If It Ain't Real-Time, It Ain't Really Real

Here’s a damning opening paragraph from an article in The New York Times about the frustrations that COVID-19 vaccinations are causing:

For a vast majority of Americans, a coronavirus vaccine is like sleep for a new parent: It’s all you can think about, even if you have no idea when you will get it.

Because, as Kaiser Health News reported: “Many states don’t know exactly where the doses are, and the feds don’t either.” 

Think about that: in 2021, we can’t – or don’t – track something as vital as where vaccine doses are, in the midst of the pandemic they were designed in record time to mitigate. Nor, as it turns out, are we doing a good job of tracking how many have already had them, who is now eligible for them, or assuring that essential workers or disadvantaged populations are getting them. 

Credit: MedCity News

Amazon tells me when my purchases have shipped, where they are in the shipping process, and when they’ve been delivered.  They even send me a picture of purchases sitting on my porch to make sure I notice. Walmart’s supply chain management is equally vaunted. 

Health care executives evidently aren’t required to learn supply chain management. 

What started me thinking about this was an article in The New York Times by three economists: Raj Chetty (Harvard), John N. Friedman (Brown), and Michael Stepner (University of Toronto) on economic data.  Early in the pandemic they realized that existing economic indicators were lagging indicators, based on surveys and transactions that happened weeks or months ago.  So, they built “a new publicly available economic tracker to better monitor the economy in real time.”

As they explain:

But we live in the age of information, where virtually all economic transactions leave a digital trail — from credit card receipts to paychecks to loans. These data are routinely used by companies and financial analysts to make better business decisions. And when the same data are put in the hands of the public, they can be used to guide our most important policy decisions, too.

The data provide “an unprecedented lens into how the economy is functioning — county by county, day by day, for low-income and high-income Americans.”  For example, they were able to show that people spent last April’s $1,200 stimulus checks very differently than December’s $600 ones.  Higher income people saved most of the latter, whereas lower income people spent most of both. 

Since Congress is now debating another round of stimulus checks, this information seems important.  The authors assert “if we make policy in February 2021 based on economic conditions in April 2020, we risk reaching the wrong conclusions.”   Good rule of thumb: the older the data, the less confidence we should have in decisions based on them.

Meanwhile, in healthcare we don’t know where our vaccines are, much less how many people are already (or have been) infected.  Other important questions like how many people lack health insurance are only estimated, months late.

Of course, the pandemic started with us failing at testing and contact tracing, so we started in a data deficit that has only gown worse, and more lethal.  It’s happening again right now, as we’re failing to accurately track and react to the new coronavirus variants that are spreading rapidly in the U.S. 

Tracking COVID-19 cases, hospitalizations, and deaths has become something of a cottage industry, with each county health department, hospital and state trying to figure out how to track and report these important data.  We may never know how accurate most of it is.  One only need look at what has been happening in Florida to get a sense of how shaky the data might be. 

Some good work has been doing during the pandemic about using more real-time data, such as use of cell phone data to track how much people are travelling and even degree of social distancing.  Similarly, there are apps that allow cell phones to warn of potential COVID-19 exposure, although the low rate of uptake has hampered their usefulness.  

But it’s not enough, and it shouldn’t just be for COVID-19.

You've got to be kidding me

It is beyond me why, for example, there’s not a universal app for people to register for COVID-19 vaccines, alert them when there are local doses, allow them to schedule appointments (including second doses as needed), track vaccination (including which vaccines were used), and report to state and federal health agencies.  It should be technologically feasible, except maybe not in healthcare due to the various siloed, creaky IT infrastructures.

I’ll go a step further.  People worry about potential vaccine side effects, but there is no systemic way to track them – just as there isn’t for other prescription drugs.  It falls to the patient to determine if they think their side effects are serious enough to alert anyone, and even then that report may not get passed on.  Again, there aren’t technological barriers to tracking these, just inertial ones.

Similarly, it has always concerned me that, if you’ve had a surgery or have been discharged from the hospital, tracking how you are doing is a rather loose affair. Patients usually have some sort of follow-up visit or phone call, but those might be days or weeks later.  Otherwise, the premise is, if the physician doesn’t hear from the patient, all is well. 

Apple Watch activity tracking rings

In fact, that is usually the premise most physicians rely on.  Their patient may suddenly be bed-ridden, or have a sharp decline in mobility, and only if the patient is concerned enough – or able – to contact them would they know.  Anyone who wears an Apple Watch, for example, can track daily, even hourly, mobility, but physicians aren’t alerted to any sudden changes in patterns.

They could, and should. 

We need “real-time, granular data,” as the professors said about their economic data, to know what is happening in our healthcare system, and to those of us who might use it.  We need to be proactive, not reactive. 

Yes, there are privacy concerns.  Not everyone will want even their physicians to know how they ae doing in real time.  It needs to be specifically targeted and permission based.  Nor will physicians be able to manage the amount of data that such tracking would generate.  This is the kind of monitoring where A.I. can help: understanding norms, identifying deviations from them, and reporting when they may pose potential health risks. 

We can’t keep running our healthcare system, or managing our health, using ad hoc, dated data.  It’s time for healthcare to be real-time and proactive.

Better Get Your Quantum Computer

By all rights, I should be writing about the battle between Reddit forum WallStreetBets and Wall Street hedge funds.  Depending on one’s point of view, it’s hilarious, frightening, or a searing indictment on stock trading – maybe all three. 

But I’m going to let Elon Musk and Elizabeth Warren handle that one.  Instead, I want to talk about quantum computing – and why healthcare needs to looking ahead to it.

Let’s start with this: for the low, low price of $5,000, you could have your very own quantum computer.  Spin Q Technology, a Chinese company, has recently introduced its Spin Q, a less expensive, less powerful version of its Spin Q Gemini, which went for $50,000.  Other quantum computers, such as those by Google, IBM, or D-Wave, have a few more zeroes in their price.  Spin Q Technology has a clear goal in offering this version:

We believe that low-cost portable quantum computer products will facilitate hands-on experience for teaching quantum computing at all levels, well-prepare younger generations of students and researchers for the future of quantum technologies.

You may remember that Steve Jobs and Apple had a similar strategy in the 1980’s, establishing a presence in the education market and among a generation of users that has served it well. 

If you’re looking for something more powerful, maybe even use for business purposes, you are also in luck: today Microsoft announced that Azure Quantum “is now open for business.”    Microsoft bills Azure Quantum as “the world’s first full-stack, public cloud ecosystem for quantum solutions.”  

The announcement waxes eloquently:

As you start on your quantum journey, you can explore at your own pace, with the peace of mind that your data is secure in the most-trusted public cloud. You pay as you go, and scale when you are ready. You have the flexibility to choose from self-service development or tailored development services with our Enterprise Acceleration Program

As with Spin Q Technology, they expect many users will treat it as a learning mechanism.  “This means that developers, researchers, systems integrators, and customers can use it to learn and build,” Julie Love, senior director at Microsoft Quantum told ZDNet.  “…I'm most excited to see what new ideas developers come up with once they've had the tools and solutions in their hands.”

Once you’ve got computers, of course, the next thing you want to do is network them, and – voila! – soon there’s a quantum internet.  A quantum internet would exchange “qubits” – the basic unit of information for quantum information, akin to how the bit is to classical computing.  It involvement “entanglement” of qubits on different machines, so that a change in one instantaneously impacting the other. 

Last summer, the U.S. Department of Energy released its blueprint for development of the quantum internet, asserting it was one of the most important technological frontiers of the 21^st century – and that a prototype was achievable within a decade.  One wonders if that goal is ambitious enough.  

Last fall researchers at Brookhaven National Lab and Stony Brook University used standard internet cables to entangle qubits from two quantum computers with a third several miles away.  “It’s not really feasible to lay new cables everywhere, so being able to use what’s in the ground was important,” said Kerstin Kleese Van Dam, the director of Brookhaven’s Computational Science Initiative. 

Then, in December, researchers from Fermilab announced they’d demonstrated “sustained, long-distance (44 kilometers of fiber) teleportation of qubits of photons (quanta of light) with fidelity greater than 90%.”  Panagiotis Spentzouris, head of the Fermilab quantum science program, bragged: “This is a key achievement on the way to building a technology that will redefine how we conduct global communication.”

It’s not entirely clear what a quantum internet would do, but it is expected to be much, much faster and allow for levels of encryption that are impossible now.  But, as Dr. Egan Figueroa told Dan Hurley of Discover Magazine:

Many of the things these devices will do, we are still trying to figure it out.  At the moment, we are just trying to create technology that works. The really far reaches of what is possible are still to be discovered.

Gary Fowler, writing in Forbes, proclaims: “The truth is, a revolution is coming. And it has already begun making significant promises for security, speed, efficiency and capabilities.”  He specifically cites healthcare and drug development as one of the industries most likely to be impacted.

Illustration: Brian Wang, South China Morning Post

It’s worth noting that, what is still to be discovered is actively being worked on in China.  It is already sending “uncrackable” encrypted messages far distances, even into space; it claims to have the fastest quantum computer; it has a quantum communications network; it is testing a mobile quantum network using drones; it has achieved three dimensional quantum teleportation. 

John Prisco warns in Forbes that, when it comes to quantum computing, “the United States isn’t winning — we’re battling for second place behind China.”

If you think this may all be very interesting but something far downstream from what healthcare, with its faxes and data interoperability issues, needs to worry about, well, the future comes at you fast.  IBM already has its list of quantum computing use cases for healthcare. 

Back in 2018 three St. Louis University researchers predicted:

We may be at the advent of a revolution in computer applications in clinical care and medical research. Quantum computing can exponentially advance computational power and promises to usher in a new epoch in computing technology.

Basically, if you’re already bought in to the application of AI to healthcare, or recognize the need for more secure healthcare data, then you better also be thinking about quantum computing and the quantum internet. 

Quantum physicist Shohini Ghose suggests business leaders should be developing strategies around:

• Planning for quantum security;
• Identifying use cases;
• Thinking through responsible design.

The latter issue is what has led a group of quantum computing experts – The Quantum Daily -- to call for open discussion of the ethics around it.  Professor John Martinis, formerly of Google, warns: “Whenever we have a new computing power, there is potential for benefit of humanity, [but] you can imagine ways that it would also hurt people.” Cambridge Quantum Computing CEO Iiyas Klan added: “This is the equivalent of a whole new industrial revolution…We ought to have those conversations today.” 

If healthcare isn’t careful, it’s not only going to use quantum computers/internet too late, but realize too late the ethical issues it should have prepared for. 

So, maybe you should buy a Spin Q and start playing with it. 

And You Thought Health Insurance Was Bad

I spend most of my time thinking about health care, but a recent The New York Times article – How the American Unemployment System Failed – by Eduardo Porter, caught my attention.  I mean, when the U.S. healthcare system looks fair by comparison, you know things are bad.

Credit: Sol Cotti for ProPublica

Long story short: unemployment doesn’t help as many people as it should, for as much as it should, or for as long as it should. 

It does kind of remind you of healthcare, doesn’t it?

The pandemic, and the associated recession, has unemployment in the news more than since the “Great Recession” of 2008 and perhaps since the Great Depression.  Last spring the unemployment rate skyrocketed well past Great Recession levels, before slowly starting to subside.  Still, last week almost a million people filed for unemployment benefits, reminding us that unemployment is still an issue.

Keep in mind that unemployment rates do not tell the full story, as they don’t count those only “marginally attached” to the workforce – people who would like to work but have given up – and counts part-time workers who would like to work full time as “employed.”  The “true” unemployment rate is reckoned to be much worse than the official rate.

Congress has enacted several COVID relief measures, including in late December, to extend duration, amount, and applicability of unemployment benefits, but our unemployment systems remain predominantly state designed and administered.  The shortcomings of these systems have been severely exposed over the past few months: neither the processes nor the actual technologies supporting them proved robust enough for the volume of applicants.  Last December Pew Trusts reported that “unemployment payments were weeks late in nearly every state.” 

It’s not just a timing problem.  Mr. Porter reports:

• “In 2019, only 27 percent of unemployed workers received any benefits, a share that has been declining over the last 20 years.

• The benefits have eroded as well, to less than one-third of prior wages, on average, about eight percentage points less than in the 1940s.”

The states range from 58% of unemployed workers in New Jersey who receive benefits to 9% -- 9%! -- in North Carolina.  Robert Moffitt, a Johns Hopkins economics professor, told Mr. Porter: “The program was set up to have tremendous cross-state variation.  This makes no sense. It creates tremendous inequities.”

In case you were wondering, red states tend to be on the lower side of the median.  I would be remiss if I did not note that all 12 states that have still not passed Medicaid expansion also fall below the median in percent of unemployed workers receiving benefits.   

Cheap is cheap.

An April 2020 paper by Steven Wandner of the National Academy of Social Insurance identified some key issues with unemployment insurance (UI):

• Congress has neglected the program, except in crises;
• Oversight by the DoL has weakened;
• State laws, programs, and policies have varied;
• The U.S. economy has changed significantly, both in terns of industries and mix of employment (e.g., away from manufacturing and full-time jobs);
• The workforce demographics have also changed significantly (e.g., female and older workers, dual income households).

Mr. Wandner concludes:

The UI program is and has been broken for a long time. Nationally, UI taxes have not been sufficient to provide adequate partial wage replacement to unemployed workers. There is great variation between the UI programs from state to state. A minority of states have a well-functioning UI program, but the program is not working well in most states—in large part because of resistance to paying for a more adequate UI program.

As with our healthcare system, “broken” isn’t really a good description.  Each is working the way they’ve been designed.  Unfortunately, if you’re poor or sick, and especially if you are both, they’re not designed to help you.  Not until the poor and sick start making significant campaign contributions anyway, or at least vote in larger numbers.

Andrew Stettner, a senior fellow at the Century Foundation, told Vox: “The system has been hobbling along, and now a crisis has hit.  Then people realize we actually want this thing to work, and it doesn’t work in the way people thought it would.” 

Many unemployed workers, of course, also lose their health insurance when they lose their jobs, since ours is a predominantly employer-based health insurance system.  As many as 15 million people may have lost their employment-based coverage due to the pandemic.  If they work for the right kind/size of employer, they may be eligible for COBRA coverage, but paying for it may be difficult, between loss of employer contribution, low UI benefits, and delays in receiving UI. 

At least under ACA they may have coverage options, including subsidies, through the Marketplace or Medicaid, -- unless they live in one of the states without Medicaid expansion.

Even in the states that have expanded Medicaid, the economic crisis has hit their tax revenue severely, while increasing the number of Medicaid enrollees, creating a double whammy.  The same, of course, is happening with the money to pay unemployment benefits, causing almost half the states to ask for federal loans.

In other words, when we have the worst crises – like a pandemic -- both our unemployment insurance and our health insurance systems do worst.  Those are the times we rely most on the government, but our federalism system of shared federal/state responsibilities is failing the latest crisis.

Mr. Porter sees hope:

Perhaps there is an upside to the current crisis: The glaring insufficiencies of the regular unemployment system may encourage states and the federal government to undertake comprehensive changes.

Perhaps.  If the pandemic continues long enough – as it might – it might force deep structural changes.  So far, the various relief bills have just added more patches to our patchwork quilt approach towards UI.  But if in the coming months vaccines mitigate the impact, and the economy picks up, then our typical reaction will be to commission some studies and just kick the can further down the road. 

ACA made our health insurance system less patchwork, with more uniform requirements, more subsidies, less discrimination against preexisting conditions, and broader Medicaid options.  The Biden Administration may, and should, further improve these.  Let’s hope that it takes a hard look at how it can do something similar with unemployment insurance.

What If Healthcare Was Like Wikipedia?

Last week I wrote about, well, how awful social media has become, so this week it’s nice to write about pretty much the opposite: Wikipedia turned twenty last Friday (January 15). 

In person years that’s not even old enough to buy alcohol, but in Internet years that makes it one of the grand old masters, like Google or Amazon.  Wikipedia is one of the most visited Internet destinations, with its 55+ million articles, in 300+ languages, getting some 10b+ views per month. 

It is something that, by all rights, shouldn’t exist, much less be successful.  A non-profit, volunteer written/edited, online encyclopedia?  An online resource widely trusted for its objective, generally accurate articles in a world of fake news?  As the joke goes, it’s good that it works in practice because it does not work in theory.

That’s sort of the opposite of our healthcare system: it’s good that it works in theory, because it sure doesn’t work in practice.

Wikipedia works due to its army of editors (“Wikipedians”); some 127,000 have edited the English edition alone within the past 30 days.  They work in virtual real time; when someone wins an Oscar the update happens almost immediately.  When the U.S. Capitol was stormed two weeks ago, Wikipedia had a page up before the protesters were gone. 

Katherine Maher, CEO of the Wikipedia Foundation, told The Washington Post:

It is remarkable that it exists when you think about the history of knowledge in the world and who has access to it and the very idea that people can participate in it. It is a somewhat radical act to be able to write your own history, and in many places in the world this is not a thing people take for granted.

In an Economist article, she attributed Wikipedia’s success to Cunningham’s Law, which holds that “the best way to get the right answer to a question on the internet...is to post the wrong answer.”  It works for Wikipedia, she says, because: “People love to be right, to demonstrate their competence.”

Academics and some professionals may scoff at its entries, since Wikipedia’s editors come from a variety of backgrounds, but multiple studies have validated that the accuracy of its articles is high, even in specialized areas like science or medicine.   Indeed, Wikipedia is believed to be the most used source of information on health – among not just patients but also physicians and other healthcare professionals.   

Wikipedia acknowledges that it still has diversity issues – the vast majority of its editors are white, English-speaking men – and that false entries can slip through, either unintentionally or maliciously.  But it certainly is no worse than other Internet giants on the diversity of its workforce and much better than them on eliminating incorrect information.  If it’s a choice of believing what you see on Wikipedia or on Facebook, it’s no contest. 

Like many sites established in the desktop era, it has struggled with the shift to mobile.  Ms. Maher told One Zero: “We missed the boat a little bit on mobile but we now have a fully integrated full-service mobile editing feature. Mobile is now the primary way in which people access Wikipedia.”

Wikipedia also struggles to make inroads in India and Africa, and is blocked in China, so there is still much work to be done. Ms. Maher says: “Our vision is a world where every single human being can share in all knowledge.”

As a non-profit, it survives on the kindness of strangers, collecting some $120 million annually in donations, mostly from small dollar donors.  Google, Facebook, and Twitter are all “free” to use as well, but they survive by selling our personal information to advertisers.  Steven Pruitt, a power Wikipedian (some 3.7 million edits!), told OneZero: “If it started selling ads, that alone probably would not get me to leave…But it would change people’s perception of the project. And I think that alone could be problematic.”

Ms. Maher added: “What we always say [about ads] is, “Never say never… But no.”’

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Co-founder Jimmy Wales described the impetus for Wikipedia:

I'd seen the growth of open-source software, free software, and to me it seemed obvious that you could use the same kind of techniques to build a free encyclopedia, so I was in a real kind of panic because I thought this is such an obvious idea that other people will do it.

So what might someone like Jimmy Wales think was “obvious” about a better healthcare system?  Some possible precepts:

• Quality, not credentials: sometimes personal experience, such as from patients, is a better source of health information than from “experts.”  Sometimes people with impressive credentials spew false or outdated information.  Quality of the information is more important than quality of the credentials behind it. 
• Sharing is caring: We spend a lot of money on healthcare.  Some people spend way too much; some people receive way too much.  Too many can’t afford as much care as they need.  There must be a more democratic way to get the right amount of money to the right people for the right care for the right people. 
• Guide the way: When you have a health issue, the healthcare system often seems like a maze. But somewhere in the world someone has had a similar issue.  Someone knows what the best treatment is, and from whom.  Someone knows what your healthcare journey is likely to entail.  The trick is connecting with them.
• Open data: I’ve lost count of how many “patient portals” I have.  None has all of my information.  Collectively, the information on them is a fraction of the data that healthcare institutions/professionals have about me.  I should be the central source; I should be the datakeeper; I should share as needed.

Think Wikipedia meets GoodRx meets GoFundMe meets PatientsLikeMe meets Ciitizen. 

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Ward Cunningham, a software developer who is credited with developing not just Cunningham’s Law but also the concept of “wiki,” told OneZero:

I don’t think the future of Wikipedia is guaranteed. But then hardly the future of anything’s guaranteed…But I think there’s a lot of smart people who understand that they’ve built something fabulous.

He’s right; the future is not guaranteed for most things – not even our massive, seemingly intractable healthcare system.  Wouldn’t it be great to have a healthcare system about which we could feel we’ve built something “fabulous?”

Happy birthday, Wikipedia – and many more!

The Cost of Free Speech

Well, you’d have to say that the past week has been interesting.  It’s not every week that Joe Biden “officially” won the 2021 election, again, as Congress certified the election results.  It’s not every century when the U.S. Capitol is overrun by hostile forces.  And it’d never been true before that Twitter and Facebook banned President Trump’s accounts, or that various tech companies belatedly acted on the threat that Parler poses.  Oh, and we hit new daily records for COVID-19 deaths (over 4,000) and hospitalizations (over 132,000) in case you’d forgotten there is still a pandemic going on. 

Yes, all in all, a very “interesting” week.

I’m going to skip talking about the horror that was the Capitol insurrection, in part because I fear that we’re going to find out more details that will make it clear that it was even worse than we now know.  Similarly, I’m not going to dwell on the shame that Republicans should feel about the fact that two-thirds of their House members still voted to object to certifying the election results even after they’d been forced to flee from the terrorists who sought that very goal with their violence.

Instead, let’s talk about “free speech,” and the social media platforms that helped foster the violence and are now trying to do something about that. 

President Trump had been making outrageous, often incendiary, usually false statements on social media for as long as he has used it, going back at least to his birther claims.  Twitter started attaching warning labels to many of his tweets during the 2020 campaign, but, despite pressure, Twitter had refused to ban his accounts, as a prominent public figure.  But last week it had had enough: “we have permanently suspected the account due to the risk of further incitement of violence,” the company wrote Friday. 

Facebook beat Twitter to the punch by a day, and other social media platforms followed suit, including Discord, Instagram, Reddit, Snapchat, TikTok, Twitch, YouTube, not to mention Shopify and Pinterest (!).  Stripe will no longer process payments for the Trump campaign website.  

Parler was initially thrilled with the bans, expecting millions of Trump followers to migrate.  That was starting to happen when tech companies put the hammer down on it too.  Google first removed Parler from its Play Store, while Apple gave it 24 hours to clean up its moderation policies.  When that didn’t happen, it, too, banned it from its App Store.  Amazon workers demanded that AWS stop hosting Parler, and within days Amazon did so.    

Parler is now offline while it looks for other hosting services; it is now suing Amazon for antitrust, breach of contract, and interference with the company’s relationships with users.  Good luck with that; Parler CEO John Matze told Fox News over the weekend that “every vendor from text message services to email providers to our lawyers all ditched us too.” 

Credit: The Atlantic

Conservatives are complaining about how their First Amendment right to free speech is being taken away.  For example, Rep. Devin Nunes lamented – on Fox News – “Republicans have no way to communicate.”  Donald Trump Jr. tweeted: “Free-speech no longer exists in America.” They ignore the fact that the First Amendment only refers to the rights that Congress cannot take away, or that they were somehow still able to widely broadcast these opinions. 

There is no right to Twitter, much less to Pinterest.

Still, there is plenty of disinformation, even hate speech, left on Facebook and Twitter; Google and Apple allow other suspect apps in their Play Stores; AWS hosts other dodgy companies.  The various bans may satisfy some desire for action -- any action -- in response to what we saw January 6, but no one should believe that the problem is solved.

If it hadn’t been clear enough before, it is now very evident how tech has allowed the problem to become more widespread – and what impact tech can unilaterally bring to bear on it.  Within the space of a few days, the leading tech giants all took strong actions that, if the government had told them to do, we’d consider censorship. 

In a statement, ACLU senior legislative counsel Kate Ruane warned:

We understand the desire to permanently suspend him [Trump] now, but it should concern everyone when companies like Facebook and Twitter wield the unchecked power to remove people from platforms that have become indispensable for the speech of billions – especially when political realities make those decisions easier

President Trump can turn his press team or Fox News to communicate with the public, but others – like many Black, Brown, and LGTBQ activists who have been censored by social media companies – will not have that luxury. It is our hope that these companies will apply their rules transparently to everyone.

Ben Wizner, an ACLU lawyer, told The New York Times: “I think we should recognize the importance of neutrality when we’re talking about the infrastructure of the internet.”   

Credit: Stephanie Rieger/Medium

The problem is that when we allow neutrality, people use the internet to publish child pornography, plan mass attacks, or try to overthrow the government – to name a few abuses.  When we try to put a stop to them, we raise the questions of who is deciding which to curtail, how.  Thorny issues all. 

It boils down to the fact that free speech isn’t free.  It has consequences.  We might all agree that falsely yelling “fire” in a crowded theater isn’t an appropriate use of free speech, but we don’t always agree on when there is a fire or on the best way to put one out. 

I’m glad that President Trump has fewer avenues on which to stoke divisions.  I’m glad that when I finally write about Parler, it’s about it being shut down, albeit temporarily.  But I despair at the disinformation and vitriol that remain on social media and other platforms.    

The bans aren’t a perfect solution, but they are a start.  There is a fire and we need to recognize the threat it poses.  There have to be lines about acceptable online behavior upon which we can agree on as a society.  If we can’t, we may not have a society much longer; at least, not one we’d recognize.

Health Care: Don't Be Evil

Google’s corporate motto – written in its original Code of Conduct -- was once “Don’t be evil.”  That softened over time; Alphabet changed it to “Do the right thing” in 2015, although Google itself retained the slogan until early 2018.  Some Alphabet employees think Google/Alphabet has drifted too far away from its original aims: they’ve formed a union in order to try to steer the company back to its more idealistic roots.

Parul Koul and Chewy Shaw, two Alphabet software engineers, announced the Alphabet Workers Union in a New York Times op-ed, vowing to live by the original motto, and to do what they can to ensure that Alphabet and its various companies do as well.  They assert: “We want Alphabet to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”

It’s past time that health care workers, including physicians and executives, stood up for the same thing.

Ms. Koul and Mr. Shaw cite several grievances, including payouts to executives accused of sexual harassment, the firing of a leading AI expert over her efforts to address bias in AI, and company efforts to “keep workers from speaking on sensitive and publicly important topics.”  Doing the work, even doing it well and being well paid for it, is not enough:

We care deeply about what we build and what it’s used for. We are responsible for the technology we bring into the world. And we recognize that its implications reach far beyond the walls of Alphabet.

Their goal is for Alphabet “to be a company where workers have a meaningful say in decisions that affect us and the societies we live in.”  Alphabet, they say, “has a responsibility to prioritize the public good. It has a responsibility to its thousands of workers and billions of users to make the world a better place.” 

Investors may not quite agree.

In an AWU statement, Nicki Anselmo, Program Manager, explained: “This union builds upon years of courageous organizing by Google workers…Our new union provides a sustainable structure to ensure that our shared values as Alphabet employees are respected even after the headlines fade.”

Google’s official response, released by Kara Silverstein, Google’s director of people operations, was predictably bland:

We've always worked hard to create a supportive and rewarding workplace for our workforce.  Of course our employees have protected labor rights that we support. But as we've always done, we'll continue engaging directly with all our employees.

So far, slightly over 200 Alphabet employees have signed on, out of some 120,000 employees (and roughly the same number of contractors or temps).  AWU is part of the Communication Workers of America (CWA) but has not had an employee election or ratification from the National Labor Relations Board, and so won’t have collective bargaining rights. 

Veena Dubal, law professor at the University of California, told NYT:

If it grows — which Google will do everything they can to prevent — it could have huge impacts not just for the workers but for the broader issues that we are all thinking about in terms of tech power in society,

I won’t try to predict how successful AWU will be, either in terms of building its membership or influencing Alphabet’s priorities, but I admire the goals.  But if there is an industry in which its employees need to speak up about their organizations’ need to prioritize the public good, it is health care.

Credit: Mario Tama/Getty Images

Right now, of course, we have healthcare workers putting themselves at risk fighting the pandemic, putting their own health and lives at risk.  It’s admirable, it’s heroic, and it must be commended.  But those efforts can’t mask actions that those same organizations are taking or allowing that aren’t so noble.

In no particular order:

• Even, or because, COVID-19 vaccines are scarce, we’re already seeing reports about rich or influential people “cutting in line” to get their vaccine early;
• We want people to get COVID tests, and they’re supposed to be free, but some health care organizations have found ways to include “surprise bills” for them;
• We’ve seen health care workers silenced, fired or forced to resign for speaking out about poor working conditions or lack of personal protective equipment (PPE) during the pandemic;
• Health care workers have had to walk off the job over wage and labor condition disputes during the pandemic;
• We still have hospitals suing patients for unpaid bills, even after promises not to during the pandemic;
• As bad as the racial disparities are in our health care system normally, they’re even worse with COVID-19, and may further worsen with the vaccine rollout;
• There are profound gender wage disparities among healthcare workers, and they may be getting worse;
• While pharma is getting plaudits for its rapid response to develop COVID-19 vaccines, it is also busy further raising prices;
• Already wealthy, nominally non-profit hospitals are raking in billions of disaster relief funds;
• Health insurers have done exceedingly well financially during the pandemic.

“Don’t be evil” would seem to apply.

What we need are the health care front line workers and leaders who will stand up and say, this is not good for our patients.  This is not good for our society.  This is when the needs or goals of our organization do not take precedence over the public good.

Credit:Marrian Zhou, Nikkei Asia

There are unions in healthcare already, even for physicians, but as a percent of all healthcare workers they have made about as many inroads as AWU has at Alphabet, and over a much longer period of time.  I have mixed feeling about unions generally; while they brought workers many important protections and benefits, they’ve often fallen ended up being more about workers’ insular interests than about broader social priorities.  But sometimes organizing is necessary.

Every health care organization should be, to quote Ms. Koul and Mr. Shaw about their goals for Alphabet, “a company where workers have a meaningful say in decisions that affect us and the societies we live in,” and which “has a responsibility to prioritize the public good.” 

If that is not true of your healthcare organization, if your healthcare organization isn’t committed to “don’t be evil,” then what are you prepared to do about it?