Digital book sales already 10% of all Amazon book sales

I guess you already know that Google has reached a settlement in its copyright case with several major publishing houses, allowing it to get on with its plans to build a “digital book archive”. All sounds a bit sinister to me. Not sure why, but there you go. I think it’s just my anti-centralisation instinct. Anyway, that’s not the point of this post. Rather, I was fascinated to learn today that sales on Kindle (not yet available in the UK) already account for 10% of all Amazon book sales. Golly.

Netbooks soar to the clouds, dragging Microsoft with them

A little cluster of stories today from the FT. Firstly, those little mini-notebooks (or ‘netbooks’) that you can get for a couple of hundred quid and slip comfortably into your bag are proving to buck the economic downturn and become bestsellers; get yours quickly, as stores reckon they’ll all be out of stock by Christmas. For the most part they generally have but little internal storage capacity, and rely instead on data and applications drawn from the internet: cloud computing. Sadly, by the way, for you Apple acolytes out there, there’s nothing on the horizon for you. Said Steve Jobs, ”We don’t know how to make a $500 computer that’s not a piece of junk, and our DNA will not let us ship that.”

But regardless of whether we think Steve Jobs will soon be eating his words, the reliance of netbooks on cloud computing acts as a nice little link to the second FT story today, and that is to announce that “after years of hesitation, Microsoft is finally ready to take a big leap into the world of internet-based computing.” Yes, we all assumed that as cloud computing slowly took over (or will it?), dearly beloved MS would slowly slip away as Google completes its takeover of the multiverse. Well, MS have decided that perhaps they need to step up to the plate (my second americanism today – what’s going on? Must be the effect of the World Series) and indeed on Monday in LA they will reveal to the world what they’ve been up to with regards to the development of their very own cloud computing platform. We should note that MS make most of their money from Word, Excel etc., and they’d be rather worried should cloud computing eat into those profits… we should also note that certain big names, such as Larry Ellison, the head of Oracle, dismiss cloud computing as “little more than a fad”. I do wonder if he might be right?

But regardless of whether I will soon be eating my words, the third story is simply that Microsoft has so far “weathered the economic downturn better than expected, with sales in the three months to the end of September topping Wall Street estimates.“, which I’m sure we all agree is good to know. I wonder what Bill will do with the money?

Twitter as a ‘virtual doctors’ lounge’

I’m way behind on the phenomenon that is Twitter.  I can already see LIS students’ cutting edge ideas for theses–”Twitter as information ground for [insert profession/ population here].”  Of course the most bleeding edge of doctors are already on there.  CaseBlog explains: Twitter allows 140 character updates–perfect for time-poor and sometimes isolated but always busy professionals.  And bless him for mentioning health librarians in the same breath.

Mortality data and transparency in the NHS (and elsewhere)

I read an article in the HSJ the other day about mortality rates during NHS operations being made available to the general public. It is, apparently, possible to find mortality rates for certain procedures on the NHS Choices website, but it certainly ain’t easy. I’ve just been pottering around for a while and, finally, for example looking at coronary bypass surgery at some London trusts, I got to this page (I hope the link works for you – if not, start on the homepage and click ‘compare hospitals’ and then ‘compare hospitals for treatments’ and, well, carry on from there). Some data is given to compare hospitals, though not explicit mortality rates – rather, they all have the same statement that with regards to mortality it is “As expected compared to the UK average”, which is not particularly helpful, especially given that the HSJ article implied that such a statement would be found for all NHS Trusts. I suppose that’s a good thing, i.e. that there’s no great disparity in care between Trusts, though it would be nice to see a few above average Trusts breaking from the pack (though of course that would then doom some to be below average…).

Other questions for which there is data for some of the Trusts are “does the surgical department have a lot of experience in this operation?”, “how long am I likely to spend in hospital?”, “how long will I wait from referral to treatment?”, and “how well does this organisation control MRSA blood infections for elective patients” (although for these last two questions the site does warn that different NHS trusts collect data in different ways, and hence the data are not comparable between trusts. Ho hum). The statistics are rather crude, and collected at the Trust level, so in real terms for the patient having to decide where to go for his/her coronary bypass operation they are pretty much useless. However, there are two things to say. One is that I expect (hope) that the data being collected will become more helpful, comparable and granular as time goes on. Secondly, even given their crude, unhelpful state at the moment, I’m delighted the data are out there.

I like being open and publishing outcome data because the act of transparency helps ensure that everyone “ups their game” as Paul Levy, a big fan of transparency (whatever the costs) might put it. It makes us all uncomfortable, as we all make mistakes and probably the natural reaction is to try and hush them up and save face, but really the improvement of a system requires that mistakes and errors are recognised and logged. Some will be human error of course, and that’s all fine and good and to be expected, but some of them are likely to be the result of systemic error – i.e. error that occurs because of a fault of the system. And while you cannot do much about human error, you can do a great deal about systemic error.

Now, while the NHS for the most part probably hates having their data out there, the reality is that it is unlikely to be used by patients during their decision making process. It probably will be used from time to time by jounalists, but journalists will just make up stats if they don’t have them to hand, so it doesn’t really make much of a difference. However, just the knowledge and discomfort of having the outcome data out there means that transparency and the acknowledgement of error is hopefully going to become more common in the NHS and, as a result, systems will be improved, to the ultimate benefit of the patient. Maybe I’m just being hopelessly optimistic, but I’m delighted to see NHS data being released to the prying eyes of all, and I hope that it’s a trend that continues even if, from time to time, it’s used against them.

Breaking News (not): NHS slow to utilise new technologies

My final pointer today (to try and make up for being so slack this last couple of weeks – holiday followed by catching up and being v busy at work – ho hum) is to a King’s Fund report on Technology in the NHS. It argues that the NHS has been slow to adopt the types of internet technology, such as email and online booking systems, that are already in widespread use in other industries such as financial services and the travel industry. The health sector needs to catch up as patients will increasingly expect to have the capacity to use technology in their health care. While the NHS has invested in a £10bn + “National Programme for IT”, it focuses on internal information management (nationwide electronic patient records etc.) and does not aim to improve the use of (let’s face it, pretty basic) technology to interact with patients. Maybe it should.

Ivy League and Pharma collusion. Allegedly…

In case anybody has been following the case of the missing journal recently, the Harvard Health Policy Review website is now back online and you can read about why it went offline – apparently no pressure was applied by any party, which sounds a little unlikely, but then what do I know? It’s all been great fun. Basically the HHPR published an article entitled “Ethical Standards for Healthcare Journal Editors: A Case Report and Recommendations” that made serious accusations of malpractice against the editors of the Journal of Health Economics – what makes it all the more interesting is the presence of drug money and collusion between pharma and Ivy League academics – the Health Care Blog covered it here. There are some serious accusations involved, and if any of the mud sticks it’s rather worrying.

India’s growing share of world’s scientific papers

Thomson Reuters has released a press release stating how since 2000 India (or rather the scientists in Indian Institutions) has significantly, year on year, increased its output of scientific papers. To quote from the press release:

“Our analysis indicates that India is moving toward greater participation in world science,” said Christopher King, editor of Science Watch.  “Besides a dramatic increase in its number of research papers and its average citation impact, the number of papers authored exclusively by India-based institutions has declined.  This allows us to draw the conclusion that India’s presence is increasing in international science.”

Certainly I’ve noticed a growing number of high impact papers coming from the subcontinent, which is good to see. And as pointed out above, there are also more colloborations happening between Indian institutions and non-Indian institutions. All of which might hopefully suggest that rather than having to leave India for (e.g.) the US or the UK, qualified Indian scientists can stay and contribute to their own economy. As our western recession hits, I wonder if we’ll find a brain drain heading towards, rather than away from, India? Certainly our cricketers already want to head that way…

Consumer health information @ the Toronto public library

Lo, a new blog from the Toronto Public Library that guides patrons to the right information and shores up the position of public libraries at the same time! It seems as though the bloggers select timely topics and provide adequate linkages to other sources of information. There is nothing worse, after all, than a blog that thinks it needs to ‘protect’ its readers from other information nuggets.

The blog links to a wiki on CHI as well. It points the way to reliable Canadian and American websites.

The one thing they might consider doing is expanding the ‘About us’ section to put more of a face on their blog and engage readers.

Genetic testing, prospect research & the psychological impact of being ‘high risk’

The health informatics blog has an interesting posting on the genetic testing service, 23andme, and Google baron Sergei Brin’s experience with being tested for Parkinson’s disease via this service. Apparently, his likelihood of getting Parkinson’s disease is higher than average.

The health informatics blog mentions that this may affect Brin’s support of certain research organisations and charities over others. Seeing as Brin is being very public about his test findings, one would expect prospect researchers affiliated with Parkinson’s disease groups to start inundating him with pleas for donations and gifts.

I wonder also about the psychological impact of knowing you are at a higher risk of a disease–will you start to see symptoms in every tic and leg cramp (a.k.a Medical students’ disease)? Is it possibly to psych yourself into having the disease? Whereas, if you hadn’t know you might be at high risk, would your ignorance have any protective effect?

A systematic review in Nature (2000) suggests that both carriers and non-carriers experienced a reduction in distress after being tested–unsurprisingly, this was more immediate in non-carriers. However these studies were few and limited to a small number of genetic conditions (ovarian and breast cancer, Huntington’s disease, familial adenomatous polyposis and spinocerebellar ataxia). The populations were self-selecting and studies were observational.

A 2008 study of testing for long QT syndrome in people with family histories suggests that there is a short-term increase in distress in carriers and their partners that returns to normal long term. However, when the electrocardiogram was uncertain, the distress was, understandably, more likely. Most of the people followed were ‘back to normal’ after 18 months of follow up.

There seems to be some consensus that although testing can be distressing, it does not cause lasting harm and proper counselling should be built into the testing procedures.

Why people do not read privacy policies

A couple of US researchers have found that the ‘average’ privacy policy on a website (where personal details are gathered) takes, on average, 10 minutes to read. The average length of a privacy policy is 2,500 words. The researchers then told a group of people to ’skim’ read (quickly read by scanning for pertinent details) a sample policy (that was only 1000 words long). They found even just doing that took the participants from 3 to 6 minutes on average (and one poor soul 42 minutes).

The part of this Outlaw article I love is where they did a cost analysis, supposing that US citizens would demand to be paid for their trouble. Minimum wage? And what number of policies were read? Their hourly wage wasn’t given, but the grand total came to about $365 billion US per year. Perhaps this excerpt from the original research paper by McDonald and Cronor better explains it:

We…used data from Nielsen/Net Ratings to estimate the number of unique websites the average Internet user visits annually with a lower bound of 119 sites. We estimated the total number of Americans online based on Pew Internet & American Life data and Census data. Finally, we estimated the value of time as 25% of average hourly salary for leisure and twice wages for time at work. We present a range of values, and found the nationwide cost for just the time to read policies is on the order of $365 billion. Additional time for comparing policies between multiple sites in order to make informed decisions about privacy brings the social cost well above the market for online advertising.

It’s an interesting idea to apply costing in this way to privacy and to assume that people compare privacy policies. I don’t think they do, in reality. Maybe in the US they do?