If You're Nervous About Quitting Your Boring Job, Don't Do It - <AUTHOR> http://calnewport.com/blog/2009/12/26/if-youre-nervous-about-quitting-your-boring-job-dont-do-it/

<comment><USER2> _My point is that if I wanted to start my own company (which I don't), I wouldn't feel nervous. The reason is clear: By earning a PhD in computer science at MIT I developed a skill that's rare and valuable to this particular economic segment._

So this guy thinks that getting emails from recruiters means that he has what it takes to be an entrepreneur? He thinks that a degree you get from a University teaches you something about running a business. Oh, and by the way, he would be fabulously successful at it _if he wanted to_. Yeah, I could dunk over Shaq too, it's just that I don't have any _interest_ in playing basketball.

Being an entrepreneur has so little to do with skills (you can always learn those). It's about decision-making, ability to learn and pivot, and guts. Frankly, I find this guys ivory-tower preaching to be grating. He doesn't know jack about entrepreneurship and yet he's willing to take a dump all over someone who happened to be starting their first business in a market segment that was hit terribly hard by the recession.

<comment><USER3> Indeed, it seems to me that he would fail miserably at starting a company because he equates the product/service his company would make/offer with his education.

It's as if Google would have been successful just by branding their search as "Google - the search engine developed by Stanford PhD's"

What's rare and valuable are people that accomplish a lot with a little. I have no idea if the culture at MIT preferentially fosters that kind of dogged resourcefulness, but thinking you're done before you even get started because of a handful of letters on a piece of paper is a start in the wrong direction.

<comment><USER4> _he would fail miserably at starting a company because he equates the product/service his company would make/offer with his education_

I think you misunderstood the post. The author said nothing about how his PhD would directly relate to starting a new company (the author's research is theoretical, anyway). Rather, the point is that by acquiring a valuable skill (a PhD from MIT), his risk profile is lower: he could go and start a new venture, or equivalently wager all his assets at the roulette table; either way, his skills mean he would be able to find a good job if the gamble doesn't turn out well.

If you like, substitute "MIT PhD" for "become one of the top 5 Linux kernel developers" for an equivalently rare, valuable skill that would help to ensure future employment.

<comment><USER3> Upon rereading, I agree with your assessment, but the crux of the issue is that his example of Lisa isn't so "pristine."

He argues that her small business failed because her skills weren't rare and valuable. Then he says his skills _are_ rare and valuable.

A consistent argument springing from those two statements would be either a) my business won't fail because my skills are rare and valuable, or b) Lisa can't find another job in marketing (the job she held for a decade before quitting) because _those_ skills aren't rare and valuable.

He didn't make either of those arguments, instead focusing on her yoga instructor skills. It makes for a muddled post.

</comment></comment></comment></comment><comment><USER5> There's a corollary in here: if you're early in your career, _optimize for skill-building as much as possible_. It doesn't matter whether you're building skills at someone else's company or at your own (though the former pays better), but it does matter that you're building them.

I quit my day job a couple years ago to found a startup with a friend. The startup flamed out miserably, and in hindsight I was woefully unprepared. But the skills I learned at my startup set me up for my _next_ job, where there are many more opportunities to learn further skills. Hopefully by my next attempt, I'll have enough "rare and desirable" skills to make it succeed.

Come to think of it, this may make a good litmus test for when to leave your job. Quit when the opportunities available for skill building are less than what you'd learn from a failed startup.

</comment><comment><USER6> This is the third article in last 24 hours in the top list where the author uses straw man to shove his own view forward by attacking an incorrectly interpreted opposing view. I hope it doesn't become a trend.

Using your nervousness level to gauge if you should go forward is as flawed as you can get. Some of the best achievers in their field--Tyson, Kobe etc.-- admit to getting nervous.

<comment><USER7> It also struck me as rather smug and arrogant: "You can't quit your job, but I have a PhD from MIT, so I can." Geez buddy.

<comment><USER6> Absolutely. The part where he says he doesn't feel nervous about doing a startup because he has a PhD from MIT. I almost threw up.

I don't know any start-up founder that cites his degree as a key motivation for doing a start-up.

All this is really sad because I think someone can write a solid post about the possible downsides of quitting your boring job and what precautions to take. This guy is trying to do that - but in all the wrong ways.

<comment><USER4> _I don't know any start-up founder that cites his degree as a key motivation for doing a start-up._

Nowhere does the post suggest that a PhD is _motivation_ for doing a startup. The point is that if you have a valuable skill (whether a PhD or experience as a successful VP), if you take a risk, you'll still have a comfortable position to fall back on.

<comment><USER6> PhD -> not nervous -> do startup

I'd say that qualifies as motivation.

</comment></comment></comment></comment></comment><comment><USER8> MIT has a mailing list devoted to CS-related job opportunities. In the last few years I've gotten over 6500 joblist emails. I recently graduated and I'm working hard on my first startup, but not a day goes by without a few emails that catch my eye. The author writes:

 _much better jobs are out there, but they're only available to people with much better skills than most of their peers_

There's a lot of truth to this statement. It almost seems unfair that my inbox is filled with jobs, while people like my mother and some of my friends spend hours sending out their resumes.

<comment><USER9> Were your mother and friends unable to acquire the required skills, or were they simply not interested in doing so? Perhaps there are thousands of job requests, but few that would suit your friend's taste?

I am pretty sure even your mom could become a Java developer...

<comment><AUTHOR> i don't know about the exact nature of these jobs emails, but oftentimes the positions are only advertised to current students and recent alums of the universities. even if his mom could learn java quickly, she might not be eligible for those jobs, since they want to interview fresh-faced 20-year-old college seniors from College X

<comment><USER9> Yeah, there are always excuses.

</comment></comment></comment></comment><comment><USER10> The only useful thing in the article is the message that "if you can get a job at an incubator before starting a company then do so". Ie, if you can simulate the experience of starting a company then do so.

Everything else is nonsense.

* Whenever your going to do something outside of your previous experience, your going to be nervous.

* Being nervous doesnt mean you give up. What if Laird had complained that he was too nervous to surf Teahupoo?

* Sometimes your not going to be able to simulate what you want to do. So make sure you have an safety net if things dont go according to plan.

IMHO In the end the regret of never having tried is far worse than any other consequence.

<comment><USER11> Teahupoo reference:

Beautiful, deadly, gorgeous

"Brad Laird surfing Teahupoo"

<http://www.youtube.com/watch?v=JfPYVYc0U3M>

<http://www.surfline.com/surfing-a-to-z/teahupoo-history_925/>

</comment></comment><comment><USER12> The implication is that "instinct" knows better than you do.

But my instinct sucks. I have no usable skills, and yet I'm not nervous at all- I'm fairly fearless in general. It's reason that's telling me that this is probably a bad idea, not instinct.

</comment><comment><USER13> In terms of startups, the question to consider is if you need a valuable and rare skill to make a valuable product.

I would guess that you need several valuable skills to build and market a great product, but those skills do not necessarily correspond to having several fantastic job offers as this writer suggests.

</comment><comment><USER14> Terrible advice. Everything in life is a risk. Chances are you will end up with many boring & comfortable jobs in your life. Sometimes you'll leave by choice, sometimes you won't have any choice at all. I figure everyone owes it to themselves to at least try their dream in life. The key is to be well prepared, pragmatic, time it right and do it before others are relying on you for their well being. Usually the worst outcome is you have to go crawling back to that boring & comfortable job.

</comment><comment><USER15> perhaps a better name for the article would be Don't Quit Your Boring Job Before You Have A Decent Replacement Revenue Strategy.

<comment><USER16> Not enough. The woman in the example given had a DRRS, but it disappeared because the skill being used was not rare, nor valuable in and of itself.

The claim in the article is that having a skill that is rare and valuable make you non-nervous, thus being nervous about taking the leap means you don't have a skill that's rare and valuable.

Clearly false - anyone can be nervous regardless of their skills. However, it's worth a moment's thought.

<comment><USER17> _The woman in the example given had a DRRS..._

It's cruel to pick on a poor unemployed entrepreneur. On the other hand, it's no crueler than life itself has been, and it might save some others, so let me apologize in advance and then say that:

 _Karma Kids Yoga — a yoga practice focused on young children and pregnant women._

... may be a Replacement Revenue Strategy, but I am not convinced it is Decent. It sounds like a terrible business idea. By definition your target market is _constantly turning over_ \-- mothers these days have one or two kids, maybe three at the outside, and those kids don't stay young for long. You build a clientele, and then that clientele graduates and you need a whole new clientele. And the plan doesn't scale -- you're limited to recruiting from a very specific demographic in one very specific location.

And it's not as if you're selling baby food, or strollers, or something that every mother actually _needs_ \-- you probably can't even net 100% of the mothers who live in your neighborhood and practice yoga [1], since anyone can practice yoga on their own, and the economy is in the dumps.

<comment><USER18> _"It sounds like a terrible business idea. By definition your target market is constantly turning over -- mothers these days have one or two kids, maybe three at the outside, and those kids don't stay young for long. You build a clientele, and then that clientele graduates and you need a whole new clientele."_

I wonder if the outcome would be different if she targeted elderly.

It seems like a better market both thanks to demographics and IMHO also as value provided to the customers (and society in general) would be higher.

</comment></comment></comment></comment><comment><USER19> Entrepreneurship is not limited to doing a tech startup. Also, going on your own is not worthwhile only for people with other comfortable options.

It is a pity that a PhD with such high credentials has such a narrow world view.

Edit: This article seems to be saying startups make sense when one has these desirable skills. In other words only start on your own if you are in a field where you need a difficult or highly prized degree. Well we all know where the highly desired financial engineering skills have led the economy.

The author is just risk averse. Which is OK. So a degree and other options - which are a hedge against startup failure - seem to him to be pre-requisites for going on your own.

</comment><comment><USER20> He's in the fortunate position of being able to increase his job-market value, while actually working. If you really want to change your job, you might have to quit and start again from scratch - whether you are nervous or not.

<comment><USER21> Best advice I've heard is to make small changes that get you closer to your desired job, while utilizing your existing skillset, like asking for additional duties at your current employer. This way, you avoid the start- from-scratch phase you describe.

<comment><USER22> That's great advice. I took a position as a dev lead at my job a while back because I wanted more experience dealing with clients, budgets, estimating, and delegating tasks. It's been far more stressful than my previous position, and my pay has yet to increase accordingly (though it should within the next month), but I consider it a win for all the experience it has provided me. I look forward to applying these skills to my own projects.

</comment></comment></comment><comment><USER23> Appendng "yet" to the title would, imo, align it more closley to the article.

</comment><comment><USER24> Many people have boring and ok jobs yet never have the courage to try something different. In this situation, it is perhaps healthy to actually quit the job and try it. In the worst case, your new startup fails, you learn something, you return to another boring job. But I guess you will feel much better about yourself, as a human being who has the courage to follow your dream, rather than as a boring person who always complains about the boring job.

<comment><USER25> That's not the worst case though. The worst case is the possibility of ruining your finances because you have no income while trying your startup. And what if you can't find a job when you finally give up?

It's not a decision to take lightly.

<comment><USER24> Well, staying at a boring job is not very healthy to career too. The worst case is losing one's job when economy is down.

Quitting job is not the solution. Finding interesting jobs (as an employee or founder) is perhaps the solution.

</comment></comment></comment><comment><USER26> The startup process has several validations built into it. First when you pitch it to your friends you see how they react..maybe build a prototype and see traction. Its not like you wake up one day, and go...I am going to quit my job and do a startup. The balance is how much you trust other people's opinion vs your own instinct.

</comment><comment><USER27> The article is contradictory: in one context being nervous is a bad thing but in another context it is considered good.

<comment><USER28> That's not contradictory. Or else, you find that being able to blow on your soup to cool it or on your hands to warm them is contradictory.

Context _is_ everything.

</comment></comment><comment><USER29> I other words what the article is suggesting is forget about your dreams, your personal goals and the ideas that along with percisentence could have a chance to make you feel good about yourself, your life and maybe even help you actually enjoy the limited amount of seconds that you have to live and instead be thankful for the opportunities you have been "given" and shut up because things could actually be worse. Look at that 90% of the world that wish they had half of what life have given you.

It's incredibly sad how what the article suggest is exactly what the majority of the world does when what we really are supposed to do with our life is so simple.

Life is short, try to enjoy it no matter what, never give up on you. If you have to spend all of your life trying to make work whatever it's you want to do and that you think it will make you happy, do it. Because if you don't, if you give up and do what you are "supposed" to do, what is safe, what society, your education, your family and your religious "beliefs" have tried to imposed on you will never be happy. That is guaranteed. But, hey! worse nothing than what you already have! right..

<comment><USER30> You can't will your rent payment into existence, and you won't fully enjoy your admittedly short life while deciding between another week of spaghetti or tuna.

He is saying you should work on developing your skills until you are good enough to be able to succeed in pursuing your dreams. You know, learn to skydive before jumping. It sounds as if you're suggesting everyone just throw themselves off the cliff.

<comment><USER29> The problem is that if we tell ourselves to wait until timing is right, we will make sure timing is never right.

It all comes down to the fact we are just scared of giving up the illusion of security or what is "convenient" even if that convenience is what is keeping us from achieving our goals, from what is truly important to us.

We will make sure we do anything possible to postpone the moment when we can say are I'm "ready".

Even if being ready just comes down to having enough money saved so we don't have to eat spaghetti or tuna while we work on our dreams, the story always goes something like this:

You want to have enough $ saved so you don't have to worry for 6 months and be able to just focus on yourself, on whatever you really want to do.

Once you have that $ saved you might tell to yourself, well, but things never work out the way we plan them so I think it would be better if I have enough saved for a year. I just need to keep doing what I would love to quit for a couple more months, and that's it, I will be ready then. Since that reasoning actually makes sense to you you end up postponing it for a bit longer.

A few months later you find yourself either worried about things like the economy, or maybe you think you need more money, or anything else you can come up with to justify postponing your dream and you keep doing it over and over.

The time is never right. You just have figure out what the worse case scenario would be, what could happen if everything you though you knew was absolutely wrong and what options you have to go back where you started in the event you fail. The chances are once you are aware of it, it won't be that bad as you though and hopefully you won''t longer be scared and will quit what you need to quit to invest your time on yourself.

<comment><USER31> While I agree with most of your comment, there is something to be said for preparation. Do you think it's unwise of me to wait until after I pay off my student loans (a year, perhaps) to quit my job and start my own business? Keep in mind that student loans are one of the only loans you can't get out of with bankruptcy. This is the kind of very specific preparation that doesn't have to keep escalating. I'm reasonably comfortable walking away from a failed startup with nothing; what I'm not comfortable with is being saddled with an ever- growing debt I can't get rid of.

</comment></comment></comment></comment><comment><USER9> Don't do a startup, because some Yoga teacher failed with her Yoga studio.

</comment><comment><USER32> In order to not be nervous this guy first has to finish is Ph.D from MIT. Then and ONLY then will he be able to start a successful company. I would bet that the vast majority of successful software entrepreneurs have much less than a Ph.d. In fact I wouldn't be surprised if even the relative percentages of Bachelors to Ph.ds starting successful companies is higher. In my experience a lot of people go for their PH.Ds because they don't know what they want to do and don't feel like getting a real job.

</comment><comment><USER33> Anyone know what Manhattan-based startup incubator he's talking about?</comment>


How to skip silences in podcasts with AVAudioPlayer - <AUTHOR> https://medium.com/breakeraudio/how-we-skip-silences-in-podcasts-with-avaudioplayer-69232b57850a <comment><USER2> Neat. Thanks for sharing.</comment>


Eating the Sun - <AUTHOR> https://www.vice.com/en_us/article/3dk4bv/human-photosynthesis-will-people-ever-be-able-to-eat-sunlight <comment><USER2> Reminds me of Quiet from MGS V.</comment>


We don't have any records - <AUTHOR> http://www.gq.com/news-politics/newsmakers/201211/truck-stop-killer-gq-november-2012

<comment><AUTHOR> Good story, but not fitting for HN, except for that paragraph on page 5:

 _I finally spoke to a woman and asked if they had a homicide record for a girl who may have been found in the Martinsburg truck stop during the summer of 1985._

 _"We don't have any records," she told me._

 _I thought she meant digitized._

 _"I can come down," I said._

 _"We don't have any records."_

 _In the 1990s, the Berkeley County sheriff's department's computer crashed and burned. The paper records had been destroyed for file space, and so nothing from the 1980s remained._

That is the best example I have ever seen of the digital dark ages (<http://en.wikipedia.org/wiki/Digital_dark_age>) we are facing</comment>


"c# programmers aren't really programmers" - <AUTHOR> http://alex.ghiculescu.com/post/8642020549/c-programmers-arent-really-programmers-its-not

<comment><USER2> Though I do agree that the current generation of developers are incredibly fortunate and most of us wouldn't be able to do the same job 20-30 years ago, the line "there's no shame in standing on the shoulders of others and building on their work" pretty much sums up the way this should be perceived. Its basic DRY.

</comment><comment><USER3> Edit suggestion: replace "C#" with "VB.NET". Just saying.

</comment><comment><USER4> Is this a joke?</comment>


Can we get more people to choose the stairs by making it fun? - <AUTHOR> http://www.youtube.com/watch?v=2lXh2n0aPyw

<comment><USER2> I don't want to be a wet blanket, but I'm guessing that once the novelty wears off, most people will return to their habit of taking the escalator.

I realize that this probably isn't a permanent installation, but someone did this in a more permanent fashion at a building near me, and people spent a lot of time playing on the stairs when they first went in, but now most people are back to using the elevator.

</comment><comment><USER3> As many reasons as there are _not_ to do this (some of which are pointed out in the comments), it's hard to argue with 66%. Sure, it's novel so that's part of it, but I think the basic idea of making things fun to get people to do them is great.

On another note, the easiest thing to do in that case would be to remove the escalator. ;)</comment>


HTML 5 Asteroids - <AUTHOR> http://dougmcinnes.com/2010/05/12/html-5-asteroids/

<comment><USER2> This was posted just a week ago here <http://news.ycombinator.com/item?id=1343546> with a pretty good discussion.</comment>


U.S. health care's widespread overbilling problem - <AUTHOR> https://www.axios.com/health-cares-widespread-overbilling-problem-2454995957.html <comment><USER3> I know this will attract a lot of people who have suggestions for healthcare.

Let me add my big one: price transparency.

I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price.

On the 10th call, I finally got someone to tell me what the out-of-pocket price would be without insurance. She told me a range! It was $96-$115. This was close to the range that google says was about average for the procedure.

So this was not a case of over-charging, or unfair pricing. I really did not know if the test was $10,000 or $100 till this call.

If they just made the pricing transparent, I think a lot of the problems would evaporate.

(Although I think the profit centers would suddenly become the emergency medicine section of the hospital.)

I know this article focuses on fraud, but the non-fraud part of the healthcare is just as broken, and probably costs more.

<comment><USER4> An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with both tacit and stated insinuations that we're placing a monetary value on her "health" by asking what procedures or drugs might cost.

I don't think price transparency will fix much, though. The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. Price transparency combined with individuals having to pay for their healthcare expenses would help, but there's blame enough to go around for _every_ player in the system, too.

<comment><USER5> My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

<comment><USER6> That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.

<comment><USER7> I find it hard to believe that a two month difference between cleanings (4 months vs. 6 months) is going to prevent any more serious dental procedure.

<comment><USER8> I have GERD but before diagnosis the acid from coughing was terrible on my teeth.

My dentist with many years experience diagnosed it. I went to the doctor who confirmed it was GERD.

I lost my job but when I was working the insurance paid for two cleaning per year. I chose to keep the insurance but it's a lesser plan that only covers one cleaning every nine months.

Twice per year was good for me since I got lazy about three or four months after visiting the dentist. I needed the twice yearly pep talk.

And I should also say that 75% of people who are diagnosed with IPF a fatal lung disease have GERD. My father has IPF and GERD I have GERD but I hope I don't develop IPF. My grandfather died of emphysema at 52 I really hope there's no connection! So yeah a dentist could point you in a direction that may help you more than you realize.

</comment></comment></comment></comment></comment></comment><comment><USER9> To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can accept a mistake from time to time but this seems to be pervasive.

<comment><USER10> but you have to also take into account that a lot of people don't pay (charity care)

<comment><USER11> Some non payment is also considered bad debt (they expect the patient to pay, the patient doesn't pay). With charity care, the bill is explicitly forgiven.

The hospital industry claims non payments total around 6% of hospital expenses.

[http://www.modernhealthcare.com/article/20120106/BLOGS01/301...](http://www.modernhealthcare.com/article/20120106/BLOGS01/301069983)

I do wonder if they calculate that 6% on what they bill though, rather than on what things actually cost. The margin on an unpaid bill isn't really a cost.

<comment><USER9> I remember reading that the 6% are from the billed prices, not the cost. The same when they claim to do things for poor people. They do a few procedures for free and claim the billed price so they can have nice PR for cheap.

<comment><USER12> Also for tax reasons, although different hospitals have different tax classifications.

</comment></comment></comment></comment></comment><comment><USER13> I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the government can afford it. When they're losing trillions of dollars on the defense side, I'm certain they can pay for every medical procedure in the country and still have plenty left over. This whole idea that the government doesn't have money to pay for healthcare and other necessary social services is such fucking bullshit when they have the ability to lose trillions in defense and just shrug it off. That's not even mentioning the money that isn't lost on the defense side. Unfortunately, I don't think people have the capability to push their government to spend that money correctly. But that's a different problem altogether.

<comment><USER14> Since when has government cared about losing money?

<comment><USER13> That's my point. They don't care that much. And if they decide to care at some point, they have the resources to fight it out. Let these abstract entities (gov't, healthcare providers) fight it out on their own so that people don't have to die.

</comment></comment></comment><comment><USER15> It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured.

It's a ridiculous system.

<comment><USER16> My experience is the opposite. The uninsured receive absurd bills because the hospital doesn't actually expect them to pay. The sell the debt to collections and get a big tax writeoff with little relation to reality.

<comment><USER9> You are probably right but this invites and rewards unethical behavior. If you pay the bill you are a sucker. You have to be a deadbeat.

</comment></comment></comment><comment> trey-jones At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this:

 __The whole system is fucked. __

I am referring to the system that facilitates American residents getting healthy and staying that way.

What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daughter was born with a chronic health problem, diagnosed at 19 weeks gestation.

Since her birth, a little over 7 years ago, we have received a bill from the hospital that provided her care at least once per week. This continues today, despite not having had _any_ services provided in almost a year.

If I paid all of these bills, bankruptcy would be my only recourse. I try to communicate with my insurance provider (employer provided), to determine what's legitimate, and what should be covered. In the end, I'm mostly left to my own devices to pay for _the services that I think I received._ Every year we pay the deductible, and every year we get billed for significantly more.

As another example, not along ago, my third daughter was born. Due to the complications of my wife's first pregnancy we received care from two different OBGYN facilities, one local to us, and one at the delivering hospital.

Though the local facility was only responsible for less than 10 checkups, they claimed that we still owed our entire deductible to them, prior to delivery. We paid half.

A week prior (this much is hilarious in itself) to delivery by a doctor from the other facility, we received a bill for the full deductible amount, due to them also.

When the delivery actually happened, it took less than 2 hours, and we stayed one night. We also had 3 checkups at this other facility. Our bill of course is the same as everybody else's, regardless of whether they had a C-Section and stayed for 5 nights, or had 30 hours of labor. I could actually be OK with this (I'm onboard for socialized healthcare), if they could get the billing part right.

Again:

* I am constantly billed directly by healthcare providers over and above what my insurance policy says I should pay.

* I pay almost 25% of my yearly earnings in insurance premiums.

* I end up deciding what I will pay and what I will not pay. I admit that this is probably not the best situation for anyone.

The whole system is fucked.

<comment><USER17> A family friend had twins. One born before midnight, the other after (different birth days). When they got their bill(s) from the hospital they noticed they were charging room fees for both infants starting the day of the first born. The second child wasn't even "alive" (born) for the first day they were trying to charge for! What's also absurd is that the first child wasn't in the receiving room until after midnight anyways (since all three, two infants, and mother were in a delivery room until the wee AM hours)!

<comment><USER18> Can confirm. Three births, hospital/insurance _both_ effed up the billing on _all three_. If we hadn't been vigilant and wasted hours, and hours, and hours, on the phone and in one case gotten our state rep and the state insurance board involved we'd have been out several thousand dollars that we shouldn't have had to pay. I hate to think how much we _didn 't_ catch. Similar stories from others, plus tales from non-pregnancy major medical procedures that shake out similarly, though are even harder to sort out.

Everything that touches healthcare billing is scammy, incompetently managed, and often outright fraudulent. Good luck getting any compensation or justice other than what you were originally entitled to, though.

</comment></comment></comment><comment><USER15> "The United States remains one of the only advanced industrialized democracies in the world without universal coverage.

While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries like Australia, Canada, the United Kingdom, Germany, France and Japan." \- [http://theconversation.com/three-reasons-the-us-doesnt- have-...](http://theconversation.com/three-reasons-the-us-doesnt-have- universal-health-coverage-67292)

<comment><USER19> I think this is because we choose to live less healthy lifestyles rather than the quality of medical care.

Super size that...

<comment><USER20> I don't think the lifestyles are all that different between Canada and the US, and the healthcare expenditures in Canada are significantly lower.

<comment><USER21> I grant this is anecdotal, but you might want to learn about the Canadian system from the point of view of sick people in Canada. [https://www.youtube.com/watch?v=q2jijuj1ysw](https://www.youtube.com/watch?v=q2jijuj1ysw)

<comment><USER20> Thanks. I live in Canada and have first hand experience with the healthcare system.

</comment></comment></comment></comment></comment><comment><USER22> I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care.

Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

<comment><USER23> What you are looking for is called Direct Primary Care. It exists in nearly every major city in the US at this point, and is very affordable.

[https://www.youtube.com/watch?v=bGZaRnC1wNg](https://www.youtube.com/watch?v=bGZaRnC1wNg) to hear one doctor talk about how this works out in practice.

Google Direct Primary Care + your city/state to see what's available. It's SERIOUSLY better than the mainstream option. I've been doing it for nearly a decade now, and would never go back. Combine it with a cost sharing plan (NOT insurance) such as [https://www.libertyhealthshare.org/3-program- options](https://www.libertyhealthshare.org/3-program-options) to achieve superior care at lower cost.

<comment><USER22> Wow that's great, thanks for the tip.

</comment></comment></comment><comment><USER24> My friend's wife resigned from a nursing position over this issue. A superior asked her to falsify billing records to say they were providing a higher level of care than they actually were, and she refused.

<comment><USER25> Instead of resigning, wouldn't it have been better if she exposed the malpractice? Or would the consequences on her part damage her so much that their lives would be destroyed? Ethics would dictate she would fight otherwise.

<comment><USER24> Due to the corruption and other factors, she didn't wish to work for them any longer. I don't recall all the specifics, but I believe she did file a complaint with the state. Hopefully the company was investigated.

</comment></comment></comment><comment><USER26> They don't even mention the harm caused by fraud that involves inventing conditions and treatments out of thin air. Those doctor's notes follow you around forever when you go to do things like purchase disability insurance or seek treatment.

Suddenly you are no longer a healthy individual you are an individual with a history of condition X and Y which you have never even heard of. And because a doctor wrote it down it's now a reality and the patient is a liar!

</comment><comment><USER27> There are so many variables that affect healthcare cost here in the US. Looking from outside, things are different than looking from inside. There is something really wrong with current US healthcare system, and it's really difficult to put a blame on one or two things.

Side note, I work IT in healthcare, so I sometimes view "interesting" things to say the least. A while back I stumbled upon a document that was accidentally shared. It showed accounts receivable in collections agencies for one hospital in our system. Between 2009 and 2012, there was $154m dollars in collection agencies from delinquent accounts. Remember, this is just one hospital that is actually in a more upscale location. We have some hospitals who are always in red due to their locations.

Then you deal with inflated prices for services and drugs. I really don't even know if they can ever fix this part.

</comment><comment><USER21> Another issue not mentioned, but associated with the same pool, is that hospitals get dramatically more money for the same procedure than a private practice doctor. Not even upcoding.

Fortunately, Medicare is looking at this problem now. [http://www.compassphs.com/blog/health-navigation/medicare- to...](http://www.compassphs.com/blog/health-navigation/medicare-to-stop- paying-more-to-doctor-office-if-owned-by-hospital-system/)

</comment><comment><USER28> I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be.

          Well-baby checkup: $120
          School sports physical: $150
          Blood tests: $80
          Minor broken bone: $400
          Major broken bone: $1200

<comment><USER17> "But we don't know [major vs minor] until we look at it!..."

So add what all car shops say:

Hourly rate: $100 / hour.

And begin with a 30 minute to 60 minute diagnostic estimate (providing findings at 30 minute increments).

<comment><USER29> But then they wouldn't be able to bill $1350 for a 15 minute visit.

</comment></comment></comment><comment><USER30> Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

<comment><USER31> Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control, and how readily you perform expensive tests) is much more important, I think.

<comment><USER19> According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x.

Edit: [http://gamapserver.who.int/gho/interactive_charts/health_wor...](http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html)

<comment><USER31> Indeed, I was misinformed. The ratio is much lower than I thought. I think my point still holds, though.

</comment></comment></comment></comment><comment><USER32> For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine.

[https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...](https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable)

<comment><USER33> There was a reform, maybe sometime around 1985, that replaced "usual, customary and reasonable" with 'what should this procedure actually cost'. Your wikipedia links to this page:

Resource-based relative value scale - [https://en.wikipedia.org/wiki/Resource- based_relative_value_...](https://en.wikipedia.org/wiki/Resource- based_relative_value_scale#History)

It took the government 20 years to figure out that they couldn't give the medical system a blank check.

/methinks a helpful medical reform would be to get insurance-paid doctors on fixed salaries. Under the present status quo, some doctors bill insurance companies for as much as they can get away with.

<comment><USER32> Actually, I used to work in health insurance, so I have a bit more insight into this than most, although I've been out of it for a while (10 years or so).

If you look into how the RBRVS are calculated, there is effectively a privately run panel that determines input variables and factors that are used in the RBRVS calculations. At some point, someone has to determine the portion of the calculation that represents "physician value added". While it is true that RBRVS is an alternative system to pure UCR rates, I can assure you that UCR rates still play a major role in many health insurance lines of business and calculations.

By the way, RBRVS aren't the only system that organizations have tried to use to figure out how to bill/cost services - there are also DRG groups (diagnostic related groups), ASC groups (ambulatory surgical center) groups and others.

RBRVS were mainly made to try to control physician office costs in Medicare and are used by HMOs that offer Medicare plans. While other HMOs and private insurers use RBRVS, there are a lot of them that still use UCR (calculated internally) as well.

There was a huge problem around 2009/10 with a big company, Ingenix, that was offering a commercial UCR database which was probably of poor data quality - based on surveys of regional prices from doctor's offices. There were lawsuits, etc. over that and many insurers moved away from commercial sources of UCR and instead brought that in-house. Here's a link that talks a little bit about that: [https://www.managedcaremag.com/archives/2009/5/ingenix- after...](https://www.managedcaremag.com/archives/2009/5/ingenix-aftermath)

Price transparency could help (if it could be achieved), but there are a lot of for-profit organizations who actively try to keep their strategies internal. Transparency might not be enough without pricing controls, but exercising control would be extremely difficult for legal/political/profit motive reasons as well. For that matter, coming up with singular pricing systems that govern controls at scale is incredibly difficult.

<comment><USER33> Thanks for your insights. I have family in the medical field, so I've heard a lot of complaints about the system. It seems like most people don't appreciate how much "complication" in the medical industry derives from third-parties paying for almost everything.

I have a doctor who gives his patients a receipt that they can use to "try" to get reimbursed by insurance. He takes cash or check, has all the patients he wants, and zero employees.

</comment></comment></comment></comment><comment><USER34> I think that people always want to look for the worst in every situation. America's healthcare system may not be up to first world standards for treatment. And it bankrupts hundreds of thousands of people a year. But, it's the most profitable healthcare system in the world, and that's the metric that investors really care about.

</comment><comment><USER35> I guess it won't hurt to offer my own anecdata point about idiot medical billing.

Stanford hospital billed us for an IVF procedure. However, we were in Paris at the time they claimed my wife was undergoing the procedure.

It took going down to the billing office with our ticket stubs and pitching a fit to get it zeroed out.

I agree there's lots of room for improvement in medical billing.

</comment><comment><USER36> Generally it is really hard to negotiate fair pricing if one side knows the other side has tons of money. "Oh gee, government contract? That'll be $15,000 more for no good reason." Perhaps anonymizing all billing would help so that negotiations simply cannot know what the other side can afford.

<comment><USER37> Whereas it's really hard to negotiate pricing with people who are going to die or be physically impaired for the rest of their lives if they don't pay whatever you ask?

</comment></comment><comment><USER38> Because there's too much coverage, and effectively no choice (due to excessive standardization), the insurance companies are forced not to operate as insurance companies at all.

No choice, no competition, no money left when they're done with you.

</comment><comment><USER39> This is what happens when you make the health care system capitalist. Despite rumours to the contrary, capitalism doesn't reduce prices, that would make no sense for a company trying to make a profit.

<comment><USER40> French outpatient care runs in a capitalist manner. You pay full price at the office, and your insurance reimburses you at 80% of "reasonable and customary". You are free to choose any Doctor, and it is up to you to decide how much any conveniences or perceived quality is worth.

<comment><USER39> Can't say I am an expert on the French system, but a quick Google says that the insurance is pretty tightly regulated by government.

</comment></comment></comment><comment><USER15> Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

<comment><USER4> I am an American.

When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die."

(My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health insurance, and the patriarchal attitudes of medical practitioners raises my blood pressure and gives me near panic attacks.)

When I'm in a more calm and normal mental state my answer would lean toward socializing as much of the healthcare system as possible.

Literally _nothing_ is a bigger fear-factor in my life than medical expenses. The fact that the entirety monetary value of my life's work could be destroyed in a moment by a medical issue freaks me out. The fact that I cannot, in any financially viable manner, insure against this kind of event amplifies that fear.

I feel comfortable in saying that, at least in an abstract way, I am less afraid of death than of leaving my family destitute as a result of unforeseen medical expense.

<comment><USER41> "fear-factor"

Worth noting that the book describing the principles of the UK NHS by its founder was called _" In Place of Fear"_:

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

Medical emergencies are stressful enough when there is no money involved - <USER2> have no idea how people cope when there is a stressful financial situation added on top as well.

<comment><USER4> Thanks for that link. I'm looking forward to reading about Bevan and, in particular, finding this book.</comment></comment></comment></comment>


Revolut just released Apple Pay in multiple countries - <AUTHOR> https://www.revolut.com/help/getting-started/adding-money-to-revolut/by-apple-pay-or-google-pay <comment><USER2> Can confirm. My friends in Bulgaria are already using it. If not for this, I don't know if Apple pay will ever show up here.

</comment><comment><USER3> Works great in Belgium!</comment>


High Frequency Trading Development Kit - <AUTHOR> http://www.stoneridgetechnology.com/products/pci-e-development-boards/hft-development-kit/

<comment><USER2> Even if this product allowed you to have picosecond processing of market data and generation of trading signals, if you don't have exchange co-location, inherent network latency in your market data from providers and order routing to exchanges will make this thing pretty useless. For a hobbyist, throw leased lines out the door, now a Linode box, even a desktop running Windows XP with full-blown Nagle's algorithm, would have good-enough performance unless you can pour serious capital into a project.

They're also very vague on the software architecture or framework "kit". They don't say which feeds they support or if they provide any domain-specific data structures/standard trading algorithms like VWAP (slicing an order up over the day to give you "better" fills). I do see mention of an _optional Feed Parser reference design_ , which I can't ascertain much value from. I am guessing it is mostly a generic kit for writing on their specialized hardware, and not specific to trading. There will be a lot of pain, maybe impossible to take vendor or open source libraries for market feed handling and compile it down using their embedded libraries. You'll be stuck doing tons of TCP/IP work, fun for hacking, but relative to the latency issues in your market data/order routing, it won't help you profit. Most people buy these appliances with included feed support.

With a big budget and co-location, this may be useful in bootstrapping some really low-level processing of market data, although there are a variety of hardware and software messaging solutions that would be a good alternative in driving latency lower if you have some money, Solace (HW), Tibco, 29West, etc to name a few.

I wish there was a hobbyist solution out there, but sorry, my initial impression says this isn't it. I would like more information, but maybe there are better hobbyist efforts out there. Interactive Brokers API isn't bad, and here's a full-blown _real_ open-source trading kit that has a similar business model to MySQL. <http://www.marketcetera.com/> Note: I feel that there are a few issues with this as well in some of the technologies they chose (JMS, Eclipse RCP).

<comment><USER3> Despite all of this, I find the most worrying thing about the recent HFT developments is the simple fact that hobbyists _want_ to get involved. Surely turning amateurs loose in such a necessarily complex world will result in large sums of money being lost.

Oh wait... I get it.

<comment><USER4> It's not lost. It goes somewhere.

<comment><USER5> Yep. Money is not lost, it just belongs to someone else ;)

</comment></comment></comment></comment><comment><USER6> In all seriousness, I would rather see a market designed explicitly around the _barring_ of high frequency trades. All trades taking a fixed and relatively long period (say, 30 minutes) to complete.

This sort of investment strategy doesn't seem to be creating long-term market value, it's exploiting short-term edge effects in a zero-sum strategy. The arms race to pursue ever more inhumanly fast automatic trades seems to have no net value at all yet is consuming resources to impoverish the algorithmically and connectively poorer at the expense of the richer.

Markets seem to be favoured because they allow prices to find their natural level from supply and demand. How is this facility helped by permitting trades to be completed and then reversed faster than any human can ever perceive? This is algorithmic gambling on edge effects far more than a true market.

<comment><USER7> I can see from your post that you're very misinformed about how markets operate and the role of high frequency traders (a.k.a. liquidity providers). Read my response to a previous comment: <http://news.ycombinator.com/item?id=2164458>

<comment><USER8> I have nothing against HFT but I don't buy your liquidity argument. Liquidity is needed most when markets are falling outside the norm. Any algorithm with a fail-safe or kill switch will immediately shut off when times get bad thereby ending their contribution to liquidity at a time when it is needed most.

Please help me understand this better if I'm incorrect.

(edited for clarity)

<comment><USER7> The main point that you're missing is that there is a huge demand for liquidity during a majority of market hours. On average, 7 billion shares of US equities are traded every day. That is a monumentally large number if you think about it. According to the TABB consulting group, roughly 50-70% of American stock trades are done by HFT [1]. Let's assume that 10-20% of trading is non-profit motivated (utilitarian, you could say). That means that roughly 1 billion shares are exchanged every day by utilitarian traders. That in itself should be clear evidence that there is a large demand for liquidity.

HFT market makers play an important role in those transactions. Specifically, they make it cheaper to buy and sell stocks by (1) tightening the bid-ask spread and (2) providing more quantity at each price, so that the average cost of executing an order is less. Not only that, when markets become tighter, they actually enable transactions to occur that would not have happened before. In other words, previously where buyers and sellers would NOT have traded because the transaction costs of crossing the bid-ask spread were too high, those two parties can now trade. Specifically, without HFT, there would be far fewer than 1 billion shares traded by utilitarian traders on a daily basis.

To address the other point of providing liquidity "when the markets need it most", let's take a step back. When you say that "market makers should step in to provide liquidity [for society's benefit]", you're implying that there's some externality to lack of liquidity in financial markets (if so, this is yet another reason that we need HFT on a daily basis). Suppose that this is the case: there is some negative externality to society when markets are illiquid, as is oft to happen when things go crazy in the world. During those times, volatility is insanely high because the risk of being in any position is also insanely high. Remember, market makers get compensated (on average) for holding risk that you don't want. If risk is higher, naturally, the compensation should be also. This is manifested in higher costs of execution: spreads widen and the available quantity at each level decreases.

If you want to force HFT market makers, which are private corporations, to step in to provide more liquidity, then you are forcing these companies to pay for that externality. In effect, they would take on huge risk for far diminished expected returns. That doesn't make any particular sense to me. However, if society as a whole has this view that some private corporations need to pay for public externalities, then that should be a matter of regulation. But if that's the case, why pick on HFT in particular? Why not force McDonalds and Whole Foods to give food to hungry people during famines? Surely, there is an externality to the food industry NOT stepping in during periods of extended hunger, "just when people need it the most."

[1] [http://georgewashington2.blogspot.com/2010/10/yes-70-of- us-e...](http://georgewashington2.blogspot.com/2010/10/yes-70-of-us-equity- trades-are-high.html)

<comment><USER8> I'm still in the "learning the syntax" stage of finance so this is great information. thank you. do you think that one reason why people say bad things about HFT is because they see them being unfairly compensated for taking on what they perceive is a small amount of risk? as in - "come on, how hard can it be to grab a block of stock on an upward trend and quickly sell it." Of course, the more I dig into this, the more I realize how hard it is to find those trends and how easy it is to lose your ass. But, people don't dig in themselves.

<comment><USER7> _do you think that one reason why people say bad things about HFT is because they see them being unfairly compensated for taking on what they perceive is a small amount of risk?_

I think that's definitely part of it. The issue is that people don't know how much high frequency traders actually make per contract. The amount is pretty small (on average). Typically, each trade takes on "bite-sized" risk and expects "bite-sized" returns. Do that thousands of times a day, and your bite- sized returns grow to something reasonable, but not ridiculous. Certainly, it's not on the order of how much other forms of proprietary trading make.

I think the other issue is that people don't understand that all traders, HFT or not, take on risk when they enter a trade. A lot of people use terms like "skimming off the top" or "making money for nothing". This indicates to me that they don't realize _why_ market makers should even make money (on average). It's simply risk transfer, and that has a price (on average).

You're right though, identifying bona fide trends are pretty difficult. If it were easy, everyone would be doing it and arbing those trends away.

</comment></comment></comment></comment></comment></comment><comment><USER9> Virtually no hobbyist would be able to compete against big financial firms' hardware and algorithms. It might be a smart move for a large high frequency trading firm to put out these sorts of tools for free. An incredibly easy to use free api with good (though not superior) speed would be pretty popular. More subpar competition == more money for them. Though, admittedly, probably nowhere near what they are making now.

<comment><USER10> _Virtually no hobbyist would be able to compete against big financial firms' hardware and algorithms._

This simply isn't true. There are many HFT firms started by hobbyists/amateurs. The company I work for started this way.

HFT is a field which has many niches and relatively low barriers to entry (thought certainly not as low as renting a linode).

</comment></comment><comment><USER8> What's that quote that says something like in a gold rush you're better off selling the picks and shovels than trying to strike gold?

<comment><USER11> Saw this quote most recently in a Chris Dixon post: [http://cdixon.org/2011/02/05/selling-pickaxes-during-a- gold-...](http://cdixon.org/2011/02/05/selling-pickaxes-during-a-gold-rush/)

</comment></comment><comment><USER12> Anyone knows how much something like this costs? My guess is around 20K.

<comment><USER13> Most solutions of this type are an order of magnitude higher than that. It's very easy to spend $20k/mo.

To give an idea of scale / endpoint, a top-tier HFT infrastructure costs on the order of $100k/day. There are probably only a half dozen total of those in the world, though.

<comment><USER12> Ouch! That's a great "incentive" for the system to work well!

</comment></comment></comment><comment><USER14> Even with this solution and well-designed code, a trader needs external infrastructure that plays on the same low-latency level. Most HFT strategies aren't as secret as you think; there are usually dozens of shops running similar trades. For that reason, something like this needs to be jacked directly into an exchange co-lo or connected through dedicated fiber. In short, the cost of this blade is just the start if you want to play with the gunslingers. Somebody else mentioned that there are prop shops that will give you the infrastructure you need for a cut of your profits. Some will even front the cash you need to trade. One such place is HTG Capital Partners of Chicago, which is where much of the HFT world is centered.

</comment><comment><USER15> So, if we limit our consideration of HFT to strategies which rely primarily upon speed-based exploits (trade decisions based on the examination of current market data w/o correlation to external data sources like, say, Twitter feeds for market "sentiment"), can we conclude from the trading stack proposed for this box that most arbitrage opportunities have been exhausted by fierce competition? If the current state of the art is measured in microseconds, how much more room is there for improvement? I understand that there's a whole world of data streams from which one might attempt to predict markets, and I am explicitly limiting my question to the genre of trading which seems to be profitable via latency reduction alone.

</comment><comment><USER16> I am waiting for one of these shops to open up the opportunity to hobbyists/devs. I would love to try and create my own decision/trade algorithms but dont have the kind of money it would take to mitigate the cost effect of the trade volume (ie, at $8 per trade and making 1000 trades per day with an average return of 2% per day you would need to be working with more than 400K to even cover your tx cost).

Strikes me that it would be a great research incubator for them to understand/learn new ideas and techniques and hunt for talent.

<comment><USER17> Set it up, trade 'virtually' (i.e., just simulate), prove your algos, get bankrolled by someone who is convinced of the algos worth. Quite straightforward. I'm highly skeptical of a hobbyist beating the competition though (maybe in micro niches, where one would add domain specific knowledge to get an edge - that's my pet idea on this topic :) )

<comment><USER18> It is straightforward, but impractical. Getting good historical market data is very, very expensive. Even recording current market data is not cheap and not without significant difficulty.

<comment><USER19> Why would one even consider entering these markets without the ability to demonstrate alpha over historical results?

Yes, your alpha needs to include the ability to beat transaction costs... so if you can't pay for the [relatively exceptionally cheap] cost of several years of your chosen market's historical data, maybe you're not really serious.

It's fun to play at being a financier, but let's not pretend that access to market data is the significant barrier to entry which is preventing disruption in the world financial markets.

<comment><USER18> The cost of market data and a system equipped to process it are not inconsiderable.

Historical tick data (quotes and trades) for US equities will run you $20k/year, minimum. US equities runs about 30-40GB/day so you are looking at almost 10TB/year. You need to be able to access the data quickly so you probably don't want to compress it and probably do want to duplicate the data, slicing and dicing it in different ways. Call it 20TB, minimum, per year of data.

Futures and options data will run another $20k/year, each, and futures has about as much data as equities and options has an order of magnitude more. That is another 100TB/year, minimum, per year, probably closer to 200TB.

How are going to to study these data? Even if you were able to operate at disk speed (which seems unlikely unless you have lots of disks and have duplicated and distributed your data amongst them) it would take you five minutes to run against one day's worth of data, or close to a day to run a year's simulation. If you consider more than a few cores in parallel, reading from disk is going to be seriously hampered.

None of this even considers the cost of the software necessary to support this effort: contending with corporate actions, tracking halts, etc.

This all adds up to a significant financial hurdle.

<comment><USER20> Surely though, one could pre-calculate potential future positions or other useful data on stock in advance of next day's trade between close and re-open of the markets?

</comment></comment></comment></comment></comment></comment><comment><USER12> I wonder what exactly the FPGA does, and how they can make it practical and flexible. Of course they could always just test with C and then compile that to HDL.

<comment><USER21> A month or two ago I spoke to someone working in these shops. Apparently, they're using the FPGAs to run many of the high-bandwidth algorithms, because going from NIC to motherboard to CPU and back again added too much latency. So they program the algorithms into the FPGA (which has its own Ethernet port) so it can receive, process, and send the data without ever hitting circuitry not dedicated to the task.

<comment><USER13> This is true, but FPGAs can still only handle relatively simple algorithms. FPGAs make certain kinds of tasks nearly trivial (think truly parallel tasks such as decoding market data for different instruments), but there's just not enough gates (in most cases) to do interesting stuff in the application / logic layer.

FPGAs canonical use case is still as very fast codecs. There are exceptions, but they're really only the very simplest of arbitrage strategies. And in order to make those work you need top-of-the-line network gear and engineers as well.

<comment><USER12> But a Virtex 5 could hold several simple CPUs designed for this task ;)

I don't know if the algorithms they use can be expressed easily as state machines though.

</comment></comment></comment></comment><comment><USER11> Is there something like AWS for automated trading? Located extremely close to the exchanges and offering specialized hardware like this?

<comment><USER22> certain exchanges are starting to standardize access to colocation(for example: [http://www.cmegroup.com/globex/trading-cme-group- products/co...](http://www.cmegroup.com/globex/trading-cme-group-products/co- location-services.html)), but there is nothing that is exchange-agnostic that I know of.

</comment></comment><comment><USER23> Actually this is a far better explanation of High Frequency Trading:

[http://www.thedailyshow.com/watch/wed- september-30-2009/cash...](http://www.thedailyshow.com/watch/wed- september-30-2009/cash-cow---high-frequency-trading)

</comment><comment><USER24> My guess, as is usually the case with these HFT technology vendors, is that this company is trying to sell the residual technology IP from a hedge fund that bellied up.

To those "hobbyists", what would you look for in a solution?

</comment><comment><USER25> That there's a market for products like this is a very bad sign. How many parasites can the market handle before it becomes completely ineffective?

</comment><comment><USER26> Why is this interesting?

<comment><USER27> It looks like you got a few downvotes because people assumed you're being snarky (maybe you are?) -- but I think that most people (even hackers) who work outside of the financial sector are going to wonder why this is on the front page. In short though, it's a 1U blade server with a full-size FPGA in it; implementing your algorithms in hardware makes them extremely fast (thus the mention of the C-to-HDL compiler), which is obviously of critical importance in high-frequency trading.

<comment><USER28> Thanks, I came to ask that question also. So is there any reason that this can't be done using OpenCL instead?

<comment><USER29> We've tried using OpenCL for pricing, the biggest bottle neck is getting data into and out of video card memory.

It's just too slow to move it from main to video memory and back.

Also OpenCL works best when working on large pieces of data at once, with High frequency trading often you want to work on very small pieces, 50 bytes, and process them as fast as possible. Batching up the data and working on it in a SIMD type fashion just takes too long:(

<comment><USER30> APU's should fix some of that.

</comment></comment></comment></comment></comment><comment><USER31> And that's exactly what the world needed. As if Wall Street was not enough to destroy the world. I also question the validity of posting this link to where entrepreneurs, a.k.a value creating people, frequent.</comment>


Prions, Nearly Indestructible and Universally Lethal, Seed the Eyes of Victims - <AUTHOR> https://blogs.scientificamerican.com/artful-amoeba/prions-nearly-indestructible-and-universally-lethal-seed-the-eyes-of-victims/ <comment><USER3> Prion disease is exceedingly rare. CJD is the most common, with an incidence of 1 per 1,000,000 person-years worldwide, inclusive of all transmission vectors (including medical procedures).

Iatrogenic transmission is a rarer subset still: the riskiest transplants (with respect to CJD) are in the central nervous system. The UK tracked their transmission rates from 1970 to 2003 (a long period is needed because surgical transmission usually occurs in folks with long incubation periods - up to ten years or so) for dura transplants (something that goes into the CNS) and found a total of eight.

This article is one good step above scare-mongering, but only one.

<comment><USER4> Infectious disease is one area where fear of the unknown is rational. We don't just need to defend against existing diseases, but also diseases yet to emerge. Just because CJD is rare doesn't mean that the next prion disease will be, so it would make sense to take measures to prevent transmission of prions now.

<comment><USER3> We take measures now, for tissues where prions are a possible transmission risk. The article mis-represented that. But:

(1) there are only so many resources to go around. Should we be devoting them to vanishingly rare things rather than things that might actually affect you?

(2) prions will never be a wildfire plague. They have little or no tranmissive ability, by nature of being absolutely naked protein. One step up from that - encoding the protein for space constraints and encapsulating it - is called a virus.

<comment><USER5> > (2) prions will never be a wildfire plague. They have little or no > tranmissive ability, by nature of being absolutely naked protein.

Chronic wasting disease (CWD) (affects deer) can be transmitted by infected saliva. One of the symptoms of symptoms of CWD is excessive saliva production. It is very transmissible, and is devastating captive populations of deer, although it is relatively rare in the wild.

I think if a similar TSE affected humans, spreadable by infected saliva, it would absolutely be a wildfire plague.

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

<comment><USER6> Is there any mammalian prion disease not linked to the PRNP gene (which is fairly conserved across mammals)?

At first I assumed that 'prions' came in many flavors, like virus. However from my brief lit search, it seems like people are talking about (p)rion proteins as if they were't all (P)rion proteins (PRNP). If all mammalian 'prion' disease can be traced to a single conserved gene, I think the risk of another 'prion-like' disease cropping up is pretty low.

But then again, who knows? Prion disease still seems shrouded mystery, which I find odd given (1) how inherently interesting this topic seems, and (2) we've gotten really, really good at molecular biology.

I feel like we are missing a key piece of the puzzle when it comes to understanding prion disease. The literature seems to want people to conceptualize the disease etiology as such: an alternately folded (disease causing) variant of PRNP protein (PrPs) bumps into a normal version of PRNP (PrPc), causing a normal copy of PrPc to also misfold into PrPs. Rinse, repeat. So you can basically think of it like an enzyme that catalyzes a conformational change on versions of itself, in a feed-forward cascade. I feel like an alternative hypothesis however, could be one of an autoimmune response. The mammalian immune system, particularly the antibody system, is mind blowing. This system can recognize virtually any foreign protein -- it can even recognize specific sub-moieties and conformations of proteins (antigens). It must, do this while never mistaking an endogenous protein to be foreign; if it does, you get an autoimmune disease. My idea is basically that PrPs is just slightly different enough from PrPc to get tagged as foreign by the antibody system (which it absolutely can do, given that we can perform western blots to detect the PrPs variant), but also just similar enough for the antibody system to mistake some endogenous PRNP for the foreign version.

</comment></comment></comment></comment></comment><comment><USER7> I had project in college on Prions. Some interesting things I remember:

* Kuru (laughing disease) was transmitted from cannibalism. Women and children of the tribe were more likely to contract it because they were more often given the less palatable parts of the bodies, which included brains

* Some countries do not trust American cattle because our standards for Prion screening are too low

* Kentucky has issues with Prions because Squirrel brains are a popular dish

Try not to eat animal or human brains and you can dramatically reduce your chances of getting Prions

<comment><USER8> A few questions:

* Do we have a good grasp on the number of prions in the world? My recollection from when MadCow became a big thing in the late 90s was that prions weren't even looked for and were hard to find as a general rule, but that was 20+ years ago. Might there be many common-but-harmless prions that we haven't even noticed?

* WHY is brain consumption (both in humans and in animals) such a source of prions? What makes that situation more likely to create prions?

<comment><USER6> Get this... there is only one (1) prion protein! All mammalian prion diseases are directly related to the PRNP gene.

People talk about Mad Cow, Kuru, Creutzfeldt-Jacobs, Chronic Wasting Disease, Scrapie, and a dozen other diseases like they are not all manifestations of the same underlying problem with PRNP gene variants.

</comment></comment></comment><comment><USER9> If you're interested in prions and some heavy science, I would highly recommend reading the research blogs of Eric and Sonia.

[http://www.cureffi.org/](http://www.cureffi.org/) and [http://www.prionalliance.org/blog/](http://www.prionalliance.org/blog/)

> Wife-husband team Sonia Vallabh and Eric Minikel are on a very personal > mission to find a cure to prion diseases. When Sonia was diagnosed as a > genetic carrier of a rare disease called Fatal Familial Insomnia (FFI), she > and Eric quit their regular jobs and began studying molecular biology to > learn as much as they could.

Theirs is an incredible story so far. [https://www.newyorker.com/books/page- turner/a-prion-love-sto...](https://www.newyorker.com/books/page- turner/a-prion-love-story)

<comment><USER10> This is pretty inspiring. Thanks for posting it.

</comment></comment><comment><USER11> A few months ago I was talking at a family gathering and learned that one of my distant relatives has CJD. They're a high-ranking company executive, but their cognition is rapidly wasting away and will be dead within a few years. Another family member that was a nurse in Kentucky(?) said they have a high rate of prion disease due to farmers inhaling contaminated dirt for years.

There are a few comments here about how talking about prion diseases are basically fearmongering. It shook me a bit, though. I always thought of CJD as one of those freak diseases that you hear about in the news, but is such low likely hood that it's basically non-existent. Not so much anymore.

<comment><USER12> > A few months ago I was talking at a family gathering and learned that one of > my distant relatives has CJD. They're a high-ranking company executive, but > their cognition is rapidly wasting away and will be dead within a few years

Are you sure it's CJD? Article says 95% of CJD patients won't live 12 months after diagnosis.

> Another family member that was a nurse in Kentucky(?) said they have a high > rate of prion disease due to farmers inhaling contaminated dirt for years.

What kind of prion disease and what kind of dirt?

<comment><USER11> I was told mad cow disease and CJD interchangably, which looking it up seems to be slightly different. I don't know the difference between CJD and vCJD and Wikipedia isn't helping much. Honestly, I don't know how fast it's progressing, so it may in fact be months. They may already be dead for all I know, but it sounded like they were diagnosed several months before - <USER2> don't know how long ago she _got_ it though, due to the long incubation. The family member mentioned mood swings, improper outbursts in conversation, and memory degeneration and how they're nearly bedbound now due to loss of balance.

The nurse family member said cow farmers, so I assume cow feces contaminated dirt, and that their brains looked "like Swiss cheese". This was also in the context of mad cow disease. I checked my notes from the day and it was North Carolina, not Kentucky.

</comment></comment></comment><comment><USER13> As someone with anxiety and eye problems, I'm not feeling great.

<comment><USER14> Same here. I've had strange eye problems that my doctor hasn't been able to explain, and I feel like my cognition is declining. It's easy to buy into unknowns like this which seem to explain everything wrong with you, but it's exceedingly unlikely.

More likely is that my eye problems are from wearing contacts in for too long and staring too long at a computer in a low-humidity environment and never blinking. My cognitive issues are probably from not eating healthily, not getting enough sleep, not exercising, and from being depressed.

<comment><USER15> > _I 've had strange eye problems that my doctor hasn't been able to explain, > and I feel like my cognition is declining_

You could also explain this with low-level heavy metal exposure, e.g. mercury, as well as a large amount of other possibilities :-)

I thought hard if I should write this, as a joke and only the above line at first, but here it goes. Having read your second paragraph too, that is pretty much exactly what I said to myself a decade ago and before. Then some things escalated a little bit and I was forced to either accept all my increasing issues, or do some research myself.

Turned out I had chronic heavy metal poisoning from mercury. Fortunately diagnosis was made easy because I actually had high levels of it in hair and blood (and urine - same as blood since that's where that comes from). Anyway, the scale of the problem was only made clear during chelation therapy, when both I as well as my (university clinic researcher) doctor were amazed at all the things that improved, including "miracles" such as thyroid normalization (had been enlarged and with a nodule for decades, completely gone within half a year of DMPS chelation, left the endocrinologist speechless, literally, he checked me _twice_ with ultrasound to make sure he had not make a mistake). This issue is next to impossible to diagnose with today's methods, unlike acute poisoning, because how much you see in blood, urine or even hair does not say anything about the size of the problem, it only shows up when it actually moves around the body which it only does after exposure.

I had had dry eyes too, and of course the ophthalmologist as well as I myself attributed it to too much screen work. Today, after years of chelation, I sit in front of a monitor much more than ever before - but now I have _zero_ issues. Same with RSI. Sooo many little things are completely gone from my body, depression too.

The crazy thing is, up to that point ~10 years ago when I had to confront that something was not quite right, I called myself "healthy". And why not? I could run a half marathon just for fun and still come back feeling relaxed. All the many little issues I had, such as a few warts on the feet (more and more over the decades but I ignored the trend), winter depression (many people have that, it's normal!), eye problems (not really severe, so not worth thinking about it) and many many other, my brain refused to think about it. The reality my brain created of my world was highly distorted, but I did not know it. Only the huge and unexpected changes happening after I began chelation (DMPS, later DMSA) showed me the extend of the thus far ignored problem.

<comment><USER16> Can I ask how you were exposed to mercury?

<comment><USER15> Beginning the story indirectly, when I began the treatment I was not even close to being sure about it all. The only reason I had even tested for mercury was because I was desperate, there just was no other option left, after consulting many doctors finding nothing. After having been given PPIs for the problems that had forced me to start looking in the first place my issues exploded in severity: I had never felt so bad in my life. With barely any stomach acid from the PPIs - I could hardly digest anything, it would lie in my stomach for way too long - I had reflux near constantly. Each time I lay down to sleep, really every single time. With much reduced stomach acid, which seemed to have a very strong opposite effect of what it was intended to do. I also had incredible bloating and my mouth felt funny. The professor gastroenterologist treating me thought it was just nerves.

The first thing I found was, after having first dismissed it as esoterics when I found it on the net, that I had a candida problem. Proven by the significant immediate effect of taking Nystatine (anti-fungal) and a doctor confirmed it. Later I even got Fluconazole, an internal antifungal, again with huge effects. Just an aside, funnily enough, the warts on the sole of my feet that every doctor would say were caused by a virus disappeared by 95% after Fluconazole.

Anyway, I learned Candida never is a cause but itself just a symptom, and since I had none of the conditions that are listed in the text books that might cause it I had to continue looking. Heavy metal poisoning was one of the only options that would explain the Candida, but also everything else. And I had only one possible source: amalgam fillings.

When the tests confirmed high levels of mercury in my hair as well as in my urine I still was not completely sure: It was high but not high enough to explain the severity of my issues. The doctor I went to said it was high enough to justify starting chelation, but I must have something else. I had the remaining three fillings removed with special equipment and protection. I had had three or four removed decades earlier without protection, just normal drilling, at the beginning of my CS study, and now something made sense: At the time I had suddenly, out of nowhere and pretty much overnight, developed almost-asthma level pollen allergy, and for half a year I had severe problems with the right leg joint. I never went to a doctor for the joint because the symptoms clearly showed me it was not "physical", I can't explain it with a few words. I also developed severe insomnia and - as I understand now but not at the time - "dumb". I had always been good at math, for example, but suddenly it was a problem. Stuff that today, after all my chelation, again looks very easy to me. I still passed and I was still very good at everything more practical so getting through the study was no problem. At the time I completely ignored all those sudden issues and took it as "that's just live".

Everything started to improve greatly during the first year of chelation, and after the fifth or so DMPS treatment in the following weeks the tissue around my right-side thyroid became very active. That was very curious, because I had had a double-sized right thyroid with a nodule for at least two decades, re- diagnosed just a year prior. Recommendation back then was surgery to get rid of the nodule. The tissues in that area became active after two or three DMPS treatments. I went to the endocrinologist again when I felt nothing else there. He did an ultrasound, and when he was done he started casually looking through his notes and became more and more agitated. He asked me to lie down again and he repeated the ultrasound, right side only this time. At the end the result still was this: Thyroid size nearly completely normal, and the nodule had disappeared completely. That was the point when I actually believed that yes, I had found the source of the problem.

Regarding an even more clear proof for amalgam fillings as the cause:

After about a year the doctor wanted to make an injection in to my buccal mucosa. It's just mucosa, so you don't need any force, but his needle ended up _deep inside jaw bone_. He found several places where the needle easily penetrated into bone. All those places where where amalgam fillings had been for two or three decades. He injected DMPS and just like in the thyroid area the are began to "work". Very actively. A year later the needle could not penetrate anywhere any more. The jaw remained a very very active area though for years, and it still reacted to chelation. An aside: The are had been OPG x-rayed a few times in the years before because I had finally gotten my crooked teeth fixed and jaw extension surgery too (now I have perfect bite and teeth, wonderful!!!). No doctor ever saw anything in my jaw. One wasn't sure about seeing a tiny shadow near one root - the one where I had the most issues and that was the most active later during chelation - but didn't take it serious enough and didn't follow up (when patients don't complain why would you if it's so subtle). But bone that can be penetrated by a needle easily is _very_ broken. This shows how much (more) broken something has to be to show up even in an OPG x-ray.

My doctor never found anything else and now he too thinks that the only problem there ever was were the amalgam fillings. A lot - _a lot!_ \- of very interesting stuff happened to me, the chelators only paved the way out and started it, 99% of the actual work was done by my body (most chelators only work in extracellular space anyway). For example, there were three months of nightly 3-4 am kidney pain, but after the nephrologist found that despite elevated protein levels in urine there was no sign of kidney disease I didn't worry about it. It fit into the pattern of stuff happening at various times all over my body and my brain, a new phase starting every few months in another area of the body. For those three kidney pain months I simply got up when it started at 3 am or so, went to bed when it stopped at 5 am and slept until 10 and still got my sleep. No problem.

Even tough I'm a CS person, I actually have a background not in medicine, but (for fun and out of interest) I've also have many courses in biology, chemistry, org.chemistry, biochemistry, anatomy, physiology, neuroscience, several courses in each. I don't care about pathologies, I only wanted to understand the basics of biology and life and of human physiology.

</comment></comment></comment></comment></comment><comment><USER17> In related prion news, does anyone have insight into the recent studies suggesting that Chronic Wasting Disease (CWD, increasingly prevalent in North American deer and elk) may be transmissible from infected animals to humans via cooked muscle meat?

In 2017, there was a Canadian study that seemed to show that feeding macaque monkeys raw muscle meat from infected deer was capable of transmitting the disease. I don't think the study has been published yet, but it's described in detail in this Norwegian report ([https://vkm.no/download/18.25950e0715e84a118a6ec492/15069251...](https://vkm.no/download/18.25950e0715e84a118a6ec492/1506925175221/Statement%20CWD.pdf)) and forms the basis of an advisory by the Canadian government ([https://www.thetyee.ca/Documents/2017/06/24/Risk-Advisory- Op...](https://www.thetyee.ca/Documents/2017/06/24/Risk-Advisory-Opinion- CWD-2017.pdf)) suggesting that consumption of all potentially infected meat be avoided.

Then in 2018, a separate seemingly very similar American study was published ([http://sci-hub.tw/10.1128/JVI.00550-18](http://sci- hub.tw/10.1128/JVI.00550-18)) , saying that no evidence was found for transmission to macaques, even after direct cerebral exposure. The NIH issued a press release ([https://www.nih.gov/news-events/news-releases/nih-study- find...](https://www.nih.gov/news-events/news-releases/nih-study-finds-no- chronic-wasting-disease-transmissibility-macaques)) with the headline "NIH study finds no chronic wasting disease transmissibility in macaques".

Suffice it to say, there seem to be contradictory messages here. Is there some overview that would help to clear things up?

<comment><USER18> I don't have studies but I did email the National Prion Disease Pathology Surveillance Center asking "is there a breakdown of cases of the individual Animal Prion Diseases by location and possibly by year (i.e. cases of human prion disease acquired by eating contaminated meat)?" and here was their response:

> To date, in the US, there have been no known cases of variant CJD, or human > prion disease acquired by eating contaminated beef. Here at the NPDPSC, we > have diagnosed 4 cases, but they were all acquired out side the US; 1 case > in 2044 acquired in UK, 2 cases in 2006 acquired in Saudi Arabia, and 1 case > in 2014 acquired in the middle east.

> In several western US states, Canada, and now South Korea and Norway, there > is concern that chronic wasting disease (CWD), the prion disease of elk and > deer, may be transmissible to people who hunt, butcher, or eat the affected > animals. Although transmission of CWD from animals to humans is unlikely, > recent data indicate that the barriers between species may be weakened when > CWD has been transmitted from animal to animal several times (as may happen > in the wild). The NPDPSC, along with the CDC, Department of Health, and the > Game and Wildlife Administration, is carefully monitoring any possible case > of acquired CWD in humans.

Asked for extra clarification, "So although there is a concern with CWD crossing that barrier, there still haven't been any recorded cases?"

> That is correct.

<comment><USER19> This is such a great comment. Thank you for doing that legwork, and for sharing it.

</comment></comment></comment><comment><USER20> Here is excellent documentary [https://www.youtube.com/watch?v=vw_tClcS6To&list=PLdO1m6dMye...](https://www.youtube.com/watch?v=vw_tClcS6To&list=PLdO1m6dMyeyS58vB1wSpnNbc1bhv_N3jd) anyone wants to see documentary related to Kuru (Prion Disease)

</comment><comment><USER21> Not all prions are bad [1]. We still need to study them and their protein precursors to understand them more.

[1] [https://www.the-scientist.com/features/the-bright-side-of- pr...](https://www.the-scientist.com/features/the-bright-side-of-prions-38210)

</comment><comment><USER22> About 20 or so years ago I was feeling bad about my chances of developing the type of CJD associated with mad cow disease because of all the burgers I'd eaten over the preceding years.

There were also human cases getting reported at a rate that some suggested matched the pattern for the early days of an epidemic.

Luckily that never materialised. Still though having lived in the UK during a certain time period precludes one from donating blood elsewhere, to this day.

<comment><USER23> Sorry friend. Not off the hook yet:

> _patients with very long incubation periods of at least 34 years, and > probably more than 40 years._

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(06\)69362-8/fulltext)

<comment><USER22> The uptick in cases should have started in about 2014 (if 34 years ) or 2020 (if 40 years) and start to tail off a decade later.

</comment></comment></comment><comment><USER24> The part about the possibility of contracting these from your doctor's equipment when you go in for an eye exam is truly scary:

"Undiagnosed CJD patients may seek testing. And the diagnostic equipment used to test them may then become contaminated, the authors write. They recommend single-use instruments or the adoption of new decontamination procedures for opthalmological equipment with better effectiveness on prions."

<comment><USER25> The fear of contracting something from equipment is one reason why I go to an eye doctor who uses contactless air-puff glaucoma diagnostic machines rather than the older style which touches the eye.

In my last several visits, nothing has touched my eye at all.

</comment></comment><comment><USER26> Slightly worrying given that I had a cataract operation in my mid-30s. OTOH, I suspect I should be far more worried about the health impact of filthy diesel.

<comment><USER27> Isn't cataract surgery _removing_ something, only?

FWIW, both my parents had cataracts removed, and my father who'd worn eyeglasses since the 1940's said he'd never seen better in his life. So, chin up.

<comment><USER28> Yes, but the article says that the instruments used in opthalmology can be vectors for the prions. OP is fine though assuming his operation was more than a year ago and he's not currently dead.

<comment><USER29> [https://www.ncbi.nlm.nih.gov/pubmed/11721058?dopt=Abstract](https://www.ncbi.nlm.nih.gov/pubmed/11721058?dopt=Abstract)

> we estimate that the mean duration of the incubation period is 16.7 years

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(06\)69362-8/fulltext)

> A comprehensive statistical analysis had earlier reported that the mean > incubation period was between 10.3 and 13.2 years, but the tail of the > distribution was long. Using these estimates, we calculated that the upper > 0.4% quantile was 40 years, and even larger for those infected young (>50 > years), very much in line with these new observations.

</comment></comment></comment></comment><comment><USER30> Well that's made me a bit more worried about my cornea transplant next year.

</comment><comment><USER31> Given that prions are proteins, why can't we use immunotherapy and vaccinate?

<comment><USER32> Well the immune system needs to be able to do something of use in response. Just putting it in even with an immune sensitizing agent would add another prion that it can't do anything useful about. But antibodies, if we had ones that worked for a strain and weren't essentially prions themselves we could vaccinate for it or use it to "chelate" assuming the prion grabbers wouldn't cause other unacceptable problems.

<comment><USER33> Passive immunization might indeed be a feasible option, but of course requires timely detection.

<comment><USER31> Couldn't we immunize _before_ exposure as we do with, say polio, TB, influenza et al? Then no detection would be needed.

Or are the abnormal prions in CJD and the like not uniform enough for general prophylaxis?

I really have a naive understanding of immunotherapy, so sorry if my question is dumb.

<comment><USER32> Whatever it is isn't that simple given that CJD is just a standard of care. I'm more an enthusiastic dabbler who occasionally checks if I could have been capable technically than an expert admittedly.

I did some more cursory research. Interestingly I was half-wrong about the immune system - while I was right about it not being equipped to stop it can do something. Monoclonal antibody treatments delay it. However another problem is that the body's own proteins which are deformed into prions aren't recognized as foreign bodies. Given that notes mention that mice vaccines only delay the onset along with monoclonal antibody treatments. Some sources seem to indicate that it only blocks prions from deforming as opposed to eliminating combined with the fact that native proteins will keep on cascading.

I wonder how much processing power would be required just to get a candidate 'prion grabber' \- never mind going through ones which won't turn out to be horrifyingly toxic in other ways.

Here are a few sources I skimmed I would be glad to know where I went wrong.

[https://www.researchgate.net/publication/233941323_Immunothe...](https://www.researchgate.net/publication/233941323_Immunotherapy_in_prion_disease)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2063508/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2063508/)

</comment></comment></comment></comment></comment><comment><USER34> I guess, this is the weapon of choice for any patient spy unwilling to send a message. One pinbrick, and the nuclear scientist/dissendent/oppossitional spy has half a year to write his/her memoir.

Are there statistics on Creuzfeld-Jakobs in Langley?

</comment><comment><USER35> It would seem the solution is to treat deceased CJD victims as bio hazard like ebola

</comment><comment><USER36> Prions are one of the things that makes me go, hey wait maybe we do live in a simulation. They're basically corrupted code (which we've yet to figure out how they get that way in the first place) that corrupts other code... what is that?!?! Reminds me a lot of the WoW 'corrupted blood incident'.

I understand how something like bacteria or a virus enters a host and replicates, but an anomalous protein corrupting other protein is just so strange. I'm sure science will adequately explain it someday but until then it's a pretty WTF anomaly to me.

<comment><USER37> At the molecular scale, everything is effectively made of springs (molecular and intermolecular bonds). Proteins are a big complicated tangle of springs, and that means they have multiple possible configurations they can spring to if you let them relax. If you bump another protein of the right shape against them, you can nudge them into a different spring configuration.

Think of "slap bracelets", those curved metal strips that spring around your wrist. If you push two straight ones together, nothing happens. But if you push a curled one against a straight one it will make the straight one curl up too. The curled slap bracelet is acting like a prion.

<comment><USER36> >Think of "slap bracelets", those curved metal strips that spring around your wrist

Wow, I've not heard someone mention those in probably 2 decades.</comment></comment></comment>