Nextgov/FCW - Authors - James Fallows

The Electronic-Medical-Records Email(s) of the Day, No. 2

James Fallows, The Atlantic — Mon, 21 Apr 2014 14:18:49 -0400

For background on the EMR saga, see this original article and previous installments one, two, three, four, five, six, and seven. Today, let's talk technical and business specifics of electronic-record software.

First, from someone in this business, a vivid and specific illustration of the overall distortion of the medical marketplace.

I'm an independent IT consultant, working mostly with solo practitioners and small (2-10 doctors) practices. My clients choose their practice management and EMR software (sometimes they ask me for advice, but usually the choice has already been made by the time I get involved) and I help them make it work.

Over the past few years, I've worked with about 15 different EMRs, and I've developed a theory: all EMRs suck; they just suck in different ways.

However, despite my frustrations, I'm convinced that this is a good and necessary thing to do, and will lead to advantages not only for wider patient care but for doctors themselves (though they'll kick and scream even while they benefit; it's just something they do.)

I thought I'd indulge myself (and bore you, no doubt) with a few observations:

- Software companies in "vertical" markets have never been magnets for top programming talent...

- Nowhere is the lack of star talent more glaringly obvious than in user-interface design. To be fair, there is an awful lot of information to be captured, and Medicare* frowns on too-great indulgence in boilerplating - but sometimes I am staggered by the sheer number of clicks required to get through even the simplest of screens, and there are far too many screens.

- Counterintuitively, some of the most physician-UNfriendly interfaces I've seen were designed by physicians. With very few exceptions, users are lousy at designing their own tools! One of the best I've seen is Practice Fusion, which is a relatively new company started by Silicon Valley/Web 2.0 types (breaking the old vertical-software paradigm.)

- The back-turned-to-the-patient issue is an easy one to solve: use a tablet, or a laptop on a rolling stand, and face the patient (or stand next to them.) The fact that such an easily-solved problem is so widely cited as a deal-breaker says more, I think, about the mindset of physicians than about the technology itself.

- Nuance Communications has a virtual lock on the voice-recognition market**, and they exploit it in ways that I frankly find appalling. Dragon Dictate Home Edition is about $50; Premium is around $100-150; Professional around $500... but Dragon Medical is $1500. The only real difference between Premium and Medical is a pre-trained vocabulary; I can see charging extra for that if the user wants it - but all non-Medical editions of Dragon check for EMR software and will not run if it's present. If you're a doctor, no edition of Dragon but Medical will run on your machine. Furthermore, updates for other editions are available on Nuance's website so that if you upgrade, e.g. from Windows XP to 7, you don't have to buy a new copy of Dragon - but Medical users are left twisting in the wind. [JF note: I agree. I like and use Dragon/Nuance software but have been astonished by the tiered pricing. For the record, I've bought and personally paid for the Professional version.]

- Data interchange between competing EMRs is laughable. There are national and international standards for this (HL7, CCR/CCD, etc.), but no EMR company takes this seriously - they generally do an OK job of exporting data but are completely clueless about importing it. (If CERN, ARPA, and the big universities had acted like these guys, there'd be no Internet.) The biggest player in "gluing" various systems/equipment/etc. together is an open-source software project called Mirth, and the company/foundation that looks after it (think Mozilla, basically.) Earlier this year, Mirth was purchased by NextGen, one of the largest EMR companies. I'm keeping my fingers crossed that NextGen will adopt Mirth's mission of connecting the medical world... but I fear that Mirth will simply wither and die.

* Medicare _and all the other insurers_, but Medicare's the one with real teeth so I use them as shorthand.

** There used to be several other players in the voice-recognition market - SpeechWorks, ViaVoice, Jott, Loquendo, Transcend, etc. - but Scansoft (now Nuance) bought them all and either killed them off or folded them into Dragon. Google's speech recognition engine is the only real competition left (Siri, of course, is powered by Dragon), and Google doesn't provide a product that works with EMRs.

Now, about the public-health advantages that may offset some of the individual-practitioner annoyances:

I've been following all the different pieces around the EMR/EHR work--and it feels like a lot of the folks who've been writing in are really missing the forest for the trees--everyone's really missing is how important these innovations are to population health. Even working in a medically underserved community, this has changed how I work with leaps and bounds over the past five years.

Want to know how many smokers there are in a specific zip code who are served by your clinic or hospital? Want to be alerted whenever one of your patients go into the ED? Want to see a panel of what percentage of patients have diet-related co-morbidities? Want to know who a patient's Primary Care Provider? Want to geographically hot-spot specific health problems? All these things are infinitely easier with the existences of both EMRs/EHRs.

In other words, we can know so much more in so much less time. Rather than sending some poor soul into stacks upon stacks of ill-organized and non-standard hard copy medical records to sort through items, you can simply find it through a relatively (though not completely) understandable electronic system.

An example from my work is telling...we work with a variety of hospitals and clinics on a large public health project, which requires them to pull data, quarterly, on how many diabetic patients they have and how many of those diabetic patients smoke. For those few facilities still using hard copy records, we can only ask them to pull a sample of their data--and it takes two full days for their entire team to pull that information. At our EMR/EHR facilities, one person can pull all of the necessary information in a fraction of that time.

Yes, its almost certainly more cumbersome for practitioners --but it makes a drastic improvement in the quality of care coordination and the quality of data collected.

(Image via EggHeadPhoto/Shutterstock.com)

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The Electronic-Medical-Records Email of the Day, No. 1

James Fallows, The Atlantic — Wed, 16 Apr 2014 12:23:38 -0400

Background: In last month's issue of The Atlantic ( subscribe !) I had a brief Q&A with Dr. David Blumenthal, who had kicked off the Obama Administration's effort to encourage use of electronic medical records. Since then, the mail has kept gushing in, as reported in previous as reported in in our April issue, about why the shift has been so difficult and taken so long. Previous multi-message compendia are available in installments one , two , three , four , five , and six .

As an operational matter, I am going to start doling these out one or sometimes two at a time, on a every-day-or-two basis. They'll have headlines based on this one's, and I will try to figure out some standardized image or illustration as cues that these are part of a series. Generally I'll post these without comment; they're meant to be part of a cumulative conversation among medical professionals, technologists, and the rest of us who are merely patients and bill-payers.

Let's start with two—one from a patient, one from a doctor.

Patient (and tech veteran): I can't stand filling out these damned forms over and over again.

I've been in the high tech industry since I graduate college in 1986, watching it grow from a specialized industry to the giant, interpenetrated octopus it is now. My wife also is in high tech, and indeed started out ... installing EMR systems in hospitals in the early 90s. Just a couple of quick thoughts:

First, if someone—ANYONE—can come up with a system that would prevent me from having to fill out THE SAME information over and over again just because I'm seeing a different doctor, I WILL TAKE IT. You get the same information requirements, but they're all on different forms, in different formats, from different doctors. But all the base information is exactly the same: Name, address, social security number, marital status, kids, insurance info, and so on. It's all the same. I'm seeing a doctor who was recommended by my GP; why in god's name am I filling out yet another form by hand. In 2014. When what most offices do is take my information and ... enter it into their databases by hand. How inefficient can you get? Hell, some doctors require you to put the exact same info *on multiple forms*. There has got to be a better way. [JF note: This is also my experience-as-patient, and I share the exasperation.]

I've long thought what we need is a card that is programmable, the size of a credit or insurance card, that you swipe through a reader, punch in a security code, and it downloads the info to the new doctor's system. Why no one has implemented this I have no idea.

Another note: I'm sure that a lot of the difficulty is incompatible systems, systems that don't play nice with various insurance companies, systems that don't interact with each well, and so on. This is not an inherent flaw of the technology—it would be no different if they were doing everything on paper, and then found, shit, we're using legal-sized, but the insurance requires 8.5 x 11! Or some other mundane problem with paper records. I don't know of any way around the problem other than mandated standards—"Everyone will use Oracle," or some such—and that's not going to happen. But the answer isn't to go backwards, or we'll end up with ink pots and quills.

Finally, I have to believe that the second doctor whom you quote is forced to use three systems partly by insurance-company requirements. I have to believe that if we had single-payer, that would simplify the record-keeping and IT problem considerably.

Doctor: A female doctor—as she notes, her gender is relevant to one of her points—says it's important to distinguish between good and bad systems.

I am a 50+ yo hospitalist (yes, the dreaded hospitalist bogeyman) and have been one for 17+ years. A couple of points, if I may:
1- there's a lot of talk about EMR as an entity without really addressing the quality of the EMR's. Just as cars are not all the same, EMR's vary greatly. A Mercedes, a Maserati and a Yugo are all cars, but you certainly wouldn't accuse someone of rejecting a used Yugo as being a Luddite and hating all cars. Similarly, you shouldn't generalize physicians who reject terrible programs as hating EMR.

They just enacted an EMR/CPOE [CPOE=Computerized Physician Order Entry] at my hospital. The reason this particular program was selected was money, savings by choosing a cheap program and avoiding the federal penalty. It is so difficult to use and (as many other commenters noted) fills your noted with drek and making the useful information difficult to find.
The program is so awful, in addition to parts of it being mouse driven, you need to use function keys and arrow keys to navigate. (Just hit F9, Dr. Smith...) When was the last time, in 2014, you were forced to learn a new program that required you to navigate that way? You can't search, you need to know the specific names for tests (CT chest rather than chest CT, dysphagia exam versus video swallow) and you need to click up to 30-40 times to get through something that previously required you to write 1 order. You can accidentally (and dangerously) erase the patient's entire plan of care with 2 clicks (one poor nurse spent 2 hours trying to recreate it) but you need click to confirm and verify multiple things that are clinically insignificant.
I would love an elegant program that enhanced patient care, was safe and made my job easier. Love, love, love it. But instead, I am painted (per lots of your communicants) as a intransigent luddite who doesn't want to move forward. Nothing could be further from the truth.

(By the way, that picture you posted on March 24, with Xrays accessed on the left, trending labs and graphs, looked great! All that info at your fingertips, integrated into the system. What program was that?) [JF note: it appears to have been an "artist's conception" image rather than a real program.]

2-I am an Apple fan. I don't care what the computer has regarding the hardware, I just want it to work, be intuitive and be reliable. (Not unusual for a woman, regarding computers or cars.) However, many of my colleagues are uber-geeks. Just being over 40 doesn't mean we can't handle the technology. We are just less patient of bad technology. I don't use the same phone I used in 1997, don't expect me to use an antiquated, poorly written program which was developed in 1997.

3--Another topic, but: Hospitalists are seeing patients because the primary care physician [PCP] chose that option. There are trade-offs for any system and thehospitalist system is no different. We may not have the longstanding relationships with people and families but we replace that with relationships forged under very emotional and intense circumstances. As with any physician, experiences vary greatly. You wouldn't slam all orthopedic surgeons because you had one bad experience or bad doctor, so you should not generalize one experience onto the whole specialty.

Also, the actual number of times people would actually see their PCP is lower than perceived, usually because of call schedules (seeing your doctor's partners instead) and going to hospitals where your PCP does not have privileges. I addition, your PCP is generally only in the house early morning and after office hours. When families come by in the middle of the day, I am available to talk to them. When someone crashes midday, I can handle it because I am there.

I got hugs from 2 patient families yesterday, one for spending the time to explain why the orthopedic surgeon was recommending an amputation ( he was at another hospital by the time the family got there) , another for transferring a patient after a terrible, prolonged, critical illness to rehab. Neither had PCP's on staff.

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Heartbleed Update: Sites That Tell You Which Passwords You Should Bother to Change

James Fallows, The Atlantic — Fri, 11 Apr 2014 13:20:33 -0400

For background, see this early Heartbleed dispatch on general principles of password hygiene, and this one on a range of test utilities to check whether possibly affected sites have yet been repaired.

Your simple two-point checklist for today and the weekend:

1) In addition to some of the other test sites already mentioned (at LastPass , Possible.lv , Qualys , Filippo.io ), check out the very convenient guide provided by the security firm IVPN . Here is a sample of what it displays:

It doesn't cover all sites, of course, but it includes many of the biggest-volume ones. The two most useful aspects of this presentation are showing which sites did not use OpenSSL at all and thus were not affected; and clarifying which affected ones have already implemented a fix, so that new, changed passwords will "stick." I can't independently vouch for all the reports here, but the ones I do know about match up with what I've seen elsewhere. Again, the advantage here is the simple clarity of the presentation.

2) As this episode recedes and tech people figure out its long-term implications, commit to heart the Basic Rules of Password Life, as reeled off and explained in the initial post:

Err on the side of changing passwords, especially after reports like this;
For sites you care about, never use a password you have ever used anywhere else;
Use a password manager to avoid going crazy from the previous two tips;
Use two-step security systems when they're available, for example in Gmail;
Remind yourself why it's worth going to this bother by reading what can happen if you don't. And anyway, that report is interesting.

That is all. Again, the upshot of recent reports is that most important sites have now patched their OpenSSL vulnerabilities, so there's no further excuse for putting off password changes where indicated.

xkcd has a wonderful visual explanation of how the bug actually works.

( Image via Rick Moser / Shutterstock.com )

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How to Check If a Site Is Safe From 'Heartbleed'

James Fallows, The Atlantic — Wed, 09 Apr 2014 16:43:55 -0400

This post follows one a few hours ago about the Heartbleed security failure, and for safety's sake it repeats information I have added to that post as an update.

Point 1 : If you would like to test to see whether a site is exposed to the loophole created (over the past two years) by the OpenSSL bug, you can go here and enter the URL you are concerned about. (This tip via Bruce Schneier .) As explained in the FAQ , the test sometimes delivers "false positives" for vulnerability -- that is, it may report problems with a site that actually is OK, or that is in the middle of taking steps to protect itself. But the site's creator explains why "false negatives" -- OK signals when there actually is a problem -- should be very rare, and practically non-existent if you perform the test several times.

Point 2 : If a site tests through as Safe, then it makes sense to change your password there. And all of my email and financial sites are now saying Safe, so the changes I am making there will stick.

But even if a site does not say Safe, the people I have asked say that it still makes sense to change -- even though you'll need to change again when the SSL for that site is fully repaired.

Reasoning: If you change it now, it's possible that a still-active hacker will capture info today. But if you don't change it now, anything exploited in the past two years is still vulnerable. Also, many sites that are not yet fully protected are on higher alert than they would have been before this news, so hackers may have a tougher time in the new environment than when this was an unknown-unknown.

Point 3 : The guy who created the test site, a young Italian cryptologist based in Milan, has a donation button on the site.

UPDATE : Here is another industrial-strength test site . I tried the same domain on it, and the score you see here is way, way close to the top of those it has tried.

Previous post

( Image via Leszek Glasner / Shutterstock.com )

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Why Doctors Still Use Pen and Paper

James Fallows, The Atlantic — Mon, 07 Apr 2014 12:11:15 -0400

The health-care system is one of the most technology-dependent parts of the American economy, and one of the most primitive. Every patient knows, and dreads, the first stage of any doctor visit: sitting down with a clipboard and filling out forms by hand.

David Blumenthal, a physician and former Harvard Medical School professor, was from 2009 to 2011 the national coordinator for health information technology, in charge of modernizing the nation’s medical-records systems. He now directs The Commonwealth Fund, a foundation that conducts health-policy research. Here, he talks about why progress has been so slow, and when and how that might change.

James Fallows: From the lay public’s point of view, medical records seem incredibly backward. Is the situation any better than it looks?

David Blumenthal: It’s on the way to getting better. But we still have a long way to go. The reason why the medical profession has been so slow to adopt technology at the point of contact with patients is that there is an asymmetry of benefits.

From the patient’s perspective, this is a no-brainer. The benefits are substantial. But from the provider’s perspective, there are substantial costs in setting up and using the systems. Until now, providers haven’t recovered those costs, either in payment or in increased satisfaction, or in any other way. Ultimately, there are of course benefits to the professional as well. It’s beyond question that you become a better physician, a better nurse, a better manager when you have the digital data at your fingertips. But the costs are considerable, and they have fallen on people who have no economic incentive to make the transition. The benefits of a more efficient practice largely accrue to people paying the bills. The way economists would describe this is that the medical marketplace is broken.

JF: This is a subset of the general brokenness of the medical marketplace, right?

DB: Yes. There are many problems that come from the brokenness of the health-care market. To put it another way, if the medical market functioned like the car industry or the computer industry or the service industry, with true competition based on quality and price, providers would have adopted electronic records long ago. I’m not advocating pure market competition in health care. But there are many ways in which the medical marketplace should work better, and this is one of them.

JF: What’s the best thought-experiment example of medical-marketplace incentives working the right way? The VA?

DB: When the benefits of using better technology are “internalized,” as the economists would say, there has been much more rapid, complete, and effective adoption of electronic medical records. So, the VA: the benefits are internalized, because the VA has to live within a budget. In private health-care organizations like Kaiser or the Geisinger plan in Pennsylvania, or the Group Health Cooperative in Puget Sound, electronic medical records were adopted decades ago, and are widely used and highly effective. You don’t need a thought experiment to find living, breathing examples of what happens when the incentives work right.

JF: What’s the connection between the electronic-records effort you directed and the larger Obamacare strategy?

DB: This may be a Beltway detail, but the law that I implemented was not in the Affordable Care Act. It was actually part of the earlier and much maligned stimulus bill. The hope was that promoting medical records would lay the groundwork for a more efficient health-care system, and thereby make universal coverage more affordable to the country—

JF: And—

DB: And you’re about to ask whether it did.

JF: Yes.

DB: It would have. And it will. But it needs time to realize its potential.

I think the parallel is the time it took from when computerization became prevalent in other industries to the time when worker productivity improved. We are only three years into the process of making digital information widely available in health care. And health care is an extraordinarily complex, knowledge-intensive industry. If you want a thought experiment, you could ask yourself how good modern medicine is when physicians and nurses know nothing at all about the patient. So information is absolutely the critical resource in health care, more important than steel in making cars. When you change the way information is used and collected in medicine, you change everything about the way work is done. It is an enormously disruptive process within the health-care system. It takes time to accommodate. In places like Kaiser and Geisinger, electronic medical records are already making a big impact. But that is mostly because those organizations started using them a long time ago.

JF: What about when you switch from too little technology in the patient experience to too much? When the doctor is staring at a laptop rather than looking at you?

DB: This is a transition issue. Most physicians’ offices, and I’ve been in a lot of them, are set up so that when the physician looks at the screen, he or she can’t look at the patient. Often they have their back to the patient. That is because no one has given a lot of thought to how to maximize the ergonomic quality of inserting this technology into the office.

That will come. I also think that voice-recognition technology is going to be an enormous relief both to the physician and to the patient, because the physician will be able to talk to a machine rather than typing into it. Those technologies are improving—as you can tell from your smartphone—and as they do, a lot of this ergonomic problem will go away.

JF: In the broadest sense, what difference will better information technology make in our lives and health?

DB: Fundamentally, every medical record is a tool for collecting information: the information a physician collects when looking at you in a physical examination; the results of lab tests. The constant automatic information collection is going to increase, whether it’s your phone monitoring your heart rate or your scale sending information about your weight to your health provider, or the contact lenses Google wants to market that measure blood glucose levels.

They all are sources of information about your health and well-being. And the challenge we face collectively, inside the health-care establishment and outside it, is how to take all this information, separate what’s useful from what’s not, and then apply it to improve the decisions of patients and care providers.

This is a generic problem in society. We have lots of information, and we don’t always know what to do with it. Your doctor, your nurse, is not prepared to process the information they already have. It’s already overwhelming. And adding more in will just make it even more anxiety-provoking and overwhelming. That is, in a sense, the big data challenge facing health care in the future.

This will move us into a field that is taking shape right now, that of analytics. It will help us take these data and turn them into diagnostic information—into recommendations a physician can give a patient or that patients can get directly, online.

That’s where the future lies, and of course people want the benefit of it right now. Before, there was no market to make this sort of analytic product. Now that we have a growing electronic infrastructure for health information, there is a surge of traditional capitalist interest in turning that information into valuable knowledge, and selling it back to patients and doctors. That will happen. But it could never have happened until we got the data into digital form.

(Image via 18percentgrey/Shutterstock.com)

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When Will Genomics Cure Cancer?

James Fallows, The Atlantic — Thu, 02 Jan 2014 07:35:06 -0500

Since the beginning of this century, the most rapidly advancing field in the life sciences, and perhaps in human inquiry of any sort, has been genomics. In 2001, rival teams from the Human Genome Project and the private company Celera each announced a draft sequence of the human genome—a map, essentially, of the 3 billion letters of DNA that make up a human being’s genetic code. Eric S. Lander was one of the leaders of the public project. Now a professor at MIT and Harvard Medical School as well as the director of the Broad Institute in Cambridge, he discusses what researchers have learned since then, and how they may soon convert many forms of cancer from fatal afflictions to manageable chronic diseases.

James Fallows: Everyone has heard about remarkable breakthroughs in genomics, but it is hard for nonscientists to put them in perspective. By analogy to aerospace, are we still at a stage like the Wright brothers’? Or are we landing on the moon?

Eric S. Lander: A good analogy is the germ theory of disease. There was a sweep of progress from the fundamental understanding around 1870 that microbes caused infectious diseases, to the widespread availability after World War II of cheap penicillin that saved millions of lives. That took about 75 years. With genomics, we’re maybe halfway through that cycle—something like the situation around 1915, when early, highly imperfect antibiotics were first introduced.

JF: What are the comparable next steps in genomics?

ESL: Before we could understand the genetic basis of inherited diseases and cancer, we first had to get a sequence of the human genome. The first 15 years of work [on the Human Genome Project], and about $3 billion of cost, was devoted to getting one sequence of one human being, to use as a starting reference point.

The next job was to go figure out how people with a disease, whether it’s diabetes, schizophrenia, or a lung tumor, differ from that reference. That would require looking at the genomes of thousands and thousands of people to spot the changes. Remember that it took 15 years and $3 billion just to get the first person’s sequence. The idea of doing that thousands of times over would have seemed crazy—except that an amazing transformation over the past 12 years brought down the cost of sequencing genomes by about a million-fold. That has allowed us to look at thousands of people and see the differences among them, to discover critical genes that cause cancer, autism, heart disease, or schizophrenia.

For the first time, after 25 years of genomics, we can finally pop the hood on the car and see what’s wrong. The rate of progress is just stunning. As costs continue to come down, we are entering a period where we are going to be able to get the complete catalogue of disease genes. I think in another five or six years, we should have a complete catalogue. That is not a cure for disease. The next level will be seeing how these individual genetic components fit together, into circuits. You could say that right now we are discovering all the parts of a Boeing 747 and meticulously laying them out on the floor of a hangar. That’s actually pretty impressive, to get all the parts! Still, the plane doesn’t fly yet. This next generation of young scientists is figuring out the functional circuits into which all these parts fit.

JF: I feel lowbrow asking this, but on what timeline will patients see the results? Are these therapies decades away, or a few years?

ESL: It’s important to define your goals. Therapeutic development has already been transformed by genomics. There are 800 different anticancer drugs in clinical development today. Cancer drugs used to be just cellular poisons, but almost all of these new ones are targeted at particular gene products that have been discovered.

But it’s just a start. Some of the new cancer drugs can miraculously make tumors disappear. The problem is that, a year later, the cancer in many cases comes roaring back, because some of the cells have developed mutations that make them resistant. So genome scientists are now finding and targeting these mutations as well. Remember in the 1980s, when HIV was a fatal disease? What made it become a chronic, treatable disease? It was a combination of three drugs. Any one of those drugs alone, the virus could mutate its way around. But with the combination of all three, the chance that a virus could find its way around all of them was vanishingly small.

That’s what’s going to be happening in cancer. If you didn’t know the HIV story, you would be depressed: you put all this work into the drug, and a year later the cancer has developed resistance. But if you understand that this is a game of probability, and there is only a finite number of cancer cells and each has only a certain chance of mutating, and if we can put together two or three independent attacks on the cancer cell, we win. If we invest vigorously in this and we attract the best young people into this field, we get it done in a generation. If we don’t, it takes two generations. That’s a very big difference.

JF: You mentioned schizophrenia alongside cancer. What is the genomic prospect for dealing with psychiatric diseases?

ESL: These diseases are the flip side of cancer. Cancer, you can study in a petri dish, because it’s about cells growing. You can also inject cancer cells into a mouse and study them. With psychiatric disease, you can’t do any of that. It is quintessentially a human condition.

That’s why genomics, in which Big Data meets DNA, has been so important for approaching psychiatric disease. By looking at tens of thousands of patients, we’ve gone from knowing about zero genes underlying schizophrenia, as recently as five years ago, to knowing roughly 100 genes today. And the genes are beginning to make sense. Some look like they’re telling us about particular kinds of calcium channels, others about particular ways that neurons grow.

I think the genetic clues as to what’s actually wrong in human disease, together with experimental tools of manipulating neurons in animal models, may allow us to produce animals that mimic the real molecular biology of human disease. I’m not Pollyanna. This is not around the corner. It’s not for next quarter; it’s not for next year. We play for the long game. I don’t want to overpromise in the short term, but it is incredibly exciting if you take the 25-year view.

JF: Any researcher can find ways to use extra money. But in genomics now, how significant is research funding as a limiting factor on progress toward therapies?

ESL: It is incredibly limiting right now. Young scientists who need to look at 100,000 cancer samples, or do functional tests inhibiting all the genes in the genome, or explore the use of chemicals in ways they never could before—they need an NIH [National Institutes of Health] that is able to place bets. With sequestration, and the NIH budget falling by about 25 percent in real terms over the past decade, the people reviewing grants naturally become more conservative. When there’s less money, reviewers don’t want to run the risk of wasting money on something that doesn’t work.

I’ve got to tell you, if you aren’t prepared to waste money on things that might not work, you can’t possibly do things that are transformative. Because for every successful transformative idea, there’s five times as many nonsuccessful transformative ideas. Nobody knows how to figure out in advance which ones they’re going to be.

We’ve got an amazing cadre of young people coming into the field, and they have this cognitive dissonance right now. On the one hand they see unbelievable opportunities, and on the other hand, for the first time they see the nation decreasing funding for biomedical research.

In a very objective sense, this is a unique moment to be investing. This is the first decade when we can actually look across diseases in this systematic way. The idea that we’re not investing to let a generation of young people try their riskiest, cleverest ideas is a tragedy. Because we’ve got such an opportunity.

(Image via majcot/Shutterstock.com)

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Your real-time cyberattack map

James Fallows, The Atlantic — Mon, 15 Oct 2012 09:00:00 -0400

I have no idea how reliable the info shown here is, but it certainly is interesting. Especially to me, as I climb onto a plane bound for southern China via Japan. It's an animated real-time visualization of (it says) attempted cyber-attacks. Click below for a more detailed view or on the link above to see the real-time map.

More on the background of the Honeynet Project and this map here. I like the tone of its explanation:

What kind of attacks are these? Are they "targeted"?
The data that is currently shown on the HoneyMap is mostly not "targeted" in the sense that a human attacker with a specific goal is monitored. Mostly, we see automated scans and attacks with the current set of sensors and they originate from infected end-user computers or hijacked server systems. This also means that an "attack" on the HoneyMap is not necessarily conducted by a single malicious person but rather by a computer worm or other forms of malicious programs.

Is the data representative?
Kind of. Historically, this kind of visualization would be skewed by the sensor location but with newer attack code (e.g., Conficker) this is not true anymore as the attack target selection is randomized.

I expect to be mainly offline for the next week, which means that the promised Jobim wrap-up, among other things, will probably need to wait. Enjoy this week's debate.

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