Sun Ra: 'I'm Everything and Nothing' - <AUTHOR> https://www.nybooks.com/articles/2020/07/23/sun-ra-everything-nothing/ <comment><USER2> Sun Ra is part of the pride of Alabama. A lot of the esoteric and mystical aspects of his music come from the time he spent growing up and studying at the local masonic library in Birmingam. At the time, masonic libraries were one of the only places where black folks had full access to literature.

In fact, some of the most famous jazz musicians were masons. I reject the author's notion that he was a god. The writer seems devoutly obsessed, almost worshipful to his cult of personality.

However, I can agree that he was undoubtedly a legendary musician with an informed talent for creating myth and interpreting mystical concepts into his music. His music is challenging and experimentally mind-expanding. He lies buried next to Bear Bryant in a cemetery that holds a dear friend of mine, so the name always catches the eye.

</comment><comment><USER3> For any Sun Ra fans in the crowd, please check out Phil Cohran. He was best known for playing trumpet in the Sun Ra Arkestra in Chicago from 1959 to 1961, but he has some really amazing solo material. His catalog is somewhat limited, but it's uniformly excellent. Two of his records, "on the beach", and "the spanish suite" are streamable in their entirety on youtube. For a quick introduction, check out his single, "frankiphone blues" (also on youtube).

</comment><comment><USER4> The documentary mentioned in the article is delightful. It captures a feel for the strange, magical culture ("reality distortion field") he wove around himself and the group of artists with him.

Sun Ra: A Joyful Noise - [https://www.imdb.com/title/tt0270677/](https://www.imdb.com/title/tt0270677/)

This "afro-cosmic" vision was carried on, and taken further by George Clinton and the Parliament Funkadelic.

[https://en.wikipedia.org/wiki/Parliament- Funkadelic](https://en.wikipedia.org/wiki/Parliament-Funkadelic)

</comment><comment><USER5> I think there's a spectrum between admiring and fetishising and this article moves too close to the latter for my taste. Even the quote in the article's title had to clean up the author's quote from Space is The Place which --maybe I'm misremembering-- featured a Sun Ra who enunciated every word.

</comment><comment><USER6> Sun Ra is absolutely worth looking into. Easily one of the most innovative American musicians of the last 100 years.

</comment><comment><USER7> Last year I went to the San Francisco Museum Of Modern Art because they had an exhibit regarding space architecture (both real and from film).

Among the space suits and models were film clips denoting different creativity and functionality in space -- buildings, clothing, interiors, exteriors, vehicles, &c.

One of the film clips was from Sun Ra's 'Space Is The Place'. When I got home I found it on Youtube to watch more. It's a trip.

</comment><comment><USER8> What a marvelous Nabokov quote! The epigraph is a lens for the article--a book review of photographs of Sun Ra, but actually about Sun Ra's extra-terrestrial vision of himself and Black America--and serves as a good introduction of Sun Ra to the uninitiated. The writer tries to describe the sublime which cannot be explained, only understood, but does a good job nonetheless.

</comment><comment><USER9> I saw the Arkestra in the late 70s at a venue on Broadway in San Francisco. I was amazed at the number of musicians. How could he pay this many people to play this small venue and cheap tickets? Amazing show. I think they played until 1 AM. Followed by the Dead Kennedies, who we weren't interested in seeing.

About 6 years later I saw a much smaller Archestra in Camp Hill, PA. Small crowd. About half of them walked out.

</comment><comment><USER10> Well-written bio and insights into Ra and his impact.

Here's a hand-made and annotated, and equally well-constructed Ra discography (links only 2 years old)

[https://www.metafilter.com/174248/A-plethora-of-Sun-Ras- four...](https://www.metafilter.com/174248/A-plethora-of-Sun-Ras-four-decades- of-baffling-dazzling-mystical-jazz)

</comment><comment><USER11> I live in the same neighborhood as Arkestra member Eddie Gale (who just recently passed away). Gale was a local treasure and an incredibly talented fellow, who definitely came from the Sun-Ra orbit.

</comment><comment><USER12> I feel like the Outer Space Employment Agency could give people a hand up in these times

<comment><USER13> [https://www.youtube.com/watch?v=cyeUGo1k1R4&t=126](https://www.youtube.com/watch?v=cyeUGo1k1R4&t=126)

"Hey, what does this job pay?" "Nothing."

</comment></comment><comment><USER14> I saw the Arkestra play live in Berlin once and it was an incredible experience. Loved this article and the photos; keen to see more of Ming Smith's work.</comment>


Thor – A Project to Hammer Out a Royalty Free Video Codec - TD-Linux http://blogs.cisco.com/collaboration/world-meet-thor-a-project-to-hammer-out-a-royalty-free-video-codec <comment><USER2> "We also hired patent lawyers and consultants familiar with this technology area. We created a new codec development process which would allow us to work through the long list of patents in this space, and continually evolve our codec to work around or avoid those patents. Our efforts are far from complete, but we felt it was time to open this up to the world."

This burden is becoming far too great, when this is the cost necessary to achieve innovation.

<comment><USER3> Amen. As Thomas Jefferson (correctly) described patents, they're a part of positive law, not natural law. In other words, their only justification is pragmatic, not moral. You can't "own" an idea the way that you can own a couch or a car. We allow for (temporary) patent protection because it's supposed to encourage innovation and help our economy. If it doesn't - and it's clearly reached the point where it hinders rather than helps innovation - then we need to change things.

<comment><USER4> To be clear, because some forget this part of patent law, the encouragement towards innovation was to encourage people to share and build on a communal set of ideas. The temporary monopoly on ideas was the carrot to get people to register their ideas in a central location (patent office) rather than lock ideas behind closed doors and secrecy.

Too many people think the carrot of the temporary monopoly was the point of the patent office.

In other words, we know that the community of ideas gets better with more sharing and building off of other people's ideas. As a society we decided to make laws to encourage this sharing. As a result, technological progress was immense.

Sadly, the current situation seems to strongly suggest that we may need to find better ways to encourage sharing (Open Source has been great for much of software).

<comment><USER5> Copyright was built with a similar purpose - enriching the public domain - <AUTHOR> has failed in a similar manner.

Both patents and copyright are failed experiments. They weren't meant to 'benefit creators' or 'guarantee an income', and they cannot take that role in a healthy society.

<comment><USER6> Copyright has succeeded a thousand times more than its failed. It's pretty great for the most part. It enables a vast, vast number of jobs and new creations. It could certainly be better. But I'd much rather have what copyright as it exists today than for it to not exist at all. And don't forget that GPL is only enforceable due to copyright law.

<comment><USER7> Good point about GPL. Some people advocate for much shorter copyright terms, just enough to make it worthwhile creating the work, like say 20 years. But that would push some GPL software into the public domain, thus damaging the GPL ecosystem by allowing commercial competitors to use the same code.

<comment><USER8> Pardon me if I have trouble seeing a terrible loss for the GNU ecosystem if releases from 1995 were transferred to the public domain.

<comment><USER7> There are some very old but hard-to-do-yourself things like compilers, early versions of Linux, etc. Sure it won't be massive, but in the long term it'd slow the ever-growing collection of GPL work, as the old stuff leaks out the back end.

<comment><USER9> We are talking about works which then has had no patches for 20 years. Even compiles of dead languages do get minor patches over time, if nothing else then to fix memory leaks, crashes, infinitive loops and compatibility with new os kernels. You would for example have to enable low memory address exception in the kernel to run many 20 year old programs, since many programs back then assumed they would start at address space zero, which modern kernel forbids for security reasons.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER10> Actually, I'm still rooting for Daala (from Xiph.org, the same folks that did so well with Opus). It's still a long ways away from being finished, but their work is awesome and I've been following it for a while now!

Either way, having another effort competing to make a great format is not a problem. Here's hoping it goes well!

<comment><USER11> Hello, I'm the Daala tech lead.

One of the things that made Opus a success was the contributions of others. We certainly don't have a monopoly on good ideas. We'll take pieces of Daala and stick them in Thor and pieces of Thor and stick them in Daala, and figure out what works best. Some of that experimentation has already begun:

[https://github.com/cisco/thor/pull/8](https://github.com/cisco/thor/pull/8)

[https://review.xiph.org/874/](https://review.xiph.org/874/)

[https://www.ietf.org/proceedings/93/slides/slides-93-netvc-5...](https://www.ietf.org/proceedings/93/slides/slides-93-netvc-5.pdf)

Because none of us have a financial incentive to get our patents into the standard, we're happy to pick whatever technology works best, as long as we end up with a great codec at the end. Hopefully NETVC can replicate the success of Opus this way.

<comment><USER12> Yeah, we're going to have to start arguing on what to name the hybrid soon, since 'Vopus' is already taken.

<comment><USER13> Brainstorming fun names combining "Thor" and "Daala" reminded me of the Robert E. Howard villains "Thulsa Doom" and "Thoth-Amon". :)

</comment></comment></comment></comment><comment><USER14> The MP4 patent situation needs another close look. MP4, which was first standardized in 1998, ought to come out of patent soon, if it hasn't already. There are a few remaining patents in the MPEG-LA package, but they're mostly for stuff you don't need on the Internet, such as interlaced video, font loading, error tolerance for broadcast, and VRML. This hasn't been looked at hard since 2011[1] and it's time for a new look. Some of the key patents related to motion compensation expired last April.[2]

It looks like the last patent on MP3 audio decoding expires next month.

[1] [http://www.osnews.com/story/24954/US_Patent_Expiration_for_M...](http://www.osnews.com/story/24954/US_Patent_Expiration_for_MP3_MPEG-2_H_264/) [2] [http://scratchpad.wikia.com/wiki/MPEG_patent_lists#MPEG-1_Au...](http://scratchpad.wikia.com/wiki/MPEG_patent_lists#MPEG-1_Audio_Layer_3_patents)

<comment> TD-Linux If by MP4 you are referring to H.264, there are still many years remaining on most of the patents. MPEG-LA publishes patent lists, if you're interested to look.

You are right in that there are many other encumbered technologies that have patents expiring soon. MPEG-1 and MPEG-2 video, MP3 and AC3 audio, and several container formats are included. Notably, this is almost all of the technologies required to make a DVD.

<comment><USER14> Yes, MPEG-LA publishes lists, and they need to be looked at closely. Most of the patents have expired. When you go down the list, you see things such as US #6,181,712, which has to do with multiplexing two unrelated video streams into one. Broadcasters and cable systems do this, but Internet video does not. US #6,160,849 only applies to compression of interlaced video, which nobody uses on line. US #7,627,041 is about dealing with missing header data due to transmission noise. US #5,878,080 is about backwards-compatible multichannel (>2 channels) audio, also seldom used on-line. US #6,185,539 is for video with overcompressed extra-low-quality audio. So is US #6,009,399.

MPEG-LA has been padding their patent portfolio by dumping in all these patents on little-used features. Until this year, they still had some good patents, such as the ones on motion estimation, which is a hard problem and is needed to make compression work. But those have now expired. What's left looks like it can be avoided as unnecessary for Internet use.

<comment><USER15> I think you're right. It's worth the hard look as it would let us take advantage of the existing format instead of push a new one. One's always easier than the other. Looks like we'll be doing same for MP3 soon, too. Glad you mentioned that one as I was going to dodge it for a future project for licensing reasons. Might not have to. :)

<comment><USER14> If you're looking at new compression ideas, take a look at FrameFree.[1] This is a technology developed around 2005 at Kerner Optical, which was an effects unit of Lucasfilm. It's a completely different approach to compression, not based on frames. It's based on delaminating the image into layers which seem to be uniform in motion, then interpolating by morphing each layer, then reassembling the layers.

Because the interpolation operation is a full morph of a mesh, (which GPUs can do easily) you can interpolate as much as you want. Ultra slow motion is possible. You can also up the output frame rate and eliminate strobing during pans.

Kerner Optical was spun off as a separate company, then went bust. The technology was sold off, but nobody could figure out how to market it. The delamination phase turned out to be useful for 2D to 3D conversion, which was popular for a while. But Framefree as a compression system never went anywhere after Kerner tanked. Nobody is doing much with it at the moment, and it could probably be picked up cheaply. At one point, there was a browser plug-in for playback and an authoring program, but they're gone. I'm not sure who to contact; the "framefree.us" domain is dead. the "framefree.com" domain is dead. Here's its last readable version: [2] The remnants of the technology seem to be controlled by "Neotopy LLC" in San Francisco, which is Tom Randoph's operation.[3]

[1] [https://hopa.memberclicks.net/assets/documents/2007_FFV_Comp...](https://hopa.memberclicks.net/assets/documents/2007_FFV_Compression_CPFvsBMA_Feb2_8_45am.pps) (Open with OpenOffice Impress; it's a slide show.) [2] [https://web.archive.org/web/20120905065521/http://www.framef...](https://web.archive.org/web/20120905065521/http://www.framefree.com/) [3] [https://www.linkedin.com/in/neospace](https://www.linkedin.com/in/neospace)

<comment><USER15> Very different type of technology. I could see this being much easier to cheaply accelerate in hardware, too, due to simplicity. Thanks for link! Will keep copies of this and see who's interested.

</comment></comment></comment></comment></comment></comment><comment><USER16> <sarcasm mode> No wonder Big Media hates tech, they are trying to take all their money away. </sarcasm mode>

I think this is a great effort, and if you'll recall Google went and attempted to do the same thing with VP8, but found that people could file patents faster than they could release code[1]. I would certainly support a 'restraint of trade' argument, and a novelty argument which implies (although I know its impossible to currently litigate this way) that if someone else (skilled in the art) could come up with the same answer (invention) given the requirements, then the idea isn't really novel, it is simply "how someone skilled in the art would do it." I've watched as the courts stayed away from that theory, probably because it could easily be abused.

[1] Conspiracy theory or not, the MPEG-LA guys kept popping up additional patent threats once the VP8 code was released.

<comment><USER17> Why attack novelty instead of non-obviousness? An expert can attest to obviousness, but not necessarily novelty (you shouldn't need an expert for that: simply produce the prior version).

<comment><USER16> In my experience (and that experience is limited, I've only participated as an expert witness in two cases that have gone to trial) looking backward through time on "obviousness" is really hard. Once you know how a magician does his trick, its obvious to you, but before you knew it wasn't. Compare that to multiple people from different places trying to solve the same problem came to implement that solution in exactly (or an infringing) way, speaks to the notion that of non-novelty more strongly. And its something that has already happened prior to disclosure, so you cannot argue that the other people were "taught" by the patent disclosure. (one of the tenets of the patent is that it should teach others skilled in the art how to do what it is you're patenting)

Anyway, I'm not a lawyer, and none of this is legal advice or patent advice. Just my thoughts (or perhaps frustrations) on how hard it is to generate deliberately patent free technology. That difficulty suggests to me a way in which patent law could be improved.

<comment><USER17> Sure, determining past obviousness can be hard. That's why you bring an expert or many experts to attest to how obvious the technique is.

But you don't need an expert for novelty. Either you can show a prior art or you can't. I'll grant that there may be some some edge cases where the prior art needs some nuanced interpretation from an expert witness.

<comment><USER16> I think we agree :-). I was thinking of the more subtle version of novelty which is perhaps best expressed as, "as requested". Here is a fictional example of what I'm thinking about.

Lets say someone asks you to make a mud pie[1] and put bits of lavastone in it. You make your mud pie and then you patent "system and method for creating a mud pie with lava stones."

Perhaps there is no prior art because nobody asked for a mud pie with lava stones, perhaps there is no prior art because others who made mud pies with lava stones didn't see anything useful about it. But someone, somewhere, filed a patent. And the patent office grants it.

The question I pose is how to come up with a defense that anyone skilled in the art of making a mud pie, would make one with lava stones in just that way ? And yes, I know all the legal arguments why it doesn't work like that, so my point is how do we fix the patent system such that utility patents on methods or combinations of methods, would likely be independently arrived at by anyone skillled in the art?

How do we fix it so that Cisco, writing their patent free video codec in the open, doesn't get "scooped" by someone taking their project, projecting out a month or a year in advance of what it is going to need to work, and then throwing together a provisional that pre-dates the open source project getting there, thus depriving the people working on Cisco's efforts their ability to ship without hindrance?

[1] Really, just dirt and water.

<comment><USER18> _> Lets say someone asks you to make a mud pie[1] and put bits of lavastone in it._

This is begging the question (in the original sense of the phrase). The process is usually not somebody saying "make me a mudpie with lava stones". It usually starts with "how do I make a more attractive mudpie?" There are countless ways of doing so. You could use marbles, leaves, different mud, different levels of consistency... But maybe using lava stones gives you the most bang for the buck. So then you are really filling a patent on "method and system for increasing mudpie attractiveness".

The infamous Amazon one-click patent can similarly be viewed that way. The patent is not really solving the problem of "how do we enable purchases with one-click?" (the solution to which is blindingly obvious) but of "how do we get people to buy more things on our online store?" Now, the path from there to "one-click buying" may also be obvious, no doubt, but it's not as obvious as the path from "how do you build one-click?" to "here's how" simply because the solution space is so much bigger.

</comment></comment></comment></comment></comment></comment><comment><USER19> Why not throw the weight behind VP9? edit: I actually am curious, this isn't a question pointed at the validity of Thor. I just really want to see a great, open-source standard emerge and see people get behind it.

<comment><USER20> I'm no expert, but the article lists VP9 as "proprietary". Which I take to mean not open source, and potentially not free. Though the proprietariness could be a response to the issues they had with VP8 and suspected reactionary patenting.

<comment><USER21> VP9 is open source and royalty-free though. I'm confused.

<comment><USER22> And it's not just open source, it's BSD which is about as none restrictive as you can get. So now 1) Open Source 2) Royalty-free 3) Free as in beer 4) Free as in freedom (Open Source OSI certified BSD)

Software can now be call proprietary?

pro·pri·e·tar·y : of or relating to an owner or ownership.

So what is this guys saying. That now anything with a company behind is is proprietary? Linux has got LMI, so I guess that's proprietary, and firefox has got Mozilla. Libreoffice...by this guys twisted version of reality, what is not proprietary?

<comment><USER23> VPx reference software is open source. The article is not referring to the software but the specification which is developed and published by Google (a private company), as opposed to an open standards consortium like ISO, ITU or the IETF.

VP8 was published as an informational RFC under the IETF, but not as part of a standards track, see "Not All RFCs are Standards": [https://tools.ietf.org/html/rfc1796](https://tools.ietf.org/html/rfc1796)

<comment><USER24> Parent has the right idea. One of the few valid criticisms of VP8 was that the code /was/ the standard, so you had to reverse engineer the encoder/decoder. This is not only a PITA but also prompts questions such as whether an obvious bug is part of the spec.

It also took a full year after Google bought the company behind VP8 to actually release the code. Someone from Firefox actually wrote an open letter to Google basically asking WTF was going on.

I don't have any first or even second hand knowledge of the current situation, but I suspect that Google has continued to ... not collaborate as much as everyone else would like.

(Caveat emptor: the above is based off of memory of events that took place a few years ago.)

</comment></comment></comment></comment></comment></comment><comment><USER25> Wasn't Ogg Theora created under just the same principles? I'm not smart enough in all things codec to know how it stacks up technically, but best I can tell, it's unencumbered.

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

<comment><USER26> Theora simply can't do what H264 can.

example: [http://www.streaminglearningcenter.com/articles/ogg- vs-h264-...](http://www.streaminglearningcenter.com/articles/ogg-vs-h264--- round-one.html)

<comment><USER15> Deleted a prior comment on "why not theora?" because this link is what I was asking for. Thanks.

</comment></comment></comment><comment><USER27> > Google's proprietary VP9 codec

That's an _odd_ choice of phrase; it's unfortunate that a press release chooses to disparage alternatives without explanation.

<comment><USER28> Why is that odd? It is pretty much a textbook example of a proprietary standard.

Here are some definitions of "proprietary" as used by members of the FOSS community when talking about standards:

[https://news.ycombinator.com/item?id=4634957](https://news.ycombinator.com/item?id=4634957) (BrendanEich)

>"Proprietary" as in "sole proprietor" is appropriate for a project with zero governance, launched by Google after some incubation closed-source, dominated by Googlers.

[https://news.ycombinator.com/item?id=9395992](https://news.ycombinator.com/item?id=9395992) (pcwalton, Mozilla employee and Rust core developer)

>In a competitive multi-vendor ecosystem like the Web, public-facing protocols that are introduced and controlled by a single vendor are proprietary, regardless of whether you can look at the source code. NaCl and Pepper, for example, are proprietary, even though they have open-source implementations.

<comment><USER29> That is a really odd thing to claim, given that there are so many proponents of the MIT license. People claim that MIT is "more free than GPL" because MIT has less restrictions. GPL has more restrictions, and although those restrictions are there to ensure that the same rights are passed on other people, MIT proponents don't buy that argument: they argue that even if someone forks an open source project, slap a GUI on it and sell it as a proprietary product, no freedom is lost because the original is still available. It does not matter that you cannot contribute to the fork. The ability to make proprietary forks is seen as good.

Yet when applied to Google's products, this is suddenly viewed in a different manner? Even if the maintainer does not accept patches, you can still fork it, so no freedom is lost. And it's ok for _other_ people to make a proprietary fork, but not ok for the author to make a proprietary fork? That sounds like hypocrisy to me.

<comment><USER28> Did you apply to the correct comment? Your post doesn't make much sense. We are talking about standards not code. Code is an implementation of the standard, and the license of the code is irrelevant to the status of the standard.

Forking standards is completely different to forking a codebase. It should be obvious why.

</comment></comment></comment></comment><comment><USER30> I am sure that some entity holds a broad enough patent that all your bases will belong to a Texas court.

<comment><USER31> And that's the real problem. Heck, it doesn't even need to be an NPE, it just needs to be one of the patent holders they're "avoiding" who wants to fire up some litigation.

They don't even need to be able to win. An existing "legit" patent holder might choose to simply throw lawyers at as a tactic to delay or defeat a potential competitor. In that case, it comes down to a cost/benefit analysis for the would-be litigator.

<comment> TD-Linux Certainly the risk is better with a royalty-free video codec, though. In the case of Daala, the goal is to be sufficiently different to avoid these broad patents, too.

Also, any companies contributing to the NETVC standard are required to declare IPR, which is not the case for MPEG standards.

<comment><USER31> > Certainly the risk is better with a royalty-free video codec, though.

I'm not sure what this means. A royalty-free video codec basically has a bullseye painted on it from the perspective of existing rightsholders. The only reason such entities might exercise restraint is because the cost/benefit analysis doesn't support litigation. Even if they don't think a competitor codec is a threat at the outset, there's nothing stopping an attacker from just sitting on the sidelines and waiting until the threat profile (and depth of infringers's pockets) becomes clearer. I.e. the "submarine patent" model, except it could even be a known patent in this case.

edit: clarity.

<comment> TD-Linux Er, sorry, you're right, that was a bad assertion. The submarine patent risk is pretty much the same in both cases - RF does not make it better. Early declarations to discourage use are more likely towards RF codecs, but are also easier to deal with.

I think Daala's development process (and IPR disclosure policies at the IETF) reduce the risk substantially. However, this is not automatically true of any RF codec.

</comment></comment></comment></comment></comment><comment><USER32> So... this is a separate project from Daala which Cisco also works on. Is there a story here?

<comment><USER33> *Daala - but yes, I was wondering the same thing...

<comment><USER32> Oops, I somhowe missed it good catch.

</comment></comment></comment><comment> Ono-Sendai What I would like to see is a video codec that has a library implementation for reading and writing video in that format, that is cross-platform and relatively easy to build, like libjpeg or libpng does for images. I have tried to build VP9 on windows and it was a tedious and ultimately unfruitful process.

I don't really care about the compression ratios achieved, or speed of compression/decompression.

Something like motion JPEG would be good, if it was actually a proper standard (AFAICT it isn't).

<comment><USER19> Motion JPEG isnt resilient. H264/H265/VP9, etc all build on some of the ideas that JPEG introduces, but introduce features that allow for the stream to be resilient to dropped packets or frames.

Its a cool idea, it just doesn't work in practice. Especially since a lot of these video standards are transmitted over UDP.

<comment> Ono-Sendai Interesting. I would have thought it would be reasonably resilient though, due to its intra-frame nature. If you get lost in the stream you could scan forward to the next JPEG header.

<comment><USER19> Thats true in a sense, actually. The thing is with H264/H265/VP9, etc dropped packets or missing data is somewhat acceptable as long as you have a key frame. You just end up with interpolated or 'guess' data (aka the droopy or ice-cream frame effects). With Motion JPEG the frame typically just freezes until another good frame is retrieved and decoded. Motion JPEG isn't a standard though, really, so perhaps what I've seen doesn't match others experiences. mJPEG is cool though for stuff on your local network or other places where you know you'll have a reliable dedicated network. If you have a nice wifi or wired network too you can crank up the quality on an mjpeg stream and get some really gorgeous quality streaming video, as long as the receiving devices can effectively buffer all that network data :)

</comment></comment></comment></comment><comment><USER34> Didn't we already go through this with VP8/VP9/WebM?

<comment> TD-Linux VP9 is a good choice if you want a royalty free video codec right now. NETVC is shooting for the next generation. In addition, the goal is to get the video codec standardized at the IETF.

NETVC participation is open to anyone though, so it is possible more players will show up.

<comment><USER35> "NETVC is shooting for the next generation."

What makes a codec "next generation"? I assume, broadly, it involves trading off more yet more computation for a tighter encode? (As nearly an embarassingly-parallel problem, video coding continues to get faster with more silicon even if serial performance is stagnant.) What kind of gains can we expect from the "next generation"?

All honest questions, BTW. Links welcome, though something focused on this question and not just a laundry list of features with no reference to the past would be preferred.

<comment><USER36> Video encoding is not embarrassingly parallel; no kind of compression ever can be, because if any bit doesn't depend on the previous bit you've wasted it. It is pretty suited to ASICs.

Codecs are only efficient up to a certain image size, and then stop working because all the details are too large-scale for them. HEVC works much better than H.264 on 4K. Besides that, there's higher bit depth pixels, 3D, that kind of stuff.

Also there's usually so many mistakes and compromises in any standard that you can always find something to fix in the next one.

<comment><USER35> "Video encoding is not embarrassingly parallel; no kind of compression ever can be, because if any bit doesn't depend on the previous bit you've wasted it."

That objection makes no sense. That just implies that at worse parallelization may cost some encoding efficiency. In general, we are quite often willing to pay for that encoding efficiency with gusto given the speedup we can obtain. For instance, [http://compression.ca/pbzip2/](http://compression.ca/pbzip2/).

<comment><USER36> * no compression aiming for efficiency can be

If you have that much need for a speedup, you probably have multiple video streams going (like you're Youtube or a livestream broadcaster). In that case, it's better to do one video per CPU, and now you really are parallel.

Also, you can get up to 4x parallel through slice-threads safely on one video, or 16x through x264's frame-threads if you don't care about your target bitrate. I wouldn't consider that embarrassingly parallel until it's up to 1024x or so, but maybe you do.

<comment><USER37> Are there not stages of compression that are highly parallelizable, though? Like basic transformations that operate locally on the image (maybe DCT, per- block motion vector calculation)?

<comment><USER36> Sure, if they worked on the original image.

But that doesn't happen - when you're encoding, the DCT isn't actually run on the image but on the output of previous compression steps (prediction) which are based on the last encoded block. So there's a dependency on every pixel of the image to the upper left of you.

And when you're decoding, it just never ends up worth it to read the whole bitstream so you have a whole frame of motion vectors to do it at once. The whole data locality thing.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER38> There should be efforts outside of large corporations dedicated to building these standards. Because in general even when large corporations promise free / open-source licensing they really only mean non-commercial licensing or "open with caveats". So they pretty much own the commercial rights.

I want open-source to subsidize a small team of engineers to create a completely open standard where no single entity owns it and everyone is free to branch / fork it.

</comment><comment><USER39> There really needs to be a change to patent law around independent derivation of a concept. At very least we need to look into generalised thicket busting laws. The current situation is fundamentally unscalable.

</comment><comment><USER40> Seems to me the success will depend on the quality and whether chip manufacturers will embrace this for hardware encoding/decoding. Right now looks to me like h265 is the winning horse

<comment><USER41> Thor is part of the NetVC effort, tentatively a royalty-free successor to HEVC.

</comment></comment><comment><USER42> i wonder how many orders of magnitude slower this one will be compared to x264. vp8/9 was like 9x slower last time i checked

<comment> TD-Linux It is currently quite a bit slower, but the goal is to make a codec fast enough for real time communication use.

VP9 is still about 9x slower than x264, but yields the same quality at half the bitrate. You can set VP9 to run a lot faster, but you'll lose some of the bitrate advantages. Still, VP9 is practical for a lot of applications, such as Youtube.

<comment><USER43> VP9 being 9x slower than x264 is hard to believe. Do you have a citation?

<comment><USER44> "VP9 encoding (using libvpx) is horrendously slow – like, 50x slower than VP8/x264 encoding. This means that encoding a 3-minute 1080p clip takes several days on a high-end machine. ... libvpx multithreading [encoding] performance is deplorable. It gains virtually nothing."[1]

1\. [https://blogs.gnome.org/rbultje/2014/02/22/the-worlds- fastes...](https://blogs.gnome.org/rbultje/2014/02/22/the-worlds-fastest- vp9-decoder-ffvp9/) n.b. x264 comparisons were taken with `--preset veryslow` which understates x264's potential performance by an order of magnitude. From the same link: "it can be fast, and it can beat x264, but it can't do both at the same time."

<comment> TD-Linux This is old. libvpx 1.4.0 is a lot faster now and has multithreading. On my i7-4900MQ laptop, I get about 3fps encoding 1080p content. Still very slow, but 24 minutes for a 3 minute clip, not days.

</comment></comment></comment></comment></comment><comment><USER45> This seems like fantastic news after the HEVC patent disaster.

Has anyone tested this or has more information on the performance/quality vs other codecs?

<comment> TD-Linux I have, at my website (for objective metrics) [http://arewecompressedyet.com/](http://arewecompressedyet.com/)

Summary is that Thor is performing at a slightly better level than Daala and worse than VP9 or H265. But it's also missing a lot of features right now, and the encoder is only tuned for PSNR.

</comment></comment><comment><USER46> Why not simply work with the VP9 project rather than starting a new effort? Per Wikipedia: "VP9 is an open and royalty free[3] video coding format being developed by Google."

</comment><comment><USER47> So Daala will be fused with Thor like happened with CELT and SILK to create Opus? Does it make sense technically, or they are radically different?

</comment><comment><USER17> Is it common to characterize BSD licensed software as proprietary? As in, 'Google's proprietary VP9 codec'?

<comment> TD-Linux This refers to the fact that the bitstream format of VP9 has not been standardized anywhere, whereas the NETVC group intends to produce a standard.

</comment></comment><comment><USER48> Yay another one!

</comment><comment><USER49> So [https://xkcd.com/927/](https://xkcd.com/927/)?

<comment><USER50> The comparison would be more accurate if most of those 14 competing standards are stated to be proprietary and burdened with patents galore; the stated goal of Thor isn't to try to unify a bunch of standards, but instead to actually create a proper non-proprietary standard.

</comment></comment><comment><USER51> See also the massively popular, and critical-to-rails Gem [https://github.com/erikhuda/thor](https://github.com/erikhuda/thor) \- naming is hard.

<comment><USER52> Isn't Thor a Norse god, too?

<comment><USER53> And a washing machine, and a family of satellites, and a ramjet engine. [https://en.wikipedia.org/wiki/Thor_%28disambiguation%29](https://en.wikipedia.org/wiki/Thor_%28disambiguation%29) . Not listed there, also a special purpose DBMS for small molecule chemistry data.</comment></comment></comment>


Google is starting to scare me - <AUTHOR> https://medium.com/@NateSwanner/google-is-starting-to-scare-me-9f212298f60b <comment><USER2> Just now starting?</comment>


Deploying meteor.js apps to e-paper - luka-birsa http://www.visionect-epaper.com/blog/e-paper-grocery-list/ <comment><AUTHOR> I work for the Metropolitan Museum of Art, and this would be perfect for multilingual labels, and a few other things.

This is exactly what I needed - I've been experimenting with rooting Nooks and making epub's for applications (which are just html/cc/js) but the browsers are not that great and rooting has its own issues.

The 200% premium over a nook may seem a bit high but could probably be attributed to a) much smaller manufacturing run, and b) not expecting to make money off of content sales.

<comment><USER2> Don't forget that with this platform you will spend way less time fiddling with each piece of hardware.

</comment></comment><comment><USER3> That was interesting! I have spent a lot of time with Meteor.js and it is cool to see it used on a different kind of device.

A little off topic, but: from my experience, Meteor.js hits a sweet spot for web apps with shared state between multiple users. It is also reasonable for a single user rich client. Because of issues like needing sticky sessions I don't think it is good at all for simpler content sites.

<comment><USER4> > It is also reasonable for a single user rich client. Because of issues like > needing sticky sessions I don't think it is good at all for simpler content > sites.

I don't think it is meant at all for simple content sites. The whole point is live-refreshing between server and other clients and that whole trick where you do something on device A and it automagically updates the view on device B as well.

Content sites need none of that. But it brings a smile every time I see an "app" site do that. Even though I know exactly how it works and I've done that stuff by hand from scratch. I just can't get over the "Wow, this is magic" feeling :)

</comment></comment><comment><USER5> I'm not gonna argue this is cool, but an iPad Mini is 249€ and you have larger support of "apps" (web or native). Sure, it's not waterproof and you have to have it connected most of the times, but you get a color screen and better touch capabilities.

</comment><comment><USER6> Interesting article. Also, I'd not heard of the e-paper based V-tablet before; seems like a good device to experiment with, so will probably order one the future.

Region redraw is included in the forthcoming Meteor UI [1], which uses the new spacebars engine, so that might negate the requirement to use the Visionect plugin.

1: [http://www.meteorpedia.com/read/Meteor_UI](http://www.meteorpedia.com/read/Meteor_UI)

</comment><comment><USER7> For anyone interested, online documentation is available at: docs.visionect.si

</comment><comment><USER8> 240€ seriously?

<comment><USER2> 1\. You sould know that Nooks and Kindles can afford for the hardware to be loss leaders.

2\. Try getting your webapp on Kindle (there's a real application stack behind V Device).

3\. Try sticking kindle into a bath tub and tell me how it goes.

4\. Try dropping kindle from your hands a couple of times and tell me how it went.</comment></comment>


Show HN: Egora – Spatial Image Board - <AUTHOR> http://egora.co/

<comment><AUTHOR> Hey everyone! This is a project I've been working on for the past year. The goal is to create a platform where users can discuss both local and global content. The main action is in filtering posts by Location and Channel. See what you think! I would really appreciate any feedback/suggestions.

</comment><comment><USER2> So now I can know from where the marine with over 9000 confirmed kills is tracing my IP?

(I'm not bagging on this, I'm just making a joke.)

</comment><comment><USER3> This is cool.</comment>


How I design JSON API responses - <AUTHOR> https://medium.com/@shazow/how-i-design-json-api-responses-71900f00f2db <comment><USER2> There should be only one API design guideline. [http://www.vinaysahni.com/best-practices-for-a-pragmatic- res...](http://www.vinaysahni.com/best-practices-for-a-pragmatic-restful-api).</comment>


Tell HN: If you liked 'our minds can be hijacked,' you'll like Robert Lustig - <AUTHOR> I missed the discussion of the 'our minds can be hijacked' thread that's on the bottom of the homepage, but I have something that I think people interested in that topic may like.
Robert Lustig has written an excellent book on the topic: "The Hacking of the American Mind."
I found that reading the book gave me good insights into how to be happier in my daily life.
If you're curious, his podcast on FT Alphachat is a good introduction and summary of his ideas: https://overcast.fm/+FaTQX2SRE <comment><USER2> I never understood Lustig on sugar. Any macro nutrient in excess can cause obesity. Often fat is more addictive than sugar. After all, many people have given up sugar so that they can eat almost exclusively fat on the Atkins diet.

<comment><USER3> > Any macro nutrient in excess can cause obesity.

I would like to see a source for that from a real world experiment. Have you ever tried to eat fat in excess? It isn't too easy. Macro nutrients aren't addictive when you eat because you need food. When you eat far more calories than you need, they are absorbed easily and stored as fat easily then you have a problem. You should watch his presentations.

<comment><USER2> Check out Jimmy Moore.

</comment></comment></comment><comment><USER4> Dr Lustig is spot on! Basically what he is trying to say is Sugar is Excito- toxin! What that means is sugar hyper-excites neurons therby killing some of the neurons post-excitement. Sugar kills neurons

</comment><comment><AUTHOR> Clickable: [https://overcast.fm/+FaTQX2SRE](https://overcast.fm/+FaTQX2SRE)

</comment><comment><USER5> Mind sharing those insights?</comment>


iOS Security - <AUTHOR> http://images.apple.com/iphone/business/docs/iOS_Security_May12.pdf

<comment><USER2> > Sorry! This document is not publicly available.

>

> The owner has set this document to private.

>

> You will not be able to read it unless the owner changes it to public on > their "My Documents" page, or sends you a direct link.

</comment><comment><USER3> Useful overview of the mechanisms if you filter out the sales-speak, but hard to evaluate for the security layman.</comment>


Ask HN: Where do backlink checking services get their data from? - <AUTHOR> I'm talking about Moz, ahrefs, megaindex and the like... <comment><USER2> There is a comment which was voted dead which actually answered the question. These services have their own crawlers. If you ever spot for example MajesticBot in your access logs you have found one of the biggest.

</comment><comment><USER3> They use distributed web crawlers to crawl 100s of billions of web pages. Probably one of the following options:

1) Built their own crawlers.

2) Using an Apache Nutch/Heritrix cluster in a colo facility.

3) Use 3rd party services like mixnode.</comment>


Ask HN: How does Google Maps transfer '0 byte' images on Street View? - <AUTHOR>

I was reading the answer to this question http://stackoverflow.com/questions/8072921/chrome-dev-tools-size-vs-content on Stack Overflow about 'Size' vs 'Content' on the Network tab of Chrome, and the accepted answer said:
...
"Size" is the number of bytes on the wire, and "content" is the actual size of the resource. A number of things can make them different, including:
* Being served from cache (small or 0 "size")
* GZip encoding (smaller size than content)
* Request/Response headers, including cookies (larger size than content)
* Redirects or authentication requests
...
So I was a little surprised when I was checking the network tab on a typical street view page on Google maps and observed that the size of almost every tile (JPEG) was 0 but it wasn't being served from a local cache nor was it gzipped.
Here's what I see (note 6th column, Size/Content): http://i.imgur.com/VpENUSC.png
How is this happening, how can the file they transfer be 0 on the wire but definitely have content (as indicated) without caching or gzipping?
I'd love some more clarification if I'm misunderstanding something obvious. Thanks! <comment><AUTHOR> Clickable links:

[http://stackoverflow.com/questions/8072921/chrome-dev- tools-...](http://stackoverflow.com/questions/8072921/chrome-dev-tools-size- vs-content)

[http://i.imgur.com/VpENUSC.png](http://i.imgur.com/VpENUSC.png)

</comment><comment><USER2> Could be wrong here but from running some tests myself I get 0 size when loading images from cache but the content stays the same.

I think maybe it's backwards?</comment>


World's longest animal discovered in Australian waters - <AUTHOR> https://www.theguardian.com/environment/2020/apr/15/like-a-spiral-ufo-worlds-longest-animal-discovered-in-australian-waters <comment><USER2> [https://en.m.wikipedia.org/wiki/Siphonophorae](https://en.m.wikipedia.org/wiki/Siphonophorae)

Siphonophores belong to the Cnidaria, a group of animals that includes the corals, hydroids, and true jellyfish. There are about 175 described species. Some siphonophores are the longest animals in the world, and specimens as long as 40 meters have been found. The majority of siphonophores are long and thin, consisting mostly of a clear gelatinous material.

[http://www.siphonophores.org/index.php](http://www.siphonophores.org/index.php)

Up-Close With a Siphonophore, a Colonial Organism | Nautilus Live

[https://m.youtube.com/watch?v=OeflgYWxyVI](https://m.youtube.com/watch?v=OeflgYWxyVI)</comment>


Ask HN: Are slavs in the US treated as disadvantaged minority? - <AUTHOR> Slavs are significantly poorer maybe even poorer than African Americans.
As a slav that is looking to immigrate to the US I am interested if some of the programs that should bring more opportunities to POC also apply to me.
I live on $480 a month at the moment. <comment><USER2> Americans mostly only care about other Americans (if that) - i.e the "Black lives matter" is just a shortcut for "Black Americans matter" \- they don't give a rat's ass about black people living in horrible conditions anywhere else in the world. They certainly don't care about your situation as well.

<comment><USER3> Yeah it's actually pretty funny/ridiculous. The level of racism, inequality, and lack of upward mobility in other areas of the planet is much much much greater than in America. Let alone the levels of _codified_ injustice.

</comment></comment><comment><USER4> I don't think you live on $480 a month because some Americans enslaved your distant ancestors and many of them spent the ensuing decades after enforced emancipation everything doing possible to informally preserve the master-slave dynamic...

As for the people disadvantaged economically simply by not being born in the United States, there's a billion or two people earning less than you and a lot of them would love to move. So I'd suggest emphasising you've got the skills instead :)

</comment><comment><USER5> I'm unsure what you mean. Typically Slav's aren't considered to be a minority in the US. There tends not to be any official programs to support POC of color in the US. Most everything is based on economic circumstance. Immigrants except for refugee's typically aren't eligible for much of anything.

</comment><comment><USER6> Employers aren't allowed to discriminate against you based on your national origin. But I don't think your nationality will fit in any of the diversity measures that companies are looking at. They mostly focus on gender, ethnicity, and maybe religion or sexual orientation.

Assuming you are a white male, there will not be any special initiatives for you. If you are female, there are some additional opportunities depending on the company.</comment>


To Jupyter and Beyond: Interactive Data Science at Scale with OmniSci - <AUTHOR> https://www.omnisci.com/blog/to-jupyter-and-beyond-data-science-with-omnisci <comment><USER2> Looks very interesting. But when would I want to use OmniSciDB and OmniSci charts? I am not a working data scientist so my understanding here is limited.

<comment><USER3> OmniSciDB is useful when you need really high-performance from a relational database. Think <100ms query times over billions of records. This level of performance is useful for streaming use cases, operations, repeated drilling into subsets of data, etc.. Note that OmniSciDB refers to the open-source relational database portion of our product.

Using any of the OmniSci open-source charting libraries is useful when you want to do something using only OmniSciDB (i.e. not wanting to purchase Enterprise Edition), or when you want to create a custom visualization that isn't provided by OmniSci Immerse (our commercial visualization tool). Some of the work referenced in the blog post was in partnership with the creators of the Vega.js library as research into high-frame rate and large data interactivity in browser visualization

<comment><USER4> RE:Streaming, Graphistry wrote much of the Apache Arrow JS lib to optimize for this case of streaming GPU DBs -> GPU browser frontends, you can see a pretty striking before/after here: [https://www.graphistry.com/blog/experiencing-the- future-of-g...](https://www.graphistry.com/blog/experiencing-the-future-of- gpu-analytics-using-nvidia-rapids-and-graphistry) . JS networking devs _can_ handwrite that stuff.. but it stinks, and this way, everyone benefits. I recall Vega folks had some fun experiments with GPU DB -> CPU frontends here (ended up part of an HCI or VLDB paper?), not sure what happened since. Our production focus on that layer is now more on scaling up node js cpu+gpu code <> pydata GPU code (Nvidia RAPIDS).

For OmniSci folks: Cool to see Jupyter embedded! Our more advanced users love this path, but we find versioning & team collab tricky in big enterprise settings, so every additional company and (hopefully) contributor here should help. Getting there :)</comment></comment></comment>


Why doctors are sick of their profession - <AUTHOR> http://online.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361?mod=WSJ_hppMIDDLENexttoWhatsNewsSecond <comment><USER2> Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a non-profit society for medico-legal cover. If I want to I can do additional private sector work to earn more (but I don't). I live in a country where a high standard of medical care and longer life expectancy is provided for less than half the per capita health spend of USA, and the public health system is so good that the private health sector really does struggle to offer much additional benefit.

There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Some of the WSJ comments list all the problems inherent in the US system and then blame socialism for them when the problem is completely the opposite?

<comment><USER3> The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the US (pop: 313 M).

The United States is an enormous country comprised of 50 separate state governments, where the powers of the federal government are extremely limited (both by the constitution itself, and by the fact that it is practically impossible to do anything at that kind of scale).

As a result, it is extremely hard to pass any sort of massive reforms. Can you imagine how difficult it would be to pass one single, uniform system of health care for all Europeans?

Talking about solutions that work well in smaller countries is all well and good, but the reality is you need different solutions if you want them to work at scale. It's the same reason why most of Facebook's backend is now written in C++ instead of PHP. It is much more painstaking to work with and harder to pick up but when you're building a huge system of interconnected parts you want something that isn't going to fall over and die suddenly.

The supposed chaos and gridlock of the US political system is a feature, not a bug. It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest.

EDIT: Sorry - not saying the US's healthcare system is the best it can be and didn't make that clear enough. Just saying that comparing it to other countries won't help as the US has a unique political reality.

<comment><USER4> I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead.

If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy and so don't participate in financing those who are sick by costing the system less.

As they grow older and get sicker they end up paying insane prices unless they are paid by employees and even there the quality of the insurance varies and you still have some really absurd pre-existing conditions rules etc. If you don't have an employer to back you up you are basically screwed.

Obama Care is an attempt at solving this issue. It's not single payer but it's closer and hopefully it will help improving the healthcare system for millions of those without either healthcare or proper healthcare.

Now in my mind there is a middle ground where you pay most of your healthcare yourself (the checkups, the sinus infection etc) but you don't end up in endless debt because you become sick, your kid gets born to early and have to stay at a neonathal facility, for a longer period of time and don't have the right insurance.

And having been through the system I must say that if people think it's less beucratic than say they Danish system (which is much more social in its approach) then they would be mistaken. The sheer number of interests involved in any single episode creates complexity way beyond what seems reasonable.

So agree it's not possible to take a small nation and apply what they do, but it is possible to look at the current system and realize that the healthcare system in the US is def not a feature but rather a system with plenty of room for improvement.

<comment><USER3> Sorry - edited my post to make clearer the fact that I'm not saying the US's healthcare system is good. I just think that comparisons with other countries are futile. My comment was intended to be a general one about the way politics works in the US.

<comment><USER4> The countries in the EU which is 400mio serms to be handling this ok and thats even with national laws. You might say the realpolitics will nok make it possible but its not a scale problem but rather a political one.

</comment></comment></comment></comment></comment><comment><USER5> I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment.

There is no chance I would do it again.

<comment><USER6> The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral.

The good news is that your rights are inalienable, you can reclaim them at any time. The doctors should go on strike and reject the assumption that anyone has the right to their work. As a patient I would support the doctors 100%. Let's see how long medical services last without doctors or how laughable it will be when the govt tries to force doctors back to work. LOL.

Health Care is Not a Right. [http://www.afcm.org/hcinar.html](http://www.afcm.org/hcinar.html)

NB: I recently dropped all my medical customers at significant drop in revenue because of HIPPA. You think things are bad now wait until that monstrosity becomes strictly enforced.

<comment><USER7> >when they agreed that people had a right to medical services ... It was self- imposed slavery...

We've had rights to medical services in most of the developed world outside the US for decades. Doctors have high salaries and reasonable conditions for the most part. Funny version of slavery.

<comment><USER8> The use of the term "slavery" here is pretty standard rhetoric used for emphasis by the American libertarian movement; its use descends from the vocabulary developed by the body of anti-Socialist thinkers in the early to mid-20th century.

A more sophisticated rhetorician would argue that the various bodies of your society (those who pay for the universal medical services via taxation, those who partake of the medical services offered, those who actually provide the services (i.e. the doctors), and those who administer and regulate the provision of service) have all internalised and unconsciously accept a worldview which debases and discredits the right to free action of individuals in society. You may not be slaves in the classical sense of being enslaved by a third party, but from the perspective of someone with a "strong" view of personal liberty, you are in a sense enslaved to your own lowered expectations and faith in liberty.

So while you might all claim that you are perfectly content with your current system, your critic would view your opinions as hopelessly biased, and point to what they would classify as numerous instances of the poor results of socialised healthcare (incessant arguments about over-spending and budget problems, claims of corruption in service administrators, complaints of high wait time and low quality of service, low morale and satisfaction among service providers) as evidence to strengthen their claim.

<comment><USER8> Wow. It absolutely astonishes me that someone would downvote this. Since when is clarifying a use of a term, then demonstrating what a contrary point of view would look like - without once stating my own personal opinion - downvote-worthy?

This is just disgusting behaviour to see on Hacker News.

<comment><USER9> Sometimes downvotes are accidental, especially on phones.

</comment></comment></comment></comment></comment></comment><comment><USER10> I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the system with professionals at each level of the training pyramid doing their part. We do this to be efficient and cost effective, but speaking from personal experience, the side effect is that information gets lost from transfer to transfer and a patient has less time to bond with a doctor. I'd like to believe that many doctors would be happier working with a patient from start to finish like in the old days.

<comment><USER11> What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale.

My optometrist (the guy selling glasses) measured my eye sight and found that I needed a correction for some corneal irregularity (pardon me if I did not translate the terms right). I had never been given such a reading from my ophthalmologist (eye doctor) who just wrote down dioptry corrections. My optometrist then told me that the specific doctor never wrote down these numbers (i.e. ignoring a condition). This tought me a lot about medical professionals and highly educated doctors. My doctor probably is just a little bored to measure and monitor visual acuity changes in a person with small eyesight issues. That ophthalmologist also had very good reputation working with accident victims, etc.

<comment><USER12> > positions somewhere between a nurse and a doctor

They call that a physician's assistant or nurse practitioner. The latter has the nurse's more user-centric approach but can do pretty much everything a general practitioner does, including writing prescriptions (though not in Texas, yeehaw).

<comment><USER13> Not to be too pedantic, but the profession is "physician assistant", not "physician's assistant." They typically have master's degrees (and all will be required to have master's degrees by 2020), can practice medicine in most specialities (including surgery, pediatrics, etc.), and can prescribe medicine in all 50 states.

Note: I work for the Physician Assistant Education Association.

</comment></comment></comment></comment><comment><USER14> This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ([http://jseliger.wordpress.com/2012/10/20/why-you-should- beco...](http://jseliger.wordpress.com/2012/10/20/why-you-should-become-a- nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of- medical-school/)), which explains everything my girlfriend wishes she'd known before she started.

<comment><USER15> I've read this before, and feel obligated to state I couldn't _disagree more_. And this is coming from someone who quit the profession (physician).

Be a nurse or PA because you have shadowed one, and enjoy the work. Their job is different than a Physicians, and personality (etc.) plays a part in which you'll enjoy. Additionally, the available specializations in medicine are something thats simply not available outside the profession. Don't settle for one or the other, choose the one that suits you.

</comment></comment><comment><USER16> Demographics is huge headwind for doctors. In the past 30 years, median age of the population in North America went from about 27 to almost 40 and is still rising.

Doctors are usually on a fixed fee for service arrangement but every year as people get older, the length of time it takes to perform the average "service" goes up. The amount of time and ressources needed to treat older patients is almost exponential with age. Older patients' state of health is often very complex with all kinds of interactions between illnesses and medication side effects to manage. Sick people get more "services" but also each service takes significantly more time to perform. Yet doctors are expected to be able to perform as many of them each year.

There is an oversized population of people in their fifties right now. This is the age where people start to get sick but are still young enough that they are often the main income earner for their family having one or more dependents.

Doctors have to work more hours for less money trying to help families cope with increasingly common and tragic medical conditions. When a family is collapsing because of an illness and people pile up in the doctor's office (justifiably) in tears, there is no ethical way to "process" these patients in the time that is supposed to be allocated to them.

</comment><comment><USER17> I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.

<comment><USER18> It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it more difficult to acquire funding, a higher probability of failure on launch, and lower returns even when they do manage to "crush it."

This has already happened to older engineering professions and it has already happened to sectors of the software engineering world that have a different supply/demand balance than the mainstream (see: game developers). It will happen to us too. Hopefully not in the near future.

<comment><USER19> I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games.

However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.

<comment><USER18> Demand is too low, supply is too high... potato potahto.

We won't run out of work across all sectors. EEs still have work. Chemists and Biologists still have work. Aerospace engineers still have work. And lots of it! But the supply/demand balance has shifted enough in their respective sectors to have a very concrete impact on their compensation.

</comment></comment></comment></comment><comment><USER20> All this sounds quite a bit like Marx's theory of alienation:

 _" The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own the things and use the value of the goods and services, produced with their labour."_

[http://en.wikipedia.org/wiki/Marx's_theory_of_alienation](http://en.wikipedia.org/wiki/Marx's_theory_of_alienation)

<comment><USER21> The article makes the opposite point - that government bureaucracy (and the mal-incentives it creates) is what is killing the relationships between doctors and patients.

<comment><USER22> I didn't see any discrepancy: both the article and Marx are criticizing the alienating effect of the added bureaucracy and the lessening of the doctors' autonomy.

</comment></comment></comment><comment><USER23> Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days.

Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods.

Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals.

A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article.

Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"

Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes.

One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing.

I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"

<comment><USER24> > A lot of doctors translate this to a lack of respect, which echoes the > quoted statement in the article.

Does this mean a lack of general respect, the type that all people deserve? Or is this some kind of extra respect and dererence due to their education or profession, which no one deserves?

Because I am constantly disrespected by the medical profession. I am sent email a day or two before each appointment, reminding me that late or canceled appointments are subject to cancellation fees, yet I have NEVER been seen on time by any doctor ever.

<comment><USER23> Just a general level of respect, from what I can gather. This is all second- hand info of course. But the stories they've told me seem to indicate this.

I should have added that my friends are specialists, not general practitioners. I've heard lots of complaints about general practitioners too, in terms of late and canceled appointments, little to no interaction, being rushed out the door, etc.

</comment></comment></comment><comment><USER25> I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me.

Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.

</comment><comment><USER26> The business model for doctors works out to is surviving a grueling educational process to gain a license against which they charge rents.

The business model for professional athletes devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.

The business model for performing musicians devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.

This has a personal cost.

</comment><comment><USER27> I think another frustration doctors are feeling today is due to a lack of patient-doctor relationships.

Society views doctors as tools that society has a legal right to.

</comment><comment><USER28> Surprised the average income for a GP is $161,000 in the US, thought they would be paid more than Canadian MDs who's average is $300k [http://www.theglobeandmail.com/life/health-and- fitness/healt...](http://www.theglobeandmail.com/life/health-and- fitness/health/how-much-are-canadian-doctors-paid/article7750697/)

Canada also heavily relies on US medical labs in Houston. I had to have a blood analysis done as part of a health check for a work contract years ago and my provincial health authority shipped my samples there for testing. It's cheaper for Canada to outsource all this work to Americans wonder what they are paying lab technicians.

<comment><USER29> A little strange to be comparing American GP average income to the average income of all Canadian MDs given that GPs are paid much less than average.

"Geoff Ballinger, manager of Health Human Resources for CIHI, said the figures represent averages and vary significantly depending on a doctor's specialty. For instance, the average family practitioner would earn less than a neurosurgeon or cardiologist."

[http://www.theglobeandmail.com/life/health-and- fitness/healt...](http://www.theglobeandmail.com/life/health-and- fitness/health/mds-gross-income-307000-report-finds/article7640498/)

</comment></comment><comment><USER30> We've all read about how much health care costs in the US, but I'd like to know: Into whose pockets is that money actually flowing? My guess is that those people will be doctors, even if directly caring for patients isn't how they make their money. From what I've gathered by reading about this over the years:

* More than half of doctors are self employed, meaning that their salaries don't tell the whole story about their incomes.

* Doctors are heavily invested as stockholders in provider businesses (insurance, HMO's, etc.), and the malpractice insurance industry. Until recently, my employer-provided health care was delivered by a large organization that was entirely doctor-owned.

Sorry, no links or evidence for either of these, and I think the gathering of that evidence may be difficult due to the complex financial relationships involved. But it makes me skeptical when I read about doctors struggling against "the system." Who owns the system? It may very well be that medical care costs less overseas simply due to a simpler system where costs can actually be tracked. Medicine might become a better profession in the US if med school were free, doctors worked for a salary, and everything else was owned by the government.

To be fair, it may be doctors exploiting doctors, and your career prospects upon finishing medical school may have a lot to do with how much investment money (e.g., inheritance) you have at your disposal to buy into the portion of the business that ultimately profits.

</comment><comment><USER31> 1\. I understand their frustration! 2\. Yes--you are fighting with insurance companies; So are your patients. 3\. No--you are not the "pillars of society" anymore. (That's change has been slowly taking place. Patients educated themselfs, I don't know, but patients wised up; they realize when when they are dragged in for unnecessary office visits--just to invoke another billing.) 4\. O.K.--You are not making the money your father did--neither are most of your patients; the world changed. Hopefully, things will get better. You guys deserve Tort Reform--I think, but then again I sometimes feel the only reason you guys pick up the phone, or refill a prescription is because you you don't want a lawsuit. (It pathetic I'm even thinking like this?) 5\. In the end, we are all in this mess together, and one day You will be a Patient. 6\. I swore I would never comment on HN again. (The political Correctness is stifflling, but I needed to respond to this article.) 7\. Goodbye again. That said, if you have realatively good genes, and you eat somewhat healthy; I would steer clear of most Doctors. I never thought I would say that about allopathic physicians.

</comment><comment><USER32> I am a physician in Australia. Being a doctor sucks here too.

I encouraged my son to avoid medicine. He followed my advice and is enjoying himself in private equity.

Anyone bright enough to do medicine would do far better in another profession.

<comment><USER33> "Anyone bright enough to do medicine would do far better in another profession."

Just as a point of reference, I'm in the U.S. and not a doctor. But I've always seen careers in medicine as a kind of social scam. Not necessarily a bad one, but there is or was something funny going on.

A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. The only thing society can really offer doctors is independence and respect. That's why -- for the longest time in this country -- doctors often owned and ran their own practices. That's why we addressed doctors with the honorific "Doctor." But the first is all but dead in this country and the second, because of some kind of unwashed, egalitarian ethic that only gets worse and worse, is starting to die out too.

We've really fucked up, as a society. No one in his or her right mind is going to want to spend life kow-towing to pervasive regulations and third-party bureaucrats second guessing them and tying their hands, while rushing to and fro like a retail clerk in an understaffed big box store, and all the while having to protect the egos of patients by introducing oneself as Bob or Sally.

Doctors need prestige and independence. Without those, the lure of "doing good" just isn't enough to convince anyone to become one -- at least, not anyone I'd want to have to trust as a patient.

<comment><USER34> > A person smart enough to be a doctor could be many things and earn a lot > more money doing one of those things.

Is that really true? Doctors are most of the best-paying jobs in the US [0] It seems to me that if you're bright, and care about making a lot of money, medicine is absolutely the way to go. Yes, there are some people who strike it rich with startups or high finance, but that's essentially buying a lotto ticket.

[0]: [http://www.bls.gov/oes/current/oes_nat.htm#00-0000](http://www.bls.gov/oes/current/oes_nat.htm#00-0000) (sort by annual mean wage, Anesthesiologists, Surgeons, Oral and Maxillofacial Surgeons, etc.)

<comment><USER33> I read this years ago. Google is a wonderful thing:

"Gilded Paychecks: Lure of Great Wealth Affects Career Choices." NY Times. November 27, 2006.

[http://www.nytimes.com/2006/11/27/business/27richer.html](http://www.nytimes.com/2006/11/27/business/27richer.html)

<comment><USER34> The first step of that career path is still "Become a doctor"

<comment><USER33> Yes.

      * Get your M.D.
      * Do anything afterward, except practice medicine
      * Profit

That's what that article is saying.

I think being a doctor is about more than making money. But it isn't simply about helping people and making a good living. Smart people want to be able to exercise their own judgment and initiative. We need to be careful as a society, or the people we want as doctors are going to be the people we chase away.

</comment></comment></comment></comment></comment></comment><comment><USER35> Is Obamacare going to be the first step towards making the U.S. a socialist country ? Is the true goal to reditribute wealth ? It is meant here, [http://www.mymustardseeds.com/ultimate-goals-of- obamacare.ht...](http://www.mymustardseeds.com/ultimate-goals-of- obamacare.html).

Or is it just verbiage to shine for the next election ?

Will people suffer from Obamacare ? Are consequences to the whole system really under control (increase of the premiums, ...) ?

</comment><comment><USER36> Most important takeaway (other than a series of anecdotes, a general history lesson, and a few random undefended policy suggestions):

"In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income."

</comment><comment><USER37> Do you know what's incredible?

Plenty of SDE 2s make more than 200k a year, and plenty of doctors don't.

I'm not sure if we are overpaid or they are underpaid.

<comment><USER38> we've got the market playing for us. Once supply catches up, there won't be as high of a salary.

</comment></comment><comment><USER39> More work for less pay huh? Being squeezed by profit taking business people at the top... surely no one other than doctors can relate to such changes in the economy.

*Edit I am of course being a bit sarcastic. It's interesting to see how shifts in the general economy are changing the medical profession.

<comment><USER40> That's not a helpful comment. It's already addressed in the article anyway:

 _Of course, doctors aren 't the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect._

Personally I think the history lesson in the article was great. It makes me wonder about programmers. We are riding high now. But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. I'm actually happy that the FTC has stepped in and constrained certain companies.

<comment><USER41> > But if we keep producing software that neglects user intent, then perhaps we > will also find ourselves regulated.

Regulation is why those professions had autonomy, status, and respect in the first place. Without legal protection, a "professional" is just a laborer, and capital always wins out over labor in the end. Temporarily the software industry is growing so quickly that programmers have a lot of leverage, but that will end. The "corporate structure" will absorb more and nore of the value created by the professional.

And that's a good thing, right? Protectionism is bad, leads to higher prices for everyone. Why should doctors or programmers be protected more than Wal- Mart shelf stockers?

</comment></comment></comment><comment><USER42> You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :).

I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I often suspect is horribly outdated.

I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

<comment><USER43> > I've never seen a doctor research anything either

That's a little surprising to me. One of the coolest things about practicing medicine today is that I can pull out my phone in front of a patient and find guidelines that I'm not familiar with, medication side-effects, and other point-of-care resources that really do enhance my clinical ability in real- time.

Granted, I work in a hospital setting. Maybe it's different in the clinics.

BTW, though I feel I'm underpaid for what I do (which many outsiders would find ridiculous), I'm overall pretty happy with being a physician.

> I'd take a crowd sourced db of health info over a doctor's personal > knowledge any day of the week.

So would I. But what you'd learn in the first week of hanging out with a doctor in a typical clinical setting is that most patients are frankly too uneducated to be able to use that kind of tool. When I did residency, I suspect most of the patients I saw didn't have internet. Many were illiterate and a disturbing number simply didn't care about their own well-being.

I'd love to build up a practice with patients like you, but people like you tend to be pretty healthy.

<comment><USER44> > When I did residency, I suspect most of the patients I saw didn't have > internet. Many were illiterate and a disturbing number simply didn't care > about their own well-being.

> I'd love to build up a practice with patients like you, but people like you > tend to be pretty healthy.

There's also the factor that teaching hospitals tend to get a lot of poor and uneducated patients. Private clinics have a different clientèle, and there are definitely plenty of individuals out there who are not in perfect medical condition, yet are educated/informed enough for doctors to interact with on a higher level than they currently do.

</comment></comment></comment><comment><USER45> In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.

<comment><USER46> > but come on they save lives.

I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem.

Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously haven't spent a lot of time around doctors/clinics/hospitals.

Most doctors rarely save lives, and often when they do it wasn't them that really did the critical life saving steps, they're just the interface the sick person is interacting with. Most doctors deal with a series of inputs (symptoms and circumstances) and output a solution (diagnosis and remedy), which requires very little critical thinking on their part. Sick kids with the flu. Idiots that took too many drugs that need fluids, benzos, cypro, or an ice bath. People at mid-life who made shitty decisions for most of their lives and now need Lipitor/Coumadin/a treadmill/a gravestone.

The truth is most doctors get paid a lot because people erroneously assign to them the ethos of miracle workers, when most of them aren't. In fact, they often can't even do anything for their patients (see above, such kids with the flu, old people who've made shitty decisions their whole lives). The cures really come from researchers and pharma companies that come up with drugs and treatments for these incredibly difficult problems. If doctors deserve their paychecks, it's because they keep alive the illusion society wants. The illusion that when something is wrong, the doc will fix them up good. And indeed that's basically what the article is about. Doctors demand respect and to be paid to keep up the illusion and to deal with the bullshit.

[1] Obvious and important exceptions to this are ER docs and trauma surgeons, who indeed save lives. There are also clinical doctors, who work tirelessly with armies of researchers to try to find new cures for cancers, autoimmune and genetic disorders (among many other things). There are surgeons who come up with new procedures to reduce the invasiveness and trauma of procedures. These are the people that deserve the lion's share of the praise that goes towards doctors, and they should get the lions share of the money as well (some certainly do).

In this whole rant, I'm not trying to lay blame on doctors for the whole mess, because problems come from all sides, as I've hinted. Patients have unrealistic expectations of what doctors can do, the health industry is trying to low-ball doctors (not always without reason) to maximize profits, and many doctors who thought they would be genuinely helping people are realizing in reality that fate is largely decided before they even meet their patient (as a criminal lawyer friend put it, "90% of my client's case is decided before I ever meet him, but he wants me to work miracles!").

This is specifically why I didn't continue into medicine like so many of my friends. If you really want to help people, you don't become a regular doctor. You become a thoracic surgeon, or you do basic research, or you work in pharma, or you start a biotech. That's how you cure people. But no one will praise you for it.

<comment><USER47> Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly.

You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions really does enable patients to live longer and more fully.

You are also wrong regarding income. Doctors in the US are getting paid less and less, while expenses of practice go ever higher. My own income is probably less than most of the people I know in other professions.

The "mess" of the health care system (to the extent it is even systematic) is the result of the constant assault of corporations and governments at all cost to "reduce costs", but the result has been the degradation you and others notice.

The most conspicuous evil has been perpetrated by the insurance industry. For example, amazingly short-sighted insistence on paying for a "generic" medication $3/mo cheaper than the drug already working is an every day challenge. If patients don't get what is really needed, they wind up getting sicker, need more care, the result is more money spent, not saved.

The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. People are not neat little uniform units produced in factories. People are enormously complex organisms that defy all rules we invent to "explain" illness and treatment. People are unique entities that require individual attention and customized approaches if true "health care" is going to be provided.

If doctors are given the resources, time and respect to do their work, I believe almost all will strive to do it right.

<comment><USER48> > The problem is that the industrialization of medicine makes it increasingly > difficult to be helpful.

Atul gawande, which is a doctor and a healthcare journalist ,and knows the medical system from inside, thinks that industrialized medicine is exactly what's needed:

[http://www.newyorker.com/magazine/2012/08/13/big- med](http://www.newyorker.com/magazine/2012/08/13/big-med)

And in general the positive results from decision support systems seem to agree with him.

<comment><USER47> Of course, talking about the US health care "system" is hazardous given the enormous diversity of systems within it.

No doubt there are instances whereby particular "industrial" implementations function well. But there are also many that function poorly. "Industrialization" is a term that can be applied to mean numerous and distinctly different things.

I was referring to situations I've observed where doctors are restricted from taking time when necessary to evaluate complex cases. Facing a patient with several serious conditions interacting and combining is far different than dealing with a patient having one condition.

It's impossible to do the job well when "bean-counters" insist on scheduling tightly and emphasis is on "production". This is particularly problematic in primary care settings.

Having been involved in quality assurance activities for many years, I fully understand the value of consistency, adherence to rational protocols, etc. But the ability to deal with "outliers", especially when the exception is the rule, is where "industrialization" is at risk of failing.

<comment><USER48> Yes i agree, sometimes "production" goes too far. In some of those complex case it's even wiser to allocate much more time in advance from doctors and nurses, to prevent future complications - which are much more costly.

But i wonder:

On what sources do you rely when it comes to managing complex cases ? is it only known hard coded medical data in books and databases ? or also some intuition ?

And if it's intuition , how can you form intuition for such complex cases where really each case is pretty unique , as you said ?

<comment><USER47> The ancient wisdom is the practice of medicine is as much art as science. There is "evidence" supporting many practices. As in every complex endeavor, evidence is not static, but evolving constantly.

Evidence is necessary but by itself insufficient. We must use our own power of observation combined with what we know and what we've learned to decide what to do.

So your question is indeed profound, cuts to the core of the issues. Intuition is one way to phrase it. I once heard a colleague say we're not paid because of what we know, but for the judgement we exercise about advice or treatment to offer.

Each human is indeed unique. Even identical twins are in fact not exactly the same. Rules have limits when no two cases are precisely the same, it always comes down to that very intuition you are intuitively aware of.

After all, we frequently wish to have a second opinion. I do often enough too. I like the saying, get 5 experts in a room, and you're likely to get at least 6 opinions on any subject.

Who said decisions should be easy? I sweat over each and every one.

<comment><USER48> > Who said decisions should be easy? I sweat over each and every one.

True medicine is a really hard job.

So maybe the way decide in medicine should be changed ? maybe they be done remotely but through a recommendation system so that each doctor would get plenty of nearly similar cases - so he could practice and hone it's intuition ?

Or since the complexity is really too great (and as a patient hearing that "this is art not science" isn't that encouraging , even if true) maybe the overarching goal of medicine should be to remove the art, and we finally have the tools to do it(watson, machine learning ,remote diagnosis , etc...) ?

And if we agree that that's a good goal, maybe the current way we try to do it (evidence based medicine) , is a bit clumsy due to both the science and the resistance by doctors , but at least it's going in the right directorion.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER49> Going into a career because it's noble, rewarding or because it "helps people" seems like a mistake.

<comment><USER50> Going into a career because it's rewarding seems like a mistake?

<comment><USER51> I think he meant financially.

<comment><USER49> I think it's a mistake whether for financial reasons or in terms of personal satisfaction. You go into a field because you are interested in learning and engaging with the problems in that field. Not for status or rewards.

You can't _enter_ a profession on the basis that it will be personally rewarding. You can only leave because it turns out not to be.</comment></comment></comment></comment>