These are a great way to spread something you appreciate with the world. I once bought a stack of 30 or so well-used Calvin and Hobbes books and would regularly seed a few every now and then.
You're absolutely right! I kid. I'm also a former avid user of the em-dash, but have mostly stopped using it. I've even started replacing em-dash usage with commas, which often results in a slightly awkward, perhaps incorrect, but quaintly artisanal sentence with a LaCroix-like spritz of authenticity.
My double-space-after-a-period though, I will keep that until the end. Even if it often doesn't even render in HTML output, I feel a nostalgic connection to my 1993 high school typing teacher's insistence that a sentence must be allowed to breathe.
And by the way, what the Hell is up with all these people claiming that two spaces is an obsolete typewriter-era pre-proportional-font thing? Narrow proportional spaces make two spaces after a period MORE important for visually separating sentences. Is it old fashioned to think logically?
Yes, I find it useful while editing regardless of the final rendering. Maybe it's a quirk of how I process information visually, or a holdover from learning to type on an avocado green Selectric.
Sadly, the comma is not a good em-dash replacement. IME, periods and semicolons do the job best. I still use em-dashes in place of parentheses though because they're so much more readable.
You know the only reason we used double spaces between sentences in the typewriter days was because everything was monospaced, right? Modern variable width fonts provide additional space automatically.
My work health insurance recently offered a free scale and blood pressure monitor, I thought that's a nice perk, I'll use that, so I ordered with the intent of never using their app, just using it for my own tracking. The first time I used it, I got an email from my insurance company congratulating me and giving me suggestions. Both devices have a cellular modem in them, and arrived paired to my identity.
I destroyed them and threw them in a dumpster like that Ron Swanson gif.
All to say, little cellular modems and a small data plan are likely getting cheap enough it's worth being extra diligent about the devices we let into our homes. Probably not yet to the point of that being the case on a tv, but I could certainly see it getting to that point soon enough.
Similarly, I had a workplace dental provider ship me a ‘smart toothbrush’.
Turns out they track the aggregate of everyone’s brushing and if every employee brushes their teeth, the plan gets a discount.
”Lower rate based on group's participation in Beam Perks™ wellness program and a group aggregate Beam score of "A". Based on Beam® internal brushing and utilization data.”
Technology is starting to become genuinely terrifying. Computers used to sit on desks in full visibility, and we used to be in control. Now they're anywhere and everywhere, invisible, always connected, always sensing, doing god knows what, serving unknown masters, exploiting us in unfathomable ways. Absolutely horrifying.
I'd have tried to disassemble it, locate the SIM card or cellular modem, and see if it could be used for other traffic. A wireguard tunnel fixes the privacy problem, and I can always use more IP addresses and bandwidth.
Until people start abusing these "features", they will not go away.
The data plans on some embedded modems are quite different from consumer plans. They are specifically designed for customers who have a large number of devices but only need a small amount of bandwidth on each device.
These plans might have a very low fixed monthly cost but only include a small data allowance, say 100 KB/month. That's plenty for something like a blood pressure monitor that uploads your results to your doctor or insurance company.
If you are lucky that's a hard cap and the data plan cuts off for the rest of the month when you hit it.
If you are unlucky that plan includes additional data that is very expensive. I've heard numbers like $10 for each additional 100 KB.
I definitely recall reading news articles about people who have repurposed a SIM from some device and using it for their internet access, figuring that company would not notice, and using it to watch movies and download large files.
Then the company gets their bill from their wireless service provider, and it turns out that on the long list of line items showing the cost for each modem, a single say $35 000 item really stands out when all the others are $1.
If you are lucky the company merely asks you to pay that, and if you refuse they take you to civil court where you will lose. (That's what happened in the articles I remember reading, which is how they came to the public's attention).
If you unlucky what you did also falls under your jurisdiction's "theft of services" criminal law. Worse, the amount is likely above the maximum for misdemeanor theft of services so it would be felony theft of services.
Through what technical or legal mechanism is the company identifying or locating you - assuming you never logged in or associated the product with your identity?
What law is preventing Best Buy from telling TVManufacturer that a credit card with these last 4 digits bought the TV with this exact serial number?
And once the SIM connects near your house, what is preventing the phone company from telling TVManufacturer the rough location of the SIM, especially after that SIM is found to have used too much data?
Then use some commercially available ad database to figure out that the person typically near this location with these last four digits is 15155.
That's just a guess, but there is enough fingerprinting that they will know with pretty high certainty it is you. Whether all this is admissible in civil court, idk.
> What law is preventing Best Buy from telling TVManufacturer
No law: reality and PCI standards prevent this. And of course, the manufacturer could get a subpoena after enough process. This also assumes the TV was purchased with a credit card and not cash.
> And once the SIM connects near your house
> what is preventing the phone company from telling
Again: reality and the fact that corporations aren't cooperative. A rough location doesn't help identify someone in any urban environment. Corporations are not the FBI or FCC on a fox hunt.
Can you cite a single case where this has happened on behalf of a corporation? These are public record, of course.
Anecdotally, you may want to avoid Best Buy either way. There's a chance the TV box contains just rocks, no TV, and that they refuse to refund your purchase.
In our market we see lots of the use of the word Montessori for marketing value only, when it practice it often means something like: "we have a bunch of wooden toys and a certain aesthetic in our classroom." I've heard these referred to as "Monte-sorta."
I live in an area with PFAS contaminated ground water (which I now aggressively filter.) To me giving blood just kind of makes sense, if there is a class of things that can enter your blood and never leave, and does not replicate on its own, why not perform a regular "oil change" and hopefully help some people at the same time. Some study has been done:
The study specifically does not look at the effect on recipients, though the donation centers do not disallow such donations. My presumption is that the donation is a net positive all around. If study comes to show the contrary, I'll certainly revise my approach.
“I’ll do something which might be beneficial or harmful to me (I don’t know) and if given evidence of harm (likely never) I’ll stop doing it.” Ok…have fun I guess.
The person you responded to didn't say anything about harm to themselves. They said there's nothing stopping them from donating even though they're aware of the PFAS contamination in their area.
And from what I understand, PFA contamination has no bearing on whether or not you can donate.
The post implied that doing a “blood oil change” was potentially a good thing. My point is, we don’t know either way, because a study hasn’t looked at that question for health outcomes. It could be doing more harm than good, the parent commenter doesn’t know.
The study doesn't show that donation is a good thing. Showing a miniscule reduction in blood markers is not the relevant variable - what you'd actually care about is: do I liver a longer or better life because of this intervention? There simply isn't any evidence that a tiny reduction in PFAS from blood donation results in any improvement in any clinical outcomes. Because we don't know either way, it's also possible that there would be harms from this - as blood donation is not entirely risk free, exposing people to syncope while driving after giving blood, skin complications like infections, or other rare issues we don't even know about.
I recently requested this test from my doctor. The lab technician asked if I had requested it or my doctor, and gave a very judgmental "that's what I thought" type response. Ends up I was 95%-tile and put on an aggressive statin therapy, from a risk profile that otherwise didn't determine statin use. The test was easy and (relatively speaking) inexpensive. It helped me in risk stratification in a determinative way.
> If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands your lifestyle, your risk factors for side effects, and your medical needs deeply. How many Americans have that? Maybe a few dozen?
A bit of a tangent: I have this here in the US, through a model called Direct Primary Care. I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.
I do worry that it's sustainable, but I think there must by a way to scale up this practice of the general practitioner working in the interest of the patient.
My previous doctor was part of a large health system, who also happens to be directly associated with the large regional insurance provider whom my employer supplied to me without another choice. Every 8 minute visit centered around insurance and billing, with my health seeming to be a distant second. It seemed every visit had to end in some kind of prescription or referral, arrived at quickly and without much discussion. It quickly became clear they were not working in my interest, and I sought other options, eventually landing on the Direct Primary Care model. Now I have full 1 hour visits, and someone who seeks to understand what is happening for me completely, not through the lens of a payer.
> I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.
Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?
It works the same way that health insurance works -- most people don't need all that much care, and when time-consuming care is needed, it is often pushed to the specialists rather than the generalist. Your $50/mo payment might not seem like much, but if all you're doing is a bi-monthly checkin with them over the phone, you're really paying more like $100/visit for a 15-30 minute visit.
A lot of these 'concierge medicine' services are set up to deal with mostly people who don't need all that much medical care, beyond relatively brisk access to the doctor in a few rare circumstances. Since they also don't really do much in terms of specialty care, they tend to have fewer Px who need extensive personal care.
It is totally feasible and not uncommon for a family doctor to have 2000+ patients. Young healthy people can go years without interacting with the medical system, and when they do it's often some thing that barely involves their doc. I mean their doc doesn't know them personally then, but they have no problems worth surfacing clearly so why do they need to? The limiting factor really is the quantity of seniors and people with complex chronic conditions that you take on.
You're not going to be seeing every patient every month. Many you might only be seeing a few times a year; They will have a quick phone chat every few months to make sure their prescriptions are up to date, maybe order a blood panel or two to stay on top of things. They're not coming in every week for an hour-long deeply-personalized appointment. As long as the practice limits itself to a reasonable number of patients, they should be plenty solvent.
We're talking about basic preventative care here. Your doctor doesn't need and probably doesn't want to be your friend for these sorts of things. There doesn't need to be a deep personal relationship there if it's not necessary.
(But also, $50/mo is a very low price. I've seen plenty of such services that are in the $500+/mo range. It's still way cheaper than health insurance would cost out of pocket, but it's not 'cheap' either.)
420 young, healthy patients probably see the doctor 2x a year at most. That's less than 20 visits a week for the doctor. And as soon as you become unhealthy you are passed along to a specialist or dropped.
You're paying for the bedside manner, not the medicine.
I’m 39 and I see my doctor once a year, at most. This year I had a urinary thing. Last year and the year before that I had a rash. The year before that I didn’t go. For all of my twenties I went three times. She still remembers me just fine, asking how is my CrossFit doing.
I see my wife’s doctor more often than my own because he is also our newborn son’s doctor.
They both have thousands of patients. The waiting rooms mostly have elderly, parents with their newborns and obese people.
How could this possibly work out for her financially? To make 120k a year, she would have to be doing this with.. 200 patients; and I think the average GP makes a bit more than that in the US. That doesn't like a good bargain on her end.
I do not think I have ever spent more than an hour per visit actually in the room with my GP. I have an annual checkup. For a while there my GP was world class and also a blood relative.
200 patients at one hour per is a bit more than a month of 9-5s.
If I visited my GP once per 1.5 months I’d be paying a fuckload more than $50/mo in copayments alone, in addition to my incredible premiums.
Healthcare becomes pretty affordable when you’re not paying for actuaries and other scammers.
I guess I see this as somewhat different. These people are proactively choosing to maintain a relationship with a physician for an elective $50/month. I think the type of patient who wants a type of this relationship is the type who is going to solicit more than a single appointment per year; otherwise, why not just use what the current system gives us?
I could see something like this being useful for me; I'm constantly nagging my physician for different drugs I am triaging for a condition I'm dealing with. But, in that case, I wouldn't be the ideal patient for the physician. I wish this kind of thing could work, but I'm not sure how I see it working in practice, unless you move up market and charge more.
I've anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.
Curious what that fee covers beyond having direct access to the physician (and even there, beyond just consultations). If you needed imaging work or even procedures or surgeries - would that be extra fees?
Can't speak to the parent posters' experience, but for me, it covers a lot of imaging, routine bloodwork, cheap Rx for a lot of basic medicines (think blood pressure medications, diabetes meds.) I can get a full basic blood panel (CBC, CMP, LDH, ALT, TPT..etc) done for a few bucks instead of paying several hundred, that alone has saved me a good chunk of change over the years.
One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.
That included lab work, talking to the front desk people, the nurse who took the blood, the GP, the drivers, the janitors, the record-keepers, the lab techs, and the calibration work on equipment and who knows who else.
I recently got a physical exam, including ultra sound, two urine samples, and bloodwork, at a private doctor in Austria and it cost 150€. You Americans are crazy.
I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Supposedly in the Salzburg airport in Austria, there's an information counter for people who have learned that they are in fact in Austria, not Australia...
Americans can order their own lab tests for pretty cheap as well. In regards to pricing, the overhead for billing is about 1/3rd of the price, though not relevant in the poster's situation. It is part of why some prices here are so inflated though.
If a patient goes to see their doctor at a major hospital, part of that bill goes to pay for uninsured patients in the ER. Hospitals in the US by law have to treat everyone who come to the emergency room, which results in a lot of losses for hospitals that they have to make up for by charging higher prices on other services.
> And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Smaller doctor's offices do their labs offsite, in the US just a couple of companies do the majority of blood work, as part of the contract with the lab, a driver comes by and picks up samples. In the great name of outsourcing, I imagine this driver works for a separate company as well, so now there is 2x outsourcing overhead, once for the lab, and again for the transport company. For doctor's offices that cannot justify their own lab, this makes some sense.
FWIW in my city at least, the majority of doctors are affiliated with large hospitals. They either work in a large hospital, in a satellite campus, or have an affiliate relationship (which from what I can tell just means medical records are automatically transferred over).
I go to a "smaller" office, it is a 3 story campus that is the satellite office of a huge hospital nearby. They do some of their own lab work and outsource other stuff. The hospital network is publicly owned and accordingly much nicer to deal with than many of the horror stories I hear online and from friends. (also the prices are reasonable and they always give me a price sheet up front of what everything will cost, which isn't always the case for some doctors...)
> I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Is that a 100% unsubsidized price?
In the US, cash price for a Comprehensive metabolic panel (CMP) is just $50. The same labs that the hospitals outsource to actually offer direct to consumer tests at really reasonable rates.
I just checked my hospitals cash rates:
A yearly checkup for an existing patient is $48.
Lab work is $48 (a $2 discount!)
Urine tests are another $20.
So in summary, OP got ripped off by their doctor's office.
Studies have shown that patient satisfaction scores are highly correlated with whether the doctor writes a prescription. When patients leave with a prescription then they feel like they got their money's worth, regardless of whether they really need it.
And even if it didn’t treat something now, it can treat things later
For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter.
Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole.
Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin.
Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.
Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.
I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot.
Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.
My previous homeowner was also a vibe maintainer! The difference that I see in this is that the LLM is reasonably at 'expert' level for many of these things. If I sit down with Stevie Wonder and ask him to help me write a song, the resulting song is probably going to be pretty good. Stevie also knows by experience lots of things to avoid, and is intuitively going to help me avoid them unless I instruct him specifically to make a poor choice.
I think there are likely opportunities too to have models or system prompts that cater or adapt to the experience level of the person it's working with. "As you interact with the user, determine their relative level of knowledge and experience. If they seem to be relatively inexperienced with software development, be much more aggressive in helping to warn them about and avoid common pitfalls, bad architectural decisions, and security issues."
I suspect it's probably going to enable a lot of poor quality stuff, but it also may to some degree raise the floor of what's being produced at the same time.
I think the difference between electrical work and software work is with electrical a lot of those standards don’t really change from year to year outside of some code updates. Wiring a wall socket or moving a socket around has been pretty much solved for decades. maybe a different kind of outlet that is a little more safe or some exception about sockets near a sink.
Versus software I were there’s hundreds of different outlets hundreds of different wires tens of different storage mechanisms. Now if the LLM is even slightly unsure, it will hallucinate leading to a mess when things go wrong that the user doesn’t know how to fix
Then an actual expert will have to come in and try to understand what went wrong, which adds additional time than if it was just built right the first time
It's going to lower the floor, because lots of stuff that would otherwise not get produced will be made, and it will be hard to see how incompetent the people behind it are at first glance because the UI could be decent. Imagine putting your valuable information into one of these garbage apps only to find out that the app wasn't even written by a programmer! If it goes just a little farther, and the AI deploys it for you too, how many disclosure and data retention laws are going to be broken by it? You'd have to be awfully desperate to want to use one of these 100% AI monstrosities created by an amateur.
Is it "artisanal" if almost every application still has to be made by humans? I think that nobody will want to run amateur AI software projects from strangers, unless it can be done in a sandbox. Even a well-meaning "creator" could have malicious garbage injected into their product by AI.
I find tools where I am manually shepherding the context into an LLM to work much better than Copilot at current. If I think thru the problem enough to articulate it and give the model a clear explanation, and choose the surrounding pieces of context (the same stuff I would open up and look at as a dev) I can be pretty sure the code generated (even larger outputs) will work and do what I wanted, and be stylistically good. I am still adding a lot in this scenario, but it's heavier on the analysis and requirements side, and less on the code creation side.
If what I give it is too open ended, doesn't have enough info, etc, I'll still get a low quality output. Though I find I can steer it by asking it to ask clarifying questions. Asking it to build unit tests can help a lot too in bolstering, a few iterations getting the unit tests created and passing can really push the quality up.
I think for me, I'm still learning how to make these tools operate effectively. But even only a few months in, it has removed most all the annoying work and lets me concentrate on the stuff that I like. At this point, I'll often give it some context, tell it what to make and it spits out something relatively close. I look it over, call out like 10 things, each time it says "you're right to question..." and we do an iteration. After we're thru that, I tell it to write a comprehensive set of unit tests, it does that, most of them fail, it fixes them, and them we usually have something pretty solid. Once we have that base pattern, I can have it pattern and extend variants after the first solid bit of code. "Using this pattern for style and approach, make one that does XYZ instead."
But what I really appreciate is, I don't have to do the plug and chug stuff. Those patterns are well defined, I'm more than happy to let the LLM do that and concentrate on steering whether it's making a wise conceptual or architectural choice. It really seems to act like a higher abstraction layer. But I think how the engineer uses the tool matters too.
reply