The Net Is a Waste of Time (1996) - <AUTHOR> http://www.nytimes.com/1996/07/14/magazine/the-net-is-a-waste-of-time.html

<comment><USER2> The headline had me cringing in expectation for a brain dead article, but how stupid of me! It's fricking William Gibson. Almost everything he said in this article seems to be spot on, then and now.

In case you have any remaining worry that Gibson is some crotchety "get of my lawn" type, check him out on twitter. He is one the most prolific, bizarre, and interesting users I follow: <https://twitter.com/GreatDismal> Recent examples:

>Once saw fake Zippo lighters with Confederate flags _with_ swastikas in Shinjuku. Mindless mashup getting it right anyway.

>I've had the tv-in-the-mirror in bathrooms of a few hotel rooms. Have never turned one on. Feels like bad sci-fi prop-design.

>Fellatio illegal in 11 states. Lawmakers afraid to risk being known ever after as "the blowjob senator", if they act to strike them down?

<comment><USER3> New York Times experimenting with link-bait headlines back in 1996.

<comment><USER4> Link-bait is just a new word, the phenomenon must date back to the invention of the printing press.

<comment><USER5> Arguably, printed materials gave you more context along with the title, without opening up the full article.

<comment><USER4> Seeing the link is akin to passing the newsstand from a medium distance. Clicking the link is akin to picking up the newspaper and seeing the small print. Skipping the ad is akin to opening the newspaper to the continuation of the story inside.

</comment></comment></comment></comment></comment><comment><USER6> If you'll read to the last paragraph, you'll find Gibson's very profound conclusion: that the 1996 Web was the early "test pattern" for what he predicts will be a world-changing, but "less fun" medium. How right he was.

<comment><USER7> Less fun? Are you high? I get more intellectual stimulation of a single site's content on one day than I've ever gotten from every dumbed-down newspaper editorial I ever read before the Web took off.

<comment><USER8> I think Gibson meant the future www would be "less fun" relative to the procrasination friendly "unsorted Global Ham Television" 1996 version

<comment><USER9> I think the internet is more fun now - there is the boring mainstream but there is also an absolutely huge lunatic fringe. The web now is more chaotic than in 1994 because its so much more accessible to chaotic minds now. In 1994 it was all just monty python scripts and references to barney the dinosaur.

</comment></comment></comment></comment><comment><USER10> The winning quote: "[sic] surfing the Web is a procrastinator's dream. And people who see you doing it might even imagine you're working."

How many people are identifying with that premonition right this second?

<comment><USER11> Agreed. Golden.

</comment></comment><comment><USER12> That was a mostly prescient and enjoyable blast from the past. One thing though I was glad Gibson was wrong about:

> _"It will probably evolve into something considerably less random, and less > fun"_

While his point was/is true of many systems and organizations, the internet is one example that has really outdone itself in terms of sustaining an unrelenting resistance towards a global monoculture.

Perhaps, like some older HN users here, when I go looking beyond the walled gardens of social networks, I feel just as fascinated by what I read today, as I did in the mid 90's.

<comment><USER13> I decided to stick my head into the "firehose" of Facebook's public graph API last night and ended up finding some strange spambots creating pages and posting thousands of Amazon links. I followed the trail, trying to figure out what they were doing and what the point was. No one had liked the pages, so it didn't seem to make sense that they were building links to Amazon and not their own site (which I could understand for SEO). Anyway, I ended up going to the furthest reaches of the internet, never really finding an answer, but I got that same feeling: holy hell, this is amazing!

It's like being an explorer, going where only a few people have gone before. The internet can still be this, if you want it to be. You can still dig around the trenches, take the back-roads, see what you find, see what's going on behind the surface of the social networks and media.

God damn, I love it.

<comment><USER14> Speaking of the furthest reaches of the internet - just last night I ended up on a website dedicated to warning us about the coming race-war between Neanderthal-humans (introvert/autistic/asperger spectrum), Cro-Magnon humans ("normal" people), and "melonheads" (psychopaths? maybe?). It appeared to be entirely serious. You see, 40,000 years ago the melonheads decided that the neanderthals needed to be wiped out, so they sent in a slave army of cro- magnons armed with high-tech weaponry such as spear throwers. And then.....you get the idea.

I love finding crazy stuff like that.

</comment></comment></comment><comment><USER15> His book "Distrust That Particular Flavor" is full of his old articles, such as this one, and his thoughts on them after looking back at them in 2012. I really recommend it if you're into William Gibson at all.

</comment><comment><USER16> It's hard to remember what the Internet was like in 1996. I do it by remembering that in 1997 I started an ISP to offer blazing-fast 56K dialup to the indifferent grandparents of Long Island for $19.95/month. We had a computer on display in the front of our office so the skeptical could poke around and see what the web had to offer. Windows did not come with a browser installed, so many of our new customers had to wait for us to mail them a Netscape CD-ROM. People frequently got upset at us for high phone bills when they discovered too late that their local calling area did not include our POP. The writing was on the wall, of course.. dialup wasn't going to be around forever, and I already had the future of telecommunications installed in my apartment: ISDN.

</comment><comment><USER17> It's actually pretty funny. I'm in the middle of writing a paper for my philosophy class, about Pieper's Leisure, the Basis of Culture, and this is the first article I click on when I start slacking off.

The points Gibson makes about the importance of down time are almost the same as Josef Pieper's. I guess I'm still working on that paper after all.

<comment><USER18> Hail slack, brother! :)

<comment><USER19> Praise Bob

</comment></comment></comment><comment><USER20> William Gibson is a strange person. I remember him making a comment at a convention once where he said he was shocked at what computers looked like on the inside, he expected them to be weird crystalline contraptions.

<comment><USER20> Well, here's an actual quote: <http://en.wikiquote.org/wiki/William_Gibson>

_"On the most basic level, computers in my books are simply a metaphor for human memory: I'm interested in the hows and whys of memory, the ways it defines who and what we are, in how easily memory is subject to revision. When I was writing Neuromancer, it was wonderful to be able to tie a lot of these interests into the computer metaphor. It wasn't until I could finally afford a computer of my own that I found out there's a drive mechanism inside — this little thing that spins around. I'd been expecting an exotic crystalline thing, a cyberspace deck or something, and what I got was a little piece of a Victorian engine that made noises like a scratchy old record player. That noise took away some of the mystique for me; it made computers less sexy. My ignorance had allowed me to romanticize them."_

<comment> guard-of-terra It caught up to his expectations with SSD.

<comment> iso-8859-1 We still have CPU fans and cables everywhere, I still think it's pretty Victorian.

<comment><USER21> Part of what makes tablets so futuristic.

<comment><USER22> Until computers stop generating so much heat that their cases become hot to touch, they're just advanced Victorian 'engines' rather than exotic futuristic. I love my SSD though, and we are getting closer to the crystalline cyberspace decks.

</comment></comment></comment></comment></comment></comment><comment> mauricio-OH I love how things have changed so much but they remain exactly the same. We're still hooked - to our smartphones. We're still wondering what the experience will be in a few years. Just like he did. Awesome.

<comment><USER23> Makes me think of Snow Crash a bit... plugged in constantly to virtual reality.

<comment><USER18> I just shipped my first AR app to a customer, and I have been having serious Snow Crash moments in real-life, lately. As a mobile developer, all I can think about now is the death of the native interface, and the new age of the rule of Augmented Reality. Yikes, I've slipped and fallen into the digital hole that is: reality with overlays.

For example I've quite literally got a little 3d animated ghost that sits in the corner of my favourite hangout, which only I can see through my phone when I point its camera in the right angle, which tells me the name of the track being played on the house speakers .. it really is a moment like Snow Crash, played out in real life, I have to say..

Up next, Finn the finger ..

<comment><USER19> The audio ghost sounds awesome, any chance it's on github?

<comment><USER18> Nope, its only in my AR app, which has a very specific set of ImageTargets only I have any interest in. ;)

But! Its an awesome tech, and I'm pretty sure its going to hit the store soon enough. I'm currently working on ways to embed tons more stuff within the target matrix .. its mind-boggling to think that any recognizable surface can be the human interface mechanism, now.

</comment></comment></comment></comment></comment><comment><USER24> > _The Web is new, and our response to it has not yet hardened. That is a > large part of its appeal. It is something half-formed, growing. Larval. It > is not what it was six months ago; in another six months it will be > something else again. It was not planned; it simply happened, is happening. > It is happening the way cities happened. It is a city._

I've always loved metaphors comparing the Internet to a growing city. The Web used to be a Wild West-style town that was ventured into only by the most daring of people and businesses, but it's now become a much more established and secure city, still full of possibilities, where everyone and their mother wants to move and try to make their fortune, but at the same time has lost a lot of its original "flavor" that made it so special.

And... I don't really know where I'm going with this...

<comment><USER25> I think it holds beyond that too. Still have the ugly neighbourhoods, properties designed in a way that give away their age, dangerous parts of town, etc.

</comment></comment><comment><USER26> I was going to reply with something like 'The NYTimes is a waste of time (2013)' - but that is a really good short piece.

</comment><comment><USER27> God damn. I don't think I've ever disagreed with William Gibson.

This documentary from 2003 (really a long-ish interview) was pretty interesting as well: <http://en.wikipedia.org/wiki/No_Maps_for_These_Territories>

</comment><comment><USER28> > I COINED THE WORD "CYBERSPACE" IN 1981

Thats not something to be proud of..

<comment><USER29> I would say it is. I don't think you can talk the concept of the data driven world without looking at how Gibson and later cyber-punk authors imagined how it might be.

We may think that the word "cyberspace" is a bit twee now, but it was an investigation about what the future might be. And it was a way to present that investigation to an audience who most likely had little to no frame of reference.

<comment><USER30> It's funny how the only ones using the word nowadays are governments and agencies.

'Cyber taskforce'? And you want me to take that serious?

<comment><USER29> Have you read Neuromancer?

I'm not quite sure how what you mention is related to the use of the word cyberspace as Gibson used it.

<comment><USER30> Yes, I have. As far as I know the word was not there before Gibson coined it, so I'm assuming that everyone using it today refer back to that, whether they know it or not.

I haven't been around in the English-languaged internet back then, so I don't have firsthand information, but it seems to have been more commonly in use everywhere in the past (I remember some hacker's handbook telling me not to associate with people calling themselves 'cyberpunk', for instance). Nowadays the only mentions I see are from governments who plan taskforces to anwer "threats in the cyberspace", which, in my eyes, makes them look incompetent. I think it's interesting that they use that terminology though. </rant>

How does that not relate?

</comment></comment></comment></comment></comment><comment><USER31> Obvious joke:

The NY Times Is a Waste of Time (2013) (news.ycombinator.com)

</comment><comment><USER32> Neuromancer had the worst sex scene I have ever read.

</comment><comment><USER33> Even more true in hindsight...

</comment><comment><USER34> They knew it back then!

</comment><comment><USER35> for some part of it, still true :-p

</comment><comment><USER36> Wonder what headlines we'll make fun of in 17 years?

<comment><USER37> I think the headline is actually self-mocking. Pretty sure the author is not actually arguing the net is a waste of time.

<comment><USER38> Gibson's point seem to be that the 1996 Web is not so much itself a waste of time as a great tool for wasting time, and that that's not necessarily a bad thing. He also notes how this state of freedom and freeform-ness that encourages "surfing the Web" is fleeting and will pass to be replaced with something more conventional and structured.

I came back to this essay several times over the years and each time I read it I take a moment to appreciate how true its core observation rings. It can be considered a successful if somewhat vague prophecy about what the WWW has since in large part become: a delivery mechanism for traditional, one-to-many media. You could see that same thing happen in miniature on YouTube throughout its short history: the many-to-many system of its early days has been overshadowed by prepackaged shows. I'm not saying it's a bad thing (personally, I enjoy some of the shows), but it's different.

</comment></comment></comment><comment><USER39> It's okay, kids these days are used to it. Just like how kids back then got used to radio, pulp, and television.

<comment><USER40> Have you even read the article?

<comment><USER39> My point is that as the fidelity of signals become stronger we acclimate to it. Turn back 6 years and the connectedest Gen Y lighting up on the internet felt the same way, in the circles I traveled many espoused the same self-aware sentiment as this, some even without the benefit of being Gibsonites.

Now that Gen Z is lighting up, crowding into Instagram, inheriting Reddit, rebuilding Tumblr, you know what I see? The most connectedest again are repeating the same sentiment and make believing they're the only ones in all of history to hold such perspective.

It's the same generational gap meme. Over and over again. Eventually the Gen Z grow old and grow out of using whatever trends charmed them. Then we get the reverb about how awkward of phase it was in the aughts and 10's that we became a generation addicted to black mirrors in the palm of our hands like the 70's was about sparking up and 80's was about indulging in cocaine in social situations.

And as I get older and on my march of filing out of the 18-35 demographics the more I learn and realize it's always been this way, but took awhile for the education to reveal itself. From the times of pulp fiction to radio surfing. And it will forever be this way as each generation arrive.

Just wait until the babies having grown up entirely with glass become self aware.

<comment><USER41> I'm not sure what you're going on about.

<comment><USER42> tldr: get off my lawn kids will forever be the sentiment of the current old generation while lol we r so hip will be the sentiment of the 18-20somethings. I don't think this realization is as profound as he is making it seem though, c'est la vie

<comment><USER39> Profundity is all personalization syntactic sugar these days anyway. La vie.

<comment><USER43> Wait, what? This made me laugh. May be true, but the way you said it, "syntacti sugar"... So cynical...</comment></comment></comment></comment></comment></comment></comment>


Gender Graph: Quantifying a Gender Bias - <AUTHOR> http://gendergraph.tk <comment><AUTHOR> We believe that bringing awareness to the biases is the first step to making a change. Observing the gender graph project clearly reveals that the media commonly associates toxic words with women. We consume this media every day therefore subliminally inherit these biases. Much of our community believes that feminism isn't relevant anymore as women and men have "equal rights". Hopefully this data driven evidence will be proof of the disparities that exist in the way we perceive gender, and that we still have a long way to go.

<comment><USER2> would it be possible to correlate this with any form of authorship of the content being analysed?

<comment><USER3> Yes but will require extra processing on the training data and code adjustment of word embedding tool. In our case the word2vec output produce binary model where each word correspond with a numerical vector with no other attributes. Also, most often then not the trained dataset itself is not categorized by article or author.

</comment></comment></comment><comment><AUTHOR> The Gender Graph uses machine learning (word2vec) to reveal gender biases in specific media sources. Users can plot where words lie on a scale of (he) to (she), and observe the differences that exist in the way we perceive gender in the media.</comment>


Why Bitcoin is guaranteed to be a crappy investment - <AUTHOR> http://greyenlightenment.com/these-people-are-not-that-smart/ <comment><USER2> I have a different theory. There will be a capped total of 21m BTC. In say 10 years, there will be a number of BTC "users". By "users" I mean people who in their ordinary business use BTC for value exchange. To facilitate that use, we need to have a certain freely available amount of BTC per user at any time, say $1000 in USD equivalent. Call this "float"

Then, assuming no BTC lost or locked in long term storage (I suspect these cause upward corrections of 5-10x from below estimates), the price of BTC will be btc_px ~= float * users / 21m.

I do not know how to estimate "float". For users there are two scenarios:

1\. Low adoption/high government restrictions, BTC is used for mostly illicit transactions: say 50,000 users worldwide

2\. High adoption, legal use: perhaps 50m users worldwide.

Assuming my float = 1000 USD we get btc_px ~$20 for scenario 1 and ~$20,000 for scenario 2. I may be off by an order of magnitude in the "float" assumption. Would love to hear your thoughts.

<comment><USER3> What do you imagine would be the incentive for users to use BTC, rather than later-generation alternatives?

<comment><USER4> What do you imagine would be the incentive for users to use later-generation alternatives, rather than BTC?

<comment><USER5> The benefits of alternative cryptocurrencies are faster, cheaper, and potentially anonymous transactions. Bitcoin's use of PoW and limited supply means that transaction fees will always be necessary to provide miners with rewards once all the coins have been mined. In my opinion that is a tradeoff that will cause most people to use BTC as a digital store of value rather than a form of payment. I think that if a cryptocurrency ever becomes widely used for payments, it will be one that uses Proof of Stake/an inflationary supply and can therefore avoid relying on transaction fees.

</comment></comment></comment></comment><comment><USER6> The article is generally factually correct. Bitcoin is a commodity; in some ways investing in Bitcoin is no different from investing in Euros (if you live in the US).

I think what wiggle room there is is in this statement:

> These astronomical early Bitcoin gains can be treated as an anomaly arising > from a price discovery process that will never be repeated.

I think there have been numerous price discovery phases in the Bitcoin price history, and that's reflective of the wild ramp-ups and following crashes, but it's by no means certain that we've passed the last of the price discovery phases. Looking only at performance over a cherry-picked timeframe is not a great way to evaluate the overall quality of a security.

</comment><comment><USER7> I got caught up in the hype of Bitcoin and thought it would change the world, but the reality is that it doesn't really 'do' anything. All the apps that I've seen on the blockchain are pointless, or more efficiently built using non-blockchain stacks.

I was interested in a coin called MedicalChain which promised to store your medical records in the blockchain, but it seems to be vaporware (lost a little bit on that one!).

When Libra came along I thought that it would be 'the one'. Finally, a blockchain that could reach the mass market and actually be usable. Just a shame it's Facebook...

<comment><USER8> Have you looked into the so-called "DeFi" space? Compound, MakerDAO, Synthetix, and others have some very interesting and surprising product offerings with incredible potential.

Celo and others are working on Libra alternatives.

Arweave has probably the most compelling decentralized but economically thoughtful web-friendly storage system I've seen — and it's launched, live, now.

They certainly "do" things, although they're in early days. And none of them are Bitcoin.

<comment><USER9> Arweave looks promising at first, but by reading their yellow paper [1], we realize they want the storage to be permanent and immutable. It seems interesting for archives that are not gigantic in size, but for websites...

[1] [https://www.arweave.org/files/arweave- yellowpaper.pdf](https://www.arweave.org/files/arweave-yellowpaper.pdf)

</comment></comment></comment><comment><USER10> GPT2-bot should autogenerate an essay like this once a month... it would be guaranteed to get attention each time.

</comment><comment><USER11> It makes more sense if Bitcoin is viewed as an insurance rather than an investment or a commodity.

It's an insurance against the whole world falling apart. Why would the whole world of finance fall apart? Same reason Roman empire fell part and lost its significance.

Long back 1000$ was a lot of money, later a million $ was a lot of money and then billion $ was a lot of money. In today's news, people are describing events in trillion $ costs. If you extrapolate this trend, money as we know will be losing its value exponentially.

Bitcoin is a money system that is defined very clearly in terms of quantity, creation process and exchange etc. This is a good minimum viable product. It definitely has value just like a commodity. It also has people working on improving it as if it were an ipo'd company.

Just like language and law, bitcoin is a product of "spontaneous order" and our knowledge of traditional finance may not have enough mental tools to value it like another financial product. Some people certainly value it more than other people. Over a long period of time take span of 100 years, it becomes easy to imagine having a bitcoin like digital currency with standardized rules for money creation not controlled by any single party.

<comment><USER12> Sorry, it's not insurance against the world falling apart because cryptocurrencies (Ccs) have no intrinsic worth. With no internet access, no internet or no miners, you can't conduct trades (unless you give wallet PK, but then it still doesn't have worth beyond what you can actually buy with it in a post-internet world).

OTOH, vital, scarce commodities and property have intrinsic worth because they can be used or are valued. Gold, silver, platinum, diesel fuel, guns, knives, equipment, huge tracks o' land

From the begging and until now, Ccs only make sense as a _transactional_ money analog, not an investment other than an extremely speculative (volatile) one that could lose most/all of its value anytime.

If you want to hide money for a couple of days, do some money laundering (j/k), buy some drugs (j/k^2) or send money anonymously, Ccs are great. Please don't put the bulk/large amount of your savings into Cc unless you're leaving a repressive regime or want to give it all to me to avoid taxes. }:D

<comment><USER13> Nothing has intrinsic value. When you say something can be used or has value, you are speaking subjectively.

To be valuable economically, something just needs to be both scarce and sought after. Just because they are valuable to a specific set of persons does not mean they have intrinsic value.

Pricing of goods and services is emergent in nature, based on demand, scarcity and rate of consumption.

The 'bitcoin hype' is exactly what you are describing when you say:

> Ccs only make sense as a transactional money analog

Bitcoin was designed to just be a general accounting ledger that can't be forged. It is supposed to be a transactional money analog.

The 'value' that you should be investing in when talking about bitcoin is not its price in dollars, but rather that the idea:

The 'value' in bitcoin is that non-mutable accounting ledgers will be more reliable and provide a better account of economic activity over some duration than its pre-existing counterpart. The only way it will lose this is if the security of the system breaks.

<comment><USER12> You're not making an honest argument while making a sweeping generalization and a strawman about something else. Money has value if you can buy things with it. Gasoline has value if you need it. Bitcoin has no value if no one will accept it or trade it. That's _reality,_ not hypotheticals.

<comment><USER13> I believe you are missing the point I was trying to make.

I was stating that nothing, not even bitcoin or money or gold or water has intrinsic value. Anything can have value to a person who is in need of a seller's goods. That was not my argument. Things have subjective value. Things do not have some mystic intrinsic property that makes them inherently valuable.

</comment></comment></comment></comment></comment><comment><USER5> >Commodities over the long-run track inflation and do not produce the sort of inflation-adjusted excess returns that stocks do. This means that Bitcoin, in spite of large gains from 2010-2013 and from 2015-2017, is guaranteed to be a shitty investment.

So commodities are bad investments, and the author deems Bitcoin a commodity, therefore Bitcoin is a bad investment? I don't find this logic very convincing. Bitcoin has numerous properties that traditional commodities do not have, which makes all the difference.

</comment><comment><USER14> Haven't seen a BTC hate post for a while here. Anyway, bitcoin is the best investment of the new century so far and that is the fact. Anything else is speculation and biased.

</comment><comment><USER15> Ah Cryptocurrencies. Like trading in bits of paper that say 'IOU some paperclips'.

</comment><comment><USER16> Bitcoin by design is not meant to be an investment. Its a bank account, that cannot be seized. It cannot be inflated. That's the solution to the worlds endless debt cycle. Although it does not do a fantastic job at day to day transactions it has other attributes that make it the most amazing technological breakthrough of our lifetime.</comment>


Google and Adobe Contribute Open Source Rasterizer to FreeType - <AUTHOR> http://www.pcworld.com/article/2037506/google-and-adobe-beautify-fonts-on-linux-ios.html

<comment><AUTHOR> it seems that patches from infinality (<http://www.infinality.net/blog/infinality-freetype-patches/>) are being merged into freetype. using it makes a _huge_ difference. in arch you can do it pretty much automatically via the freetype2-infinality package (available in aur). more information here: [https://wiki.archlinux.org/index.php/Font_Configuration#Patc...](https://wiki.archlinux.org/index.php/Font_Configuration#Patched_packages)</comment>


Our deepest view of the X-ray sky - <AUTHOR> http://www.mpe.mpg.de/7461761/news20200619 <comment><USER2> "But wait, how can you perform telescopic observations in X-rays? They tend to penetrate matter (including telescopes), right?"

Correct, normal optics would not work. X-ray telescopes use grazing incidence mirror arrangement (Wolter telescope [1] [2]).

[1] [https://en.wikipedia.org/wiki/Wolter_telescope](https://en.wikipedia.org/wiki/Wolter_telescope)

[2] [https://en.wikipedia.org/wiki/EROSITA](https://en.wikipedia.org/wiki/EROSITA)

</comment><comment><AUTHOR> I'm a scientist on the team who did this (I actually helped put this picture together), so I can try to answer questions...

<comment><USER3> I helped build and calibrate XMM, earning my PhD [https://www.researchgate.net/publication/252418991_The_X- ray...](https://www.researchgate.net/publication/252418991_The_X- ray_observational_satellite_XMM_its_spectrometer_and_observations_of_supernova_remnants) in the 90s, before leaving academia to start my first company.

I haven't kept track of the field. Has eROSITA reproduced most of XMM's data? I expect XMM will keep collecting data, but how useful/obsolete has it become?

<comment><AUTHOR> XMM is still extremely useful. There was a recent report that using clever techniques ESA are going to keep it going for another 10 years: [https://www.esa.int/Enabling_Support/Operations/Teaching_an_...](https://www.esa.int/Enabling_Support/Operations/Teaching_an_old_satellite_new_tricks)

XMM has a smaller field of view than eROSITA, but more light gathering capability (effective area), particularly at higher energies. It also has different types of instruments, such as the X-ray gratings.

eROSITA is really designed for doing surveys with its wide unobstructed field of view, and it will be doing just that for the next 3.5 yrs. We really need XMM to follow up in detail the most interesting sources we discover during the survey.

</comment></comment></comment><comment><AUTHOR> The eROSITA telescope onboard the SRG observatory has completed its first survey of the sky in X-rays, producing the deepest ever map in X-rays and finding over a million sources. Most of these sources are active black holes, clusters of galaxies, supernova remnants and stars.

Annotated and high res images can be found here: [http://www.mpe.mpg.de/7461950/erass1-presskit](http://www.mpe.mpg.de/7461950/erass1-presskit)

</comment><comment><USER4> This just blew my mind, from the fifth image:

"Vela Junior was discovered just 20 years ago, although this object is so close to Earth that remains of this explosion were found in polar ice cores."

Aside from being some serious Hurcule Poirot meets Kip Thorne crossover stuff, I want to ask "How do we know?" but I'm pretty sure I wouldn't understand the answer.

</comment><comment><USER5> Imagine a whole article about high-energy astronomy never even mentioning plasma or synchrotron radiation.

Trotted out "hot gas", though.

<comment><USER5> I am mistaken: "plasma" appears once in a hidden caption I missed first time through.

<comment><AUTHOR> I'm not sure why you're bringing up synchrotron radiation in particular. Although it's important for some sources, it's not driving the majority of what is being seen here. Comptonization is important for active black holes. The radiation from the milky way has strong emission lines - it's not a synchrotron spectrum. Mostly thermal emission is emitted from clusters of galaxies. There are a lot of different emission processes to consider in astrophysics.

<comment><USER5> If, as you say, there are a lot of different emission processes, why only ever mention the, by far, least interesting? Elsewhere in science exceptions are interesting. The unexplained is interesting.

Lev Landau is reputed to have said, "Cosmologists are often in error, never in doubt." Doubt is productive.</comment></comment></comment></comment>


Noisebridge SF might shutdown - <AUTHOR>

From Shannon Lee via Noisebridge-announce:
Hi All,
We have a problem.
Actually, I think we have several problems, but we have one major manifestation of our problem:  We are broke.  We are not going to be able to pay February's rent at the current rate of input/output.  We're currently taking in about $2500/month in dues & donations, and we're spending about $5000 in rent and utilities and whatnot.  This is a dramatic drop-off from this summer, when we were doing a little better than breaking even.
So, no joke, Noisebridge may close its doors in February, unless we can solve our problem.  This is way past the time for "let's have a party and charge money!" -- the thing we need is for people who don't want Noisebridge to close to reach into their wallets and shell out some cash.  Some of you will have noticed the new donation box with a sign that says "It costs $165 per day to keep us open" -- this is true, $165 per day is our burn rate; this means we need roughly two full members, or four "starving hacker" members, to pay for every day we're open; this works out to 60 "full" members or 120 "starving hacker" members, or some combination thereof.
Ways to donate are spelled out on the wiki here:
https://www.noisebridge.net/wiki/Donate_or_Pay_Dues
They come down to: we take cash, checks, paypal and straight up bank-transfer.
If you are not sure about having a committed relationship with Noisebridge (I know, commitment is scary) consider sponsoring a day:
https://www.noisebridge.net/wiki/SponsorADay
For those of you who are confused about the membership process -- being a member of Noisebridge costs $80 per month.  If you're a regular user of the space, you should become a member.  Membership can be either formal (in which case you have a voice in political processes) or informal (wherein you simply donate money to the space, but don't participate in decision making); if you are only interested in supporting the space, simply start donating $80 per month; if you want to be a formal member, ask a member for details, or attend a Tuesday meeting.
Please support us or we will be gone, and soon.
Thanks for your time,
--S <comment><USER2> This is too bad. I had not had time to stop by there for about a month but it's a really great place and if you live in or near SF you should check it out. I've signed up for a monthly donation. Hopefully others will follow and Noisebridge will do a better job of keeping the community informed of their financial situation. (Put you monthly intake on the homepage or the intranet that unlocks the door) No one likes to ask for money but there is a generous community of people out there and I hope we can do what it takes to keep the lights on.

</comment><comment><USER3> I'm here right now, and haven't been able to get a chance to check it out due to school restrictions in the past.

I think anyone living within the proximity of the bay area should definitely check this out. There are literally shelves of tools, nuts, bolts, circuit boards, video cards, RAM, circuit boards, etc. to use.

Not to mention the people here have been great so far to welcoming us. Seriously, check it out, and donate. I will be.

</comment><comment><USER4> Joining my local Hackerspace(theTransistor in Provo, Ut) made my life better. The people I met, and the projects I have worked on there are amazing. If you have a Hackerspace near you, go check it out.

</comment><comment><USER5> Maybe you could get some kind of co-membership thing going on with hacker dojo?

SF is just too far for me to go most days.</comment>


Unbluring web font icons: Response to GitHub's Octicons post - <AUTHOR> http://bens.me.uk/2012/web-font-icon-canvas-rendering

<comment><USER2> All this work of trying to achieve "pixel alignment" on icons is useless, in my opinion. Just change the browser zoom level, and it all breaks. It Retina, it's not necessary. And font rendering is so different between platforms and browsers, it's too hard to try to accomodate.

End-users don't really care about "blurry" (i.e. anti-aliased) icons, since all their text is rendered the same way. They only care if the icons aren't _legible_.

Much better than trying to hack hard pixel edges, would be not to cram so much stuff into an icon in the first place. Examples:

\- Instead of a dogeared document with lines on it (indicating text), just use a blank dogeared document

\- Instead of a book+bookmark icon, just use the bookmark part, or just the book part, depending on what the icon is for

\- Instead of slapping a "+" onto an existing icon (e.g. on top of a book with a bookmark, to indicate "new repository" on Github), just use a "+" icon by itself, and ensure the context makes it clear that we're talking about a repository

GitHub tried to cram way too much information into a lot of their icons, and it's basically useless IMHO. Icons shouldn't be self-contained complex symbol languages; they should be simple and depend on context for full meaning. They're not sentences, they're signposts.

<comment><USER3> How many typical users change their zoom level? I suspect not many. What % of users online have retina displays? I suspect a growing but still small number. So, it would still matter.

<comment><USER4> > How many typical users change their zoom level? I suspect not many.

How many people have less than perfect eyesight? I suspect very many.

</comment></comment></comment><comment><USER5> With an insight into font technologies, this is actually very easy to solve. Opentype fonts can contain TrueType or Postscript curves. These two have a very different approach to hinting: In TrueType the font is clever and the renderer is stupid (lots of very complicated hints in the font). In Postscript the font only has a few simple hints, and the renderer does the rest.

On Windows an unhinted TrueType text font looks horrid, an unhinted Postscript font is ok.

So, if you want an unhinted font, because you're using icons, just use TrueType shapes and don't hint them (like Font Awesome seems to do) (This doesn't cover the native mac renderer, it ignores any hints and does all the work itself)

</comment><comment><USER6> I'm using Firefox, and It looks perfectly clear to me. <http://i.imgur.com/1GMdY.png>

<comment><USER7> The same here, Firefox on Win7 seems to be doing it better than chrome.

<http://i.imgur.com/Vmbh2.png>

</comment></comment><comment><USER8> Another way to sharp icon fonts (at least in Webkit) is using the SVG font format (placing it above ttf in the webfont stack). I demo'd this on my blog:

[http://t.cem.re/post/21179547863/the-secret-to-custom- sharp-...](http://t.cem.re/post/21179547863/the-secret-to-custom-sharp-icon- fonts-use-svg)

<comment><AUTHOR> Swapping the order and removing the woff format in my example to match your scheme didn't result in sharp icons for me. Which OS and browser did you use?

</comment></comment><comment><USER9> Font Awesome looks decent across browsers.

<http://fortawesome.github.com/Font-Awesome/>

<comment><AUTHOR> In Firefox on the Mac, square elements have blurred edges. Look at icon- envelope-alt, icon-table, etc. And the round icons, eg icon-circle-*, have flattened edges.

<comment><USER9> Just FYI...

In FF 13, IE 8, and Chrome (21.0.1180.15 dev-m) on Windows XP, I'm not seeing blurred or flattened edges with Font Awesome at all.

Actually, I'm not seeing any improvements in your "Web font icons rendering proof of concept" demo with either. Before and after look the same here for FF and IE. For Chrome, the after column is blank. (?)

I do see the blurriness in your PNG graphic on your page, so it's apparently not my eyes that are to blame: Safari looks good; FF, bad; IE9, fair.

</comment></comment></comment><comment><USER10> I wonder if setting opacity to 0.999 in CSS would prevent the blurring without stopping scaling on zoom.

<comment><AUTHOR> Nice idea, but it doesn't stop the blurring.

</comment></comment><comment><USER11> On the iPad3 canvas looks blurry, the normal rendering looks sharp.. Maybe best to make it conditional?

<comment><AUTHOR> Absolutely. If I deploy something like this, it'll only do the canvas rendering on non-WebKit browser.

<comment><USER12> canvas is inconsistent on webkit too. On iOS you need to create the element at twice the size because canvas size == backing size, while Safari/Mac "transparently" does this (and breaks direct pixel access). Chrome/Mac hasn't made up their mind which model to follow.

You need to look at both window.devicePixelRatio and canvasContext.webkitBackingStorePixelRatio to detect if you need to do manual pixel-doubling.

</comment></comment></comment><comment><USER13> Except that it doesn't work when you increase the zoom level on Firefox on mac.

<comment><AUTHOR> That's because it's effectively zooming a fixed size image, so you see the same effect as you would if you were zooming an img.

If it's possible to detect the zoom level and rerender, it should be possible to work around this.</comment></comment>


Skyfire Launches the First Flash Video Enabled Mobile Browser for Android - <AUTHOR> http://www.skyfire.com/

<comment><USER2> Just so anybody wanting to try this browser knows: this browser is similar to Opera in that all requests are proxied, then processed and compressed by their servers prior to hitting your phone. This includes all interactions with Flash, as well as all forms (even encrypted). If this sort of thing is no issue to you, Skyfire works, and works well (when I tried it on Windows Mobile 6 a year ago).

<comment><USER2> To clarify: I mean Opera Mini, not the desktop version.</comment></comment>


The Cost of an ACL Injury - <AUTHOR> http://calv.info/the-cost-of-an-acl/ <comment><USER2> This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university.

Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medical devices so worth bearing in mind).

To put in perspective, that is approximate the same total cost (~$5000) as just _one_ of the pieces of equipment ("Cannula Fast Fix CVD") that the OP lists.

It's one thing if doctors are more expensive because they have to carry higher insurance charges to protect against negligence lawsuits, etc, but that the equipment alone is multiple times the cost seems crazy.

Mental.

<comment><USER3> We hear about medical tourism from the US to India, Thailand, etc., but with these kinds of price discrepancies between the US and UK private practices, I wonder why there aren't more Americans who go to the UK for surgery?

<comment><USER4> The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny.

My impression is that medical tourism from the U.S. is not typically for cost savings, but rather because particular procedures are either completely unavailable (experimental stem cell treatments) or could require long wait times (liver transplants). I'd love some data on this. Wikipedia's rather poorly written article suggests MT is more popular _from_ countries with socialized systems in order to reduce wait time, but I'm skeptical.

<comment><USER5> > The fraction of patients without insurance but with enough cash and > motivation to fly to the UK purely to seek savings on medical treatment has > got to be fairly tiny.

Well, if my options are to spend 60 grand on an ACL repair in the U.S., or significantly less than that on a first-class ticket to London, some serious fun, and an ACL repair...I know which one I would choose.

<comment><USER6> Those weren't your options. As with most things health related in the US, someone else was paying (the "insurer" in this case). Given the choice between you paying $2,400 in the US (and the insurer paying an amount you don't see or care about), or you going to the UK and paying 3,000GBP plus accommodation and tickets, I'll bet you pick the former.

It is in the insurer's interest for you to go somewhere cheaper as it saves them (not you) money. There are various press articles about this happening such as this 2009 article [http://usatoday30.usatoday.com/news/health/2009-08-22-medica...](http://usatoday30.usatoday.com/news/health/2009-08-22-medical- tourism_N.htm?csp=34)

<comment><USER7> If the insurance company pays the remainder i.e. >60k why don't they offer you this deal:

\- No out of pocket cost

\- Free all expenses paid one week trip to England with your surgery

Would cost them the 3k pounds+2.5k$ of your share+maybe another 3k for a good trip..<10k total compared to 60k

I take it they simply can't get that 3k pounds deal as an insurance company.

<comment><USER8> Insurance company will not pay >60K. It will be <10K. Typical insurance pays around 80%, patient 20% of the 'negotiated rates'.

</comment></comment></comment></comment></comment></comment></comment><comment><USER9> Excellent read.

One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct.

At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and correct. Once you have a complete set of nice hand-me-down spares squirreled away for coarse work, any subsequent used tools go in the recycle bin.

For the computer-inclined, this practice is no different from taking a perfectly functional linux installation you've used for a little while for a side project and using it on a mission-critical task. It's easier and more reliable to reformat and reinstall than to inherit whatever curiosities might emerge from the past.

When quality matters, provenance matters.

<comment><USER10> To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance.

Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

<comment><USER11> "Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal"

Very well could be some liability potential wrapped into reuse of a device. After all part of the cost does go toward covering things that go wrong for whatever reason.

If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it?

An inverse analogy might be the difference in potential problems from using a hard drive that has been previously used where _something is later found_ vs. using a brand new hard drive.

<comment><USER12> >If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it?

There's something on the order of 100,000 ACL tears per year. Even with no reuse, it seems odd that economies of scale can't get that well below $900.

<comment><USER13> Economies of scale have nothing to do with medical billing in the US. For example, IV bags of saline don't cost $100 in the real world (more like $1).

<comment><USER14> This becomes readily apparent with medical care for animals. Your vet will send you home with bags of Ringer's, line, and a bunch of cannulae for $50.

It's not as simple as insurance alone driving the cost, but having a throat to choke if something goes wrong does contribute to it.

As has been mentioned elsewhere, random overhead is covered in weird places, as well.

<comment><USER13> And human medical procedures that aren't typically covered by insurance. LASIK for example, imagine what laser eye surgery would cost if it was billed like an ACL reconstruction. Instead you have to pay yourself and doctors compete, the entire bill (at a nice place) ends up being what a couple of ACL knives cost.

<comment><USER14> Gah, excellent point. Elective retail procedures such as vision improvement surgery and dental crowns, bonding, veneers, etc., all seem to top out around the average FSA limits of $5,000 or so. It's especially notable around the end of the year when advertisements encouraging people not to waste their FSA funds start picking up on the radio.

Now that the IRS has apparently imposed a limit of $2,500 on FSA deductions, I wonder if that's going to create pricing pressure on the "high end" procedures such as custom/wave/whatever LASIK here in the USA.

If I weren't a lazy sod, I'd look up capital equipment costs for medical procedures such as those and compare them to MRI, EKG, and other items used primarily for "need" based, insurance paid, procedures.

(Actually, I haven't used any fancyhands requests in a couple months. I'll be lazy and have someone google for me.)

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER15> Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there.

My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including physician fees, equipment etc. Most of the population would not, and likely could not, pay 68,000 for an ACL repair, which would leave medical providers the option of 1) lowering prices substantially or 2) being out of work. Having put ourselves on high deductible health plans, we are super vigilant now about how we spend our healthcare dollars. And having realized the impact of this, since we are medical providers ourselves, we are now transitioning to a model where we are not participating with many insurance plans, but our fees will be completely transparent - published online - and fairly reasonable (I think).

<comment><USER11> "with insurance only for real medical emergencies"

You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line.

I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. Then because of lack of that maintenance the compressor fails on the HVAC and you end up having to replace a unit. Good luck with trying to tie that to the lack of maintenance. Or saying you won't cover it.

<comment><USER16> The idea is to have the right incentives in place. The premium for medical emergency insurance would go down as you are more proactive in your healthcare.

For example, by having an annual physical, maintaining your weight, etc. you would get a discount.

<comment><USER17> > The idea is to have the right incentives in place.

The recent article about Finland's baby box was a great example of this and their infant mortality statistics show that it worked.

</comment></comment></comment></comment><comment><USER18> When I was in college, I couldn't afford health insurance (no parents + financial aid does not cover it). I played rugby (generally not the safest sport) for two years, in addition to playing pickup basketball all four years. I very fortunately did not sustain any major injuries.

Six months after graduating (and getting a job with health insurance), I tore my ACL while playing pickup basketball. The costs were as insane as outlined in this post, but, again, I had health insurance. However, to this day, I'm horrified at the thought of what would've happened if I'd sustained the injury in college when I _didn't_ have health insurance. Shame on me for putting myself in those sorts of situations, but it feels like there's something wrong when the penalty is so harsh.

<comment><USER19> You wouldn't have paid anything like $68k. As mentioned in the article, those prices are inflated for charging the insurance company, who in turn negotiates a much better actual price. Similarly, the hospital would have likely worked out a better deal with you. Or, if you qualified (and it sounds like you would have), then Medicaid would have initially picked up the tab and _they_ would have negotiated a better deal for themselves.

In none of these scenarios does anybody actually pay the made-up $68k number.

<comment><USER18> That's true, though even 10% of that number (more than twice the out-of-pocket cost with insurance) would've been financially crippling.

<comment><USER20> Possibly, but look at the picture of the sliced out tendon. ACL replacement is an inherently complicated operation, from a highly skilled practitioner. The take-away from that is: you can't afford to play a dangerous sport like rugby if $5-7k is financially crippling.

</comment></comment></comment></comment><comment><USER21> The most useful aspect of this article is the pie charts and line-item comparisons. Ignore the dollar amounts themselves. Why? Because almost no one pays that. Why?

\- In California, MediCal (state-wide health insurance safety net) pays about 20% of the cost (not price) of treatment for those without insurance. So if a surgery costs $10k, MediCal says "Here's your $2k. That's all you get."

\- Nationwide, Medicare pays something closer to 90%. Much better, but still a loss to the hospitals.

\- Insurance companies negotiate with hospitals, but (from what I've heard) generally pay 115-125% of the cost, giving hospitals a 15-25% margin. Certainly better, but not necessarily making up for the above.

\- Some patients with no insurance, especially at major academic medical centers, are rich folks looking trying to get the best care in the world for something particularly complicated. UCSF in my neighborhood even has an in- house Saudi liaison for Saudi royals. These folks pay the full rate, which may represent an enormous markup, which does help subsidize the care of the top two categories.

For those without insurance, who don't have the money to pay the full fare (meaning you're not a foreign prince or similar), you're going to get freaked out by the bill, which is based on the last category. But in reality, the moment you ask a billing person about the costs, you'll almost always get knocked down into the insurance rate tier, just for asking. Show proof that you have next to nothing, and you could get well down into MediCal levels.

In order to get the ultra-rich to subsidize the patients that generate the loss, the price card needs to be high. Really high. So they give breaks to everyone else, since you can't do it the other way -- "Oh, you look rich, so we're going to charge you double the rate sheet."

This doesn't happen in community hospitals quite as dramatically, since they don't have the ability to handle the crazy conditions that will result in the high-revenue customers. So their rack rate for an ACL will be at the low end, while the academic medical centers that offer the $2MM neurosurgery will have rack rates for every procedure on the high end.

Is it messed up? Sure. But does it mean that normal people are paying $65k for this ACL procedure? Usually not.

<comment><USER22> This is true, but often the discounts aren't as steep as you'd think. I had a mitral valve replacement a couple years back (at age 29, due to a one in a million condition), and the insurance company was billed ~350k for the surgery + recovery in hospital. Even after their discounts, the total still came to $~250k (this is not the normal price - I had a complicated recovery, and spent an abnormal amount of time in the cardiac ICU). I, however, only had to pay ~$4,500 or so (high-deductible plan).

<comment><USER21> Yup, and if course it varies. Complications are a huge driver of costs, so making marginal improvements to the complication rate (either by improving the standard of care OR by insisting that you go to a place with a low complication rate) can have an outsize impact on the cost of care in the aggregate.

Companies like ConsultingMD (horrible name, <http://consultingmd.com>) are taking this approach to reducing costs.

</comment></comment></comment><comment><USER23> A few things to consider:

1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that.

2) All medical supplies are expensive in part because your body is pretty sensitive, and you need to be careful about what's in there, but also because doctors almost always have _COMPLETE_ control over what equipment they use ... including screw and tool brands. This means that hospitals have little-to-no leverage to get lower prices. This is particularly true for implants & other complicated equipment.

3) Insured people subsidize the uninsured.

<comment><USER10> So, it sounds like we need to stop coddling the doctors and standardize on a particular set of tools.

<comment><USER24> The issue with that is that no hospital is willing to be the first.

Hospital: We're going to lower costs by not letting doctors choose their equipment.

Talented surgeons: Welp, don't want to work there.

Patients: Why would I go to the hospital that doesn't have any of the good surgeons?

<comment><USER10> So, have a deal that says "Hey, if you want to be able to receive Medicare/Medicaid payments, you have to standardize tools."

All the hospitals will say "Wow, holy shit, alright", and the surgeons will have to play ball--because a surgeon without a proper OR is basically just a butcher or barber.

EDIT: Please explain why this is a bad idea instead of just downvoting.

<comment><USER25> As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices but there is that 1 out of a 1000 chance (slim but not unrealistically slim because I do >1000 intubations a year) that I cannot intubate you and you need to have a tracheostomy or worse, you die.

Some may argue that we should all train with the same equipment, but even then, what about inherent differences in the physician or the patients. Maybe where I trained, all my patients had large tongues and I need a particular blade more often so I became better skilled with that or maybe my hands are just better with a particular blade.

<comment><USER10> If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint.

If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly.

If I dropped a line chef off at a kitchen and they didn't have their favorite knife available and they held up orders for a whole night, their boss would fire them.

~

This custom bespoke medicine nonsense is increasingly seeming to be just that: nonsense.

Sure, there's this .1% chance that you might screw up an intubation, but that seems to be more of an issue of bad training than bad equipment.

As far as your point about differences in patients or physicians: that's a cop-out. Part of being good at what you do (as a dev, as a maker, as a person) is being flexible enough to make do and succeed.

In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.

<comment><USER26> > If I dropped a Linux admin off at a shop which didn't have emacs on their > boxen and he refused to work because he might accidentally screw up a config > file, he'd be laughed out of the joint.

The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of errors that could be expected from a surgeon being forced to use non-preferred equipment.

So the situations aren't exactly parallel.

> In a system which costs as much as ours does to people who simply can't > afford it, we (as a society) cannot afford to cater to the whims of > overspecialized professionals.

In a system which costs as much as ours does _compared to every other advanced country_ , while providing worse access and not producing better outcomes, we certainly can't afford to not do some research to figure out what everyone else is doing _right_ and we aren't.

But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference.

<comment><USER10> _"But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference."_

In isolation, your intuition is correct. But, with thousands and thousands of surgeons performing hundreds of thousands of surgeries a year, we end up with a logistical nightmare. This doesn't scale.

It's perhaps not the main difference, but I'm willing to wager it is at the least a symptom of whatever the underlying problem is.

<comment><USER26> > It's perhaps not the main difference, but I'm willing to wager it is at the > least a symptom of whatever the underlying problem is.

I doubt its even a symptom: because I don't think the other OECD countries that spend less for broader access and equal or better outcomes use one-size- fits-all-surgeries standardized equipment kits, either. But even if it was a symptom, it would be better to treat the underlying problems.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER27> One thing to be aware of in how all of this stuff works; oftentimes medical billing codes don't map 1:1 to exactly how things work in the hospital, so the medical staff puts together a statement of everything they did, and then the billing staff (approximately) maps it to billing codes.

This means that they'll overshoot on some codes to make up for other acts and overhead that doesn't have an exact billing code, and every medical provider has different places that they'll overestimate, and by different amounts.

Additionally, as most people know, the billed amount is usually FAR in excess of what the insurance company actually pays.

I'm not in the industry so I may be off base here, and someone who is can correct me, but I just finished Oreilly's excellent ("Hacking Healthcare") which is about how patient services and billing work.

<comment><USER28> [http://www.thedailybeast.com/articles/2013/02/22/how- hospita...](http://www.thedailybeast.com/articles/2013/02/22/how-hospital- administrators-hide-the-umbrella.html)

 _His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses._

 _...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!_

</comment></comment><comment><USER29> I was expecting this to be about Access Control Lists being slow or requiring more complex security reasoning (vs owner/group/other). It's not, it's about health care and injuries and something that's part of your knee.

<comment><AUTHOR> Good point, updated the title to be a bit more clear.

</comment></comment><comment><USER30> (I am slightly hesitant to publicly share info like this, but what the heck...for science!)

I tore my ACL 1.5 years ago playing soccer, and went through a similar surgery as the OP at NYU Langone Medical Center in New York. Interestingly, my final bill for the surgery (including the same things as the OP) was almost the same - $67k and change.

However, more importantly, the actual amount paid to the doctor/hospital etc. was $18k, of which I think I had to pay around $2k, insurance covered the rest. So while the sticker price might be $67k, the actual cost is significantly lesser. In the bills that I saw from my insurance company (BCBS), for each line item, they would have a column for "Allowed Amount" or something like that which generally varied between 20-30% of the billed amount.

On a different note, I don't whether the cost would have been the whole $67k if I was uninsured. I hope not. But if yes, that's really punitive to the people who can least afford it. For that matte, even a 18k cost is prohibitively expensive for someone who cannot afford insurance.

<comment><USER31> The way understand it, yes, the uninsured person would receive the $67k bill, but can then go and negotiate to lower the amount payable. Insurance companies just did that negotiation beforehand and have a standing agreement with the provider. All of this reeks of huge inefficiencies to me. There are people at both the insurance companies as well as at every health care service provider whose full time job is to negotiate rates with each other?

<comment><USER32> I've been in this situation, and there is no comparison at all. Nobody but the very wealthy can afford to pay out of pocket for healthcare. A single, minor injury can cost you $50,000 - $100,000. A chronic condition, cancer treatment, or major surgery can easily head north of $1 million.

Sure, you can try to negotiate pretty much anything. But what kind of leverage do you think you have? Insurance companies can put many millions of dollars of revenue at risk with the threat of dropping a stubborn healthcare provider from their network.

In contrast, your negotiation position is A) please? and B) I may be forced to declare bankruptcy, in which case you may or may not get your money. If you have enough assets, then option B is basically another form of A: "please, don't take away my house or the savings I've spent my life earning." The bigger your bill, the greater the incentive to deal with the annoyance involved in collecting from you. The likely consequence of your personal financial ruin doesn't enter into their calculations.

</comment></comment></comment><comment><USER33> _Achilles tendon harvested from a cadaver_

Yeah, I wouldn't recommend this route, either. I read an article in The New Yorker about body parts harvested from cadavers that were used in transplants. The parts were way past their harvest-by date. This was discovered, at least partially, by someone having an ACL transplant from one of this bad parts, and the recipient of the bad part died from bad infection due to a mold on the tendon.

The lack of controls on that business forever made me wary of using cadaver parts for transplants.

<comment><USER34> _The lack of controls on that business forever made me wary of using cadaver parts for transplants._

I didn't know that, but cadaver parts freak me out so when I had my ACL done I did the standard patellagraph. If I tear the same knee again I'll have to go cadaver or hamstring, but hopefully that never happens (knock on wood). The problem with the hamstring is it never quite heals as strong.

As an aside, pro-athletes typically go cadaver because the time to heal can be quicker. They probably aren't getting bad ones though.

</comment></comment><comment><USER35> ACL stands for Anterior Cruciate Ligament. (In case I'm not the only one who didn't know and was surprised to see this was never mentioned in the article or the comments.)

</comment><comment><USER36> I had ACL & torn miniscus surgery 16 months ago and live in Canada, here are my experiences (excellent breakdown btw). It changed my life in many ways, but that's another story.

Though surgery is voluntary and I injured it playing soccer, the operation is covered by Medicare (which is a mandatory $64/month as I am self-employed).

So not including opportunity costs for missed work and time for pre and post- op doctor's visits (about 8 of them), my costs not covered were: \- Post- surgery pain killers: $30 for T3's for a week. I refused the Percocet's, although the pain was bad I could still sleep. \- Physio visits. They'd have you 2-3X per week for the whole duration if they had it their way, at $70 per appointment. I can't afford that, so I went once a week for three months = $840. \- I declined the $900 custom knee brace that helps you get back playing sports sooner. \- Rental of crutches for two months $25

And crutches are NOT as easy as I once thought, when you'd hop around on hour friends crutches for a few steps. I'm pretty fit, but a few blocks in them has you sore and sweating. Take care of those knees!!

</comment><comment><USER37> I also had my ACL replaced (hamstring autograft), in SF, about 2.5 years ago after a basketball injury.

I'm pretty sure these prices are starting 'list' prices, whereas the negotiated/'allowed' cost that you and your insurance company actually wind up paying tends to be 1/2 to 1/3 these numbers.

My surgery was also about 3 months after the injury, which isn't optimal. It took me a few weeks to see a doctor, I didn't like the 1st doctor I saw, and by the time I'd settled on a preferred one, I needed 6 weeks of physical therapy to undo some of the post-injury weakening of surrounding muscles. (Since there's also atrophying due to surgical damage and post-surgery immobilization, it's best for recovery for the muscles to be as strong as possible going in. So diagnosis/surgery ASAP after injury, with muscles nearly at their pre-injury best, is preferred... if you suspect your ACL is torn see a doc quickly!)

<comment><USER34> Depends. An ACL tear can feel better on it's own after a few weeks assuming you don't go running into any hard direction changes. Many docs would prefer pre-hab prior to surgery in order to get maximum flexibility and strength for every patient, but most insurance will not pay for it.

</comment></comment><comment><USER38> For comparison, the full cost of a hernia repair (<http://en.wikipedia.org/wiki/Inguinal_hernia_repair>) in a private hospital in Poland is below $1500. Sure, this is a much simpler procedure than the OP's one, but still -- it involves an operating room, a surgeon, an anesthesiologist, assistants/nurses, and 2 days of hospital care. I don't imagine the materials are much different to the ones used in the US.

Even accounting for the lower cost of labor, the prices in the US are insane.

<comment><USER39> I don't know the statistics overall, but in my case the comparison of the inguinal hernia repair is even more damning: I'm positive it was more costly, but to add insult to injury, it (my hernia repair) was done as an outpatient procedure.

Although I am not a doctor (just a patient), if anyone tries to pitch you this as a good idea, _run_. The effective recovery time was insane, and not to mention the pain/temporary disability (also insane). An inpatient stay wasn't even offered, but in hindsight it shouldn't have even been optional.

By contrast, an unrelated abdominal surgery a few years later, despite being a much more involved procedure, had a much faster recovery. (10 day inpatient stay + probably 5 days of that with some physical therapy.)

Health care costs are a secondary issue to me, right behind health care quality. Unfortunately, I don't think either can be fixed unless they are entirely divorced from each other.

</comment></comment><comment><USER40> I'd be interested in seeing this analysis using what the actual final cost incurred was (normally the fees you are shown are negotiated down by your insurance company to the amount they actually pay).

</comment><comment><USER41> I am actually 4 months out from my own ACL surgery, tore mine skiing and one thing the OP forgets to mention is many insurance will never pay that $60k as they have pre-negotiated rated with the hospitals and doctors. My surgery was done in SF (not the cheapest city in the world..) and according to the bill came out to just over 100k, but, my insurance paid 17k. What happen to the rest? Well I assume it was just inflated costs that the hospitals adds to the bill so the insurance can negotiate down.

</comment><comment><USER42> This is amazing to me. I am from Australia and did my ACL when I was 15, and the cost was around $3000. It was an overnight stay in hospital, the only costs not incurred for the actual surgery and operation were MRI's and physiotherapy. How that could cost 20x the amount in America, I could not possibly fathom.

It is always a struggle for me to understand how health insurance is such a major expense in America, but when relatively routine surgery such as an ACL repair costs that much, things are put into perspective.

</comment><comment><USER43> I had this exact same surgery 7 years ago after tearing ACL/meniscus playing basketball. Patellar tendon graft FTW! (I joke that _real men_ donate their own tissues)

For me, the ACL has been perfect ever since. Wish I could say the same for my meniscus and cartilage - I subsequently tore my meniscus 2 more times (each time in a non-vascular area so they just sanded it down, no sutures like you had), and then 5 years later I tore a chunk out of my articular cartilage that had probably been weakened years before when I did my ACL.

That led to an OATS procedure where they took bone plugs from a non-weight bearing part of the knee and transplanted them in holes bored where the lesion was. That last procedure was pretty fun as it entailed 6 weeks on crutches, non-weight bearing, during which period my wife and I had our first kid (yay for timing!).

Anyway, that just to say hang in there (I imagine your rehab is pretty much over by this point, but it probably still aches?), and I hope your ACL graft (good call with the patellar) holds up as well as mine and your meniscus better. Oh and enjoy the achiness that comes with changing weather. I was rather amused that that apparently is a real thing. :)

</comment><comment><USER44> Great read. Very well researched and written.

As a side note, medical insurance much like construction is a 'cost-plus' industry. The insurance companies actually have incentive to make prices go up.

For example, insurance companies are required to spend 80% on medical expenses. So if cost of an ACL surgery skyrocketed $100,000 then, they would make $20,000 off of it. Instead, they only made about $14k off of Calvin's surgery.

</comment><comment><USER45> I ruptured my left ACL during the final year of our college during a cultural fest (in India). It was a complete tear and required surgery to return to normal knee movement (Instability due to knee cartilages tears/injuries suck, and lead to further secondary injuries).

I had to differ my surgery for a couple of months since we had our final exams and I had to walk with a brace and avoid injury-causing activities. The surgery at one of the leading hospitals in the country cost me around ~$3000 and was completely covered by my Health Insurance, the care I received was exceptional and I could see why "Medical tourism" to India is on the raise. The costs are mostly around 1/10 of what any procedure costs elsewhere.

P.S. Incidentally, I had a freak accident a few days back and I'm positive I tore one (or many) of my ligaments in the other knee, and I had just started training to run a marathon within the next year :( (Lady luck hates my knees)

</comment><comment><USER46> Interesting to read of a 'normal' person sustaining an ACL injury and the subsequent fixing thereof (especially detailed costing breakdown - thanks for the detailed analysis). There has been somewhat of an 'epidemic' of ACL injuries in the AFL[0] this year. So far at least 15 players, some of them quite well-known, have succumbed to a season ending ACL injury already[1], much more than previous years. The difference? They have access to a complete rehabilitation package of priority surgery and follow up physio program. Such is the professional sports industry I suppose...

[0] Australian Football League; <http://en.wikipedia.org/wiki/Australian_Football_League>

[1] [http://www.abc.net.au/news/2013-04-29/afl-acl- injuries-2013/...](http://www.abc.net.au/news/2013-04-29/afl-acl- injuries-2013/4658058)

</comment><comment><USER47> I wonder how the cost would compare at a special-purpose orthopedic surgery center vs. a general hospital? I actually thought that otherwise healthy people are encouraged to utilize specialty facilities rather than hospitals as they can be optimized to the procedures performed, and may have lower risk of post-op infections.

</comment><comment><USER48> It was $1,600 have ACL surgery on our dog. Think about that one for a while.

<comment><USER49> Crazy, but dog lifespan is considerably less. How long does the repair really have to last for?

<comment><USER50> I doubt that has a significant impact on the cost of the procedure, though, right? I mean, sort of like replacing the clutch on a car -- the cost isn't (necessarily) based on the lifetime/quality of the new clutch, but rather the labor required to pull the engine, install the clutch, button everything back up.

</comment></comment></comment><comment><USER51> I had my ACL repaired in 2007. I don't remember the costs any more, but I had essentially the same procedure using my patella and a meniscus tear repair. While I was able to put weight on my injured leg and was out of physical therapy after only a few months, it has taken several years to "fully" recover; even then I have the occasional gentle reminder that my knee is not the same as before my soccer mishap.

</comment><comment><USER52> Here is an idea for an awesome law that might fix some of the problems with the medical industry! Remove the ability of the billing departments to determine who has insurance and who doesn't. That way, everyone is charged the same amount for similar procedures. The whole practice of over-billing insurance companies has simply become ridiculous.

Why do the insurance companies tolerate this practice?

</comment><comment><USER53> I dunno about the surgery time which is probably the only overpriced thing worth the money if done right but WTF is this?

       First 30 minutes in the post-anesthesia care unit  $2,057
       Additional time in the post-anesthesia care unit   $3,894

What exactly cost $6000 ? Laying in a room? Seriously? Like you have a choice - which is probably why.

</comment><comment><USER25> I would like to pose a question to the Hacker News community. If you had to, where would you cut costs? Do you think doctors are paid too much? Or nursing staff? Obviously, we think these services are overbilled but the reality of it is that most of these bills are not paid at all or paid for a fraction of what is billed.

</comment><comment><USER54> I'd like to see the actual negotiated rate the insurance company paid for those items. I'd be surprised if it was more than 40%, and perhaps it might be less?

It's quite bad that those who can afford it the least pay the highest(sticker) prices, though. If Obamacare fixes that one thing, it's done the US health care world good!

</comment><comment><USER55> The article ends with "this sector needs innovation". Even though it does, what it really needs is better (and tighter) regulation. The situation in the US (costs through the roof, a lot of people that can't get medical care), health is something that can't totally be left to the private sector.

</comment><comment><USER56> Earlier this month in NY Times: Hospital Billing Varies Wildly, Government Data Shows [http://www.nytimes.com/2013/05/08/business/hospital- billing-...](http://www.nytimes.com/2013/05/08/business/hospital-billing- varies-wildly-us-data-shows.html?pagewanted=all)

</comment><comment><USER57> here a link to compare the cost of the same injury in France:

[http://blogs.wefrag.com/Naudec/2011/11/05/rupture-du- ligamen...](http://blogs.wefrag.com/Naudec/2011/11/05/rupture-du-ligament- croise-anterieur-un-an-plus-tard/)

basically it's about 7559 euros all inclusive (MRI, etc..)

<comment><USER58> In fact, in the link you provide, the 7559 euros also cover 75 sessions of physical therapy, a nurse coming at home every working day during a month and various drugs.

It would be interesting to have a global comparison (operation+therapy).

Here, the operation including all appointments before is about 5274 euros.

</comment></comment><comment><USER59> It seems to me that the balance of power has shifted far over to the providers and away from the insurance companies. Would allowing more mergers give them more bargaining power and bring these costs down? Or is that just too simple?

<comment><USER26> > It seems to me that the balance of power has shifted far over to the > providers and away from the insurance companies.

That's because you are looking at an accounting of the _nominal charges_ , and not what the insurance actually _paid_. If you look at what the insurance actually paid based on those nominal charges, you'll see that the balance of power isn't where you think it is.

<comment><USER59> Oh yes it is! I know exactly what my insurance company's negotiated prices are (because I pay them!) and they are astronomical. I just had an emergency visit and the nominal charge was $1700. The negotiated charge was $1500. That's _nothing_. I added up the medicare schedule prices for the entire visit and it was about $350. So, yes, a large insurance plan (like medicare) seems to be able to negotiate far better than my insurance company.

</comment></comment></comment><comment><USER60> ACL Graft Knife $900

Here is a pack of 4 on ebay for $35 [http://www.ebay.com/itm/ACL-GRAFT- KNIFE-10MM-REF-232110-DEPU...](http://www.ebay.com/itm/ACL-GRAFT-KNIFE-10MM- REF-232110-DEPUY-MITEK-LOT-OF-4-PCS-/390521554893)

</comment><comment><USER61> Contrast this to the cost of a typical ACL injury in Australia: [http://www.injuryupdate.com.au/forum/archive/index.php/t-801...](http://www.injuryupdate.com.au/forum/archive/index.php/t-801.html)

</comment><comment><USER62> Wow, so much of that is overpriced.

The medication costs, especially the fluids, are much higher. I checked a UK pharmacy for costs for buying small amounts so the discount they get for buying in bulk suggests a very large mark up in price.

<comment><USER63> Did you include the cost of having a trained medical professional administer them? The cost of hospital aspirin isn't the pill it is the doc deciding to give them to you and the nurse who dispenses the pills( don't forget the billing person who charged you for the pills, the staff lawyer who was retained just in case you sue over the aspirin, and the payout to the last guy who sued and won).

As with every service industry from the local pizza joint on up COGS(Cost Of Goods Sold) is one of the smallest parts of the pricing puzzle.

<comment><USER64> Is the cost of staff included in the cost of the meds, or elsewhere? Are they double-billing for staff costs?

<comment><USER32> If you read the recent Time cover story about medical costs, you'll see examples of people being recursively double-billed for items, at least according to the Medicare guidelines. e.g., and my memory's a little fuzzy on the specifics, but I believe one case was being billed for the operating room, then billed for the prep kit (which is supposed to be included in the room charge), then billed for every individual item in the prep kit.

If I hire a contractor to do something and he charges $X/hour, I don't expect him to mark up the materials he might use, too. I'm already paying for his time and expertise. I shouldn't also be paying the drywall for his expertise.

</comment></comment></comment></comment><comment><USER65> There is a cost in not getting your ACL repaired. I waited 4 years (due to the fact that the buffoon physios / doctors I saw didn't diagnose it correctly) and put on 20kg in the interim because I stopped playing sport.

</comment><comment><USER66> Coming from the mobile app market where consumers are reluctant to spend 99 cents on your app/game, this is revolting. Something has to be done (in the medical field and in the mobile app field as well)

</comment><comment><USER67> Why don't the medical tools get reused? That seems absolutely insane to me.

<comment><USER68> Yeah I also don't get that. Would they not be able to just be disinfected and resealed?

<comment><USER26> > Would they not be able to just be disinfected and resealed?

Blades that need to be very sharp and of very particular dimension are going to need sharpened, which is going to change their dimensions. So there is limited, if any, reusability in any case.

And the keeping, transporting to a cleaning facility, cleaning, sharpening, etc., is going to come with an additional cost cost and risk of accident that you don't have with immediate disposal.

</comment></comment></comment><comment><USER69> I had ACL surgery in November in Italy and it costed 2200€(I did not pay anything we have public health care luckily). US health care system is just crazy in my opinion.

</comment><comment><USER70> The insurance company didn't pay that much.

This article is silly.

Our health care system certainly has lots of problems but at least know how it works before sharing commentary on it.

</comment><comment><USER71> this is an industry not just ripe for disruption but instead ripe for some anti-trust laws and investigation for fraudulent behavior

</comment><comment><USER64> So, I have a few questions.

> Going in, I had anticipated that doctors would take the lion's share of the > costs. I was surprised when the facilities ended up being the dominant cost; > over 40% of the total.

Is that because you're paying for the cost of nurses here, rather than breaking that cost out elsewhere?

> This centimeter-wide cutting machine cost $900 according to the price sheet.

That seems to be a bit much. I'm used to silly prices for tools and equipment in electronics, but still. Perhaps they're charging you for the whole tool, and not just the disposable blade? (Which would seem to be a bit cheeky.) Have you tried to get a price quote from anywhere else? (<http://www.arthrex.com/products/AR-2285-10>) Because they sometimes turn up on Ebay ([http://www.ebay.com/itm/Arthrex-AR-2285-10-Parallel- Device-1...](http://www.ebay.com/itm/Arthrex-AR-2285-10-Parallel-Device-10mm- Qty-1-EX-/300801588750))

> but the blades get thrown out after just a single use

One reason for that, at least in the UK, and maybe this is historical, is because of diseases like CJD.

But as ISL said a sharp blade is a good blade and when you're slicing people you want the best blades you can get.

> Most of the other drugs cost between $40-60 per dosage.

In England everything is free at the point of delivery. Medications are a bit different. If you're in hospital they're free. Most people get exemptions from paying. The people who do pay need to pay about £7.50 per line item per month. There are discounts for people who need a lot of meds.

> The screws and washer are made out of titanium. I haven't had any problems > with MRIs or the metal detectors at the airport, but they do show up very > clearly on my x-rays:

When my father died he had left me his artificial knees in his will. Luckily he had also asked to be cremated, so it was nice and easy to get them.

What I'm particularly curious about is why this market doesn't seem to work.

Insurance companies want customers to pay them. Insurance companies don't want to pay too much to hospitals because that's cutting the margins. So why don't insurance companies seem to be driving the costs down? Are insurance companies equipped to investigate the costs reported by hospitals?

Some kind of anonymised crowd-sourced data would let people know if their operation was around the same price as other people were paying. Perhaps you'd need to break the price down so people were able to compare similar things.

I hope your knee heals well and that you start to feel the benefit of that surgery!!

<comment><USER50> > So why don't insurance companies seem to be driving the costs down?

They are driving down costs -- as the OP mentions elsewhere in this thread, while he was _billed_ nearly $49k for facilities/equipment, the insurance company only _paid_ $15k.

There certainly are a lot of rich doctors and hospital executives who are being paid ludicrous amounts of money (especially considering the hospitals themselves are billed as not-for-profit), but the insurance companies are making money hand-over-fist in the current regime.

<comment><USER64> That feels, and I'm not sure what the right word is, "corrupt"?

</comment></comment></comment><comment><USER72> Is there any way to get data about how much insurance companies actually pay? I'm assuming it's different from amount billed.

</comment><comment><USER73> Reading the article my knees both began to ache and I started to rethink my choice of sports - squash and indoor soccer...

</comment><comment><USER74> For the sake of clarity:

Tendons link muscle to bone; Ligaments link bone to bone;

He tore a ligament, and it was replaced with a ligament, not a tendon.

</comment><comment><USER75> this is an amazing article for me since I also tore my acl and am considering getting the reconstruction described in the article done, any one out here who recommends/ does not recommend this ? I am developer with a 9-6 desk job and usually go jogging rarely and don't find time to work out due to a busy schedule

<comment><USER36> If you don't plan on playing semi-competitive sports ever again, I wouldn't recommend surgery. It's all about the planting of the foot and changing direction, which you don't do with straight line activities like running or biking.

Forget about working the first week after surgery. You need to elevate and extend your leg constantly for the first few months, which gets uncomfortable when sitting.

Pre-surgery you need to strengthen the muscles around the knee to speed up recovery, so my physio got me to go to the gym 3X a week for two months, biking hard. Post-surgery you need to use some gym equipment as home rehab doesn't cut it.

Also it takes two years to fully heal. After seven months I could hike and bike, but now I'm sixteen months in and only now have started to play light competitive sports again. However mine is more complex as I have torn miniscus and some residual scar tissue that may be removed in the future. Let me know if you have other questions about the process, it's a long one!

</comment></comment><comment><USER76> Had the same procedure done and paid equally as much. I was shocked how much it cost.

</comment><comment><USER77> Had ACL repaired privately as a Canadian and the total cost was around $7000

</comment><comment><USER78> great presentation and vibrant discussion. I wonder: how much attention does this article owe to effective use of highcharts, a clean palette, and freight sans pro? Not knocking, just wondering.

</comment><comment><USER79> I saw "ACL injury" and my first thought was "ultimate frisbee."

</comment><comment><USER80> Great Read</comment>


Ask PG: Can you add a frame to visited pages? - <AUTHOR> The problem with the current situation lies with the way I use YC(I don't think I'm the only one). I usually go through multiple pages on YC, opening the links I like as tabs in the background. The current system forces me to trackback the pages I like just so I can vote.
One solution is to add a frame on top of pages accessed from YC that allows you to vote for the page. I think the frame works well in this case because links are usually articles. So usually, you just read the page, and then close it. The frame is not a nuisance in that case.
Thanks <comment><USER2> Open two pages for each link, the link itself and the comments behind that. Don't forget to refresh the comment page when you want to contribute.

</comment><comment><USER3> the median user of this site is against framing

<comment><USER4> I love the frame reddit has and most folks here use reddit so I disagree.

<comment><USER5> what frame?

</comment></comment></comment><comment><USER6> about 10% of the sites have javascript that forces the page to break out of the frame.</comment>


Ask HN: Is there an immutable and decentralized database out there? - <AUTHOR> Hi Guys,
I am in need of a database that is decentralised and would allow one or more privileged users perform only INSERT and READ operations. This means data stored in it would be replicated across all nodes and are immutable. Immutable in the sense that the principal cannot delete or edit a record even though it is the reason the database exists. Anyone can join the network, but only one or more privileged users can perform operations.
The reason I need this is because I am looking for non-blockchain based model for achieving data integrity and ensuring that a centralized entity cannot mutate data secretly.
Do you think this is feasible? Are there any existing open source solutions out there? <comment><USER2> I believe you're describing what is typically referred to as an "append only" datastore.

The biggest-name in the game is Google BigQuery. From their docs:

 _" BigQuery tables are append-only. The query language does not currently support either updating or deleting data. In order to update or delete data, you must delete the table, then recreate the table with new data. Alternatively, you could write a query that modifies the data and specify a new results table."_

There are others databases, like Datomic, which are less popular. Typical use- cases are usually log-storage, so search around for databases meant for logging, and I'm sure you'll find a lot more.

<comment><AUTHOR> Thanks for your suggestion. The fact that data written to BigQuery can still be modified is not so great for my case. I want to be able to make data immutable forever. Nobody should be able to modify or delete it. Malicious alterations should not affect other nodes holding replicated data.

<comment> a-saleh I remember watching a talk about apache Samza [1] that tries to envision a database model that would be truly append only. It is based on Apache Kafka, so it would satisfy your "distributed" and "immutable forever" requirements.

Talk was really interesting, I haven't used it yet, so I am not sure how mature for use as the canonical data-store it is.

As my college professor would put it "I don't thing these have found their Ulman yet." and if you look at companies using it now [2] it seems mostly stream-processing/data-analytics.

Another thing is, I really don't know how Kafka handles checking of the data authenticity, because in my mind there is not that big of a difference between malicious alteration and malicious append.

Because if you then use something like CRDT [3], or DDD style agregates [4] on top of your immutable data , your end users would still see their view on data mutate.

The thing the immutability would mostly give you is log of all the changes and simple way to restore it. And most mutable databases give you that capability as well.

[1] [http://www.confluent.io/blog/turning-the-database-inside- out...](http://www.confluent.io/blog/turning-the-database-inside-out-with- apache-samza/) [2] [https://cwiki.apache.org/confluence/display/SAMZA/Powered+By](https://cwiki.apache.org/confluence/display/SAMZA/Powered+By) [3] [https://en.wikipedia.org/wiki/Conflict- free_replicated_data_...](https://en.wikipedia.org/wiki/Conflict- free_replicated_data_type) [4] [https://en.wikipedia.org/wiki/Domain- driven_design#Building_...](https://en.wikipedia.org/wiki/Domain- driven_design#Building_blocks)

</comment></comment></comment><comment><USER3> IPFS, with a chain of objects, signed with one of a set of whitelisted keys. You'd need a bit of logic on each node to pull the latest objects (maybe using IPNS).

<comment><AUTHOR> IPFS looks quite interesting. I will study it more to see whether it would play an important part in solving my problem. It appears there isn't an exact open source solution out there.

</comment></comment><comment><USER4> Any distributed database with support for User roles/access will fulfill your requirements.

<comment><AUTHOR> The distributed databases I have looked into have a user who grants roles/access to every other user. This means someone has to be trusted with full privileges. A solution where the access/role is baked into the software could be ideal.

<comment><USER5> You want the database to be its own admin?

<comment><AUTHOR> Actually, I want no admin.

Maybe this might sound a little crazy, I am trying to build a system where arbitrary number of persons maintain nodes (I don't even need to know these persons) that have my data. The software managing my data should only allow me append and read from it.

This kind of database makes it impossible for me to alter data once appended.

</comment></comment></comment></comment><comment><USER6> Can you say more about why you're avoiding the blockchain?

<comment><AUTHOR> I am not exactly avoiding the blockchain. There isn't any production ready database that I am aware of that provides immutability like the blockchain and an advanced querying system like NoSQL database systems.

I looked at BlockchainDB which solves my immutability requirement but I don't think it's production ready yet and if I host one myself, I can mutate the data by destroying my BlockchainDB machine.

</comment></comment><comment><USER7> > and ensuring that a centralized entity cannot mutate data secretly

Hello paranoia.

<comment><AUTHOR> Justified paranoia :)</comment></comment>