NOTES

We believe that accurately identifying and articulating the most critical unmet needs in health is the first and most fundamental step in deriving solutions that positively impact health at scale. A meaningful understanding of such needs requires a broad view, one that embraces how questions of science and technology are tied inextricably to economic, policy, and social circumstances and histories.

Here we write and publish on human health and animal health.

The hardest problem in collective life isn't finding people who share a goal. It's getting them to pay the cost of pursuing it together.

Notes on Engineering Health

Osteoarthritis (OA) is a chronic disease of joints marked by inflammation and cartilage breakdown and is a common problem in aging pets. While it can’t be prevented, there are a number of ways that owners can help mitigate the impact of OA as their pets grow older. 

Notes on Animal Health

Healthcare's failures are not accidents of policy or lapses of political will. They are the predictable output of a political economy designed largely by interested parties to stay broken.

Noes on Engineering Health

How do we build the governance structures—intellectual, financial, and ethical—that allow multiple simultaneous dissolutions to be productive rather than merely chaotic?

Notes on Engineering Health

Just as in human medicine, there is a lot of hype around what promotes longevity in pets, and it can be difficult to discern fact from fiction. It is important for pet owners to know what steps they can take now that will help their pets age well and live a long and healthy life.

Notes on Animal Health

In 1990 Paul Romer published a paper entitled Endogenous Technological Change that explained the production of new ideas (technology) as a product of economic activities and decisions. Romer described long-run economic growth as being built off of five properties.

Notes on Engineering Health

The last Note of the year is traditionally an opportunity for us to reflect one more time on the topics we covered throughout the year. This year our Notes were again organized into three broad themes: Theoretical Concepts, Rapid Innovation Challenges, & Historical Context and Necessary Mechanisms.

Notes on Engineering Health

Notes on Animal Health, December 2025: A Natural History of Pets

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole, DVM, PhD, DACVCP

December 11, 2025

Although we may not give much thought to it, the presence of dogs and cats in our lives is a fascinating tale of evolution that began tens of thousands of years ago.

Notes on Animal Health

The error bar is one of the most ubiquitous yet least understood features of modern research. It is ultimately a small mark with an enormous burden: to remind us, in every scientific chart and graph, that knowledge is hard-won, that certainty is rare, and that acknowledging what we don't know is the beginning of wisdom.

Notes on Engineering Health

The rush to commercialize disruptive technologies is accompanied by the need to create a new set of rules for how such technologies fit into existing society, and for the most part, the rule-making process lags the technology-making process.

Notes on Engineering Health

Notes on Animal Health, October 2025: A Rabies Resurgence?

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole, DVM, PhD, DACVCP

October 15, 2025

In 300 BCE, the Greek philosopher Aristotle described dogs suffering from “a madness” and noted that other animals became similarly diseased if bitten by affected dogs. He was recounting rabies, an acute, progressive, ultimately fatal inflammation of the brain and spinal cord, and one of the oldest recognized zoonotic diseases.

Notes on Animal Health

Many urgently needed technology-based goods and services that could improve the human condition are under-funded and thus under-produced in our current economic system.

Notes on Engineering Health

Protocols are simultaneously conservative and revolutionary—they preserve the accumulated wisdom of communities while enabling radical departures from conventional thinking. In an era when expertise itself is under assault, when the very idea of authoritative knowledge faces skepticism, protocols offer something invaluable: a transparent pathway from question to answer, from hypothesis to conclusion.

Notes on Engineering Health

Notes on Animal Health, August 2025: Is Better Breeding Best?

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole DVM, PhD, DACVCP

August 18, 2025

The promise of genome editing is enormous, but there are ethical implications to consider, including unintended consequences, animal welfare, and its long-term effects on genetic diversity.

Notes on Animal Health

In 2008, a small biotech company called Smart Genetics was quietly shuttered after just a few months of operation. Their crime? Offering direct-to-consumer genetic tests that could predict a person's risk of developing Alzheimer's disease. The company hadn't violated any FDA regulations or committed scientific fraud. Instead, they had run afoul of something far more unusual: the moral convictions of a neurologist named Alan Roses, embedded in the fine print of a patent license.

Notes on Engineering Health

In 1930, a young British mathematician named Frank Ramsey published a paper containing a theorem that would come to bear his name. His insight was deceptively simple: complete disorder is impossible. No matter how chaotic things appear, patterns inevitably emerge.

Notes on Engineering Health

Notes on Animal Health, June 2025: Sweating Like a Pig

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole DVM, PhD, DACVCP

June 10, 2025

Animals have developed through evolution many ways of coping with heat stress depending on their environment, energy expenditure, and access to water. Understanding the differences can help humans protect themselves and their pets from the heat.

Notes on Animal Health

The modern contract is something of a paradox: simultaneously the most ignored and most consequential document in American life.

Notes on Engineering Health

In the murky realm between subatomic particles and living cells, a new scientific frontier is emerging—quantum biology. Quantum biology seeks to explain how the counterintuitive rules of quantum mechanics may underpin some of life's most fundamental processes.

Notes on Engineering Health

Notes on Animal Health, April 2025: Who Doesn’t Get Cancer?

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole DVM, PhD, DACVCP

April 11, 2025

Whales, elephants, bats and naked mole rats all have relatively long lives but rarely develop cancer. Understanding the mechanisms by which these species protect themselves against cancer may give us new approaches to treating and preventing cancer in humans and companion animals.

Notes on Animal Health

Recursion is simultaneously a mathematical concept, a computational strategy, a biological principle, and a way of understanding complex systems. As a fundamental principle, recursion manifests in numerous contexts, representing a powerful mechanism for generating complex structures, processes, and systems through repeated self-similar patterns. At its core, recursion demonstrates how simple rules, when applied repeatedly, can create intricate and sophisticated phenomena.

Notes on Engineering Health

The flu, as most all of us know all too well at this time of year, is an acute viral infection of the respiratory tract. The story of the flu is, in many ways, the story of human civilization itself: a tale of migration, mutation, and the unrelenting tension between our social nature and our biological vulnerabilities.

Notes on Engineering Health

Notes on Animal Health, February 2025: A Veterinary Fenomenon

Cindy Cole, DVM, PhD, DACVCP

Cindy Cole, DVM, PhD, DACVCP

February 14, 2025

When we visit a veterinary clinic today, the doctor examining our pet will likely be female because women now make up the majority of the veterinary workforce. According to the American Veterinary Medical Association (AVMA), in 2023, of the 127,131 employed veterinarians in the United States, approximately 67% (85,337) were female and 32% (41,253) were male. The predominance of women in the field, however, is a relatively new development.

Notes on Animal Health

A recent commentary in the journal Neuron titled “The unbearable slowness of being” estimated that the speed of information flow in the human brain is just 10 bits per second (bps). The Neuron paper’s authors estimated that the millions of photoreceptor cells in a single eye can transmit 1.6 billion bps. In other words, we sift about one bit out of every 100 million we receive.

Notes on Engineering Health

As is now our tradition, the last Note of the year is an opportunity for us to reflect again on the topics we covered throughout the year in our Notes on Engineering Health. This year our Notes organize into three broad themes:

Notes on Engineering Health