Finding the Light

[This is my introduction to a course I teach at Suffolk University, Big Data Analytics for Health.  I play this video in the background.]

The underlying theme and tone of the course is finding the light.

Using data analytics to find the truth, to discover, to guide.  We will be on this journey together for the next 14 weeks.  I hope you will become...a believer.

·        Analytics can illuminate the facts…it can put a spotlight on the evidence--and guide decisions.

·        It can provide insight into challenges we just have not been able to understand—through research discoveries and precision medicine. 

·        It can automate many jobs, thereby reducing costs and improving productivity, changing the nature of human work, and displacing hard hit workers.

·        It can drive the creation of new, very profitable, disruptive industries.

·        It can be used against us by exploiting our personal data for the purposes of surveillance and marketing. 

·        We must stand on the side of light using this amazing asset for the right reasons.

I have been a geek for most of my life.  Not as a coder or app developer.  I have certainly been a number cruncher and have done my time in the back office.  Mostly been a manager specializing in data translation--at the intersection of what the business needs and IT or research can produce. 

I knew I was a geek in the fifth grade.  I remember it clearly.  The class was boring and I did surveys to develop class names.  I tabulated the frequency of the first, second, third, etc. letters of names in the class., selecting the letters with the highest counts and then stringing them out into a name.  I think my most popular name was Joram Sornt.  It didn’t catch on.  But I was fascinated with computational technologies.  I remember sailing from Nantucket to Block Island with my young children and a soupy fog dropped down on us.  It was very scary.  But we sailed on and found the buoy exactly on target because of my GPS system.  We need an elaborate GPS system for health care.

It’s a great time for health analytics.   Data is abundant.  It’s like the gold rush.  It’s there to be harvested.  The tools for doing so are sophisticated in terms of processing speeds, storage, emerging capabilities with machine learning and artificial intelligence, and the development of talent like yourselves.

Please join with me to find the light.  Data does not always show the right path, sometimes it’s not very truthful at all, and all too often it is wasted.  But, in this period we are going through where facts are dismissed, experts are forsaken, and fake news runs wild, more than ever we need evidence, insight, and guidance.  That’s what we are going to find in this course.  

Sneaky Software: From VW to Newspapers

VW’s fall from grace as a trusted automotive engineering powerhouse resulted from its hubris and greed for better profits by executing a deceit on consumers facilitated by sneaky software.   This is consistent with a new rash of brash corporate behavior including the salmonella-peanut-CEO who said “just ship it” and the price-gouging prescription drug CEO who said “this is about trying to stay in business.”   But, what is yet to emerge is the widespread misuse of sneaky software for corporate profits across many industries, including newspapers. 

A New York Times editorial asked “what was Volkswagen thinking?...It is incredible that anyone at the company thought that the company could get away with it.”  But, the Times should get off its pedestal and critically examine its own practices with sneaky software. 

A bit of background.  The Time’s stock price is down almost 20% over the last three months and it is barely scratching out a profit.  But, the bright spot in Q1 was digital advertising which increased 14%.  It now accounts for one third of all advertising.  And advertising accounts for 40% of the newspaper’s revenue.  At this growth rate, compared to its circulation growth (i.e., people actually buying the product), the company will be predominately an advertising company in just a few years.  An industry analyst said “the company needs to continue execution on digital to return to a path of revenue growth.”

The digital strategy is all about getting more ad revenues through targeted ads based on cookie spies injected into computing devices that discover where you have traveled, what you have read, what you have shared with your connections on social media, and more.  I have suggested in another piece that you may not want your mother to know that you were at the Happy Times Hotel at 2 in the morning, so why would you share that with the Times?  

What’s interesting about digital advertising is its audaciousness.  The Times is “open” about its policies if you have the wherewithal to find, read and understand its 4000 word privacy policy.   There you will find some brazen statements such as the following.  (My comments are italicized.)

•  “If you choose to use NYTimes.com…you will be agreeing to abide by all of the terms and conditions… which we may change at any time… It is your responsibility to review these Terms of Service prior to each use.”  This lawyerly statement means that just clicking on the site absolves them of any actions they take as described in the terms and conditions that may be harmful to you. 
•  “You may register or enhance your profile by linking to your Facebook or Google account… and you are authorizing us to collect, store, and use what they send us…”  What you record on other sites is shared with the NYT for its data mining purposes.
• “We may collect non-personal information about the computer, mobile device or other device you use to access the NYT Services, such as IP address, geolocation information, unique device identifiers, browser type, browser language and other transactional information.”  This is a curious use of the term “non-personal” since this information is very personal.  It is an obfuscating attempt to give the impression that it does not collect personal information.
• “We may transmit non-personally identifiable website usage information to third parties in order to show you advertising.”  This sharing is the bedrock of targeted digital advertising.  
•  “We gather certain information automatically and store it in log files.”  How long is it stored, how is it protected, when and how is it destroyed?
•   “Some of the services and advertisements included in the NYT Services…are delivered or served by third-party companies…These companies may place or recognize cookies, Web beacons or other technology to track certain non-personal information about our website users… an advertiser or ad server may also be able to collect your device’s unique identifier in the course of serving an ad.   In many cases, this information could be used to show you ads… We do not have access to, nor control over, these third parties' use of cookies or other tracking technologies or how they may be used.”  They acknowledge that they facilitate the spying by third parties.  But, why are they not responsible for the activities of their paid advertising partners?  Are these third parties trustworthy?  Do we need to check out their Terms of Service on a daily basis?  But, how do we find out who they are?

The New York Times is my favorite newspaper.  I have been a subscriber for decades.  It has a dedication to reporting excellence.  I had the same loyalty to VW.  Sneaky software got in the way.  The desperate reach for revenues distorted smart thinking.  It is foolish to believe that all these data collected for advertising will not end up being stolen or used for purposes such as profiling people that may result in a loss of a job, mortgage, or marriage.  As the New York Times pursues it digital advertising strategy, I sincerely hope that hubris, profits, and sneaky software do not conspire to ruin it.

Mom, 10, and TOU

My mother always warned me not to accept gifts from strangers.  She was especially concerned about those men driving by on my way to school who might lure me into their car with an offer of candy. 

So, when I got the persistent pop-up reminders from Microsoft to download the free version of Windows 10, I was skeptical.  Geez, I paid $100 for Version 8 a few years ago (and that dog certainly should have been given away for free!).  But, 10 gets good marks on its improvements in the operating system. 

I finally “scheduled” my 10 download appointment (like going to the doctor!) and the first thing that pops up is the Accept button that must be clicked, otherwise the download will not start.   I was so excited from all the marketing about 10 that I just wanted to get it...it’s free…it’s new!  But, then I started reading the TOU (Terms of Use) and I got the shivers. 

I usually click through these things thinking they are innocuous.  Spoiler alert:  Times have changed in the wild-wild-west digital world and you have to read them and take the decision seriously.  By the way, these things are legally binding.  Now, the install site only provides a few lines of the agreement at a time so it is oh-so-surprisingly hard-to-navigate and the words need a legal Google Translator to understand.  I scoured the site and found the “legal” button for access to the full agreement.  It is 45 pages long.

The TOU contains the usual disclaimers that “in no event” is the corporation liable for “any damages whatsoever” resulting from the “use or performance of the software”.  And if you do find reason to raise a legal concern that would question this disclaimer, you must use “binding arbitration” and “not sue in court”.   The scary stuff is in the Privacy Statement and the information they can collect from you from your searches, geographical location (GPS), data from messages, calendars, contacts, Cortana, and much more. 

The purpose of collecting all these data is for advertising revenues…to target you with customized ads to make you buy more.  As I suggested in my last blog, Google, Facebook, and now Microsoft are not search, social exchange, or operating system companies.  They are advertising companies.  As the old saying goes, “follow the money”. 

But in the wild, wild digital west, where there is very little privacy oversight, things can go wrong with your data, and they do.  My data “in the cloud” with organizations I do business with has been hacked three times.  But, the data on my computing devices is hacked every day. 

Getting back to Mom.  Would you want her to know that you were at a liquor store on 4^th Street at 11 PM, and then went to the HappyTimes Hotel at midnight, and then stopped along the highway at 1 AM for 20 minutes?  Then why would you want Microsoft and their affiliates to know it?  What other purposes will the data be put to?  It is very possible that an unsavory big data monger and algorithm expert could tap this stored personal data and develop a character profile that could influence whether you get a job, a mortgage, or a divorce.

Take your Windows 10 privacy into your own hands.  When installing 10, you can turn a lot of this tracking off.   Do not use the Express Install button which installs it all.  Rather, customize your setting and opt out of most of the stuff offered.  And if you have already installed it, use this easy guide to change the settings.  Or better yet, leave the trackers behind and consider a better operating system, Ubuntu, based on Linux. 

This unfettered appetite of advertisers and their partners, like Microsoft, to spy on you and use your data for their profit must and can be stopped.

OWN YOUR BILLBOARD

What would you do if a truck pulled into your yard, a crew erected a billboard in front of your living room window, and ads were beamed at you at all hours?  Or what if you hired a plumber to fix a pipe and, while he was in your house, he took an inventory of your belongings and sold it to ad companies resulting in yet more nuisance calls to sell you stuff.  I bet you would tell them to get lost and never do business with them again. 

So why do you allow this to happen on your computing devices?  Your device screen is a billboard, controlled by others, to sell you stuff that they predict you will buy as derived from spying on your Internet clicks through their insertion of cookies into your operating system.  I guess you didn't “get the memo” that in exchange for free Internet content and apps you agreed to a constant barrage of ads and legions of spies infiltrating your computer.  What’s next, GPS tracking of our car journeys, cookies on our smart TVs, face recognition in stores?  Well, er, yes!  There appears to be no end in sight to advertisers’ intent and ability to get more information about you to sell you more stuff.  

There needs to be an advertising industry smackdown.  Clearly the industry will not restrain itself and government will not act. It's up to us to shut them down.   And we have the tools to do so.

According to Forbes magazine, online ad spending will exceed $135 billion in 2015.  This is in addition to the $150 billion spent on conventional ads.  It is clear that digital commerce companies like Google, Facebook, and even newspapers like the New York Times are really not in the business of search, social exchange or news.  They are advertising companies.  Google’s ad revenues in 2014 were $60 billion, accounting for 89% of company revenues.  Search, email, and maps and all the rest are just means to the end of extracting personal information from you to fine tune ad promotions to increase the clicking and purchase conversion rate.  Facebook is designed specifically for people to “share” their intimate details with friends…and with advertisers.  The New York Times allowed 26 trackers, such as Doubeclick, Optimizely, and google analytics, into my computer when I clicked on a news article.  How much money did they make by selling me off?  Maybe I forgot to read the fine print in the terms and conditions that they can auction me off at will.

Pervasive ads are distracting, suck up your computer’s cpu and batteries, and condone breaking and entering and theft of personal information.  Why can’t digital companies make money the old-fashioned way?   You know, by creating valuable products and services that people will pay for directly. 

Here’s what to do.  Get an ad blocker, such as AdBlock, to kill the ads. Your screen will be so much cleaner…and you will own your billboard!  Get a tracker buster such as Ghosterly to stop the cookies from infiltrating your computer when you click on content.  And get a browser tracking buster, such as Disconnect, to stop browsers from gathering data on your searches.   Check it out…these apps work well.  It is one big step you can take to preserve your privacy within this overbearing surveillance society we live in.  And, if enough of us to so, it will send a resounding message to advertisers to actually listen to customers and change the way they do digital business. 

Alien Intelligence Has Landed

The aliens are coming and they can help us.  With the information explosion, our human RAM is overloaded and bogged down.  We need an external drive and complementary, sophisticated software to make sense of it all and guide us toward a healthier future.  Indeed, researchers at the University of California at Berkeley have given birth to robots that can learn to screw the cap on a bottle, even figuring out the need to apply a subtle backward twist to find the thread before turning it the right way.  This may seem like a minor task but the underlying, pioneering technologies will migrate to worthwhile applications in health and healthcare.

In health care, the increasing volume of data produced from scientific reports, medical records, and personal information has far outstretched human capacities to digest and make sense of it and to act upon it.   Help is on the way in the form of artificial intelligence (AI). Artificial is a strange term for what it has to offer. It may be produced in a seemingly nonhuman way, but rather than being artificial, it is quite genuine, albeit different in some ways. In fact, its greatest contribution may be what Kevin Kelly from Wired Magazine calls “alien” intelligence.

The promise of AI has been touted for decades. Twenty years ago, I was part of a team at GTE Labs that developed an AI system that analyzed health insurance claims data and provided an automated analysis of “multiple dimensions to determine the most interesting deviations of specific quantitative measures relative to norms and previous values...and generated simple recommendations for correcting detected problems.” Our reason for developing the system was that each time I wanted a report on health claims data, I paid a consulting firm tens of thousands of dollars. It seemed that this could be automated through good logic and code for routine analysis and reporting. It did a nice job and reduced consultant expenses.

Flash forward to realize that there is reason to believe that the long “AI winter” is nearly over and its capabilities are stronger and much more relevant. Eric Topol, in his new book, The Patient Will See You Now: The Future of Medicine is in Your Hands, states that “Computers will replace physicians for many diagnostic tasks.” Similarly, Alan Greene, chief medical officer of Scanadu, a start-up that is building a diagnostic device based on AI, says “At the rate AI technology is improving, a kid born today will rarely need to see a doctor to get a diagnosis by the time they are an adult.”   And Michael Ford, in his new book, Rise of the Robots:  Technology and the Threat of a Jobless Future, predicts that many high skilled jobs will be taken over by AI robots.  For example, he says that radiology will be a job performed by machines as computers are rapidly getting better at analyzing images.

The fact is that prominent technology companies like Google and Facebook have gone way beyond their standard search function to embed it with AI for intelligent search.  And according to Kelly, AI has attracted more than $17 billion in investments since 2009 and the “business plans of the next 10,000 startups are easy to forecast: Take X and add AI.”  The reasons for the breakthrough in AI are mostly due to converging advances in computing, including cheap parallel computation for immense computing power, big data fueling natural language engines making AI smarter, and better algorithms for deep learning.

On the one hand, AI will automate routine tasks better than the ubiquitous smart chips in everything from vacuum cleaners to dishwashers. In health care, this will include mining information stored in the EHR to provide real-time clinical support or mining the literature and the experiences of many providers and patients to recommend potential treatment options to physicians, as is being pioneered with applications from Modernizing Medicine. IBM has demonstrated the capabilities of AI for machines to outwit humans as with Deep Blue for winning chess or Watson for winning Jeopardy!  Ford also suggests that wearable medical devices are already monitoring “just about any kind of biometric data that can be collected in an I.C.U.”  McNeill, in his book Using Person-Centered Health Analytics to Live Longer, asserts that AI can offer significant functionality to finally engage people with personal digital health devices.

On the other hand, AI’s most useful feature may be decidedly unhuman. It will not just automate and accelerate what our brains usually do. It will think differently. This is partly because artificial intelligence learns from all the data and the decisions it makes. It will add wisdom because it will look at the world differently and offer new perspectives, thereby becoming irresistible and keeping us interested in learning more about how we do important things in our life, like living a long and healthy life.

I’ll Have a SOPrDiMoCa

SOPrDiMoCa is not a popular travel destination in Italy, nor is it a seasonal coffee from Starbucks. It is an acronym for Self- Oriented Prevention, Diagnosis, Monitoring, and Care.

SOPrDiMoCa tools help people assess their own risk factors; sort out symptoms and learn what to do next; monitor a wide variety of signs, symptoms, and life events; and adjust their own care. All of these tasks can be done effectively and safely in real time and in one’s own home, and they can save time and cost less than going to a doctor’s office. According to Christensen, Grossman, and Hwang in their book, The Innovator’s Prescription:  A Disruptive Solution for Health Care, “Following the diagnosis and treatment by physicians, in many instances physicians can’t add much additional value beyond teaching patients broad categories of do’s and don’ts. Patients and their families typically must distill from their own experience algorithms of diet and activity that minimize the severity of their symptoms. Patients with these behavior–intensive diseases can generally formulate better algorithms of care through trial and error than their physicians can.”

The trend away from professionalism and centralization and toward simplicity, convenience, and a consumer-focused market is, according to Christensen et al, a natural progression during the “second and third waves of growth” of all industries.  For example, people are questioning why some of the things done in doctors’ offices have to be done there. Alternatively, they go to box stores like Walmart and health stores like CVS Health to receive “retail” clinic care for common ailments. In most cases, it is equivalent, quicker, more convenient, and cheaper. And while they are in these stores, they see a growing list of high-quality products that they can use to test and take care of themselves in aisle 7, SOPrDiMoCa.

The availability of home testing tools is expanding quickly. For example, OPTUM, a subsidiary of UnitedHealthcare, provides an At-Home Kit for members for biometrics. “This easy, self-administered test offers remote employees, spouses and new hires a private way to ‘self-screen, leveraging step-by-step instructions and a screening kit delivered directly to their doorstep.”  The Public Health Foundation of India deploys an android-based mobile system called the Swasthya Slate, which can perform 33 tests, including blood pressure, glucose, hemoglobin, and ECG. It can also test for pregnancy, dengue, and malaria. It retails for Rs 25,000 (or about $400) and has been tested and approved for use by community health workers.  A proponent says, “When we get sick, we won’t need to go—in high temperature and in severe pain—to our doctors’ offices, only to wait in line with patients who have other diseases that we may catch. Our doctors will come to us over the Internet.”  SimulConsult is a diagnostic tool that ingests the complete body of research literature for certain disorders.  The tool prompts doctors to enter information about the patient’s condition. It then generates hypotheses with associated probabilities about what the patient may have.  With a little more translation and technology to make it simpler, it could become a tool for people to use.

People have already adopted a more self-reliant role in other aspects of their lives. They use data and tools, make their own decisions, and prefer to “do-it-yourself” instead of relying on professionals to do their finances (e.g., online banking, electronic tax preparation and filing), travel (e.g., navigating directions, using online travel services), education (e.g., online coursework and degrees), shopping (e.g., buying online), and more. In these areas, technological advances have equipped and enabled people to take on these functions and have “changed cultural expectations regarding what people can learn, know, and do.”  The notion that people will not use data and tools to take a more active and decisive role in their lives has been debunked.

From Slick and Click...to Tick and Stick

Despite the tens of thousands health apps, it is clear that digital health developers are not winning over consumers.   A killer app has not swept the market. Even the commanding iPhone 6 and IOS8 and the Apple Watch may not carry HealthKit in its bountiful wake to ignite consumers’ interest in a digital health revolution.

Thus far, digital health technology for consumers has been slick and focused on making people click.  It is premised on the belief that the great successes with functions and apps delivered through smartphones can spill over into health. But, what people like to do on smartphones is mostly entertainment and social communications: Technology developers:

• Miscalculate that the technology, such as the-data-platform, is a “big deal” and will interest consumers as much as it does techie developers.
• Presume that the click mentality for revenue production derived from advertising and will work in health.
• Perpetuate uni-focused apps, like hailing an Uber cab, buying a product on Amazon, or making an airline reservation, will also work in health. 

These conventions are constraining and not an easy transplant for the health market. Apps perpetuate the characterization of people as extremely distractible, only capable of handling one simple function at a time, and not willing to pay for digital services while accepting the hidden costs of marketing intrusion.

When it comes to changing people’s behavior, technology has to understand what makes people tick and how to make them stick. The big draw of activity sensors seems to be that it lets people know when they reach 10,000 steps with its beeps and this insight can be shared with friends and family.  But, is this simple model really enough to hook people on a sustained program of activity for health? I think not.  Technology can offer so much more.