#but at the same time supporting one of their own being arbitrarily locked up

[realasslesbian]

Also, I hope Brittany gets off that plane and takes a damn knee on the tarmac just to make all the big mad straight people even madder lmao

#if anything #this whole Brittany Griner saga has actually just proves the point she was tryna make #by taking a knee during the national anthem #that point being that racism is still a huge problem in the US #you got all these people foaming at the mouth about freedom and democracy in merica #but at the same time supporting one of their own being arbitrarily locked up #with no access to true democratic process #all because she exercised her US rights to freedom of speech #people are dogpiling on Griner because apparently the exchange of an innocent civilian for a criminal is suddenly not good enough for them? #despite that being the modus operandi of basically every prisoner exchange since the dawn of time #and no one has ever batted an eyelash over the numerous (and far shadier) innocent civilian for criminal swaps that have happened #they just suddenly happen to lose their minds about it when it involves a black lesbian? #literally Griner's point in taking a knee has been proved a billion times over #smdh #lesbian #lgbt #feminism #brittany griner

[humanoidmindbox]

Us Vs. Them

Abstract

In this essay, I will be assessing my personal feelings and attitudes toward different and defined groups. During this analysis, I will be breaking up the population into four groups: Us, Them, Allies, and Enemies. These groups have been formulated by and based on the workings and fields of psychology, psychiatry, individuals with mental illnesses (including me) and how societal norms fit into issues raised in this paper. I hope you find this to be worthwhile and I hope this sparks the fire of your intellectual flame.

-‐----------------------------------------

The American population, in the terms of mental illness, psychology, and sociology, fall into one of four categories which are detailed below:

US

This group of people are those who suffer from profound mental illness. The affliction must be (Your illness doesn't have to be all of these things, but it must be most of them):

Chronic; recurring; cause suffering; affect your relationships with others; make it so you cannot keep a job; make it so you cannot function in society; possibly get government compensation for your illness; *been hospitalized in the psych ward; been arrested when your symptoms were active; reckless and/or impulsive behaviors; suicide attempt(s); and became violent when your symptoms were active. 

Them

These people are the majority of the population. They blindly follow pop culture and buy into what the masses are doing, believing, and saying. They do not have severe mental illness although they may be diagnosed with the garden-variety depression and anxiety. They have never been to inpatient for mental disorders, except maybe once, a long time ago. They will try to relate to you when it comes to mental health but they are just regurgitating what the trendy treatments and hardships are (the commonplace “social anxiety” is on the rage right now). In the inpatient hospital, the Them are the hospital staff. Especially the ones who give you the shot and put you in isolation. They are the ones who pink slip you and call the police. They think drugs are bad. You can’t truly trust Them. They don’t understand you and they probably never will. Most of Them are not hateful or mean. They are just ignorant, inexperienced, and constantly lecturing you or preaching to you. Most of Them view you as less-than, whether it is intended or not. 

Allies

Imagine a straight line down the middle of a square. This divides the “Us” and “Them” that we already went over. But directly on that line, not leaning to one side or the other, sits the “Allies.” The Us’s allies have most likely not gone to the mental hospital except maybe once, long ago. But they have a mental illness that brings them suffering. They may be in mental health treatment. They struggle almost every day and their behaviors reflect that. They are a part of society and will never and have never been deemed unfit to be a working part of society. They get along with others although they feel like no one completely understands them. They do not blindly follow all of pop culture’s rules and trends. They support the Us. We can trust them somewhat. They are our allies. 

Enemies 

The Enemies only exist within the “Them” group. They are the ones we must watch the most carefully and never trust. Most of “Us'' do not have many Enemies on the outside but we have plenty of Enemies on the inside (inpatient). The Enemies at the hospital are those who give you the shot after they have to hold you down when you’re screaming and thrashing around because you’re so fucking freaked out. They are the ones who put you in four point restraints and let you “tire yourself out.” On the outside, the police are the Enemy for apprehending you while they get a pink slip. They are anyone who pink slips you. The Enemy tells you that you’re crazy when you know you are doing well. They threaten the hospital and hang it over your head. The Enemy treats you unfairly because something that you cannot control or help is wrong with you. The reason why Them can never be fully trusted is because any one of Them could become the Enemy at any time.

-------------------------------------------------------

I first felt the “Us Vs. Them” divide when I started frequenting mental hospitals. And when I started showing signs of severe  symptoms of mental illness. In the hospital, you are a “rat in a cage” (Smashing Pumpkins song) with the staff holding the only key to get out. A drastic power imbalance exists between the staff and the patient: we are the prisoners and they are the guards. All we want to do is get out. All we want to do is go home. And if not home, then at least to a different, free place. 

When I had my major mental breakdown/manic episode of winter 2019, I had been taking my medications- they were just the wrong ones. In the cage, you must take your medications, whether you want to or not. Whether you trust Them or not. If you refuse medication, They take you to court and get a court order forcing you to take your medication while you are inpatient. 

There are some key ways that the “Us” and the “Them” are different in the mental hospital dynamic. They own your body: you are forced to take medications, you are locked in a box (hopefully not isolation). You can’t hurt yourself and if you do, you will stay longer (same goes for violence against others). They control your behaviors: They deem what is “appropriate” and “inappropriate” behaviors. If you break the rules surrounding these behaviors, you will get the shot, isolation, moved to a worse ward (for the more violent and disruptive patients), restraint holds, staying longer, or any combination of these events. The worst one I can think of is moving wards up a number. They try to brain-wash you: They say: “There is only one way to live life and we know the correct way to live it.” “The correct way to live is only what we arbitrarily and subjectively call “healthy coping mechanisms” and you must abandon all “unhealthy” ones in order to live life correctly and avoid being society’s pariah.” “Your only hope to be a functioning person is to abide by the teachings of CBT and DBT. All other methods will not work.” They have the opinion that their methods of recovery always  work and if you are not having positive effects from their treatments, you must be doing it wrong- they deny that their treatments do not work for everybody and fail to recognize that the “bad” coping mechanisms are the only way that certain people can get by.

When you are mandated as an inpatient in the hospital, you have no rights. They take away your rights as a person. They tell you where to go, what to eat, and they control how long you are in there, what medication you take, and worst of all- when you get put down like a dog with a shot or when you switch to a more severe level. You are treated like an animal in a cage, and there is nothing that you can do about it. Losing control of your own body to this degree leads to something inside of you breaking  and you turning into a feral animal (hospital song). After that happens (especially if it happens multiple times), you are never the same. 

There are laws to keep other people from harming you or your property. I believe that it is a good thing that these laws are in place and that they should be upheld. But there are also laws that are made to prevent you from harming yourself and I don’t think such laws should exist. Once again, I question what the authorities, our working society (Them) and the masses (Them) deem “harmful” and ultimately illegal.

Most people in society simply follow popular culture. They just look to what the majority of others do and follow suit. But they have blinders on: they don’t see that they come up with justifications and sorry attempts at reasons to back-up their choice to blindly follow the majority.

The authorities and society says:

Drugs = Bad→ Laws against it.

Self-harm = Bad→ No laws against it but there is intense societal disapproval and shaming connected to it.

*It is the least harmful on this list because it does not alter your mood or drastically change your brain chemistry for prolonged periods of time. But, apparently, it is the most shocking and the most taboo. 

Medication = Good→ Sometimes there are laws enforcing it.  

I believe all of these things can be good or bad depending on the specific person that it affects. Everyone is different and if you simply follow what pop culture’s opinion is on these issues without looking into them further, it shows ignorance, a lack of curiosity and exploration, rigidity, and a propensity towards the judgement of others. It often signifies that the “Them” in question is too weak to think for themselves and to withstand society’s brainwashing. 

I will never think of cutting or drugs as “bad coping skills.” “Good coping skills” consist of talking about your issues and crying according to the “Them.” And according to the hospitals, CBT, and DBT, good coping skills include activities like aroma therapy and drawing. But what do these things do? Nothing. You need a release or a change in the state of mind. Talking about what upsets you is just reliving it all over again. Plus, what if you do not trust anyone enough to tell them what's on your mind? Crying is bullshit. I feel that it is pathetic for me to cry. That’s just how I feel. I have trained myself not to. So why should I do something detrimental to myself when I am already in distress? “Good” coping skills don’t really work and only the simple-minded buy into them. “Bad” coping skills shouldn’t be judged as bad or taboo just because others have all-or-none thinking about them when it's the only thing that helps some people.

Medication: Taking medication should be the mentally ill’s choice. Medication is not right for everybody; it is not always the best thing to do. Not everyone likes themselves on medication. Who are we to judge if a person is the “correct” version of themselves or not? Forcing someone to take psychiatric medications is rooted in a power and control structure that overshadows others. I believe that we should leave others alone when it comes to this and let them live how they want to live. Just because we’re mentally ill, doesn't mean we have to do what you want with our bodies anymore.

In conclusion, I believe individuals and society as a whole should look beyond the systems of the law, procedures in mental health facilities, standard practices of therapies, pop culture trends/rules , and societal norms to find each of our unique spots in this society. We need to rethink what is considered “unhealthy” and what is “healthy” and why we put actions into those categories. We need to be more open and steer clear of letting others dictate what we believe. I’m tired of being lectured and shamed. Let's move on together. 

#mental hospital #mental illness #mental health #mental disorder #essay #prose #prose essay #sociology #abnormal psychology #psych #psychology #psychology student

[soakinforsif]

Just Let Logan Read 2020 (1865 words)

Quick A/N before the fic, this is set outside of canon in what I call ‘everyone gets along verse’ inside my head, and I have put them in my version of the ‘mindscape’, where they can go into the real world to interact with Thomas, but they can’t interact with anything from the real world that Thomas hasn’t (in the case of this story, that applies to books) Logan uses they/them and Virgil uses ze/zem/zir because I said so and NB sides rule. 

All of the sides and THomas (except Roman, who is referenced) are in it and sympathetic, besides that, TWs for implied nudity and kissing. Please let me know if there are any others I need to tag!

Logan finally set aside the last of their work for the foreseeable future. They’d been working just about nonstop for the past week, trying to catch up with their normal scheduling and editing as well as trying to assuage some of Thomas’s fears about the quarantine. Now that they had some free time, they wanted nothing more than to curl up with a new book and a cup of tea. The problem with that, was that being an actual human’s ‘side’, and thus not having access to the real world past Thomas’s experiences, they could not read any books that Thomas had not, and therefore needed to convince Thomas to read something new, preferably a horror book, their favourite genre. 

Logan did briefly worry that reading a horror book, and by extent Thomas reading a horror book, might worry Virgil even more about the current pandemic, but they had an arsenal of research on escapism to defend himself, and Virgil had a very good support system in place in case of this, having recently reconciled and resumed zir romantic relationship with Janus and Remus. Logan was very glad to hear this, as they cared about the anxious side very much. (This care was, in part, due to Logan being head over heels in love with zem, although you’d have a hard time getting them to admit even a slight romantic attraction.) 

The much more pressing obstacle that Logan expected in his quest to finally get to read was Roman and Patton. Unlike the former ‘dark sides’, the two of them had been together for quite some time. The longevity of their relationship had done nothing to curb their enthusiasm, however, and they spent a great deal of their time together, and in spare time for them all like this tended to engage in rather grandiose displays of their affection. 

Due to this, Logan decided that if they wanted their quiet afternoon of reading, they would have to ask the two lovebirds to tone it down for a while, please and thank you. 

They chose to approach Patton (assuming Roman wasn’t already with him) mainly arbitrarily, but also because Logan was a bit worried that asking Roman to tone down his… romantic tendencies might offend him somewhat (especially in conjunction with their rather blunt phrasing) 

They knocked on Patton’s door, barely having time to bemoan about the peeling stickers covering it to themselves before it opened. 

“Heya, Logan!” Patton greeted, smiling, “Finally taking a break?” Logan smiled back, 

“Yes, Patton, thank you for your concern. I actually came to ask a favor, if that’s alright?” 

“‘Course, Lo! Whatcha need?” Patton looked just as happy, if maybe a little concerned for Logan, and they had to take a second to remind themselves that they weren’t asking for that much really and that they are not a burden before they spoke again 

“Um, I was wondering, if it’s not too much trouble,” Patton was looking increasingly concerned for Logan, 

“If you and Roman could, um, tone it down? With the romance today? As you know, our emotions impact Thomas’s somewhat, and I’d like to finally get to a new book today.” 

“Oh, sure! We actually didn’t have anything planned today, so if anything we’ll just hang out.” 

“Thank you Patton, I appreciate that.”

“No problem Lo, good luck with the reading!” Logan muttered a thanks, and left with a wave. 

Now they just needed to convince Thomas. 

When Logan popped up in the living room, Thomas was reading something on his phone. He seemed remarkably engaged, he hadn’t even noticed Logan pop up. 

“Thomas?” no such luck. They leaned away from the stairs, towards Thomas. 

“Thomas!” 

“AH- oh hey Logan!” Thomas recovered quickly from his startle. 

“Hello, Thomas, I apologize for scaring you.” 

“Nah, you could never scare me Logan, you just startled me, you do it almost as well as Virgil!” he joked. Logan knew it was a joke and an offhand one at that, but he still blushed at the comparison. Thomas cocked an eyebrow at them, but relaxed it quickly, resuming his cheerful expression. 

“So, what’s up? You don’t usually pop up if it’s not for a video or something,” Logan frowned at that, perhaps they should venture to make more social calls? 

‘Well, not this time, in fact I actually have some free time and I came to ask you a favor,” Thomas motioned for them to continue.

“Well, you know about my… penchant for reading, particularly horror novels, and I was hoping that you, er, we might read a new one?” 

“Oh, buddy, you didn’t have to be nervous about that!” Logan bristled a little at how easy they were to see through, and Thomas chuckled a bit.

“How much free time do you have? I’m pretty into this story I’m reading now, maybe we could read IT or something tomorrow?” Logan was disappointed at that, but tried to contain it, nodding at Thomas. They were quite ahead after all. 

“Of course, Thomas, I’ll still be free then,” They tried to smile reassuringly at Thomas, but the answering one was still apologetic. 

“If I may ask, what were you reading just now? Perhaps it might interest me as well.” 

“Oh, well, I don’t know, maybe, it was just some fanfiction for that new anime I’m into, it’s pretty good but I don’t know if ‘found family’ is really your thing?” That caught Logan’s interest, wasn’t that why they asked Patton and Roman to tone it down? But… Patton was anything but a lier, and a found family fic was a little… soft to be influenced by those two. 

Oh shit. If it wasn’t them, then that meant the others, which meant Virgil. Logan was not looking forward to this conversation. 

“Apologies, Thomas, I understand now. I will see you tomorrow.” And with that, they sunk out, cutting off whatever confused utterance Thomas was about to say. 

They rose up near Virgil’s door, dreading another ‘can you please not be horny so I can read’ conversation, especially with their crush. Well, at least they were giving some warning this time, and maybe that warning would help prepare zem for what Logan planned to read tomorrow? 

Logan gave a courtesy knock to Virgil’s door (which had fewer sticker’s than Patton’s, but the artfully distressed and chipped paint irritated Logan no less) Logan and Virgil had been quite close lately, a double edged sword in Logan’s opinion, since it meant Logan was frequently close to zem, but nowhere near as close as they would like, but regardless, due to the close nature of their relationship as of late, they had agreed that they were welcome in Virgil’s room anytime (and vice versa) so long as they knocked, so after doing so, Logan opened the door, a greeting on their lips. 

Oh. Logan froze. In the back of their mind they told themselves that agreement or no agreement they would definitely wait for Virgil to answer next time. Because while the three sides in the room were technically doing little more than kissing, it was still a very… intimate moment, and Remus was wearing very little. 

Finally having processed enough to realize that they should definitely not be standing in the doorway still, Logan moved to back out and close the door, but before they could, a pair of eyes locked onto their own. 

“L! What are you doing?” Virgil was bright red, and while Logan couldn’t be sure, they were pretty sure they were blushing just as much as zem. 

“I- it’s not important, I will leave.” 

Janus looked at ehm, considering, the same time Remus exclaimed, 

“No need to do that!” 

“Remus!” Virgil admonished, turning to Logan, apologetic. Logan wanted nothing more than for the ground to swallow him. They wanted nothing more than to join the three sides, and it was the three of them, they realized, Remus with his earnest curiosity and enthusiasm, Janus with his sly flirting and tendency to bully his loved ones into self care, not to mention Virgil with zir intelligence and fierceness and softness. Shit. 

Logan almost dared to have hope for a second when he looked back up at his three crushes. Remus was smiling a little unnervingly at them, Virgil was still looking at them apologetically with that blush on zir face, and Janus, Janus was smirking at Logan in a way that made them feel just a little bit like prey, but by no means in a bad way.

“Remus is right,” Janus purred, ignoring Logan and Virgil’s shock, 

“After all, you came here to tell V something, didn’t you?” 

“This is not how we agreed to do this,” Virgil grumbled, and Logan couldn’t even begin to wrap their head around what that meant, so they just decided to answer Janus’s question.

“Why I came is… not important. You were busy, I should leave.” Janus hummed, 

“That’s not a lie, but I don’t think it’s quite the truth either… regardless, it’s not an answer.” Logan sighed, stubborn as they were, Janus had them beat in that regard, as well as the fact that (provided he was paying enough attention), he could tell when they were lying. They were going to have to tell them why they were here. 

“I wanted to ask if, tomorrow, you all could tone it down with the… romance, so that Thomas can focus on reading, but as I said, it is not important and I can leave.” Remus laughed, and Janus looked just as amused. 

“And, do you still want us to ‘tone it down’? As ze said,” Janus motioned to Virgil, “This wasn’t exactly our plan, but I have no complaints with you staying.” Remus grinned and nodded enthusiastically at Logan, looking at them hungrily. Logan looked, shocked, at Virgil, and ze met their eyes with a shy smile. 

“Just to make sure I’m not… misinterpreting, what exactly are you offering?” Logan asked quietlyC. Remus got up then, the first of them to leave the bed, and Logan realized that he was wearing even fewer clothes than they had realized. 

Logan very pointedly looked up at Remus’s face, and he took their hand, (if it hadn’t been Remus, Logan might have thought he seemed shy) 

“We were gonna ask tomorrow since Virgey said you’d be free!” Remus started leading them towards the other two, all three of them looking at Logan with different degrees of nerves and affection, 

“We really like you,” Virgil said, and Logan gasped, unbelieving how lucky they were, 

“So, L, would you want to join us? Our relationship?” Virgil finished. 

Logan lunged at Virgil then, kissing zem briefly before switching to Janus. They broke away, looking at Remus. “Yes,” they said, “I’d love to!” Remus moved to kiss them then, but Logan stopped him. 

“I’m not kissing you until you put on some pants.” 

“Lie” Janus said, and Remus’s disappointment melted away as he moved to kiss his new partner. Virgil threw some shorts at Remus, winking at Logan when they turned to look. Logan laughed, the happiest they’d been in a long time. 

Maybe they could settle for a romance, instead of a horror. 

#sanders sides #sanders sides fanfiction #logan sanders #character thomas #patton sanders #virgil sanders #janus sanders #remus sanders #tw kissing #tw nudity mention #long post

[threewaysdivided]

Quality Should Not Be Binary

In my wanders through life in general - and the internet in particular - I’ve noticed a strange mindset regarding the quality of media and the people who produce it.  It’s this weird idea that something is either 100% perfect, flawless and ‘how dare you claim to be a real fan while suggesting there’s anything wrong’, or that it’s completely awful, valueless and ‘you’re a terrible person for enjoying that or thinking it has anything to offer’ - sometimes flipping from one to the other as soon as a ‘flaw’ is revealed, or a ‘bad’ work does something suitably impressive.

This mindset has never really made sense to me.  Maybe I’m a just habitual over-thinker who spends unhealthy amounts of time analysing things, but I can’t see how this sort of absolutist approach would do anything other than shut down discourse, limit the value to be had from a piece and maybe make people angry.

So in honour of that please enjoy some indulgently long navel-gazing about critical analysis and media quality.

Disclaimer: This post is going to summarise my personal philosophy. Everyone approaches life - and especially art - in their own way and far be it for me to say you’re wrong if you prefer a different approach.  You do you.

Blindness Hurts Both Ways

To an extent I get the simple yes/no mindset.  Analysis takes time and it would be exhausting to give an extensive, nuanced breakdown on your view at the start of every discussion.  Plus the whole ‘dissecting the frog’ thing can definitely apply to enjoyment of media.

However, taking it to the point where you’re denying the positive side of things you dislike or refusing to acknowledge faults in works/people you enjoy has the potential to swing around and bite you in the butt.

Why deny yourself a useful experience? I think there’s an important distinction to make between being good and being useful. Subjective, technical or, ethical ‘badness’ is not the same as having no value. Similarly, being touching, entertaining or otherwise enjoyable doesn’t preclude something from having genuine problems.

Personally, I can find it difficult to work out exactly what’s going right in a generally positive piece.  After all, ‘good’ doesn’t hinge on a single point - it’s usually the product of a lot of things working well together, and it can be hard to figure out cause and effect in a system like that. It’s much easier to look at a failed attempt and identify the specific elements that caused problems, where it had the potential to recover, and places where it might be succeeding in spite of those issues. Similarly, some works can be very strong except when it comes to ‘that one thing’, which in itself is a useful reference.  Negative examples can be just as beneficial as positive ones, and turning a blind eye to a piece’s weaker aspects just denies you that tool.

On the other hand, sometimes a piece and/or creator can be ethically awful while being technically strong or succeeding at its intended purpose. In this case, while they’re not positive it can certainly be valuable to analyse the techniques they use, and even apply those tools when selecting and creating things for yourself.

It’s important to remember that acknowledging where something is strong isn’t the same as endorsing or supporting it, and that there’s a huge difference between pointing out a genuine weakness or failing and maliciously hating on a work or creator.

Why give something that much power? Starting with the gentler side, I think it’s important to remember that a work being ‘good’ on the whole shouldn’t be an excuse to gloss over possibly troubling elements or to give creators a free pass on their actions.  Sure, even the best-intentioned artists make bad PR and creative decisions sometimes but it’s also valid to acknowledge and call out possible misbehaviour when it crops up, rather than blindly playing defence until it reaches critical mass and undermines the good of their work (or worse, actually hurts someone).

There can also be a danger to simply writing off and ignoring ‘bad works’, especially if you dislike them based on ethical grounds.  If something ‘bad’ is becoming popular it’s usually a sign that it’s getting at least one thing right - whether that be plugging into an oft-ignored hot-button issue, or simple shock-value and shameless marketing.  Attributing the success of such pieces to blind luck and ignoring any potential merits that got them there opens up the potential for other, similarly objectionable works to replicate that outcome.

Not to mention the issues that can come from letting these things spread unchecked.  Think about how many crackpot theories and extreme notions have managed to gained traction, in part due to a lack of resistance from more moderate or neutral parties who at the time dismissed them as ‘too stupid’ or ‘too crazy to be real’.  Unpleasant as it may be, I think there’s some value in dipping into the discourse around generally negative media.  If nothing else, shining a spotlight on the misinformation or insidious subtext that a work might be propagating can help genuine supporters notice, sidestep or otherwise avoid the potential harms even as they keep enjoying it.

Why lock yourself into a stance like that? Maybe it’s just my desire to keep options open, but it seems like avoiding absolutist stances gives you a lot more room to move.  Publicly championing or decrying a work and flatly rejecting any counterpoints runs the risk of trapping yourself in a corner that might be hard to escape from if your stance happens to change later.  If nothing else, a bit of flexibility can help you back down without too much egg on your face, not to mention shrinking the target area for fans or dissenters who you might have clashed with in the past.

A little give and take can also help build stronger cases when you do want to speak out.  Sometimes it’s better to just acknowledge the counterpoints you agree with and move on to the meat of the debate rather than wasting time tearing down their good points for the sake of ‘winning’.  The ability to concede an argument is a powerful tool - you’d be surprised how agreeable people become when they feel like they’re being listened to.  

Finally, from an enjoyment perspective, is it really worth avoiding or boycotting what could otherwise be a fun or thought-provoking experience just because you don’t 100% agree with it or have criticised it in the past? Sure, there are absolutely times when a boycott is justified but why deny yourself a good time just because it involves an element that’s been arbitrarily labelled ruinous.  ‘With Caveats’ is a perfectly acceptable way to approach things.

Existence vs Presentation of Concepts

A rarer argument that occasionally pops up is the idea that certain works are inherently ‘inappropriate’, ‘distasteful’, or should otherwise be avoided purely based on their subject matter.  Usually this revolves around the presence of a so-called ‘controversial’ topic; things like war, abuse or abusive relationships, sexual content, bigotry and minorities (LBGT+ relationships being a big one right now).

Personally I think this is a reductive and pretty silly way to choose your content.  No topic should be off-limits for any kind of media. (With the possible exception of holding off until the target audience has enough life experience and critical thinking skills to handle it.  There is some value in TV rating systems.)  Yes, some concepts will be uncomfortable to confront, but they are part of life and trying to keep them out of mainstream art simply stifles the valuable real-world discussions and conversations they might spark.

What we should be looking for is how a work handles the concepts it chooses to use.  There’s a world of difference between presenting or commenting on a controversial topic as part of a work, and misrepresenting or tacitly condoning inappropriate behaviour through sloppy (or worse, intentional) presentation choices.  The accuracy of research and portrayals, use of sensitivity and tact, consideration for the audience and overall tone with which a topic is framed are much more worthy of consideration than simply being offended that the idea exists in media at all.

‘Bad’ Art, ‘Good’ People and Vice Versa

I think it’s important to remember that our content creators are, well, people.  They’re going to have their own weird taste preferences, personal biases and odd worldviews that will sometimes show through in their output. They’re also going make mistakes - after all, to err is human.  Unfortunately, in the creative pool you can also find some genuine bigots, egotists, agenda-pushers, abusers and exploitative profiteers who don’t care about the damage their work might be doing.

It can be discomfiting to notice potentially negative subtext in the work or actions of a creator you like, and upsetting to realise that a work you love is the product of a person who you can’t in good conscience support.  Which of course leads to the discussion of art, artists, whether they can be separated and what to do when things go wrong.

Obviously I’m going to be talking primarily about the ethical/moral side of things, as I think most of us are willing to forgive the occasional technical flub, production nightmare or drop in outward quality from creators we otherwise enjoy.

It can also be a touchy subject so I’d like to reiterate that this is just an explanation of my personal philosophy.  My approach isn’t the only way and I won’t say you’re wrong for taking a different stance or choosing to stay out of it entirely.  

‘Bad’ art from an apparently ‘Good’ person In general, when it comes to apparent bad behaviour or negative subtext from otherwise decent creators, I favour the application of Hanlon’s Razor.

Hanlon’s Razor Never attribute to malice that which can be adequately explained by incompetence - at least not the first time.

Art is a subjective medium, with multiple readings and interpretations being possible from the same piece.  It’s definitely possible for an author to lack the  awareness or experience needed to notice when unintended implications or alternate readings have crept into their work.  Sensitive topics are tricky to handle at the best of times and seemingly harmless edits or innocuous creative choices can stack into subtly nastier tonal shifts. Similarly, being a good creator doesn’t automatically make them good at PR or talking to fans - it’s easy to get put on the spot or to not realise the connotations of their phrasing and how it may have come across.   Of course this still means someone messed up, and it’s totally reasonable to call them out for ineptness, but I’d take an unfortunate accident over malicious intent any day.

Then there are times when the negative subtext is a lot less unintentional.  In that case I think it’s important to make the distinction between creator sentiment and the sentiment of the work, character or their production team (if collaborating) before making a judgement on them as an individual.  For example, the presence of casual bigotry might be justified in historical piece that’s attempting to accurately portray the culture of the time, and a creator/actor might write/portray a protagonist with biases and proclivities that they personally disagree with for the sake of a more compelling story.  The presence of a worldview within a work doesn’t automatically translate to the opinion of it’s creator.

Similarly, when considering a problematic production or team it’s worth acknowledging which positions hold creative power, if every member is complicit and why a dissenting individual might stay silent; whether out of contractual obligation, a desire not to throw colleagues under the bus or just because they don’t have the financial security to risk rocking the boat or walking away from the role.   It’s important to figure out who the buck stops with before we start pointing fingers.

Overall, I don’t think there’s much value in passing judgement on an artist for the troublesome content in a single work.  You’ll get more mileage and a fairer assessment from looking holistically across their collection and personal/private channels for telling patterns of subtexts and behaviours.  For the most part I prefer to offer the benefit of the doubt until there’s enough supporting evidence or they do something to definitively out themselves.  Speculation fuelled witch-hunts are no fun for anybody.

‘Good’ art from ‘Bad’ people Exactly what defines a ‘bad’ creator will vary (there’s a reason I’ve been putting the terms in inverted commas).  Whether it’s a disagreement with a key opinion/ creative philosophy/ method, that they’ve done something actually heinous/ illegal, or anywhere in between, enjoying a work while being in conflict with the creator can be a difficult situation to reconcile.  Personally I think there's power to the Death of the Author argument in these cases:

Death of the Author An author's intentions and biographical facts (political views, religion, race etc.) should hold no special weight in determining an interpretation of their writing.

If you’ve found value or enjoyment in a work then you’re well within your rights to enjoy the work on those grounds, even if the message you’ve personally taken from it runs counter to the original author’s opinions or intentions.  

It’s also important to remember that a creator’s personal and/or moral failings don’t retroactively invalidate their skill and achievements in their field.   It’s possible for a person to continue offering valuable insights, observations and lessons on their chosen speciality in spite of their other behaviour or stances.  Their work can have value in isolation, although it may be worth taking the information with a grain of salt when it comes to possible biases.

This becomes a little harder when the disagreeable sentiments bleed directly into their creations but, again, there’s no reason why you can’t decide that the strengths of a work are worth looking at even if they take some squinting past uncomfortable elements to appreciate.

The question should never be ‘can I still enjoy the art?’ because that answer is always yes - if you liked it before learning about the artist then you’re allowed to keep doing so afterwards.  The new context may add caveats to the discussion but it doesn’t demerit the existing positive aspects.

However, Death of the Author runs into problems when the creator is still alive.  If the artist is out of the picture then you can engage freely without any financial support or publicity going back to them.  When they’re still around the question becomes ‘do I still feel comfortable supporting them?’ This is particularly relevant when it comes to online creators, as just interacting with their content can generate passive ad revenue, increase view counts and contribute to algorithm boosts.

I honestly don’t think there’s any one answer to this particular question.  It all comes down to a personal case-by-case judgement; weighing the severity of the conflict against how much you value their work and, in the case of creative teams, whether you think their colleagues are worth supporting despite them.  Even if you decide to pull back there are soft options before going for a full boycott; using ad-block to limit passive financial contributions, buying physical media second-hand or lending/borrowing hard copies to avoid generating any new purchases.

There are creators that I disagree with politically but continue to enjoy because their stance isn’t especially harmful or is relatively minor compared to the value of their work.  There are creators who I no longer want to support but whose pieces I like enough that I don’t regret having purchased from them in the past.  On the other hand, there’s a creative team whose content I adore in isolation but who I’ve had to drop entirely after their leader was outed as an emotionally manipulative office bully.  Where someone else would draw that line comes down to their own personal standards, and it wouldn’t surprise me if another person took a completely different approach.

Don’t be a Jerk

I feel like this should go without saying.  Rational discussion is great.  Being able to have a critical discourse - even one that’s focused on the more negative sides of a work - is wonderful.  Opinions are fun.

However, the thing with opinions is that a lot of them differ.  We aren’t always going to sync up and there are times when you shouldn’t, and won’t be able to, force someone to agree.  In that case, please don’t attack them over it.  You don’t have to like or respect their views but some basic civility would be appreciated.  You’re trying to have a conversation, not win a catfight.  Condescension, derision, high-horsing, ad hominem and otherwise getting personal doesn’t tend to win many friends or endear them to your perspective.   And to the rare few who go so far as to threaten or harass fans, creators and their families; that’s an awful, completely unnecessary, out of line thing to do. (Seriously, never do this, it won’t help and just makes you look crazy.  Also, it can be considered criminal behaviour.)

It’s also important to know when to let things go.  You’re not always going to be able to turn the tide and constantly chasing the argument, stirring the pot and fighting waves of push-back eventually reaches a point of diminishing returns.  No matter how important the issue is there’ll be times when you’re just screaming into the void.  The best you can do is make your peace, say your piece and take your leave.  After all it’s not the school playground.  And unlike the playground, we’re not obliged to stick around.

Value Judgements: It’s Good to Examine Your Tastes

At the end of the day I think you get more mileage from reaching an opinion based on a value judgement of a work’s positive and negative sides than you do from just bandwagoning into blind adoration or hate.  ‘Perfect’ and ‘Unsanctionable’ aren’t binary boxes - they’re points on a scale, and figuring out where you stand on a piece can be a useful mental exercise.  Even if your opinion ends up matching the general consensus, at least you know how you got there and can defend yourself if challenged.  

If nothing else this kind of thing can help you figure out what elements you like, dislike and prioritise in media, and where your personal boundaries lie in regard to different issues.

Still, even after all this there are plenty more factors that determine whether or not you’ll enjoy something.  I’ve dropped way more pieces for not being to my subjective liking than I have due to technical or ethical flaws.  Your tastes are your own, and if needed you can stop the conversation at ‘it’s just not my thing’.

In the end there’s no ‘correct’ way to be a fan of something.  We’re all just here to have fun.  So try not to be an ass when you run across someone who does things differently.

#Scattered thoughts #thinking about media #examining your tastes #acknowledging flaws doesn't make you less of a fan #no work is perfect #your tastes are your own #and that's fine #critical thinking #long post #really long post

[livinginlandmarketing]

When the coronavirus pandemic hit, Paco Licea and his wife immediately had a question: Where were they going to eat?

Both spend a lot of time on the road, he as a real estate agent, she as a police officer.

“And I thought, ‘Wouldn’t it be good to call all the restaurants and see what’s opened and closed,’” Licea said.

But when he started talking to restaurant owners, the grim reality of the situation set in.

“The owners told me they’re really hurting,” Licea said. “I was around in ’07, ’08, ’09, so I know what it’s like to have your business dry up.”

And the Riverside man decided to do something about it, starting the Facebook group now known as Riverside Area Food Open After Lock Down.

Sign up for The Localist, our daily email newsletter with handpicked stories relevant to where you live. Subscribe here.

“Social media was the fastest way” to get the word out, Licea said.

As was free food.

Licea would go to a restaurant, take photos and talk about his meal, but not identify the restaurant. Commenters — and the group now has more than 2,500 members — would guess the restaurant. Those guessing correctly would be entered in a drawing for a free gift card to eat at the restaurant, which Licea paid for out of his own pocket.

“Every time I would post a picture in a contest, a lot of people would be asking ‘Where is that from? What is that?’” Licea said. “And people would chime in saying where it is, ‘they’ve got the best pastrami,’ and people would say they’ve got to go there.”

Paco Licea, right, is seen with Eduardo Pintos, owner of Pepito’s, in Riverside on Wednesday, Dec. 16, 2020. Licea uses Facebook to drum up support for local restaurants during the pandemic. (Photo by Watchara Phomicinda, The Press-Enterprise/SCNG)

The first restaurant profiled was Pepito’s Mexican Restaurant on Canyon Crest Drive in Riverside.

“Any publicity is good publicity at this point,” owner Eduardo Pintos said.

The pandemic hit business hard, forcing Pintos to close one of the restaurant’s two locations, on Magnolia Avenue.

Pintos said he appreciates Licea’s focus on local restaurants over chains.

“It’s a different ballgame for big corporations. They have money coming in from other sources. We depend 100% on our local customers,” he said. “When they decided to go out and support local businesses, what they’re really doing is keeping us alive. Every penny they get, it goes to paying the bills and keeping the doors open.”

Licea said the page appears to have opened members’ eyes to the many great local options they had driven past for years without ever trying.

More about restaurants during the pandemic

Riverside County coronavirus hospitalizations hit 1,000 for first time

Hometown Buffet holds liquidation auctions across Southern California

Judge says L.A. County acted ‘arbitrarily’ closing outdoor dining in ruling

Which Downtown Disney and Buena Vista Street restaurants are open and closed

Restaurant closings top 110,000 with industry in ‘free fall’

“It’s bringing awareness to restaurants that we didn’t even know existed before COVID, to be honest,” Licea said. “We’re creatures of habit, we always eat at the same sushi, same Mexican restaurant, same Subway shop. I know that’s what I would do.”

Facebook group member Lashon Halley is impressed by what Licea is doing for his community.

“He’s just trying to keep the businesses on people’s radar,” she said. “To me, that’s what it’s about: being out there and providing a picture of what we don’t see.”

Now, as Southern California is back in a lockdown and local businesses are reeling as COVID-19 cases spike to record levels, Licea is asking group members to post their receipts when they eat out locally and is submitting those who do into a twice-monthly drawing for $50 in lottery scratch-off tickets.

“We’ve got to go from this mentality of thinking that times are tough, so let’s not do anything, to the opposite, and work with our community,” Licea said.

-on December 21, 2020 at 05:01AM by Beau Yarbrough

#riversidenews

[the-merricatherine]

"Gender and the Abjection of Blackness"'

Sabine Broeck on Mary Wollstonecraft's antiblackness / racism (pp. 57-60)

To illustrate the Vindication's textual and political saturation, even infatuation, with the slave as a troping device, I have contracted three paradigmatic passages, which illustrate the paramount value of slavery for Wollstonecraft's argument. These passages also amplify the process by which a progressive and libel-awry textual concept of women's genderedness—a concept to write woman into Enlightenment as a subject, that is, a mode to create intelligibility for the female complaint and her demand—emerges by way of writing woman as not a slave.  Wollstonecraft's project is white women's liberation from the constraints of early modern patriarchal society that renders them childlike, immature, bereft of property, education, and rights, subject to sexual exploitation and abuse, and submitted to legal, political, and social dependency on husbands or families. In order to realize this project, she needed to construct woman as a promising antagonist to man. Woman needed to be cast as a subject who could and would be able to struggle for and negotiate, As a call for the acceptance of her gender's humanity, the rights of women to participation in civil society and for equality with men in political, cultural, and social life. In order to create gender as a potentially successful site of struggle for the reform of modern views of humanity, that is in order to gender the human, Wollstonecraft needs to position white woman as human in the first place. The rhetorical device most immediately available, given Wollstonecraft's historical context, is the dramatic and proactive separation of his woman from the slave. Only if woman can be clearly separated from the slave, can she enter the discourses and practices of civil society as a human member, however discriminated against. This maneuver entails that, on one hand, the Vindication makes use of the slave as a richly productive metaphor in absurd profusion, but, on the other hand., that metaphor must be safely kept severed from its potential to signify actual enslavement of Black being. That means the metaphor must be kept within a referential horizon of the white female complaint. At the time of the Vindication's publication, however, this was by no means a settled issue; the material presence of the Black abject slave thing, and the late, of white women's closeness to slave, or slave-like status, always already threatened to destabilize the workings of gender as a manageable binary intrahuman contradiction. 

Shrewdly, Wollstonecraft positions white women as willing cooperands in what she considers their slavery and exhorts them to abandon the state of slavishness which keeps them fastened to patriarchy's reign. Only if women will abandon this slavishness—so their dramatic appeal—will civil society recognize white women as human agents, because they are not slaves, which they demonstrate by the very propagandistic refusal of their own slavishness. One needs to acknowledge the very political ingenuity and textual creativity to have lit upon anti-slavery to preemptively counteract the latent threat, in Wollstonecraft's moment, of women being left behind by the humanist, bourgeois revolutionary ferment emerging in Western societies, and abandoned to poverty, childbearing, and drudgery, or wealth and boredom. At our point in time, to see the woman-as-slave metaphor in operation might not strike one as particularly innovative, but for the late 1700s, with actual Black enslavement being a controversial fact of public life in enslavist nations like Britain, it must be considered a breathtaking textual breakthrough: to have found a rhetorical device which would speak to Wollstonecraft's potential female audience by appealing to their social, cultural, and political emergence as civic actors, thus giving them the horizon of futurity and a possible genealogy of freedom that the slave precisely could not have. It also launched a sense of white feminist avant-gardeness based on the textual installation of a necessary female abhorrence vis-à-vis the slave's assumed slavishness, that even at her historical moment could have—and did with Black protest—registered as an interested white fiction. And, last but not least, this device shrewdly enabled more progressive,  enlightened masculine potential support by way of illustrating to interested parties the social, political, and cultural waste dynamic that rapidly modernizing and capitalizing societies would risk by keeping woman in the state of frivolous, under-challenged and dependent ridiculousness of the slave's purported flippancy, incapacity, ignorance, and mental weakness. The gross anti-Black violence here lies in the supreme irony with which Wollstonecraft's astute observations of wealthy women's actual behavioral frilliness and inconsequential existence—kept as they were as ornamental appendages to their husbands and families—is being scripted back on the slave, making a specifically aristocratic version of white femininity the sign of the slave's inherent character. This rhetorical move of purposefully endowing the slave and his or her Black progeny with ascriptions of useless femininity attached to the adynamic commodity has lasted way into our contemporary moment. Here are the Vindication's passages (Macdonald and Scherf), which I quote at length and give together, for rhetorical effect: 

Is not the following portrait—the portrait of a house slave? "I am astonished at the folly of many women, who are still reproaching their husbands for leaving them alone, for preferring this or that company to theirs, for treating them with this and the other mark of disregard or indifference; when, to speak the truth, they have themselves in a great measure to blame. Not that I would justify the men in anything wrong on their part. But had you behaved to them with more respectful observance, and a more equal tenderness; studying their humours, overlooking their mistakes, submitting to their opinions in matters indifferent, passing by little instances of unevenness, caprice, or passion, giving soft answers to hasty words, complaining as seldom as possible, and making it your daily care to relieve their anxieties and prevent their wishes, to enliven the hour of dullness, and call up the ideas of felicity: had you pursued this conduct, I doubt not but you would have maintained and even increased their esteem, so far as to have secured every degree of influence that could conduce to their virtue, or your mutual satisfaction; and your house might at this day have been the abode of domestic bliss." Such a woman ought to be an angel—or she is an ass—for I discern not a trace of the human character, neither reason nor passion in this domestic drudge, whose being is absorbed in that of a tyrant's." (97-98) 

"A slavish bondage to parents cramps every faculty of the mind; and Mr. Locke very judiciously observes, that "if the mind be curbed and humbled too much in children; if their spirits be abased and broken much by too strict an hand over them; they lose all their vigor and industry." This strict hand may in some degree account for the weakness of women; for girls, from various causes, are more kept down by their parents, in every sense of the word, than boys. The duty expected from them is, like all the duties arbitrarily imposed on women, more from a sense of propriety, more out of respect for decorum, than reason; and thus taught slavishly to submit to their parents, they are prepared for the slavery of marriage. I may be told that a number of women are not slaves in the marriage state. True, but they then become tyrants; for it is not rational freedom, but a lawless kind of power resembling the authority exercised by the favourites of absolute monarchs, which they obtain by debasing means. I do not, likewise, dream of insinuating that either boys or girls are always slaves, I only insist that when they are obliged to submit to authority blindly, their faculties are weakened, and their tempers rendered imperious or abject. I also lament that parents, indolently availing themselves of a supposed privilege, damp the first faint glimmering of reason, rendering at the same time the duty, which they are so anxious to enforce, an empty name; because they will not let it rest on the only basis on which a duty can rest securely: for unless it be founded on knowledge, it cannot gain sufficient strength to resist the squalls of passion, or the silent sapping of self-love. But it is not the parents who have given the surest proof of their affection for their children, or, to speak more properly, who by fulfilling their duty, have allowed a natural parental affection to take root in their hearts, the child of exercised sympathy and reason, and not the over-weening offspring of selfish pride, who most vehemently insist on their children submitting to their will merely because it is their will. On the contrary, the parent, who sets a good example, patiently lets that example work; and it seldom fails to produce its natural effect—filial reverence." (160-61) (continued...) 

https://books.google.com.ua/books?redir_esc=y&hl=uk&id=edVdDwAAQBAJ&q=wollstonecraft#v=onepage&q&f=false

#mary wollstonecraft #racism #womanism #feminism #Sabine Broeck #antiblackness #wollstonecraft

[euteh]

The Biggest Problem for ICOs? In 2018, It Was Their Own Investors

Simon Seojoon Kim is CEO and partner at Hashed, a crypto-focused accelerator focused on community building and impact investing. The following is an exclusive contribution to CoinDesk’s 2018 Year in Review. 

At the beginning of 2018, the blockchain community reached the pinnacle of the ICO bubble. The slogan of ICOs, which promised that “anyone can invest in an initial project,” sounded wonderful and future-oriented. However, as the prices of most ICO tokens continued to tumble over the past year, it appears that the first chapter of this grand experiment has ended in failure. Why do most ICOs fail to succeed? Some would cite the greed of individuals blindly looking to make a quick fortune, incompetent project teams led by entrepreneurs that lack expertise, the technical limitations of platform blockchains that lack scalability and inadequate regulations in countries that have been unable to keep up with changing market conditions. These are all true. However, there is little to learn from this, as these are difficulties that all innovative, paradigm-shifting technologies face when forging new markets in their early stages. In this article, I aim to take stock of the current situation by examining the inherent limitations of ICOs, in particular the belief that “anyone can invest in an initial project,” and discuss some potential solutions.

The popularity of group purchasing channels

Despite the burst of the ICO bubble, the blockchain craze in Asian markets is not waning. In fact, interest in new technological trends and expanding ecosystems is growing. In particular, in markets like China and Korea where cryptocurrencies have gained greater acceptance, retail investors continue to take part in initial investments for blockchain projects through a variety of methods. In China, the secondary market has become popular because Chinese nationals are restricted from participating in ICOs by law, while in Korea, a number of ‘coin group purchase’ channels are being operated surreptitiously through KakaoTalk messenger or other communities. Setting aside government regulation, there are other important reasons behind these trends. Up until as recently as mid-2017, anyone with an interest in blockchain projects could participate in an ICO without much difficulty. However, from the second half of 2017, there has been a movement towards larger private rounds instead of public sales and lower participation from individual investors. In particular, projects that were more confident in their fundraising ability increasingly sought a greater proportion of investment from institutional investors or dedicated crypto VCs instead of through public sales. Key examples of this are Ontology or Handshake, who simply engaged in community airdrops after a private sale, without conducting an ICO. Individual investors interested in these projects attempt to get involved through influential brokers that can grant them access to the private round. At the same time, there are many complaints within the community about the expanding trend of institutional investors taking up the lion’s share of private rounds.

A reluctance to accept individual investors

There is a large gap between the role that many projects had hoped individual investors would play during the ICO, and the reality that they have been faced with afterwards. While providing the public with a fair investment opportunity, project teams also hoped to create a loyal community that would be aligned with the project’s incentives and share in its growth. Compared to the existing startup model, where the company grows based on investment received from a small number of institutional investors through closed channels, teams believed that ICOs would facilitate the creation of a more open ecosystem which would lead to a virtuous cycle of rapid growth. However, individual investors in blockchain projects ultimately failed to provide much help to the projects in many cases. The majority of ICO participants who formed the community’s persona were often “creditors” who only cared about the token price, rather than “contributors.” Many of these individuals simply jumped on the bandwagon of popular projects without a clear understanding of or trust in the project’s core technology or business. Accordingly, they contributed very little to the productive activities that promote healthy growth within communities. In addition to this, few of the individual investors who took part in ICOs for blockchain projects actually used the tokens they received for the intended purpose once the dapp or platform was released. Instead, they were essentially free riders who sold off their tokens as soon as the price hit a certain level. This led to a growing awareness among teams that they could actually threaten the long-term development of projects. From the perspective of project teams, it seems more efficient to manage a small number of professional investors rather than have to communicate and provide explanations to a community of individual investors who constantly ask about the price and listing on exchanges, especially during the launch stage when the team is naturally spending most of its energy on development. Institutional investors also tend to have their own networks and greater insight into the blockchain industry. In many cases, institutional investors have provided practical assistance to help grow the project by playing an advisory role to entrepreneurs or recruiting team members during the early stages. These investors can provide support in a number of ways, including building local communities in key locations, hosting hackathons to connect developers to the project, or acting as a liaison with major media channels. Because there is a longer lock-up period in private rounds than in public rounds, institutional investors have no choice but to believe in the mid-to-long-term growth of the project and offer assistance where they can. Of course, not all institutional investors effectively contribute to the development of a project. The behavior of some institutional investors who fail to provide promised support or lack expertise and judgment has also been a source of complaints within communities. However, the competitive nature of markets is helping to correct this problem. Because of the free and transparent flow of information in the hyper connected crypto ecosystem, information about reputable and not so reputable institutional investors spreads quickly between blockchain entrepreneurs. In time, only reputable crypto funds will be given the opportunity to invest in promising projects, similar to the growth process that venture capital markets went through.

Is investment the only way to contribute to a project?

Thus far I have looked at the growing trend of smaller public rounds in 2018. I am not trying to raise the dichotomous question of whether individual or institutional investors are more suitable for investment in initial projects. The more fundamental question is, “How do we create an ecosystem in which those who contribute to projects can become initial shareholders?” and I believe the mechanism to enable this is Proof of Contribution. Think back to the advent of the world’s first cryptocurrency, bitcoin, which represented the beginning of the decentralization paradigm, and the process through which tokens were issued. Bitcoin issued tokens to the community purely through mining, without any token sale targeting investors. When miners provided hash power, their contribution would be verified in a way that enhanced the security of the network, and they were rewarded with bitcoins in return. Although the protocol-defined method of contribution to the network was simple, it was fundamentally a proof-of-work (PoW) concept, which could also be viewed as a form of ‘Proof of Contribution’ that reflected the philosophy of compensating those who contribute to a project. During the long period where no one paid attention to the price of Bitcoin, the majority of early shareholders in the network were people who carried a strong belief in decentralized currencies rather than those looking to make a short-term profit. In the IT industry, there is a clear distinction between the role of 1) investors, 2) the company and 3) employees during the early stages of a startup. Investors receive equity in the company in return for providing initial capital. It is then the company’s job to use these funds effectively to grow the company. Employees receive stock options upon joining the company, and are incentivized to work hard because of the clear upside potential of a higher share price. I believe that this stock options system was the biggest driving force behind innovation in the Silicon Valley startups of today. Accordingly, it is unfortunate that most blockchain projects have reduced the role of external stakeholders who join the project in its initial stages to that of ‘investors’ in traditional IT startups. This is demonstrated by the fact that the token allocation section in the white papers of most blockchain projects resembles a business development plan and marketing budget that was determined entirely by the project team, instead of a system of autonomous token distribution through the protocol. In most cases, the token model is only described briefly, with a focus on the main activities that will take place once the network is sufficiently established. In other words, the model for network growth is selling tokens to investors through marketing, sales or partnership activities, with the use of such funds arbitrarily determined by the project team. This suggests that blockchain projects to date have not taken full advantage of the benefits of decentralization. Instead of treating individuals who make early contributions as merely financial investors, projects that are truly pursuing decentralization should recognize them as more akin to employees who receive stock options (and can actively contribute to the network from outside the organization) and adopt a philosophy of ‘compensation through the protocol’ to leverage them. Blockchain projects have the potential to design detailed and effective reward systems catered to the nature of their token model that can verify the contributions of members and compensate them accordingly. For example, even if initial investors are given bonuses as a reward for financial contributions, the calculation and payment of the bonus could take place at a later date once it has been proved that the individual has reached a certain level of use on the project’s sapp or made a contribution to PR activities though a method defined by the protocol. This would incentivize investors to participate in a more substantive way. In addition to this, a variety of protocols could be designed that encourage non-investors to contribute through participation in permissionless networks, and distribute tokens for such involvement. In the future, we will see blockchain projects with more complex value chains that have greater crossover with the real world. The ultimate goal of decentralized projects should be decentralizing the project’s entire value chain. To achieve this, all of the key sections of the value chain of ordinary companies, from R&D to marketing and sales, should be turned into protocols that are as detailed as possible, and companies should also consider mechanisms to incentivize top experts from outside the organization to contribute to the project’s growth in efficient ways by offering rewards. Tokens can be used as effective tools in this scenario, but it is critical that the method for calculating incentives for contributions is based on a transparent and defined protocol that is made public, unlike in centralized startups where it is based on the fleeting, arbitrary decisions of the management team. This can give protocol-based organizations the competitive edge over centralized companies.

Distributing tokens only to real contributors

Investment is merely one of many ways to contribute to the growth of a project. I believe that the underlying reason behind the failure of so many ICOs these days is that the communities are filled with initial shareholders who only care about the token price because they joined as investors. The identity of any organization is determined by the nature of its initial shareholders. This leads to a chain reaction which influences those who join the community later on, and also has a critical influence on the direction and speed of the network’s growth. In order to succeed, blockchain projects from 2019 onwards will have to demonstrate more advanced methods than their predecessors when it comes to determining the composition of their initial shareholder pools. They should look to move away from the current methods of giving tokens to anyone who invests, random airdrops and relying on partnerships based on the decisions of centralized entities when forming initial shareholder communities. Despite the failure of so many ICOs, many still believe in the strong underlying value of blockchain technology which has the potential to completely change the foundations of our economic systems. Moving forward, I hope that more blockchain projects will take up the challenge of using token distribution models where ‘not just anyone can become an initial shareholder,’ and consider a “proof of contribution” model which distributes tokens only to those who have made a substantive contribution. Have an opinionated take on 2018? CoinDesk is seeking submissions for our 2018 in Review. Email news  coindesk.com to learn how to get involved.  Piggy bank image via Shutterstock !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function(){n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)};if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=;t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e);s.parentNode.insertBefore(t,s)}(window, document,'script','//connect.facebook.net/en_US/fbevents.js'); fbq('init', '239547076708948'); fbq('track', "PageView"); Source link Read the full article

#Biggest #ICOs #Investors #Problem

[cryptoquicknews-blog]

New Post has been published here https://is.gd/s26sxh

The Biggest Problem for ICOs? In 2018, It Was Their Own Investors

This post was originally published here

Simon Seojoon Kim is CEO and partner at Hashed, a crypto-focused accelerator focused on community building and impact investing.

The following is an exclusive contribution to CoinDesk’s 2018 Year in Review. 

At the beginning of 2018, the blockchain community reached the pinnacle of the ICO bubble.

The slogan of ICOs, which promised that “anyone can invest in an initial project,” sounded wonderful and future-oriented. However, as the prices of most ICO tokens continued to tumble over the past year, it appears that the first chapter of this grand experiment has ended in failure.

Why do most ICOs fail to succeed? Some would cite the greed of individuals blindly looking to make a quick fortune, incompetent project teams led by entrepreneurs that lack expertise, the technical limitations of platform blockchains that lack scalability and inadequate regulations in countries that have been unable to keep up with changing market conditions.

These are all true. However, there is little to learn from this, as these are difficulties that all innovative, paradigm-shifting technologies face when forging new markets in their early stages.

In this article, I aim to take stock of the current situation by examining the inherent limitations of ICOs, in particular the belief that “anyone can invest in an initial project,” and discuss some potential solutions.

The popularity of group purchasing channels

Despite the burst of the ICO bubble, the blockchain craze in Asian markets is not waning.

In fact, interest in new technological trends and expanding ecosystems is growing. In particular, in markets like China and Korea where cryptocurrencies have gained greater acceptance, retail investors continue to take part in initial investments for blockchain projects through a variety of methods.

In China, the secondary market has become popular because Chinese nationals are restricted from participating in ICOs by law, while in Korea, a number of ‘coin group purchase’ channels are being operated surreptitiously through KakaoTalk messenger or other communities.

Setting aside government regulation, there are other important reasons behind these trends.

Up until as recently as mid-2017, anyone with an interest in blockchain projects could participate in an ICO without much difficulty. However, from the second half of 2017, there has been a movement towards larger private rounds instead of public sales and lower participation from individual investors.

In particular, projects that were more confident in their fundraising ability increasingly sought a greater proportion of investment from institutional investors or dedicated crypto VCs instead of through public sales. Key examples of this are Ontology or Handshake, who simply engaged in community airdrops after a private sale, without conducting an ICO.

Individual investors interested in these projects attempt to get involved through influential brokers that can grant them access to the private round. At the same time, there are many complaints within the community about the expanding trend of institutional investors taking up the lion’s share of private rounds.

A reluctance to accept individual investors

There is a large gap between the role that many projects had hoped individual investors would play during the ICO, and the reality that they have been faced with afterwards.

While providing the public with a fair investment opportunity, project teams also hoped to create a loyal community that would be aligned with the project’s incentives and share in its growth.

Compared to the existing startup model, where the company grows based on investment received from a small number of institutional investors through closed channels, teams believed that ICOs would facilitate the creation of a more open ecosystem which would lead to a virtuous cycle of rapid growth.

However, individual investors in blockchain projects ultimately failed to provide much help to the projects in many cases.

The majority of ICO participants who formed the community’s persona were often “creditors” who only cared about the token price, rather than “contributors.” Many of these individuals simply jumped on the bandwagon of popular projects without a clear understanding of or trust in the project’s core technology or business.

Accordingly, they contributed very little to the productive activities that promote healthy growth within communities. In addition to this, few of the individual investors who took part in ICOs for blockchain projects actually used the tokens they received for the intended purpose once the dapp or platform was released. Instead, they were essentially free riders who sold off their tokens as soon as the price hit a certain level.

This led to a growing awareness among teams that they could actually threaten the long-term development of projects. From the perspective of project teams, it seems more efficient to manage a small number of professional investors rather than have to communicate and provide explanations to a community of individual investors who constantly ask about the price and listing on exchanges, especially during the launch stage when the team is naturally spending most of its energy on development.

Institutional investors also tend to have their own networks and greater insight into the blockchain industry. In many cases, institutional investors have provided practical assistance to help grow the project by playing an advisory role to entrepreneurs or recruiting team members during the early stages. These investors can provide support in a number of ways, including building local communities in key locations, hosting hackathons to connect developers to the project, or acting as a liaison with major media channels.

Because there is a longer lock-up period in private rounds than in public rounds, institutional investors have no choice but to believe in the mid-to-long-term growth of the project and offer assistance where they can. Of course, not all institutional investors effectively contribute to the development of a project. The behavior of some institutional investors who fail to provide promised support or lack expertise and judgment has also been a source of complaints within communities.

However, the competitive nature of markets is helping to correct this problem.

Because of the free and transparent flow of information in the hyper connected crypto ecosystem, information about reputable and not so reputable institutional investors spreads quickly between blockchain entrepreneurs. In time, only reputable crypto funds will be given the opportunity to invest in promising projects, similar to the growth process that venture capital markets went through.

Is investment the only way to contribute to a project?

Thus far I have looked at the growing trend of smaller public rounds in 2018.

I am not trying to raise the dichotomous question of whether individual or institutional investors are more suitable for investment in initial projects. The more fundamental question is, “How do we create an ecosystem in which those who contribute to projects can become initial shareholders?” and I believe the mechanism to enable this is Proof of Contribution.

Think back to the advent of the world’s first cryptocurrency, bitcoin, which represented the beginning of the decentralization paradigm, and the process through which tokens were issued. Bitcoin issued tokens to the community purely through mining, without any token sale targeting investors. When miners provided hash power, their contribution would be verified in a way that enhanced the security of the network, and they were rewarded with bitcoins in return.

Although the protocol-defined method of contribution to the network was simple, it was fundamentally a proof-of-work (PoW) concept, which could also be viewed as a form of ‘Proof of Contribution’ that reflected the philosophy of compensating those who contribute to a project. During the long period where no one paid attention to the price of Bitcoin, the majority of early shareholders in the network were people who carried a strong belief in decentralized currencies rather than those looking to make a short-term profit.

In the IT industry, there is a clear distinction between the role of 1) investors, 2) the company and 3) employees during the early stages of a startup. Investors receive equity in the company in return for providing initial capital. It is then the company’s job to use these funds effectively to grow the company. Employees receive stock options upon joining the company, and are incentivized to work hard because of the clear upside potential of a higher share price.

I believe that this stock options system was the biggest driving force behind innovation in the Silicon Valley startups of today.

Accordingly, it is unfortunate that most blockchain projects have reduced the role of external stakeholders who join the project in its initial stages to that of ‘investors’ in traditional IT startups. This is demonstrated by the fact that the token allocation section in the white papers of most blockchain projects resembles a business development plan and marketing budget that was determined entirely by the project team, instead of a system of autonomous token distribution through the protocol. In most cases, the token model is only described briefly, with a focus on the main activities that will take place once the network is sufficiently established.

In other words, the model for network growth is selling tokens to investors through marketing, sales or partnership activities, with the use of such funds arbitrarily determined by the project team. This suggests that blockchain projects to date have not taken full advantage of the benefits of decentralization. Instead of treating individuals who make early contributions as merely financial investors, projects that are truly pursuing decentralization should recognize them as more akin to employees who receive stock options (and can actively contribute to the network from outside the organization) and adopt a philosophy of ‘compensation through the protocol’ to leverage them.

Blockchain projects have the potential to design detailed and effective reward systems catered to the nature of their token model that can verify the contributions of members and compensate them accordingly. For example, even if initial investors are given bonuses as a reward for financial contributions, the calculation and payment of the bonus could take place at a later date once it has been proved that the individual has reached a certain level of use on the project’s sapp or made a contribution to PR activities though a method defined by the protocol.

This would incentivize investors to participate in a more substantive way. In addition to this, a variety of protocols could be designed that encourage non-investors to contribute through participation in permissionless networks, and distribute tokens for such involvement.

In the future, we will see blockchain projects with more complex value chains that have greater crossover with the real world. The ultimate goal of decentralized projects should be decentralizing the project’s entire value chain. To achieve this, all of the key sections of the value chain of ordinary companies, from R&D to marketing and sales, should be turned into protocols that are as detailed as possible, and companies should also consider mechanisms to incentivize top experts from outside the organization to contribute to the project’s growth in efficient ways by offering rewards.

Tokens can be used as effective tools in this scenario, but it is critical that the method for calculating incentives for contributions is based on a transparent and defined protocol that is made public, unlike in centralized startups where it is based on the fleeting, arbitrary decisions of the management team.

This can give protocol-based organizations the competitive edge over centralized companies.

Distributing tokens only to real contributors

Investment is merely one of many ways to contribute to the growth of a project.

I believe that the underlying reason behind the failure of so many ICOs these days is that the communities are filled with initial shareholders who only care about the token price because they joined as investors.

The identity of any organization is determined by the nature of its initial shareholders. This leads to a chain reaction which influences those who join the community later on, and also has a critical influence on the direction and speed of the network’s growth. In order to succeed, blockchain projects from 2019 onwards will have to demonstrate more advanced methods than their predecessors when it comes to determining the composition of their initial shareholder pools.

They should look to move away from the current methods of giving tokens to anyone who invests, random airdrops and relying on partnerships based on the decisions of centralized entities when forming initial shareholder communities.

Despite the failure of so many ICOs, many still believe in the strong underlying value of blockchain technology which has the potential to completely change the foundations of our economic systems.

Moving forward, I hope that more blockchain projects will take up the challenge of using token distribution models where ‘not just anyone can become an initial shareholder,’ and consider a “proof of contribution” model which distributes tokens only to those who have made a substantive contribution.

Have an opinionated take on 2018? CoinDesk is seeking submissions for our 2018 in Review. Email news [at] coindesk.com to learn how to get involved. 

Piggy bank image via Shutterstock

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Tailscale needed a better IP address type

Tailscale is a networking application so naturally we need to work withand manipulate IP addresses and sets of IP addresses often.

Being written almost entirely in Go, the obvious choice would be forTailscale to use the Go standard library’snet.IP address type for individualIPs and net.IPNet type fornetworks. Unfortunately, the standard library’s types have a number ofproblems, so we wrote a new package,inet.af/netaddr (github) containinga new IP type and more.

What’s wrong with Go’s net.IP type?

When I was working on Go full time, I filed Go issue#18804 to track somethings that aren’t great about Go’s IP address:

It’s mutable. The underlyingtype of a net.IP is just a()byte, which means anything you pass it to might mutateit. Immutable data structures are safer, easier to reason about, anddon’t require defensive copies.

It’s notcomparablebecause a slice in Go is not comparable, which means it doesn’tsupport Go’s operator and can’t be used as a map key.

There are two IP address types in the standard library: net.IP for justa basic IPv4 or IPv6 address, and then alsonet.IPAddr if you need to supportIPv6 zone scopes.Having two types in the standard library means youneed to decide which type to accept or return from your code, orhave two+ variants, which gets annoying (e.g. Go’s Resolver.LookupIPvs Resolver.LookupIPAddr)

It’s large. A Go slice is 3 words (so 24 bytes total on 64-bitmachines) just for the slice header, without counting the underlyingarray that the slice points to (background).So an IP address with Go’s net.IP istwo parts: the 24 byte slice header, and then also the 4 or 16 bytesof IP address. If you want an IPv6 zone, you have to use net.IPAddr witha 16 byte string header also.

It allocates, #43451. Go’s net package is full of allocations everywhere,putting more work on the GC and thus the CPU. If you callnet.ParseIP or receive a UDP packet, it needs to allocate theunderlying array where it records the IP address, to put thatpointer in the returned slice header of the net.IP.

When parsing an IP from its string form, Go’s IP type can’tdistinguish betweenIPv4-mapped IPv6addressesand IPv4 addresses. The Go IP type doesn’t record the original address family.This is tracked in Go issue #37921.

It’s a transparent type. The definition of net.IP is: type IP ()byte,which means its underlying type is a byte slice,which is part of its public API and unchangeable. By contrast, Go’stime.Time type is defined like type Time struct ( /* unexported */ )so it’s free to change without breaking API promises. In fact, Go’s Time did changeits representation recently in Go 1.9 when it gainedtransparent monotonic time support.That would not have been possible if the type weren’t opaque.As some trivia: the Go Timeused to be transparent prior to Go 1.Unfortunately we weren’t wise enough at the time to do the samefor the IP address type.

Some of this was by design at the time, before Go 1 locked in thecompatibility promise in 2012, butmuch of it was just never considered well or predated enoughexperience with Go to learn what patterns worked well and whichdidn’t. In any case, the Go standard library can’t change much now.

What do we want?

In summary, this is what we want, and how Go’s net.IP fares:

FeatureGo's net.IPImmutable❌, sliceComparable❌, sliceSmall❌, 28-56 bytesAllocation free❌, slice's underlying arraySupports IPv4 & IPv6✅Can distinguish IPv4/IPv6❌, #37921Supports IPv6 zones❌, has separate net.IPAddr typeOpaque type❌, defined as ()byteInterops with standard library✅

So, let’s do better.

This story has several parts:

Take 1: wgcfg.IP

The story begins in April 2019 with89476f8cb5 in which David Crawshaw, aware of all these problems,created an IP type like:

That’s a bit better:

Featurenet.IPwgcfg.IPImmutable❌, slice✅Comparable❌, slice✅Small❌, 28-56B✅, 16BAllocation free❌✅Supports IPv4 & IPv6✅✅Can distinguish IPv4/IPv6❌❌Supports IPv6 zones❌❌Opaque type❌❌Interops with standard library✅❌, with adapters

We used that for quite a bit in some places but it wasn’t quite good enough tostart using more widely.

Making it opaque would be easy enough (unexporting the Addr field, renaming it to addr), butthat still would leave us with the lost address family bit and lackof IPv6 zones.

Take 2: netaddr.IP, opaque comparable interfaces

One bit about the Go language specification that many people don’t know isis that interfaces are comparable (support & being map keys),but they panic at runtime if theunderlying value in the interface is not comparable.

Taking advantage of that to be comparable, the firstversionof netaddr.IP was represented like this:

Notably, the IP type there is an opaque struct embedding aninterface. An interface, being 2 wordswide, is 16 bytes on 64-bitmachines, so the IP type here is 16 bytes. That’s better than thestandard library’s 24 byte (3 word) slice header used for net.IP.But both still need to a pointer to the actual bytes of the IPaddress. At least with this representation, the interface’s type wordencodes whether the address is IPv4, IPv6, or IPv6 with a zone scope.

It was good in some ways, but not perfect:

Featurenet.IPwgcfg.IP'Take 2'Immutable❌, slice✅✅Comparable❌, slice✅✅Small❌, 28-56B✅, 16B🤷, 20-32BAllocation free❌✅❌Supports IPv4 & IPv6✅✅✅Can distinguish IPv4/IPv6❌❌✅Supports IPv6 zones❌❌✅Opaque type❌❌✅Interops with standard library✅❌, with adapters❌, with adapters

I got the impression that Crawshaw in particular was very “meh” onthis representation needing to allocate compared to our existingwgcfg.IP type.

Let’s do better.

Take 3: allocation-free 24 byte representation

At some point I realized that the maximum tolerable size of our IPaddress type was 24 bytes: that’s the same size as Go’s net.IP sliceheader, and Go slices are very common. A time.Time is also a 24byte value type, so surely the compiler deals with 24 byte value typesjust fine. But mostly I didn’t want our new IP type to be worse inany dimension compared to the standard library’s net.IP, which is(in part) 24 bytes. So I somewhat arbitrarily decreed that 24 byteswas our limit.

Since an IPv6 address is already 16 bytes, that leaves us 8 bytesremaining in which to encode the following things:

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the address family (v4, v6, or neither, such as the IP zero value). There’sat least two bits.

the IPv6 zone

Also, we need to be comparable.

Using an interface is out: that’s two words (16 bytes), so that’s toobig. Likewise, a string is also two words (a pointer and length), sothat’s out.

We could play bit-packing games like:

… and try to encode the address family and zone into the 64 zoneAndFamily bits, but how?

If we have 1 or 2 bits for the address family, we have 62 or 63 bitsleft. Various options included:

shove the 7-bit ASCII string into the remaining 62 bits. But thatlimits us to 8 characters. Even our default 'tailscale0' interfacename wouldn’t fit.

encode a zone index into the 62 or 63 bits instead. But then we can’t parseand represent an interface that the local machine doesn’t have.

use a zone mapping table, mapping between zone index integers and zone name strings.That’s what the Go standard library does internally. But then we’re left susceptible to an attack where an adversary forcesus to parse a bunch of IP addresses with scopes and we forever bloat a mappingtable that we don’t have a good opportunity to ever shrink. The Go standardlibrary doesn’t need to deal with this, as it only ever maps interfaces thatexist on the machine and doesn’t expose the integers to users in representations;its net.IPAddr.Zone field is a string.

So, I didn’t like any of those options.

But then I thought of something gross. Or awesome.

We could use a pointer!

Ignoring the zone and actual definition of T for now, the addressfamily is easy: we make three sentinel pointer values to represent thefamily, and whether the IP address is the zero value (as opposed to,say, actually '0.0.0.0').

But how do we represent the zone string such that it’s comparable soGo’s works and IP values can be map keys?

Remember, our goal is that this prints true:

But comparisons on Go pointers compare the pointer values, not whatthey point to. That is, new(string) != new(string).

So we need to make sure that two separate ParseIP calls with same'eth0' zone at any point and any time in the program always returnthe same pointer value for that process.

That implies we need a mapping between these pointer values and theirprocess-wide-unique names ('eth0', etc). If this sounds a lot likethe earlier problem with the zone indexes, it is, but there’s onething that’s different: when shoving a zone index into an integerabove, we didn’t have a way to do any cleanup of the mappingtable. But with a pointer, we can useruntime.SetFinalizer.Using SetFinalizer is gross and scary and you should think twicebefore using it. We sure did. But sometimes gross and scary things arethe right tool for the job.

What we ended up writing was thego4.org/intern package tohide the bodies so ourinet.af/netaddr package couldhave plausible deniability as to its innocence.

The go4.org/intern package is tiny and worth reading infull (and perhapsworthy of a future blog post on its own), but thecore of it is this ungodliness:

Basically, it’s playing unsafe games behind the Go garbage collector’sback, hiding pointers in untyped uintptr integers so Go will beforced to eventually garbage collect things which then causes thefinalizer to be invoked to step in and either clean up its lies orclean up the map.

But the end result is that this is now true:

So our IP representation can be:

The accessors to get/set the zone are then:

How we’d do?

Featurenet.IPnetaddr.IPImmutable❌, slice✅Comparable❌, slice✅Small❌, 28-56B✅, 24B, alwaysAllocation free❌✅Supports IPv4 & IPv6✅✅Can distinguish IPv4/IPv6❌✅Supports IPv6 zones❌✅Opaque type❌✅Interops with standard library✅🤷, adaptor methods

Nailed it.

Take 4: uint64s for speed

We were pretty happy, but Dave Anderson took advantage of the type’sopaque representation and changed the representation to make it faster in4eb479db13,replacing the addr (16)byte with a pair of uint64 values:

The compiler liked that much more.

Take 5: a uint128 type

But why stop there? Being able to change the representation without affecting the API is too muchfun, so in 318330f177I replaced the uint64 pair with a new uint128 type, as Go doesn’t have a native one.

We’re now at:

But the compiler didn’t like that,so bf0e22f9f3broke it back down into:

And that’s basically where we’re at today.

We’re talking about breaking out the uint128 type into its own packagebut haven’t done so yet.

Other inet.af/netaddr fun

In addition to just IP addresses, inet.af/netaddr contains:

IPPort: a value type for an IP address and a port

IPPrefix: a value type for an IP address and a CIDR prefix (e.g. 192.168.0.1/16)

IPRange: a value type for range of IPs (e.g. 10.0.0.200-10.0.0.255)

IPSet: an efficient, immutable set of IP addresses, built with anIPSetBuilder.

As one contrived example, this code:

Outputs:

FAQ

Should you use netaddr.IP?

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If you work with a lot of IP addresses and sets, ranges, andprefixes thereof, you’d probably benefit from using netaddr.IP overthe standard library’s types.

Is the API stable?

Mostly. We haven’t done a 1.0.0 yet and we might yet change a fewminor things, but it’spretty much done at this point.

What’s with the package name’s inet.af?

AF_INET, of course.

Was IPv6 worth it?

It is what it is.

This was too many words.

If you’d like this blog post in video form, my FOSDEM2021 talk, “Go atTailscale”discusses this starting at time 18:45.

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Thanks

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Writing the inet.af/netaddr package was a fun collaborationwith@crawshaw,@danderson,@josharian,@mdlayher, and@tklauser.

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The Biggest Problem for ICOs? In 2018, It Was Their Own Investors

Simon Seojoon Kim is CEO and partner at Hashed, a crypto-focused accelerator focused on community building and impact investing.

The following is an exclusive contribution to CoinDesk’s 2018 Year in Review. 

At the beginning of 2018, the blockchain community reached the pinnacle of the ICO bubble.

The slogan of ICOs, which promised that “anyone can invest in an initial project,” sounded wonderful and future-oriented. However, as the prices of most ICO tokens continued to tumble over the past year, it appears that the first chapter of this grand experiment has ended in failure.

Why do most ICOs fail to succeed? Some would cite the greed of individuals blindly looking to make a quick fortune, incompetent project teams led by entrepreneurs that lack expertise, the technical limitations of platform blockchains that lack scalability and inadequate regulations in countries that have been unable to keep up with changing market conditions.

These are all true. However, there is little to learn from this, as these are difficulties that all innovative, paradigm-shifting technologies face when forging new markets in their early stages.

In this article, I aim to take stock of the current situation by examining the inherent limitations of ICOs, in particular the belief that “anyone can invest in an initial project,” and discuss some potential solutions.

The popularity of group purchasing channels

Despite the burst of the ICO bubble, the blockchain craze in Asian markets is not waning.

In fact, interest in new technological trends and expanding ecosystems is growing. In particular, in markets like China and Korea where cryptocurrencies have gained greater acceptance, retail investors continue to take part in initial investments for blockchain projects through a variety of methods.

In China, the secondary market has become popular because Chinese nationals are restricted from participating in ICOs by law, while in Korea, a number of ‘coin group purchase’ channels are being operated surreptitiously through KakaoTalk messenger or other communities.

Setting aside government regulation, there are other important reasons behind these trends.

Up until as recently as mid-2017, anyone with an interest in blockchain projects could participate in an ICO without much difficulty. However, from the second half of 2017, there has been a movement towards larger private rounds instead of public sales and lower participation from individual investors.

In particular, projects that were more confident in their fundraising ability increasingly sought a greater proportion of investment from institutional investors or dedicated crypto VCs instead of through public sales. Key examples of this are Ontology or Handshake, who simply engaged in community airdrops after a private sale, without conducting an ICO.

Individual investors interested in these projects attempt to get involved through influential brokers that can grant them access to the private round. At the same time, there are many complaints within the community about the expanding trend of institutional investors taking up the lion’s share of private rounds.

A reluctance to accept individual investors

There is a large gap between the role that many projects had hoped individual investors would play during the ICO, and the reality that they have been faced with afterwards.

While providing the public with a fair investment opportunity, project teams also hoped to create a loyal community that would be aligned with the project’s incentives and share in its growth.

Compared to the existing startup model, where the company grows based on investment received from a small number of institutional investors through closed channels, teams believed that ICOs would facilitate the creation of a more open ecosystem which would lead to a virtuous cycle of rapid growth.

However, individual investors in blockchain projects ultimately failed to provide much help to the projects in many cases.

The majority of ICO participants who formed the community’s persona were often “creditors” who only cared about the token price, rather than “contributors.” Many of these individuals simply jumped on the bandwagon of popular projects without a clear understanding of or trust in the project’s core technology or business.

Accordingly, they contributed very little to the productive activities that promote healthy growth within communities. In addition to this, few of the individual investors who took part in ICOs for blockchain projects actually used the tokens they received for the intended purpose once the dapp or platform was released. Instead, they were essentially free riders who sold off their tokens as soon as the price hit a certain level.

This led to a growing awareness among teams that they could actually threaten the long-term development of projects. From the perspective of project teams, it seems more efficient to manage a small number of professional investors rather than have to communicate and provide explanations to a community of individual investors who constantly ask about the price and listing on exchanges, especially during the launch stage when the team is naturally spending most of its energy on development.

Institutional investors also tend to have their own networks and greater insight into the blockchain industry. In many cases, institutional investors have provided practical assistance to help grow the project by playing an advisory role to entrepreneurs or recruiting team members during the early stages. These investors can provide support in a number of ways, including building local communities in key locations, hosting hackathons to connect developers to the project, or acting as a liaison with major media channels.

Because there is a longer lock-up period in private rounds than in public rounds, institutional investors have no choice but to believe in the mid-to-long-term growth of the project and offer assistance where they can. Of course, not all institutional investors effectively contribute to the development of a project. The behavior of some institutional investors who fail to provide promised support or lack expertise and judgment has also been a source of complaints within communities.

However, the competitive nature of markets is helping to correct this problem.

Because of the free and transparent flow of information in the hyper connected crypto ecosystem, information about reputable and not so reputable institutional investors spreads quickly between blockchain entrepreneurs. In time, only reputable crypto funds will be given the opportunity to invest in promising projects, similar to the growth process that venture capital markets went through.

Is investment the only way to contribute to a project?

Thus far I have looked at the growing trend of smaller public rounds in 2018.

I am not trying to raise the dichotomous question of whether individual or institutional investors are more suitable for investment in initial projects. The more fundamental question is, “How do we create an ecosystem in which those who contribute to projects can become initial shareholders?” and I believe the mechanism to enable this is Proof of Contribution.

Think back to the advent of the world’s first cryptocurrency, bitcoin, which represented the beginning of the decentralization paradigm, and the process through which tokens were issued. Bitcoin issued tokens to the community purely through mining, without any token sale targeting investors. When miners provided hash power, their contribution would be verified in a way that enhanced the security of the network, and they were rewarded with bitcoins in return.

Although the protocol-defined method of contribution to the network was simple, it was fundamentally a proof-of-work (PoW) concept, which could also be viewed as a form of ‘Proof of Contribution’ that reflected the philosophy of compensating those who contribute to a project. During the long period where no one paid attention to the price of Bitcoin, the majority of early shareholders in the network were people who carried a strong belief in decentralized currencies rather than those looking to make a short-term profit.

In the IT industry, there is a clear distinction between the role of 1) investors, 2) the company and 3) employees during the early stages of a startup. Investors receive equity in the company in return for providing initial capital. It is then the company’s job to use these funds effectively to grow the company. Employees receive stock options upon joining the company, and are incentivized to work hard because of the clear upside potential of a higher share price.

I believe that this stock options system was the biggest driving force behind innovation in the Silicon Valley startups of today.

Accordingly, it is unfortunate that most blockchain projects have reduced the role of external stakeholders who join the project in its initial stages to that of ‘investors’ in traditional IT startups. This is demonstrated by the fact that the token allocation section in the white papers of most blockchain projects resembles a business development plan and marketing budget that was determined entirely by the project team, instead of a system of autonomous token distribution through the protocol. In most cases, the token model is only described briefly, with a focus on the main activities that will take place once the network is sufficiently established.

In other words, the model for network growth is selling tokens to investors through marketing, sales or partnership activities, with the use of such funds arbitrarily determined by the project team. This suggests that blockchain projects to date have not taken full advantage of the benefits of decentralization. Instead of treating individuals who make early contributions as merely financial investors, projects that are truly pursuing decentralization should recognize them as more akin to employees who receive stock options (and can actively contribute to the network from outside the organization) and adopt a philosophy of ‘compensation through the protocol’ to leverage them.

Blockchain projects have the potential to design detailed and effective reward systems catered to the nature of their token model that can verify the contributions of members and compensate them accordingly. For example, even if initial investors are given bonuses as a reward for financial contributions, the calculation and payment of the bonus could take place at a later date once it has been proved that the individual has reached a certain level of use on the project’s sapp or made a contribution to PR activities though a method defined by the protocol.

This would incentivize investors to participate in a more substantive way. In addition to this, a variety of protocols could be designed that encourage non-investors to contribute through participation in permissionless networks, and distribute tokens for such involvement.

In the future, we will see blockchain projects with more complex value chains that have greater crossover with the real world. The ultimate goal of decentralized projects should be decentralizing the project’s entire value chain. To achieve this, all of the key sections of the value chain of ordinary companies, from R&D to marketing and sales, should be turned into protocols that are as detailed as possible, and companies should also consider mechanisms to incentivize top experts from outside the organization to contribute to the project’s growth in efficient ways by offering rewards.

Tokens can be used as effective tools in this scenario, but it is critical that the method for calculating incentives for contributions is based on a transparent and defined protocol that is made public, unlike in centralized startups where it is based on the fleeting, arbitrary decisions of the management team.

This can give protocol-based organizations the competitive edge over centralized companies.

Distributing tokens only to real contributors

Investment is merely one of many ways to contribute to the growth of a project.

I believe that the underlying reason behind the failure of so many ICOs these days is that the communities are filled with initial shareholders who only care about the token price because they joined as investors.

The identity of any organization is determined by the nature of its initial shareholders. This leads to a chain reaction which influences those who join the community later on, and also has a critical influence on the direction and speed of the network’s growth. In order to succeed, blockchain projects from 2019 onwards will have to demonstrate more advanced methods than their predecessors when it comes to determining the composition of their initial shareholder pools.

They should look to move away from the current methods of giving tokens to anyone who invests, random airdrops and relying on partnerships based on the decisions of centralized entities when forming initial shareholder communities.

Despite the failure of so many ICOs, many still believe in the strong underlying value of blockchain technology which has the potential to completely change the foundations of our economic systems.

Moving forward, I hope that more blockchain projects will take up the challenge of using token distribution models where ‘not just anyone can become an initial shareholder,’ and consider a “proof of contribution” model which distributes tokens only to those who have made a substantive contribution.

Have an opinionated take on 2018? CoinDesk is seeking submissions for our 2018 in Review. Email news [at] coindesk.com to learn how to get involved. 

Piggy bank image via Shutterstock

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[kristinsimmons]

Cats & Dogs: Can We Find Unity on Health Care IT Change?

By MATTHEW HOLT

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 they passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

  Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

Let’s be clear, the stimulus package’s main role is to stop the patient from bleeding out and will probably need to be joined by a bank restructuring the likes of which we’ve never seen. Health care is a sideshow, but $20 billion is still $20 billion, and given that the current health IT market is only between $20 and $30 billion annually, it’s a huge potential increase for the industry.

This spending is separate from any larger health care reform proposed by Obama, even though it appears that such a reform package is fairly likely to appear in Congress as soon as Daschle, Baucus and Kennedy get their ducks in a row. And of course, most of the issues that divide THCB’s various commentators on health IT are rooted in problems that only a major reform can solve. And realistically even those most optimistic about the prospects for reform don’t believe that the Obama/Daschle/Baucus plan will get at the core problems of the U.S. health care system any time soon.

The underlying problems: American health care has two linked and intertwined problems. First, (and it is first) due to America’s unique political history, most of the pain of dealing with increasing health costs is deposited on a poor (or soon to be poor) and relatively powerless minority of the population—the sick who are uninsured and underinsured. No one is really responsible for their financial well being, nor is any entity forced to make their cost of care equal to that of the rest of society. So the health care system has reacted rationally over the years by increasing what it charges the majority, and not worrying too much about that minority even as it grows. Every other rational country instead distributes that cost evenly by putting (more or less) everyone in the same financial pool, and puts someone (usually the government) in charge of the total cost of the system to society. The US is different, as it’s the only place where for the players in the system doing more means getting more absolutely. Everywhere else, the rest of society stops the health care system arbitrarily grabbing more resources.

The process whereby the health care system grabs more and more in the US comes mainly via an incredibly strong supplier community that has political control over the large share of spending that is government funded, and economic control over the main providers of private spending—employers. Of course it may not feel that way to the suppliers in the system but the numbers (share of GDP going to health care more than doubling over 30 years) don’t lie.

This leads to the second problem: The mechanism of that provider control is a payment system that encourages piece work, acute care, fixing rather than prevention, specialization over primary care, and—not least—big hospitals over community based clinics. Now as Atul Gawande points out in the New Yorker this week, it’s not as if every other country does exactly the opposite, but the scale by which we’ve tipped over here is unprecedented. And multitudes of articles on THCB over the years prove it out, and show that it’s very hard to change that status quo.

This starts to get us back to IT. The first significant use of IT in health care in the US was in large hospitals primarily aimed at accounting (and billing) for piece work. Eventually most large and many smaller hospitals began to extend their IT capabilities to automate other aspects of their activity, but even among the most sophisticated, the role of IT supported rather than transformed the way they delivered care. The goal of the hospital is after all for the hospital to thrive and prosper, not for the community to improve the care it gets at a lower cost. This has continued as IT investment has picked up, especially since 2003, and of course it’s been reflected in the stock price and profitability of the winners in health IT, notably Cerner and Epic.

Some other countries were introducing more clinically-based IT into their health care systems over the 1990s, and they tended to place it where their systems were focused—which tended to mean in primary care. The three Ns (Norway, Netherlands, New Zealand) along with the Danes & the Brits were close to 100% EMR use in office based primary care by the early 2000s. The UK was able to use this to actually track what its primary care docs were doing, and started paying them bonuses for doing the “right thing” in terms of prevention and evidence based medicine. But note that the IT was shoe-horned into a system which was by and large doing that already. It did not change the core way care was delivered. In fact in the UK the links between primary care (GPs) and specialty care (hospitals) are still by and large absent—despite a huge budgeted (and not fully spent) investment in Healthcare IT that exceeds what’s in the current US stimulus package for a country 1/5th the population! The astute observer will also notice that several countries that don’t have EMRs in universal use among physicians, notably France and Germany, also have pretty well regarded health care systems.

So it’s a pretty fair assumption that IT use in health care will reflect the system it’s put into, rather than transform it to something completely different.

So why all the aggro? Since the Obama win and the recession made the stimulus a certainty and health care IT’s inclusion in it a reality, THCB has been the venue for a series of articles in the form of Open Letters to the Obama Administration by David Kibbe & Brian Klepper, a defense of the proposed spending by John Halamka, an analysis of the perversion of administrative simplification under HIPAA by interested parties (clearinghouses) from Rick Peters, all culminating in a declaration that Health IT is in fact ready, just add $20 billion, by Mark Leavitt yesterday. This argument has by no means been confined to THCB, and in fact this latest discussion was started mostly in a series in Health Affairs, in which Carol Diamond and Clay Shirky accused the current health IT establishment of “magical thinking”, while somewhat surprisingly Microsoft—which sells a lot more in copies of Windows and Office to hospitals than health care tools to consumers or small practices—in the person of its health care leader Peter Neupert suggested that we should take a pause before hitting the “buy” key, and spend money on outcomes not on technology for its own sake. And enfant terrible Jonathan Bush is warning anyone who’ll listen that we’ll be locking in place outmoded technology.

Essentially the argument comes down to two things (Warning—gross generalizations ahead!). I liken this to the common truism that dogs attach themselves to people while cats attach themselves to places

Outcomes vs. technology: The Kibbe/Klepper/Peters/Neupert/Bush faction (the dogs)assumes that we need to change the incentives in the system, and then IT will naturally follow—and the current embryonic decision support systems will flourish quickly. But that current clinical systems aren’t good enough to invest in mostly because current results from EMR installations are very disappointing.

Although they discuss incentives (and most of the $20 billion will probably be aligned with some P4P measures), the cats’ (Leavitt/Halamka/Kolodner) view is closer to the thought that if you get the appropriate clinical technology (essentially in-patient and outpatient EMRs) into the hands of clinicians, then they’ll figure out what to do with it, and eventually the government can pay them according to how well they do it. (Halamka is a bit more open about this also being an IT public works scheme).

Patients vs. facilities: There’s also a more philosophical bias which harkens back to the difference between American and European health care systems, but not in the way you might think. The dog faction is in general primarily in favor of light-weight tools (and standards) that allow for innovation and service of the consumer patient by primary care teams (that’s the European part). The recent emergence of Web-based tools and patient communities that allow patients to apply self-service techniques and easy communication with teams of providers (yes, yes, that’s Health 2.0) are for them the keys to enabling better care. These tools are relatively cheap (and flexible) and mirror the SaaS trends in the rest of technology. (Think Gmail vs Outlook).

The cats’ view is closer to the opinion that the real work in American health care happens in big hospital systems, and that the key is to get everyone connected to their core clinical systems. Hence the concern with standardizing on products and private networks (RHIOs) rather than allowing a mass of anarchic applications out on the Internet which are more likely to “mash-up” together.

What about the biases? There have been plenty of accusations of bias and self-interest on these pages, and it’s worth quickly looking at it. For example, Jonathan Bush believes he’s riding a wave towards a SaaS future, whereas most of his competitors are still MUMPS-based client sever technologies—he fears the $20bn will be used to subsidize SUVs in a world where AthenaHealth is selling the Prius. Mark Leavitt, while on loan to the Chairman of CCHIT is the former CEO of MedicaLogic (now the core of GE’s Centricity EMR product) and a former HIMSS official. Most people in health care think of HIMSS as a vendor promotion association. Halamka of course is part of a very large AMC and the chair of the HITSP standards organization which tends to favor larger systems, whereas Kibbe is well know for his work promoting the lighter weight CCR standard and his involvement in the American Academy of Family Physicians—long the orphans of our specialty dominated medical culture. I also suspect that Kibbe’s recent criticisms of the EMR haven’t exactly helped his chance of receiving consulting dollars from the major HIT vendors, but he is also involved in consulting with smaller companies that stand to benefit from the emergence of new models of care. And of course Brian Klepper and I are involved in Health 2.0 (together in a consulting venture and me as co-founder of a conference).

However, I perhaps naively choose to believe that everyone involved is motivated more by their cultural takes on what’s important for health care, than their desire to put a hand-out for the $20 billion. I think that these same positions would have been taken by the same people 6 months ago when the bailout was yet a twinkle in Obama’s eye.

So in change, can we find unity? So despite the fierce words and the grave differences of opinion, can cats and dogs live together in harmony? I think that in the spirit of Obama’s first days in power we can find some unity. At the same time we need to be realistic about what comes next.

First, we need to get rid of the notion that IT is going to transform our health care system. To transform healthcare we need to get real health reform right. Obama is not doing IT any favors by imposing that pressure on its use—the dogs are correct here.

Second, we are not immediately going to move away from an acute care, large system-focused health care environment. Any change towards overall more consumer-focused health management will continue to be slower than some of us might like. So getting those acute care facilities that are not at BIDMC or InterMountain levels of technology readiness in better shape can’t hurt.

Third, despite all the harsh words, as the bill now stands, most of the $20 billion will reward actions with some form of P4P. If the folks at HHS & CMS who will be responsible for crafting the incentive structures hear a more unified voice from the assorted commentators, geeks, cats & dogs arguing over here, we’ll likely get more incentives rewarding better process and less direction on particular technologies—which will be a good thing.

Fourth, there’s an underlying concern among the dogs that in the cat view (which is more clearly the “establishment view”) the patient is lost. Yet I still see Leavitt and the others from the establishment keen to bridge the gap to patients with connectivity tools and to give them control over their data in PHRs. And I don’t believe anyone is suggesting that we halt the rapid development in the ability of patients to manage themselves, and communicate with each other and clinicians, which is at the heart of Health 2.0.

So I have hope that, while the health IT part of the bailout will not be the ultimate cure for our health care system, it will help in many ways all over the system. I also hope that while there won’t be complete consensus both cats and dogs will agree that it should fit some core basic principles so that in years to come we’ll judge that this money was wisely spent.

Of course I’ll be reserving judgment at least till the bill makes it out of committee, and probably until we see exactly how CMS wants to spend the money!

Matthew Holt is to Founder of THCB. Follow him at @boltyboy. This piece was originally published in 2009. Read it here.

Cats & Dogs: Can We Find Unity on Health Care IT Change? published first on https://wittooth.tumblr.com/

[isaacscrawford]

Cats & Dogs: Can We Find Unity on Health Care IT Change?

By MATTHEW HOLT

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 They passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

Let’s be clear, the stimulus package’s main role is to stop the patient from bleeding out and will probably need to be joined by a bank restructuring the likes of which we’ve never seen. Health care is a sideshow, but $20 billion is still $20 billion, and given that the current health IT market is only between $20 and $30 billion annually, it’s a huge potential increase for the industry.

This spending is separate from any larger health care reform proposed by Obama, even though it appears that such a reform package is fairly likely to appear in Congress as soon as Daschle, Baucus and Kennedy get their ducks in a row. And of course, most of the issues that divide THCB’s various commentators on health IT are rooted in problems that only a major reform can solve. And realistically even those most optimistic about the prospects for reform don’t believe that the Obama/Daschle/Baucus plan will get at the core problems of the U.S. health care system any time soon.

The underlying problems: American health care has two linked and intertwined problems. First, (and it is first) due to America’s unique political history, most of the pain of dealing with increasing health costs is deposited on a poor (or soon to be poor) and relatively powerless minority of the population—the sick who are uninsured and underinsured. No one is really responsible for their financial well being, nor is any entity forced to make their cost of care equal to that of the rest of society. So the health care system has reacted rationally over the years by increasing what it charges the majority, and not worrying too much about that minority even as it grows. Every other rational country instead distributes that cost evenly by putting (more or less) everyone in the same financial pool, and puts someone (usually the government) in charge of the total cost of the system to society. The US is different, as it’s the only place where for the players in the system doing more means getting more absolutely. Everywhere else, the rest of society stops the health care system arbitrarily grabbing more resources.

The process whereby the health care system grabs more and more in the US comes mainly via an incredibly strong supplier community that has political control over the large share of spending that is government funded, and economic control over the main providers of private spending—employers. Of course it may not feel that way to the suppliers in the system but the numbers (share of GDP going to health care more than doubling over 30 years) don’t lie.

This leads to the second problem: The mechanism of that provider control is a payment system that encourages piece work, acute care, fixing rather than prevention, specialization over primary care, and—not least—big hospitals over community based clinics. Now as Atul Gawande points out in the New Yorker this week, it’s not as if every other country does exactly the opposite, but the scale by which we’ve tipped over here is unprecedented. And multitudes of articles on THCB over the years prove it out, and show that it’s very hard to change that status quo.

This starts to get us back to IT. The first significant use of IT in health care in the US was in large hospitals primarily aimed at accounting (and billing) for piece work. Eventually most large and many smaller hospitals began to extend their IT capabilities to automate other aspects of their activity, but even among the most sophisticated, the role of IT supported rather than transformed the way they delivered care. The goal of the hospital is after all for the hospital to thrive and prosper, not for the community to improve the care it gets at a lower cost. This has continued as IT investment has picked up, especially since 2003, and of course it’s been reflected in the stock price and profitability of the winners in health IT, notably Cerner and Epic.

Some other countries were introducing more clinically-based IT into their health care systems over the 1990s, and they tended to place it where their systems were focused—which tended to mean in primary care. The three Ns (Norway, Netherlands, New Zealand) along with the Danes & the Brits were close to 100% EMR use in office based primary care by the early 2000s. The UK was able to use this to actually track what its primary care docs were doing, and started paying them bonuses for doing the “right thing” in terms of prevention and evidence based medicine. But note that the IT was shoe-horned into a system which was by and large doing that already. It did not change the core way care was delivered. In fact in the UK the links between primary care (GPs) and specialty care (hospitals) are still by and large absent—despite a huge budgeted (and not fully spent) investment in Healthcare IT that exceeds what’s in the current US stimulus package for a country 1/5th the population! The astute observer will also notice that several countries that don’t have EMRs in universal use among physicians, notably France and Germany, also have pretty well regarded health care systems.

So it’s a pretty fair assumption that IT use in health care will reflect the system it’s put into, rather than transform it to something completely different.

So why all the aggro? Since the Obama win and the recession made the stimulus a certainty and health care IT’s inclusion in it a reality, THCB has been the venue for a series of articles in the form of Open Letters to the Obama Administration by David Kibbe & Brian Klepper, a defense of the proposed spending by John Halamka, an analysis of the perversion of administrative simplification under HIPAA by interested parties (clearinghouses) from Rick Peters, all culminating in a declaration that Health IT is in fact ready, just add $20 billion, by Mark Leavitt yesterday. This argument has by no means been confined to THCB, and in fact this latest discussion was started mostly in a series in Health Affairs, in which Carol Diamond and Clay Shirky accused the current health IT establishment of “magical thinking”, while somewhat surprisingly Microsoft—which sells a lot more in copies of Windows and Office to hospitals than health care tools to consumers or small practices—in the person of its health care leader Peter Neupert suggested that we should take a pause before hitting the “buy” key, and spend money on outcomes not on technology for its own sake. And enfant terrible Jonathan Bush is warning anyone who’ll listen that we’ll be locking in place outmoded technology.

Essentially the argument comes down to two things (Warning—gross generalizations ahead!). I liken this to the common truism that dogs attach themselves to people while cats attach themselves to places

Outcomes vs. technology: The Kibbe/Klepper/Peters/Neupert/Bush faction (the dogs)assumes that we need to change the incentives in the system, and then IT will naturally follow—and the current embryonic decision support systems will flourish quickly. But that current clinical systems aren’t good enough to invest in mostly because current results from EMR installations are very disappointing.

Although they discuss incentives (and most of the $20 billion will probably be aligned with some P4P measures), the cats’ (Leavitt/Halamka/Kolodner) view is closer to the thought that if you get the appropriate clinical technology (essentially in-patient and outpatient EMRs) into the hands of clinicians, then they’ll figure out what to do with it, and eventually the government can pay them according to how well they do it. (Halamka is a bit more open about this also being an IT public works scheme).

Patients vs. facilities: There’s also a more philosophical bias which harkens back to the difference between American and European health care systems, but not in the way you might think. The dog faction is in general primarily in favor of light-weight tools (and standards) that allow for innovation and service of the consumer patient by primary care teams (that’s the European part). The recent emergence of Web-based tools and patient communities that allow patients to apply self-service techniques and easy communication with teams of providers (yes, yes, that’s Health 2.0) are for them the keys to enabling better care. These tools are relatively cheap (and flexible) and mirror the SaaS trends in the rest of technology. (Think Gmail vs Outlook).

The cats’ view is closer to the opinion that the real work in American health care happens in big hospital systems, and that the key is to get everyone connected to their core clinical systems. Hence the concern with standardizing on products and private networks (RHIOs) rather than allowing a mass of anarchic applications out on the Internet which are more likely to “mash-up” together.

What about the biases? There have been plenty of accusations of bias and self-interest on these pages, and it’s worth quickly looking at it. For example, Jonathan Bush believes he’s riding a wave towards a SaaS future, whereas most of his competitors are still MUMPS-based client sever technologies—he fears the $20bn will be used to subsidize SUVs in a world where AthenaHealth is selling the Prius. Mark Leavitt, while on loan to the Chairman of CCHIT is the former CEO of MedicaLogic (now the core of GE’s Centricity EMR product) and a former HIMSS official. Most people in health care think of HIMSS as a vendor promotion association. Halamka of course is part of a very large AMC and the chair of the HITSP standards organization which tends to favor larger systems, whereas Kibbe is well know for his work promoting the lighter weight CCR standard and his involvement in the American Academy of Family Physicians—long the orphans of our specialty dominated medical culture. I also suspect that Kibbe’s recent criticisms of the EMR haven’t exactly helped his chance of receiving consulting dollars from the major HIT vendors, but he is also involved in consulting with smaller companies that stand to benefit from the emergence of new models of care. And of course Brian Klepper and I are involved in Health 2.0 (together in a consulting venture and me as co-founder of a conference).

However, I perhaps naively choose to believe that everyone involved is motivated more by their cultural takes on what’s important for health care, than their desire to put a hand-out for the $20 billion. I think that these same positions would have been taken by the same people 6 months ago when the bailout was yet a twinkle in Obama’s eye.

So in change, can we find unity? So despite the fierce words and the grave differences of opinion, can cats and dogs live together in harmony? I think that in the spirit of Obama’s first days in power we can find some unity. At the same time we need to be realistic about what comes next.

First, we need to get rid of the notion that IT is going to transform our health care system. To transform healthcare we need to get real health reform right. Obama is not doing IT any favors by imposing that pressure on its use—the dogs are correct here.

Second, we are not immediately going to move away from an acute care, large system-focused health care environment. Any change towards overall more consumer-focused health management will continue to be slower than some of us might like. So getting those acute care facilities that are not at BIDMC or InterMountain levels of technology readiness in better shape can’t hurt.

Third, despite all the harsh words, as the bill now stands, most of the $20 billion will reward actions with some form of P4P. If the folks at HHS & CMS who will be responsible for crafting the incentive structures hear a more unified voice from the assorted commentators, geeks, cats & dogs arguing over here, we’ll likely get more incentives rewarding better process and less direction on particular technologies—which will be a good thing.

Fourth, there’s an underlying concern among the dogs that in the cat view (which is more clearly the “establishment view”) the patient is lost. Yet I still see Leavitt and the others from the establishment keen to bridge the gap to patients with connectivity tools and to give them control over their data in PHRs. And I don’t believe anyone is suggesting that we halt the rapid development in the ability of patients to manage themselves, and communicate with each other and clinicians, which is at the heart of Health 2.0.

So I have hope that, while the health IT part of the bailout will not be the ultimate cure for our health care system, it will help in many ways all over the system. I also hope that while there won’t be complete consensus both cats and dogs will agree that it should fit some core basic principles so that in years to come we’ll judge that this money was wisely spent.

Of course I’ll be reserving judgment at least till the bill makes it out of committee, and probably until we see exactly how CMS wants to spend the money!

Matthew Holt is to Founder of THCB. Follow him at @boltyboy. This piece was originally published in 2009. Read it here.

Article source:The Health Care Blog

[fubavaxuci-blog]

Payday 2 Xbox 360 Cheats

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[kristinsimmons]

Cats & Dogs: Can We Find Unity on Health Care IT Change?

By MATTHEW HOLT

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 They passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

Let’s be clear, the stimulus package’s main role is to stop the patient from bleeding out and will probably need to be joined by a bank restructuring the likes of which we’ve never seen. Health care is a sideshow, but $20 billion is still $20 billion, and given that the current health IT market is only between $20 and $30 billion annually, it’s a huge potential increase for the industry.

This spending is separate from any larger health care reform proposed by Obama, even though it appears that such a reform package is fairly likely to appear in Congress as soon as Daschle, Baucus and Kennedy get their ducks in a row. And of course, most of the issues that divide THCB’s various commentators on health IT are rooted in problems that only a major reform can solve. And realistically even those most optimistic about the prospects for reform don’t believe that the Obama/Daschle/Baucus plan will get at the core problems of the U.S. health care system any time soon.

The underlying problems: American health care has two linked and intertwined problems. First, (and it is first) due to America’s unique political history, most of the pain of dealing with increasing health costs is deposited on a poor (or soon to be poor) and relatively powerless minority of the population—the sick who are uninsured and underinsured. No one is really responsible for their financial well being, nor is any entity forced to make their cost of care equal to that of the rest of society. So the health care system has reacted rationally over the years by increasing what it charges the majority, and not worrying too much about that minority even as it grows. Every other rational country instead distributes that cost evenly by putting (more or less) everyone in the same financial pool, and puts someone (usually the government) in charge of the total cost of the system to society. The US is different, as it’s the only place where for the players in the system doing more means getting more absolutely. Everywhere else, the rest of society stops the health care system arbitrarily grabbing more resources.

The process whereby the health care system grabs more and more in the US comes mainly via an incredibly strong supplier community that has political control over the large share of spending that is government funded, and economic control over the main providers of private spending—employers. Of course it may not feel that way to the suppliers in the system but the numbers (share of GDP going to health care more than doubling over 30 years) don’t lie.

This leads to the second problem: The mechanism of that provider control is a payment system that encourages piece work, acute care, fixing rather than prevention, specialization over primary care, and—not least—big hospitals over community based clinics. Now as Atul Gawande points out in the New Yorker this week, it’s not as if every other country does exactly the opposite, but the scale by which we’ve tipped over here is unprecedented. And multitudes of articles on THCB over the years prove it out, and show that it’s very hard to change that status quo.

This starts to get us back to IT. The first significant use of IT in health care in the US was in large hospitals primarily aimed at accounting (and billing) for piece work. Eventually most large and many smaller hospitals began to extend their IT capabilities to automate other aspects of their activity, but even among the most sophisticated, the role of IT supported rather than transformed the way they delivered care. The goal of the hospital is after all for the hospital to thrive and prosper, not for the community to improve the care it gets at a lower cost. This has continued as IT investment has picked up, especially since 2003, and of course it’s been reflected in the stock price and profitability of the winners in health IT, notably Cerner and Epic.

Some other countries were introducing more clinically-based IT into their health care systems over the 1990s, and they tended to place it where their systems were focused—which tended to mean in primary care. The three Ns (Norway, Netherlands, New Zealand) along with the Danes & the Brits were close to 100% EMR use in office based primary care by the early 2000s. The UK was able to use this to actually track what its primary care docs were doing, and started paying them bonuses for doing the “right thing” in terms of prevention and evidence based medicine. But note that the IT was shoe-horned into a system which was by and large doing that already. It did not change the core way care was delivered. In fact in the UK the links between primary care (GPs) and specialty care (hospitals) are still by and large absent—despite a huge budgeted (and not fully spent) investment in Healthcare IT that exceeds what’s in the current US stimulus package for a country 1/5th the population! The astute observer will also notice that several countries that don’t have EMRs in universal use among physicians, notably France and Germany, also have pretty well regarded health care systems.

So it’s a pretty fair assumption that IT use in health care will reflect the system it’s put into, rather than transform it to something completely different.

So why all the aggro? Since the Obama win and the recession made the stimulus a certainty and health care IT’s inclusion in it a reality, THCB has been the venue for a series of articles in the form of Open Letters to the Obama Administration by David Kibbe & Brian Klepper, a defense of the proposed spending by John Halamka, an analysis of the perversion of administrative simplification under HIPAA by interested parties (clearinghouses) from Rick Peters, all culminating in a declaration that Health IT is in fact ready, just add $20 billion, by Mark Leavitt yesterday. This argument has by no means been confined to THCB, and in fact this latest discussion was started mostly in a series in Health Affairs, in which Carol Diamond and Clay Shirky accused the current health IT establishment of “magical thinking”, while somewhat surprisingly Microsoft—which sells a lot more in copies of Windows and Office to hospitals than health care tools to consumers or small practices—in the person of its health care leader Peter Neupert suggested that we should take a pause before hitting the “buy” key, and spend money on outcomes not on technology for its own sake. And enfant terrible Jonathan Bush is warning anyone who’ll listen that we’ll be locking in place outmoded technology.

Essentially the argument comes down to two things (Warning—gross generalizations ahead!). I liken this to the common truism that dogs attach themselves to people while cats attach themselves to places

Outcomes vs. technology: The Kibbe/Klepper/Peters/Neupert/Bush faction (the dogs)assumes that we need to change the incentives in the system, and then IT will naturally follow—and the current embryonic decision support systems will flourish quickly. But that current clinical systems aren’t good enough to invest in mostly because current results from EMR installations are very disappointing.

Although they discuss incentives (and most of the $20 billion will probably be aligned with some P4P measures), the cats’ (Leavitt/Halamka/Kolodner) view is closer to the thought that if you get the appropriate clinical technology (essentially in-patient and outpatient EMRs) into the hands of clinicians, then they’ll figure out what to do with it, and eventually the government can pay them according to how well they do it. (Halamka is a bit more open about this also being an IT public works scheme).

Patients vs. facilities: There’s also a more philosophical bias which harkens back to the difference between American and European health care systems, but not in the way you might think. The dog faction is in general primarily in favor of light-weight tools (and standards) that allow for innovation and service of the consumer patient by primary care teams (that’s the European part). The recent emergence of Web-based tools and patient communities that allow patients to apply self-service techniques and easy communication with teams of providers (yes, yes, that’s Health 2.0) are for them the keys to enabling better care. These tools are relatively cheap (and flexible) and mirror the SaaS trends in the rest of technology. (Think Gmail vs Outlook).

The cats’ view is closer to the opinion that the real work in American health care happens in big hospital systems, and that the key is to get everyone connected to their core clinical systems. Hence the concern with standardizing on products and private networks (RHIOs) rather than allowing a mass of anarchic applications out on the Internet which are more likely to “mash-up” together.

What about the biases? There have been plenty of accusations of bias and self-interest on these pages, and it’s worth quickly looking at it. For example, Jonathan Bush believes he’s riding a wave towards a SaaS future, whereas most of his competitors are still MUMPS-based client sever technologies—he fears the $20bn will be used to subsidize SUVs in a world where AthenaHealth is selling the Prius. Mark Leavitt, while on loan to the Chairman of CCHIT is the former CEO of MedicaLogic (now the core of GE’s Centricity EMR product) and a former HIMSS official. Most people in health care think of HIMSS as a vendor promotion association. Halamka of course is part of a very large AMC and the chair of the HITSP standards organization which tends to favor larger systems, whereas Kibbe is well know for his work promoting the lighter weight CCR standard and his involvement in the American Academy of Family Physicians—long the orphans of our specialty dominated medical culture. I also suspect that Kibbe’s recent criticisms of the EMR haven’t exactly helped his chance of receiving consulting dollars from the major HIT vendors, but he is also involved in consulting with smaller companies that stand to benefit from the emergence of new models of care. And of course Brian Klepper and I are involved in Health 2.0 (together in a consulting venture and me as co-founder of a conference).

However, I perhaps naively choose to believe that everyone involved is motivated more by their cultural takes on what’s important for health care, than their desire to put a hand-out for the $20 billion. I think that these same positions would have been taken by the same people 6 months ago when the bailout was yet a twinkle in Obama’s eye.

So in change, can we find unity? So despite the fierce words and the grave differences of opinion, can cats and dogs live together in harmony? I think that in the spirit of Obama’s first days in power we can find some unity. At the same time we need to be realistic about what comes next.

First, we need to get rid of the notion that IT is going to transform our health care system. To transform healthcare we need to get real health reform right. Obama is not doing IT any favors by imposing that pressure on its use—the dogs are correct here.

Second, we are not immediately going to move away from an acute care, large system-focused health care environment. Any change towards overall more consumer-focused health management will continue to be slower than some of us might like. So getting those acute care facilities that are not at BIDMC or InterMountain levels of technology readiness in better shape can’t hurt.

Third, despite all the harsh words, as the bill now stands, most of the $20 billion will reward actions with some form of P4P. If the folks at HHS & CMS who will be responsible for crafting the incentive structures hear a more unified voice from the assorted commentators, geeks, cats & dogs arguing over here, we’ll likely get more incentives rewarding better process and less direction on particular technologies—which will be a good thing.

Fourth, there’s an underlying concern among the dogs that in the cat view (which is more clearly the “establishment view”) the patient is lost. Yet I still see Leavitt and the others from the establishment keen to bridge the gap to patients with connectivity tools and to give them control over their data in PHRs. And I don’t believe anyone is suggesting that we halt the rapid development in the ability of patients to manage themselves, and communicate with each other and clinicians, which is at the heart of Health 2.0.

So I have hope that, while the health IT part of the bailout will not be the ultimate cure for our health care system, it will help in many ways all over the system. I also hope that while there won’t be complete consensus both cats and dogs will agree that it should fit some core basic principles so that in years to come we’ll judge that this money was wisely spent.

Of course I’ll be reserving judgment at least till the bill makes it out of committee, and probably until we see exactly how CMS wants to spend the money!

Matthew Holt is to Founder of THCB. Follow him at @boltyboy. This piece was originally published in 2009. Read it here.

Cats & Dogs: Can We Find Unity on Health Care IT Change? published first on https://wittooth.tumblr.com/

[kristinsimmons]

Cats & Dogs: Can We Find Unity on Health Care IT Change?

By MATTHEW HOLT

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 They passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

Let’s be clear, the stimulus package’s main role is to stop the patient from bleeding out and will probably need to be joined by a bank restructuring the likes of which we’ve never seen. Health care is a sideshow, but $20 billion is still $20 billion, and given that the current health IT market is only between $20 and $30 billion annually, it’s a huge potential increase for the industry.

This spending is separate from any larger health care reform proposed by Obama, even though it appears that such a reform package is fairly likely to appear in Congress as soon as Daschle, Baucus and Kennedy get their ducks in a row. And of course, most of the issues that divide THCB’s various commentators on health IT are rooted in problems that only a major reform can solve. And realistically even those most optimistic about the prospects for reform don’t believe that the Obama/Daschle/Baucus plan will get at the core problems of the U.S. health care system any time soon.

The underlying problems: American health care has two linked and intertwined problems. First, (and it is first) due to America’s unique political history, most of the pain of dealing with increasing health costs is deposited on a poor (or soon to be poor) and relatively powerless minority of the population—the sick who are uninsured and underinsured. No one is really responsible for their financial well being, nor is any entity forced to make their cost of care equal to that of the rest of society. So the health care system has reacted rationally over the years by increasing what it charges the majority, and not worrying too much about that minority even as it grows. Every other rational country instead distributes that cost evenly by putting (more or less) everyone in the same financial pool, and puts someone (usually the government) in charge of the total cost of the system to society. The US is different, as it’s the only place where for the players in the system doing more means getting more absolutely. Everywhere else, the rest of society stops the health care system arbitrarily grabbing more resources.

The process whereby the health care system grabs more and more in the US comes mainly via an incredibly strong supplier community that has political control over the large share of spending that is government funded, and economic control over the main providers of private spending—employers. Of course it may not feel that way to the suppliers in the system but the numbers (share of GDP going to health care more than doubling over 30 years) don’t lie.

This leads to the second problem: The mechanism of that provider control is a payment system that encourages piece work, acute care, fixing rather than prevention, specialization over primary care, and—not least—big hospitals over community based clinics. Now as Atul Gawande points out in the New Yorker this week, it’s not as if every other country does exactly the opposite, but the scale by which we’ve tipped over here is unprecedented. And multitudes of articles on THCB over the years prove it out, and show that it’s very hard to change that status quo.

This starts to get us back to IT. The first significant use of IT in health care in the US was in large hospitals primarily aimed at accounting (and billing) for piece work. Eventually most large and many smaller hospitals began to extend their IT capabilities to automate other aspects of their activity, but even among the most sophisticated, the role of IT supported rather than transformed the way they delivered care. The goal of the hospital is after all for the hospital to thrive and prosper, not for the community to improve the care it gets at a lower cost. This has continued as IT investment has picked up, especially since 2003, and of course it’s been reflected in the stock price and profitability of the winners in health IT, notably Cerner and Epic.

Some other countries were introducing more clinically-based IT into their health care systems over the 1990s, and they tended to place it where their systems were focused—which tended to mean in primary care. The three Ns (Norway, Netherlands, New Zealand) along with the Danes & the Brits were close to 100% EMR use in office based primary care by the early 2000s. The UK was able to use this to actually track what its primary care docs were doing, and started paying them bonuses for doing the “right thing” in terms of prevention and evidence based medicine. But note that the IT was shoe-horned into a system which was by and large doing that already. It did not change the core way care was delivered. In fact in the UK the links between primary care (GPs) and specialty care (hospitals) are still by and large absent—despite a huge budgeted (and not fully spent) investment in Healthcare IT that exceeds what’s in the current US stimulus package for a country 1/5th the population! The astute observer will also notice that several countries that don’t have EMRs in universal use among physicians, notably France and Germany, also have pretty well regarded health care systems.

So it’s a pretty fair assumption that IT use in health care will reflect the system it’s put into, rather than transform it to something completely different.

So why all the aggro? Since the Obama win and the recession made the stimulus a certainty and health care IT’s inclusion in it a reality, THCB has been the venue for a series of articles in the form of Open Letters to the Obama Administration by David Kibbe & Brian Klepper, a defense of the proposed spending by John Halamka, an analysis of the perversion of administrative simplification under HIPAA by interested parties (clearinghouses) from Rick Peters, all culminating in a declaration that Health IT is in fact ready, just add $20 billion, by Mark Leavitt yesterday. This argument has by no means been confined to THCB, and in fact this latest discussion was started mostly in a series in Health Affairs, in which Carol Diamond and Clay Shirky accused the current health IT establishment of “magical thinking”, while somewhat surprisingly Microsoft—which sells a lot more in copies of Windows and Office to hospitals than health care tools to consumers or small practices—in the person of its health care leader Peter Neupert suggested that we should take a pause before hitting the “buy” key, and spend money on outcomes not on technology for its own sake. And enfant terrible Jonathan Bush is warning anyone who’ll listen that we’ll be locking in place outmoded technology.

Essentially the argument comes down to two things (Warning—gross generalizations ahead!). I liken this to the common truism that dogs attach themselves to people while cats attach themselves to places

Outcomes vs. technology: The Kibbe/Klepper/Peters/Neupert/Bush faction (the dogs)assumes that we need to change the incentives in the system, and then IT will naturally follow—and the current embryonic decision support systems will flourish quickly. But that current clinical systems aren’t good enough to invest in mostly because current results from EMR installations are very disappointing.

Although they discuss incentives (and most of the $20 billion will probably be aligned with some P4P measures), the cats’ (Leavitt/Halamka/Kolodner) view is closer to the thought that if you get the appropriate clinical technology (essentially in-patient and outpatient EMRs) into the hands of clinicians, then they’ll figure out what to do with it, and eventually the government can pay them according to how well they do it. (Halamka is a bit more open about this also being an IT public works scheme).

Patients vs. facilities: There’s also a more philosophical bias which harkens back to the difference between American and European health care systems, but not in the way you might think. The dog faction is in general primarily in favor of light-weight tools (and standards) that allow for innovation and service of the consumer patient by primary care teams (that’s the European part). The recent emergence of Web-based tools and patient communities that allow patients to apply self-service techniques and easy communication with teams of providers (yes, yes, that’s Health 2.0) are for them the keys to enabling better care. These tools are relatively cheap (and flexible) and mirror the SaaS trends in the rest of technology. (Think Gmail vs Outlook).

The cats’ view is closer to the opinion that the real work in American health care happens in big hospital systems, and that the key is to get everyone connected to their core clinical systems. Hence the concern with standardizing on products and private networks (RHIOs) rather than allowing a mass of anarchic applications out on the Internet which are more likely to “mash-up” together.

What about the biases? There have been plenty of accusations of bias and self-interest on these pages, and it’s worth quickly looking at it. For example, Jonathan Bush believes he’s riding a wave towards a SaaS future, whereas most of his competitors are still MUMPS-based client sever technologies—he fears the $20bn will be used to subsidize SUVs in a world where AthenaHealth is selling the Prius. Mark Leavitt, while on loan to the Chairman of CCHIT is the former CEO of MedicaLogic (now the core of GE’s Centricity EMR product) and a former HIMSS official. Most people in health care think of HIMSS as a vendor promotion association. Halamka of course is part of a very large AMC and the chair of the HITSP standards organization which tends to favor larger systems, whereas Kibbe is well know for his work promoting the lighter weight CCR standard and his involvement in the American Academy of Family Physicians—long the orphans of our specialty dominated medical culture. I also suspect that Kibbe’s recent criticisms of the EMR haven’t exactly helped his chance of receiving consulting dollars from the major HIT vendors, but he is also involved in consulting with smaller companies that stand to benefit from the emergence of new models of care. And of course Brian Klepper and I are involved in Health 2.0 (together in a consulting venture and me as co-founder of a conference).

However, I perhaps naively choose to believe that everyone involved is motivated more by their cultural takes on what’s important for health care, than their desire to put a hand-out for the $20 billion. I think that these same positions would have been taken by the same people 6 months ago when the bailout was yet a twinkle in Obama’s eye.

So in change, can we find unity? So despite the fierce words and the grave differences of opinion, can cats and dogs live together in harmony? I think that in the spirit of Obama’s first days in power we can find some unity. At the same time we need to be realistic about what comes next.

First, we need to get rid of the notion that IT is going to transform our health care system. To transform healthcare we need to get real health reform right. Obama is not doing IT any favors by imposing that pressure on its use—the dogs are correct here.

Second, we are not immediately going to move away from an acute care, large system-focused health care environment. Any change towards overall more consumer-focused health management will continue to be slower than some of us might like. So getting those acute care facilities that are not at BIDMC or InterMountain levels of technology readiness in better shape can’t hurt.

Third, despite all the harsh words, as the bill now stands, most of the $20 billion will reward actions with some form of P4P. If the folks at HHS & CMS who will be responsible for crafting the incentive structures hear a more unified voice from the assorted commentators, geeks, cats & dogs arguing over here, we’ll likely get more incentives rewarding better process and less direction on particular technologies—which will be a good thing.

Fourth, there’s an underlying concern among the dogs that in the cat view (which is more clearly the “establishment view”) the patient is lost. Yet I still see Leavitt and the others from the establishment keen to bridge the gap to patients with connectivity tools and to give them control over their data in PHRs. And I don’t believe anyone is suggesting that we halt the rapid development in the ability of patients to manage themselves, and communicate with each other and clinicians, which is at the heart of Health 2.0.

So I have hope that, while the health IT part of the bailout will not be the ultimate cure for our health care system, it will help in many ways all over the system. I also hope that while there won’t be complete consensus both cats and dogs will agree that it should fit some core basic principles so that in years to come we’ll judge that this money was wisely spent.

Of course I’ll be reserving judgment at least till the bill makes it out of committee, and probably until we see exactly how CMS wants to spend the money!

Matthew Holt is to Founder of THCB. Follow him at @boltyboy. This piece was originally published in 2009. Read it here.

Cats & Dogs: Can We Find Unity on Health Care IT Change? published first on https://wittooth.tumblr.com/