The Integrative Stream

Sid Blumenthal on Katrina damage

Brought to my attention by a friend: Former Clinton Advisor: “No One Can Say they Didn’t See it Coming”. Depressing.

Sloan Startup

Monday was the first official day at the Sloan School of Management, although I was on campus all last week for some optional pre-term activities. Actual coursework doesn’t start until next week, since we’re in orientation mode through Thursday (for the MBA program) and again on Friday (for the Health, Sciences and Technology group). Today is an off-site team building event.

As of right now, there isn’t much to say about the orientation process, particularly since I’m not planning on blogging (at least in any detail) about individual people or conduct in any particular class. I even made sure to disclose this blog when I met my core team members this morning. At MIT, you rely on a small team (six or seven people) for support in most of your first semester classes. My team seems quite promising, and that’s about all I’m going to say on the subject. For one thing, virtually every team apparently suffers some sort of meltdown between now and December, and I have no desire to hasten that along.

The only real observation I’ve made so far is that the culture here seems very much what I expected: very open and collaborative, which fits well with what I’ve seen of MIT in general. I attribute some of this to a wide variety of post-MBA aspirations. We are not all fighting for the same fifteen investment banking jobs, and that shows. The high number of engineering graduates (40%, not counting computer science, which adds about another 15%) gives the place a very practical feeling.

Carnival of the Capitalists

Welcome to visitors from the Carnival of the Capitalists! If you haven’t seen the CotC before, it’s a worthwhile expenditure of your Monday afternoons.

Just some background for those new to this blog (which is pretty much everybody): the Integrative Stream is a relaunch of William Crawford’s (that’s me!) old blog, which started up in 2002. It covers technology, policy, the biomedical industry, software development and whatever else catches my eye (hence the title), from the perspective of a former CTO currently in hot pursuit of an MBA and a degree in healthcare technology. So come back often!

More Vioxx Commentary

On why the Vioxx verdict creates a public health risk. From Richard Epstein writing on OpinionJournal. The author is, like me, in the industry, but I believe his points are quite solid. My initial take on the subject is here.

To balance out my reporting, I’ve been looking for a good editorial commentary praising the verdict, but I haven’t found anything that isn’t absolute lunacy. One article, from a health “news” site found via Google which I will refrain from linking to, makes the totally unsubstantiated claim that Vioxx has killed tens of thousands of people. The same site also promotes a book promising a homeopathic cure for cancer that “they” don’t want you to know about. And it just goes downhill from there.

So if you’ve got an alternate take, let me know.

Google’s IM Strategy

I’d better get my two cents in on Google’s entry into the Instant Messaging market before it’s old news, so here goes:

As anyone who hasn’t been living under a rock for the last week has noticed, Google has launched an Instant Messaging network. Google has generally been good at producing very simple, clean user interfaces, and the Talk client is good example, without the bells and whistles (and incessant advertising) of the default Yahoo and AOL software. And that’s about it, really. I haven’t tried the voice functions yet, since I don’t have a microphone on my testing PC, but the various reviews say it works fine.

The problem is that that there are already too many instant messaging networks. With Talk, I now have accounts on three of them. But I generally don’t think about the network at all - I use Trillian on the PC, which combines my AIM and MSN (and now Google Talk) contacts into a single client. A surprising number of instant messaging users still don’t know about software like Trillian, but more learn every day, and eventually I fully expect to see instant messaging networks treated like long distance networks: it doesn’t matter if I have MCI or Sprint. The only difference is that the translation will take place on the client PC, via software that can access multiple networks, rather than at the local carrier level.

In fact, since Google Talk uses Jabber, a standard protocol, it’s already supported by clients like Trillian Pro and the latest versions of Apple’s iChat. That means that Google’s Talk client is unlikely to achieve much market share in the end, however clean it is, because there are so many other options and nobody is going to abandon their other networks just for Google’s client. It doesn’t add much residual value except the voice functions, and Trillian and iChat already support that over AOL’s network (and it works fine). Since it’s so easy to be on multiple networks, the advantage of being on a single large network is minimal. This may make it easier for “upstarts” like Google to get into the space, but at the same time it’s unlikely that the introduction of Google Talk is going to bring large numbers of people into instant messaging who weren’t already using it. And voice-over-IM has been around for years, and I haven’t really seen it take off. It’s not going to be the differentiating feature. So why bother?

I think there’s a good reason. Even if you don’t use Google’s Talk client, you’re still using Google’s servers, and that gives Google the opportunity to index your conversations. As of today, the Google Talk privacy policy states that they will not do this - text and voice conversations are not held in the server logs. But the privacy policy can be changed, and doing so gives Google the opportunity to create a valuable service: online, web searchable records of all your IM conversations. I would actually like to have this available to me. That’s the real appeal of webmail, and GMail in particular: I can access my extensive email archive, which is full of addresses, phone numbers, and old conversations, from rural Cambodia.

Google’s strategy doesn’t require server based indexing, though. After installing Google Talk I installed the new version of the Google Desktop software. They’re already integrated–the Talk client becomes a plugin to the new Google Sidebar. As far as I can tell, Talk conversations aren’t being indexed, at least not in real-time. But they will be. And this will be useful. Instant messaging isn’t just for teenagers - it’s a valuable business tool. About five years ago I spoke with IBM’s John Patrick about instant messaging use, and was told that somewhere around a quarter million messages were exchanged within the corporation every day. This was five years ago. More recently, I’ve seen major software specification work go on via instant messaging, and my last company relied heavily on IM technologies for interoffice collaboration.

Since Google’s strategy is clearly to own, if not the desktop itself, the information retrieval aspects of the desktop. There are really only two ways people communicate personal or business information online: email and instant messaging. Google Desktop already indexes GMail and can also index email from other email clients (I had it index my Thunderbird email). It even indexes stored conversations from the AOL and MSN IM clients. Since the Talk interface is built in, it’s inevitable that Talk conversations will be indexed as well. It has to be – otherwise the product is a point solution that won’t even drive any advertising revenue.

All of which wraps back around to the question of why they started their own network in the first place, rather than just building the indexing support into Google Desktop, and possibly launching their own Trillian-like multi-protocol client to embed within the Desktop sidebar. As discussed above, I the only answer I can come up with is that there will be a server-based indexing offering in the future.

Microsoft, incidentally, really missed the boat on this one. Outlook’s index functions have been so bad in the past that I haven’t even tried using the last few releases for email. Microsoft has had years to integrate Outlook with MSN Messenger, and they haven’t.

Personalized Medicine

BusinessWeek has a nice, non-technical overview of the development-to-date of personalized medicine: Drugs Get Smart.

Biotech MBAs

Just came across an article in Nature entitled Making it in the biotech business, discussing some of the rationale for doing a biotech/pharma/healthcare focused MBA, including MIT’s BEP program.

Deciphering Pivot Tables

I’ve spent my share of time in Excel over the years, but up until now haven’t used it for any really complex data analysis. Since this may change over the three years of my MBA, I thought it made sense to learn a little more, and happily just came across the following article on the O’Reilly DevCenter:

WindowsDevCenter.com: What Is a Pivot Table

Java Enterprise 3rd Edition Cover

I’m not entirely done with tech yet; here’s a sneak preview of the cover for the 3rd edition of Java Enterprise in a Nutshell:

Amazon Shorts

Amazon has introduced Amazon Shorts, selling short stories and essays from big names online, for minimal money. One of the nice things is that there’s no digital rights management on the downloads. I like it when companies don’t automatically treat me like a criminal. Over the years Amazon has been very good at making me feel like a valued customer.

The always interesting John Scalzi reviews the service and discusses what it may mean for authors. I’ve had most of my books available online via Safari for a while now, although the jury is still very much out on whether or not I’ve actually made more money that way.

Vioxx Verdict

There are two very good articles in today’s Wall Street Journal (link here if you happen to have a subscription to the online version) detailing the jury process that went into the Vioxx ruling. I haven’t followed the case all that closely, but what I’ve seen is worrysome. In particular, the jury seems to have effectively tuned out the scientific evidence presented by Merck in favor of rather more emotional arguments by the plaintiff’s attorney–such as wheeling in 146 boxes of regulatory documents to imply that Merck had deluged the FDA with data to cover up defects. Every drug approval requires huge volumes of documentation; making a big stack in front of the jury means nothing.

Whatever the specifics, it’s pretty clear the case was not tried on its merits, and that’s a bad sign.

Business education shifts toward life sciences - The Boston Globe

Perfect timing; for my first day at Sloan, the Boston Globe has a short interview with the dean, Richard Schmalensee:
Business education shifts toward life sciences.

How appropriate.

For tomorrow we…study?

The first three posts on this blog hit my professional interests - the biomedical and software businesses. That’s not actually what this blog is going to focus on. That’s because tomorrow morning is the real day of my MBA at MIT’s Sloan School of Management. After several years in the private sector, I’m going back to school.

Actually, it’s not really the first day. Tomorrow is the start of “pre-term,” where a few [presumably] overworked teaching assistants attempt to refresh our collective memories with all the mathematics, economics and accounting we’ve managed to forget since our last entry into a classroom. Or, in the case of accounting, that we never really learned in the first place. Not strictly required, and hopefully relatively trivial. The official start of the school year is a week from Monday, with orientation. Actual MBA classes are two weeks out. Courses in the Biomedical Enterprise Program don’t start until next semester.

IDEA 5

I had a few residual Java things to finish up before turning into a full-time MBA seeker, so I just tried out IDEA 5.0 from Prague-based JetBrains. Earlier versions of IDEA were the best development environments available at the time. The software had (and has) quite a developer cult, too: when I fired it up on stage at a conference last year the software got applause (people seemed to like my talk, too).

They might have been a little ahead of themselves on this release, though. Since integration with Subversion (my version control system of choice for both software and personal documents) was new in this release, the first thing I did was start the new repository browser and point it to my home svn server. Somewhat to my surprise I was met by the blue screen of death. I’ll try it later on another PC.

The moral of the story is that copious pre-release testing is always indicated. JetBrains had this problem with version 4.0, too, although things got better with 4.5 (I never used version 4 in production, sticking instead with the “classic” version 3).

Agile Software vs. Big Design

Joel Spolsky takes a clear stance against “eXtreme Programming.”

Software development methodology is hard. I’m not particularly advocate of either main approach - not “Big Design Up Front” or “Agile” (which, for those not familiar, can be summed up as rapid iterations based on evolving requirements, although purists will tell you there’s a lot more to it than that). I’ve used both, and when I managed software development teams the process we used was generally a hybrid. I don’t think Spolsky’s anti-XP example holds as argument, since it’s entirely possible that the change he’s discussing would have become evident much earlier if the team had been using an Agile process. Or, possibly not.

Like most technology debates, this one isn’t going to end, partially because there’s no way to get reasonable comparative data, other than by designing some very, very expensive simulations, developing a range of products at least twice.

More on software management as this blog continues.

Do you want a new drug?

NPR’s Morning Edition on Thursday devoted a lot of time to the final report of the space shuttle Columbia accident review board. It’s quite clear that we’ve changed our standards for space exploration. Without the Soviets to compete against, we’ve changed our safety expectations; the clear goal being to take the risk entirely out of space travel. Even with the Columbia tragedy, the shuttle program has a 98% safe return ratio, which is probably better than any series of exploratory ventures in history. Apollo, by contrast, opened with the Apollo 1 disaster and was punctuated by Apollo 13. That’s an 83% success rate, but Apollo 13 was followed by Apollo 14 in less than seven months. NASA in the 1960s may have been a more dynamic and aggressive organization than today, but public attitudes have clearly changed; risk, even risk that the crew might happily accept, is out of the equation.

Which brings me back to Thursday morning. I heard the Columbia report on the way to an MIT Center for Biomedical Innovation forum titled “New Medicines: Can Innovation and Safety Coexist?” The issue was more or less the same, just with drugs rather than spaceships. How do we balance the need to provide safe and effective medicines with the risk associated with developing innovative treatments? If even a small percentage of negative outcomes triggers a backlash as large as yesterday’s Vioxx Verdict, will it be possible to develop novel treatments without setting aside billions for lawsuits?

It’s almost impossible to conduct a clinical trial large enough to identify all the potential side effects of a drug. In the case of Rotarix, a rotavirus vaccine marketed by GSK, a 75,000 person trial was conducted, and even that might not have been sufficient to determine whether the incidence of certain complications was statistically above the background level. The vaccine still isn’t available in the US; GSK launched it internationally, and will likely try to bring it to the US market based on post-marketing surveillance of foreign patients (MIT’s Technology Review has an excellent article on the development of the Rotavirus vaccine, and one of the principals from GSK’s biotech partner, Avant, participated in the CBI conference).

I don’t see much difference between giving a drug to a hundred thousand people in a clinical trial setting and giving a drug to a hundred thousand people with a reasonable level of post marketing surveillance. Many people, myself included, try to avoid taking anything that hasn’t been on the market for a few years anyway. We treat new drugs as intrinsically risky. So why not create a probationary category? Start with smaller clinical trials and an expedited approval process. Then, for several years, require the same disclosures as for a clinical trial, and create patient registries to track everyone who is taking the drug - and include the rest of their medical histories, too. Give drug companies the opportunity to release new products through the current system or the new one, and give patients the opportunity to decide what risk/benefit profile they’re willing to accept.

Careful readers will notice that the proposal above requires complete patient registries for probationary drugs, and will likely comment that the infrastructure to deploy those registries in an efficient manner across all participating doctors would be hideously expensive and difficult. And the careful reader would be right. Requiring entry of a patient’s entire medical history, which would be required to properly screen for negative drug interactions, into a separate system for each probationary drug would be extremely time consuming. So the proposal doesn’t work without standardized electronic medical histories, which come with a host of practical and privacy concerns.

Publications

A lot of my more technical writings are available on genuine dead trees. In particular, I’ve written or had a hand in the following books from O’Reilly & Associates:

• Java Enterprise in a Nutshell, Third Edition (Sample Chapter (PDF))
• J2EE Design Patterns (Sample Chapter (PDF))
• Java Servlet Programming, Second Edition (Sample Chapter)

About & Contact

This website is about the interactions between business, technology, politics, economics and personal life. Sure, that’s a fairly pretentious way of saying that this web site is about whatever I find interesting. I like systems, and I believe that most subjects tie together. Since my career so far has been at the intersection of technology and healthcare, there’s a lot of that here, too.

I (William Crawford) have been a software developer, a manager, a Chief Technology Officer and an author of books about enterprise computing. In 2006-2007, I spent a year working on Healthcare Information Technology policy issues at the United States Department of Health and Human Services, in the Office of Policy at the Centers for Medicare and Medicaid Services, the largest healthcare payor in the world.

Right now I’m focused on industry liasion activities for the Harvard Medical School Center for Biomedical Informatiocs, and am an MBA candidate at the Sloan School of Management at MIT. I’m also an SM candidate in the MIT Biomedical Enterprise Program, which focuses on bringing together management and scientific professionals to create innovative biomedical businesses. You can never have too many graduate degrees.

This web site replaces two other efforts, one launched in 2002 and an earlier site from the mid-1990s. To celebrate the start of my b-school career I decided to start over. However, a few of the greatest hits can still be found at my O’Reilly & Associates weblog.

I can be reached via email at “will” AT “integrativestream.com” (obviously, remove quotes and replace the AT with an @).