Author Archives: reidcurtis

Freedom chasers, equilibrium chasers.

Freedom chasers, equilibrium chasers.

We don’t talk about it enough.

Walls throw it off
And make us wonder what’s on the other side.
Make us want to jump over them, go around them, scale them.

“Something there is that does not love a wall”.

Walls make us insecure, as we wonder who is trying to get in.
Without a wall, you know.
With a wall, you wonder.

Censors throw it off.
And make us wonder what the censored would say.
Make us want to say it, shout it, scream it.

Censors make us insecure, as we wonder whether we have the truth.
Without a censor, you know.
With a censor, you wonder.

Subsidies throw it off.
And make us wonder what things are really worth
Make us all crazy.
Those with them want more. Those without them want them.

Subsidies make us insecure, as we wonder whether the demand is real.
Without a subsidy, you know.
With a subsidy, you wonder.

New policies throw it off.
They jolt the old equilibrium,
Send the system into oscillations,
Throw it out of equilibrium,
Force a new equilibrium to be reached … or else.

New technologies throw it off.
They disrupt the old way.
Send the system into oscillations,
Throw it out of equilibrium.
Force a new equilibrium to be reached … or else.

New polluters throw it off.
They jolt the equilibrium in the commons.
Send the commons into oscillations,
Throw it out of equilibrium,
Force a new clean-up or cleansing equilibrium … or else.

New diseases throw if off.
They jolt body.
Send the body into oscillations,
Throw it out of equilibrium.
Force a new immunity equilibrium … or else.

Freedom at first is chaos,

And then the stop signs go up.
And most everyone agrees they are useful.

And then the rules are made.
And most everyone agrees they are useful.

And then decency rises to the top.
And most everyone agrees that its useful.

And then freedom is channeled, and settles down to equilibrium-chasing.

Freedom chasers, equilibrium chasers.

Pittsburgh

I’m struck by how many locals are here. Like Boston, if you grew up in Pittsburgh, it seems like you never leave. Lots of natives.

The importance of the city seems so obvious, now that I know what I know.

For starters, it’s location is strategic. It’s literally sits at the point of land where two great rivers, the Allegheny and the Monongahela, come together to join the Ohio River. These are massive bodies of water.

Before rail and interstate highways, how does the growing economy move its steel, industrial products and consumer products?

The rivers!

And it now makes perfect sense to me… That, where the Three Rivers join, the leadership of this area decided that this point should be commemorated as a major park.

Point Park is just that. It’s a monument to this area, where everyone can come and see why the area exists in the first place. And as a monument inside of a monument, a massive fountain stands at the point of Point Park.

As I look to the Ohio River, to my left is the train tracks. I see a massive freight train passing, with hundreds of cars. I see an incline up to Mount Washington, which overlooks the city. The inclines are a vestige of a past when it was difficult to access the hill tops. They are everywhere.

Also to my left is the Fort Pitt Tunnel, the exit from the city to the east across the M river.

Heinz Park, the stadium, over looks Point Park to the right.

So this is where it all begins. Point Park.

The city seems to grow out of Point Park, in a gradual incline from there, with the Allegheny to the left and the M to the right.

The M River is made for walking and biking.

Three Rivers heritage Trail is the bike/walking path that goes from downtown all the way up west side of the M river

Great Appalachian Trail goes up the east side of M River.

Lots of hills. Lots of green (Schenley, Point, Highland and Frick Park are extra special).

They talk here about the “Pittsburgh Renaissance”.

They mean by that the transition of Pittsburgh from being at the center of the industrial economy, with all of its disgusting grit, to being at the center of the knowledge economy, with the University of Pittsburg, Carnegie Mellon, and Duquesne university leading the way.

Fifth Ave., Forbes Avenue, and Center Street, Penn, and Liberty all connect downtown to these outer neighborhoods.

The neighborhoods are Squirrel Hill, East Liberty, Lawrenceville, the Strip District, Bloomfield, Oakland, Shadyside, and Southside. Like Atlanta, they each have their own pride and style.

Oakland is the Univ. of Pittsburgh and Carnegie Mellon and Schenley Park. Fifth Ave runs through it. The University of Pittsburgh is center stage. It’s a huge urban campus, with all of the hallmarks of classical architecture great libraries, chapels etc. But everyone knows that Carnegie-Mellon is the powerhouse – where you find the rocket fuel of the knowledge economy. It is every bit as much to Pittsburgh as MIT is to Boston.

Shadyside is a great little find. A real neighborhood, centered on Walnut Street (at Ivy). Only a mile walk to Oakland, East Liberty, and Squirrel Hill. Girasole is here – Italian upscale.

Bloomfield is “little Italy”. Not a very good little Italy, but maybe they will keep trying.

Squirrel Hill is awesome. Highly diverse. Walkable. On top of a hill. Close to everything. Great houses. A great find: Everyone Noodle, the home of soup dumplings in Pittsburgh. Place is always full. Big Jewish Community here too. Frick Park is here.

Strip District is warehouses, converted. 21st street and Penn is the center. My favorite: Wholey’s Seafood Market. It’s massive and very cool retail. Like Stew Leonard’s , only better.

Southside is bars, lots of them. The main drag is East Carson. It’s a wide, flat street that looks more like Texas than Pittsburgh. One place in particular, Hofbrahaus, is a raucous German beer hall, with steins, sausages, oom-pah-pah live music. In a section of Southside called Southside Works. At night, ask Uber to take you to the Bartram House Bakery at 2612 East Carson. Easy walk from Birmingham or Hot Metal Bridge.

Lawrenceville is restaurants, lots of them. It’s 48th – 40th. Past the Strip District near Penn. it’s a hike, but a good walk takes you from 48th to 21st.

Everyone here believes that Pittsburgh, a finalist, it’s going to land the second headquarters of Amazon.

Their attitude toward Amazon is a little bit like their attitude toward all sports, but particularly the Steelers: can do.

SmartWatch Technology Reliably Detects Afib

The quantified self movement strikes again!

CREDIT: Cleveland Clinic Article on Detection of Afib via SmartWatch

Smartwatch Technology Reliably Detects Afib Prior to Cardioversion
Study suggests a role for KardiaBand when paired with physician review

A newly FDA-approved smartwatch accessory can record heart rhythm and successfully differentiate atrial fibrillation (AF) from normal sinus rhythm (SR) through an automated algorithm, according to a Cleveland Clinic investigation. The study, which will be presented March 11 at the American College of Cardiology’s 67th Scientific Session, also showed that the accuracy of interpretation gets even better when the accessory is supported by physician review.
The findings suggest that the wearable technology, known as KardiaBand™, can help screen patients before presentation for elective cardioversion to avoid unnecessary procedures, among other potential uses.
KardiaBand, which consists of a software app for an Apple Watch® and a sensor band that replaces one of the watch’s straps, provides a 30-second recording of an ECG rhythm strip when the wearer places a thumb on the sensor band. The app contains an algorithm for automated detection of AF.
“Our objective was to determine how accurately KardiaBand and its algorithm can differentiate AF from sinus rhythm compared with physician-interpreted 12-lead ECGs,” says senior author Khaldoun Tarakji, MD, MPH, a Cleveland Clinic electrophysiologist. In November 2017, the device became the first smartwatch healthcare accessory to be approved by the FDA, “but we wanted to test it ourselves to determine how well it would perform in clinical practice,” Dr. Tarakji explains.
Study essentials
To that end, he and Cleveland Clinic colleagues prospectively enrolled 100 consecutive patients (mean age, 68 ± 11 years) with chronic AF who were scheduled to undergo cardioversion. Upon presenting for the cardioversion procedure, all patients were given a KardiaBand-equipped smartwatch and trained in its use, after which they underwent traditional ECG assessment and a 30-second KardiaBand recording. If cardioversion was still indicated, they underwent ECG and KardiaBand testing after the procedure. KardiaBand recordings were then compared with the physician-reviewed ECGs and also reviewed by two blinded electrophysiologists, with these readings compared to ECG interpretations.
Eight patients did not undergo cardioversion because they presented in SR; these patients were excluded. Among the remaining patients, a total of 169 pairs of ECG and KardiaBand recordings were available for comparison (each patient had two before and two after cardioversion).
Key findings
• Of the 169 pre-cardioversion KardiaBand recordings, 57 fell out as “unclassified,” meaning that the KardiaBand algorithm did not draw a conclusion of either AF or SR.
• Among the remaining 112 pairs of recordings, the reviewing electrophysiologists determined that the KardiaBand algorithm correctly detected AF with 93 percent sensitivity and 84 percent specificity compared with ECG.
• When the blinded reviewers bypassed the automated algorithm and interpreted each patient’s KardiaBand strips against his or her ECG, sensitivity rose to 99 percent and specificity was 83 percent. Further, in the 57 unclassified cases, the reviewers were able to use the strips to correctly diagnose AF versus SR with 100 percent sensitivity and 80 percent specificity.
“This study shows that KardiaBand provides excellent sensitivity and good specificity in identifying AF,” says Dr. Tarakji. “The numbers improve further with physician overview of these recordings, indicating that even unclassified KardiaBand strip recordings could be of value to reading physicians.”
Smart devices demand smart use
KardiaBand carries the benefit of enabling patients to record their rhythm at any time, as opposed to only when they are wearing a Holter monitor or at a physician’s office. “We can catch intermittent episodes when they happen, and we’re not limited to a specific duration of monitoring time,” Dr. Tarakji says. He adds that wearable devices like this can also reduce time spent responding to false alarms if a recording taken at the same time shows normal rhythm.
Yet many questions remain about how KardiaBand and similar products may ultimately be used in practice. Dr. Tarakji cites a few examples:
• Which patients are best suited to this technology? For many patients dealing with AF, KardiaBand can provide reassurance when they need it. But for others, having constant access to their ECG data may lead them to check their rhythm obsessively, raising anxiety. “In general, however, patients value the instant feedback they get,” Dr. Tarakji observes.
• Do physicians have the IT infrastructure in place to make these devices part of their practice? Wearable devices can mean a flood of event reports to clinicians’ email boxes. At Cleveland Clinic, information from patients’ KardiaBands bypasses the email system and feeds into a cloud-computing platform that physicians can access anytime.
• How should clinicians respond to short episodes, particularly in asymptomatic patients? “We currently have a gap in our clinical knowledge about whether brief, random episodes that are asymptomatic warrant anticoagulation or not,” Dr. Tarakji explains, adding that ongoing studies are trying to address this important question.
“Future studies will focus on how we can use these smart devices intelligently to make sure they’re improving quality of care rather than just producing noise for physicians,” he observes.
A parallel goal, he says, is to ensure that the devices provide value by making care delivery more efficient. Noting that patients currently need to pay for KardiaBand out of pocket, Dr. Tarakji says that “developing a richer body of research evidence is the best way we can demonstrate cost-effectiveness to healthcare payers.”
Tech like this can’t be ignored
Indeed, KardiaBand could prove cost-effective by allowing patients who are in SR to avoid needless trips for elective procedures, such as in the case of the eight patients in the study who were found to be in SR when they presented for cardioversion and did not require the procedure. Other potential uses of KardiaBand for the longitudinal management of AF patients could well prove cost-effective too.
Regardless of how quickly such cost-effectiveness evidence may come, Dr. Tarakji says clinicians cannot be passive in the face of technologies like KardiaBand. “Patients will come to us with new products, and we can’t turn away,” he observes. “We need to test these products and find ways of responding to the information they deliver in a way that improves patient outcomes, all while remaining mindful of both patient and physician satisfaction.”
The researchers report that KardiaBand’s manufacturer, AliveCor, provided smartwatches for the study but was not involved in the study’s design, implementation, data analysis or interpretation.

Well-Being – Real Time Revisited

NOTE: This post revisits a post titled “Well-Being Real Time”. The original post was May, 2014, and can be found at: http://johncreid.com/2014/05/well-being-real-time/.

Well-Being – Real Time Revisited

Well-being is arguably the central mega-trend of the 21st century. As we look to the future, we have an obligation to “unpack” this dense concept, and find its essential component parts.

We describe these components here as “ACE” – ACT, CARE, and EAT. The wish we have for ourselves and for others is to be well. “Be Well” is our salutation and our call to actions.

How far out are we looking?

The future is now. ACE is here – together with real time measuring and monitoring. ACE is our pathway to greater and greater levels of personal well-being.

ACE measuring and monitoring will be supported by all elements of the quantified self movement. FitBit, Apple Watch, and so many other new monitoring devices will allow us to to bring personal well-being into a real-time modality.

ACE represents three pillars, each deceptively simple:

A – ACT: ACT is short for activity. The call to action is “stay active”. Well-being activity has physical activity at its center, but the pillar also embraces social activity, and activities of the mind. Staying active is a critical element of being well.
C – CARE: CARE is short for well-being care. The call to action is “care for yourself” and “care for others.”Well-being care of course has health care at its center, but there is so much more. e.g. genomics, massage, essential oils, acupuncture, etc. “Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care” regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.
E – EAT: EAT is short for eating and drinking. The call to action is “Eat well.” Well-being eating is the exploration of how what we eat and drink contributes to our well-being.

As simple as these pillars appear, each is complex: deep enough for a life-time of focus. Each represents bodies of research, skills, capabilities, and areas of professional endeavor. All together, these pillars represent pathway that each of us will follow as we attain greater and greater levels of personal well-being.

Discussion:

ACT

A – ACT (walking, running, calories burned etc)

Staying active is a critical element of being well. Well-being activity has physical activity at its center: sports, walking, lifting, climbing, yoga, and all of the other activities that light up a FitBit. The pillar also embraces activity of other kinds, e.g. social activity, and activities of the mind.

CARE

Well-being care is all about promoting health. Of course, it has health care at its center, but there is so much more. e.g. mental health, addictive behaviors, massage, genomics, essential oils, acupuncture, etc.

“Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care”, eldercare and aging, palliative care are included, but so are regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.

The ability to routinely monitor vital signs at home or at the office will be a part of this pillar. Lab work – including saliva, blood, and stool samples, will be more real time, more regular and less expensive. These trends will be one of the keys to progress in the care pillar. On the innovation side of this pillar will be many technologies, but breakthroughs in genomics will certainly be high on the list. Telemedicine is another innovation that will alter access to well-being care.

Predictive modeling will be more relevant than never. Am I headed for pre-diabetes? If so, what evidence shows me a path to avoid that condition?

CARE-MMEDS (what MEDS I take, what compliance I have, etc)

CARE-RResting Metabolic Rate (calories burned at rest)

CARE-VVITALS (pulse, BP, etc)

CARE-LLABS (blood testing, etc)

CARE-SSleep (duration, deep sleep, etc)

EAT

EAT is short for eating and drinking. The call to action is “Eat well.”

Well-being eating is the exploration of how what we eat and drink contributes to our well-being. Naturally, there is a social element, where eating and drinking together makes the experience more fulfilling. There is a physiological element, having to do with ingestion, osmosis, calories, glucose and glycogen, enzymes, etc. There is a psychological element, related to the feelings of satiety, or hunger, or thirst, and their related cravings. There is a sensory element, where sweet and sour contrasts, aromas, and their related metaphorical associations, play a part.

Eating delicious food and drink with friends is certainly a component. But achieving a balanced diet, with moderation as a central tenant,

On the one hand, this pillar is ancient. For thousands of years, elders have taught daughters and sons how to cook well. and cooking techniques have evolved

On the other hand, this pillar is ripe for innovation. The new breakthrough science related to the micro-biome is a part.

EATS (what I eat and drink, especially calories)

Implications

Monitoring all components of ACE (MEDS, Activity, Resting Metabolism,VITALS, EATS, LABS, Sleep) is now going to accelerate at an exponential rate.

There will be three settings where ACE monitoring will accelerate:

Employees in Workplaces: Employers will offer employees routine monitoring as part of employee benefits and/or health insurance.
Residents in Communities: Communities will offer residents routine monitoring as one of their amenities. Wellbeing facilities and programs will become as important as golf courses and swimming pools. Look for HOA’s,Condo and Coop associations, and subdivision developers to increasingly view MARVELS as critical to “place-making”.
Clients of service-providers: Hotels, spas, assisted-living centers, nursing homes, and many others will increasingly offer MARVELS monitoring as one of their base services.

The Privacy Imperative will be the critical success factor for all of these pushes into the future. It is foundational.

Without it, there will be no progress.

With it, personalized, real-time care will flourish. Each individual will be able to opt-in to his care-coaching community (and to opt-out whenever they choose), and get the extraordinary benefits that such a community can provide.

Want to talk to your well-being coach? FaceTime them, and they – with your permission – will help you sort out what’s going on with you.

Feel like you might need a check-in with a doctor? Send them an email – with your ACE history embedded in it, or get them on the phone or FaceTime, and see if they need you to come in.

The future is now.

BEWELL Centers will be everywhere. Look for:

DWELL CENTERS (part of BEWELL Centers) – for community ACE measuring and monitoring support. Target population is neighbors in the community.

Employee BEWELL CENTERS (part of BEWELL Centers) – for employees in workplaces ACE measuring and monitoring support. Target population is employees in the workplace.

CLIENT BEWELL CENTERS (Part of BEWELL Centers – for service-providers ACE measuring and monitoring support.Target population is clients of the service provider.
(Walgreens and CVS are already moving aggressively in this direction>

References:
The Privacy Imperative
LABS revolution
LABS By Disease
Quantified Self Movement

Co-Working – Update

In my first post on this subject, dated 1/2015, copied below, I said “This field is going to explode”.

Today’s Sunday Times published a major article on WeWork, which confirmed my suspicion.

JCR notes:
– they have 200,000 members
– they are in 20 countries
– revenue this year should to $2.3 billion
– apparently, he has convinced investors, including SoftBank and Benchmark, that it deserves a valuation around $20 billion, more than 10x IWG, its publicly traded competitor.
– they have started WeLive, its residential offering, and Rise, its gym.
– they acquired Meetup, the social network that facilitates in-person gatherings, and the Flatiron School, a coding academy.
– they bought the iconic Lord & Taylor building on Fifth Avenue in Manhattan, which is being transformed into the company’s new headquarters.
– SoftBank, the Japanese technology group led by the enigmatic billionaire Masayoshi Son, recently invested $4 billion
– in plans: WeGrow, the company’s for-profit elementary school, set to open in September.
– IWG,IWG, better known as Regus, has been around for decades. It is a publicly traded co-working company that has more members and more real estate than WeWork. IWG is valued at just $2 billion. Yet Mr. Neumann has convinced investors that WeWork is worth 10 times that figure.

Here it the article:

CREDIT: Sunday New York Times article on WeWork

The WeWork Manifesto: First, Office Space. Next, the World.

The brash, ambitious founders of WeWork, a global network of shared office spaces, want nothing less than to transform the way we work, live and play.

By DAVID GELLES
FEB. 17, 2018

On a cold February morning at the Brooklyn Navy Yard, the skeleton of a modern 15-story building was rising from a muddy construction site along the East River. As long and as tall as a cruise ship, the sleek glass structure loomed above rusty, century-old dry docks, serving notice to the industrial neighborhood that the new economy was coming.
The project, known as Dock 72, is the brainchild of WeWork, the fast-growing New York start-up valued at a whopping $20 billion. In just eight years, WeWork has built a network of 212 shared working spaces around the globe. But WeWork’s chief executive and co-founder, Adam Neumann, isn’t content to just lease out communal offices. Mr. Neumann — a lanky, longhaired 38-year-old Israeli — wants nothing less than to radically transform the way we work, live and play.

When Dock 72 is completed this year, if the aggressive timeline holds, it will represent the fullest expression of Mr. Neumann’s expansive vision to date. There will be an enormous co-working space, a luxury spa and large offices, for other companies like IBM and Verizon, that are designed and run by WeWork. There will be a juice bar, a real bar, a gym with a boxing studio, an outdoor basketball court and panoramic vistas of Manhattan. There will be restaurants and maybe even dry cleaning services and a barbershop.

It will be the kind of place you never have to leave until you need to go to sleep — and if Mr. Neumann has his way, you’ll sleep at one of the apartments he is renting nearby.

It’s an all-encompassing sort of ambition, and Mr. Neumann is the brash and idealistic pitchman. Simply by encouraging strangers to share a beer at the office, he argues, WeWork can heal our fractured society.

“How do you change the world?” Mr. Neumann asked in a recent interview. “Bring people together. Where is the easiest big place to bring people together? In the work environment.”

It may sound simplistic, but around the globe, companies are buying whatever it is that Mr. Neumann and his co-founder, Miguel McKelvey, are selling. WeWork has rapidly expanded to 20 countries, assembled a formidable executive team and attracted some 200,000 members. Big companies like JPMorgan Chase and Siemens are signing on as tenants, and revenues are growing fast, expected to top $2.3 billion this year.

WeWork last year bought the iconic Lord & Taylor building on Fifth Avenue in Manhattan, which is being transformed into the company’s new headquarters. That deal was made possible in part by a recent $4.4 billion investment from SoftBank, the Japanese technology group led by the enigmatic billionaire Masayoshi Son.

Already the company has started WeLive, its residential offering, and Rise, its gym. It acquired Meetup, the social network that facilitates in-person gatherings, and the Flatiron School, a coding academy. Still to come: WeGrow, the company’s for-profit elementary school, set to open in September. WeWork has even invested in plans to create giant wave pools for inland surfing.

A company ostensibly about co-working now employs yoga instructors, architects, teachers, environmental scientists, software engineers, molecular biologists and social psychologists.

Is it all a bit much for a young company still trying to build out its core business? “I’ve made that argument,” said Bruce Dunlevie, a WeWork board member and partner at the venture capital firm Benchmark. But, he said, “great entrepreneurs like Adam don’t listen to guys like me.”

As WeWork expands in all directions, it faces persistent questions about its rich valuation and the durability of its business model. Critics argue that the company does little more than corporate real estate arbitrage — leasing a space, spiffing it up, then subleasing it out to other tenants. The company owns hardly any properties, giving it precious few hard assets. Its growth projections strike many as unattainable, and it has missed expectations before. A number of upstarts loom as potential competitors, seeking to replicate WeWork’s success. And many WeWork tenants are unproven start-ups that could quickly fold.

IWG, a publicly traded co-working company that has more members and more real estate than WeWork, is valued at just $2 billion. Yet Mr. Neumann has convinced investors that WeWork is worth 10 times that figure.

“Adam’s explanation for the valuation of WeWork speaks for itself,” said Chris Kelly, co-founder and president of Convene, a company that offers flexible event spaces and is backed by major real estate firms. “This is not an Excel spreadsheet calculation. He believes there’s an energy behind the brand, and he’s gotten people to invest at that valuation. He has not tried to explain it in traditional financial terms.”

Indeed, to assess WeWork by conventional metrics is to miss the point, according to Mr. Neumann. WeWork isn’t really a real estate company. It’s a state of consciousness, he argues, a generation of interconnected emotionally intelligent entrepreneurs. And Mr. Neumann, with his combination of inspiration and chutzpah, wants to transform not just the way we work and live, but the very world we live in.

It’s an audacious, perhaps delusional plan for a company that made its mark by building communal desks and providing refreshments. And so far, it seems to be working.

Mr. Son, WeWork’s largest investor, is betting that the company will grow exponentially in the years to come, making his multibillion-dollar investment a veritable bargain.
“Make it 10 times bigger than your original plan,” Mr. Son told Forbes late last year. “If you think in that manner, the valuation is cheap. It can be worth a few hundred billion dollars.”

Close Communities
The notion that white-collar workers might actually like their offices is a relatively new one. From the countinghouses of industrial England to the skyscrapers of 1980s Manhattan, offices were mostly uninspiring places designed to maximize space, often with row upon row of unglamorous desks.

“The only kind of model that anyone had for laying out a large workplace was a factory,” said Nikil Saval, author of “Cubed: A Secret History of the Workplace.” “So the office was made to resemble an assembly line.”

This dreary state of affairs began to change in earnest, at least for some, during the dot-com bubble. Tech companies built playful offices with beanbags and Ping-Pong tables, making work spaces less formal. Free food became commonplace.

Raised expectations for amenities and interior design gradually seeped into the mainstream, and today, more and more employees — especially millennials — expect enlightened, unconventional offices.

Enter WeWork. With people bouncing between employers, jobs concentrated in cities and technology making it easier to work remotely, the demand for co-working was suddenly real, and ready to be monetized. Mr. Neumann, who grew up on a kibbutz in Israel, had an epiphany: Bring the communal vibe to the office.

Soon he and a friend — Mr. McKelvey, an equally tall Oregonian who grew up on a collective and was working as an architect — founded an eco-friendly co-working space in Brooklyn. They sold it, but they quickly turned around and started WeWork in 2010.
“Me and Miguel have this common ground,” Mr. Neumann said. “We both grew up in very close communities.”

WeWork didn’t invent co-working spaces, of course. IWG, better known as Regus, has been around for decades. But Mr. Neumann and Mr. McKelvey quickly hit upon a recipe that drew throngs of start-ups: an industrial chic aesthetic, some big common areas with comfy couches, free beer and piped-in pop music.

Individuals pay as little as $45 a month for occasional access to a desk in a common area. Start-ups can pay a few thousand dollars for a private room on a month-to-month basis, and some big companies pay millions of dollars a year for spaces that hold thousands of employees over multiple locations.

It’s a formula that has caught on from New York to Tel Aviv to Shanghai. In New York alone, WeWork has 49 spaces, most of them nearly full. At the WeWork in Harlem, dance companies share space with hair care start-ups in a common area adorned with murals of jazz musicians. At a WeWork in TriBeCa, fashion designers and alcohol distributors work shoulder to shoulder in a spartan space decorated with neon lighting.

For WeWork to really succeed in changing the way we all work, it is going to have to win over big corporations seeking space for thousands of employees. The strategy is an odd reversal for WeWork, which made its name catering to freelancers and start-ups.
The Weather Channel recently moved its ad sales team into an enormous WeWork in Midtown Manhattan. Barbara Bekkedahl, who runs the group, said the transition was easy and the space comfortable and stylish.
But Ms. Bekkedahl had a complaint, too, one that highlights one of the downsides of communal work space. She suggested that the hygienic and sartorial habits of some of her new office mates were lacking.

“As a TV sales team, we groom and dress for outside sales,” she said. “Some of the techie and start-up types housed at WeWork aren’t facing customers all day, so don’t always have the same standards.”

Gripes about grooming are unlikely to slow down WeWork’s business with corporate clients, especially if Mr. Neumann makes good on his promise to save them money. Because WeWork is building out so much space and buying so much furniture, Mr. Neumann says, he can renovate and operate an office for a fraction of the cost that companies would normally spend.

“We have economies of scale,” he said. “I’ll cut your operational costs between 20 to 50 percent.”

It might seem like another instance of Mr. Neumann’s talking a big game but for the fact that more and more companies — GE, HSBC, Salesforce and Microsoft among them — are signing on.
For years now, big companies have outsourced payroll processing, janitorial services and security. It’s not a stretch to imagine more of them outsourcing the design and maintenance of their offices to a company like WeWork.
“We only have 200,000 members,” Mr. McKelvey, 43, said. “That’s ridiculous. We need to have two million and then 20 million.”

More ‘We’ Than ‘Me’
Bankers and lawyers poured out of skyscrapers and made for the suburbs on a recent Monday night in Manhattan’s financial district. But at 110 Wall Street, a building controlled entirely by WeWork, the party was just getting started.

Last year, this 1960s-era office tower was converted into a mixed-use development of Mr. Neumann’s design. There is a co-working space. On the ground floor are trendy restaurants including Westville, Fuku, Momofuku Milk Bar and a bar called the Mail Room.

And then there is a WeLive: a complex of about 200 fully furnished apartments rented out on a short-term basis. Tenants get the signature WeWork aesthetic of unpolished wood and wrought iron, as well as various perks. There are hot tubs on the terrace. There are arcade games and a pool table in the laundry room. There are a chef’s kitchen and a communal dining room. At a bar on a residential floor, a happy hour was brewing and free Tempranillo was flowing.

In the communal dining area, three brothers — Jordan, Jake and Jimmy DeCicco — were cooking for a half-dozen social media influencers, hoping to stir up enthusiasm for their protein-infused iced coffee company. Over rib-eye steaks and brussels sprouts, they talked about promoting the brand and breaking into new markets, passing out beers to anyone who walked by.

The brothers are all in: They live in WeLive, work in the adjacent WeWork space and exercise at WeWork’s nearby gym, Rise.

“It’s awesome,” Jake DeCicco said. “You just roll out of bed, go down the elevator and get to work.”

Had Mr. Neumann been there to share a beer, those words would have been music to his ears. He believes that creating a work and living environment where people mingle is in fact a world-changing innovation. Each WeWork has a “community manager” who keeps tabs on members, makes introductions and organizes social activities.

If more strangers are colliding by the grapefruit water, the thinking goes, they are more likely to meet up and invest in one another’s socially responsible start-ups, and then the world will be a better place.

“Once you choose to enter a WeWork, you choose to be part of something more ‘we’ than ‘me,’” Mr. Neumann said. “People start coming together. They’ll see each other in the elevator, they talk in the stairways. There’s a thousand other things they do.”
Elevators. Stairways. Hardly world-changing innovations. But WeWork takes extra steps to encourage fraternization. Like beer kegs that never run dry.

More than most companies, WeWork promotes the consumption of alcohol as an inherent virtue. Posters on the wall encourage people to have a drink. There are wine tastings at WeLive. Company parties feature top-shelf liquor. Mr. Neumann has a well-known penchant for tequila, and a well-stocked bar is prominent in his office.

On a recent Tuesday at 4:07 p.m., the community manager of a WeWork in Midtown Manhattan sent an email reading: “It’s time to get your creative juices flowing! Join us on the 5th floor to drink some wine & paint a beautiful picture.” Just after noon on Valentine’s Day, there was an invitation to share wine and cake in the common area.

Though alcohol is a social lubricant for some, it can be off-putting to many others. Many women have shared stories of feeling uncomfortable with what they described as a frat house culture at some WeWorks, prompting some to leave.

As WeWork has grown, minor scandals have rattled the company. In 2015, the company grew ensnared in a complicated legal dispute with a group of former janitors who tried to unionize at a subcontractor that WeWork used. The next year, WeWork drew scrutiny for its use of arbitration to settle workplace disputes, and for its firing of an employee who refused to adhere to a related policy.

But so far nothing — not alcohol, labor disputes, questions about the business fundamentals or bad publicity — has managed to alter the company’s trajectory.
“We’re a disrupter of the way people view the spaces they work in on a day-to-day basis,” said Mr. Dunlevie of Benchmark. “And we’re in the early days of taking advantage of that phenomenon.”

Teaching Tykes
In September, WeWork will open its most ambitious project to date: a kindergarten. It may also be the effort that tests whether WeWork is flying too close to the sun.
The creation of Mr. Neumann’s wife, Rebekah, 39, the school is known as WeGrow. When it opens, it promises a well-designed space with a curriculum that emphasizes socializing and entrepreneurship for 3-year-olds on up.

WeGrow fits neatly into Mr. Neumann’s expansive vision for creating a generation of empathetic social impact entrepreneurs. But the risk-reward calculus is different when starting a school.

WeGrow won’t scale as rapidly as WeWork has, so the financial upside is limited. Yet should something go wrong, the fallout could be devastating: It’s one thing to be responsible for the internet going out or paper running low at the communal printer. It’s another thing to take responsibility for the health and development of someone’s child.

Though Ms. Neumann has no background in education (on the website, she describes herself as “an avid student of life” and says her “superpower” is “intuition”), she has applied for accreditation from the state, has hired a team of career educators and is accepting applications for the coming school year. Tuition for toddlers: $36,000 a year.

“We all understand how complicated and regulated school is compared to the simpler business that we are already in,” Mr. Neumann said. “But we decided we’re going to go into education. If you really want to change the world, change kids when they’re 2.”
As he proselytized, Mr. Neumann was sitting on an enormous leather couch in his Chelsea office, which is bigger than many New York City apartments. It included a conference table, a video conferencing setup, several desks, a bar, spreads of food, a Peloton exercise bike, a climbing machine, a boxing bag hanging from the ceiling, a gong, an antechamber where assistants work and a private bathroom.

“It’s going to work,” Mr. Neumann continued. “Is it going to be perfect? Definitely not. Are we going to make mistakes? A hundred percent. Are we going to be comfortable admitting those mistakes? Definitely. It’s what we do here.”

Though such unbridled zeal can be abrasive to some, it could also be viewed as the mark of a peripatetic savant. Walter Isaacson, the biographer of Steve Jobs, Albert Einstein, Benjamin Franklin and Leonardo da Vinci, counts Mr. Neumann as a friend, and said he shared some of the attributes that had allowed those other titans to succeed.

“He has an instinctive feel for how millennials are going to want to have community work experiences without joining large corporations,” Mr. Isaacson said. “And like Steve Jobs and other great entrepreneurs, he knows how to connect the humanities with business and technology.”

‘Make a Life’
It can be tempting to dismiss WeWork as just another overvalued start-up that is high on its own rhetoric and flush with easy money from naïve investors. With little more than faddish interior design, free beer and an invitation to socialize with strangers, Mr. Neumann claims to have conjured up a whole new paradigm for white-collar workers — and for education — and vows that it can change the world.

It’s the kind of utopian prattle that can come off as dangerously out of touch at a moment when a backlash against big tech is brewing. But if any of these potential pitfalls concern Mr. Neumann, he doesn’t show it.
On a Wednesday night in January, Mr. Neumann strode onstage before a packed house at the Theater at Madison Square Garden, basked in spotlights. Wearing a black leather biker jacket and a T-shirt that read “High on We,” Mr. Neumann was playing host at his own extravagant party, a multiday celebration of WeWork and its extended community.

On this, the first night of festivities, Mr. Neumann would oversee a “Shark Tank”-like competition for socially responsible small businesses — ranging from a start-up that made customized prosthetics to a food-delivery service staffed by refugees — each vying for a $1 million prize.

Earlier, Mr. Neumann had rattled off the company’s achievements and outlined some of its more outsize ambitions. As the evening’s performer, the Grammy-winning rapper Macklemore, waited backstage, Mr. Neumann went on an impromptu riff about how people should “make a life, not just a living,” the company’s aspirational motto.

Mr. Neumann also stated that it was important to support social entrepreneurs. “Of course that makes a lot of sense, but who’s going to pay for that?” he said. “And we said, ‘Well, Masa might!’”

The line generated a laugh among the hundreds of knowing employees in the room — Mr. Son, whose nickname is Masa, was conveniently absent — but it was a tell from Mr. Neumann, a sly admission that at this point he is playing with house money.

Then, when the time came to choose a winner, Mr. Neumann made a surprise announcement: Instead of choosing one recipient, WeWork would give away $1 million each to two of the companies — Re:3D, a 3-D printing company, and Global Vision 2020, a nonprofit that provides prescription glasses to people in the developing world. And it would give another couple of million to the other half-dozen finalists.

Confetti fell from the rafters. The winners cried on stage. Mr. Neumann took it all in, beaming.

Even Macklemore was taken aback by all the money flying around. “I was just watching it, chugging a Red Bull,” he said shortly into his set, “and I immediately thought, ‘Damn, I should have got into technology.’”
Continue reading the main story

Cole Wilson for The New York Times
David Gelles is the Corner Office columnist and a business reporter. Follow him on Twitter @dgelles and LinkedIn.

A version of this article appears in print on February 18, 2018, on Page BU1 of the New York edition with the headline: First, Office Space; Then the World.

=================== PRIOR POST from January, 2015 ============
Co-Working

The field is going to explode.

The model for co-working is ROAM. GREAT business model – huge uptake. Place was packed.

They currently are in Alpharetta and Dunwoody, and are opening a Buckhead facility in Tower Place this summer. They have a mini-cafeteria, office space, mail handling, membership services, printing, etc.

Here is the download:

http://meetatroam.com

“Roam is the innovator’s workplace; a meeting and gathering experience for the new workforce. We are partnering for success by creating environments where people focus, collaborate, learn and socialize.”

“We are a Collective, a Local Community of Innovators, Pioneers and Visionaries.”

From a member: “Patrick also thinks that energy is Roam’s differentiator. “When you walk into Roam Dunwoody, it’s like you walk into a room full of vibrations,” he says. He loves interacting with the other members here and feeding off of that energy. “Every Roam member is passionate about whatever they do. They really want their business to make an impact.” The members as a whole are a forward-thinking group, open to new ideas and supportive of innovation, “

This entry was posted in Architecture, Well-Being – PersonaL and tagged Architecture, personal well-being, Serenbe on January 14, 2015.

Brother Jim

Here’s a short biography of my older brother James Robert Reid, born December 10, 1948:

Fall of 1967*, commuter freshman at Northeastern (with Bobby Tallent, Tommy Carabine, Peter Flynn) , Business Administration major. Bad student.
Joined rowing team. At 6’2″ I was the smallest guy in the boat.

Fall of 1968, made the Varsity, our eight won The Head of the Charles Regatta.*
Worked an interesting variety of NU Co-Op jobs, Boston Globe*, Haskins and Sells*.
1969, changed major to English, better student.

1970, my fiancee, Jeanne Nelson’ s father, a towboat captain for Perini Corp. finagled me a deckhand job (perhaps my best job ever) on Dredge #111 which was dredging the inlet/cooling water channel for the Plymouth Nuclear Power Plant.*
1970, married Jeanne Nelson (too young, imo). First apt at 287 Beacon Street. I could bike to NU, both school and the crew boathouse (stored my treasured Mercier 10 speed in the bathtub). Jeanne could walk to work for the Sonnabends at the Sonesta.
Fall, 1970, Still in the Varsity boat, Olympians Dietz and Coffey powered us to another win in the Head of the Charles Regatta.

June 1972, graduated from NU at Boston Garden, enduring the hot, hanging stink of the previous week’s circus animals.

August, 1972, reported to US Naval Reserve, AOCS and flight training, in Pensacola Florida, 95° and 95% humidity. Met my first surly Marine D.I., Sgt. E. Beadle.*
Dec 1972, graduated from AOCS, commissioned as an Ensign, USNR. Reported for Primary flight training at NAS Saufley, flying T-34, single engine, low wing trainer. Instructor Lt. Ron Pritz, USMC (helicopter pilot).

May 29, 1973, daughter Amy born on base hospital, costing $5.25 (Jeanne’s meals).
Left flying and applied for honorable discharge. While waiting for BUPERS paperwork, I was stationed as a P.A. (Public Affairs) Officer with The Blue Angels, traveled the country to airshows, ironically promoting Navy flying, even though I had left it.*
Summer, 1973, Navy moved us back to Winthrop during the Arab oil embargo, recession, no jobs, scary with young family. From that point, personal and economic frustration ate at our marriage, probably doomed it, we divorced in 1975. Lived out of boxes with my parents for awhile. Moved to Boston, walking distance from where I was working (at NU). Started MBA studies, A student.

I’ll tell you the “rest of the story” when I see you. All good now, just celebrated 36 years of second marriage, writing (two children’s books for sale on Amazon). Along the way, I worked in Admin for 3 tech companies, learned hardscaping and landscaping, frame and finish carpentry, cabinet making, land surveying, stone masonry, woodstove installation, served 6 years on regional school committee, had a stint in direct sales, drove executive cars for BostonCoach, now still work on my 1953 Ford Jubilee farm tractor, still felling trees, burning wood, just held 24th Extreme Camping with old, and good friends (long story).

* I have written extensively about these experiences. Stay tuned for self-publication of my collection of “memoir essays”, working title, Missing Man.

Amazon, BH, JPMorgan

With 1.2 million employees, Amazon, Berkshire Hathaway, and JP Morgan have decided to venture together into health care for their employees.

Following in the grand tradition of Henry Ford, who set up Henry Ford Hospital in Detroit, these three giants are stepping in too.

They have no illusions about how difficult it will be. But with premiums rising 19% per year, its clear that Congress is doing nothing, and someone has to do something.

“Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.”

The article points out that there are others working on this.

“Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.”

“Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care.”

“Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.”

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers”

=================
CREDIT: https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html?smid=nytcore-ipad-share&smprod=nytcore-ipad

TECHNOLOGY
Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care

By NICK WINGFIELD, KATIE THOMAS and REED ABELSON
JAN. 30, 2018
SEATTLE — Three corporate behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States.

The alliance was a sign of just how frustrated American businesses are with the state of the nation’s health care system and the rapidly spiraling cost of medical treatment. It also caused further turmoil in an industry reeling from attempts by new players to attack a notoriously inefficient, intractable web of doctors, hospitals, insurers and pharmaceutical companies.
It was unclear how extensively the three partners would overhaul their employees’ existing health coverage — whether they would simply help workers find a local doctor, steer employees to online medical advice or use their muscle to negotiate lower prices for drugs and procedures. While the alliance will apply only to their employees, these corporations are so closely watched that whatever successes they have could become models for other businesses.

Major employers, from Walmart to Caterpillar, have tried for years to tackle the high costs and complexity of health care, and have grown increasingly frustrated as Congress has deadlocked over the issue, leaving many of the thorniest issues to private industry. About 151 million Americans get their health insurance from an employer.
(Why will health care be so difficult for these companies to untangle? Analysis from The Upshot.)
But Tuesday’s announcement landed like a thunderclap — sending stocks for insurers and other major health companies tumbling. Shares of health care companies like UnitedHealth Group and Anthem plunged on Tuesday, dragging down the broader stock market.

That weakness reflects the strength of the new entrants. The partnership brings together Amazon, the online retail giant known for disrupting major industries; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

They are moving into an industry where the lines between traditionally distinct areas, such as pharmacies, insurers and providers, are increasingly blurry. CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the changes underway. Separately, Amazon’s potential entry into the pharmacy business continues to rattle major drug companies and distributors.
(Here’s a look at how the even the threat of Amazon’s entry into an industry can rattle stocks.)

The companies said the initiative, which is in its early stages, would be “free from profit-making incentives and constraints,” but did not specify whether that meant they would create a nonprofit organization. The tax implications were also unclear because so few details were released.
Jamie Dimon, the chief executive of JPMorgan Chase, said in a statement that the effort could eventually be expanded to benefit all Americans.

“The health care system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” Jeff Bezos, Amazon’s founder and chief executive, said in a statement. “Hard as it might be, reducing health care’s burden on the economy while improving outcomes for employees and their families would be worth the effort.”

The announcement touched off a wave of speculation about what the new company might do, especially given Amazon’s extensive reach into the daily lives of Americans — from where they buy their paper towels to what they watch on television. It follows speculation that the company, which recently purchased the grocery chain Whole Foods, might use its stores as locations for pharmacies or clinics.
(We asked health care experts to imagine what the three corporations might do.)

“It could be big,” Ed Kaplan, who negotiates health coverage on behalf of large employers as the national health practice leader for the Segal Group, said of the announcement. “Those are three big players, and I think if they get into health care insurance or the health care coverage space, they are going to make a big impact.”

TAKING ON ‘THE HUNGRY TAPEWORM’
A look at the three companies that announced a joint health care initiative on Tuesday.

Total employees: 1.2 million 
Amazon: 540,000 
Berkshire Hathaway: 367,000
JPMorgan Chase: 252,000.
Individual strengths 
Amazon: logistics and technology
Berkshire Hathaway: insurance
JPMorgan Chase: finance.

Jeff Bezos of Amazon:
“The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.”
Warren E. Buffett of Berkshire Hathaway:
“The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable.”
Jamie Dimon of JPMorgan Chase:
“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

But others were less sure, noting that the three companies — which, combined, employ more than one million people — might still hold little sway over the largest insurers and pharmacy benefit managers, who oversee the benefits of tens of millions of Americans.

“This is not news in terms of jumbo employers being frustrated with what they can get through the traditional system,” said Sam Glick of the management consulting firm Oliver Wyman in San Francisco. He played down the notion that the three partners would have more success getting lower prices from hospitals and doctors. “The idea that they could have any sort of negotiation leverage with unit cost is a pretty far stretch.”

Even the three companies don’t seem to be sure of how to shake up health care. People briefed on the plan, who asked for anonymity because the discussions were private, said the executives decided to announce the initiative while still a concept in part so they can begin hiring staff for the new company.

Three people familiar with the partnership said it took shape as Mr. Bezos, Mr. Buffett, and Mr. Dimon, who are friends, discussed the challenges of providing insurance to their employees. They decided their combined access to data about how consumers make choices, along with an understanding of the intricacies of health insurance, would inevitably lead to some kind of new efficiency — whatever it might turn out to be.

“The ballooning costs of health care act as a hungry tapeworm on the American economy,” Mr. Buffett said in the statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Over the past several months, the three had met formally — along with Todd Combs, an investment officer at Berkshire Hathaway who is also on JPMorgan’s board — to discuss the idea, according to a person familiar with Mr. Buffett’s thinking.

The three chief executives saw one another at the Alfalfa Club dinner in Washington on Saturday, but by then each had already had dozens of conversations with the small in-house teams they had assembled. The plan was set.

Mr. Buffett’s motivation stems in part from conversations he has had with two people close to him who have been diagnosed with multiple sclerosis, according to the person. Mr. Buffett, the person said, believes the condition of the country’s health care system is a root cause of economic inequality, with wealthier people enjoying better, longer lives because they can afford good coverage As Mr. Buffett himself has aged — he is 87 — the contrast between his moneyed friends and others has grown starker, the person said.

The companies said they would initially focus on using technology to simplify care, but did not elaborate on how they intended to do that or bring down costs. One of the people briefed on the alliance said the new company wouldn’t replace existing health insurers or hospitals.

Planning for the new company is being led by Marvelle Sullivan Berchtold, a JPMorgan managing director who was previously head of the Swiss drugmaker Novartis’s mergers and acquisitions strategy; Mr. Combs; and Beth Galetti, a senior vice president at Amazon.

One potential avenue for the partnership might be an online health care dashboard that connects employees with the closest and best doctor specializing in whatever ailment they select from a drop-down menu. Perhaps the companies would strike deals to offer employee discounts with service providers like medical testing facilities.

“Each of those companies has extensive experience using transformative technology in their own businesses,” said John Sculley, the former chief executive of Apple who is now chairman of a health care start-up, RxAdvance. “I think it’s a great counterweight to what government leadership hasn’t done, which is to focus on how do we make this health care system sustainable.”

How Amazon Rattles Other Companies
The e-commerce giant’s actions – some big, like buying Whole Foods Markets; some smaller, like Amazon meal kits – have led to stock sell-offs for a wide range of businesses.

Erik Gordon, a professor at the University of Michigan’s Ross School of Business, predicted that the companies would attempt to modernize the cumbersome process of doctor appointments by making it more like booking a restaurant reservation on OpenTable, while eliminating the need to regularly fill out paper forms on clipboards.

“I think they will bring the customer-facing, patient-facing thing into your smartphone,” he said.

Amazon has long been mentioned by health care analysts and industry executives as a potential new player in the sector. While the company has remained quiet about its plans, some analysts noted that companies often use their own employees as a testing ground for future initiatives.

The entry of Amazon and its partners adds to the upheaval in an industry where much is changing, from government programs after the overhaul of the tax law to the uncertain future of the Affordable Care Act. All the while, medical costs have persistently been on the rise.

Nationwide, average premiums for family coverage for employees rose to $18,764 last year, an increase of 19 percent since 2012, according to the Kaiser Family Foundation. Workers are increasingly paying a greater share of those costs — they now pay 30 percent of the premium, in addition to high deductibles and growing co-payments.
“Our members’ balance sheets speak for themselves — health care is a growing cost at a time when other costs are either not rising or falling,” said Robert Andrews, chief executive of the Healthcare Transformation Alliance, a group of 46 companies, including Coca-Cola and American Express, that have banded together to lower health care costs.

Other major employers have also sought more direct control over their employees’ health care. Walmart contracted with groups like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need organ transplants and heart and spine care. Caterpillar, the construction equipment manufacturer, sets its own rules for drug coverage, which it has said saves it millions of dollars per year, even though it still uses a pharmacy benefit manager to process its claims.

Suzanne Delbanco, the executive director for the Catalyst for Payment Reform, a nonprofit group that mainly represents employers, said controlling rising prices is especially hard in markets where a local hospital or medical group dominates. While some have tried to tackle the issue in different ways, like sending employees with heart conditions to a specific group, “it’s piecemeal,” she said.

She added, “There are so many opportunities to do this better.”

The issue is not solely a 21st-century concern: In 1915, Henry Ford became increasingly worried about the quality of health care available to his growing work force in Detroit, so he opened the Henry Ford Hospital. It is still in existence today.

Nick Wingfield reported from Seattle, Katie Thomas from Chicago and Reed Abelson from San Francisco. Michael J. de la Merced contributed reporting from London, and Emily Flitter from New York.

A version of this article appears in print on January 31, 2018, on Page A1 of the New York edition with the headline: 3 Giants Form Health Alliance, Rocking Insurers. Order Reprints| Today’s Paper|Subscribe

Prevention Revisited

The essay below is an argument for the quality of life benefits of prevention. But its conclusions about whether prevention saves money? Those conclusions are depressing.

But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

The source of this essay is worth considering. If you look below, Dr. Aaron just published a book arguing that bad foods are not so bad – in moderation. This is a conclusion I happen to agree with. I agree with “all things in moderation”.
 
For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!
 
I publish but do not endorse…..

================
CREDIT: Essay in the New York Times

THE NEW HEALTH CARE

The essay below is depressing. But I want to consider it. If prevention doesn’t save money, this goes against every intuition I have ever had on the subject.

I definitely don’t trust the source of this essay, or its conclusions.

For example, a primary conclusion is that insuring people makes them more, rather than less, likely to use the emergency room. But this conclusion is about insurance, not prevention, and speaks to people’s need for convenient access to health care.

Or a second example used: anti-smoking. The essay’s conclusion is outrageous: it says that society will pay more because people who stop smoking will live longer! So, if society wishes to reduce costs, a mass euthanasia program, at, say, age 67, will really do the trick!

I publish but do not in any way endorse…..

=======================

CREDIT: New York Times Essay

THE NEW HEALTH CARE

Preventive Care Saves Money Sorry, It’s Too Good to Be True

Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price.

By Aaron E. Carroll
Jan. 29, 2018

The idea that spending more on preventive care will reduce overall health care spending is widely believed and often promoted as a reason to support reform. It’s thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in emergency rooms, where it costs more. It should follow then that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run.
Unfortunately, almost none of this is true.

Let’s begin with emergency rooms, which many people believed would get less use after passage of the Affordable Care Act. The opposite occurred. It’s not just the A.C.A. The Oregon Medicaid Health Insurance experiment, which randomly chose some uninsured people to get Medicaid before the A.C.A. went into effect, also found that insurance led to increased use of emergency medicine. Massachusetts saw the same effect after it introduced a program to increase the number of insured residents.

Emergency room care is not free, after all. People didn’t always choose it because they couldn’t afford to go to a doctor’s office. They often went there because it was more convenient. When we decreased the cost for people to use that care, many used it more.
Wellness programs, based on the idea that we can save money on health care by giving people incentives to be healthy, don’t actually work this way. As my colleague Austin Frakt and I have found from reviewing the research in detail, these programs don’t decrease costs — at least not without being discriminatory.

Accountable care organizations rely on the premise that improving outpatient and preventive care, perhaps with improved management and coordination of services for those with chronic conditions, will save money. But a recent study in Health Affairs showed that care coordination and management initiatives in the outpatient setting haven’t been drivers of savings in the Medicare Shared Savings Program.

There’s little reason to believe that even more preventive care in general is going to save a fortune. A study published in Health Affairs in 2010 looked at 20 proven preventive services, all of them recommended by the United States Preventive Services Task Force. These included immunizations, counseling, and screening for disease. Researchers modeled what would happen if up to 90 percent of these services were used, which is much higher than we currently see.

They found that this probably would have saved about $3.7 billion in 2006. That might sound like a lot, until you realize that this was about 0.2 percent of personal health care spending that year. It’s a pittance — and that was with almost complete compliance with recommendations.

One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made.

This doesn’t mean it saves money.

In 2009, as part of the Robert Wood Johnson Foundation’s Synthesis Project, Sarah Goodell, Joshua Cohen and Peter Neumann exhaustively explored the evidence. They examined more than 500 peer-reviewed studies that looked at primary (stopping something from happening in the first place) or secondary (stopping something from getting worse) prevention. Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained.

But all of these analyses looked within the health care system only. If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all?

A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending. It found that such a tax would cause many people to quit smoking — the desired result. In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.
But in the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit — even with the increased revenue from taxing cigarettes.

But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.
There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.
Sometimes good things cost money.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of The Bad Food Bible: How and Why to Eat Sinfully.

====================APPENDIX================

CREDIT: https://www.npr.org/sections/thesalt/2017/11/19/564879018/the-bad-food-bible-says-your-eating-might-not-be-so-sinful-after-all

The Bad Food Bible
How and Why to Eat Sinfully
by Aaron, M.D. Carroll and Nina Teicholz
Hardcover, 272 pages

There are some surprises in your book, like milk isn’t as nutritious as some might think?

This is one of those where, if you just look at nature, we’re the only animal that consumes milk outside of the infant period. Now there’s no need for it. Part of that is politics, and the fact that the United States got involved in promoting dairy and the whole dairy industry. But there’s really no good evidence outside of the childhood period that milk is necessary. One of the things that I tried to state in the book, and this is true of all beverages with calories, you should treat them like you treat alcohol. I mean, what else are you going to do with a good chocolate chip cookie? Of course you need a glass of milk with that. That’s like dessert — it’s something you should have because you want it, not because you need it.

Raw eggs often get a bad reputation, particularly when it comes to cookie dough. How bad are they, really?

The raw egg is another one where of course there is a risk. But you have to weigh that against joy again. The truth of the matter is that if you committed to eating raw eggs in cookie dough once a week every week for the rest of your life, you’d almost never come into contact with salmonella. If you did, you’d almost never get sick. If you got sick, you’d almost never notice. Even if you noticed, it would almost never result in something serious. The chance of you actually getting seriously ill is infinitesimal. … The joy of doing those kinds of things with your kids or enjoying the process of baking is much more satisfying and will lead to greater increases in quality of life than the infinitesimal risk that you’re hurting your health in some way.
So, it sounds like there’s a lot of misinformation surrounding what food is bad for us. What’s your eating advice then?

So I think you know, in general, one thing you can do is limit your heavily processed food as much as possible. Nature intended you to get the appley goodness from an apple, not from apple juice. But the more we can do to smile, to cook for ourselves, to know where our food is coming from, to be mindful of it, the better. But we shouldn’t be so panicked and fearful and constantly believing that if we don’t do what we’ve heard from the latest expert, that we’re going to get sick and die. That is just not true.

Of course, we are staring down the barrel of Thanksgiving, which for many of us can be a moment that produces a lot of anxiety, especially food anxiety nowadays. It just feels like it’s all so fraught. I’m evil if I eat meat. I’m bad if I like Diet Coke. Food is loaded.
It’s also really important, it’s one day a year! Your health and your eating habits are not established by one day a year. It’s perfectly fine to enjoy yourself and to live! You need to weigh — in all your health decisions — the benefits and the harms. And too often we only focus on the latter. And included in benefits are joy, and quality of life and happiness. There are times when it’s a perfectly rational decision to allow yourself to be happy and to enjoy yourself. I’m not sort of giving a license for people to eat whatever they want, anytime they want. Yes, the Diet Coke, the pie, these are all processed foods. So you should think about how much you’re eating them in relation to everything else. But on the other hand, a piece of pie on Thanksgiving is not going to erase everything else you’ve done the rest of the year. Thanksgiving is easily my favorite holiday and it’s not just because of the food, but also because of the meal and the fact that you get to enjoy it with family and friends.

I’ve got to ask you, what are you having for Thanksgiving?

As much as I can cram into my body on that day. But, I love turkey, really well-done turkey. I love mashed potatoes, and stuffing and gravy, and I think pie is the greatest dessert that exists, so I’m sure I’ll be having too much of that as well.

Producer Adelina Lancianese contributed to this report.

Homeostasis

One of the smartest guys in the room, Antonio Damasio, give his views about neuroscience and its relationship to pain, pleasure, and feelings. He points out that they all play a giant role in one of life’s most important concepts: homeostasis.

CREDIT: http://nautil.us/issue/56/perspective/antonio-damasio-tells-us-why-pain-is-necessary

Antonio Damasio Tells Us Why Pain Is Necessary
The neuroscientist explains why feelings evolved.

BY KEVIN BERGER
JANUARY 18, 2018

Following Oliver Sacks, Antonio Damasio may be the neuroscientist whose popular books have done the most to inform readers about the biological machinery in our heads, how it generates thoughts and emotions, creates a self to cling to, and a sense of transcendence to escape by. But since he published Descartes’ Error in 1994, Damasio has been concerned that a central thesis in his books, that brains don’t define us, has been muted by research that states how much they do. To Damasio’s dismay, the view of the human brain as a computer, the command center of the body, has become lodged in popular culture.

In his new book, The Strange Order of Things, Damasio, a professor of neuroscience and the director of the Brain and Creativity Institute at the University of Southern California, mounts his boldest argument yet for the egalitarian role of the brain. In “Why Your Biology Runs on Feelings,” another article in this chapter of Nautilus, drawn from his new book, Damasio tells us “mind and brain influence the body proper just as much as the body proper can influence the brain and the mind. They are merely two aspects of the very same being.”

BEYOND SCIENCE: Antonio Damasio, director of the Brain and Creativity Institute at USC, sings the glories of the arts in his new book, The Strange Order of Things: “The sciences alone cannot illuminate the entirety of human experience without the light that comes from art and humanities.”

The Strange Order of Things offers a sharp and uncommon focus on feelings, on how their biological evolution fueled our prosperity as a species, spurred science and medicine, religion and art. “When I look back on Descartes’ Error, it was completely timid compared to what I’m saying now,” Damasio says. He knows his new book may rile believers in the brain as emperor of all. “I was entirely open with my ideas,” he says. “If people don’t like it, they don’t like it. They can criticize it, of course, which is fair, but I want to tell them, because it’s so interesting, this is why you have feelings.”
In this interview with Nautilus, Damasio, in high spirits, explains why feelings deserve a starring role in human culture, what the real problem with consciousness studies are, and why Shakespeare is the finest cognitive scientist of them all.

One thing I like about The Strange Order of Things is it counters the idea that we are just our brains.

Oh, that idea is absolutely wrong.

Not long ago I was watching a PBS series on the brain, in which host and neurologist David Eagleman, referring to our brain, declares, “What we feel, what matters to us, our beliefs and our hopes, everything we are happens in here.”

That’s not the whole story. Of course, we couldn’t have minds with all of their enormous complexity without nervous systems. That goes without saying. But minds are not the result of nervous systems alone. The statement you quote reminds me of Francis Crick, someone whom I admired immensely and was a great friend. Francis was quite opposed to my views on this issue. We would have huge discussions because he was the one who said that everything you are, your thoughts, your feelings, your mental this and that, are nothing but your neurons. This is a big mistake, in my view, because we are mentally and behaviorally far more than our neurons. We cannot have feelings arising from neurons alone. The nervous systems are in constant interaction and cooperation with the rest of the organism. The reason why nervous systems exist in the first place is to assist the rest of the organism. That fact is constantly missed.

The concept of “homeostasis” is critical in your new book. What is homeostasis?

It’s the fundamental property of life that governs everything that living cells do, whether they’re living cells alone, or living cells as part of a tissue or an organ, or a complex system such as ourselves. Most of the time, when people hear the word homeostasis, they think of balance, they think of equilibrium. That is incorrect because if we ever were in “equilibrium,” we would be dead. Thermodynamically, equilibrium means zero thermal differences and death. Equilibrium is the last thing that nature aims for.

The importance of feeling is that it makes you critically aware of what you are doing in moral terms.

What we must have is efficient functioning of a variety of components of an organism. We procure energy so that the organism can be perpetuated, but then we do something very important and almost always missed, which is hoard energy. We need to maintain positive energy balances, something that goes beyond what we need right now because that’s what ensures the future. What’s so beautiful about homeostasis is that it’s not just about sustaining life at the moment, but about having a sort of guarantee that it will continue into the future. Without those positive energy balances, we court death.

What’s a good example of homeostasis?

If you are at the edge of your energy reserves and you’re sick with the flu, you can easily tip over and die. That’s one of the reasons why there’s fat accumulation in our bodies. We need to maintain the possibility of meeting the extra needs that come from stress, in the broad sense of the term. I poetically describe this as a desire for permanence, but it’s not just poetic. I believe it’s reality.

You write homeostasis is maintained in complex creatures like us through a constant interplay of pleasure and pain. Are you giving a biological basis to Freud’s pleasure principle—life is governed by a drive for pleasure and avoidance of pain?

Yes, to a great extent. What’s so interesting is that for most of the existence of life on earth, all organisms have had this effective, automated machinery that operates for the purpose of maintenance and continuation of life. I like to call the organisms that only have that form of regulation, “living automata.” They can fight. They can cooperate. They can segregate. But there’s no evidence that they know that they’re doing so. There’s no evidence of anything we might call a mind. Obviously we have more than automatic regulation. We can control regulation in part, if we wish to. How did that come about?
Very late in the game of life there’s the appearance of nervous systems. Now you have the possibility of mapping the inside and outside world. When you map the inside world, guess what you get? You get feelings. Of necessity, the machinery of life is either in a state of reasonable efficiency or in a state of inefficiency, which is most often the case. Organisms with nervous systems can image these states. And when you start having imagery, you start having minds. Now you begin to have the possibility of responding in a way that you could call “knowledgeable.” That happens when organisms make images. A bad internal state would have been imaged as the first pains, the first malaises, the first sufferings. Now the organism has the possibility of knowingly avoiding whatever caused the pain or prefer a place or a thing or another animal that causes the opposite of that, which is well-being and pleasure.

Why would feelings have evolved?

Feelings triumphed in evolution because they were so helpful to the organisms that first had them. It’s important to understand that nervous systems serve the organism and not the other way around. We do not have brains controlling the entire operation. Brains adjust controls. They are the servants of a living organism. Brains triumphed because they provided something useful: coordination. Once organisms got to the point of being so complex that they had an endocrine system, immune system, circulation, and central metabolism, they needed a device to coordinate all that activity. They needed to have something that would simultaneously act on point A and point Z, across the entire organism, so that the parts would not be working at cross purposes. That’s what nervous systems first achieve: making things run smoothly.

Now, in the process of doing that, over millions of years, we have developed nervous systems that do plenty of other things that do not necessarily result in coordination of the organism’s interior, but happen to be very good at coordinating the internal world in relation to the outside world. This is what the higher reaches of our nervous system, namely the cerebral cortex, does. It gives us the possibilities of perceiving, of memorizing, of reasoning over the knowledge that we memorize, of manipulating all of that and even translating it into language. That is all very beautiful, and it is also homeostatic, in the sense that all of it is convenient to maintain life. It if were not, it would just have been discarded by evolution.

How does your thesis square with the hard problem of consciousness, how the physical tissue in our heads produces immaterial sensations?

Some philosophers of mind will say, “Well, we face this gigantic problem. How does consciousness emerge out of these nerve cells?” Well, it doesn’t. You’re not dealing with the brain alone. You have to think in terms of the whole organism. And you have to think in evolutionary terms.

The critical problem of consciousness is subjectivity. You need to have a “subject.” You can call it an I or a self. Not only are you aware right now that you are listening to my words, which are in the panorama of your consciousness, but you are aware of being alive, you realize that you’re there, you’re ticking. We are so distracted by what is going on around us that we forget sometimes that we are, A-R-E in capitals. But actually you are watching what you are, and so you need to have a mechanism in the brain that allows you to fabricate that part of the mind that is the watcher.
You do that with a number of devices that have to do, for example, with mapping the movements of your eyes, the position of your head, and the musculature of your body. This allows you to literally construct images of yourself making images. And you also have a layer of consciousness that is made by your perception of the outside world; and another layer that is made of appreciating the feelings that are being generated inside of you. Once you have this stack of processes, you have a fighting chance of creating consciousness.

Why do you object to comparing the brain to a computer?

In the early days of neuroscience, one of our mentors was Warren McCulloch. He was a gigantic figure of neuroscience, one of the originators of what is today computational neuroscience. When you go back to the ’40s and ’50s, you find this amazing discovery that neurons can be either active or inactive, in a way that can be described mathematically as zeroes and ones. Combine that with Alan Turing and you get this idea that the brain is like a computer and that it produces minds using that same simple method.

Religions have been one of the great causes of violence throughout history. But you can’t blame Christ for it.

That has been a very useful idea. And true enough, it explains a good part of the complex operations, that our brains produce such as language. Those operations require a lot of precision and are being carried out by cerebral cortex, with enormous detail, and probably in a basic computational mode. All the great successes of artificial intelligence used this idea and have been concerned with high-level reasoning. That is why A.I. has been so successful with games such as chess or Go. They use large memories and powerful reasoning.

Are you saying neural codes or algorithms don’t blend with living systems?

Well, they match very well with things that are high on the scale of the mental operations and behaviors, such as those we require for our conversation. But they don’t match well with the basic systems that organize life, that regulate, for example, the degree of mental energy and excitation or with how you emote and feel. The reason is that the operations of the nervous system responsible for such regulation relies less on synaptic signaling, the one that can be described in terms of zeroes and ones, and far more on non-synaptic messaging, which lends itself less to a rigid all or none operation.
Perhaps more importantly, computers are machines invented by us, made of durable materials. None of those materials has the vulnerability of the cells in our body, all of which are at risk of defective homeostasis, disease, and death. In fact, computers lack most of the characteristics that are key to a living system. A living system is maintained in operation, against all odds, thanks to a complicated mechanism that can fall apart as a result of minimal amounts of malfunction. We are extremely vulnerable creatures. People often forget that. Which is one of the reasons why our culture, or Western cultures in general, are a bit too calm and complacent about the threats to our lives. I think we are becoming less sensitive to the idea that life is what dictates what we should do or not do with ourselves and with others.

What is love for?

To protect, to cause flourishing, to give and receive pleasure, to procreate, to soothe. Endless great uses, as you can see.

How do emotions such as anger or sadness serve homeostasis?

At individual levels, both anger and sadness are protective. Anger lets your adversary know that you mean business and that there may be costs to attacking you. These days anger is an expression of sociopolitical conflicts. It is overused and has largely become ineffectual. Sadness is a prelude to mental hibernation. It lets you retreat and lick your wounds. It lets you plan a strategy of response to the cause of the wounds.

You say feelings spurred the creation of cultures. How so?

Before I started The Strange Order of Things, I was asking friends and colleagues how they thought cultures had begun. Invariably what people said was, “Oh, we’re so smart. We’re so intellectually powerful. We have all this reasoning ability. On top of it all, we have language—and there you are.” To which I say, “Fine, that’s true. How would you invent anything if you were stupid?” You would not. But the issue is to recognize the motive behind what you do. Why is it that you did it in the first place? Why did Moses come down from the mountain with Ten Commandments? Well, the Ten Commandments are representative of homeostasis because they tell you not to kill, not to steal, not to lie, not to do a lot of bad things. It sounds trivial but it’s not. We fail to think about motivation and so we do not factor it into the process of invention. We do not factor in the motives behind science or technology or governance or religion.

How does consciousness emerge out of nerve cells? Well, it doesn’t. You’re not dealing with the brain alone.

And there’s one more thing: The importance of feeling is that it makes you critically aware of what you are doing in moral terms. It forces you to look back and realize that what people were doing historically, at the outset, at the moment of invention of a cultural instrument or a cultural practice, was an attempt to reduce the amount of suffering and to maximize the amount of wellbeing not only for the inventor, but for the community around them. One person alone can invent a painting or a musical composition, but it is not meant for that person alone. And you do not invent a moral system or a government system alone or for yourself alone. It requires a society, a community.

The assertion that intellect is governed by feelings can sound New Age-y. It seems to undermine the powers of reason. How should we understand reason if it’s always motivated by subjective feelings?

Subjective simply means that it has a personal point of view, that it pertains to the self. It is compatible with “objective” facts and with truth. It is not about relativism. The fact that feelings motivate the use of knowledge and reason do not make the knowledge and the reason any less truthful or valid. Feelings are simply a call to action.

If humans formed societies and cultures to avoid suffering and pain, why do we have violence and wars?

Your question is very important. Take developments of political systems. On the face of it, when you look at Marxist ideas, you say, “This is obviously homeostatic.” What Marx and others were trying to do in the 19th century is confront and modify a social arrangement that was not equitable, that had some people suffering too much and some profiting too much. So having a system that produced equality made a lot of sense. In a way that is something that biological systems have been trying to do, quite naturally, for a long time. And when the natural systems do not succeed at improved regulation, guess what? They are weeded out by evolution because they promote illness.
Biological evolution, through genetic selection, eliminates those mechanisms. At the cultural level something comparable occurs. Seen in retrospect, Marxism as applied in Russia resulted in one of the worst tragedies of humankind. But Russian communism was ultimately weeded out by cultural selection. It took around 70 years to do it, but cultural selection did operate in a homeostatic way. It led to the fall of the Berlin Wall and the Soviet empire. It was a homeostatic correction achieved by social means.
The same reasoning applies to religions. For example, we can claim that religions have been one of the great causes of violence throughout history. But you certainly can’t blame Christ for that violence. He preached compassion, and the pardoning of enemies, and love. It does not follow that good recommendations can be implemented correctly and always produce good results. These facts in no way deny the homeostatic intent of religions.

You write, “The increasing knowledge of biology from molecules to systems reinforces the humanist project.” How so?

This knowledge gives us a broader picture of who we are and where we are in the history of life on earth. We had modest beginnings, and we have incorporated an incredible amount of living wisdom that comes from as far down as bacteria. There are characteristics of our personal and cultural behavior that can be found in single-cell organisms or in social insects. They clearly do not have the kind of highly developed brains that we have. In some cases, they don’t have any brain at all. But by analyzing this strange order of developments we are confronted with the spectacle of life processes that are complex and rich in spite of their apparent modesty, so complex and rich that they can deliver the high level of behaviors that we normally, quite pretentiously, attribute only to our great human smarts. We should be far more humble. That’s one of my main messages. In general, connecting cultures to the life process makes apparent a link that we have ignored for far too long.


What would you be if you weren’t a scientist?

When I was an adolescent, I often thought that I might become a philosopher or perhaps a playwright or filmmaker. That’s because I so admired what philosophers and storytellers had found about the human mind. Today when people ask me, “Who’s your most admired cognitive scientist?” I say Shakespeare. He knew it all and knew it with enormous precision. He didn’t have the nice fMRI scanner and electrophysiology techniques we have in our Institute. But he knew human beings. Watch a good performance of Hamlet, King Lear, or Othello. All of our psychology is there, richly analyzed, ready for us to experience and appreciate.