Comments

Bob Paddock November 25, 2020 6:56 AM

In today’s medical system prevention is not reimbursable so very view have any interest.
Lets hope the Cyber model can come up with a better model base.

Medical Economics Magazine has covered the increasing number of suicides by doctors and medical students, due to the current medical model. Many new grads are rapidly disillusioned when they learn The System is not at all about helping people, and regret getting into the field.

Grahame Grieve November 25, 2020 7:16 AM

In other words, it would be the poor step child every talks up but never does anything about?

Kurt Seifried November 25, 2020 9:43 AM

Congratulations, you’ve discovered the law of large numbers:

1) make dinner for yourself at 6pm
2) make dinner for 10 people at 6pm
3) make dinner for 10,000 people at 6pm

one of these is something we can all do, the second one becomes tricky especially if you want all the food hot at the same time and #3 shows that:

all large problems stop being their original problem and become a problem of logistics, strategy and policy

This holds true for dinner (you vs. a restaurant vs. a military feeding their troops in the field), potholes (you can fix a pothole, you can’t maintain a cities road network without an organization), public health, InfoSec and, well, everything.

xcv November 25, 2020 9:46 AM

@ O.P.

a discipline of cyber public health. It would relate to cybersecurity in a similar way that public health relates to medicine.

No. Locker room jock therapy does not work.

“The usual” crew of unskilled or semi-skilled, uneducated, low-paid workers — caregivers, nurses, therapists, counselors, social workers etc. — have a disastrous negative impact on public health under the modern regime of medieval European medicine where doctors are treated and paid like rock stars, but not held responsible for the malpractice that is committed or the care or treatment that is delivered, such as it is, or however such atrocities come to be committed.

There is already a pernicious atmosphere in cyberspace of proprietary Microsoft-only software, waiting till Patch Tuesday for a fix, the Geek Squad of low-level techs and Cisco certs who can’t code or develop software on their own, uneducated and unskilled IT staff adhering to arbitrary rules that get in the way of real work, and so on and so forth.

“The usual” pot of coffee in the break room is not for those who take pride in their work or for workers who wish to remain clean and sober on the job.

That system is doomed to failure, and there will be no end to the vengeance we inflict on those who impose it unjustly upon us.

Etienne November 25, 2020 10:09 AM

The first thing I would do, is vaccinate 100% of the email clients, so they could not use the Internet unless they have a certificate issued by an FCC licensed (fineable) authority.

Then make any SMTP server contraband. Foreign countries would need to implement the same protocols, or their email be subject to quarantine, or deletion.

Unsigned email shall not be allowed, in order to prevent pandemic diseases (SPAM, Phishing, etc).

MikeA November 25, 2020 11:01 AM

@Etienne

So, Lèse-majesté meets RoboCop.

When you outlaw dissent, visible corruption will vanish, but that bulge in the carpet will grow without bound.

JonKnowsNothing November 25, 2020 11:19 AM

@Etienne

re: they have a certificate issued by an FCC licensed (fineable) authority.

FCC à la USA? Surely you make a joke? Because the FCC in the USA is pretty much that.

Hoskins November 25, 2020 12:20 PM

What does Shostack mean by the term Public Health ?

He initially avoids defining his key term Public Health, but reveals his true colors a bit later in his monologue: he directly uses the words coercive and mandatory to outline the standard top-down government-control of the overall national healthcare delivery system, negating most of the private voluntary markets in healthcare.

Allegedly we NEED government experts to run things properly.
This is the age old leftist/socialist worldview with a slight new twist of cyberstuff… to make it sound trendy.

Winter November 26, 2020 1:00 AM

@Hoskins
“negating most of the private voluntary markets in healthcare.”

And that works?

In the grand scheme of things, aka, the world, Americans pay premium prices for at best mediocre health care. There are few countries where people are bankrupted by medial costs when they get sick. None of them developed countries.

h ttps://apps.who.int/iris/handle/10665/330305

In fact, the most efficient and effective parts of the US health care system are Medicare and Medicaid, both outside part of the “private voluntary markets in healthcare”.

Onanyon November 26, 2020 7:25 AM

@Winter

how could there be any widespread dissatisfaction with the current American health care system? It’s mostly structured the way you want it to be.

Health care is the most heavily regulated economic sector in the U.S. and the government controls nearly two-thirds of all medical spending, directly or indirectly.
Medicare and Medicaid are model government programs — fiscally sound long term, waste free, highly efficient, and beloved by all (?)
ObamaCare as originally enacted was the epitome of rational government health care management — dramatically reducing personal medical costs, expanding consumer choice and quality care, and sharply cutting back the huge government health care bureaucracy (?)

A few little cyber tweaks and your current government directed American health care system will be near perfect {?}

Winter November 26, 2020 8:28 AM

@Onan
“Medicare and Medicaid are model government programs — fiscally sound long term, waste free, highly efficient, and beloved by all (?)”

Indeed, remember what happens to any politician who advocates to abolish them. Or how attempts to abolish Obamacare fare in Congress when the voters get wind of them.

xcv November 26, 2020 11:23 AM

@ Winter • November 26, 2020 8:28 AM

@Onan

And Onan knew that the seed should not be his; and it came to pass, when he went in unto his brother’s wife, that he spilled it on the ground, lest that he should give seed to his brother. And the thing which he did displeased the Lord: wherefore he slew him also. Then said Judah to Tamar his daughter in law, Remain a widow at thy father’s house, till Shelah my son be grown: for he said, Lest peradventure he die also, as his brethren did. And Tamar went and dwelt in her father’s house. — Gen. 38:9–11

“Medicare and Medicaid are model government programs — fiscally sound long term, waste free, highly efficient, and beloved by all (?)”

Medical technology nowadays has advanced greatly beyond that of medieval Europe, but our intstruments and techniques of punishing doctors out of their malpractice and holding them accountable for their billing fraud, mass murder, and routine mayhem have not kept pace.

Indeed, remember what happens to any politician who advocates to abolish them. Or how attempts to abolish Obamacare fare in Congress when the voters get wind of them.

The voters? Those voters are nothing but drug addicts on the dole who get doctors’ prescriptions for recreational drugs. Obamacare is offered on the premise of mandatory payment of premiums, for mental-health-only coverage, on a basis of civil commitment for involuntary treatment in psychiatric wards, mental hospitals, Alzheimers’ units, assisted living centers, and insane asylums.

1&1~=Umm November 26, 2020 11:57 AM

@Onanyonder:

“how could there be any widespread dissatisfaction with the current American health care system?”

US healthcare the pinical of the great American dream and all it’s failings…

The most expenseve medications in the world due to ‘profit’ the most expensive medical staff in the world due to ‘profit’ the most expensive medical instruments due to ‘profit’, the most expensive administration in the world due to ‘profit’, the most expensive insurance in the world due to ‘profit’. Thus vastly over inflated cost to patients who then discover that despite the 1000’s of USD they pay every month they are so means tested that getting a simple infection might not be covered so could kill them, not by the pathogen but by the bankruptcy.

But the real thing that suffers behind the price gouging is not the individual but society as a whole.

For years now it’s been pointed out that ‘disease is no respector of wealth or status’ thus society needs to be well for individuals to not be at risk of illness.

Something I never expected to get so catastrophically demonstrated by a pandemic. If you look at the US graph for COVID cases compared to other countries, you notice it is markedly different to that of countries with more society orientated healthcare.

Thus it’s fair to say that many of those who have suffered from COVID and even died from it in the US have not just moronic politics but the grossly deficient US healthcare system to blaim, which of course is in the state it is due to moronic politics…

Sometimes you have to consider the needs of society of which all individuals are part of, over and above individual notions of self entitlement. Because pathogens care not a jot for the suit you wear, the vehicle you drive, or any other trappings of wealth and status you might display. All the pathogen sees is the next host it can breed and mutate in. Thus if areas of society are ‘sick’ as they clearly are, or lack the healthcare to be kept well, then even the rich with personal trainers and physicians are going to get sick and die as pathogens hop from host to host like animated fleas.

It’s a point many US citizens have been raised to ignore or abhor, but now it’s come and well and truly bitten the US… Do you think teaching is going to change to accept the reality of ‘Hey boys and girls you are going to die at a younger age than your parents and grandparents’.

Probably not so the next pandemic that comes along is going to lay further waste to the US untill maybe the lesson gets through, but will you be alive to see it? Possibly not.

US healthcare can not actually survive the way it is set up, something will have to give, the question is what will snap first?

There are plenty of signs that US healthcare is dysfunctional to the point it is beyond failing patients. They’ve been mentioned before on this blog but the truth causes some to “rail not read” to “shout mantras not quietly learn” thus to die at an early age than those that read and learn in other places…

I’m just thankful I don’t live where such a barbaric rent seeking system is in place that actively causes harm for profit…

JonKnowsNothing November 26, 2020 12:58 PM

@All

Any discussions about the failing or successes of Health Care Systems (US or Global) need to step up about the entire process from access to education through board certifications and reciprocity.

Such systems are in place for many “profession” attributes: electricians, carpenters, plumbers, engineers, doctors, lawyers and dentists.

All such systems are “gating” systems, market place manipulation to max salary-profit and limit competitive down pricing pressures by limiting supply.

That’s not a small pile of potatoes to chew on.

It is one that is getting more noticeable with student debt, high cost of education, long periods of mandatory under-market indentureship. This crosses all aspects of what are termed “professional” accreditation.

In the USA pre-neoliberal policies, we had many independent clinics run by MDs, they billed medicare (et al) and had to shoulder all the business costs themselves. At that time, they had considerably higher incomes than the people who came to use their services. Few had healthcare, and fewer had jobs that had healthcare policies.

USA Post-neoliberal enactments saw a huge consolidation of medical services into massive corporations. Stories abound about how these transfers took place, the impacts on individuals and families as they struggled to find the fees and insurance approvals needed for care. There are still single practitioners but even small clinics need multiple MDs and support staff. Many of these clinics exist(ed) in rural communities. They have mostly been replaced by corporate owned-franchised UrgentCare 24h walk-in-drop-dead corner shops.

What you won’t find much in the USA are MDs supplied from Cuba. There are to be sure a lot of Cuban immigrants in the USA, but I am referring to the MDs that are trained and deployed directly from Cuba.

In Brazil, Bolsonaro removed the visas and canceled contracts for the Cuban Contingent of MDs that had provided much of the medical support in remote areas of Brazil for political reasons.

What you won’t find in most countries are “open access” to education and open systems for certification. If you want to improve the supply of healthcare you have to start where the educations systems begin. Every gate has to be removed and the process restructured.

In the USA, in order to fill-in the dearth of MDs, we promoted everyone else in line up one or two ranks. Physicians Assistants, Nurse Practitioners all down the chain of medical care. Consider carefully that each of these groups are qualified but are restricted in their work assignments.

fwiw: I live in the USA. I rarely have health care provider solely educated in the US System. International Medical Personnel are the backbone of the local system: Russia, Armenia, Turkey, Mexico, India, various Middle East Countries, Ireland, England and many more.

The USA is not alone in poaching medical staff from other countries who struggle to educate their own MDs and Health Care Support for their own requirements.

You have to ask: Why? Why is it so difficult and expensive? Why is is harder to become a veterinarian than an MD?

If you all back to the old arguments put forth by Universities and Professional Organizations, you won’t find the answer the world needs to find.

ht tps://www.cnn.com/2020/03/26/world/cuba-coronavirus-medical-help-intl/index.html
  Cuba saw hundreds of doctors sent home from medical missions in Brazil, Ecuador and Bolivia in recent years, after the US criticized Cuba’s medical assistance programs

ht tps://www.theguardian.com/world/2020/nov/25/sicily-asks-cuba-to-send-medics-as-italy-fights-second-covid-wave
(url fractured to prevent autorun)

xcv November 26, 2020 9:59 PM

Cyber Public Health? Now I know rravel is restricted in the U.S. due to COVID-19. Then I saw this.

Defense Travel System

The Defense Travel System (DTS) is a fully integrated, automated, end-to-end travel management system that enables DoD travelers to create authorizations (TDY travel orders), prepare reservations, receive approvals, generate travel vouchers, and receive a split reimbursement between their bank accounts and the Government Travel Charge Card (GTCC) vendor. DTS operates at over 9,500 total sites worldwide. On average, DTS processes more than 25,000 transactions while approximately 100,000 unique users access it on a daily basis. Defense Manpower Data Center (DMDC) Program Management Office DTS (PMO-DTS) has the program (acquisition, technical, operation and maintenance) oversight of DTS and the Defense Travel Management Office, OUSD (P&R) has functional oversight.
Who May Use DTS?

DTMO focuses on making improvements to DTS to ensure that the system better meets the needs of the DoD traveler. This is being done by incorporating changes already identified through a change management process and implementing system usability improvements.

Available DTS Training
Training is available for all levels of DTS users. To view available training by Type, Role, Topic, or Series visit the Training section of the DTMO website.

I don’t like the implications. These are sneaky wartime measures that really never really go away when peace concludes.

Hacked? You’d better believe it is!

More analysis? We the people need to know what is going on here!

JonKnowsNothing November 27, 2020 12:53 AM

@xcv

re: Travel non-Civilian Style

There are a number of “other” status flyers that get to by-pass general aviation civilian travel systems.

  * VIP business
  * VIP VIPs
  * Private Planes (Air Force One etc)
  * Government Personnel
  * Diplomatic Personnel
  * Military
  * and a bunch more that jump to the head of the line

This is not new news but it may be that it’s news not often reported unless someone makes a blurp while traveling. Such as Anne Sacoolas.

Government folks fly and travel all the time and generally they do not want their travel itineraries known to the public. Same with celebrities.

Normally such travel arrangements are not publicly known but paparazzi have been known to stake-out airports hoping to find a jet-lag-suffering celeb or politician, having taken the red-eye flight from hell, staggering into the bright lights of the terminal.

There’s a whole other section about how to get troops from point A to point Z. In theory the USA has troops Ready-To-Go on a moment’s notice. The “moment” part is closer to 6 months or maybe 2 years.

ht tps://en.wikipedia.org/wiki/Death_of_Harry_Dunn

Harry Dunn was a 19-year-old British teenager who died following a road traffic collision, on 27 August 2019. He was riding his motorcycle near Croughton, Northamptonshire, United Kingdom, near the exit to RAF Croughton, when it collided with a car travelling in the opposite direction. The car was driven by Anne Sacoolas, a former CIA operative and the wife of Jonathon Sacoolas, a CIA operative working at the United States Air Force listening station at RAF Croughton.[1] Sacoolas admitted that she had been driving the car on the wrong side of the road, and the police said that, based on CCTV footage, they also believed that was the case. Dunn was pronounced dead at the Major Trauma Centre of John Radcliffe Hospital, Oxford.

The collision became the centre of an international diplomatic incident after the United States government advised and then assisted Sacoolas to flee the country while claiming diplomatic immunity. On 20 December 2019 the Crown Prosecution Service said that Sacoolas was to be charged with causing death by dangerous driving.

(url fractured to prevent autorun)

Cassandra November 27, 2020 4:04 PM

I want to write a long and carefully considered comment, but other things are taking up my time so it’ll have to be bullet points.

1) Cyber public health is a very young discipline.
2) Humans have different levels of public health mechanisms, some of which have been around for a long time:
2a) The immune system has evolved over millions of years to deal with infectious diseases.
2b) Human behaviour has developed over a shorter timescale to minimise gross infectious assaults e.g. we tend not to prepare food in the vicinity of where we defecate and urinate; and we have learned to process food in ways to diminish the chance of eating rotten food.
2c) Some people theorise that some religious practices, including dietary restrictions, are an encoding of behaviors that have (or had) positive survival merit.
2d) Scientific investigation and the germ theory of disease gives a good theoretical basis for improvements in practices meant to minimise the spread of infectious diseases.

3) However, humans are extremely poor at practising the basics of more recent (the last couple of hundred years) knowledge. Ignaz Semmelweis (hxxps://en.wikipedia.org/wiki/Ignaz_Semmelweis)demostrated that handwashing was important in reducing disease in the 1840s, yet even now, getting medical personal to practice good hand-hygiene in hospitals is an uphill struggle.

4) We are in a ‘Cambrian Explosion’ of information technology evolution and development, and as humans we have not internalised (and therefore practice) best practices, good practice, or any practice at all that minimises ‘infections’ and other catastrophic events. Ask an average person about information security, and you might get a reference to usernames and passwords: but the use of poor passwords is still endemic; let alone knowing other techniques.

5) As individuals, we don’t think about how our immune systems are successfully dealing with challenges every minute of every day.

At this point I’ll quote the beginning of an article in The Atlantic ( hxxps://www.theatlantic.com/health/archive/2020/08/covid-19-immunity-is-the-pandemics-central-mystery/614956/ )

There’s a joke about immunology, which Jessica Metcalf of Princeton recently told me. An immunologist and a cardiologist are kidnapped. The kidnappers threaten to shoot one of them, but promise to spare whoever has made the greater contribution to humanity. The cardiologist says, “Well, I’ve identified drugs that have saved the lives of millions of people.” Impressed, the kidnappers turn to the immunologist. “What have you done?” they ask. The immunologist says, “The thing is, the immune system is very complicated …” And the cardiologist says, “Just shoot me now.”
The thing is, the immune system is very complicated. Arguably the most complex part of the human body outside the brain, it’s an absurdly intricate network of cells and molecules that protect us from dangerous viruses and other microbes. These components summon, amplify, rile, calm, and transform one another: Picture a thousand Rube Goldberg machines, some of which are aggressively smashing things to pieces. Now imagine that their components are labeled with what looks like a string of highly secure passwords: CD8+, IL-1β, IFN-γ. Immunology confuses even biology professors who aren’t immunologists—hence Metcalf’s joke.

All this complexity operates below the level of our consciousness, and our collective scientific knowledge-base still does not understand it fully. Compared to the immune system, ‘cyber’ security is decidedly primitive.

6) What this leads up to is that, if you can’t convince medical professionals to wash their hands, you will have a difficult job to convince members of the public to take basic ‘cybersecurity’ precautions.

7) So Cyber Public Health is incredibly immature. Therefore, do not expect miracels. It will likely take far longer than you expect to get to a level where IT systems have ‘immune systems’ that can be relied on to work in the background allowing behaviours like ‘washing hands’ and ‘sewerage and clean water’, and ‘vaccination’ to have an effect.

Who are the cyber equivalents of Semmelweis, John Snow ( hxxps://en.wikipedia.org/wiki/John_Snow ), and Edward Jenner ( hxxps://en.wikipedia.org/wiki/Edward_Jenner ) & Jonas Salk ( hxxps://en.wikipedia.org/wiki/Jonas_Salk )?

Hopefully I can spark some ideas in people.

Cassie

Bret Bernhoft December 2, 2020 2:40 AM

This is a critically important conversation to be having right now. The average person needs to understand how much they can help themselves with a couple of changes made. And if one wants to go further, the security transformations experienced are unreal.

Thank you for the link to the CASA lecture.

Melania June 17, 2021 10:34 AM

Thank you for bringing this topic to the public. In fact, we have been evolving for a very long time, and as my beloved person says, “we don’t live so long as sentients.” Under this phrase hides the fact that in fact we have not so long ago ceased to be monkeys and we still have something to work on. Let’s take at least the simplest hand washing that some people may not be able to do or may not want to do. It seems to me that we need to look at the problem deeper and then perhaps we can avoid such pandemics in the further history of mankind.
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