Researching Stem cell therapies for degenerative disc disease or DDD.

April 27, 2014

So on my brother’s birthday I read an article that blew wide open the practical possibilities of treating my pain. First let me just elaborate on my medical condition.

At the start of 2011 I was suffering from severe and debilitating pain that started at my neck and ran down my right arm. I lost sensation in my thumb and index finger and had limited neck movement. I couldn’t look up or cock my head to the right. 2 weeks of physio did nothing, except that using the recommended pillow gave me some critical relief, and I went to see a orthopaedic surgeon in Cape Town. An MRI revealed I had herniated discs between C5 and C7. Spinal discs are the shock absorbers and hinges of the spine. However, they cause problems for large segments of the population, a throwback to the fact that humans are still learning to stand upright from an evolutionary perspective. I was told that if the pain was in the neck area, operating was not recommended and I was told to see how it recovers on it’s own.

dan_cervical_mri

My MRI. The grey vertical line next to the spine is the spinal chord. The white surrounding it is the spinal fluid. See how the two black discs push against the spinal chord. The green is radioactive material from my failed super hero operation ūüėČ …just arrows showing the herniations

And it did heal somewhat, but not completely. I have a constant dull pain and still limited sensation in the two fingers mentioned. If that were the state of play, I would be happy to live with it. However, as I found out when deciding to ride the Argus this year, I can’t spend more than 5 minutes on a bike without experiencing significant pain (that ended any ambition of riding). I refrain from getting involved in any rough and tumbles. I get very itchy arms that are impossible not to scratch. I need to travel with the pillow or perhaps similar substitute. And every other month, something gives in my neck and I need to be bed bound for about a week to manage the pain and limited mobility. After my initial healing from whatever trauma that caused the inflammation (unknown), it is unlikely that DDD will get better over the years. It is necessarily going to get worse.

So what can be done about it? Well treatment options have been limited. Either one commits to full blown and very invasive surgery, either fusing the spine around the disc with metal screws or replacing the disc itself with an artificial metal one.

Results of artificial disc replacement.

Results of artificial disc replacement.

However, even choosing the best hospital/surgeon/technique for ADR has around 15% complication rate ranging from worse results to death in the worst case. Fusion also often introduces problems with discs above and below. Deciding whether to go ADR or fusion is another hairy issue¬†which I won’t get further into here. If you don’t opt for surgery, you can opt for lifestyle changes like quitting smoking (never been a smoker), or lose some weight that may improve or worsen your results. Please don’t suggest going to a chiropractor… There is also steroidal injections into the spinal fluid column, but the consensus is they are only palliative.

Enter Stem Cells.

You constantly hear about the promise of stem cells but they became real for me when I saw the incredible, if anecdotal results of a man growing his finger back.

Naturally it seems obvious then to investigate how they are using this technology to treat DDD.

Stem cells have been known for a while to treat a variety of diseases but even in 2012 NCBI scientific review papers suggested promising but inconclusive results for disc degeneration.

The paper mainly deals with the conclusions about animal studies, which are more positive for smaller animals than bigger ones. The spine is an inhospitable place for cellular activity given that not much blood flow gets in there which carries vital nutrients for cell growth. So early work was right to be sceptical… but we now have more data than that.

While reading about some amazing techniques in this regards involving animals, I found out that injecting stem cells had already been used in phase 2 human trials by an Australian company called Mesoblast. The results were really positive and they were applying for the final phase before approval. That didn’t really help me now though, as that probably meant that a product for people would be around at 2016 or 2017 at the earliest for lumbar (lower back) region. Even later than that for cervical (neck) use.

Then I read the article which I mentioned in the beginning which is an interview with medical analyst Jason Kolbert. From the article:

TLSR: The therapy that you had administered did not have to be approved by the FDA. There is an exemption for minimally manipulated biological tissues. No premarket approval (PMA) or even 510(k) clearance is necessary. Correct?

JK: That is exactly correct. In the case of IntelliCell BioSciences, cells are extracted from adipose tissue, but there is no collagenase (collagen enzyme) added to digest it. The company essentially applies sonification (ultrasound) and separates out the stem cells. Within an hour it reintroduces the cells to the patient. Because cells are so minimally manipulated and because the entire process is done onsite, in the room adjacent to the patient, it likely qualifies under the FDA exemption that allows physicians to treat patients at their discretion as a “practice of medicine” issue.

Essentially it means that if the Stem cells are harvested from me, rather than another person/animal etc, they are not considered a drug by the FDA and can be re-administered as therapy. That meant I could instead be searching for surgeons prepared to treat me today! Turns out that this has already been happening and even some high profile cases. In fact governor Rick Perry has come under scrutiny for being treated for back pain by using Stem Cells.

rickperry

I’ve already been turned down by my surgeon in Cape Town for exploring this approach. I respect the conservative impulse of doctors, but that doesn’t mean that they are right from the perspective of the patient. The data and incentives are complex here, for example look at an extract of Jason’s interview.

TLSR: I have one last question. What’s to stop an anesthesiologist or neurosurgeon or orthopedist who treats back pain from extracting a stromal vascular fraction and treating their patients? How is that going to affect Mesoblast and others who have gone the long route with the great expense of clinical trials?

JK: There is nothing to stop people from doing that. But the caveat is that once a product is approved and has a label, things change. Imagine that two patients are treated, one with the Mesoblast product and one with the do-it-yourselfer. Let’s say something goes wrong with the do-it-yourselfer, and that patient’s pain is not ameliorated. It gets worse, and a fusion is required. The patient calls a lawyer, and the lawyer sues the doctor. The lawyer asks the doctor why he used an “unapproved do-in-yourself” therapy versus the FDA-approved product. That’s not a position I would want to be in as a treating clinician.

Once there is an approved therapeutic project, the do-it-yourselfers tend to go away. Therefore, we don’t see these as a fundamental threat to companies like Mesoblast or Cytori Therapeutics Inc. (CYTX:NASDAQ) because once clinical trials are completed and the product is approved, clinicians will use it.

In other words, the risk adjusted return to the patient given the data, may not be the same as the risk adjusted return to the physician. That also assumes that all people do and should have the same risk tolerance, which I don’t think is the case. There have been very few complications that I know of regarding Stem cells. The only¬†horrific case publicized that I know of happened to a woman who had Stem cell botox around her eyes. However the doctor screwed up and administered other botox agents besides the stem cells which had the effect of confusing the cells into growing into bone.

So where to next? How do I work out who is a cowboy and who isn’t? How can I work out which teams are mindful of the research as it’s changing (as in the dosages of Mesoblasts trials, or the fact that adipose stem cells may be different than bone marrow ones), and which ones are selling a product they are merely comfortable in performing, but which may be ineffective? Or worse that they aren’t competent in performing? That’s the difficult part.

Here are some leads in no particular order.

Reganadisc at the laser spine institute. Although he seems to certain about the outcomes in the video, and apparently sites touting patient experiences aren’t to be trusted.

Dr Joseph Meyer in Colorado¬†who uses bone marrow, at least he is upfront about his patients who felt it worked and those that didn’t (by the numbers).

… I will add to this list as I increase my research.

Additional information: This may be the best summary of the scientific research before the Mesoblast trial. The unfortunate reality is that on the one hand they want to take more care given potential hypothesized risks… but on the other hand they admit that the longer one waits, and the more deterioration that occurs of the disc and the end plates, the more unlikely it is for patients to reap the benefits of stem cell therapy. This puts me in a bind, one that I personally would prefer to err on taking the risk given the best practises today, with the knowledge that I could potentially fall back on ADR/fusion if it doesn’t pan out.

Here is another interesting take on the delivery mechanism of cell therapy for DDD from Duke University. The researchers suggest that up to 100% of the injected cells leak out of disc using traditional methods of injection. Although it’s noted that they didn’t use stem cells but specifically cultured disc NP cells. Possibly, this may suggest why although Mesoblast’s results are positive, they aren’t stellar as they could be. Here’s a surgery that seems to think they’ll be able to employ these techniques soon, although I don’t see how in the USA.

Here’s a patient for whom stem cell therapy didn’t end up working. He ended up travelling to the UK to have ADR on his lower back.

Here’s the story of a pro football athlete who ended up having a spinal fusion on a cervical disc, but had stem cell therapy that may or may have not worked.

 

 

 

The Friendship paradox not explained by position of median

January 18, 2014

The fascinating story of the Friendship paradox, and two examples to show that knowing whether the median is higher or lower than the average, doesn’t help explain the paradox. Just a recap for myself. The median is the value of dividing the sample in half and looking at the highest value of the lowest set averaged with the lowest value of the highest set… or the middle one. The mode is the most recurring value in the sample.

The way to read

A:BX

means that A is friends with B and X

First example – median higher than average

A:BX 3,5=4 <---------list of each friend's count, then average friend count after =
B:ACX 2,3,5=10/3
C:BDX 3,3,5 = 11/3
D:CEX 3,2,5=10/3
E:DX 3,5=4
F:G 1
G:F 1
X:ABCDE 2,3,3,3,2=13/5
Median = 3 friends
Mode = 3 friends
Average friends. = 2.5
Friend's average = 2.866

2nd example – median lower than average

A:BX 3,4 = 7/2
B:ACX 2,3,4=3
C:BDX 3,2,4=3
D:CX 3,4=7/2
E:FG 2,2=2
F:EG 2,2=2
G:EF 2,2=2
H:IK 2,2=2
I:HK 2,2=2
K:HI 2,2=2
X:ABCD 2,3,3,2=10/4

median = 2
mode = 2 
average friends = 2.363636
Friend's average = 27.5/11= 2.5

Summary of Cholesterol research

September 17, 2013

So this post aims to provide evidence for the skeptical reader (Larry) as to why the status quo on both the intake and measurement of cholesterol has been woefully off the mark. For those who are satisfied with summaries from those with a pedigree, I’d skip this document and click on the links provided in this blog post.

My own education on this topic started with a video I saw by Gary Taubes on the history of this controversy. I then endeavoured to try and follow his citations, which is difficult because many of his citations aren’t easily available online… and I’m too cheap to buy them or even his book. ūüôā

However, we’ll save his research for later (scroll down to the bottom)… because we’ll agree that although he cites his data, it isn’t the data itself. So let’s continue with primary data available. It is interesting to note that Gary’s approach and mine are different in focus. Gary prefers to retrace a historical account of how current medical institutions got it wrong and then doubled down on their error. I prefer to look at how current data throws confusion on the status quo.

As always in science, it’s the data that doesn’t fit that should cause the most alarm.

Epidemiological contradictions

We’ll start with what is generally the weakest form of data (as Gary points out beautifully), that of epidemiology. This data focusses on the outliers of Ancel Keys’ 7 country study, the landmark that made fat out to be an evil in the first place. Incidentally the best summary of interpreting Ancel’s work, given later published critiques by Yerushalmy and Hilleboe, is beautifully cited in this blog post. She gets my full respect for a wonderful piece.

The first outlier that should be considered while we’re fighting epidemiology with epidemiology is summarized by this paper about the French paradox:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768013/

Although several explanations for the paradox are explored (wine drinking, diet-heart hypothesis), the authors conclusions are admittedly by their own writing inconclusive.

The French outlier isn’t the only important outlier. However it’s important to note that that these authors and many others wish to preserve the notion that we should be allowed to interpret the data WITHOUT the outliers, which would indicate that high fat diets (high in cholesterol intake) should be bad for the heart. No-where in their writing do they acknowledge the potential that their primary hypothesis may be measuring confounders.

Let’s continue, but before we leave epidemiology, let’s just note another contradiction since this debate started with an assessment of the notion that¬†reducing caloric intake reduces one’s risk of heart disease. These studies find exactly the opposite correlation: http://www.ncbi.nlm.nih.gov/pubmed/7460234?dopt=Abstract

“Men who had a greater caloric intake or a greater caloric intake per kilogram of body weight were less likely to develop CHD manifest as myocardial infarction (MI) or CHD death, even though men of greater weight were more likely to develop CHD.”

This supports the notion that if you can find calorie-neutral ways of keeping off the weight, you’re in a good position.

Of course the study also finds that 2 out of the 3 populations in the study found benefit from CHD in consuming more starches (a mixed result). But let’s leave these studies be, as unless epidemiological studies have the kind of statistical significance of the smoking data, survey food data should be considered extremely unreliable. Tit for tat, and lets move on.

Moving on to non-survey data.

Chipping away at the status quo

Part of this debate is about the contention of the usefulness of total cholesterol.

The next contradiction comes from Petah Tikva medical centre confirming that higher cholesterol levels were associated with a decrease in morbidity for the elderly. Although they make reference to the status quo knowledge relating to middle aged men, their own data presents a departure from convention.

http://www.ncbi.nlm.nih.gov/pubmed/23273646
“In very elderly hospitalized subjects, increased levels of serum total cholesterol and albumin may be associated with reduced mortality risk.”

So maybe this presents two hypotheses: either the elderly who survive are a selected population of strong hearts who benefit from increased cholesterol intake OR yet again the correlation we are observing in the middle-aged here is yet again the result of confounders.

The subjects of the study were a mix of men and women with a mean age of 81 years deviating by about 6 years either side.

What about the men of say 50-70? This says nothing about them. Well according to Taubes:

Researchers involved with the Framingham Heart Study found that in men and women 50 and older, ‚Äútotal cholesterol per se is not a risk factor for coronary heart disease at all.‚ÄĚ

Unfortunately it’s difficult to find the original study, so if you don’t want to take Taubes’s word (and the NYT editorial team), the best I can do is the 30 year follow up to framingham which is written with some caveats.
http://www.ncbi.nlm.nih.gov/pubmed/3560398
“After age 50 years there is no increased overall mortality with either high or low serum cholesterol levels.”

Update: Found Framingham. http://www.ncbi.nlm.nih.gov/pubmed/193398

What should be clear by now is that taking the advice of trusting in the predictive powers of total cholesterol numbers alone is starting to look unwise. One should also be clear that what we’re investigating is the predictive power of total cholesterol for incidents and mortality relating to CHD (coronary heart disease). As can be seen from the following study, total cholesterol has no predictive powers when it comes to strokes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765509/
“This analysis of the EUROSTROKE project could not disclose an association of total cholesterol with fatal, non-fatal, haemorrhagic or ischaemic stroke. HDL cholesterol however, seemed to be related to stroke differently in men than in women.”

and as we shall see in the next section, HDL is the starting clue to the prediction conundrum (thanx Gary).

Just to give food for thought, it’s worthwhile reviewing the results of this paper.

http://www.ncbi.nlm.nih.gov/pubmed/7114080?dopt=Abstract

“Although it correlated with the number of severely narrowed coronary arteries per subject, the serum total cholesterol level did not correlate with the percentage of 5 mm segments of coronary artery with severe narrowing.”

In other words, the narrowness of arteries due to plaque build up did not correlate with serum total cholesterol. Of course, although many segments were analysed, this was only 40 patients.

Multivariate Regression Analysis.

The following data from the Israel Ischemic Heart Disease Study is key to sandboxing serum total cholesterol.

http://www.ncbi.nlm.nih.gov/pubmed/6112410?dopt=Abstract
“Multivariate analysis of the data to adjust for possible confounding effects of additional mortality risk factors demonstrated that total cholesterol made no independent contribution to total mortality, but that the contribution of low HDL to mortality persisted after adjustment. CHD mortality consistently increased with rising concentrations of total cholesterol.”

So let’s unpack this. In this study, they did in fact link total cholesterol to mortality risk of CHD. However, despite CHD related deaths representing 37% of all deaths in the study, total cholesterol fails to have any predictive benefit on total mortality when adjusted for confounders! Low HDL on the other hand remained a predictive indicator of risk (conversely high HDL remains an indicator of health).

This helps corroborate Gary’s assertion that HDL is 4 times the predictor compared to that of LDL, which serum total cholesterol is a proxy for. Of course it may be that HDL predicts many ailments unrelated to CHD, all the more case not to primarily focus on total cholesterol.

I actually find the wording of the conclusions of this paper overly timid: “These results indicate that, particularly in older age-groups, measures designed to increase HDL cholesterol may prove as valuable in preventing CHD as those designed to reduce low density lipoprotein cholesterol.”

This, despite the fact that HDL performed significantly better! Perhaps it’s because they didn’t want to rock the boat with one of it’s funders?? Conspiracy theory anyone? hehe.

I don’t have access to Gary’s citations from the original HDL studies conducted under NIH auspices, but if we extend him a professional courtesy for the moment (and he corrects himself when he’s wrong), he cites that the original studies came to the conclusion that total cholesterol numbers were meaningless (see his video below).

How do we reconcile the fact that some studies attribute weak prediction of total cholesterol (compared to HDL) and some studies suggest no predictive power what-so-ever?

Reconciling Total Cholesterol, HDL & LDL

The problem (as highlighted by Gary’s video), is that high HDL levels are associated with decreased risk. However, HDL is a component of total cholesterol… so if you act to increase your HDL levels, you are also increasing your total cholesterol levels!?! So how should total cholesterol be interpreted?

If increasing your total cholesterol levels means increasing equal rates of HDL and LDL, or only increasing HDL, then not much can be said about the risk factors associated with total cholesterol.

In populations where increased total cholesterol is correlated with increased levels of LDL then this may be a problem. However, it’s more complicated by the invention of new tests and data. As the Mayo Clinic writes in 2011 about the new LDL particle size test, the extent of increases in one’s LDL is relatively dangerous in proportion to the increase in one’s small LDL particle size count. Again, if one’s total cholesterol has been increasing due to an increase in ones large LDL particle count, then this is significantly less risky.

Update: Although HDL is a good predictor compared to say total cholesterol, studies have not managed to record a benefit of increasing one’s HDL-C without lowering the other stuff.¬†http://www.ncbi.nlm.nih.gov/pubmed/22447463

This is only the basic story, as the role of triglycerides and VLDL etc has not been discussed.

However, if the assertions follow, then it would be silly for anyone with the means of tracking small LDL particles and HDL levels, to instead be tracking serum total cholesterol.

Updated, particle size no longer relevant

Even the distinction between large and small LDL particle count, based on research from the top people in the field is potentially no longer the relevant indicator. According to famed Thomas Dayspring, the counts of various LDL particles can differ from total counts of LDL and the composition of whether LDL is cholesterol depleted and carrying triglycerides can be of critical importance.

Update: This man’s eloquence is backed up by the following study¬†http://www.ncbi.nlm.nih.gov/pubmed/21392724¬†and¬†http://www.ncbi.nlm.nih.gov/pubmed/23386699

Additionally we are learning the roles of HDL particle counts also.

http://www.jaccjournaloftheacc.com/article/S0735-1097%2812%2901699-3/abstract

And as an aside, it’s worth listening to this interview, for fuller explanations, as well as his first interview on this channel.

Gary’s research

So the thing that set me off on my cholesterol research was Taube’s video here:

A more formally written account can be found in his New York Times article here: http://www.nytimes.com/2008/01/27/opinion/27taubes.html

Although I can’t find the original framingham stuff, some of the contentiousness of the original data, even before it was assumed settled by policy makers can be found here:

http://garfield.library.upenn.edu/classics1983/A1983QX23400001.pdf

…and diet

Given how all this got started with comments about the sustainability, effectiveness and health of atkins style diet, I thought I’d post some of the latest data comparing the most popular diets out there with a view to optimizing for sustainability and health for the most at risk group: Those displaying insulin resistance and hence most highly at risk for metabolic syndrome.

From Stanford medicine.

http://www.youtube.com/watch?v=siuew4blOdw

This talks cites a number of papers highlighting the most interesting parts of the new literature.

RitchieFruitBat on Integrity

April 3, 2013

So I watched RitchieFruitBat’s video on integrity inspired by our conversation and now I feel I’ve been misrepresented!

Let me explain.¬†Read these 3 questions about how his audience will perceive his portrayal of my remarks ¬†to see how I’ve been misrepresented.

QUESTION 1) Will his readers think that I ultimately think “the scientists decided to attack Taubes and pretend they were misinterpreted”? I think YES

Do I think they wanted to pretend to be misinterpreted to justify an attack? NO.

QUESTION 2) Do you think, after watching, that his audience thinks I ultimately think the other scientists “were¬†either dishonest or dumb”? I think YES.

Do I really think they were dumb or dishonest? NO.

QUESTION 3) Will his readers ultimately think that I “was going to keep an open mind” about either our arguments about misrepresentation or the vegan diet, as in I was coming around to Richie’s way of thinking? I think YES.

Is this what I wrote? Not really. Our arguments ended on the Ansel Keys 7 countries study and so my open mind was chiefly limited to saturated fat. I did write the following sentence immediately after one about a set of conflicting saturated fat studies:

“It’s why I am not convinced of any particular diet yet and keep an open mind.”¬†

However writing about an open mind without referencing the¬†scepticism¬†suggests that I’m open to adopting other radical diets when in reality I’m only moving to a middle ground between theories and being repelled by the main ones. Further, specifically at the end of the debate, I was not backtracking on my thoughts on the views of the offended scientists. In fact Richie acknowledged that we ended this agreeing to disagree.

Richie: “Ok, we’ll agree to disagree on the misrepresentation.”

Explanation of Questions 1 and 2

So let’s backtrack.

I started by giving an example of how he may have logically quoted their work in a way that may be would be misrepresented but would be of no consequence.

“Your piece hasn’t proved anything. I might want to show that proposition A shows B which shows C… or more concisely A->B->C . You might be a scientist who has shown that A->B->X . You might disagree that B->C, but me quoting your work that A->B is completely justified, and you showing that B->X says nothing about whether B->C. This is not cherry picking, but logic 101. The fact that these scientists are ‘misrepresented’ is neither here nor there in the fat debate.”

I felt this was a legitimate explanation of why the scientists may have felt misinterpreted, while at the same time Gary would have done nothing wrong.  Richie then challenged me if I thought that that meant that misrepresentation in general is okay. I said not all kinds, I then thought about it and qualified my example again (replacing with A, B, X):

“I¬†quote A->B and attributes it to you, but omit any reference to whether or not you agree that B->C. Is that misrepresentation? Only if you think the audience is likely to infer it. Dumb readers will, smart readers won’t.”

Skipping a little for brevity, Richie then wanted to know if I thought that meant the upset scientists were dumb if they couldn’t forgive Taubes by this explanation. I thought that was one possibility, but I don’t want to suggest that people are dumb if there are other explanations, so I suggested yet another: That they did so because it was in their incentive to do so for funding reasons. Now I realize that at this point I wasn’t happy with either of those explanations, because it generally shifts bad faith from Taubes to the other scientists. The reason I was suggesting these explanations at all is because¬†I was alarmed at the speed at which RichieFruitBat concluded that Taubes was guilty, and that he operated in bad faith (was a liar). ¬†At least the possibility that it may have been the other scientists should give one pause. Of course I dislike suggesting that anybody operated in bad faith if there are other options, so I wrote:

“Those are two hypotheses. But they are not the ones I would pick. I think that they understood perfectly well that he used their work appropriately from a logical point of view. However, they worry about how it will be interpreted by the public at large? Academics often worry about this. They claim he misrepresented their views TO THE PUBLIC. However, Gary was aiming his article at the discerning reader… . Nobody operated in bad faith, just at cross purposes.”

Richie pressed me to explain why they would be upset if it was only Taubes’s conclusions that were wrong, that may lead the non-discerning public down the wrong path. I responded:

“You are trying to make out that being wrong is simply an intellectual consequence of academic debate, and that being wrong has no real world consequences. It’s exactly because of the real world consequences to real people that when one’s work is referenced (logically) to support a cause one doesn’t believe in, that it’s worth speaking out.”

Now Richie seemed to be unhappy about this explanation because he thought it didn’t justify the scientists attacks. In his words

“Reaven and the others are smearing Taubes’ name to punish him because they believe Taubes is wrong? Sorry, but this is just not convincing.”

I thought that worrying about Taubes articles causing early deaths in my estimation is something to worry about. Richie continued:

Ok, we’ll agree to disagree on the misrepresentation.

We agreed to disagree because I don’t think the scientists want to “pretend” to be misinterpreted at all. However, Richie can’t rationalize it any other way.

BOTTOM LINE

Do I feel misrepresented by his integrity video? YES

Am I upset that I’ve been misrepresented? Yes, a little. Not quite so much as if I’d been referenced in the New York Times. The harm done in this context is minimal. Misrepresentations here will not lead to early deaths in my estimation.

Is it okay that I’ve been misrepresented? YES!!! At least in the sense that I don’t blame Richie, thinking that he has done this wilfully. He’s simply made a mistake interpreting my responses, which is okay! and does happen especially on Youtube. I did suggest taking our conversation onto email, because I feel it offers tools for better clarity, but he declined.

Is it possible Richie is a liar? YES

Will I be calling Richie a liar from here on in? Absolutely not! and I hope he now respects the difficulty of reflecting other people’s remarks in the context of producing his own piece for publication.

Comments on new Windows Live sign in tech

September 18, 2011

Comments on Dare’s video about Windows live sign in tech embedded in Windows 8.

Easy sign in:

Why Live and not Facebook-connect? At over 700 million users and counting, as a web developer I would rather have them use Facebook connect to sign in. There is a further benefit to this, in that immediately Facebook marketing strategies are available, which is kind of non optional now-a-days for most developers.

Even if Microsoft Live becomes dominant (imagineable because of Windows’s dominance), I still need Facebook sign in to market the app. Means I need Facebook-connect. So rather than have 2 sign ins, I’d rather have one.

Live sign in:
You just used an email address to sign in and never demonstrated a password presumably because that is an account that Windows 8 knows about.  Further when logging into to a web app in IE it was single click, because of the previous login.  But do Chrome and Firefox (probably just over 50% of the browser market) support this functionality& the WL object? Does Microsoft have buy in here? an NPAPI plugin preinstalled for those browsers perhaps?

Doesn’t seem that some of ¬†this live id tech is as complete a ¬†solution to the ¬†‘universal problem’ talked about in the beginning given iOS and Android & other platforms.

Additional:
Zeroclick sign in isn’t always a benefit, if you have private info in some of your accounts.
The way the project I’m working on works is using Facebook connect (using the facebook app token as a timeout) to sign in for private info… and using our own cookie for personalization which lasts months.

Same code:
It’s nice when you said it’s javascript everywhere. However it’s a pity that it’s javascript. Later Dare said that there are different objects for C++/c#/java style apps (maybe that’s not what metro is about), so you can’t simply copy and paste code ūüôā

Ranting about language tech though…. I think what Google is doing with efforts like GWT (same code everywhere) & Native Client is more future looking. Not that those two are addressing the same concerns. But I like that they are trying to get strongly-type languages, with refactoring capabilities and stronger (potentially with GWT/Angry birds) efficiency experiences in the browser. I think that Native Client will revolutionize games in the browser. Even thinking about sign in, should be future thinking with respect to these technologies… of course this is more a comment about the prevalence and assumed superiority of javascript.. so just a bit of a rant ūüôā

Sessions:
Sessions were mentioned in the video with respect to data sharing… but no mention of the data itself. Seems to me that these are intimately connected. Are these simply blobs? Or do they represent some form of structured data? If you have large sets of data, can you cache/page as necessary and get at data granularily. I remember syncing Windows profiles on a network and waiting for your profile to copy over and back when logging in and off on different machines was a pain in the neck. I’m sure there are answers to these questions, but since I’m not on Windows 8, I have no incentive to look it up at the moment. Would have been useful in the talk.

Software FAIL eulogy

February 1, 2011

This is in response to Dare Osbanjo article about failed software technologies.

Great summary article.

I agree with the WARNING of the article, in terms of considering the adoption of new technology.
However, academically, I’d point out that the technology that supplanted the hyped tech was not necessarily a better solution, just an easier one. I.e. the problems remained in some form. I’m not necessarily defending the older solution, just pointing out that the solving of these problems is necessarily an evolutionary process. Sometimes early adoption puts you two steps ahead, sometimes late adoption does.
With regards to NoSql… I’ve used Db4o and Google’s BigTable (two examples in this space). Neither offer a heavenly solution as opposed to traditional relational databases. Both have advantages, from scalability, to queryability… and both have disadvantages when you inevitably come across ” but all I want to do is…” scenarios.
I suspect that the current frustrating choice of what to adopt here is an indication that yet a better solution exists. Until you can simply and effectively ask for ‘half an object’ from an object database, relational databases will have one upper hand… the solution probably requires new concepts added to typed languages… which will create it’s own set of problems.
Having said all this, I do feel that SQL is long overdue to get replaced by something, even if Relational databases are here to stay for a while.

Technology is both frustrating and invigorating precisely because it is both a solver and creator of problems.

Occam’s razor. Now all new and improved in the digital age.

September 28, 2009

Dare Obasanjo’s blogged about the danger of complex solutions and the benefits of duck-tape programming.

Indeed, this philosophy can be applied outside the programming world, but since I’m responding to this specifically I’ll continue to use the software context.

I don’t agree. Of course I acknowledge that in order to get software out the door, sometimes you have to scale back on feature creep and can’t always satisfy all concerns on version one. Very often by seeing your software being used you find that all the concerns you had thought to satisfy originally aren’t real concerns. What I disagree with is the mantra that ‘Simpler is always better’. I prefer the Occam’s razor version : ‘Keep things as simple as possible, but no simpler’.¬† It’s ironic that this is easier to understand than the literal translation “Don’t multiply entities unnecessarily”. ūüôā

It’s easy to find examples to counter the WWW/Xanadu example that Dare points out. In fact a surprising number of them come from Google. A notable one is Gmail. I was a hotmail user and liked the benefits of a web client. Gmail was late to the game, but they brought with their client significantly more complexity. Namely, threaded conversation view, tagging of emails instead of folders (and the inbox tag, for archiving), and a thick javascript client that would take longer to load initially, but user experience once logged in would be super quick. Coupled with the incentive of significantly more space which was actually eventually matched by hotmail at the time I switched, the added complexity/functionality was a boon for the user. Even as I show off the features of my gmail client to users of MSNLive and Yahoo, they grimace to think that all their organizing of their mail would be lost if they were to switch, the plight that can come from early adoption, coupled with a fear of the unknown.

More examples from Google: GWT, a more complex and yet surprisingly powerful way to write javascript, without more simply hacking away at native JS. And Google Wave, a potentially incredibly powerful and more complex way of merging chat, document editing and email into one. Of course it’s usefulness has yet to be proven at the time of writing. Inevitably Google Wave has already been under attack by the same people that live in the ‘Simpler is always better’ camp.

Of course duck-tape programming is often inevitable. Working in software, I often choose a duck-tape solution knowing full and well that it won’t scale simply because I don’t have the confidence in management to back me up were I to suggest the more complex solution. Complexity needs more time and educating to implement. I view this as not my problem because I know I probably won’t be around when it finally fails and it’s not worth the career risk to vouch for the better solution. It’s great when you do work under projects where you know that management has the foresight to stick with the better/disruptive solution even if that means coming at loggerheads with clients for a while. It’s incredibly dismaying to occasionaly see the hacky solution being chosen even when the better solution would take the same amount of time to implement, but is simply harder to think through.

I feel that an article favouring simplicity doesn’t do justice to the problem because sometimes the more complex solution is better. A more mature take would be to advise programmers to strike the right balance. Of course this is particularly hard advice to give and I fear I have no more generalized rules to offer than say look at all cases on a case by case basis. This would be a worthwhile area of research.

Zeitgeist! What an entertaining load of …

August 12, 2009

Warren! This is for you, because I’m sick with flu and have nothing better to do today and I’ve had this conversation one too many times.

Let me start by saying the show is very entertaining viewing. In fact I highly recommend everyone gets it out and watches it with friends and pizza… provided you can take almost all of it with a pinch of salt. It gives you that feeling of -all the dots are connected man- running up and down your spine. I briefly looked for a decent commentary of it on the net (so I wouldn’t have to write one) but most of the decent detractors out there seem to use an argument of “if you have common sense, you know it’s BS”. That’s not helpful for people who want to know why. The problem is that it takes a lot of work to explain why it’s BS in full. Like the Myth Busters episode debunking the moon landing nay-sayers (a great show!), it took a lot of work to go through each claim to show why we actually DID land on the moon. However, I’ll give a stab at some of the points. Not all of them… I have a life.

It’s been said that a lie is more dangerous depending on the amount of truth it contains. There are three major claims if I remember correctly. One, that all the major religions share the same story based on the pagan astrology. That 911 is a government created conspiracy. Lastly, the conspiracy that central bankers and politicians cause all the wars for profit and oil.

I’ll start with the most ridiculous claim, that 911 is a conspiracy. More specifically that some large secret organization was responsible for collapsing the world trade centres and that it wasn’t the airliners crashing into them. I’ve worked for some time in the VFX industry in London on movies with a fair number of explosions (Poseidon, Kingdom of Heaven, Harry Potter), admittedly on the CG side of things but I know how much time/effort (months/years) and planning the pyro guys take to prepare for much much simpler drops. Now if you’re talking about having demolitions specialists drop the World Trade Centre (THE BIGGEST DROP IN HISTORY) there would only be a very short list of companies with enough experience to tackle such a project. So the creators want us to suspend disbelief that not only was such a group of people found, but they were acquired to perform this drop despite moral misgivings, all keep quiet about it, prepare for it all without twin tower workers suspecting, perform it on not one but two buildings! And sync the drops with just after two airliners had hit the buildings to give them credibility. And lastly (phew) ensure that all the charges and triggers laid would go off exactly as planned despite the disruption that airliners hitting the building would cause? Sure, I have no problem believing this theory ūüėČ

A much less theoretical approach to dismiss this is to tackle the claim proposed by a so called “expert” that there is no way a building like that can cascade collapse due to a fire caused by airline fuel. To see this as bogus, it’s worth looking at the collapse of a much smaller building, a faculty of Architecture in the Netherlands. Here a simple fire started by a fault in a coffee machine which spread throughout the building and eventually caused it’s demise in a very similar fashion. In this case the fire wasn’t as equally concentrated because there was no aid of jet fuel and the building wasn’t as top heavy, and yet still similar results are seen. You can click on the video here on youtube. Also the claim that lower floors are seen shattering before the building had reached them could be explained by the centre of the building collapsing faster than the exterior, causing pressure to explode out the windows… but hey… I’m no expert.

The claim about the religions being simplistic folk tales is not one that I really want to bash… because I agree with it. Even still, anyone critical can’t buy in to the extent of the conclusions that they draw. Never mind that the difference between -sun- and -son- only works in the English language, which wasn’t the language of Christ. They go through fact by fact from messiahs in various religions showing how the data is EXACTLY THE SAME. A simple follow up of Horus on wikipedia shows that he was principally the sky god and a sun god in as much as the sky contains both the sun and the moon. There are also many other sun gods in the Egyptian religion. If he was of a virgin birth, it was a bizarre one. Two female gods ‘merged’ together and out he came… whatever that means (ask an Egyptian). Feel free to look up the deities in other religions but the point is that the creators of the film cherry pick facts and twist them to suit their argument so it seems the details are identical. I think the theme is right, but it is not nearly as awe-inspiring as they would have you believe. I know my religious friends will hate me for saying this.

The most dangerous claim is the one about bankers. Hey… having switched industries I now work at Allan Gray, an investment bank, so obviously you can’t believe what I’m going to write because I’m technically a banker. Haha. Let me just state that the views stated on this blog are my own and in no way reflect the views of my employer. The claims are dangerous because they are mixed up in a lot of truth. If you are looking for a more rational conspiracy theory about the Federal Reserve then check out this podcast interviewing Edward Griffith, the author of “The creature from Jekyll Island” about the creation of the Fed. It’s at least a much more measured conspiracy theory, but at least goes to show how complex financial situations are and that to say that wars are created by bankers is far fetched. Even this however is far too conspiratorial, but I’ve already listed my complaints about that interview in a previous separate blog post. The bottom line is that central banks can do a lot of damage and a lot of good, and anything futher than that has yet to be properly resolved. It is particularly relevant for the current crisis and we’re all waiting to see what changes are in the pipeline if any.

In conclusion. Zeitgeist gives us the illusion that big brother is out there, the world is not what it seems and there is indeed a target that we can blame for all our troubles and misfortunes. The idea that “we now know the REAL story” is an incredibly empowering feeling. It is much less satisfactory to delve into the complexities of the world and find that our misfortunes are the results of complex ever changing scenarios which tend not to be clear cut nor someone’s fault specifically. Definitely not the witch-hunt that Zeitgeist claims. Zeitgeist’s simplistic point of view of stories that are easily digestible ultimately shares a lot of parallels with the way it describes the dogma of the major religions.

People that have invested too much in these concepts are likely to retort “But the greatest trick the Devil ever pulled was convincing the world he didn’t exist”. I read this as saying that a world without the stories of good and evil is a much sadder ordinary world and people are simply not ready to believe it.

Apologies for spelling and grammar. I simply don’t care too much.

Vouchers and Medical Aid

August 12, 2009

I was watching family friend and South African talk show host Judge Dennis Davis on his show You be the Judge. The topic was about the free market vs government on service delivery. I came in late in the show so there may have been more discussed but really it looked like from where I was standing that the free market speaker was losing the debate. Quite simply he didn’t have good arguments which was a pity for the free market camp. Instead of accepting accusations that the free market allows for some powerful players to have disproportionate impact on consumers, but showing how this tends not to be a problem when there are lots of players in the market and the service delivery is still better on aggregate than government, he chose instead to deny the existence of this problem. This had the effect of making him look phony compared to the speakers arguing in favour of government intervention.

However the debate centred around the interesting problem of national health. Now I could site material that my dad told me about showing how life expectancy in the US on terminal diseases was better than that of the UK NHS but I won’t. It’s a mute point as France has come out tops in health ratings by a number of studies over recent years. France has had private doctors but public health care (and public hospitals for doctors to operate in) for all citizens, although there is some evidence that is not financially sustainable. The sustainability can be left for a different debate.

To the pro government speaker’s credit, he didn’t mention whether he wanted state provided health or state funded health (not that I saw anyway). We’ll give him the benefit of the doubt and assume he was only proposing state funded health like France and not like Britain. Now his argument can be put as follows “Even if a government solution provides better health care for the people than a private one, players in South Africa like the company Discovery health insurance will fight against such proposals by scaring patients with marketing claims of how they will be left destitute and lobbying against proposed bills to make sure they aren’t passed”. I personally don’t think Discovery has that much power … but again that’s not the point.

The point is I started wondering if there wasn’t a solution that would work for both debaters. My dad had always told me about the benefits of a voucher system for education, and so successful they are in countries like Sweden that despite it’s more socialist attitudes can’t do anything to remove it. Could the same system not be used for medical aid?

It seems so simple that I couldn’t believe that no-one else had thought of it. I did a brief search in google but found only rru.worldbank.org/Documents/PublicPolicyJournal/243Sandi-042302.pdf describing how the voucher system lowered the emotional transaction cost of providing health at clinics in a poor country case study. Not the same thing.

So this is how it would work. The country would offer medical aid vouchers to all citizens at a particular value defined by the budget to give whatever health standard the government could afford to pay from taxes for the entire population. These vouchers would only be redeemable from registered health insurance firms. The government would also create and maintain a default insurer similar to France with policies on what they are and not prepared to cover for that amount for equal cover for all citizens. This is where it gets interesting. You would be able to move your voucher to any private insurer that you wished. The private insurers would have to offer a basic plan equal to that of the government one, BUT would give you the option of topping up the amount for more cover. The top up feature is unique to that of a voucher as opposed to pure public health which doesn’t offer better service even if you’re prepared to pay for it. See more about the advantages of that on education vouchers on wikipedia. Also by empowering the population with vouchers, it gives people the power to decide which insurer they are going to move their account to, which improves service delivery. Discovery might actually make more money under such a system as they would potentially have revenue from the budget assuming they delivered a good service. Everybody wins!

There are other details that need ironing out like insolvency of firms and past payments, and moving people back to the default insurer, but all these issues can be sorted out. I think that such a system would improve the lifes of all. Is it likely to happen? You’d need some serious visionaries in power to suggest and implement such a system, so I’m not hopeful.

Re McAlvany’s and Jekyll Island

July 30, 2009

Listening to this week’s McAlvany’s podcast which you can find here.

I always find their shows contrarian which is great however this week they made no effort to find fault in Edward Griffin’s analysis. Now a lot of what he says make sense, but they brush over the subtleties of the claims.

I’m willing to believe that the Federal Reserve was forged in the way claimed. I’m willing to believe that it acts as a cartel in that it limits the extent to which members can do business.

However from here I have questions.

Regular cartels is that the action of cartels always hurt the consumer for the period in which they last. They don’t perform any benefit to the consumer. When the Fed is allowed to be a lender of last resort, it does offer a benefit to consumers. When Lehman brothers was allowed to collapse, credit markets seized up. This is demonstrable. The Government/Fed won’t allow this to happen again. It is true that they are experimenting as they go because no-one is certain of the rules.

Once a cartel is written into law it is no longer a cartel. Cartel’s don’t work in practise over long periods as members that have a competitive advantage to break from the rules will do so when the incentives are right. That is not possible here, so even if it was a means of enforcing the rules of a cartel at one point, it no longer is. It is law. Because of these points it is unfair to call the Fed a ‘regular’ cartel.

Other claims that were made were that the whole inflation scenario works in the banks and governments favour. “That’s where the money goes”. Inflation undermines the value of all assets in the designated currency, whether they are being held by banks, government or the private sector at large. Can Mr Edward Griffin please provide data to show that bank’s shareholders have outperformed other sectors over the period since the Fed’s creation? The barriers of entry to becoming a bank are not so great that other companies could not become banks if they saw a market opportunity in doing so.

The biggest claim of Mr Edward Griffin’s which stinks of propaganda is that he gave an example that the banks would easily pass up on the small person’s loan, but wouldn’t when it came to cities, big corporations or foreign countries. Now although it may be true that there are banking departments geared for different kinds of loans, the US housing bubble is a clear indication that they would extend easy credit to the small man as well.

Come on McAlvany! You need to drill your guests when they make claims that sound bogus, even if they have a lot of good points as well. Otherwise your show doesn’t sound credible.