Tuesday, October 17, 2023

Whoop - First Look


Amazfit - First Look - Oct 20th, 2020

Due to various issues I decided to move away from the crowd-funded Amazfit X that I had been using as an activity tracker for the past few years. Its sleep tracking (my primary use) suddenly became less accurate and it started to consistently misreport my sleep duration. I would go to bed around 10 pm, falling asleep within a few minutes. Then the next day it would show my sleep starting at 1am or 2 am, etc. Clearly, a very undesirable situation. After checking Google and reading about various trackers, I decide to go ahead and sprang for a year's subscription to Whoop.

Another reason to get a working solution is that I am going to be paying a lot more attention to my activity levels and sleep quality, see Biological Age Testing.

The unboxing photos:

The companion app is downloaded from Google Play:

You need to charge the Whoop, pair it with your phone, and then it starts collecting your information and building a baseline over your first 30 days...  More to come once this has taken place!

Whoop Reviews:
Whoop Band Review (Sleepfoundation)

Whoop YouTube Reviews:

Friday, October 13, 2023

Amazon & One Medical

Amazon's One Medical integration is still in "early days," see Why One Medical's CMO believes Amazon Health can make a big impact tackling chronic diseases.

How they envisage eventually/potentially leveraging One Medical is what I suggested be the value-added part of ๐‡๐š๐ฏ๐ž๐ง - see my Apr 2018 article.

P.S. Note, with Haven their reach would have been ๐ฆ๐ฎ๐œ๐ก ๐›๐ซ๐จ๐š๐๐ž๐ซ.

Thursday, October 12, 2023

Biological Age Testing

I recently took Elysium's ๐ˆ๐ง๐๐ž๐ฑ ๐›๐ข๐จ๐ฅ๐จ๐ ๐ข๐œ๐š๐ฅ ๐š๐ ๐ž ๐ญ๐ž๐ฌ๐ญ - https://elysiumhealth.com/products/index - and just received the results. It started off well - overall my 'biological age' is lower than my chronological age. Then I looked at the system age scores, and ๐˜๐ˆ๐Š๐„๐’!

How concerned should I be about the 'brain' score? Well, enough that I've decided to do more of a few of the recommended follow-up actions:
  • Greatly increase my activity and exercise levels!
  • Try to improve my sleep - levels and quality
  • Learn something new - I've signed up with Babbel to learn a new language. 

I'll redo the Index test in 12 months and report back if any of this has made a difference.

Tuesday, October 3, 2023

Random Thought

๐‘๐š๐ง๐๐จ๐ฆ ๐ญ๐ก๐จ๐ฎ๐ ๐ก๐ญ: Want to sell pharmaceuticals in the U.S.? The government should require that ๐š๐ฅ๐ฅ such entities develop a ‘๐ฆ๐š๐ง๐ฎ๐Ÿ๐š๐œ๐ญ๐ฎ๐ซ๐ข๐ง๐  ๐š๐ง๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐ฅ๐ฒ ๐œ๐ก๐š๐ข๐ง ๐๐ข๐ ๐ข๐ญ๐š๐ฅ ๐ญ๐ฐ๐ข๐ง’ for their operations. A standard model to be developed (in cooperation with pharmaceutical manufacturers, etc.) by NIST who will define the data elements, etc., definitions, metrology/measurement, information collection, reporting, technology used, etc., etc. 

Data from the various manufacturers’ digital twins would regularly (e.g. daily) ‘feed’ a government-controlled ‘๐ฉ๐ก๐š๐ซ๐ฆ๐š ๐ข๐ง๐๐ฎ๐ฌ๐ญ๐ซ๐ฒ ๐ฆ๐š๐ง๐ฎ๐Ÿ๐š๐œ๐ญ๐ฎ๐ซ๐ข๐ง๐  ๐š๐ง๐ ๐ฌ๐ฎ๐ฉ๐ฉ๐ฅ๐ฒ ๐œ๐ก๐š๐ข๐ง ๐๐ข๐ ๐ข๐ญ๐š๐ฅ ๐ญ๐ฐ๐ข๐ง.’ 

This will require enabling legislation e.g. to overcome manufacturer claims of proprietary information, trade secrets, etc. that they historically have used to not provide information. A wide variety of “carrots” and "sticks" will need to be used to gain industry cooperation, for example the government underwriting the costs of development, deployment, and implementation, with the benefits of having such a system accruing to the manufacturers. 

Once the FDA’s QMMP is deployed to manufacturers its data can then also be folded into the digital twin. With the resulting complete transparency and end-to-end visibility across the entire industry now available to the government (manufacturing information, quality information, supply chain information, etc.), the use of AI, ML, and other such tools should support the ability to forecast and anticipate problems, issues, disruptions, etc. so that the appropriate efforts at prevention, mitigation, etc. can be carried out successfully.

6-part article of which the above is a sub-part

Thursday, August 10, 2023

Book Review: The Death of Death


๐•ป๐–Ž๐–ˆ๐–™๐–š๐–—๐–Š ๐•ฎ๐–—๐–Š๐–‰๐–Ž๐–™: ๐•พ๐•น๐–Ž ๐–š๐–˜๐–Ž๐–“๐–Œ '๐•ด๐–’๐–†๐–Œ๐–Š ๐•ฒ๐–Š๐–“๐–Š๐–—๐–†๐–™๐–”๐–— ๐–‡๐–ž ๐•ธ๐–Ž๐–ˆ๐–—๐–”๐–˜๐–”๐–‹๐–™ ๐•ญ๐–Ž๐–“๐–Œ' ๐–Ž๐–“ ๐–™๐–๐–Š ๐–˜๐–™๐–ž๐–‘๐–Š ๐–”๐–‹ ๐•ต๐–”๐–๐–“ ๐•ญ๐–š๐–“๐–ž๐–†๐–“'๐–˜ '๐•ฟ๐–๐–Š ๐•ป๐–Ž๐–‘๐–Œ๐–—๐–Ž๐–’'๐–˜ ๐•ป๐–—๐–”๐–Œ๐–—๐–Š๐–˜๐–˜.'

Here I review “The Death of Death: The Scientific Possibility of Physical Immortality and its Moral Defense”. The authors are Josรฉ Luis Cordeiro and David Wood; and you can scroll to the bottom where (in the interest of complete transparency) I provide some background information on my connection to one of the authors.

From the back cover: “Is death inevitable? Until now, nothing has been more certain... But according to Josรฉ Luis Cordeiro and David Wood, the prospect of death is no longer inevitable... Cordeiro and Wood not only present the major developments, initiatives, and ideas for eternal life, but also share powerful arguments for seeing death for what it is: the last undefeated disease."

The Table of Contents

Preliminary Warning: Even before I get into my review, I would like to preface it with this warning: This is not a quick or light read! A little over two hundred pages, this book is “dense!” Dense in the sense of encyclopedic, as it crams in an incredible amount of data and information from areas as diverse as history, philosophy, theology, geopolitics, and the sciences – general chemistry biology, and physics; cell biology, cryonics, genetics, etc. I read the book over a three-week period, and I’m a “2-3 books every weekend” type of guy! In reality, if a reader were to follow up by reviewing the copious notes (in the form of links) provided at the end of each chapter and dipping into the 9-page bibliography this could easily take several months to get through. 

Suggestion to the authors: perhaps you should talk to someone about turning this into a university course!

Despite having a density approaching that of a black hole, the authors are masterful in pulling off the feat of integrating everything and delivering it with a logical, coherent “flow” that enlightens while not overwhelming the reader. Finish the book and you will have been introduced to concepts and theories as diverse as ‘negligible senescence,’ ‘Malthusian trap,’ ‘longevity escape velocity,’ ‘terror management theory,’ the Pyszczyncki paradox,’ and many, many others. And you may find yourself convinced by the book's message... Or perhaps not.

So, what is in the book? It starts off discussing the possibility of biological immortality, providing examples of this in several lower life forms and speculating if this can be extended to man. This is followed by the scientific study of aging - what it is, what are the factors that affect it, and much more. Next up is a look at a new, developing anti-aging "industry," which traces the ecosystem of groups that have developed. It dives into 'scientific rejuvenation' and highlights eminent researchers/organizations and some of their successes and advancements in various related fields. A quick side trip ventures into the importance of and examples of exponential thinking, providing additional information on investors and different scientific approaches. Next up is a discussion of costs - the existing costs related to aging and death (for example, costs related to the burden of age-related disease); looking at research, etc. costs; and a discussion of the quantification of financial benefits that could theoretically result from a 'longevity dividend.' Then back to the subject of 'the end of death,' looking at many of the objections to this proposition and providing counterpoints. Current medical skepticism on this subject is compared to historical examples where medical thoughts and beliefs that had lasted for decades and centuries were eventually proven incorrect (two examples being medicine's reaction to Semmelweis and his ideas, and the practice of bloodletting, respectively). Next is a brief side trip into the subject of cryopreservation, set up as a Plan B "bridge" to the future. The authors then discuss the path forward, discussing potential obstacles on the 'abolition of aging' pathway. Finally, they conclude that the elimination of aging and death is an idea whose time is now upon us! Their final clarion call? "The future begins today. The future begins here. The future begins with us. The future begins with you today. Who if not you? When if not now? Where if not here? Join the revolution against aging and death! Death to Death!"

Conclusion: I definitely recommend that everyone read this book. You will not regret it. Even if not fully convinced you will still be greatly informed and 'up to speed' on where the world currently stands on this very interesting subject that effects everyone!

As for me, I started out very skeptical, see my tweet of July 13th below:

And now? I remain skeptical regarding 'the death of death.' Somewhat paradoxically, the more I read about the multiple scientific areas being pursued (senolytics, telomeres, stem cells, etc., etc.) the less I felt that the overall proposition was valid. The very multiplicity of approaches merely reinforced in my mind the astounding complexity of the endeavor and the difficulty of attaining the goal! Of course, this could just be an indication of a paucity of imagination on my part!

In the interest of full transparency, here is some ๐›๐š๐œ๐ค๐ ๐ซ๐จ๐ฎ๐ง๐ ๐ข๐ง๐Ÿ๐จ๐ซ๐ฆ๐š๐ญ๐ข๐จ๐ง:

I first met Josรฉ Luis while both of us were attending The Fund for American Studies’ Institute on Comparative Political and Economic Systems summer program. It was what now seems like eons ago (in 1988!) and was held at Georgetown University in Washington, D.C. We struck up a friendship back then that has lasted, even though we are in touch rather infrequently via email, and have only met four or five times over the intervening years. My last email to Jose was probably six plus months ago, and I haven’t see him ‘in the flesh’ for several years. Below is a reference I gave Josรฉ Luis on LinkedIn almost a decade ago, it still describes him to ‘T.” I do not know, and have never met, the co-author, David Wood.

This review is entirely my own, I purchased the book via Amazon when the English edition became available, then read the book.

I'm not exactly sure why, but as I was about to read "The Death of Death" it brought to my mind the tale of Christian in John Bunyan's "The Pilgrim's Progress."

In this case, Mr. and Mrs. Tout-le-Monde are weighed down by great burdens (here their impending old age and death), but seek to shed them and get to life eternal in the Celestial City. I used "Image Creator by Microsoft Bing, powered by DALL-E" to generate some relevant images that I then combined to produce the header picture.

Additionally, the picture also includes some of their travails along the way - their transit of The Slough of Despond; having to choose the correct path, one of three at the Hill of Difficulty (the correct path being the most difficult-looking one, with the easier-looking byways leading to "Danger" and "Destruction"); having to pass on the path between the two lions; and having to defeat Apollyon (a huge demonic creature with fish's scales, the mouth of a lion, feet of a bear, second mouth on his belly, and dragon's wings). I also included a LEV (Longevity Escape Velocity) signpost! Completing the analogy, Josรฉ Luis Cordeiro and David Wood fill the roles of the Evangelist and the Interpreter.

Covers of various editions (English, French, German, Spanish, Chinese, Turkish, Bulgarian)

Monday, July 3, 2023

Drug Shortages - Part IV (Reaction)

Note: This article is the fourth entry of a series of mind maps listing actions that can be taken in various areas, that if/when taken and implemented collectively can contribute to systematically improving the situation.

Framework Needed:

I - Development/Implementation of New Capacity and Capabilities

II - FDA Quality Program

III - Transparency & End-to-End Visibility

IV - Ongoing Oversight and Reaction

V - Overall Coordination of Efforts

VI - Putting It All Together

Wednesday, June 14, 2023

Drug Shortages - Part III (Transparency & End-to-End Visibility)

Note: This article is the third entry of a series of mind maps listing actions that can be taken in various areas, that if/when taken and implemented collectively can contribute to systematically improving the situation.

Framework Needed:

I - Development/Implementation of New Capacity and Capabilities

II - FDA Quality Program

III - Transparency & End-to-End Visibility

Tuesday, June 13, 2023

Drug Shortages - Part II (Quality Program)

Note: This article is the second entry of a series of mind maps listing actions that can be taken in various areas, that if/when taken and implemented collectively can contribute to systematically improving the situation.

Framework Needed:

I - Development/Implementation of New Capacity and Capabilities

II - FDA Quality Program

III - Transparency & End-to-End Visibility

IV - Ongoing Oversight and Reaction

V - Overall Coordination of Efforts

VI - Putting It All Together

Interesting development: Valisure and DoD Signed a Cooperative Research & Development Agreement to Conduct a Pharmaceutical Quality Risk Assessment Pilot Study https://www.prnewswire.com/news-releases/valisure-signs-agreement-with-department-of-defense-to-independently-test--quality-score-drugs-301895301.html

Sunday, June 4, 2023

Drug Shortages - Part I (New Capacity and Capability)

Background: Drug shortages are back in the news. This time it is a shortage of some essential cancer-fighting drugs such as cisplatin and carboplatin, see: FDA allows temporary import of unapproved Chinese cancer drug to ease U.S. shortage. Although there are multiple factors that can occur to cause drug shortages (see the list of possible causes I put together in 2002 with contemporaneous examples, republished on my blog in 2011 and on LinkedIn in 2015.), in this case the issue was caused by an Indian manufacturer (Intas) halting production at one manufacturing site following the discovery of quality deficiencies during an FDA inspection. This then snowballed, threatening lives, and leading to the FDA's emergency approval of the import of 'unapproved' versions of the drugs from China. 

According to the New York Times - Drug Shortages Near an All-Time High, Leading to Rationing - "The shortages are so acute that they are commanding the attention of the White House and Congress, which are examining the underlying causes of the faltering generic drug market, which accounts for about 90 percent of domestic prescriptions. The Biden administration has assembled a team to find long-term solutions for shoring up the pharmaceutical supply chain..." Unfortunately, we have heard this many times before. For example in 2018, the FDA (once again) put together a drug shortages task force to produce solutions. I expressed skepticism at the time!

It's long been clear to me that there has been a market failure and that a root cause for many of our drug shortage problems is that the segment of our drugs ("old," long-available, off-patent and generic sterile injectable drugs) that are disproportionately responsible for drug shortages are priced too low. As such, the usual 'article of faith' that is so often served up as a supposed solution to the issue (example from the NYT, 2017) i.e. "Increasing the number of competitors for a given drug in the marketplace will also help prevent and mitigate future shortages" is nonsensical!

The below, from January 2018, is exactly why we just have had the availability issues for cisplatin and carboplatin!

Unfortunately, as I observed, a solution that requires higher prices is not very palatable. The fact is that many (most) people think of drug manufacturers as a monolith, instead of recognizing that there are distinct segments that operate under very divergent conditions. In February 2019 I asked the question: "Drug pricing- is there a topic more fraught with simplism in this day and age?" Unfortunately, the answer was and continues to be "no!"

The bottom line? We will need to eschew simplistic thinking if we are to make any lasting progress in this area. Additionally, looking to the FDA to come up with a solution is flat out wrong. The solution to decreasing the frequency of drug shortages and mitigating their effects is multifactorial and will require a 'Whole of Government' approach that also includes collaboration and partnerships with industry, scientific organizations, public-private partnerships, academic organizations, and non-profits.

Note: This article is the first entry of a series of mind maps listing actions that can be taken in various areas, that if/when taken and implemented collectively can contribute to systematically improving the situation. First up, we need to improve pharmaceutical manufacturing capacity and capability!

Framework Needed:

I - New Capacity & Capability - the development and implementation of needed new capacity (e.g. plant, inventory) and new capabilities (e.g. advanced manufacturing technology) for drug manufacturing:

II - FDA Quality Program

III - Transparency & End-to-End Visibility

IV - Ongoing Oversight and Reaction

V - Overall Coordination of Efforts

VI - Putting It All Together

Thursday, May 18, 2023

The Tipping Point?

TSMC & TSMC-AZ in the scales. Image credit: SNi 5/23

Taiwan (Republic of China) and China (People's Republic of China) have been in the news recently as tensions between the two have increased recently. The U.S. ostensibly agreed to a "One China" policy with The Shanghai Communique of 1972.

FOREIGN RELATIONS OF THE UNITED STATES, 1969–1976, VOLUME XVII, CHINA, 1969–1972 203. Joint Statement Following Discussions With Leaders of the People’s Republic of China1 Shanghai, February 27, 1972.

The U.S. has always maintained some level of ambiguity, acknowledging there is only one China while simultaneously expressing opposition to any unilateral changes of the (undefined) status quo. And there are variations on how the U.S. views Taiwan which have varied depending on who is speaking or acting on the subject e.g. see 'The One-China Policy in Transition.'

OK, given this background, let's focus on semiconductors. Here is a backgrounder by McKinsey & Co. One of the most important and valuable companies that designs and manufactures cutting-edge semiconductors is the Taiwan Semiconductor Manufacturing Company Limited (TSMC) with the majority of its facilities located on the island of Taiwan. This items plays an important role in considerations related to Taiwan, China, and any potential military solution initiated by the Chinese leadership. For example, "๐๐ซ๐จ๐ค๐ž๐ง ๐ง๐ž๐ฌ๐ญ" is the idea that if China invades Taiwan ๐‘กโ„Ž๐‘’ ๐‘ˆ.๐‘†. ๐‘ โ„Ž๐‘œ๐‘ข๐‘™๐‘‘ ๐‘‘๐‘’๐‘ ๐‘ก๐‘Ÿ๐‘œ๐‘ฆ ๐‘‡๐‘†๐‘€๐ถ ๐‘ก๐‘œ ๐‘๐‘Ÿ๐‘’๐‘ฃ๐‘’๐‘›๐‘ก ๐ถโ„Ž๐‘–๐‘›๐‘Ž ๐‘“๐‘Ÿ๐‘œ๐‘š ๐‘”๐‘Ž๐‘–๐‘›๐‘–๐‘›๐‘” ๐‘๐‘œ๐‘›๐‘ก๐‘Ÿ๐‘œ๐‘™. This was first mooted in 2021 in a scholarly journal, Parameters (U.S. Army War College); however, this has been picked up and similar thoughts have been expressed by various U.S. officials, politicians, etc.

However, adherents of this supposedly 'deterrent' suggestion appear not to have seriously thought through this scenario! Since China is already cut off from TSMC chips by U.S. sanctions (see here and here), this would only effect China ๐ฅ๐จ๐ง๐ -๐ญ๐ž๐ซ๐ฆ while being a huge and immediate blow to the U.S. (and world) economy. As such, this threat may ๐ง๐จ๐ญ be quite the deterrent some think it is! In fact this could, perversely, ๐›๐ž ๐š๐ง ๐ข๐ง๐œ๐ž๐ง๐ญ๐ข๐ฏ๐ž for China to take action sooner!

Meanwhile, there is another 'wild card' at play in this consideration - following pressure by the U.S. government, TSMC is currently building a huge fab/foundry in the U.S. ( in Arizona) which when completed (initial production is forecast to begin in 2024, with a second fab coming online in 2026) would ensure a safe and sufficient supply of chips for the U.S. So, what might be some of the consequences of this new plant (which I will refer to as TSMC-AZ) to the various parties? There are both beneficial and adverse possibilities.

  • What effect might this have on the U.S. commitment to and support of Taiwan? With its reliance on Taiwan-based production eliminated, the opportunity cost to the U.S. of a Chinese takeover of Taiwan would be greatly reduced, and it is conceivable that this could lessen the likelihood of the U.S. choosing to take military action in support of Taiwan!

  • What effect might this have on the Chinese calculus with respect to their timeline to 'incorporate' Taiwan? This could depend on their forecast of what the U.S. might do. If they come to believe that the U.S. would indeed be more likely to follow through with a 'broken nest' approach once they were insulated by the Arizona-based manufacturing, then China might feel the need to move on Taiwan before TMSC-AZ achieves critical mass. However, if they come to believe that U.S. support for Taiwan would 'soften' after TMSC-AZ comes online and that 'broken nest' would not be implemented, that might cause the Chinese leadership to opt for a longer time frame before taking any action.

With TMSC-AZ coming along, we might know sooner rather than later!

On a side note, simply destroying the main fabs/foundries in Taiwan, while certainly dealing China a major setback, would not necessarily eliminate the associated knowledge, expertise, and know-how. To really cause a decades-long setback it would be necessary to also destroy all the design facilities, online documentation, knowledge repositories, etc., and also the associated human capital. If I were a Taiwan-based semiconductor engineer/expert, I might be more than a little uncomfortable in the near future.