Thursday, March 28, 2013

Takedown Breakdown

My previous post about a page takedown due to a supposed DMCA (Digital Millenium Copyright Act) violation attracted a comment:
I am going through the appeal process regagrding D360 threats myself. My hosting provider did lock down my entire site and I am working to get it back up. D360 contacted me and I responded immediately and removed the state map images for the U.S. that one of my researchers found through Google Images, and in our rush to complete a project last Fall 2012, it went without proper review as to the origins of those maps. An honest error on our part, admittedly, but these asshats are in this to suit people and are not interested in simple resolutions. I have had my site at godsownparty(dot)com for over 5 years without ever experiencing this type of aggressive attack over an unintentional error. When my site returns...guess who I am writing about?
And this comment attracted another comment (which was posted three times as the author, whom I would have thought was quite web-facile, had trouble understanding's controls):
This Anonymous person's name is Leah and she's pretty upset at her website begin down. Destination360 filed a DMCA complaint on her website because they took 3 maps on 3 separate articles. Example: Its pretty clear there's a copyright and who owns it right? Her webhost was pretty heavy handed in their response but we have no control over that. She's now posting nasty anonymous comments on our Google+ acct. Why not just take responsbility for your actions and move on? Because its the internet and people can be anonymous.
To which I answered, in comment form:
Dear Local Trips/Destination360: Thank you so much for sending the same comment three times. I guess it never hurts to be certain you were heard, but you do apparently believe in taking responsibilities for your actions... When you file a DMCA complaint, as you seem to enjoy doing quite often, it causes undue havoc and pain upon people who were really not trying to harm you. In my case, I credited your photo to your site. Had you left it alone, you might have generated additional business, as the Hunter post is one of my most popular. The credited link could have drawn in more people to your site. And even if you don't want additional traffic to your illustrious site, you COULD have simply contacted me and asked nicely for me to take down the image. I would have done so, but had I refused, it would THEN be the proper course of action to file the DMCA. With your petty behavior, you now inspire people like me and Leah to let others know, and not only do you not gain any traffic, you lose potential customers and viewers. Is it worth that? And by the way, as noted in the post, I've found duplicates of your photos and your copy elsewhere...who stole what from whom?
To which Dan Taylor, the principle (and I have to admit superb photographer of answered:
Dalai, Obviously that wasn't the intention to post multiple times, feel free to delete extras if you care. The commenting confirmation on this has something to be desired. I cannot comment on your specific instance regarding DMCA but we're fine with someone filing a DMCA on Destination360 we hire all our writers and content is run through copyscape so our work is vetted. Thanks for allowing us rebuttal on this issue.
And I responded:
Here's a rebuttal for you...why are you at Destination 360 being such BUTTS about this? WHY couldn't you simply contact me, which you can see is quite easy to do, and ask NICELY for me to remove the image in question? WHY did you feel it necessary to go straight to a DMCA filing? DO you possibly grasp that this just works against you in the end? Probably not.
Dan has the last word to this point:
Sorry but in order to process DMCA's you must follow certain procedures. Most people taking images are doing it for profit "traffic theft". On occasion innocent users get caught in this. Its impossible to determine who this is without significant work on our part. So the only way we can effectively and legally process these is to send to the website user email adddress and webhost. In the case of the Leah incident she had her whois hidden as private so we had no way. We sent 5 emails over the course of one month. I doubt you will understand our position but if you were in our shoes you might. In all fairness you say easily contact you. In looking at I cannot find anyway to contact you on this blog. I must go back to my dayjob. Cheers! 
Well, Dan, old friend, you really should consider putting in that "significant work", as you might be taking away the livelihood of others. My blog exists mostly for my own amusement, but other people actually depend on theirs for a living. I notice produces something under $200/day in advertising, which may or may not be enough to keep you in Nikon D800's without your day job. "Leah's" site isn't back up even yet, so I don't know if this is something that generates food-money for her or not. Would you be at all sorry for your actions if it did? Was her goal actually traffic theft? Mine certainly wasn't. If by that term you mean using the photos in question to divert web traffic from your site to mine, well, I guess that practice does exist.  However, I seriously doubt it represents the majority of people who use your photos, ESPECIALLY those who do so and give you credit for them as I did. With the crediting link, YOU, Dan, and your illustrious site, get FREE advertising. The "Doctor Hunter" post was one of my most popular. I used the photo of the hunter to represent my friend the hunting doctor, and it had nothing to do with anything on Nothing but upside for D360 to just leave it and me alone.

There's a punch line here...the photo in question wasn't taken by Dan or anyone else associated with was a STOCK PHOTO from  So I bought the rights to use it myself, and it's back up on the Doctor Hunter post:
Order Summary
File: #1162020
Standard License (Included) Order number: 19731992

Please save this invoice/receipt as a record of your purchase.

iStockphoto LP, Suite 200 - 1240 20th Ave SE
Calgary, Alberta T2G 1M8 Canada

Now, isn't that interesting? How did they know my use of the photo was not kosher? Well, I made it easy for them by posting the credit right there by the picture. It's also possible to check the source of a download by examining the EXIF data of the photo. In this case, the version I borrowed from D360 mentions their website, and that from iStock contains their info, and that is perhaps another way to search. (I will of course assume that D360 licensed this picture either from iStock or in another legal manner.)

It's pretty clear that my friend Dan is trolling the 'net looking for photos (and maybe text) that match the content of, without bothering to find out the origin of the material. To be fair, I had not properly obtained permission to use the photo in question (which I have now), and in MY case, D360 truly did have the right to file the DMCA action. BUT, this isn't always the case with Dan and company, as he himself admits above, and some others like "Leah" will suffer. Others have had similar amusing experiences as this blog post and attached comments will illustrate:
My frustration at GoDaddy has gone to a whole other level this week.

I used to be a loyal GoDaddy customer from day 1. I hosted over a hundred websites, including 3 dedicated and 2 virtual servers, had all my domains through there all purchases through my reseller account which was also doing very well. Needless to say I feel I am a pretty reliable source to be giving a GoDaddy review.

Over the last 2 years, my loyalty to GoDaddy has been steadily dwindling. It wasn’t the customer support that was steadily getting worse, or the constant mistakes in billing….it wasn’t even the malware attacks that prayed on server vulnerabilities, infecting over 87 of my wordpress sites that they stubbornly insisted to the bitter end, wasn’t their fault.

But the nail in the coffin for me, was finding out that GoDaddy does not enforce their own terms to protect our servers, and that anyone with an email has the power to take your server down.

Scary right? Its the truth and here is what happened.

Recently one of our Dedicated Servers was suspended because of a Copyright Complaint. No notice, no warning…nothing. One minute its up and the next its down.

There is no way to contact the Copyright department by phone. You can only contact them through email. And they are the only one with the power to restore your server. You are supposed to receive an email notifying you as to why the server was taken down but since most of us with dedicated servers also host our emails on the server, that did not happen in our case.
So we had to send them a request by email to find out why our server was suspended and they took their sweet time responding. Nearly 5 hours later we got an email with a complaint that was attached from who claimed an image we had on the site was theirs and they swore under penalty of perjury to that fact. They provided a link of the image on their own site, and then one that showed it on our site. That was it.

Our first issue was to get the server restored. And in order for us to do that we had to follow this list of things which included swearing under penalty of perjury that we would remove the image immediately. I found that interesting considering you can’t remove the image when the server is down. We responded with the things they asked us for, and told them we would remove the image as soon as they put the server back up. But we kept getting rejected with an auto response referring us to the terms and instructions. I just continued to submit the same response and the 4th time it was accepted. FINALLY, After 12 hours of being down and waiting for responses, we were told we would be restored. But it didn’t happen and when we called to see why, we found out they went home and we would have to wait until the next morning!

Eventually they got the server back up. Total down time, 20 hours, just long enough to lose traffic from a breaking news story linked to on drudge, affect the sites ranking and lose advertisers.

I decided to now look into this situation that caused all this which was the copyright violation claim. Imagine my surprise when I searched the image in question on, to find out that the image was in fact owned by IStock photo. Further research showed we had a license for it.

So why was filing complaints about images they don’t own? And how was this claim validated by GoDaddy? Can anyone claim copyright infringement and just take down a website? Does GoDaddy just yank your website, no questions asked?

It seems so, how else could this have happened when clearly the accuser did not own the image and could not have provided proof of such.

SO the questions is, does GoDaddy just automatically suspend service when they get complaints and then sort out the details later? Because that seemed to me like a very dangerous power to give to someone who wants to take a site down. There had to be something that prevents false claims or malicious intent.

I called an talked to a manager named Chris to ask this very question. Chris assured me that although they wont make the decision who is right and who is wrong when the complaints are received, they do make them follow a strict complaint submission protocol and will verify the complaint before they suspend. They admit they take action swiftly but they do not just suspend all sites that get complaints arbitrarily.

I checked out the rules for submitting a copyright complaint. To my surprise, the complaint that Desintation360 provided did not provide the necessary information to have a valid complaint according to the terms of GoDaddy.

So how was that claim aloud to pass as valid? Can anyone just lie and say we stole their image and take our server down?

But even more surprising is that they do NOT ask you to provide proof of some kind of documentation of the actual copyright when making a complain. Which means if someone has malicious intent, all they have to do is swear that they believe you have violated their copyright (even if no such copyright exists) by using something of theirs on your website, and GoDaddy will suspend the website. No questions asked.

I contacted ISTOCK who immediately called me, concerned and provided us with proof for GoDaddy, that we were within our rights to use that image. My goal was to not only show GoDaddy the claim was not valid but to show we had the right to put the image back up.

I immediately emailed that to GoDaddy the license and letter from ISTOCK, along with several requests for a manager to review this situation. I was very concerned that our server was not safe, and wanted to know why the complaint was allowed to be escalated to server suspension and how they thwart malicious intent, if they are not asking for any kind of proof. Chris the manager said they do look into these things first. But clearly that didn’t happen here. So what happened?

I expected someone to email me back. But we got nothing but automated responses containing instructions on how to get our server back up which proved they were clearly not even reading our emails considering the site had already been back up for 2 days.

When I finally did get a response from someone named Michelle, she asked me why the image was still up when we promised to remove it. That concerned me again considering it wasn’t up and hadn’t been for 2 days. But even worse was that we had provided our license for the image and should have been able to put it back up anyway. SO no one was even looking at our emails and documentation. GoDaddy didn’t care that we were wrongly accused.

Hey wait, aren’t they supposed to be on our side?

After providing her with a link to the images 404, and again asking how we can document with GoDaddy that this claim was not valid and did not comply to their terms and asking to be allowed to republish the image, she responded asking us file a counter claim.

So we did. She responded to tell us that the server would need to be suspended until the court date.

Wait….court date? What court date? I thought we were just providing you with information about why the complaint was not valid so we could put the image back up and not get in trouble for it. Apparently there is NO way to do this. There is no way to disprove a bogus claims with GoDaddy and NO way to hold someone accountable for false claims under penalty of perjury without taking them to court. And the best part is that godaddy supports you through this process by taking your server down until it is resolved, something that is not mentioned in their terms.

In the end, we never got a call or email responding to our concerns, nothing assuring us it wouldn’t happen again, nothing explaining the situation, nothing acknowledging the proof we had the rights to the image, nothing assuring us that they do look into claims before yanking servers and sites. Just Nothing.

Oh and I emailed Destination360 several times to tell them about their mistake and how it affected our website. Guess what I got from them? Yep. Nothing.

So what does all this mean to you? It means your GoDaddy server and website is vulnerable. And until GoDaddy decides to listen to its customers and better protect them, this is not going to change anytime soon.

I certainly don’t intend in staying around to find out.

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June 26, 2012 at 3:42 pm

I, too have had the same issue with this malicious company Godaddy. On the 25th of this month, June 2012 they took my site down after they received the same complaint of a copyright violation from the same company They simply emailed Godaddy and said we stole one of the photos from their site. We did not steal anything, as the photo was licensed by Istock. Godaddy never contacted us and just immediately took our site and hosting down. After they did they emailed us. And by violating our contract with them, Godaddy, they ruined our online business.

I will look into filing a lawsuit against Godaddy and against for libelous and false claims.

Godaddy must actually believe they are too big to fail…they are wrong. Once a company reaches success, like GM and thousands of other companies, they treat their customers like dumb ignorant cash-cows.


June 26, 2012 at 4:14 pm

Email me and I can give you the name of the manager at ISTOCK who has been dealing with Destination360 already about this issue. ISTOCK is NOT happy as it harasses their customers and I am sure they will be concerned to hear this is still occurring. I will be sure to email my contact there and let her know.

You have a valid reason to pursue legal action as in order for them to take down your server, they have to swear under penalty of perjury and since they have done it more than once and have already been warned about it, it is not longer something they can claim is an oversight. I am happy to provide you with details of our situation for your court case if it helps.


May 21, 2012 at 4:36 pm had our site removed for using an image of a windmill we had a legal license from istock to use! It was a huge problem for us and took us nearly a week to resolve. Worse yet, we also could not put the image back up as godaddy did not seem to care that we had a license, and said they would take our site down if we put the image up. So we paid for a license we can’t use. Your site is about godaddy, but it seems to me the real problem is istock! In other words, if you buy an istock license you are at risk from a company who has decided they own images that they don’t and will have your site taken down? Your article is a year old, it is unacceptable that istock has not fixed this issue. They need to take action against Destination360. Suspend their account!

I don’t understand what Destinantion360 has to gain by doing this? Do they really think that they own these images??
Dan, buddy, pal, mate, friend...THIS is what your blind shotgunning accomplishes. For every real case of "traffic theft" you eliminate, you cause a boatload of grief for several more innocents.

Not that you really care, but IF you and want to be a good citizens of the web, Cease and Desist from your belligerent practices outlined above. Yes, it is your right to pursue those who actually ARE trying to steal your customers (although I'll bet you don't get much revenue from the vast majority of those viewers who might be so enticed anyway), but you should have the common courtesy to find out BEFORE you go, ummm, gunning for them. You are doing nothing more than turning away potential visitors to your site. You are firing a shotgun into a crowd which you think might contain someone who ripped you off. This is not the way to win friends and influence people. Not at all. In fact, Dan, you posted something on your own forum about "" which I won't reproduce as you might get upset. The gist of the post was that "image scrapers" are trolling for your content and using it as an easy source of revenue. Really, Dan? Are the dozens of little piss-ant blogs out there that you have prosecuted (under pain of perjury) REALLY using your content for revenue? Certainly, a site that DOES do this deserves the full weight of your wrath, the rest of them, the rest of us, probably not.

Since you are quite concerned with Internet piracy, as we all should be, by the way, you might be glad one of your images was lifted to be used in a talk about...Internet piracy.  The image of the Mexican Caribbean is yours. Have fun prosecuting the Hong Kong police.

There are a lot of sites dedicated to travel beyond I'll be visiting those, and not yours. I urge my readers to do the same. THIS is what your behavior brings you, Dan. Yes, mine is a small blog with few readers. But they have friends, and the friends have friends...

Next time, send the perpetrator an email, a common courtesy which you didn't afford me. Most of us out there will do the right thing. Unlike those who indiscriminately file DMCA notices.

Sunday, March 24, 2013

Dalai Speaks! No One Falls Asleep!

I had the honor of speaking to the South Carolina Radiological Society Annual Meeting yesterday. Clearly, the organizers wanted to intersperse some entertainment and low-brow amusement into the schedule of academic presentations, and I was more than happy to oblige.

My talk was a revamped version of what I said at RANZCR in 2010, updated appropriately to reflect the few areas of improvement I've seen since then.

Because the presentation computer was a Dell running Windows Vista (I guess someone actually bought a copy), two video clips that were supposed to be part of my PowerPoints didn't work. So, if anyone who attended the meeting actually was motivated to check them out, here they are...

The Scope of the Project

This fanciful piece is inspired by the rigidity of the IT mentality...

Dalai's PACS Fix

This is how I would handle some of the PACS problems I encounter...if I could.

Now here's something that will shock the pants off of some out there.  After my talk, I was approached by one of the participants who asked me if I had time for "some advice".  I naturally assumed he was going to tell me how awful a speaker I was (I used my old iPad 1 for a teleprompter). But no, on the contrary, he thanked me for the talk, and proceeded to ask which of a restricted list of PACS vendors he should consider. Here's the shock...WITHIN the constraints under which he was operating, I felt the best choice was.....

Wait for it.....


You're welcome.

Wednesday, March 20, 2013

Lessons From Steubenville

Dalai's Note:  It seems that Dalai, Jr., has discovered the cathartic effects of writing, especially after a brutal Chem exam! Here is is latest, and I agree with every word....

The light shining through your window hits your face, and you instinctively open your eyes. Big mistake. The drinks from the night before have taken a toll on your body, and the hangover is hitting you like a massive freight train carrying twenty cars of nausea, headache, and dehydration. You hear a buzzing, and see your phone is lighting up with 1, 2, 5, 10 new text messages. You read everything from “R u ok?” to “I CNT BELIEVE U DID THT U WHORE!” You wonder what everyone’s talking about, but realize that you don’t know because you don’t remember anything from last night. Something about a party…some drinks…a car ride… and then nothing.

The next Monday at school, you’re ignored by all your friends, who call you a liar and a slut. You’re still not sure why. That is until someone waves the pictures in your face. Suddenly it becomes clear. You’re afraid to say anything, because after all, you’re the one who got drunk. You’re the one who didn’t stay in control of yourself. It’s your fault. Not those guys. They didn’t mean any harm, they were just messing around. It’s how guys are, everyone knows that.

Eventually though, you confide the truth in someone, and accusations are made. Even though the boys are put in prison, you’re publicly shamed and faulted for being unconscious. For drinking too much. For letting yourself be raped. You’re told on the national stage that you should have kept better control. That you were asking for it. That you have no right to press charges. All your fears are coming true, and you wish you had never said anything at all. Because after all, it is your fault. Right?

As I’m sure we’ve all heard by now, two high school football players in Steubenville, Ohio were accused of raping an unconscious sixteen year old girl at a party last August. There are several pictures of the two boys digitally penetrating the helpless, passed out young woman, but for some reason the world, and especially the mainstream media, has continued to try to protect them. At first, the entire incident was nearly swept under the rug by local officials who didn’t want to see the local high school’s star players kept out of the game. Later, once the guilty verdict was handed down earlier this week, the world cried out for the “two young men [who] had such promising young futures" (CNN), instead of rejoicing in the fact that two criminals had been brought to justice.

So what does that say about us as a nation? First and foremost, the amount of victim blaming that has occurred over the course of this trial has been, frankly, sickening. Yes, the survivor of this heinous—but all too common—crime should not have drunk as much as she did. Yes, she should have kept better control over herself and her actions. But does that give someone the right to do whatever he wants to her as she is passed out and probably in need of medical attention? I am ashamed to live in a country that so clearly thinks along these lines.

If you think that this girl is to blame for getting herself into the situation, then you could not be more wrong. Yes, we are responsible for our actions, regardless of whether we are drunk or high or sober, but does that mean that those around us are allowed to suspend their accountability and human decency simply because it’s our fault for getting drunk? No. In fact, situations like that are where our kindness is supposed to shine through. Instead of videotaping their buddies, those bystanders should have been calling an ambulance, the police, or at the very least keeping those two animals away from her.

You may question my use of that word to describe Trent Mays and Ma'Lik Richmond, but that’s exactly what they behaved like that evening. Sure, you can say that they were drunk as well, but then again, aren’t we responsible for what we do when we’re drunk? No, these boys acted with no regard for the humanity or well being of their victim. They saw something they wanted and took it. They’d been taught their entire lives that they could have everything they could possibly desire as long as they were good at throwing, catching, and hitting a couple strips of leather.

I grew up in a small Southern town, where high school football was overshadowed only by college football and church, but mostly college football. During my high school years, I served a stint on the school’s Honor Council, the committee of students tasked with trying cases of cheating on campus. In my second trial ever, we were brought what should have been a very cut and dry case. A student was caught with a cheat sheet during an exam, and the teacher turned him in. Under most circumstances, our recommended punishment, a one day suspension, would have been carried out immediately that Friday. There was one small problem, though. The defendant was not any ordinary student. He was the quarterback of the football team, with no real second string replacement. With the biggest game of the season coming up on Friday, the defendant was let off with a slap on the wrist and one early morning detention the next week.

Is this fair? No, but not just to those around this student. This young man was taught his entire life that he could do no wrong and that all his messes would be cleaned up for him, simply because he was an athlete. Yes, those students who actually work for their grades had been cheated, but they at least know how to function as ordinary human beings. When they go out into the world, they will know how to take responsibility for their actions and take care of themselves. I don’t think I can say the same of the quarterback. While his peers learned early on that their actions have consequences, he will one day have to realize this truth the hard way, much like Mays and Richmond did. He is not the one we should crucify for this travesty of school hall justice.

So who is to blame?

In short, everyone. You, me, the media, politicians, everyone is at fault. We have developed and sustained a society that teaches its youngest generation so many warped lessons. Girls are taught not to dress provocatively because it’s asking to be raped. Boys are taught to worship athletes, musicians (if you can call rappers musicians), and movie stars who sexually and physically abuse women, take illegal drugs, and routinely act as if they are above the law.

You may be thinking to yourself, “I don’t respect those people, and I certainly wouldn’t want my kids to do so, either.” Then do something about it. Sit your kids down and tell them that no matter how famous or rich or attractive they may or may not become, they are still and will always be human beings. Don’t show your boys how to hold a bat, teach them to hold themselves accountable for their actions. Take your daughters to a self-defense class, don’t tell her that she is a helpless victim. Your son deserves to know how to act as a functioning member of society, and your daughter deserves to be able to go to a party without fear.

Fortunately, a good majority of parents already do those things. However, there are still plenty of parents that need to wake up to reality themselves. These patterns in our society have taken root because plenty of people believe that their sons or daughters will grow up to be the next Peyton Manning or Beyonce. Sadly though, all these parents are doing is setting their children up to be the next Mays or Ma’Lik, so engrossed in themselves and their own wants that they harm those around them with their selfishness and lying.

Monday, March 18, 2013

Lipitor of the Soul: One Man's Response to Society's Heart Problems

Dalai's Note:  My son, Dalai, Jr., offers this response to my recent post...
Recently, my father, Doctor Dalai, wrote an article entitled “Atherosclerosis of the Soul” in which he describes “a thickening, a coarsening of whatever it is that makes us, well, us.” As a Freshman at BigBucks University, a medium sized research institution in the Midwest known for its rigorous Pre Med curriculum, I have both witnessed and experienced this phenomenon first hand. I have seen behavior that those removed from the situation would call soulless, robotic, and callous. I have watched myself and my fellow students push ourselves well beyond our breaking points with sleep deprivation, overloaded schedules, and extracurriculars. I have seen and, in many cases dealt with myself, depression, doubt, and even suicidal thoughts brought on by upcoming tests, returned grades, and vast, intangible plans for the future.

At the beginning of the semester, I studied for five or more hours a day, slept maybe four hours a night, and had an A+ GPA. I also hated every second of it. The draining hours spent in the library only reminded me that I had plenty of time to take care of my grades, but not myself. I ate terribly, saw my non-premed friends little, and kept up with the bare minimum of hygiene. Showering became an extra alarm clock to wake me up in the morning instead of a way to smell presentable.

After my first round of tests, I found myself sitting on one of the highest GPA’s on campus, with 3 A’s and a B+. But instead of the satisfaction that I had expected to follow from my success, I felt hollow and numb. I had the grades, but they meant nothing to me since they had come at the sacrifice of “whatever it is that makes us, well, us.” Staring at my 69 (a B+ on a test where the mean was in the low fifties), I realized that I had to take better care of myself. I knew that I needed to make a change, or I would explode. The problem, though, was I had no idea where to start. In high school, I had sports and other extracurriculars to keep me sane, but adding another activity to my already packed schedule would have only made things worse for me. Instead, I examined my daily routine and decided that I would focus on reshaping that to meet my needs. I started by forcing myself to sleep more each night, putting my work down by 3:00 AM and waking up no earlier than 9:00 AM. The benefits were tremendous, physically, but not mentally. I still felt overwhelmed by everything going on, resorting to shutting myself in the library all day to avoid dealing with the stress of anything beyond schoolwork. I let my already flimsy social life crumble as I simply could not handle the drama, effort, and emotional drain of being a good friend. Physically, I was never better, but my atherosclerosis of the soul was nearing terminal stage.

Almost a month of living in this empty, inhuman state left me depressed and unsure of my direction in life. I needed a change, and I needed it fast, so I began where I did with my first change. Looking over my day, I tried to find parts that I could make relaxing and peaceful. Studying was already my drug, laundry was too much of a hassle, and showering simply existed as a means to a socially acceptable end. Plenty of friends (though I’m not sure that’s the right word) offered me numerous drugs as a way of “chillaxing,” but I was far too afraid of losing my precious grades—the only prizes I really had left—to even consider taking their offers. Eventually, I remembered an article I had read years before about traditional straight shaving and its supposed meditative quality. Being in college with a minor allowance, I decided to make the fifteen dollar investment and tried it out.

Put quite simply, the results were incredible. Not only did I have the satisfaction of fighting against a steep learning curve, I had a beautiful—well, beautifully smooth anyway—final product to show for it. Unlike my classwork, I could feel my success in my hands and had immediate feedback for where I was doing well and where I needed to improve. I got to spend twenty or thirty minutes a day simply working with my hands and focusing on nothing but blade angle, pressure, and technique. My skin felt BBS—baby’s butt smooth for those of you outside the culture—all day and stayed hydrated and toned despite the bitter winters we get here.

I want to be clear that I do not think that everyone should partake in this hobby—especially those of you who shave areas more sensitive than your face. No, straight shaving is not the answer for everyone, or frankly, barely anyone. It worked for me, but only because it gave me the ability to wake up to reality. Our quick-fix, throwaway society leaves us doing things as speedily and efficiently as possible. We get more done faster, but often at the expense of our results or physical and mental well being. We slap some goo on our face, drag a disposable multi-bladed contraption across it, and run out the door for our jobs. Yes, we may be razor burnt and cut up, but that doesn’t matter as we get to our work a minute earlier so that we can read our scans, take our depositions, or crunch our data that much faster. It doesn’t matter to us if we miss a detail here or there, as is bound to happen with such a mindset, regardless of who we harm in the process. After all, we did the best we could, and if that isn’t good enough, then it’s not our fault. Therein lies the true horror of atherosclerosis of the soul. There is no responsibility and no ownership of mistakes. Not only are we hardened against everything that goes on around us, but we are totally untouched by our contribution to that torrid state of affairs.

So what can we do?

How do we snap out of it?

I don’t know. I struggle with my soul-plaque as much as the next person, even though I can now recognize it for what it is. But in the end, it’s true: the first step is admitting you have a problem.

An atherosclerotic patient has two choices: treat their disease and improve their lifestyle, or accept the possibility of total blockage and eventual death that can result. It’s easy to take pills and undergo bypasses; it’s hard to run every day and eat healthily. But in the end, it’s the long term effort that will make the difference and beat the disease, not the quick fix. Unfortunately, people have found a third option that’s even more detrimental than the second. Instead of accepting the disease for what it is and dealing with it, they have buried their heads in the sand and are indifferent to and oblivious of its existence.

As a society, maybe it’s time we realized that and decided on a change, but I don’t think that will be anytime soon. The simple truth is, it’s easy to be isolated and numb, and the vast majority of people want what’s easy. Until people wake up and decide that our humanity is worth working for, we have no choice but to wait for the heart attack.

Thursday, March 14, 2013

Smart Watches: Pebble, Vea Buddy, and iWatch

Most everyone has heard of Kickstarter, the crowd-funding site that most recently delivered us the Pebble watch:

The Pebble is in pre-release status, with early versions going only to those who helped fund the project. Of course, Pebble got $10M from the unwashed, having requested only $100K! Apple, take note, there is a HUGE demand for the smart watch, a companion device, if you will, to an iPhone or Android phone. (I'm not even going to get into the plethora of actual wrist-phones, made mostly in China and found on eBay, which appear to have about 10 minutes of battery-life before cutting off the conversation you were having with your wrist.)

Being impatient, I paid a little extra to buy a Pebble watch recently from a Kickstarter, and I'm not at all sorry. Software is still in a primitive state, but it works, and fairly well at that. I miss far fewer calls and texts, as my wrist now vibrates when something comes in. 

Apple will certainly produce an iWatch at some point, and in fact, there are some unofficial (not from Apple) designs out there that are most intriguing:

Yes, I'll be first in line at the nearest Apple Store to plunk down whatever it takes to get one of these. Personally, I like the first one in the series. Are you listening, Apple?

In the meantime, there are others working on the Smart Watch concept. There is, in fact, another crowd-funding site, Indiegogo, and there, I found the Buddy Watch by Vea Digital of France.

The perhaps unfortunately-named Buddy has a much larger screen (and color at that) and several more applications out of the box, or crib, or whatever births crowd-funded projects:

The Indiegogo campaign is progressing slowly, however, with only about $77,000 donated out of the required $320,000.  I did get in on the ground floor on this one, and I'll get the watch (they promise!) for $99 instead of the $250 it will ultimately fetch in the stores. You can still get one for a pledge of $150, or you can wait for me to get mine and get bored with it, and sell it on eBay for something in between.

My gosh, but there's a lot of cool stuff on Kickstarter and Indiegogo...wallet beware!

Paper...It's Not Dead, Yet!

Tuesday, March 12, 2013

Atherosclerosis of the Soul

As you may recall, my daughter, Dolly, is a medical student in at a Big (read: expensive) school in the Midwest. She's now in her third year, experiencing the joys of the clinical rotations.

Dolly has seen the usual suffering one observes in a hospital, particularly in the teaching institutions, and has had to learn to deal with her own internal reactions to the pain, sorrow, and even stupidity of the patients. Many times these past few months, she has called me in a state somewhere between tears and laughter, quite able to understand the science of what she saw that day, but wondering how to react and respond to the patient. I can see her distance herself from the victims, and on rare occasions, even from the rest of humanity, which is purely a survival technique in this business.

Oh, my. Did I really just say that? Yes, I did. One must distance ones' self from the pain of others to survive as a doctor. Ouch. Our dirty little secret revealed. But this shielding can go too far.

You have certainly heard of atherosclerosis, also known as hardening of the arteries. From the WikiPedia:
Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol. It is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, caused largely by the accumulation of macrophage white blood cells and promoted by low-density lipoproteins (LDL, plasma proteins that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol from the macrophages by functional high-density lipoproteins (HDL), (see apoA-1 Milano). It is commonly referred to as a hardening or furring of the arteries. It is caused by the formation of multiple plaques within the arteries.
I really though I had coined the term "Atherosclerosis of the Soul" all by myself, but a quick Googling shows a few previous appearances. one of which I might have seen years ago. From Philip Jose Farmer's The Dark Design, a part of the spectacular Riverworld series, comes this passage:
Groaning, Burton half-awoke.

For a moment, he didn't know where he was. Darkness surrounded him, darkness as thick as that which he felt filled him.


He lay for a while, rigid as a corpse, thinking, Here I am, a one-hundred-and-one-year-old man in the body of a twenty-five-year-old.

The Ethicals had softened the hardened arteries of the candidates. But they had not been able to do anything about atherosclerosis of the soul. That repair was apparently left up to the candidate.
The longer I live, the more I see this phenomenon affecting humanity at large, though perhaps physicians, including radiologists, are overly prone to contracting this debilitating disease. I confess to having it myself.

But just what do I mean by the phrase, atherosclerosis of the soul?  Like pornography, it's hard to define, but we know it when we see it. If we choose to see it, that is. It is a thickening, a coarsening of whatever it is that makes us, well, us.  It is a narrowing of our connection to others, an accumulation of the detritus of day-to-day living plastered across our being, choking off our humanity, limiting the communication to and understanding of the world itself.

We physicians acquire this disease early, though to varying degrees. The application process for medical school, I believe, selects for those who are more prone to catching it. One must be the best of the best, have good grades and dozens of extracurricular activities, the pursuit of which often limits any time to develop as a human being. The med school experience itself, while better than in my day, still promotes the shielding of feelings. Yes, there is lip service paid to caring, but situational grading is based more on how much one can regurgitate and how few feathers can be ruffled. Caring about the patient too much, and G-d forbid coming up with something the attending overlooked is rewarded by icy stares, and cold silence. The student learns quickly to simply "Keep calm and carry on". And to do what it takes to be noticed, climbing on top of the other skulls full of mush, but ONLY in the right context and setting.

And so it goes into residency and practice. The young physician is trained, subtly and not so subtly, to care more about themselves than anything else. The Doctor as G-d syndrome starts to kick in, and the youngsters come to believe that M.D. might just stand for Minor Deity as well as Mucho Dinero.  The outside of the soul is honed and polished, but this obscures the plaques within. Caring for patients, once an honor, an obligation, a privilege, has morphed into an entitlement, a position from which it's hard to retreat. Too bad the economy will no longer support an unlimited number of little tin gods.

I've been particularly saddened to see the feral, hungry tempers of more than a few posters on It's all about them, it seems. The old radiologists need to retire (or die) so as to make room for the young who are, of course, better radiologists than any 60 or 70-year-old has-been could ever hope to be. And some of those who do have jobs are quite upset that, again, it isn't all about them: their nasty, elderly superiors don't put out enough work, but parasitize their hard-working Bob Cratchit-esque junior radiologists. Here is a typical quote:
Too many old rads around skimming profits from hard-working young rads...(A)t least half of older rads in my group are gaming the system...It seems that most groups, at least in my experience, are squeezing the younger rads so the senior guys can maintain the income/lifestyle they had a decade ago.
And indeed there are at least a few old Scrooges out there who DO profit more than is justified from the efforts of those junior to them, who have declared that employees won't get a raise as long as their salaries are falling, and the like. A quote from a young radiologist on one of the AuntMinnie threads cuts both ways:
Why should we feel bad at all for people who were gifted a gravy train era and blew their money like pimps, or at least live beyond their means?

In the past, doctors were regarded with respect, and maybe even love, and some of today's entitled divas might have prospered way back when, even with the limited contact time they are now allowed with their clients. But patients' souls can corrode as well, and what was once a partnership has become in many cases an adversarial relationship. Bad outcomes, or even less than perfect results, prompt a phone-call to the medical board, and the lawyer who advertises in the back of the Yellow Pages.  Among the many foibles of Obamacare is the provision that requires patients have a direct portal to their medical records, and you can rest assured that many will peruse their data with great vigor, looking for anything and everything that sounds to their uneducated, cholesterol-coated souls like an attack their right to exemplary care at no cost or effort on their part.

Doctors (and patients) are reflective of society as a whole. We have to note the overall deterioration in the world around us. We recently reached what some call the tipping point, where the electorate now consists of a majority of takers rather than makers. The entitlement generation wins. Political power is purchased with the products of the efforts of others. What can you give ME? On a more personal level, you can see plaquing of souls in your daily life. I was on a plane recently, seated across the aisle from a couple in their mid-to-late thirties, and their 7 or 8 year-old son. Immediately upon buckling in, Dad stuck his headphones in his ears, and checked out, ignoring his son's screeching. Not that Mom did a lot to help calm the kid either, but at least she was fractionally engaged. Upon reaching 10,000 feet, however, Mom handed the kid his iPhone, and he was occupied for the rest of the flight. Like father, like son, eh? None of the three of them had an obligation to anyone but himself. Dad might just wake up about 30 years from now and beat himself for losing these precious moments with his kid, and he might wonder why his son is now an adult with intolerable behavior. But when your soul is corrupted, your spiritual nourishment compromised, you can't see beyond your own sphere.

I would love to provide the solution to this problem, Lipitor® for the Soul, if you will. While it's becoming less and less popular, I do think some sort of religious faith is critical to keeping the disease at bay. But even without that, we must start by looking around us, and trying to have some empathy, but we must also take responsibility where appropriate. Patients must realize doctors are human. Perfect results may not be forthcoming, especially for those who ignore advice and continue to smoke, drink, and do other bad things to themselves.

Young doctors need to have some respect for what their elders have built through sacrifice and risk. They have to realize that times have changed, and salaries will fall. That's just reality. Older doctors need to have some sympathy for the predicament of the young, with families to raise and student loans to repay. As one young fellow put it on AuntMinnie:
Those of us at the end of our training don't feel entitled, we are disillusioned and fearful. I have 300k in educational debt (in-state medical school) at a weighted average interest rate of about 5.5% and essentially zero assets. My ideal job was always to be in a small to medium sized democratic group where I could help build the business and become an integral part of the local medical community. Not in New York, Chicago, Boston, CA, etc, but within driving distance of my family in flyover country where most of you wouldn't dream of taking a job. Until 2-3 years ago, this was essentially a given. Now my concern is finding ANY job so I can pay off debt and actually start my adult life.
Sadly, he isn't speaking for all of his generation. That being said, however, expecting a seasoned doc to up and leave just so the young-in can march in is ludicrous at best. And no one, physician or otherwise, should expect anyone else to pay for their bad decisions. That you married the wrong person after building a McMansion is not my fault or my problem. That you chose a field with falling reimbursement is not my problem. That the economy is now in the toilet is not my fault (I voted for the fellow with business acumen).

For what it's worth, I will vacate my position as soon as is feasible, but don't expect to walk right in to my job. Chances are, I won't be replaced.

I've been trying to write this piece for a while. Now that it's done, I'm not sure if it serves as Lipitor® or a Bloomin' Onion with respect to atherosclerosis of the soul. Or maybe it's just a big dose of GoLYTELY®.

The Sistine...Temple?

In the frenzy of activity since the historic resignation of Pope Benedict XVI, we have heard mention more than once of the Sistine Chapel within the Vatican. I've had the privilege of visiting this holy place (I deem religious structures of all faiths holy) twice, once in 1972, and once in 2007, after the magnificent frescoes had been restored. The difference was astounding:

Michelangelo's The Creation of Adam, Sistine Chapel, Courtesy
What was once dull was rendered colorful and alive by the restoration process, truly a miracle to behold at multiple levels.

What I didn't realize on either visit, and really not until today, was that the Sistine Chapel was inspired by...Solomon's Temple in Jerusalem!  Here is the story from
The irony could not be more striking.

More than a billion Catholics around the world wait with bated breath as the College of Cardinals prepares to begin the procedure to select a new Pope. Since Pope Benedict XVI announced his intention last month to retire, the leadership of the church will meet behind closed doors in the Sistine Chapel to agree upon a replacement.

And the location for that momentous decision has a remarkable connection to the Jewish people and the site of its holiest place on earth.

Let me share with you some of the historic background.

According to Roman tradition, the Palatine Hill was where Romulus founded the city in 753 BCE. Every Roman ruler constructed one spectacular Palace after another on that hill. When the church came to power it was determined to prove that it replaced the emperors as the religious spokesmen for God. In the Middle Ages, on that very spot, they built the Palatial Chapel, designed to be a harbinger of the coming triumph of Christianity. Here was a place of prayer for the Pope himself, and its opulence was meant to overshadow that of any other Royal Chapel on earth.

When Pope Sixtus IV began his reign in 1471, the Palatine Chapel was falling apart. It was a heavy building resting perilously on the soft soil of the former Etruscan graveyard slope of the Vatican. Sixtus spent vast amounts of the Vatican’s gold on reviving the splendors of Rome, rebuilding churches, founding the Vatican library and – his most famous project of all – the reconstruction of the Palatine Chapel which, with no attempt at humility, he renamed the Sistine Chapel after himself.

Work began on renovating the Chapel in 1475. By one of those inexplicable serendipities of history, in that very same year in the Tuscan town of Caprese, Michelangelo Buonarroti was born and the unparalleled significance of the Sistine Chapel as the repository of the world’s greatest artistic genius was much later to be assured.

We do not know whether the all-important decision that followed came from the Pope himself or from the Florentine architect he commissioned. What we do know of a certainty is that the Sistine Chapel was designed to be a copy of the holy Jewish Temple in Jerusalem built by Solomon many centuries before.

The exact measurements are found in the Bible. As recorded by Samuel the prophet, the measurements of the heichal, the long, rectangular back section of the first holy Temple completed by King Solomon and his architect King Hiram of Tyre in 930 B.C.E., are 134.28 feet long by 43.99 feet wide by 67.91 feet high. Those were the exact dimensions used for the construction of the Sistine Chapel.

More remarkable still, and a fact that most visitors to the Chapel do not realize, is that in keeping with the intent to simulate the sacred site that existed in ancient Jerusalem, the sanctuary was built on two levels. The Western half, containing the altar and the private area for the Pope and his court, is about six inches higher than the Eastern half, originally meant for the common onlookers. This elevated section corresponds to the farthest recesses of the original holy Temple – the Kodesh Kodoshim , the Holy of Holies – where only the high priest could enter, only once a year, on Yom Kippur, the day of atonement.

To show exactly where the Porochet, the curtain separating the two, would have been in the temple of Jerusalem, a huge white marble partition grill was commissioned, with seven marble flames on top, to correspond to the holy menorah that glorified the Jewish sanctuary in biblical times.

What was the purpose of this mimicry of the holiest place of worship for the Jewish people?

Its theological significance can best be realized by noting that this Catholic effort was something explicitly forbidden to Jews. In the Talmud it is clearly legislated that no one may construct a functioning full-size copy of the holy temple of Jerusalem in a location other than the temple mount itself. Neither the Pope nor his architect however felt themselves constrained by Talmudic law. They chose to build an incredible, full-size copy of the inner sanctum of King Solomon’s temple right in the middle of Renaissance Rome.

Clearly their intent was to give concrete expression to the theological concept of successionism, an idea that had already found an important place in Christian thought. Successionism means that one faith can replace a previous one that has ceased to function. Specifically, the Vatican preached that because the Jews rejected the teachings of Christianity they were punished with the loss of their holy Temple and the city of Jerusalem as well as being damned to wander the earth forever as a divine warning to anyone who might refuse to obey the church.

We leave it for readers to contemplate what the rebirth of Israel and the return of the Jews to their homeland means in this context.

Today the Sistine Chapel, in all probability because of its magnificent Michelangelo frescoes, is the most visited museum in the world. More than four million people a year come to view its treasures.

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Most of them are unaware of the intent of its architects to have Rome replace Jerusalem and the Sistine Chapel to be a substitute for the Temple of Solomon.

It is important to note that since the second Vatican Council in 1962 the church itself has categorically rejected the theological underpinnings of its intolerance towards the Jews.

It is to be hoped that as the Cardinals gather to choose their new Pope in the very place originally meant to demonstrate Christian successionism, they will find the wisdom to follow in the ways of mutual respect, brotherhood and understanding. In that way perhaps the Sistine Chapel will be able to best fulfill the message of Solomon’s Temple.
So I guess this is as close as I will get to seeing the Temple itself. Although I don't think Solomon had any works from Michelangelo in the original version. Nor did the Temple have a chimney to announce his successor.

It is said that the Vatican Library contains in its bowels some of the greatest treasures of all history, perhaps including the Menorah from the Second Temple, sacked by Titus in 70 CE. I wonder if even the Pope himself is allowed to see such things...

Friday, March 08, 2013


Agfa Agility
Agfa Agility's Mascot

Following on the heels of GE's Universal PACS Viewer, Agfa will announce its new Agility PACS (affectionately known as IMPAX 7 to me, anyway) at ECR 2013. Here is today's press release from Agfa HQ in Mortsel, Belgium:

- Unifies RIS, PACS, reporting, 3D, connectivity and clinical applications - Streamlined interface and intuitive features help enhance productivity - Hanging protocols, task-based workflow engines and macros for reporting meet radiologists’ specific viewing and workflow needs.

Agfa HealthCare today announces that it will showcase its work-in-progressIMPAX Agility at ECR 2013. This next generation IMPAX is a completely unified imaging management platform designed to achieve clinical productivity, improve serviceability and streamline integration efforts across the enterprise. This comprehensive solution redesigns capabilities typically found in a Radiology Information System (RIS), Picture Archiving and Communication System (PACS), reporting and connectivity into a single system.

Maximizing the potential of today's imaging technologies

The imaging modalities used today - such as MRI, cardio-CT and mammography - stretch the capabilities of the hospital's PACS infrastructure while also demanding more effort from the radiologists themselves.

IMPAX Agility solves these challenges by providing a fully integrated solution that offers medical imaging professionals access to relevant and varied clinical data in one platform. Its streamlined interface and intuitive features make it user-friendly, enhancing the radiologist's productivity.
IMPAX Agility offers support for a broad range of diagnostic areas. It includes dedicated tools for general radiology, mammography, cardiology, ultrasound and angiography.
The zero-footprint, Web 2.0 viewer, based on Agfa HealthCare's XERO visualization platform, provides convenient access to results on a variety of the most popular web browsers.
Technology that matches radiologists' individual workflows and needs
IMPAX Agility uses hanging protocols, which present studies and images in a consistent manner, even from different modalities. These hanging protocols were built based on real radiologist behavior, for an automated workflow that reduces redundant, manual tasks.
A 3D imaging engine offers new, intuitive ways to explore anatomy and pathology without requiring a separate application. Axial, coronal, and sagittal planes, for example, can be combined to constitute a 3D view of the body from any perspective. The 3D engine can also render MIP/MPR/3D in any viewport.
Macros in reports provide an exam-based template structure for the radiologist. This both speeds up the reporting workflow and helps avoid omissions.
Smoother workflow supports enhanced productivity and best practices
Powerful task-based workflow engines help to ensure that all users follow the appropriate steps for each procedure and circumstance, and for their own workflow. This supports the hospital in meeting regulatory obligations and workflow best practices, as well as improving communication.
Image management across healthcare functions
IMPAX Agility has been successfully deployed at the AZ Sint-Rembert hospital, in Torhout, Belgium. Radiologists there found the image display, workflow management and personalized settings supported their efforts to provide top patient care. "IMPAX Agility has enabled us to improve our service and increase productivity. With IMPAX Agility we can cope with the challenge of increasingly complex imaging and software developments, such as cardio- or angio-CT, which can be easily integrated. We are convinced Agfa HealthCare will be our partner on our path to the future of medical imaging" says Dr. Biebau, Medical Director and Head of Radiology.
"We are very excited to show the investments we are making in the IMPAX product line with IMPAX Agility at ECR 2013," comments James Jay, Vice President and Global head of Radiology IT, Agfa HealthCare. "It is much more than a PACS; it is an intuitive platform with an innovative approach to workflow optimization, which supports our vision of image management across the healthcare continuum."

By "Work in Progress, Agfa means that this has been in the pipeline for several years. I know because I and two of my partners have been able to help with it here and there, although we are under NDA and can't talk about it. (Am I allowed under the NDA to say that I'm under the NDA??)

What I can tell you is that, like GE, Agfa has seen fit to copy AMICAS' offerings from the early to mid 2000's, which you can gather from reading between the lines above. Agility will provide a simpler, yet more powerful interface as compared to the earlier impact of earlier IMPAX's. Hanging protocols will be a welcome addition, something IMPAX has never done well if at all. But despite my cynicism, Agility will actually be a very worthy competitor in this space, and while it offers many of the advantages pioneered (or borrowed or lifted or whatever) by AMICAS 10+ years ago, it puts some new and quite powerful spins on what it does, and I think it will be very favorably received. I, for one, would love to have it in place NOW. I'm told this is possible, but then I would have to deal with angry partners who would pine for the "old days". That's why Moses had to wander the desert for 40 years...

I'll report my "hands on" experience as soon as possible.


In the meantime, Agfa published a report from a beta-test site at the Hospital IGESP in Sao Paulo, Brazil. Naturally, the story is a PDF in Portuguese, but with a bit of digging and translating with Google, I've got an English version for you:
In late 2012 Agfa HealthCare, a leader among the providers of medical imaging and IT solutions to the healthcare, took a step forward in the evolution of their systems by announcing its new generation of RIS / PACS to IMPAX called Agility.Within a select group of customers, one in Europe, one in North America and another in Brazil, IGESP Hospital, located in the district of Bela Vista, Sao Paulo, was a guest validate the platform.

The IMPAX Agility mobilized the market because it is a system developed on the Web platform and with complete portability for use on mobile devices, unifying environments RIS / PACS in the same database, which facilitates the management of the entire environment, as well a significant simplification in the process of implementation, upgrade, support and maintenance.

With this platform Agfa HealthCare again revolutionizes the market as integrate into a single system, images and workflow services of Radiology (ultrasound, MRI, CT, mammography and x-rays) and cardiology, which still has resources preparation of structured reports, using voice recognition, which facilitates the extraction of statistical data and streamlines the delivery of results to patients.

Already familiar with digital imaging systems, staff IGESP mobilizes to absorb and adapt new technology to the needs of the hospital. "Being the first to use the solution has allowed even contribute suggestions to make the system even better and more effective. In practice, we gain flexibility in displaying images and preparation of reports, especially with the voice recognition tool," says Dr. Alexander Oksman, radiologist at Hospital IGESP.

The union between Agfa HealthCare and Hospital IGESP is very positive and promising in the evaluation of Dr. Alcides Felix Terrible, vice president of the hospital. "The partnerships have been instrumental in the consolidation of our technology park. Agfa HealthCare With this relationship is productive few years, thanks to solutions that meet the needs of IGESP and streamline our operation. We feel proud to be among the hospitals selected to validate Agility design, being pioneers in Latin America.'s a stimulus for future business, for sure, "he concludes.