Sunday, October 13, 2019
Saturday, October 12, 2019
Artificial Intelligence: What’s to Fear?
In 2017, scientists at Carnegie Mellon University shocked the gaming world when they programmed a computer to beat experts in a poker game called no-limit hold ’em. People assumed a poker player’s intuition and creative thinking would give him or her the competitive edge. Yet by playing 24 trillion hands of poker every second for two months, the computer “taught” itself an unbeatable strategy.
Many people fear such events. It’s not just the potential job losses. If artificial intelligence (AI) can do everything better than a human being can, then human endeavor is pointless and human beings are valueless.
Computers long ago surpassed humans in certain skills—for example, in the ability to calculate and catalog. Yet they have traditionally been unable to reproduce people’s creative, imaginative, emotional, and intuitive skills. It is why personalized service workers such as coaches and physicians enjoy some of the sweetest sinecures in the economy. Their humanity, meaning their ability to individualize services and connect with others, which computers lack, adds value. Yet not only does AI win at cards now, it also creates art, writes poetry, and performs psychotherapy. Even lovemaking is at risk, as artificially intelligent robots stand poised to enter the market and provide sexual services and romantic intimacy. With the rise of AI, today’s human beings seem to be as vulnerable as yesterday’s apes, occupying a more primitive stage of evolution.
But not so fast. AI is not quite the threat it is made out to be. Take, for example, the computer’s victory in poker. The computer did not win because it had more intuition; it won because it played a strategy called “game theory optimal” (GTO). The computer simply calculated the optimal frequency for raising, betting, and folding using special equations, independent of whatever cards the other players held. People call what the computer displayed during the game “intelligence,” but it was not intelligence as we traditionally understand it.
Such a misinterpretation of AI seems subtle and unimportant. But over time, spread out over different areas of life, misinterpretations of this type launch a cascade of effects that have serious psychosocial consequences. People are right to fear AI robots taking their jobs. They may be right to fear AI killer robots. But AI presents other, smaller dangers that are less exciting but more corrosive in the long run.
by Ronald W. Dworkin, The American Interest | Read more:
Many people fear such events. It’s not just the potential job losses. If artificial intelligence (AI) can do everything better than a human being can, then human endeavor is pointless and human beings are valueless.
Computers long ago surpassed humans in certain skills—for example, in the ability to calculate and catalog. Yet they have traditionally been unable to reproduce people’s creative, imaginative, emotional, and intuitive skills. It is why personalized service workers such as coaches and physicians enjoy some of the sweetest sinecures in the economy. Their humanity, meaning their ability to individualize services and connect with others, which computers lack, adds value. Yet not only does AI win at cards now, it also creates art, writes poetry, and performs psychotherapy. Even lovemaking is at risk, as artificially intelligent robots stand poised to enter the market and provide sexual services and romantic intimacy. With the rise of AI, today’s human beings seem to be as vulnerable as yesterday’s apes, occupying a more primitive stage of evolution.But not so fast. AI is not quite the threat it is made out to be. Take, for example, the computer’s victory in poker. The computer did not win because it had more intuition; it won because it played a strategy called “game theory optimal” (GTO). The computer simply calculated the optimal frequency for raising, betting, and folding using special equations, independent of whatever cards the other players held. People call what the computer displayed during the game “intelligence,” but it was not intelligence as we traditionally understand it.
Such a misinterpretation of AI seems subtle and unimportant. But over time, spread out over different areas of life, misinterpretations of this type launch a cascade of effects that have serious psychosocial consequences. People are right to fear AI robots taking their jobs. They may be right to fear AI killer robots. But AI presents other, smaller dangers that are less exciting but more corrosive in the long run.
by Ronald W. Dworkin, The American Interest | Read more:
Image: Wikimedia Commons
Everything Going Wrong in Okinawa
On 23 February 2016 Admiral Harry Harris, then Commander US Forces Pacific, testifying before the Senate Armed Services Committee, was asked how the construction of the Futenma Replacement Facility was progressing. This refers to the super airbase the Japanese Defense Ministry is building at Henoko in northern Okinawa to house the units of the First Marine Air Wing now deployed at Futenma Air Station, in crowded central Okinawa.
Admiral Harris, his voice betraying irritation, replied, ”it’s . . . a little over two years late. It was going to be done by 2023, now we’re looking at 2025 . . . “
This made the front pages in Okinawa, though probably nowhere else. The next day Suga Yoshihide, Japan’s Chief Cabinet Secretary, was asked about this at a press conference. He wanted to say Admiral Harris was wrong, but attempted to put it more diplomatically: “It’s too early to say”, – which amounts to the same thing.
Harris was indeed wrong, but not in the way Suga wanted his listeners to believe. A year before this, in 2015, the Okinawa Defense Bureau, the Defense Ministry’s branch in Okinawa, completed a report stating that their soil tests of the sea bottom of Oura Bay, scheduled to be filled to support the new airstrips, had yielded an N-value of zero. N-value is derived by dropping a 140 pound hammer on a hollow drill resting on the sea bottom. The number of blows required to drive it down six inches is the N-value. Thirty or more is considered a firm base. Zero means no blows were required; the drill sank of its own weight.
This information was kept from the Okinawan Government and public for two years, until an independent engineer managed to obtain a copy of the report. Judging from Admiral Harris’ statement, the information had also been kept from the US, and had not been taken into account in Harris’ (as we now know, wildly optimistic) “two years”. Before anything can be built on the “mayonnaise sea bottom”, as it is popularly known in Okinawa, it must be firmed up. The preferred way to do this is by implanting “sand piles” (pillars) into the slime. Huge hollow drills filled with sand are driven down until they reach bedrock. The drills are raised, the sand is left behind. The Okinawa Defense Bureau estimates that if this operation is repeated 77,000 times, the sea bottom will be sufficiently firm to begin construction. This is expected to take as much as five years. That means that 2025, the year Harris predicted the base will be completed, will be the year the sand pillar operation will be completed and sea wall construction on Oura Bay can begin – if all goes well.
If all goes well – and if Murphy’s law ceases to operate (Murphy’s law, If there is anything that could go wrong, it will).
But from the standpoint of the Okinawa Defense Bureau, everything is going wrong. First of all, they have failed to persuade (or to force) the Okinawans to give up their opposition to the new base, which they see as a danger, an environmental catastrophe and an insult. From the Governor’s office through the Prefectural Assembly through Okinawa’s two newspapers down to the daily sit-ins at various points where trucks can be blocked, from every direction, and using every non-violent tactic, including lawsuits, construction is being slowed. Then there is the fact that the site is surrounded by dozens of structures that violate FAA and DOD height regulations for airports. Then there are the two earthquake faults beneath the site, which the Defense Bureau has addressed by going into denial.
But it is on Oura Bay where Murphy’s law is doing the most damage. The Okinawa Defense Bureau’s soil tests have shown that in some places the mayonnaise sea bottom extends to 90 meters below sea level. Sand pillar implantation to 90 meters has never been attempted in Japan (some say, never in the world), nor do rigs exist capable of drilling to that depth. It’s not clear how the Okinawa Defense Bureau plans to deal with that – unless the comment by a government official that “maybe 60 meters will be good enough” can be considered a plan.
Admiral Harris, his voice betraying irritation, replied, ”it’s . . . a little over two years late. It was going to be done by 2023, now we’re looking at 2025 . . . “
This made the front pages in Okinawa, though probably nowhere else. The next day Suga Yoshihide, Japan’s Chief Cabinet Secretary, was asked about this at a press conference. He wanted to say Admiral Harris was wrong, but attempted to put it more diplomatically: “It’s too early to say”, – which amounts to the same thing.
Harris was indeed wrong, but not in the way Suga wanted his listeners to believe. A year before this, in 2015, the Okinawa Defense Bureau, the Defense Ministry’s branch in Okinawa, completed a report stating that their soil tests of the sea bottom of Oura Bay, scheduled to be filled to support the new airstrips, had yielded an N-value of zero. N-value is derived by dropping a 140 pound hammer on a hollow drill resting on the sea bottom. The number of blows required to drive it down six inches is the N-value. Thirty or more is considered a firm base. Zero means no blows were required; the drill sank of its own weight.
This information was kept from the Okinawan Government and public for two years, until an independent engineer managed to obtain a copy of the report. Judging from Admiral Harris’ statement, the information had also been kept from the US, and had not been taken into account in Harris’ (as we now know, wildly optimistic) “two years”. Before anything can be built on the “mayonnaise sea bottom”, as it is popularly known in Okinawa, it must be firmed up. The preferred way to do this is by implanting “sand piles” (pillars) into the slime. Huge hollow drills filled with sand are driven down until they reach bedrock. The drills are raised, the sand is left behind. The Okinawa Defense Bureau estimates that if this operation is repeated 77,000 times, the sea bottom will be sufficiently firm to begin construction. This is expected to take as much as five years. That means that 2025, the year Harris predicted the base will be completed, will be the year the sand pillar operation will be completed and sea wall construction on Oura Bay can begin – if all goes well.
If all goes well – and if Murphy’s law ceases to operate (Murphy’s law, If there is anything that could go wrong, it will).
But from the standpoint of the Okinawa Defense Bureau, everything is going wrong. First of all, they have failed to persuade (or to force) the Okinawans to give up their opposition to the new base, which they see as a danger, an environmental catastrophe and an insult. From the Governor’s office through the Prefectural Assembly through Okinawa’s two newspapers down to the daily sit-ins at various points where trucks can be blocked, from every direction, and using every non-violent tactic, including lawsuits, construction is being slowed. Then there is the fact that the site is surrounded by dozens of structures that violate FAA and DOD height regulations for airports. Then there are the two earthquake faults beneath the site, which the Defense Bureau has addressed by going into denial.
But it is on Oura Bay where Murphy’s law is doing the most damage. The Okinawa Defense Bureau’s soil tests have shown that in some places the mayonnaise sea bottom extends to 90 meters below sea level. Sand pillar implantation to 90 meters has never been attempted in Japan (some say, never in the world), nor do rigs exist capable of drilling to that depth. It’s not clear how the Okinawa Defense Bureau plans to deal with that – unless the comment by a government official that “maybe 60 meters will be good enough” can be considered a plan.
by Doug Lummis, Counterpunch | Read more:
[ed. They don't want it, we can't build it. Imagine what that money could do for infrastructure in the US. See also: The Pentagon is Pledging to Reform Itself, Again. It Won’t. (Counterpunch). $1.4 trillion/two years.]
Friday, October 11, 2019
The Biggest Lie Tech People Tell Themselves — and the Rest of Us
Imagine you’re taking an online business class — the kind where you watch video lectures and then answer questions at the end. But this isn’t a normal class, and you’re not just watching the lectures: They’re watching you back. Every time the facial recognition system decides that you look bored, distracted, or tuned out, it makes a note. And after each lecture, it only asks you about content from those moments.
This isn’t a hypothetical system; it’s a real one deployed by a company called Nestor. And if you don’t like the sound of it, you’re not alone. Neither do the actual students.
When I asked the man behind the system, French inventor Marcel Saucet, how the students in these classes feel about being watched, he admitted that they didn’t like it. They felt violated and surveilled, he said, but he shrugged off any implication that it was his fault. “Everybody is doing this,” he told me. “It’s really early and shocking, but we cannot go against natural laws of evolution.”
As a reporter who covers technology and the future, I constantly hear variations of this line as technologists attempt to apply the theory Charles Darwin made famous in biology to their own work. I’m told that there is a progression of technology, a movement that is bigger than any individual inventor or CEO. They say they are simply caught in a tide, swept along in a current they cannot fight. They say it inevitably leads them to facial recognition (now even being deployed on children), smart speakers that record your intimate conversations, and doorbells that narc on your neighbors. They say we can’t blame these companies for the erosion of privacy or democracy or trust in public institutions — that was all going to happen sooner or later.
“When have we ever been able to keep the genie in the bottle?” they ask. Besides, they argue, people buy this stuff so they must want it. Companies are simply responding to “natural selection” by consumers. There is nobody to blame for this, they say. It’s as natural as gravity.
Perhaps no one states this belief more clearly than inventor and futurist Ray Kurzweil in his 2005 book The Singularity Is Near: “The ongoing acceleration of technology is the implication and inevitable result of what I call the law of accelerating returns, which describes the acceleration of the pace of and the exponential growth of the products of an evolutionary process.”
In fact, our world is shaped by humans who make decisions, and technology companies are no different.
To claim that these devices are the result of some kind of ever-improving natural process not only misunderstands how evolution works, but it also suggests that everything from biological weapons to fraudulent startups like Theranos to Juicero (the $400 machine that squeezed juice out of packets) are necessary and natural.
While these “innovations” range from the dangerous to the silly, they share a common thread: Nothing about them is “natural.” No natural process is creating a “smart” hairbrush or a “smart” flip flop or a “smart” condom. Or a Bluetooth-enabled toaster, a cryptocurrency from a photography company, or an internet-connected air freshener.
Evolution is a terrible metaphor for technology
Technologists’ desire to make a parallel to evolution is flawed at its very foundation. Evolution is driven by random mutation — mistakes, not plans. (And while some inventions may indeed be the result of mishaps, the decision of a company to patent, produce, and market those inventions is not.) Evolution doesn’t have meetings about the market, the environment, the customer base. Evolution doesn’t patent things or do focus groups. Evolution doesn’t spend millions of dollars lobbying Congress to ensure that its plans go unfettered.
In some situations, even if we can’t literally put a technological genie back in a bottle, we can artificially intervene to make sure the genie plays by specific rules.
There are clear laws about what companies can and can’t do in the realm of biological weapons. The FDA ensures drugs are tested for efficacy and safety before they can be sold. The USDA ensures new food research is done with care. We don’t let anybody frack or drill for oil or build nuclear power plants wherever they like. We don’t let just anybody make and sell cars or airplanes or guns.
So the assertion that technology companies can’t possibly be shaped or restrained with the public’s interest in mind is to argue that they are fundamentally different from any other industry. They’re not. (...)
This endless, punishing race in the name of “progress” is often what drives consumer behavior, too. Despite the “American dream” — security, safety, prosperity — being more and more out of reach for everyday Americans, the idea that it’s just around the corner drives people to purchase these products.
If you have the newest app, people think their lives will be easier, you’ll have more free time, more quality time. Commercials promise more backyard barbecues under sparklers and birthday surprise parties facilitated by internet-connected light bulbs.
And when we buy the products, tech companies take that as a green light to continue on their “inevitable” path, inching ever toward a world where Amazon knows exactly what you’re doing, thinking, feeling — perhaps even before you do. “It’s all a loop,” says Stark. “It’s weird. That’s what puts people in this bind. They think they should be able to have it all. They can’t, and technology is a kind of prophylactic to cope with this stuff.”
by Rose Eveleth, Vox | Read more:
Image: Zoë van Dijk
This isn’t a hypothetical system; it’s a real one deployed by a company called Nestor. And if you don’t like the sound of it, you’re not alone. Neither do the actual students.
When I asked the man behind the system, French inventor Marcel Saucet, how the students in these classes feel about being watched, he admitted that they didn’t like it. They felt violated and surveilled, he said, but he shrugged off any implication that it was his fault. “Everybody is doing this,” he told me. “It’s really early and shocking, but we cannot go against natural laws of evolution.”
As a reporter who covers technology and the future, I constantly hear variations of this line as technologists attempt to apply the theory Charles Darwin made famous in biology to their own work. I’m told that there is a progression of technology, a movement that is bigger than any individual inventor or CEO. They say they are simply caught in a tide, swept along in a current they cannot fight. They say it inevitably leads them to facial recognition (now even being deployed on children), smart speakers that record your intimate conversations, and doorbells that narc on your neighbors. They say we can’t blame these companies for the erosion of privacy or democracy or trust in public institutions — that was all going to happen sooner or later.“When have we ever been able to keep the genie in the bottle?” they ask. Besides, they argue, people buy this stuff so they must want it. Companies are simply responding to “natural selection” by consumers. There is nobody to blame for this, they say. It’s as natural as gravity.
Perhaps no one states this belief more clearly than inventor and futurist Ray Kurzweil in his 2005 book The Singularity Is Near: “The ongoing acceleration of technology is the implication and inevitable result of what I call the law of accelerating returns, which describes the acceleration of the pace of and the exponential growth of the products of an evolutionary process.”
In fact, our world is shaped by humans who make decisions, and technology companies are no different.
To claim that these devices are the result of some kind of ever-improving natural process not only misunderstands how evolution works, but it also suggests that everything from biological weapons to fraudulent startups like Theranos to Juicero (the $400 machine that squeezed juice out of packets) are necessary and natural.
While these “innovations” range from the dangerous to the silly, they share a common thread: Nothing about them is “natural.” No natural process is creating a “smart” hairbrush or a “smart” flip flop or a “smart” condom. Or a Bluetooth-enabled toaster, a cryptocurrency from a photography company, or an internet-connected air freshener.
Evolution is a terrible metaphor for technology
Technologists’ desire to make a parallel to evolution is flawed at its very foundation. Evolution is driven by random mutation — mistakes, not plans. (And while some inventions may indeed be the result of mishaps, the decision of a company to patent, produce, and market those inventions is not.) Evolution doesn’t have meetings about the market, the environment, the customer base. Evolution doesn’t patent things or do focus groups. Evolution doesn’t spend millions of dollars lobbying Congress to ensure that its plans go unfettered.
In some situations, even if we can’t literally put a technological genie back in a bottle, we can artificially intervene to make sure the genie plays by specific rules.
There are clear laws about what companies can and can’t do in the realm of biological weapons. The FDA ensures drugs are tested for efficacy and safety before they can be sold. The USDA ensures new food research is done with care. We don’t let anybody frack or drill for oil or build nuclear power plants wherever they like. We don’t let just anybody make and sell cars or airplanes or guns.
So the assertion that technology companies can’t possibly be shaped or restrained with the public’s interest in mind is to argue that they are fundamentally different from any other industry. They’re not. (...)
This endless, punishing race in the name of “progress” is often what drives consumer behavior, too. Despite the “American dream” — security, safety, prosperity — being more and more out of reach for everyday Americans, the idea that it’s just around the corner drives people to purchase these products.
If you have the newest app, people think their lives will be easier, you’ll have more free time, more quality time. Commercials promise more backyard barbecues under sparklers and birthday surprise parties facilitated by internet-connected light bulbs.
And when we buy the products, tech companies take that as a green light to continue on their “inevitable” path, inching ever toward a world where Amazon knows exactly what you’re doing, thinking, feeling — perhaps even before you do. “It’s all a loop,” says Stark. “It’s weird. That’s what puts people in this bind. They think they should be able to have it all. They can’t, and technology is a kind of prophylactic to cope with this stuff.”
by Rose Eveleth, Vox | Read more:
Image: Zoë van Dijk
Jeff Bezos’s Master Plan
Where in the pantheon of American commercial titans does Jeffrey Bezos belong? Andrew Carnegie’s hearths forged the steel that became the skeleton of the railroad and the city. John D. Rockefeller refined 90 percent of American oil, which supplied the pre-electric nation with light. Bill Gates created a program that was considered a prerequisite for turning on a computer.
At 55, Bezos has never dominated a major market as thoroughly as any of these forebears, and while he is presently the richest man on the planet, he has less wealth than Gates did at his zenith. Yet Rockefeller largely contented himself with oil wells, pump stations, and railcars; Gates’s fortune depended on an operating system. The scope of the empire the founder and CEO of Amazon has built is wider. Indeed, it is without precedent in the long history of American capitalism.
Today, Bezos controls nearly 40 percent of all e-commerce in the United States. More product searches are conducted on Amazon than on Google, which has allowed Bezos to build an advertising business as valuable as the entirety of IBM. One estimate has Amazon Web Services controlling almost half of the cloud-computing industry—institutions as varied as General Electric, Unilever, and even the CIA rely on its servers. Forty-two percent of paper book sales and a third of the market for streaming video are controlled by the company; Twitch, its video platform popular among gamers, attracts 15 million users a day. Add The Washington Post to this portfolio and Bezos is, at a minimum, a rival to the likes of Disney’s Bob Iger or the suits at AT&T, and arguably the most powerful man in American culture.
I first grew concerned about Amazon’s power five years ago. I felt anxious about how the company bullied the book business, extracting ever more favorable terms from the publishers that had come to depend on it. When the conglomerate Hachette, with which I’d once published a book, refused to accede to Amazon’s demands, it was punished. Amazon delayed shipments of Hachette books; when consumers searched for some Hachette titles, it redirected them to similar books from other publishers. In 2014, I wrote a cover story for The New Republic with a pugilistic title: “Amazon Must Be Stopped.” Citing my article, the company subsequently terminated an advertising campaign for its political comedy, Alpha House, that had been running in the magazine.
Since that time, Bezos’s reach has only grown. To the U.S. president, he is a nemesis. To many Americans, he is a beneficent wizard of convenience and abundance. Over the course of just this past year, Amazon has announced the following endeavors: It will match potential home buyers with real-estate agents and integrate their new homes with Amazon devices; it will enable its voice assistant, Alexa, to access health-care data, such as the status of a prescription or a blood-sugar reading; it will build a 3-million-square-foot cargo airport outside Cincinnati; it will make next-day delivery standard for members of its Prime service; it will start a new chain of grocery stores, in addition to Whole Foods, which it already owns; it will stream Major League Baseball games; it will launch more than 3,000 satellites into orbit to supply the world with high-speed internet.
Bezos’s ventures are by now so large and varied that it is difficult to truly comprehend the nature of his empire, much less the end point of his ambitions. What exactly does Jeff Bezos want? Or, to put it slightly differently, what does he believe? Given his power over the world, these are not small questions. Yet he largely keeps his intentions to himself; many longtime colleagues can’t recall him ever expressing a political opinion. To replay a loop of his interviews from Amazon’s quarter century of existence is to listen to him retell the same unrevealing anecdotes over and over.
To better understand him, I spent five months speaking with current and former Amazon executives, as well as people at the company’s rivals and scholarly observers. Bezos himself declined to participate in this story, and current employees would speak to me only off the record. Even former staffers largely preferred to remain anonymous, assuming that they might eventually wish to work for a business somehow entwined with Bezos’s sprawling concerns.
In the course of these conversations, my view of Bezos began to shift. Many of my assumptions about the man melted away; admiration jostled with continued unease. And I was left with a new sense of his endgame.
Bezos loves the word relentless—it appears again and again in his closely read annual letters to shareholders—and I had always assumed that his aim was domination for its own sake. In an era that celebrates corporate gigantism, he seemed determined to be the biggest of them all. But to say that Bezos’s ultimate goal is dominion over the planet is to misunderstand him. His ambitions are not bound by the gravitational pull of the Earth. (...)
In a way, Bezos has already created a prototype of a cylindrical tube inhabited by millions, and it’s called Amazon.com. His creation is less a company than an encompassing system. If it were merely a store that sold practically all salable goods—and delivered them within 48 hours—it would still be the most awe-inspiring creation in the history of American business. But Amazon is both that tangible company and an abstraction far more powerful.
Bezos’s enterprise upends long-held precepts about the fundamental nature of capitalism—especially an idea enshrined by the great Austrian economist Friedrich Hayek. As World War II drew to its close, Hayek wrote the essay “The Use of Knowledge in Society,” a seminal indictment of centralized planning. Hayek argued that no bureaucracy could ever match the miracle of markets, which spontaneously and efficiently aggregate the knowledge of a society. When markets collectively set a price, that price reflects the discrete bits of knowledge scattered among executives, workers, and consumers. Any governmental attempt to replace this organic apparatus—to set prices unilaterally, or even to understand the disparate workings of an economy—is pure hubris.
Amazon, however, has acquired the God’s-eye view of the economy that Hayek never imagined any single entity could hope to achieve. At any moment, its website has more than 600 million items for sale and more than 3 million vendors selling them. With its history of past purchases, it has collected the world’s most comprehensive catalog of consumer desire, which allows it to anticipate both individual and collective needs. With its logistics business—and its growing network of trucks and planes—it has an understanding of the flow of goods around the world. In other words, if Marxist revolutionaries ever seized power in the United States, they could nationalize Amazon and call it a day.
What makes Amazon so fearsome to its critics isn’t purely its size but its trajectory. Amazon’s cache of knowledge gives it the capacity to build its own winning version of an astonishing array of businesses. In the face of its growth, long-dormant fears of monopoly have begun to surface—and Amazon has reportedly found itself under review by the Federal Trade Commission and the Department of Justice. But unlike Facebook, another object of government scrutiny, Bezos’s company remains deeply trusted by the public. A 2018 poll sponsored by Georgetown University and the Knight Foundation found that Amazon engendered greater confidence than virtually any other American institution. Despite Donald Trump’s jabs at Bezos, this widespread faith in the company makes for a source of bipartisan consensus, although the Democrats surveyed were a touch more enthusiastic than the Republicans were: They rated Amazon even more trustworthy than the U.S. military. In contrast to the dysfunction and cynicism that define the times, Amazon is the embodiment of competence, the rare institution that routinely works. (...)
In its current form, Amazon harkens back to Big Business as it emerged in the postwar years. When Charles E. Wilson, the president of General Motors, was nominated to be secretary of defense in 1953, he famously told a Senate confirmation panel, “I thought what was good for our country was good for General Motors, and vice versa.” For the most part, this was an aphorism earnestly accepted as a statement of good faith. To avert class warfare, the Goliaths of the day recognized unions; they bestowed health care and pensions upon employees. Liberal eminences such as John K. Galbraith hailed the corporation as the basis for a benign social order. Galbraith extolled the social utility of the corporation because he believed that it could be domesticated and harnessed to serve interests other than its own bottom line. He believed businesses behave beneficently when their self-serving impulses are checked by “countervailing power” in the form of organized labor and government.
Of course, those powers have receded. Unions, whose organizing efforts Amazon has routinely squashed, are an unassuming nub of their former selves; the regulatory state is badly out of practice. So while Amazon is trusted, no countervailing force has the inclination or capacity to restrain it. And while power could amass in a more villainous character than Jeff Bezos, that doesn’t alleviate the anxiety that accompanies such concentration. Amazon might be a vast corporation, with more than 600,000 employees, but it is also the extension of one brilliant, willful man with an incredible knack for bending the world to his values.
At 55, Bezos has never dominated a major market as thoroughly as any of these forebears, and while he is presently the richest man on the planet, he has less wealth than Gates did at his zenith. Yet Rockefeller largely contented himself with oil wells, pump stations, and railcars; Gates’s fortune depended on an operating system. The scope of the empire the founder and CEO of Amazon has built is wider. Indeed, it is without precedent in the long history of American capitalism.
Today, Bezos controls nearly 40 percent of all e-commerce in the United States. More product searches are conducted on Amazon than on Google, which has allowed Bezos to build an advertising business as valuable as the entirety of IBM. One estimate has Amazon Web Services controlling almost half of the cloud-computing industry—institutions as varied as General Electric, Unilever, and even the CIA rely on its servers. Forty-two percent of paper book sales and a third of the market for streaming video are controlled by the company; Twitch, its video platform popular among gamers, attracts 15 million users a day. Add The Washington Post to this portfolio and Bezos is, at a minimum, a rival to the likes of Disney’s Bob Iger or the suits at AT&T, and arguably the most powerful man in American culture.I first grew concerned about Amazon’s power five years ago. I felt anxious about how the company bullied the book business, extracting ever more favorable terms from the publishers that had come to depend on it. When the conglomerate Hachette, with which I’d once published a book, refused to accede to Amazon’s demands, it was punished. Amazon delayed shipments of Hachette books; when consumers searched for some Hachette titles, it redirected them to similar books from other publishers. In 2014, I wrote a cover story for The New Republic with a pugilistic title: “Amazon Must Be Stopped.” Citing my article, the company subsequently terminated an advertising campaign for its political comedy, Alpha House, that had been running in the magazine.
Since that time, Bezos’s reach has only grown. To the U.S. president, he is a nemesis. To many Americans, he is a beneficent wizard of convenience and abundance. Over the course of just this past year, Amazon has announced the following endeavors: It will match potential home buyers with real-estate agents and integrate their new homes with Amazon devices; it will enable its voice assistant, Alexa, to access health-care data, such as the status of a prescription or a blood-sugar reading; it will build a 3-million-square-foot cargo airport outside Cincinnati; it will make next-day delivery standard for members of its Prime service; it will start a new chain of grocery stores, in addition to Whole Foods, which it already owns; it will stream Major League Baseball games; it will launch more than 3,000 satellites into orbit to supply the world with high-speed internet.
Bezos’s ventures are by now so large and varied that it is difficult to truly comprehend the nature of his empire, much less the end point of his ambitions. What exactly does Jeff Bezos want? Or, to put it slightly differently, what does he believe? Given his power over the world, these are not small questions. Yet he largely keeps his intentions to himself; many longtime colleagues can’t recall him ever expressing a political opinion. To replay a loop of his interviews from Amazon’s quarter century of existence is to listen to him retell the same unrevealing anecdotes over and over.
To better understand him, I spent five months speaking with current and former Amazon executives, as well as people at the company’s rivals and scholarly observers. Bezos himself declined to participate in this story, and current employees would speak to me only off the record. Even former staffers largely preferred to remain anonymous, assuming that they might eventually wish to work for a business somehow entwined with Bezos’s sprawling concerns.
In the course of these conversations, my view of Bezos began to shift. Many of my assumptions about the man melted away; admiration jostled with continued unease. And I was left with a new sense of his endgame.
Bezos loves the word relentless—it appears again and again in his closely read annual letters to shareholders—and I had always assumed that his aim was domination for its own sake. In an era that celebrates corporate gigantism, he seemed determined to be the biggest of them all. But to say that Bezos’s ultimate goal is dominion over the planet is to misunderstand him. His ambitions are not bound by the gravitational pull of the Earth. (...)
In a way, Bezos has already created a prototype of a cylindrical tube inhabited by millions, and it’s called Amazon.com. His creation is less a company than an encompassing system. If it were merely a store that sold practically all salable goods—and delivered them within 48 hours—it would still be the most awe-inspiring creation in the history of American business. But Amazon is both that tangible company and an abstraction far more powerful.
Bezos’s enterprise upends long-held precepts about the fundamental nature of capitalism—especially an idea enshrined by the great Austrian economist Friedrich Hayek. As World War II drew to its close, Hayek wrote the essay “The Use of Knowledge in Society,” a seminal indictment of centralized planning. Hayek argued that no bureaucracy could ever match the miracle of markets, which spontaneously and efficiently aggregate the knowledge of a society. When markets collectively set a price, that price reflects the discrete bits of knowledge scattered among executives, workers, and consumers. Any governmental attempt to replace this organic apparatus—to set prices unilaterally, or even to understand the disparate workings of an economy—is pure hubris.
Amazon, however, has acquired the God’s-eye view of the economy that Hayek never imagined any single entity could hope to achieve. At any moment, its website has more than 600 million items for sale and more than 3 million vendors selling them. With its history of past purchases, it has collected the world’s most comprehensive catalog of consumer desire, which allows it to anticipate both individual and collective needs. With its logistics business—and its growing network of trucks and planes—it has an understanding of the flow of goods around the world. In other words, if Marxist revolutionaries ever seized power in the United States, they could nationalize Amazon and call it a day.
What makes Amazon so fearsome to its critics isn’t purely its size but its trajectory. Amazon’s cache of knowledge gives it the capacity to build its own winning version of an astonishing array of businesses. In the face of its growth, long-dormant fears of monopoly have begun to surface—and Amazon has reportedly found itself under review by the Federal Trade Commission and the Department of Justice. But unlike Facebook, another object of government scrutiny, Bezos’s company remains deeply trusted by the public. A 2018 poll sponsored by Georgetown University and the Knight Foundation found that Amazon engendered greater confidence than virtually any other American institution. Despite Donald Trump’s jabs at Bezos, this widespread faith in the company makes for a source of bipartisan consensus, although the Democrats surveyed were a touch more enthusiastic than the Republicans were: They rated Amazon even more trustworthy than the U.S. military. In contrast to the dysfunction and cynicism that define the times, Amazon is the embodiment of competence, the rare institution that routinely works. (...)
In its current form, Amazon harkens back to Big Business as it emerged in the postwar years. When Charles E. Wilson, the president of General Motors, was nominated to be secretary of defense in 1953, he famously told a Senate confirmation panel, “I thought what was good for our country was good for General Motors, and vice versa.” For the most part, this was an aphorism earnestly accepted as a statement of good faith. To avert class warfare, the Goliaths of the day recognized unions; they bestowed health care and pensions upon employees. Liberal eminences such as John K. Galbraith hailed the corporation as the basis for a benign social order. Galbraith extolled the social utility of the corporation because he believed that it could be domesticated and harnessed to serve interests other than its own bottom line. He believed businesses behave beneficently when their self-serving impulses are checked by “countervailing power” in the form of organized labor and government.
Of course, those powers have receded. Unions, whose organizing efforts Amazon has routinely squashed, are an unassuming nub of their former selves; the regulatory state is badly out of practice. So while Amazon is trusted, no countervailing force has the inclination or capacity to restrain it. And while power could amass in a more villainous character than Jeff Bezos, that doesn’t alleviate the anxiety that accompanies such concentration. Amazon might be a vast corporation, with more than 600,000 employees, but it is also the extension of one brilliant, willful man with an incredible knack for bending the world to his values.
by Franklin Foer, The Atlantic | Read more:
Image: Bloomberg/Landov via
Who Killed the American Arts?
The arts in America are dying. In the 20th century, Americans defined the world’s popular culture, but the 21st century world has no need of America’s arts. Through technology transfer, the world entertains itself with knock offs like Bollywood and K-Pop. In the 20th century, Americans created a new art form in jazz and its derivatives, and turned Hollywood into the world’s dream factory. In the 21st century, African American music has collapsed into monotone misogyny, and digital sex (see Julie Bindel) is America’s real movie business. Americans are in the gutter, looking up at porn stars. And the rest of the world is barely looking, or listening, or reading at all. (...)
Everything is derivative and nostalgic. Nothing of note happened in painting or dance — or criticism, because the task of the American critic is to write obituaries and rewrite press releases. In music, Taylor Swift, once the Great White Hope of a dying industry, emitted a scrupulously bland album by committee. The jazz album of the year was, as it was last year, a studio off cut from John Coltrane, who died in 1967. The show, or what remained of it, was stolen by Lizzo, an obese but self-affirming squawker who, befitting an age of irony and multi-tasking, is the first person to twerk and play the flute at the same time. Meanwhile at the Alamo of high culture, 87-year-old John Williams marked the Tanglewood Festival’s 80th anniversary by perpetrating selections from Star Wars and Saving Private Ryan for an audience of equally geriatric and tasteless boomers.
In a dying culture, the best cases, like Wynton Marsalis and Bob Dylan in music, are curators of the Museum of American Greatness. The worst reflect a spiral into coarse nostalgia, as the needle wears out the groove: Stadium Country, Quentin Tarantino, the decay of fiction into self-help and affirmative action. The worst of all subordinate aesthetic values to political dogma, which is why it’s an offense to point out that the decline from Duke Ellington and Aretha Franklin to A$AP Rocky and Lizzo is a slide from civilization to barbarism.
by Dominic Green, The Spectator | Read more:
Image: MTV
[ed. See also: Who’s Got the Country Music Blues? (The American Conservative).]
Everything is derivative and nostalgic. Nothing of note happened in painting or dance — or criticism, because the task of the American critic is to write obituaries and rewrite press releases. In music, Taylor Swift, once the Great White Hope of a dying industry, emitted a scrupulously bland album by committee. The jazz album of the year was, as it was last year, a studio off cut from John Coltrane, who died in 1967. The show, or what remained of it, was stolen by Lizzo, an obese but self-affirming squawker who, befitting an age of irony and multi-tasking, is the first person to twerk and play the flute at the same time. Meanwhile at the Alamo of high culture, 87-year-old John Williams marked the Tanglewood Festival’s 80th anniversary by perpetrating selections from Star Wars and Saving Private Ryan for an audience of equally geriatric and tasteless boomers.In a dying culture, the best cases, like Wynton Marsalis and Bob Dylan in music, are curators of the Museum of American Greatness. The worst reflect a spiral into coarse nostalgia, as the needle wears out the groove: Stadium Country, Quentin Tarantino, the decay of fiction into self-help and affirmative action. The worst of all subordinate aesthetic values to political dogma, which is why it’s an offense to point out that the decline from Duke Ellington and Aretha Franklin to A$AP Rocky and Lizzo is a slide from civilization to barbarism.
by Dominic Green, The Spectator | Read more:
Image: MTV
[ed. See also: Who’s Got the Country Music Blues? (The American Conservative).]
Betteridge's Law
Betteridge's law of headlines is an adage that states: "Any headline that ends in a question mark can be answered by the word no". It is named after Ian Betteridge, a British technology journalist who wrote about it in 2009, although the principle is much older. (...)
Ian Betteridge's name became associated with the concept after he discussed it in a February 2009 article, which examined a previous TechCrunch article that carried the headline "Did Last.fm Just Hand Over User Listening Data to the RIAA?".(Schonfeld 2009):
Ian Betteridge's name became associated with the concept after he discussed it in a February 2009 article, which examined a previous TechCrunch article that carried the headline "Did Last.fm Just Hand Over User Listening Data to the RIAA?".(Schonfeld 2009):
This story is a great demonstration of my maxim that any headline which ends in a question mark can be answered by the word "no." The reason why journalists use that style of headline is that they know the story is probably bullshit, and don’t actually have the sources and facts to back it up, but still want to run it.A similar observation was made by British newspaper editor Andrew Marr in his 2004 book My Trade, among Marr's suggestions for how a reader should interpret newspaper articles:
If the headline asks a question, try answering 'no'. Is This the True Face of Britain's Young? (Sensible reader: No.) Have We Found the Cure for AIDS? (No; or you wouldn't have put the question mark in.) Does This Map Provide the Key for Peace? (Probably not.) A headline with a question mark at the end means, in the vast majority of cases, that the story is tendentious or over-sold. It is often a scare story, or an attempt to elevate some run-of-the-mill piece of reporting into a national controversy and, preferably, a national panic. To a busy journalist hunting for real information a question mark means 'don't bother reading this bit'.by Wikipedia | Read more:
Must the House Vote to Authorize an Impeachment Inquiry?
Since taking control of the U.S. House of Representatives in the midterm election of 2018, the Democrats have been exploring how it might be possible to pursue an impeachment inquiry while retaining some plausible deniability about whether they are actually doing so. As President Trump has continued to behave in his usual manner, and as the Democratic caucus has gradually coalesced around the view that an impeachment might be necessary, the process has become more explicit. As the center of gravity in the caucus shifted toward impeachment after the revelation of Trump’s phone call within Ukrainian President Volodymyr Zelensky, Speaker of the House Nancy Pelosi finally announced that the “House of Representatives is moving forward with an official impeachment inquiry.”
But what counts as an “official impeachment inquiry,” and what is required to move forward with one? House Minority Leader Kevin McCarthy sent a letter to Pelosi asking her to “suspend” the impeachment inquiry until “transparent and equitable rules and procedures” could be put in place and a floor vote authorizing an impeachment inquiry could be taken. Pelosi responded that no vote was necessary. Now White House Counsel Pat Cipollone has written to Pelosi informing her that the administration will not cooperate with the House’s “constitutionally invalid” impeachment inquiry, in part because the House had not voted “to authorize such a dramatic constitutional step” or provided the president with “due process protections.”
Is it constitutionally acceptable for the House speaker to initiate an impeachment “by means of nothing more than a press conference”? In short, yes.
The constitutional text on this issue is spare. The Constitution simply says that the House has the sole power of impeachment. Ultimately, if the House wants to impeach someone, it needs to muster a simple majority in support of articles of impeachment that can be presented to the Senate. How the House gets there is entirely up to the chamber itself to determine. There is no constitutional requirement that the House take two successful votes on impeachment, one to authorize some kind of inquiry and one to ratify whatever emerges from that inquiry. An impeachment inquiry is not “invalid” because there has been no vote to formally launch it, and any eventual impeachment would not be “invalid” because the process that led to it did not feature a floor vote authorizing a specific inquiry. (...)
Impeachment has frequently been analogized to a grand jury indictment, and the analogy is informative here. The House is a prosecutorial body in an impeachment context. The House members themselves must decide what steps they think are necessary to satisfy themselves that a particular impeachment is warranted and to prepare a credible case that can be argued in the Senate, where the defense will have an opportunity to poke holes in it. It might be prudent for the House to create a more robust adversarial proceeding in order to help the House members themselves assess the strength of the case, but any such process is for the benefit of informing the House, not protecting the accused from a possible impeachment. A federal officer has no particular right not to be impeached, and the bar for impeachment is consequently set low.
The Senate trial, by contrast, provides an opportunity for an accused officer to mount a robust defense, plead his or her case, and seek total vindication. The procedural bar for a Senate conviction is set high. There, the House can have no expectation of a sympathetic hearing and the defendant can make use of the fact that a bipartisan supermajority in the upper chamber will almost always be necessary to remove him or her from office. It might not be possible to impeach a ham sandwich in the House, but the accused has no expectation of a fair or bipartisan hearing in the lower chamber.
Politically, the Democratic leadership is avoiding a vote to authorize an impeachment inquiry because thus far they seem uncertain whether they could win such a vote. If a vote authorizing an impeachment is seen by some citizens as indistinguishable from a vote to impeach, then House members in purple districts might well prefer to know how strong the case for impeachment actually is before they have to go on record effectively supporting an impeachment. In a perfect world, voters would be able to distinguish support for an impeachment inquiry from support for an impeachment—but in our imperfect world, the House leadership is expected to protect caucus members from unnecessary politically damaging votes. As a matter of institutional design, Congress’s ability to inquire into misconduct should not be held hostage by such electoral calculations. Rather, the system should allow for a process that allows the investigation of allegations of misconduct and uncovering of the facts, and that forces politicians to take responsibility for how they respond to those facts. A system that instead puts a thumb on the scale on the side of hiding potential misconduct is hardly in the public interest, even if it might serve the immediate personal or partisan interests of those who fear that their conduct might come under scrutiny. Americans should be reluctant to build into constitutional practice such a bias toward obstructing investigations. The constitutional framers did not themselves build in that kind of bias.
by Keith E. Whittington, LawFare | Read more:
Image:D. Myles Cullen
But what counts as an “official impeachment inquiry,” and what is required to move forward with one? House Minority Leader Kevin McCarthy sent a letter to Pelosi asking her to “suspend” the impeachment inquiry until “transparent and equitable rules and procedures” could be put in place and a floor vote authorizing an impeachment inquiry could be taken. Pelosi responded that no vote was necessary. Now White House Counsel Pat Cipollone has written to Pelosi informing her that the administration will not cooperate with the House’s “constitutionally invalid” impeachment inquiry, in part because the House had not voted “to authorize such a dramatic constitutional step” or provided the president with “due process protections.”Is it constitutionally acceptable for the House speaker to initiate an impeachment “by means of nothing more than a press conference”? In short, yes.
The constitutional text on this issue is spare. The Constitution simply says that the House has the sole power of impeachment. Ultimately, if the House wants to impeach someone, it needs to muster a simple majority in support of articles of impeachment that can be presented to the Senate. How the House gets there is entirely up to the chamber itself to determine. There is no constitutional requirement that the House take two successful votes on impeachment, one to authorize some kind of inquiry and one to ratify whatever emerges from that inquiry. An impeachment inquiry is not “invalid” because there has been no vote to formally launch it, and any eventual impeachment would not be “invalid” because the process that led to it did not feature a floor vote authorizing a specific inquiry. (...)
Impeachment has frequently been analogized to a grand jury indictment, and the analogy is informative here. The House is a prosecutorial body in an impeachment context. The House members themselves must decide what steps they think are necessary to satisfy themselves that a particular impeachment is warranted and to prepare a credible case that can be argued in the Senate, where the defense will have an opportunity to poke holes in it. It might be prudent for the House to create a more robust adversarial proceeding in order to help the House members themselves assess the strength of the case, but any such process is for the benefit of informing the House, not protecting the accused from a possible impeachment. A federal officer has no particular right not to be impeached, and the bar for impeachment is consequently set low.
The Senate trial, by contrast, provides an opportunity for an accused officer to mount a robust defense, plead his or her case, and seek total vindication. The procedural bar for a Senate conviction is set high. There, the House can have no expectation of a sympathetic hearing and the defendant can make use of the fact that a bipartisan supermajority in the upper chamber will almost always be necessary to remove him or her from office. It might not be possible to impeach a ham sandwich in the House, but the accused has no expectation of a fair or bipartisan hearing in the lower chamber.
Politically, the Democratic leadership is avoiding a vote to authorize an impeachment inquiry because thus far they seem uncertain whether they could win such a vote. If a vote authorizing an impeachment is seen by some citizens as indistinguishable from a vote to impeach, then House members in purple districts might well prefer to know how strong the case for impeachment actually is before they have to go on record effectively supporting an impeachment. In a perfect world, voters would be able to distinguish support for an impeachment inquiry from support for an impeachment—but in our imperfect world, the House leadership is expected to protect caucus members from unnecessary politically damaging votes. As a matter of institutional design, Congress’s ability to inquire into misconduct should not be held hostage by such electoral calculations. Rather, the system should allow for a process that allows the investigation of allegations of misconduct and uncovering of the facts, and that forces politicians to take responsibility for how they respond to those facts. A system that instead puts a thumb on the scale on the side of hiding potential misconduct is hardly in the public interest, even if it might serve the immediate personal or partisan interests of those who fear that their conduct might come under scrutiny. Americans should be reluctant to build into constitutional practice such a bias toward obstructing investigations. The constitutional framers did not themselves build in that kind of bias.
by Keith E. Whittington, LawFare | Read more:
Image:D. Myles Cullen
Thursday, October 10, 2019
Don't Force Patients Off Opioids Abruptly, New Guidelines Say, Warning Of Severe Risks
There's no doubt that opioids have been massively overprescribed in U.S. In the haste to address the epidemic, there's been pressure on doctors to reduce prescriptions of these drugs — and in fact prescriptions are declining. But along the way, some chronic pain patients have been forced to rapidly taper or discontinue the drugs altogether.
Now, the U.S. Department of Health and Human Services has a new message for doctors: Abrupt changes to a patient's opioid prescription could harm them.
On Thursday, the agency issued new guidelines for physicians on how best to manage opioid prescriptions. They recommend a deliberate approach to lowering doses for chronic pain patients who have been on long-term opioid therapy.
"It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way."
This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off.
These guidelines led to rigid rules in some cases. Giroir says it's concerning that some clinicians, policymakers, and health systems are "interpreting guidelines as mandates."
"A guideline is a guideline it's not a mandate or a rule that works for every single patient," he says.
The new HHS guidance cautions that a hasty removal of the medication can lead to acute withdrawal symptoms, provoke thoughts of suicide and lead patients to seek out illicit opioids "as a way to treat their pain or withdrawal symptoms."
Entirely discontinuing opioids for a chronic pain patient is not always appropriate, according to the guidelines: "Unless there are indications of a life-threatening issue, such as warning signs of impending overdose, HHS does not recommend abrupt opioid dose reduction or discontinuation." (...)
A growing concern about prescribing rules
The new tapering guidance follows earlier efforts to signal that too much emphasis on reducing opioids for chronic pain patients may backfire.
Earlier this year, both the CDC and the U.S. Food & Drug Administration put out statements about the dangers of suddenly discontinuing the medication or rapidly decreasing the dose.
In March, more than 300 doctors and health professionals, including three former White House Drug Czars, warned the CDC in a letter of the "widespread misapplication" of its 2016 opioid prescribing guidelines for chronic pain.
Even though the guidelines were voluntary and geared toward primary care doctors, the recommendations became a template for states and others seeking to minimize the risk of opioids.
Dr. Stefan Kertesz, a professor of medicine at the University of Alabama at Birmingham School of Medicine, was a lead author on that letter to the CDC.
He says the new guidance from HHS does well to highlight the risks of tapering, but there are still many obstacles to making it "useful and protective of patients."
"We have to be concerned that the governmental and nongovernmental agencies continue to incentivize dose reductions that violate the precepts of this document and hold no one accountable for harm to patients when doses are forced down across the board," says Kertesz.
Clinicians across the country remain under immense pressures to curb prescribing. Kertesz notes that Medicaid, as well as states and private payers, still have policies that lead to forced dose reductions.
"Until those laws, regulations, quality metrics and criteria are revisited, we will have to live with a heart-breaking conflict between what well-intentioned experts think is good practice and what our health system and laws incentivize," he says.
In the current environment, doctors worry prescribing opioids could endanger their ability to practice, especially if state medical boards or law enforcement agencies identify them as high prescribers in the electronic databases maintained by states.
Kertesz says a growing body of research is undermining the "foolish assumption that because pills have gone down, safety has been created."
"Taper might help some patients if you do it 100% correctly," he says, "And in reality, we are mostly doing it wrong."
Increasingly, patients with chronic pain are echoing these concerns as their doses are being lowered or discontinued.
Lessons learned from a Seattle clinic
The dangers of paring back opioid prescribing came into sharp focus for Dr. Joseph Merrill when his primary care clinic in Seattle tightened its rules around opioid prescribing nearly a decade ago.
The new policy at Harborview Medical Center aimed for a more cautious approach to prescribing the pills – measures like urine drug tests, dosing recommendations and guidance to taper patients on higher doses.
"We felt there was enough data to show high doses of opioids for chronic pain could be unsafe," says Merrill, a professor at the University of Washington School of Medicine.
After the rules took effect, Merrill began to notice certain patients weren't faring well. Some were missing appointments. Others appeared to be using illicit drugs or misusing their prescriptions.
"We had the sense that we were losing some patients," he says.
Over the next five years, the clinic used an in-house registry to track 572 of its patients who were on chronic opioid therapy for pain. More than half had their opioids discontinued.
Merrill says the results were a "wake-up call"
About 20% of the patients died during the study period of all causes. Close to 4% died of a definite or possible overdose and most of those were people whose prescriptions were stopped.
"The most concerning finding was that the group of patients whose opioid prescriptions were discontinued had a higher rate of overdose death than the group who stayed on their opioid medications," Merrill says. (...)
About half of the patients who were discontinued later experienced an opioid-related hospitalization or emergency department visit.
"The typical rate of discontinuation was one day, which essentially means people were not tapered at all – they were just stopped," Mark says.
She says the University of Washington study is more evidence that doctors don't feel well-equipped to help patients who are potentially misusing opioids, "other than by having them discontinue opioids which resulted in as high or higher opioid death rates." (...)
In the big picture, Merrill says, the seesaw in opioid prescribing – from liberal dispensation to the current climate of restriction – needs to stop.
"I think neither of those extremes is appropriate," he says.
Now, the U.S. Department of Health and Human Services has a new message for doctors: Abrupt changes to a patient's opioid prescription could harm them.
On Thursday, the agency issued new guidelines for physicians on how best to manage opioid prescriptions. They recommend a deliberate approach to lowering doses for chronic pain patients who have been on long-term opioid therapy.
"It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way."This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off.
These guidelines led to rigid rules in some cases. Giroir says it's concerning that some clinicians, policymakers, and health systems are "interpreting guidelines as mandates."
"A guideline is a guideline it's not a mandate or a rule that works for every single patient," he says.
The new HHS guidance cautions that a hasty removal of the medication can lead to acute withdrawal symptoms, provoke thoughts of suicide and lead patients to seek out illicit opioids "as a way to treat their pain or withdrawal symptoms."
Entirely discontinuing opioids for a chronic pain patient is not always appropriate, according to the guidelines: "Unless there are indications of a life-threatening issue, such as warning signs of impending overdose, HHS does not recommend abrupt opioid dose reduction or discontinuation." (...)
A growing concern about prescribing rules
The new tapering guidance follows earlier efforts to signal that too much emphasis on reducing opioids for chronic pain patients may backfire.
Earlier this year, both the CDC and the U.S. Food & Drug Administration put out statements about the dangers of suddenly discontinuing the medication or rapidly decreasing the dose.
In March, more than 300 doctors and health professionals, including three former White House Drug Czars, warned the CDC in a letter of the "widespread misapplication" of its 2016 opioid prescribing guidelines for chronic pain.
Even though the guidelines were voluntary and geared toward primary care doctors, the recommendations became a template for states and others seeking to minimize the risk of opioids.
Dr. Stefan Kertesz, a professor of medicine at the University of Alabama at Birmingham School of Medicine, was a lead author on that letter to the CDC.
He says the new guidance from HHS does well to highlight the risks of tapering, but there are still many obstacles to making it "useful and protective of patients."
"We have to be concerned that the governmental and nongovernmental agencies continue to incentivize dose reductions that violate the precepts of this document and hold no one accountable for harm to patients when doses are forced down across the board," says Kertesz.
Clinicians across the country remain under immense pressures to curb prescribing. Kertesz notes that Medicaid, as well as states and private payers, still have policies that lead to forced dose reductions.
"Until those laws, regulations, quality metrics and criteria are revisited, we will have to live with a heart-breaking conflict between what well-intentioned experts think is good practice and what our health system and laws incentivize," he says.
In the current environment, doctors worry prescribing opioids could endanger their ability to practice, especially if state medical boards or law enforcement agencies identify them as high prescribers in the electronic databases maintained by states.
Kertesz says a growing body of research is undermining the "foolish assumption that because pills have gone down, safety has been created."
"Taper might help some patients if you do it 100% correctly," he says, "And in reality, we are mostly doing it wrong."
Increasingly, patients with chronic pain are echoing these concerns as their doses are being lowered or discontinued.
Lessons learned from a Seattle clinic
The dangers of paring back opioid prescribing came into sharp focus for Dr. Joseph Merrill when his primary care clinic in Seattle tightened its rules around opioid prescribing nearly a decade ago.
The new policy at Harborview Medical Center aimed for a more cautious approach to prescribing the pills – measures like urine drug tests, dosing recommendations and guidance to taper patients on higher doses.
"We felt there was enough data to show high doses of opioids for chronic pain could be unsafe," says Merrill, a professor at the University of Washington School of Medicine.
After the rules took effect, Merrill began to notice certain patients weren't faring well. Some were missing appointments. Others appeared to be using illicit drugs or misusing their prescriptions.
"We had the sense that we were losing some patients," he says.
Over the next five years, the clinic used an in-house registry to track 572 of its patients who were on chronic opioid therapy for pain. More than half had their opioids discontinued.
Merrill says the results were a "wake-up call"
About 20% of the patients died during the study period of all causes. Close to 4% died of a definite or possible overdose and most of those were people whose prescriptions were stopped.
"The most concerning finding was that the group of patients whose opioid prescriptions were discontinued had a higher rate of overdose death than the group who stayed on their opioid medications," Merrill says. (...)
About half of the patients who were discontinued later experienced an opioid-related hospitalization or emergency department visit.
"The typical rate of discontinuation was one day, which essentially means people were not tapered at all – they were just stopped," Mark says.
She says the University of Washington study is more evidence that doctors don't feel well-equipped to help patients who are potentially misusing opioids, "other than by having them discontinue opioids which resulted in as high or higher opioid death rates." (...)
In the big picture, Merrill says, the seesaw in opioid prescribing – from liberal dispensation to the current climate of restriction – needs to stop.
"I think neither of those extremes is appropriate," he says.
by Will Stone and Allison Aubrey, NPR | Read more:
Image: Douglas Sacha/Getty Images
[ed. Who could have known? Well, actually, anyone with half a brain. I've been highlighting this problem for years. See here, here, here, here, here, here, here, here, here and here. It's as if during the AIDS epidemic the only response doctors, hospitals and politicians could come up with was to tell patients to stop having sex. They've all been complicit in making this epidemic worse. It remains to be seen whether there'll be any real change.]
The Dawn of the Age of Geoengineering
Let’s be honest. The world’s governments might not coordinate to stop climate change.
Between bickering over which country is paying the bill, the fact that the major costs of climate change are decades away, and countless more urgent political problems caused by the sudden surge of populism around the world, it’s possible sensible policies like carbon taxes won’t be fully adopted in time.
Fortunately, technology and entrepreneurship are contributing solutions. Solar and wind energy is plummeting in price. Transport is electrifying because it turns out electric cars are simply better than conventional ones.
But also, there is still a chunk of humanity with the determination, audacity, and ingenuity to succeed on a massive scale where political coordination has so far failed. Meet the geoengineers.
Here are four of my favorite large-scale projects to improve Earth’s environment.
Pleistocene Park
I’ve been following the effort to bring Mammoths back to Siberia since 2017 when I read Ross Andersen’s spellbinding feature on the subject in The Atlantic (highly suggested).
The core idea is delightfully counterintuitive: Siberia has too many trees. In ages past, Siberia used to be grassland, and today it is mostly forest. Although trees can sequester carbon in their trunks and branches (at least until they burn or decompose), Siberian forests have significant drawbacks with respect to climate change.
First, forests don’t reflect a lot of solar radiation. A treeless, grassy Siberia would increase Earth’s albedo, reflecting more solar energy back into space. Forests absorb more solar radiation and put it into the ground as heat.
Second, forests are poor habitats for snow-trampling herd animals. In the winter, a thick layer of snow acts as an insulator on the permafrost, preventing frigid above-ground temperatures from reaching deep into the Earth’s crust, where they can shore up the frozenness of the permafrost. When large herds of grazing animals trample the snow, its insulating properties are reduced and the permafrost can hard freeze. Forests reduce these snow-trampling grazing populations.
These effects matter because Arctic permafrost is potentially a carbon bomb. Legions of microbes lay in suspended animation in the frozen soil. If the temperature of the soil rises only 3 more degrees (C), the microbes will come to life, eat, reproduce, and start generating carbon emissions. Arctic permafrost contains more carbon than all the planet’s forests and the atmosphere combined. Thawing permafrost could therefore be a tipping point, leading to significantly more carbon in the atmosphere and a runaway warming scenario. An increase in albedo from converting the terrain to steppe would mean that the Siberian permafrost would absorb less heat, allowing it to stay frozen longer. And the trampled snow from the return of herding animals would allow Siberia’s frigid winter air to keep the permafrost deep-frozen.
So how do we convert Siberia to grassland? Nikita Zimov is already doing it. He is director of Pleistocene Park, a 144 km² grassy Siberian reserve founded by his father, gonzo scientist Sergey Zimov. The Zimovs have spent the past two decades ripping up trees and reintroducing grazing herds, including bison, moose, wild horses, yaks, and reindeer.
The plan is working. Nikita Zimov says the permafrost, which is at around –3º outside the park, is 17º colder (!) inside the park. The question then, is how to expand the park as efficiently as possible.
Here’s where the project gets really audacious: the plan is to bring back woolly mammoths. Like much other megafauna, mammoths died out around 10,000 years ago, hunted to extinction by our human ancestors. Mammoths provided the Pleistocene with the valuable services of grazing, trampling snow and moving it around to get to the grass below, and uprooting trees. Nothing will make a mammoth happier, it is thought, than ripping a tree out of the icy ground, just as modern elephants enjoy doing the same in the warmer ground of Africa. Based on everything we know, mammoths were a critical part of the Siberian Steppe ecosystem, and their extinction at human hands is what caused the forests to take hold.
To bring back woolly mammoths, we don’t need mammoth DNA perfectly preserved in amber as in Jurassic Park. Instead, geneticists are starting from mammoths’ closest living relative, the Asian elephant, and adding genes that provide traits that could help them to survive in cold climates. If we give Asian elephants a nice layer of subcutaneous fat, a thicker coat of hair, smaller ears (so that the extremities don’t freeze), and some hemoglobin adapted for the cold, that may be enough to allow them to survive in the cold, Siberian winter. Modify perhaps as few as 50 genes. From there, it is thought, evolution will resume and make them more mammoth-like.
This genetic work is going on at the Wyss Institute at Harvard, led by ubiquitous geneticist George Church. There, scientists are identifying genes that could aid winter survival of Asian elephants, CRISPRing them into living elephant fibroblasts, and reprogramming the fibroblasts into pluripotent stem cells. These stem cells, with luck, will be used to produce new “mammoth” embryos. Once enough likely-to-survive mammoth-like elephants are incubated (artificially, because Asian elephants are endangered) to form a herd, they can be released into Pleistocene Park to help transform, maintain, and expand it—and, over a few generations, to transform themselves into better mammoths.
Between bickering over which country is paying the bill, the fact that the major costs of climate change are decades away, and countless more urgent political problems caused by the sudden surge of populism around the world, it’s possible sensible policies like carbon taxes won’t be fully adopted in time.
Fortunately, technology and entrepreneurship are contributing solutions. Solar and wind energy is plummeting in price. Transport is electrifying because it turns out electric cars are simply better than conventional ones.
But also, there is still a chunk of humanity with the determination, audacity, and ingenuity to succeed on a massive scale where political coordination has so far failed. Meet the geoengineers.
Here are four of my favorite large-scale projects to improve Earth’s environment.
Pleistocene Park
I’ve been following the effort to bring Mammoths back to Siberia since 2017 when I read Ross Andersen’s spellbinding feature on the subject in The Atlantic (highly suggested).
The core idea is delightfully counterintuitive: Siberia has too many trees. In ages past, Siberia used to be grassland, and today it is mostly forest. Although trees can sequester carbon in their trunks and branches (at least until they burn or decompose), Siberian forests have significant drawbacks with respect to climate change.
First, forests don’t reflect a lot of solar radiation. A treeless, grassy Siberia would increase Earth’s albedo, reflecting more solar energy back into space. Forests absorb more solar radiation and put it into the ground as heat.Second, forests are poor habitats for snow-trampling herd animals. In the winter, a thick layer of snow acts as an insulator on the permafrost, preventing frigid above-ground temperatures from reaching deep into the Earth’s crust, where they can shore up the frozenness of the permafrost. When large herds of grazing animals trample the snow, its insulating properties are reduced and the permafrost can hard freeze. Forests reduce these snow-trampling grazing populations.
These effects matter because Arctic permafrost is potentially a carbon bomb. Legions of microbes lay in suspended animation in the frozen soil. If the temperature of the soil rises only 3 more degrees (C), the microbes will come to life, eat, reproduce, and start generating carbon emissions. Arctic permafrost contains more carbon than all the planet’s forests and the atmosphere combined. Thawing permafrost could therefore be a tipping point, leading to significantly more carbon in the atmosphere and a runaway warming scenario. An increase in albedo from converting the terrain to steppe would mean that the Siberian permafrost would absorb less heat, allowing it to stay frozen longer. And the trampled snow from the return of herding animals would allow Siberia’s frigid winter air to keep the permafrost deep-frozen.
So how do we convert Siberia to grassland? Nikita Zimov is already doing it. He is director of Pleistocene Park, a 144 km² grassy Siberian reserve founded by his father, gonzo scientist Sergey Zimov. The Zimovs have spent the past two decades ripping up trees and reintroducing grazing herds, including bison, moose, wild horses, yaks, and reindeer.
The plan is working. Nikita Zimov says the permafrost, which is at around –3º outside the park, is 17º colder (!) inside the park. The question then, is how to expand the park as efficiently as possible.
Here’s where the project gets really audacious: the plan is to bring back woolly mammoths. Like much other megafauna, mammoths died out around 10,000 years ago, hunted to extinction by our human ancestors. Mammoths provided the Pleistocene with the valuable services of grazing, trampling snow and moving it around to get to the grass below, and uprooting trees. Nothing will make a mammoth happier, it is thought, than ripping a tree out of the icy ground, just as modern elephants enjoy doing the same in the warmer ground of Africa. Based on everything we know, mammoths were a critical part of the Siberian Steppe ecosystem, and their extinction at human hands is what caused the forests to take hold.
To bring back woolly mammoths, we don’t need mammoth DNA perfectly preserved in amber as in Jurassic Park. Instead, geneticists are starting from mammoths’ closest living relative, the Asian elephant, and adding genes that provide traits that could help them to survive in cold climates. If we give Asian elephants a nice layer of subcutaneous fat, a thicker coat of hair, smaller ears (so that the extremities don’t freeze), and some hemoglobin adapted for the cold, that may be enough to allow them to survive in the cold, Siberian winter. Modify perhaps as few as 50 genes. From there, it is thought, evolution will resume and make them more mammoth-like.
This genetic work is going on at the Wyss Institute at Harvard, led by ubiquitous geneticist George Church. There, scientists are identifying genes that could aid winter survival of Asian elephants, CRISPRing them into living elephant fibroblasts, and reprogramming the fibroblasts into pluripotent stem cells. These stem cells, with luck, will be used to produce new “mammoth” embryos. Once enough likely-to-survive mammoth-like elephants are incubated (artificially, because Asian elephants are endangered) to form a herd, they can be released into Pleistocene Park to help transform, maintain, and expand it—and, over a few generations, to transform themselves into better mammoths.
by Eli Dourado | Read more:
Image: uncredited
[ed. See also: Can we really prevent all warming for less than 10B$ with the mostly side-effect free geoengineering technique of Marine Cloud Brightening? (LessWrong)
[ed. See also: Can we really prevent all warming for less than 10B$ with the mostly side-effect free geoengineering technique of Marine Cloud Brightening? (LessWrong)
Wednesday, October 9, 2019
Costco Doesn’t Make Much Money Selling You Groceries
Have you ever wondered how Costco makes money?
Most people know that the membership-only mega-retailer sells items in large quantities at what are basically wholesale prices, so where’s the profit in that? Turns out, it’s all in the membership fees, according to a Twitter thread that went viral over the weekend.
The thread by an investor explained to the general public what most experts in retail circles have known for some time — Costco’s high volume of sales and rapid turnover of inventory are not the real reason the company is so profitable: the memberships are. The cheapest membership option is the Gold Star card, which costs $60 annually. The more expensive membership card, the Gold Star Executive card, costs $120 a year and has added perks like 2% cash back on eligible purchases.
Here’s how it works:
Since Costco operates at very low gross margins — if you buy 5 pounds of peanut butter for $10, the company makes only $1 off your purchase, according to the thread — it can’t make big bucks just by selling you things cheaply. But, since the retailer has developed a reputation for having consistently lower prices than its competitors, it has something called “price authority,” meaning Costco can lean on suppliers for competitive prices and also rely on consumers to steadily continue signing up for and renewing their memberships. The company had a 90% member renewal rate in the U.S. and Canada last year (and 88% worldwide), according to the company’s annual report.
There are more than 53 million paid members as of this year, according to the Twitter thread. That means Costco is on track to make $4.3 billion from memberships in 2019, which accounts for essentially all of the company’s profit so far, the thread says.
by Alix Langone, Money | Read more:
Image: via
Most people know that the membership-only mega-retailer sells items in large quantities at what are basically wholesale prices, so where’s the profit in that? Turns out, it’s all in the membership fees, according to a Twitter thread that went viral over the weekend.
The thread by an investor explained to the general public what most experts in retail circles have known for some time — Costco’s high volume of sales and rapid turnover of inventory are not the real reason the company is so profitable: the memberships are. The cheapest membership option is the Gold Star card, which costs $60 annually. The more expensive membership card, the Gold Star Executive card, costs $120 a year and has added perks like 2% cash back on eligible purchases.Here’s how it works:
Since Costco operates at very low gross margins — if you buy 5 pounds of peanut butter for $10, the company makes only $1 off your purchase, according to the thread — it can’t make big bucks just by selling you things cheaply. But, since the retailer has developed a reputation for having consistently lower prices than its competitors, it has something called “price authority,” meaning Costco can lean on suppliers for competitive prices and also rely on consumers to steadily continue signing up for and renewing their memberships. The company had a 90% member renewal rate in the U.S. and Canada last year (and 88% worldwide), according to the company’s annual report.
There are more than 53 million paid members as of this year, according to the Twitter thread. That means Costco is on track to make $4.3 billion from memberships in 2019, which accounts for essentially all of the company’s profit so far, the thread says.
by Alix Langone, Money | Read more:
Image: via
Off the Rails
Hanoi closes trackside cafes thronged by selfie-seeking tourists.
It's the kind of shot every Instagram connoisseur yearns for: century-old railway tracks cutting through dusty backstreets, flanked by tourists drinking beer or iced tea mere inches from the slow-moving trains.
The sight has become such a draw in the Vietnamese capital of Hanoi that authorities have set a weekend deadline for the removal of dozens of cafes that have cropped up, citing safety concerns.
"I love it. It's crazy, and completely different to anywhere I've been before," said Australian tourist Laura Metze, after a train rumbled by.
"I can also see why they would close it down because it's pretty dangerous."
Built in 1902 under French colonial rulers, the railway to Vietnam's northern provinces carries passengers and cargo mostly between Hanoi and the eastern city of Haiphong, and the remote towns of Lang Son and Lao Cai, on the mountainous border with China.
It uses an old-fashioned French narrow gauge, and is so old that when North Korean leader Kim Jong Un visited Hanoi in February for a summit with U.S. President Donald Trump, he had to stop at the border and continue by car.
In Hanoi, the line brushes the rear of houses and shops as it snakes through the city's dense centre. Vendors stroll on the tracks, selling snacks on skewers, while some visitors sit on the railway lines and soak in the vibe.
In recent months, crowds of tourists have gathered along the railway to snap selfies with passing trains or lounge at trackside cafes.
On Sunday, a train had to make an emergency stop soon after leaving Hanoi railway station to avoid hitting tourists, state media said.
The next day, the city's governing body ordered the cafes removed by Saturday to "ensure traffic safety", at the request of the transport ministry.
"Though the railway cafes attract tourists, they are, in fact, violating some regulations," Ha Van Sieu, a government tourism official, told media on Tuesday.
New and creative tourism products are encouraged, but must conform to legal regulations, Sieu added.
Vietnam received 12.87 million foreign visitors in the first nine months of this year, up nearly 11% on the year, government data shows.
by Khanh Vu, Yahoo News | Read more:
Image: Reuters/Kham via
[ed. See also: Has Overtourism Killed Big Sur? (Outside). I know, irony.]
The sight has become such a draw in the Vietnamese capital of Hanoi that authorities have set a weekend deadline for the removal of dozens of cafes that have cropped up, citing safety concerns.
"I love it. It's crazy, and completely different to anywhere I've been before," said Australian tourist Laura Metze, after a train rumbled by.
"I can also see why they would close it down because it's pretty dangerous."Built in 1902 under French colonial rulers, the railway to Vietnam's northern provinces carries passengers and cargo mostly between Hanoi and the eastern city of Haiphong, and the remote towns of Lang Son and Lao Cai, on the mountainous border with China.
It uses an old-fashioned French narrow gauge, and is so old that when North Korean leader Kim Jong Un visited Hanoi in February for a summit with U.S. President Donald Trump, he had to stop at the border and continue by car.
In Hanoi, the line brushes the rear of houses and shops as it snakes through the city's dense centre. Vendors stroll on the tracks, selling snacks on skewers, while some visitors sit on the railway lines and soak in the vibe.
In recent months, crowds of tourists have gathered along the railway to snap selfies with passing trains or lounge at trackside cafes.
On Sunday, a train had to make an emergency stop soon after leaving Hanoi railway station to avoid hitting tourists, state media said.
The next day, the city's governing body ordered the cafes removed by Saturday to "ensure traffic safety", at the request of the transport ministry.
"Though the railway cafes attract tourists, they are, in fact, violating some regulations," Ha Van Sieu, a government tourism official, told media on Tuesday.
New and creative tourism products are encouraged, but must conform to legal regulations, Sieu added.
Vietnam received 12.87 million foreign visitors in the first nine months of this year, up nearly 11% on the year, government data shows.
by Khanh Vu, Yahoo News | Read more:
Image: Reuters/Kham via
[ed. See also: Has Overtourism Killed Big Sur? (Outside). I know, irony.]
Tuesday, October 8, 2019
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