Relieving Suffering without Head Transplants

In 2013, Dr. Sergio Canavero published a paper outlining a potential method for performing a head transplant in humans. A later study by Dr. Xiaoping Ren involved head transplantation in mice. Dr. Robert White performed head transplants on monkeys in the 1970s, but the animals didn’t survive very long. The next step is to test head transplants in nonhuman primates using modern surgical techniques, though Dr. Canavero disagrees and is morally opposed to experiments on lab animals. Dr. Canavero and his plans for a human head transplant serve as the basis for a new in-depth Guardian article. Dr. Canavero and a team in China plans to perform a human head transplant (which may really be more of a body transplant) as soon as 2017. Dr. Michael Sarr, editor of the journal Surgery, thinks a human head transplant is plausible.

Head transplant volunteer Valery Spiridonov suffers from a form of spinal muscular atrophy. The transplant team plans for him to be the second or third patient after testing the procedure on other patients with reduced life expectancy, like those with terminal cancer. I wonder if the patient and his doctors have tried alternate treatments for SMA, including those that have only been tested in lab animals. Maybe gene therapies or cell therapies from the studies referenced at the end of this post could bring relief in less invasive ways than a head transplant. I’ve seen videos where paralyzed lab animals that could only drag their hindlimbs before can now run on treadmills. However, this was from research on treating spinal cord injuries rather than curing spinal muscular atrophy.

The question is whether treatments from lab animal studies transfer to adult human patients. Most experimental treatments for spinal muscular atrophy involve administering the treatment to neonatal mice instead of adult animals. If no alternative therapies (gene therapy, cell transplantation, nerve regeneration) end up working for this particular patient, people should respect the patient’s desire for a head transplant. They should accede to Mr. Spiridonov’s wishes instead of letting the obsolete philosophical beliefs of bioethicists and religious figures control his life.

These are the steps outlined in Dr. Canavero’s initial paper on head transplantation:

1. Match donor for height and build.

2. Screen donor immunotype.

3. Set up autotransfusion protocol using donor’s blood.

4. Intubate receiver and donor and ventilate through tracheotomy.

5. Lock heads in rigid pin fixation.

6. Place leads for ECG, EEG, oxygen saturation measurement, and external defibrillation.

7. Position temperature probes.

8. Insert radial artery cannula.

9. Administer antibiotics throughout procedure.

10. Administer barbiturate or propofol to receiver.

11. Keep constant cooling infusion.

12. Start lidocaine infusion.

13. Cool receiver’s head to 10 degrees C.

14. Use spinal hypothermia in donor.

15. Place receiver supine during induction of hypothermia.

16. Place receiver in the sitting position while keeping donor upright.

17. Make incisions around the necks of donor and receiver.

18. Separate the structures at C5/6 level forward below the cricoid.

19. Perform two cuts along the anterior margin of the sternocleidomastoids.

20. Perform one standard midline cervical incision.

21. Cut spinal cords simultaneously in both subjects while allowing for some slack.

22. Create a strain-free fusion to avoid the natural retraction of both segments.

23. Transfer receiver head onto donor body.

24. Connect the receiver head onto the donor circulation tubes.

25. Accost, adjust, and fuse the cord stumps.

26. Infuse chitosan-PEG into donor bloodstream.

27. Apply loose sutures around joined cord to thread the arachnoid.

28. Perform laminectomies in receiver and donor.

29. Perform a durotomy on receiver and donor to expose the cords.

30. Use bicarotid-carotid and bijugular-jugular silastic loop cannulae to accomplish vascular anastomosis for the cephalosomatic preparation.

31. Remove vessel tubes one by one.

32. Sew the arteries and veins of the transplanted head together with those of the new body.

33. Tip-clamp main vessels during head transference to avoid air embolism.

34. Verify donor blood flow begins to rewarm receiver head.

35. Reconstruct vertebral arteries.

36. Sew the dura in a watertight manner.

37. Perform anterior followed by posterior stabilization.

38. Connect the trachea, esophagus, vagi, and phrenic nerves.

39. Join muscles together by using color-coded markers.

40. Sew up skin.

41. Bring receiver to the intensive care unit and keep sedated for three days.


A large animal model of spinal muscular atrophy and correction of phenotype.

A Novel Morpholino Oligomer Targeting ISS-N1 Improves Rescue of Severe Spinal Muscular Atrophy Transgenic Mice.

A Short Antisense Oligonucleotide Ameliorates Symptoms of Severe Mouse Models of Spinal Muscular Atrophy.

A single administration of morpholino antisense oligomer rescues spinal muscular atrophy in mouse.

Allogeneic head and body reconstruction: mouse model.

Antisense Oligonucleotides Delivered to the Mouse CNS Ameliorate Symptoms of Severe Spinal Muscular Atrophy.

Bifunctional RNAs Targeting the Intronic Splicing Silencer N1 Increase SMN Levels and Reduce Disease Severity in an Animal Model of Spinal Muscular Atrophy.

Brain Transplantation: Prolonged Survival of Brain after Carotid-Jugular Interposition.

Celecoxib increases SMN and survival in a severe spinal muscular atrophy mouse model via p38 pathway activation.

Decreasing Disease Severity in Symptomatic, Smn−/−;SMN2+/+, Spinal Muscular Atrophy Mice Following scAAV9-SMN Delivery.

Direct central nervous system delivery provides enhanced protection following vector mediated gene replacement in a severe model of Spinal Muscular Atrophy.

Effect of Combined Systemic and Local Morpholino Treatment on the Spinal Muscular Atrophy Δ7 Mouse Model Phenotype.

Gene therapy rescues disease phenotype in a spinal muscular atrophy with respiratory distress type 1 (SMARD1) mouse model.

Genetic Correction of Human Induced Pluripotent Stem Cells from Patients with Spinal Muscular Atrophy.

Head Transplantation in Mouse Model.

HEAVEN: The head anastomosis venture Project outline for the first human head transplantation with spinal linkage (GEMINI).

Hypothermic preservation and transplantation of brain.

Improved Antisense Oligonucleotide Design to Suppress Aberrant SMN2 Gene Transcript Processing: Towards a Treatment for Spinal Muscular Atrophy.

Increasing expression and decreasing degradation of SMN ameliorate the spinal muscular atrophy phenotype in mice.

Increasing SMN levels using the histone deacetylase inhibitor SAHA ameliorates defects in skeletal muscle microvasculature in a mouse model of severe spinal muscular atrophy.

Peripheral Androgen Receptor Gene Suppression Rescues Disease in Mouse Models of Spinal and Bulbar Muscular Atrophy.

Peripheral SMN restoration is essential for long-term rescue of a severe spinal muscular atrophy mouse model.

Postsymptomatic restoration of SMN rescues the disease phenotype in a mouse model of severe spinal muscular atrophy.

PTEN Depletion Decreases Disease Severity and Modestly Prolongs Survival in a Mouse Model of Spinal Muscular Atrophy.

SMN2 splicing modifiers improve motor function and longevity in mice with spinal muscular atrophy.

Sodium vanadate combined with l-ascorbic acid delays disease progression, enhances motor performance, and ameliorates muscle atrophy and weakness in mice with spinal muscular atrophy.

The “Gemini” spinal cord fusion protocol: Reloaded.

Translational Fidelity of Intrathecal Delivery of Self-Complementary AAV9–Survival Motor Neuron 1 for Spinal Muscular Atrophy.

Only 60s, 70s, and 80s Kids will Remember the Threat of Nuclear Annihilation

I was born in the mid-1980s and only started to gain awareness of the world around me as the Soviet Union began falling apart. I vaguely remember the fall of the Berlin Wall but I don’t recall any news or discussions about the potential for nuclear attacks. When I was a teenager I became aware of the potential of nuclear war between India and Pakistan, but the conflict seemed so far away. Most of the recent nuclear discussions in the news focus on Iran’s nuclear capabilities, but these ignore the approximately 4000 active warheads other countries still have. Luckily, that’s down from a high of 68000 active nuclear weapons in 1985. I could have easily died in a nuclear war when I was just an infant, along with millions of other people.

The book The Dead Hand discusses the Soviet Perimeter system, which used communication lines and sensors to detect an ongoing nuclear attack and automatically launch nuclear missiles in retaliation. This system may still be in operation. Nuclear expert Bruce Blair described the system in a 1993 article in the New York Times. CIA Director Robert Gates, who went on to be Secretary of Defense, thought the system possibly existed. William Odom (former head of the NSA) thought the system sounded implausible but not impossible. An automated doomsday weapon is scary enough, but it’s even more frightening when considering the nuclear near-misses that happened in the past. The Autumn Forge and Able Archer strategic exercises nearly provoked the Soviet Union into launching nuclear weapons in the 1980s. Ronald Reagan joked about bombing the Soviet Union, which understandably unnerved people around the world. The Norwegian rocket incident was enough to bring Russian nuclear forces to high alert and to put Russian president Boris Yeltsin in the position of deciding whether or not to launch nuclear weapons at the USA in response.

An automated doomsday system presents even more challenges to the world when realizing how bugs in software and flaws in human systems can lead to disaster. As someone who works as a software tester, the irony of a software defect causing the end of the world is not lost on me. Soviet military officer Stanislav Petrov decided against reporting an apparent attack from the United States – a perceived attack that would almost certainly have led to Soviet retaliation. It’s a good thing he waited, because the “attack” turned out to be a system malfunction. Zbigniew Brzezinski, National Security Advisor to President Jimmy Carter, was put in the position of deciding whether to launch the USA’s arsenal of nuclear weapons after being alerted of an apparent launch of 2200 Soviet nuclear missiles. In reality, there was no missile launch. It was a false alarm from a faulty computer chip. In the 1960s, Vasili Arkhipov refused to fire a nuclear torpedo, which might have led the USA to attack with 5500 nuclear weapons in retaliation.

Eric Schlosser’s book Command and Control goes into great detail about mistakes and human error involving the handling of nuclear weapons. Articles like Five Ways a Nuclear War Could Still Happen and How America and Russia Could Start a Nuclear War don’t really help my anxiety. Thousands of active nuclear weapons still present a danger to the world. The USA is planning on spending nearly a trillion dollars to modernize its nuclear arsenal. I had no idea that the renovation of nuclear weapons was taking place at the National Security Campus in Kansas City Missouri, which is only 50 miles away from me! If a nuclear war happened, those who didn’t die from the initial blast or radiation poisoning would have to eat insects and fungus during a years-long nuclear winter, if there was even anything to eat at all. Mushrooms are fine, but they would get boring after a decade as the only source of food while going from mushroom clouds to mushrooms. The deaths of tens of millions or hundreds of millions of people would also be extremely depressing.

As attested to by several studies, some children and adolescents (along with plenty of adults) in the 1970s and 1980s lived in fear of nuclear war as the Cold War between the USA and Soviet Union raged on. Fear of nuclear war may have also reduced savings rates, as people saw no reason to save for retirement if they and everyone they cared about could just die without warning from a nuclear attack at any time. The potential of a future Baltic conflict between Russia and the USA is frightening. Those bad old days should stay in the past. All nuclear wars are ultimately unwinnable. To forge peace, both countries should focus on joining together to pursue shared medical research into topics like curing aging. Maybe someone like Yuri Milner, Dmitry Itskov, or Maria Konovalenko could unify Russia and the USA in this shared medical goal.


Adolescent Attitudes to Nuclear War.

Adolescents’ attitudes about nuclear war.

Attitudes Toward Nuclear Weapons and Nuclear War: 1945–1982.

Australian children and the threat of nuclear war.

Background, personality, and behavioral correlates of nuclear anxiety.

Children, Adolescents and Nuclear War Anxiety.

Children’s fear of nuclear war: An empirical Danish study.

Concern about the threat of nuclear war: Just another worry?

Developing a measure of nuclear war anxiety: a factor analytic study

Did Americans’ Expectations of Nuclear War Reduce Their Savings?

Dimensions of the shadow: Children of six nations respond to the nuclear threat.

Everybody’s scared—but life goes on: coping, defense and action in the face of nuclear threat.

Fear of Nuclear War and Intercountry Differences in the Rate of Saving.

Fear of nuclear war increases the risk of common mental disorders among young adults: a five-year follow-up study.

Increasing fear of nuclear war among adolescents before the outbreak of the Persian Gulf War.

Indirect assessment of concern about nuclear war.

International Reactions to the Threat of Nuclear War: The Rise and Fall of Concern in the Eighties.

Living in the nuclear age: An Australian study of children’s and adolescent’s fears.

Nuclear Anxiety and Psychological Functioning Among Young Adults.

Nuclear attitudes and reactions: Associations with depression, drug use, and quality of life.

Nuclear Fears and Concerns among College Students: A Cross-National Study of Attitudes.

Nuclear War as a Source of Adolescent Worry: Relationships with Age, Gender, Trait Emotionality, and Drug Use.

Parent-Child Agreement Regarding Nuclear Issues.

Personality Correlates of Nuclear War Threat Perception.

Predictors of College Students’ Levels of Knowledge and Concern about Nuclear War.

Psychological reactions to the nuclear war threat.

Race, sex, and nuclear war.

Relationships between the life values of U.S. college students and their cognitive/affective responses to the threat of nuclear war.

Self-Reports of Soviet and American Children on Worry about the Threat of Nuclear War.

Sex and drugs and nuclear war: secular, developmental and Type A influences upon adolescents’ fears of the nuclear threat, AIDS and drug addition.

Sex Differences in Attitudes toward Nuclear War.

Spontaneous concern About Nuclear War by College Students.

The psychosocial impact and developmental implications of the threat of nuclear war on adolescents.

The relationship between adolescents’ concern over the threat of nuclear war and several personality dimensions.

The Threat of Nuclear War and the Nuclear Arms Race: Adolescent Experience and Perceptions.

Thinking about the threat of nuclear war: Relevance to mental health.

Thinking about the Unthinkable: The Relationship between Death Anxiety and Cognitive/Emotional Responses to the Threat of Nuclear War.

Threat of nuclear war related to increased anxiety and psychosomatic symptoms among adolescents.

Transitions in the nuclear age: late adolescence to early adulthood.

What Soviet Emigré Adolescents Think about Nuclear War.

When Thoughts Turn Toward Nuclear War: Stress Responses, Coping Strategies, and the Importance of Trait Anxiety in Moderating Effects on “Mental Health”.

Working with children in a nuclear age: the counselor’s role.

The Hussman-Sornette Market Predictors

John Hussman of Hussman Funds and Didier Sornette of ETH Zurich separately provide guidance on how to interpret market valuation and market bubbles. In one of his weekly market comment articles, Hussman introduced the Market Cap/GVA measure. This valuation method has more predictive power than tests of other measures of market valuation (P/E, forward operating P/E, Shiller P/E, Fed model, Tobin’s Q, price/revenue). GVA – Gross Value Added – computes the value of output created across all producers in the economy in a way that avoids duplication of sales. Market Cap/GVA has a correlation of 92% with subsequent S&P 500 market returns. This indicates a decade-long period of zero returns for the S&P 500.

Market Cap/GVA is better correlated with subsequent market returns than other measures, as shown in this article. The S&P 500 will only reach 10% annual returns after a decline of 50% (as of June 2015 when that article was written). A scatter plot in this article adds additional evidence for S&P 500 returns remaining at zero for a decade. These high valuations are also associated with major subsequent losses.

Sornette made his name studying the dynamics of bubbles in financial markets. Hussman explains Sornette’s work and correlates movements of the S&P 500 with bubble behavior in these articles:

April 15, 2013: Increasingly Immediate Impulses to Buy the Dip (or, How to Blow a Bubble)

November 11, 2013: A Textbook Pre-Crash Bubble

November 25, 2013: An Open Letter to the FOMC: Recognizing the Valuation Bubble in Equities

December 9, 2013: The Truth Does Not Change According To Our Ability to Stomach It

In a log-periodic bubble, prices experience increasingly frequent but shallower dips. This pattern finally ends in major losses. Such bubbles occurred in oil prices in 2008 and gold prices in 2011, as well as in the Dow Jones Industrial Average in 1929. These bubbles eventually reach overvalued, overbought, overbullish circumstances. In bubbles, prices become detached from fundamentals. Federal Reserve quantitative easing can keep the bubble inflated for a while, but the power of QE eventually runs out.

Sornette recently described the real-time identification of a stock market bubble in a paper titled Real-Time Prediction and Post-Mortem Analysis of the Shanghai 2015 Stock Market Bubble and Crash. This echoes his earlier successful prediction of the Chinese stock market crashing in 2009: Bubble Diagnosis and Prediction of the 2005-2007 and 2008-2009 Chinese stock market bubbles. Use of the log periodic power law fitting technique, sampling many intervals, Lomb spectral analysis, and unit-root tests can diagnose the formation of market bubbles. Sornette also identified the housing bubble in the USA in his aptly-titled 2006 paper Is There a Real-Estate Bubble in the US? His Financial Crisis Observatory researches market inefficiencies and monitors developing bubbles. The FCO report for September 2015 says this about global equities:

April/May 2015, many, if not most, indices gave bubble warnings. This was followed by a correction and, logically, a drop in warning signals that has been as sudden as its prior rise. Now, we are only seeing negative bubble signals. These are indications that we are shifting from high momentum rising markets, to high momentum decreasing markets.

Putting all this together, high valuations and deterioration in market internals help predict points where market losses are more likely to occur.

Religions are Just Fandoms

Even though religions are thousands of years older than Tumblr, they share common traits with modern fandoms. Both form into groups united by common interests, proselytize to potential recruits, defend their belief systems from outsiders, write fanfiction, and create art. Exploring religion through the lens of fandom helps show the absurdity of organized religion. Imagine a religion where you had to kneel down twelve times a day to worship each of the Doctors from Doctor Who. Fringe sects might spring up who deny the righteousness of the Eighth Doctor due to his limited TV appearances, or who criticize the Sixth Doctor for his ego and violence. Heretics might generate apocrypha based on lost BBC episodes from earlier in the series. Imagine if Sherlock Holmes’ techniques for solving mysteries were codified into a how-to guide that children had to read and memorize or risk punishment. What if not worshipping the Hunger Games series meant that you risked being condemned to fight in a spiritual hunger games after death?

Like fandoms, religions often maintain obsessive interests about certain topics. They also develop structures to keep the belief system going. These are hierarchical in many organized religions and more loosely organized in fandoms. Religions maintain a tax-exempt status and use blasphemy laws to stamp out criticism. What if fans of Supernatural or One Direction or any other form of entertainment could use the legal system to their advantage to exploit the tax code or put people in jail for criticizing the object of fandom? I believe both religious people and fans have basic human rights. That doesn’t mean religious people (or any other type of fandom) should have control over others’ minds and lives.

The End of the Set Top Box and The End of TV

People will keep saying that the set top box industry is doing fine right up to the point where it isn’t. Cisco gave up $1.8 billion in yearly revenue just to get rid of its set top box division. Cisco acquired the Scientific Atlanta set top box business for $6.9 billion in 2005 and sold it for just $600 million a decade later. Motorola acquired General Instrument for $17 billion in the year 2000 and combined it with some other companies to form the Motorola Home division. Motorola Mobility (then a subsidiary of Google) eventually sold that division for $2.35 billion in cash and stock in 2013. Intel announced a planned set top box with great fanfare in 2013 and then sold off that project to Verizon only a year later. What was once envisioned as a multibillion dollar business unit turned into a $200 million sale.

Microsoft tried to develop a set top box but those plans went nowhere. The world was indifferent to a me-too set top box offering from the famous Redmond copycat. When it came to the Xbox One, gamers rebelled against what they saw as an unnecessary focus on video entertainment over gaming and Microsoft now seems to have no interest in set top boxes. Most of the Xbox TV executives ended up leaving the company without achieving the broad television integration they originally envisioned. The Google Nexus Player is failing in the marketplace. Revenue from the sale of set top boxes dropped for the first time since 2002. Set top boxes continue to earn money for companies but it’s ultimately a mature market, not an exciting growth area filled with potential profits. Set top boxes still earn billions of dollars in yearly revenue, but they aren’t the trillion dollar markets envisioned by start-up unicorns.

The stodgy set top box industry is ripe for disruption by big disruptors – large companies like Amazon and Apple with divisions that act like startups. These big disruptors are made up of more innovative and driven people than those who work in the boring and declining set top box industry. At least people who work in the set top space aren’t as bad as the type of people who work in advertising, as I’ll discuss later in this post. The industrial design of set top boxes is retro and not in a good way. Set top box manufacturers added extra hard drive space but stuck with the same old 1990s designs. Lots of wasted plastic and metal went into manufacturing those boxes. It’s like having a big outdated VCR stuck in your living room. Satellite TV also requires a box that takes up space, in addition to an intrusive dish and installation. Even Apple TV and Roku boxes are like what the 2000s imagined set top boxes would look like in the 2010s. At the D8 Conference in 2010, Steve Jobs described the fundamental problems of set top boxes and their role in the television industry:

The problem with the television market, the problem with innovation in the television industry is the go-to-market strategy. The television industry fundamentally has a subsidized business model that gives everybody a set-top box for free, or for $10 a month, and that pretty much squashes any opportunity for innovation, because nobody is willing to buy a set-top box. Ask Tivo. Ask ReplayTV. Ask Roku. Ask Vudu. Ask us. Ask Google in a few months. All you can do – Sony has tried as well, Panasonic has tried, a lot of people have tried, they’ve all failed – so all you can do is add a box on to the TV system… Well, you just end up with a table full of remotes, a cluster full of boxes, a bunch of different UIs, and that’s the situation we have today. The only way that’s ever going to change is if you can really go back to square one and tear up the set-top box, and redesign it from scratch with a consistent UI, across all these different functions, and get it to the consumer in a way they’re willing to pay for it. And right now, there’s no way to do that. So that’s the problem with the TV market.

The technology that powers devices like the Google Chromecast and Amazon Fire TV Stick will likely grow even smaller and cheaper in the future, allowing it to be integrated directly into televisions. Smart TVs have had apps for Netflix and Amazon Instant Video for years. 56% of homes now have at least one TV connected to the Internet, up from 44% in 2013. Many set top boxes also have clunky user interfaces that lack the responsiveness of web or mobile apps. A decade of trying various strategies to improve the UI of the traditional set top box accomplished very little aside from frustrating customers even more. Few if any companies developing set top box user interfaces tried to innovate outside of the traditional program guide model. Adding to the frustration is the continued existence of ancient set top box remotes that operate in the same unintuitive ways they did for decades. It’s possible that at some point in the future the existing cable infrastructure will just be used to deliver internet video instead of cable TV, especially as mobile video viewership continues to grow. Companies like Sling TV and HBO are putting pressure on the cable television industry and its outdated business model. People age 55 and over actually make up the second-largest group of cord cutters.

During the announcement of the newest Apple TV, Apple CEO Tim Cook mentioned that 60% of paid streaming TV is watched on Apple devices. A report from Adobe confirms these numbers. This doesn’t even include Apple’s rumored upcoming streaming service, which is planned to include popular networks and content partners. At the Apple Event, Cook also said that apps are the future of TV and the television experience has been standing still while innovation in the mobile space raced ahead. The new Apple TV is now the best streaming box with the best UI available, but it’s still a box with a remote. Maybe someday this type of technology will fit in a USB stick and feature voice activation. However, Google Ventures partner MG Siegler makes an interesting point about Apple’s video strategy. In this scenario, instead of focusing on the TV screen, Apple actually has hundreds of millions of screens currently in use. John Gruber of Daring Fireball predicts Apple TV will be Apple’s most disruptive product since the iPhone in terms of reshaping an entire industry.

Linear programming is declining. According to MoffetNathanson Research analyst Michael Nathanson, Nielsen C3 total day ratings were down 9% in 2014. Once-dependable shows with reliable gross margins are losing viewers. Traditional TV viewing is declining. Media buyer ZenithOptimedia shows that people viewed less TV in 2014 compared to 2010, and that viewing time is projected to decline further. Much of this lost television consumption is migrating to digital video. A report from the FCC showed continued declines in the number of TV subscribers. FCC data from 2013 found that the total number of MVPD (multichannel video program distributor) subscribers dropped for the first time since it’s been collecting data. Cable subscribers fell from 56.4 million to 54.4 million.

Cord cutting is on the rise. IHS Technology estimated that pay TV businesses lost more than 658,000 subscribers in the second quarter. IPTV had been the only category to experience growth, but even that growth began to decline. According to Parks Associates, about 25% of pay TV subscribers made changes to their service over the past 12 months. This growing familiarity with the process of changing service may give customers more knowledge of how to reduce the amount of options they subscribe to. In fact, more cable subscribers are downgrading from premium to basic cable. Customers are downgrading their cable service and using more streaming services instead. Analyst Horace Dediu says the industry may have reached peak cable. The industry reached saturation a long time ago and hasn’t offered much in the way of innovation. Disruption is finally beginning to occur.

Customer satisfaction with pay TV reached seven-year lows in a recent American Customer Satisfaction Index report. Satisfaction with subscription TV service dropped the most. Increasing video alternatives are finally making cable TV providers unable to get away with unsatisfactory customer service. Problems are also appearing on the network side of the equation. ESPN lost 3.2 million subscribers over the course of just a year. This has forced the network to cut costs. The ESPN loss along with other subscriber losses led to nearly $60 billion in media company stock market value being wiped out. Investors finally started to realize that online video and other entertainment options were dramatically changing the media landscape. Coveted younger audiences are spending more time on mobile apps and less time on traditional television. The disruption and disintermediation that affected the music industry are also affecting other media industries.

BTIG Research analyst Rich Greenfield says the pain is just beginning for the cable companies. Stocks of media companies like 21st Century Fox and CBS TV dropped even though earnings were ahead of analysts’ expectations. Some media executives maintain their misplaced confidence in the face of increasingly stronger competitors like Netflix, but even the new chairman of 21st Century Fox acknowledged that the TV business is rapidly changing. Ratings are down and programming costs are up even as more programmers offer their shows to over-the-top services. As cord-cutting and streaming services gain in popularity, they have the potential to harm programmers’ and cable operators’ business models.

TV everywhere viewership increased 467% over the past two years, which familiarizes cable subscribers with alternatives to TV. Viewership increased across multiple forms of content on both broadcast and cable. As viewers become more comfortable with online viewing, they may wonder why they need conventional cable and satellite TV services in the first place. Subscription video on demand services are entering more households. Live viewing is down in those households while delayed viewing has gone up. Gone are the days where people had to adjust their schedules for something as inconsequential as TV. Video on demand viewership keeps rising. The CEO of Rentrak says that 57 million homes have access to VOD service, up by 2 million in the past year. People are watching TV on different devices and at different times. A report commissioned by Ooyala and Vindicia estimates that over-the-top video on demand service revenues will more than double between 2014 and 2018. The ongoing expansion of cloud services is making this possible. A report from Juniper Research says that subscription video on demand revenue for providers like Amazon and Netflix will reach $31.6 billion in 2019, compared to $8 billion in 2014. Asia-Pacific countries are projected to contribute much of this revenue growth.

Nearly 60% of homes with broadband use over-the-top video services according to a recent analysis from Parks Associates. 11% of households are already relying exclusively on shared accounts for the OTT services they subscribe to. As this number grows, it could take even more market share away from cable and satellite services. Spending on digital entertainment is expected to rise. A report from PriceWaterhouseCoopers finds that mobile and digital services are increasingly attractive to consumers. According to the CEO of In Demand, consumers have access to more than 360,000 hours a year of on-demand content. The greater choice in movies and episodes offered by on-demand service providers makes traditional TV even less appealing. A report from Ericsson found that 50% of people now stream video from online services, compared to only 30% in 2010. The industry is reaching an inflection point where more people each day are streaming rather than watching traditional TV.

The CEO of Cablevision thinks that over-the-top video will become competitive with cable over time. This will happen eventually as more programming migrates to OTT. He also says that connectivity is outpacing video as cable’s true product. As video margins decline, the connection to the Internet becomes more important for providers and customers. Channels that don’t belong to bundles will experience increasing pressure. Broadband can also deliver useful services for online learning and telehealth, not just entertainment. According to a survey from Parks Associates, 8.4 million households in the USA already subscribe to an over-the-top service but not a traditional pay TV service. 57% of broadband households in the USA subscribe to an over-the-top service in addition to their other service. Many of those households could eventually migrate to online streaming options as they grow disenchanted with the cost of cable and satellite TV.

Netflix is contributing to traditional pay TV ratings drops. Netflix has exceeded expectations for subscriber growth both in the USA and internationally. Netflix contributed to 43% of the decline in linear TV viewing. Poorer and older households who traditionally stuck with cable and satellite may migrate to Netflix as it becomes even more attractive to those households and as traditional pay-TV options increase in cost. More viewers are binge watching episodes instead of being constrained by live TV. A survey from TiVo found that more than 30% of viewers put off watching individual episodes of a show so they can watch them in bulk when the season ends. 39% of viewers said that watching episodes back-to-back is even better than the traditional viewing experience.

HBO Now rapidly emerged as one of the strongest competitors in the subscription streaming video market. HBO CEO Richard Plepler believes that his online service will help HBO gain a greater portion of the $236 billion in subscription television spending estimated for 2018. HBO appears to be one of the few networks that truly understands the competitive threat Netflix poses to traditional networks. Like HBO, Showtime recently launched a standalone streaming service. The ability to subscribe to individual channels is the ultimate app for the many pay TV customers who only watch a few channels. Former Fox executive Peter Chernin says Netflix and YouTube will force cable bundles to justify themselves. Plenty of opportunities still remain for new companies to enter the video on demand space.

AT&T and DirecTV see a shift to mobile video. Companies with both wireless and video offerings are promoting new ways to package those services together. Releases of multiscreen apps are speeding up according to a survey from S3 Group. Pay TV operators are deploying multiscreen software releases at faster rates in both the USA and Europe. Horowitz Associates found that multicultural viewers stream more video than white viewers. Around half of African-American, Hispanic, and Asian customers already spend more than 20% of their TV viewing time watching over-the-top services. 88% of multicultural viewers in urban areas have the ability to stream video content to their computer or another device. At the same time, a Nielsen Total Audience Report shows that multicultural viewers are watching less broadcast and cable TV.

Online video continues to displace live TV. Video quality used to discourage viewers from streaming options, but Conviva found that online video quality has improved. Bitrates improved by 19% since the beginning of 2015 alone. Hub Research says that more than 75% of TV consumers in the USA view at least some of their video online. 40% of viewers age 16 to 24 replaced traditional TV with Netflix for their default viewing option. Information from Ofcom shared by Benedict Evans and John Gruber shows that 52% of people say that a smartphone or tablet is the most important device they use to connect to the internet. This is up from just 23% only two years ago. Verizon recently launched a beta of its Go90 service. This mobile video service is targeted at viewers in the millennial generation. Millennials are watching video on TV sets less often.

Traditional TV viewing among viewers ages 18 to 34 declined 10.6% between September 2014 and January 2015. The median age of the traditional TV audience reached age 50 this year. A third of Australians ages 14 to 29 don’t watch pay TV or even free TV at all. An analysis of 19,000 consumers in 19 countries from the Arris Consumer Entertainment Index found that 59% of consumers watch mobile TV. This number reaches as high as 72% of 16 to 24 year-olds. Broadband households with children spend 90% more on over-the-top services and digital video. Younger kids prefer mobile screens for watching videos according to a survey of 800 parents of children aged 2 to 12. Many parents even take away tablets when children are acting up, so traditional TV is now seen as a punishment.

Set top box rental fees cost the average household over $230 a year. Since 99% of cable customers rent their equipment, this unnecessary industry costs consumers $19.5 billion a year. These numbers come from the offices of US Senators who are attempting to quantify the set top box rental market. This led to calls to allow customers to buy their own set top boxes (at least until the set top box goes extinct). This could save cable subscribers hundreds of dollars each. Congress repealed the set top box integration ban, which means cable companies may no longer be required to make their services compatible with set top boxes bought by retail consumers.

Cable companies are fighting against set top box choice, which is another reason to bypass the cable companies. The cable industry remains stuck in the past and opposes innovations like virtual headends and other cloud options. Set top box rental fees add to TV bills that keep rising, up 9% in just one year. TV bills are up 39% from five years ago and up 100% from ten years ago. Cutting the cord may accelerate even more as the overvalued stock market falls and impacts the rest of the economy through job losses and reduced consumer spending. Pay TV operators lost 625,000 subscribers in the second quarter. This is the biggest quarterly loss ever reported for the sector. According to an estimate from MoffettNathanson, 18 million homes don’t have pay TV. There’s plenty of room for that number to grow as discretionary income falls for poor and middle class households. Even wealthy households may not not have time to watch TV if they have to spend much of their spare time navigating their businesses and assets through a global economic downturn. The CEO of Charter admits that many households already can’t afford full cable bundles. Money will go to food and housing before it goes to TV spending.

The average viewer in the USA watches nearly six hours of TV a day according to research from IHS. How do people even find time to watch TV for hours a day in a world where automation and offshoring eliminate jobs and people have to constantly work multiple jobs in the freelance economy and pay off student loans and gain new skills to avoid slipping through the torn social safety net and into abject poverty? Most viewing time for traditional TV is taken up by ads and promotions and shows that aren’t even that good in the first place.

Even pay TV wastes viewers’ time with advertising and product placement. More and more channels are increasing the number of ads they run. As ratings fall, companies decrease the customer experience by barraging subscribers with ads. Ad insertion targeted to set top boxes increases the advertising nuisance even more. As the 2016 election season heats up, political ads will appear on cable channels to join broadcast TV in a race to aggravate and annoy the greatest number of viewers. While advertising spending is increasingly going to digital outlets, the bulk of ad spending will still focus on TV. At least ad blocking browser plugins can block political ads online. Wherever there’s some form of entertainment that brings people joy, advertising eventually tries to inject itself into events like some kind of creepy stalker.

Advertising is invading the over the top video world. As any new entertainment service grows in popularity, advertising parasites eventually start to infest it. Over-the-top video services are the fastest growing channel for ad growth. Ad viewing on OTT devices rose 194% in the second quarter of 2015. This means advertisers will try to jam more intrusive advertising into those services in the future. Some products integrate broadcast advertising with digital advertising, ensuring there’s no escape from ads. Those products gather data from online social networks to thrust ads at people using any medium.

Comcast acquired a company that does dynamic ad insertion across multiple screens. Verizon’s AOL division acquired Millennial Media, potentially to integrate the company’s advertising solutions into its streaming video services. Sadly, Google is tarnishing its Google Fiber service by placing an emphasis on advertising shaped by viewing history. What could have been an innovative video service is reduced to showing ads like other pay TV services while gathering invasive data at the same time. To see the advertiser mindset in action, one media executive brags about how advertising can hijack viewers’ emotions while forcing people to watch ads. Micro-targeting mind-control is coming to a TV near you. Product placement continues to infiltrate traditional TV programs as ad skipping rises. The vapid reality stars and sitcom actors must be seen using certain products before commercial breaks featuring the same products. Advertising is even interrupting program guides. Nowhere is safe from shoving ads at unwilling viewers. Advertising is also defiling video on demand services as advertisers see the role of VOD ads in boosting retention.

The CEO of Netflix emphasized the company’s commitment to an ad-free experience in a Facebook post that was even liked by Facebook CEO Mark Zuckerberg. Netflix subscribers have such a dislike for ads that nearly 80% of them would pay to keep the service ad-free. 56% of Netflix subscribers would cancel the service if it showed third-party ads. 27% would be willing to pay $4 or more each month just to avoid ads. Online ad spending is migrating from TV to online, where fortunately for consumers it’s easier to block with ad-blocking and privacy add-on plugins.

Executives at Meredith and Media General claim that their merger will reach 30% of TV households in the USA and give them access to 100 million “unduplicated women” as potential advertising victims. Is “unduplicated women” the new “binders full of women”? This is just another effort in the long-running advertising strategy of controlling women by making them feel inadequate. Advertising makes everyone feel inadequate, but women and girls often bear the brunt of sexist and materialistic ads. The Digital Marketing Association thinks that industry self-regulation is good enough to avoid tracking children, but the advertising industry has a fundamentally predatory mindset and I don’t trust their promises. Advertisers have incentives to warp kids’ minds for the opportunity to create lifelong customers.

Even excluding advertising, TV programming just makes viewers feel bad about themselves by constantly showing celebrities with unattainable looks and lifestyles. Younger generations are spending increasing amounts of leisure time on social networking and mobile gaming anyway. Maybe there will even be a generation of cord nevers that doesn’t get traditional TV subscriptions in the first place. As video migrates online, it gives viewers more options to block ads in the first place instead of the added annoyance of fast-forwarding through them on a DVR. The recent launch of the free Adblock Browser for iOS helps protect users from mobile ads and tracking. Browser extensions like AdBlock prevent ads from showing up on YouTube videos. Ad blockers like Crystal will be available in Safari in iOS 9. As more video viewing migrates online, hopefully developers will keep up with the demand for blocking ads on streaming video services.

There’s also the hassle of buying and setting up big home theater systems and cable subscriptions, especially for millennial workers and generation Z students moving to new cities. A form of online subscription video on demand service without ads could eventually replace what we think of as television. TV could follow the set top box into irrelevance. Maybe live video offerings from companies like Meerkat and Periscope will take up a greater share of younger viewers’ media time. Better mobile experiences, video games, virtual reality that actually works, or some new entertainment technology we haven’t even thought of yet could send TV the way of newspapers.

Comcast is attempting to develop a competitor to YouTube but initial reports make the service seem underwhelming. It sounds like a tentative way for the company to hedge its bets rather than a true mobile-centric strategy. Other service providers are investing heavily in dedicated over-the-top video solutions. Daniel Frankel of FierceCable asks big cable companies uncomfortable questions in their quest for younger viewers:

In the race for young-consumer acceptance, is an unpopular, entrenched telecommunications monolith like Comcast really just going to overwhelm a well-backed Silicon Valley start-up with a catchy name simply because Comcast says it now understands the market? The battle seems far more uphill than that to me. Can services like Go90, Watchable and Xfinity on Campus really foster deep emotional connections with young, rebellious, tech-savvy consumers who view their corporate backers as “The Man”?

Live sports are still stopping many people from cutting the cord. Luckily for fans, sports companies are just as greedy as cable companies and Hollywood and see ways to profit in the shift from TV to streaming video. CBS CEO Les Moonves says the CBS All Access over-the-top video service could get NFL games someday. New subscription-based apps that show all games played in a pro sports league could offer fans new ways of seeing their favorite players develop brain damage that sends those players into a spiral of domestic violence and depression. And all this without the frustration of certain games being blacked out (the players will still be blacked out from concussions though).

Like other mature industries, the set top box and television will plod along while declining over the years. The billions in set top box revenue are small compared to home entertainment revenue. They’re tiny compared to total entertainment revenue. Television revenue is miniscule compared to total technology revenue. The set top box is just a conduit for greedy cable companies and media & advertising executives to invade your home. So long, set top box. So long, TV. So long, video advertising. Nobody ever loved you in the first place.

Emma Stone, Lena Dunham, Rita Ora, and Death Anxiety (Stars: They’re Just Like Us!)

Like me, celebrities are opening up about their experiences with death anxiety and living in fear of death.

Emma Stone: “I’m close to my mortality. I think about it every day. Not in a freaky way, but constantly. I feel hyper-aware that everything could end. That’s always been in my mind, for whatever reason, since I was very small.”

Lena Dunham: “I think a fair amount about the fact that we’re all going to die. It occurs to me at incredibly inopportune moments… I wish I could be one of those young people who seems totally unaware of the fact that her gleaming nubile body is, in fact, fallible… But I am not one of those young people. I’ve been obsessed with death since I was born… I walked into the kitchen, laid my head on the table, and asked my father, ‘How are we supposed to live every day if we know we’re going to die?'”

Rita Ora: “Death is my biggest phobia. I used to have panic attacks when I was little, saying, ‘Mum, I don’t want to die.’ I’ve been to therapy and still try to go every week.”

Uncertainty and ambiguity surround death, since nobody is one hundred percent sure what happens after death. Some people claim to know with absolute certainty, but how do you even test what happens after death? Uncertainty and ambiguity are major drivers of anxiety. Terror management theory and the book The Worm at the Core describe how a large amount of human psychology involves grappling with death anxiety. The human struggle with how to think about death shaped religions and world history.

Some people grow up with an intense fear of hell as a result of fundamentalist religious backgrounds. This often manifests in Religious Trauma Syndrome. Fundamentalist religions control people by exploiting the human mind. Even if people didn’t grow up with a traumatic religious background, religious authoritarianism pervades many societies and their political systems. This constant background of religiously-motivated fear affects people predisposed to anxiety. Belief in a punitive god is associated with psychiatric symptoms. Atheists responded to these religious excesses with their own attempts to relieve the fear of death by describing a state of nothingness after death, but I also find those attempts lacking. So far I haven’t found any useful ways of dealing with death anxiety aside from distraction through workaholism and exercise and meditation and minor tranquilizers, but these only provide temporary relief.

People lucky enough to live without death anxiety use flippant arguments to dismiss others’ fear of death. Examples of all these lame arguments are offered in the comments of a recent Guardian article on death anxiety. Maybe those commenters won’t be so lucky if the afterlife isn’t as pleasurable or nonexistent as they assume. I think all of humanity’s effort should be devoted to extending lifespan at any cost, since the tiny possibility of a hostile afterlife is terrifying. The following flawed arguments often get deployed in discussions of death anxiety, and this list also includes my responses to those arguments:

Appeal to acceptance: Fearless people tell individuals suffering from death anxiety to just get over it. Anxiety has a neurobiological basis in the brain where thoughts are determined and some people can’t simply choose to think different thoughts or stop worrying about death.

Appeal to nature: This is the naturalistic fallacy. Death is natural, but so was dying in infancy before antibiotics. Dying from malaria in childhood is natural in certain parts of the world, but philanthropists and medical professionals are working to change that.

Appeal to religion: How do people know they picked the correct religion or belief system that leads to a happy afterlife? What if an advanced species that operates in more dimensions than humans has materialist methods to extract human consciousness and torture it?

Appeal to social justice: Some people take a perverse pleasure in thinking that death is the final outcome of both rich and poor. Isn’t it more important to work to extend the lifespan of everyone from every economic and social class?

Appeal to nothingness: Most atheists say that consciousness emerges from the brain and just disappears after death. Biology professor and atheist Richard Dawkins says that those who die after living are the lucky ones since DNA allows for a massive number of potential people who never existed in the first place. That’s not very comforting to someone living in fear of uncertainty about what happens after death. The following arguments are similar to the appeal to nothingness argument.

Appeal to anesthesia: Many people have experienced unconsciousness caused by anesthesia at some point in their lives. One minute you’re conscious and breathing an anesthetic, the next minute you’ve woken up wondering what happened. Most general anesthesia is combined with other medications in ways that lead to short-term amnesia. There’s no guarantee that the subjective experience of anesthesia is the same as what happens to consciousness after death.

Appeal to resuscitation: Some people who died on the operating table claim to have experienced nothingness before they were resuscitated. This isn’t necessarily the same as what happens to consciousness after death.

Appeal to time before birth: Nonreligious people often quote Mark Twain, who talks about being dead for billions of years before being born. However, this doesn’t necessarily mean that what comes after death is the same state.


Afterlife Beliefs and Death Anxiety: An Exploration of the Relationship between Afterlife Expectations and Fear of Death in an Undergraduate Population.

Does Religiousness Buffer Against the Fear of Death and Dying in Late Adulthood? Findings From a Longitudinal Study.

Fear of Death in Older Adults: Predictions From Terror Management Theory.

“I’m not afraid to die”: the loss of the fear of death after a near-death experience.

Predictors of Fear of Death and Self-Mortality: An Atlantic Canadian Perspective.

The Gifted and the Shadow of the Night: Dabrowski’s Overexcitabilities and Their Correlation to Insomnia, Death Anxiety, and Fear of the Unknown.

Existential Risks, Ordinary Risks, and Living in Fear

I’ve met people who escaped war-torn countries who are much less anxious and fearful than me. I’ve met plenty of women and girls who have much less fear and anxiety than I do. Anxiety is a stereotypically feminine trait, so most males don’t talk about it even though anxiety disorders affect millions of males. Lots of anxious guys cover it up with alcoholism since cultural history and alcohol advertising made binge drinking into a macho pastime. I’ve had wine before but I’ve never had enough alcohol to make me feel any different than normal. I always worried about accidentally drinking too much and thinking I was in a dream and losing control and punching men and groping women and leading police on a high speed chase and then ending up in prison. I never really trusted anyone I was drinking around to keep me out of jail or the gutter. I should probably just learn more about the effects of alcohol on the brain through PubMed, where it’s indexed as ethanol to differentiate it from other alcohols.

The risk of drinking too much is very real but pales in comparison to what forecasters call global catastrophic risk or existential risk. People with anxiety disorders are preoccupied with “what-if” scenarios and the study of global catastrophic risk and existential risks provides plenty of these scenarios that could destroy humanity or wipe out the planet. What if viral bioweapons kill a billion people? What if tension reignites conflicts between the USA and Russia leading to use of those countries’ thousands of nuclear weapons? What if simple human or computer error like the Dead Hand system causes the launch of thousands of nuclear missiles? What if electromagnetic pulses knock out electrical grids and cause human society to descend into chaos filled with murderous roving gangs? What if methane gets released from the ocean floor leading to runaway global warming and mass extinctions? What if a supervolcano eruption causes a volcanic winter that destroys the global food supply? What if humanity is causing extinction of some species necessary to the food chain that will cause massive human starvation due to its absence?

Some existential risks can be dealt with through science and engineering, but others are much more catastrophic. What if a large asteroid is on a direct path towards Earth? What if a black hole wanders into the solar system? What if a gamma ray burst wipes out all life on Earth in an instant? What if a cosmological event that no one knows about in advance destroys the planet? Maybe an advanced future civilization could deal with a risk like that, but our current civilization sure can’t.

Ordinary risks like heart disease and automobile accidents provide other things to worry about. Heart disease and accidents (not just vehicle accidents) cause around 750,000 deaths each year in the USA alone. Worldwide, road injuries by themselves cause 1.3 million deaths. A common argument about the safety of flying is that it’s much safer by mile than driving (which it is) but that just brought my attention to how many people still die in car accidents and how terrifying driving can be. More people should have a fearful attitude towards vehicles since we’re inattentive primates piloting thousands of pounds of metal. Why even bother working hard at anything in life if all your effort can be wiped out in an instant by a drunk or distracted driver?

Medical errors contribute to the deaths of hundreds of thousands of patients each year. One estimate using the Global Trigger Tool found that adverse events occurred in one-third of all hospital admissions. Another estimate suggested that more than 400,000 deaths were attributable to hospital care. Those are just the deaths associated with hospital care and not even the deaths associated with regular medical care, which probably adds to the total number of deaths due to medication interactions, infections, and other risks.

I wonder how people dealt with major risks in the dangerous Cold War era with its mutually assured destruction and nonexistent automobile safety. In those days a tiny dispute in Cuba could escalate to the USSR launching thousands of nuclear warheads. Someone’s kid could go off to prom one minute and end up decapitated in a car accident the next minute. Maybe that’s why alcohol and cigarettes and tranquilizers were so popular. Before antibiotics were perfected, someone could get scratched by a rose bush and end up dying. Antibiotic resistant bacteria threaten to return us to those days. How did people ever get out of bed knowing that a single tiny mistake could lead to death? Maybe that’s why religion became so widespread throughout history.

Human mortality provides a classic source of existential anxiety. Human consciousness probably just disappears after the irreversible loss of brain function when a person dies, but how do you test that? The easiest method is to compare brain scans of healthy people with the brains of dying people to find which brain networks lose activity. One evil idea is to try to induce near death experiences in people by stopping their heart in an attempt to replicate others’ reported experiences with the afterlife and then question them for details of other realms. A more humane approach comes from Dr. Sam Parnia who offers the hypothesis that freezing trauma patients with therapeutic hypothermia may lead to more near death experiences and reports of the afterlife when they recover.

Religious people are confident their religion is true, but what if they’re wrong? What if Muslims are right and all the Christians end up in hell? What if Christians are right and all the Muslims end up in hell? What if nobody is right because the true religion was lost to history and everyone now ends up in hell after they die? Religions are probably just human inventions, but there are other frightening possibilities compatible with a material universe. What if the universe is a simulation and people go through an infinitely prolonged and infinitely painful transition process at the hands of the simulation creators after they die? What if extraterrestrials or other beings figured out a way to use advanced technology to extract human consciousness in some form and reassemble it elsewhere to torture it forever?

If such a hellish scenario really existed it would be a moral imperative to develop the technology to enter that dimension and overthrow those superbeings to rescue trapped and tortured human consciousness. If the many worlds interpretation of quantum physics is true, this means there are numerous universes where human beings undergo excruciating pain at the hands of godlike beings. To test these ideas, scientists would have to know everything about the universe (or multiverse) and furthermore figure out a way to know that they know everything.

A near-impossible task like preventing every cause of death seems almost reasonable compared to this. Can existing humans with their feeble brains even estimate the probability of ordinary and existentially catastrophic events without some kind of intelligence augmentation? There’s a need to create ways of augmenting human intelligence with implants and artificial intelligence to better deal with risks. Some of the potential causes of global catastrophic risks like genetic enhancement and nanotechnology and artificial superintelligence are also some of the things we need in order to prevent those same catastrophic risks.