American growth
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American growth

Summary
Robert Gordon argues that the inventions of the second industrial revolution were the foundation for American economic growth.  Gordon shows how flows of people into difficult rural America built a population base which then took the opportunity to move on to urban settings: Houses, Food in supermarkets, Clothes in department stores; that supported increasing productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
and standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  .  The deployment of nationwide networks: Rail, Road, Utilities; terminating in the urban housing and work places allowing the workers to leverage time saving goods and services, which helped grow the economy. 

Gordon describes the concomitant transformation of:

Counter intuitively the constraints introduced before and in the Great Depression and the demands of World War 2 provide the amplifiers that drive the inventions deeply and fully into every aspect of the economy between 1940 and 1970 creating the exceptional growth and standard of living of post war America. 

Subsequently the rate of growth was limited until the shift of women into the workplace and the full networking of voice and data supported the Internet and World Wide Web completed the third industrial revolution, but the effects were muted by the narrow reach of the technologies. 

The development of Big Data, Robots, and Artificial Intelligence may support additional growth, but Gordon is unconvinced because of the collapse of the middle class

Following our summary of Gordon's book RSS is Rob's Strategy Studio frames his arguments from the perspective of complex adaptive system (CAS) theory. 

The Rise and Fall of American Growth
In Robert Gordon's book 'The Rise and Fall of American Growth' he argues that:
Gordon concludes that labor productivity and TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
surged between 1920 and 1970 relative to before and after that period. 

He identifies the reasons for this 'great leap forward' and for the subsequent 'headwinds': Inequality, Education, Demography, Debt repayment; that are constraining the effect of additional technological advances.  The bottom 99% of the income distribution now has a zero growth rate of real disposable income! 

Gordon views the aging of the American population, the relatively poor academic performance of US high school pupils, and the growing value of stocks as predictors of the recent problems continuing. 

Inventions and Inventors
Gordon identifies a set of 19th century individual inventors responsible for transformational innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
:

1870 to 1940 The great innovations create a revolution inside and outside the home

1870 represents the start of modern America.  Over the next six decades every aspect of life was revolutionized.  By 1929 the transformation included:

Starting Point: Life and Work in 1870

The transcontinental railroad, with support from the telegraph, completed the integration of the North American continent into the US federal system based on the Louisiana Purchase and the subsequent annexation of California from Spain.  This allowed the integration and transformation of rural farming communities through: steam engines, cotton gins, railroads, steamships, agricultural machinery, communications; easing the burden of farm labor.  But in 1870 light was still generated by candles, whale oil & town gas, and motive power came from steam engines, water wheels, and horses.  People walked, used horses or slow trains to move about. 

Wood and coal was used for heating and cooking, and had to be gathered, adding to the already time-consuming preparation of food.  The 75% rural population produced their food and clothing on the farm.  They cooked on the hearth.  Leftovers were served at subsequent meals.  They had to generate cash to obtain the limited choices of: cloth for making clothes, sugar, coffee, and spices; from barrels at the monopoly is a power relation within:
  • A state in which a group has enough power to enforce its will on other citizens.  If this is a central authority with a cohesive military, it can overpower other warlords and stabilize the society. 
  • An economy in which one business has enough share in a market segment to control margins to its advantage.  An economic monopoly can be broadly beneficial: AT&T monopoly, US patent monopoly rights;
country store, slowly filled by clerks while the customers waited.  Most goods were initially supplied on credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles. 
.  The wealthy paid more. 

The population growth rate was rapid at 2.3% per year driven by immigration and a high birth rate.  7/8 were white and the other 1/8th black.  59% of the population was under 25 years of age.  14% had been born in Europe.  There were relatively high percentages of married couples and large families.  76% of teenage males worked.  98% of adult males worked without retirement until they died or became disabled.  Teenage girls did housework like their mothers.  20% of Americans lived in the former confederate states, in dismal conditions due to Civil War deconstruction.  Another 4% lived in the west.  25% of the population was urban mainly living in the north east.  Immigrants, all from Europe, settled in climates similar to where they had emigrated from.  They were encouraged to move west leaving the eastern US to cope with a relative scarcity of labor.  Gordon explains this led to mechanized solutions which ensured the US a leadership position in the competition with Europe based on technical innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 


All dwellings lacked electricity, central heating, running water, bathrooms, and indoor flush toilets.  Plumbing was little known, even in the cities.  So a lot of time was taken up getting water, the most physically demanding chore, and fuel.  To keep a fire burning all day long used 50 pounds of coal or wood. 

The rural 75% of the population lived in single family farm houses which included a kitchen, parlor and sometimes a dining room on the ground floor and three bedrooms on the upper floor.  There was typically a yard which allowed gardening.  The urban poor in the cities lived in much more confined conditions, but paid high rents.  Water was obtained from a communal tap.  The urban workers included 15% who were middle class, which Gordon categorizes as employing a servant.  The middle class built impressive houses that are still standing.  But they were designed and constructed before they could integrate the inventions

The rural population was quite isolated due to the dependence on slow horse-drawn transport, limited pot-holed roads and no communications infrastructure.  Horses' carcasses, manure & urine were a health hazard

Consumer spending was almost entirely applied to food, clothing and shelter. 

Working-class entertainment was limited to the head of household drinking with friends at the saloon.  The rest of the family did chores.  However, New York offered the Coney Island amusement park, for working class entertainment.  And other cities began to offer similar entertainment. 

Life expectancy is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
was 45 years in 1870, reflecting infant mortality of 176 per thousand.  Poor milk quality was a significant contributor.  Birth occurred at home with assistance from a midwife.  Medicine only began to be standardized and regulated after 1870

Work was mostly: unpleasant, physically demanding; and was dominated by agriculture (50% of workers) in 1870.  Non-farm work was mainly blue-collar.  8% were middle and upper class: managers, professionals, business owners.  Lack of knowledge and offers of free land encouraged migrants to farm land with huge climate extremes. 

The southern cotton economy of 1870 had to recover from wartime destruction and competition from Egypt and India.  And railway freight overcharging and tight credit were also problems. 

The working class moved a lot.  This left a small group of middle and upper class to build a community and capture the political institutions. 

The 60% of the population under 25 in 1870:
The 3% of the population older than 65 in 1870 was miserable:
  • Male heads of households had to support their families.  As they aged they became less physically productive.  Farmers could get support from their sons.  The urban working-class lost earning power and were shunned by employers. 

What They Ate and Wore and Where They Bought It

Gordon describes the transformation in food and clothing production and purchase between 1870 and 1940.  In a subsequent chapter he describes the additional changes that occurred between 1940 and 2015

The majority of people were rural in 1870.  Large families and lots of immigrants maintained an unusually high growth rate. 

Pigs were the livestock of choice since they needed no management.  Corn was the staple vegetable.  In the north turnips, pumpkins and beans were grown since they could be stored or preserved.  Apples were the only fruit.  There was no fish.  Food was humdrum.  Chocolate, tea & coffee were the staple drinks.  Milk and water were consumed in large quantities but were problematic: Milk was transported in unrefrigerated containers and was adulterated by dilution or masking of contamination.  Pasteurized was invented in 1864 by Louis Pasteur.  It uses heat treatment to kill any bacteria that may spoil or poison cow's milk or infect the drinker. 
milk was first introduced in 1907 in Pittsburgh, but the benefit of this processing was constrained by lack of home ice boxes until the 1880s.  Beef was initially sent to the cities live on slow trains.  It was often spoiled before being sold to urban consumers.  People responded to the scandal, highlighted in Upton Sinclair's The Jungle, by reducing meat consumption.  Gordon notes that average calories of food consumed hardly changed between 1800 and 1980 -- 2,950 in 1800 and 3,200 in 1980.  But it has grown significantly since that point.  The percentage of consumer spending on food also remained constant between 1888 and 1919 at 42%.  After 1935 the percentage spent on food finally declined as consumers increased spending on: insurance reduces volatility in standard of living by compensating for losses of income during periods of unemployment, for catastrophic losses from disaster, or death of a family income earner as described by Gordon.  Insurance companies must set aside reserves to handle such claims.  Britain initially required that insurance buyers also have an insurable interest.  That is required in insurance markets to ensure buyers of insurance don't destroy their asset just to obtain the insurance.  Health insurance is treated separately being unusual, since the subscriber is likely to know more about their state of health than the insurer is and the subscriber is more likely to purchase the health insurance when aware of their increased risk.  This behavior collapses the risk pool by: forcing the insurer to increase the premiums, and encouraging healthy individuals to opt out of health insurance coverage. 
, medical care, tobacco, haircuts, meals out, furniture, union dues, church contributions and public transit fees. 

The most significant change in what people ate and wore was due to how food and clothes were produced and where they were purchased.  Urbanization and increasing wealth supported a reduction in the share of food and clothing produced at home.  This also removed the preparation time constraint.  Processed foods were developed and brands established which have become household names.  Chain stores allowed shoppers to purchase most of their food at a single location. 

Urban dwellers used cash income to purchase all their food.  Depressions during the 1870s and 1880s created a large underclass that was sustained by soup kitchens.  The undernourishment caused deterioration of health, which was amplified by crowded living spaces with minimal light and ventilation. 

Urbanization generated a host of health problems.  The diet in 1870 was mainly meat and starch so people were typically deficient in vitamins and minerals resulting in: rickets, pellagra, scurvy and consumption.  Insects were allowed into houses bringing disease.  Water was also infected with typhoid is an acute bacterial infection from Salmonella typhimurium.  It is transmitted by the fecal-oral route from contaminated water or food.  It grows in the intestines and blood.  Vaccine exists and is 30 to 70% effective.  It is treated with azithromycin, fluoroquinolones or cephalosporins.  As of 2018 about 21 million people suffer from typhoid infections each year with 161,000 deaths. 
.  But the 1906 food and drug legislation is the pure food and drug act of 1906.  After Upton Sinclair's best seller The Jungle, described the horrific conditions in the Chicago stockyards, panic at the exposure of the highly adulterated urban food supply and President Roosevelt's interest, caused Congress to develop and pass the act.  It was the precursor of the FFCDA. 
initiated a transformation of the food supply, removing rotten meat, diluted milk, and corrupt measurements. 

The invention of refrigerated rail cars in 1871 catalyzed, an infrastructure amplifier.   the distribution of Midwestern beef and Californian lettuce.  Ice was delivered to cities to provide refrigeration.  This allowed perishable food to be kept, which reduced the prices of these items and fluctuations in prices.  This finally improved the nutrition and stature of the population.  One-half of the improvement in nutrition in the 1890s was judged directly attributable to refrigeration. 

From corn flakes to catsup: the rise of processed foods
Between 1870 and 1900 there was huge growth of processed foods.  Consumption of: canned and dried fruits and vegetables; processed butter, cheese, and margarine; processed flour, hominy, grits, oatmeal, and breakfast food; refined sugar; macaroni and noodles; pickles, preserves, and sauces; bottled mineral and soda water; processed fresh and cured meat; grew substantially.  By 1900 the food-processing industry accounted for 20% of manufacturing output. 

Until households earned enough cash, they had baked: bread, cakes; at home.  By the 1920s taste and preference became important factors. 

By 1910 more than 3 billion cans of food were manufactured: 
  • Processed foods had existed for centuries: crackers on ships.  The secret French technique of canning was discovered in the 1830s. 
  • Underwood switched from glass jars to cans in the 1840s and trademarked his ham and turkey in 1867. 
  • The union army used canned food supplies introducing many Union soldiers to these products. 
A number of firms started between 1869 and 1900 which became giants: Swift & Armour; General Mills; Pillsbury; H.J. Heinz; Coca-Cola invented in 1886, first mass bottled in 1899; Campbell's Soups; Quaker Oats; Libby's; Kellogg's cornflakes and Post Grape-Nuts, cold cereals that, compared to hot mush, were convenient and labor-saving breakfasts. 

Frozen food production had been perfected in the 1920s by Birdseye, based on Labrador Inuit techniques, but it could not gain broad market access until the 1950s when household refrigerators included frozen food compartments. 

By 1900 an average family in New York City consumed:
  • 10.5 pounds of meat: beef, corned beef, mutton, & chicken
  • Two pounds of fish & a can of salmon
  • Two pounds of dairy: butter, cheese; 16 eggs, 21 quarts of milk
  • Cereal: 7 loaves of bread, 49 roles, 2 boxes of crackers, 3.5 pounds of flour, one box of breakfast cereal
  • Vegetables: potatoes, carrots, other
  • Fruit: apples, oranges, bananas
  • Coffee, Tea, sugar, whisky, and wine
Lunches were subsidized by the liquor industry which supplied food in volume to the saloon keepers.  The urban working-class male could purchase a five cent beer and eat rye bread, baked beans, cheese , sausage, sauerkraut, and dill pickles at no extra charge. 

By the 1920s the US diet had fully migrated from "hog's'hominy" of the 1870s to today's more varied choices.  The influence of Italian, German & Eastern Europeans shifted dinner from roasted or fried meat to one-dish meals of multiple ingredients: stews, goulashes and pasta; which potentially explain the decline in meat consumption.  Restaurants: French, German, Chinese, Italian; had begun to expand in the late 1890s.  White Castle hamburger chain was established in 1921.  Automobiles, widely adopted by 1920, supported drive-in restaurants along major highways. 

From general store to supermarket: how food was sold
The 1870 75/25 division of rural to urban residents constrains food retailing at that time.  While farms produced most of their produce they went to the monopoly is a power relation within:
  • A state in which a group has enough power to enforce its will on other citizens.  If this is a central authority with a cohesive military, it can overpower other warlords and stabilize the society. 
  • An economy in which one business has enough share in a market segment to control margins to its advantage.  An economic monopoly can be broadly beneficial: AT&T monopoly, US patent monopoly rights;
market to trade farm goods for credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles. 
to purchase shoes, men's clothes and fabrics.  Most non Southern, American farmers owned their farms and paid their debts enhancing the development of credit systems.  There was significant price gouging.  Before the civil war southern plantation owners purchased in bulk from wholesale merchants.  After the war, merchants rushed to supply goods to impoverished communities.  There were ten stores where there had been one before the war.  The commerce was supported by rising debt

Large, densely populated cities had centralized markets which housewives walked to.  Competition kept prices low.  The chain food store: A & P, Grand Union, Kroger; was a major marketing innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
enabled by road networks and cars.  These chains undercut prices of local merchants.  They offered national brands but had poor selections of local produce, so niche specialty stores avoided the threat.  Chains deployed relatively modern, large grocery markets but with clerks fetching goods from stock for the queue of customers.  Local direct competitors leveraged credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles. 
, at an additional 10% cost, to compete with the cash oriented chains.  Gordon notes that this standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  growth effect of price competition was not accurately represented in the CPI is consumer price index.  It reflects the prices of a market basket of consumer goods.  Weights are used to reflect models of the share each item in the basket.  Gordon notes it suffers from miss-representing standard of living changes due to outlet substitution bias.  And it ignored automobiles until 1935 and under-represented their quality impact prior to 1940.  Digital channels & products have added to the bias issues (Jun 2018)
because of outlet substitution bias is a statistical miss-representation of actual cost of goods purchased as the relative prices of alternative goods change between different forms of value delivery system.  Consumers typically substitute lower priced equivalents, offered at more cost-efficient retail channels, but the statistical samples represented in the CPI reflect only changes in the price of goods within a specific retail alternative. 
.  His analysis suggests the impact of chain stores was comparable in magnitude to Wal-Mart's in the 1980s and 1990s

Brand advertising and mass production supported one another.  The deployment of radio in the 1920s was catalytic, an infrastructure amplifier.   to the mass produced brand strategy.  Advertising allowed marketing to signal potential benefits of regional brands: Butter, which traditionally was produced and sold locally with flavours reflecting the proximate environment, was undermined by bland regional brands associated with the 'quality of the PFDA is the pure food and drug act of 1906.  After Upton Sinclair's best seller The Jungle, described the horrific conditions in the Chicago stockyards, panic at the exposure of the highly adulterated urban food supply and President Roosevelt's interest, caused Congress to develop and pass the act.  It was the precursor of the FFCDA. 
.'  The problems of milk and meat distribution were eventually constrained by regulated inspection, but this added significantly to the cost of the end products. 

A generation of midgets: why did people grow shorter?
Gordon leverages studies by Richard Steckel that indicate:
  • Deprivation stunts growth while extreme affluence does not increase height, so
  • The height of a given population declines with greater income inequality.  
  • Native-born US males declined by > 3% from 68.3 inches for those born in 1830 to 66.6 inches for those born in 1890. 
  • Heights increased to 69.6 inches for those born in 1940. 
  • Heights have changed little since then. 
Gordon notes that the declines only associate with data on infant mortality is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
.  He concludes that non-food aspects of health were responsible for the decline in heights between 1830 and 1890. 

Put down the needle & thread: the rise of market-purchased clothing

In 1870 women, including mothers and their daughters, spent much of their time making clothes for themselves.  In the middle class they were under considerable pressure to cut and sew well-tailored outfits to demonstrate good character.  Children wore hand-me-downs.  Only the wealthy purchased made to order clothes from specialty city shops or from Europe.  Beginning in 1875 a transformation occurred in clothing, with the development of the department store and mail-order catalog.  At the same time European immigrants, who could tailor, supported the trend towards purchasing clothes and spending expanded in this area.  Sears catalog demonstrates the expansion of woman's fashion including trends. 

From general store to grandeur: The urban department store
Rural customers, subjected to monopoly is a power relation within:
  • A state in which a group has enough power to enforce its will on other citizens.  If this is a central authority with a cohesive military, it can overpower other warlords and stabilize the society. 
  • An economy in which one business has enough share in a market segment to control margins to its advantage.  An economic monopoly can be broadly beneficial: AT&T monopoly, US patent monopoly rights;
pricing at the general store, found mail-order catalogs had very attractive product offerings with standardized low prices, leverging the national railway hub in Chicago and rural free delivery starting in the early 1890s.  Catalogs offered all durable goods except food.  Eventually cars allowed farm families to drive to retail stores. 

From 1862 Paris's Bon Marche provided a model of innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
: Low fixed prices with high volume, Money back guarantee, No obligation to buy, Bright electric lighting, Elevators; that was leveraged by American department stores from 1870 to 1910.  The American stores operated cash only with discounts from suppliers generating margin.  The department stores placed restaurants, and other helpful services: beauty salons, post offices, repairs; on the top floor to pull customers through the merchandize. 

In 1902 J.C. Penney setup the first clothing & dry goods chain store.  In 1925 Sears followed suit, augmenting its catalog service.  Woolworth started its variety stores in 1879.  Walgreen's drug store chain started in 1909. 

Gordon asserts that price-index bias is a statistical miss-representation of actual cost of goods purchased as the relative prices of alternative goods change between different forms of value delivery system.  Consumers typically substitute lower priced equivalents, offered at more cost-efficient retail channels, but the statistical samples represented in the CPI reflect only changes in the price of goods within a specific retail alternative. 
underestimates the rise in food and clothing purchases.  But he sees the exclusion of added value: recovered time, increased
To benefit from shifts in the environment agents must be flexible.  Being sensitive to environmental signals agents who adjust strategic priorities can constrain their competitors. 
flexibility
from electric infrastructure & major health benefits; from GDP is:
  • Gross domestic product which measures the total of goods and services produced in a given year within the borders of a given country (output) according to Piketty.  Gordon argues to include products produced in the home & market-purchased goods and services, following Becker's theory of time use.  Gordon stresses innovation is the ultimate source of all growth in output per worker-hour.  GDP growth per person is equal to the growth in labor productivity + growth in hours worked per person.  GDP has many problems.  Gordon concludes that between 1870 and 1940 all available measures GDP is hugely understated because:
    • GDP is a poor measure of:
      • Value & wealth
      • Who gets what
      • Global supply chains
    • GDP excludes:
      • Reduction in infant mortality between 1890 (22%) and 1950 (1%)
      • Brightness & safety of electric light,
      • Increased variety of food including refrigeration transported fresh meat and processed food
      • Convenience and economies of scale of the department store and mail order catalog and resulting product price reductions
      • Services by house makers
        • Time & health gains from having flush toilets, integrated sewer networks; rather than having to physically remove effluent and cope with fecal-oral transmission
      • Leisure
      • Costs & benefits of different length work weeks
      • Speed and flexibility of motor vehicles - which were not included in the CPI until 1935, after the transformation had occurred.  And competition from improved foreign vehicles, while it provides purchaser/user with improved standard of living (less breakdowns, repairs, etc.) is measured as reduced domestic manufacture
      • Coercion and corruption to obtain resources 
      • Consumption impact of finite resources: coal, oil;
      • Destruction impact of loss of entire irreplaceable species
    • GDP includes items that should be excluded:
      • Cost of waste - cleaning up pollution (single use indestructible plastic bags), building prisons, commuting to work, and cars left parked most of the time; should be subtracted
  • Guanine-di-phosphate is a nucleotide base. 
estimates as even more significant. 

American Home: Dark & isolated to bright & networked
Between 1870 & 1940 the US deployed new dwellings, which were networked to infrastructure services: electricity, water, sewage, telephone; including apartment blocks with elevators and single-family detached houses, in 57% of cities larger than 2500 inhabitants.  77% of the new 1940s dwellings were built after 1900 and incorporated support for networked services.  After 1910 the dwellings were centrally heated.  By 1940 a natural gas pipeline network was deploying and for urban America electricity was universal. 

Gordon notes network deployment correlated with housing density, so small-towns and farmland America took longer to connect.  But the drift from rural to urban dwellings compensated.  He stresses that these two transformations could only occur once.  Since 1940 dwellings have remained networked.  These services liberated American women and massively increased living standards. 

93% of dwellings in the US were constructed after 1880.  Very few reflected the dreadful situation of tenements of New York City.   Half the units present in 1880 had been replaced by 1940.  The new stock had fewer rooms reflecting the reduction in family size.  After 1910 children were completing high school, some went on to college.  And the families were migrating.  Most eastern cities in the 1890s included well-spaced workingman's cottage dwellings integrated by streetcars.  Newer Midwestern cities did not have legacy housing and so migrants settled into new buildings. 

The diffusion rates of networked technologies into dwellings, clusters into two groups:
  1. Automobiles, washing machines, and central heating plateaued at 80% coverage by 1970. 
  2. Others: Refrigerator, Radio, toilets, water, electric lights, electric irons, vacuum cleaners; reached 96 - 100% by 1970. 
Electric light was cheap and powerful.  It transformed life after dark, in streets and within dwellings.  Electric power also enabled labor & time saving home appliances, manufacturing, retailing, electric railways, and streetcars.  The diffusion occurred rapidly in cities, but was very slow in farms, especially in the south. 

Piped fresh water, and waste water networks, were a further major labor and time saver for American women.  Most cities had deployed the infrastructure by 1900.  Effective plumbing fixtures were being mass-produced and retailed by 1915.  Sears catalog was already offering them by 1908. 

Central heating was slowly deployed into housing to heat icy bedrooms.  By 1940 58% of urban housing had central heating.  Once deployed:
  • Windows could become larger. 
  • Cellars could be made into dwelling spaces. 

Motors Overtake Horses and Rail: Inventions and Incremental Improvements

Gordon describes the transformation of transportation that occurred in the US is the United States of America.   between 1870 and 1940.  In a subsequent chapter he describes the transformation of air travel and other additional transportation improvements that occurred between 1940 and 2015

Gordon notes that from 1820 steam power allowed the first fast, cheap, global connectivity based on steamships. 

By 1870 the US is the United States of America.   had a 60,000-mile rail network, including Stanford's transcontinental and was connected to the rest of the world by steamships.  Between 1850 & 1870, the federal government granted 7% of the continental US land area to railroads, conditional on deployment of new track.  The rail infrastructure was deployed by businesses that repeatedly failed generating two nation-wide depressions.  Between 1870 and 1900 total network length increased fivefold.  Passenger travel peaked in 1911 to 1920.  Rail usage declined after the Second World War. 

Chicago was the fastest growing US city from 1970 to 1930 leveraging its position as the central rail hub.  It routed California's fresh produce and Western meat to consumers.  Rail's performance continuously improved: mergers, interconnections, switching, bearings, diesel-electric power from the 1930s, and air-conditioning; ensuring ever faster travel. 

While the national rail network integrated cities, in 1870 the cities were still totally dependent on horse based transportation.  Steam engines were too: loud, dangerous, heavy; to compete.  Most small town business districts radiated out from the rail depot, which included the telegraph office

Intra-city transport rapidly shifted from horse powered: omnibuses, streetcars; to cable cars, electrified streetcars and electric trains.  Automobile ownership spread even faster from 1910 to the majority of households by 1930 in a single occurrence revolution.  Mass production drove down prices and quality improved.  Consumer credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles. 
supported purchase, ensured manufacturer power and helped support the yearlong automobile production schedule mismatched to the summer peak in consumer demand, with finance to incent dealers to maintain inventory.  Although cars increased
To benefit from shifts in the environment agents must be flexible.  Being sensitive to environmental signals agents who adjust strategic priorities can constrain their competitors. 
flexibility
, roads were primitive and cars unreliable.  Pressure to improve roads came from bicycling in the 1890s and Rural Free Delivery of post after 1913.  The Federal Aid Road Act of 1916 provided catalysis, an infrastructure amplifier.  .  Today's major road network was fully deployed by 1940.  Public transport could not remain cost competitive until the development and deployment of buses in the 1930s.  Gordon stresses that after the introduction of each technology there was also
Walter Shewhart's iterative development process is found in many complex adaptive systems (CAS).  The mechanism is reviewed and its value in coping with random events is explained. 
iterative improvement


Rural isolation was sustained by:
  • High cost of transatlantic rail tickets
  • Few, un-metaled, roads that were impassable after rain.  Only post Second World War prosperity supported rural integration.  But it ended by 1924 with 6.5 million U.S. farms equipped with 4.2 million automobiles, 370,000 trucks and 450,000 tractors.  This freedom undermined the rural general store & the local bank. 
Highway development was transformed by the flexibility of automobiles.  Hotels and commerce: supermarkets; could develop on route for the first time.  Urban sprawl resulted with the support of government before and after the Second World War. 

Gordon notes that the transportation revolution includes a further aspect that is masked by his use of 1940 to separate eras.  Passenger air travel was progressing in the 1930s but was not fully transformed until the 1970s. 

From Telegraph to Talkies: Information, Communication, and Entertainment

Gordon explains that between 1870 and 1940 isolation was replaced by communication.  This was a transformation in the existence of humans.  They could communicate, coordinate and use printed media, radio and motion pictures to understand and model the wider world or just be amused.  In a later chapter he describes the additional changes in entertainment and communications that occurred between 1940 and 2015

The US population was rapidly expanding.  Universal primary education for whites resulted in 90% literacy by the 1870s.  Southern blacks were constrained from accessing education, with 20.1% literate.  After 1880 black literacy rates improved reaching 88.5% by 1940. 

Technological change after 1870 hugely reduced the price of paper and printing.  This enabled the cost effective production of:
  • Newspapers allowing everyone to read the news. Steam powered presses appeared in 1813 catalyzing America's low cost newspaper business model.  There was rapid growth from 1870 to 1900.  The papers market extended from news to gossip, travel, leisure, comics and sports.  Newspaper magnates had the power to shape the news and significant world events. 
  • Books deployed in shops and libraries.  But Gordon laments records of books published are inconsistent. 
  • Mass-market magazines started as general-interest periodicals with national readership.  Through the 1920s sex & confession magazines expanded the market.  By the 1930s the product was mature, until cable-news appeared in the 1980s. 
Networking is the first important transformation for information, communication and entertainment: 

Edison invented the phonograph in 1877.  But his design was flimsy and strategy deploying it as a business tool was flawed.  Berliner's flat disc design was robust and deployed for enjoyment in saloons and soda fountains.  After 1900 home use increased, expanding the market for additional types of music recordings.  The fidelity was poor compared with competing technologies: player piano; but as it improved people wanted to experience professional music performances.  Electric recording with microphones developed in the mid-1920s. 

David Hughes first demonstrated radio transmission in 1879.  Marconi succeeded in sending radio waves over long distances.  After the invention of the vacuum tube in 1907, and generators, antennas, amplifiers, receivers, the First World War interrupted market development.  GE formed Radio Corporation of America (RCA) before the first commercial radio broadcast.  Radio and the commercial radio station appeared in the 1920s and deployed rapidly.  Within 20 years 80% of homes had a radio.  RCA, Westinghouse and GE jointly formed the National Broadcasting Company (NBC) in 1926 to allow radio stations to share and distribute programming.  Battery powered radio sets allowed rural deployment of radios in the 1930s even though the electricity network still had not extended there yetRadio based advertising could not be skipped.  The advertisers were happy to pay for the programming which supported the extremely rapid deployment.  The FCC is the Federal Communications Commission established in 1934. 
forced the broadcasters to improve the quality of their programming including: news broadcasts. 

In 1889 George Eastman invented film, integrating the 1879 invention of dry plate negatives, to enable photography.  Thomas Armant developed the powerful light projector which allowed motion photographs to be displayed enlarged and at a distance.  By 1908 nickelodeons were attracting 4 million customers a day, gaining their first experiences of foreign sites.  Movie palaces began in 1911 with far more seating and pipe organs.  Between 1910 and 1920 the content expanded to full length feature films.  36% of the population of the US went to the movies each week by 1922.  Effective synchronization of sound and motion did not occur until Lee de Forest's sound-on-film, first deployed on a feature in 1927.  Attendance reached 60% in the 1940s.  But the advent of television saw movie attendance plummet to 10% in the 1950s. 

Progressive deployment of
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
infrastructure amplifiers
allowed information sources to reach larger and larger audiences.  Phonographs and motion pictures allowed replication to exponentially increase the reachable audience. 

Information and communication innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
increased the productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
of workers and firms. 

Nasty, Brutish & Short: illness & early death

Around 1870 there were epidemics of: yellow fever is an infectious disease of primates caused by a flavivirus, yellow fever virus.  The virus is vectored by mosquitos: In the canopies of Rain Forest trees where monkeys are infected, Aedes aegypti in cities; but hunters can act as a reservoir for infection into aegypti.  Monkeys are tracked by public health officials as signals for outbreaks of the disease.  Often asymptomatic but patients who develop severe symptoms die within 10 days.  Symptoms include: Jaundice, High fever and multiple organ failure. 
, cholera, small pox.  Other diseases were constantly present: Influenza is a virus, normally hosted in birds, which jumps to humans causing pandemics of infection and deaths.  There are various types including: H1N1, H3N2 which mutates more causing vaccination strategies problems, B/Victoria, B/Yamagata; strains.  The "Spanish flu" epidemic of 1918-1919 killed between 50 and 100 million people.  Infection in people appears to depend on host genetics but no mechanism has been identified.  Flu is spread by droplets in the air.  Being within 3 to 6 feet of someone who is affected means likely breathing in their exhaled virus.  In the initial one to four day phase of infection the virus latches onto the mucous membranes that line the back of the nose, throat, and bronchial tubes.  The viruses then leverage the metabolic and replication systems of the epithelial cells that make up the mucous membranes.  People typically don't know they are infected in this first phase.  In the next phase the immune system mounts an attack on the virus which is concentrated in the respiratory tract: releasing interferon and cytokines generating the classic symptoms: aches, fever, dehydration; of flu.  Drinking lots of fluids compensates for the dehydration and helps the immune system agents to circulate.  The respiratory tract epithelial cells are typically inflamed and damaged and release their contents which are experienced as a runny nose and cough.  Stay upright and get fresh air to support the coughing.  Medications that suppress this are not helping with recovery.  If enough cells in the bronchial tubes are destroyed to create holes then secondary bacterial infections can occur including pneumonia.  , pneumonia is an inflamed lung.  It can be caused by infection with viruses or bacteria, drugs and autoimmune diseases.  HAP, including VAP can be very troubling. , typhus, scarlet fever, measles, or rubeola, is a highly contagious respiratory viral infection that can be dangerous in young children.  It is easily avoided by M.M.R. vaccination.  
, whooping cough, TB, consumption or otherwise TB, is mostly an airborn bacterial lung infection, but it can also infect the brain, kidneys and other parts of the body.  The only vaccine is still the BCG.  The deployment of antibiotics during the 1940s allowed effective treatment: Streptomycin.  Diagnostic tools for TB are insufficient.  And because TB grows slowly in walled off pockets in the lungs it takes many months of treatment for antibiotics to eradicate the infection.  TB benefits from compromised hosts and has benefited from HIV/AIDS.  TB is also leveraging the plasmids that now carry immunity to all current antibiotics.  In 2016 it is estimated to latently infect two billion people.  9.6 million worldwide became infected in 2014.  1.5 million people will die from TB in 2016.  Deaths from the disease have fallen drastically since 2000.  TB has been halted or reversed in 16 of the 22 countries: India (Sep 2016, Infection base estimate increased Oct 2016), Vietnam, Indonesia; that have the majority of cases.  But it is still the infectious disease causing the most deaths world-wide.  Nano scale drug delivery has the potential to push back on TB and is being actively researched (May 2016).   .  Workers frequently died from industrial accidents.  Gordon describes the transformation of wellbeing is described by Angus Deaton as all the things that are good for a person:
  • Material wellbeing includes income and wealth and its measures: GDP, personal income and consumption.  It can be traded for goods and services which recapture time.  Material wellbeing depends on investments in:
    • Infrastructure
      • Physical
      • Property rights, contracts and dispute resolution
    • People and their education
    • Capturing of basic knowledge via science.  
    • Engineering to turn science into goods and services and then continuously improve them. 
  • Physical and psychological wellbeing are represented by health and happiness; and education and the ability to participate in civil society through democracy and the rule of law.  Life expectancy as a measure of population health, highly weights reductions in child mortality. 
between 1870 and 1940.  And in a subsequent chapter he describes the additional changes that occurred from 1940 to 2015

There was a dramatic increase in life expectancy is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
after an initial drop.  From 1820 to 1890 people moved from safer rural settings with local evolved food supplies, to dangerous urban areas where they were at significant risk from:
The long term trends included key developments:

These developments had a huge direct effect on productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
and growth.  Citizens gained time and transformative products and services contributing to improved utility and health. 

What did doctors do?
There had been no significant physician based treatment in rural America which subsisted on self-help medicated with: Opium, Cocaine, Alcohol; and foreign born midwives supporting child birth at home.  The majority of doctors were trained at homeopathic medical schools representing evolved folk science.  But with the deployment of the car and telephone, physicians were able to operate a surgery and home visits.  Rural self-sufficiency transitioned to house-calls, office visits and stays in the newly cleaned up hospitals

As of 1870 there were no general surgeons due to the impact of: pain amplifies the aggression response of people by interoceptive signalling of brain regions providing social emotions including the PAG projecting to the amygdala; making aggressive people more so and less aggressive people less so.  Pain is the main reason people visit the ED in the US.  , sepsis is an infection triggered over-reaction by the immune system which causes general inflammation resulting in a cascade of problems: Blood clots, Leaky blood vessels; impeding blood flow to vital organs which can induce septic shock: Blood pressure drops, multiple organ failure, Heart damage and death.  For every hour without antibiotics the probability of death increases 8%.  Most cases start before people are hospitalized.  People over 65, infants under 1 year, people with chronic diseases such as diabetes, or weakened immune systems and healthy people with incorrectly treated infections are most likely to contract sepsis.  Most often the infections are of: lungs, urinary tract, skin, gut or intestines.  Typically such infections were the result of a previous visit to a clinic or hospital.  Symptoms of sepsis include: chills or fever, extreme pain or discomfort, clammy or sweaty skin, confusion or disorientation, shortness of breath and high heart rate.  Dr. Diane Craig noted that sepsis had become the leading cause of death among hospitalized patients.  Using patient matching on: age, symptoms, degree of illness; from the hospital system EHR, Craig identified the blood-lactate test as the key diagnostic that supported early, aggressive treatment of sepsis.  She argued that whenever a patient had two symptoms of significant infection a lactate test be used along with EGDT treatment for patients with lactate counts as low as 2.5 millimoles/liter.  This reduced sepsis mortality to 40% below the national average.  But only half the hospitals in the US followed Craig's recommendations.  Dr. Robert Pearl concludes this is because of the high risk of killing a patient with EGDT treatment, even though the protocol will reduce overall mortality by half.  Doctors don't want to be responsible for killing patients so they opt not to order the lactate test.  In 2017 sepsis is estimated to cost the US health care system more than $20 billion a year.  The C.D.C. is concerned (Sep 2016) with antibiotic resistance generating more sepsis. 
, cross-infection within the large urban hospital wards. 

Medical tools started to appear: X-rays, EKG or ECG is electrocardiogram which generates a record of the heart's activity. 
, Blood pressure cuff, Scopes;

Medicine became respected during the 1920s as doctors gained control of their own regulation.  As a result:

Hospitals - cesspools to curing disease
The wealthy had traditionally avoided hospitals, which were places where the poor died and the indigent sheltered and obtained free food. 

Late 19th century innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
: Anesthesia is the temporary removal of sensation.  It can be local, regional or general. 
, Antiseptics; allowed germ theory is a platform of related discoveries in microbiology by Koch (postulates developed from 1870s) and Pasteur (1880) and antiseptic surgery by Joseph Lister (1879).  These innovations were made necessary by the stresses of the industrial revolution 
to transform hospital operations and surgery. 

There was significant investment in new model hospitals during the 1920s and 1930s:

As hospitals increased the practice of specialized medicine: More rich people began to use hospital services, Working poor could use Workers Compensation (the initiation of US is the United States of America.   health insurance) to recover from industrial accidents; prices rose dramatically through the 1920s. 

After 1950 hospitals abandoned long-term care, shifting it to lower profit PAC providers is a Post-Acute Care provider.  A three-day hospital admission and discharge are prerequisite requirements to receiving Medicare PAC services.  Acute care hospitals become portals to the PAC business.  Referrals are key.  PAC includes different types of facility focused on different severity of illness (high to low):
  • Long term care Hospital (LTCH),
  • Inpatient rehabilitation facility (IRF),
  • Skilled nursing facility (SNF),
  • Home health agency (HHA) - most acute care hospitals and EMR providers have strategies for integration with home based care,
  • Outpatient rehabilitation.  SNF and HHA represent 80% of discharges and expenditures.  Assisted living is not part of federal Medicaid, but states often include it through a waiver. 


Childbirth shifted to hospitals, increasing the cost, because of:
The increased cost of childbirth: Discouraged large families, Supported lower infant mortality; helped improve the standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  of families.  

Medical Research, Medical Schools, & the Transformation of Medical Knowledge
Development is a phase during the operation of a CAS agent.  It allows for schematic strategies to be iteratively blended with environmental signals to solve the logistical issues of migrating newly built and transformed sub-agents.  That is needed to achieve the adult configuration of the agent and optimize it for the proximate environment.  Smiley includes examples of the developmental phase agents required in an emergent CAS.  In situations where parents invest in the growth and memetic learning of their offspring the schematic grab bag can support optimizations to develop models, structures and actions to construct an adept adult.  In humans, adolescence leverages neural plasticity, elder sibling advice and adult coaching to help prepare the deploying neuronal network and body to successfully compete. 
of medical schools reflected the coups and schisms of doctors.  Homeopathy was ingrained and disbelief in science was supported by doubts that tiny, invisible germs could cause epidemics is the rapid spread of infectious disease: AIDS (Oct 2016), Cholera (2010), Clostridium difficile (May 2015), Ebola, Influenza, Polio, SARS, Tuberculosis, Typhoid (Apr 2018), Malaria, Yellow fever, Zika; to large numbers of people in a population within a short period of time -- two weeks or less.  Epidemics are studied and monitored by: NIAID, CDC, WHO; but are managed by states in the US.  Infection control escalation is supported by biocontainment units: Emory, Nebraska.  Once memes are included in the set of infectious schematic materials, human addictions can present as epidemics concludes Dr. Nora Volkow of the NIDA.  CEPI aims to ensure public health networks are effectively prepared for epidemics.  PHCPI aims to strengthen PCPs globally to improve responsiveness to epidemics.  GAVI helps catalyze the development and deployment of vaccines.  Sporadic investment in public health enables development of conditions for vector development: Mosquitos.  The increasing demands of the global population are altering the planet: Climate change is shifting mosquito bases, Forests are being invaded bringing wildlife and their diseases in contact with human networks.  Globalized travel acts as an infection amplifier: Ebola to Texas.  Health clinics have also acted as amplifiers: AIDS in Haiti, C. diff & MRSA infections enabled & amplified by hospitals.  Haiti earthquake support from the UN similarly introduced Cholera. 
and death. 

The 1870 syllabus of medical schools focused on details of 'how to'. 

Traditionally trained doctors had to die off before the germ theory of medicine is a platform of related discoveries in microbiology by Koch (postulates developed from 1870s) and Pasteur (1880) and antiseptic surgery by Joseph Lister (1879).  These innovations were made necessary by the stresses of the industrial revolution 
displaced homeopathy & became widely utilized.  The theory drove increased emphasis & operational understanding of cleanliness & sterilization and undermined homeopathic medical schools which disappeared by the 1920s. 

The 1910 AMA is the American Medical Association. 
Flexner report questioned the need and value of the medical schools.  It resulted in:

How did patients pay for medical care?
From 1910 to 1920 charges by doctors were exceptionally low, based on home visits and almost no hospitalization

After 1910 the cost of treatment began to rise:

By 1920 doctors had organized into individual practices:

Each participant in the mix of care services billed the patient: PCP is a Primary Care Physician.  PCPs are viewed by legislators and regulators as central to the effective management of care.  When coordinated care had worked the PCP is a key participant.  In most successful cases they are central.  In certain Medicare ACO models (Pioneer) PCPs are committed to achieve meaningful use requirements.  Working against this is the: replacement of diagnostic skills by technological solutions, low FFS leverage of the PCP compared to specialists, demotivation of battling prior authorization for expensive treatments. 
, Specialists, Laboratories, Nurses, Nurses board, Anesthetists is the temporary removal of sensation.  It can be local, regional or general. 
, OR is operating room.  , Recovery, Medicines; 

From 1900 to 1920 health insurance (sickness funds) developed.  Commercial health insurance included all the present day issues:
  • Skimming
  • Age limits
  • Exams to detect pre-existing conditions
  • Reluctance to insure lower classes, who were assumed to be sicker
  • German 1880 & UK 1911 political decisions to provide universal health insurance resulted in a battle during the Presidency of Woodrow Wilson between proponents of universal coverage and Doctors, Pharmacists, Employers and labor unions; which never resolved

With the increase in hospital capacity to treat, there was an increase in high charges.  This was supported by:

Death rape accidents & homicides
Gas and kerosene use had resulted in deadly fires.  So there was a huge benefit in shifting to electric light. 

Railways were dangerous, killing workers, passengers and horses due to open access to US is the United States of America.   rail tracks: 
  • The poor hopped freight trains and
  • Walked along the tracks
Cars were initially slow and relatively safe.  But by 1918 as the numbers and power increased cars using narrow rutted public roads matched railways in deaths.  By 1921 car deaths were 2* rail deaths. 

Gun violence is an order of magnitude higher in the US is the United States of America.   than Europe.  While the rate drifts cyclically it:
  • Increased at the end of prohibition in 1923
  • Increased during the peak of drug violence in the 1980s
  • Traditionally higher in the South than the North:
    • South encouraged self-help justice and retaliation
    • Great migration saw violence move north. 
  • African American rates 10* for whites
  • Wild West was extremely violent catalyzed by: Youths, Alcohol, Guns, Little law, Extreme heat; but as cities developed the levels of violence subsided. 

Working Conditions on the Job and at home

Between 1870 & 1940 work became less arduous and physically taxing.  In 1870 80% of jobs were: hazardous, tedious, and unpleasant; on the land, stockyards, and railways or in mills and factories.  Over time the standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  improved - more than any other period before or after.  Additional roles: clerks, sales people, managers, and professionals; were asked to perform less tedious or even stimulating tasks.  Females entered the labor force, as the demands of their time reduced at home: electricity, piped water and gas, electric appliances, gas ranges, manufactured clothes; and jobs became less physical, at an average rate of 2.2 points per decade from 1880 to 1940 and 6.5 points per decade between 1940 and 2010.  95% of Adult males continued to participate in the work force, until the 1970s when a decline accelerated.  As life expectancy is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
increased, the quality of old age improved with the introduction of paid retirement. 

Gordon notes three significant themes:
  1. The gradual shift in labor participation rate towards equality for women
  2. The rise of education and disappearance of child labor
  3. The introduction of paid retirement. 
Additionally arduous and boring types of work: farming, domestic service, digging, repetitive assembly; declined 5% per decade from 87.2% in 1870 to 21.6% by 2009.   Only after 1970 were significant numbers of non-routine, cognitive jobs generated.  Computerization slowly eliminated repetitive reentry tasks. 

The work week transitioned to less days and hours per day as manufacturing jobs hours reduced from more than sixty per week, and as part-time working increased.  Much of the transition occurred between 1910 and 1920 as progressive era legislation constrained working hours for women and children.  Since 1940 people have been pushed into part-time work against their wills. 

Farming was dependent on the unpredictable weather, resulting in over and under-production.  Both situations drove farmers into debt. 

The 1862 Homestead Act of 1862 allowed any adult, who was a citizen, or had applied to be one, and had never taken up arms against the US to stake a claim to land.  10% of the US public land was given away to homesteaders.  Although the land was free, its preparation for living was difficult and labor intensive.  Some of the land in the Midwest and Great Plains was forest which had to be cleared.  Other areas had difficult soil to prepare.  These costs forced many homesteaders to become tenants.  The isolation and hardship caused by isolation and the extreeme weather conditions added to the numbers who subsequently quit farming for urban America. 
encouraged
Flows of different kinds are essential to the operation of complex adaptive systems (CAS). 
Example flows are outlined.  Constraints on flows support the emergence of the systems.  Examples of constraints are discussed. 
people to move west to the Midwest and Great Plains
.  Thousands of the frontier claims were subsequently abandoned due to drought, insect plagues, low crop prices, extreme variation in temperature, and isolation.  Gordon explains that this expansion caused debasing of the land from 1870 as buffalo were replaced by cattle and sheep and plowing & wheat crop caused soil damage.  By 1934 to 1936 it culminated in the Dust Bowl disaster resulted from deep plowing of the American and Canadian prairies, removing the deep rooted grasses which bound the soil, during the period from 1870 through 1940; and severe drought: 1934, 1936, and 1939 to 1940; which together caused massive soil erosion.  The soil became airborne dust which blew as far as the East Coast. 
disaster.  And the work of farming these lands was physically demanding from dawn to dusk. 

The share cropping system of the south was even more difficult with all
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
buildings, tools
, supplies and product controlled by an owner, with the tenant in effect a wage laborer but with all the risk, is an assessment of the likelihood of an independent problem occurring.  It can be assigned an accurate probability since it is independent of other variables in the system.  As such it is different from uncertainty. 
of over and under production.  The farms in the 1890 to 1910 were isolated and disconnected from modern
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
infrastructure
This page discusses the effect of the network on the agents participating in a complex adaptive system (CAS).  Small world and scale free networks are considered. 
networks


The 1833 to 1834 invention of the horse-drawn mechanical reaper, replaced five men harvesting with hand scythes.  Horses remained the main source of locomotion until internal combustion. 

By 1915 schools of agriculture and seed company researchers had developed crop systems that could resist insects and drought. 

People driven off the land by hardship joined immigrants who
Flows of different kinds are essential to the operation of complex adaptive systems (CAS). 
Example flows are outlined.  Constraints on flows support the emergence of the systems.  Examples of constraints are discussed. 
moved to urban America
, resulting in urban growth from 9.8 million in 1870 to 74.3 million in 1940. 

Non-farm work in 1870 included:
The courts in the late 19th century concluded that people knew the risks of employment in these industries, pushing the risks, is an assessment of the likelihood of an independent problem occurring.  It can be assigned an accurate probability since it is independent of other variables in the system.  As such it is different from uncertainty. 
onto the workers.  But work provided the income on which the whole family depended.  Business cycles included depressions in: 1873 to 1878, 1893 to 1897, 1885, and 1907; leaving workers unemployed.  Federally supported unemployment benefit provided some support by 1940.  Workers compensation was handled by states until 1938.  Turnover of unskilled labor was high as most roles were similar allowing job hopping. 

Wages were suppressed by competition during the mass immigration before 1910.  World War One and legal restrictions on immigration: 1921, 1924, 1929; and New Deal was FDR's political platform to help the poor, support the economy and reform the banking system.  The architects included Henry Morgenthau, Harry Hopkins, and Frances Perkins.  It:
  • Included liberal legislation: Emergency Banking Relief Act, Banking Act, SSA, Securities Act, Securities Exchange Act, National Housing Act, NIRA, National Labor Relations Act, FLSA, RTAA, Wealth Tax Act;
  • Presidential executive orders,
  • Enhanced the role of federal government in promoting economic growth with programs supporting:
    • Reformed trade policy with the RTAA. 
    • Blocked deflation by limiting economic competition with the NRA. 
    • Rural standard of living through electrification with the REA and TVA.  
    • Reduced unemployment with the WPA and CCC.  
    • Made taxation progressive through the Wealth Tax Act, capturing private wealth and allowing income to flow to the emergent middle class. 
unionization helped drive up wages between 1920 and 1940.  Subsequently Gordon argues that technological change introduced more specialized tasks, encouraging employers to pay to retain experience necessary to maintain production line flows. 

Unmarried women were flowed into particular jobs: servants, clerks, school teachers, nurses and textile & apparel manufacturing; having little power, being unskilled and non-unionized.  This work was less isolated but no less arduous than the household drudgery: getting fuel & water, cooking, cleaning, waste removal, laundry; they helped with at home.  Once electric machinery allowed women to participate in factory work they were used to undercut the wages of men.  Gordon notes how jobs became more routine, supervised and tedious over time.  Typical was the male dominated AMA is the American Medical Association. 
forcing the elimination of midwifery, moving birthing from home to hospitals.  And librarians, nurses and teachers found themselves subject to male supervision. 

The twentieth-century infrastructure and tools alleviated the burden of housework for women.  Gordon notes that women still spent as long on housework now focused by germ theory is a platform of related discoveries in microbiology by Koch (postulates developed from 1870s) and Pasteur (1880) and antiseptic surgery by Joseph Lister (1879).  These innovations were made necessary by the stresses of the industrial revolution 
on cleaning and bathing children.  Men's work hours reduced but as they moved to suburbs they did more maintenance on their houses & gardens. 

Gordon notes that level of education achieved depended on the opportunity cost:
  • Urban manufacturing center children could obtain wages from child labor. 
  • Farm families kept children in school longer than blue collar families as there was no extra wage compensation for quitting school.  This produced the education belt.  
  • But there were few high school graduates and only 1% of college age population enrolled in 1870.  Secondary education levels surged between 1910 and 1940.  This enabled the rapid expansion of college enrollment after the Second World War. 

Taking and Mitigating Risks: Consumer Credit, Insurance, and the Government

Gordon explains that consumer credit catalyzes the purchase of homes and durable goods by spreading out the payment into a series and removing the need to obtain the entire purchase price in advance as described by Gordon.  It is supported by an evolved amplifier, including: a clear benefit to the purchaser, a profit stream captured by the lender, enforceable contractual agreements, within a schematic regulatory framework.  Taibbi describes the amplifier's architecture as deployed by Chase.  Nineteenth century US rural purchases were credit based but with a large initial commitment.  Cash purchases increased between 1890 and 1910.  Between 1910 and 1915 cash purchasing shifted back to leveraging credit.  By 1920 credit accounts were offered at department stores.  Installment plans, provided by finance companies: GMAC; with minimal upfront commitments supported the purchase of costly durable items including automobiles. 
and insurance reduces volatility in standard of living by compensating for losses of income during periods of unemployment, for catastrophic losses from disaster, or death of a family income earner as described by Gordon.  Insurance companies must set aside reserves to handle such claims.  Britain initially required that insurance buyers also have an insurable interest.  That is required in insurance markets to ensure buyers of insurance don't destroy their asset just to obtain the insurance.  Health insurance is treated separately being unusual, since the subscriber is likely to know more about their state of health than the insurer is and the subscriber is more likely to purchase the health insurance when aware of their increased risk.  This behavior collapses the risk pool by: forcing the insurer to increase the premiums, and encouraging healthy individuals to opt out of health insurance coverage. 
can reduce the volatility of a household's standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  .  Inventions and an innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
driven accumulation of private capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
, with support from government, drove an increase in the standard of living between 1870 & 1940. 

He notes pervasive consumer credit operating in the early 1800s in rural general stores and via pawn brokers in urban environments.  Farmers in the north borrowed for: every day goods, land purchases, farm machinery, to build houses; with loans lasting a maximum of 8 years inducing refinancing.  The deflation of the late nineteenth century is a period of low level deflation (2%) that occurred from 1870 to 1890 due to productivity increases in the global economy as work in agriculture shifted to industrialization: Steel, Railroads, Steam powered ships, and machinery; initially in the UK induced by 1850 by the global cotton VDS, France, Germany, Belgium, Russia and the US.  The prices of basic commodities produced in factories fell continuously. 
reduced prices and incomes, while the debts were of fixed value.  Highly leveraged credit networks expanded beyond country stores, through traveling salesmen, supplied by wholesalers and financed from New York or Chicago.  With no central bank, until 1913 of 1913 was a response to a series of banking panics with the goal of responding effectively to stresses.  It setup:
  • At least 8 and not more than 12 private regional Federal Reserve banks.  Twelve were setup
  • Federal Reserve Board with seven members to govern the system.  The President appointed the seven, which must be confirmed by Congress.  In 1935 the Board was renamed and restructured. 
  • Federal Advisory Committee with twelve members
  • Single US currency - the Federal Reserve Note. 
, to stabilize the network, the farther a farmer was from New York or Chicago the more interest they would pay on loans.  Catastrophic crop failures or produce price declines in the 1920s and 1930s caused farm bankruptcy is a legal status for an entity that cannot repay its creditor's loans.  It holds creditor lawsuits in abeyance while the restructuring process proceeds to allow the entity to continue operations.  It also has legal tools for forcing holdout creditors to accept repayments that are lower than the bond sale initially promised. 
and foreclosure. 

In the late nineteenth century the government was influencing the economy is the study of trade between humans.  Traditional Economics is based on an equilibrium model of the economic system.  Traditional Economics includes: microeconomics, and macroeconomics.  Marx developed an alternative static approach.  Limitations of the equilibrium model have resulted in the development of: Keynes's dynamic General Theory of Employment Interest & Money, and Complexity Economics.  Since trading depends on human behavior, economics has developed behavioral models including: behavioral economics.   by promoting development, mitigating risk, is an assessment of the likelihood of an independent problem occurring.  It can be assigned an accurate probability since it is independent of other variables in the system.  As such it is different from uncertainty. 
and increasing security and well-being is described by Angus Deaton as all the things that are good for a person:
  • Material wellbeing includes income and wealth and its measures: GDP, personal income and consumption.  It can be traded for goods and services which recapture time.  Material wellbeing depends on investments in:
    • Infrastructure
      • Physical
      • Property rights, contracts and dispute resolution
    • People and their education
    • Capturing of basic knowledge via science.  
    • Engineering to turn science into goods and services and then continuously improve them. 
  • Physical and psychological wellbeing are represented by health and happiness; and education and the ability to participate in civil society through democracy and the rule of law.  Life expectancy as a measure of population health, highly weights reductions in child mortality. 
through:
Gordon argues electricity, and the internal combustion engine,
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
supported the development
of powerful new products: washing machines, electric refrigerators, automobiles; at greatly reduced prices between 1910 and 1920 which fueled
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
the provision of consumer credit
which further catalyzed, an infrastructure amplifier.   durable production, cost reduction and purchases.  But he sees nondurables, services, government spending and exports as growing just as rapidly.  And rapid increase in availability of credit from 1920 to 1940 is largely independent of the share of consumer durables in total spending. 

For house purchase, mortgage contracts were mainly provided by individuals, savings banks, and building and loan associations is savings and loan association.  These S&Ls were deregulated by the 1982 Garn-St. Germain act. 
.  Building and loan associations pioneered amortized loans include interest & repayment of principal in the monthly payment.  No lump-sum payment is left when the loan matures.  Varying the number of payments helped limit the size of the monthly payment. 
.  They were innovative is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
, reducing the risk for both lender and borrower and became the standard by the 1920s.  Most houses in 1890s were built for rental but by 1920 90% were purchased with building and loan association support.  85% of the houses were purchased by working men. 

Home and apartment building was facilitated in the 1920s by real estate mortgage bonds.  By the 1930s this had exploded to $43 billion before collapsing in the great depression.  After World War Two the financial environment eased. 

Gordon explains that by the 1900s life insurance depends on the date of death being highly uncertain, but in a large enough group of people a predictable percentage will die each year, unless a catastrophe occurs such as a war or epidemic.  Life insurance companies benefit from keeping the insured alive and provided policy holders with personal health and hygiene instruction.  Gordon explains that by the 20th century:
  • Regulations defined the percentage of outstanding insurance that had to be held as assets that could pay benefits to policy beneficiaries. 
  • Life insurance was used as a mechanism to increase saving. 
was used to force people to save and the assets of life insurance companies doubled from 4.5% of GDP is:
  • Gross domestic product which measures the total of goods and services produced in a given year within the borders of a given country (output) according to Piketty.  Gordon argues to include products produced in the home & market-purchased goods and services, following Becker's theory of time use.  Gordon stresses innovation is the ultimate source of all growth in output per worker-hour.  GDP growth per person is equal to the growth in labor productivity + growth in hours worked per person.  GDP has many problems.  Gordon concludes that between 1870 and 1940 all available measures GDP is hugely understated because:
    • GDP is a poor measure of:
      • Value & wealth
      • Who gets what
      • Global supply chains
    • GDP excludes:
      • Reduction in infant mortality between 1890 (22%) and 1950 (1%)
      • Brightness & safety of electric light,
      • Increased variety of food including refrigeration transported fresh meat and processed food
      • Convenience and economies of scale of the department store and mail order catalog and resulting product price reductions
      • Services by house makers
        • Time & health gains from having flush toilets, integrated sewer networks; rather than having to physically remove effluent and cope with fecal-oral transmission
      • Leisure
      • Costs & benefits of different length work weeks
      • Speed and flexibility of motor vehicles - which were not included in the CPI until 1935, after the transformation had occurred.  And competition from improved foreign vehicles, while it provides purchaser/user with improved standard of living (less breakdowns, repairs, etc.) is measured as reduced domestic manufacture
      • Coercion and corruption to obtain resources 
      • Consumption impact of finite resources: coal, oil;
      • Destruction impact of loss of entire irreplaceable species
    • GDP includes items that should be excluded:
      • Cost of waste - cleaning up pollution (single use indestructible plastic bags), building prisons, commuting to work, and cars left parked most of the time; should be subtracted
  • Guanine-di-phosphate is a nucleotide base. 
in 1875 to 10.4% in 1905.  This saving increased domestic investment and economic is the study of trade between humans.  Traditional Economics is based on an equilibrium model of the economic system.  Traditional Economics includes: microeconomics, and macroeconomics.  Marx developed an alternative static approach.  Limitations of the equilibrium model have resulted in the development of: Keynes's dynamic General Theory of Employment Interest & Money, and Complexity Economics.  Since trading depends on human behavior, economics has developed behavioral models including: behavioral economics.   growth. 

In 1925 states began requiring automobile liability and collision insurance.  The laggards did not do so until the early 1950s.  The policies were standardised by the National Bureau of Casualty and Surety Underwriters. 

1940 to 2015 - The golden age & the early warnings of slower growth

Gordon sees:

Fast Food, Synthetic Fibers, and Split-Level Subdivisions: The Slowing Transformation of Food, Clothing, and Housing
Gordon considers there to be little fundamental change in food.  While the Great Depression and Prohibition undermined supply and demand, by 1940 the situation was similar to 2015.  War time rationing constraints on red meat encouraged the post war shift to chicken & fish consumption.  The supply chain was relatively uncontaminated & urban retailers had large refrigerated cabinets.  There was a shift to eating out and fast-food.  And there was more inequality & obesity

Clothing innovations were relatively small from 1940 to 2015.  But leverage of the global supply chain for clothing ensured major price reductions. 

Housing stock was significantly altered after 1940.  The initial batch of post war housing was small and of poor quality.  A gradual trend in expanded size of single family houses was accompanied by government policy placing the new stock in suburbs distant from the city centers and connected to them by superhighways, rather than rail networks. 

Food Marketing from A&P to Whole Foods and Trader Joe's
Gordon notes three important shifts in food retailing from the 1930s through to the 1980s:
  1. All foods offered in a
    This page discusses the benefits of bringing agents and resources to the dynamically best connected region of a complex adaptive system (CAS). 
    centralized
    store.  Overtime the continued expansion of markets has undermined this added value.  Eventually Target, Costco & Walmart centralized all shopping.  And upscale specialists: Trader Joe's and Whole Foods; emerged in the 1990s.  Supermarket chains collapsed. 
  2. Centralized payment for all goods in the market
  3. Barcode labels and computerized inventory checkout in the 1980s
Restaurants and fast food
Gordon sees the increase in working mothers and incomes supporting a shift from cooking at home to eating out.  And the cost of eating out decreased over time from 1940 to 2008.  He also notes fast-food chains using military style training and high technology: Three channel head-sets, point-of-sale order integration; to develop two or three minute drive-through delivery which resolves 70% of fast food revenue.  But he argues the technology that supports fast-food was all developed in the 1990s. 

Food Issues: Inequality and Obesity
Gordon notes the inequality evident in food consumption in 2014 US is the United States of America.  Wealthy is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker.  It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche.   , eating fine meals made from exclusive ingredients transported globally, Poor 17% (50 million - in northern inner cities and one parent southern families) live in food insecure households. 

The US obesity is a disorder where the brain is induced to require more eating, often because of limits to the number of fat cells available to report satiation (Jul 2016).  It is associated with: metabolic syndrome including inflammation, cancer (Aug 2016), high cholesterol, hypertension, type-2-diabetes and heart disease.  It is suspected that this is contributing to the increase in maternal deaths in the US (Sep 2016).  Obesity is a complex condition best viewed as representing many different diseases, which is affected by the: Amount of brown adipose tissue (Oct 2016), Asprosin signalling by white adipose tissue (Nov 2016), Genetic alleles including 25 which guarantee an obese outcome, side effects of some pharmaceuticals for: Psychiatric disorders, Diabetes, Seizure, Hypertension, Auto-immunity; Acute diseases: Hypothyroidism, Cushing's syndrome, Hypothalamus disorders; State of the gut microbiome.  Infections, but not antibiotics, appear associated with childhood obesity (Nov 2016). 
rate of 27% (1/3 adults and 1/5 children) vs.: Italy 8%, France 6%, Japan 2%; is an outlier.  Gordon asserts that US inequality is the key factor leaving poor children idle, watching television while eating fast food.  He also claims that almost none of the caloric increase is due to sugar consumption. 

Slow evolution of clothing
Gordon explains that between 1940 and 2010 the percentage of consumption on clothes has declined significantly while the changes to clothing have been relatively trivial: introduction of manmade fabrics.  Imported articles have driven down the price of clothes as real clothing purchases per person rose 2.7 percent a year.  Department stores did not leverage centralization leaving them open to attack from Walmart

From Levittown to McMansions: The postwar evolution of housing
By 1940 urban housing is fully networked.  Rural and southern housing was upgraded by 1970.  Central heating reached 78% of all dwellings by 1970 & 94% by 2010 with no real need for the other 6%.  Central or window air-conditioning was installed in 37% of American homes by 1970 and in 89% by 2010, enabling the flows of population to Miami and Las Vegas.  Air-conditioning also had a 25% effect on productivity when installed in offices

Gordon notes that housing overbuilding had been a problem in the 1920s, contributing to the depression of the 1930s.  It was not until 1950 to 1954 that housing starts peaked again.  After the 2008 housing crisis the ratio fell back to 30% of the 1929 level.  A long-term decline in the building of new units per household resulted from: satisfaction of demand by 1970, increased costs of construction, and a gradual slowdown in population growth rate.  Houses have got bigger.  Formal dining rooms were exchanged for flexible Kitchen/family rooms, which Gordon notes is a throwback to the 1870's kitchen.  And prices have mostly risen from 1945 until 2006 and then fell.  This separated those owning houses purchased between 1950 and 2001 who have seen their capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
appreciate and those who purchased in
A key agent in the 1990 - 2008 housing expansion Countrywide is linked into the residential mortgage value delivery system (VDS) by Paul Muolo and Mathew Padilla.  But they show the VDS was full of amplifiers and control points.  With no one incented to apply the brakes the bubble grew and burst.  Following the summary of Muolo and Padilla's key points the complex adaptive system (CAS) aspects are highlighted. 
2001 to 2006 who found themselves trapped with negative equity
that pulled down GDP is:
  • Gross domestic product which measures the total of goods and services produced in a given year within the borders of a given country (output) according to Piketty.  Gordon argues to include products produced in the home & market-purchased goods and services, following Becker's theory of time use.  Gordon stresses innovation is the ultimate source of all growth in output per worker-hour.  GDP growth per person is equal to the growth in labor productivity + growth in hours worked per person.  GDP has many problems.  Gordon concludes that between 1870 and 1940 all available measures GDP is hugely understated because:
    • GDP is a poor measure of:
      • Value & wealth
      • Who gets what
      • Global supply chains
    • GDP excludes:
      • Reduction in infant mortality between 1890 (22%) and 1950 (1%)
      • Brightness & safety of electric light,
      • Increased variety of food including refrigeration transported fresh meat and processed food
      • Convenience and economies of scale of the department store and mail order catalog and resulting product price reductions
      • Services by house makers
        • Time & health gains from having flush toilets, integrated sewer networks; rather than having to physically remove effluent and cope with fecal-oral transmission
      • Leisure
      • Costs & benefits of different length work weeks
      • Speed and flexibility of motor vehicles - which were not included in the CPI until 1935, after the transformation had occurred.  And competition from improved foreign vehicles, while it provides purchaser/user with improved standard of living (less breakdowns, repairs, etc.) is measured as reduced domestic manufacture
      • Coercion and corruption to obtain resources 
      • Consumption impact of finite resources: coal, oil;
      • Destruction impact of loss of entire irreplaceable species
    • GDP includes items that should be excluded:
      • Cost of waste - cleaning up pollution (single use indestructible plastic bags), building prisons, commuting to work, and cars left parked most of the time; should be subtracted
  • Guanine-di-phosphate is a nucleotide base. 
through until 2015. 

Labor saving appliances: Washing machines, refrigerators; were only installed in 40 - 44% of houses by 1940.  By 1970 these were ubiquitous at 92 - 100%.  Refrigerators also doubled in size and had a dramatic increase in useful capabilities, and energy efficiency (especially after the 1974 energy price shock).  Clothes dryers also provide significant labor and time savings, reaching 80% of houses by 2010.  Microwave ovens arrived late but reached 96% by 2010.  All appliances became increasingly robust. 

Suburbanization & sprawl
Gordon explains how the US built a competitive advantage in productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
relative to Europe and Japan, through the redistribution of expanding urban population from city centers to new housing built in inner suburbs in the 1940s and 1950s, outer suburbs in the 1970s and 1980s and then after 1990 in exurbs.  These populations were efficiently interconnected by expressways.  Commerce
This page discusses the effect of the network on the agents participating in a complex adaptive system (CAS).  Small world and scale free networks are considered. 
leveraged the network
culminating in the
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
big box stores, with massive economies of scale
, near suburban interstate highway junctions. 

The G.I. Bill is the Serviceman's Readjustment Act of 1944 (G.I. Bill) which provided benefits to soldiers returning from the Second World War: tuition payments and living expenses, low-cost mortgages, low-interest loans to start businesses and one year of unemployment compensation; acting as a major catalyst in generating human capital. 
allowed white veterans initial entry to small suburban houses.  In contrast during the 1940s and 1950s southern black sharecroppers migrated on mass to northern cities: Chicago, Detroit; initially encouraged by the tight labor markets of World War 2.  While there were jobs,
Terrence Deacon explores how constraints on dynamic flows can induce emergent phenomena which can do real work.  He shows how these phenomena are sustained.  The mechanism enables the development of Darwinian competition. 
access to family housing was constrained
: FHA is either the:
  • Federal Health Architecture an E-Government Line of Business initiative managed by the ONC, or the  
  • Federal Housing Administration. 
'red-lining' of unstable areas - as blacks began entering a residential area whites would start migrating to the suburbs and the area would be designated unstable - denied mortgage financing to the black migrants.  And racial segregation was even more extreme in the suburbs, enforced by government loan policies and 'redlining' by local bankers. 

The US was able to support a doubling of population between 1950 and 2015 while Europe's growth was less than 20%.  The American middle classes left the city centers leaving them isolated and containing African American populations in ghettoes.  The
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
US provided a mansion subsidy
tax deduction that grew with the size and expense of a home.  The developments also leveraged the much more rapid deployment of cars in the US.  All levels of US government subsidized construction of urban expressways.  These provided the links back from the suburban housing to city shops.  In the mid-1950s regional shopping centers and malls were deployed.  Shopping malls provided: Plentiful parking, On site security, Delivery tunnels and loading courts, and Air conditioned stores usable year round.  This trend undermined the less efficient older city shopping areas.  In cities without public transportation city stores closed. 

As large parts of the population of industrial northern (mid-western) states migrated to suburbs and warmer situations in the south and southwest the cities populations collapsed along with the industry. 

Gordon notes how energy inefficient the eventual distribution of American households has become.  They are geographically spread out and dependent on cars to remain connected.  And he asserts that the US is cordoned off into a multiplicity of local governing units that allow the most prosperous citizens to avoid transferring financial resource to poorer districts.  This has undermined public school funding contributing to a vicious cycle of increasing inequality. 

See the USA in Your Chevrolet or from a Plane Flying High Above
Gordon argues post war prosperity depended on:
By 1970 progress was being undermined:
  • During the period 1970 to 2010 there remained two cars per family.  Growth from automobiles slowed to replacement rates.  
  • Vehicle miles per person grew at 6.2% between 1950 and 1980.  From 1980 onwards it was 1.1%
  • US car manufacturers lost market share & position.  And with huge volume of deployed cars pollution was becoming a significant issue.  
  • Air travel also grew significantly: 32% from 1940 to 1960, 16.5% from 1960 to 1980, and 7.8% from 1980 to 2000; until 2000 when it grew at 0.6%

Entertainment and Communications from Milton Berle to the iPhone
Gordon explains that television dominated the mass communication innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
post-1940.  It entered living rooms at an exceptional rate, leveraging infrastructure developed to support: radio, newspapers, recorded music: records, Walkman, digital CDs allowing mobility and personal focus; motion pictures; driving these other communication media to
This page reviews the implications of selection, variation and heredity in a complex adaptive system (CAS).  The mechanism and its emergence are discussed. 
evolve
.  Printed news has struggled with its lack of immediacy.  Television news became highly significant before losing share to laptop, desktop computer and smartphone delivered news. 

Personal communications also evolved dramatically: mobile phones in the 1980s enabling mobilization, reaching average Americans in the 1990s and then transforming into the highly
This page discusses the effect of the network on the agents participating in a complex adaptive system (CAS).  Small world and scale free networks are considered. 
networked
and
To benefit from shifts in the environment agents must be flexible.  Being sensitive to environmental signals agents who adjust strategic priorities can constrain their competitors. 
flexible
smartphone in the 2000s.  Gordon notes problems introduced by cell phones: intrusion, addiction,

Television also improved: quality (bigger screens, better images, thin screens, lighter, higher energy efficiency, more robust with less repairs), color, cable channels, VCR, DVR; with improvements continuing through to 2014. 

The rapid innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
in entertainment and communications is in contrast to food, clothes, dwellings and travel.  It has continued to get faster with digitization in the 1990s transforming its meaning: digital devices including iPods, streaming services, smartphone services and applications. 

Computers and the Internet from the Mainframe to Facebook
Computer performance has
Brynjolfsson and McAfee explore the effects of Moore's law on the economy.  They argue it has generated exponential growth.  This has been due to innovation.  It has created a huge bounty of additional wealth.  But the wealth is spread unevenly across society.  They look at the short and long term implications of the innovation bounty and spread and the possible future of technology. 

Following our summary of their arguments RSS comments from the perspective of CAS theory. 

improved exponentially ever since the 1960s
.  The Internet further supported analysts' arguments that economy-wide progress was the fastest in history and would continue to improve.  Gordon disagrees, noting that computers contribute only 7% to the total GDP is:
  • Gross domestic product which measures the total of goods and services produced in a given year within the borders of a given country (output) according to Piketty.  Gordon argues to include products produced in the home & market-purchased goods and services, following Becker's theory of time use.  Gordon stresses innovation is the ultimate source of all growth in output per worker-hour.  GDP growth per person is equal to the growth in labor productivity + growth in hours worked per person.  GDP has many problems.  Gordon concludes that between 1870 and 1940 all available measures GDP is hugely understated because:
    • GDP is a poor measure of:
      • Value & wealth
      • Who gets what
      • Global supply chains
    • GDP excludes:
      • Reduction in infant mortality between 1890 (22%) and 1950 (1%)
      • Brightness & safety of electric light,
      • Increased variety of food including refrigeration transported fresh meat and processed food
      • Convenience and economies of scale of the department store and mail order catalog and resulting product price reductions
      • Services by house makers
        • Time & health gains from having flush toilets, integrated sewer networks; rather than having to physically remove effluent and cope with fecal-oral transmission
      • Leisure
      • Costs & benefits of different length work weeks
      • Speed and flexibility of motor vehicles - which were not included in the CPI until 1935, after the transformation had occurred.  And competition from improved foreign vehicles, while it provides purchaser/user with improved standard of living (less breakdowns, repairs, etc.) is measured as reduced domestic manufacture
      • Coercion and corruption to obtain resources 
      • Consumption impact of finite resources: coal, oil;
      • Destruction impact of loss of entire irreplaceable species
    • GDP includes items that should be excluded:
      • Cost of waste - cleaning up pollution (single use indestructible plastic bags), building prisons, commuting to work, and cars left parked most of the time; should be subtracted
  • Guanine-di-phosphate is a nucleotide base. 
in 2014 and the effects are swamped by other aspects that are slowing down

A stream of innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
based on computing have occurred: mainframe computers, networked ATM is automated teller machine, supporting consumers by reducing the time for banking teller transactions and extending access to 24/7.   s & barcoding in 1960s, Calculators in the 1970s, Word processors, Personal computers in the 1980s enhancing personal productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
with word processing, spreadsheets and electronic mail, the Internet in 1990s finally allowing the networking of the American people, World Wide Web accessible on any Microsoft Windows 95 based computer through Internet Explorer, Search engines, Broadband home access deploying from 2000 to 2010, Electronic commerce which supported supply chain optimization by Wal-mart but later helped Amazon
This page reviews Christensen's disruption of a complex adaptive system (CAS).  The mechanism is discussed with examples from biology and business. 
disrupt
brick and mortar retailers. 

Internet access has transformed: Airline booking, hotel reservations, recorded music and movie access, encyclopedias; and enabled: e-commerce including Amazon with its irresistible Prime service, Social networking;

Gordon notes there have been problematic side effects of networked computing: Exacerbating inequality, Data overload, Distraction, Cost of technology when there are no positive effects. 

Antibiotics, CT Scans, and the Evolution of Health and Medicine

Gordon explains that after World War 2, medicine became a metaphor for progress.  Growth of life expectancy is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
slowed after 1940 due to its increasing dependency on marginal improvements amongst the elderly.  Prior success with infectious diseases meant that by 1945 two thirds of all deaths were attributed to chronic disease

A move away from public health is the proactive planning, coordination and execution of strategies to improve and safeguard the wellbeing of the public.  Its global situation is discussed in The Great Escape by Deaton.  Public health in the US is coordinated by the PHS federally but is mainly executed at the state and local levels.  Public health includes:
  • Awareness campaigns about health threatening activities including: Smoking, Over-eating, Alcohol consumption, Contamination with poisons: lead; Joint damage from over-exercise;
  • Research, monitoring and control of disease agents, processes and vectors by agencies including the CDC. 
  • Monitoring of the public's health by institutes including the NIH.  This includes screening for cancer & heart disease. 
  • Development, deployment and maintenance of infrastructure including: sewers, water plants and pipes.  
  • Development, deployment and maintenance of vaccination strategies.  
  • Development, deployment and maintenance of fluoridation. 
  • Development, deployment and maintenance of family planning services. 
  • Regulation and constraint of foods, drugs and devices by agencies including the FDA.  
to professional health care progressed with a focus in high-technology specialized hospitals:
  • Slowly improving outcomes
  • Rising costs 
America's uniquely flawed health financing system:
  • Deprived millions of access to medical care
  • Leaves diseases untreated
  • Sets death rate higher than necessary

Health care responses to heart disease is cardiovascular disease which refers to:
  • Conditions where narrowed and blocked blood vessels result in angina, hypertension, CHD and heart attacks and hemorrhagic/ischemic strokes.  Mutations of the gene PCSK9 have been implicated in cardiovascular disease.  Rare families with dominant inheritence of the mutations have an overactive protein, very high levels of blood cholesterol and cardiac disease. Other rare PCSK9 mutations result in an 88% reduced risk from heart disease.  Inflammation is associated with cardiovascular disease (Aug 2017). 
included: Control of hypertension is high blood pressure.  It is directly associated with death rate due to pressure induced damage to the left ventricle and in general to cardiovascular diseases.  Treated with antihypertensives: Diuretics, Calcium channel blockers, Angiotensin receptor blockers or Beta blockers.  , Effective ED is emergency department.  Pain is the main reason (75%) patients go to an E.D.  It has traditionally been part of an acute care hospital but recently is being deployed standalone as a catchment funnel to the owning hospital.  The EMTALA legislation requires E.D. treatment to stabilize every person seeking treatment by most hospitals.  Unreimbursed care is supported from federal government funds.  E. D. profitability has been helped by hospitals contracting with 3rd party companies who are able to improve margins through surprise billing.  The standalone E.D. competes with the positioning and brand power of lower cost urgent care clinics.  Commercial nature of care requires walk-ins to register to gain access to care.  With the focus on treatment of pain, E.D.s are a major distributor of opioids (5% of opioid prescriptions) and a major starting point of addiction in patients but are cutting back (Jun 2016). 
s, Deployment of specialized coronary care units;

During the 1960s commercial health care moved to capture profitable geographic niches producing areas of shining abundance as well as health care deserts - clear signals, is an emergent capability which is used by cooperating agents to support coordination & rival agents to support control and dominance.  In eukaryotic cells signalling is used extensively.  A signal interacts with the exposed region of a receptor molecule inducing it to change shape to an activated form.  Chains of enzymes interact with the activated receptor relaying, amplifying and responding to the signal to change the state of the cell.  Many of the signalling pathways pass through the nuclear membrane and interact with the DNA to change its state.  Enzymes sensitive to the changes induced in the DNA then start to operate generating actions including sending further signals.  Cell signalling is reviewed by Helmreich.  Signalling is a fundamental aspect of CAS theory and is discussed from the abstract CAS perspective in signals and sensors.  In AWF the eukaryotic signalling architecture has been abstracted in a codelet based implementation.  To be credible signals must be hard to fake.  To be effective they must be easily detected by the target recipient.  To be efficient they are low cost to produce and destroy. 
of growing US is the United States of America.   inequality. 
 
As heart disease deaths declined from 1963 to 2010 people lived longer and contracted cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).   which has proven far harder to constrain or treat effectively


Healing from war: early postwar innovations
Key innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
of the 1940s included:

Shift in focus: the campaigns against chronic diseases
Chronic disease became a clear priority: Heart attack is an AMI. It can induce cardiac arrest.  Blocking the formation of clots with platelet aggregation inhibitors, can help with treating and avoiding AMI.  Risk factors include: taking NSAID pain killers (May 2017).  There is uncertainty about why AMI occur.  Alternative hypotheses include:
  • Plaques started to gather in the coronary arteries and grew until no blood flow was possible.  If this is true it makes sense to preventatively treat the buildup with angioplasty. 
  • Plaques form anywhere in the body due to atherosclerosis and then break up and get lodged in the coronary artery and start to clot.  If this is true it makes sense to preventatively limit the buildup of plaques with drugs like statins or PCSK9 inhibitors. 
, Cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).  , Stroke is when brain cells are deprived of oxygen and begin to die.  750,000 patients a year suffer strokes in the US.  85% of those strokes are caused by clots.  There are two structural types: Ischemic and hemorrhagic.  Thrombectomy has been found to be a highly effective treatment for some stroke situations (Jan 2018). 
, Emphysema is the long term destruction of the tissues that support the shape and function of the lungs.  /bronchitis is an inflammation of the medium size airways in the lung.  It is defined clinically as a persistent cough with mucus.  , Cerebrovascular disease, Alzheimer's disease is a dementia which correlates with deposition of amyloid plaques in the neurons.  As of 2015 there are 5 million Alzheimer's patients in the USA.  It was originally defined as starting in middle age which is rare, so it was a rare dementia.  But in 1980s it was redefined as any dementia without another known cause. Early indications include mood and behavioral changes (MBI) and memory and thinking problems (MCI).  Variants include: late-onset sporadic; with risk factors - ApoE4, presenilin, androgen deprivation therapy (Dec 2015).  There are multiple theories of the mechanism of Alzheimer's during aging: Allen Roses argues that it is due to gene alleles that limit the capacity of mitochondria to support neuron operation; It may be initiated by: stress induced HHV-6a, HHV7 herpes activation (Jun 2018) and or an increasingly leaky blood-brain barrier; and a subsequent innate immune response to the infections (May 2016).  The Alzheimer's pathway follows:
  • Plaques form and set off the formation of tangled thread-like tau protein.
    • Solanezumab aimed to inhibit plaque formation but clinical trials failed (Nov 2016).  
    • BACE inhibitors block an enzyme needed to form amyloid. 
  • The Tau tangles kill nerve cells.  LMTX is a drug treatment targeted at these tangles. 
  • The brain becomes inflamed resulting in the killing of many more nerve cells. 
where the estimates may be too low. 

Heart disease is cardiovascular disease which refers to:
  • Conditions where narrowed and blocked blood vessels result in angina, hypertension, CHD and heart attacks and hemorrhagic/ischemic strokes.  Mutations of the gene PCSK9 have been implicated in cardiovascular disease.  Rare families with dominant inheritence of the mutations have an overactive protein, very high levels of blood cholesterol and cardiac disease. Other rare PCSK9 mutations result in an 88% reduced risk from heart disease.  Inflammation is associated with cardiovascular disease (Aug 2017). 
was and is at 24% of all deaths, the leading killer.  The CVD is cardiovascular disease which refers to:
  • Conditions where narrowed and blocked blood vessels result in angina, hypertension, CHD and heart attacks and hemorrhagic/ischemic strokes.  Mutations of the gene PCSK9 have been implicated in cardiovascular disease.  Rare families with dominant inheritence of the mutations have an overactive protein, very high levels of blood cholesterol and cardiac disease. Other rare PCSK9 mutations result in an 88% reduced risk from heart disease.  Inflammation is associated with cardiovascular disease (Aug 2017). 
rate peaked in 1965, at 55% of all deaths, but may be resurging in the 21st century supported by the broad health impacts of obesity

Heart disease and stroke is when brain cells are deprived of oxygen and begin to die.  750,000 patients a year suffer strokes in the US.  85% of those strokes are caused by clots.  There are two structural types: Ischemic and hemorrhagic.  Thrombectomy has been found to be a highly effective treatment for some stroke situations (Jan 2018). 
prevention focused on:
Heart disease treatment focused on:

Cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).   research and treatment actions have expanded and investments have increased hugely with little impact on rising death rates from cancer.  Since the early 1900s cancer had been treated with radiotherapy and surgery.  In the 1940s chemical weapons developed for the Second World War were focused on cancer treatment: nitrogen mustards.  By 1960 chemotherapy is the treatment of cancers by highly cytotoxic chemicals: Paclitaxel, Platinum, 6-mercaptopurine; assuming that cancer cells are unusually active and will be differentially poisoned.  It has been successful in offering treatments when no other course was available, but non-specificity means that healthy cells also get poisoned resulting in side effects which increase with age: Permanent nerve damage, heart failure (4-5%) and leukemia (0.5-1%). 
had produced remissions and cured patients with acute leukemia is a group of cancers of blood forming tissues: bone marrow, lymphatic network; where abnormal white blood cells are generated.  One type of leukemia is induced when TAD boundaries near the TAL1 gene fail allowing promotors from across the TAD border to distort the operation of the TAL transcription factor.  Mutation clusters common in leukemia have been identified in CHIP. 
and HL is Hodgkin lymphoma which is characterized by an orderly spread of the cancerous lymphocytes from one lymph group to the next.  It has a 95% survival rate.  Treatments can include:
  • PD-1 inhibitors such as nivolumab, because HL protects itself by signalling PD-1 to T-lymphocytes. 
  • Hematopoietic stem cell transplantation
  • Radiation therapy
  • Chemotherapy 
CT is computerized tomography in which a series of X-ray views taken from many angles are combined by computer processing to create 3-D images.  It is very useful for examining people who have been subject to trauma such as car accidents.  The high dose of radiation is a cause for concern with over use of CT scanning (Jan 2014).  The Banyan Brain Trauma Indicator blood test should help here. 
allowed greater detection of tumors, but it is very costly, and the high radiation dose can itself induce cancer.  By 1973 mammograms is an X-ray record of the breast used for screening and diagnosis of breast cancer.  Mammograms have become progressively more sensitive allowing detection of smaller tumors.  This has allowed aggressive treatment practices which may be counterproductive (Aug 2015).  Mammography policies are defined by: ACOG, ACS, NCCN, USPSTF; 
were in use. 

Gordon asserts that even with the $200 billion in funding from 1971 to 2004 due to the NCA is the national cancer act of 1971.  The determined advocacy of Mary Lasker convinced President Richard Nixon to support the bill and sign the act. It had driven $200 billion in funding to cancer research by 2004.  
, cancer innovations have been sparse since the 1970s. 

HIV is human immunodeficiency virus, an RNA retrovirus which causes AIDS.  It infects T-lymphocytes destroying the host's immune system. 
/AIDS is acquired auto-immune deficiency syndrome, a pandemic disease caused by the HIV.  It also amplifies the threat of tuberculosis.   Initially deadly, infecting and destroying the T-lymphocytes of the immune system, it can now be treated with HAART to become a chronic disease.  And with an understanding of HIV's mode of entry into the T-cells, through its binding to CCR5 and CD4 encoded transmembrane proteins, AIDS may be susceptible to treatment with recombinant DNA to alter the CCR5 binding site, or with drugs that bind to the CCR5 cell surface protein preventing binding by the virus.  Future optimization of drug delivery may leverage nanoscale research (May 2016).   was detected in the US is the United States of America.   in 1981.  Treatments were approved by the FDA Food and Drug Administration. 
by 1987: AZT which was of limited effectiveness, ART is an ARV therapy for H.I.V.  ART is a cocktail of drugs, such as the three in HAART, which prevents the virus from replicating leaving it dormant so AIDS does not develop. 
which makes HIV a chronic condition; for 1.2 million American sufferers. 

Transformations in public awareness of health issues
The altered perception of cigarettes:
  • From 1900 to 1960 there was a rapid expansion in the consumption of cigarettes, which were ubiquitous by 1950.  Use peaked in 1963 corresponding with the peak in cardiovascular disease.  
  • In 2016 the impact of cigarettes still costs $200 billion.   The poor still persist in smoking. 

Gordon explains that awareness of mental health increased during World War 2 with expanded military deployment of psychiatric medical officers.  Consequently psychiatry shifted from a focus on the insane to treating the general population's mental health.  This reduced the stigma that had previously constrained the seriously mentally ill from getting help. 

Gordon writes that air polution became a highly visible issue during the 1960s, culminating in the 1963 CAA is the clean air act of 1963.  It controlled air quality at the national level.  Air pollution laws followed.  The CAA amendments of 1970 expanded the mandate at the federal level and required federal and state regulations for stationary and mobile pollution sources. 
.  The CAA was updated in 1970.  This focus improved air quality which resulted in a significant (15%) of the 2.7-year improvement in life expectancy is a measure of the average life time of a new born baby.  Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group.  There are representational and data capture problems with the model:
  • Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person.  No adjustment can be made for increased wellbeing. 
  • Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
  • Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients.  For life expectancy calculations in subsequent years the impact is ignored.  
  • Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.  
  • Vital registration systems gather accurate data for life expectancy.  But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys. 
between 1980 and 2000. 

Accidents and violence
The massive increase in the number of cars caused the most significant increase in accidents.  Over time better highways, and effective safety equipment: bumpers, seat-belts, air-bags; helped reduce the associated death rate.  


The homicide rate has cycled during the 20th century:
  • From 1960 to 1980 there was a flood of violence
  • Violence declined in the 1990s
  • Violence against women fell in the late 1970s & by 2009 was a fifth of the 1973 level
  • Violence trended down after 1990 (10.5 death per 100,000) to 5.5 deaths per 100,000 by 2000

Changes in the medical profession
Doctors succeeded in gaining professional autonomy by the 1920s.  They spearheaded the construction of new hospitals & formal training institutions

The profession successfully resisted the nationalization of health insurance, which has had a hugely detrimental impact on the US
The complexity and problems of the US Health network is described in terms of complex adaptive system (CAS) theory. 

The network:
  • Is deeply embedded in the US nation state. It reflects the conflict between two opposing visions for the US.  The emergence of a parasitic elite supported by tax policy, further constrains the choices available to improve the efficiency and effectiveness of the network.  
    • The US is optimized to sell its citizens dangerous levels of: salt, sugar, cigarettes, guns, light, cell phones, opioids, costly education, global travel, antibacterials, formula, foods including endocrine disrupters;
    • Accepting the US controlled global supply chain's offered goods & services results in: debt, chronic stress, amplified consumption and toxic excess, leading to obesity, addiction, driving instead of walking, microbiome collapse;
  • Is incented to focus on localized competition generating massive & costly duplication of services within physician based health care operations instead of proven public health strategies.  This process drives increasing research & treatment complexity and promotes hope for each new technological breakthrough. 
  • Is amplified by the legislatively structured separation and indirection of service development, provision, reimbursement and payment. 
  • Is impacted by the different political strategies for managing the increasing cost of health care for the demographic bulge of retirees.  
  • Is presented with acute and chronic problems to respond to.  As currently setup the network is tuned to handle acute problems.  The interactions with patients tend to be transactional. 
  • Includes a legislated health insurance infrastructure which is:
    • Costly and inefficient
    • Structured around yearly contracts which undermine long-term health goals and strategies.  
  • Is supported by increasingly regulated HCIT which offers to improve data sharing and quality but has entrenched commercial EHR products deep within the hospital systems. 
health care network


Laws, finance and organization of the health care network all reflected the priorities of the medical profession:
  • Providing the best clinical medicine to every sick patient
  • Enhancing the prestige and income of the profession
  • Protecting the autonomy of physicians
By 1938 the medical profession had gained power over pharmaceuticals with prescription requirements for:
  • 12% of pharmacy sales in 1940
  • 40% of pharmacy sales by 1965
  • Drug company's marketing and sales strategies shifted from a consumer focus to targeting physicians.  By 1960 60% of the advertising budget of the 22 largest pharmaceutical manufacturers was dedicated to physicians. 
The profession became increasingly specialized over this time period:
  • Specialists salaries were much larger so
  • Training physicians chose to specialize
    • 24% in 1940
    • 69% in 1966
  • Resulting in
    • Doctors becoming increasingly disconnected from patients which started to reduce patient's trust and doctors political influence. 
      • The AHA is the American_hospital association. 
        boosted its relative power with a patients bill of rights.  
      • The extremely male medical profession was viewed as paternalistic and condescending to women.  The women's movement demanded more say in treatment decisions. 
    • Increased coordination issues
    • Increased costs

Electronics, Technology, and the most recent medical innovations
Gordon concludes that technology has been over-applied in health care:
Gordon sees technology and specialization trends as interlinked and adding to the increasing cost of health care.  Specialists have become more focused on pathology and consequent scientific recognition, rather than clinical interventions.  Clinicians have less opportunity to contribute and most of their patients, except for the terminally ill, are not interested in participating in trials. 

Hospitals: Gleaming palaces of science and waste
The Hill-Burton Free and Reduced-Cost Health Care act of 1946 gave health facilities including: Hospitals: General, Long-term care, Mental; Nursing homes, Outpatient facilities, Public health centers; grants and loans for construction and modernization.  It specified administration through the HRSA.  It was amended by Congress in 1954 to cover development of nursing homes. 
act initiated a massive build out of hospitals that supported growth of admissions that continued until the 1980s.  Gordon explains that Medicare & Medicaid based 3rd party health insurance removed cost constraints from hospitals which expanded staffing: Enabling growth in surgery; & equipment: Diagnostic X-ray, Clinical labs, Recovery rooms, ICU is intensive care unit.  It is now being realized that the procedures and environment of the ICU is highly stressful for the patients.  In particular sedation with benzodiazepines is suspected to enhance the risk of inducing PTSD.  Intubation and catheterization are also traumatic.  Sometimes seperated into MICU and SICU.  eICU skill centralization may bring down costs. 
s; to become 'technological emporiums'. 

This growth in services was matched by growth in costs that resulted in rampant medical cost inflation. 

During the 1970s and 1980s hospitals became more profit oriented.  Gordon argues that this resulted in huge duplication of services between competing hospitals, making the network even less efficient, but highly optimized to extract profits from reimbursements is the payment process for much of US health care.  Reimbursement is the centralizing mechanism in the US Health care network.  It associates reward flows with central planning requirements such as HITECH.  Different payment methods apportion risk differently between the payer and the provider.  The payment methods include:
  • Fee-for-service,
  • Per Diem,
  • Episode of Care Payment, 
  • Multi-provider bundled EPC,
  • Condition-specific capitation,
  • Full capitation.  
.   There was little focus on prevention or community education.  Hospitals focused on serving affluent suburbs.  These would develop next to medically abandoned neighborhoods with no: Doctors, Public Health is the proactive planning, coordination and execution of strategies to improve and safeguard the wellbeing of the public.  Its global situation is discussed in The Great Escape by Deaton.  Public health in the US is coordinated by the PHS federally but is mainly executed at the state and local levels.  Public health includes:
  • Awareness campaigns about health threatening activities including: Smoking, Over-eating, Alcohol consumption, Contamination with poisons: lead; Joint damage from over-exercise;
  • Research, monitoring and control of disease agents, processes and vectors by agencies including the CDC. 
  • Monitoring of the public's health by institutes including the NIH.  This includes screening for cancer & heart disease. 
  • Development, deployment and maintenance of infrastructure including: sewers, water plants and pipes.  
  • Development, deployment and maintenance of vaccination strategies.  
  • Development, deployment and maintenance of fluoridation. 
  • Development, deployment and maintenance of family planning services. 
  • Regulation and constraint of foods, drugs and devices by agencies including the FDA.  
, Preventative Care; University of Chicago Medical Center is located in the violent, poor, South Side of Chicago.  It closed its trauma center in 1988 and none has replaced it in the neighborhood. 

Assessing the value of extended lives
Inequality imbalances persist. 

Some medical technology has provided substantial benefits at no cost:
Extending old age has resulted in increasing chronic degenerative diseases: Cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).  , Alzheimer's disease is a dementia which correlates with deposition of amyloid plaques in the neurons.  As of 2015 there are 5 million Alzheimer's patients in the USA.  It was originally defined as starting in middle age which is rare, so it was a rare dementia.  But in 1980s it was redefined as any dementia without another known cause. Early indications include mood and behavioral changes (MBI) and memory and thinking problems (MCI).  Variants include: late-onset sporadic; with risk factors - ApoE4, presenilin, androgen deprivation therapy (Dec 2015).  There are multiple theories of the mechanism of Alzheimer's during aging: Allen Roses argues that it is due to gene alleles that limit the capacity of mitochondria to support neuron operation; It may be initiated by: stress induced HHV-6a, HHV7 herpes activation (Jun 2018) and or an increasingly leaky blood-brain barrier; and a subsequent innate immune response to the infections (May 2016).  The Alzheimer's pathway follows:
  • Plaques form and set off the formation of tangled thread-like tau protein.
    • Solanezumab aimed to inhibit plaque formation but clinical trials failed (Nov 2016).  
    • BACE inhibitors block an enzyme needed to form amyloid. 
  • The Tau tangles kill nerve cells.  LMTX is a drug treatment targeted at these tangles. 
  • The brain becomes inflamed resulting in the killing of many more nerve cells. 
; with the quality of life dropping during the years gained.  Some offsetting benefits: hip replacements, air quality; but a lack of low-tech, 'high touch' solutions.  Gordon suspects that given a choice many would choose: Less, but better years. 

Breast cancer is a variety of different cancerous conditions of the breast tissue.  World wide it is the leading type of cancer in women and is 100 times more common in women than men.  260,000 new cases of breast cancer will occur in the US in 2018 causing 41,000 deaths.  The varieties include: Hormone sensitive tumors that test negative for her2 (the most common type affecting three quarters of breast cancers in the US, BRCA1/2 positive, ductal carcinomas including DCIS, lobular carcinomas including LCIS.  Receptor presence on the cancer cells is used as a classification: Her2+/-, estrogen (ER)+/-, progesterone (PR)+/-.  Metastasis classes the cancer as stage 4.  Genetic risk factors include: BRCA, p53, PTEN, STK11, CHEK2, ATM, GATA3, BRIP1 and PALB2.  Treatments include: Tamoxifen, Raloxifene; where worrying racial disparities have been found (Dec 2013).  International studies indicate early stage breast cancer typed by a genomic test: Oncotype DX, MammaPrint; can be treated without chemotherapy (Aug 2016, Jun 2018)
interventions did not achieve a cost benefit. 

Raising the standard of living goes beyond increasing life expectancy
Some changes have improved the quality of life while leaving life expectancy unchanged:
  • Replacement surgery has steadily improved: better techniques and materials enabling 719,000 total knee replacements and 332,000 total hip replacements. 
  • Birth control pill is transformational.  Mexican yam was developed by Gregory Pincus & Planned Parenthood's founder Margaret Sanger into a pill, which was trialed in Puerto Rico in mid 1950s.  The pill gained FDA Food and Drug Administration. 
    approval in 1960.  In 1965 consenting couples allowed to use pill based on privacy rules.  By 1972 all citizens given the right to use the pill.  The effect was to reduce family size and help women to enter the work force. 
  • Fluoridation initiated in 1945 in Grand Rapids Michigan.  Evanston Illinois followed in 1946.  Test trials of effect on tooth decay were highly successful.  Fluoridation was adopted as a public health policy reducing decay by 56%.  64% of the US population in 2016 fluoridated. 
  • Pfizer developed Viagra.  

Paying for healthcare
Gordon quotes from Pozen & Cutler's comparative study of health care cost benefits:
Gordon asserts the high costs and inefficiency are
This page discusses the impact of random events which once they occur encourage a particular direction forward for a complex adaptive system (CAS). 
frozen accidents
and
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
evolved amplifiers
starting with the:

Work, Youth, and Retirement at Home and on the Job
Gordon explains that by 1940 working and home conditions have vastly improved due to a one off transformation after farm families migrated to urban settings:
Farm work declined from 20% in 1940 to a 2% plateau between 2000 and 2013 with the jobs replaced by machines.  Manufacturing jobs peaked at 30% in 1953.  In the 1980s global supply and machines replacing labor induced a rapid drop until by 2015 manufacturing jobs were just 10%. 

Due to active job discrimination women could not migrate en-mass from the home to working in the marketplace until the 1960s and 1970s.  At that point this non-recurring productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
improvement started along with increased educational attainment. 

Child labor had been replaced by universal high school education.  The completion rate climbed to 75% in 1970.  But the poor and minorities fail to complete high school and are left in minimum wage jobs.  The G.I. Bill is the Serviceman's Readjustment Act of 1944 (G.I. Bill) which provided benefits to soldiers returning from the Second World War: tuition payments and living expenses, low-cost mortgages, low-interest loans to start businesses and one year of unemployment compensation; acting as a major catalyst in generating human capital. 
catalyzed, an infrastructure amplifier.   college education making the US the leader.  Gordon notes the decline over the last two decades that left the US fifteenth in international comparisons.  And in recent years 40% of college graduates have not been able to find an appropriate job.  Gordon notes troubling recent trends that make education a headwind:
  • Percentage of males in college education has been falling: <50% in 1978
  • Real cost of college has been rising
  • Student debt, with draconian contractual conditions, has been rising to over $1 trillion. 
  • Appropriately skilled job availability has been falling, but job outcomes are still better for graduates on average - especially for engineers - and those with masters and doctorates. 

The lives of the elderly were revolutionized by the SSA is the social securities act of 1935 was part of the second New Deal.  It attempted to limit risks of old age, poverty and unemployment.  It is funded through payroll taxes via FICA and SECA into the social security trust funds.  Title IV of the original SSA created what became the AFDC.  The Social Security Administration controls the OASI and DI trust funds.  The funds are administered by the trustees.  The SSA was amended in 1965 to include:
  • Title V is Maternal and child health services. 
  • Title XVIII is Medicare.  
providing an adequate lifestyle and reducing elderly poverty from 35% in 1959 to 10% in 2003.  Medicare is a social insurance program that guarantees access to health insurance for Americans aged 65 and over, and younger people with disabilities and end stage renal disease or ALS.  Medicare includes:
  • Benefits
    • Part A: Hospital inpatient insurance.  As of Dec 2013 Medicare pays for home care in only limited circumstances, such as when a person needs temporary nursing care after a hospitalization.  Part A covers 20 days of inpatient rehabilitation at a SNF after discharge from inpatient care at a hosptial. 
    • Part B: Medical insurance
    • Part C: Medicare Advantage 
    • Part D: Prescription drug coverage The MMA prohibits Medicare from directly negotiating drug prices. 
  • Eligibility
    • All persons 65 years of age or older who are legal residents for at least 5 years.  If they or a spouse have paid Medicare taxes for 10 years the Medicare part A payments are waived. 
    • Persons under 65 with disabilities who receive SSDI. 
    • Persons with specific medical conditions:
      • Have end stage renal disease or need a kidney transplant. 
      • They have ALS. 
    • Some beneficiaries are dual eligible. 
    • Part A requires the person has been admitted as an inpatient at a hospital.  This is constrained by a rule that they stay for three days after admission.  
  • Premiums
    • Part A premium
    • Part B insurance premium
    • Part C & D premiums are set by the commercial insurer.  
added to the transformation in 1965.  The deployment of house based air-conditioning enabled these retirees to migrate to sunny southern destinations.  The percentage of retirement-aged people has risen due to immigration and birth trends over the decades.  The baby boomers started retiring in 2008 generating concerns over the financial stability of social security and the uncertainty is when a factor is hard to measure because it is dependent on many interconnected agents and may be affected by infrastructure and evolved amplifiers.  This is different from Risk.   introduced by defined contribution retirement plans.  The fiscal strains on Social Security, and Medicare were amplified by the Great Recession when many 401(k) owners converted their collapsed stock holdings into cash. 

Sources of faster & slower growth
Gordon explores:
Looking back at the details of labor, capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
and TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
during the period from 1920 to 1970 allows Gordon to characterize economic progress. 

Great Leap Forward from the 1920s to the 1950s: What Set of Miracles Created It?
Gordon explains that the Great Depression and the onset of the Second World War masked the underlying changes in economic progress.  But it is clear that huge spending from 1938 to 1945 occurred.  And as this stimulus curtailed in 1945 to 1947, the economy did not collapse. 

Gordon notes the important contribution of Hoover's National Bureau of Standards in catalyzing standardization of the components leveraged in the Second World War plants. 

Gordon argues that the investment in infrastructure and labor during the Great Depression:
The closing off of the US market to immigrants (Emergency quota act of 1921, limited immigration flows into the US.  It placed a 3% immigration quota of current US residents from a particular country.  After World War 1, economic collapse in Europe encouraged emigration.  The act was a response to the demobilization driven rise in unemployment in the US.  One effect of the limits was to cut the number of foreign born midwifes who entered the country encouraging the shift from home to hospital based births. 
& Immigration act aimed to extend the emergency quota act in limiting immigration of Southern and Eastern Europeans into the US.  It also severely restricted the immigration of Africans, and banned Arabs and Asians.  It divided the implementation of immigration controls between the state department and the immigration and naturalization service.  It established consular control by mandating that no alien be allowed to enter the US without a valid visa issued by an American consular officer abroad. 
) and imported goods (Ford-McCumber & Smoot-Hawley raised import duties on over 20,000 imported goods.  It was signed into law by President Herbert Hoover in 1930.  ) likely improved the power of unions and increased wages between 1930 and 1960 adding to the Great Compression. 

Gordon demonstrates that World War 2 justified:
Education expanded via the G.I. Bill is the Serviceman's Readjustment Act of 1944 (G.I. Bill) which provided benefits to soldiers returning from the Second World War: tuition payments and living expenses, low-cost mortgages, low-interest loans to start businesses and one year of unemployment compensation; acting as a major catalyst in generating human capital. 
particularly for those educated between 1940 and 1950. But it can't logically contribute to the growth ramp from 1920 to 1950. 

Innovation: Can the Future Match the Great Inventions of the Past?
Gordon has already argued that the innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
of industrial revolution 3: Entertainment, Communications and networked computing; are less broad based than those of industrial revolution 2.  Now he explores the future by reviewing recent innovations and comparing them with future aspects of technology change that are widely judged as leading to an increased standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  .  Gordon views the current pace of innovation as frenetic but he judges the impact on labor productivity and TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
as limited. 

Gordon notes that in 1870 inventions were produced by individuals.  And he sees the situation returning to this paradigm around 1975: Bill Gates, Steve Jobs, Mark Zuckerberg; while the intervening years were dominated by industrial research labs.  Additionally he views the impact of industrial revolution 3 being concentrated in the period 1994 to 2004, with the subsequent decade slowing down.  Gordon accepts that techno-optimists see robots and artificial intelligence building a new surge in productivity growth and massive job destruction.  He subscribes to an alternative vision where these technologies slowly destroy jobs allowing the economy to maintain full employment while job types and catagories
This page reviews the implications of selection, variation and heredity in a complex adaptive system (CAS).  The mechanism and its emergence are discussed. 
evolve
and growth resembles the slow pace of 2004 to 2015.  But he sees globalization and outsourcing continuing to drive middle class opportunities to other countries undermining the wealth effect that supported growth

Innovation through history: the ultimate risk-takers
Gordon explains that capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
per worker accumulates because of the profits generated by successful innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
.  Technological change induced capital accumulation supports creation of machines and structures that enable invention.  Education and reallocation also support growth, but Gordon stresses they depend on innovation to generate the wealth is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker.  It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche.    that funds: staying in school or moving from a rural existence to an urban one. 

Gordon notes that from the end of the Roman era to the 1750s peasant life remained unchanged, constrained by the lack of wealth, from changing and innovating.  Gordon views the urban industries, which emerged from the innovations is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
of the 2nd industrial revolution, as generators of incentives that induced farm workers to change to urban life.  He views the inventors as risk takers and major contributors to economic growth.  Entrepreneurial innovation was, from 1870 to the early 1900s, the catalytic, an infrastructure amplifier.   vision of success and freedom while being an employee was to accept dependency and a moral failing.  By the 1920s corporate labs: IBM,
A government sanctioned monopoly supported the construction of a superorganism American Telephone and Telegraph (AT&T).  Within this Bell Labs was at the center of three networks:
  1. The evolving global scientific network. 
  2. The Bell telephone network.  And
  3. The military industrial network deploying 'fire and missile control' systems. 
Bell Labs strategically leveraged each network to create an innovation engine. 
They monitored the opportunities to leverage the developing ideas, reorganizing to replace incumbent opposition and enable the creation and growth of new ideas. 
Once the monopoly was dismantled, AT&T disrupted. 
Complex adaptive system (CAS) models of the innovation mechanisms are discussed. 

Bell Labs
, GM, GE; had become more significant innovators but by the 1980s Gordon asserts individual inventors were again key: Bill Gates & Paul Allen, Jobs, Bezos, Brin & Page, Zuckerberg.  Gordon sees the early US patent system as specifically & exceptionally designed to support individual invention, being: low cost, tradable through licenses and based on extending property rights.  The individual inventors in the 1980s leveraged the ease of setting up a corporation in the US instead of the protection of individual patents. 

Historical record: the growth of TFP
Gordon asserts that TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
was higher during 1920 to 1970 and 1994 to 2004 because of the implementation and extension of  the inventions of industrial revolution 2 and industrial revolution 3

Achievements to date of the third industrial revolution
The impact of industrial revolution 3 after 1994 was due to the catalysis, an infrastructure amplifier.   of computers finally networked together through the Internet, web browsing, search engines, and e-commerce and integrated seemlessly with digital voice by the smartphone in 2007.  Prior to this point the communications:
In the late 1990s digital network architectures supported effective integration of computer and telephony endpoints.  But Gordon laments most human activities are not affected by these innovations, unlike those of industrial revolution 2, because computers are not everywhere. 

Gordon suspects TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
will remain subdued in the future.

Could the third industrial revolution be almost over?
Internet integrated capabilities have been ubiquitous since 2004.  But Gordon notes:

Objective measures of slowing economic growth
Gordon sites evidence of slowing growth from 2004 to 2014:

Can future innovation be predicted?
Gordon sees some success in the past predictions of what would be invented in the future.  And he notes some inventions are now able to be forcasted and so their effect on TFP can be reviewed. 
Inventions that are now forecastable
Brynjolfsson and McAfee explore the effects of Moore's law on the economy.  They argue it has generated exponential growth.  This has been due to innovation.  It has created a huge bounty of additional wealth.  But the wealth is spread unevenly across society.  They look at the short and long term implications of the innovation bounty and spread and the possible future of technology. 

Following our summary of their arguments RSS comments from the perspective of CAS theory. 

Brynjolfsson, McAffee
and others promote four significant future advances is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
:
  1. Medical & Pharmaceutical Advances - Gordon notes medical technology success occurred in 1920 - 40, with technology advances between 1940 - 1980.  Since then the pace is slow and steady, except in mental disease where there could be a dementia is a classification of memory impairment, constrained feelings and enfeebled or extinct intellect.  The most common form for people under 60 is FTD.  Dementia has multiple causes including: vascular disease (inducing VCI) including strokes, head trauma, syphilis and mercury poisoning for treating syphilis, alcoholism, B12 deficiency (Sep 2016), privation, Androgen deprivation therapy (Oct 2016), stress, Parkinson's disease and prion infections such as Alzheimer's disease, CJD and kuru.  The condition is typically chronic and treatment long term (Laguna Honda ward) and is predicted by Stanley Prusiner to become a major burden on the health system.  It appears to develop faster in women than men.   bulge caused by the very slow progress resulting in huge Alzheimer's is a dementia which correlates with deposition of amyloid plaques in the neurons.  As of 2015 there are 5 million Alzheimer's patients in the USA.  It was originally defined as starting in middle age which is rare, so it was a rare dementia.  But in 1980s it was redefined as any dementia without another known cause. Early indications include mood and behavioral changes (MBI) and memory and thinking problems (MCI).  Variants include: late-onset sporadic; with risk factors - ApoE4, presenilin, androgen deprivation therapy (Dec 2015).  There are multiple theories of the mechanism of Alzheimer's during aging: Allen Roses argues that it is due to gene alleles that limit the capacity of mitochondria to support neuron operation; It may be initiated by: stress induced HHV-6a, HHV7 herpes activation (Jun 2018) and or an increasingly leaky blood-brain barrier; and a subsequent innate immune response to the infections (May 2016).  The Alzheimer's pathway follows:
    • Plaques form and set off the formation of tangled thread-like tau protein.
      • Solanezumab aimed to inhibit plaque formation but clinical trials failed (Nov 2016).  
      • BACE inhibitors block an enzyme needed to form amyloid. 
    • The Tau tangles kill nerve cells.  LMTX is a drug treatment targeted at these tangles. 
    • The brain becomes inflamed resulting in the killing of many more nerve cells. 
    driven medical costs.  Gordon notes analysts who conclude pharmaceutical research has stalled with a focus on niche problems and impacted by burdensome regulations Food and Drug Administration. 

  2. Small Robots & 3D Printing - Gordon notes technical drivers that are advancing robots: Moore's law, Gordon Moore characterized the two yearly doubling of the number of transistors in each new generation of integrated circuit. 
    , Electro mechanical design tools, Batteries, Data storage, Internet, Wireless LANs; to become cheaper and more capable.  He sees competitive and complemenary developments with humans.  Gordon sees the current limitations as remaining for some time: Workflow, in business processes define the movement of a case file between cooperating agents who when they possess the case perform the activities outlined in the flow to complete a process.  The flows and their control have been automated with workflow servers moving the case to the agents.  The flowchart style model of the automated flows does not typically reflect the true adaptive nature of the collaborative interactions of the agents.   approaches are not generally applicable but alternatives such as multi-function machine learning are also currently brittle, Balance is hard to sustain; so robot fitness in humanity's niche is Tooby & DeVore's theory that reflects a flexible competitive strategy, described by Steven Pinker, which leverages the power and flexibility of intelligence to defeat the capabilities of genetically evolved specialists focused on specific niches.   will remain limited.  Gordon sees 3D printing as a niche solution that will not transform US mass production. 
  3. Big Data encompasses the IT systems and processes necessary to do population based data collection, management and analysis.  Rather than depending on averages, analysis at Verisk drills down to specifics and then highlights modeling problems by identifying the underlying CAS.  For the analysis to be useful it requires a hierarchy of supporting BI infrastructure:
    • Analytics utilization and integration delivered via SaaS and the Cloud to cope with the silos and data intensive nature. 
    • Analytics tools (BI) for PHM will be hard to develop.  
      • Complex data models must include clinical aspects of the patient specific data, including disease state population wide.  
      • A key aspect is providing clear signals about the nature of the data using data visualization. 
    • Data communication with the ability to exchange and transact.  HIEs and EMPI alliance approaches are all struggling to provide effective exchange. 
    • Data labeling and secure access and retreival.  While HIPAA was initially drafted as a secure MPI the index was removed from the legislation leaving the US without such a tool.  Silos imply that the security architecture will need to be robust. 
    • Raw data scrubbing, restructuring and standardization.  Even financial data is having to be restandarized shifting from ICD-9 to -10.  The intent is to transform the unstructured data via OCR and NLP to structured records to support the analytics process. 
    • Raw data warehousing is distributed across silos including PCP, Hospital system and network, cloud and SaaS for process, clinical and financial data. 
    • Data collection from the patient's proximate environment as well as provider CPOE, EHRs, workflow and process infrastructure.  The integration of the EHR into a big data collection tool is key. 
    and Artificial Intelligence - is the core technology of Brynjolfsson et-al.'s arguments for transformation.  Gordon notes analysis to-date of most Big Data suggests use in marketing analysis by large corporations driving a competitive symmetric arms race.  But the exponential growth in data has not improved TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
    growth much because these technologies have not improved output per hour significantly. 
  4. Driverless Cars - Gordon views cars as initially transformational.  But he judges driverless cars as having an incremental effect on TFP is total factor productivity which represents the residual sources of growth once worker-hours and physical capital per worker-hour are accounted for.  It primarily reflects  the contribution of innovation and technological change, but must also account for the productivity generated when the large number of rural American farm workers in low-productivity jobs migrated to urban high productivity jobs while working less hours.  TFP is often equated to output divided by a weighted average of labor (0.7) & capital (0.3) input.  TFP 'typically' represents the portion of output that can't be explained by 'traditional' measures of labor and capital used in production.  But many aspects of productivity are missing from calculations of TFP: energy, workforce attributes, public infrastructure including highways; making 'total' a misnomer. 
    even while improving wellbeing is described by Angus Deaton as all the things that are good for a person:
    • Material wellbeing includes income and wealth and its measures: GDP, personal income and consumption.  It can be traded for goods and services which recapture time.  Material wellbeing depends on investments in:
      • Infrastructure
        • Physical
        • Property rights, contracts and dispute resolution
      • People and their education
      • Capturing of basic knowledge via science.  
      • Engineering to turn science into goods and services and then continuously improve them. 
    • Physical and psychological wellbeing are represented by health and happiness; and education and the ability to participate in civil society through democracy and the rule of law.  Life expectancy as a measure of population health, highly weights reductions in child mortality. 
    .  Driverless cars use immature technologies that are unreliable, and depend on hand-crafted workflows, in business processes define the movement of a case file between cooperating agents who when they possess the case perform the activities outlined in the flow to complete a process.  The flows and their control have been automated with workflow servers moving the case to the agents.  The flowchart style model of the automated flows does not typically reflect the true adaptive nature of the collaborative interactions of the agents.  .  Similarly driverless trucks do not provide the shelf stacking that drivers perform and target a limited niche of the US economy is the study of trade between humans.  Traditional Economics is based on an equilibrium model of the economic system.  Traditional Economics includes: microeconomics, and macroeconomics.  Marx developed an alternative static approach.  Limitations of the equilibrium model have resulted in the development of: Keynes's dynamic General Theory of Employment Interest & Money, and Complexity Economics.  Since trading depends on human behavior, economics has developed behavioral models including: behavioral economics.  

Inequality and other Headwinds: Long-Run American Economic Growth Slows to a Crawl

The first headwind: dimensions of rising inequality
Piketty & Saez show capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
and income has been migrating to the top 1% of the population since the 1970s.  Gordon suggests the diversion is due to: changes in tax policy, decline in union influence, increases in immigration and trade, automation has driven down wages for the bottom 90% by replacing middle class routine roles, education driven wage gains for college-educated workers and declining minimum wage.  He notes this transfer is modulated by tax transfers, but is still present (Aug 2018).  The transfer limits the wages and leverage obtainable from the bottom 99% of the population. 

Education as a source of growing inequality
Wages have grown for the highest educational achievers.  College completion has also grown for households in the top quartile of income distribution (1970 to 2013).  But with an increasing pool of educated workers competition has driven educated workers to move down market. 

Education as the second headwind
The US led the world in the percentage of youth completing college in the 20th century.  It has now dropped to 12th place.  Gordon describes a complex network that enables the wealthy and undermines the poor:
  • Gordon notes the elementary system is financed by property taxes which are funneled towards wealthy suburbs which provide effective facilities.  While other countries provide free education for 3 year olds the US does not. 
  • Growth in educational attainment is dropping: only 25% of high school students are effectively prepared for college. 
  • 40% of high school graduates enter two-year community colleges, and these have low graduation rates:
    • Attendees are working part time to fund their education
    • The preparation is poor  
  • College affordability is dropping and the poor fail to leverage the opportunities that do exist: 
    • The cost of a university education has increased at 3* rate of inflation since 1972.  State & local funding of higher education has declined.  Forcing students to borrow: US college debt > $1.2 Trillion.  
    • More than half of recent graduates did not find jobs needing college skills. 
    • High-achieving students from low-income families don't apply to the elite schools which can sponsor them and enhance their chances of a high paying job. 
  • Increasing student debt is also inhibiting graduation for the 99% due to two risks:
    1. Falling short of average income will undermine the graduate's ability to pay off the debt.  
    2. Failing to complete college leaves the dropout with low wage options and no way to pay off the debt.  
  • Demand for non-routine abstract cognitive skills has been dropping since 2000. 
This network undermines productivity growth. 

The third headwind: demography
The retirement of the baby boomers, and deindustrialization of under 55s, ensures hours worked per person will drop. 

The fourth headwind: repaying debt
With slowing population growth and more retirees and each one of them living longer, there will be fewer workers, making it harder to repay a growing national debt is a pool of payment promises developed to finance costly discrete and transient activities, Johnson & Kwak explain.  Repayments of the capital and interest are made regularly through mechanisms such as a sinking fund.  Charles Montague first setup such an indirect arrangement that allowed thirteen and a half million pounds in British war debt (using a million-pound loan serviced by 99 years of new excise duties sold to the public as annuities) to persist in 1693 and supported it with a sinking fund in 1696.  This strategy was viewed as scandalous by conservatives at the time.  The conservatives argued the debt should be liquidated but Montague's strategy allowed Britain to develop and sustain, until the 20th century, a triple-A fiscal reputation and allowed it to use financial leverage as a weapon of war.  Montague's strategy was enabled by the revenues Britain's merchants were obtaining from its developing global trade.  CAS theory looks at the pool as a collection of commitments to provide energy to the owners' of the promises. 
load:
And Gordon notes many states have significant unfunded pension liabilities

Gordon reports on Charles Murray's research that indicates that disappearing jobs have resulted in collapse of marriage and increasing social decline.  The educational and inequality headwinds interact generating a prediction of continuing slippage of the US in educational competitiveness. 

Gordon notes that globalization has been a significant issue:
  • Driving manufacturing plant closures and pushing workers into short term construction jobs. 
  • Supporting a shift in manufacturing jobs to right to work states, especially in the automotive industry.  
Gordon estimates the growth rates for productivity is the efficiency with which an agent's selected strategy converts the inputs to an action into the resulting outputs.  It is a complex capability of agents.  It will depend on the agent having: time, motivation, focus, appropriate skills; the coherence of the participating collaborators, and a beneficial environment including the contribution of: standardization of inputs and outputs, infrastructure and evolutionary amplifiers. 
and standard of living is the relative wealth, comfort, useable time, goods and necessities available to particular [classes of] people.  As illustrated for the US, it is affected by availability and quality of: employment, housing, tools for risk management, percentage of salary required to purchase essential items: food, clothing & its VDS; communications & entertainment, transportation, information and computerized network support, health care, leisure time, paid retirement and education; and the rate of inflation and GDP.  Gordon extends standard of living to include conditions of work inside and outside of homes.  for 2015 to 2040: Labor Productivity 1.2, Hours per Person -0.4, Real GDP is:
  • Gross domestic product which measures the total of goods and services produced in a given year within the borders of a given country (output) according to Piketty.  Gordon argues to include products produced in the home & market-purchased goods and services, following Becker's theory of time use.  Gordon stresses innovation is the ultimate source of all growth in output per worker-hour.  GDP growth per person is equal to the growth in labor productivity + growth in hours worked per person.  GDP has many problems.  Gordon concludes that between 1870 and 1940 all available measures GDP is hugely understated because:
    • GDP is a poor measure of:
      • Value & wealth
      • Who gets what
      • Global supply chains
    • GDP excludes:
      • Reduction in infant mortality between 1890 (22%) and 1950 (1%)
      • Brightness & safety of electric light,
      • Increased variety of food including refrigeration transported fresh meat and processed food
      • Convenience and economies of scale of the department store and mail order catalog and resulting product price reductions
      • Services by house makers
        • Time & health gains from having flush toilets, integrated sewer networks; rather than having to physically remove effluent and cope with fecal-oral transmission
      • Leisure
      • Costs & benefits of different length work weeks
      • Speed and flexibility of motor vehicles - which were not included in the CPI until 1935, after the transformation had occurred.  And competition from improved foreign vehicles, while it provides purchaser/user with improved standard of living (less breakdowns, repairs, etc.) is measured as reduced domestic manufacture
      • Coercion and corruption to obtain resources 
      • Consumption impact of finite resources: coal, oil;
      • Destruction impact of loss of entire irreplaceable species
    • GDP includes items that should be excluded:
      • Cost of waste - cleaning up pollution (single use indestructible plastic bags), building prisons, commuting to work, and cars left parked most of the time; should be subtracted
  • Guanine-di-phosphate is a nucleotide base. 
per Person 0.8, Median vs. Average -0.4, Median real GDP per Person 0.40, Real Disposable Income vs. GDP -0.10, Real Median Disposable Income per Person 0.30; seeing a continuing fall and increasing inequality.  

Gordon concludes that the forces driving rising inequality are powerful: globalization, robots, big data and artificial intelligence; will continue to erode middle-class jobs. 

America's Growth Achievement and the Path Ahead
Gordon concludes that 1870 to 1970 was a unique situation where many inventions happened and others reached their limits.  Subsequently American inventions show continued global dominance: software, organizational creativity; with eight of the ten most valuable companies located in the US.  They are supported by a sophisticated venture capital industry and government funded science.  R&D as a percentage of GDP is high.  The US dominiates pharmaceuticals.  It has a monopoly is a power relation within:
  • A state in which a group has enough power to enforce its will on other citizens.  If this is a central authority with a cohesive military, it can overpower other warlords and stabilize the society. 
  • An economy in which one business has enough share in a market segment to control margins to its advantage.  An economic monopoly can be broadly beneficial: AT&T monopoly, US patent monopoly rights;
position in top institutions of high education.  The US is not aging as fast as Western Europe and Japan.  But he views the four headwinds: inequality, education, demography, debt load; as undermining subsequent growth. 

Gordon reviews policy shifts that can improve equality of
  • Outcomes: Progressive taxes, Higher minimum wage, Earned income tax credit, Reduced incarceration, Drug legalization;
  • Opportunity: Expanded preschool education, More equitable financing of secondary and higher education, Limits on monopoly privileges; 
Gordon confronts demographic and fiscal headwinds with: Easier immigration for foreign-born graduates of US universities, Imposition of a carbon tax to fund equity adjustments to the tax system, expanded taxation to manage the growing national debt is a pool of payment promises developed to finance costly discrete and transient activities, Johnson & Kwak explain.  Repayments of the capital and interest are made regularly through mechanisms such as a sinking fund.  Charles Montague first setup such an indirect arrangement that allowed thirteen and a half million pounds in British war debt (using a million-pound loan serviced by 99 years of new excise duties sold to the public as annuities) to persist in 1693 and supported it with a sinking fund in 1696.  This strategy was viewed as scandalous by conservatives at the time.  The conservatives argued the debt should be liquidated but Montague's strategy allowed Britain to develop and sustain, until the 20th century, a triple-A fiscal reputation and allowed it to use financial leverage as a weapon of war.  Montague's strategy was enabled by the revenues Britain's merchants were obtaining from its developing global trade.  CAS theory looks at the pool as a collection of commitments to provide energy to the owners' of the promises. 
; although he accepts the fundamental nature of the causes limit fixes.  




This page introduces the complex adaptive system (CAS) theory frame.  The theory is positioned relative to the natural sciences.  It catalogs the laws and strategies which underpin the operation of systems that are based on the interaction of emergent agents. 
John Holland's framework for representing complexity is outlined.  Links to other key aspects of CAS theory discussed at the site are presented. 
Complex adaptive system (CAS) theory
views systems as composed of
Flows of different kinds are essential to the operation of complex adaptive systems (CAS). 
Example flows are outlined.  Constraints on flows support the emergence of the systems.  Examples of constraints are discussed. 
flows
, all far from equilibrium, moving between
Plans are interpreted and implemented by agents.  This page discusses the properties of agents in a complex adaptive system (CAS). 
It then presents examples of agents in different CAS.  The examples include a computer program where modeling and actions are performed by software agents.  These software agents are aggregates. 
The participation of agents in flows is introduced and some implications of this are outlined. 
agents
. Gordon provides detailed descriptions of flows and agents contributing to the US economy from 1870 to today. 

The US is the United States of America.   flows were part of a global transformation:

Gordon notes advantages that the US possessed in 1870.  These supported a powerful
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
evolved amplifier
:

The development of network integrated dwellings is judged a
This page reviews the catalytic impact of infrastructure on the expression of phenotypic effects by an agent.  The infrastructure reduces the cost the agent must pay to perform the selected action.  The catalysis is enhanced by positive returns. 
powerful amplifier
of innovation is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
from 1870 to 1940.  There were major changes in housing stock after 1940, with suburban housing tracts deployed of dwellings of increasing scale.  Government policy placed the developments farther from the old city centers.  The suburbs were integrated to the cities by superhighways requiring cars to commute in.  Rail networks were encouraged to wither away.  Through the 1950 to 80s period of the golden age, political constraints ensured capital flows associated with housing were limited to whites. 

The end of the Second World War saw the US is the United States of America.   dislodge the UK is the United Kingdom of Great Britain and Northern Ireland.   from the
The position and operations of different agents within a complex adaptive system (CAS) provide opportunities for strategic advantage.  Examples of CAS agents leveraging their relative positions are described. 
center of the global trade network
.  Europe's manufacturing base had collapsed and US goods flowed into the vacuum. 

Gawande notes how
Atul Gawande writes about the opportunity for a thirty per cent improvement in quality in medicine by organizing to deploy as agent based teams using shared schematic plans and distributed signalling or as he puts it the use of checklists. 

With vivid examples from a variety of situations including construction, air crew support and global health care Gawande illustrates the effects of complexity and how to organize to cope with it. 

Following the short review RSS additionally relates Gawande's arguments to its models of complex adaptive systems (CAS) positioning his discussion within the network of US health care, contrasting our view of complexity, comparing the forces shaping his various examples and reviewing facets of complex failures. 
checklists
used by teams have improved airline maintenance and flight crew procedures. 

Gordon views the mid-1960s as the start of reducing growth in output per person.  Viewing the global CAS network:

RSS is Rob's Strategy Studio asserts
The productivity of complex adaptive system (CAS) is reviewed.  The CAS and classical economic approaches are compared.  Important CAS aspects are highlighted:
  • CAS reflect the history of all the events of the network of agents and their environment 
    • The relevent economic history is reviewed
  • Chemical structures capture and preserve important recipes that allow agents to increase search/operational effectiveness and wealth & the system to be robust
  • Environment matched to system strategy: Superorganism and beetle
  • Cliodynamic models of historical agent networks allows a realistic assessment of productivity over a full network cycle 
    • The models must be matched to the proximate environment 
  • Internal failures of the agent network
  • Existential threats to the agent network 
Agents must dedicate: focus, time, coherence and skills; to productively generate wealth. 

CAS level productivity improvements are due to:
  • Meta ideas that can be reused and recombined
  • Isolated agents can be integrated into the current network during each growth phase, but cliodynamic assessments show agents are dropped again from the network during the decline phase of the cycle 
  • Network effects and leverage of power drive productivity improvements. 
Agent level productivity
  • Agent level productivity improvements of significance
    • More time: Increased light, reduced moving & travelling, quicker & better eating, reduced rework, motivated & effective
    • Weapons & armor
    • Power available: Driving flows & actions in required direction
    • Iterative theory & practice
    • Infrastructure & tools: catalytic reduction in cost of repeated operations
  • Agent level productivity improvements of limited effect
CAS productivity
is best understood when viewed over full cliodynamic cycles of a CAS

Gordon looks at the evolution of the food supply network.  While he sees it reflecting inequality Pollan's
Through the operation of three different food chains Michael Pollan explores their relative merits.  The application of complex adaptive system (CAS) theory highlights the value of evolutionary testing of the food chain. 
investigations
illustrate how the "industrial" fast food network enables: Choice, Speed; through leverage of fossil fuel enhanced growth of corn, but it needs metabolically toxic levels of: Fat, Sugar - which Gordon oddly defends, Salt; to sustain consumer interest and drive growth.  

The expansion of cigarette use was catalyzed, an infrastructure amplifier.   by their distribution to US is the United States of America.   and allied troops in both the First and Second World Wars. 
  • Smoking is being supported by similarly addictive vaping.  

Cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure.  It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA.  In 2010 one third of Americans are likely to die of cancer.  Cell division rates did not predict likelihood of cancer.  Viral infections are associated.  Radiation and carcinogen exposure are associated.  Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).   is a major problem but it seems likely it is due to a myriad of mutations which will require many limited scope solutions.   This has increased the risk of pharmaceutical business disruption

The expansion of mental health services treating the general population is necessary but typically problematic:
  • Brains are complex and poorly understood
  • Mental health problems are costly to cope with
  • Institutions find it difficult to ensure power is used humanely
  • Community alternatives require control of funds, but there are many situations where shortfalls undermine the network of support. The mentally ill are often incapable of championing their own cause.  Within a network of public organizations funding can easily be diverted or removed. 
Pinker
Computational theory of the mind and evolutionary psychology provide Steven Pinker with a framework on which to develop his psychological arguments about the mind and its relationship to the brain.  Humans captured a cognitive niche by natural selection 'building out' specialized aspects of their bodies and brains resulting in a system of mental organs we call the mind. 

He garnishes and defends the framework with findings from psychology regarding: The visual system - an example of natural selections solutions to the sensory challenges of inverse modeling of our environment; Intensions - where he highlights the challenges of hunter gatherers - making sense of the objects they perceive and predicting what they imply and natural selections powerful solutions; Emotions - which Pinker argues are essential to human prioritizing and decision making; Relationships - natural selection's strategies for coping with the most dangerous competitors, other people.  He helps us understand marriage, friendships and war. 

These conclusions allow him to understand the development and maintenance of higher callings: Art, Music, Literature, Humor, Religion, & Philosophy; and develop a position on the meaning of life. 

Complex adaptive system (CAS) modeling allows RSS to frame Pinker's arguments within humanity's current situation, induced by powerful evolved amplifiers: Globalization, Cliodynamics, The green revolution and resource bottlenecks; melding his powerful predictions of the drivers of human behavior with system wide constraints.  The implications are discussed. 

explains
how important uncompromised demonstrations of status is a publically accepted, signal that one possesses assets: wealth, beauty, talent, expertise, access & trust of powerful people; to be able to help others. 
were for reproductive success of hunter gatherers in the African savanna is the environment where hunter-gatherers primarily evolved.  Its grassland supported large herbivores that could be hunted.  Clumps of trees & rocks supported places to hide from large carnivores.  Streams and paths add to the signals enabling orientation. 
.  It is less clear that this strategy is a signal of effective health care even though it shows a hospital's effectiveness at gaining access to capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 


While Gordon's point about health care deserts is well made, his criticism of University of Chicago Medical Center is being resolved with Holly Cross Hospital's level 1 trauma center.  

Paying for health care introduces:
The Nixon administration's HMO strategy was modified by the Reagan administration to allow Wall Street to recapitalize hospital systems and capture profits. 

Stanford's Robert Sapolsky notes that a decline in the murder rate has been tightly associated with increased access to abortion services

The ACA was an oddly structured
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
evolved amplifier
since the individual mandate is ACA quality affordable care for all Americans.  It mandates community rating & essential health benefits.  It includes:
  • Subtitle A: Immediate improvements in health care for all Americans. 
  • Subtitle B: Immediate actions to preserve and expand coverage. 
  • Subtitle C: Quality health insurance coverage for all Americans.  Which reforms the health insurance markets and prohibits preexisting condition exclusions and forms of health status discrimination.  
  • Subtitle D: Available coverage choices for all Americans. 
  • Subtitle E: Affordable coverage choices for all Americans. 
  • Subtitle F: Shared responsibility for health care which mandates individuals and employers to pay for insurance.  
    • The employer mandate requires employers with more than 50 full-time workers to offer most of their employees insurance or face penalties. 
, copayments is a fixed payment for a covered service after any deductible has been met.  It is a key strategy of the ACA to make subscribers aware of the costs of treatment and to put pressure on high cost health services.  As such suppliers and providers are keen to undermine the copayment: value based health insurance, Paying the copayment (Oct 2015), Place on the USPSTF list of preventative services (Sep 2016);
and narrow networks - When all health insurance plans are comparable on line people are expected to choose narrower less costly plans.  This has the effect of encouraging providers and PCP to compete to be part of the narrow plan by reducing their charges and driving down the prices of the plans.  By limiting the number of providers/doctors offered in the plans the few that are included should get more business.  Across the US in 2015 39% of health plans offered in public exchanges are narrow (30 - 70% of areas providers) or ultra-narrow (30% or less of providers).  In large cities narrow networks are even more common.  Typically if consumers go outside of the choices offered in their narrow network they will be responsible for the high bills.  There are problems induced by narrow network constraints:
  • Queuing issues - while a surgeon and a hospital may be in-network other agents in an operation, such as anesthesiologists or anesthetists, may not have the same set of insurance contracts.  Even if a subset do, once these are allocated to a task the hospital must then manage a complex set of resource constraints to keep its ORs running.  If it does this by ignoring the 'out of network' status of these necessary resources the patient will be impacted by a high bill.  
  • Success is more likely when the plan maintains a broad list of PCPs but a narrow list of specialists and hospitals (Oct 2016). 
all induced frustration in the body of people provided with health care.  The wealthy is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker.  It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche.    people that were being taxed to fund the additional cost stream were similarly hostile to the law.  The ACA is the Patient Protection and Affordable Care Act amended by the Health Care and Education Reconciliation Act of 2010 (Obama care).  In part it is designed to make the health care system costs grow slower.  It aims to do this by: increasing competition between insurers and providers, offering free preventative services to limit the development of serious illnesses, constraining patients' use of expensive services, constraining the growth of payments to Medicare providers and piloting new ways for PCPs to manage patient care to keep patients away from costly E.D.s.  It funds these changes with increased taxes on the wealthy.  It follows an architecture developed by Heritage Action's Butler, Moffit, Haislmaier extended by White House OMB health policy advisor Ezekiel Emanuel & architect Jeanne Lambrew.  The Obama administration drafting team included: Bob Kocher; allowing it to integrate ideas from: Dartmouth Institute's Elliot Fischer (ACO).  The ACA did not include a Medicare buy in (May 2016).  The law includes:
  • Alterations, in title I, to how health care is paid for and who is covered.  This has been altered to ensure
    • Americans with preexisting conditions get health insurance cover - buttressed by mandating community rating and
    • That they are constrained by the individual mandate to have insurance but the requirement was supported by subsidies for the poor (those with incomes between 100 & 400% of the federal poverty line).  
    • Children, allowed to, stay on their parents insurance until 26 years of age. 
  • Medicare solvency improvements. 
  • Medicaid expansion, in title II: to poor with incomes below 138% of the federal poverty line; an expansion which was subsequently constrained by the Supreme Court's ruling making expansion an optional state government decision. 
  • Hospital Readmissions Reduction Program (HRRP) which was enforced by CMS mandated rules finalized in 2011 and effected starting Oct 2012.  
  • Medical home models.  
  • Community transformation grants support the transformation of low income stressed neighborhoods to improve their lifestyles and health. 
  • Qualifications for ACOs.  Organizations must:
    • Establish a formal legal structure with shared governance which allows the ACO to distribute shared savings payments to participating providers and suppliers. 
    • Participate in the MSSP for three or more years. 
    • Have a management structure. 
    • Have clinical and administrative systems. 
    • Include enough PCPs to care for Medicare FFS patient population (> 5000) assigned to the ACO. 
    • Be accountable for the quality and cost of care provided to the Medicare FFS patient population. 
    • Have defined processes to promote: Evidence-based medicine, Patient-centeredness, Quality reporting, Cost management, Coordination of care; 
    • Demonstrate it meets HHS patient-centeredness criteria including use of patient and caregiver assessments and individualized care plans.  
  • CMMI Medicare payment experimentation.  
  • Requirements that pharmaceutical companies must report payments made to physicians (Sunshine Act). 
  • A requirement that chain restaurants must report calorie counts on their menus. 
continues the costly focus on health care research, development and deployment instead of public health is the proactive planning, coordination and execution of strategies to improve and safeguard the wellbeing of the public.  Its global situation is discussed in The Great Escape by Deaton.  Public health in the US is coordinated by the PHS federally but is mainly executed at the state and local levels.  Public health includes:
  • Awareness campaigns about health threatening activities including: Smoking, Over-eating, Alcohol consumption, Contamination with poisons: lead; Joint damage from over-exercise;
  • Research, monitoring and control of disease agents, processes and vectors by agencies including the CDC. 
  • Monitoring of the public's health by institutes including the NIH.  This includes screening for cancer & heart disease. 
  • Development, deployment and maintenance of infrastructure including: sewers, water plants and pipes.  
  • Development, deployment and maintenance of vaccination strategies.  
  • Development, deployment and maintenance of fluoridation. 
  • Development, deployment and maintenance of family planning services. 
  • Regulation and constraint of foods, drugs and devices by agencies including the FDA.  
.  And the ACA left the MMA is:
  • The Medicare Modernization Act of 2003.  It includes Medicare part D, the Medicare prescription drug benefit, which constrains Medicare from negotiation of its drug prices and created MAC and RAC.  It was sponsored by Senator Bill Tauzin and implemented by Tom Scully.  
  • Mammalian meat allergy which is induced by a month prior tick bite that introduced the allergen alpha-gal.  About 1% of bitten humans develop the allergy & prevalence is increasing.  Humans & old world primates & monkeys don't make alpha-gal (Jul 2018).  Symptoms can include: hives, anaphylactic shock, low blood pressure. 
's constraint on Medicare is a social insurance program that guarantees access to health insurance for Americans aged 65 and over, and younger people with disabilities and end stage renal disease or ALS.  Medicare includes:
  • Benefits
    • Part A: Hospital inpatient insurance.  As of Dec 2013 Medicare pays for home care in only limited circumstances, such as when a person needs temporary nursing care after a hospitalization.  Part A covers 20 days of inpatient rehabilitation at a SNF after discharge from inpatient care at a hosptial. 
    • Part B: Medical insurance
    • Part C: Medicare Advantage 
    • Part D: Prescription drug coverage The MMA prohibits Medicare from directly negotiating drug prices. 
  • Eligibility
    • All persons 65 years of age or older who are legal residents for at least 5 years.  If they or a spouse have paid Medicare taxes for 10 years the Medicare part A payments are waived. 
    • Persons under 65 with disabilities who receive SSDI. 
    • Persons with specific medical conditions:
      • Have end stage renal disease or need a kidney transplant. 
      • They have ALS. 
    • Some beneficiaries are dual eligible. 
    • Part A requires the person has been admitted as an inpatient at a hospital.  This is constrained by a rule that they stay for three days after admission.  
  • Premiums
    • Part A premium
    • Part B insurance premium
    • Part C & D premiums are set by the commercial insurer.  
prescription drug pricing in place.  

The traditionally experimental nature of pharmaceutical drug development coupled with traditional intuitive diagnosis and treatment encouraged development of a highly constrained drug development and trial process.  Christensen describes the potential for the pharmaceutical business to
This page reviews Christensen's disruption of a complex adaptive system (CAS).  The mechanism is discussed with examples from biology and business. 
disrupt
and generate new value.  There is also the possibility to leverage the growth of precision models, diagnosis and treatments with a less onerous regulatory scheme: I-spy-2 trial is the investigation of serial studies to predict your therapeutic response with imaging and molecular analysis 2.  It aims to significantly reduce the cost, time and number of patients required for efficiently bringing new drug therapies to breast cancer patients who need them urgently. 
  • It:
    1. Uses tissue and imaging markers from individual cancer patients' tumors to determine eligibility, guide/screen promising new treatments and identify which treatments are most effective in specific tumor subtypes. 
    2. The trial's adaptive design allow the I-SPY 2 team to 'learn as we go,' enabling researchers to use data from patients early in the trial to guide decisions about which treatments might be more useful for patient who enter the trial later.  I-SPY 2 provides a scientific basis for researchers to eliminate ineffective treatments and graduate effective treatments more quickly. 
    3. The I-SPY 2 neoadjuvant treatment approach, where chemotherapy is applied prior to surgery, allows the team to evaluate tumor response with MRI before removing the 'evidence'.  This approach is as safe as treating after surgery, allowing tumors to shrink, and most importantly, it enables critical learning early on about how well treatments work. 
    4. Key to the trial's distinctive design, the team will screen multiple drug candidates developed by multiple companies--up to 12 different investigational drugs over the course of the trial.  New drug agents will be selected and added as those used initially either graduate to Phase III or are dropped for futility, based on their Bayesian predicted efficacy in targeted patient subgroups.  Not only does this enable an enormous improvement in efficiency but, by using only one standard arm for comparison throughout the trial, it also immediately saves 35% of the costs of standard Phase III trials. 
    5. The trial incorporates a robust informatics system that allows data to be collected, verified and shared real-time and to be accessed early and in an integrated fashion--enhancing and encouraging pre-competitive collaboration.  
  • By using the cellular signalling pathways as targets of 'targeted' therapies.  In I-SPY 2 the pathway information forms the basis of rationalized therapeutic guidance for patient selection, stratification and further exploration to find response-predictive biomarkers.  From an overview of gene mutations, gene copy number, gene expression as mRNA and protein and protein phosphorylation of both tumor and background tissue and blood a patient and tumor sub-group specific set of diagnostics and therapies.  The biomarkers include:
    • Standard, FDA approved, biomarkers to determine patient eligibility and allow randomization. 
    • CLIA biomarkers to aid hypothesis testing. 
    • Exploratory biomarkers to aid hypothesis generation. 
  • I-SPY 2 adaptively randomizes its iterative allocation of the initial/current patient population to either:
    • Existing standard of care or
    • Various experimental arms which eventually should graduate to phase III, or be abandoned, for some patient subgroup.  Abandoned arms are replaced by alternative experimental regimes in a new randomized arm.  Deciding to graduate or abandon uses Bayesian modeling.  That requires (1) a reasonable model that allows simulation to assess behavior and (2) a simulation.  Want to favor treatments that, on average, have superior interim results for specific biomarkers (patient segments).  Aim to graduate experimental treatments with the largest signature that is likely to benefit.  Graduate small signatures if it is unlikely that a larger signature benefits.  Want to evaluate many drugs and combinations. 
  • I-SPY 2 collects data from each patient:
    • Biomarkers (HR+/-, HER2+/-, MP1/2) -> 2(8) combinations but treated as 10 subgroups (1. All, 2. HR+, 3. HR-, 4. HER2+, 5. HER2-, 6. MP2, 7. HR-HER2-, 8. HR-HER2+, 9. HR+HER2+, 10. HR+HER2-;
    • MRI volume at baseline, 2, 4 & 6 months; 
    • pCR at 6 months;
    • Treatment. 
  • I-SPY 2 benefits:
    • Reduce the cost of bringing a drug from discovery to market. 
    • Reduce the time to conclusive results.
    • Reduce the number of patients needed to enroll in the trial.  There is a tenfold reduction for Phase III. 
    • Improve the pace of innovation. 
    • Improve the success rate of Phase III trials (85% vs. 25%)
    • Improve pre-competitive collaboration for applying molecular and protein pathway profiling and imaging in clinical trials. 
    • Improve the efficiency of drug evaluation and approval in concert with the FDA, and provide support for innovation in regulatory decision-making.  
, Pharmacogenomics studies how genes affect a person's response to drugs so as to develop personalized drug treatment plans, tailored to a person's specific phenotype.  The process optimizes the treatment process but there are barriers to its deployment:
  • Large scale clinical trials may test 20,000 individuals, but if a toxic response impacts only 0.1% of them there would only be 20 cases found which is often too few to identify the cause of the response.  Instead a process for capturing adverse drug reactions after approval and marketing must be used along with the ability to take a blood sample in these cases.  
  • Simplified studies on a subset of individuals that have the target allele should be cheaper but are unattractive to pharmaceutical companies which typically want to maximize their target market (Aug 2016).  
  • F.D.A. has not required genomic testing for most drug developments.  
  • Health care providers are being slow to use pharmacogenomics.  Often third-party payers are unwilling to reimburse the tests. 
  • Transportation to centralized laboratories for genomic testing causes delays which makes some drug therapy applications impractical.  An alternative solution would be to have a patient's EHR contain their genome sequence for immediate genomic implications.  
.  But the treatment transaction remains a challenge to simplify. 

Christensen
US healthcare is ripe for disruption.  Christensen, Grossman and Hwang argue that technologies are emerging which will support low cost business models that will undermine the current network.  Applying complex adaptive system (CAS) theory to these arguments suggests that the current power hierarchy can effectively resist these progressive forces. 
asserts
medical
This page reviews Christensen's disruption of a complex adaptive system (CAS).  The mechanism is discussed with examples from biology and business. 
transformation based on disruption
will leverage imaging, molecular diagnostics & EHR refers to electronic health records which are a synonym of EMR.  EHRs have strengths and weaknesses:
  • The EHR provides an integrated record of the health systems notes on a patient including: Diagnosis and Treatment plans and protocols followed, Prescribed drugs with doses, Adverse drug reactions;
  • The EHR does not necessarily reflect the patient's situation accurately. 
  • The EHR often acts as a catch-all.  There is often little time for a doctor, newly attending the patient, to review and validate the historic details. 
  • The meaningful use requirements of HITECH and Medicare/Medicaid specify compliance of an EHR system or EHR module for specific environments such as an ambulatory or hospital in-patient setting. 
  • As of 2016 interfacing with the EHR is cumbersome and undermines face-to-face time between doctor and patient.  Doctors are allocated 12 minutes to interact with a patient of which less than five minutes was used for recording hand written notes.  With the EHR 12 minutes may be required to update the record!


The development of generally intelligent robots requires advances on a broad series of fronts

Medical education, focused onto Johns Hopkins and Harvard's methods, has sustained educational flows and methods developed by the Prussians & English.  Christensen argues this is ripe for
This page reviews Christensen's disruption of a complex adaptive system (CAS).  The mechanism is discussed with examples from biology and business. 
disruption
.  Currently it
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
encourages specialization
including through loading debt onto the trainees. 

Gordon's conception of invention as powering capital accumulation aligns with Beinhocker's brilliant schematic analysis of wealth is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker.  It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche.   .  The transformation of the US is the United States of America.   additionally leveraged:

Gordon's view of the essential and risky nature of invention and inventors is reflected in Johnson's
Good ideas are successful because they build upon prior developments that have been successfully implemented.  Johnson demonstrates that they are phenotypic expressions of memetic plans subject to the laws of complex adaptive systems (CAS). 
Where Good Ideas Come From
, although Gordon concludes individual risk taking is important being driven by an entrepreneurial vision of Alger & later Bell & Edison, while Johnson stresses the value of cooperation.  The idea that jobs build problematic dependence is explored by Muhammad Yunus

The limited productivity benefits of the integrated communication and computing solutions is in part due to:
Integrated communication and computation with effective application trust models pioneered by Airbnb demonstrate that these inventions can provide more deeply and broadly innovative is the economic realization of invention and combinatorial exaptation.  While highly innovative, monopolies: AT&T, IBM; usually have limited economic reach, constraining productivity and supporting the use of regulation, or even its threat, that can drive their creations across the economy. 
services.  And the Internet Of Things aims to place network connected computers within all physical items. 

Retail transformation, reflected in Amazon's business strategies, forces us to question Gordon's assertion about retail

The
Charles Ferguson argues that the US power structure has become highly corrupt. 

Ferguson identifies key events which contributed to the transformation:
  • Junk bonds, 
  • Derivative deregulation, 
  • CMOs, ABS and analyst fraud,
  • Financial network deregulation,
  • Financial network consolidation, 
  • Short term incentives
Subsequently the George W. Bush administration used the situation to build a global bubble, which Wall Street leveraged.  The bursting of the bubble: managed by the Bush Administration and Bernanke Federal Reserve; was advantageous to some. 

Ferguson concludes that the restructured and deregulated financial services industry is damaging to the American economy.  And it is supported by powerful, incentive aligned academics.   He sees the result being a rigged system. 

Ferguson offers his proposals for change and offers hope that a charismatic young FDR will appear. 

Following our summary of his arguments, RSS comments on them framed by complex adaptive system (CAS) theory.  Once the constraints are removed from CAS amplifiers, it becomes advantageous to leverage the increased flows.  And it is often relatively damaging not to participate.  Corruption and parasitism can become entrenched. 

corruption of finance
and its ability to allocate capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty.  Capital includes: real property, financial capital and professional capital.  It is not immutable instead depending on the state of the society within which it exists.  It can be owned by governments (public capital) and private individuals (private capital). 
globally means that the financial sector will benefit from assisting in the disintermediation of the US economy.  But this will likely weaken the carrying capacity of the economy resulting in reduced ability to fund costly military and social welfare infrastructure.  The nation state will become more fragile. 

The
This page reviews the strategy of setting up an arms race.  At its core this strategy depends on being able to alter, or take advantage of an alteration in, the genome or equivalent.  The situation is illustrated with examples from biology, high tech and politics. 
evolved amplifier
that social media uses to encourage users to access the platform and give up their personal
Plans emerge in complex adaptive systems (CAS) to provide the instructions that agents use to perform actions.  The component architecture and structure of the plans is reviewed. 
memetic schemata
is continuing a power shift from the middle class to the 1%.  This power shift itself changes the schematic relationships that define wealth is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker.  It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche.   .  But the situation is unstable due to US economy's dependencies on the consumer activity of the collapsing middle class. 

Gordon's influential book describes his view that there have been a series of one time transformations that enabled high growth in the American economy is the study of trade between humans.  Traditional Economics is based on an equilibrium model of the economic system.  Traditional Economics includes: microeconomics, and macroeconomics.  Marx developed an alternative static approach.  Limitations of the equilibrium model have resulted in the development of: Keynes's dynamic General Theory of Employment Interest & Money, and Complexity Economics.  Since trading depends on human behavior, economics has developed behavioral models including: behavioral economics.  .  The arguments when contrasted with
Brynjolfsson and McAfee explore the effects of Moore's law on the economy.  They argue it has generated exponential growth.  This has been due to innovation.  It has created a huge bounty of additional wealth.  But the wealth is spread unevenly across society.  They look at the short and long term implications of the innovation bounty and spread and the possible future of technology. 

Following our summary of their arguments RSS comments from the perspective of CAS theory. 

Brynjolfsson & McAffee's
, frame the discussions of high technology and
The complexity and problems of the US Health network is described in terms of complex adaptive system (CAS) theory. 

The network:
  • Is deeply embedded in the US nation state. It reflects the conflict between two opposing visions for the US.  The emergence of a parasitic elite supported by tax policy, further constrains the choices available to improve the efficiency and effectiveness of the network.  
    • The US is optimized to sell its citizens dangerous levels of: salt, sugar, cigarettes, guns, light, cell phones, opioids, costly education, global travel, antibacterials, formula, foods including endocrine disrupters;
    • Accepting the US controlled global supply chain's offered goods & services results in: debt, chronic stress, amplified consumption and toxic excess, leading to obesity, addiction, driving instead of walking, microbiome collapse;
  • Is incented to focus on localized competition generating massive & costly duplication of services within physician based health care operations instead of proven public health strategies.  This process drives increasing research & treatment complexity and promotes hope for each new technological breakthrough. 
  • Is amplified by the legislatively structured separation and indirection of service development, provision, reimbursement and payment. 
  • Is impacted by the different political strategies for managing the increasing cost of health care for the demographic bulge of retirees.  
  • Is presented with acute and chronic problems to respond to.  As currently setup the network is tuned to handle acute problems.  The interactions with patients tend to be transactional. 
  • Includes a legislated health insurance infrastructure which is:
    • Costly and inefficient
    • Structured around yearly contracts which undermine long-term health goals and strategies.  
  • Is supported by increasingly regulated HCIT which offers to improve data sharing and quality but has entrenched commercial EHR products deep within the hospital systems. 
health care
which are key to understanding today's American
This page introduces the complex adaptive system (CAS) theory frame.  The theory is positioned relative to the natural sciences.  It catalogs the laws and strategies which underpin the operation of systems that are based on the interaction of emergent agents. 
John Holland's framework for representing complexity is outlined.  Links to other key aspects of CAS theory discussed at the site are presented. 
CAS





























































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integrating quality appropriate for each market
 
This page looks at schematic structures and their uses.  It discusses a number of examples:
  • Schematic ideas are recombined in creativity. 
  • Similarly designers take ideas and rules about materials and components and combine them. 
  • Schematic Recipes help to standardize operations. 
  • Modular components are combined into strategies for use in business plans and business models. 

As a working example it presents part of the contents and schematic details from the Adaptive Web Framework (AWF)'s operational plan. 

Finally it includes a section presenting our formal representation of schematic goals. 
Each goal has a series of associated complex adaptive system (CAS) strategy strings. 
These goals plus strings are detailed for various chess and business examples. 
Strategy
| Design |
This page uses an example to illustrate how:
  • A business can gain focus from targeting key customers,
  • Business planning activities performed by the whole organization can build awareness, empowerment and coherence. 
  • A program approach can ensure strategic alignment. 
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