> Where are you driving where you need an AWD vehicle?
I live in the mountain suburbs West of Denver, Colorado, currently. AWD is not strictly required (I only have FWD and RWD vehicles today), however if I am buying a new car, it /will/ be AWD, I have no motivation other than getting AWD and EV to buy a new car vs maintaining and driving my existing vehicles. All my vehicles are >10 years old except my race car, and I want a new car to replace the oldest vehicle, hence my desire for AWD EVs.
I can't imagine the benefit of sleeping in the office, especially as a PM. What is a PM doing around the clock to help ship any feature beyond helping morale?
As a One Medical customer, the experience post IPO has been awful. Hard to get appointments and less and less MDs available with incredibly high turnover. I wouldn't say their interests are aligned with mine at all, but agree the customer data being in Amazon's hands isn't great.
That's probably an industry-wide phenomenon. One Medical IPO'd in January 2020. You know what happened after that? Covid, mass deaths, high burn out amongst medical staff, and a lot of career changes away from meeting Facebook-informed clients face to face.
this is not a problem with just One Medical - it is a huge problem in primary care everywhere.
New doctors generally don't want to go into primary care anymore - it doesn't pay nearly as much as being a specialist does, and you are expected to be available to your patients 365 days a year, 24 hours a day (at least that is what many patients think).
It is a pretty miserable business to be in right now, and not sure what is going to make it better.
> In Atlantic Canada (the four easternmost provinces) it is impossible, repeat impossible, to get a family doctor if you don't have one ..[snip].. I've heard the same occurs in Vancouver too.
I am confused. Vancouver is on the West Coast of Canada while your statement is about "four eastermost provinces". Is it then a nation-wide problem?
I've seen news articles discussing the issue occurring in Atlantic Canada, and have been told that it is also an issue in Vancouver. I do not know about elsewhere.
> and you are expected to be available to your patients 365 days a year, 24 hours a day
Boy, I wish. I've never had a doctor with any kind of special availability. I can leave a message at their office but it's not like I'll get any kind of response until later the next business day, and that will just be from an assistant.
For 24/7 needs that's what urgent care is for, or the emergency room if it's more serious.
I know a few doctors and they're not necessarily directly available to patients but have to be on-call for nurses, MAs, etc. It's not 24/7/365 but its more than I get pinged when I'm on-call.
Let's segregate customer data from medical data: The US has some (IMO) pretty strict laws about protecting PHI. One Medical isn't going to keep your data in an open public S3 bucket, and random Amazon employees aren't going to be snooping around your medical records on their intranet.
> The US has some (IMO) pretty strict laws about protecting PHI. One Medical isn't going to keep your data in an open public S3 bucket, and random Amazon employees aren't going to be snooping around your medical records on their intranet.
HIPAA provides far fewer protections than you probably think it does, and flagrant violations are frighteningly common.
Worse, HIPAA provides no private right to recourse, so even if your PHI is exposed, you're not entitled to a penny in compensation.
HHS may fine Amazon, but to Amazon, $1.5 million (the maximum cap for all violations of a provision due to negligence) might as well be the cost of doing business. And you won't receive one cent of that.
> Can you give an example about fewer protections than people think?
For starters, HIPAA doesn't actually prevent your doctor or health insurer from selling your data to a third party. It also doesn't prevent that third party from giving that data to a fourth party, who can give it to another, and so on.
What happens if one of those tertiary parties has a breach and ends up exposing your data? In theory they're supposed to report it back up the chain, but in practice it doesn't go more than one or two links, if that.
So in short:
- you have no way of enumerating the number of entities who have legal access to your health data
- you have no way of finding out when it's been illegally exposed by any of the parties who have legal access to it
- if by chance you happen to find out about an exposure[0] you have no recourse except to report it to HHS, who may apply a statutory fine, but the fine is typically minuscule compared to the size, revenue, and profit of the guilty party
- if by chance you find out about an exposure of your PHI, you are not entitled to receive any compensation
All things considered, it's easier to enumerate the very limited ways that HIPAA does actually protect you than to enumerate the protections that most people incorrectly think HIPAA provides.
[0] a real-life example is you Googling the name of your partner and stumbling upon a publicly visible Excel spreadsheet containing the name, SSN, addresses, and medical diagnoses of thousands of patients
Used to be the Joint Commision took HIPAA violations seriously. Do HIPAA violations no longer cause risk of losing Join Commision accreditation? That used to be the big sanction everyone worried about.
> Your consent to be used in research is basically baked into anything you’ve whipsaw signed at a doctor’s office.
Eh, that's not exactly true. HIPAA isn't the only (or even primary) vehicle for safeguarding patients from research, and most research is conducted under the auspices of large (usually academic) institutions that have processes to ensure informed consent, which are in turn backed by other legal statutes or contracts. Those aren't perfect, but it's not correct to say that patients provide blanket consent when they begin at a new practice, or that HIPAA is responsible.
Not to mention that there is already a better than decent chance that no matter who has your medical records, they are already being stored or backed up into one of the major cloud providers anyway.
> The US has some (IMO) pretty strict laws about protecting PHI.
But it has some pretty huge holes in it. A lot of telemedicine services aren't covered by HIPAA, for instance.
I'm not worried about Amazon keeping my data in a public bucket, nor about Amazon employees snooping in it -- but I am 100% worried about Amazon pulling some "anonymization" BS and using my data for purposes other than providing health care to me.
I don't trust Amazon with my less sensitive data as it is -- I absolutely wouldn't want Amazon anywhere near my health data.
I’m imagining a utopia now where my privacy was protected as well as my medical data is with HIPAA.
Some of my family works in medicine and there is nothing that scares the pants off of medical administration more than a HIPAA data breach. There are real penalties for it from the government and they have to be reported. People responsible get fired.
> I’m imagining a utopia now where my privacy was protected as well as my medical data is with HIPAA.
I'm imagining a utopia in which our medical data is as well protected as people think it is under HIPAA.
> Some of my family works in medicine and there is nothing that scares the pants off of medical administration more than a HIPAA data breach. There are real penalties for it from the government and they have to be reported. People responsible get fired.
The penalties are usually in the tens of thousands of dollars. That sounds like a lot, but it's really not when you consider that most breaches for which fines are levied usually affect many patients, not just one, and when you consider the annual revenue and margins of most of these responsible parties.
The fines are capped by statute at a value (about $1.5 million for all violations of a provision in a single year) that is laughably low.
Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws.
The USA has demonstrated time and time again a pattern of fining corporations a minuscule amount in comparison to the damage done.
Besides, even before it comes to fines and it's in discussion in Congressional chambers, Amazon lobbyists can say to practically any senator or congressman/congresswoman: "you want to go against us for antitrust reaons? Oh well, guess we're going to have to close that Amazon warehouse in your district that creates so many jobs...and oh yeah looks like that Whole Foods in your district isn't profitable, we're going to have to close that one up too."
> Strict yes, but a company with the lobbying budget of Amazon can easily get around those laws.
They don't even need to lobby. They can just pay the fines. The fines are capped by statute at an egregiously low value, which to Amazon is chump change.
And that's just disturbing to me - that a corporation can willingly and knowingly break the law, and the money they'll make from doing so is significantly larger than the fine they'll pay.
Why is that even remotely acceptable in a democratic society?
See the big banks collective responses to regulations placed on the financial industry in the aftermath of 2008 - if the fine is significantly smaller than the potential for profits, they will do those activities and pay the fine 100% of the time. This mentality is evident in many other sectors as well, especially with publicly traded companies.
Yes, I know HIPPA fines are public. However, Amazon has enough money to not care, and to never care. You know how many labor laws Amazon has blatantly violated and not cared? If they can capture an entirely new vertical (healthcare), their share price will increase despite looming lawsuits and pesky regulations. Amazon is a multi-trillion dollar company that focuses on growth at any and all costs.
It shouldn't be, but that's how the game has been played for longer than you or I have been alive.
The fact that the penalty for many serious violations consists of fines that represent a tiny fraction of the company's worth means that breaking the law is an easy economic decision for companies. Fines are just a cost of doing business, and not even a major one.
That's really disappointing to hear. I stopped using One Medical because I moved out of the country. I loved One Medical and was thinking about moving back to it this year now that I've returned to the US. Good to know that it's not a good idea.
They're testing features to let you "reset" your algorithm to improve content diversity. But even without that kids spend over 80 minutes a day on TikTok.
They don't gravitate towards it. The algorithm inches them towards that. It starts with exercise videos and healthy eating, which is fine, but eventually goes towards eating-disorder content. Similar for boys.
Here's an analogy to understand ad-driven social media apps:
Imagine a world where there are thousands of companies out there that produce these strange little unpleasant pellets of food that they want people to eat. They don't want people to buy them—the company is happy to send out pellets for free because they make money when the pellets get eaten. (Let's not worry about how that could make economic sense. Maybe the pellets are made of sequestered carbon and the company is selling carbon credits.)
So all these companies want to get millions of people eating their pellets, but people don't want to. They don't taste very good and they've got, like, better shit to do with their lives.
But people do like eating other food. And usually they have to pay for it, which kind of sucks.
An opportunity exists here, and "social eating" companies pop up. These companies will ship you food for free, and you can eat as much as you want. What joy! The only catch is they've mixed some of these not-very-tasty pellets in with the food they send you. The social eating companies get paid by the pellet companies, which is how they're able to make and send you food for free.
Here is the interesting question: What kind of food do the social eating companies make? You might think that since they want to get as many people eating their food mixed-with-pellets as possible, they would make the best food they can. And, indeed, they do want to make food that is scrumptious, compelling, and mouth-watering. But what they don't want it to be is satisfying. Because once you're sated, you stop eating. That's the last thing they want because the more pellets you choke down, the more they get paid.
So what they make is junk food like chips and cookies. Each serving is a single tiny delicious bite, but as soon as it goes down, you're even hungrier than before. Its high in anticipation and desire, but low is satisfaction and satiety. You crave it, but once you have it, you don't actually feel any better. If anything, the craving is even more intense.
Now apply that metaphor to information. The most junk-food-like content is the stuff that triggers anxiety and anticipation if you don't watch it: fear of missing out, question-inducing "You won't believe...", alarming "You're doing ___ wrong...", etc. The content doesn't make you feel good if you do watch it, it makes you feel bad if you don't. Because that way, when you do watch it, the nagging anxiety goes away a bit, but you still don't feel "done" and still want more.
that which inflames or causes controversy gets sent around or reposted.
clicks == money.
as does "sponsored content" aka "post this to everyone who meets demographic groups X and Y". just so happens that some of those people want folks angry about some topic.
I guess that makes sense. Just following the user's preference gets only positive content, which is great, but carefully steering them to something darker is even better.
They also don't just optimize for consumption, but also for new users. Don't have concrete proof, but it seems they help new users get more views to give them that taste of "15 minutes of fame" as early as possible.
Yeah I tend to agree regarding the 15 minutes of fame for new users. It's doesn't even need to go insanely viral.
How many people have created and published videos on YouTube and got maybe a few tens or a couple hundred views over years.
TikTok new users gets a couple THOUSAND views and the user is like "people like my content I MUST make more!!" And now they're hooked trying to get the same high view count as before.
I would assume (as I have never used the platform) it's also a way for TikTok to grab you financial information "you earned x$ from you first video, please supply you financial information and a scan of your ID for payment.
I don't know much about the partner program but if I change the wording to this:
"You _could have_ earned x$ from your first video. Good job! You're on your way to the Partner Program please supply your financial information and a scan of your ID for future payment."
Since you seem to have experience. Did you notice 15 minutes of fame on your first uploaded video? How many views did your first video get? What was the topic and soundtrack of your first video? I'd love to dig a little deeper.
Similarly, the various dating apps I have used clearly front-loaded the matches with the objectively attractive women in the area. This has been especially hilarious to me as a female friend will often start the process for me (search store, download, sign up, start searching) and more than once they have gotten this skewed version of what's out there, thinking that every nearby woman looks like a movie star.
You don't have to look that far for proof, there are plenty of people who made videos complaining about how they don't get good views anymore, they aren't pushed out anymore. Search "why isn't my tiktok account being pushed anymore" and you'll find similar outcry on various forums. You see it by scrolling through their profile enough, they go from 300k views and 50k likes to 1k views and 100 likes. Massive drops, where they haven't reached "self-sustaining" status yet like a Selena Gomez account.
Also as another potential source of proof, tiktok is really effective at pushing alt pages to people's FYP. Which is interesting because their old account will stagnate, but their alts will get pushed quite aggressively despite the content being very similar. So obviously it's not a content issue, tiktok is evaluating them equally and thinking you'll like it, but their old account(s) don't show up as much anymore.
Tiktok isn't as overtly aggressive with this method though, it seems like there's a cooldown period of sorts where it might start pushing you out again if you remain committed to the platform. Still, it's severe enough for people to make note of it and feel seriously demoralized by it.
I think a key part of their new user optimization is putting very little weight on your previous performance. So if you make a great video as a user with 0 followers, you still have similar odds to a 10M follower user to making it big on the FYP.
There might, of course, still be additional new-user weight. But I think this is at least a part of it.
I don't, no matter how much they ask. The most I've acquiesced to is a small amount of YouTube time per day. It gets harder the older they get. My daughter can now just use her school laptop (while at school, at least) to watch as much YouTube as she can find time for. I'm not real happy about it, but part of raising kids is learning to accept the steady transfer of their autonomy over to them. I just keep gently harping on how low quality this kind of content is, what the motivations behind it are, etc.
There's dogshit content on YouTube (Mr Beast, moronic reaction and gaming videos, alt-right propaganda), but there's also more interesting content than you can watch in several lifetimes (documentaries, speeches and lectures, recorded courses from top universities on everything from physics to music, etc).
It's about curating this yourself for your child (as opposed to giving them unrestricted access), and then slowly giving them control and hope they have good taste :)
It’s funny you lump in MrBeast with the other two. I’ll admit his content is 0 value, but in terms of entertainment, it’s far higher than anything else on the platform. I’d be far more upset at my kids for watching a reaction YouTuber or any influencer, than I would mrbeast.
He's a downright clever guy who knows exactly what he's doing to maximize entertainment value, and, by proxy, clicks and therefore revenue. He was on the Lex Fridman podcast a few weeks back, pretty good listening.
I absolutely detest those videos, and I have to say I don't understand the appeal at all. It's a combination of of unhinged consumerism and that uncanny fake excitement which is extremely off-putting to me.
Twitter has a large off platform impact though. It's where information starts and/or spreads and eventually hits Facebook, less mainstream news sources, and in real life conversations.
