sits on the bike. Turns out it has nothing to do with what stuff is made of carbon fiber or what pro has signed the frame, the bike just needs to fit right.
So…85% has nothing to do with the bike. Well, as they say in both France and Lithuania: bollocks.
We seem to be failing in the world healthcare. We are certainly performing below the metric I set when I compared myself to other middle-aged triathletes while systematically disregarding anyone I felt had more time to train, more natural talent, or fewer children than me. The WHO regurgitates a lot of data on our travails in this arena, and there seems to be a hauntingly similar stat: 85% of the health of an individual is due to the environment in which they live, not the delivery of healthcare.
You heard that right: it matters more how and where you live than it does what doctors do to you when something goes wrong. And yet, like a cyclist obsessed with bolting on every high-dollar go-fast gadget made by man, we continue to pour money into the healthcare blackhole without taking a few minutes to think about the repercussions of our fruitless efforts, or even consider why – despite our incredible advances – we might be failing. Miserably. The cost of healthcare continues to climb: between 2012 and 2017, the per-patient spend for diabetes in the US went up over 25%. Twenty-five percent. Here. In the US.
Every time we create a new treatment, the cost is equitable to outfitting a bike with a comprehensive purple-anodized bolt kit: nothing is going to change except the size of the credit card bill.
What would happen if we devoted the same collective effort and financial leverage to the community that is the source of all that drag? We intend to see.* For sure, solving problems is not a way to make money, which is by far the greatest driving force in modern society. But, as stated here at least a baker’s dozen times, there is nothing preventing such a lewd quest for speed. So, as they say in Letterkenny: pitter patter, let’s get at ‘er.
*This ludicrous project was once just a rumination in my arguably tangential brain, but now there are others. Smart, innovative, motivated, successful others. Read about them here.