The Takeaways: Week 31 of 2021

A periodic review of articles, newsletters, and podcasts that I found interesting, inspiring, or otherwise worth remembering.

Closed Tab of the Week

Megan Molteni, WIRED. The 60-Year-Old Scientific Screwup That Helped Covid Kill (May 13, 2021)

It's challenging to keep track of what is a fact and what is a hypothesis or an assumption. In the first many months of COVID-19, we heard over and over again that we had to worry about communication via droplets. These agglomerations of bodily fluid fell rapidly once expelled, and did so within a radius of 3-6 feet. This was the primary mode of transmission for this coronavirus. Some researchers thought the evidence coming from outbreaks among groups who had been in close indoor contact suggested it could be airborne, carried on the cloud of particles made by human respiration.

When it came to flecks of soot and ash belched out by smokestacks and tailpipes, the organization readily accepted the physics [atmospheric physicist Lidia Morawska] was describing—that particles of many sizes can hang aloft, travel far, and be inhaled. Now, though, the WHO’s advisers seemed to be saying those same laws didn’t apply to virus-laced respiratory particles. To them, the word airborne only applied to particles smaller than 5 microns.

The accepted boundary between droplets and aerosols lay at 5 microns. Another researcher, aerosol scientist Linsey Marr, had found in her own work that "[r]eality is far messier, with particles much larger than 5 microns staying afloat and behaving like aerosols, depending on heat, humidity, and airspeed." Working closely with a few others, her disquiet with the public health response led a Virginia Tech graduate student named Katie Randall to dig not into the clinical record, but the historical and institutional context out of which the 5 micron boundary had emerged: scientific publication and citation.

In particular, Ramndall focused on research from the 1940s to the 1960s by engineer William Firth Wells suggesting that aerosolized particles could be particularly pernicious and invasiive. His research further suggested that the boundary lay at 100 microns. However, when these ideas crossed into the worlds of medicine and public health, the occupational context of much of Wells's research seems to have made it easy to disregard. Here we read about Alexander Langmuir, chief epidemiologist of the CDC beginning in 1949 and for around two decades following.

Like his peers, Langmuir had been brought up in the Gospel of Personal Cleanliness, an obsession that made handwashing the bedrock of US public health policy. He seemed to view Wells’ ideas about airborne transmission as retrograde, seeing in them a slide back toward an ancient, irrational terror of bad air—the “miasma theory” that had prevailed for centuries. Langmuir dismissed them as little more than “interesting theoretical points.”

After Wells dies in 1963, Langmuir mentions him in an address to public health workers - in the context of tuberculosis. Here, Randall finds a likely nexus out of which comes a garbled new apparent pattern of facts:

What must have happened, she thought, was that after Wells died, scientists inside the CDC conflated his observations. They plucked the size of the particle that transmits tuberculosis out of context, making 5 microns stand in for a general definition of airborne spread. Wells’ 100-micron threshold got left behind. “You can see that the idea of what is respirable, what stays airborne, and what is infectious are all being flattened into this 5-micron phenomenon,” Randall says. Over time, through blind repetition, the error sank deeper into the medical canon.

By winter, clinical evidence and a campaign of persuasion and insistent overtures from Marr and others finally begins to take hold. This article treats Randall's research as a motivator for these scientists, but does not say whether this reading of the documentary record helped make a difference.

For me, it highlights the challenge of trying to remember not just what I know, but why I know it and not something else. Ideas always come from somewhere.

CMD-W

Podcasts

Nils Davis (host), The Secrets of Product Management. Episode 89: 3 Decision-Making Hacks for Product Managers) (August 21, 2021)

Nils Davis (host), The Secrets of Product Management. Episdo 90: Agile Product Management From First Principles (August 4, 2021)

Dave Rupert and Chris Coyier (hosts), ShopTalk. Episode 473: Brad and Ian Frost - From Meteorologist to Web Developer (July 26, 2021)

William Vincent and Carlton Gibson (hosts), Django Chat. Episode 97: Contributing to Django - David Smith (August 4, 2021)

Newsletters

Gibson Biddle, Ask Gib Summer Reading (August 5, 2021)

I love a good reading list.

John Cutler, The Beautiful Mess. TBM 32/52: The Form That Stole 20,531,250 Seconds (August 5, 2021)

If a lack of experience doesn't get you, then a lack of trust will get you. If a lack of trust doesn't get you, then the blinders of past successes and overconfidence will get you. If the blinders don't get you, then the time crunch will get you. If the time crunch doesn't get you, an investment in tools will get you.

Hilary Milnes and Web Smith, 2PM. No. 733: Anatomy of a DTC Acquisition (August 2, 2021)

On Square's acquisition of Afterpay:

It’s also telling, and worth reminding, that there is still a world in e-commerce ecosystems outside of Shopify.

Kevin O’Leary and Ryan Russell, Health Tech Nerds. Weekly Health Tech Reads 8/8 (August 8, 2021)

Chas Roades and Lisa Bielamowicz, MD, The Weekly Gist. (August 6, 2021)

Vaccine mandate reveals staff in domestic violence situations: When one of the systems we work with mandated the COVID vaccine last month, its leaders were surprised to have some employees raise a concern about getting vaccinated that they had not anticipated. A small number of women confidentially disclosed that they wanted to receive the vaccine, but were hesitant because of threats and intimidation from their spouses or domestic partners. They had been told to “not come home”, or in some cases worse, if they got the shot. One employee hoped to find a way to get the shot—and keep her much-needed job—but be able to signal to their spouse that she had avoided the mandate. A handful of staff facing these threats shared their stories directly with the CEO, who was rounding through the system to get staff reactions to the mandate, and who, to her credit, quickly mobilized the system’s domestic violence resources to connect with these women, and informed leaders and managers to be on the lookout for other associates in similar situations.

Ernie Smith, Tedium. Plug and Play History: The Design Decision That Made PCs Complicated (August 4, 2021)

Over time, hardware came to be developed with plug and play in mind. Many of the devices you use today—whether SATA hard drives, PCI Express cards, or USB interfaces—have the ability to self-configure, so there’s no direct conflict with the machine you’re plugging it into. Which is why, when I plug in a 30-year-old keyboard via USB (given the right adapter) it works right away.

It’s wild to consider, but we can now take for granted something that was once a wild, never-ending source of frustration for early generations of PC users.

Ben Thompson, Stratechery. Metaverses (August 3, 2021)

In other words, I think that Stephenson got the future exactly backwards: in our world the benevolent monopolist is the reality of atoms. Sure, we can construct borders and private clubs, just as the Metaverse has private property, but interoperability and a shared economy are inescapable in the real world; physical constraints are community. It is on the Internet, where anything is possible, that walled gardens flourish.

Olivia Webb, Acute Condition. Pear Therapeutics and how we price apps (August 5, 2021)

It’s almost like consumers need the insurer reimbursement to think of the app as a legitimate treatment. In other words, we’re so conditioned to treatments and medications being expensive that we trust something to work more if it’s $800 than if it’s $10.
...
But because digital therapeutics are so new, and because so many people can code, I think the healthcare system will at least have to acknowledge that this software can’t be gatekept in the same way as prescription medications—and maybe that will democratize access in some way.

Articles

Mario Aguilar, STAT. High-tech headphones drown out the scary noises inside an MRI (August 2, 2021)

The system’s solution, in part, is a sophisticated electrostatic headphone design that delivers a high sound quality without the use of magnets. Conventionally, electrostatic headphones require a very thin diaphragm coated in a conductive metal, are very large, and require powerful external amplifiers — all no-gos inside an MRI. To get around those problems, Audeze turned to carbon nanotubes to create the film and used glass, rather than the usual metal, for the plates that surround it.

Jay Barmann, SFist. If You Got the Johnson & Johnson Shot, SF General Will Give You a 'Supplemental' Pfizer or Moderna Shot (August 3, 2021)

"It's not a booster because it's not specific for some of the variants, which the booster ultimately will be," says Dr. Chris Colwell, chief of emergency medicine at ZSFG, speaking to ABC 7. He adds, regarding the decision to offer these mRNA extra shots, "Potential benefit, no downside. To me, as we look at the future of this virus and now we're facing a fourth surge, it does make sense."

Frankki Bevins, Kathryn Fox, Duwain Pinder, Jimmy Sarakatsannis, and Shelley Stewart III, McKinsey Institute for Black Economic Mobility. HBCUs as engines of black economic mobility (July 30, 2021)

According to our research and calculations, HBCUs have the potential to produce more high-earning graduates, support the development of more entrepreneurs, decrease student debt, and remove barriers for Black consumers. If the current level of attention and funding given to HBCUs can be sustained over time, these institutions can continue the critical work they have been doing since 1837: dramatically improving lives and livelihoods and advancing economic mobility for Black Americans.

Tyler Cowen, Marginal Revolution. What makes an interview podcast good or great? (August 4, 2021)

Since my podcast is far from the most popular, and since most podcasts are not like mine, and do not (and should not) try to be like mine, perhaps I am not the right respondent. Nonetheless I offered a simple formula:

A podcast really works when it is the dramatic unfolding of a story and mood between the guest and host.

Or expressed in other words:

What makes for a good podcast is the dramatic tension between the guest and host.

Matt Drange, Business Insider. How Silicon Valley's Tech Giants Use NDAs to Create a Culture of Silence (July 27, 2021)

Nondisclosure agreements, or NDAs, strike directly at the heart of one of America's most fundamental individual liberties, limiting what someone can talk about and who they can talk to. Yet even as they've spread throughout the corporate world in the span of a few decades, the dizzying scope and legality of the contracts have received relatively little scrutiny.

Nadia Eghbal. The New American University (August 4, 2021)

There’s a reason why I prefer being in tech, even though I might have otherwise found a comfortable home in academia: 1) everything moves faster in tech, and 2) people in tech actually care about making ideas happen, not just talking about them. From this lens, my experience in tech has been more uniformly positive, whereas my experience with academia is that it seems to have become an uneven, unreliable source of great new ideas, while still cashing in on some ambiguous notion of “prestige.”

Despite its modern shortcomings, however, I have no deep-seated qualms with academia, and my frustrations come only from my disappointment that it is supposed to be so much more than it currently is. Love it or hate it, academia is the closest we’ve ever come to having a multigenerational professional sector dedicated to the production of knowledge.

Blake Farmer, Kaiser Health News. A Health Care Giant Sold Off Dozens of Hospitals — But Continued Suing Patients (August 3, 2021)

Then the pandemic hit. She was furloughed from work for three months. And soon after, a letter arrived. A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do, since she couldn’t come up with all the cash. She was in a holding pattern until the knock on the door from the legal assistant [who served her with papers naming her in a lawsuit].

Andrew Gelman, Statistical Modeling, Causal Inference, and Social Science. In which we learn through the logical reasoning of a 33-year-old book that B. H. Liddell Hart wasn’t all that (August 2, 2021)

Reputation management and war-fighting strategy are not the same, but they are not wholly different either.

John Gruber, Daring Fireball. Apple’s New ‘Child Safety’ Initiatives, and the Slippery Slope (August 6, 2021)

But the “if” in “if these features work as described and only as described” is the rub. That “if” is the whole ballgame. If you discard alarmism from critics of this initiative who clearly do not understand how the features work, you’re still left with completely legitimate concerns from trustworthy experts about how the features could be abused or misused in the future.

Jeet Heer, The Nation. Bourdain’s Wake (August 4, 2021)

But the impulse to revive the dead in Roadrunner becomes sometimes too literal and gimmicky: Neville replicated Bourdain’s voice using a computer program and uses this AI-generated voice to read from his letters. This a minor foible, but it still serves to undermine our trust in a film that gets its best power from moments of candor about Bourdain’s vulnerabilities and flaws. If the power of the film is to bring us nearer to the Bourdain as seen by his intimates, the use of a computer voice conjures up a different experience: an animatronic Bourdain at Disneyland, an engineered revenant designed to feign life in order to replicate a now-lost experience.

Mar Hicks, MIT Technology Review. The voices of women in tech are still being erased (August 3, 2021)

The good news is that historians and journalists, as well as the women themselves, have been working hard to reverse this erasure and are having significant success. In the past decade, new books, articles, and films have set the record straight and changed our understanding about the importance of women’s contributions to high tech. The bad news is that those contributions are still being erased in real time, including the work of women who are trying to solve some of the most important problems in tech today. As long as that’s true, no matter how fast we try to correct the record, we will still end up in the same place.

Hailey Mensik, HealthCare Dive. Utilization bounced back for payers in Q2, dinging profitability (August 6, 2021)

Both payers and providers reported a bounce back in utilization and volumes during the second quarter, though it remains to be seen when the patchy rally in deferred care will come to push them past pre-pandemic levels.

Rebecca Pifer, Healthcare Dive. DOJ reportedly considering suit to block UnitedHealth-Change tie-up August 5, 2021)

The Department of Justice is reportedly considering a lawsuit to block UnitedHealth Group's $8 billion acquisition of data analytics company Change Healthcare as the Biden administration steps up its antitrust efforts.

Melissa Santos, The Columbian. Despite law, 20 Washington counties don’t offer public-option health plans (August 2, 2021)

[T]he state contracts with private insurers to offer the plans, while setting certain rules and cost limits. The public-option plans are then sold alongside other insurance plans on the state’s public insurance marketplace.

Except this year, people could buy the plans in only 19 of the state’s 39 counties. As of May, fewer than 2,000 Washingtonians were enrolled.

State Rep. Eileen Cody, who chairs the House Health Care and Wellness Committee, said the main reason so many counties didn’t have public-option plans available is because some hospitals refused to participate.

A.J. Venkatakrishnan, Colin Pawlowski, David Zemmour, et al, npj Digital Medicine. Mapping each pre-existing condition’s association to short-term and long-term COVID-19 complications (July 27, 2021)

Understanding the relationships between pre-existing conditions and complications of COVID-19 infection is critical to identifying which patients will develop severe disease. Here, we leverage ~1.1 million clinical notes from 1803 hospitalized COVID-19 patients and deep neural network models to characterize associations between 21 pre-existing conditions and the development of 20 complications.