Lab Soft News

Can or Should News Web Sites Charge Google from Indexing their Articles?

As everyone knows by now, the print media are in the midst of a dilemma. Much of the industry is dead or failing financially. The print publishers need to embrace various types of electronic forms of communication and the webisphere. The dilemma is that the business model for electronic media is not lucrative enough to support their current budgets. The standard business model for most bloggers is to devote many hours per week to the task merely for the love of it. It's touch to compete with those who will work for free and enjoy doing it. Nick Carr, who blogs over at RoughType, raises the topic of whether Rupert Murdoch, the print and electronic media czar, intends to charge Google for the privilege of indexing the online content of his various publications (see: Murdoch's wink). Here's an excerpt from his note:

Earlier this month, Rupert Murdoch sat down for an interview with Sky News Australia (a company that Murdoch's News Corporation partially owns).....Murdoch seemed to be saying...that News Corp is planning to block Google from indexing its content. But when you listen to his full answer, in which he confuses opting out of Google's search engine with raising pay walls on sites, it's hard to know what he was actually intending to say. But inadvertent or not, Murdoch's suggestion that he'll pull News Corp content out of Google's database could turn out to be a brilliant signaling strategy....Last spring, in my post Google in the Middle, I described the dilemma in which newspapers find themselves when it comes to to Google's search engine. On the one hand, Google is an important source of traffic for their sites. On the other hand, Google prevents them from making decent money online - by massively fragmenting traffic, by undermining brand power, and by turning news stories into fungible commodities. Individual newspapers can't live with Google, but they can't live without it either. What Murdoch effectively did in his interview with Sky News was to send a signal to other newspaper companies: We'll opt out if you'll opt out. Murdoch positioned himself as the would-be ringleader of a massive jailbreak, without actually risking a jailbreak himself.

In my opinion, this is just a "shot across the bow" of Google by Murdoch and that he has no intention of charging Google for anything. It's also unlikely that any of his prestigious competitors such as the New York Times or the Washington Post would align themselves with Murdoch in any joint effort to thwart Google, or any other search engine, in its indexing activities. Print newspapers, if they are serious about extending their reach into the webisphere, will need the support of all of the search engines including Google, Bing, and Yahoo. In a very clever counter move, Google now provides the various news publishers the opportunity of "opting out" of participation in Google News, a news aggregator (see: Google Makes It Easier for News Sites to Opt-out). Here's a quote from this article:

In what will be seen as a concession to media baron Rupert Murdoch, Google has made it easier for news sites--such as those Murdoch controls--to opt-out of Google News. Where they used to have to fill out an online form to opt-out of Google's news aggregation site, publishers will soon have a means to opt-out or set other options automatically, using a small file placed on their sites. Murdoch has previously threatened to take News Corp. content, including the Times of London, and the Australian, off Google when at some point in the future they become paid sites. His Wall Street Journal and Barron's are already largely subscription-based....Murdoch has also reportedly been in talks with Microsoft that would result is News Corp. content being removed from Google and enhanced on Microsoft's Bing, which would pay News Corp. a fee in return for exclusivity. Recent reports, however, say the talks have been overplayed in the media.

In my option, this is all a case of high-stakes-poker and posturing. From the perspective of this blog, much of my quoted material comes from the New York Times and the Wall Street Journal. I mainly discover this material by reading the hardcopy publications, which I subscribe to. rather than through search engines. I will continue to operate in this way because the country would suffer badly without these prestigious publications and I want to provide them with at least some small financial support.

Respiragene as a "Not So Useful" Lung Cancer Risk Test Comes to Market

We are entering the golden era of diagnostics ushered in by new biomarkers with greater specificity, measured alone and in also in groups called IVDMIAs. For me, the value of any lab test is whether the integrated result provides key diagnostic or therapeutic information that is otherwise unobtainable. A recent story appropriately questioned the value of a new lab test now being marketed for lung cancer (see: Questioning a Test for Cancer). Below is an excerpt from it:

Christopher Taylor says he never lasted more than a week when he tried to quit smoking in the past. But it has been four weeks and counting this time, since a genetic test indicated he had a much higher risk of developing lung cancer than the average smoker. Of course, said Mr. Taylor, a 45-year-old salesman who has smoked for 25 years, he already knew that cigarettes were dangerous. But he thought, “It’s not going to happen to me.” Then came the gene test....Scaring people into quitting is the marketing rationale for that new genetic test, called Respiragene, which purports to identify which smokers have the highest risk of developing lung cancer. The test, developed by a company called Synergenz BioScience in New Zealand, where Mr. Taylor lives, is now being offered over the Internet in the United States for $700....Respiragene has not been approved by the Food and Drug Administration, which usually does not regulate such tests. Some states do, however, and the test has not been approved for use by residents in New York, California and Maryland....The justification for many of these tests is that knowing one’s risk will prompt people to change their behavior. Such is the premise, for example, of the genome scans offered by 23andMe, costing $400, and one by Navigenics, for $1,000, that are meant to tell one’s propensity for numerous diseases. Navigenics and an organization affiliated with the Scripps Research Institute are now monitoring 4,800 people to see if the Navigenics test results prompt them to eat better, exercise more or get more medical checkups. But smoking could prove the clearest test yet of the behavior modification pitch.

As far as I can determine from this story, Synergenz BioScience developed this test by choosing a list of biomarkers that can purportedly determine whether one is at "high risk" for lung cancer. I take this to mean that one is predisposed to the disease and that this predisposition can be exacerbated by smoking or by being exposed to other risk factors. The company then markets the test based on the premise that it's more "scary" than having your physician say that you are at higher risk. Although not referenced in the story, the picture of the Respiragene report shows the MDL logo, referring to what I assume to be the performing laboratory for the test, Molecular Diagnostic Laboratories. This lab's web page also displays the Respiragene logo.

This notion of using a genetic test to assess whether a current smoker or a previous smoker is at risk for cancer strikes me as sketchy, particularly for a price $700. Here's what I would recommend instead. Stop by one of the local panhandlers on the street, hand him $10, and tell him that you have a 20-pack-year history of smoking. Then, ask him if you have an increased risk of developing cancer. I also suspect that some smokers who don't want to quit smoking are using the test to determine if they are in the lucky minority who have a low cancer risk and can thus continue with their addiction. It's not worth it, pal.

Geolocation -- A New Solution Emerging from Twitter for the TMI Problem

I am someone who is constantly grappling with a TMI problem -- Too Much Information. I have cobbled together a patchwork of solutions in response. For example, I have commented in the past about how I select people to follow in Twitter who function as filters and present me with new ideas and information that would be difficult to obtain working on my own (see: Extracting Value from Twitter Messages Using Filters). Recently and in order to cope with my TMI problem, I have begun to use my Palm Pre to quickly scan incoming email during my odd downtime intervals. Email browsing is so easy on this device and it is so readily accessible that I can compress this activity into this previously unused time. When I return to my desktop PC, the remaining email in my inbox has been filtered and thus merits more serious attention.

A recent article in the New York Times presents a TMI problem of a different type that is being addressed by Twitter in a clever way (see: Refining the Twitter Explosion). Here's the nub of the Twitter TMI problem. When there is a disaster like the one that recently struck at Fort Hood, there is a rapid influx of Tweets from a large number of putative on-site, real-time observers. Many of these messages are short, written under duress, and do not provide reliable information about their geographic origin. Twitter has come up with a means to group Tweets by their point source using the GPS geolocation feature present on many cellphones. Read more about this below in an extract of the article:

Simply put, there is way too much information on Twitter — lately, it defies navigation. In January, there were 2.4 million tweets a day....Until lately, the main way to make sense of an urgent outpouring of tweets on a particular subject was to use text searches: look for the phrase “Fort Hood,” for example, or maybe an agreed-upon label [tag], “#fthood,” within tweets. Yet during events like the shootings on Thursday at Fort Hood that left 13 people dead, this method is useless. Hundreds of “relevant” tweets pop up every minute, most repeating the same news reports over and over again or expressing concern from far away. Which is why a new feature that Twitter says it could unveil in the next few weeks — “geolocation” — holds such potential to make the Twitter rapids navigable. The idea is to take advantage of global positioning systems on cellphones to allow Twitter users to include a precise location with each tweet. Users would be able, right off the bat, to limit their searches to tweets from a particular location. “Proximity can be this proxy for relevance,” said Ryan Sarver, the director of the Twitter platform, who led a “fairly small team” of programmers who after a few months are close to completing the geolocation project. “We are about delivering the right information to the right people.” After limiting searches to those from within 15 miles of Killeen, Tex., a town near the Army post, you easily find messages sent by soldiers describing what it is like to be on lockdown or worrying about their children at school on the post....Because GPS will provide the ability to become very “granular” with locations, you could mimic through Twitter the banter at the local diner or a barbershop, by limiting a search of tweets to a two-block radius.

The use of geolocation serves a couple of purposes. First of all, it provides reliable information about the location of the reporter even if he or she does not provide it. Secondly, it provides some degree of validation that the reporting party is in the vicinity of the event being referred to in order to differentiate the message from someone who is spoofing. Geolocation of Tweets does not, however, solve the major problem of many short messages generated from disaster sites. Many of them are garbled and may provide misinformation, often because the observer reports rumors or is only observing a limited portion of the event. Information scientists developers are now working on this problem and you can expect some sort of solution in the near future. They are developing software that "ingests" myriad fragmentary real-time Tweets about an event and then develops some semblance of "truth" by parsing multiple messages, analyzing them syntactically, and looking for common themes and scenarios within them.

Are You a Primary Care Pathologist, Asks Dr. Henderson

A new pathology blogger has appeared on the scene -- Dr. Gregory Henderson. He calls himself a primary care pathologist and his first blog note is about this very topic (see: You Might Be A Primary Care Pathologist). Here are the criteria he lists to determine whether one falls into this category:

• If you have ever taken phone calls from patients to help explain their diagnosis, you might be a primary care pathologist.
• If you have ever scrubbed into a surgical procedure to help the surgeon identify key areas to sample for frozen section, you might be a primary care pathologist.
• If you have ever manned a booth at a community health fair that educates women about Pap and HPV testing, you might be a primary care pathologist.
• If you have spent an enormous time over the past 3 months helping your hospital prepare for the impending H1N1 epidemic, you might be a primary care pathologist.
• If you look around your lunch table most days and see physicians of other specialties and no other pathologists, you might be a primary care pathologist.
• If your pattern of practice looks anything like any of the pathologists on this CAP website, you might be a primary care pathologist.

I need to confess that my first reaction, on reading his inaugural note, was to flinch a bit. After all, the notion of "primary-care-anything" seems to be quickly losing its luster in our rush to become uber-specialists, particularly those who can bill for a procedure. However, and after reading his list, I have changed my mind. There is a tendency for one's first blog note to focus on a topic that one really cares about. It goes to the nature of this obsession -- the need to communicate one's ideas on a broader scale. There is the ring of authenticity and sincerity about his list that any pathologist will be proud of. I wish him the best of luck in his future blogging career. I am sure that he will provide us all with better insights into the valuable services that individuals like him provide to their communities. Oh, and the fact that Dr. Henderson refers to Lab Soft News on his home page as one of his favorite blogs had no influence on these remarks.

Decision-Aids for Helping Consumers Make Informed Medical Decisions

Who is the best person to advise you on important medical decisions? Nearly everyone would respond to this question by citing their family physician. It turns out that this ain't necessarily so according to a recent article (see: Weighty Choices, in Patients’ Hands). Here are some of the details:

For patients [with serious diseases], the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to the disadvantages. The study also found that doctors often offer their opinion but much less frequently ask the patient’s own opinion....Though decision-aid programs cost money to deliver, they appear to save money in the long run. Studies show that when patients understand their choices and share in the decision-making process with their doctors, they tend to choose less-invasive and less-expensive treatments than they would have otherwise received. A number of states and policymakers in Washington are considering legislation that would provide funding to study the use of shared-decision-making programs and in some cases require such programs to be offered to patients as part of the informed-consent process. A growing number of hospitals, medical groups and health plans are using decision aids offered by the Foundation for Informed Medical Decision Making, which grew out of research at Dartmouth University, for conditions where there is no consensus as to the best course of treatment. The foundation offers decision aids for 23 diseases and conditions including breast and prostate cancer, knee surgery, end-of-life care and uterine fibroids. Health Dialog, its for-profit partner, provides the programs to health plans and employers reaching about 20 million beneficiaries. Using claims data, Health Dialog determines which patients might benefit from shared decision making, then reaches out to them by mail or phone to offer informational DVDs and telephone-coaching sessions to help make decisions.

I believe, as stated above, that physicians are more like to discuss the advantages and benefits of treatment than the disadvantages. In effect, they are trained to "sell" various treatments and therapies. After all, that is the business that they are in and all of them firmly believe in what they are "selling." Coupled with this, there is always the problem that surgeons like to operate and oncologists are trained to offer chemotherapy to nearly all of the patients who are referred to them. Some of these problems can be reduced by the use of multidisciplinary teams (MDTs) in cancer hospitals and breast clinics (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.). One of the antidote to this problem is the well-informed patient and the web is one of the vehicles for educating healthcare consumers.

I think that it would be a bit of a stretch to suggest that all patients should make use of the "decision-aids" described above to help them navigate through complex medical decisions. The use of such products could seriously disrupt the critical patient-physician relationship. Obviously, health plans and employers, as described above, could mandate their use because they are paying the medical bills. The experience gained in these new approaches will be invaluable. Meanwhile, it would help if these "decision-aids" as well as supplemental educational materials could be made more broadly available on the web. In this way, motivated patients needing help in making significant medical decisions could have access to them in parallel with discussions with their personal physicians. Ideally, the advice obtained on the web would reinforce the same decisions arrived at in discussions with their physicians. If not and perhaps for some patients, these decision-aids could guide them in a better direction based on their individual needs.

Are We Turning into Informavores?

Although the word imformavore was new to me when I ran across it on the web recently, it turns out that I myself have always had these tendencies. Here's a definition of the term:

The term informavore ... characterizes an organism that consumes information. It is meant to be a description of human behavior in modern information society, in comparison to omnivore, as a description of humans consuming food. George A. Miller...coined the term in 1983 as an analogy to how organisms survive by consuming negative entropy ...."Just as the body survives by ingesting negative entropy, so the mind survives by ingesting information. In a very general sense, all higher organisms are informavores." (see: Wikepedia)

Until the emergence of the web, I have always considered libraries as my second home and was quite content to wander through the shelves, pulling books at random, and briefly scanning the titles and a few pages for bits of information. Information grazing if you will. The idea of the informavore calls to mind the discussion in recent months on the web about whether the web search engine Google was making us stupid. All of this angst was precipitated by Nick Carr who blogs over at Rough Type. The underlying idea is that web search has now been made so efficient and painless that we seek out snippets of information the same way that squirrels search for nuts. Some conclude pessimistically that we have lost our capability to leisurely consume the linear content of printed books.

The term informavore apparently refers to someone who acquires information anywhere, whether on the web or the printed page. The Google/stupid dialogue focuses on only web search. I personally acquire information via both the printed page and the web. If I am trying to understand some new idea quickly, however, I always turn to the web. For me, this is a matter of efficiency. Of course, there is a downside to being an informavore -- information fatigue syndrome. The cure for this latter condition is well understood.

Top Ten Trends in Healthcare, Lab Medicine, and Pathology Informatics

I am currently in Canberra, Australia, where I am participating in the HIC 2009. This is the annual healthcare informatics conference sponsored by HISA, which is the Health Informatics Society of Australia. Yesterday afternoon, I delivered a 40-minute lecture to the group entitled: Interpreting the Tea Leaves: Ten Trends in Healthcare, Lab Medicine, and Pathology Informatics. It's an expanded version of a previously posted lecture that I presented to the DxMA in Chicago on July 22, 2009.

After some introductory explanatory material in the talk, I tease out the ten macro trends that I believe are occurring now in the U.S. with particularly relevance for pathology and lab medicine. Most of them have significant implicatiions for pathology informatics. I consider this "top-ten" approach a work-in-progress such that some new trend may occur to me later, or be suggested by a reader, that will displace an item in the current list. Submit a comment if you have any ideas.

Exploring the Deep or Hidden Web with WebMynd

The deep or hidden web refers to web content that is not part of the surface web, which is indexed using standard search engines. When researching notes for this blog, I commonly fail to take advantage of videos and images accessible, for example, on YouTube or Flickr. These assets could be instructive but will be missed by my Google searches. I could go directly to the search engines embedded in these sites but this requires additional effort on my part. There is now an easy solution to this problem -- WebMynd.

I installed this program as as extension of Mozilla Firefox, which is my web browser. Whenever I launch a search with Google, the upper right-hand portion of the search engine retrieval page (SERP), the normal location for Google sponsored links, is taken over by WebMynd for its own results. These include links to Twitter, YouTube, Flickr, Digg, OneRiot, SnappyFingers, and BackType. The user is provided the opportunity to customize the WebMynd search to include or exclude these, and other sites, based on personal preferences. My guess is that you will not be familiar with some of these specialized search applications -- nor was I. By configuring the program to view their search results, you can view the links that they provide without any effort. If you do not find them to be useful, you can then remove them from your list.

It seems to me that WebMynd offers both a challenge and opportunity for Google. It is a valuable asset for users but the program also takes over valuable "real estate" for its own purposes. It seems to me that Google will now be challenged either to extend its own search capabilities or purchase this upstart company.

Finally, Some Insightful Commentary about the Implications of Chrome OS

Much has been made of the recent announcement of Google that it is converting its browser, Chrome, to Chrome Operating System. I have tracked this story closely with an eye toward posting a blog note about the topic but none of them made much sense to me until I read the recent commentary by Robert Cringely (see: Chrome vs. Bing vs. You and Me). Below is an excerpt from it:

The battle between Microsoft and Google entered a new phase last week with the announcement of Google’s Chrome Operating System — a direct attack on Microsoft Windows....This is all heady stuff and good for lots of press, but in the end none of this is likely to make a real difference for either company or, indeed, for consumers....Microsoft makes most of its money from two products, Microsoft Windows and Microsoft Office. Nearly everything else it makes loses money, sometimes deliberately. Google makes most of its money from selling Internet ads next to search results. Nearly everything else it does loses money, too. Neither company really cares because both make so much from their core products that it simply doesn’t matter....The vast majority of Google searches are, of course, done on PCs running Microsoft Windows and Internet Explorer. It is not in Google’s real interest to displace these products, which have facilitated so much of its success. Chrome products are given away, so they bring in no revenue for Google, and they don’t even provide a better search or advertising experience for their users, the company admits. So why does Google even bother? To keep Microsoft on its toes....This makes even more sense given the recent advent of Microsoft’s Bing search technology, which performs precisely the same competitive control function against Google. Bing hasn’t a hope of toppling Google as the premier search engine and Microsoft knows it. To date, Bing’s success has actually been at the expense of Google’s competitors, not Google itself. But thanks to Microsoft’s deep pockets and fierce screwball reputation, Bing has already accomplished its main purpose: reminding Google executives who they’re messing with.

To summarize, Google needs Microsoft badly because PCs running Windows are critical for web search, which is the source of most of its profits. Microsoft needs Google badly because Google search is valuable for PC users browsing the web. It's one of the major reasons for owning such a device. Google has developed Google Apps, which will never displace Microsoft Office, to put Microsoft on warning. Microsoft recently offered its new search engine, Bing, to keep Google on its toes. By the way and for readers arriving at this blog, the most commonly used search engine is Yahoo; next comes Bing and Google competing for second and third place. Bing rose to this position in a matter of weeks but Microsoft has various ways to promote its products on the Windows desktop. Incidentally, Bing is a very good search engine.

I believe that Chrome OS may eventually allow netbooks to operate more efficiently for users who work mainly in the cloud. The price of laptops, soon powered by Windows 7, (Goodbye, Vista, you will not be missed) keeps dropping, rivaling the rock-bottom price of netbooks. The only way that netbooks will survive is if they continue to be cheaper, lighter, and faster than laptops. This is a fluid situation, at least at Wal-mart. In my view, all of this competition is very healthy. However, netbooks powered by Chrome OS will only be a niche market. It's a standoff for Microsoft and Google and both of them continue to do pretty well in this little game.

Tabulating the Cost of Undiagnosed Diabetes in the U.S.

The cost of care for various chronic disease is a growing concern (see: Seeking Solutions to the Chronic Disease Epidemic, Cost Savings Associated with Home-Based Physiologic Monitoring) with a special focus on diabetes (see: The Staggering Cost of Treating Diabetes, Mandatory Pre-employment Lab Testing for Acute or Chronic Disease). Now comes an article discussing the cost of undiagnosed cases of diabetes (see: Costs Are High From Undiagnosed Diabetes). This new idea poses a number of interesting issues and challenges. Below is an excerpt from the article with boldface emphasis mine:

Scientists used data from more than 3 million people included in the National Health and Nutrition Examination Survey to estimate costs and numbers of people in the U.S. with undiagnosed diabetes, tabulating bills for treatment of various symptoms of the disease.... [R]esearchers say their calculations suggest that about 6.3 million adults -- about a fourth of the people in the U.S. with diabetes -- have the disease but haven't been diagnosed. This undiagnosed population accounts for about $18 billion in health care costs annually, the study shows. Researchers examined the health care use patterns of a group of people for the two-year period leading up to their diagnosis of diabetes. Diabetes costs the American economy about $174 billion in medical care expenses and lost productivity, based on calculations for 2007, the study shows. But that figure is a significant understatement, according to the researchers, who say costs related to undiagnosed people with diabetes could raise the total to more than $192 billion. Annual health care needs for people with undiagnosed diabetes tend to be higher than for people who do not have the disease, the study of the federal statistics indicated....The economic cost of undiagnosed diabetes is $2,864 per person.

To briefly summarize, diagnosed cases of diabetes account yearly for about $174 billion in healthcare costs. This includes medical care expenses and lost productivity. It has been estimated that the costs related to undiagnosed people with this disease could raise this total to more than $192 billion. Identifying these undiagnosed patients would save money in the long-run because their healthcare needs are higher. I suspect, however, that there will be little organized effort to identify members of this group. The obvious reason is that such surveillance programs consume healthcare dollars that can be devoted to the treatment of current diagnosed cases.

I have posted many previous notes to the topic of the web and PHRs as a vehicle for inexpensively communicating public health messages and alerts to the general public (see: Increasing Patient Involvement with Their Personal Health Issues, Paging Dr. Google! We Are Waiting for a Second Opinion). Cell phones are another platform for the transmission of such messages, although active cell phone users tend to skew toward a younger population (see: Younger Web Users as Both Consumers and Conduits of Information). Perhaps we can look forward to public health education campaigns to reach out to undiagnosed diabetics using less expensive and perhaps more effective channels such as the web, PHRs, and cell phones.