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themodernA couple weeks ago I took a walk around the historic neighborhood in Fort Lee where my extended family had a home — 2063 Hoyt Avenue — from the turn of the last century into the 1950s. It’s where my parents lived when I was born, and where my aunt and grandmother sat for my sister and me (taking us often for walks across the George Washington Bridge, which my father helped build) and held big warm Thanksgiving dinners.

It was all erased years ago, and the parts that aren’t paved over are now turning into high-rises, starting with The Modern (there on the left), a 47-floor mirror-glass monolith that towers over the George Washington Bridge, and straddles what used to be Hoyt Avenue, exactly next door to the old house, which was paved over by Bruce Reynolds Boulevard. A twin of The Modern will go up nearby, as part of the Hudson Lights project. The whole thing is freaking huge and will change the New Jersey skyline and Fort Lee community absolutely.

It’s also where “Bridgegate” happened.

Anyway, I shot a bunch of pictures. More in the captions.

Back in the early ’90s I was waiting for an elevator one night at a high rise hotel when I was joined by a group of Miami heat basketball players and Jack Ramsay, who was then most famously the former coach of the Portland Trailblazers, a team he led to an NBA championship in 1977. But he had coached a number of other teams, including the Buffalo Braves (now the Los Angeles Clippers) during my former schoolmate Bob Kauffman‘s time there. So I thought, “Oh. Jack Ramsay is coaching the Heat now.” Back in those days Miami was not a great team, and even as a fan I was paying no attention to them. But the team was paying attention to Dr. Ramsay. That much was clear.

We got on the elevator together. The tallest players, 7-foot Matt Geiger among them, had to cock their heads toward one shoulder to avoid bumping the ceiling. I was crowded into a corner like a piece of luggage. The team had just lost a game. For the whole trip up to the Nth floor, Jack talked to the guys about what you can learn by losing that you can’t by winning — in useful detail. It was obvious that the old guy was still a great coach, and that the players had great respect for him. By that I mean, they weren’t just being nice. They were listening, carefully.

It was only later that I learned that Jack was not the coach, officially. His job was color commentary on Heat broadcasts.

All basketball fans by now have learned something from Doctor Jack, who went on to share his wisdom and experience over ESPN and other outlets. The man always had something interesting to add to the time-filling blather that comprises most of sports commentary.

So I just learned that the good doctor passed this morning, at age 89. I also learned that he enlisted for service in the U.S. Navy at age 19 during World War II, and shortly thereafter became the platoon leader of an underwater demolitions team — the forerunner of today’s Navy Seals. I suppose he was younger during his service than most or all of the players he taught in that elevator. Tougher too, I’m sure.

Ghandi said we should learn as if we’ll live forever and live as if we’ll die tomorrow. Jack Ramsey was clearly one of those guys who did both, for all his life.

This post is a hat tip toward Rusty Foster’s Today In Tabs, which I learned about from Clay Shirky during a digressive conversation about the subscription economy (the paid one, not the one Rusty and other free spirits operate in), and how lately I’m tending not to renew mine after they run out, thanks to my wife’s rational approach to subscriptions:

  1. Don’t obey the first dozen or so renewal notices because the offers will get better if you neglect them.
  2. See if you miss them.
  3. If you don’t miss them, don’t renew.

While thinking about a headline for this post, I found that searches for theater and theatre are both going down, but the former seems to be holding a slight lead.

While at Google Trends, I also did a humbling vanity search. Trust me: it helps not to give a shit.

Other results::: tired is up… stupid still leads dumb, but dumb is catching up… Papua New Guinea leads in porn. And Sri Lanka takes the gold in searches for sex. They scored 100. India gets the silver with 88, and Ethiopia settles for the bronze with 87. Out of the running are Bangladesh (85), Pakistan (78), Nepal (74), Vietnam (72), Cambodia (69), Timor-Leste (67) and Papua New Guinea (66) — perhaps because porn is doing the job for them.

Michael Robertson continues to invent stuff. His latest is Clock Radio, a Chrome browser extension that lets you tune in, by genre or search, to what’s playing now on the world’s Internet radio stations. Links: bit.ly/ClockRadio & bit.ly/ClockRadioVideo. Here’s what mine looks like right now:

I’m not surprised (and I don’t know why) that most of the stations playing music I like are French.

David Drummond, SVP, Corporate Development and Chief Legal Officer at Google, will talk about The Fight for Internet Freedom tomorrow at Stanford. Register by 5:30pm Pacific, today. @Liberationtech is hosting. Oh, and Google Fiber may be coming to your city.

George Packer says Amazon may be good for customers but bad for books, because Amazon is a monopoly in that category. Paul Krugman meanwhile says the same kinda thing about Comcast, and the whole cablecom biz. He’s not alone. Nobody likes the proposed Comcast acquisition of Time Warner Cable, other than Comcast, their captive regulators and their big-biz amen corner in what’s left of the press. (Watch: it’ll pass.) FWIW, Quartz has some nice charts explaining what’s going on.

What’s the word for a business nobody dominates because basically the whole thing, as we knew it, looks like Florida a week after Chicxulub? That’s what we have with journalism. The big reptiles are gone or terminal. The flying ones are gonna be birds one of these eras, but for now they’re just flying low and working on survival. For a good picture of what that looks like, re-dig A Day in the Life of a Digital Editor, 2013, which Alexis Madrigal posted in The Atlantic on March 13 of last year. In it he said,

…your total budget for the year is $12,000, a thousand bucks a month. (We could play this same game with $36,000, too. The lessons will remain the same.) What do you do?

Here are some options:

1. Write a lot of original pieces yourself. (Pro: Awesome. Con: Hard, slow.)
2. Take partner content. (Pro: Content! Con: It’s someone else’s content.)
3. Find people who are willing to write for a small amount of money. (Pro: Maybe good. Con: Often bad.)
4. Find people who are willing to write for no money. (Pro: Free. Con: Crapshoot.)
5. Aggregate like a mug. (Pro: Can put smartest stuff on blog. Con: No one will link to it.)
6. Rewrite press releases so they look like original content. (Pro: Content. Con: You suck.)

Don’t laugh. These are actual content strategies out there in the wilds of the Internet. I am sure you have encountered them.

Myself, I’m very partial to one and five. I hate two and six. For my own purposes here, let’s say you do, too, and throw them out.

That leaves three and four…

You’re reading #4. Flap flap flap…

Speaking of trash talk, Polygon says NBA 2K14 gives you a technical foul for swearing at the game.

I like the Fargo2 model:

Want to know where your Internet comes from? Look here. While it lasts. Because what that describes is infrastructure for the free and open world wide Internet we’ve known since the beginning. Thanks to the NSA spying, national leaders are now floating the idea of breaking the Internet into pieces, with national and regional borders. That seems to be where Angela Merkel is headed by suggesting a Europe-only network.

Progress: there’s an insurance business in protecting companies from data breaches. No, they’re not selling it to you, because you don’t matter. This is for big companies only.

Finally, because you’re not here — or you wisely don’t want to be here — dig what parking in New York looks like right now, after two weeks of snow, rain, freezing, melting and re-freezing:

parking in NYC

Let’s hope it thaws before alternate side parking goes back into effect.

I grew up on Woodland Avenue in Maywood, New Jersey, a few miles west of where I am now in New York City. Flexible flyerThe street was unremarkable, except when it snowed. Then the town would often block it off, so kids could sled on it. It wasn’t a big hill — just an ideal one for sledding: steep at the top, with a long glide path. With a good start you could ride your Flexible Flyer down past Garden, Cole and Elm Streets, all the way to Cole’s Brook. On the other side of that was Borg’s Woods, which was then owned by the Borg Family. They had a steep back yard behind their house on Summit Avenue in Hackensack, and kindly encouraged neighborhood kids to sled there.

So snow was a big deal for us, and still is for me. I love it. Alas, too often Winter forecasts in New York went like this: “Snow, changing to rain.”

Well, that’s what happened today in New York. We had a beautiful snowy day before it turned into rain and worse. For the last hour or so we’ve also had lightning, thunder and hail. The result is thick white slop, atop the frozen and half-thawed mess left over from the last storm. Here is how it looks right now at Weather.com:

I am sure there are kids in Maywood (and all over the East Coast) who wish the snow didn’t turn to slush today. My inner kid knows how they feel. (I’m also hoping my grandkids in Baltimore fared better. They got a bunch of snow today too — I think with less rain.

(By the way, our original Flexible Flyer looked just like the one above, only a bit longer. It could seat three or four kids. And nobody ever wore helmets.)

The power is out and won’t be back for awhile. That’s what the guys in the hard hats tell me, down where they’re working, at the intersection where our dead-end street is born. Many trucks are gathered there, with bright night-work lights illuminating whatever went wrong with the day’s power pole replacement job. The notices they left on our doors said they’d be done by five, but now it’s eight and I’m sitting in a house lit by candles, working on the nth draft of a writing assignment, in the absence of a steady flow of electrons off the power grid. Also in the absence of connection except to the physical world alone. Connectivity = 0. My laptop is good for another four hours or so, but without a connection I lack the building materials I need for constructing the piece. So I’m writing this instead.

Some other utilities are unaffected by the power outage, of course. I have matches, and can fire up the gas stove. Water runs, cold and cold. It also drips out of the little motel-grade refrigerator upstairs, defrosting itself into towels I’ve fed under it. The freezer in the kitchen remains closed, to keep whatever is in there from thawing and requiring use in the next couple days. What I’m witnessing is a gradual breakdown that is easy to imagine accelerating fast, especially if I was coping instead with a wildfire or an earthquake.

Three interesting facts about California and the people who — like me — choose to live here:

  1. The state tree is the California redwood. What made these things evolve into groves of spires with thick bark, standing at heights beyond three hundred feet, with branches in mature specimens that commence a hundred or more feet above the ground. I say they are adapted to fire. A cross section of a mature redwood will feature black edges to rings spaced thirty, fifty, two hundred apart, all marking survival of wildfire at a single location.
  2. The state flower is the California poppy. Here is what makes poppies thrive in dry rocky soils that are poor for agriculture but rich with  freshly exposed minerals: they are adapted to earthquakes. More than any other state, except maybe Alaska, California is a product of recent earth movement. Imagine looking at the southern Appalachians in the U.S. or the Blue Mountains of Australia, two million years ago. It’s not hard: they would pretty much like they do now. If you looked at the site of the future California from anywhere two million years ago, you would recognize nothing, unless you were a geologist who knew what to look for. All of California has been raised up or ferried in by tectonic forces that have been working at full throttle for a couple hundred million years, and aren’t moving any slower today.
  3. Neither of those facts teaches caution to human beings who choose to live here. For example, the home where I write this, in Santa Barbara, has been approached, unsuccessfully, by two wildfires in recent years. The Tea Fire in November 2008 burned 210 homes and the Jesusita Fire in May 2009 burned other 80 more. The Tea Fire came straight at us, incinerating everything but rocks and soil for a mile in its path before stopping a quarter mile and ten houses short of where I’m sitting right now. (Here is my report on the aftermath.) The Coyote Fire in September 1964 burned the same area, and much more. The Sycamore Fire in 1979 came even closer, burning houses just up the street from here.

“We live in the age of full convenience,” John Updike wrote, at a time when it made sense to think copiers and fax machines marked some kind of end state.* But the lessons that matter at the moment arise from the absence of the two most essential utilities in my life, and probably yours too: the electric grid and the data network. (Yes, I can get on the Net by tethering my laptop to my mobile phone, but both use batteries that will run out, and the phone is down below 20% already anyway.) So here are three lessons that come to me, here in the dark, all of which we are sure to continue ignoring::::

  1. Civilization is thin. A veneer. Under it nature remains vast, violent and provisional. In the long run, which may end at any time for any of us, nature will prove no easier to tame than the tides. For three great perspectives on this, I highly recommend John McPhee‘s The Control of Nature. The title is taken from a plea to students, carved into sandstone over the door of a building at the University of Wyoming in Laramie: STRIVE ON — THE CONTROL OF NATVRE IS WON, NOT GIVEN. (I also recommend this blog post, by Themon The Bard, who went to UW and provides a photo.) Its chapters are “Iceland versus the volcanoes,” “Los Angeles versus the San Gabriel Mountains” and “The Army Corps of Engineers versus the Mississippi River.” The New Yorker re-ran a set piece from the third of those, right after Hurricane Katrina, which produced what New Orleans natives call “The Flood.” In it McPhee describes what would happen to New Orleans when a levee is breached. Here is the original, published years before reality certified true McPhee’s prophesy.
  2. Humanity is insane. A good working definition of psychosis is disconnection of the mind from reality. As a species we have proven ourselves nuts for the duration, as the examples above attest. Present company included. (Further proof: war, genocide.) It should be clear by now that humanity is not merely at the top of the food chain around the world, but a pestilence to everything God (or whatever) put in position to be exploited in the short term, regardless of the obvious fact that it took approximately forever to put those resources in place, and how much of it cannot be replaced. While it’s true that in the very long run (a billion years or few), the aging Sun will cook the planet anyway, we are doing our best to get the job done in the geologic present. This is why many geologists propose renaming our current epoch “Anthropocene.” Bonus question: Why do political conservatives care so little about the long-term conservation of resources that are, undeniably, in limited supply and are clearly bound for exhaustion at any consumption rate? Before categorizing me, please note that I am a registered independent, and in sympathy with economic conservatives in a number of ways (for example, I do like, appreciate and understand how the market works, and in general I favor smaller government). But on environmental issues I’m with those who give a shit. Most of them happen to be liberals (or, in the current vernacular, progressives). George Lakoff provides some answers here (and in several books). But, while I love George, and while he has probably influenced my thinking more than any other human being, it still baffles that opposing conservation of resources fails to seem oxymoronic to most avowed conservatives.
  3. The end is in sight. Somewhere I’ve kept a newspaper story that did a great job of listing all the resources our species is bound to use up, at current rates of exploitation, and how long that will take. On the list were not only the obvious “reserves,” such like oil, gas, coal and uranium, but other stuff as well: helium, lithium, platinum, thorium, tungsten, neodymium, dysprosium, niobium… stuff we use to make stuff that ranges from balloons to hard drives to hybrid car engines. Many of the heavier elements appear to have been deposited here during bombardments by asteroids several billion years ago, when the Earth has hard enough not to absorb them. Helium, one of the most abundant elements in the universe, is produced on Earth mostly by decay of radioactive elements in certain kinds of natural gas. Much of the world’s helium comes from the ground here in the U.S., where our enlightened congresspeople decided a few decades back to hand the reserves over to private industry, where “the market” would decide best how it would be used. So, naturally, we are due to run out of it within maybe a couple dozen years, and have not yet found a way to replace it. Read on.

[Later...] I wrote this three nights ago, but didn’t put it up until now because I was already way overdue on the  writing assignment I mentioned up top, and I had to deal with other pressing obligations as well. So I just went through the post, copy-edited it a bit and added some links.


* Special thanks goes to anybody who can find the original quote. I’ve used it so often on the Web that I’ve effectively spammed search results with unintended SEO. The closest thing I can find is this from Google Books, which fails to contain the searched-for nugget, but still demonstrates why Updike’s criticism earns the same high rank as his fiction.

Fort Lee has been in the news lately. Seems traffic access to the George Washington Bridge from Fort Lee was sphinctered for political purposes, at the spot marked “B” on this map here:

The spot marked “A” is the site of my first home: 2063 Hoyt Avenue. Here’s how it looked in 1920:

My grandfather, George W. Searls, built it in 1900 or so. He and grandma, Ethel F. (née Englert) Searls, raised thee children there: Ethel M. Searls, born in 1905, Allen H. Searls (my father), born in 1908, and Grace (née Searls) Apgar, born in 1912. Grandpa died in 1935, but Grandma and Aunt Ethel lived here until 1955, when I was eight years old.

It was in a fine old neighborhood of similar mansard-roofed homes, most of which were built before the George Washington Bridge showed up and became the town’s landmark feature. Pop, who grew up climbing the Palisades and had no fear of heights, helped build the bridge, mostly by rigging cables.

Not long after finding a place to stay in New York in Fall of 2012, my wife and I took a walk across the bridge to visit the old neighborhood. I knew the old house was gone, the land under it paved over by Bruce Reynolds Boulevard. What I didn’t expect was finding that the entire neighborhood had been erased. See the brown area on the map above, between the highway and Main Street? That was it. Palisade Avenue, behind Hoyt, is now a house-less strip of rotting pavement flanked and veined by wild grass. The only animal life we spotted was a large groundhog that ran to an old storm drain when we approached.

Little of the Fort Lee I knew as a kid is still there. The only familiar sights on Main Street are City Hall and the old fire station. Dig this: City Hall also shows up in the background of this shot of Mom with my cousin Paul and I, when we were both a few months old, in April 1948. This street too has been obliterated: replaced by stores and parking lots, with no trace of its old self.

When I was a kid in the ’50s, my grandparents’ generation — all born in the second half of the 19th Century — was still going strong. One relative I remember well was great-aunt Eva Quackenbush, Grandpa Searls’ older sister. Here she is with Mom, and the baby me. Eva was born in 1853, and was twelve years old when President Lincoln was shot — and event she talked about. She visited often from her home in St. Louis, and died just a few days short of 100 years old, in 1953. Living long is a Searls family trait. Grandma made it to 107 and Aunt Grace to 101 (she passed just last month, fun and lucid to the end).

So to me the world before cars, electricity and other modern graces was a familiar one, because I heard so many stories about it. Grandma grew up in The Bronx, at 742 East 142nd Street, when it looked like this:

Today, according to Google’s StreetView, it looks like this:

The red A marks 732. On the left, behind that wall, is a “towed car” lot. It sits atop a mound of rubble that was once “old Lincoln Hospital”:

According to the Wikipedia article on Lincoln Hospital, “In 1895, after more than half a century of occupying various sites in Manhattan, the Board of Trustees purchased a large lot in the South Bronx—then a semi-rural area of the city—at the corner of 141st Street and Southern Boulevard.” This is a morning view, lit from the southeast, looking north across 141st Street. Grandma’s place was on the back side of the hospital. Amazing to think that this scene came and went between the two shots above it.

Grandma’s father, Henry Roman Englert, was the head of the Steel and Copper Plate Engravers Union in the city. His trade was also destroyed by industrial progress, but was an art in its time. Here he is, as a sharp young man with a waxed mustache:

Henry was a fastidious dude who, on arriving home from work, would summon his four daughters to appear and stand in a row. He would then run his white glove over some horizontal surface and wipe it on a white shoulder of a daughter’s dress, expecting no dust to leave a mark on either glove or girl. Or so the story went. Henry was the son of German immigrants: Christian Englert and Jacobina Rung, both of Alsace, now part of France. They were brewers, and had a tavern on the east side of Manhattan on 110th Street. Jacobina was a Third Order Carmelite nun, and was buried in its brown robes. Both were born in 1825. Christian died in 1886 while picking hops in Utica. Jacobina died in 1904.

Grandma met Grandpa in 1903, when she was twenty and he was forty. She was working as a cleaning woman in the Fort Lee boarding house where Grandpa lived while he worked as a carpenter. One day she saw him laying asleep, and bent down to kiss him. He woke, reached up, and kissed her back. Romance commenced.

Grandma didn’t like to admit having done cleaning work, insisting always that she was “lace curtain Irish,” to distinguish her family from “shanty Irish.” When ethnic matters came up in conversation over dinner, she would often say “All for the Irish stand up,” and everybody would rise. In fact she was only half Irish. Her mother, Catherine “Kitty” Trainor, died in her thirties. Henry later married an Italian woman and produced more progeny, only one of which was ever mentioned by Grandma. That was Harry, who died at age five. The largest framed photograph in Grandma’s house was one of Harry, looking up and holding a toy.

Kitty’s dad was Thomas Trainor, who came over from Ireland in 1825 at age 15 to escape England’s harsh penal laws. (He shipped out of Letterkenny with an uncle, but the Trainors were from south of there. Trainor was anglicized from the Gaelic Tréinfhir, meaning “strong man.”) Thomas worked as an indentured servant in the carriage trade, and married Catherine McLaughlin, the daughter of his boss. Thomas then prospered in the same business, building and fixing carriages at his shop at the south end of Broadway. His two daughters were Kitty and “Aunt Mag” Meyer, whom Grandma often quoted. The line I best remember is, “You’ve got it in your hand. Now put it away.” Mag taught Grandma how to walk quietly while large numbers of other people in the house were sleeping. Grandma passed the same advice to her grandkids, including me: “Walk on the balls of your feet, toes first.” The Trainors also had a son, who ran away to fight in the Civil War. When the war ended and the boy didn’t come home, Thomas went down to Washington and found his son in a hospital there, recovering from a wound. The doctors said the boy would be home by Christmas. And, when Christmas came, the boy indeed arrived, in a coffin. Or so the story went.

An interesting fact about Fort Lee: it was the original Hollywood. The Searls family, like most of the town, was involved. Grandpa was D.W. Griffith’s head carpenter, building film sets such as this one here. Here he is (bottom right) with his crew. Here’s a link for the Fort Lee Film Commission, featuring samples of the silent movies made there. Among the extras are family members. Lillian Gish and Lon Chaney both boarded upstairs at 2063 Hoyt. So did the dad of the late Elliot Richardson, a cabinet member in the Nixon and Ford administrations.

Time flies, and so do people, places and memories. My parents’ generation is now gone, and family members of my own generation are starting to move on. I can count ten places I used to live that are now gone as well, including my high school. Kevin Kelly told me a couple years ago that none of us, even the famous, will be remembered in a thousand years. I’m sure he’s right.

But I still feel the urge to pour as much as I can of what I know into the public domain, which is what you’re witnessing now, if you’re still with me at the bottom of a long post. I believe it helps to see what was, as well as what is.

For example, this view up Hoyt Avenue from the site of the old Searls place, in 2012, is now filled with a high-rise that is almost complete. The little bridge-less town where my grandparents met and my father and his sisters grew up is now a henge of high-rises. Fort Lee itself is now also known as Fort Lee Koreatown. In this constantly shifting urban context the current scandal seems a drop in the bucket of time.

 

Obamacare matters. But the debate about it also misdirects attention away from massive collateral damage to patients. How massive? Dig To Make Hospitals Less Deadly, a Dose of Data, by Tina Rosenberg in The New York Times. She writes,

Until very recently, health care experts believed that preventable hospital error caused some 98,000 deaths a year in the United States — a figure based on 1984 data. But a new report from the Journal of Patient Safety using updated data holds such error responsible for many more deaths — probably around some 440,000 per year. That’s one-sixth of all deaths nationally, making preventable hospital error the third leading cause of death in the United States. And 10 to 20 times that many people suffer nonlethal but serious harm as a result of hospital mistakes.

The bold-facing is mine. In 2003, one of those statistics was my mother. I too came close in 2008, though the mistake in that case wasn’t a hospital’s, but rather a consequence of incompatibility between different silo’d systems for viewing MRIs, and an ill-informed rush into a diagnostic procedure that proved unnecessary and caused pancreatitis (which happens in 5% of those performed — I happened to be that one in twenty). That event, my doctors told me, increased my long-term risk of pancreatic cancer.

Risk is the game we’re playing here: the weighing of costs and benefits, based on available information. Thus health care is primarily the risk-weighing business we call insurance. For generations, the primary customers of health care — the ones who pay for the services — have been insurance companies. Their business is selling bets on outcomes to us, to our employers, or both. They play that game, to a large extent, by knowing more than we do. Asymmetrical knowledge R them.

Now think about the data involved. Insurance companies live in a world of data. That world is getting bigger and bigger. And yet, McKinsey tells us, it’s not big enough. In The big-data revolution in US health care: Accelerating value and innovation (subtitle: Big data could transform the health-care sector, but the industry must undergo fundamental changes before stakeholders can capture its full value), McKinsey writes,

Fiscal concerns, perhaps more than any other factor, are driving the demand for big-data applications. After more than 20 years of steady increases, health-care expenses now represent 17.6 percent of GDP—nearly $600 billion more than the expected benchmark for a nation of the United States’s size and wealth.1 To discourage overutilization, many payors have shifted from fee-for-service compensation, which rewards physicians for treatment volume, to risk-sharing arrangements that prioritize outcomes. Under the new schemes, when treatments deliver the desired results, provider compensation may be less than before. Payors are also entering similar agreements with pharmaceutical companies and basing reimbursement on a drug’s ability to improve patient health. In this new environment, health-care stakeholders have greater incentives to compile and exchange information.

While health-care costs may be paramount in big data’s rise, clinical trends also play a role. Physicians have traditionally used their judgment when making treatment decisions, but in the last few years there has been a move toward evidence-based medicine, which involves systematically reviewing clinical data and making treatment decisions based on the best available information. Aggregating individual data sets into big-data algorithms often provides the most robust evidence, since nuances in subpopulations (such as the presence of patients with gluten allergies) may be so rare that they are not readily apparent in small samples.

Although the health-care industry has lagged behind sectors like retail and banking in the use of big data—partly because of concerns about patient confidentiality—it could soon catch up. First movers in the data sphere are already achieving positive results, which is prompting other stakeholders to take action, lest they be left behind. These developments are encouraging, but they also raise an important question: is the health-care industry prepared to capture big data’s full potential, or are there roadblocks that will hamper its use

The word “patient” appears nowhere in that long passage. The word “stakeholder” appears twice, plus eight more times in the whole piece. Still, McKinsey brooks some respect for the patient, though more as a metric zone than as a holder of a stake in outcomes:

Health-care stakeholders are well versed in capturing value and have developed many levers to assist with this goal. But traditional tools do not always take complete advantage of the insights that big data can provide. Unit-price discounts, for instance, are based primarily on contracting and negotiating leverage. And like most other well-established health-care value levers, they focus solely on reducing costs rather than improving patient outcomes. Although these tools will continue to play an important role, stakeholders will only benefit from big data if they take a more holistic, patient-centered approach to value, one that focuses equally on health-care spending and treatment outcomes.

McKinsey’s customers are not you and me. They are business executives, many of which work in health care. As players in their game, we have zero influence. As voters in the democracy game, however, we have a bit more. That’s one reason we elected Barack Obama.

So, viewed from the level at which it plays out, the debate over health care, at least in the U.S., is between those who believe in addressing problems with business (especially the big kind) and those who believe in addressing problems with policy (especially the big kind, such as Obamacare).

Big business has been winning, mostly. This is why Obamacare turned out to be a set of policy tweaks on a business that was already highly regulated, mostly by captive lawmakers and regulators.

Meanwhile we have this irony to contemplate: while dying of bad data at a rate rivaling war and plague, our physical bodies are being doubled into digital ones. It is now possible to know one’s entire genome, including clear markers of risks such as cancer and dementia. That’s in addition to being able to know one’s quantified self (QS), plus one’s health care history.

Yet all of that data is scattered and silo’d. This is why it is hard to integrate all our available QS data, and nearly impossible to integrate all our health care history. After I left the Harvard University Health Services (HUHS) system in 2010, my doctor at the time (Richard Donohue, MD, whom I recommend highly) obtained and handed over to me the entirety of my records from HUHS. It’s not data, however. It’s a pile of paper, as thick as the Manhattan phone book. Its utility to other doctors verges on nil. Such is the nature of the bizarre information asymmetry (and burial) in the current system.

On top of that, our health care system incentivizes us to conceal our history, especially if any of that history puts us in a higher risk category, sure to pay more in health insurance premiums.

But what happens when we solve these problems, and our digital selves become fully knowable — by both our selves and our health care providers? What happens to the risk calculation business we have today, which rationalizes more than 400,000 snuffed souls per annum as collateral damage? Do we go to single-payer then, for the simple reason that the best risk calculations are based on the nation’s entire population?

I don’t know.

I do know the current system doesn’t want to go there, on either the business or the policy side. But it will. Inevitably.

At the end of whatever day this is, our physical selves will know our data selves better than any system built to hoard and manage our personal data for their interests more than for ours. When that happens the current system will break, and another one will take its place.

How many more of us will die needlessly in the meantime? And does knowing (or guessing at) that number make any difference? It hasn’t so far.

But that shouldn’t stop us. Hats off to leadership in the direction of actually solving these problems, starting with Adrian Gropper, ePatient Dave, Patient Privacy RightsBrian Behlendorf, Esther Dyson, John Wilbanks, Tom Munnecke and countless other good people and organizations who have been pushing this rock up a hill for a long time, and aren’t about to stop. (Send me more names or add them in the comments below.)

Grandma Searlsfootstone says “1882 -  ” and is hardly and overstatement. She died pushing 108 in 1990, and was lucid, loving and strong in all the ways that matter.

She was one of four sisters in her family. That’s them, with their dad, on the left. Grandma is the one on the bottom right.

My father was one of three sibs, with two sisters, Ethel and Grace. My mom was one of three sisters and one brother. My wife is one of six sisters, plus two brothers. All those women were, and are, strong too. (Grace is now 101 and doing great.) My sister (Commander in the U.S. Navy), daughters and granddaughter too. Love ‘em all.

It’s Grandma’s birthday tomorrow, her 131st. It’s my wife’s birthday today. My daughter’s was yesterday. (Also JP Rangaswami‘s and RageBoy‘s.) So here’s a toast to all of them — and especially to the strong women who have been raising me all my life.

Hart Island

As Halloween approaches (and death itself, for all of us, eventually), I find myself thinking, Do zombies always have to be bad? And, What if zombies were good? And, Hey, maybe good zombies are what we call ‘angels’.

Then I find myself wondering where one would recruit armies of zombie angels (let’s call them “zangels”), besides your basic headstone-studded cemeteries. Then it comes to me: Hart Island, New York’s potters field, and home to a million or more of New York’s unclaimed dead, off the coast of The Bronx. What a great name and place for a movie starring zombie angels!

I see it opening on the plaque at the base of the Statue of Liberty, with that familiar passage from Emma Lazarus‘ sonnet The New Collosus:

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”

The camera sweeps upward, past Liberty’s lifted lamp, to the lifting lid of a plain wooden coffin, topmost of a stack among many in a trench on Hart Island, where the City accumulates boxed bodies by the dozen before a bulldozer, operated by inmates from the Department of Corrections, mass-buries them.

Correction is the theme. The zangels, wretched refuse all, teeming on a shore forgotten by all but the forsaken living, stir awake on a holy mission: to warn the living that the gap between rich and poor is stretching to a breaking point more dangerous than any terrorist plot.*

The zangels aren’t decayed, but appear in their living form, absent the infirmities and temporal concerns that put them in the ground. And they have a plan.

First they confront the very inmates whose work on the island is burial. These they recruit to spread the word. But they do this selectively, starting with just one or two of the inmates, met by one or two of the zangels. The inmates, convinced (after first disbelieving, of course — gotta have that stage), plot next steps with the zangels, who then swim over to City Island, steal some fresh clothes off some clotheslines and head for meetings with a few of the zangels’ surviving friends, co-workers and loved ones. These too are shocked and disbelieving at first, but become disciples of the zangels, who are expert at disappearing and reappearing when necessary.

A code line — “Take liberty to Hart” — is used by the secretive but growing cohort of zangel disciples to organize meetings and start spreading the word.

Not sure what the big conflict with bad guys should be. Gotta have that too. Maybe the bad guys are Gordon Gecko types living in penthouses, working in high-floor offices, making money with work that creates wealth only for themselves. That’s a bit too Hollywood and pat, but I’m just thinking out loud right now, and need to get back to Real Work. But there are plenty of movie-making folk among readers here. I’m hoping those folks pick this up and run with it. I think it’s a hell of a good idea (puns intended).

Meanwhile, here’s a key resource that’s also the main cause:  The Hart Island Project, which seeks to de-shroud Hart Island, bring full respect to those buried there, open access to the public, and unearth and organize good records for those buried there. The project’s founder, Melinda Hunt (@hartisland), owns HartIsland.com as well as HartIsland.net and HartIsland.org. I’m sure she’d let the movie (provided it’s a good one) use HartIsland.com. (She also has a documentary on the island you can sample and buy here.)

Anyway, with Halloween front and center at the moment, I can’t think of a better way to organize and bring attention to a good cause by focusing on a Real Issue.

* Three good sources on this: Chris Hedges, writing about societal collapse and the seductions of warJoseph Stiglitz, whose latest book is The Price of Inequality: How Today’s Divided Society Endangers Our Future; and Stephen Lewis, a New York native and an authority on many relevant topics, blogging at Bubkes.com.

A decent provision for the poor is the true test of civilization. — Samuel Johnson

Hart Island

Visitors to New York’s Orchard Beach (at the top of the photo above) probably don’t know that the low wooded island offshore will, at the current rate, contain a million buried human bodies, if it doesn’t already.

The site is Hart Island (aka Hart’s Island), and it is New York’s Potter’s Field: where the city’s “unclaimed and indigent” dead are buried by inmates of the Department of Corrections, which also controls the island. Visitors are not welcome.

I knew nothing about Hart Island until I found myself looking at the picture I shot of the place, above, while seeking information about something else. Though bleak, the stories of the place are fascinating — and, it seemed to me, far too important to leave as far out on the margins of consciousness as they are of the City. So I compiled a list in a Fargo outline, which I’ve arranged below.

One item I’ll pull out of the list to start with is The Hart Island Project, by Melinda Hunt (@hartisland) and a team of collaborators. Melinda has been leading a steady effort to open up the island to visitors and to humanize and modernize the records kept of persons buried there. Her constituency includes all who reside in what we might call the Mass Grave of the Barely-Known Outcasts — and too few of the living, so far. So dig:

In fact Hart Island is New York’s ninth Potter’s Field. Writes Melinda Hunt,

A few of these early potters fields remain in the public domain as smaller parcels of land now known as Madison Square Park (1794), Washington Square Park (1797), Bryant Park and the Public Library (1823). Except for the last potter’s field in Manhattan, located at the current Waldorf Astoria Hotel (1836), no records exist of the bodies being moved elsewhere. At all other sites, parks were created after the cemeteries, parade grounds, and the reservoir closed. Once the city expanded beyond 50th Street, the East River became a more convenient route for transporting the bodies. Potter’s fields opened briefly on Randalls Island (1843) and Wards Island (1846) before moving much further out to Hart Island.

It’s a haunting history. Another excerpt:

  The burial records show an ever-changing pool of immigrants, diseases and disabilities administered to by a range of institutions. It remains too mixed and varied to become the darling of any special interest group. Genealogists that I have spoken with claim that most families with immigrant roots in New York City probably have lost relatives buried on Hart Island. As one recently told me: “People come to me hoping to discover ‘nobility’ in their ancestry, but the missing people usually turn out to have had alcohol problems or mental illness and were buried in Potter’s Field.”

In New York City, the combined nine potter’s fields have close to one million burials. An immense amount of history is associated with these places. Yet, there is almost no academic or institutional interest in the public cemeteries. Most of the writing about Hart Island takes the form of journalism documenting specific events. Distinctive in these accounts is the unanswered question of why such a place continues to exist. Most other American cities cremate the unclaimed and unwanted. If burials are provided they are in more accessible places. Chicago has a potter’s field with mass graves as part of a private cemetery. New York City offers burial assistance to families who organize an application. Nonetheless, the burials continue to number two to three thousand a year. Even with the twenty-five year time limit, the northern 45 acres of Hart Island named Cemetery Hill is full. Current burials have moved to the shallow grounds south of the workhouses.

New York City has a long-standing policy of respecting diverse religious practices. Many religions do not permit cremation. Until recently Catholics buried on Hart Island were placed in separate “consecrated ground.” In 1913, “baby trenches” were separated from “adult trenches.” Starting in 1935, “catholic babies” had separate trenches from “regular babies.”

Incredible care and expense goes into conducting the burials. In 1990 the cost of flowers, tools, heavy equipment, parts to repair equipment, general maintenance equipment, fuel and inmate labor, at thirty-five cents per hour, drove the cost of each burial to $346. In addition, the city provides for free exhumation if family members claim a body within seven years of burial.

During the first fifty years of Hart Island burials, “unclaimed” people were buried in single graves. Only the “unwanted” whose relatives assigned them to a public burial were in mass graves. Today, all bodies are carefully organized into a grid. The ends of trenches are marked by a number pressed into a concrete block. Re-excavations require locating the designated body within this numbered scheme.

Perhaps it is the abstraction of human lives into trench numbers and statistics that is most disturbing about the potter’s field. I was impressed by the fact that the burial records from the nineteenth century contain full names, causes of death and countries of origin. In this century the names of babies up until 1940 are strictly female; each child’s identity is linked exclusively to the mother. She is the person forever associated with the potter’s field. After 1940, only surnames are listed. By 1955, the causes of death for children are uniformly listed as “confidential.” By 1970, the category “cause of death” is left blank. That the island is prohibitively difficult to visit adds another level of removal.

Then there is this, from Thomas Badhe, in a Common Place essay,” The Common Dust of Potter’s Field: New York City and its bodies politic, 1800-1860″:

The first Potter’s Field burial ground in New York City was located at the site of what would become the militia parade ground and city park at Washington Square. On this nine-and-a-half-acre plot, at the city’s pastoral northern edge, lay the densely packed corpses of about 125,000 “strangers,” many of whom had died during two separate yellow-fever epidemics between 1795 and 1803. Not surprisingly, local residents who had fled crowded lower Manhattan for country estates in the region came to find in Potter’s Field an intense nuisance. Whatever sympathy anyone had for the anonymous dead did not supersede wealthy New Yorkers’ sense of entitlement when it came to their comfortable insulation from the city’s darker side. In a letter to the Common Council, they wrote, “From the rapid Increase of Building that is daily taking place both in the suburbs of the City and the Grounds surrounding the field alluded to, it is certain that in the course of a few years the aforementioned field will be drawn within a precinct of the City.” Within the first two decades of the nineteenth century, their prediction had been realized, and the Potter’s Field began a lengthy series of migrations in a vain effort to stay a step ahead of the city’s relentless growth.

In 1823, the city moved Potter’s Field to an empty lot at the corner of Forty-ninth Street and Fourth Avenue—what would then have been the far northern reaches of the metropolis. This place served as the Potter’s Field until the 1840s when, as the city grew northward, it was relocated once again to Randall’s Island in the East River. Cast off the Island of Manhattan like so many family farms, Potter’s Field would no longer clash with the New Yorkers’ Victorian sensibilities or inhibit the Manhattan real-estate boom.

Just south of Randall’s Island, separated by a treacherous, narrow channel known as Little Hell’s Gate, was Ward’s Island, the site of another Potter’s Field in the mid-1850s. Both Randall’s and Ward’s Islands already housed other city institutions for the indigent, including the Emigrant Refuge and Hospital, the State Inebriate Asylum, the juvenile branch of the Almshouse Department, and the headquarters for the Society for the Reformation of Juvenile Delinquents. As one guide to New York and its benevolent institutions observed, “multitudes of persons went from the dram-shop to the police-station, and from the police courts to the Workhouse from whence, after a short stay, they returned to the dram shop . . . until they at length died on their hands as paupers or criminals, and were laid in the Potter’s Field.” For most of New York’s institutionalized underclass, there was literally a direct path from the door of the asylum or workhouse to the Potter’s Field.

Relocating the city’s cemetery from Manhattan’s urban grid to an island in the East River did not put an end to the city’s problem with the indigent dead. In 1849, the Daily Tribune reported on the political and legal wrangling between the governors of the Almshouse and the Common Council (the nineteenth-century name for the City Council), the former seeking to wrest authority over Potter’s Field from the latter. The governors cited the poor management of the paupers’ burial ground, which the Tribune referred to as “that den of abominations,” as evidence that the Common Council was unable to manage the Potter’s Field. “We do sincerely trust somebody will shoulder the responsibility of the Potter’s Field,” the Tribune pleaded, “and rid the Island of the abomination before the advent of another warm and perhaps an epidemic season.”

The Common Council and the Governors of the Almshouse traded letters, pleas, and vitriol for the better part of a decade. In May of 1851, the Governors warned the Common Council that, “the land now appropriated [for the Potter’s Field] is now nearly full, and the small space left for further interment (which now average upwards of one hundred per week), renders prompt action necessary.” Four years later, it was still unclear who had control over the Potter’s Field, and conditions were worsening. By this time, there were two burial grounds for paupers: the primary site on Randall’s Island and a smaller one on Ward’s Island to the south. The Board of Governors proposed to expand the Ward’s Island site in 1854, and the Times supported the proposition, suggesting that “it is time that the remains of paupers were interred in some quarter better fitted for their last resting-place than the one now used on Randall’s Island.” In their reports to the Board of Health and the Common Council, the Governors of the Almshouse urged that, “humanity, a due regard for the living, and a sense of proper respect for the dead” be part of any effort “to remedy the existing and impending evils.”

In the meantime, the disinterment of bodies at the old site on Fourth Avenue aroused its own controversy. In 1851, a plan was adopted by the Common Council to expand Forty-ninth Street through the old Potter’s Field, which required the disinterment of thousands of bodies. This project stretched on for nearly the entire decade, accompanied by foot-dragging and corrupt contractors. Commenting on the enormity of the project, the Times reported in the spring of 1853 that “the City Authorities are cutting a street through the old Potter’s Field . . . where so many victims of the Cholera were hurriedly interred in 1832. The coffins were then, in many instances, stacked one upon another; and now, in digging through the hill, the remains of twenty coffins may be seen thus piled together.”

As with the active Potter’s Field, the old paupers’ burial ground aroused no small amount of controversy. In the summer of 1858, the Timesagain reported on the work, claiming that “within three weeks past about 3,000 skeletons have been exhumed from the old Potter’s Field . . . and removed to Ward’s Island.” The winter of 1858-59 passed without any further exhumation, and “meantime the thin layer of earth which covered some hundred half-decayed coffins has fallen away, and . . . crowds of urchins assemble there daily and play with the bones of the dead; troops of hungry dogs prowl about the grounds and carry off skulls and detached parts of human bodies.”

Many of the old potter’s fields became parks. Washington Square is said to have twenty thousand bodies beneath it. Yet today it seems no more haunted than is Paris by its Catacombes, which I visited and wrote about three years ago, and which contains a population of dead that outnumber the city’s live citizens. The real haunting, I believe, is within our culture and its institutions. On that I’ll give Thomas Badhe the last words:

Having strolled through the rural cemeteries, we can better appreciate why the piles of moldering coffins exposed to the public in the 1850s caused New Yorkers to question their city’s claims to “civilization.” But the Potter’s Field was not only the antithesis of the rural-cemetery ideal (as well as a failure of municipal administration); it was also a site of spiritual death, obliterated social identity, and the graveyard of vice. If, as one proponent of rural cemeteries claimed in 1831, “the grave hath a voice of eloquence,” the Potter’s Field spoke in a dark chorus about the failures of democracy and civilization, the stark and messy exigencies of urban inequality, and thousands of individual lives wrecked on the shores of the great metropolis.

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