Monday, November 23, 2009

Breast Examiners Wanted

Yes, yes, very rude indeed. We were talking about the smart grid at lunch today - I treated my former IT colleagues using a going-away gift certificate I'd been given for my favorite restaurant. The lunch was what they call NSFW (I think that means Not Safe For Work) and these poor guys had to return to there, while I could wend my way back home. I felt lucky for a day!

Being a bunch of open-minded and pretty smart guys, we were relating all these seemingly unrelated concepts, which is fun to do over lunch. I was telling them about, and what we hope to accomplish, and encouraging them about how important IT will be to the smartening of our power grid, and to the health-care debates. (I was feeling guilty about being glad to leave IT behind)

How important it will be to wash your clothes when the wind is blowing, say, and have your meter tell you the current price of power, and advise you about what time will be best to use it. Little stimuli to meet the problem from both ends. How you can power up your electric car at home during the night and then sell the excess back during the day in the big city.

And inevitably, we talked about the risks of colonoscopy (we'll all getting up there in age) which are significant, and add to its cost via the insurance system. And then the reverse lottery of the breast exam, which gives so little collective value, but which you manifestly can't deny to women who feel entitled to it. All the motives in place for disinformation, because everyone - and they have lobbyists - wants to preserve their piece of the franchise.

Just like when I'm selling my house, I have to pay all this protection money about the title and the survey, even though nothing's changed. IT could help here too, since not every case requires the full treatment. The land surveys could be matched against one another. But there are a lot of franchises to be protected.

Not every woman is at enough risk to get any real benefit from breast screening. But of course, we worry about the genetic data - which would help determine who needs the most frequent exams - getting into the wrong hands. Speaking of which, the one young guy in the crowd was limber enough of mind to suggest the obvious - that there are lots of guys out there'd who'd be willing to be trained to do breast exams for free!

OK, sure, it's a crude and very politically incorrect guy joke. But it puts me in mind of the brilliant scholar who has exposed the incredible costs of free parking. He pretty convincingly demonstrates that if we were simply to charge drivers the true cost to park their car, almost all the insanity on the planet could be resolved. We wouldn't have to tax gasoline, we wouldn't have to massively subsidize mass transit, and we would instantly get readers of newspapers again, regardless of the medium on which they get delivered, because people wouldn't waste so much time driving and looking for parking!

So, lots of guys think they want to examine women's breasts, right? The key issue being that the whole clinical setting required for such examinations pretty much kills the motive. I've been examined plenty of times by women doctors, and it seems pretty clear to me that arousal under such circumstances would be about as out of bounds as lots of kinds we put people in jail for. It's not clear to my head. It's clear to my body.

But I don't know, everyone has different thresholds. Once, when I had phlebitis in my leg, this truly very fetching blond nurse - I'm really not making this up - ran this ultrasound device way way up my leg, riding on some sort of lubricant. The lights were out and there was soft music playing, and I swear I could sense people snickering beyond the door. It seemed a cruel sport.

I guess people get their jollies all sorts of different ways. All I felt was some sort of terror that my alternate brain would get the better of me, which was pretty inhibiting in and of itself. Who knows if I passed or flunked that particular exam. Well, at least I didn't die of a deep blood clot like other folks who drive too much sometimes do. And I'm not as stiff as Richard Nixon, who famously had phlebitis.

So, these unpaid breast examiners would have to pass some kind of female yuch test. They'd have to learn the clinical facade which keeps our doctors honest. And sure, they'd get pretty bored pretty quickly.

But then think of the upside! We could attract the most breast-obsessed guys, cure them of the obsession, and at the same time lower the cost of what has proven to be a pretty low-value reverse lottery scheme to get everyone to be examined. I know it sounds a little too much like A Clockwork Orange. . .

 . . .  but traffic on the Internet could be diverted to more worthwhile things. People might have the time to read some of the cool stuff out there, and lots of wives might save lots of cosmetic surgery.

And in the meantime, we could employ IT to help us decide which women might actually, statistically, benefit from earlier and more frequent exams.

Well, except for that trust issue, which prevents our most private data from making it into the hands of private insurers, who are almost required to use it against us, individually, or be sued by their shareholders.

It's a good argument for the public funding of healthcare, except no-one trusts the government either, likely because of all those lobbyists protecting their franchises. Even or especially the guys in power can't seem to get good intel that isn't motivated somehow.

Still, again, let me digress a little bit more. I know you will!

As I was wending my way home after too much coffee, I saw a wandering cat. All wandering cats seem to look like Stella to me, who is my cat, but who often wanders away for days at a time. And then just when I start mourning, she shows up.

Once, while staying with a friend while I went out West, she disappeared into his walls and didn't come out for nearly two weeks, no matter the enticements offered of tuna and more. She's been given up for dead many many times. That time, she wasn't lost so much as, well, unwilling.

So, apart from the nine lives thing, I was wondering how cats can wander so far and not get lost. Clearly, they don't have any kind of map "in their head" the way we think we do. They aren't doing any kind of spatial analog, which even for people is pretty demonstrably a stretch.

We pore over maps to find our way, and now lots of people obsessively watch these moving GPS maps up toward where they should be watching the road, but it's pretty easy to demonstrate to people the strangeness of their chosing this route to go to this destination and that route to go to that one, when the two paths cross in the middle. Our cognitive maps may be dysfunctional!

I have a pretty good sense of direction; a kind of internal gyroscope which gets me where I want to go, with or without any map. I used to take off on my motorcycle with only a compass, and only once ended up at the road's bitter end, and even then some Methuselah guy pulled me across the river on his handwheel driven ferry. For me, the map was getting in the way of discovery. Some might say I live my life that way, but still I do have that internal compass thing.

Mabye getting our cars off the road would turn us away from our geographic obsession with routes and speed and shortest ways. And we could find our way home however cats do. Probably by smell, and light, and slope and god knows what all. There must be some sort of simple decision tree, allowing each dimension a kind of toward and away.

I've told you before, this works for searching massive data sets too.

I'll just bet the cat also is driven by some emotional compass, where home feels this way and not that. I'll bet none of it is very cognitive at all. I'll bet we humans overpower our own emotional mappings, focusing instead on the triggers for our other brain. Except that, just like cats, when there is no emotional clarity, we just hunker down and stop moving too.

Well, it's a guy thing. We can't ask for directions. We'd rather feel our way along, ahem. And searching massive data sets, we think there must be some GPS too, which will take us to our destination without the need for deciding turns along our way.

But wait! The GPS can help then, to dispose of our internal maps, just like the cellphone address book can do away with the need to remember anyone's number.

I know I'm not the only one to find it strange that we are terrified of terrorists and identity theft, when most of us now hold devices in our hands which can, in principle, target any one of us for individual and anonymous smart-destruction.

We act amazed and a little terrified that Googling ourselves reveals things we didn't think others could know. We want to know how to block that. And yet if each one of us really were public about our genetic and other foibles, that in itself might provide the protection we need against those who would use it against us. But first we'd have to be comfortable doing it.

This is some kind of 40th anniversary year. The CEO of, the moonwalk, the summer of Woodstock, and the Stonewall demonstrations. Where people added up free love and free expression and discovered things about their own feelings they never would have been allowed to know all alone and scared.

Some peoples' defects are on display and public. Some are as private as our genes. It might be time to really let it all hang out. And, um, defuse a little of the power of our great big marketing machines. To me, that's an encouraging thought. But then there really isn't very much that I hold back from you, dear reader.

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