MSVC CRT Sneaks in Telemetry by Default? - <AUTHOR> https://www.reddit.com/r/cpp/comments/4hoyzr/msvc_mutex_is_slower_than_you_might_expect/d2thalz <comment><USER3> Lots of things inside Windows emit ETW events, which is Windows equivalent of DTrace (basically the entire OS, and .NET), it's super useful for debugging performance related events. It's not "Telemetry" like Google Analytics, it's for _you_ to debug your own programs.

The easiest way to view the output of them is via WPA, you can watch some videos about it at [https://msdn.microsoft.com/en- us/library/windows/hardware/hh...](https://msdn.microsoft.com/en- us/library/windows/hardware/hh448170.aspx)

<comment><USER4> Man, you're fighting uphill battle. This is a typical case of people being scared of something they don't understand coupled with not willing to learn. Yesterday[1] I read that RFID tags emit radiation because RF means radio frequency, so it's harmful. Today I read that ETW is harmful telemetry and MS injecting code into binaries.

I thought I got over the fact that a lot of people programming on Windows don't understand its internals. But I didn't. Understanding ETW is essential on Windows, just like DTrace is a must on Linux or ktrace on OpenBSD. It's also well documented on MSDN[2]. ETW also typically boils down to a single check for any listener interested in messages. This info is public and has been for ages. I guess I'd understand this attitude if there were no real reasons to bash MS.

But I guess what pisses me the most is the context of that reddit thread. People complain about mutex performance and show code where they mutex vector accesses. This kind of code does not belong in performance critical game code. "Hey, I've got a salad to make, what tools do I need? I've got a hammer but these veggies are not a nail. But I'm sure if I take two hammers to the task my problem suddenly changes to nailing things together!"

For Pete's sake, if a slight performance drop in mutex performance of user mode code hogs your application, you're mutexing too much. Your code is a problem, not a mutex. And if you're using single threaded STL primitives for communication between threads you have no right to complain about CRT performance. None. This lack of intellectual curiosity in people sinks my heart.

Rant out. :S

[1] not on HN though, thankfully [2] well by MSDN standards at least - <USER2> documentation is hard to grok without referencing sample code in the Windows SDK

<comment><USER5> Another good example was when Microsost introduced C++/CX, their language extensions for creating WinRT components in C++.

Lots of devs were up in arms that C++ was going to be managed in the new WinRT world, just because C++/CX syntax is based on C++/CLI.

Microsoft had to do lots of sessions to clarify that, and I bet even today there are developers that don't get the difference between C++/CX and C++/CLI.

</comment></comment></comment><comment><USER6> A different post showing exactly what the info is and where it goes (hint: nowhere):

[https://www.reddit.com/r/cpp/comments/4ibauu/visual_studio_a...](https://www.reddit.com/r/cpp/comments/4ibauu/visual_studio_adding_telemetry_function_calls_to/)

There is no info going in and out, it just adds hooks to the runtime for you to add telemetry if you want it.

<comment><USER7> _you can link notelemetry.obj and the calls are removed_

It's still a ridiculous idea to make this the default. Rather, it should be something you opt-in to if you want to debug, more like

 _you can like telemetry.obj and the calls are inserted_

<comment><USER8> Why is this comment down voted? Is it not a good suggestion? Opt-in to telemetry vs opt-out seems like a pretty reasonable thing to choose? Is that not true?

<comment><USER7> _Is that not true?_

Microsoft recently doesn't seem to think so.

</comment></comment></comment></comment><comment><USER9> Just to mirror what's in the reddit thread the quick "fix" for this is to simply link to notelemetry.obj just as you would with the other small obj files included in the CRT lib directory[1]. Oddly notelemetry.obj is missing from their list.

[1] [https://msdn.microsoft.com/en- us/library/ms235330.aspx](https://msdn.microsoft.com/en- us/library/ms235330.aspx)

<comment><USER10> [https://gist.github.com/aicpp](https://gist.github.com/aicpp)

</comment></comment><comment><USER11> I was looking at the C Runtime Library the other day and found the following series of article on how to remove msvcrt.lib:

[https://hero.handmade.network/forums/code- discussion/t/94](https://hero.handmade.network/forums/code-discussion/t/94)

Basically, the entrypoint for Win32 isn't actually WinMain, but WinMainCRTStartup. To replace it you need to reimplement a few things, including an implementation of memcpy() and memset(), some allocation routines for 32 bit code under 64 bit systems and some floating point routines.

Curious to know what the new universal runtime loads up. I'd love Microsoft to be a bit more open about what their C runtime actually does before a program linked to it loads. Of course, perhaps they are, and I've missed it.

 _Edit:_ looks like someone was pissed about this lack of documentation in the beta Vususl Studio beta:

[http://levicki.net/articles/2015/12/03/RANT_Microsoft_Visual...](http://levicki.net/articles/2015/12/03/RANT_Microsoft_Visual_Studio_2015.php)

<comment><USER12> > I'd love Microsoft to be a bit more open about what their C runtime actually > does before a program linked to it loads. Of course, perhaps they are, and > I've missed it.

The source code to the CRT ships with Visual Studio.

> Basically, the entrypoint for Win32 isn't actually WinMain, but > WinMainCRTStartup.

The entry point is whatever appears in the PE header and you can name it whatever you want. It just so happens that the default linker settings point it at CRT, which calls into you. You can change this with linker settings.

<comment><USER11> Ya, I didn't explain that as well as I might have. That is correct :-)

</comment></comment></comment><comment><USER13> Note this Reddit comment by what appears to be a couple of MS devs:

 _(fourbadcats) Indeed. This sure better be an oversight of something not disabled when transitioning from release candidate to RTM. We will lose credibility with our customers if we claim that our application does not collect any usage data when this is going out over the wire. I noticed that notelemetry.obj is not present with VS 2015 Update 1 so this may have been introduced with Update 2. Let 's hope it's gone in Update 3._

and this too:

 _(spongo2) Let me gather some details_

However, this is definitely highly disconcerting.

<comment><USER14> The first comment, from fourbadcats, is apparently from a customer of MS (I don't know who they are), referring to their customers in turn. The second from spongo2 is VC's dev manager, my double boss. (I know very little about this topic as the STL's senior developer; this stuff is in the vcruntime layer below the STL.)

<comment><USER15> Yes ask your boss.

> We will lose credibility with our customers if we claim that our application > does not collect any usage data when this is going out over the wire.

Microsoft wasted Win10 and Office 2016 already (and sneaked it into newer Win7&8 updates). It would have been such a great chance after the misguided/failed Win8, but then MS decided to add invasive telemetry and other phone home crap incl whitelisting IPs and URLs in kernel mode network layer, with no way to deactivate all of it - don't even think MS respects you as a end consumer (you are their sheep and loose control of your PC) and not even as enterprise customer nor with LTSB (except you request a custom build of the network stack).

</comment></comment></comment><comment><USER16> So, MSFT is injecting code into a binary? This probably won't be a popular opinion here, but this does seem like a pretty good definition of malware to me. It doesn't make it okay that just because it's MSFT they can get away with it.

<comment><USER17> I don't know if it's malware, but it's something really close.

<comment><USER18> Or, to put it another way, it's Microsoft saying, "Hey, you probably want local event tracing in your application, so we enabled it by default." Been a while since I've done Windows dev (and I'll install VS Beta to check this out), but it might be as simple as the default project skeleton including an instrumentation manifest whose presence adds EWT tracing to the build chain. It's basically Windows' syslog equivalent, so unless Win10 is sending back all EWT eventing as a matter of course -- which, Win10 being a privacy carwreck, it might well be! -- I'm not too alarmed.

<comment><USER17> I don't think it's a reason to be alarmed regardless of the intention, it's just one of those "Huh, isn't that funny?" moments IMO.

</comment></comment></comment></comment><comment><USER19> Data isn't free for end users; it's capped for a lot of them. While I get that devs can 'fix' this I wonder how many will in practice.

<comment><USER6> The data stays local at most. It's a hook for devs to add telemetry, not telemetry that goes to the mothership or anything like that.

</comment></comment><comment><USER20> So much for "developers developers developers developers developers" [https://www.youtube.com/watch?v=Vhh_GeBPOhs](https://www.youtube.com/watch?v=Vhh_GeBPOhs)</comment>


How Bitcoin Looked 11 Years Ago - <AUTHOR> https://old.reddit.com/r/Bitcoin/comments/ejvhri/how_bitcoin_looked_11_years_ago/ <comment><USER2> It's a shame how the Pay-to-IP functionality went nowhere (despite the rather insecure implementation back then). If one could pay to a DNS record it would allow for human-friendlier addresses without encouraging address reuse.</comment>


Why Health Care Tech Is Still So Bad - <AUTHOR> http://www.nytimes.com/2015/03/22/opinion/sunday/why-health-care-tech-is-still-so-bad.html <comment><USER2> I work in the medtech/health IT field at a startup doing a lot of clinical analytics. There's a very blunt and obvious explanation of what's wrong here, and it's the very unpolitical one.

Here's the deal. Physicians and nurses and administrators are overworked and untrained to handle a modern operational model. The hospitals tend to be based around politics rather than patient care, though the party line is invariably "help the patient". Doctors will, under the aegis of "help the patient", justify hoarding equipment, setting up alarm thresholds that screw up operations across the unit, block acquisitions, and in general just make everything terrible left to their own devices.

Nurses are overworked and are charged with increasingly important parts of patient care, and at the same time are treated as annoying appendages of the rest of the medical apparatus and not given the respect or authority that they require to perform well at their jobs.

Billing is handled through arcane back-and-forths between the care providers themselves, the hospitals, insurance companies, the government, and collections agencies. I've seen at least one local children's hospital (the economics of such institutions are quite fascinating) have banking and financing services occupying the same building as care (something you'd expect at a car lot, not a place where injured children are healed). Claims may take months or years to process, which is absurd.

The whole stinking mess should have been grist for the capitalist grinder decades ago. However, clever regulatory capture by hospitals and manufacturers and labor policies restricting the supply of new physicians has managed to prevent any of the normal efficiencies from being introduced.

When trying to introduce new technology, you have to fight the most conservative and risk-averse institutions you'll ever encounter. People that do not understand basic statistics or mathematics, or that flat out refuse to recognize the value of operational data research in making decisions because "they know better". You'll be turned away because you're not one of the chosen few, and ignored unless you can convince them that they get to put their name on the new shiny.

This is but the first level of the fractal of sadness and absurdity that is modern medicine in America.

<comment><USER3> > I work in the medtech/health IT field at a startup doing a lot of clinical > analytics. There's a very blunt and obvious explanation of what's wrong > here, and it's the very unpolitical one.

Actually, it's very political--it's the AMA--the American Medical Association.

The doctors are fighting the automation of their jobs tooth and nail because once we have data we can see that ... gee ... most of them suck. Nurses could do their job ... better.

<comment><USER2> I rather meant to explain that the problems--and their implied solutions--are not politically viable, mainly because of what you've mentioned. :)

</comment></comment></comment><comment><USER4> Apologies if too far OT.

I accompanied my wife earlier this week to two appointments with her docs. Both docs showed up wearing Google Glass, which is a New Thing at this clinic.

This use case provides an audio feed through Glass to a human transcriber. I asked both docs about it, and they said that they'd started with video feed as well but patients were not comfortable with it. Both docs were happy to spend 10 minutes each answering questions about the new thing.

Both docs were able to call up my wife's records on Glass, which saved their having to break contact with the patient, sit at the computer, enter passwords and start searching. Seamless.

Both docs said they liked it because it kept them connected with their patients and offloads composing their after-visit notes. My wife liked it for keeping connection with her docs during the visits.

I learned a lot from these two encounters. On its face, the clinic's Glass use is pretty primitive - stream audio to a human scribe and serve the patient's records to the doc's FOV. But I saw that this simple use greased the interactions to everyone's benefit. My wife found her experience considerably improved over earlier non-Glass visits.

<comment><USER5> Very interesting - do you mind sharing where/which clinic was this..

<comment><USER4> Palo Alto Medical Foundation, at their Palo Alto location

</comment></comment></comment><comment><USER6> To me the question comes down to money. How much is it going to cost to create a modern, technology-aided health infrastructure that is actively utilized, in a top-down fashion? I think the answer is a lot more than we would guess, and a lot more than anyone is willing or able to pay.

I don't think a startup really wants to be in this space, even though it seems like a great idea. The size of the necessary workforce, the legal complexities, the complicated interface with government and regulatory bodies and the enormity of the required indemnity make life impossible. I mean Dropbox of all companies has Condeleeza Rice on their board to smooth over dealing with the government - the mind boggles who on earth a successful startup in the healthinfotech space would need on their board, but half of congress might be a start...

I would stop trying to kill yourself dealing with hospitals, it isn't worth it. They are run by either status quo bureaucrats or cost slashers. The only way to reform things is bottom-up - creating applications that patients or clinical staff will use en masse outside of a hospital's IT system eg on their smart phones.

<comment><USER7> The EMR industry has a huge bureaucratic barrier to entry, which is why you don't see it technologically progressing at the rate of other industries.

The space is dominated by major players that have existed since the 1980's (Epic, Cerner, etc.), which also employ the technology of the same era (MUMPS, Caché, etc.).

If anyone is going to disrupt the EMR industry, it is going to be a bigger company that can sink the costs necessary to get up to speed for an entire HMO, and a couple HMO's willing to take the risk of piloting the software.

<comment><USER8> I want to add that a lot of value of the EMR system comes from integration - i.e. smooth data flow between touch points / care areas / visits / institutions. So it is rather hard to disrupt the industry using the typical "disruptive technology" idea because your niche solution may not play well with the rest of the system. And the incumbent has every incentive to make integration with a potential disruptor as difficult as possible.

</comment></comment></comment><comment><USER3> There are political issues, but there is also an impedance mismatch between "medical programming" and 99.9% of all other programming.

Nobody in programming gives two shits about quality. "Ship it and patch it later" is a religion.

That doesn't work in healthcare. If your software screws up, somebody dies, and you are on the hook for several million dollars. (See: Therac-25 and concurrency problems [https://en.wikipedia.org/wiki/Therac-25](https://en.wikipedia.org/wiki/Therac-25))

So, the technology pace winds up moving much slower.

I also like that they mentioned false positives in the article being a problem. That's an understatement. A friend had to wear a portable defibrillator vest after a heart attack. It was _atrocious_. It sounded warnings after a shower. The battery was hard to keep in and sounded warnings when one popped out. After a week, lifesaving technology was back with the doctor because it was too irritating to use.

This wasn't some random schmuck. This was a person who used to write technical users manuals. A normal person would have had no hope.

<comment><USER2> So, that's the shitty thing, right?

If you're software is being used in, say, an ICU--guess what? The patient is already in bad shape.

There's some weird conception in the medical industry and public at large that the software has to be perfect the first time, every time. And that just isn't possible or economical. And then when people _try_ to do that, they find out that getting test data or trials done is near impossible. Hell, you can't even get the _standards_ to develop with without shelling out thousands and thousands of dollars.

The same institutions that clamor so hard for absurd reliability in software make it almost impossible to test that software safely without a gigantic war chest.

And they look the other way when they fail to provide patient care or outright butcher people.

The difference between your code and a doctor? You can fix your code after it kills a patient.

EDIT:

And no, this doesn't mean that I suggest that we all should write bad software until the bodycount suggests a refactor.

What I mean is that we should write it as well as we're able, and that we should _fix_ it as data for improvement becomes available.

On a related note, this is why decision-making should--for now anyways--rest with a physician. We can give them better advice, but the moral accountability should remain with the human at the bedside.

<comment><USER9> _There 's some weird conception in the medical industry and public at large that the software has to be perfect the first time, every time._

Come again? In the real world the reliability problem has been solved. Nuclear power has been around for 60-odd years now and atomic powerplants do not regularly explode. Software on the other hand, has been around for the same time, and we expect it to be bug-afflicted. What is is that nuclear engineers have but software "engineers" are missing?

<comment><USER10> Nuclear power is, as far as I know, a consistent problem, meaning that it's not like the requirements and shape of the problem changes that much.

Medical programming, on the other hand, means programming for anything medical. You cannot really pre-model the problem with a general solution, because you don't know what salient problem is going to capture social attention in the next few years. You don't know what devices are going to be created.

People might have programming standards and methods for building secure systems, but I would say it's a lot easier to work around a problem that has remained mostly still.

Another thing is cost-efficacy. You can always have better and more safe of anything, not just in programming. Aren't car accidents so tragic? They are also one of the prominent causes of accidental death. Well, why don't we mandate that car manufacturers must include better collision safety? We could. We could mandate until all our fears are gone. Then fewer people would have cars. Ecological and public transportation arguments aside, I don't like a world where the gateway of money requires a much higher bar to pass.

Wouldn't it be unfortunate if fewer patients could access the range of medical devices which have been rigorously analyzed by a team of better-than-average engineers, and consequently the public experienced net damage?

</comment></comment></comment></comment><comment><USER11> "It means federal policies that promote the seamless sharing of data between different systems in different settings."

I've been promoting this concept for quite some time [1]. The state of electronic medical records is not very good and integrating data from multiple systems is even worse.

[1] [http://siculars.posthaven.com/health-data-integration- regula...](http://siculars.posthaven.com/health-data-integration-regulation- and-incentivization)

EDIT: To clarify, I'm in no way advocating that the government set data model or schema standards. I'm simply suggesting that the government level the playing field by mandating that if you do anything with health data you openly publish your specification and methods by which others can programmatically read or write to those data repositories. Obviously, this is separate from having the security access to do so.

Ive worked with EMR systems that have thousands of tables. Yes. Thousands of tables. I can't tell you how many hours of reverse engineering I've dedicated to groking these schemas. Not to mention on the wire protocol decoding from medical devices. It's insane and the government should not allow it to happen.

<comment><USER8> One of the reason why this has been so difficult is the mind-bogglingly high dimensionality of the data.

For example, a general medicine physician is interested in the body weight of the patient currently (to dose medications), but a cardiologist may be interested in short/long-term trend as it may be indicative of heart failure. Then there are ideal body weight, adjusted body weight, dry body weight, etc etc. Do you link each body weight reading to a patient? A visit? An order? Is there a freetext remarks that can be associated with a reading? Is there any status of "unable to take reading", "weighing balance faulty", null values? Some of the systems would have dissimiliar data schema.

<comment><USER12> I think the data format is more the problem. What you describe is a problem, but of the annoying sort. If all the vendors spoke JSON (or some common, generic format) then you would only need to figure out a mapping for each vendor to your unified, internal schema. Granted it would be time-consuming because of the high dimensionality but it is doable. Instead they each have their own data format and in some cases binary and proprietary which is the worst combination. And they may not be willing to share a data format spec for some reason so you have to reverse-engineer their format.

Regarding my last statement, overall the healthcare software landscape feels like pre-2000 in the greater sofware industry where everyone is trying to build every possible product to own every market and there is little or no cooperation.

<comment><USER8> I would actually think otherwise. The message format standard commonly used to pass HL7 messages right now are quite easy to parse, it is basically a CSV file using pipes and carets as field separators. Any technology worth integrating right now speaks HL7 one way of another already. Even if some reverse-engineering is needed, it is a 100% technical endeavour that does not need any political buy-in (except budgeting) - this is what I like to define as "annoying sort of a problem".

> If all the vendors spoke JSON (or some common, generic format) then you > would only need to figure out a mapping for each vendor to your unified, > internal schema.

This is not easy at all if your internal schema has less fidelity/dimensionality than the vendor. Expanding on my example above, suppose you have a smart weighing scale a la Withings scale that integrates with the EMR. The weighing scale has the patient's height input so it is able to send BMI <[http://en.wikipedia.org/wiki/Body_mass_index>](http://en.wikipedia.org/wiki/Body_mass_index>) reading to the EMR as well. However, your EMR does not have a field for BMI because it is a computed/derived value of weight and height.

If your internal schema has higher fidelity than the vendor, you also are forced to impute data - this is not as bad but may cause unintended behaviours as well. A contrived example: the weighing scale only has the patient's identity information. However in your EMR the weight readings can only be stored associated with a visit/encounter (aka a hospital stay or appointment). You can associate the reading with the last open visit/encounter, but this will have undesirable repercussions e.g. during system downtime (it might become associated with the wrong visit).

There are ways to solve the above integration issue but they would cost a lot and may significantly impact the EMR all the way to end-user UI. So it is not only a technical issue but also whether the users are comfortable with the amount of complexity introduced in the UI, data imputation, etc.

<comment><USER12> I think the big assumption I was making, and probably should have said is that you have complete control over your own internal schema. The sort of control that allows you to modify that internal schema to incorporate a new vendor's schema regardless if it is more or less complex. If you don't have that control then yes it is a very difficult problem.

</comment></comment></comment></comment></comment><comment><USER13> I've been in the sector for about 11 years and I've grown to take very dim view of the entire industry.

There is so much money sloshing around in the industry, yet people are getting less and less for their dollars.

Everyone loves to criticize financial and telecom companies for bad behavior but healthcare puts them to shame.

You have Copay, out of pocket, deductible, co-insurance, HSA, HRA, FSA, preferred drugs, generic drugs, single source, multi source, in-network, out of network, lifetime CAP, etc.

These are essentially instruments that healthcare companies use to reduce their payouts and shift costs.

Where is all the money going? (no need to answer)

It makes me sick that this year's SXSW focus was on healthcare. We don't need more startups and MBA types trying to 'fix' healthcare.

The current healthcare problem is purely political and regulatory in nature.

<comment><USER14> >You have Copay, out of pocket, deductible, co-insurance, HSA, HRA, FSA...

You have that in the US but not necessarily in other countries. The UK NHS doesn't have that stuff but still managed to screw up:

[http://www.independent.co.uk/life-style/health-and- families/...](http://www.independent.co.uk/life-style/health-and- families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html)

which suggests there are technical difficulties also.

<comment><USER13> Very interesting.

"One supplier, Computer Sciences Corporation (CSC), has yet to deliver the bulk of the systems it is contracted to supply and has instead implemented a large number of interim systems as a stopgap,"

Google "CSC" and "fraud" together and you'll find some interesting tidbits.

</comment></comment></comment><comment><USER15> Everything in this article is true.

I work for Syapse ([http://www.syapse.com](http://www.syapse.com)), and we are trying to do something about this problem. As a startup, we have a laser focus - we are building systems that help practicing doctors, mainly oncologists, take advantage of genomic data. We focus on improving UI, workflows, alerts, access to up-to-date knowledge and yes, data entry.

If you are interested in this field, please consider applying for one of the open positions. We are looking for server engineers, data systems engineers, UI engineers, DevOps, etc. We are located in downtown Palo Alto, CA.

<comment><USER16> I looked at your website, but alas I didn't go to Stanford or a UC.

<comment><USER17> Don't worry about that, I work at Syapse too and I have an MA in Chinese lit from UMASS. You could be totally self taught like me and as long as you have skills and a good attitude you will be considered. Everyone there is super nice and open minded.

</comment></comment></comment><comment><USER18> "In health care, changes in the way we organize our work will most likely be the key to improvement. This means training students and physicians to focus on the patient despite the demands of the computers. It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse's station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings."

I think the author is right about the problems, and these solutions seem sound. These are the kinds of things ossified institutions always say, and they're actually usually right (e.g. Bill Gates's prescient Internet Tidal Wave memo which predicted the ways in which Microsoft would fail to become a dominant player on the web, or the peanut butter memo at Yahoo).

The trouble is that actually implementing changes like these at an incumbent institution is hard. Really hard. So hard, in fact, that failure is overwhelmingly the rule. In most industries, the way that plays out is that incumbents fail to change, new competitors emerge with the new processes baked into them from the beginning, and they then kill the incumbents. A few years later, those new folks ossify and then themselves get killed by the next wave. And so on.

A healthy industry offers all its players a choice: "Evolve or die. Do whichever one you want, but one of those two things _will_ happen." There's no third option, "Do your best to evolve". The institution _succeeds_ at changing or it dies, and that's all there is to it.

The trouble in healthcare is that incumbents _do_ get that third option. And the reason they get it is that for the most part, there are no new competitors to kill them off.

</comment><comment><USER19> A few months ago, I went to a dentist in Palo Alto for the first time...by far the most hi-tech dentist office I've been in...though it's been awhile for me. I guess I was most impressed with the digital x-ray machine, in which they could snap shots, and we'd see them pop up right away in front of the flatscreen in front of me.

However, the experience was marred when I went upstairs from the xray room to the dentist's operating room. He couldn't find the digital files. The reason was, he told me, because over the past few days, the office was finally upgrading its system from Windows XP...to Windows 7. I wish I had taken notes overhearing him talk to the assistant and the totally random sounding hacks and procedures they had for just getting through the computer system, I'm surprised I didn't hear "Turn off the computer, wait at least 30 seconds, then turn it back on"...suffice to say, the mystery of the missing digital files was never really solved and took up about half an hour of the appointment time.

I'm surprised a Palantir-for-Doctors hasn't yet come up...a company that maybe doesn't build anything revolutionary but makes billions from an audience with a lot of money and very low standards.

<comment><USER20> OT, but what exactly _does_ Palantir do?

<comment><USER21> From the recruiting presentations I saw while at university: they primarily do large scale information grouping and retrieval. It seemed like their systems (at least the ones they were public about while trying to recruit from undergrads) were aimed at taking large numbers of random facts about actors ("this person has made a lot of phone calls to this person", "this person was seen in place a", etc.) and making them all traversable as a sort of information-visualization graph. It seemed likely rather math-y and very interesting.

So basically the "information collation and noise reduction" part necessary for any mass surveillance system to be actually useful.

Palantir for doctors would basically just be Palantir with people's medical information and medical research plugged in, and maybe family connections, instead of "Person a called person b", "Person b has known terror connections.", etc.

</comment></comment></comment><comment><USER22> I believe in developing a product, especially the UI, by constantly getting feedback from the user but I'm racking my brain on how to do that for a product for medical professionals.

I can't observe them when they are with a patient and its impossible to schedule time to get feedback, they are so overworked.

My theory why the UIs of these EMRs are so awful is because of this very reason: there's no feedback loop. And I'm not blaming the doctors, they have no time.

</comment><comment><USER23> There's OneMedical.com, a kinda startup as far as I understand. $140/year doesn't sound too much, so I signed up for it, will see how it goes, don't have an opinion for now. As far as I understand, they do only physicians stuff, have offices in major metropolias. Their main point I liked was that they finally do documentation/appointments/labs online, and treat online as first-class. Anyone had experience with it?

</comment><comment><USER24> [http://www.bloomberg.com/news/articles/2015-03-20/dozens- of-...](http://www.bloomberg.com/news/articles/2015-03-20/dozens-of-startups- in-obamacare-s-wake-reveal-law-as-job-creator)

I want real statistics...anyone with interesting source?

</comment><comment><USER25> [http://health.gnu.org](http://health.gnu.org) \+ [https://arvados.org](https://arvados.org)

</comment><comment><USER26> The article mentions time-consuming and distracting data entry.

Other than wearables, does anyone have a good solution for this?

<comment><USER27> Yes, non-terrible data entry UI.

Seriously, have you ever looked at the software your nurse or doctor is dealing with while they are supposed to be talking to you? It's hot garbage.

<comment><USER28> Why is it garbage? It seems to me that most programmers who care about their craft would make a halfway decent UI by default.

I believe that interfaces end up the way they do for a reason. I'm curious what the reason is for healthcare -- is it a disconnect between stakeholders in the design stage? Lack of budget?

I'm hoping you can help me learn beyond the "design by committee" or other cliches. or at least understand those cliches in a medical setting.

<comment><USER29> Its garbage because its written by big companies with slick salesforces like oracle, etc. The design/UX is an afterthought; the main thrust of these companies is suits closing the big deal. The interfaces built by these companies are almost never designed by anyone with taste, done in java, and look like your typical j2ee architecture with circa 2006 web interface sensibilities.

<comment><USER30> This is the "enterprise software problem," to wit: All enterprise software sucks because it's sold to administrators and not to users.

A friend of mine works for one of the EMR software companies, though he doesn't program any more. I've also experienced the adoption of large scale enterprise packages such as SAP and SharePoint.

As I understand it, the UI design is _literally_ an afterthought, because it doesn't exist at the time of sale. The expectation is that somebody will adapt the software to the customer's processes by creating custom UI's, data base structures, and work flows. There is a mad scramble to throw this stuff together and make it work. I suspect there is simply no time to sit down with workers and respectfully find out how they do their jobs. And processes that worked because the employees didn't follow the procedure, suddenly stop working when coded into software.

</comment></comment></comment></comment></comment><comment><USER31> The important point seems to be the absence of user centered design.</comment>


Song of the Introvert - <AUTHOR> http://randsinrepose.com/archives/the-song-of-the-introvert/ <comment><USER2> Way off. Maybe it fits some, but is far from definitive "introvert". Maybe some are fear-driven, but author seems to miss the point that many (most?) introverts just LIKE solitude, communicating thru contemplative mediums, are more about doing than talking, and just find smalltalk insufferably boring/pointless.

Post sounds more like a non-introvert trying to understand & explain, having concluded "well, they're just _afraid_ of disruptive contact with others." No, we just don't like expending resources on the uninteresting.

<comment><USER3> The OP clearly has Social Anxiety Disorder, also known as "social phobia". The result is introversion, but the cause is a psychiatric issue. You joke, but the OP is likely _legitimately_ afraid of making eye contact.

It's too bad people with Social Anxiety (like me) are just told their "introverted" or "shy" their whole lives. Social Anxiety is a very real psychiatric disorder that should be identified and treated in people like this.

<comment><USER4> > The OP clearly has Social Anxiety Disorder, also known as "social phobia".

Has anyone considered that giving an empty name to a description adds nothing to the conversation? Until the day Social Anxiety Disorder shows up in an electron micrograph (pics or it didn't happen), it's something that psychologists made up, like Asperger Syndrome (now abandoned) or homosexuality as a mental illness (abandoned in the 1970s).

The fight against homosexuality as a mental illness was terrifying to watch. Many professionals appeared before hearings wearing masks, to argue against this addition to their oppression, before psychologists finally realized their disease mongering was causing real harm and removed homosexuality from the DSM.

With Asperger's it was exactly the opposite -- it was an attractive diagnosis, everyone wanted it, such that psychologists finally realized they had created a monster lacking the clear definition that might have brought it under control.

<comment><USER5> I really wish the Scientology-esque anti-psychology crowd would stop using the struggles of queer people as an excuse to be anti-scientific.

Social anxiety disorder definitely exists, it can be treated chemically (meaning that it is biologically real), and arguing about this anyway is a fundamental misunderstanding of how mental illnesses are defined and diagnosed.

Virtually every mental illness include a diagnostic criteria of interference with normal life functioning. If you have the symptoms the OP has and you feel you live a normal, happy life, you do not have social phobia.

Further, saying that social anxiety is something "psychologists made up" is grossly insulting to people who actually have the disorder. Saying that _recognizing_ it as a disordered state and not as "just being shy" adds nothing is grossly insulting as well. Some people live their whole lives, afraid of making eye contact, ruminating on every interaction, thinking that they are just "awkward" or "shy" or "introverted" and as a result never form close connections to humans and die alone.

I hope the OP gets the help he or she needs, and I hope that you stop standing in his or her way.

<comment><USER4> > I really wish the Scientology-esque anti-psychology crowd would stop using > the struggles of queer people as an excuse to be anti-scientific.

You mean, like Thomas Insel, sitting director of the NIMH, who recently described psychiatry as pseudosciene and announced the abandonment of the DSM, on the common-sense ground that it has no scientific content? Read more here:

[http://www.newyorker.com/tech/elements/the-rats-of-n-i- m-h](http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h)

Maybe you could read up on current events in the field before posturing as though you know what's up?

As to "anti-scientific" there is nothing more anti-scientific than a group of people who invent diseases by voting rather than research, that we're all supposedly suffering from. Asperger's was included in DSM-IV by vote, not research. Asperger's was removed from DSM-5 by vote, not research. As a result, the DSM is being abandoned along with Asperger's.

> Virtually every mental illness include a diagnostic criteria of interference > with normal life functioning.

That's true, and that is why the DSM is being abandoned -- it's a description of symptoms with no hint of causes, and in a scientific era, that is both absurd and offensive. Here's what NIMH director Insel said as he announced the DSM's abandonment:

[http://www.nimh.nih.gov/about/director/2013/transforming- dia...](http://www.nimh.nih.gov/about/director/2013/transforming- diagnosis.shtml)

Quote: "While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" – each edition has ensured that clinicians use the same terms in the same ways. _The weakness is its lack of validity_."

"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."

By the way. Insel isn't a Scientologist, he's a psychiatrist. Like many in the field, it has come to him that psychiatry is standing in the way of progress toward a scientific approach to mental illness diagnosis and treatment.

<comment><USER5> Personal attacks are unbecoming. I probably have more experience in this area than you do. But I'm not going to stoop so low as to use logical fallacies, because I'm confident that I'm on the right side of this particular disagreement. You don't seem to be. It's worth noting your entire argument is an appeal to authority or a personal attack.

For what it's worth, though, I think that it's positive for the NIMH to move away from DSM guidelines for research, because research should inform the DSM, not the other way around. Further, the DSM and mental health as a whole has been trending towards cultural models of mental illness rather than authoritarian mindsets that attempt to proscribe rather than describe.

Ironically, the main reason for doing so is the backlash the psychology community suffered from the categorization of homosexuality and gender identity disorder. This is why modern mental illness diagnosis requires an interference with life functioning, as decided by the patient, not the medical establishment. I think this is generally the right way for the community to go in, for a couple of reasons.

For one, very few mental illnesses will have an empirically detectable "cause" aside from some combination of experiences. It's not clear by any stretch that all mental illnesses have even a biological component. The (empirically detectable) success of cognitive-behavioral therapy seems to indicate that since minds can be built in any number of ways, they can also be broken and need repair purely using their own mechanisms.

If someone has PTSD because they were sexually assaulted, it's not clear to me that you could ever say with empirical validity (beyond what the DSM already provides you) that they have any disorder. You could be neurologically reductionist, but even if that's possible it's several years off before that's an effective diagnostic mechanism, and even then the original cause of the disorder is far removed from the person's life, leaving only... the symptoms.

Second, disregarding the subjective distress of the patient is the path towards medicalization of abnormality, just as happened with homosexuality, hysteric personality disorder, etc.. In the extreme cases, legal structures exist to determine if a person is not responsible for themselves. At the end of the day, mental health is inherently socially constructed rather than objective, and you're never going to be able to bottom out to something objective.

To say that the DSM is devoid of scientific context is simply false; the DSM is written by scientists, based on all available scientific research available at present. It evolves, like everything else does. I don't think there's any better way to resolve disagreements among scientists than by voting; it's worth noting that medicine as a whole merely allows individual practitioners to make their own judgments as opposed to regulating the field, which is a definite trade-off without a clear winner.

<comment><USER4> > It's worth noting your entire argument is an appeal to authority or a > personal attack.

You mean, like when I pointed out that Asperger's was created and destroyed by votes rather then scientific evidence? Or was it when I pointed out that the NIMH is abandoning the DSM because it lacks scientific content?

As to personal attack, physician, heal thyself.

> To say that the DSM is devoid of scientific context is simply false ...

Don't tell me. Tell NIMH director Insel, who says that same thing I do for the same reason -- the DSM lacks scientific substance. Insel recently said ([http://www.nimh.nih.gov/about/director/2013/transforming- dia...](http://www.nimh.nih.gov/about/director/2013/transforming- diagnosis.shtml)):

"While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" – each edition has ensured that clinicians use the same terms in the same ways. _The weakness is its lack of validity_."

"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."

On that basis, on that _evidence_ , you should address your beliefs about the DSM to the highest-ranking psychiatrist in the country, rather than to me. Of course, if you actually understood what constitutes science, you wouldn't be taking the position you are.

> I don't think there's any better way to resolve disagreements among > scientists than by voting ...

Ah. Now I see the problem. Scientific questions are never resolved by voting -- _not ever_. They are all resolved by empirical evidence. For questions that cannot be resolved by evidence, scientists adopt the null hypothesis, the precept that an idea is false until it is supported by evidence.

The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

This is why Insel, and his predecessor, Steve Hyman, have taken the positions they have. This is why psychiatry and psychology are in the midst of an historical transformation, one that faces up to the fact that they are not scientific enterprises and considers a course of corrective action.

<comment><USER5> Yes, I read that quote when you posted it the first time. I notice you've posted it many times in this thread, so maybe you got confused.

By the way, the director of the NIMH isn't the "highest-ranking psychiatrist". That title doesn't exist.

>Ah. Now I see the problem. Scientific questions are never resolved by voting -- not ever. They are all resolved by empirical evidence. For questions that cannot be resolved by evidence, scientists adopt the null hypothesis, the precept that an idea is false until it is supported by evidence.

This is not true.

In most fields, including general medicine, there is no governing licensing body similar to the APA. This is because psychiatry is the only medical discipline that postdates the concept of regulatory bodies.

In general medicine, it's very common for two doctors to treat the same illness differently. This is why cancer patients can choose between radiology and surgery and chemotherapy.

Now, the APA could abandon the concept of regulation and allow any licensed psychiatrist to treat anything in any way, but as a society we've democratically (by vote) decided that psychiatry should be regulated, so its regulatory body decides the treatments that can and cannot be administered, and what constitutes something worth treating. (If you want to go outside this structure, you just can't call the person you're getting treatment from a psychiatrist. Priests, consolers, social workers, etc., are examples of alternatives.)

So, the world does not work the way you think it does. This is because you're espousing a philosophy of science called Positivism or Verificationism: [https://en.wikipedia.org/wiki/Logical_positivism](https://en.wikipedia.org/wiki/Logical_positivism)

This school of thought was abandoned in the early 1900s. Currently, the dominant philosophy of science is Falsificationism: [https://en.wikipedia.org/wiki/Falsifiability#Falsificationis...](https://en.wikipedia.org/wiki/Falsifiability#Falsificationism)

...which holds that ideas compete via aggregate evidence judged by each individual scientist, gaining ground via confirmatory evidence (though never being proven) and losing ground via falsifying evidence.

>The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

This is also not true. Doctors offer treatments that aren't definitively explained all the time. It's far better to treat something however you can than to hold off for some logical positivist verification of your claim.

\</comment></comment></comment></comment></comment></comment></comment></comment><comment></comment><comment>--

But, you've said a lot about what other people think. What is _your_ opinion, and how did _you_ form it?

<comment><USER4> > By the way, the director of the NIMH isn't the "highest-ranking > psychiatrist". That title doesn't exist.

Of course it does. In psychiatry, authority matters. In science, it doesn't. How else could Insel unilaterally describe psychiatry as a pseudoscience and rule that the DSM is to be abandoned, as he recently did? That would never be accepted in a scientific field, where authority is disparaged.

How else could a panel of authorities vote to include some imaginary conditions, and exclude other imaginary conditions, from the latest DSM? They did just that, and one change from the past was that the votes were held in secret. Another difference was that the governmental agencies that rely on the DSM have decided to abandon it.

>>The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

> This is also not true. Doctors offer treatments that aren't definitively > explained all the time.

This kind of reply makes me wonder what is the point of this exchange. Doctors are not scientists, they are to medical research what an engineer or a technician is to a scientist in another field. Further, if a doctor really offered a treatment not vetted by research, he would have his license pulled.

> What is your opinion, and how did you form it?

My opinions are irrelevant, and I have not been expressing opinions, but facts. Note my use of literature references to support any facts I post.

</comment></comment><comment><USER6> I don't think I fit in any of these boxes. Before I ever took the Myers Briggs or read Quiet[1] or people started talking a lot about I and E and other shortcuts I realized that I was different than most of my friends and that I needed to change. I was 14 and wanted to be able to carry on wide ranging conversations in the effortless manner that many of my friends and the adults in my life could.

So I watched an older brother of a classmate(he was a senior in HS) who could talk for hours about anything. I watched people at church and at family gatherings and community celebrations like 4th of July parades and Labor Day barbecues.

And I learned how to make small talk and how to engage people around me and I learned that I could find out interesting things about people and that many times you had to go through a ritual of small talk, sometimes for months worth of meetings and greetings and regularly seeing someone before you really learned anything about them.

And I learned that usually it was worth it. And eventually as I got older and became an adult I learned to tell when someone just didn't know how to talk about something difficult and so they talked about nothing and everything instead and how to read them and help them just by talking something over with them.

And I'm still learning.

[1][http://www.thepowerofintroverts.com/about-the- book/](http://www.thepowerofintroverts.com/about-the-book/)

<comment><USER7> To quote Jane Austen: "I certainly have not the talent which some people possess," said Darcy, "of conversing easily with those I have never seen before. I cannot catch their tone of conversation, or appear interested in their concerns, as I often see done."

"My fingers," said Elizabeth, "do not move over this instrument in the masterly manner which I see so many women's do. They have not the same force or rapidity, and do not produce the same expression. But then I have always supposed it to be my own fault -- because I would not take the trouble of practising. It is not that I do not believe my fingers as capable as any other woman's of superior execution."

</comment></comment><comment><USER8> as an alternative, i've heard these definitions of introvert / extravert:

an introvert is someone who recharges their social energy by going off somewhere familiar and likely alone.

An extrovert is someone who recharges by going off to be with lots of people and commotion.

...what i like about these definitions is that neither are anti-social. both can be "the life of the party" or "the quieter ones". ...is more about where your charging cradle is.

<comment><USER9> and what if you find things like small talk the most boring thing in your life which simply steals your energy in such big chunks that you can last only couple short conversations, while there is nothing more powering in your life than having a great debate, and it doesn't really matter much whether it is with your friends or strangers.

I have always found people classifications slightly weird thing, not because there is something fundamentally wrong with it, but because of how majority of the people perceives them. We tend to simplify things in our heads, and most of us start to treat these classifications as a final explanation to things (using as a labels), without remembering that when it comes to classifying people (especially their character), classification at its best is nothing more than a guideline and should be treated cautiously.

Well at least this is how I see the world and people around me.

<comment><USER8> people classifications are mos def hard.

at the extreme end, i once heard someone say "there are two kinds of people in the world : those who say there are two kinds of people and those who don't."

</comment></comment></comment><comment><USER10> _I am fascinated by how you punctuate your sentences with your hands. You pause for as long as it takes to makes sure you are going to say something of value. Sometimes these pauses are maddeningly long. You are fiercely optimistic and state outlandish impossible things. You are fearless in giving feedback to strangers. You are less fearless, but you can deliver the same feedback with a momentary glance. It's fascinating how all of you have built all of your systems to get through your day. I am fascinated because…_

Even though I believe I can do almost anything, I can't imagine myself being like you...

Until I learned how to write.

I write like you talk. When you call, I email. When you skype, I tweet. When you take to the room, I take to the forum.

That's my response, because...

I am an introvert.

</comment><comment><USER11> Song of the Extrovert

You are interesting.

I like the stuff that you bring to the table. I like your Cave. Can I see your Cave? Can I show you my Cave? I want to share the ideas from Cave with your ideas.

You are frusturating.

Why don't you return my emails? I share your passion. I share your ideas. I just want to engage with you to create something bigger and better. I enjoy learning and sharing. I feel that we can learn more together. Why don't you just give me a shot? I'm willing to take risks but you are stuck in your own comfortable situation. Let's break on through together.

<comment><USER12> ...said the startup marketing director to the coder.

<comment><USER13> So sadly, sadly true.

And note that, in business, you need the former--the latter is a nice bonus.

</comment></comment></comment><comment><USER14> This isn't describing an introvert in any way. I'd guess this is more along the autism spectrum, but even that's an inflammatory statement said from someone who doesn't have the proper background to speculate (probably like most of us here).

</comment><comment><USER15> I seem to be at the opposite end of the spectrum. I'm pretty good at smalltalk, sociable, do not dislike eye contact, etc. but most people seem... boring.

So you went shopping? Huh, I don't care. But tell me something interesting and, oh boy, I can chat for hours.

It's like I had already beaten the game and were patiently waiting for the sequel. Fortunately DLCs are released once in a while ;)

<comment><USER13> Conversely, if you can't at least feign interest in the minor minutiae of my life, why the fuck would I want to share anything I'm actually passionate about with you? Would be a waste.

<comment><USER15> I don't follow your logic. Why would it be a waste? Wouldn't it actually be a waste of both your resources and mine if I feigned interest? You'll keep talking, and my mind will keep drifting.

I understand smalltalk is necessary to break the ice. I'm perfectly fine with the _" How you doin'? Fine. It's hot today, isn't it? Well last week was worse!"_ exchange. I can even understand the _" I went shopping"_ comment.

What I don't really welcome is a walk through your shopping day.

</comment></comment></comment><comment><USER16> I love this one. I recognize myself in most of this (and linked) descriptions (GTD notebook, lol). Except for the bits I don't.

But the thing is, the bits that do not reflect me are because I had life experiences that taught me the value of skills to acquire those other habits.

For example, I am no longer afraid of small talk (most of the time) and random people. But, I used to be. I know exactly when it changed. When dotcom bubble burst, I chose to do a senior tech support job for three years. Going into the job, I had no people skills. Leaving it, I had plenty and kept developing. Turned out to be a super-useful skill in our "public communication shy" general community. And by combining ability to communicate with geek's ability to connect the dots and see the critical communication path, I can do things that are hard for people with only one of those skills.

Of course, now I see pretty much all of my projects/activities as "Hero's Journey". But that's another discussion.

</comment><comment><USER17> I dunno, I'm supposed to be an introvert but I'm chaos incarnate. What does that make me?

<comment><USER18> Some introverts are prone to rushes of sociability, what I heard that really clicked with me was that it's how you relax or recharge. If you relax or recharge best alone then you're basically introverted, if you relax or recharge best by being social you're basically extroverted. I can be incredibly social and am prone to frenzies of activity that cause many to think of me as an extroverted person. Afterwards however I need to retreat to my space and spend a lot of time alone to recharge, also if I don't get that alone time for too long I end up run down and worn out. It's just part of the fun. I would definitely say there are pros and cons to both sides the biggest seem to be that introverted people lose out since we are such a socially connected society while gaining in independent action. Extroverts seem to effortlessly maintain social connections that they often can use as resources however often suffer from loneliness or fear of being alone. These are purely my own experiences of course, YMMV. In any case learning to relax and your own particular way of doing it is important no matter what category you feel most comfortable under.

<comment><USER17> I get that. There are times I need to relax by being alone. Then I'm the Earth flipping magnetic poles and being alone irks the shit out of me.

It is most annoying.

</comment></comment></comment><comment><USER19> I'm increasingly thinking that the E/I distinction is not useful and maybe even harmful. It causes too many assumptions and generalizations that aren't valid classifications or often even close to it. This is a good example.

Personalities are complex. People can be introverted or extroverted. They can also have personality disorders and deficiencies independent of the two. I think generalizing and pigeon holing either introverts or extroverts does them a disservice.

Above all, people are incredibly malleable and adaptable. Most people are somewhere in the middle, or go through several states of personality based on their experience and stage of life. I know I have.

</comment><comment><USER20> Not introverted, more like Aspergers or obsessive-complsive I would think. This description covers some aspects of introversion, but most of it was not typical introversion. You can be a messy, uninterested, boring and unintelligent slob of an introvert - it doesn't matter.

Introversion/Extroversion is not a polar-thing like gender anyway. I dislike it when you do tests/training/exercises or whatever and they declare "You are Introverted" or "You are Extroverted" like it is a single binary option that you can only ever be one of the other.

I've always thought of it as more shades of grey (in both directions).

</comment><comment><USER21> In the article the author refers to his want to return to his cave. It made me think, today's cave is connected to the web. Not only is there an endless archive of knowledge in this cave, but it also can be a social place (via online collaboration). I'm wondering, what fellow introverts did in their caves before caves were connected to the web? Were caves filled with library books? How did we satisfy the need for collaboration while being in the cave?

<comment><USER8> fidonet and bbs's

before that pen-pals

before that ( help me out here...)

<comment><USER22> There was (is?) a whole mail-relay postal service culture. In the mid-90s my grandmother was a node in semi-formalized mailing list system that more than anything resembled a mimeograph version of Reddit. you'd get packets of stuff (jokes, photos, recipes, poems, stories, coupons, what-have-you) from people and sort of mix and match them and send them on to other people in your mailing list who'd like them, copying the good stuff and pruning the uninteresting.

I remember seeing literally the same fw: fw: fw: jokes that were circulating on BBSes at the time being circulated on hand-typed pages.

<comment><USER8> thats really cool. as i was writing my comment above i was imagining that there must have been something just like that. ..but would never have guessed it existed in the 90s!

</comment></comment></comment></comment><comment><USER23> I've been two different kinds of introverts over the course of my life. One is as rands describes it: A person in their cave not wanting their life to be disturbed. The other kind is the type who can and understands how to interact with you, but usually would rather be deep in thought solving my latest puzzle.

But those times when I make room for socializing... woof. Those are some good times. :)

<comment><USER24> i just like quiet and solitude. people are so noisy and they are always talking and asking so many questions. and some of them despise quiet so much that they will fill any silent patches with artificial noise - radios or talking to themselves or humming, or tapping or whatever. and i am fine with this except when they feel that they must force their noise onto everybody else which they so often do.

<comment><USER25> This is an annoying trait my family has, it's becoming more noticeable when you're away from them for a while. Can't they just sit still for five minutes?

Not that I enjoy silence, mind; at home I usually have music or the TV on shortly after I arrive.

</comment></comment></comment><comment><USER15> Completely off-topic but I'm very curious.

Why is wdewind's comment marked as [dead]? It's his first dead comment and seems completely respectful. Did it trigger some kind of bot detection or something?

Makes me think if any of my comments were marked as [dead] without me realizing too. Including this one I guess :P

</comment><comment><USER26> Definitely not accurate. My wife is one of the most extroverted introverts I know. She loves spending time with other people and doesn't consider them threatening in the slightest. She just needs her downtime to recover from the energy she expends in being social.

</comment><comment><USER27> just another self-indulgent blogger (but I repeat myself)

<comment><USER13> You're just jealous because your website is down.

<comment><USER27> well played, sir</comment></comment></comment>


Students are returning to US universities in a unplanned pandemic experiment - <AUTHOR> https://www.nature.com/articles/d41586-020-02419-w <comment><USER2> It's tragic that the US has politicized this pandemic and decided that rolling the dice with student lives is the right outcome.

<comment><USER3> It could be "the right outcome". Consider the facts. Very, very few young people die from this, almost none. Median age of those dying is something like 80. The virus is now endemic - it's never going away. We are not guaranteed to have a vaccine, in spite of the valiant efforts by multiple companies - there's no vaccine against any other coronavirus, and it's not for the lack of trying. Hospitals are not overloaded right now. They likely will be, come late fall/winter. So one could argue that transmission among the young, mostly healthy people off peak of hospital capacity constraints is not the worst thing that could happen. Done right, in fact, such transmission could be our "get out of jail free" card, as long as we properly isolate the sick and the elderly and maintain some semblance of hygiene and social distancing for those at moderate risk.

<comment><USER4> > there's no vaccine against any other coronavirus, and it's not for the lack > of trying.

It wasn't economical to develop those. So far, coronaviruses were responsible for either common colds (small impact) or MERS/SARS (which were quickly contained to their region).

We're now facing one with a global scale, and high impact (to society & the economy). Governments will pay for those vaccines to be developed, deployed and used. And if it isn't as effective and needs to be reapplied every X years, so much more economical incentive to develop a vaccine.

<comment><USER3> > It wasn't economical to develop those.

It was, if you run the numbers. There's over a billion of cases of common cold in the US alone every year, people have it 3-6 times a year, every year. The economic loss is insane. If you want to target just the coronaviruses for starters, 20% of common cold is caused by them. People with comorbidities and weak immune systems die from common cold too. And yet we don't have a vaccine. Nor do we have a vaccine against HIV for example. Vaccines are hard to do for some things, and C19 could easily be one of such things. What I find especially pernicious is that people don't realize that it's _not going away_, ever. It's going to be seasonal now.

</comment></comment></comment></comment><comment><USER5> A lot of universities may never reopen if they don't bring students back this year. It's not surprising they're choosing to cash the tuition checks as long as that remains a legal option.

<comment><USER6> People are worried about what's going to happen when schools reopen. I'm not because it'll blow up within a week. It's just not going to happen.

<comment><USER7> UNC Chapel Hill is back on-line after a week of in-person instruction. Four clusters in dormitories. That was fast.

</comment></comment></comment><comment><USER8> The only possible good thing is it collects a large number of highly resistant young people to speed herd immunity.

But really this is just greedy colleges being greedy.

</comment><comment><USER9> If universities were tax funded, they wouldn't have to endanger their students now (and costs would be way lower, of course, as they are in the rest of the world).</comment>


I bought my daughter heroin - happy-go-lucky http://www.bbc.com/news/magazine-39212295 <comment><AUTHOR> I read this yesterday on the BBC, and was struck by, among many other things, the fact that this woman was put into this position in the first place. Most of all, that she was essentially turned into a criminal through the failure of the state. I also hope that people can read that, and understand the trap that so many addicts find themselves in. Instead of medical treatment they're referred to 12 step programs or told to "kick it", unless of course you can pay, of you're lucky.

The system is set up to create failure and re-offense, although I'm not arguing that it was designed that way, the result is the same. All of this comes down to a single root cause _which can be addressed_ : the "war on drugs". It's insane, it's wasteful, it's already going to have generations of negative impacts around the world. The sooner we stop it, the sooner we can start to heal the damage.

<comment><USER2> Apart from the terrible human suffering that drugs (and their criminalization create), there is another factor that is not, in my opinion, discussed enough.

Drugs are and amazing business and making them illegal, make rich to the worst kind of people. It's giving power to the last people you would want in power.

So, in the consumer countries you have addicts suffering. In the producers countries you have wars and societies totally corrupted, and the worst of the worst get rich.

Amazing strategy.

It looks more like a war on humanity that a war on drugs.

<comment><USER3> It's not a war on humanity it's a war on the working class. The capital class can pay lower wages the more of the labor class are dealing with drug addicted family members. Because it makes the employee afraid.

Companies make a 2x, 3x, 10x, 100x premium off of labor. The only way they can do that is with a perceived shortage of "work". The way they do that is to make enough political instability that a strong single digit percentage of people are visibly falling through the cracks of solvency. Drugs help.

Many business owners are aware on some level that they could double salaries and stay solvent, but they don't think about it, they think in terms of "market rates" for labor, and they want rates to be as low as possible, so they subconsciously collude in cultural movements which make work seem scarce, and life scary and chaotic.

Their brains don't drift to the "what if we all just work hard and get paid a fair share? what if every employee was on a partner track?" scenario because they would lose money. And they're the ones deciding what the partner agreement says so it doesn't change.

There's no technical reason in 2017 for there to be any unemployment, for anyone to be hungry or need health care, lack access to the internet, or anyone to work more than 20 hours a week.

The problem is if that happens, the working class will rest up, get educated, and demand fair compensation for their wages, and the capital class will be stuck with a piddling 20% of the global economy instead of the 80% they currently get.

So they fight tooth and nail to keep a certain level of instability, in the workforce, and in far away places.

<comment><USER4> The war on drugs is reducing the amount of labor available. If we follow the principles of supply and demand-- if Business Owners wants to pay employees less, then they want _more_ people to be available to work, and they also want those people to have lower cost of living. Having people in prison and having people pay for their family member's drug addiction reduces labor supply and increase cost of living.

I think you have a conspiracy narrative, and you are trying to fit evidence to support it.

<comment><USER5> The principle of supply and demand doesn't really work, it's too simplistic a view. In the small scale, in a controlled environment sure it works fine, but real markets are messy with lots of factors impacting them, so it tends to break down rapidly. This has always been the failing of those that hew to the freemarket capitalist ideal, this unfailing belief in supply and demand as a market driver.

One (but certainly not the only) missing factor here is a discussion of skilled vs. unskilled labor. The market for skilled labor is relatively small compared to unskilled labor, but even in that market companies struggle sometimes to fill positions, that's one of the claims companies backing H1B programs make (even if it is a bit dubious). On the other hand, there's an almost unlimited supply of unskilled labor available, and that's growing all the time. Further complicating things is the fact that the demand for unskilled labor is directly driven by the size of the market, and they tend to scale together.

People desperate for _any_ work to offset their costs of living are more willing at accept lower pay if it means getting a job and that's exactly the situation we see evolving now. All of this so far has been predicated on the supply side of things being the driver, but there's also the question of demand. If people had options they could fall back on then the unskilled labor market would _demand_ higher wages and refuse to work under the poverty line forcing employers to increase wages. The problem is of course that people are so desperate for _anything_ at all that they're willing to work in jobs that can't keep them financially viable because it at least slows the collapse. Eventually they'll either move into a skilled position that gives them a better chance, get sick, die, or turn to crime or drugs to try to cope. Long term this is of course economically disastrous, the middle class has all but ceased to exist, and the economy is slowly grinding to a halt as more and more of the population finds themselves unable to take part meaningfully in it. However in the short term it means record breaking profits for corporations. It's pretty obvious to anyone who's watched the policies that corporations have pushed for the last 40 years exactly what choice they're going to make.

<comment><USER6> Very lucid viewpoint

</comment></comment></comment></comment></comment></comment><comment><USER7> I want to use this message thread to tell a story and make a point. If it is off-point, delete it, give it negative votes, whatever.

I had abdominal surgery. They had to remove 14cm of my colon which was badly inflamed due to diverticulitis. When I woke up, I was so doped up that I felt no pain. I even danced a jig in my room.

That evening they hooked me up to a hydromorphone injector for the inevitable pain. Every 12 minutes or so, I could give myself a shot into my IV. Hydromorphone is about 100 times stronger than morphine, so the doses were in micrograms. I was allowed, like, 5 shots per hour, and the machine could get loaded with about 50 shots. I kept a record of the shots in my Iphone Notes. I tried to space them further than 12 minutes, but I only decreased the frequency by a few minutes. I liked those shots. They worked. The nursing staff encouraged me to use this. They could reload the machine, no trouble.

Now the thing about colon surgery is, your colon has to get working. Those opiate shots very effectively prevent this. I wanted to get out of that place. So the next night, I quit cold turkey. I was freezing cold, and the pain I felt was not just from the after effects of the surgery, I am pretty sure. It was fucking horrible.

Now the things is, I was addicted. I did succeed in quitting cold turkey. My colon still didn't work for a day, so I vomited almost a gallon of green bile over the edge of my gurney. It was so much, it lapped up against the walls. Then my colon worked, and I got to go home.

But I was addicted, and I am a recovering addict, from that one time. And every nurse I mention this to says, "Oh no, you weren't an addict." They even quote some bullshit criterion for addiction, which I've forgotten.

I haven't had any problems since, and if I have to take oral oxycodone, or hydrocodone, there have been no problems or instance of abuse.

But I was an addict.

<comment><USER8> I don't think you know what you're talking about.

For how many weeks were you on the medication? For how long were you in withdrawal? Heroin, hydromorphone, oxycodone, etc the withdrawal lasts 5-7 days. Were you in withdrawal for that long? I guess the point I'm trying to make is that most addicts are on much higher doses for much longer periods of time -- and the withdrawal is insane. Furthermore, there's a big difference between physical and psychological addiction. If there weren't, then everyone who takes prescribed pain meds for any length of time would be "an addict" because they'll experience a degree of withdrawal. If you identify as a drug addict, that's fine (though I certainly hope you aren't one!).

IV Hydromorphone is also, by the way, 5x stronger than IV morphine. Granted, that's a lot, but nowhere near 100x!

<comment><USER9> Personally speaking I was on hydromorphone (orally) for a shattered ankle, and just 72 hours of taking it (at 66% max dose) was enough. Dropping from 2 pills to 1 caused some withdrawal symptoms, and 1 to 0 definitely caused nausea and insomnia.

The surgeon nodded when he heard about this and said yep, that's expected. It's addictive over that short a timespan.

<comment><USER7> Thanks. I'm indeed not crazy.

</comment></comment></comment></comment><comment><USER10> Opiate addiction is hell. Just pure unadulterated hell. I've been through a lot of hardships in life but I honestly can't begin to explain to you the amount of pain this has caused me. I'm currently in a methadone program after relapsing for the first time since I got clean five years ago. Just.. stay as far away from this stuff as you possibly can. It has the potential to swallow you whole.

<comment><USER11> Not to pry, but did it start with a doctor's prescription for you?

<comment><USER10> It actually didn't start with a prescription.. For me it started as casual use here and there and very quickly turned into self-medication. I've had issues with depression and anxiety for a long time and opiates were a really easy way of dealing with those problems. However I can't tell you how many people I knew who started using after being prescribed opioid painkillers.

<comment><USER12> I've only ever had opioid painkillers after dental work, and it's enough to convince me that I must _never_ try heroin. You have my kind thoughts and best wishes.

<comment><USER13> I never understood how people could be addicted to drugs until the middle of the night screaming in an emergency room bed. A kidney stone was causing so much pain morphine wouldn't touch it. Unbearable.

The nurse came in and put something in my IV and I just stopped. The pain stopped. I stopped talking to my wife in mid-sentence. Everything was fine. My world just stopped and I liked it.

As the nurse left my wife asked what I was given and it was dilaudid, which is equal to heroin on the equianalgesic scale.

It was right then I understood how people become addicted to drugs. Like you, it convinced me to never try heroin or any other opiates outside of emergency medical care.

</comment></comment></comment></comment></comment><comment><USER14> This reads like a laundry list of exactly what not to do when you find out your child is addicted to opiates. Everything they do, from being overly controlling to kicking her out and pressing charges against her, is a self- righteous act and harms her greatly. At one point, I thought I was reading a scene cut from Trainspotting for being too mundane. The naivety about the legal and health systems is also appalling. These are people who claim the ability to function in the world, yet they don't know the most basic things about the world they claim the ability to function in. I think towards the end, the mother actually starts to get a glimpse of the reality of what is going on with her daughter and is more compassionate by letting her live in their house again. I hope their daughter recovers and other parents heed this story as to what not to do to their sick children.

<comment><USER15> Out of curiosity, what would you do instead?

From person experience with a family member who had a severe case of alcoholism (and eventually died from it)... there's very little you can do to help somebody if they don't want to quit. After a while these behaviors start to negatively affect everyone else in the household, too.

(Also, keep in mind we're actually talking about an adult here... since they're old enough to join the military.)

<comment><USER16> It says "five years ago, when she was 18".

So it's not relevant, but you can join the British Army at age 16, though it's controversial: [https://www.child-soldiers.org/uk](https://www.child- soldiers.org/uk)

</comment></comment></comment><comment><USER8> GPs should know about clonodine. It's a blood pressure medicine that counteracts the massive norepinephrine dump you experience when you kick (and which is the number one thing that makes it so unbearable). It helps a lot.

Besides methadone there's also buprenorphine and Suboxone, which are opiate replacements. Not the kind of thing you take to get high, something to use to taper off so the withdrawals aren't so intense.

Heroin abuse is a big problem that's only going to get bigger in the US. A lot of folks got addicted back when Purdue was pushing Oxycontin, and now that it's harder for them to obtain they've switched to the cheaper and more potent stuff.

Doctors need to know how to treat withdrawal, period. There are lots of options besides methadone (which has it's own nightmare withdrawal if stopped abruptly, and which lasts three times longer than heroin withdrawal).

<comment><USER17> _" Heroin abuse is a big problem that's only going to get bigger in the US. With legal weed, a lot of former marijuana producers are getting wise and starting to farm the opium poppy. Plus a lot of folks got addicted back when Purdue was pushing Oxycontin, and now that it's harder for them to obtain they've switched to the cheaper and more potent stuff."_

I'd really like to see some numbers on this.

From what I understand, there are far, far more marijuana users than there are heroin users -- like many orders of magnitude more. So, yeah, illegal marijuana growers could certainly switch to growing opium, but they're not going to magically get anywhere near the number of customers.

<comment><USER8> I did a quick google search:

* [https://www.cdc.gov/drugoverdose/data/heroin.html](https://www.cdc.gov/drugoverdose/data/heroin.html)

* [http://www.cbsnews.com/news/heroin-use-in-u-s-reaches-alarmi...](http://www.cbsnews.com/news/heroin-use-in-u-s-reaches-alarming-20-year-high/)

* [http://time.com/3946904/heroin-epidemic/](http://time.com/3946904/heroin-epidemic/)

* [http://www.cnn.com/2016/09/16/health/huntington-heroin/](http://www.cnn.com/2016/09/16/health/huntington-heroin/)

<comment><USER17> Versus the number of marijuana users, please.

<comment><USER18> Also consider what the average marijuana user is spending per day vs what the average heroin user is spending.

</comment></comment></comment></comment></comment><comment><USER19> This is really sad. I got the impression while reading through that whole sorry story that the poor girl's parents really just don't see how they are a huge source of negativity and pain in their daughter's life. They kick her out of the house, sabotage her job, put conditions on their provision of love and support. These are terrible parents. I feel awful just reading about that whole situation.

<comment><USER20> Here in the USA, you have to kick them out. If you don't, your house can be taken via civil asset forfeiture laws. Landlords also have to kick out renters. Kick them out ASAP or risk the loss of your property. You can't even let them loiter outside.

<comment><USER19> that's an absurd thing to say. can you provide a citation of a parent's house being seized because their child was arrested for drug possession?

<comment><USER21> While I, uh, don't necessarily support the advice given by your parent comments ... this was literally the top result of a Google search for [a parent's house being seized because their child was arrested for drug possession]: [http://www.cnn.com/2014/09/03/us/philadelphia-drug-bust- hous...](http://www.cnn.com/2014/09/03/us/philadelphia-drug-bust-house- seizure/)

Most of the top results are about that case. Maybe it's misleading or simply inaccurate. However, check out this webpage (the fourth result) which offers legal advice: [http://www.criminaldefenselawyer.com/resources/if-my-kid- arr...](http://www.criminaldefenselawyer.com/resources/if-my-kid-arrested- smoking-marijuana-my-house-can-i-l)

Choice quotation: "In 1988, Paul and Ruth Derbacher, a couple in their eighties, lost their Connecticut home after police raided their house and arrested their twenty-two year old grandson for selling drugs. Police found $50,000 worth of marijuana and cocaine in the house. The grandson was convicted of drug charges and sentenced to prison. The Derbachers were also charged with drug possession and were placed on probation. Prosecutors claimed the drugs were kept in plain view and that the Derbachers must have been aware of their grandson's illicit activities. Although the Derbachers fought the seizure of their home, they ultimately reached a settlement agreement. The house was sold, and the couple split the proceeds of the sale with the government."

</comment></comment></comment></comment><comment><USER22> And here in the United States we are talking about removing drug treatment options from our health care. Over a million people.

</comment><comment><USER23> Economics-wise, drug manufacturing can be the next-big-thing for the US economy. Sprinkle in some regulation and oversight for quality, and BAM we're good to go.

</comment><comment><USER24> This is a good book on drugs and the history of prohibition.

[https://www.amazon.com/Pursuit-Oblivion-Global-History- Narco...](https://www.amazon.com/Pursuit-Oblivion-Global-History- Narcotics/dp/0393325458)

</comment><comment><USER25> They teach you in school, drugs are bad. Don't do drugs. Just say no. At least where and when I went to school, they went out of their way, above and beyond to ensure this simple message was hammered into every single child.

The image of a drug addict in pop culture -- it's never a pleasant one. They lie, cheat, steal. They're a burden and a trial to their families.

People are warned about what happens when you get addicted to drugs. I simply fail to understand why so many people do drugs in the first place, and I have little sympathy for addicts.

The world is a dangerous place. If you drive your car off the side of a bridge, or you mix the wrong household chemicals, or you stay in a running vehicle in an enclosed garage, or you grab on to a downed powerline, you'll probably die. It's simple cause and effect, and for the most part people understand it and aren't stupid enough to do these things unless they're suicidal.

If you do drugs, you'll probably ruin your life. It's simple cause and effect. For the most part people understand it, but it seems that enormous hordes of people do them anyway. I don't get it, what's the difference?

<comment> nv-vn Just curious, but what are your thoughts on alcohol?

</comment></comment><comment> xkcd-sucks It seems a little bit dramatic-- Heroin withdrawal symptoms are pretty much the same as those of influenza, except the flu can actually kill you.

<comment><USER26> Have you had severe withdrawals? I've withdrawn cold turkey off of a $500/day heroin habit. It is the worst pain I have ever experienced. If I had a gun on me at the time, I am 100% sure that I would have killed my self. You have no idea what you're talking about

</comment></comment><comment><USER27> clickbait cancer

<comment><USER28> Please stop posting unsubstantively like this here.</comment></comment>


TSA Modernization Act Could Be a Dry Run for a National Surveillance System - <AUTHOR> http://www.slate.com/blogs/future_tense/2017/10/03/airport_face_scans_could_be_a_dry_run_for_a_national_surveillance_system.html <comment><USER2> Similar things are already happening in China, where malls and public transit stations are outfitted with cameras everywhere. Some cameras are even pointing at the escalators so its really hard to avoid being filmed. And in the background massive facial recognition engines run 24/7\. With such power it's hard to imagine that it won't be abused.

</comment><comment><USER3> The simple reality is that being in public, is public. I dont think you can put the genie back in the bottle at the point.

<comment><USER4> There are many genies. Some of them can be put back. Some of them don't need to be released in the first place.

Some other countries have much more restrictive surveillance laws than the US. Some have even more surveillance. It's not like it's completely uncontrollable once the technology becomes possible.

<comment><USER3> The US is for the most part against restrictive laws with the whole freedom thing and all. But that's a two way street. Most people don't want the government telling them what to do or monitoring their activities. It seems like this is more an issue of government reform because they are overreaching in their duties. However, I see no merit in additional laws to the citizen on the freedom to record in public.

<comment><USER4> I think you've changed the topic?

The topic was on the US government using technology like face recognition as part of a surveillance system across the general public.

The "whole freedom thing" doesn't preclude passing a law which prohibits that from happening, similar to Montana's new law limiting automatic license plate readers.

So I don't see how your response is related. I think you are referring to increasing use of facial recognition by someone who isn't the government, yes?</comment></comment></comment></comment>