Keep It Short

OK, I admit it: I’m on Facebook. I still use Twitter – whoops, I mean X. I have an Instagram account but don’t think I’ve ever posted. Although I’ve written about TikTok numerous times, I’ve never actually been on it. And while I am on YouTube, it’s more for clips from movies or TV shows than for videos from creators like MrBeast.  

So forgive me if I’m only belated taking a look at the short form video revolution.

Hint: it's not TV he's watching. Credit: Bing Image Creator

As is often the case, a couple articles related to the topic spurred my attention: Caroline Mimbs Nyce Twitter’s Demise Is About So Much More Than Elon Musk in The Atlantic, and Jessica Toonkel’s Wall Street Journal article Your Kid Prefers YouTube to Netflix. That’s a Problem for Netflix. I urge you to read both.

Ms. Nyce makes that point that, while Elon may be doing a pretty good job damaging Twitter, much of its woes really are due to microblogging falling out of favor. Her take:

In the era of TikTok, the act of posting your two cents in two sentences for strangers to consume is starting to feel more and more unnatural. The lasting social-media imprint of 2023 may not be the self-immolation of Twitter but rather that short-form videos—on TikTok, Instagram, and other platforms—have tightened their choke hold on the internet. Text posts as we’ve always known them just can’t keep up.

She notes that Twitter is still the dominant platform, by far, for microblogging, but quotes a prediction from data.ai: “While platforms like X are likely to maintain a core niche of users, the overall trends show consumers are swapping out text-based social networking apps for photo and video-first platforms.”

“Short-form videos have become an attention vortex,” Ms. Nyce reports, citing figures from Sensor Tower that users spend an average of 91 minutes daily on TikTok and 61 minutes on Instagram.  

Indeed, Insider Intelligence estimates that video’s share of average daily social media went over 50% in 2022, and will reach 60% by 2025. It predicts that the short video “craze” will cool, but admits: “platforms must contend with the reality that consumers still love short videos.”

Meanwhile. Ms. Toonkel quotes a father of a 8 year-old, who has stopped watching shows like “Thomas and Friends”: “Now, all he wants to do is watch gamers and basketball clips and highlights on YouTube.” She adds: “The Levy family learned what has become clear across the media industry: When it comes to children’s entertainment preferences, YouTube trumps all.”

She reports: “Netflix’s share of U.S. streaming viewership by 2- to 11-year-olds fell to 21% in September from 25% two years earlier, according to Nielsen. Meanwhile, YouTube’s share jumped to 33% from 29.4% over the same period.” Michael Hirsh, co-founder of WOW Unlimited Media, confirmed: “These viewers are watching on their iPads or on other platforms that have moved to shorter and shorter segments, and it’s a real issue for the streamers.”

Ms. Toonkel cities an animation studio that released one new children’s film on Roblox, and other that premiered on YouTube instead of a streaming service. In both cases, the streaming services were a secondary priority. “It’s really about following the consumer,” the studio’s global chief marketing officer told her.

Two weeks ago Pew Research issued a study directly on point: Teens, Social Media and Technology 2023. YouTube, to no one’s surprise, is the top platform for teens 13 to 17, with 93% using. TikTok (63%), Snapchat (60%), and Instagram (59%) followed. Facebook (33%) and Twitter (20%) are barely an afterthought.

Seventy-one percent of teen YouTube users go on daily, with 16% on “almost constantly.” For TikTok, the corresponding figures were 58% and 17%.

YouTube’s popularity isn’t just among teens, of course. The Social Shepherd compiled some fun YouTube facts, such as: 

• It has some 2.7 billion monthly users, with 1.5b on YouTube Shorts;
• There are 122 million daily users;
• 98% of US internet users are on YouTube monthly, 92% weekly, 62% daily;
• US children spend 77 minutes daily on YouTube;
• The aforementioned MrBeast is YouTube’s biggest earner, raking in an estimated $82 million annually;
• 70% of viewers have made a purchase after seeing the brand on YouTube.

Companies better be paying attention. Ms. Nyce warns: “In a recent survey by Sprout Social, a social-media-analytics tool, 41 percent of consumers said that they want brands to publish more 15- to 30-second videos more than they want any other style of social-media post. Just 10 percent wanted more text-only content.”

Digiday’s Krystal Scanlon believes: “The latest pivot toward video is in full swing, and unlike previous occasions, agencies must now master the art of short-form video rather than focusing solely on specific platforms.” She clarifies that not all platforms’ version of short form videos are the same, contrasting TikTok’s “short, engaging, creative videos” with YouTube Short’s “informational or tutorial-style videos.”

Her bottom line: “Simply put, the video content needs to be native to the platform, because consumers are fed up of seeing ads.” As TikTok said when introducing TikTok for Business, “Don’t Make Ads, Make TikToks.”

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Earlier this year Monigle released its Humanizing Brand Experience report. Among other things, it suggested a decline in consumers’ interest in “watching/reading about health and wellness topics,” and an increase in their distrust of healthcare providers.  Neither results are yet dismal, but they underscore that in a short form video world, even healthcare companies need to be rethinking their brand and content strategies.

Detailed web pages of health advice?  Who reads? Catchy TV ads? Who watches? Helpful videos with health information from respected physicians? Too long. Health is complicated, health care is idiosyncratic, so short form anything isn’t natural, but it may now be necessary.  

Those of us of a certain age may not quite understand or appreciate short form videos, but they’re not something we can ignore. Ms. Nyce’s closing thoughts are ominous:

Perhaps the biggest stress test for our short-form-video world has yet to come: the 2024 U.S. presidential election. Elections are where Twitter, and microblogging, have thrived. Meanwhile, in 2020, TikTok was much smaller than what it is now. Starting next year, its true reign might finally begin.

And, I might add, in a time of vaccine skepticism and rampant health misinformation, misleading/simplistic short forms videos pose an existential threat, unless countered by equally effective ones.

Time to up your short form video game, everyone.

A Place to Call Home

Congratulations, America. We have another new record, albeit a dismal one. According to the Department of Housing and Urban Development (HUD), there are now 653,000 homeless people, up 12% from the prior year. As one can imagine, compiling such a number is problematic at best, and no doubt misses a non-trivial number of such unfortunate people.

There but for the grace of God go I.  Credit: Bing Image Creator

“Homelessness is solvable and should not exist in the United States,” said HUD Secretary Marcia L. Fudge. Well, yeah, like kids without enough food, pregnant women without access to adequate prenatal care, or people without health insurance, yet here we are.

HUD says that the increase was driven by people who became for the first time, up some 25%. It attributes this to “a combination of factors, including but not limited to, the recent changes in the rental housing market and the winding down of pandemic protections and programs focused on preventing evictions and housing loss.” As with the recent increase in child poverty, the lessons that we should have learn from our COVID response didn’t survive our willingness to put the pandemic behind us.

Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, told AP: “The most significant causes are the shortage of affordable homes and the high cost of housing that have left many Americans living paycheck to paycheck and one crisis away from homelessness.” The National Low Income Housing Coalition estimates we’re missing some 7 million affordable housing units, so I suppose we should be relived there are “only” 653,000 homeless people.

“For those on the frontlines of this crisis, it’s not surprising,” Ann Oliva, CEO of the National Alliance to End Homelessness, also told AP. Indeed, we’ve all seen news accounts of homeless encampments spreading seemingly out of control, many of us have spotted homeless people as we go about our daily lives, and yet most of us don’t want either homeless people or low income housing units in our neighborhoods.

We often tell ourselves that homeless people are mentally ill or drug users, but data suggests that most are homeless due to economic reasons.  As many as 60% of them are still working, but just can’t afford housing. Too many of us are one missing paycheck away from being on the street.

They’re more likely to be victims of crimes than criminals; in fact, BBC reports that violence against homeless people – including homicide – seems to be on the rise, although there is no systemic tracking of such violence.

In a searing piece in The Atlantic,  Anne Lowrey blasts our lack of anything resembling a national housing policy. She notes: “…today’s HUD is not much of a housing agency. And it is definitely not much of an urban-development agency.” Secretary Fudge told her: “HUD is doing all in our power to invest in those who have often been left out and left behind.” And that’s a big part of the problem.

As Ms. Lowry laments, despite the obvious housing crisis and record number of homeless,

Yet legislators have not passed a significant bill to get people off the streets and out of shelters. Joe Biden has not signed a law to increase the supply of rental apartments in high-cost regions or to protect families from predatory landlords. Congress has not made more families eligible for housing vouchers, or passed a statute protecting kids from the trauma of eviction, or set a goal for the production of new housing.

“The country’s lack of a national housing policy is part of the reason we are in a housing crisis,” she says, “and Washington needs to take a real role in ending it.”

What really got my attention was that a number of states and cities – most of them run by Democrats – want the Supreme court to overturn Martin vs. Boise, which ruled that evicting homeless people who had no choice of indoor housing was “cruel and unusual punishment” and thus unconstitutional. If you want to evict them from their outdoor housing, the court said, you better have places to put them.

Seems reasonable to me. I mean, they’re already homeless; where else do you expect them to go? It doesn’t help that many places are criminalizing homelessness, as though it was a choice those people were making.

I don’t usually look to Texas for solutions to social issues, but when it comes to the homeless, it may be a leader. Over the last decade, Texas has decreased its homeless population by nearly a third, in part because it builds more housing, and less expensive housing.

Cities such as Austin, Houston, and San Antonio have been particular innovators. Houston has cut its homeless population by two-thirds. There was a concerted city-county effort to coordinate the work of public agencies and over 100 non-profits. (Outgoing) Houston Mayor Sylvester Turner brags. “Instead of a hundred NGOs competing with each other, we’ve kind of pulled them all together. They’re now operating under a single umbrella, The Way Home.”

Credit: The Way Home Houston

The focus is to get homeless people into housing first, then address their other issues. As The Way Home says, “first, we give them a key.” Then they work on providing them supportive services to help stabilize their lives. Even law enforcement is on board; Harris County Sheriff Ed Gonzalez says:

…I think it’s important for us to recognize that it really is a public health issue: How can we better develop those systems of care, to better route people where they may need to be, rather than just looking at it through the lens of policing.

That sure beats just breaking up encampments.

Meanwhile, Austin has focused on providing “tiny homes,” while San Antonio has built a huge homeless shelter. It’s important to note that these are local initiatives; Texas itself provides very little state funding for the homeless.  None of these cities has “solved” homelessness, but they’ve shown ways to lessen it.

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Like poverty, homelessness isn’t inevitable; it is a policy choice. Sociologist Matthew Desmond, author of the must-reads Poverty and Evicted, told Ms. Lowrey: “Think of lining up families who qualify for food stamps and only one in four families gets to eat. That’s exactly how we treat housing policy today. It doesn’t make a lot of sense, because, without stable shelter, everything else falls apart.” Accordingly, Ms. Lowrey asserts: “affordable housing for everyone, everywhere, and the end of homelessness should be the policy priority now.”

We may not be able to end homelessness, but we can and should stop treating them as undesirables and start treating them as people – people who first and foremost need a place to live. 

From Xenobots to Anthrobots

There were many things I could have written bout this week – e.g., in A.I., in quantum computing, even “transparent wood” -- but when I saw some news about biological robots, I knew I had my topic.

Yep, those are robots -- biological robots. Credit: Gizen Gumuskaya

The news comes from researchers at Tufts University and Harvard’s Wyss Institute. Their paper appeared in Advanced Science, introducing “a spheroid-shaped multicellular biological robot (biobot) platform” that they fondly dubbed “Anthrobots.” Importantly, the Anthrobots are made from human cells.

Let’s back up. In 2020, senior researcher Michael Levin, Ph.D., who holds positions at both Tufts and Harvard, worked with Josh Bongard, Ph.D. of the University of Vermont to create biological robots made from frog embryo cells, which they called Xenobots.  They were pretty impressive, capable of navigating passageways, collecting material, recording information, healing themselves from injury, and even replicating for a few cycles on their own, but the researchers wanted to find out if they could create biological robots from other types of cells – especially human cells.

Well, the new research showed that they could. They started with cells from adult trachea, and without genetic modification were able to demonstrate capabilities beyond those Xenobots had demonstrated. Lead author Gizem Gumuskaya, a PhD. student said: “We wanted to probe what cells can do besides create default features in the body. By reprogramming interactions between cells, new multicellular structures can be created, analogous to the way stone and brick can be arranged into different structural elements like walls, archways or columns.”   

The Anthrobots come in different shapes and sizes, and are capable of different motions. Ms. Gumuskaya is quite excited about their capabilities:

The cells can form layers, fold, make spheres, sort and separate themselves by type, fuse together, or even move. Two important differences from inanimate bricks are that cells can communicate with each other and create these structures dynamically, and each cell is programmed with many functions, like movement, secretion of molecules, detection of signals and more. We are just figuring out how to combine these elements to create new biological body plans and functions—different than those found in nature.

Even better, Ms. Gumuskaya pointed out: “Anthrobots self-assemble in the lab dish. Unlike Xenobots, they don’t require tweezers or scalpels to give them shape, and we can use adult cells – even cells from elderly patients - instead of embryonic cells. It’s fully scalable—we can produce swarms of these bots in parallel, which is a good start for developing a therapeutic tool.”

They tested Anthrobots’ healing capabilities by scratching a layer of neurons, then exposed the gap to a cluster of Anthrobots called a “superbot.”  That triggered neuron growth only in that area. The researchers noted: “Most remarkably, we found that Anthrobots induce efficient healing of defects in live human neural monolayers in vitro, causing neurites to grow into the gap and join the opposite sides of the injury.”

“The cellular assemblies we construct in the lab can have capabilities that go beyond what they do in the body,” said Dr. Levin. “It is fascinating and completely unexpected that normal patient tracheal cells, without modifying their DNA, can move on their own and encourage neuron growth across a region of damage.”

Xi “Charlie” Ren, a tissue engineer at Carnegie Mellon University who was not involved with the research, told Science that the work “is amazing, and groundbreaking,” and “opens the way to personalized medicine.” Ron Weiss, a synthetic biologist at the Massachusetts Institute of Technology who also was not involved with the work added: “Levin demonstrated that cells can be coached to do something they would never have done on their own.”

Some researchers are not yet convinced. Jamie Davies, a developmental biologist at the University of Edinburgh in Scotland, who was not involved in the 2020 study or this recent one, told Scientific American: “I cannot see how these clumps of cells with flailing cilia merit the term ‘bot.” Dr. Levin and his team, of course, don’t believe the movements are random, and that Anthrobots “could be designed to respond to their environment, and travel to and perform functions in the body, or help build engineered tissues in the lab.”

The ultimate hope is that clinicians would be able to use Anthrobots created from a patient’s own cells to perform therapeutic work. Those bots shouldn’t trigger an immune response, would be bioresorbable, and couldn’t survive outside the lab or the body (making risk of any unintended spread minimal).

The researchers see a wide variety of potential uses in health care:

…various applications can be imagined, including but not limited to clearing plaque buildup in the arteries of atherosclerosis patients, bulldozing the excess mucus from the airways of cystic fibrosis patients, and locally delivering drugs of interest in target tissues. The possible applications will represent those arising from exploiting surprising novel behaviors of cells and engineering new ones via future synthetic biology payloads, such as novel enzymes, antibodies, and other ways to manipulate the cells they traverse and interact with. They could also be used as avatars for personalized drug screening^[32] having the advantage of behavior over simple organoids, which could be used to screen for a wider range of active, dynamic phenotypes.

That’s 21^st century medicine. That’s the kind of health care I want to see.

21st century medicine in action. Credit: Bing Image Creator

The researchers have a number of research areas they want to further explore, including:

• What other cells can Anthrobots be made of?
• What other behaviors might they exhibit, and in what environments?
• What other tissue types can they repair or affect in other ways?
• Can transcriptional or physiological signatures be read out in living bots, that reflect their past and immediate interactions with surrounding cellular or molecular landscapes?
• Do they have preferences or primitive learning capacities, with respect to their traversal of richer environments?

As researchers like to say, more research is required – and, from where I’m sitting, eagerly awaited.

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OK, so these aren’t like the cute robots you see doing flips. They’re not the nanobots many of us have been waiting for. We don’t (yet) have to worry about Asimov’s Three Laws of Robotics with them. But, boy, if we’re going to have robots crawling around inside us doing therapeutic things – and we are -- what could be better than a biological robot made from your own cells?

Lead Pipe Cinch

The term “lead pipe cinch” means something that is very easy or certain. Here’s two things that are lead pipe cinches: first, that ingesting lead, such as from the water or the air, is bad for us. It’s especially bad for children, whose cognitive abilities can be impaired. Second, that the Biden Administration’s latest proposal to reduce the lead in our drinking water is not going to accomplish that.

Is it safe? Credit: Bing Image Creator

The new proposed rules would require that lead service lines be replaced within ten years; there are estimated to still be some 9.2 million such lines in the U.S. The trouble is, no one really knows how many there are or where exactly they are, making replacement difficult. So step two of the rules is for an initial inventory by next October. The “acceptable” parts per billion would drop from 15 to 10. Utilities would also have to improve tap sampling and consumer outreach.

“This is the strongest lead rule that the nation has ever seen,” Radhika Fox, the E.P.A.’s assistant administrator for water, told The New York Times. “This is historic progress.”

Erik Olson, an expert with the Natural Resources Defense Council is also hopeful, telling NPR: "We now know that having literally tens of millions of people being exposed to low levels of lead from things like their drinking water has a big impact on the population. We're hoping this new rule will have a big impact."

The EPA estimates the replacement will cost $20b to $30b over the next decade; the 2021 Infrastructure Act allocated $15b, along with 11.7b available from the Drinking Water State Revolving Fund. Of course, the cost will be much higher.

Chicago alone claims it will cost $10b to replace its estimated 400,000 lead pipes. The Wall Street Journal reports: “David LaFrance, CEO of the American Water Works Association, a trade group, said the total cost could “easily exceed” $90 billion. He said the average cost to replace a single lead service line is more than $10,000, nearly double the EPA’s estimate.”

Digging up all those lead pipes won't be easy. Or cheap. Credit: Bing Image Creator

If the federal funds aren’t enough, Ms. Fox says: "We strongly, strongly encourage water utilities to pay for it," but you should probably expect customers will end up paying – or that some of those pipes won’t be getting replaced.

It’s not like any of this is catching us by surprise. You probably remember the 2014 scandal with the Flint (MI) water crisis, with all those people lining up for bottled water. You may not remember similar crises in Washington D.C., Newark (NJ), or Benton Harbor (MI). “The Washington, D.C., lead-in-water crisis was far more severe than Flint in every respect,” Yanna Lambrinidou, a medical anthropologist at Virginia Tech and co-founder of the Campaign for Lead Free Water, told AP.

The EPA issued a set of rules around lead pipes in 1991, but those rules were watered down, and little progress has been made since. Ronnie Levin, an EPA researcher at the times, also told AP: “But, you know, we’ve been diddling around for 30 years.”

Because, you know, that’s what we do, especially when fixing a problem costs too much money.

The water companies may replace their water lines but not the ones that go under private property, and the pipes inside homes or offices -- well, you should start thinking about a water filter (ones certified for lead, of course).

You wouldn’t buy a house that you knew had lead paint or had asbestos, but most people don’t know if any part of their water supply comes through lead pipes. Dr. Lambrinidou told Fast Company: “We know that the majority of homes, if not all, have lead-bearing plumbing. And we know from the science that as long as you have lead-bearing plumbing, you are at risk of exposure.”

It shouldn’t be a surprise that the problem is worst in cities and in older housing stock. “This a public health concern that has, unfortunately, spanned generations and an issue that has disproportionately impacted low-income and minority communities,” EPA Administrator Michael Regan said at the EPA briefing. “Everyone in this country should be able to turn on their tap for a glass of water and know that it’s safe to drink.”

"We're trying to right a longstanding wrong here," Radhika Fox, head of the EPA Office of Water, echoed. "We're bending the arc towards equity and justice on this legacy issue."

Experts estimate some 500,000 children have high levels of lead in their blood; that number may be overstated, or wildly low. Adults are at risk as well, especially pregnant women. The EPA believes its rules would generate between $9.8b and 34.8b in economic benefits each year, making it a good return on the replacement investments. But the rub is that those economic benefits are from less cognitive impairments and health disorders, in populations we tend to neglect anyway, and so are much “softer” than the direct budget hits of replacing the pipes.

“We have failed generations of children by not eliminating lead,” Mona Hanna-Attisha, the Michigan pediatrician whose research helped to exposed the 2014 Flint water crisis, told NYT. True, but we’ve been failing generations of kids for generations in many ways, such as child poverty or infant mortality. We have generations of “lost Einsteins," kids who never had a chance to reach their full potential due to their surroundings while growing up, whether from lead in their water, insufficient food, polluted air, or failing public education.

We’re the champs at failing kids. And at addressing structural issues like infrastructure.

The new rules now have a waiting period, and final rules aren’t expected until next fall. Then there will be a waiting period before they go into effect. By the time the lobbyists and the politicians – we can’t afford it! – have their say, I’m not optimistic how much impact the final rules will have.

I’m freaked out that there might be lead in my water lines. I’m saddened that there are perhaps hundreds of thousands, if not millions, of children who will never reach their full potential due to having adsorbed too much lead. And I’m furious that we allow our public goods, like clean water or air, to be compromised by politicians whose only concern is reelection.

We can do better, Sadly, it’s a lead pipe cinch that we probably won’t.

Amazon Can Still Surprise Me

It’s Cyber Monday, and you’ve probably been shopping this weekend. In-stores sales on Black Friday rose 2.2% this year, whereas online sakes rose almost 8%, to $9.8b – over half of which was via mobile shopping.  Cyber Monday, though, is expected to outpace Black Friday’s online shopping, with an estimated $12b, 5.4% higher than last year. 

Lest we forget, Amazon’s Prime Day is even bigger than either Cyber Monday or Black Friday.  

Credit: Amazon

All that shopping means lots of deliveries, and here’s where I got a surprise: according to a Wall Street Journal analysis, Amazon is now the leading (private) delivery service.  The analysis found that Amazon has already shipped some 4.8 billion packages door-to-door, and expects to finish the year with some 5.9b.  UPS is expected to have some 5.3b, while FedEx is close to 3b – and – unlike Amazon’s numbers -- both include deliveries where the U.S. Postal Service actually does the “last mile delivery.” 

Just a few years ago, WSJ reminds us, the idea that Amazon would deliver the most packages was considered “fantastical” by its competitors.  “In all likelihood, the primary deliverers of e-commerce shipments for the foreseeable future will be UPS, the U.S. Postal Service and FedEx,” the then-CEO of Fed Ex said at the time. That quote didn’t age well.

Amazon’s growth is attributed in part to its contractor delivery program, whose 200,000 drivers (usually) wear Amazon uniforms and drive Amazon-branded vehicles, although they don’t actually work for Amazon, and a pandemic-driven doubling of its logistics network.  WSJ reports: “Amazon has moved to regionalize its logistics network to reduce how far packages travel across the U.S. in an effort to get products to customers faster and improve profitability.”

It worked.

WSJ calculations from company documents. Credit: WSJ

But I shouldn’t be surprised.  Amazon usually gets good at what it tries. Take cloud computing.  Amazon Web Services (AWS) in its early years was considered something of a capital sink, but now not only is by far the market leader, with 32% market share (versus Azure’s 22%) but also generates close to 70% of Amazon’s profits. 

Prime, Amazon’s subscription service, now has some 200 million subscribers worldwide, some 167 million are in the U.S. Seventy-one percent of Amazon shoppers are Prime members, and its fees account for over 50% of all U.S. paid retail membership fees (Costco trails at under 10%). There’s some self-selection involved, but Prime members spend about three times as much on Amazon as nonprime members.

The world’s biggest online retailer.  The biggest U.S. delivery service. The world’s biggest cloud computing service. The world’s second largest subscription service (watch out Netflix!).  It’s “only” the fifth largest company in the world by market capitalization, but don’t bet against it. 

I must admit, I’ve been a bit of a skeptic when it comes to Amazon’s interest in healthcare.  I first wrote about them almost ten years ago, and over those years Amazon has continued to put its feet further into healthcare’s muddy waters.

For example, it bought online pharmacy Pillpack in 2018. “PillPack’s visionary team has a combination of deep pharmacy experience and a focus on technology,” said Jeff Wilke, Amazon CEO Worldwide Consumer. “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier. We’re excited to see what we can do together on behalf of customers over time.”

PillPack still exists as an Amazon service, but has broadened into Amazon Pharmacy. PillPack focuses more on people with chronic conditions who like the prepacked pills, while Pharmacy offers home delivery to other customers.  At its introduction, Doug Herrington, Senior Vice President of North American Consumer at Amazon, said: “PillPack has provided exceptional pharmacy service for individuals with chronic health conditions for over six years. Now, we’re expanding our pharmacy offering to Amazon.com, which will help more customers save time, save money, simplify their lives, and feel healthier.”

Amazon Pharmacy has since introduced RxPass, a $5/month subscription service for many common generic drugs, but it still hasn’t cracked the top ten U.S. pharmacies, so there’s work to be done. One pharmacy analyst writes: “Perhaps one day Amazon will be a true disrupter.  For now, Amazon is choosing to join the drug channel not fundamentally change it.”

PillPack’s co-founders have recently left.    

Earlier this year, after all the fumbling around with Haven and Amazon Care, Amazon bought One Medical. “We're on a mission to make it dramatically easier for people to find, choose, afford, and engage with the services, products, and professionals they need to get and stay healthy, and coming together with One Medical is a big step on that journey,” said Neil Lindsay, senior vice president of Amazon Health Services.

Credit: Amazon

Then this month Amazon sought to entice Prime members to join One Medical by offering membership for $9/month, or $99 per year.  "When it is easier for people to get the care they need, they engage more in their health, and realize better health outcomes,” said Mr. Lindsay. “That’s why we are bringing One Medical’s exceptional experience to Prime members—it’s health care that makes it dramatically easier to get and stay healthy.”

Of course, One Medical is only in 25 metro markets, with some 200 doctors office, and it doesn’t contract with every insurance plan. Plus, One Medical CEO Amir Dan Rubin is already on his way out of the door. Scaling will not be easy.

Amazon’s success with its healthcare ventures is hard to tell.  HT Tech reports that monthly active users of the One Medical app are up 16% since the acquisition, and that Amazon claims Amazon Pharmacy doubled its active customers from 2022 to 2023. Still, Lisa Phillips, an analyst with Insider Intelligence, scoffed: “It really hasn’t made a big dent. I don’t think anybody is scared of it anymore.”

Maybe. Healthcare is hard, and usually confounds outsiders who aren’t familiar with its byzantine structures.  But I look at it this way: Amazon has been delivering its own packages for less than 10 years, and now it is bigger than UPS and FedEx.  That’s not nothing. So for the first time I’m starting to think that maybe Amazon can make its mark in healthcare. 

Amazon the biggest healthcare company in ten years?  Don’t bet against it.

(We Don't) Trust the Science

I know the A.I. community is eagerly waiting for me to weigh in on the Sam Altman/OpenAI dramedy (🙄), but I’m not convinced this isn’t all a ploy by ChatGPT, so I’m staying away from it.  A.I. may, indeed, be an existential issue for our age, but it’s one of many such issues that I fear we’re not, as a society, going to be equipped to handle.

We like using the results of science, but not learning it. Credit: Bing Image Creator

Last week the Pew Research Center issued an alarming report Americans’ Trust in Scientists, Positive Views of Science Continue to Decline. Now, a glass half-full kind of person might look at it and say – no, it’s good news!  Fifty-seven percent of Americans agree science has a mostly positive impact on society, and 73% have a great deal or a fair amount in confidence in scientists to act in the public’s best interests.  For medical scientists it was 77%. Only the military (74%) also scored above 70%. That’s good news, right?

The glass half-empty person would point to the downward trend in just the past few years: at the beginning of the pandemic (April 2020) the respective percentages were 87% (scientists), 89% (Medical scientists), and 83% military.  The faith in them has continued to drop since.  Things are trending in the wrong direction, quickly.

If the glass was half full, it’s spilling now.

About a third (34%) of the public thinks that the impact of science on society has had an equally positive and negative impact, while 8% think science has had a mostly negative impact. Again, the trend has been negative since the pandemic; the 57% who think science has a positive impact was 73% in January 2019. That’s alarming.

The skepticism about scientists and the value of science has increased generally, but is more pronounced among Republicans and those without a college degree.  E.g., only 61% of Republicans have a fair/great amount of confidence in scientists, versus 85% in April 2020 and versus 86% of Democrats now.  Fewer than half (47%) of Republicans think science has had a mostly positive impact on society, versus 70% on January 2019.

In the supposed most developed country in the world, thirty-nine percent of Americans think the U.S. is losing ground in science achievement versus the rest of the world, and only 52% even agree it is important for the U.S. to be a world leader in scientific achievements.  Ten percent didn’t think it was important at all. Young people, surprisingly, were most skeptical. 

I wonder what the doubters do think it is important for us to be the world leader in.

The problem may be that a third thought developments in science were changing society too quickly (43% among Republicans).  They want their new iPhones, they like fast internet speeds, they demand the latest treatments when they get sick, but somehow they don’t connect those to science.

I think about this when I read about the Texas board of education fighting about how science is taught in Texas schools. This year climate change and evolution were, again, hot topics.  Evelyn Brooks, a Republican board member, said: “The origins of the universe is my issue — big bang, climate change — again, what evidence is being used to support the theories, and if this is a theory that is going to be taught as a fact, that’s my issue. What about creation?”   

Ms. Brooks also declared: “There is no evidence that an entirely different species can come from another species,” which suggests she’s not keeping up with the fossil record or DNA analysis.

Never mind that evolution continues to be validated by finding after finding; some 40% of Americans believe in “creationism.” Never mind that the world has just passed the landmark 2 degrees Celsius above pre-industrial age global temperatures or that 97% of climate scientists agree humans are causing global warming and climate change.  Never mind all that because, you know, an outspoken minority don’t believe in science or in scientists.  And they’re determined to not help our children prepare for the world they’re inheriting.  

A recent study looked specifically at how climate change is – or isn’t – being taught in U.S. K-12 schools, and found that, indeed:

While planetary health education varies widely across the USA with respect to the presence and depth of terms, most science standards neglected to convey these concepts with a sense of urgency. Furthermore, state/territory dominant political party and primary gross domestic product (GDP) contributor were each predictive of the quality of planetary health education. 

We’re worried that artificial intelligence may kill us off, but plain old human intelligence (or lack thereof) may do that first.

All that, of course, assumes that we’re teaching our kids generally, but the evidence is pretty grim on that point – again, especially since the pandemic.  The pandemic led to drastic declines in math and reading scores (only 26% of 8^th graders are proficient in math, only 31% are proficient in reading). The National Science Board warns: “U.S. student performance on standardized tests in science and math has not improved in over a decade, placing the U.S. in the middle of a long list of global competitors,” and urges: “the U.S. needs “all hands on deck” to modernize K-12 STEM education and to hold itself accountable with reliable, up-to-date data.”

Some of that poor performance is because absenteeism has soared since the pandemic started.  According to Attendance Works, in the 2021-22 school year chronic absence affected nearly 30% of students.  Yes, it disproportionately impacted minority students and high poverty schools, but all schools and all demographics were impacted. Parents wanted schools to reopen in the early days of the pandemic, but evidently they weren’t as insistent that students actually attended.

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Science is a self-correcting endeavor, which means it isn’t always right at first. Scientists are human, which means they sometimes act out of impure motives. The pace of change enabled by science is, indeed, getting faster; just look at use of A.I. in the past year. But the “solution” to all that isn’t to turn our backs on science or to distrust scientists; it is to improve science literacy among all of us so that we are better equipped to adapt to what science offers us.

Hug a scientist – or better yet, help your children become one.

Pin Me, Please

You had to know I’d write about the new Humane AI Pin, right?

The Humane AI pin. Credit: Humane

After all, I’d been pleading for the next big thing to take the place of the smartphone, as recently as last month and as long ago as six years, so when a start-up like Humane suggests it is going to do just that, it has my attention.  Even more intriguing, it is billed as an AI device, redefining “how we interact with AI.”  It’s like catnip for me.

For anyone who has missed the hype – and there has been a lot of hype, for several months now – Humane is a Silicon Valley start-up founded by two former Apple employees, Imran Chaudhri and Bethany Bongiorno (who are married).  They left Apple in 2016, had the idea for the AI Pin by 2018, and are ready to launch the actual device early next year.  It is intended to be worn as a pin on the lapel, starts at $699, and requires a monthly $24 subscription (which includes wireless connectivity).  Orders start November 16.

Partners include OpenAI, Microsoft, T-Mobile, Tidal, and Qualcomm.

Mr. Chaudhri told The New York Times that artificial intelligence  “can create an experience that allows the computer to essentially take a back seat.” He also told TechCrunch that the AI Pin represented “a new way of thinking, a new sense of opportunity,” and that it would “productize AI” (hmm, what are all those other people in AI doing?).  

Humane’s press release elaborates:

Ai Pin redefines how we interact with AI. Speak to it naturally, use the intuitive touchpad, hold up objects, use gestures, or interact via the pioneering Laser Ink Display projected onto your palm. The unique, screenless user interface is designed to blend into the background, while bringing the power of AI to you in multi-modal and seamless ways.

Basically, you wear a pin that is connected with an AI, which – upon request – will listen and respond to your requests. It can respond verbally, or it can project a laser display into the palm of your hand, which you can control with a variety of gestures that I am probably too old to learn but which younger people will no doubt pick up quickly.  It can take photos or videos, which the laser display apparently does not, at this point, do a great job projecting. 

Here's Humane’s introductory video:

Some cool features worth noting:

• It can summarize your messages/emails;
• It can make phone calls or send messages;
• It can search the web for you to answer questions/find information;
• It can act as a translator;
• It has trust features that include not always listening and a “Trust Light” that indicates when it is.

It does not rely on apps; rather, it uses “AI Experiences” – on device and in the cloud -- to accomplish whatever goals smartphone apps try to accomplish.  The press release brags: “Instead, it quickly understands what you need, connecting you to the right AI experience or service instantly.”  

Ken Kocienda, Humane’s head of product engineering, contrasted the AI Pin with smartphone’s addiction bias, telling Erin Griffin of The New Times: “It’s more of a pull than pushing content at you in the way iPhones do.”

Health and nutrition is said to be an early focus, although currently it is mostly calorie counting.

The laser display. Credit: Humane

Ms. Griffin summarizes the AI Pin thusly: “It was, like any new technology, equal parts magic and awkward.”  Inverse’s Ian Carlos Campbell was also impressed: “Added together, the Ai Pin is exciting in the way all big swings are, the difference being it seems like Humane could back up its claims.”  

Mark Wilson of Fast Company, on the other hand, was more reserved, noting: “In practice, the AI Pin reminded me of an Echo Dot on your chest,” and wondering: “Where was all the magical stuff?...The stuff where, because the AI Pin is so overtly planted on our person, the rest of its demands could disappear?”    

Mr. Chaudhri defended using a pin instead of another version of smartglasses, telling Mr. Wilson:

Contextual compute has always been assumed as something you have to wear on your face. There’s just a lot of issues with that...If you look at the power of context, and that’s the impediment to achieving contextual compute, there has to be another way. So we started looking at what is the piece that allows us to be far more personal? We came up with the fact that all of us wear clothing, so how can we adorn a device that gives us context on our clothing?

Or, as Mr. Chaudhri said earlier this year: “The future is not on your face.”

Color Mr. Wilson unconvinced:

Humane’s issue in a nutshell isn’t that a wearable assistant is inherently a flawed idea, it’s that Chaudhri’s product doesn’t yet solve the problem he has diagnosed and set out to mitigate: that removing a screen will solve our dependence on technology…it appears Humane hasn’t unlocked the potential of AI of today, let alone tomorrow, nor has it fundamentally solved any significant problems we have with technology.

To be honest, it isn’t everything I’d hoped it’d be either. The AI is impressive but, at this point, still limited. The laser display is cool but not really ready for prime time. The pin is sleek, as would be expected from Apple alums, but I don’t want to even be aware of a device; I want it embedded in my clothes, maybe worn as a “smart tattoo.”  

But these are, really, quibbles. The AI will get exponentially more useful. The device will get much smaller. The display will get much better. As others have pointed out, the iPod was a revolution but was limited, and led to the iPhone, which itself was initially fairly limited.  Similarly, the AI Pin should get much, much powerful, and have even more awesome successors.

In the press release, Ms. Bongiorno and Mr. Chaudhri say:

AI Pin is the embodiment of our vision to integrate AI into the fabric of daily life, enhancing our capabilities without overshadowing our humanity. We are proud to finally unveil what we and the team at Humane have been working on for the past four years. For us, Ai Pin is just the beginning.

The introductory video closes with Mr. Chaudhri promising: “It is our aim at Humane to build for the world not as it is today, but as it could be tomorrow.”  We should all be designing for that.