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Medical records on the blockchain – the history of a bad idea

davidgerard.co.uk

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Re: Medical records on the blockchain – the history of a bad idea

#141

Post by DebtDeflation »

dikei wrote: post #133
DebtDeflation wrote: post #132

Earlier quoted context omitted.

>"immutable, distributed, cryptographically-verified database" >Byzantine fault tolerance, public consensus, and mining Why would I want ANY of these things associated with the system that manages my medical records? I don't want them to be immutable, if there's an error I want it corrected. Clearly there should be security to control who (my provider) can update them, and perhaps turn on the database transaction log…

>> I don't want them to be immutable, if there's an error I want it corrected. Immutable here means no in-place update, you have to update using an "errata" record. This is the requirement for many type of official documents, even before computers were used. >> I don't want my medical records to be distributed for obvious reasons. Distributed here means no single point of failure. >> Encrypted, sure, but "cryptograph…

>>>Immutable here means no in-place update, you have to update using an "errata" record.

Yes, and people have been building financial systems with relational databases using this journaling principle (updates and deletes handled by inserting new records and timestamping) for decades.

>>>Distributed here means no single point of failure.

Which can be done with most standard RDBMS or NoSQL databases and clustering/sharding. Not that the scale of medical records is anywhere near requiring any of this. Do you really want multiple copies of your personal medical records on some public blockchain?

>>>Encryption without authentication opens up many types of attack. You almost always want authenticated encryption

For financial transactions, sure, but for medical records? For what purpose? Other than me and my provider (and any specialist I select) why would anyone else even need to access my medical records? Who would be faking them?

None of this makes any sense for medical records.

Re: Medical records on the blockchain – the history of a bad idea

#142

Post by JohnFen »

killjoywashere wrote: post #88
JohnFen wrote: post #26

Earlier quoted context omitted.

> I've been a medical doctor for 10 years and think that it is. Can you explain how blockchain is useful for this in a more nuts-and-bolts way?

"I'm a medical doctor" is, in most cases outside of hospitals and clinics, entirely superfluous to the issue at hand. And it's frequently less relevant than you might think inside a hospital or clinic. If you hear someone saying this in any situation outside a medical emergency, I hereby give you permission to deduct 1 point from their debate score. I say this having also been a medical doctor for 10 years.

> I hereby give you permission to deduct 1 point from their debate score.

I already did, because it looked like a clear invocation of the "appeal to authority" fallacy.

While being an MD can provide insight (depending on the nature of the doctor's practice) in terms of how things impact the practice of medicine, being an expert in a field only really matters when discussing topics that are in that field. Outside of their field, an expert's evaluation carries no more weight than anybody else's.

Re: Medical records on the blockchain – the history of a bad idea

#143

Post by DennisP »

acdha wrote: post #51
DennisP wrote: post #50

Earlier quoted context omitted.

Do you mean outside of any involvement with currency, or just outside of simple transfers of currency? Because a lot of things are applications of programmable money, like derivatives, exchanges, and gambling. Beyond that, some games are using public blockchains to track ownership of game items.

None of which seem to intrinsically need a blockchain or be more competitive for using one. All of the real volume in those activity classes not using blockchains would need some explanation.

It's just computation and storage, so of course you can do it on a server. Three things blockchains provide: you don't need to trust anyone with custody of your assets, you have censorship resistance, and users pay for all the resources they use so don't need a business model just to keep it running.

Re: Medical records on the blockchain – the history of a bad idea

#144

Post by darawk »

acdha wrote: post #129
darawk wrote: post #117

Earlier quoted context omitted.

> From whom? What are the actual rates? The rates are the cost of buying/selling bitcoin on both ends, let's call that 20 bps on each side, and then the cost of a single bitcoin network transaction, which is about 66 cents at the moment, if you're willing to wait 6 blocks [1]. So, to send $1000 it'll cost you 40 bps + 66 cents = $4.66. By comparison, international wires at your local bank will run you around $50 all…

> The rates are the cost of buying/selling bitcoin on both ends, let's call that 20 bps on each side, and then the cost of a single bitcoin network transaction, which is about 66 cents at the moment, if you're willing to wait 6 blocks [1]. So, to send $1000 it'll cost you 40 bps + 66 cents = $4.66. Don’t forget to add in the currency conversion fees on either side since most people transfer money to use it. Walmart c…

> Don’t forget to add in the currency conversion fees on either side since most people transfer money to use it.

Hm? That would be factored in already. If I wanted to send money to say, India, I would buy Bitcoin with US dollars and then send it to someone's account on an Indian exchange, where they'd sell it for Rupees. The conversion is already baked in.

> Walmart charges $8 for the same service. There is some potential savings here but it seems unlikely to argue that Bitcoin’s enormous costs can be justified by the number of people who need to regularly do international transfers and, if everything is lucky, save a dollar or two on the transfers.

I'm not arguing that international wires are the only useful thing it can do. It's simply a counter-example to the idea that there are none.

> “Extremely solvable” but unsolved a decade later suggests that they are not in fact that easy and will end up making the cost even less competitive. People have been preaching that Bitcoin will take over for years but even most advocates don’t use it for a non-token percentage of their transactions because it’s simply not financially sensible to do so.

It's already solved if you keep your money on an exchange.

Re: Medical records on the blockchain – the history of a bad idea

#145

Post by JohnFen »

kbenson wrote: post #35
JohnFen wrote: post #33

Earlier quoted context omitted.

> there is a whole industry of universities of finding a technology and then licensing it out or spinning a company off to do something with it. Kinda sorta, but that's a difference in kind. Most university research tends to be "basic research", meaning that it tends to be focused on understanding how things work rather than developing anything that is immediately useful. In the course of doing that, sometimes someth…

If you look at all their research, sure, but then you might as well include all their education too, which muddies it more. They definitely seem to also go for directed advances in specific areas. For example, battery technology. Usually, what's developed isn't something to replace the current best choice for most applications, but sometimes it does have features that make it extremely useful for specific application…

> Were they also hoping to develop something they could make some revenue from? Surely.

That depends on who you mean by "they". The researchers themselves generally don't give this any thought. The university administration, however, is always hoping for additional revenue streams.

Re: Medical records on the blockchain – the history of a bad idea

#146

Post by tracker1 »

encloser wrote: post #39
tracker1 wrote: post #36

I cringe every single time someone suggests blockchain in our space. Either it's easier with other tech (even public/private key tech doesn't require blockchain), or open to potential leaks/abuse in the future (tracking how everyone voted). There are a lot of use cases, most even, where it's not a great fit, and there are other, better, approaches. Disclosure, I work for an election services company...

I like to provide people the NIST Blockchain Overview pdf. Particularly the decision flowchart. https://nvlpubs.nist.gov/nistpubs/ir/2018/NIST.IR.8202.pdf

I've actually forwarded a lot of that to the higher ups... There are places that it could be useful, I just feel that most cases it creates more problems than it really solves.

Re: Medical records on the blockchain – the history of a bad idea

#147

Post by acdha »

darawk wrote: post #144
acdha wrote: post #129

Earlier quoted context omitted.

> The rates are the cost of buying/selling bitcoin on both ends, let's call that 20 bps on each side, and then the cost of a single bitcoin network transaction, which is about 66 cents at the moment, if you're willing to wait 6 blocks [1]. So, to send $1000 it'll cost you 40 bps + 66 cents = $4.66. Don’t forget to add in the currency conversion fees on either side since most people transfer money to use it. Walmart c…

> Don’t forget to add in the currency conversion fees on either side since most people transfer money to use it. Hm? That would be factored in already. If I wanted to send money to say, India, I would buy Bitcoin with US dollars and then send it to someone's account on an Indian exchange, where they'd sell it for Rupees. The conversion is already baked in. > Walmart charges $8 for the same service. There is some pote…

> Hm? That would be factored in already. If I wanted to send money to say, India, I would buy Bitcoin with US dollars and then send it to someone's account on an Indian exchange, where they'd sell it for Rupees. The conversion is already baked in.

Right, but if you're comparing apples to apples, you need to compare the cost of, say, going to Walmart.com (or a bunch of other places) with $1,000 and sending it to someone in India vs. starting with the same $1,000 and shipping it. Unless the conversion rates for gating in and out Bitcoin are always exactly the same you need to measure the whole cost.

> I'm not arguing that international wires are the only useful thing it can do. It's simply a counter-example to the idea that there are none.

Note that I wasn't saying that there no things which were technically possible, only that very few people have a situation where it's advantageous to use Bitcoin. A possible modest savings on international transfers does not seem like a viable foundation for a decade of big world-changing rhetoric.

> > “Extremely solvable” but unsolved a decade later suggests that they are > not in fact that easy and will end up making the cost even less competitive. People have been preaching that Bitcoin will take over for years but even most advocates don’t use it for a non-token percentage of their transactions because it’s simply not financially sensible to do so. > > It's already solved if you keep your money on an exchange.

… so, you get rid of banks by creating a new bank, putting a “not a bank” sign on it, and hoping nobody will notice a) how many people have lost money by trusting Bitcoin exchanges and b) how quick the community was to blame them for the loss and saying that they were fools to trust an exchange?

Re: Medical records on the blockchain – the history of a bad idea

#148

Post by JohnFen »

DebtDeflation wrote: post #132
smt88 wrote: post #43

Earlier quoted context omitted.

I've discovered that some people say "blockchain" when they mean "immutable, distributed, cryptographically-verified database" -- which is actually a useful thing for many people. The Byzantine fault tolerance, public consensus, and mining aspects that we associate with "true" blockchains are the parts that people can't find a way to justify and can typically be ignored.

>"immutable, distributed, cryptographically-verified database" >Byzantine fault tolerance, public consensus, and mining Why would I want ANY of these things associated with the system that manages my medical records? I don't want them to be immutable, if there's an error I want it corrected. Clearly there should be security to control who (my provider) can update them, and perhaps turn on the database transaction log…

> I don't want my medical records to be distributed for obvious reasons.

Technically, you do. If you go to see a different health care provider than usual, you want them to access your medical records.

I don't see how the blockchain is the best solution for this, but the distributed part isn't really the problematic part.

Re: Medical records on the blockchain – the history of a bad idea

#149

Post by davidgerard »

darawk wrote: post #61
davidgerard wrote: post #22

Earlier quoted context omitted.

The obviously convincing argument would be - after ten years - "something to show for it all." That is, something that blockchain is clearly and obviously the use case for. "Potential" goes only so far. Eventually you need kinetic.

Programmable money is not a thing to show?

so far its overwhelming use case has been selling people questionable ICO tokens, so you'll excuse me if I'm not convinced by the observable outputs

Re: Medical records on the blockchain – the history of a bad idea

#150

Post by AmericanChopper »

acdha wrote: post #137
AmericanChopper wrote: post #121

Earlier quoted context omitted.

What makes git different from a blockchain? A blockchain is a data structure, and a data structure doesn’t change based on who has permission to write to it.

Those terms don’t have the meanings you’re using. Being a data structure is not a distinguishing factor – try finding a common definition which excludes Git – and there’s no definition of the term which excludes modifications.

I’m not sure why you’re trying to say. The data structure is immutable by design. You can’t modify a git commit. But you haven’t answered my question. What’s the difference between a blockchain, and git?
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