Mirror, Mirror...Everywhere

One biology fact that, until last week, that I never had to worry about is why life on earth not just is all DNA-based but also all share the same chirality. E.g., all life we know about has DNA with a right-handed double helix, uses right-handed sugar molecules, but builds proteins with left-handed amino acids. That’s just how life is, right?

DNA's mirror image could be scary. Credit: Bing Image Creator

But it turns out that life’s chirality is not a law of nature, and that scientists believe that “mirror life” is not only theoretically feasible but plausible within the next ten years. And, many of them believe, that is something we should be very worried about.

Last week, a group of scientists released a lengthy Technical Report on Mirror Bacteria: Feasibility and Risks, along with an accompanying commentary in Science: Confronting risks of mirror life. Long story short, this is a mirror into which we should look very cautiously – if at all.

The report explains the fundamentals:

In a mirror bacterium, all of the chiral molecules of existing bacteria—proteins, nucleic acids, and metabolites—are replaced by their mirror images. Mirror bacteria could not evolve from existing life, but their creation will become increasingly feasible as science advances.

Credit: Adamala, et. alia

That’s the kind of progress science makes, for better and, sometimes, for worse. The problem, as the report also points out, is:

Interactions between organisms often depend on chirality, and so interactions between natural organisms and mirror bacteria would be profoundly different from those between natural organisms. Most importantly, immune defenses and predation typically rely on interactions between chiral molecules that could often fail to detect or kill mirror bacteria due to their reversed chirality. It therefore appears plausible, even likely, that sufficiently robust mirror bacteria could spread through the environment unchecked by natural biological controls and act as dangerous opportunistic pathogens in an unprecedentedly wide range of other multicellular organisms, including humans.

“The threat we’re talking about is unprecedented,” co-author Prof Vaughn Cooper, an evolutionary biologist at the University of Pittsburgh, told The Guardian. “The consequences could be globally disastrous,” another co-author, Jack W. Szostak, chemist at the University of Chicago, agreed in The New York Times. 

OK, that does sound bad.

Michael Kay, MD, PhD, professor of biochemistry at the University of Utah and one of the contributors to the report & commentary, warns:

If these bacteria are able to grow at all—and there is evidence that they probably would be able to grow, at least to some extent, in our natural world—maybe, over time, they could evolve the ability to eat our food and convert it to mirror food. If that happened, that would release a brake on their growth, and then all these other controlling mechanisms, as far as we can tell, would not be effective against these mirror bacteria.

I was especially chilled by this statement from Professor Kay: “There is a real possibility that mirror bacteria would struggle to find enough food to eat in order to grow, but we are humble in the face of evolution.”

As we should be. Evolution tells us that life finds a way (or did you not see Jurassic Park?).

Credit: Adamala, et. alia

The authors believe this is a time for caution. They urge:

However, in the absence of compelling evidence for reassurance, our view is that mirror bacteria and other mirror organisms should not be created…In light of our initial findings, we believe that it is important to begin a conversation on how the risks can be mitigated, and we call for collaboration among scientists, governments, funders, and other stakeholders to consider an appropriate path forward.

The people involved in the report and commentary are not alarmists. They are scientists who have been working in the field. “It’s inherently incredibly cool,” co-author Kate Adamala, a synthetic biologist at the University of Minnesota, told The New York Times. “If we made a mirror cell, we would have made a second tree of life.”

Cool indeed. But when they started talking about risks, they grew more concerned. “We’ve all done our best to shoot it down,” Professor Cooper admitted to The New York Times. “And we failed.”

Not everyone is so worried. Andrew Ellington, a molecular biologist at the University of Texas at Austin, told Scientific American:  “I’d argue a mirror-image bacteria would be at a gross competitive disadvantage and isn’t going to survive well.” He is dismissive of efforts to curb research: “This is like banning the transistor because you're worried about cybercrime 30 years down the road. I’m not particularly worried about a mostly unknown threat 30 years from now versus the good that can be done now.”

For example, one of the uses researchers were investigating mirror life for was for prescription drugs. Professor Kay explains: “they have the potential to last for a much longer period of time and to open up a whole new class of therapeutics that would allow us to treat a variety of diseases that are currently challenging.” A moratorium on research could hamper progress in drug development, such as for H.I.V. or Alzheimer’s.

The authors conclude their commentary with a very reasoned plan: “To facilitate greater understanding of the risks associated with mirror life and further progress on governance, we plan to convene discussions on these topics in 2025. We are hopeful that scientists and society at large will take a responsible approach to managing a technology that might pose unprecedented risks.”

Yeah, well, that’s not going to happen. As with AI, nuclear weapons, or any other transformative technologies, we’re more likely to plunge ahead regardless of risks, afraid that other scientists/companies/countries will get a jump on us if we slow up.

I wish we were more thoughtful; I wish we were better at anticipating risks versus benefits. I’m proud of these scientists for their innovative work, and for being brave enough to advocate caution about it, but I’m not optimistic that their plea will be heeded. Someone is going to make mirror cells, and probably sooner than we expect.

Then, Professor Kay predicts: “Once a mirror cell is made, it's going to be incredibly difficult to try to put that genie back in the bottle.”

You, Me, and Our Microbiome

You may have heard about the microbiome, that collection of microorganisms that fill the world around, and in, us. You may have had some digestive tract issues after a round of antibiotics wreaked havoc with your gut microbiome. You may have read about the rafts of research that are making it clearer that our health is directly impacted by what is going on with our microbiome.  You may even take probiotics to try to encourage the health of your microbiome.

Our microbiome is all around us. Credit: Bing Image Creator

But you probably don’t realize how interconnected our microbiomes are.

Research published in Nature by Beghini, et. al., mapped microbiomes of almost 2,000 individuals in 18 scattered Honduras villages. “We found substantial evidence of microbiome sharing happening among people who are not family and who don’t live together, even after accounting for other factors like diet, water sources, and medications,” said co-lead author Francesco Beghini, a postdoctoral associate at the Yale Human Nature Lab. “In fact, microbiome sharing was the strongest predictor of people’s social relationships in the villages we studied, beyond characteristics like wealth, religion, or education.”

“Think of how different social niches form at a place like Yale,” said co-lead author Jackson Pullman. “You have friend groups centered on things like theater, or crew, or being physics majors. Our study indicates that the people composing these groups may be connected in ways we never previously thought, even through their microbiomes.”

“What’s so fascinating is that we’re so interconnected,” said Mr. Pullman. “Those connections go beyond the social level to the microbial level.”

Credit: Beghini, et. alia

Study senior author Nicholas Christakis, who directs the Human Nature Lab, explained that the research “reflects the ongoing pursuit of an idea we articulated in 2007, namely, that phenomena like obesity might spread not only by social contagion, but also by biological contagion, perhaps via the ordinary bacteria that inhabit human guts.” Other conditions, such as hypertension or depression, may also be spread by social transmission of the microbiome.

Professor Christakis thinks the findings are of broad importance, telling Science Alert: "We believe our findings are of generic relevance, not bound to the specific location we did this work, shedding light on how human social interactions shape the nature and impact of the microbes in our bodies." But, he added: "The sharing of microbes per se is neither good nor bad, but the sharing of particular microbes in particular circumstances can indeed be good or bad.”

This research reminded me of 2015 research by Meadow, et. al., that suggested our microbiome doesn’t just exist in our gut, inside other parts our body, and on our skin, but that, in fact, we’re surrounded by a “personal microbial cloud.” Remember the Peanuts character Pigpen, who walked around in his personal dirt cloud? Well, that’s each of us, only instead of dirt we’re surrounded by our microbial cloud – and those clouds are easily discernable from each other.

We're all like that, but with a microbiome cloud. Credit: Charles M. Schulz 

Dr. Meadow told BBC at the time: "We expected that we would be able to detect the human microbiome in the air around a person, but we were surprised to find that we could identify most of the occupants just by sampling their microbial cloud."

Those researchers predicted:

While indoors, we are constantly interacting with microbes other people have left behind on the chairs in which we sit, in dust we perturb, and on every surface we touch. These human-microbial interactions are in addition to the microbes our pets leave in our houses, those that blow off of tree leaves and soils, those in the food we eat and the water we drink. It is becoming increasingly clear that we have evolved with these complex microbial interactions, and that we may depend on them for our well-being (Rook, 2013). It is now apparent, given the results presented here, that the microbes we encounter include those actively emitted by other humans, including our families, coworkers, and perfect strangers.

Dr. Beghini and colleagues would agree, and further suggest that it’s not only indoors where we’re sharing microbes.

I would be remiss if I didn’t point out new research which found that our brains, far from being sterile, are host to a diverse microbiome and that impacts to it may lead to Alzheimer’s and other forms of dementia.

Could we catch Alzheimer’s from someone else’s personal microbiome cloud?  It’s possible. Could we prevent or even cure it by careful curation of the brain (or gut) microbiome? Again, possible.

The truth is that, despite decades of understanding that we have a microbiome, we still have a very limited understanding of what a healthy microbiome is, what causes it to not be healthy, what problems arise for us when it isn’t healthy, or what we can do to bring it (and us) to more optimal health. We’re still struggling to understand where besides our gut it plays a crucial role.

We now know that we can “share” parts of our microbiome with those around us, but not quite what the mechanisms for that are – e.g., touch, sharing objects, or having our personal clouds intersect.

We feel like we are where scientists were two hundred years ago in the early stages of the germ theory of disease. They knew germs impacted health, they even could connect some specific germs with specific diseases, they even had rudimentary interventions based on it, but much remained to be discovered. That led to vaccines, antibiotics, and other pharmaceuticals, all of which gave us “modern medicine,” but failed to anticipate the importance of the microbiome on our health.

Similarly, we’re justifiably proud of the progress we’ve made in terms of understanding our genetic structure and its impacts on our health, but fall far short of recognizing the vastly larger genetic footprint of the microbiome with which we co-exist.

A few years ago I called for “quantum theory of health” – not literally, but incorporating and surpassing “modern medicine” in the way that quantum physics upended classical physics. That kind of revolution would recognize that there is no health for us without our microbiome, and that “our microbiome” includes some portion of the microbiomes of those around us.  We talk about “personalized medicine,” but a quantum breakthrough for health would be treating each person as the symbiosis with our unique microbiome.

We won’t get to 22^nd century medicine until we can assess the microbiome in which we exist and offer interventions to optimize it. I just hope we don’t have to wait until the 22^nd century to achieve that.

You Can't Spell Fair Pay Without AI

Everything’s about AI these days. Everything is going to be about AI for a while. Everyone’s talking about it, and most of them know more about it than I do. But there is one thing about AI that I don’t think is getting enough attention. I’m old enough that the mantra “follow the money” resonates, and, when it comes to AI, I don’t like where I think the money is ending up.

Will we use AI to help workers, or to eliminate them? Credit: Bing Image Creator

I’ll talk about this both at a macro level and also specifically for healthcare.

On the macro side, one trend that I have become increasingly radicalized about over the past few year is income/wealth inequality.  I wrote a couple weeks ago about how the economy is not working for many workers: executive to worker compensation ratios have skyrocketed over the past few decades, resulting in wage stagnation for many workers; income and wealthy inequality are at levels that make the Gilded Age look positively progressive; intergenerational mobility in the United States is moribund.

That’s not the American Dream many of us grew up believing in.

We’ve got a winner-take-all economy, and it’s leaving behind more and more people. If you are a tech CEO, a hedge fund manager, or a highly skilled knowledge worker, things are looking pretty good. If you don’t have a college degree, or even if you have a college degree but with the wrong major or have the wrong skills, not so much.  

All that was happening before AI, and the question for us is whether AI will exacerbate those trends, or ameliorate them. If you are in doubt about the answer to that question, follow the money. Who is funding AI research, and what might they be expecting in return?

It seems like every day I read about how AI is impacting white collar jobs. It can help traders! It can help lawyers! It can help coders! It can help doctors! For many white collar workers, AI may be a valuable tool that will enhance their productivity and make their jobs easier – in the short term. In the long term, of course, AI may simply come for their jobs, as it is starting to do for blue collar workers.

Automation has already cost more blue collar jobs than outsourcing, and that was before anything we’d now consider AI. With AI, that trend is going to happen on steroids; jobs will disappear in droves. That’s great if you are an executive looking to cut costs, but terrible if you are one of those costs.

So, AI is giving the upper 10% tools to make them even more valuable, and will help the upper 1% further boost their wealth. Well, you might say, that’s just capitalism. Technology goes to the winners.

That's how rich people view AI. Credit: Bing Image Creator

We need to step back and ask ourselves: is that really how we want to use AI?

Here’s what I’d hope: I want AI to be first applied to making blue collar workers more valuable (and I’m using “blue collar” broadly). Not to eliminate their jobs, but to enhance their jobs. To make their jobs better, to make their lives less precarious, to take some of the money that would otherwise flow to executives and owners and put it in workers’ pockets. I think the Wall Street guys, the lawyers, the doctors, and so on can wait a while longer for AI to help them.

Exactly how AI could do this, I don’t know, but AI, and AI researchers, are much smarter than I am. Let’s have them put their minds to it. Enough with having AI pass the bar exam or medical licensing tests; let’s see how it can help Amazon or Walmart workers.

Then there’s healthcare. Personally, I have long believed that we’re going to have AI doctors (although “doctor” may be too limiting a concept). Not assistants, not tools, not human-directed, but an entity that you’ll be comfortable getting advice, diagnosis, and even procedures from. If things play out as I think they might, you might even prefer them to human doctors.

But most people – especially most doctors – think that they’ll “just” be great tools. They’ll take some of the many administrative burdens away from physicians (e.g., taking notes or dealing with insurance companies), they’ll help doctors keep current with research findings, they’ll propose more appropriate diagnoses, they’ll offer a more precise hand in procedures. What’s not to like?

I’m wondering how that help will get billed.

Doctors see AI assisting. Credit: Bing Image Creator

I can already see new CPT codes for AI-assisted visits. Hey, doctors will say, we have this AI expense that needs to get paid for, and, after all, isn’t it worth more if the diagnosis is more accurate or the treatment more effective? In healthcare, new technology always raises costs; why should AI be any different?

Well, it should be.

When we pay physicians, we’re essentially paying for all those years of training, all those years of experience, all of which led to their expertise. We’re also paying for the time they spend with us, figuring out what is wrong with us and how to fix it. But the AI will be supplying much of that expertise, and making the figuring out part much faster. I.e., it should be cheaper.

I’d argue that AI-assisted CPT codes should be priced lower than non-AI ones (which, of course, might make physicians less inclined to use them). And when, not if, we get to the point of fully AI visits, those should be much, much cheaper.

Of course, one assignment I would offer AI is to figure out better ways to pay than CPT codes, DRGs, ICD-9 codes, and all the other convoluted ways we have for people to get paid in our existing healthcare system. Humans got us into these complicated, ridiculously expensive payment systems; it’d be fitting AI could get us out of them and into something better.

If we allow AI to just get added on to our healthcare reimbursement structures, instead of radically rethinking them, we’ll be missing a once-in-lifetime opportunity. AI advice (and treatment) should be ubiquitous, easy to use, and cheap.

So to all you AI researchers out there: do you want your work to help make the rich (and maybe you) richer, or do you want it to benefit everyone? 

Stick to the Science

A year ago I wrote about disturbing news from the Pew Research Center that trust in science, and in scientists, had fallen since the pandemic. I am slightly relieved to report that a new follow-up study by Pew indicates that trust is up slightly – but still way below where they were pre-pandemic.

Trump won, but, with RFK Jr and his ilk, will science lose? Adriana Zehbrauskas for The New York Times

Overall, 76% of Americans express fair or a great deal of confidence in scientists to act in the public’s best interests (versus 87% in April 2020). The public is about evenly split about how active a role scientists should take in policy debates – 51% think they should, 48% think they should stick to science. A year ago those numbers were flipped.

I think about all this in the context of the proposed members of President-elect Trump’s health team, whose takes on “science” are often considered out of the mainstream.

Trump surprised many a few months ago when he brought Robert F. Kennedy Jr. into his fold. Over the years, RFK Jr., an environmental lawyer by background, has expressed numerous startling views about health and our healthcare system. According to Jennifer Nuzzo, the director of the Pandemic Center at Brown University, RFK Jr. “is just in a category by himself. R.F.K. Jr. just willfully disregards existing evidence, relies on talking points that have been consistently debunked.”

Nonetheless, Trump vowed: “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” He has now named him as his candidate for Secretary of Health and Human Services.

The team behind RFK Jr. have their own unconventional views. A quick rundown:

Dr. Dave Weldon for CDC Director: He has a long history of vaccine skepticism, and while in Congress authored the Weldon Amendment, which provided protections for anti-abortion healthcare workers and organizations. Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told The New York Times: “The notion that this man who held a series of false beliefs about science and medicine could rise to the position where he would head the C.D.C. is in some sense frightening.”

Dr. Marty Makary for FDA Commissioner: During the pandemic, he expressed a great deal of sympathy for letting herd immunity work, and opposed vaccine mandates/masking requirements. He has charged: "the greatest perpetrator of misinformation has been the United States government with the food pyramid," and – very similar to RFK Jr’s views -- has said: “We have poisoned our food supply."

Dr. Mehmet Oz for CMS: On his long-running TV show, Dr. Oz was known for advocating a variety of dubious health claims, and was especially known for marketing supplements, about which he once admitted “don’t have the scientific muster to present as fact.”

Dr. Jay Bhattacharya for NIH Director: He was the coauthor of the controversial “Great Barrington Declaration,” which decried what the authors thought was government overreaction to COVID and called for more “focused protection.” He particularly was critical of Dr. Fauci.

Dr. Janette Nesheiwat for Surgeon General: In theory, she supports vaccines, but she has also touted the “transformative power of prayer,” and has hawked her own line of dietary supplements.

Benjamin Mazer, writing in The Atlantic, says: “But what unites them all—and what legitimizes them in the eyes of this next administration—is a lasting rage over COVID.” He further explains:

The world, as Kennedy, Makary, Bhattacharya, and their compatriots variously understand it, is dreadful: SARS-CoV-2 was likely created in a lab in Wuhan, China; U.S. officials tried to cover up that fact; and the government responded to the virus by ignoring scientific evidence, violating citizens’ civil rights, and suppressing dissent.

As a result, many experts are wary. “When we get into another firefight with a microbe, we need all hands on deck, and we need the best science and the best public health practice to come forward,” Michael T. Osterholm, a University of Minnesota infectious-disease expert, told The Washington Post. “I’m not confident at this point that this administration can do that.”

“It seems that these picks are more focused on talking points of the past (and some unsubstantiated) than preparing for the future,” Katelyn Jetelina, a California epidemiologist tracking bird flu and other outbreaks, also told WaPo.

Some more mainstream experts see the picks as part of the libertarian “medical freedom” movement. “We’ve gone back to the idea of ‘every man his own doctor,” Howard Markel, an emeritus professor of pediatrics and history at the University of Michigan, told KFF Health News. He called it a bad idea then, and a bad idea now.

“Science is losing its place as a source of truth,” Dr. Paul Offit told WSJ. “It’s becoming just another voice in the room.”

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The sad thing is that we do need major changes. CDC made many blunders during the pandemic. Over the past forty years, we have allowed the food industry to create an obesity crisis. The FDA is riddled with conflicts of interests, and its regulation has often been ineffective. Our payment structures for Medicare and Medicaid are at best antiquated and at worse incentivize expensive and often ineffective care. I could go on.

“We are playing with fire with the shake-ups and choices, but at this point change is needed,” Dr. Michael Mina, an epidemiologist and former Harvard professor, told NYT. “At least there’s a better chance of positive change compared to complacency and more of the same.”  Even the liberal Editorial Board of WaPo agrees the FDA needs an overhaul.

Neal Barsky, writing in The Guardian, argues to give RFK Jr. a chance:

He recognizes the inordinate control the pharmaceutical and food industries over healthcare policy, and the revolving door that exists among congressional staffers, pharmaceutical lobbyists and corporate executives…He advocates banning pharmaceutical advertising on television, and wants to clamp down on the corporate ties to federal agencies such as the Food and Drug Administration and National Institute of Health.

Mr. Barsky’s key advice: “Lose the conspiracies and stick to the science.”

The Pew report found people generally don’t think scientists make better policy decisions than others, and are split about equally as to if scientists base decisions on facts or are as biased as the rest of us. These appointees are going to test our views on science versus science that is really just someone’s opinion.  

I’m hoping all Trump’s appointees take Mr. Barsky’s advice and stick to actual science. And I’m hoping that in its zeal to get rid of the “deep state” we don’t lose the expertise that we still very much need.

Listening to Podcasts Is So Gen X

There are a lot of people, myself included, who think Kamala Harris may have lost the election by not going on the Joe Rogan Experience. He has a huge audience of young males – a weak demographic for her – yet one that is split roughly evenly between Republican, Democrat, and independent (according to Edison Research). Trump appeared, as did JD Vance and RFK Jr., but not the VP or Gov. Walz. She did plenty of other podcasts, but somehow chose to avoid JRE.

TV? No, Gen Z is watching podcasts. Credit: Bing Image Creator

As Tatiana Siegal and Todd Spangler wrote in Variety: “it is clear that Harris relied on an outdated playbook — one that opted for Howard Stern, who pioneered bro radio in the ’90s but whose influence is now negligible — and failed to see the significance of Rogan.”

The above notwithstanding, I promise this is not going to be about politics. It’s not even going to be about listening to podcasts. Rather, it’s about a trend with podcasts that took me by surprise: we’re more likely to watch podcasts than listen to them, and when we do, we’re most likely to do so on YouTube -- not the usual podcast kings, Apple and Spotify,

Ben Cohen reported on this trend in The Wall Street Journal a few days ago, based on research Edison Research published last month. Edison found that 31% of weekly podcast listeners chose YouTube, whereas 27% for Spotify and 15% for Apple Podcasts. Edison said: “A few years ago, YouTube might have seemed like an unlikely platform for podcasts. But as the world of podcasting evolves, many podcasters have embraced video podcasting, recording their shows in both audio and video formats.” 

In fact, Edison goes on to say:

…84% of Gen Z monthly podcast listeners ever listen to or watch podcasts with a video component. For this younger audience, the ability to watch their favorite podcasters, not just listen, adds a layer of engagement that traditional audio platforms lack. Forty-nine percent of Gen Z monthly podcast listeners say video provides a better understanding of context/tone through facial expressions and gestures, while 45% feel more connected to the podcaster(s) through video podcasts. The preferences of the Gen Z demographic are redefining the podcasting landscape, and YouTube is uniquely positioned to cater to their habits.

Mr. Cohen notes: “The most improbable thing about how YouTube made the podcast market all about video is how swiftly it happened. Only four years ago, when it was less popular for podcasts than both Spotify and Apple, YouTube becoming a podcasting colossus sounded about as realistic as Martin Scorsese releasing his next movie on TikTok.”

“We saw this trend organically emerging,” Tim Katz, YouTube’s vice president of partnerships, told him, “and then we wanted to invest in it.” And, boy, it sure is paying off.

Mr. Cohen further points out that YouTube has also recently passed Netflix as the most watched TV streaming service in the U.S., with 150 million households. That’s important because, as he says: “We’re also consuming more podcasts through YouTube because we’re consuming more of everything through YouTube.”

It’s interesting to note that when Joe Rogan signed a new, $250 million deal with Spotify, it was no longer exclusive – and he has some 18.5 million subscribers on YouTube already.

Spotify is not sitting idly. Last week it upped its video game too, announcing “a series of new offerings aimed at helping creators significantly grow their audiences and better monetize their video podcasts on Spotify.” 

Spotify founder and CEO Daniel Ek promised creators:

By delivering a best-in-class video offering uninterrupted by ad breaks, combined with Spotify’s flexibility and ubiquity, we can provide an experience for your audience that is superior to any platform. And by giving you, the creators, another path to monetization beyond ads, we’re freeing you up to spend more time doing what you love: creating.

Listeners “can expect an array of great video features, including chapters, comments, pinch-to-zoom, thumbnail scrubbing, and new ways to find and go deep on podcast,” but, more importantly, starting in January they can view videos uninterrupted by ads.  

All told, Spotify thinks the changes are “the biggest update to podcasts on Spotify ever.”

The announcement admits: “We’ve seen shifts in podcast trends across the industry globally, and one of them is that video consumption hours have expanded rapidly—more than 250 million users have watched a video podcast on Spotify, and nearly two-thirds of podcast listeners say they prefer podcasts with video.”

As Mr. Elk told Anne Steele of WSJ: “It’s becoming all about video. It’s kind of an irony,” He went on to add: ““If you said five years ago that people would want to watch people talking and sitting in front of a microphone, I’d say probably not.”

Mr. Cohen describes this new world:

All of this is beginning to change the entire medium in a fundamental way. For a decade, podcasts were something you listened to while you were doing something else: driving, working out, unloading the dishwasher. That was a passive experience. Now an entire generation has been conditioned to think of podcasts as something they can actively watch any time on any kind of screen—a phone, a computer, a TV. 

Which might sound nuts to you. But to young people, it just sounds normal.

Video podcasts are the new normal.

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I don’t really listen to podcasts, but, if I did, I’d be more inclined to watch than just listen. I waste plenty of time as it is on YouTube and if I wanted to spend some of that time on podcasts, I’d probably use YouTube for them as well.

But I feel about podcasts and especially video podcasts much the way I started to worry about TikTok a few years ago: I don’t really get it, but I have to acknowledge that young people do. Baby Boomers like me and Ms. Harris, and maybe many Gen X, are operating with “an outdated playbook” when it comes to how younger people want to get their information. 

I hate to admit it, but Joe Rogan knows something that many traditional media, marketers, advertisers, and executives don’t, and they better learn those lessons quickly. Podcasts should be a great way to get good information: lengthy discussions with experts. But those experts often have “expertise” that is dubious, and can become major sources of misinformation/disinformation. 

Those of us who care about that better get a new playbook, soon, and that playbook better include podcasts – preferably video ones.    

America the Schizophrenic

I must admit, last week’s election took me by surprise. I knew all the polls predicted a close race, but I kept telling myself that the American I believed in would not elect such a man, again, knowing full well all the things he has said and done – in his personal, professional, and political lives.  I was giving us too much credit.

There's the America we believe in, and the America we actually live in. Credit: Bing Image Creator

Democrats might tell the public that Wall Street was hitting record highs, that GDP growth was among the best in the world, that unemployment was low, and that inflation was finally back under control, but voters didn’t believe them. For most people, the economy isn’t working.

Where you live matters to what you make. Credit: Visual Capitalist

When two-thirds of voters say the country is on the wrong track (NBC News), when almost three-quarters of Americans are dissatisfied with the way things are going in the U.S. (Gallop), when 62% of voters think the economy is weak and 48% say their personal financial situation is getting worse (Harvard CAPS/Harris) – well, threats to democracy tomorrow don’t compare to the price of eggs today.  

Let’s face it: we are on the wrong road. We’re not on a road that is good for most people. We’re not on a road that is getting us ready for the challenges and opportunities that the 21^st century is bringing/is going to bring us. And we’re kidding ourselves about the America we believe in versus the America we actually live in.  Our views about our country are delusional, they’re disorganized thinking, they may even be hallucinations. I.e., they’re schizophrenic. 

For example:

The land of opportunity: The great thing about America is supposed to be that anyone can make it, if they just work hard enough. And there is some truth to that; everyone has their favorite rags-to-riches story. Americans like to believe we have high economic mobility, but, in fact, we’re pretty mediocre, ranking only 27^th in the last Global Social Mobility Index Western European countries do particularly well). “Intergenerational mobility, on average, is significantly lower in the United States than in most other developed countries,” says Professor Raj Chetty, the guru of the field. Mobility matters where you live, how good local schools are, and what kind of family structure you grow up in.

Robust middle class: If lower and middle income workers feel they are not benefiting as much from economic growth as they used to, they’re right. Most workers have seen, essentially, wage stagnation over the past fifty years, in part due to increasing share of the economy going to executives. CEOs make, on average, almost 200 times as much as workers do, and the ratio increasing.  As a result, the U.S. has some of the highest income inequality in the world. Unions – one of the few counterweights to income inequality – have been on the decline for decades, although 54% of US adults think that is bad for the country and 59% think it is bad for workers.

The wealth inequality is even worse. According to the Fed, the top 10% of US households have 67% of total wealth; the lowest 50%, only 2.5%. Blacks owned 23 cents for every $1 white families have; Latinos only 19 cents. Intergenerational transfers perpetuate the gaps.

Liberty and justice for all: America is the jailor of the world. We have about 1.8 million people incarcerated; China is next, with about 1.7 million – but, of course, it has over four times as many people. Think about that. We’ve created a private prison industry to house them all, so someone can get rich off them. Even worse, our prisoners are disproportionately people of color.  All that says more about us than it does them.

We care about the poor: Some 37 million people live in poverty (12 million of whom are children). Some 42 million rely on SNAP to help pay for food. Some 26 million school children receive subsidized lunches. We replaced welfare with TANF, but it has largely just hurt poor people. At least a half million people – and I have to assume the real; number is much higher – are homeless.  We not only accept these, we allow spending on social services to be the first to be cut.

Education is key: Our K-12 educational outcomes trail many other countries, and scores are at their lowest level in decades. Only 28% of America adults think our STEM education is above average compared to other countries…a third think it is below average.  Our worse schools are often in the areas that need them most.

Instead of investing in our public education system, politicians would rather divert that money on vouchers to private schools, with less oversight (and, in many cases, less diversity).

Best health care in the world: Some 26 million Americans (about 8%) have no health insurance (and that is much better than it was pre-ACA). One in four Americans have skipped health care in the last 12 months due to costs, and one in five have not filled a prescription due to costs. We lead the world in chronic diseases, and die sooner than in peer countries. Our infant and maternity mortality rates are shameful, comparable to supposed third world countries. So called “deaths from despair” are higher than in other countries. Our gun violence is at levels unfathomable in other countries, as are our motor vehicle deaths. And, of course, as much as 25% to 33% of our healthcare spending is considered wasted, even though that spending is the highest in the world. 

Democracy is priceless: I’m not sure that was ever true, but ever since Citizens United we’ve learned that it does have a price, and that the rich are willing to pay it. Think the Trump victory reflected the will of the working class? They might have voted that way, but their perceptions were heavily influenced by megadonors like Timothy Mellon and Elon Musk. Five Republican donors gave over $100 million each.  In total, federal election spending in 2024 reached about $16b. Hey, the Republicans are looking to give away $4 trillion in tax cuts next year, mostly favoring the ultra-rich, so $16b seems like a great investment.

I could go on, but if I haven’t made my point by now, I’m not going to.

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We cannot have a democracy when the plutocrats buy elections. We cannot have an economy where the rich get richer and everyone else works in an Amazon warehouse or at Walmart, with maybe some gig jobs on the side. We cannot hold together as a country where most of our counties are struggling economically while a few areas boom. We cannot give our children a future in which they don’t think they will be able to buy a house or raise children. And we can’t let politicians persuade us climate change isn’t real and, in any event, we don’t need to do anything yet.

Right now, I don’t see that either political party is willing to acknowledge these problems, much less take them on. Too many of our politicians are mainly interested in staying in office, which means not rocking their donors’ world. They stay in office too long and are woefully unprepared to take on the technological, social, and economic issues facing us. We keep electing them anyway.

I’m hoping for the movement that will take on these challenges, but I’m fearing the revolution we’ll have if we don’t.

Inventors (and Innovators) Wanted

I thought about writing about tomorrow’s election, but I’m too anxious – and a little terrified – about it, so I’ll take a pass. I was intrigued by Oracle Health’s promise of an AI-driven, “next-generation” EHR, or the news that OpenAI was introducing ChatGPT search, but I felt that each was inevitable and yet that both would prove underwhelming in the short term.

So I decided to write about invention.

Credit: Bing Image Creator

The November issue of IEEE Spectrum magazine is all about invention, starting with the tantalizing overview Why the Art of Invention Is Always Being Reinvented. “Invention doesn’t come from some innate genius, it’s not something that only really special people get to do,” says Stephanie Couch, executive director of the Lemelson MIT Program. 

Still, authors Eliza Strickland and Peter B. Meyer warn, “…the limits of what an individual can achieve have become starker over time. To tackle some of the biggest problems facing humanity today, inventors need a deep-pocketed government sponsor or corporate largess to muster the equipment and collective human brainpower required.”

Tell that to UTEP student Tayia Oddonetto. While an undergraduate, she had an epiphany. “During class, the professor said that if someone discovered how to turn brine, water with a high salt concentration, into something of value, it’d be revolutionary for the planet. At that moment, I told myself I was going to be the one who found the solution for brine, and that thought has never left me.”

And she did it. Instead of the more common reverse osmosis (RO) method of desalination, which at best converts 85% of salt water into fresh water and leaves a problematic 15% of concentrated brine, Ms. Oddonetto used something called salt-free, electrodialysis metathesis. As the press release describes it: “Salt-free electrodialysis metathesis treats brine by passing it through ion exchange membranes, thin sheets or films, and electrical currents that work to separate salt from water at the molecular level.”

Her approach produced over 90% fresh water, and generated higher levels of valuable metals and minerals that can be repurposed across several industries including technology, health and food.

“Tayia’s research will help public utilities save money while enabling people nationwide to reduce their utility bills in a meaningful way, advancing society's aim of water conservation,” said Ivonne Santiago, Ph.D., an associate professor in the Department of Civil Engineering at UTEP and now Ms. Oddonetto’s doctoral advisor. “In the next few years, I anticipate that we will see Tayia’s research applied on a large scale and fully see the tremendous benefit her work can have on humankind. Her journey is a testament to her perseverance, the importance of working on challenging problems and the value of a strong work ethic and positive attitude.”

“Earning an award and funding for my research is incredibly validating. This is a complex and difficult challenge to tackle and the journey has been full of roadblocks and setbacks,” said Ms. Oddonetto. “But I kept at it, and to be recognized for the value of my work is proof that all my effort and belief in this project was worthwhile.” She’s now working with the National Alliance for Water Innovation (NAWI), El Paso Water, the Kay Bailey Hutchison Desalination plant, New Mexico State University and the U.S. Bureau of Reclamation to refine the process.

UTEP doctoral student Tayia Oddonetto (right) and doctoral advisor Ivonne Santiago, Ph.D., (left). Credit: UTEP

Or take a group of four engineering students at the University of Toronto. As profiled by The Wall Street Journal, the four students entered into an anti drone technology competition (Counter Uncrewed Aerial Systems Sandbox 2024) hosted by the Canadian military, and – against competitors like Boeing and Teledyne -- tied for second, winning some $375,000 (Canadian). First place was C$1 million.

Ms. Poletaev, a material science student, was having coffee with Parth Mahendru, an aerospace-engineering student while discussing the competition. They enlisted Asad Ishaq, a robotics student, and Michael Acquaviva, an electrical engineering student.

Instead of using flashy approaches like lasers, the team used sound to take down drones. “Not everything has to be violent or… destructive,” Anna Poletaev said. “[Our technology can make a drone] think that it’s 5,000 feet off the ground when it’s actually just a few metres above,” Mr. Mahendru explained.

According to the UT press release, “the system can also disrupt visual feeds for drones relying on cameras, making navigation nearly impossible. It can reduce visuals to mere pixels or even disable the camera.”

They did all this spending $17,000 of their one money, mostly via credit cards.

The students have founded Prandtl Dynamics as they seek to commercialize their product, as well as make it more robust (for example, extending its range from 100 meters). “We have a different market that does not… conflict with anyone else, just because of the novelty of the idea,” Mr. Mahendru noted. The team is also actively seeking partnerships and expertise from industry experts.

They have some challenges ahead. As WSJ notes: “Funding for earlier-stage companies, though, is often hard to come by. Globally, only two seed-capital investments, worth a total of $14.2 million, were made in defense startups last year, according to the data provider PitchBook. The federal government has spent billions in recent years on technology from top national-security startups, but most U.S. defense spending continues to go to traditional military contractors.”

Still, Mr. Mahendru insists, “Working for ourselves, that’s what’s most exciting.”

Prandlt Dynamics team. Credit: Joel Rodriguez

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In the IEEE Spectrum invention issue, inventor Dean Kamen warned: “Today, while invention is getting easier and easier, I think there are some aspects of innovation that have gotten much more difficult.” He defines innovation as when something reaches the scale to impact or transform the world. For software, that’s easy; for physical objects, not so much. He blames competition and regulatory environments.

If any sector inhibits inventions from becoming actually innovations, it has to be health care. All anyone has to say is “patient safety” and inventors get cold feet. The hoops inventors have to jump through to get FDA approval or to be covered by health insurers is daunting. Innovators beware.

But I’m reminded of people like Susannah Fox, who writes about the Maker movement in health care, where patients and their families aren’t willing to wait for “the system” to get around to solving their problems. Instead, they invent solutions on their own. We need more Makers in health care, and we need to help them reach Mr. Kamen’s innovation stage of transforming the world – or, in this case, the healthcare system.

More of us need to take Ms. Oddonetto’s attitude: “I told myself I was going to be the one who found the solution.”