Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, May 08, 2024

As We All Know The myHealth Record Is A Collossal Failure!

This just dropped:

Health portal ‘plagued by incomplete records and poor usability’

Tom Burton Government editor

Less than 2 per cent of documents in the My Health Record system are being looked at by doctors, with incomplete records, poor interoperability and clunky usability frustrating patient and clinical use of the $2 billion federal portal, according to a new Productivity Commission report.

“Despite major investment in the My Health Record system, patient data is still fragmented and spread across different digital systems maintained by individual healthcare providers,” commissioner and economist Catherine de Fontenay said.

“The usability of MHR [currently described as a ‘shoebox of PDFs’] needs to improve in tandem with its coverage. Government should work to break down or ‘atomise’ data in MHR to make it more useful.”

Telehealth can save nearly $900 million in travel time and waiting room costs, says the Productivity Commission.

“We estimate that making better use of data in electronic medical records systems can save up to $5.4 billion per year by reducing the length of time patients spend in hospital, and $355 million in duplicated tests in the public hospital system alone.”

Dr de Fontenay said artificial intelligence and automation presented a major productivity opportunity for healthcare. She cited studies suggesting 30 per cent of the tasks currently undertaken by the healthcare workforce could be automated, equal to 11 hours a week.

The commission’s report said My Health Record was intended to be a central access point for a patient’s most important health data, but despite an investment of more than $2 billion, it continued to be “plagued by incomplete records and poor usability”.

There are now 23 million records with 1.2 billion documents in the federal portal, but the report said only a fraction were being accessed by clinicians.

“Commission estimates suggest that around 2 per cent of documents uploaded by healthcare providers are viewed by other healthcare providers,” the report says.

“For clinicians who do use MHR, it is not clear that they regularly use it as a source of information.

“Providers are generally more likely to upload information to MHR than they are to actually view it.”

Dr de Fontenay said the lack of take-up of the federal portal was resulting in state governments expanding their own state-based medical reporting systems, including to patients, further fragmenting health information. 


Reduce decision-making time

She said the electronic medical report systems enabled modern digital workflows, reducing decision-making time. This, in turn, shortened hospital admissions stays, yielding an estimated $5.4 billion in savings based on 2020-21 costs.

The report also found virtual health initiatives such as telehealth could save up to $480 million in travel cost times and around $415 million in surgery wait times.

“Telehealth use has exploded since 2020, but uptake of remote patient monitoring and digital therapeutics has lagged behind,” Dr de Fontenay said.

With less than a third of specialists and only 6 per cent of aged care providers using the MHR system, the federal government is mandating the uploading of diagnostic imaging and pathology results.

“But getting the information onto the system is only half the challenge – clinicians also need to draw on this valuable information,” the report says.

“If this is to occur, mandatory uploading will need to be accompanied by changes that allow practitioners to efficiently search large volumes of data and display reports in a way that is easy to read and accessible.”

Dr de Fontenay also picked up previous recommendations to have health information presented in formats that enable easy searching rather than PDFs, which are problematic to search.

“Shifting towards storing data in an atomised format would help. Atomisation would involve storing individual pieces of information at their most basic level, rather than in a format that is more difficult to reduce,” she said.

She said the greatest potential benefits of this change would be realised if MHR information was capable of being used by other digital systems.

Here is the link:

https://www.afr.com/policy/health-and-education/health-portal-plagued-by-incomplete-records-and-poor-usability-20240506-p5fpeo

So tell us something we didn't already know!!

David.

What Do You Think Are The Deeper Causes Of The Alienation, Violence and Disaffection We Seem To Be Seeing More Of At Present?

This appeared last week:

‘Radicalised’ teen shot dead after stabbing in Perth

By Paul Garvey Senior Reporter

and Tricia Rivera Journalist

12:00PM May 5, 2024

A 16-year-old boy who was believed to have been radicalised has been shot dead in Western Australia after allegedly stabbing another person and charging at police.

WA Premier Roger Cook and Police Commissioner Col Blanch disclosed details about the incident at a press conference in Perth on Sunday morning, saying the teen called police just after 10pm on Saturday to let them know he was going to “commit acts of violence”.

Mr Cook said members of the Muslim community had made multiple calls to 000 concerned about the boy shortly before the incident occurred. He said authorities believed that the boy had been “radicalised”.

The victim of the attack is currently in hospital with a stab wound to the back. He is in a serious but stable condition.

The boy is known to police and was involved in a countering violent extremism program. He joined the program in 2022.

The incident took place in a carpark outside a Bunnings store in Willetton.

The Premier labelled the incident as “extremely confronting’.

“A 16 year old male with a knife who had already wounded a member of the public rushed attending officers. In response, a police officer discharged his firearm.

“There are indications he had been radicalised online. But I want to reassure the community at this stage it appears that he acted solely and alone.

“Members of the WA Muslim community who were concerned by his behaviour contacted police prior to the incident, and I thank them for their help.”

Commissioner Blanch said police received a call from the young man before the attack.

“That male indicated that he was going to commit acts of violence. He didn’t provide his name nor location and the phone was in a phone call was in terminated.,” Mr Blanch said.

“Some minutes later, police received another triple zero call from a person ... stating that a male with a knife was running around the car park.”

He said three officers attended the location within three minutes of the call and were confronted with the man who was wielding a large kitchen knife.

“Two officers drew the tasers and one of the officers drew his firearm and challenged the male to put down the knife which he did not comply.”

The 16-year-old allegedly rushed one of the officers who tried to deploy a taser on him.

Commissioner Blanch said a second taster was also used but it did not have the “full desired effect”.

“The male continued to advance on the third officer with a firearm, who fired a single shot and fatally wounded the male,” he said.

“He was taken to hospital and declared deceased at approximately 11pm.

“It’s a very tragic event in Western Australia. It saddens me that I have to be here today talking about it.”

He said that the officers acted in line with their training,

Anthony Albanese said their was no place violent extremism in Australia.

“My thoughts are with those who have been affected by the incident in the Perth suburb of Willetton overnight,” the Prime Minister said in a statement.

“I have spoken with WA Premier Roger Cook this morning, and I thank the WA Police for acting swiftly to contain the incident.”

Mr Albanese said he had received a briefing on the incident from ASIO Director-General Mike Burgess and Australian Federal Police Commissioner Reece Kershaw and that there is “no ongoing threat” to the community at this time.

“We are a peace-loving nation and there is no place for violent extremism in Australia,” he said.

Here is the link:

https://www.theaustralian.com.au/nation/radicalised-teen-shot-dead-after-stabbing-in-perth/news-story/39e693dbfc18105f468edfb89c5b3293

I am really beginning to wonder just what is happening here. It seems clear that none of these incidents are unexpected by people close to the affected nippers and it is very sad more cannont / has not been done to address the underlying issues.

Issues of this sort do not come out of a “clear blue sky” in my view and those close to the problems cannot just ignore the warning signs, if catastrophes are to be avoided. That said it can be very hard to identify the individuals who will really run off the rails vs those who can make it safely to the station! This is really an amazingly difficult for any health system!

I have teen-age grandchildren and I know just how hard it can be to be sure that all is within reasonable bounds…..

That said some of the behaviour we have seen recently is clearly of concern and needs well-thought out and effective responses!

Is it my imagination or are these problems becoming more common?

David.

Tuesday, May 07, 2024

It Seems There Has Been A Major Policy Change With The MyHealthRecord,

 This appeared last week:

Patients given immediate access to results on MHR

The DoHAC has scrapped a seven-day delay in patients viewing pathology and diagnostic imaging results, against the advice of medical colleges.

The My Health Record changes were one recommendation of the Strengthening Medicare Taskforce.


Patients will be able to access certain test results immediately and without the supervision or oversight of their doctor, following a change to My Health Record (MHR) access rules.

Michelle Wisbey


03 May 2024

 
The Department of Health and Aged Care (DoHAC) has confirmed patients will no longer have to wait seven days before they can see their pathology and diagnostic imaging reports.
 
It says this change will give both patients and their doctors better access to information, empower patients to participate in their own healthcare, and reduce duplication.
 
While there will still be a delay in some circumstances, such as where there is evidence of clinical safety or other risks, the decision overrides serious concerns from the RACGP and other medical groups about the potential risks of making results immediately available to patients.
 
‘Maintaining the seven-day rule allows consumers to have access to their health information, albeit with a small delay that allows their GP or other clinician to discuss their results with them,’ the college said in a submission last year.
 
‘We do not consider the benefit of real-time access to results outweighs the potential harm of consumers misinterpreting results or receiving unfortunate results with no immediate clinical support.’
 
Dr Emil Djakic,a member of the RACGP Expert Committee – Funding and Health System Reform, told newsGP the changes mean medical information could reach patients in a way that cannot be contextualised by their GP.
 
‘Some patients are very literate and will be more than happy to look, some patients will not even bother looking at it, and there’ll be a few that will look at it and probably see some pretty scary outcomes,’ he said.
 
‘Some of the language in these reports does create quite a lot of anxiety without a level of health literacy, so that is concern.
 
‘It comes with a responsibility, and that is the responsibility of the patient who, on viewing that data, has to accept what they’re seeing is something they’re reading without any assistance or interpretation.’
 
The changes were one of the recommendations of the Strengthening Medicare Taskforce, which also called for public and private pathology and diagnostic imaging providers to share their reports to MHR by default.
 
However, Dr Djakic said the lack of a seven-day access delay means some patients could see their results and choose not to follow-up with their healthcare provider.
 
‘They will choose to interpret it themselves because it avoids a visit to the doctor, or a phone call, or a consult – there are all sorts of reasons that the consumer might choose to say, “that’s adequate for me”,’ he said.
 
‘We need to be making sure it’s somehow reflected in My Health Record that this consumer has viewed the data and if they don’t proceed with engaging with the appropriate clinician, to help steer them through that data.’
 
Currently, 99% of GPs are registered and using MHR, with the service seeing a 24% increase in people using it to view their pathology reports in the past 13 months.
 
The volume of pathology and diagnostic imaging reports uploaded is also in the rise, with both up around one third in just one year.
 
As the popularity of MHR continues to grow and as patients demand more digitised and modernised access to their healthcare records, Dr Djakic said GPs must adapt.
 
‘In health system reform, we’re clearly keen to see data move more easily and make the patient the centre of their healthcare, and this is a step to that,’ he said.
 
‘We’re seeing these sorts of adaptions every day, and our industry is in the midst of seeing what this means, how it works, and how we continue to serve the patient with the best possible care with this information.
 
‘We’re in this reform space where we’re looking at how do we how to manage this in a way that meets the patient’s needs as safely, and with as much care and quality as required.’
 
To accommodate the access changes, the Australian Digital Health Agency will soon begin helping healthcare providers to meet the new requirements.

Here is the link:

https://www1.racgp.org.au/newsgp/professional/patients-given-immediate-access-to-results-on-mhr

This looks to me rather like a population wide experiment that will probably work out most of the time but my cause all sorts of problems with a few. I hope there is a safety net to catch those patients but I am not sure there is.

We can all wait and see how it goes!

David.

Sunday, May 05, 2024

Are We Beginning To See Protests Which Are Really Not Addressing Subjects That Matter?

 This appeared a few days ago

Brendan O’Neil

Protesters seek to wash away the ‘sin’ of their own privilege by donning keffiyeh

12:00AM May 4, 2024

Whatever happened to the sin of “cultural appropriation”? You remember that wacky idea. It involved blue-haired woke activists raging against anyone who dared to “appropriate” the culture of a different ethnic group. On campuses across the Anglo-American world, “cultural appropriators” were forever being called out.

Whether it was a white dude sporting dreadlocks or a drunk student putting on a sombrero, the cry would go up: “Stop stealing other people’s culture!” I’m not joking about the sombreros. Student officials at the University of East Anglia in England went so far as to ban non-Mexican students from donning Mexican headgear on the basis that it’s “racist”.

Pop singer Katy Perry was accused of “appropriating black culture” after wearing her hair in cornrows. Even the sainted Beyonce got it in the neck after sporting a sari in a Coldplay video. Is she “misusing Indian culture”, pondered the lunatic BBC?

Cultural appropriation, declared the Oxford Dictionary, refers to “Western appropriations of non-Western (culture)”. You must never do this, barked PC finger-waggers. Yet fast forward to today and cultural appropriation seems to be acceptable again. In fact, it’s all the rage.

Right-on campuses are awash with upper-class white kids wearing the garb of “non-Western” people. No, not the sombrero or forbidden Afro hairstyles but the keffiyeh. Everywhere you look, from Los Angeles to London to Sydney, students are adorned in these checkered scarfs from the Middle East.

The kind of people who just a few years ago would have harangued some white girl for getting a Japanese-style tattoo now spend their days decked out in Arab attire.

They call it solidarity, of course. We wear the keffiyeh to show our support for the beleaguered Palestinians, they say.

I’m not buying it. Since when did solidarity involve fancy dress? I don’t remember those 1960s kids who protested against the Vietnam war putting on bamboo conical hats in mimicry of the Vietnamese peasants who often felt the heat of US bombs. Or Western supporters of the Quit India Movement wearing white dhotis in the style of Mohandas Gandhi.

The keffiyeh craze feels more like radical chic than meaningful activism. The Arab cloth has become an essential fashion item for the woke, the mandatory uniform of the self-righteous. Keffiyeh-wearing is less about drawing attention to the plight of the Palestinians than drawing attention to “you”. Pulling on a keffiyeh is a shortcut to the moral high ground. Hipsters will smile at you in the street. Your local craft coffee house may even give you your macchiato for free.

When I see students camping out for Gaza with keffiyehs wrapped around their necks and faces, I don’t think: “Now that’s solidarity” – I think: “Now that’s showing off.” It’s an act of moral distinction, a way for the educated elites to differentiate themselves from the supposedly indifferent throng.

These keffiyeh wearers are plundering foreign culture far more egregiously than some legless bloke in a sombrero propping up the student bar. For they don’t only dress up like Gazans, they creepily mimic their living conditions, too.

Witness the student leader at Columbia University in New York City – in a keffiyeh, of course – saying that she and her fellow campers required “humanitarian aid”. Do you want us to “die of dehydration and starvation”, she crazily asked university bosses.

There is something gross about privileged kids on an Ivy League campus cosplaying as victims of a humanitarian crisis. These people could have pizza Deliverooed at a moment’s notice.

In one truly cringe-worthy clip, a group of Columbia students could be seen receiving “humanitarian aid” through the college gates. I say humanitarian aid – it was probably just their Starbucks order or a blueberry muffin from a local bodega.

It came off as a crass re-enactment of the scenes we’ve seen in Gaza: hyper-privileged Ivy Leaguers masquerading as the wretched of the earth.

When mainly Jewish counter-protesters confronted the Gaza camp at the University of California, Los Angeles, the campers denounced them as “Zionist thugs”.

This is what life must be like for the Palestinians, some said. These people have no shame. It’s not enough to appropriate Palestinian scarfs – they want to appropriate Palestinian suffering, too.

This is a new, strange and unsettling kind of activism. It’s not ’60s-style solidarity with foreign struggles. And it actually goes beyond radical chic, beyond politics as fashion statement.

No, this is about coveting suffering. These activists, it seems to me, crave the moral rush of oppression, the thrill of persecution. They pull on the garb of a beleaguered people to escape, however fleetingly, the spoilt, pampered reality of their own lives, to taste that most prized of social assets in the woke era: victimhood. In draping the keffiyeh around their shoulders, they get to be someone else for a while. Someone less bourgeois, less white. Someone a little more exotic, a little more interesting.

It’s not politics – it’s therapy. They seek to wash away the “sin” of their own privilege through mimicking what they consider to be the least privileged people on earth: the Palestinians. It’s not Gaza they want to save but their own souls. It feels as if they’re more interested in what Palestine can do for them than in what they can do for Palestine. Palestine becomes little more than a source of meaning, a fountain of purpose, in the lives of bored youths on leafy campuses.

It’s a toxic mix of narcissism and racism, with Arabs reduced to the lowly role of soothing the white guilt of privileged Westerners.

Listen, that’s not solidarity, it’s the opposite – selfishness.

Here is the link:

https://www.theaustralian.com.au/inquirer/keffiyeh-cosplay-for-gaza-all-the-rage-for-righton-elite/news-story/39bb35a517bda03b038779ec86d5602d

I may have this wrong but is seems to me there is a war happening in Gaza and people are dying because of it. To me the rights and wrongs of this conflict have been lost with the passage of time and so what we now need to do is work out a way forward for both the Israelis and he Palestinians.

Much smarter and better informed people than me have tried for a long time (100+ years) to solve this conflict and have failed so it really does seem that the only solution involves the two sides being separated and getting on with their respective lives – enclosed and separated by agreed borders. How we get there is well above my pay grade but get there we must!

There is way too much suffering, starvation etc. happening in this tiny speck of land and the world really has a responsibility to end it. It is a blight on all our consciences until it is addressed and I hold in awe those from MSF and WCK (among others) who are working to reduce the suffering….

I really hope that sanity will soon prevail, while understanding there is little I can do to actually fix things!

Every once in a while you just need to let off a little steam and hope sanity is a little closer than it was!

David.

AusHealthIT Poll Number 745 – Results – 05 May, 2024.

Here are the results of the poll.

Does The Government Have Any Plans That Will Make A Real Difference To The Rate Of Domestic Violence In Australia?

Yes                                                                                1 (3%)

No                                                                                34 (94%)

I Have No Idea                                                             1 (3%)

Total No. Of Votes: 36

An almost perfectly unanimous vote – with 2 hold-outs - make it clear most would not put much confidence Government to fix the issue!

Any insights on the poll are welcome, as a comment, as usual!

A pretty good number of votes. 

1 of 36 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

Friday, May 03, 2024

Sorry, But These Have Been My Favourite Creatures Since My Early University Days!

This popped up last week:

The Evolution of Stupidity (and Octopus Intelligence)

What we can learn about intelligence, stupidity, and ourselves—from some of the smartest, strangest, alien-like creatures on the planet.

Brian Klaas

Apr 23, 2024

I: “But I wore the juice”

At 2:47pm on January 6, 1995, Clifton Johnson and McArthur Wheeler walked into the Mellon Bank branch in Swissvale, a small suburb of Pittsburgh. One of them pointed a handgun at the teller, demanding cash. The teller, shaking with fear, handed over some money. The robbers ran out.

Unlike most bank robbers, Johnson and Wheeler made no attempt to disguise themselves, nor to obscure their faces with masks. They looked straight into security cameras. This was particularly puzzling because Wheeler, five foot six and 270 pounds, had an easily identifiable physique—and a distinct face. Sure enough, his conspicuousness doomed him. The local news flashed a photo of Wheeler on the 11 o’clock news. An hour later, after tip-offs flooded in, Wheeler was arrested.

“But I wore the lemon juice. I wore the lemon juice,” Wheeler protested as he was taken into custody. When the cops showed him surveillance footage in which he’s clearly visible robbing the bank, Wheeler’s face contorted in disbelief. Something in his ingenious plan, he realized, had gone very wrong.

Somehow—perhaps due to its relation with disappearing ink—Wheeler believed that lemon juice could make human faces invisible to security cameras. So, even though it made his eyes sting, Wheeler slathered on the juice.

But Wheeler was no sheep-like simpleton. He wisely tested the efficacy of the juice before the robbery. He squirted it on his face, then attempted to take a photo of himself with a Polaroid camera. When the image came out, Wheeler was astonished: he wasn’t in the shot. Convinced by his rigorous scientific experiment, he proceeded to rob the bank, protected by the magic juice. (It’s likely Wheeler pointed the Polaroid camera in the wrong direction and just didn’t realize it).1

This story, which inspired the research into what we now know as the Dunning-Kruger Effect, is a testament to the extraordinary power of human stupidity.

Sadly, so much of our discourse around intelligence and stupidity gets hijacked by pseudoscience, racism, and debates over whether arbitrary measurements like IQ are valid. We ignore more interesting questions around intelligence and stupidity that we can learn not from ourselves, but from other species. In particular:

1. What, specifically, does it mean to be “intelligent?” What do we mean when we say that humans and chimps and dolphins and crows are intelligent?

2. Why did some species—including us—become smart, while others didn’t?

3. Why is stupidity still so widespread in humans?

Pondering these questions requires going on a bit of a wild ride, exploring fascinating animal worlds from chimpanzees to cephalopods, as we begin to understand our own cleverness—and stupidity—through the eyes of an octopus, the closest thing to alien intelligence on Earth.2

II: Chimpanzees, Rubik’s cubes, and disappearing ink

“It’s quite common for people [scientists] to talk about intelligence. It’s less common for people to talk about stupidity, though, arguably, it’s more common.” So observes David Krakauer, evolutionary biologist, genius polymath, and president of the world hub of complex systems research, the Santa Fe Institute.

Krakauer has devoted himself to the study of stupidity. In the process, he has made a series of illuminating arguments about how to consider cross-species intelligence, since IQ tests aren’t an effective tool to determine whether an elephant is smarter than a crow.

Krakauer points out that humans and chimpanzees share nearly 99 percent of our genetic code. “Imagine I gave you Hamlet,” Krakauer says, “and I changed less than 1 percent of the text and I said, ‘What’s the play?’ and you said, ‘It’s Hamlet.’ And I said, ‘What have I changed?’ ‘I’m not quite sure…I did see a few typos.’”

Like a few typos in Hamlet, we are divided from chimps by tiny, almost imperceptible variations. So, how can there be this massive chasm in behavioral intelligence and complexity between chimps and humans with such small divergences in genetics? It’s an enduring puzzle; we still don’t have the answers.

But Krakauer distances himself from what he sees as unhelpful debates around IQ and instead focuses on more general ideas around intelligence, ignorance, and stupidity. His definitions have the advantage of applying across diverse species.

· Ignorance is a lack of relevant data; you don’t have the information necessary to solve a problem. It’s about a gap of information, not limited cognition.

· Intelligence is when one can derive simple solutions to complex problems—and make it look effortless. With intelligence, more relevant information helps you solve a problem faster. Intelligence means you will solve a problem at a rate significantly faster than by trying solutions at random.

· Stupidity is when you use a rule, or a system of thought, in which adding more data or information doesn’t make it any more likely that you’ll get the correct answer. In the extremes of stupidity, one would solve a problem more slowly than if that creature just tried solutions derived from random chance.

To illustrate these points more precisely, Krakauer draws on the example of a Rubik’s cube. There are 43 quintillion possible arrangements of the cube. If you were immortal and randomly moved bits of the cube, eventually, you’d solve it—but it would take a ridiculously long time—billions upon billions of years.

A stupid solution would be to simply keep rotating the same face, over and over, even if someone came along and gave you instructions on how to solve it. With that stubbornly stupid strategy, you’d never solve the puzzle.

The intelligent solution lies at the other extreme: the Rubik’s cube world record currently stands at 3.13 seconds, set in July 2023.

However, the record-holder, 23 year-old Max Park, didn’t discover the insights that allowed him to solve the Rubik’s cube. His success was built atop a foundation of accumulated knowledge that mathematicians and puzzle enthusiasts derived—mental algorithms that enable “cubers” to solve the puzzle with lightning speed.

Collectively, humans have produced an extremely intelligent solution to a complex problem—and it’s trillions of times faster than trying random solutions.

This is one of the unique tricks that has allowed humans to collectively become the world’s smartest species. Krakauer refers to this secret weapon as exbodiment, the transfer of knowledge from our brains to external repositories and tools, which can be shared, iteratively improved, and transferred across space and time.

“Most of what happens cognitively doesn’t happen in here [our brains], but out there,” Krakauer explains, “stored in the world—in books, in folklore, in symphonies and so forth.”

We, today, can still gain intelligence from reading Aristotle or Lao Tzu, whereas chimpanzees and octopuses only learn from those who are currently alive.3

This, Krakauer argues, is the critical difference between us and our primate cousins. The ability to accumulate intelligence through cultural transfers is likely the crucial tipping point, or phase transition, that explains how tiny genetic fluctuations could express themselves in wildly different levels of complex cognition. As Krakauer explains:

Imagine that I gave you an ink that was very volatile, such that when you wrote down text you could only transmit it to at most one other individual, and once those people had it—and tried to propagate it—the message will have disappeared.

If we lived in such a world there would be no culture; because we couldn’t transmit across many generations what we had learned in our lifetime. So just by changing the chemical constituents of the ink—one little chemical change—you make the difference between no culture and a culture. And I think that’s what we have to look for. There’s something about the capability of humans to integrate over time what they have acquired and incrementally, and collectively, add to culture.

This logic neatly resolves the paradox of tiny genetic markers producing enormous shifts in cognitive complexity. Of course, the disappearing ink is a thought experiment—not a literal scientific solution. But it helps provide a framework for understanding how little tweaks, evolutionary flukes if you will, can unlock profound improvements in intelligence. In our complex, non-linear world, small changes often produce big effects.

But even if we accept that logic, there’s a deeper, lingering question: why are some species smart and others…not so much? 

III: Cephalopods and the evolution of alien intelligence

In 2008, researchers at a German aquarium grew perplexed: each morning, when they came into work, they found the electricity shut off. With the power shorted out, the filtration pumps turned off, imperiling other animals. Finally, a few researchers volunteered to stay overnight—to figure out what was going on.

To their astonishment, they found the culprit: an octopus named Otto, who was climbing to the rim of his tank and shooting jets of water at an overhead light that was annoying him. He had figured out that several squirts would cause the light to switch off, short-circuiting the electricity in the process. (A similar behavior was observed at the University of Otago in New Zealand, and it was so expensive that they eventually just released the octopus back into the sea).

One intrepid octopus named Inky even managed to permanently escape from his tank. When researchers found he had disappeared, they discovered tracks, showing he walked eight feet across the floor, entered a drainpipe only six inches wide, and proceeded 164 feet to oceanic freedom. (Octopuses4 have soft bodies, so their only limiting factor is their hard beak. They can squeeze through even the smallest cracks. If you haven’t seen this video, watch it).

It’s plausible that Otto’s great escape was the culmination of several reconnaissance missions: at a UK aquarium, one octopus was caught escaping on a nightly basis, exploring to snatch prey from other tanks, then returning back to his own lair, a cephalopod caper worthy of an Arthur Conan Doyle title: The Case of the Disappearing Fish.

Octopuses also seem to take a like or dislike to individual humans, with one feisty octopus squirting water at a particular researcher, but nobody else. Even when researchers wore identical uniforms, the octopus could recognize different faces.

These behaviors are evidence of complex cognition, an advanced level of intelligence few creatures on Earth possess. But what’s most intriguing about octopuses is that they’re so unlike us—and unlike everything else that’s evolved to be a hyper-intelligent species. Other than coleoid cephalopods (octopus, squid, and cuttlefish), all animals with advanced intelligence are vertebrates, from corvids (crows and jays); to cetaceans (whales, dolphins, and porpoises); to primates like ourselves. And birds, great apes, and dolphins are broadly on the same evolutionary lineage, with reasonably similar brain architectures.5

Cephalopods are the only supremely intelligent creatures on the planet that have emerged from the separate evolutionary limb of invertebrates (cold-blooded animals with no backbone that comprise 95 percent of animal species on Earth). But what’s particularly remarkable is how distantly we separated from the octopuses and squid and cuttlefish on the tree of life.

Our last common ancestor was probably a worm-like creature something like 550 million years ago. The mystery of how octopuses evolved complex cognition deepens when we consider that their closest ancestors are species like slugs, snails, oysters, and clams—hardly the kinds of animals we’d choose to invite along to help us win a pub quiz.

With such a distant common relative, it’s no surprise an octopus would be quite unlike ourselves. But the divergences in their brains go well beyond the weird and into the territory of alien-like. An octopus arguably has not one brain, but nine, a hub in its mantle (what we think of as the head) and then eight brains the reside in each of its arms. Approximately three-fifths of the roughly 500 million neurons in an octopus are housed in its arms.6

Even more bizarre, a severed octopus arm can behave similarly whether or not it is attached to the body. For over an hour, the detached arm will still search for food and try to feed a mouth that’s no longer there.7 When the rest of the body of the octopus encounters its own severed arm, it will recognize it as itself—whereas if it’s presented with any other octopus arm, it will realize it is not part of itself. This has raised the possibility that octopuses have several separate hubs of consciousness housed in one body, a profoundly spooky idea that resonates with humans from split-brain experiments.

Octopus camouflage—and that of cuttlefish—is so magical that it’s difficult to believe. And using a special trick from a part of their anatomy known as photophores, many cephalopods can even emit light in a technique known as counter-illumination, matching the exact light intensity of the stars or moonlight from the sky above the ocean, so they won’t cast a conspicuous silhouette that a predator could see from below.

But my favorite cephalopod behaviors are their unique form of sexual mimicry, in which males of a species of cuttlefish are able to make the top of its body look sexy and masculine, while making the bottom of its body mimic the appearance of a female. That way, its potential mate will see the enticing bits, while a rival male looking up from below will think it’s just two females hanging out and won’t interfere. Similarly, when a lady of the opalescent squid variety (Doryteuthis opalescens) wants to rid herself of a pestering male, she’s able to flash a white stripe down her body that appears to be the testes of a male squid—an extreme, clever form of sexual rejection. (Quite an escalation from a woman at a bar giving out a fake phone number).

Many of those examples are evolved traits of strange bodies, not necessarily evidence of advanced cognition. But octopuses are absurdly smart, embodying the Krakauer definition with elegance, as they solve complex problems but make it look easy. They use tools: one has been filmed carrying coconut shells, an exercise that shows a trait of advanced cognition called mental time travel, in which they plan for an unforeseeable future moment when sharks may arrive, hiding their entire body in a bit of brown, hairy, impenetrable armor.

Mimic octopuses are routinely filmed masquerading as flounders, adjusting their body shape, undulating across the ocean floor in convincing cosplay, making it less likely that a predator will nip at one of their vulnerable arms, tucked behind them as they glide across the sea floor.

In another study, octopuses were presented with two similar shells and one odd one. If they grabbed the odd one, they were given a food reward. Soon, they transferred that learning to a more general rule, identifying the odd item out in sets they hadn’t seen previously. Cuttlefish have also passed the marshmallow test.

An octopus may not challenge Max Park for the Rubik’s cube world record, but carrying around foraged body armor in the ocean depths and inferring rules and categories to extract rewards? That is seriously smart.

 IV: Live slow and social, die smart?

Yet, octopus intelligence poses a tricky puzzle. For every vertebrate with complex cognition, two main theories of intelligence help explain how it emerged.

1. The Ecological Intelligence Hypothesis: intelligence emerges to help creatures find food in difficult environments.

2. The Social Intelligence Hypothesis: creatures that live in social groups require complex cognition to cooperate, deceive, form social bonds, and learn from one another.

The latter, in particular, makes sense if you’re planning to stick around for a while, learn smarter strategies for survival, and teach your young how to behave. These theories match the vertebrate data really well: crows, dolphins, and primates (including us) all have long lives (a minimum of 15+ years); take care of their offspring; and are capable of reproducing multiple times in one lifespan.

By contrast, most cephalopods live alone, survive for between six months and two years; don’t take care of their offspring, and produce children just once, then die.

Researchers have recently proposed that the evolution of advanced cephalopod cognition emerged when they were forced to become more adaptable, and jettisoned their hard shells (which persisted in cousin species like nautiluses). This had a major advantage—flexibility in habitat—which is why cephalopods are found pretty much everywhere in oceans. But it came with a cost: without a shell, they faced an abrupt surge in predators eating them, which required a get-smart-quick scheme, a pressure that led to advanced cognition. The puzzle persists, however. After all, many animals get devoured; few become brainiacs.' We don’t have the answers.

Why, other than the fact that octopuses are stupefyingly interesting, should we care about this? Because it implies a profound idea: there are multiple evolutionary pathways and biological architectures that create intelligence. The study of cephalopods can yield new ways of thinking about artificial intelligence, consciousness, and plausible imaginings of unknown alien intelligence.

V: Why we are uniquely stupid

But there’s another lesson we can learn from cephalopods about our own stupidity. What an octopus lacks—which we have in spades—is rigid, stubborn ideology. Our unique ability to reason with generalized concepts, to imagine worlds that don’t exist, to conjure up distorted mental models of how we think reality functions—from outlandish conspiracy theories, to religious and political zealotry—can blind us to obvious truths.

In Fluke, I mention Alfred Wegener, the balloonist who proposed that the continents must have drifted, given how clearly their coastlines fit together like a jigsaw puzzle. Blinded by scientific precepts, what is now plainly obvious to any child who glances at a map of South America and Africa, was resisted—for vast stretches of time—by the world’s smartest thinkers.

Or, more prominent today, consider a conspiracy theorist or political ideologue who will never change their mind, no matter the evidence. That’s a uniquely resilient form of stupidity, more familiar to Marjorie Taylor Greene than to, say, the average porpoise. After all, an octopus or squid may not solve a Rubik’s cube, but cephalopods are unlikely to resist relevant, useful information simply because the data doesn’t match its ideology about how the world should work.

Humans, therefore, arguably possess the widest spectrum of behaviors along the Krakauer definition of intelligence. We are capable of the most astonishing feats of cognition, externalized outside our minds across vast stretches of time and space. But we are also capable of breathtaking stupidity, imagining that it’s a good idea to turn over a nuclear arsenal to Donald Trump, or, at the delightful pinnacles of human beclowning, that we can camouflage ourselves by making our faces invisible with lemon juice.

If you enjoy my writing, or learn something new from it, consider an exbodiment of your intelligence, by doing the smart thing and upgrading to a paid subscription for the low, low price of just $4 per month. Or, you can show off your advanced cognition by doing something no octopus can: buy and read my new book, FLUKE.

Here is the link:

https://www.forkingpaths.co/p/the-evolution-of-stupidity-and-octopus

I hope you enjoyed the read!

David.

Thursday, May 02, 2024

This Is A Really Useful Discussion Of The Vagaries Of The Private Hospital Sector

 I found this a useful summary of the current situation.

Productivity link a solution to private hospital red ink

John Durie

1:52PM April 26, 2024

The first two rules of insurance are don’t pay and don’t rush. But if you are a private hospital and your financial survival depends on insurance payments, the tensions are somewhat greater.

Covid-19 flipped the balance between private hospitals and insurance, and the latter enjoyed a resurgence in profit margins – it seems at the expense of the hospitals.

Patient numbers crashed during Covid-19 and are still to return, while insurers with high reserves were able to return funds to members.

Conversely NIB chief executive Mark Fitzgibbon is also clear, telling The Weekend Australian that “without private hospitals there is no private health insurance”.

Worse, if private hospitals fail, the pressure increases on the public sector; and in the past five years 71 private hospitals have closed as health costs increase, to take more than 10 per cent of the national income.

Federal Health Minister Mark Butler and some state colleagues are acutely aware of the problems and Butler is considering some sort of inquiry by the ACCC or Senate to look at the plight of the sector.

Insurers like Fitzgibbon says there is no need as “there is no evidence of market failure”.

The private hospitals would welcome an inquiry to prove their case but are also aware that government inquiries are a delaying mechanism by politicians wanting to be seen to be doing something without actually doing anything.

The fact is the market has long failed and governments have been knee-deep in the mess as they attempt to resurrect the private hospital sector over recent decades, moving from crisis to crisis – with the latest spots mental health and pregnancy.

Private health insurance is now relatively healthy. About 55 per cent of the population has some sort of insurance, up from 29 per cent in the mid 1990s.

The industry has lifted its game but government regulations were the key to the market share increase, including rebates and rules imposing penalties on those who don’t join at a set age.

Insurers naturally would prefer us to all stay healthy and out of hospital as they pocket your premiums, but few people would credit their insurer as the reason for their good health. Ultimately it’s the doctors who call the shots and direct the flow of funds.

They have proved unreliable sources of supply, in part because they may be linked to multiple hospitals, are increasingly building their own hospitals and, post Covid-19, have also learned the lifestyle benefits of working less.

Doctors, just like Qantas learned, understand the laws of economics when it comes to restricting supply to drive prices higher.

Insurer Medibank is in the same game with its own day hospitals.

The solution is for the insurers to pay the hospitals more but it’s way more complex than that simple metric and much of it is out of the hospitals’ control.

For a start neither the hospital nor the insurer owns the patient and while everyone talks about consumer benefits at the end of the day it’s the doctor who controls the supply chain.

The doctor decides when surgery will happen and at what facility.

The increasing financial plight of the sector means it is looking to insolvency practitioners for assistance, such as Arnold Bloch’s Leon Zwier.

Two out of five hospital admissions are to private hospitals which do two out of three elective surgeries.

State and federal governments pay $5.6bn a year to the sector and the other $11.5bn comes from private health funds.

Governments spend in total $60bn on public health services, but less than 10 per cent of which goes to private hospitals that account for 40 per cent of admissions.

The insurers say they have rationalised and it’s time for the hospitals to do likewise.

NIB, by way of example, used to have 80 retail shopfronts. It now has zero.

They have also invested in technology while the hospitals lag on this score.

The health funds tend to compare themselves to general insurers and claim to return 86 per cent of premiums against 65 per cent for general insurers.

They claim an average management expense ratio of 10.8 per cent against general insurers at 22.6 per cent.

They also say are now paying for two thirds of all elective surgery procedures in Australia, including more than 80 per cent of hip and knee replacements and more than 70 per cent of cataract surgery in the private sector.

These claims depend on which side of the fence you sit.

Their premiums are set by government which this year approved a 3.03 per cent increase compared with sector increases of 16 per cent.

No one disputes the financial pain, and the big five hospital groups last year lost $553m on $11.2bn in revenues.

By way of example, the Bermudan-based fund Brookfield paid $4.4bn for Healthscope in 2019 with $1.6bn in debt.

It collects about $2.3bn in revenues against which staff costs total $1.1bn, medical and consumables $290m, prosthetics $302m, occupancy costs of $195mn and debt service of $230mn.

The industry like everyone else has had to cope with higher energy costs, a rising wages bill and staff shortages.

The big trend in the industry is shorter stays, more day surgeries and more care from home, which everyone supports.

But obviously a private hospital geared to longer stays is going to need to change its cost base.

Estimates put savings in hospital from home at $1.3bn.

The debate is over how much is covered by the insurer and the hospitals want a default benefit which is a multiple of what the insurers say they should pay. The default is based on a set amount depending on the procedure.

Prosthetics is another perennial but the immediate debate is not over tungsten or ceramic hips but the long list of what are called general use items like gauze and staples.

The prosthetic list has long been debated about the hefty cost differential paid for replacement hips in Australia compared with offshore.

The everyday list is a bit more basic and arguably important but the insurers oppose the inclusion of some items.

They are due to drop off what is known as the “prescribed list” in July, subject to what the government says.

This debate highlights what happens between the two as the insurers are trying to exclude some items and the hospitals want more covered.

This is at the centre of the hospital-at-home debate whereby insurers and hospitals are at opposite ends of the spectrum on the cost of the procedure and hence amount of funds to pay for the service.

The list is much longer and, given the size of the sector, the solutions hold many of the keys to the drive for productivity reform in Australia.

Here is the link:

https://www.theaustralian.com.au/business/productivity-link-a-solution-to-private-hospital-red-ink/news-story/cc94d3423e72fa407d1feedee0b83021

Well worth a read to catch up on what has been going on!

David.