Flyover Country [...]

Flyover Country is an app that lets you study geology from the window seat of a plane.

I was on a flight from Chicago to Phoenix, peering out the window as the sun rose over the snow-dusted alien topography of the southwest, when I saw it, what could only be describes as a volcano-like formation rising out of the ultra-flat landscape around it. I nudged my seatmate to check it out, wondering out loud what it was. (He gave me the side-eye.)

If I’d had the new app Flyover Country, I would have been able to pull up the exact coordinates of our flight using my iPhone’s GPS signal, which works even when in airplane mode. It would have explained that the formation below was a nine-mile-wide extinct volcano called Sierra Grande. It’s part of a line of faults, the Raton hotspot trail, stretching from Colorado into Arizona, roughly the route our flight was taking that morning.

Following the information trail in the app’s UI, I could have read about the many other formations I had already spotted flying along this million-year-old fault line. I also could have seen where dinosaur bones have been discovered down below, or how a nearby volcanic field had gotten its name.

Not everyone has a burning desire to know what they’re seeing 35,000 feet below. But for Flyover Country’s creator Shane Loeffler, who traveled the world for his field work at the University of Minnesota, flying is a chance to observe “planetary scale processes and the ways humans live around them.” The app, which launched on iTunes and Google Play in December, was developed after Loeffler pitched the idea to his cocreator, University of Minnesota’s Amy Myrbo, and it was funded by a National Science Foundation grant that was accepted just “29 hours after we sent it in,” Myrbo says in a presentation.

Unsurprisingly, Loeffler got the idea for the app on a plane. “I realized that most people don’t have my geology background, and that they might be missing out on some of the wonder of that view because there was no good way to know where exactly your plane was, let alone what stories the landforms below could tell,” he tells Co.Design over email. “I tested the GPS in my phone while flying, found that it worked, and realized that there was a great scientific outreach tool waiting to be made.” When you open the app, you draw your flight path (it can be very rough) to access the relevant data points, which are then downloaded to the app so you can access them offline. (Source)

Tolerance Beats Understanding [...]

Fran Leibowitz on how tolerance is a better social goal than understanding or love.

For instance, I, unfortunately, take the subway a lot. It’s not my preference, but it is my lot in life. You sit or stand in the subway, and you look around —I do, because I don’t have a phone so I’m not playing a game—and you see people. You see a young girl wearing a headscarf, and standing next to her is a Hasid. And if you asked them, “Do you like that Jew?” She would say, “No, I hate him.” “Do you like that girl in the head scarf?” “No, I hate her.”

But here’s the great thing about New York: They leave each other alone. So in New York we have zillions of different kinds of people, many of them hate each other, but violence based on that hatred is really uncommon here.

This idea that people have to love and understand each other is absurd. It’s not human nature. But this idea that people cannot kill each other? It actually works here. More than it works in any other place. We have something here that you don’t hear about anymore; we have tolerance. Tolerance is really a better thing than understanding. Because it doesn’t agitate against human nature. Like love does. Or acceptance or understanding. Not only don’t they not understand people different from them, they hardly understand themselves. It’s placing too great a burden on the average intelligence. So forcing people into a situation where they’re supposed to adore each other is probably bad. But letting people get on and off the 6 train without stabbing each other, that’s good.(Source)

See also Paul Bloom Against Empathy

The Analytics of Empathy suggests that keeping opponents from talking to one another makes for a better experience for everyone.

Pain is the Fifth Vital Sign [...]

“Pain is the Fifth Vital Sign” was a campaign which changed doctor’s views about prescribing opioid medications. It is largely seen to have been a mistake, and many have claimed that it was funded and pushed by the maker of OxyContin.

Between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of OPRs for chronic non-cancer pain (86). As part of this campaign, Purdue provided financial support to the American Pain Society, the American Academy of Pain
Medicine, the Federation of State Medical Boards, the Joint Commission, pain patient groups, and other organizations (27). In turn, these groups all advocated for more aggressive identification and treatment of pain, especially use of OPRs.

For example, in 1995, the president of the American Pain Society introduced a campaign entitled “Pain is the Fifth Vital Sign” at the society’s annual meeting. This campaign encouraged health care professionals to assess pain with the “same zeal” as they do with vital signs and urged more aggressive use of opioids for chronic non-cancer pain (9). Shortly thereafter, the Veterans’ Affairs health system, as well as the Joint Commission, which accredits hospitals and other health care organizations, embraced the Pain is the Fifth Vital Sign campaign to increase the identification and treatment of pain, especially with OPRs. Similarly, the American Pain Society and the American Academy of Pain Medicine issued a consensus statement endorsing opioid use for chronic non-cancer pain (31). Although the statement cautioned against imprudent prescribing, this warning may have been overshadowed by assertions that the risk of addiction and tolerance was low, risk of opioid-induced respiratory depression was short-lived, and concerns about drug diversion and abuse should not constrain prescribing.

The JCAHO would later give an even more direct push to opioid prescription with its report Improving the Quality of Pain Management Through Measurement and Action

Some studies in the 1980s and 1990s had argued for more liberal use of OPRs. See Perils of a Small Study, Opioid Edition

Between 1995 and 2000, as this campaign was being pushed to doctors, Purdue Pharma saw A 2,000 Percent Increase in sales, mostly in OxyContin.

Improving the Quality of Pain Management Through Measurement and Action [...]

This was the report that kicked off the current opioid crisis in earnest. The Joint Commission, an accrediting agency, suggested that hospitals take pain management more seriously, and tie rewards to patient satisfaction with pain management. PDF

The opening lines set the tone:

Despite ongoing, significant advances in treatment options, studies indicate that pain continues to be poorly managed and undertreated. The increase in clinical information related to pain management, as well as recent high-profile press coverage of individual cases of undertreatment, has resulted in heightened awareness among health care professionals and the public that this critical issue must be addressed.

This in itself isn’t bad. But in practice it led to the opioid epidemic, killing tens of thousands (maybe eventually hundreds of thousands) of people.

One of the visible elements of the shift was the use of the Wong-Baker FACES Scale

Some of the shift was based on surprisingly small studies. See Perils of a Small Study, Opioid Edition

JCAHO was at the core of the opioid epidemic. See JCAHO and the Opioid Epidemic

Wong-Baker FACES Scale [...]

The Wong-Baker FACES scale traces its roots back to the 1980s, but came into wide use after the Joint Commission, an accrediting agency, named it as one of three possible measures for the assessment of pain.


While the scale itself is useful and continues to be used, the application of it shifted in the early aughts. If you went into your doctor for anything — anything — you might be asked to rate your pain. When patients indicated high pain, a pain medication discussion with their doctor would be initiated.

The scale was one of the more visible elements of the shift in hospitals to assess pain treatment and reward doctors for assigning pain medications. See Improving the Quality of Pain Management Through Measurement and Action

Perils of a Small Study, Opioid Edition [...]

One of the early influential studies to claim that oxycodone might be safe for chronic pain had only 38 patients in the intervention condition. Of those, two (2!) had issues, but these were dismissed as both had had a history of drug abuse.

But let’s consider this. In a random sample 2 out of thirty-eight (5%) had “management” issues.

Thirty-eight patients maintained on opioid analgesics for non-malignant pain were retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene, meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for pain management while receiving therapy. Few substantial gains in employment or social function could be attributed to the institution of opioid therapy. No toxicity was reported and management became a problem in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics, including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social variables capable of explaining the success of long-term management. We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse. (Source)

The problem with dismissing a drug as “safe for anyone without a history of or propensity to drug abuse” is that a large number of patients fall into that category. Take a group of twenty people, and the likelihood is that more than one or two will have some history of addiction, either personally or through a relative.

Hyperalgesia [...]

The potential side effects of prescription narcotics include constipation, sexual dysfunction, cognitive impairment, addiction, and overdosing. When patients receive narcotics for long periods, they can even become more sensitive to pain, a condition called hyperalgesia. (J. David Haddox, the vice-president of health policy at Purdue Pharma—the manufacturer of OxyContin—acknowledged “opioid analgesics have sometimes been associated with diminished pain relief in the face of increasing doses.”) (Source)

Hyperalgesia was dismissed as a concern in an influential study. See Perils of a Small Study, Opioid Edition

The Opioid Epidemic Ground View [...]

This is what the Pain Pill Epidemic looked like from the ground:

When I started working as a medical resident, in 2004, I heard from a patient I had inherited from a graduating resident. The patient had an appointment scheduled in a couple weeks. “But I need your help now,” he said.

He was a former construction worker who had hurt himself on the job a couple of years earlier. He told me, “I also need some more OxyContin to tide me over until I can see you.” The hospital computer system told me that he had been taking twenty milligrams of OxyContin, three times a day, for at least the last couple of years. I had rarely seen such high doses of narcotics prescribed for such long periods of time. I’d seen narcotics prescribed in the hospital to patients who had been injured, or to those with pain from an operation or from cancer. But I didn’t have much experience with narcotics for outpatients. I figured that if the previous resident—now a fully licensed doctor—was doing this, then it must be O.K.

What I didn’t know was that my time in medical school had coincided with a boom in the prescribing of narcotics by outpatient doctors, driven partly by the pharmaceutical companies that sold those drugs. Between 1999 and 2010, sales of these “opioid analgesics”—medications like Vicodin, Percocet, and OxyContin—quadrupled.

One issue with chronic use is chronic use can actually increase sensitivity to pain. See Hyperalgesia

JCAHO Newspaper Notice [...]

A notice in the newspaper from the JCAHO announcing their certification program, 2003. Ukiah Daily journal, 9 July 2003. The JCAHO led the movement to push “pain management medications”.

The basis of the training and certification they talk about here is discussed in Improving the Quality of Pain Management Through Measurement and Action

Some have accused the JCAHO of pushing too hard on OPR use (and for less than stellar reasons). See JCAHO and the Opioid Epidemic

JCAHO and the Opioid Epidemic [...]

The solution? Simple. Manufacture a demand. Establish not only a new system that gives doctors more freedom to prescribe narcotics for non-postoperative and non-malignant pain, but create an environment that actually demands it. Instead of fighting a losing battle against the existing medical framework, create an entirely new one — one that promotes opioid and opiate painkillers for everyday aches and pains — and work from within it.

To understand just how the American medical system became corrupted in the 2000s, you have to understand the role of Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the most powerful accreditation institution in the world.

The Joint Commission is the gatekeeper. They’re the last line of defense between the patients over here and the drugs over there. The Joint Commission is a nonprofit organization based out of a Chicago suburb, charged with setting the standards of care for hospitals in this country and accrediting more than 20,000 facilities in all but four states. They’re the ones tasked with inspecting hospitals and ensuring adequate care is being given and standards are being met. They also issue directives in care.

In 2001, while the pharmaceutical lobby spent just under $100 million in lobbying efforts, the Joint Commission issued a new directive to its 20,000+ hospitals across the country:

It was time to start treating pain.

And who did the Joint Commission bring in to teach the hospitals how to treat the pain?

Purdue Pharma. (Source)

See also JCAHO Newspaper Notice

A 2,000 Percent Increase [...]

Family owned and operated, Purdue Pharma struck narcotic gold. Not many companies can boast a product whose sales increased 2000 percent in five years, but the Sacklers can do just that. In 1995, the year after receiving FDA approval, OxyContin accounted for $45 million in sales. By 2000, sales increased to $1.4 billion. (Source)

New Data Set for Police Shootings [...]

An example of how often we miss data sources that are “right under our nose”.

Now, researchers from Harvard University and Northeastern University say they have identified an overlooked source that could offer the most complete accounting yet of fatal encounters with police. In a paper published in the American Journal of Public Health, the researchers point to the National Violent Death Reporting System, a database maintained by the Centers for Disease Control and Prevention. The CDC’s trove of data on violent deaths, they write, “captures detailed coded data and rich narratives that describe the precipitating circumstances and incident dynamics for all suicides and homicides.” In other words, the data gives a pretty clear picture of the deceased and the moments leading up to their death. (Source)

Netflix is Shrinking [...]

While variety of platforms has exploded, so have exclusivity deals. As a result, the average user of online digital services has less choice than before.

It’s not your imagination – Netflix’s catalog is getting smaller. As competition in the OTT streaming space has increased, Netflix’s once-massive selection has decreased. In fact, it has shrunk by a third in less than two and a half years.

The statistics are simple and remarkable: in January of 2014, Netflix offered its US-based users a selection of 6,494 movies and 1,609 TV shows, for a total of 8,103 titles. As of March 23, 2016, they offer just 4,335 movies and 1,197 TV shows – 5,532 titles in total. That’s 2,571 fewer titles. In other words, Netflix’s catalog has shrunk 31.7% in less than two and a half years! (Source)

Crash Test Dummies So White [...]

Reed points out that race is also important in civilian contexts. Think about your car. Reed designs crash test dummies. If a car is tested only with “Caucasian” dummies, it may not be as safe for Asians or African Americans. Why? Leg length determines how far back you sit from the steering wheel — a major impact point — and your proximity to the airbag. Seated height also affects what you can see. “We don’t want to build a dummy that’s based only on white guys,” Reed said. (Source)

Diabetes as Foot-Size Confound [...]

Past attempts to target clothing to an ethnicity have sparked some controversy. In 2007, for example, Nike launched a line of sneakers decorated with colorful geometric patterns and arrowhead designs for Native Americans, called Air Native N7. Native Americans had wider fore-feet, Nike claimed, and thus needed wider shoes.

But from the moment he heard about the shoes, Alan Goodman, a biological anthropologist at Hampshire College in Amherst, Mass., suspected that Nike’s science was weak.

Nike says it measured 224 Native Americans’ feet around the country before concluding that Native feet were wider in the front. Who was measured, Goodman wonders, how old were they, and what was their condition? Native Americans have double the risk of diabetes compared to the national average. Was Nike really selling colorful, “native” sneakers for swollen diabetic feet? Or as one online commentator put it, “If this isn’t an example of corporate manipulation of race, I don’t know what is.” (I reached out to Nike for a response, but never heard back.) (Source)

Conflict of Attention [...]

We confuse attention as an objective fact, attention for the observer, with attention as consciously experienced. During complete absorption an onlooker may remark how attentive such a person is, or after such an absorption one may look back and say how attentive one was; but taking the absorption when it occurs, it means that only the subject matter is present in consciousness, not attention itself. We are conscious of being attentive only when our attention is divided, only when there are two centers of attention competing with each other, only when there is an oscillation from one group of ideas to another, together with a tendency to a third group of ideas, in which the two previous groups are included. The sense of strain in attention, instead of being coincident with the activity of attention, is proof that attention itself is not yet complete.

To establish the identity of attention with the formation of a new act through the mutual adaptation of two existing habits, would take us too far away from our present purpose; but there need he no hesitation. I believe, in admitting that the sense of attention arises only under the conditions of conflict already stated. (Source)

GitHub Streaks [...]

GitHub interface encourages long unbroken stretches of work. It motivates developers, but does it do so in the right way?

Stepping away from our work regularly is not only important to uphold high quality work, but also to maintain our well-being. For example, I personally do not generally work in the weekends. That’s completely healthy. I take a step back from work and spend time on other things. But in the contribution graph it means I can never make a long streak, even though I do work virtually every day except weekends. So the graph motivates me to work in my weekends as well, and not take breaks.

When I see someone with a 416 day streak, it means they haven’t taken a break for a single day in over a year. Although everyone can make their own choices, it makes me very worried about their well-being. Being based on git activity, which can easily backdated, the graph is also trivial to spoof – so not all long streaks may be real. (Source)

Colonial Facebook [...]

Programs such as Facebook’s “Free Basics” and Wikimedia Zero have disturbing parallels to colonial patterns of corporate behavior. In particular the pattern involves “saving” the population while in reality really just propping up market advantages.

“I’m loath to toss around words like colonialism but it’s hard to ignore the family resemblances and recognizable DNA, to wit,” said Deepika Bahri, an English professor at Emory University who focuses on postcolonial studies. In an email, Bahri summed up those similarities in list form:

  1. ride in like the savior

  2. bandy about words like equality, democracy, basic rights

  3. mask the long-term profit motive (see 2 above)

  4. justify the logic of partial dissemination as better than nothing

  5. partner with local elites and vested interests

  6. accuse the critics of ingratitude(Source)

Sometimes this fails. See Networks Route Around Colonialism

To Boldly Colonize [...]

Star Trek is a bit of a mish-mash of colonialism and the desire to rise above colonialism. The famous intro is a good example of that tension.

The juxtaposition of TOS and later Star Trek franchise installments both reveals progress internal to the franchise and continuities that refuse to leave the past behind. For instance, TOS opened each episode with Captain James T. Kirk’s (William Shatner) masculine mission: “to explore strange new worlds, to seek out new life and civilizations, to boldly go where no man has gone before.” While this statement promised that Star Trek would bring viewers to peoples and places hitherto unknown, its purportedly universal “man” evinced the gendered exclusions of a utopian journey. Fittingly, TNG revised TOS’s mission in the late 1980s by informing viewers that they would “boldly go where no one has gone before.” This shift to the gender neutral corrected past omissions to make Star Trek’s travels more inviting to female voyagers.

This updated statement, however, does not include everyone. The persistent use of the phrase “new worlds” evokes a long history of inequality forged between “discoverers” and “discovered.” Though Kirk and Picard promise “to go where no man/one has gone before,” they expect to find “others” already there. Though Star Trek imagines social progress through the allegorical veil of extraterrestrial cooperation, its mission statement and naval metaphors reveal how the franchise maintains a Eurocentric vision of progress and discovery that excludes the rest from the West. By reconsidering Star Trek’s linear progress—a viewing practice facilitated by video on demand services such as Netflix, but prompted by the production history of Star Trek itself—we can see how Star Trek’s future remains mired in the past. (Source)

The Colonial North American Project [...]

This website provides access to some of the remarkable materials digitized as part of the ongoing, multi-year Colonial North American Project at Harvard University.

When complete, the project will make available to the world digitized images of all known archival and manuscript materials in the Harvard Library that relate to 17th and 18th century North America. Scattered through twelve repositories, these documents reveal a great deal about topics such as social life, education, trade, finance, politics, revolution, war, women, Native American life, slavery, science, medicine, and religion. In addition to reflecting the origins of the United States, the digitized materials also document aspects of life and work in Great Britain, France, Canada, the Caribbean, and Mexico. The ‘Essays’ on this website are the work of a Summer 2015 Arcadia Fellow, Alicia DeMaio, who was one of the first researchers to connect thematically related material from among the images digitized to date.

This website is updated continuously. Check back regularly for new content and features. (Source)

Networks Route Around Colonialism [...]

The controversial Wikimedia Zero program “zero-rates” Wikipedia access for Angolans (similar to the Facebook program Marc Andreessen got in trouble over). So, ho-hum, another example of digital colonialism, right? Except for this: wiki allows one to work around such barriers…

Wikimedia and Facebook have given Angolans free access to their websites, but not to the rest of the internet. So, naturally, Angolans have started hiding pirated movies and music in Wikipedia articles and linking to them on closed Facebook groups, creating a totally free and clandestine file sharing network in a country where mobile internet data is extremely expensive. (Source)

How to Choose Good Passwords [...]

A good password is:
private: it is used and known by one person only;
secret: it does not appear in clear text in any file or program or on a piece of paper pinned to the monitor;
easily remembered: so there is no need to write it down;
at least 8 characters long;
a mixture of at least 3 of the following: upper case letters, lower case letters, digits and symbols;
not listed in a dictionary of any major language;
not guessable by any program in a reasonable time, for instance less than one week. (Source)