Health Care in Abundance

A recent report from Moody’s Analytics, by chief economist Mark Zandi, had an eye-opening fact: the top 10% of earners in the U.S. – those who make $250,000 or more – now account for just shy (49.7%) of half of consumer spending. If that strikes you as unusual, you’re right. It is a record since at least 1989. Thirty years ago the comparable percentage was 36%.

This too often describes our healthcare system. Credit: Council on Europe

“The finances of the well-to-do have never been better, their spending never stronger and the economy never more dependent on that group,” wrote Dr. Zandi. He added: "Wealthier households are financially more secure and thus more able and willing to spend their income. That is, they save less than they would otherwise.”

The rest of us are struggling to hold our own against inflation, not always successfully. It’s why companies like Costco and Walmart are trying to target upscale shoppers, while “value” oriented firms like Big Lots, Family Dollar, or Kohl’s are closing stores or even declaring bankruptcy.

This extreme bifurcation, of course, made me think of healthcare, where – as is famously known – half of all spending is attributable to only 5% of patients. In case you’d forgotten, in healthcare, half the population accounts for 97% of all spending, so the other half accounts for a measly 3%.

Now, you might say, neither of those is surprising: rich people spend more, and sicker people cost more. But somehow neither of those seems right to me.

I started thinking more about this after reading a recent New York Times op-ed from Ezra Klein. In it he makes the following assertion:

The answer to a politics of scarcity is a politics of abundance, a politics that asks what it is that people really need and then organizes government to make sure there is enough of it.

Mr. Klein didn’t coin the phrase “politics of abundance,” but he and Derek Thompson did just write a book on the topic (Abundance) that discusses their thoughts at more length. I have not read the book, but I saw a quote from it that I quite liked: “What is scarce that should be abundant? What is hard to build that should be easy?”

And so we’re back to healthcare.

We seem to live in a country where healthcare is too scarce. A new analysis suggests that we have a looming shortage of hospital beds, and if you live in a rural area, it’s already here. If you believe the Association of American Medical Colleges, we have a looming physician shortage, and if you’re looking for primary care, it’s already here. We’re facing nursing storages, pharmacist shortages, nursing home worker shortages, home health worker shortages, to name a few. We even have shortages of many critical prescriptions, including some needed for cancer treatments.         

Despite all these shortages or would-be shortages, of course, we manage to spend way more than other countries on healthcare. One can only imagine how much we might be spending if there were no shortages. I take that back: I’m not sure I can imagine.   

In the category of things that are scarce that should be abundant, and/or things that are hard to build that should be easy, I’d probably put housing at the top but healthcare as a close second. The trouble is, when we pour more money into healthcare, as we are wont to do, we don’t seem to fill any of our many shortages, much less improve the quality of care or outcomes.

In his article, Mr. Klein recounts the long saga of California’s Prop 1A, which called for a high speed rail line between Los Angeles and San Francisco. Other countries have high speed rail lines, most notably Japan, so certainly the richest state in the richest country should be able to build such a line. But, nope, 15 years later the predicted cost of the line has ballooned 300%, not much of the line is actually complete, and there is no end in sight, much less money available to complete it.

It reminds me of ACA: important goals, lots of money spent towards achieving them, some key accomplishments to show, but oh-so-far from achieving what we actually need.

We can’t keep going on the way we’ve been going on. We need to make scarce health care abundant, and to make things that are hard to build in healthcare easy to build.  Finally, we may be approaching technologies that would allow those.

It starts with A.I., as everything seems to these days. Healthcare, to my surprise, has started to embrace the use of A.I. Whether it is to assist physicians, to handle the too-many administrative tasks, to develop new drugs, it’s clear there will be a role for A.I. in healthcare.

Credit: PwC

My worry is that our healthcare system will absorb A.I. the way it did digital, making use of it but not using it to drive costs lower or to increase access. My worry is that it will be used to make more money for the people already making money in the system. My worry is that it be used to put a shiny new coat on our healthcare system, not to revamp or to reinvent it.

Here’s my plea: let’s use A.I. to make health care abundant – and cheap. Let’s make A.I. make building resources used in healthcare – be they people, devices, drugs, or buildings – easy to build. Simply adding A.I. into our existing system won’t do those. We have to design it towards those ends.

And let’s not stop at A.I. I’ve long been a fan of robots – be they full-sized, nano, or anything in-between – in healthcare. We know we have people shortages, especially for caregiving, and we should be planning for how robots can help fill those. But we need to use them with the abundance mentality: make them cheaply, use them ubiquitously, make them readily available. I think of how Ukraine has reinvented drones for its war efforts, because American drones were too expensive, too few, and too uncertain. We need that mentality for building healthcare robots.

Same for 3D printing. Medical devices, supplies, even prescription drugs: we should be ramping up use of 3D printing to make them – you guessed it – more abundant and easier to build, not to mention much cheaper. The companies currently making them won’t like it, of course, but our healthcare system doesn’t exist to make them money.  Or, at least, it shouldn’t.

The people and companies currently profiting from healthcare thrive on scarcity – perceived or real—and on making things hard to build. We need healthcare leaders that want us to thrive on abundance.  

Next Up: Fiber Computers

I know: you’re pretty proud for being into “wearables” to help monitor your health and other functions. You’ve got some apps on your smartphone. You use a smartwatch. Maybe you’ve tried one of the many iterations of smart glasses, like Google Glass or Meta’s Ray Bans. You were disappointed when Humane’s AI pin bit the dust.

What, you've never seen a fiber computer? Credit: Hamilton Osoy, IFM

Forget all that. With fiber computing, your clothes can be your wearable.

A new paper from MIT researchers discussed the ability to use “single fiber computers” that can be woven directly into clothing. According to the MIT press release:

The fiber computer contains a series of microdevices, including sensors, a microcontroller, digital memory, bluetooth modules, optical communications, and a battery, making up all the necessary components of a computer in a single elastic fiber.

 It also has embedded lithium-ion batteries that power it.

You can see the LEDs. Credit: Yoel Fink/MIT News

MIT has a lab devoted to fiber computing (fibers@mit), led by Professor Yoel Fink, who has been working on it for over ten years. According to its website: “Our research focuses on extending the frontiers of fiber materials from optical transmission to encompass electronic, optoelectronic and even acoustic properties,” with the goal of fibers that can See, Hear, Sense and Communicate.

The lab has had many accomplishments, but the mismatch between the shape of a chip and the shape of a fiber became a problem. Co-lead author Nikhil Gupta, an MIT materials science and engineering graduate student explains the problem:

But we hit a wall in terms of the complexity of the devices we could incorporate into the fiber because of how we were making it. We had to rethink the whole process. At the same time, we wanted to make it elastic and flexible so it would match the properties of traditional fabrics.

The solution: “In this new design, the researchers map the 2D pad alignment of each microdevice to a 3D layout using a flexible circuit board called an interposer, which they wrapped into a cylinder.” Mr. Gupta says: “This advance was crucial for us in terms of being able to incorporate higher functionality computing elements, like the microcontroller and Bluetooth sensor, into the fiber.”

The result is a machine-washable, elastic fiber that can stretch more than 60 percent without failure, Try that with your smartwatch.

These advances allow them to build these fiber computers into clothing. Each fiber computer incorporates LEDs and light sensors that enable multiple fibers in one garment to communicate, creating a textile network that can perform computation. They also have a Bluetooth communication system that can stream information wirelessly to other devices, such as a smartphone.

Why clothing? Professor Fink points out:

Our bodies broadcast gigabytes of data through the skin every second in the form of heat, sound, biochemicals, electrical potentials, and light, all of which carry information about our activities, emotions, and health. Unfortunately, most — if not all — of it gets absorbed and then lost in the clothes we wear. Wouldn’t it be great if we could teach clothes to capture, analyze, store, and communicate this important information in the form of valuable health and activity insights?

Well, they did. They added four fiber computers to a top and a pair of leggings, and had the wearer perform various exercises, such as squats, planks, arm circles, and lunges. Using a machine-learning model, each such fiber computer recognized the exercises with an average accuracy of about 70%; when the four fibers were allowed to communicate, the accuracy went up to 95%.

Professor Fink says that this demonstrates “the importance of residing on multiple body areas and forming a network between autonomous fiber computers that does not need wires and interconnects.” He predicts: “In the not-too-distant future, fiber computers will allow us to run apps and get valuable health care and safety services from simple everyday apparel.”

We’ll soon find out. The team is working with DARPA, the Army, and the Navy to conduct tests in the Artic. Service members will wear shirts with fiber computers in a monthlong winter study, tracking their health and activity over 1000 kilometers and an average temperature of – 40F.

Again, try that with your smartwatch.  

They're wearing fiber computers. Credit: US Army Cold Regions Research and Engineering Lab

“As a leader with more than a decade of Arctic operational experience, one of my main concerns is how to keep my team safe from debilitating cold weather injuries — a primary threat to operators in the extreme cold,” says U.S. Army Major Mathew Hefner, the commander of the project. “Conventional systems just don’t provide me with a complete picture. We will be wearing the base layer computing fabrics on us 24/7 to help us better understand the body’s response to extreme cold and ultimately predict and prevent injury.”

Karl Friedl, U.S. Army Research Institute of Environmental Medicine senior research scientist of performance physiology, says the technology may become a “gamechanger for everyday lives.” He goes on to add:

Imagine near-term fiber computers in fabrics and apparel that sense and respond to the environment and to the physiological status of the individual, increasing comfort and performance, providing real-time health monitoring and providing protection against external threats. Soldiers will be the early adopters and beneficiaries of this new technology, integrated with AI systems using predictive physiological models and mission-relevant tools to enhance survivability in austere environments.

Professor Finks is excited: “We are excited to see glimpses of this future in the upcoming Arctic mission through our partners in the U.S. Army, Navy, and DARPA. Helping to keep our service members safe in the harshest environments is a honor and privilege.”

We’re not quite in this future yet. The fiber computers don’t have much memory or computing power, and it’s not clear how they would be recharged. There are going to be real-world setbacks. Mass production and cost haven’t yet been considerations. But, Professor Finks believes: “The convergence of classical fibers and fabrics with computation and machine learning has only begun.”

Let it begin.

Goodbye, American Science

Many people don’t realize it, but a hundred years ago America was something of a scientific backwater. Oh, sure, we had the occasional Nobel laureate, but the center of science was in Europe, particularly Germany. Then in the early 1930’s the Nazis decided that “purity” – of political ideas, of blood – was more important than truth, making life uncomfortable at best and deadly at worst for their scientists. So hundreds of them fled, many of them ending up in the U.S. And – voila! – American science came of age and hasn’t looked back.

If we're not careful, scientists are going to pack up & leave the U.S. Credit: Microsoft Designer

Until now. Now, I fear we’re going to suffer what Germany did, a brain drain that will bode well for some other country’s scientific fortunes.

Once of the first chilling announcements from the Trump Administration was that it was freezing NIH grants in order to ensure they were in compliance with Trump’s executive order banning DEI-related efforts. That froze some $1.5b in grant funding.

Piling on, the Administration announced that NIH grants would limit indirect costs to 15%. Sounds reasonable, you might say, but the vast machinery of U.S. biomedical research uses these “indirect” costs to fund the infrastructure that makes the research possible. Numerous state Attorney Generals immediately filed a lawsuit to block the cuts, claiming:

This research funding covers expenses that facilitate critical components of biomedical research, such as lab, faculty, infrastructure and utility costs. Without it, lifesaving and life-extending research, including clinical trials, would be significantly compromised. These cuts would have a devastating impact on universities around the country, many of which are at the forefront of groundbreaking research efforts – while also training future generations of researchers and innovators.

Oh, and on top of all this, as many as 1,500 NIH employees are in line to be laid-off.  

Credit: M. Scott Brauer for The Chronicle of Higher Education

Katie Witkiewitz, a professor at the University of New Mexico, lamented to The New York Times: “The N.I.H. just seems to be frozen. The people on the ground doing the work of the science are going to be the first to go, and that devastation may happen with just a delay of funding.”

Universities are similarly frozen, not sure when or how much money they can expect. The University of Pittsburgh has paused all Ph.D. admission, until it can better understand its funding future. One has to suspect it won’t be the only such program to do so, and we may never know how many would-be Ph.D. students will simply decide a future in U.S. science is too bleak to risk.

The effects of all this will be long lasting. Bita Moghaddam, a behavioral scientist at Oregon Health & Science University, warned The Washington Post: “Things aren’t going to get slowed down for six months — they may get slowed down for years.”

“The discoveries that aren’t made — you can’t point to them, because they will never be made,” Jeremy Berg, a former director of the National Institute of General Medical Sciences, told WaPo. “The hard part is you don’t know what you missed until years later, when something doesn’t happen.”

It’s not just NIH and not just biomedical research at risk. The National Science Foundation laid off some 10% of its workforce. "These arbitrary firings and failure of leadership directly impact the agency's ability to evaluate and fund good science," Mary Feeney, a public policy researcher at Arizona State University, said to NPR. "[It] is demoralizing for those who remain at the NSF, and will negatively affect the government's ability to attract talent to public service in the future."

NSF research funding could also be cut by half or more, as well as more staff cuts.  The cuts disproportionately impact young scientists, the future of our science. “There’s going to be a missing age class of researchers that will reverberate for years,” one federal scientist fears, reports Katie Langin in Science.

Don’t even get me started on RFK Jr. and his advocacy of junk science.  Don’t get me started on how federal agencies are purging datasets in order to meet vague DEI demands either; short-sighted and stupid.. Don’t get me started on climate change denialism, with the Trump Administration doing its best to kill participation by U.S. researchers on the next major report from the Intergovernmental Panel on Climate Change (IPCC).

Science is under attack. “Everyone is in a panic right now,” Mati Hlatshwayo Davis, the director of health for St. Louis, told Katherine Wu in The Atlantic. “And when researchers don't know what they’re allowed to do, science is not going to get done.”

“If you believe that innovation is important to economic development, then throwing a wrench in one of the most sophisticated and productive innovation machines in world history is not a good idea,” Deborah Seligsohn, an assistant professor of political science at Villanova University, told Karen Ho in MIT Technology Review. “They’re setting us up for economic decline.”

Ms. Ho predicts:

For starters, the purging of tens of thousands—and perhaps soon hundreds of thousands—of federal workers is removing scientists and technologists from the government and paralyzing the ability of critical agencies to function. Across multiple agencies, science and technology fellowship programs, designed to bring in talented early-career staff with advanced STEM degrees, have shuttered. Many other federal scientists were among the thousands who were terminated as probationary employees, a status they held because of the way scientific roles are often contractually structured.

She believes that talent will flow elsewhere – such as to China, to Canada, and even, ironically, to Germany. According to a report from the Center for Security and Emerging Technology (CSET), over the past decade or so, Chinese universities have made “significant gains” in listing of world universities, driven largely by research productivity. U.S. universities remain among the best in the world, but number in the top 500 has dropped.   

One can only imagine what such a listing will look like in a few years.

Things aren’t frozen everywhere. Ms. Ho points out: “China has made a remarkable ascent to become a global peer in scientific discoveries. By some metrics, it has even surpassed the US; it started accounting for more of the top 1% of most-cited papers globally, often called the Nobel Prize tier, back in 2019 and has continued to improve the quality of the rest of its research.” 

If you’re not worried, read Ms. Hao’s The foundations of America’s prosperity are being dismantled. Read Ms. Wu’s The Erasing of American Science. Read Ms. Langin’s U.S. early-career researchers struggling amid chaos. Then tell me you’re not worried.

Science will go on. Scientists will continue to invent the future. But it doesn’t have to be here, and, if we’re not careful, it won’t be.

Patients are NPCs

I found a new way to think about patients in an opinion piece by Ezra Klein: they’re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren’t controlled by live players; they’re part of the game, serving as background for the actions the actual players take.

When it comes to healthcare, we are, alas, just NPCs

Not a very flattering metaphor.

Mr. Klein’s article is neither about healthcare nor gaming, but about politics: The Republican Party’s NPC Problem — and Ours. Conservatives, Mr. Klein explains, accused liberals of being NPCs -- passive, conformists, deferential – whereas they were the live players, willing to take chances and make things happen. He goes on to explain why this is not at all accurate, especially in the Congress, but this paragraph is what really struck me:

It’s a genuine failure of Democrats that they didn’t put more energy into making the government faster and better when they were in charge. How did the Biden administration pass $42 billion for broadband in 2021 and have basically nothing to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only a few hundred chargers by the end of the term?

I.e., Democrats had some good ideas, took action to try to make them happen, but failed in the delivery. Good intentions matter, but are necessary, not sufficient.

Marc J. Dunkelman makes a similar argument in The Atlantic: How Progressives Broke the Government (an adoption of his new book Why Nothing Works: Who Killed Progress--And How to Bring It Back). Here are a couple of the relevant passages, aimed at the Progressive movement:

Progressives are so fearful of establishment abuse that reformers tend to prefer to tighten rather than loosen their grip on authority. The movement discounts whatever good the government might do in service of ensuring that it won’t do bad. And that’s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.

At present, progressives are too inclined to cut public authority off at the knees. And that’s why they so often feel like they can’t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism’s political appeal.

America can’t build housing. We can’t deploy high-speed rail. We’re struggling to harness the promise of clean energy. And because government has failed in all these realms—because confidence in public authority has waned through the years—progressives have found it difficult to make a case for themselves.

What does any of this have to do with healthcare, much less NPCs? It’s this: we talk a good game about health care, especially Democrats, but we consistently fail to deliver. Pick your poll: Americans are critical of the healthcare system in general, of the quality of care, and especially its costs.  Americans hate Big Pharma, we hate health insurers, and our trust in doctors and hospitals has plummeted, especially since COVID.

U.S. researchers develop innovative, life-saving treatments, but we often can’t get them to the people who need them most. U.S. produces miraculous prescription drugs, but we pay far more for them than anywhere in the world. Healthcare professionals and institutions urge us to get preventive care, to seek care when needed, and to go to the ER in a crisis, but put us in a queue when we try to do any of those. “Complicated” is perhaps the kindest description one could use for our healthcare system.

Every healthcare organization claims to “put patients first.”  It’s all about the patients. Except, of course, it isn’t. Healthcare has been invaded by private equity, which offers no pretenses about its priorities. If your health care or health insurance is delivered by a publicly traded company, it can say all it wants about patients but its mission is to deliver for its shareholders. Even supposed non-profit healthcare institutions are increasingly acting like for profits, and if you don’t believe that, ask your local hospital how many patients it has sued for nonpayment.

Democrats tout Obamacare as evidence of improving the healthcare system, and it is a great improvement over what it was before, but no one believes it “fixed” anything. Tell that to the residents of the ten states that have still not expanded Medicaid, or to the twenty million who would lose Medicaid coverage under proposed House Medicaid cuts. Tell that to the millions of Americans whose bankruptcy is directly tied to their medical debt.

Who would put up with all this? NPCs, of course.

The “live” players in the healthcare system are the ones making money; patients are the means to that end. We may be the ones suffering, but that suffering makes other parties’ money. The game isn’t about our health; the game is about returns on investment. If you don’t believe that, you probably still believe Facebook is all about connecting the world and Google is all about making the world’s information accessible. We’re the product; we’re in NPCs in their game.

We need a healthcare system that works for patients, one that treats us like individuals with unique challenges, not like nameless NPCs.

Our healthcare system is not sustainable as is. Credit: Harvard Health

Our government – at the state, local, and federal level – is not delivering. Our major institutions are not delivering. And our healthcare system is most definitely not delivering. I have to modify all that; if you are in the 1%, things are pretty good. Otherwise, though, you’re just an NPC in their world.

We need leaders who won’t just talk a good game but play it well. Last year Democrats campaigned as though health care meant abortion access, transgender care, and capping prescription costs (e.g., transferring them to the insurer, and into premiums). Not bad goals, but not getting at root problems either.

Mr. Dunkleman argues:

Populism takes hold not when democracy works well, but rather when it doesn’t deliver. No amount of righteous sanctimony can substitute for the political benefits of making public authority serve the public interest. That should be the progressive movement’s north star.

Similarly, conservative Bret Stevens, in the most recent The Conversation with liberal Gail Collins, asserts: “A better motto for Democrats, I think, is “Effective government,” which is primarily about delivering the services people need or expect and not just about saving money, which seems to be the central criterion of “efficiency.””

That needs to be more than a motto, and not just for Democrats.  Healthcare would be a great place to start.

The World Is a Little Off-Center

I’m not going to write about the NIH cuts, devasting though they will be (to researchers, universities, and all of America). I’m not even going to touch on healthcare, or even technology per se, as I usually do. Instead, I want to write about some really cool Science, emphasis on the capital “S.”

Earth’s inner core, it seems, is not always the same shape.

The inner core was previously considered to be solid. (USC Graphic/Edward Sotelo)

Now, in case you forget your high school geology, we live on the Earth’s surface, which rests on the crust, followed by the mantle (which accounts for 84% of the earth), and then, some three thousand miles down, is the core. Think about that carefully: three thousand miles down. By comparison, Mt. Everest is less than 30,000 feet high. The deepest point in the ocean is 36,000 feet down. The deepest hole we’ve ever bored into the earth is 40,000 feet.  Three thousand miles is a looong way down. So, no, we’re never going to get to the core (despite what movies you might have seen). We may get to Mars or even the stars, but not the core.

And it’s big. It’s about 70% of the size of the moon. As one expert put it, “it’s like a planet within a planet.” It is about a third of the Earth’s mass, since it is primarily made of metals (mostly iron and nickel). It’s incredibly hot, close to 10,000 degrees Fahrenheit at its surface, which is about the temperature of the surface of the sun. There’s the inner core, which is basically solid, and the outer core, which is molten. The inner core is only solid, despite the temperature, due to the high pressure it is under.

Now researchers from USC are telling us that the inner core is not quite as solid as we’d thought; it changes shape. John Vidale, Dean’s Professor of Earth Sciences at the USC Dornsife College of Letters, Arts and Sciences and principal investigator of the study, says: “What we ended up discovering is evidence that the near surface of Earth’s inner core undergoes structural change.”

Scientists studying the core had previously found that the core didn’t spin at the same speed or even in the same direction as the rest of the earth, both of which are mind-blowing in themselves. (It’s that spinning, by the way, that generates the magnetic fields which prevents life on earth from being scorched by radiation.) Pretty cool stuff, but the researchers now state: “Previous research has proposed that the inner core has undergone either rotational or shape changes through time, but not both simultaneously.”

If you’re wondering how we can possibly know anything about the core, researchers analyze seismic waves, using them kind of like a form of radar. In this case, USC researchers analyzed what are called “earthquake pairs” – earthquakes that happen in the same place and at about the same magnitude but at different times. “But as I was analyzing multiple decades’ worth of seismograms, one dataset of seismic waves curiously stood out from the rest,” Professor Vidale said. “Later on, I’d realize I was staring at evidence the inner core is not solid.”

“Basically, the wiggles are different,” Dr. Vidale told The New York Times.

“This is kind of the first time we’ve seen the evidence for this kind of motion,” he told The Washington Post. “The surface of the inner core is moving around in ways we hadn’t detected and still don’t understand very well.”

The hypothesis is that, though it may be solid, the edge of the inner core isn’t solid enough to withstand the gravitation pressures from the outer core and the mantle. “Even though that inner core part is really solid, [this boundary] is really soft,” Guanning Pang, a co-author and geophysicist at Cornell University, explained to WaPo. “Maybe as soft as jelly.”

They call these changes “viscous deformation.” Dr. Vidale told Live Science: "We sort of expect that the motion could be on the order of hundreds of meters, maybe a kilometer or two, and we don't know how broad. It could be hundreds of kilometers across."

Wow.

No everyone is convinced. “The offered interpretation is sound,” Hrvoje Tkalcic, a professor of geophysics at the Australian National University who was not involved with the research, told The New York Times, “although it is not the only possible explanation, as the authors acknowledge.” Dr. Vidale acknowledged that the paper is not the final word: “We’re pretty sure we were right, but this isn’t a bulletproof paper. How sure? I sort of put it at 90 percent.”

Bruce Buffett, a geoscientist at the University of California, Berkeley, who was not involved in the work, told Live Science: "Maybe everyone's a little bit right."

That’s how science words; theories are only as good as the next set of facts.

"We'll need to keep accumulating the data and keep searching for the inner core behaviors," Xiaodong Song, a geophysicist at Peking University who coauthored important earlier work on the inner core, told Live Science. "I won't be surprised by future surprises about the inner core behaviors as we keep searching." Dr. Tkalcic believes we should build “seismological infrastructure in remote areas of the planet, including the ocean floor” to help accumulate such data.

In case you’re wondering, the results don’t offer any immediate practical benefits.  The researchers think they may help improve our understanding of Earth’s thermal and magnetic fields, but we’re a long way off from being able to do anything with that understanding. Again, that’s how science works. History suggests that this kind of knowledge will end up being useful someday.

I think it’s great. A part of the Earth that is crucial to our existence yet can’t be directly experienced can be indirectly measured, detecting what are relatively minuscule variations. We still don’t fully understand it, but we understand it better today than we did yesterday.

Gotta love scientists!

DEI Is Now a Four Letter Word

I’d love to be writing about something fun. Something that makes us think about things in a new way, or something exciting that will take us into the future. There are lots of such things happening, but there’s too many Orwellian actions happening that I can’t be silent about.

Diversity, we’re told, is actually a pretext for racism – against white people. Equity is foolhardy at best and pernicious at worst. Inclusion only matters if you are the “right” kind of person. “Meritocracy” is the new buzzword; we want only the “best and brightest,” with none of the lowering of standards that we’re being told comes with trying to ensure that everyone has a fair chance to prove their merits.

The Trump Administration has declared war on DEI. It has fired scores of workers whose jobs involve DEI, has asked other workers to inform on people they think may be involved in DEI, and is searching out even workers who attended diversity training (mandated or not). All that would be horrifying enough but it isn’t ending there.

Federal websites are being cleansed of any references to anything that might be construed as DEI. Pages are being edited, or taken down entirely. The NIH has ground to a halt until the appropriate authorities can ensure that no grants are being even to anything that might possibly be related to DEI. The CDC has been forced to pull papers from its researchers that are up for publication for similar review.

The Atlantic reports: “the government was, as of yesterday evening, intending to target and replace, at a minimum, several “suggested keywords”—including “pregnant people, transgender, binary, non-binary, gender, assigned at birth, binary [sic], non-binary [sic], cisgender, queer, gender identity, gender minority, anything with pronouns”—in CDC content.”

Thousands of pages of data from the CDC and Census Bureau have “disappeared,” and the same from other agencies. Health data is prominent among the missing. Angela Rasmussen, a virologist at the University of Saskatchewan, told Science: ““I knew it was going to be bad, but I didn’t know it was going to be this bad. It’s like a data apocalypse.”

Just one example

Elon Musk, who has no official power yet seems to have control over government IT and the data it contains, is shutting down U.S.A.I.D., who provides almost $40b annually in health services, disaster relief, anti-poverty, and other social mission programs. Previously the Administration had shutdown, then reinstated, PEPFAR, a vital international HIV program that has been credited with saving millions of lives.

The President and his team even tried to blame last week’s Washington D.C. plane-helicopter collision on DEI.  That’s just “common sense, ok,” according to President Trump.

As if all that wasn’t enough, The Washington Post reported:

Late Friday, newly confirmed Defense Secretary Pete Hegseth ordered the agency to stop commemorating cultural celebrations such as Black History Month. The message to staff was headlined: “Identity Months Dead at DoD.”

On Thursday, the FBI directed janitorial staff at Quantico to paint over a multicolored mural that once featured the words “FAIRNESS,” “LEADERSHIP,” “INTEGRITY,” “COMPASSION” and “DIVERSITY.”

I can’t even…

The breadth and depth of the changes caught many off guard, but people are starting to respond. Stat reports that CDC’s advisory board has demanded to be told why information has gone missing from CDC websites, and when it will be restored. “Silence is not an option right now,” said one advisory board member, Daniel Dawes. “I try to use the term unprecedented sparingly, but I believe this is an unprecedented moment. There will be dire consequences if they do not restore this information and it may not come back if we do not speak out.”  

The Guardian reports that a union representing 5,000 NIH researchers filed a legally binding demand to bargain over the sweeping changes. Marjorie Levinstein, a postdoctoral fellow at the National Institute on Drug Abuse and a union bargaining committee member, told The Guardian: “We cannot do our research effectively, and this is putting into question delaying research on cancer and diabetes, on drug addiction, on heart disease. And this is going to delay medical breakthroughs that the American people deserve.”

Alexander Jordan Lara, a postbaccalaureate fellow at the National Institute of Dental and Craniofacial Research and also a member of the union’s bargaining committee, added: “We were anticipating changes, and that it would be a new relationship we would have to manage but I don’t think anyone expected this firehose.”

We should have expected it.

Let’s be clear what all this is. “His attacks on diversity, equity and inclusion aren’t about a particular program or some acronym — they’re just a sanitized substitute for the racist comments that can no longer be spoken openly,” Margaret Huang, the Southern Poverty Law Center’s president and chief executive said.

When I heard “meritocracy,” I think of an exchange in the TV adaption of Celeste Ng’s Little Fires Everywhere. When the rich employer criticizes her minority employee about her life choices, the latter responds: “You didn’t make good choices. You had good choices. Options that being rich, and white, and entitled gave you.”

Somehow the meritocracy never see that.

And let’s be clear where this is all going.  As George Orwell’s 1984 said:

Now I will tell you the answer to my question. It is this. The Party seeks power entirely for its own sake. We are not interested in the good of others; we are interested solely in power, pure power. What pure power means you will understand presently. We are different from the oligarchies of the past in that we know what we are doing. All the others, even those who resembled ourselves, were cowards and hypocrites. The German Nazis and the Russian Communists came very close to us in their methods, but they never had the courage to recognize their own motives. They pretended, perhaps they even believed, that they had seized power unwillingly and for a limited time, and that just around the corner there lay a paradise where human beings would be free and equal. We are not like that. We know that no one ever seizes power with the intention of relinquishing it. Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power. Now you begin to understand me.

Sadly, we’re only beginning to understand.

As Professor Dawes said, silence is not an option now. Make yourself heard.

Expect the Unexpected

Most people probably know about Alexander Fleming “discovering” penicillin by accident, thus inventing the field of antibiotics. Others may know that Viagra was originally developed to combat hypertension and angina pectoris. You may think of Botox for its cosmetic purposes, but it was originally intended to treat strabismus (cross eyes), and has a host of other medical purposes as well. All of those, and countless other examples, speak to the importance of serendipity in science.

Science often surprises. Credit: Microsoft Designer

A new study, by Aslan et. al., attempts to quantify how common such serendipity is. Bottom line: it is way more common than you think.

The team analyzed over 1.2 million publications, which had resulted from 90,000 NIH grants between 2008 and 2016. They used the NIH's Research, Condition, and Disease Categorization (RCDC) to categorize what the researchers said they were looking for in their grant application versus what their findings were when published.

The results:

We found that 70 % of the publications have at least one RCDC category not in its grant, which we termed ‘unexpected’ categories. On average, 40 % of categories assigned to a publication were unexpected. After adjusting for similarity across some of the RCDC categories by empirically clustering the categories, we found 58 % of the publications had at least one unexpected category and, on average, 33 % of publication categories were unexpected.

Larger grants tend to result in more unexpected results, as do results published longer after the grant was issued.

Fig. 1. Proportion of publications with (A) one or more unexpected categories or (B) one or more unexpected categories (clustered); distribution of (C) unexpected category proportions and (D) unexpected category proportions (clustered).

“The bottom line is that ‘unexpectedness’ is not rare — this came through loud and clear,” said Ohid Yaqub, a biochemist and social scientist at the University of Sussex in Brighton, UK, who led the work. According to Nature, this research is “part of a wider project to understand the role in research of serendipity, of which unexpectedness is just one aspect.”

The researchers do caution: “what we are calling “unexpected” on the basis of text in the grants and publications may not in fact be unexpected for the investigators, or others in the field. Future research could make progress on these issues by using interviews and surveys to validate text-based measures of unexpected spillovers.” Professor Yaqub admits: “What we’ve looked at is only just scratching the surface.”

Telmo Pievani, a philosopher of biological sciences at the University of Padua in Italy, told Nature that the results go “beyond the anecdotal view of serendipity in science” and “for the first time verifies it on a quantitative and statistical level.” It is, indeed, part and parcel of how science works.

Somewhat surprisingly, the researchers also found:

Our results suggest that disease-orientation and clinical research were less likely to be associated with spillovers. Grants resulting from targeted requests for applications were more likely to result in publications with unexpected categories, though the magnitude of the differences was relatively small.

E.g., one would think those targeted requested would result in more targeted results, but that was not the case.

Samatha Copeland, a philosopher at Delft University of Technology in the Netherlands, told Nature that she worries that funding pressures may inhibit such serendipitous findings: “What’s happening right now is, scientists have actually been working around funding processes in order to make room for unexpected discoveries,” with Ph.D. students in particular likely to feel “oppressed by the scientific method and model of producing exactly the results you said you would produce.” Getting unexpected results may not be good for tenure or for Ph.D. thesis approval.

The key is being open to the unexpected results. Professor Pievani believes: “It is okay to fund both basic research and applied research, as long as both are open to unexpected results and do not eliminate anomalies too hastily.” Indeed, in his recent book Serendipity: The Unexpected in Science, he writes: “The common thread is chance and observational sagacity: a mixture of skill, clairvoyance, an incisive and fortunate mind, and the ability to discover connections.”

As the saying goes (oft attributed to Louis Pasteur), chance favors the prepared mind.

Still, Professor Pievani worries: “In the dictatorship of an instantaneous, emotional, and overwhelming present, you can always look for something specific with a quick google and find it for sure. Serendipity instead blossoms in the bends and meanders, the dull moments and wanderings.” Scientists struggling to stay within their funding or to attract new funding may be more reluctant to follow those bends and meanders, wherever they might lead.

Innovation expert John Nosta, founder of Nostalab, believes that AI can serve as “serendipity engines” by using AI’s so-called hallucinations. “What if these hallucinations could be harnessed to create a serendipity engine?” he writes. “An AI that doesn’t merely predict the next word but facilitates unexpected connections, delightful surprises, and groundbreaking insights?”

If you doubt that, note that a 2024 Wharton study found that AI was more creative than Wharton students (which may say more about Wharton students than AI): “There was a significantly higher preference for the ideas created by AI than by the Wharton students…Of the 400 ideas generated, only five human-created ideas were among the 40 most desirable products in this experiment.” The researchers say: “ChatGPT-4 can generate ideas much faster and cheaper than students, the ideas are on average of higher quality (as measured by purchase-intent surveys) and exhibit higher variance in quality. More important, the vast majority of the best ideas in the pooled sample are generated by ChatGPT and not by the students.”

The authors of that study, Christian Terwiesch and Karl Ulrich, wrote in The Wall Street Journal:  “First, generative AI has brought a new source of ideas to the world. Not using this source would be a sin…Second, the bottleneck for the early phases of the innovation process in organizations now shifts from generating ideas to evaluating ideas.”

The question is whether organizations are open to unexpected results when evaluating those new ideas.

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In an era of Big Science, with expensive projects staffed by dozens or hundreds of researchers, is there flexibility to pursue unexpected results? In an era of corporate innovation centers, can those workers really follow the “bends and meanders,” or are they constrained by budget and corporate goals? I.e., is there room for serendipity?

Science and innovation do not show linear progress. They take unexpected turns, they run into dead ends, and they take leaps no one could have predicted. If we’re not open to serendipity, if we’re not encouraging it and on the lookout for it, we’re going to miss those leaps.