As many of you know, I have been a chronic sufferer of tinnitus, or ringing in my ear, for decades. Back in 2018, I went to Iowa City for the annual summer conference on this subject, which I reported on here. Attending this conference changed my life, and my interaction with the medical-industrial complex. I saw first-hand how research items became clinical trials which further evolved into accepted science and treatment options.

I went back to this summer’s conference and today’s post summarizes what I learned. I apologize for the numerous links in this post but wanted you to have access to this material  as you explore your own health journey.

One of the problems with treating tinnitus is that it is a very personal set of symptoms and handicaps. That makes it hard for medical professionals to treat it. One way to figure out what “flavor” a patient has is to use a series of self-reporting questionnaires that can try to guide treatment. One of them is the Miller Hope Scale, a series of 40 questions that is used to show how the patient sees themself. Another is the Tinnitus Reaction Questionnaire, which can quantify how the patent reacts to their tinnitus, and the Iowa researchers have two others of their own design. Another is the Meaning of Life Questionnaire. The first two instruments have long been used by Dr. Brittany Grayless, such as this summary of her research shown below. As the lead off speaker last week, she mentioned how a provider needs to set realistic goals so patients can be encouraged to progress towards them, something that makes total sense to me but that I never thought about before — either with respect to tinnitus or other professional or personal choices.

Harnessing Hope for Tinnitus Recovery

Over the years I have gone through these and other questionnaires, and they are very hard for me to complete. Maybe I am bad at self-assessment of my own tinnitus or emotional state. Maybe I am uncomfortable with such subjectivity, and would rather be asking a medical professional to interpret a blood test or something more concrete. Maybe these tests are designed more for folks that have more severe tinnitus. I raised these issues with several of the speakers when I was in Iowa, and they agreed with me that these tools are admittedly imperfect, but the best things we have at present.

Ann Perreau from Augustana College also makes use of these questionnaires to develop a sequence of self-paced online videos that help provide remote counseling. She reported on the clinical benefits she saw — sadly, this courseware is not yet available to the general public.

Sarah Kingsbury of the Mayo Clinic in Arizona presented her research on the connection between diet and tinnitus, showing some progress (she has been working on this area for many years). Some patients benefit from additional vitamins. I might give this a try.

One enormous data source that was cited by several speakers is the UK’s Biobank effort to catalog 500,000 patients’ data over a long period of time. Ishan Bhatt used this for his research into what is now called the “gut/ear” connection to see if genetic markers could be a cause of both tinnitus and depression. He disproved this connection, although both conditions make use of the same genetic code.  Other work was presented at the conference to further understanding of this connection.

When I was first investigating getting hearing aids, I wasn’t too sure that they would help my regular hearing — irrespective of tinnitus. Last week several researchers pointedly mentioned how aids can help people with “normal” hearing solve other issues, such as social awareness or anxiety in noisy situations, or for children.

One of the reasons why I like the Iowa conference is that it brings together doctors, nurses, audiologists (some of whom are doctors doing active research), patients and vendors. After decades of covering enterprise technology, I love hearing from vendors and last week saw several both presenting their wares and describing their research efforts, such as SoundPillow (that embeds speakers to play custom programs inside a pillow), Neuromonics (an iOS-based software solution that has a six month course to habituate patients), and Neuromod (hardware that stimulates the tongue while playing sounds). Neuromod was just starting clinical trials back in 2018, and now has a commercial product called Lenire that has given relief to some tinnitus patients. (It is rather pricey, just so you know.)

After the first Iowa conference that I attended, I got my first hearing aid, and learned how to own my tinnitus. This year, I upgraded to a second pair of aids, running programs not just for masking tinnitus but also providing stereo sound via its CROS software. A careful reading of my prior posts will show you that I wasn’t impressed with the older CROS capabilities, but they have come a long way and I am now a big fan.

There will never be “a cure” for tinnitus, but bit by noisy bit there are ways to make it better for those of us who have it. Thanks for tagging along and hearing about my own journey.

What do Abe Lincoln and Agatha Christie have in common? Let me rephrase that: what do actors who have portrayed both historical figures have in common? Both have used advanced technologies to help make their performances more believable and interesting to modern audiences. Let’s take a closer look at what is going on.

Last week, the NYTimes wrote a piece about a new series of lectures available on the BBC’s Maestro series delivered by Christie. Well, by the actress Vivian Keene who plays the part of the noted author and playwright. The lectures, which are available as a series here, are designed to teach you how to write fiction, and in particular crime fiction. They were assembled from her words and writings over her career, including the specifics of how she chooses her plots and characters. The lectures are supplemented with a variety of written exercises and other materials, and here you can watch an introductory episode for free. Otherwise, you need to pay about $90 for the whole lot. Keene is just one of many dozens of contributors that helped pull this production together. And what you hear is not her own voice but speech which has been altered by an AI tool to make it sound more like Christie. (BTW, there are a number of these tools available, such as from ElevenLabs.io, Hume.ai, and ReplicaStudios.com, just to name a few that I have used.)

I found the first few minutes of the freebie lecture interesting, but then my attention waned and I thought this wasn’t very compelling. Perhaps because I try not to write fiction I wasn’t really interested in spending the dough and watching the paid lectures. But I did like the fact that the underlying tech isn’t really all that noticeable, which I guess is the whole point of the BBC exercise.

It reminded me of watching Hal Holbrook play Mark Twain for many decades. Indeed, when you think of what Twain looked like, you probably recall the image of one of Holbrook’s performances. But he wasn’t trying to teach us anything about how Twain wrote his books, just entertain us.

Let’s move on to Lincoln and a production called “Ghosts of the Library” at his own presidential museum in Springfield, Ill. I saw it many years ago. To be accurate, Lincoln is not the star attraction of the show, who instead is an actor playing a librarian and who explains his craft. What is interesting about this live performance is that it makes use of a variety of technologies, one of which dates back to the Civil War era, to project holographic images on a glass panel which separates the set from the audience. (Back then the projections used candlepower rather than electricity.)

At the Lincoln museum, the technology is also not immediately apparent, and when I saw the show I was accompanied by the PR person who took time to explain it to me and introduce me to the actor. The show depends on split-second timing and the ability of the actor to hit his marks exactly so that he matches up with the projected images.

The other exhibits at the Lincoln museum are notable in how they used various tech trickery, something that I wrote about for a 2008 piece in the NYTimes. For example, when entering the room containing the exhibit about Lincoln’s death, the thermostats are set to cool the room so you feel a bit of a chill.

Tech will continue to improve the audience experience to be sure. The real effort is to make it part of the production background, and to do that right requires a lot of time and effort and expertise. If you do sign up for the BBC lectures, do let me know what you think.

I have known Rich and Marcia, an American married couple, for decades, both of whom work in tech. This is their story about how they decided to pack up and move to a suburb of Lisbon Portugal. I recently interviewed them via Zoom.

They started looking at so-called Golden Visas back in 2016. (You can figure out the significance of that date.) This type of visa is a way for ex-pats to emigrate to a country, with sufficient means to live there permanently. The couple became interested in Portugal and vacationed there a few times before the Covid lock-downs. “There was no second choice country,” Marcia said. They got temporary resident status last summer, and moved there for good in March. They are both about my age, and mostly retired, although Rich continues to work in tech a few days a week. “We wanted a higher quality of life, and wanted to find a place where people aren’t as obsessed with work or doing the Silicon Valley 24/7 hustle to get ahead,” they said. So far things are working out — “We are eating better things that taste better and cost much less.”

Well, almost. “March was horrible,” she said. “Our cognitive load was intense, and we found bunching up errands wasn’t going to work. We had to spread them out more.” Part of the problem is the way Portuguese do things is somewhat different, such as activating a credit card (you first use it to buy something in an actual store, then go through the activation process in person) or doing more business f2f, or navigating governmental processes that involve multiple forms and understanding the sequence involved. (I would say I have the same problem dealing with the City of St. Louis.)

But since then things have gotten better. “It really changes your nervous system, and we are a lot more chill here than in the States,” she said. As an example, the recent extended power outage wasn’t any big deal for either the couple or their neighbors.

Here are some lessons they have learned:

1. If you make the move, understand that you aren’t going to replicate your American lifestyle. “You need to figure out what the natives do and how they live, and build on that,” they said.
2. Throw away any preconceptions that you have formed before the move. “Most of them were flat out wrong,” they said. Amazon Prime next-day delivery? Not in Portugal. Packages will arrive seemingly at random. (I could say the same thing about my own Prime service, sometimes.) Two-factor authentication works slightly differently too. Milk is sold via shelf-stable ultra-pasteurized containers, not in the fridge aisle. There is less of a selection of consumer goods but a wider range of less expensive options to balance it out.
3. Be patient with building your personal friend community. “There is a lot more emphasis on f2f interactions,” they said, and also your community might end up spreading across several cities or even countries. Expect this to take months if not years to build up your network. They initially picked their location because of a large ex-pat English-speaking community, which while true still will take time to find their peeps.
4. Understand your relationship dynamics as a couple. If you are thinking about moving as a couple, realize that after you move you will be dependent on each other for large portions of the day and the majority of situations. If you are used to spending time apart for particular activities, that may require some adjustments. “We are a much more tightly bound to each other and have a different dynamic, because we don’t speak the language and have to depend on each other,” she said.
5. Get your consulting team together to ease the transition, especially if you aren’t fluent in the language. The couple does speak a little Spanish, which is a different language from Portuguese. “But it is the little things that catch us,” they admitted. Who is on their team? Someone who can help navigate the healthcare system (a combination of private and public providers), someone who can help navigate government paperwork and processes, a relocation consultant that is local to your target area to help set up your household, and a lawyer to handle the initial visa requirements. All of these folks will save you a lot of time and frustration and school you in how Things Get Done.
6. Don’t make the move all about saving money. Yes, plenty of places are less expensive than the States (which the couple charmingly refer to as “the old country”), but not necessarily by a big enough discount. And not necessarily uniformly across all expense categories. For example: healthcare. “We get ten times the service at a tenth of the cost of what we had in the States,” Rich said. “Healthcare is a human right here,” said Marcia.

I probably should have written this post a few months ago, but a friend reminded me that it is still relevant, even though many of us filed our taxes last week. As the number of federal employees drops, the time to get online with various agencies makes more sense. And for those of you that have so far resisted the effort to do this — and of course, it is an effort, even for the most technical and computer literate among us — now is the time to get online with the feds. If you have tried to call the IRS for example, or visit a local Social Security Administration (SSA) office (those that are still staffed), you will have to have a tremendous dose of patience.

I should state that getting online with the US government is not quite what it could be, and for that we should look to Estonia where they have been doing this really well for a number of years. The initial experience in getting on board was also somewhat daunting, but now every federal agency there has some form of online access using a single system.

Anyway, back home we have two different central authentication service providers, because why not? The two are ID.me and Login.gov. Not all agencies use both — such as the IRS, which only uses ID.me. But if you pay your taxes online through the EFTPS.gov service, and want to access your account with the SSA, you can authenticate with either one. The two providers have somewhat different processes to get your credentials verified and your account setup.

ID.me has had a lot of growing pains when it was first introduced several years ago. (I wrote about this for Avast’s blog here.) I would not recommend using ID.me if you can use Login.gov as a way into your accounts.

One additional caveat about the IRS. Every January you should be using your online account to request a filing PIN. This prevents anyone else from filing a return with your social and name. Make sure to put this PIN someplace where you will remember it when you do file several months later. you need to request a new PIN each year.

Still with me?

Once you sign up and prove who you are to the service(s) — and the effort isn’t trivial and can be frustrating — you can then create an online account with whatever federal (and in some limited circumstances, state and local) agencies you want to conduct your affairs with that supports the provider. And even if you aren’t old enough to start receiving SSA benefits, you should still have an account with them just to check and make sure your deposits over the years have been properly recorded.

Okay, one final caveat about setting up your accounts. You should protect your account with an additional authentication factor, and both Login.gov and ID.me offer numerous options. The one that I use is a USB hardware key (Google sells its Titan keys shown above, but there are other vendors if you would rather deal with someone else). If you go this route, you should buy at least two keys, and put them in different places (such as office and home). You and your spouse can share the same key if that works for you. After you login to either service, you are asked to insert the key in your computer or phone (or use its NFC radio) and press the blinking icon on the key to finish the login process. One authentication method you should NOT choose is to send a code via SMS to your phone.

Once you get a hardware key, you should augment your logins with it wherever you can. Google, Facebook, your bank, your insurance company, etc. Not all places that you’d like to use it support these keys, which is sad and frustrating. Some banks only support two different keys, which is annoying.

I understand that getting this all setup will take time, and working through the various user interfaces will try your patience. But once this is done, you can interact with the feds digitally, which is a Good Thing. And maybe someday we will approach the digital density that they have in Estonia.

(revised 4/25/25)

A few weeks’ back, I wrote about a friend of mine that I called Jane who had suffered from a phishing attack that led towards her losing more than $30,000 in a pig butchering scheme. She called me last week and stopped by to show me that thanks to her homeowners’ insurance policy, she was able to be reimbursed for $25,000 in losses. This is because of an endorsement that included personal cyber insurance. This is the first time that I have ever heard of such coverage, so naturally I wanted to take a deeper dive.

Probably the best starting point is this 2023 Nerdwallet blog, which also helpfully links to the various insurers. It shows you the numerous perils that could be covered by any policy and makes a point that this insurance can’t cover things that happened before the policy is in force. Another good source is this 2023 blog in Forbes. If scroll down past the come-on links, you will see the perils listed and some other insurers mentioned.

This complexity is both good and bad for consumers who are trying to figure out whether to purchase any cyber insurance. It is good because the insurers recognize that cyber is not just a category like insuring a fur coat, or some other physical item. If your washing machine springs a leak and you have coverage for water damage — something that happened to me a few years ago — it is nice to be insured and be reimbursed. Whether you get the level of reimbursement that will enable you to rip out your floors, replace it with something of approximate value, and get your expenses of having to move your stuff and live in a hotel for a couple of weeks is up to the insurer. And whether your claim will eventually trigger your insurer to drop you, and place you on a block list for the next five years is another story. But you can still purchase coverage and the coverage is — for the most part– well defined.

But cyber insurance is not well defined, because of all these various categories of perils can spill over. If your computer is infected with malware and the attackers ultimately get access to your bank accounts, how do you prove that causality to the satisfaction of the insurer? What happens if you are faced with a demand to pay a ransom to get access to your data? Or if you think you are sending funds to help a family member or co-worker in distress that turns out to be a criminal? Many of the problems happen at that hairy intersection between technology and human error.

Before you go any further down this path, I want to take a moment and describe an entirely different approach. What if the financial vendors took a more pro-active role in stopping cyber fraud? It is happening, albeit slowly and under certain specific situations.

One such example is Coinbase, who wrote about what they are doing in a February blog here. The post presents a series of situations where social engineering played a role in a particular fraudulent scheme. “Coinbase will never make an unsolicited phone call to a customer. Anyone who calls you indicating that they are from Coinbase and wants you to move assets is a scammer. Hang up the phone!” There are other recommendations that span the technical spectrum such as using better authentication factors and rotating API keys. As you may or may not know, Coinbase is deeply involved in crypto transactions, so this is a natural fit.

Contrast this with Bank of America, just to choose someone at random. If you know where to look, you can review five red flags used by scammers, including being contacted by someone unexpectedly, being pressured to act immediately, pay in an unusual way or asked for personal information. Unfortunately, they only allow you to specific two hardware security keys, which seems to go against best security practices.

And this is why we are in the state of affairs with scammers today. Incomplete, imperfect solutions have enabled the scammers to build multi-million dollar scam factories that prey on us all the time. Just this past weekend, both my wife and I got text reminders that the balance on our EZ Pass accounts was low. There were only two problems: neither of us use or even live near anyplace we can use them, and both originated from a French phone number. Sacre bleu! This is an attack which has been around for some time but recently resurfaced.

If you have decided to purchase this type of insurance for you or your family, there are two basic paths. First is to see if you can add a cyber “endorsement” to your existing homeowners or renters policy. If this is possible, decide how much coverage you need. Many insurers have these programs, and here it pays to read the fine print and understand when coverage will kick in and when it won’t:

• • • AIG
    • ​Acuity
    • State Farm 
    • Mercury Insurance​ ​
    • PURE​
    • Integrity Insurance​

If you have an insurer that doesn’t have this capability, you can go with one of two specialist cyber policies. Nerdwallet summarizes these offerings by NFP (they call it Digital Shield) or Blink, a division of Chubb. USAA (my current home insurer) works with Blink for example and offered me an add-on policy for $19/month. Blink doesn’t cover fraud from malicious family members or cyberbullying by employers, a widespread cyber-attack and some other situations. From my reading of the NFP’s Digital Shield webpage, it seems like these situations are covered by their policies. They told me, “We provide coverage under two different plan options, DigitalShield Advantage and DigitalShield Advantage Plus. Because it is a policy designed specifically to cover cyber risks, it may offer more flexibility and broader coverage than the options afforded by some of the “add-on” cyber options offered by home insurers. We offer coverage limits starting at $25,000 for $64 a year, with options up to $250,000 and also additional home office coverage.” You can price these out on this webpage.

The bottom line? While my friend was able to benefit from her cyber policy, you might not. Visesh Gosrani, who is a UK-based cyber insurance expert, told me “The limits these policies come with are normally going to be disappointing. The reason these policies are being bundled is that in the future homeowners are expected to realize that cyber insurance is important and more open to increasing their coverage if they have already had the policy. The short-term risk is that they end up being disappointed by the policy that they had for free or very little cost.”

All this talk about Occupy Greenland this week got me reading this 2013 report from the US Naval Institute about the harsh realities about shipping goods across the Arctic seas. The TL;DR: shipping loads of containers across the top of the world, while shorter in distance than sending it through Panama and Suez — isn’t necessarily cheaper when you do the basic math. Here is why:

First off, the problem is that the typical container ships are huge, and they come that way for a simple reason: the more they carry, the cheaper the cost per container to send it from one port to another. The smaller container ships that could be run in the Arctic are because the ice breakers aren’t as wide. There are also shallower channels that restrict the size of these ships when compared to the global routes. When you add all these factors up, a container going through the Arctic will cost more than twice as much as sending it “the long way around.”

Second, the Arctic isn’t ice-free year round. In actuality, even with global warming, routes are ice-free for only a third of the year, and sometimes less. On top of this, weather conditions can change quickly. Global shipping depends on tight schedules. These also involve making several stops along the way to supply just-in-time manufacturing systems, and spreading the costs of shipping across the route. A typical 40-some-day trip from the eastern US to Asia route is shared by a series of six ships making regular stops. This is called the network effect. Going across the Arctic would not have as many intermediate stops.

But what about other kinds of shipping, such as minerals or energy products that come from Arctic sources? It is possible, but still depends on all sorts of infrastructure to extract and load this material — which does not exist and probably won’t for quite some time.

Finally, with or without Greenland, to send stuff across the Arctic isn’t the same as crossing the Pacific or Atlantic oceans because the connectivity is poor. A typical route has to transit a series of narrow straits that is currently claimed by Russia, with high fees to move through these straits.

“Arctic routes do not now offer an attractive alternative to the more traditional maritime avenues, and are highly unlikely to do so in the future,” the report concludes. And while things have changed somewhat since this report was written, the factors cited above are still valid.