Kritik Toolbox Supplement – bfhhr general

No miscalc

1. Nukes are air gapped

2. Nukes are aimed at the ocean

But Gates also let slip a bit of information that may give pause to environmentalists: most U.S. nuclear missiles are now targeted at the world’s oceans. “Our ICBMs are all targeted right now on the oceans, so that if, God forbid and for the first time in 60 years, there were an accidental launch or a problem …it would put a missile right into the middle of the ocean, rather than targeted on any country,” Gates told a news briefing. The vice chairman of the Joint Chiefs of Staff Gen. James Cartwright explained the details of “open ocean targeting”, part of a broader package of measures the United States has undertaken for some time to reduce the threat of nuclear war by mistake. “For a weapon that has a target associated with it, that is on alert, there is a specific target: that target is the ocean, it is the center of the ocean,” Cartwright told the same news briefing, adding that the U.S. military kept specific areas of the ocean in mind “for that type of work.” “That is done to ensure that, God forbid, if there were an inadvertent launch, that guidance systems would take you to a known place and that known place would not be inhabited,” he said. He said the overall goal of the “posture” (a word apparently much beloved by nuclear planners) would be to ensure that “no mistake or errors in a launch system could but put (missiles) in a place where we wouldn’t want them to be.”

3. Two Person Rule

No risk of retaliation- many constraints

Miniter 16 Richard Miniter (“Don't Worry About Trump And Nuclear Codes”, 11/7/16, https://www.forbes.com/sites/richardminiter/2016/11/07/dont-worry-about-trump-and-nuclear-codes/2/#4affa167a196)JK

“Like giving a hand grenade to a drunk monkey” is how one veteran political reporter explained it to me, at a party on Saturday night. That’s his colorful take on the dangers of giving President Donald Trump access to the nation’s nuclear codes. This is a surprisingly widely shared view up and down the Acela Corridor. Go to a cocktail party, black-tie dinner or hang out in a network “green room” and you will hear some variant of this nuclear worry. In reality, this view is smug, superficial and completely misinformed. It is not even original to this presidential race. MSNBC’s Joe Scarborough offers the account, hotly debated by the Trump campaign, that an unnamed foreign-policy advisor met with Trump and the candidate asked the would-be advisor three times about nuclear weapons. “If we have them, why don’t we use them?” Trump supposedly said. First of all, there is no reason to believe this anonymous account. Why doesn’t the accuser come forward into the sunlight, provide the day and time of the meeting and offer some proof that he even met the candidate? His anonymity is, itself, suspicious. This is a classic journalistic example of a story “too good to check.” Second, even if the quote were accurate, and I doubt it is, there are plenty of contexts that could render it benign. As any arms-control observer can tell you, the way a nation uses nuclear weapons is by implicitly threatening to use them, not by actually detonating them. It is not an accident that the only time that atomic bombs were ever dropped was in 1945, when only one nation had them. Once the nuclear club became multi-national, every atomic nation knew it invited immediate and devastating retaliation if it ever launched one. The classic Cold War thought experiment: imagine a locked room with nine men, each pointing pistols at one other. Can any one of them fire first and win? Perhaps Trump was speculating that America could use its implied nuclear power as negotiating lever as the Soviets once did and as the North Koreans do today. Even the Soviets did not verbally threaten nuclear war; they would simply deploy nuclear-armed ships or planes to certain regions and the point would be made. Again, without the context, the alleged Trump remark is impossible to evaluate. Then there is Sen. Marco Rubio’s statement that America can't give “the nuclear codes of the United States to an erratic individual.” That is self-evidently true, but it is not how decisions to deploy nuclear weapons are made in the United States. The American president can’t unilaterally send nuclear missiles to targets he personally chooses. For more than 50 years, America was continuously refined a system of checks-and-balances to prevent accidental or impulsive launches. Given the stakes, this is how any responsible nation should operate. If Sen. Rubio, and his fellow worriers, thought about it for a minute, they would realize that president gives his approval (after a series of decisions works its way through the military command structure and the secretary of defense) and, then, another series of checks-and-balances clicks into motion before the actual missile is launched. It ends with two military officers simultaneously pushing buttons to fire a missile. It may only take four minutes, as Hillary Clinton said recently, but it involves dozens of independent people, any one of whom can put a stop to the launch process. Yet reason has flown, while missiles have not. Huffington Post recently expressed great surprise that Sen. Ron Johnson isn’t worried about giving President Trump the nuclear codes. The writer apparently thought that the other senators were actually worried. This “nuclear codes” worry is actually a very old argument that, in one form or another, has been flung against almost every Republican presidential nominee since 1964. That’s when the LBJ campaign aired the infamous “daisy ad,” that featured a little girl picking flowers who is vaporized by an atomic mushroom cloud. The not-so subtle message? A vote for Barry Goldwater is a vote for nuclear war because he was a dangerous extremist. Hillary Clinton, incredibly, recently brought back the “daisy ad” star to repeat the message, this time regarding Trump. The same argument was trotted out against Ronald Reagan, who worrywarts called a “nuclear cowboy” and a warmonger. “What a strange nuclear place Ronald Reagan has brought himself and the rest of us to. Just a few years ago the air was thick with denunciations of him as a nuclear cowboy, the mad bomber of the West, the relentless nuclear armer,” Stephen S. Rosenfeld, a Washington Post writer, noted in 1988. The reporter was surprised that Reagan had succeeded in an array of arms-control treaties with the Soviet Union, despite being dogged by liberal critics as a nut who was eager to drop the big one. (Indeed, Reagan might have succeeded partly because his critics gave him such a fearsome reputation.) Reagan knew how his benighted critics saw him and once joked about “outlawing Russia forever” and the “bombing begins in five minutes.” Whoever wins the White House, there is no need to worry he or she will let the missiles fly. And the insiders—reporters, senators and so on—know it. This is cynical argument meant to scare the rubes into voting for another candidate. It is not a worry that should move the mind of any serious person. A friend recently recently returned from a U.S. Air Force base in Minot, North Dakota, where crews launch planes that carry nuclear missiles. All of the air crews, that she talked to, say that they are voting for Trump. If they are not worried about Trump and nuclear codes, why should we?

at: m.i.c.

There is no military-industrial complex- their evidence is hype

Thompson 17 Loren B. Thompson is Chief Operating Officer of the non-profit Lexington Institute and Chief Executive Officer of Source Associates, a for-profit consultancy. Prior to holding his present positions, he was Deputy Director of the Security Studies Program at Georgetown University and taught graduate-level courses in strategy, technology and media affairs at Georgetown. He has also taught at Harvard University’s Kennedy School of Government (“Eisenhower's 'Military-Industrial Complex' Shrinks To 1% Of Economy”, 5/8/15, https://www.forbes.com/sites/lorenthompson/2017/05/08/eisenhowers-military-industrial-complex-shrinks-to-1-of-economy/2/#186f56f5661e)JK

The United States did not have a large defense industry for most of its history. Because threats were episodic rather than continuous, the traditional practice was to mobilize the commercial economy for war production when danger arose, and then demobilize when it had passed. That all changed with the coming of the Cold War, because threats remained elevated for 40 years and policymakers decided the nation must be ready for war on short notice. So a sprawling defense sector dedicated to making advanced weapons came into being, which President Dwight Eisenhower memorably described in his farewell address on January 17, 1961, as the "military-industrial complex." That phrase became the basis for endless conspiracy theories about the undue influence that arms merchants supposedly exercised over government decisions. The theories typically argue that senior military officers, industry executives and key members of Congress collude to drive up weapons spending and distort national priorities. Having spent my entire adult life working with the industry, I can testify to the fact that the conspiracy theories are not groundless. However, they are almost always an exaggeration of reality, and that has become more true with time. Today, the notion that a military-industrial complex is calling the shots in Washington has become laughable. The federal budget only claims 22% of the economy, and defense in turn represents a mere one in every seven federal dollars (14% of the federal budget). Do the math, and it turns out that all that money Washington spends on the military only amounts to about 3% of the economy. Furthermore, most of the defense budget is not spent on weapons, it is spent on items like military pay and benefits, training, maintenance and the like. The amount of money set aside for developing and procuring military equipment in the budget agreement Congress reached last week is $197 billion -- a third of the $593 billion defense budget, and barely 1% of GDP (which stands at $19 trillion). Granted, this may represent close to a tenth of all U.S. manufacturing, given the way so many industries have fled the U.S. for Mexico and Asia. But how much of a problem can the "military-industrial complex" be when it only represents 1% of the economy? Healthcare is 17%, but nobody refers the "healthcare-industrial complex." President Eisenhower may have had a valid point when he warned, "we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex." The U.S. had never had a big peacetime defense industry before his administration, and military spending claimed 9% of the economy -- and 52% of the federal budget -- the year he made the remark. That was pretty typical for the Eisenhower years, and Ike worried constantly about excessive military spending damaging the economy. Moreover, weapons spending was 44% of the defense budget in 1961, reflecting the fact that personnel costs were low thanks to conscription. But that changed with the coming of the All Volunteer Force in 1973, a Richard Nixon innovation fashioned at least in part to defuse opposition to Vietnam War policies. After 1973, the military had to compete in the job market for skilled labor, and compensation increased accordingly. As the cost of military pay, healthcare and retirement benefits rose, the portion of the budget available for buying weapons declined. Ronald Reagan was the last big spender on military technology, with money for development and procurement totaling 46% of the defense budget at the height of his buildup in 1986. That was nearly 3% of an economy that in inflation-adjusted terms was about half the size it is today. After Reagan, though, the Cold War ended and weapons spending went off a cliff. Secretary of Defense Dick Cheney killed a hundred major weapons programs between 1989 and 1992. So the "military-industrial complex" shrunk by two-thirds, and became a much smaller factor in the nation's economic life. It has remained relatively small to this day, thanks to the fact that no matter which party controls the White House or Congress, military personnel and readiness always get funded ahead of weapons. With healthcare costs continuing to rise and military outlays capped by Congress since 2012, there just isn't much money for buying weapons. As I often point out, the amount of money the Army gets for weapons each year is a fraction of what Americans spend on beer or cigarettes. This probably isn't going to change much under President Trump because he hasn't made any moves to recruit the eight Senate Democrats he needs for the super majority of 60 votes that repeal of budget caps would require. With proposed tax cuts likely to balloon deficits and infrastructure spending waiting in the wings, there won't be much funding in the defense budget for new weapons once personnel and readiness are covered. So the idea of a military-industrial complex shaping federal priorities has become more myth than reality, the artifact of an era now long gone. Defense companies still lobby and they still do well by their shareholders, but they have ceased being the industrial colossus they once were. Trump might be well advised to spend more money on weapons as a way of stimulating manufacturing -- the money will get spent here rather than overseas -- but the military-industrial complex that Eisenhower warned of is history.

at: military bad

US hegemonic, militaristic, and cybernetic thought and action is necessary in today’s world to prevent worldwide death and suffering and prevent a much worse alternative world of non-US dominance. The alternative merely allows powers such as China to take over the world order and cause mass amounts of suffering and damage

Brooks 17 Rosa Brooks is a professor at Georgetown University Law Center and the author of "How Everything Became War and the Military Became Everything." (“A hawk argues that U.S. military might is necessary in an uncertain world”, 1/26/17, https://www.washingtonpost.com/opinions/a-hawk-argues-that-however-flawed-us-military-might-is-necessary-in-an-uncertain-world/2017/01/25/74d1897e-e124-11e6-a453-19ec4b3d09ba_story.html?utm_term=.f7fcd03587bf)JK

Don’t let the title fool you: Eliot A. Cohen’s newest book, “The Big Stick: The Limits of Soft Power and the Necessity of Military Force,” isn’t a pro-war polemic. Instead, it’s very much in the “older, sadder, wiser” vein: Once seen as a cheerleader for the George W. Bush administration’s ambitious neo-conservative agenda, Cohen now offers a vision of American power largely stripped of illusion. The United States must enhance its military capabilities and remain engaged in shoring up the international order, he contends in this thoughtful and erudite book — but not because it is infallible. It’s simply that in this messy and uncertain world, there are currently no better alternatives. Even though Cohen is passionate about a United States that is militarily powerful and internationally engaged, he is also a student of history, and for the most part, he owns up to recent U.S. failures. In Iraq and Afghanistan, the United States was “unprepared, intellectually and organizationally.” It made “fundamental misjudgments,” and the military adapted only haltingly and intermittently to the new forms of conflict it faced. Ultimately, Cohen concludes, the Iraq War, which he once staunchly supported, was “a mistake.” False intelligence about weapons of mass destruction damaged U.S. credibility, as did the abuses at Abu Ghraib and elsewhere. More broadly, the war strained civil-military relations, caused tensions with key U.S. allies and left the United States weaker rather than stronger. Cohen is equally critical of American military and political leaders. Enamored of Special Operations forces and drone strikes, U.S. policymakers have confused tactical success with strategic progress, and the military has failed to invest in “the intellectual infrastructure” of hard power and to develop innovative new ways to bring in vital talent. Why, then, should the flawed and error-prone United States not simply cultivate its own garden, reserving the use of military force for narrow, defensive purposes? Cohen has an answer, and it’s far from triumphalist: We live in a country that has been continuously at war for the past 15 years and continually at war throughout its history, and we belong to a species that seems uniquely prone to bouts of mass slaughter. As Leon Trotsky is said to have remarked, “You may not be interested in war, but war is interested in you.” If we take that seriously, the United States needs to be engaged in the ongoing project of shoring up the international order it helped create, and it needs to accept that there may be times when political leaders will conclude, “however reluctantly, that violence is the least bad policy choice.” (Basic) That international order (and the American interests it protects) faces four main challenges. The first is China. China’s worldview is fundamentally incompatible with that of the United States, Cohen asserts. In the South China Sea, for instance, “China has made claims that would not only deny other countries access to the riches of the seabed, but would, by constraining commerce, render them vassals to their giant neighbor.” More broadly, China refuses to “recognize a state system based on equality and sovereignty, and an economic system built around globalized free trade supported by the rule of law.” Instead, “it has a hierarchical conception of international relations.” China, one supposes, might say the same of the United States. Still, Cohen is surely right that China’s recent attempt to claim most of the South China Sea as part of its territorial waters runs afoul of international law and greatly increases the risk of international conflict. “War,” Cohen notes, “may come without either side willing it from the beginning”; even an “accidental or nearly accidental clash between American and Chinese forces” could quickly spiral into overt conflict, and there is no guarantee that the United States would emerge victorious. Washington, Cohen contends, must therefore “convince [this] rising, assertive and yet vulnerable peer” that attacks on its neighbors or on the United States would “not only fail, but endanger the regime that launched them,” something that can “only be accomplished by an American force structure, alliance system, and mobilization capacity that makes such attacks self-evidently unwise.” Cohen sees a second challenge to U.S. interests in the behavior of powerful nuclear and near-nuclear states such as Russia, Iran and North Korea. Each aims to change regional balances of power in ways that could trigger widespread conflict, and each, he argues, can be deterred only by clear evidence that the United States will, if necessary, respond to aggressive or destabilizing actions with decisive force. In Cohen’s eyes, a third threat is posed by the “various jihadi movements — al-Qaeda, the Islamic State, al-Shabaab, Boko Haram, and others.” Traditional models of deterrence have little to offer when it comes to ideologically motivated, violent nonstate actors, and the United States has struggled both to define and to respond to these nontraditional foes. On the one hand, such extremist groups pose no existential threat to the United States; on the other hand, they can’t merely be ignored. Cohen advocates a combination of “lethal operations . . . to tamp down, disrupt, and limit a virus that cannot, however, be destroyed this way”; a focus on capturing “and where possible, turning” leading terrorists; and a greatly expanded effort to harness American “soft power” to counter extremist ideologies. Finally, “The Big Stick” turns to the challenges posed by ungoverned spaces and the global commons. Here, there is often no “enemy” but rather a compelling U.S. interest in ensuring that the world’s trouble spots don’t boil over. The refugee flows engendered by Syria’s civil war are destabilizing Europe; internal conflicts in Yemen, Iraq and a dozen other places also threaten regional stability. Similarly, tensions over access to and control of the oceans, over the potentially vast resources beneath the melting polar ice caps, over outer space, and over cyberspace could easily escalate. Complex as they are, Cohen insists, “in all these dimensions of ungoverned space and the commons,” American “military power remains the ultimate guarantor that the diverse great commons of mankind remain accessible to all.”

at: hacking

We should probably not hack hospitals

Griffin 17- Andrew Griffin (“NHS cyber attack: Large-scale hack plunges hospitals across England into chaos”, 5/12/17, http://www.independent.co.uk/news/uk/home-news/nhs-cyber-attack-hospitals-hack-england-emergency-patients-divert-shut-down-a7732816.html)JK

Dozens of hospital trusts across the country have been hit by a huge cyber attack, plunging the NHS into chaos. IT systems appear to have broken and emergency patients are being diverted to other areas, with hospitals across England and Scotland affected. The NHS was just one of the victims of the huge attack, which spread across the world infecting computers in 74 countries in Europe and Asia. On Friday night, US firm Fedex announced its operations in the US were also affected. Russia's interior and emergencies ministries, as well as the country's biggest bank, Sberbank, also said they were targeted. The hack appears to be an example of ransomware – malicious hackers breaking into computers and only allowing their owners back in when they pay enough money. Gadgets and tech news in pictures 43 show all A message showing on computers tells users that they can recover files but only if they send $300 of bitcoin to a specific address. The price will rise with time and the files will eventually be deleted, the warning reads. Affected NHS trusts said that IT systems had been shut down in order to protect them. That meant that all systems were offline and hospitals were unable to accept incoming calls. Scheduled appointments had to be cancelled, ambulances were diverted and some departments shut down entirely. What staff were working had to do so with pen and paper and without access to any digital files. Leaders including Theresa May and Nicola Sturgeon held crisis meetings on the issue to attempt to stem the effects. The attack appeared to be a new strain of a relatively well-known piece of ransomware known as Wanna Decryptor. That was updated on the day of the attack and spread around the world soon after, according to security experts. A conversation circulating online saw one doctor saying "our hospital is down". "We got a message saying your computers are now under their control and pay a certain amount of money," the messages read. "And now everything is gone.” The NHS has been hit by such attacks before. But this was by far the worst, experts said, taking down an unprecedented number of trusts and hospitals. It came soon after a report was published in the British Medical Journal in which neurologist Dr Krishna Chinthapalli warned hospitals that they were at risk of an attack. "We should be prepared: more hospitals will almost certainly be shut down by ransomware this year," he wrote. He warned just hours before the hack broke out that IT departments needed to do more to keep hospitals safe, and that such hacks – which have already hit some hospitals in the US – were a problem waiting to happen. However, the new attack was the worst ever seen, he said. "I've never heard about a ransomware attack being so widespread - affecting so many hospitals across such a wide area," he said. "There have been many isolated attacks but this is the first to be so coordinated - a number of attacks in different parts of the country. "We have not seen this either here or in other countries - such as America." NHS trusts also were asking people not to come to A&E, but instead to ring 111, or 999 in the case of an emergency.

Hacking is pretty bad- hospitals, banks, military

Leetaru 16- Kalev Leetaru (“Hacking Hospitals And Holding Hostages: Cybersecurity In 2016”, 3/29/16, https://www.forbes.com/sites/kalevleetaru/2016/03/29/hacking-hospitals-and-holding-hostages-cybersecurity-in-2016/#4188fc4e7d59)JK

Yesterday morning MedStar Health became just the latest organization to suffer the damage of a cyberattack in what early reports suggest may be yet another ransomware attack. Unlike traditional cyberattacks designed to exfiltrate records, delete data or physically damage computing systems, ransomware attacks appear to be on the rise due to the ease in which such extortion translates directly to money in the pockets of cyber criminals. If MedStar’s cyberattack turns out to be ransomware, it would join at least three other medical institutions breached in just the last few weeks. Combined with the anonymity of bitcoin and the rise of targeted attacks focused on soft targets like hospitals, 2016 is shaping up to be a bountiful year in the extortion business. While the underlying technology has been around for several decades, ransomware has enjoyed a renaissance of sorts with the confluence of improved targeting, the all-digital workplace and bitcoin to provide secure anonymized funds transfer. Modern ransomware attacks increasingly target small business, local government and medical institutions due to their historically poor cyber posture. Medical facilities in particular are proving to be a target-rich environment in that they are all too often a hodgepodge of outdated systems and rushed employees with little cyber training. Hospitals can ill-afford the downtime of restoring from backups or shutting down their systems for extended periods of time and so may be viewed in the eyes of cyber criminals as more likely to pay up without a fight. The Hollywood image of a hospital held hostage by hackers burst into national headlines last month when Hollywood Presbyterian Medical Center announced it had been infected by ransomware and elected to pay the ransom in order to restore access to its files. The dystopian nightmare of an entire city being held hostage has even become reality as municipalities are finding their outdated IT infrastructure a severe liability. ADVERTISING As ransomware tactics have evolved, attacks have shifted from high-volume blind targeting to carefully orchestrated breaches in which the attackers sometimes burrow into a victim’s network for months in order to infect the furthest corners of the network and encrypt or corrupt backup files, making payment the only way to get back the missing data. In the physical world, law enforcement acts as a deterrence to a group of criminals raiding a hospital and holding its workers and patients hostage and will respond quickly and in force to end any hostage situations that do occur. In the cyber domain, however, law enforcement is largely absent, unable to offer any meaningful deterrence or protection. When a cyber hostage situation does occur, all police can do is conduct a postmortem at best. Even if a victim is able to definitively identify its attackers, they are frequently based outside of law enforcement jurisdiction and the legal rights of a company to launch its own cyber operations to forcibly end an attack and recover its data are murky at best. Even banks are no longer safe in the cyber world. While robbing the New York Federal Reserve is usually limited to Hollywood blockbusters the Bangladesh Central Bank learned last month that bank robbers today are increasingly using computers instead of guns when hackers transferred more than 100 million dollars out of its accounts at the Federal Reserve. An Austrian aerospace company similarly lost 54 million dollars this past January when hackers got ahold of login credentials for its corporate treasury management system. Government itself, including its most senior intelligence and national security officials are no better off when a single phishing email can redirect their home phone service and personal email accounts. Today such ransomware attacks are largely the work of criminal actors looking for a quick payoff, but the underlying techniques are already part of military planning for state-sponsored cyberwarfare. Russia showcased the civilian targeting of modern hybrid operations in its attack on Ukraine’s power grid, which included software designed to physically destroy computer equipment. Even the US has been designing crippling cyberattack plans targeting the civilian sector. In case its nuclear negotiations with Iran failed, the US was prepared to shut down the country’s power grid and communications networks. Imagine a future “first strike” cyberattack in which a nation burrowed its way deeply into the industrial and commercial networks of another state and deployed ransomware across its entire private sector, flipping a single switch to hold the entire country for ransom. Such a nightmare scenario is unfortunately far closer than anyone might think.

impact turn – health care

Cybernetics is crucial to all aspects of health care- its life or death

Hiroshi 82 Abe Hiroshi (“Cybernetics in Medicine”, P 50-55, https://www.jstage.jst.go.jp/article/internalmedicine1962/21/1/21_1_50/_article)JK

From the time of G. Bernard the existence of a dynamic regulation system for living organisms was recognized, but the clarification of this mechanism as being based on a simple but important principle called a "feedback system" dates from cybernetics. And from this principle came the elucidation of a design for the regulation of endocrine secretion, body fluids, circulation, respiration, and the nervous and other systems. Furthermore, even for the complex regulation mechanism of enzyme levels, working hypotheses were established from the feedback control viewpoint, accelerating research in this field. With the capability to use concepts of control in this way to understand the life phenomenon, and with the discovery of DNA, on the other hand, clarifying the physical bases for life information generation, there came about a recognition of the importance of "information", added to the concepts of "matter" and "energy" which had formerly reigned supreme in the biological sciences, to the extent that it could be said, "Without information, there can be no life." After this came the beginning of the discourse on organism system as to the study of biological information: on the one hand, research at the molecular level for information on heredity, immunity, etc., and concurrently, on the other hand, attmpts to grasp the phenomenon of life from the aspect of information distribution and transformation with regard to such functions as control, communication, and assessment. ILLNESS There is also a new perspective on illness, based on the information science view of life. Analysis of the etiology and interpretation of the phenomena of endocrine, metabolic, circulatory, and nervous diseases, amongothers, are nowcarried out from the standpoint of a malfunction or failure of feedback control mechanisms. Statistics and probability theory have been adopted in the understanding of illness. With the analysis in multidimensional space of the primary factors and aspects of chronic diseases with complex causes and variegated symptoms, and the weighing of the individual factors and symptoms,the boundary between health and illness is being grasped, not in the black-and-white manner of conventional infectious diseases, but in terms of probability. DIAGNOSIS It was pointed out from the advent of cybernetics that the process of diagnosis and treatment, as mutual exchange of information between doctor and patient, is a type of feedback system. Diagnosis has been recognized as a purposeful decision process to determine the optimummedical treatment for the patient. For this reason, diagnosis is not merely a matter of assigning a name to the illness. The view has been advanced that diagnosis includes measuring the state of the illness, estimating the effectiveness of the treatment methods, and making a prognosis. Furthermore, from the standpoint of the apprehension of illness in multidimensional space as mentioned above, advanced statistical techniques were used, e. g., multivariate analysis methods for differential diagnosis and selection of treatment methods. Moreover, through probability theory the uncertainty of clinical diagnosis was recognized, and prognosis and diagnosis are now conceptualized using stochastic models like the Bayes' theorem and the Markov process. In order to introduce statistical and probability science to diagnosis, the necessity for standardization of clinical data and the construction of large-scale medical record management systems was emphasized. TREATMENT Like diagnosis, treatment has also been redefined by control concepts, and there is better understanding of diagnosis and treatment as inseparable, comparable to the system measurement and control of information science. That is, although conventional medicine was mostly straightforward logic in which the selected treatment method followed arbitrarily from naming the malady, which was equated with diagnosis, in the information science approach, treatment is now grasped as a control process which includes feedback, and clinical treatment is understood from the standpoint of the optimization of this "loop". To materialize this type of schema, a necessity to describe a patient's condition in mathematical time and space has emerged along with the need for development of superior means of biological measurement and treatment. 2. Application of Information Science to Internal Medicine The following is an outline of the forms in which information science is applied to medical science. The number of scientific journals specializing in the application of information science to medicine or biology at present exceeds 40. If the treatises since 1960 are analyzed, the number of reports rises about 1965, and from 1970 there is a rapid increase. As for the subject range, the most are those related to internal medicine, especially the cardiovascular system, but there are applications beginning with diagnosis and treatment and extending to such far-flung fields as preventive medicine, epidemiology, education, and hospital administration. Classified by technique, the greatest number are related to image processing techniques, with such diverse information processing for medical imaging as ECGs, electromyograms, X-rays, RI imaging, and ultrasonic imaging. Next come statistical analysis including multivariate analysis methods, classical control theory including transfer function and frequency analysis, and system and control theory including optimization and state space methods. (1) Modeling and simulation With the advent of the computer it became possible to carry out vast quantities of calculations in a short time, and analysis of physiological dynamics using simulation methods was brought about4)5)6). Guyton et al drew up enormous models of the body fluid and circulatory systems using nearly 600 factors based on many years of experimental data ; beginning with the relationship of blood pressure to body fluids, they analyzed the influence exerted by changes in individual factors on other factors and on the whole body. Using a super-large-sized computer, we reconstructed a QRS-T wave of an electrocardiogram from the action potential of myocardial cells and clarified the relationship of the polarity of the T wave to the action potential^, and we also made models of coronary circulation^ and cardiac dynamics, and applied the results to evaluation of cardiac functions and assessment of treatment effectiveness. The advantage of simulation methods is in showing more concretely the results of deductive reasoning from experimental data, in aiding the understanding of complex systems, and in selecting the next experimental proposition. Their clinical usefulness is in the application of mathematical descriptions, verified by simulation, to evaluation of organ function and to treatment control. The insulin secretion model applied in the 52 JapJ Med Vol 21, No 1 (January 1982) Cybernetics in Medicine artificial endocrine pancreas system is one example of this. That is, the dynamic properties of the insulin secretion from the endocrine pancreas are revealed to be proportional to the blood glucose concentration and its derivative ; then, clinical application of the same dynamic properties to an artificial endocrine pancreas system was successful^. (2) Improvements in ability to measure biological systems There are a great manyexamples of the contributions made by the application of control and statistical theory to the improvement of measuring ability. The HodgkinHuxley voltage clamp, applying feedback control, and measuring electric current in a membrane, is a classic example, and computed tomography is a recent example. Others are RI tomography and ultrasonotomography ; the ultrasonic pulsed Doppler flowmetry, which can measure the blood flow velocity at any location inside the cardiac chambers8), also belongs in this category. (3) Information processing GTand RI tomography are information processing systems directly linked to meas- uring apparatus, but off-line information processing is also widely used. Especially flourishing areas of research are information processing of ECGs and image processing. Research into information processing of ECGs began early, and automatic EGG diagnosis9)10) and the extended-time ECG recording and reproduction analysis apparatus are successful examples. At present in the U.S.A. 9% (10,000,000 cases per year) of all recorded ECGs are diagnosed automatically, but it is after a lapse of almost 30 years since the commencementof research that automatic diagnosis has finally obtained the confidence of doctors. The extendedtime ECGs are recorded on magnetic tape; 10-24 hours of ECGs can be reproduced in a few minutes and rhythm or pattern abnormalities are analyzed, so that today this apparatus is essential to diagnosis of rhythm disorders. As for image processing, improvements in image quality have been devised by means of such measures as noise elimination, marginal outline extraction, and enhancement of distinctive features. Along with extensive research to aid the physician in diagnosis, recently such advanced technology as three-dimensional image construction and moving image processing have been applied to medical imaging. As for processing of cardiac images, we developed a system to reconstruct a threedimensional image of the heart by computer processing from a series of ultrasonic tomogramsn), and a system to obtain automatically the dimension of the ventricular cavity and wall thickness during one cardiac cycle, from cine left ventriculograms12). These systems were used in the evaluation of regional cardiac function. (4) Diagnosis quantification When computers were introduced to the domain of medical science, one of the first themes to be taken up was the useofcomputers to quantify diagnosis13). Boolean algebra, the Bayes' theorem, the discriminant function, and other methodswere used as the logic of computer diagnosis for differential diagnosis of each type of disease. Unfortunately, however, there are few examples which are still of clinical value even today. The reason for this is not that the theory is in error, but that there were problems in the quality and extent of the data used. In fact, for applications in which the projected large amounts of data were gathered, such as assessing the efficacy of drugs and analysis of risk factors, multivariate analysis and multilogistic models are extremely useful. A little over ten years ago we had the experience of analyzing, using a discriminant function, the adaptation of steroid therapy for nephrotic syndrome ; subsequently, followup examinations for prognosis of nephrotic syndrome and chronic nephritis have been carried out nationwide. If quantitative analysis theory can be applied to data in this way, we can look forward to the demonstration of diagnosis models JapJ Med Vol 21, No 1 (January 1982) 53 Abe of clinical value. (5) Treatment control Treatment control is made possible by coming to grips with treatment from the standpoint of system control theory. In order to carry out treatment control, both precise modeling and continuos, quantitative measurement of the subject are necessary, as well as a computer with extensive capacity. With these, one can measure and determine the current condition of the patient, make a prognosis, and decide the kind and quantity of treatment to be given. The results of this treatment should be fed back once moreinto the same process. In this way the final goal of the introduction of information science to medicine and internal medicine can be considered to be treatment control. Until now reports of clinical examples of treatment control based on system theory have been very few, but we adapted a simulation of a blood-sugar regulation system to treatment control, and we successfully constructed a computer program for adaptive optimization of administration of insulin dosage to patients in diabetic coma14). Control of plasma concentration of drugs is also an important step in treatment control; by simulating the dynamics of the drug in the blood with a compartment model, the conditions for reasonable control ability can be clarified from the standpoint of linear system theory15). (6) An accumulation and retrieval system for extensive data One of the outstanding functions of a computer is its memory.If extensive patient medical records are entered into a computer, research into such subjects as the elucidation of etiology, efficacy of a drug and evaluation of its side effects, quantification of diagnosis, and prognosis can be facilitated by statistical analysis16). Instances of success in ideal medical record managementso far are rare, however. The reasons are that medical data are not standardized for every individual, and that the data to be managed are not only numerical but also include the large volume of qualitative data, graphic data, and descriptive data. Accordingly, until now successful medical databases have been limited to those with specific diseases as their object, or to those in which standardized data can be obtained as from a check-up unit, or to some specific areas of epidemiological research. It is clear, however, that to make better use of information science in the future, the full development of medical databases is an extremely important condition.

Technology is key to hospital productivity- otherwise people can’t get healthcare

Le et al 12- Jinhyung Le is a Professor of Neuroscience and Engineering at Stanford Jeffrey S. McCullough, Robert J. Town (“The Impact of Health Information Technology on Hospital Productivity”, April 2012, http://www.nber.org/papers/w18025)JK

We study the effect of IT capital and labor on productivity. We employ a variety of identification strategies as hospitals’ IT investments are both persistent and endogenous. Naive identification strategies underestimate the effect of IT on productivity, suggesting that IT investments are correlated with negative productivity shocks. These shocks may include unobserved quality or patient severity. Hospitals’ IT investments are highly productive at the margin. The median long-run net marginal products of IT inputs are $1.04 for IT capital and $0.73 for IT labor. We find that the value of increased IT inputs diminishes slowly and that inputs are complementary (consistent with the Cobb-Douglas constant elasticity of substitution assumption). Health IT’s high marginal product suggests that widespread adoption may generate large productivity gains. While the marginal benefits are high, IT represents a small share of total inputs and the absolute benefits are modest. Doubling IT capital inputs would increase total valueadded by less than 2%. These findings suggest that federal initiatives aimed at increasing IT investments may lead to efficiencies, but they are unlikely to transform health care delivery. These high marginal products raise interesting questions about the efficiency of IT adoption. In equilibrium, hospitals should employ inputs until their long-run net marginal products are $0. An important limitation of our study is that we do not observe complementary organizational inputs such as training or work-flow reorganization. Complementary input costs could lead us to overestimate the marginal products of IT inputs. While unobserved complements certainly matter, we perform a series of robustness tests that suggest the magnitude of such bias is small. Our findings suggest that IT inputs are, at the margin, under-utilized. Several mechanisms could lead to underinvestment in health IT. With a rapidly changing technology, there may be imperfect information or uncertainty regarding the costs and benefits of investment. This uncertainty may be important as Song et al. (2011) find that even sophisticated health care systems have made no attempt to calculate the return on IT investments and the empirical literature provides few insights into this question. Furthermore, hospitals (particularly 24 not-for-profit institutions) often lack access to capital markets. The high marginal products could also reflect shortages in skilled IT labor in the California market, either for hospitals or health IT vendors. Under these conditions, adoption subsidies would be welfare enhancing. We also consider the possibility that health IT’s value depends on network externalities. For example, neighboring providers’ use of interoperable medical records systems could increase the value of health IT investments. Alternatively, provider and staff learning could lead to indirect network effects. We test this issue directly and find no evidence of network externalities. However, we recognize that comprehensive electronic health records systems are rare (Jha et al., 2009) and direct network effects may be realized in the future as more sophisticated IT systems are widely adopted.

Cybernetics are important for healthcare

Yu 09- Dr. Simon Yu (“Bio Cybernetics and Energy Medicine Conference, The vital link to vibrant health”, October, http://www.preventionandhealing.com/articles/Bio-Cybernetics-and-Energy-Medicine-Conference-the-Vital-Links-to-Vibrant-Health.pdf)JK

The Sixth International Medical Conference, with this year's focus of Bio-Cybernetics and Energy Medicine, is taking place in Saint Louis on October 9-11, 2009. It is sponsored by The Foundation for Applied Science for Alternative Medicine and The Healing Arts. What is Bio-Cybernetics and Energy Medicine? Bio-cybernetics is a hot topic in the emerging field of energy medicine in Europe. Bio-cybernetic medicine is not a new idea but an old concept that has been given a new name. A bio-cybernetic matrix is a modern term for the acupuncture meridian system and the related medical field of acupuncture meridian assessment developed by Reinhold Vol!, MD in Germany in the 1950's. It has been previously known as Electro-Acupuncture according to Dr. Voll (I. A V ). ' In November, 2006, I attended the International Symposium of Biocybernetic Medicine in Germany. The symposium included medical doctors, acupuncturists, dentists, natural medical doctors, and engineers, physicists and mathematicians who developed instruments that detect how cells communicate with each other. For cellular communications. Professor Fritz-Albert Popp, Ph.D., a theoretical physicist and bio-physicist from Germany, proved that cells communicate by means of bio-photons as information carriers. A bio-photon is a photon of light that is emitted from a biological system that can be detected with a special measuring instrument (photometer). Bio-photons trigger all biochemical reactions in living cells. All living organisms possess complex electromagnetic fields creating an "invisible body." The electromagnetic fields disappear completely with death. To my amazement, we already have "an invisible body map of the bio-cybernetic matrix" in the acupuncture meridian system taught by Traditional Chinese Medicine (TCM) and the chakra system taught in Ayuvedic medicine. The main theme for this year's conference focuses on the bio-cybernetics approach that establishes a new system science of energy medicine linking the human body, mind and spirit. This unique conference covers a variety of subjects that influence the bio-cybernetic systems of the body such as the latest research in mercury toxicity presented by world prominent chemist. Professor Boyd E. Haley, Ph.D., dental related medical problems, and gcopathic disturbance. Many outstanding speakers discuss evaluation techniques for measuring the health of the body's biocybernetic systems including computerized acupuncture meridian assessment analysis and the latest techniques in infrared thermography. Other speakers discuss therapies to bring the body back into balance including color therapy, complex homeopathy, environmental medicine, hormonal therapy and spiritual wellness. Why is there a need for an Complementary Medical Conference? Western medicine uses a model based on bio-mechanical and bio-chemical medical science. Their solution relies heavily on a pharmaceutical approach to control symptoms or surgical corrections, such as a heart by-pass operation, that do not address the underlying problems. Lowering cholesterol levels with statin drugs arc not the solution either. Let us also not be seduced by targeted genetic modulation based on the newest and latest advancements in genetics and molecular biology. Most chronic illness like heart disease, diabetes, and cancer is mainly based on our life styles, eating habits, and the environment in which we live. Genetics play a lot smaller role than you may be led to believe. Our health is directly related to several factors including a healthy diet of foods that aren't highly procesed; the quality of the soil and the practice of sustainable organic farming to promote nutrient rich foods; and the avoidance of chemical laden Frankenstein Pharming. Our plants capture photons from the sun for photosynthesis and convert it to edible crops. When we eat fruits, vegetables, meats or fish, we go through reverse engineering accomplished by mitochondria to release the bio-photons while producing the energy currency, ATP. Photons and Bio-photons are the basis of life, the invisible force. Incurable means immeasurable by western medical science. Bio-cybernetics and energy medicine understand the existence of "invisible energy fields" that can be measured based on the ancient principles of Acupuncture and Traditional Chinese Medicine. Curing the "incurable" can become possible when we can measure the immeasurable. All health professionals are welcome to attend the Bio-Cybernetics and Energy Medicine Conference to absorb the latest scientific medical knowledge from leading medical doctors, dentists, chiropractors and other health practitioners. It is time to bridge the missing links between traditional western medical science and Bio-cybernetics and Energy Medicine to achieve successful outcomes from chronic illness to vibrant health and healing.

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