Sunday, October 16, 2011

Singularity on a Plane

I had a delightful conversation on a plane (new for me) with a gentleman who was reading about Gettysburg. I was advocating futurism, he was celebrating history, but somehow, we both agreed with Ray Kurzweil. Things change at an ever increasing rate- what will happen when this rate is really, really fast?

Kurzweil's ideas are controversial, and I rarely share my enthusiasm for fear that I'll be labelled a freak. It took a conversation about the Civil War to build my confidence to defend Kurzweil here.

Kurzweil's main point is so simple, and yet so devastatingly undeniable, that even this older Gettysburg enthusiast supported it:

1. Things change. (Undeniable)
2. The pace of change itself is quickening (The Law of Accelerating Returns).
3. Will this continue to quicken? (History shows no significant slow-downs.)
4. What will happen when things change so fast that it's hard to keep up? (Kurzweil's guesses are fun.)
5. When will the pace of change reach this rate? (Read The Singularity is Near for more fun guesses.)

To dismiss these points as unimportant is cavalier. To dismiss those, like Kurzweil, who actively engage these questions and pose answers based on a solid look at evidence is not fair.

Why do I still feel nervous endorsing Kurzweil in public?

The Head Down: Alone together

I've started conversing with strangers in elevators.

After reading Sherry Turkle's Alone Together: Why we expect more from our technology and less from each other, I've become uncomfortable when I find myself with three or four others, head down, peering at my phone in an elevator. Or walking past someone in the hall, head down, both of us making our way slowly by sheer dint of peripheral vision.  

Before reading Turkle (and really, up until the epilogue of her book), I was dismissive of any critique of the head down. Our phones connect us in rich, genuine ways, with those we care about. They also forge new relationships with those we might not meet otherwise. Best of all, phones enable us to transcend the fickle bondage of location and even time to interact with those who otherwise just aren't here. Most of Turkle's book fell flat as she, like so many other critics, brushed these attributes aside, and instead embraced the tired bromides about why I don't "just call" my "real" friends.  

Now, I've admitted to myself that I just feel uncomfortable when head down. When I see the head down, I react similarly to when I see teenagers all conforming to the same fashion trend, clearly more interested in fitting in than being themselves.

And this, according to thinkers from Ken Wilber to Clay Shirky and, most recently, Michael Chorost*, is the real issue. Connectedness is fitting in, at the opposite end of a spectrum from disconnection, which is standing out. Our lives are somewhere in between, and our personalities place us closer to one pole or the other. Neither pole is right or wrong, and where you are depends on your comfort.

I like to stand out, but that's just me. I try not to give other people a hard time for when and where and how often they prefer to fit in (so long as they stop meandering down the hallway), and I certainly won't castigate our new way of life as somehow a degradation of a better time. 

Maybe the other stand out people are just upset because they're losing what used to be a captive audience?

*Chorost's new book World Wide Mind is really a great piece of writing, as well as eye-opening. 

Friday, October 7, 2011

How A Disruptive App Disrupts: Skin of Mine

Skin of Mine is an impressive tool that allows the analysis of one's skin condition (from acne to psoriasis, moles, vitiligo, and more) with nothing more than an iPhone. 

To appreciate the nature of a disruptive innovation, see how this app changes the very structure of the doctor-patient relationship.


1. Call primary care doctor and schedule appointment. 
2. Take time off from work etc. to see primary doc.
3. Get referral to dermatologist.
4. Call dermatologist to schedule visit.
5. Take time off from work etc. to see dermatologist. 
6. Act on diagnosis and prescription.
7. Call to schedule appropriate follow up.


1. Take picture, complete a questionnaire, and submit to the expert of your choice.
2. Receive diagnosis, prescription, and therapeutic advice within 24 hours.
3. Act on diagnosis and prescription.
4. Call or use app to schedule appropriate follow up.

Crucial Points:

The app obviates two office visits and the time needed off from work.
The app is faster.
One health care provider and many staff are cut out of the loop.
The patient has a personal record of what happened.

Note: I have no connection with or support from Skin of Mine

Thursday, October 6, 2011

Losing Jobs Matters

The passing of Steve Jobs matters; technology will be less human than it could be.

Apple is one of the world's most influential organizations, not by sheer wealth, but by impact across variegated industries beyond technology: music, publishing, retail, and more.

Yet, as beautifully detailed by David Pogue Steve Jobs: Imitated, Never Duplicated, this influence was created and wielded by an iconoclast. Lots of companies are run by geniuses, but Jobs defined himself by running against the grain, doing things "wrong," and yet hewing to principle's of beauty that engendered cult status.

I can't imagine a board electing a CEO who, like Jobs, dropped out of college, never worked for anyone else, and simply didn't give a damn what other people thought.

So how did Jobs wind up running one of the world's top companies? It's because he built it, and he did so at the time of the industry's inception. Since the computer industry is long past its inception, we can be confident that it simply won't see another titanic iconoclast at the helm.

And this is a great loss.

Innovations will continue to pour out at an accelerating pace, but they will not cut to the soul as beautifully as those created in the world of Jobs. Simply put, Apple makes products that are, above all, powerfully human.

Is there another force on this planet as powerfully human-oriented than Apple? Oriented in practice, not simply ideology or disposition? I submit that the key was Jobs's deep, micro-managing, hands-on involvement in production, bringing the corporate might Apple to bear on the most minute impediments for common users to achieve their goals.

The entire might of one of the wealthiest companies was, for a time, directed at removing the impediments of common people from achieving their desires.

According to Pogue, there will not be another Steve Jobs, ever, and we are worse off for it.

Wednesday, October 5, 2011

How To Look Serious With Your Phone (5 Tips)

It happens daily. I'm faced with some serious work that can easily be handled with my phone, but I'm nervous to pull it out of my pocket. In the medical world in particular, the workplace is not a time for mobile frivolity, and skeptics abound.

Here are my five tips for looking serious when being serious with your phone.

1. Hold a pen in one hand. It just looks like you're working instead of chatting, I suspect it reminds onlookers of the Palm Pilots of yesteryear. I like to extend the pinky finger of the hand that's holding the pen. I'll occasionally draw attention to my pen by subtly tapping it against my forehead or pressing it against my temple, just to create the sell that I'm being serious here. If you're more adventurous, use another prop like a book- just holding it open can look like you're cross-referencing. Very serious.

2. Cradle with care. Hold the phone in your non-dominate hand, and tap at it with your dominate hand. If available, set the phone on a table. This looks like you're engaged in a task and either entering or manipulating content, rather than just consuming it. Even when I'm typing into a text field, I hunt-and-peck with one finger so that it doesn't look like I'm texting.

3. Don't hunch. Don't be caught cradling the phone in both hands, elbows bent, hunched over the screen like you're texting or trying to view someone's profile picture. If the phone is at a distance, it looks like you are open to sharing its content with others around you, creating the semblance that you are accessing professional material.

4. Share your screen. As often as possible, engage others around you in the content you are consuming. This helps establish you as a serious user because others can see that you're not fooling around. Additionally, it promotes the idea that a phone can have serious uses. Furthermore, even if you aren't shutting people out while engrossed in your phone, it's polite not to LOOK like you're shutting others out. However, be careful not to be that guy who is gleefully showing everyone how irrelevant they all are thanks to your snappy apps. (Even if you think it's true.)

5. Adopt a pensive look. This seems trivial, but really, who texts or scans Facebook with a knit brow and protruding lips? If the app is making you think, look like you are thinking (even if you're not).

Any other tips out there?

Tuesday, October 4, 2011

Disruption in the Doctor's Office

In Clay Shirky's engaging book Here Comes Everybody, he describes how professionals can be blindsided by disruptive competitors. It got me thinking about medicine.

Traditionally, new technologies reached medicine in a top-down direction. The invention of MRI, for example, was first introduced to hospital administrators and department chairs as a potential new diagnostic tool. Once accepted, others further down in the medical hierarchy gained exposure. 

This technology wasn't disruptive because it didn't change the overall structure of the field. As before, patients still came to hospitals for sophisticated diagnostic work-ups, only now the hospital had a better, albeit more expensive, tool.

Many of today's medical technologies are disruptive, which is different.

Take, for example, the iPhone app Skin of Mine. Take a picture of a suspicious mole and get either automated analysis about its likelihood of melanoma, or an online consultation with a dermatologist. 

This invention is entirely unlike the MRI scenario. Instead of entering the field from the top down, it comes from the bottom up. Patients can walk into their doctor's office with this invention already in their pocket, asking questions about a diagnosis made by their free mobile app, all without the department chair or hospital administration even knowing of its existence. 

This changes the overall structure of the field: the patient has direct and cheap access to diagnostics, less need for an office visit, and more information in the patient's hands. 

A crucial question for medice is how to respond to disruptive changes that come from the bottom up? My guess is that most clinicians, understandably, will not take kindly to innovations that reorganize their workflow. The nightmare of adopting a new EMR is trivial compared to the challenge of restructuring how and where a doctor sees patients. Nonetheless, I'm guessing this change will be inevitable as patients clamber for the cheap convenience of such disruptive technologies.

Personally, I think medical schools hold the key to ushering this bottom-up transformation. They can serve as the field-testing ground for disruptive innovations, training the near-future doctors as well as offering exposure to their more entrenched clinicians, but in a structured way that blunts the stress of disruption.