Science Makes America Great, and President Trump's Budget Aims to Destroy It

President Trump's first budget proposal is calling for dramatic cuts to many agencies, including the National Institutes of Health (NIH), one of the leading funders of research in the USA - the NIH would face around a $6 billion cut (~20%). The NIH is the largest funder of medical research in the world, and back much of the medical research in universities and labs around the country. Many of the medications and treatments used today had their start in NIH grants, and key research leads to entire industries, such as what arose from the Human Genome Project. The NIH have a nice list of the value they add to society, the economy, and our lives, here.

In large part it's the Research and Development funding from the US federal government that makes the USA the global leader in technology. Studies demonstrate that funding at the R&D level result in up to $8.38 of economic activity 8 years later for each $1 invested - infrastructure debt, that supposedly we'll find $1 trillion for under the mattress, would be expected to show around $1.92 return per dollar within a few years, and about $3.21 over 20 years. 

By a factor of 3 or more, spending on basic R&D returns huge economic benefits to the country compared to infrastructure, and it's simply short sighted to cut. (Of course a functional infrastructure is also needed, hard to drive to your research lab without roads! But it's not a binary either/or choice - and 'infrastructure' like a pointless/counterproductive border wall will cost more than is saved with the NIH cuts) This has been something that every administration for over 40 years has recognised, and can be seen in data collected by the American Association for the Advancement of Science.

The Clinton years saw a massive rise in NIH spending, and we're reaping the benefit of that investment now. Even in the Bush through Obama years, while NIH remained flat (barring the ARRA boost), other agencies saw an increase. The cuts in the Trump budget are unprecedented in the last half century.

The smartest students from around the world come to US universities to study, both as undergraduates and researchers - and the US gains the best and the brightest of the rest of the world, and without paying the cost of raising those people. It's a huge net positive for the country, especially when those people stay, become citizens, and have children, as people tend to do when they are welcomed and given a chance to contribute. Those children of immigrants themselves are typically far more likely to contribute to the advancement of the country in science. Consider this statement from a Forbes article on immigrants:

A new study from the National Foundation for American Policy found a remarkable 83% (33 of 40) of the finalists of the 2016 Intel Science Talent Search were the children of immigrants. ... In fact, 75% – 30 out of 40 – of the finalists had parents who worked in America on H-1B visas and later became green card holders and U.S. citizens. That compares to seven children who had both parents born in the United States.

So this science spending results in economic returns of at least a factor of 8 within 8 years, and encourages smart, law abiding, company founding, job creating immigrants to come to the USA, have children who are then the most driven of their generation, will improve society and the economy decades from now, and make sure we can all retire well in a booming economy. Why would you destroy that?

Well allow me to answer that. It could be you are:

A) Ridiculously stupid and short sighted, utterly unaware, and uncaring, of the consequences
B) An idealogical zealot intent on destroying goverment at any cost
C) Racist and want to discourage immigration
D) Intent on damaging the tech industry out of spite
E) An agent of a foreign power intent on destroying the long term effectiveness of your enemy
F) All of the above

Given this current administration, it's 'F', with each person in it more of one of those than the other. Bannon and Miller are simply white supremacists and want to end all immigration, legal or not, to the country - they've literally said "legal immigration is the real problem". The tech industry has been vocal in its opposition to the Executive Order that has now been rejected by the courts twice, and by cutting science funding it harms them, despite the negative consequences to the country - a price the likes of Bannon would pay given he doesn't like the race of many Silicon Valley company CEOs. Price, as head of Health and Human Services, is a member of a group that is anti-vaccine - which is one of the greatest success stories in saving lives and health in the 20th Century. The President shrugged his shoulders last week claiming "Nobody knew that healthcare could be so complicated", which even for Donald Trump manages to rank as one of the dumbest things he's ever said (despite the pretty stiff competition). 

And then there's the 'agent of a foreign power' - Vladimir Putin must be giving himself a hernia from laughing so much at the self inflicted damage the USA (and the UK with Brexit) are inflicting on themselves. There's no proof it's a direct agent doing this, but "useful idiots" helped into positions of power are achieving what Russia and other unfriendly nations can only dream of.

While the administration has to get this budget through Congress (Republican controlled and so far they seem unwilling to stand up to even the most ridiculous of his behaviours, even when he literally fabricates a felony perpetrated by his predecessor.) but the President has lost on pretty much everything he's pushed as signature policies over the last 2 months (still waiting to be "so sick of winning"). Hopefully the worst of this will be stopped, but will only happen if Congress sees their own hides, or money to their constituencies, threatened. Sadly, 'upset scientists' is not a key demographic - at least not yet - and regardless of what happens here, it's clear that the President and his administration are intent on gutting one of the great American success stories of the last half century.

Science is global, it doesn't care about national boundaries, and published research is by definition known to all, not restricted to a few. Scientists want to educate children to be knowledgeable, thoughtful, inquisitive, and also work with the best and the brightest wherever they are, whatever their gender, religion, race, or country of origin. It's what's raised our life expectancy, our quality of life, our productivity, and our opportunities, and been part of what has kept the USA as a global leader. And all these things are antithetical to a group of people mired in the past, who are wanting to divide us based on religion and race, and destroy one of the most critical things that Made America Great.

What can we do? It's important that those who will vote on this budget know these cuts are counter productive. Call your House and Senate representatives, let them know this can't be allowed to pass in the budget. Make no mistake, there's no sense or logic in these cuts, and the country will be damaged because of them - and for the people proposing this, that's seemingly the intent.

Another One Bites the Dust

Hot on the heels of uBeam's apparent demo of a phone screen turning on, it seems there's been a change at the company. Their COO appears to have departed and become the EVP of Operations at Fitbit. Stunning that a C-level exec would leave when the company is on the verge of greatness, especially an Operations person who is not so much R&D but very much product delivery, exactly what you need when looking to transition to a new phase of growth. Here is one of the announcements of his joining the company from 18 months ago, along with then CFO Monica Hushen (who left the company last year).

Devine was one of the three executives, along with Taffler and Chandler, mentioned by name by the lead investor in his defence of uBeam in May last year as being key in the company's progress. All three have since left the company.

Per LinkedIn, this leaves Larry Pendergrass as the sole executive with significant industry experience. He joined last September, announced here.

uBeam - Still All Sizzle?

An eventful day yesterday on the uBeam front, with Meredith Perry finally giving a demo of uBeam technology and showing it charging a phone at the Upfront Summit - well more precisely showing a big box and then a light on a phone coming on if it was put in front of it. Essentially a slightly more glitzy version of the "All Things D" demo done in 2011, showing what 6 years and $25 million gets you.

Wireless charging of a phone thru the air. Woh. 👏 1st public demo ever @ubeam #UpfrontSummit pic.twitter.com/I6GZx7KDri

— Spencer Rascoff (@spencerrascoff) February 3, 2017

From what we see here, in my opinion, is proof that you can take a non-technical audience and baffle them with bullshit - if you want to know that the phone is charging, you need to do more than turn a screen on. Perhaps there is more not seen here, I'm just going on the info that's public, but you need to show voltage, current (at both transmitter and receiver to get efficiency), and the phone sitting in front of that panel for several minutes and see the actual charge level increase over time. But that isn't what they showed - and if it isn't, please enlighten me and tell me what is the difference between what's shown in that video, and what was shown at All Things D 6 years ago.

It seems at least some are not convinced and there are journalists taking a sceptical view, such as Axios (albeit promoted with a tweet that is more sensational than what was shown and the content of the article, and sadly is all that is quoted by most)

This is a science project that is clearly progressing, but not nearly finished yet.

Pretty faint praise after $25 million. There was also this interesting statement:

we're told Perry picked that particular Android for the demo because of its highly-visible charging icon

Why would that be mentioned so specifically by the company, and why does it make me raise an eyebrow?

Now, let's be clear, no-one ever said that transmitting power via ultrasound is impossible, of course it's possible - but is there a way to do so in a safe, efficient, and cost effective manner? That's the challenge, and in any practical sense it had never been shown publicly. In my opinion, it still hasn't. All that has been shown is a screen lighting up.

I'm sure uBeam now have potential funders lining up outside willing to throw money at them, based on this, even though nothing was really shown. And if I'm wrong about that, tell me what was shown that proves it works. What's the charge rate? How long to charge a phone? What is the efficiency? How does this line up with "4 meters, any angle, multiple devices, faster than a wire" touted before? Is it a safe and legal level? (OSHA now seems to have gone back to a 115 dB limit, not the 145 dB from a few years ago, I certainly hope there's no-one in the way of that beam, or there are any grating lobes giving the audience a facefull.)

Now the fact the phone charge indicator comes on proves they are charging at a minimum of 500mW (around 5 volts at 100 mA) needed on the USB port, which is awesome as that's enough to at least trickle charge a phone over about 10 hours. Or does it? Potentially you could access the Qi chipset on the phone to show the charging light when at <500 mW, or other similar bypassing of standard input methods, but in the end there's no way to know without looking at actual charge rate - which isn't shown in any form. If it works so well, I'm surprised those numbers aren't released - "more than 500mW" is a very straightforward statement to make. Or leave the phone in front of the transmitter and see it gaining battery level during the talk. But that would be too easy.

And at what efficiency? At 30% end-to-end it's incredible, at 1% it's very difficult to justify, at <1% it's ridiculous. We don't know those numbers.

How many devices can this charge at a time? What does the system cost? Can it track the phone? What happens at an angle? Was the beam always on, or did it switch on when it saw the phone? What were the safety measures to stop an always on-beam being pointed at someone accidentally? If this is the best case demo today, why were some people saying they had seen a similar working demo years ago? Weren't they moving to production 18 months ago? All questions still unanswered.

I'm really sad, of course, for the senior staff who just left the company over the last couple of months, and what I guess is the closure of the San Jose office (or that's how it appears if you check the LinkedIn profiles). Amazing they would leave just on the verge of a breakthrough like this, but more fool them I guess, what do they know? Passing by on the billions... 

Overall, with a skeptical eye, there's nothing new here. IMO, no significant new information, nothing to show commercial success or capability, and no path to a realistic product. But it won't stop investors from piling in without doing significant due diligence (investors, feel free to call me and prove me wrong), and it won't convince anyone with one iota of technical capability that there's more there than they thought a week ago. More of the same, move along.

For those of you with a technical bent, I'm including a more detailed analysis from what I saw in that demo below. Anyone non-technical, you may want to stop now.

Taking a technical look at what's there and bearing in mind this is with a lot of assumptions - the video shows an array that seems to be made up of a (approx) 30 by 30 collection of circular transmitters, and given what I see on stage it's about a 30 by 30 cm panel, so each is a 1 cm diameter cylinder. Very much like the Murata MA40S4S used in car parking sensors and available off the shelf at around $3 each in bulk. Of course they couldn't use them because that would be a $2700 transmitter BOM component right there, but let's use them as a starting point.

Assume 40 kHz, and let's say we can drive much harder because why not, something like 6 times more (120 volts p-p, or approx 16 dB in sound pressure) to be generous so that's 120 + 16 = 136 dB sound pressure level. They are circular, so we lose 2 dB from area, that's 134 dB out, across a 0.09 m², and at that level that means a peak pressure of 180 Pa and about 37 W/m² or actual 3.35 W transmitted. Incidentally the capacitance of those devices at 2550 pF means (at P=nCV²f) gives 1.3 kW (900 * 2550e-12 * 120 * 120 * 40e3) so right there is around 0.25% efficient on transmit at best, along with a one bar electric fire (update: this capacitance calculation is not correct, I need to update it). A few million people doing this every day means GW more generation capacity, so I hope I'm wrong or we better start building some power stations. (updated efficiency numbers below - a bit better than here, but still pretty awful).

As a side note, those values of amplitude, if I'm in the right ballpark, may avoid the worst effects of acoustic nonlinearity in the distances shown, but in my opinion (and that of physics), would result in nonlinearity if you tried to increase from there, decreasing efficiency considerably.

Now at 1 to 2 m distance you're probably looking at around 3dB loss in the air (pretty low, yay, but still 50% efficiency), so saying you get all of that power at the phone (about 5 by 10 cm) you'd have an focus gain of around 18 times (25 dB), so now we're at 156 dB (wow, that's loud). Now we convert back to electricity, let's say 30% efficient there (massively higher than the Murata MA40S4S), and around 90% on some awesome conversion electronics, it's about 27% conversion efficiency, and you now get to 450 mW to the battery which is almost enough to charge it. Let's go with that - yay we're charging a phone in about 11 hours. If I'm assuming low numbers, then divide that by about 5 to get a 5% overall rate and 90mW, maybe enough to turn on the charging light (and about 2 days to charge your phone, if you don't move it)

At what efficiency? 0.25% at transmitter (I'm ignoring some losses here, but they're minor in comparison to that capacitive loss), a further 50% in the air, and 27% at the receiver, and you've got 0.034% efficiency. (As noted earlier, not including non-linearity). At 12 c/kWh, that's $2 to charge your phone. Ouch. OK, I'm being mean, let's say it's 10x more efficient, it's 20 cents to charge your phone, only $70 per year done every day, still an ouch. And you can heat your room at the same time with a kW scale transmitter, that costs $7500 because of the high BOM and doesn't make you feel so bad about having spent $1500 on a toaster oven.

As an added note from the original post, I noticed on a Twitter feed that some there indicate that the transmitter seemed to be covered by some form of fabric, which looking again at the video you can see is there. This does not mean that ultrasound can pass through clothing, as was previously claimed, but a thin membrane that is significantly smaller than a wavelength and is of a low enough impedance material will not be 'seen' by the ultrasound, for example a mylar film on the order of 10s microns compared to around 8mm wavelength in air at 40 kHz will likely have a minimal effect. Just as with the membranes or meshes used on car parking sensors like the Murata mentioned above... 

I'll add to this as I have time to do so, and check my calcs for any mistakes. Comments welcome on why I'm wrong, and just a disgruntled former employee :)

Edit: Just an update to some of my numbers here. Looking at the Murata data sheet is seems that SPL was measured at 30cm, not at the source, so some modification needed to the calcs. Using Murata's published factors, a further ~10dB needs applied for the diffraction and absorption (BTW that's quite a good document on how those transducers work), so they could be producing as much as 130 dB at source, so I can reduce the applied voltage by a factor of around 3 to around 40 volts, and does reduce the capacitive loss to around 130 W for 3.35 W acoustic transmitted, meaning 2.5% efficiency in that portion of the calculation, so it's overall 0.34% efficient at best, not 0.034%. Yes, that means the sound field could be of greater intensity and higher power, however that would start to push it into the nonlinear regime, and also you'd then be beaming very high sound levels at that cameraman and of course they totally considered safety in this demo...

Interestingly, this means those Murata's can put out over the 115dB level mandated by OSHA, however I'd note that a) the Murata operate at a duty cycle of about 0.4% or less (20 cycle bursts until return signal at up to around 2 m, another good link on car parking sensors), and b) there is a single transmitter, that is as loud as it will get, and decay rapidly after that - unlike a phased array for power which operates at a 100% duty cycle and uses antenna gain to amplify the sound by a factor of several hundred.

Right vs Wrong

It's not about Right vs Left anymore.

It's about Right vs Wrong.

Old labels, old enmities over the trivial that we could afford when times were easy, don't apply anymore.

Everyone who knows right from wrong has to work together no matter what tribe we used to think we belonged to. 

We can't be divided, we have to stand up for the weakest and easiest targets, no exceptions.

Support those who stand for what's right, condemn those who promote and enable what's wrong. 

There's no hiding anymore, no more abdication of responsibility. This is where we learn who we really are. Don't disappoint your children.

Word of the Day

Kakistocracy

noun

Government by the least qualified or most unprincipled citizens.

How Do These Keep Becoming Things?

Two weeks ago the Consumer Electronics Show (CES) gave its yearly insight into the tech we'll all be getting to buy in the coming months and years. Companies reveal major products like cool new TVs with more pixels and better colours, the latest phones, new processors and things we actually use - and then there are the more bizarre things which continue to show that for every joke idea an engineer can come up with, there's a marketing manager who is dumb enough to run with it.

This year had a high bar to try to beat the previous competition, with the likes of Juicero and the June Oven, but the tech world rose to the challenge and brought us toothbrushes with AI, mirrors to tell you that you are not the fairest of them all, and my favorite being the smart hairbrush to help you brush better. All these paled in my reaction, however, to the incredible wonder that was forwarded to me today - Moodo, the smart home fragrance box.

Moodo is an electronic air freshener, programmable with a variety of scents, and you can even create your own scent with it and then share with others. Who wouldn't want to create their own 'Gardens of Isphahan' or 'Cozzzy' scents and share them? It's an amazing package, and only took three years from concept to delivery (well, promised delivery), where you just pop your Keurig style pods in (yay for the consumable business model!), and use the wifi connection to your smartphone app (of course) to dial in the aroma of your dreams from anywhere! Who wouldn't want one?

Now, at least they aren't asking for $700 or $1500 for it, the Indiegogo campaign seems to have it listed around $230 retail for each unit (only moderately outrageous but still pretty expensive for an air freshener), but only $140 or so if you are an Indiegogo 'early bird'. It's the $20 per set of four fragrances for the consumables where the money likely is, following the printer model of giving the printer itself away at cost or small profit, but charging heavily for the ink. Except a printer is actually useful.

Normally I'd say I can see the pitch to the VCs, who really weren't paying attention to the product but saw the consumable sales, the hockey stick revenue growth, and the smartphone/wifi/app nature of it and the cheque was written - but in this case it may not be so ridiculous. The parent company seems to be Agan Aroma/ADAMA Agricultural Solutions which produce chemicals and components for the fragrance industry, and so if they can sell their products direct to consumers at whatever x000% markup compared to industrial purchasers then it's a good deal. So this is something that really seems like a pointless product, but you can understand why the company pursued it. What I can't understand though, is why a company that supposedly has between 1000 and 5000 employees (according to LinkedIn) would use an Indiegogo campaign to get $50,000 of funding to promote it? Seems an odd mix of approaches, and I don't follow the combination of bootstrapping and larger company product promoter. I'll keep following the Indiegogo numbers, as of now 44 people have put in $8,726, let's see if it hits the goal by the end of the month.

Before I leave this topic, there's an update to the Juicero story from the first "How is this a Thing?" Fortune reports that Juicero's new CEO has slashed the price on their product from $700 to $400, after he remembered his Economics 101 class where someone said that you sell slightly more of a useless thing at $400 than at $700. Or was it that you take a loss on each but then make it up in volume? Still, I laughed at the report saying:

Dunn and his team made the decision to cut the cost now after running a test on Black Friday. They priced the machine for less than $400 and doubled their current number of users in one day.

Great, you went from 1 unit sold to 2, (though maybe that was the new CEO's granny feeling sorry for him). Still, you have to wonder about the journalist who didn't follow up on this obvious statement and ask "How many have you sold in total then?". Even if they got a "Can't release sales figures" answer, it takes it from a marketing piece to something more akin to journalism. Come on reporters, how can you build credibility if you can't even take a swing at softballs like that?

Consider the Lily

Once again there's a ton to write about - Brexit, Theranos, Energous, Erin Griffith's article on Ethics in Silicon Valley, and recent developments with uBeam, but a combination of work plus, hunting for a house, buying a house, getting contractors in, and moving, are eating up all my time. Hopefully next month things will be a little more settled and I'll be back to writing more like a post a week.

In the meantime, I wanted to cover the startup story of the moment, Lily Robotics. Lily is a drone company, promising a simple to use drone (throw it in the air, that's it), that follows you and uses a superb camera to take great videos and stills without a controller - ideal for sports enthusiasts to create videos of themselves doing cool stuff. It looks fantastic, with great demo videos and a strong demand. They raised $1 million in seed funding in mid-2014, and then in mid-2015 started taking pre-orders following some amazing videos and marketing - its pre-order list reached 60,000, at over $500 each, for around $34 million in pre-sales. At the end of 2015 they then raised a further $14 million in VC (no surprises - who wouldn't invest with pre-orders like that!)

Units were supposed to ship to customers in Feb 2016, but that was delayed until summer 2016 - no surprises as hardware is hard, give the newbies a break. Then it was delayed again, this time until December 2016 (time-to-carrot of around 6 months), but once again that date came and went, until suddenly last week they simply closed down with a message to their pre-customers that they were sorry, they couldn't manage to make it, but refunds were on offer. A sad tale, a startup that bit off more than it could chew, and ultimately had to close but sought to return the money to the customers and make them right. Sad until it became public that the same day they shut down, they were sued by the San Francisco DA for misleading business practices and false advertising.

I'll leave the other details to The Register, sUAS News, and the EEV Blog, and hone in on a couple of the most interesting points in this case. Remember that one of the key parts of fundraising is to get VCs to think that there are huge numbers of customers out there for your product, and so once you have 'traction', that they want to invest (de-risked is a term used, others simply wonder why you need a VC once you have customers and profits). If you plan on 'hacking' the system to get the VC money, then you aim to get customers - but what if you have no product to sell? Then go with pre-orders! Show the customer an imaginary future product you plan to make, play up the 'plucky little startup' card, and before you know it you've got $34m in sales and VC's knocking down your door, giving you all the money and time you need to make the product and get it to your customer.

That would be the (mostly) legal way to do it, tell pre-customers it's a planned product, tell them what you are showing them is "hoped for" or "aspirational" and do your best to hit it. Or you could simply show them a faked demo and video and hope you've got time to make it a reality by the date delivery is due - 'fake it til you make it' - and this is what the SFDA is claiming Lily did. In effect, it's a variation on what it appears Theranos and others did, except faking the demos to customers, not to investors (who are still likely defrauded, if this is true).

The customers were led to believe the company had more than it did through their promotional video of the Lily in action, however all was not what it seemed. From the SFDA complaint:

Lily Robotics did not have a single Lily Camera prototype that had all of the features advertised in the Promotional Video. Instead, its co-founders Balaresque and Bradlow, who were present during the filming, brought several prototypes to use during the filming. Some, which looked good on the outside but were not fully functional, were used only for “beauty shots.” Others had some functionality but did not look like the product being advertised. Some were able to film video but even those were merely Lily Camera prototypes with GoPro-branded cameras mounted on them.

This is an important point as it highlights something I've seen happen and I think is more prevalent than most want to believe - showing mockups as working devices, claiming many features and achievements in the product, yet not revealing that not only are they not currently available simultaneously in the same product, but that they may even be mutually exclusive. The analogy would be to claim that your company's new aircraft can fly at 90,000 feet, at Mach 1, with a range of 5000 miles, carrying a 100,000 lb load and leading people to believe it can do all at the same time, when that is impossible. It can be done to investors, though they should have the resources and experience to vet such claims, so let's do it to consumers instead - they're gullible and good natured, let's fleece them! 

Of course, I'm being cruel to Lily here, founders never think like that. They're all starry-eyed idealists just looking to follow their dreams and change the world, at worst you can say they are true-believers who wanted to make it all happen, but their reach exceeded their grasp. Let's forgive them, they tried and failed, but at least they tried. 

And then you read excerpts of emails from a Lily founder talking about their demo video:

Are you sure that the GoPro lens does not create a unique deformation/pattern on the image? I am worried that a lens geek could study our images up close and detect the unique GoPro lens footprint. But I am just speculating here: I don’t know much about lenses but I think we should be extremely careful if we decide to lie publicly.

The founder was worried that smart people would find out the demo was faked, and explicitly and in writing admits that they know they are lying. It's the equivalent of being found at the murder scene, covered in blood and carrying an axe, with a signed letter about how you have to be careful if you decide to kill someone with an axe. Despite knowing it was lying and fraudulent, they decided to go ahead with it anyway. Why? Because the funding 'game' is structured to incentivize exaggeration, fabrication, and lying, and to punish honesty. Honesty doesn't get you funded, lying does. When there's millions of dollars at stake (amounts that people kill for), why wouldn't someone tell a few lies, especially when if they succeed, no-one will ever know? And that part is critical - they didn't think they'd get caught, and why would they? How many startup founders have you heard of going to jail for this kind of thing?

A further question that springs to mind is why the VC firm that invested after the pre-sales didn't spot this during their due diligence. Surely they learned that the promo video didn't match what was shown? If they didn't, they were either lied to and also defrauded, or it smacks of incompetence if they missed it. If they did find it, then it's even worse, because they're then complicit in the deception. Faced with being labelled incompetent, fraudsters, or themselves defrauded, I wonder how long before the VC in question joins in the complaint against Lily and sues.

Which then brings the next question - who gets paid back first? Normally in liquidation the VCs get pain off first (preferred stock), but if there is debt then that has to be paid first. In suing to get back their $15m the VCs will have to wait behind the customers' $34m of refunds (who themselves are behind a $4m bank loan) - thus surprising the investors that for once, they aren't at the front of the line. This is something I expect we'll see more of later this year, from companies where debt and convertible debt are sitting ahead of the institutional investors. It will be interesting to see how the VC community reacts to these new circumstances, and how they explain it to their LPs.

As for the customers and their refunds? Apparently there is over $25m in the company accounts, with the accounts now frozen other than to pay employees and debts, so once there is at least a chance customers will get some money back. Glad to see consumer protections working, while we still have them that is...

Quick guide to spotting non-existent tech

I covered this earlier in a different post, but I wanted to highlight this list from an article in The Register, as a "Quick guide to spotting non-existent tech". Read the company press then go through this checklist when questioning their claims and whether there's more sizzle than steak.

• Refusing to give a launch date.
• Refusing to talk about the tech, claiming confidentiality or trade secrets.
• Using news of investments or hires as evidence of technological progress.
• Promoting itself on a big stage rather than in a small room.
• Offering a well-crafted message and vision but becoming immediately vague when pushed on actual details.
• Offering "exclusive access" – with restrictions.
• Confusing working hard with making progress.

What's interesting in this is how many of these points require a compliant press, many of whom prefer publishing hagiographies rather than investigative pieces - after all it's quicker, easier, and doesn't end up making enemies among some rich and well connected people. Look at the months and years of work it took for John Carreyrou to uncover what was happening at Theranos, all the lawsuit threats and denials by the company. Isn't it much easier to do a puff piece on Elizabeth Holmes and how she just wanted to save the world? Garrett Reim of the LA Business Journal tweeted a comment on this yesterday following an article on the Unethical Side of Silicon Valley by Erin Griffith (which I'll comment on in a separate post).

Many tech "writers" are guilty helpers. Praising unproven products & services just for a pat on the head from a big name investor or exec. https://t.co/F3JR6KyYii

— Garrett Reim (@garrettreim) December 29, 2016

This hits the nail on the head, though I think he may be being a little kind - and don't know which of the terms "enabling", "willfully ignorant", or "complicit" is more apt. That may sound harsh, but remember that the press is part of an ecosystem, and it's clear the incentives now reward them more for page views than accuracy or in depth reporting. They're supposed to be watchmen, but some are making money while choosing to look the other way.

How to improve this situation? All I can suggest is to follow the work of the good journalists, and ignore the 'work' of stenographers posing as reporters. Subscribe to the publications that do the hard work, and deny the others the benefit of claiming page views. In the end, money talks.

Edit: Here's another nice blog post on the "Anatomy of a Scam", specifically regarding Theranos.

Medical Ultrasound Systems Pt III, Where I Talk About Some of the Interesting Portable Devices That Are Now Available

I hope everyone had a great Christmas. Having taken a couple of days off, there were some questions that came in on the two previous posts I wanted to answer and give some decent answers to, mostly regarding the newer portable devices that are available. I have not personally used these devices so can only go by what I have read online and can estimate based upon images, specs etc, and am neither endorsing nor criticising. This is also not an exhaustive list.

First of all, new products testing out the new parts of the market are great, and I'm really glad to see them. For those of you who think that the "Cabal of Wicked Ultrasound Engineers" is trying to protect their vast and profitable market from cannibalisation, I can just say that there are so many imaging modalities and opportunities still to be exploited within ultrasound that as premium features migrate to lower cost systems, I have no doubt that the premium systems will add new features and still provide value at the high end. This will result in a larger market for ultrasound that is split into multiple segments and price points, which I think benefits patients as well as the entire industry and all the people in it.

So onto the products. First, Lumify. This is a handheld device from Philips for use with tablets, here's a basic review of one. They currently have three transducers, which look to be one each for cardiac, abdominal, and vascular. Both power and data use a micro-USB cable to the tablet, which seems to be Android only, I'm going to guess that Apple taking 30% of the price via the app-store is a product killer. Given they charge $199/mnth and up, I'm assuming (given a 36 month period which is usual) that purchase price is between $7000 and $10,000 but have no hard data one way or another on that. At that price, it would be cheaper to buy a tablet, pre-install the software, and sell it than pay the 30% Apple tax. As an aside, I'm surprised Apple don't have a program for hardware and larger companies to pay a smaller percentage or fixed fee in order to open up this type of market for their products.

It looks to use the standard micro-USB B connector, which means up to 480 Mbps data and depending on what they use for power can supply between 2.5 and 10W at 5 Volts from my reading of the spec. All power is supplied from the tablet/phone, which will limit the total usage time since a phone has around a 5Wh battery, and tablets maybe 30 Wh. Both tablet and phone will be using power as well for some computation, graphics, and display, all of which are big power draws. I posted a link to the Verasonics system specs in a previous thread, which noted between 8 and 100W supply, so you can imagine that use time will be severely limited between charges. Also note that the Verasonics system supplies up to 190V signals, so at 5V supply there's going to need to be some electronics to step up the drive signal.

Looking at the probe images, the handles are large, there may be not just electronics in there but perhaps also a small battery to extend use time. It would be interesting to know what a sonographer thinks using it, as I expect it to be heavy, as well as potentially awkward to hold especially if a fair amount of force has to be applied for a good acoustic window, but it does have the advantage of a very thin and light cable.

Given it's USB, there have to be ADC's in the transducer taking it to digital, and you can see with a limit of 480 Mbps, that if you assume 100 channels that's basically 5 Mbps per channel, for a multi-MHz probe. It's clear that some form of compression, early beamforming etc is going on. Where those compromises are made I can't say, as I have no images etc to evaluate it on beyond marketing.

There's more than just basic b-mode imaging (an explanation of imaging modes is here) in these probes according to the website, which is good to see and more than I expected. I can't evaluate anything on image quality, and have to expect that a lot of compromises have been made in order to create them within a very limited power and computation budget. Other reviews of similar products seem to indicate that as a basic imaging device it performs well, though certain more precise or complex imaging needs (such as needle location) are not well supported. To expect such a system to do everything that a full cart does is, of course, ridiculous, and it's a question of whether the team created a product that's useful enough to serve a function.

These products have been out on the market for over a year, nearly 2 now, and I've yet to hear a huge buzz regarding them, though I think the general consensus is an appreciation for the work that went into them and that a good job was done. Is it enough? Over time the market will tell - perhaps a further generation or two of development is needed to really have them take off.

Note that all these type of products still require FDA clearance to be sold as medical devices, so it seems that regulatory compliance is definitively not what is stopping ultrasound at a lower price point. The existence of these devices is a pretty good proof point that the regulation-as-the-bad-guy argument is not appropriate. Further, despite the claims that sub $3,000 systems surely can be made on this blog and others, note that even with all the compromises made, and the screen/computation cost externalised, the price point is still estimated to be $7,000 to $10,000.

Another similar product just out is from Vancouver based Clarius, having also just been FDA approved (go regulation). This is an entirely wireless device, though if you look at the pictures the handle is enormous and has to be held in a very non-traditional manner, as what I assume is the large battery pack and vents for air cooling (or maybe not, I just saw a picture of one underwater) take up the majority of the device. Specs say it weighs 1.2 lbs, which is pretty heavy, and claims ~45 minutes usage. I'd really like to hear a sonographer's take on using this for extended periods - though extended use may not be the target use case. Online prices seem to also be in the $7,000 to $10,000 range. It uses wireless-N so has similar bandwidth limits to the Lumify, and so most if not all the processing will have to be done in the handle. It seems to support fewer imaging modes than the Lumify, but does use iPads, so would be interesting to know how that economic model works (transducers and software sold separately, with most cost in the hardware side?). Hard to say more, but it looks like a first generation device that's made compromises to achieve some very specific goals (like all good engineering does!), I'll be interested to see how it does in the market.

Just as another point, I wonder how the support for these devices works when it's connected to a standard, general use, tablet/phone? Having supported commercial software on multiple OS's, it's a support nightmare when you have to deal with OS versions, drivers, firmware, and all the other variations that a non-dedicated hardware platform brings. I might be tempted to simply sell the tablet with the transducer as a dedicated device that's locked down and save myself the support headache.

There are also some very low cost devices I see on Alibaba, such as here, claiming to be $200 to $1,500 for a wireless transducer. To include the transducer, the electronics, the battery, the wifi, the software at that price (esp $200!), I simply don't believe it, you just can't even buy the parts for that, let alone pay for labor or make a profit, even under the most generous assumptions. The devices covered above will meet a need and deliver performance, this no-name thing, just no. You'll get what you pay for here, but feel free to go buy one if you want to prove me wrong!

So in summary - and remembering I've not used these devices myself and am only going by what's online - they look to be interesting devices that serve a limited function, and have made compromises to meet the lower cost and portability goals. It's low cost, no frills, and great that this part of the market is being tested - and the market will respond. If they meet a need, at the right price, they'll be bought, and companies will move more resources toward it, and over time as electronics and battery tech improves, they'll get smaller, lighter, and higher performing. I don't, however, know if there is pressure for the premium systems coming down in price range, just more and better capabilities added, and the overall market growing.

Medical Ultrasound Systems Pt II, Where I Stand by My Statements That They're Actually Inexpensive

So my recent post on ultrasound systems costs got a lot of attention, more than any article in some time, mostly due I think to a thread in HackerNews dedicated to it. My original post had some good questions pop up in the comments, and same in the HN thread, along with some replies that clearly had particular assumptions about the medical ultrasound industry. I'll try to address them all in this post.

Now, for those of you who are genuinely interested to get answers, I want to provide them as best I can, and any snark in my post here is not aimed at you. For those who want to sit on the sidelines and snipe, the snark most definitely is. Each of those groups, please read what I write with that in mind.

First the more technical side of things. (When I reference a conference, I'm meaning this one the IEEE UFFC Society International Ultrasound Symposium. There are others, but this is a great example.)

1) "What about more electronics in the transducer, and GPUs for beamforming?"

Good question, and transducers are already headed in that direction. After Philips introduced the first real 2D array in around 2003 that was enabled by sub array beamforming electronics in the transducer, there have been advances in that area. However it's important to understand that development of electronics (usually an ASIC) dedicated to a single transducer application is a large investment in money, manpower, and time, then there's the integration of that in the acoustic stack, and making the whole thing work together. It typically takes a substantial team several years to develop that product, and while advances in processes available make this far easier in 2016 than it was in 2003, it's still a lot of work to do. Each of the large companies has a small number of 2D arrays available, but they have to offer substantial benefits over their 1D counterparts as, no surprise, they are a lot more expensive.

Further, make an array 2D instead of 1D and now you've got new data processing challenges - volumes instead of planes, thousands of individual signals instead of ~200. It's all the more computation, so even though the compute available today is increased over the past, the demands are growing too. At some point the computation available economically will exceed the need, but we're not there yet.

But what about the regular 1D arrays? Well, yes there can be more electronics put into there, but remember there are 10 to 20 transducer types per system (cardiac, abdominal, vascular, obstetrics etc each with their own needs), and what makes more sense - a single system with all the common hardware for sampling and beamforming that serves multiple transducers, or all the electronics replicated in each transducer and a simpler system? Economically, right now it makes sense to have all common components in the system, but if electronics get much cheaper/better, then that equation will change and it's something under observation all the time.

If you look here, you'll see the specs for Verasonics open platform which is a nice hardware package for someone to learn, test, and develop ultrasound on, though commercial premium ultrasound systems are often specced somewhat higher. Sampling is up to 62.5MHz, 14 bit, 256 channels - that's up to 224 Gb/s, or around an entire Blu-ray DVD per second. Thunderbolt will get you to 40 Gbps, so place that all in context and realise that as good as modern electronics are, the demands from high end ultrasound are still beyond it. That will change in time, but again, we're not there yet.

Also note that the voltage that system supplies is up to 190V p-p, which means you can't use the smallest process nodes and get a lot of electronics on each wafer, you have to stick with a process node capable of handling that, so larger electronics and higher cost - and that's not likely to change anytime soon, the fundamental physics limits performance per volt (again, at least for now until better materials come along). The last several years have seen an improvement with the advent of single crystal piezoelectrics, but right now there's nothing on the horizon giving such a leap again in sight.

Then there's heat. Electronics generate heat, it's just in their nature. A few watts in something as small as a handheld transducer can rise in temperature very quickly, and either burn the patient or the sonographer. There are stringent FDA rules as to how hot a transducer can get, and performance is always limited to make sure that never happens - the transducer basically performs worse than it could in order to be safe. If the electronics for each channel produces 50mW then on a 200 channel probe that's 10W, and will be too much - but if the electronics are 5mW it's 1 Watt total and now gets more interesting. If power consumption could be so low, then it's more of a size/economics argument, not practicality.

Now beamforming. To begin with, for the technically minded among you, here's a great presentation covering that topic in way more detail than most need. It's from 2005 so a little outdated on some specs, but the basics are still the same. For everyone else, beamforming is taking the raw data and creating an image from it. This involves taking that large flow of data (that 224Gbps), performing a ton of maths operations on it depending on what the imaging mode is, and displaying it, basically a lot of signal processing. The presentation ends with a summary of trends "Analog electronics into probe, digital electronics into software" and that is exactly what is happening, with GPUs now powerful enough to begin to take over from specialised hardware beamformers in some cases, and is likely to increase in speed over the next few years. It will take some time before you see it in the clinic as systems tend to last a decade or more, but it's coming.

So as far as electronics are concerned, there is progress, it is happening, but some of the intense demands of ultrasound mean that the electronics isn't quite there yet, or is only just getting there, and at the same time demands are growing as 2D devices become more prevalent. I expect in 20 years that we'll be looking at a different ecosystem for ultrasound, as cost and performance of electronics shifts workloads between system and transducer.

2) "What about micromachined devices or 3D printing of them?"

Another great question, and something that's been investigated in ultrasound over the last couple of decades. MEMS have been the subject of a lot of funding by both companies and industry for over 20 years for ultrasound. For example, in the early 1990's cMUTs (Capacitive Micromachined Ultrasound Transducers) were hailed as the next great thing in ultrasound, and today in 2016, outside certain specific applications, we're only just starting to see the first commercial devices. That's not due to a lack of effort on the industry's part, all the major players have put major investments into it, but it hasn't quite panned out. There have been issues, many of which have been dealt with, but overall at this time they simply can't outperform piezoelectrics and standard manufacturing in quality and price. There's still work to be done in them, and if they can be made a little better, a bit more consistent, and a bit lower cost, then they will grow in a number of areas, but they need to reach that level of performance that makes them viable. At that point then cost can come down as demand grows, and that virtuous cycle will push more lower cost applications out there. Check out the conference I noted above, there were multiple sessions dedicated to this topic there, and it's got a lot of people working in it. Foundries and semiconductor companies would love to have another high volume application for their fabs, but the right mix of performance, cost, and demand aren't there yet.

pMUTs (piezoelectric Micromachined Ultrasonic Transducers) are being looked at but have some additional difficulties on top of cMUTs. Piezo materials tend to be lead based for good performance, and people don't tend to like lead in their semiconductor fabs, essentially it is often 'not process friendly'. The materials that are, such as ZnO and AlN, are much lower performing so it's limited to applications like FBARs (filters in your phones). There's some promise with scandium doped AlN for better performance, and fabrication methods that allow for better performing piezos, and it's a field to watch but there are still issues. Again, the conference I mention above had a special session on exactly this topic with invited speakers, and was a big draw. Smart experienced people in this field are interested and it will grow.

And 3D printing? It's tough to print some of the active materials and other specialised components of a transducer, but again it's being looked at.  GE, among others, is putting huge company efforts into this, and they and others have given presentations on this effort (again, that conference mentioned - it's almost as if smart people in the industry are thinking about this kind of stuff! :) ) So again, early days, but advanced manufacturing is coming, and it will help with performance, reliability, and prices.

3) "I can buy off the shelf parts for $x, why does the system cost more than $x?"

Quite simply because it takes a lot of effort and manpower to put together a reliable, robust, validated platform upon which people's medical decisions can be based. This would be the case with or without regulation, any product takes this amount of work. If you build something poor quality, you get one sale and no repeat business, and word travels fast - in a competitive world like ultrasound, you lose your name quickly and you're done. Each transducer has to support multiple imaging modes - b-mode, harmonic, doppler etc - and each takes time to program and validate. Then you have to support it, and keep your customer happy, all while keeping your staff paid well enough to not jump ship to the latest social app, and be building the next generation of improved systems. Basically, standard business issues and costs that face any long term enterprise. Oh, and profit, that helps to keep companies going, products being made, and new advances worth funding.

In summary - this stuff is coming, but it's not as easy as you might think, and it's not a microphone on a smartphone that can fail or be disposed of in a couple of years.

Want to be a part of it and learn more? Please do, our industry is always looking for talented people to help make ultrasound better. Attend conferences, take it as a postgraduate course of study, join an ultrasound company or start one. Want to really get involved? Message me, I'm well connected in the industry and will put you in touch with anyone I can to help.

Now the more business side of things - and again, remember the snark is not aimed at those with genuine questions and interest:

4) "You didn't give detailed costs of all the components to prove it's priced low"

First of all, doing so would lead to an exceptionally bland article reading more like a parts list, where I wanted to give more of an idea of what is involved in building a system and that it's not as simple as you would think. The original piece in Medium was based on a number of statements about the simplicity of ultrasound and I wanted to make the point it's a difficult, multi-disciplinary task with a lot of trade-offs. To someone versed in the field, it basically read as "I can build a soapbox derby car for $100, if I stick a motor in it I have a car! Why do these car companies charge $50,000 for one of their cars!?!" (I exaggerate, but not by much.)

Secondly, I actually have to be careful about stating specific numbers, both in pricing and capabilities. I've done work for a number of ultrasound manufacturers, and I have to be sure I do not release any proprietary information, so I tend to err on the side of caution here and make sure to be certain that everything I talk about is already public domain. I'm happy when people not encumbered by such restrictions pitch in.

Lastly, the market is highly competitive, and the fact that it's not priced lower is indicative that something is both worth paying for and priced correctly. If you think the market isn't competitive, I'm not sure what I can say to convince you otherwise, but this next part will try.

5) "There's a conspiracy among manufacturers to keep prices high"

I have to say, hearing this surprised me. I've been in the industry for over 20 years and never once even seen the hint that this is happening in ultrasound, with massive evidence pointing instead to intense competition. It's a multi-billion dollar market (est ~$6 billion), with several large international players (this link here has some of the larger, this link here shows dozens of smaller ones, this market research report mentions 25 companies), and regulated in a way that it's hammered into everyone to be sure there's no price fixing, collusion/cartels, or other anti-competitive behaviour. Companies have moved up and down the rankings significantly over the last decades, each is always looking (ethically and legally) for a technical or price advantage over its competitors. Medical ultrasound is also a heavily regulated market, and multiple countries (esp the EU and US) will come down hard on a company in this space participating in anti-competitive behaviour.

In every company I've worked I've seen strong pressure to simultaneously raise quality and reliability while lowering costs, and if you look at systems on the market today compared to the past then there have been major improvements at the top end where prices have remained fairly constant, and this has had the knock on effect of allowing the introduction of lower cost and capability systems further down the chain that exceed the capability of yesterday's premium systems.

If someone could start a company that produced ultrasound systems at quality and consistency, with volume, but lower cost, I guarantee you they would be bought by one of the bigger players to incorporate and take advantage of that technology. So if you feel there is a conspiracy, and that ultrasound systems are in fact easy to make, then feel free to start that company yourself and take advantage of the free money everyone else is passing up. Or, even better, I'll help you - quite seriously, email me, tell me what we're doing wrong, and I'll either find a way to hire you, get you a job in the industry, or let's start that company and make our millions. Seriously, mail me and let's do that, or if you're certain there's a conspiracy then I can provide you with the contact details for various regulatory agencies in various countries who would love to see your evidence they can prosecute with.

To make it clear - few industries actually operate in a market that has such intense competition, among many large players, each trying to provide the customer with the best price and quality mix to make the sales, and leapfrog their competition. This is not an "Intel own 99% of the server market and have little competition to drive prices down", it's more like competition in the car industry where there are many players competing.

6) "Engineers don't know what they are doing and are passing up really obvious and simple things that will make the products much faster, better, and cheaper."

This industry is made up of thousands of dedicated engineers, researchers, and support staff who are smart, highly educated, very experienced, and highly capable. If they wanted to, many could move to doing things like apps, social media, or whatever the fad of the moment is and make more money with less stress. But they don't, because they love what they do, they live to make technology better, or faster, or cheaper, and because they know that the work they do in ultrasound imaging helps people and makes a difference. That they'd willingly pass up technology advances and better methods just goes against character, and given the attitude of these people and the competition in the industry, if management decided for them not to pursue such benefits, they'd leave for another company or start their own. 

There are multiple professional organisations that are dedicated solely to ultrasound, and heavily to the medical side of that. IEEE UFFC is one such organisation, I'm heavily involved in it, and there are several others. The IEEE is non-profit, solely concentrating on technology, and does not support any single company or commercial interest. They produce peer reviewed journals on state of the art in transducers, materials, electronics, systems, and imaging, and every year have a conference where a couple of thousand people attend and present, discuss, and learn about the best practices and technologies. This year I watched presentations on 3D printing of transducers, new materials, rapid imaging techniques made possible by GPUs, micromachined devices, and advanced electronics for transducers (This page has a list of talks and the abstracts if you want to see what was covered). These are things that companies are spending plenty of resources researching, universities have students doing Ph.D's on them, and over time will make their way into products as the technology matures and becomes reliable and cost effective.

If you feel that, without experience in this industry, you are already superior to those who have worked in it for years, then send me your resume. I know companies that will hire someone so skilled to give them an advantage over the competition, or will hire you as a consultant. Or I'll help you get an abstract accepted to the IEEE UFFC conference so you can get your knowledge out there. I'll work with you to get a grant from the NIH or NSF to develop your technology and patent it, or just put it out there online for the world to see - do it for the benefit of the world. Or admit it's armchair quarterbacking. Plenty of options.

Summary - The field is made up of smart, dedicated, and committed people who strive to make quality, well priced products at a variety of price points that make technical and economic sense. Please don't make statements that are predicated on them being stupid, ignorant, or greedy without some evidence to back it up.

7) "All the costs are regulatory, without the FDA we'd have safe machines at a fraction of the cost!"

This is going to be tough to disprove without giving internal costs from various companies, and I can't, and won't do that. I know that regulatory is certainly an aspect of it, but doing a headcount it's not in the top few for costs. There are engineering tests and documentation burdens, but they're really not far beyond what any engineering team concerned with good record keeping and producing a safe device would do. And importantly, having clear regulations allows all participants to compete on a level playing field, knowing that everyone is playing by the same rules.

Yes, you can buy a veterinary, unregulated ultrasound machine from AliBaba. Good luck with it giving you a quality or even useful image, not injuring you, being reliable, or getting any support on it. Or getting it to do a fraction of the things a premium ultrasound system will.

Once again, there's a reason that ultrasound is the most widely used medical imaging modality, and is incredibly safe, and part of that is the FDA and similar regulation.

8) "Are you stupid you can't make a transducer without sharp edges!"

This is to reply to one specific comment. Ultrasound is unlike MR and CT in that it is both operator and patient dependent - each image can be different and some skill is required. The acoustic window in which clinically useful images can be gained sometimes involves placing the transducer in a location, and applying sufficient force, that it can be uncomfortable for the patient. If the patient starts to move because it's uncomfortable, it makes getting a good image harder. Some transducers have a tradeoff of minimised size for access to certain locations, but maximised acoustic area for good image, which can lead to corners that are not very smoothly rounded, and while not 'sharp' as in 'cuts the patient', might lead to more discomfort than necessary if not designed correctly. Oh, and yes building a 200 wire cable with minimal crosstalk is easy, doing it and making it flexible so a sonographer can use it (like I said in the original post), and at a reasonable cost isn't. Congratulations to the person that asked that question and showed their genius in how dumb we ultrasound people are - you actually managed to annoy me with those comments! You, in particular, are an author I aimed the "Since you're so smart, why don't you clean up in our industry of charlatans and idiots?" snark at.

9) "Phones are cheap and have a ton of technology in them, why aren't you that cheap?"

>Several hundred million phones are sold every year, probably 4 orders of magnitude more than ultrasound systems. On average they last about 18 months to 2 years, compared to a decade or more for an ultrasound system. No-one's life depends on them. One of the simplest things here is there just isn't the economy of scale for ultrasound to hit those price points. Perhaps it's a chicken-and-egg thing, that the "killer app" for ultrasound isn't here because it's too expensive, but if the demand is there then the tech will come. Got that application? As some have noted, there are rumours that's what Butterfly Labs are working on, but despite being well connected in the industry, I've heard nothing on what they are really doing after several years of effort. I hope they produce something astounding, but until then, no smartphone market economies of scale for ultrasound. 

OK, I'm done for now and leave you with this, once again - If you can make a difference in this industry in price, performance, reliability, or application then get in touch, there are companies and universities that want good people to work on this. Don't armchair quarterback or cite imaginary conspiracies, get involved. 

Merry Christmas everyone.