The Last Social Network

We could have prevented a lot of damage and waste, with the "new" "social network" called Binky. Binky that dispenses with illusion that social networks give us useful information that we need to check frequently; Binky exists solely to pacify. But Binky's designed to never disappoint or enrage its users - and all your likes and comments disappear into the ether.
Binky is a social network app with no network and no socializing. And yet, Binky is not just as satisfying as “real” social apps like Twitter or Instagram, but even more satisfying than those services. Its posts are innocuous: competent but aesthetically unambitious photos of ordinary things and people. Should binkers feel the urge to express disgust at Linus Paulding or Lederhosen, they can swipe left, and Binky accommodates without consequence. And the app doesn’t court obsession by counting followers or likes or re-binks. 
There’s a use of cigarettes beyond their chemical effects. Smoking gives people something to hold and something to do with their hands. McLuhan called it poise. And smartphones offer something similar. At the bus stop, in the elevator, in front of the television, on the toilet, the smartphone offers purpose to idle fingers. To use one is more like knitting or doodling than it is like work or play. It is an activity whose ends are irrelevant. One that is conducted solely to extract nervous attention and to process it into exhaust.

Social media is a little like smoking - it started with the elites and spread everywhere, then the elites got wise. Maybe that's what's happening now with social media too. The elites are now (belatedly) treating social media like a cesspool, but the masses are adopting it wholeheartedly. Perhaps Binky will be the Nicorette or e-cig that weans people off their destructive addiction. 

Paul Ford's not sentimental

Well, when I was thinking up and writing my last post, Paul Ford was writing this, on the occasion of 20 years of blogging:

I took it very seriously for many years and it earned me thousands of readers, thousands of emails, and tons of opportunity. It was better at generating opportunity than money. I drifted away for all the regular reasons. 
I had many thoughts about how to mark this moment and all of them were self-indulgent and exhausting. What I do is completely relevant and alive, thank you, and what was lost was lost. People keep expecting me to be wistful and nostalgic. But there was no innocence or purity. Not ideologically, politically, textually, technologically, sexually, or personally. Everything powered by ambition comes with compromise and taint, and is made under ridiculous circumstances. Everything good is transmuted from grudge-fueled self-doubt into something that other people love and criticize, knowing they could do better if given the time and resources.
That's a pretty economical encapsulation, looking back from my mid-career perspective. The ending is also quite a kicker.


Six (!) years ago I collected a lot of my writing from EPMonthly and Medscape, in links on Tumblr. I thought it looked pretty spiffy, and that I was establishing a beachhead on the next big platform. That didn't exactly work out. I had a splash page to organize my online web presences, but they closed down.

I set up a Medium account a while back, but haven't done a great job of maintaining that, either. This morning I cross-posted a few of my recent articles for EPMonthly and Telemedicine Magazine to Medium - they make it easy to import, and I like how the retrospective on pagers turned out. Maybe it'll get some claps.

Why not use Blogger more? I was thinking about this the other day, as I set up yet another health app blog. When I dashed off the first entry and clicked Publish, Blogger yielded to Google Plus, and I was prompted to share my writing amongst my Circles. I audibly groaned.

First, those Circles haven't been updated since 2012 or so. But most importantly, this latest post was intended for a finely-tuned audience of health app users; not my circle of high school friends or workplace acquaintances. The folks in these Circles, in fact, have never been the audience for this blogging.

An under-appreciated aspect of the blogging scene of the 00's was that we were essentially writing in the dark. The audience might show up, or might not. You could register with Technorati and other indices to popularize your stuff, or try to find an audience with Grand Rounds or other carnivals. But if you didn't want to, that was ok too.

I guess I got used to that environment - because the idea of putting each new blog post in front of old friends and acquaintances, like Google Plus suggests, seems pretty abhorrent. It's probably discouraged my blogging, over the years - certainly on this platform. Imagine if, at the end of each day, a publisher took the output from an aspiring novelist and asked, "are you ready to share this with your family and high school friends?"

Maybe it's time for (sigh) yet another platform. Fortunately, I have a home at EPMonthly (and Telemed Mag) that will continue to inspire and encourage my writing.

The shape of things to come

What's Apple going to do in a few years, when smartphone technology plateaus, and people don't spring for an upgrade every 2-3 years? There's been speculation about a car, but I think the world's most profitable company isn't going to add much to its profits by selling something out of the reach of most of the world (and those that can buy an Apple car probably won't do it as often as they buy an iPhone).

Instead, I think the answer is now apparent, with the new product introductions of the Tim Cook era - Apple Watch, AirPods, and the forthcoming HomePod. These interconnected "smart" devices are all relatively inexpensive (as far as Apple products go). Interactions are largely through voice, or a few taps. You forget you're wearing the Watch or AirPods, and the HomePod looks pretty unobtrusive.

A smartphone is pretty much required to use any of these devices today, but you can imagine that won't always be the case (recall the iPhone required a Mac or PC running iTunes, in its early years).

While none of these devices are essential now, when you need them they're really nice to have handy. They're definite improvements on dumb watches, dumb speakers and regular headphones. I already use my Watch to pay for coffee and taxis, respond to texts, and in the years to come it will probably assume more of my phone's role. The HomePod right now is limited to music, HomeKit, and simple cloud queries, but it seems a safe bet that in the years to come its capabilities will grow (merging with or running Apple TV, serving as a phone, sending and relaying messages to contacts, etc).

Macs will continue to be around, for "serious" work (though they've made up a tiny fraction of Apple's revenue and profits and that seems unlikely to change). Other screened devices, like iPads and TVs, will be around for play, photos and short written notes. If there's one element missing it might be a standalone TouchID keyboard. But more of our future, I think, has come into view this week - and it's mostly screenless, distributed between wearables and innocuous furnishings like the HomePod.

Health IT, under attack

With the recent news of the WannaCry ransomware attack and how it particularly hurt UK hospitals, I figured it was appropriate to link to our writeup of An Academic Medical Center's Response to Widespread Computer Failure (PubMed / ResearchGate). This was our experience in the hours and days following a botched 2010 McAfee's antivirus update, which began attacking a core component of Windows, and rendering PCs unusable. While accidental, in many ways it resembled a cyberattack.

Of course, there's been great coverage of the attack and its implications. Halamka was quoted:

“By prioritizing clinical functionality and uptime, healthcare organizations may not always have the most up-to-date software. Thus, healthcare, in general, may be more vulnerable than other industries to cyberattacks, and the scope of the impact to the NHS in the U.K. illustrates the problem." 
He said that some mission-critical systems were built years ago and never migrated to today’s modern platforms. In 2017, there are still commercial products that require Windows XP for which few patches are available, he said.

Other useful perspectives on healthcare IT's vulnerabilities emphasize HIPAA / business associate concerns when accepting patches. Lessons abound. Hopefully we'll learn them well enough to prevent future episodes.

A year without blogging

It's not I've stopped writing - besides the peer-reviewed stuff there's articles and commentary at EPMonthly and Telemedicine magazine, tweets @nickgenes, and the occasional piece for Medscape.

But coming to blog at this site doesn't just feel like a chore - it's laden with a sense of guilt. I was so very wrong about the potential of blogging and social media.

There were warnings. Back in 2010 I commented on a WSJ blog about our experience implementing electronic medical records in our ED. Another commenter then accused me of practicing "Tuskegee medicine" and experimenting on patients without consent, because EMRs hadn't been shown to be safer and more efficient than paper records in randomized trials. I'd seen trolls before but not for academic discussions like this - and the troll was signing his note with an MD's name (though not someone I could find in US physician databases).

Elevating the status of online discourse is something I've wondered about for years - it's the reason this blog adopted Facebook-authenticated comments. Our research found value even in the web's darkest corners, like YouTube comments. But of course in general, commentary kept getting worse. Last winter I lamented that the media framed stories much like Vegas sets the spread, to ensure maximum pageviews, debate and ultimately, vitriol.

All this was before the 2016 presidential election really heated up. Eventually last year, every news story was quickly put in terms of your team vs the other team. Our team is always noble and wise, but the other team is misguided at best, hypocritical and probably evil, often dumb or short-sighted, and if they're making any gains it's because they're cheating. Interacting with old friends online became a fraught exercise. Even the #FOAMed community began to see polarization and personal attacks.

So blogging and using social media, for me, if it's going to continue, must take the form of record-keeping and journaling - links to useful resources, or snapshots of what I'm up to at a particular point in time. Anything more would be a waste of time.

One week in

I've commented before that politics is increasingly like sport - more and more we're just rooting for our side. Ultimately it means policy and ideas don't matter; only winning does. One side has already made this an explicit part of their strategy; they're playing to win, not respecting "norms," and using every tool at their disposal to keep winning.

A quote from The Economist, on the occasion of President Trump's inauguration:
All populists are at heart conspiracy theorists, who pretend that easy solutions exist to society’s woes and have only not been tried to date because elites are wicked and deaf to the sturdy common-sense of decent, ordinary folk.
 So how can populism be challenged? A lesson from Venezuela:
Your organizing principle is simple: don’t feed polarization, disarm it.
This means leaving the theater of injured decency behind.
The Venezuelan Opposition struggled for years to get this. It wouldn’t stop pontificating about how stupid it all is. Not only to their international friends, but also to the Chavista electoral base itself.
“Really, this guy? Are you nuts? You must be nuts.” We’d say.
Don’t waste your time trying to prove that this ism is better than that ism. Ditch all the big words. Why? Because, again, the problem is not the message but the messenger. It’s not that Trump supporters are too stupid to see right from wrong, it’s that you’re much more valuable to them as an enemy than as a compatriot.
The problem is tribal. Your challenge is to prove that you belong in the same tribe as them: that you are American in exactly the same way they are.
But if you want to be part of the solution, the road ahead is clear: Recognize you’re the enemy they need; show concern, not contempt, for the wounds of those that brought Trump to power; by all means be patient with democracy and struggle relentlessly to free yourself from the shackles of the caricature the populists have drawn of you.
Unfortunately these tactics against Chavez were never truly successful; he was never ousted and died in office. His reputation among the people remains good, even though he didn't do enough strength Venezuela before its economic crisis. 

I suspect, like Chavez, Trump's reputation will remain strong with his core supporters, no matter what messages the opposition adopts. Like anti-vaxxers and climate deniers, too many people are just too isolated from the consequences of their beliefs; there's not enough pain or suffering to make them doubt the messages they're hearing. Unless we have a similarly bad economic crisis while Trump is in power, or another 9/11 or Katrina-style catastrophe that he obviously mishandles, this will continue.