My favorite pastime on Sunday, when I'm not drinking wine of course, is to throw out the trash. And so I will start with this. I will try to clear a lot of nonsense online, which unfortunately made its way offline as well. And we will be discussing the role of genetics and heredity in narcissism. Is narcissism, pathological narcissism, and more specifically narcissistic personality disorder, is it an inherited thing? Are you born with it? Or are you made into a narcissist in early childhood? As the vast majority of psychological theories suggest. Now, this is not the first video I'm making about this topic. There are a few others. You're well advised to look for them. Search. Search the channel. And to watch them perhaps before you watch this one. This one is a bit more grounded in studies and literature and research and is cutting edge. I'm going to bring you the latest in the field, as I always do on this channel. Because I am Sam Vakni, the author of Malignant Self-Love. Narcissism revisited a former visiting professor of psychology and currently on the faculty of C.U.P.S. Let's start by clearing one major misconception. Heritability is not the same as gene specificity. What a mouthful! Heritability means that when we see a trait, a phenotypic trait in a population, a component is hereditary. Some segment, some element of the trait is hereditary. We would tend to believe that or we would tend to think that the trait is manifested in the cohort in the population because of some genetic transmission or transmission via genes. This is heritability. So heritability is never in individuals. And it is an observational thing. We observe traits, the manifestation of traits, and we make an assumption, assumption that there is a contribution of heredity or genetics or genes to the emergence of the trait the way it does and in the frequency it does in a population. Now this is not the same as gene specificity. In other words, by saying that a certain trait manifests because of heredity or there's a hereditary component, genetic component, it's not the same like saying that a specific gene is responsible for this trait. There's no one-to-one correspondence or mapping. Moreover, genes never operate alone. It's not a light switch. Genes even never express themselves alone. Genes work in groups known as arrays. So gene arrays are responsible for the emergence of traits. And the gene array, which sometimes includes thousands of genes, the gene array interacts with the internal environment, for example, hormones, and with the external environment. This is known as epigenetics. So it's much more complicated. There is absolutely no such thing as a gambling gene or a narcissism gene, or this is rank, unmitigated, total horse, you know, total nonsense. And the irresponsible scientists who appear in the media because they like to see their ugly faces reflected, it's a narcissistic, grandiose thing, they are ruining the profession. What they are doing is utterly unethical. There is no single gene that is responsible to any human trait, let alone a combination of traits, let alone a confluence of traits and behaviors, for example, in a personality disorder. So heritability means nothing. It just means that in large populations, a certain trait would be manifested more than probability would allow. And this indicates an underlying genetic propensity, but not any specific gene and not a genetic substrate. So this is number one. Number two, narcissistic personality disorder is not, I don't know, tuberculosis. It's not localized. It's all pervasive. Narcissism is the narcissist. Narcissism is a personality structure. It encompasses traits, behaviors, reactions, responses, emotions, cognitions. It's a multifaceted, ginormously complicated phenomenon that cannot be reduced to any single gene, any single neural pathway in the brain, any single area of the brain. It cannot even be reduced to the total activity of the brain or the total genetics or genetic map or genome of the individual. No, it cannot be reduced this way. And anyone who says otherwise is either a charlatan or someone in pursuit of instant celebrity, both frowned upon in academia. Number three, the very definition of the construct of narcissistic personality disorder is in flux. It's in flux. Today, we are phasing out the main criteria of narcissistic personality disorder that characterize the fourth edition of the diagnostic and statistical manual, the being phased out. Then being phased out in favor of a dimensional alternative model. And this will be the diagnostic landscape in the sixth edition of the DSM, the forthcoming edition of the DSM. Additionally, we are transitioning from a static view of narcissistic personality disorder, type constant view. You're grandiose, so you're grandiose, so you're grandiose. That's it. We're transitioning from this very primitive view of narcissism to a much more nuanced and dynamic model where there is no type constancy, where every overt grandiose in your face defiant obnoxious narcissists is also shy and fragile and vulnerable, depending on circumstances, on anxieties, on stress, on life events, life crisis and so on and so forth. So there's no type constancy. There's a dynamic landscape. Narcissism is a flux. It's a river, not a pond. And finally, we are transitioning from an egocintonic view of narcissism. The belief that the narcissist is happy or lucky, is comfortable with who he is, admires himself, feels good about himself and believes that he is the next stage in evolution. All true at times, but we are transitioning from this model to an egocintonic model, compensatory model, where we believe that pathological narcissism compensates for deep set insecurities and a sense of inferiority. So we are transitioning from an overt to a covert model. Now all this is still work in progress, and therefore it begs the question, if we don't know what is narcissistic personality disorder, how can we then map it onto a gene? How can we say a gene or an array of genes cause narcissistic personality disorder if we fail either to even define what narcissistic personality disorder is? And remember, heritability is not gene specificity. So the answer to the question is no. We are not aware of any gene or combination of genes which are responsible for narcissism, period. We are not even aware of any brain activity or abnormality, structural or functional, which causes narcissism. Again, period. You can switch off now because the rest of the video substantiates what I just said. Okay. I would start by acknowledging that there is a hereditary contribution, a genetic contribution in other cluster B personality disorders, most notably borderline personality disorder, an antisocial personality disorder, especially the malignant extreme form known colloquially but not clinically as psychopathy. So I refer to a study by Dilala, Diaz, Janik and others, titled toward the dark side temperament personality and genetics related to antisocial behaviors. It was published in Behavior Genetics of Temperament and Personality Advances in Behavior Genetics. It's a book by Springer published in 2020. And there's a great literature review there. That's why I'm referring to this specific. Now in the literature, under the description, under the video, there's a literature list as is my habit. And I'm going to read to you the summary of the chapter. Several personality factors associated with criminality, for example, impulsivity, psychopathy, have genetic components. Specifically, the dopaminergic system and various dopamine candidate genes may be related to these personality traits. Preliminary research on gene environment correlations, it's known as RGE. Gene environment correlations may shed some light on the relationship between genetic and environmental influences. Although these assumptions remain challenging to test empirically. In contrast, several researchers have found interactions between genes and environment, GXE, such that certain environmental stressors, harsh interactions, poverty may impact the phenotypic presentation of genetic vulnerabilities. In other words, how specific genes express themselves and are observable via traits or behaviors. So to summarize, antisocial aspects, antisocial behaviors, antisocial traits in antisocial personality disorder, including but not limited to criminality, do probably reflect some genetic contribution, possibly even a pronounced genetic contribution. It's a behavior, a specific behavior. It's not a complex, it's not a whole picture, it's not a big picture, highly specific behavior. So there is a chance that one day we'll be able to reduce it to an array of genes and then maybe turn them off. And prevent crime altogether. Similarly in borderline personality disorder, there is heritability. Your chances to develop borderline personality disorder is anywhere from three to five times higher if any of your relatives has borderline personality disorder, which is why borderline personality disorder is definitely a clinical entity and anyone who says otherwise have no idea what he's talking about. Borderline personality disorder is real and it is a clinical entity. However, it may be best captured and best described as a form of post-traumatic emotional dysregulation, that I agree. But clinically, of course it exists and it has a strong, indisputable, observable genetic component. Now, even when the relative in question, the relative with the borderline personality disorder does not reside with the child, does not educate the child, does not raise or care give, even then someone born into a family of borderlines is a lot more likely to develop borderline even if that person has not been exposed to the family at all. And that is a strong indicator of genetics. Also we know that in both psychopathy and borderline personality disorder, there are abnormalities structural and functional of the brain, multiple areas in the brain and multiple pathways and multiple interconnectedness between various areas. So this is all true to psychopathy and borderline and this raises the question, if narcissism and borderline are so closely related if their first cousins or even if they are flip sides of the same coin, as Kernberg does claim, and I'm very close to claiming, if this is the case, then is it not safe to assume that narcissism also has a pronounced genetic component? Well, possibly. I'm saying possibly and not of course and not certainly because narcissism is a different set of defenses. And these defenses manifest and are expressed in a way so dissimilar to borderline personality disorder that we are forced to give up on the assumption, however appealing, the assumption that they both share the same genetic substrate or the same genetic environment or the same genetic predisposition or proclivity. It seems that narcissists and borderlines evolve so differently, choose different defense mechanisms, process reality very differently, because they are very different in the genetic sense. They're very different. They're predisposed differently. They are similar in psychodynamic ways. They're similar in some ways, but these ways, the similarities are ironically not reducible to genetics, while the dissimilarities can easily be attributed to genetics. That's why, no, we can't learn anything from the genetics or heredity of borderline personality disorder with regards to narcissistic personality disorder. In a study published in 2015, researchers at the University of Michigan, they recruited 40 plus boys between the ages of 16 and 17, some like that, adolescents, and they administered to them the MPI, the narcissistic personality inventory, and they isolated those of the boys who were more narcissistic than the others. So they had like a control group of non-narcissistic boys and a group of narcissistic boys.  It's bad practice. So the whole study is tainted from its very inception. We cannot safely diagnose narcissistic personality disorder prior to age 21 at least, and many scholars say 25, and these are dominant scholars. So the whole study is questionable to use an understatement. But they have discovered that teenagers with higher levels of grandiose narcissism had a higher activity in an area of the brain known as the social pain network. So the more grandiose the kid, the more narcissistic the teenager, the more active was the part of the brain known as the social pain network. It's a collection of brain regions, including the insula, the anterior, cingulate, cortex and so on and so forth.  That's fascinating, because first of all, it implies vulnerability. It's more covert than overt. And it demonstrates on the cerebral neurological level the narcissist's absolute dependence on other people's input, acceptance, approbation, adulation, admiration, or at the very least attention, which what all scholars have been saying for like 100 years. So even more interesting was the fact that the area in the brain which processes distress in social exclusion cases, when the child is, when the person is ostracized, shunned, ridiculed, mocked, avoided, etc. This area lights up. And there's a lot of distress of course, subjective distress. Ask anyone who has social anxiety or is avoidant and they will tell you how distressing this is. It's very traumatic and it leads often to depression. So they ask the kids, they ask the adolescents, are you feeling distress? And none of them said, I'm feeling distress. Even the narcissistic grandiose adolescents whose brain was signaling enormous distress, even they did not report subjective experienced distress. And that is the denial part in narcissism. Narcissists have no access to their own internal world. They have no introspection. They have access, but they have no introspection. They falsify everything. They have a pronounced fantasy defense. They deny any vulnerability and any imperfection. There was another study by Jouk and Gratz in Gratz, I'm sorry. So Jouk and his colleagues conducted a study, an fMRI study with men and women. And they discovered something very interesting. Women react very, very differently to men. Very, it's as if there were two species. Both men and women in the study had high levels of grandiose narcissism and both of them were subjected to the same set of experiments. And yet the men showed higher activity in parts of the anterior singulate cortex associated with negative emotions, social pain and so on and so forth. And the women didn't, but the women reacted this way when they were shown images of themselves. I'm going to repeat this. It's a very fascinating, fascinating experiment. But when men were exposed to what they perceived to be social pain, negative emotions and so on, and these men had higher levels of grandiose narcissism, they showed more activity in the area of the brain that is a part of the social exclusion or social pain network, area known as anterior singulate cortex. But women didn't react this way. Even when women were exposed to social pain and social exclusion, they didn't react like the men. So this is very interesting. And it begins to tell us that narcissism in men is not the same as narcissism in women. And of course it falsifies many of the things I've been saying, but I owe you the truth and I follow where the evidence leads. I was of the opinion that female narcissism and male narcissism, especially in today's world, where women are very masculinized according to studies, to many studies, especially in today's world, both women and men would basically have the same type of narcissism. But brain studies demonstrate that women react very differently, at least they react very differently to rejection and so on. Men are much more invested emotionally in being accepted, belonging, in influencing, in gathering narcissistic supply. The bodies of narcissists, both men and women, indicate extremely elevated stress. The bodies of narcissists are flooded with stress hormones, especially cortisol. That is easily explained by traditional theory. Narcissists are constantly anxious. Now we know that psychopaths are actually anxious as well. And there are even outliers, myself included, who are trying to reconceive of psychopathy as an anxiety disorder. But put that aside, anxiety is a very common reaction in narcissism. So is depression. The narcissist is anxious. Will he be able to obtain supply? Will he fail to garner supply? Will he experience a collapse? Is someone insulting him? Is this an injury? Is he about to be modified? Is he being betrayed? Is it a bit paranoid? Because paranoid ideation, paranoia, is a form of narcissism. It puts the paranoid in the center of attention. It places the paranoid at the heart of conspiracies and malevolent intent. So paranoia is a variant of narcissism. Paranoid are, of course, all the time anxious. Narcissism is anxiety. It's very often comorbid with anxiety and depression, as we see in the work of Ilza Roninstein. So it's not surprising that narcissists' bodies are suffused, drowning, flooded with cortisol and other stress hormones. In 2020, there was a study by Royce Lee at the University of Chicago and his colleagues, of course. No one works alone. And they reported that people with NPD and also, by the way, BPD, so both narcissists and borderline, have greater concentrations of molecules associated with oxidative stress, a stress response at the cellular level. So their blood was flooded with the byproducts of processing stress on the cellular level. I want to read to you something that Jaouk said in an interview he granted to the September 2023 edition of Scientific Merit. He said, vulnerability is always there, but maybe not always expressed. And under particular circumstances, such as in the lab, you can observe signs of vulnerability at the physiological level, even if people say, I don't have vulnerability. He continued to say that the neuroscience of narcissism is incredibly interesting, but at the same time, I'm very hesitant to interpret any of these results. Actually, this was someone else. It was Mithjabeck, a psychologist in Germany. So I would say this is a great summary. All narcissists are vulnerable, but many of them are not aware of the vulnerability until they experience an adverse circumstance, a life crisis, a threat, an abandonment, humiliation, modification, injury. Only then, the most in-your-face, antisocial, resilient, powerful, amazingly untouchable narcissists, even then they fall apart and they discover their vulnerability. It's point number one. Point number two, neuroscience and genetics are not conclusive sciences. They are correlative sciences. And I'm hesitant to use the word sciences. So be careful. Don't jump to conclusions and don't listen to know-it-alls online, including know-it-alls with academic degrees who unscrapulously and unethically misinterpret results of flimsy research, non-representative samples and basically useless studies, non-rigorous studies in order to make proclamations and promulgations of breakthroughs and amazing discoveries. Don't listen to these sensationalists. Science is not sensational. Science is incremental, gradual, slow and glacial. Now let's proceed. It's from the Oxford Handbook of Evolution and Emotions, published by Oxford University Press and it's a chapter titled, Narcissism and Narcissistic Personality Disorder, Evolutionary Roots and Emotional Profiles. I'm going to read to you again a paragraph. Behavioral genetics has established, say the authors, a heritability component for narcissists and they refer to an overview by Vernon in 2008. While this does not imply that specific genes are associated with narcissism because heritability does not signify a genetic substrate. Remember how we opened the video? And also I refer you to work by Jackson, 2011. The authors continue, this finding that there is a heritable component in narcissism. This finding is a necessary yet insufficient condition for showing that narcissism is a genetic basis. They refer to studies by Lysley, which I will analyze in a minute. These are the original studies of genetics in narcissism, in 1993. I'll deal with these studies in a minute. Evidence, the authors continue. Evidence in search of specific genes that reflect narcissism is lacking. There is scant research evidence on the molecular genetics of narcissism. So it is difficult to draw conclusions regarding putative gene narcissism associations. Some research has examined polymorphisms in the five HDT-LPR gene, which codes for serotonin transporters. This genetic variant has been linked to a variety of psychiatric disorders and symptoms, including several personality traits associated with psychopathy and narcissism. I'm also referring to studies by Bremer, 2016. Luo and Kai, 2018. Sadegh, as early as 2010 and so on, so forth, this particular gene is well studied. And it really makes an appearance in many mental disorders, dysfunctions, and illnesses. And still, this research, they say, and it's a recent book. This research is in its infancy, and it is not yet known what genes or combinations of genes are likely a role in the development of narcissism. Indirect evidence of a genetic basis for narcissism comes from genetic associations with antagonism and extraversion, and the corresponding biological psychology literature pertaining to these broad-band personality traits. As noted earlier, both grandiose and vulnerable narcissism are antagonistic traits at their core, and they are referring to work by Krau, Weiss, and others, 2020. Consistent with this view, grandiose narcissism and vulnerable narcissism involve disagreeableness. Miller, 2011, Paul Housen, Williams, as early as 2002, Vazir, and others, in 2008 and so on, so forth. In other words, there are traits. These traits are heritable, but we are very far from identifying specific genes which work in narcissism, extremely far. We are not even sure that there are such genes, and what would their individual contribution be. Maybe it's not the genes. Maybe it's a combination of genes, and the interaction of the genes with the internal environment, or its response to an external environment. Maybe 6,000 genes are involved. We don't know yet. Neighboring research has shown that narcissism, particularly the grandiose variant, is strongly positively correlated with extraversion. Lee and Ashton, 2004, Paul Housen, Williams, 2002, which is indeed evident across different measures of the Big Five personality traits. Most research in this literature, including both self-report and behavioural measures, is consistent with Paul Housen's minimalist assertion that grandiose narcissists are disagreeable extroverts. Because grandiose narcissism manifests as disagreeable extroversion, any genetic basis for disagreeableness and for extroversion could be taken as indirect evidence of a genetic basis for narcissism. Multiple studies have provided evidence of specific genes associated with extroversion and agreeableness. Kim, 2015, Sanchez, Voyage, 2018, and others. Although there is stronger such evidence for extroversion than agreeableness. Luo, 2017, and again Sanchez-Woyes, who kind of was critical of some of the studies. These genetic factors, continues the text, account for approximately 1 to 20% of the variants in extroversion and agreeableness in genome-wide association studies and polygenic studies. We will use a round number percentage, let's say 10%, as a heuristic for the genetic basis for narcissism, recognising that the Confidus interval is large. By the way, across the field, heritability has been linked to specific genes or gene arrays only 5% of the time. That's how weak the connection is. We assert, say the authors, that the genetic components for these two traits, agreeableness and extroversion, are approximately 10%, which, albeit lower than the common heuristic of 50% heritability for personality traits based on behavioural genetic research, indirectly suggests a genetic basis for narcissism. Because narcissism appears to be partly genetically inherited, next we consider two primary pathways, perhaps somewhat positively intertwined, that may help explain the evolution of narcissism and how it was selected, sexual selection and natural selection. Are personality disorders the outcomes of inherited traits? Are they brought on by abusive and traumatising upbringing? Or maybe they are the said results of the confluence of both. So, this is the question that I posed in 2000, the year 2000 exactly. That's the question I posed. And I would like to review the beginnings of the literature, how the initial, the first, the pioneers try to tackle the question. I think their choices, their decisions, their preferences dictated the field and the study and the biases to this very day. To identify the role of heredity, researchers have resorted to a few tactics. They studied the occurrence of similar psychopathologies in identical twins separated at birth. The twins and siblings who grew up in the same environment and in relatives of patients, usually across a few generations and the extended family. Tellingly, twins, those raised apart and those raised together, show the same correlation of personality traits which is 0.5. And I'm referring to studies by Bouchard, Licken, Migu, Siegel, Teledgan, 1990. Even attitudes, values and interests have been shown to be highly affected by genetic factors in twins. Waller, Kojitin, Bouchard, Licken, again 1990. That was the beginning of the whole field. A review of the literature demonstrates the genetic component in certain personality disorders, mainly antisocial, schizotypal, is strong. And I'm referring to studies by Thapar and McGuffin in 1993. Negan Goldsmith found a connection in 1993 between schizoid and paranoid personality disorders and schizophrenia, which we know is genetically determined. Or at least as a strong genetic component. The three authors of the dimensional assessment of personality pathology, Lysley, Jackson and Schroeder, joined forces with Jang in 1993 to study whether 18 of the personality dimensions are heritable. They found that 40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity. Most notably, anxiousness, callousness, cognitive distortion, randiosity, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder and with a hereditary component. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary. And this goes a long way towards explaining why in the same family, with the same set of parents in an identical emotional environment, children who were brought up the same way, like the same people, even twins, grow to have personality disorders, while others are perfectly normal. So you could have five children, one of them becomes a narcissist, one becomes a codependent, and three of them are totally normal and healthy and mock the other two. Life long. Surely this divergence indicates a genetic predisposition of some people to develop personality disorders.  And that's absolutely not the case. A very small minority of children go on to develop personality disorders. And still, this off-doubted distinction between nature and nurture may be merely a question of semantics. And this is where the origin of the field in the early 90s, in my view, created a stalemate, led to stagnation, to a dead end, because the original thinkers, including Lifesley, who is great, the original thinkers assumed that it's a yes or no proposition. Either genetics influence, either genetics genes determine the emergence of personality disorders later in life, or they don't. There's no middle ground. And there's no interaction between genes and environment, internal, external, circumstances. They were not aware, in other words, of possible epigenetic effects. I wrote in my book, Malignans of Love, Gossis and Revisited, in 1995. When we are born, we are not much more than the sum of our genes and their manifestations.  Mental illness cannot be explained without resorting to the body, and especially to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neuro-psychology is lacking.  Psychoanalysis, for instance, is often accused of being divorced from corporeal reality. I would just add that today neuroscientists are trying to create a bridge between neuroscience and psychoanalysis, with amazing results by the way. I'm continuing to read from my book, Malignans of Love, Gossis and Revisited, written in 1995. Our genetic baggage makes us resemble a personal computer. We are an all-purpose universal machine. Subject to the right programming, conditioning, socialization, education, upbringing, we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set. A television set is constructed and expected to do one and only one thing. It is a single purpose and a unitary function. We, human beings, are more like computers than like television sets. It is true that single genes rarely account for any behavior and any trait. An array of coordinated genes is required to explain even the minutest human phenomenon. Discoveries of a gambling gene here and an aggression gene there are derided by more serious and less publicity-prone scholars. Yet it would seem that even complex behaviors, such as risk-taking, reckless driving and compulsive shopping, have some genetic underpinning. And to end, I refer you to the Seminal Study, which is still cited, decades later, by Lifesly, Jank, Jackson and Vernon in 1993, titled Genetic and Environmental Contributions to Dimensions of Personality Disorders. It was published by the American Journal of Psychiatry, Vol. 150. What a way to end.


Hello, hello, writers. I'm Kristen Kiefer, author of fantasy fiction and creative writing resources, and you are listening to the Well-Sturried podcast, where I share insights, encouragement, and actionable advice designed to help you craft sensational novels and build your best writing life. Always in 30 minutes or less, so you can get back to writing, of course. Ready for the show? Let's get talking. Hello, writers, and welcome or welcome back to another episode of the Well-Sturried podcast. I'm your host, Kristen Kiefer, and today is Friday, October 29th, 2021. Today's episode is titled, How to Market a Book with Amazon Ad Campaigns. This episode gets a little bit into the technical weeds of running an Amazon ad campaign, and you might find it easier to implement this information if you're looking at it directly on a screen. So if you would like to check out the article that corresponds with today's episode, then you can find it listed at well-sturried.com slash marketing. Now let's dive in. Running an Amazon ad campaign can be a great way to introduce your book to new readers and increase sales, but there's no denying that Amazon advertising comes with a learning curve. Let this episode serve as your introductory guide to effective Amazon ad campaigns. As of October 2020, you can run two types of ads through Amazon advertising, sponsored product ads and lock screen ads. Sponsored product ads appear on relevant search result pages and individual product listings, while lock screen ads are shown on readers Kindle lock screens. When creating either type of campaign, you'll have the option to enter a list of relevant keywords that will determine which shoppers see your ad. Good keywords are words or phrases that your ideal reader might search on Amazon when looking for their next great read. For example, if you've written a sword and sorcery fantasy novel, then some of your ad keywords might include epic fantasy, magical quest, Brandon Sanderson, Lord of the Rings, and Hero's Journey. Choosing strong keywords that are relevant to your book boosts the number of impressions your ad receives. Impressions are the number of times your ad is shown to shoppers. The number of clicks your ad generates indicates how many shoppers clicked through your ad to view your book's listing, while orders refers to the number of sales your ad has generated. From these three numbers, impressions, clicks, and orders, Amazon derives two metrics that determine the overall effectiveness of your ad campaign. The first metric is ZTR, which stands for click-through rate. This is the ratio of clicks per impressions. Essentially, CTR indicates the percent of shoppers who, after seeing your ad, choose to click on it to learn more about your book. The higher your ad's CTR, the better. The second metric is ACOS, or Advertising Cost of Sale. This is the percent of your ad's sales revenue that you spent running the ad. ACOS is calculated by dividing your sales revenue by your ad spend. The lower your ACOS, the more effective your ad. With Amazon advertising, ad spend is determined by the number of clicks your ad receives, rather than sales or impressions.  But if your ad receives a large number of clicks and no sales, then you'll be in the red. Therefore, it's important to ensure that your ad copy accurately represents your book and that your book's listing, such as its description, reviews, the cover design, and the inside look, effectively entices readers to purchase. With all of this foundational information out of the way, let's create your first Amazon ad together. After logging in to your KDP account, that's Kindle Direct Press, scroll to the book you'd like to advertise and click the Promote and Advertise button. On the next page, find the Run and Ad Campaign section and choose the Amazon Marketplace where you'd like your ad to run from the drop-down menu. Then select Create an Ad Campaign. You should now have the option to choose which type of campaign you'd like to create, a sponsored product ad or a lock screen ad. Most writers choose to run sponsored product ads for two reasons. One, only Kindle readers will see lock screen ads, severely limiting the reach of your campaign. And two, it's very easy for readers to accidentally click on a lock screen ad, which will drive up your ad spend and decrease profit. So that is why most writers choose to use sponsored product ads, and in this tutorial, we are going to create a sponsored product ad together. Ready to dive in? Step one, name your campaign. Under Settings, give your new ad campaign a name. I recommend creating a naming system that will help you better identify your ads once you have multiple ongoing campaigns. You might consider, for example, Book Title plus Ad Type plus Ad Focus plus Date. Using this system, I might name my campaign BYBWL SP Publish 720, which indicates that this ad is for my book, Build Your Best Writing Life, that it is a sponsored product ad, that's where the SP comes from, that I launched the ad in July 2020, and that it's geared towards writers who are interested in self publishing resources. If you find that bit confusing, you will definitely want to check out today's episode transcript at well-story.com slash marketing. Step two is to choose your ad's start and end date. If you'd like your campaign to run for a specific amount of time, such as during a certain sales window, then enter that information now. If you don't know when you'd like your ad to end, simply choose no end date. You can pause or archive an ad campaign at any time. Step three, set a daily budget for your ad. Your daily budget is the max amount you'd like your campaign to cost per day. Setting a budget might seem daunting, but generating clicks and thus ad spend on a new campaign is difficult. I'll explain why in a moment, but suffice it to say for now that new campaigns rarely spend more than a buck or two per day. Set your budget somewhere between $5 and $20 and you should be good to go. If you find that your ad is spending more than you'd prefer, you can always pause or edit your ad as needed. Step number four, opt in to manual targeting. Under settings, you'll be prompted to choose between automatic targeting and manual targeting. Automatic targeting allows Amazon to choose keywords for you based on information from your book's listing. These auto-generated keywords are rarely as effective as those gleaned through active keyword research. Therefore, I highly recommend selecting manual targeting. Step five, set your campaign bidding strategy.  I'll explain how to set an effective bid in step nine. For now, simply decide your bidding strategy, which is how you'd like Amazon to manipulate your bid based on the likelihood that you'll earn a sale. You can choose between three bidding strategies. Strategy one, dynamic bids down only. Choose this option if you want Amazon to lower your bid when your ad is unlikely to make a sale, which will prevent you from overspending on clicks made through non-competitive keywords. Strategy two, dynamic bids up and down. Choose this option if you want Amazon to raise or lower your bid depending on the likelihood that you'll earn a sale. Some writers don't like this option because it offers limited control over how much Amazon might raise your bid. And strategy three, fixed bids. Choose this option if you only want Amazon to spend the exact bid amount that you specify. Step six, choose your ad format. Because high quality sales copy can encourage shoppers to click on your ad, thus increasing the likelihood of a sale, I recommend selecting the custom text option in this section of your ad campaign setup. Step seven, select the product you'll advertise. You can feature one specific edition of a book in your ad campaign, such as your ebook or paperback edition. So choose the edition you'd like to promote wisely. The menu provided in the product section allows you to scroll through each edition of the books you've published through KDP. Step eight, identify your targeting strategy. If you selected manual targeting in the settings section, you'll now see a targeting section that presents you with two options, keyword targeting and product targeting. I recommend selecting keyword targeting as this option allows you to target the largest number of potential shoppers via search terms. Choose product targeting if you'd prefer that your ad only be shown on a specific product or category pages. Step nine, add your keywords and select your bids. If you selected keyword targeting in the last section, you'll now be prompted to add the keywords you'd like to target. Though you can choose from a list of suggested keywords that Amazon has generated based on your book's listing, manually entering a list of relevant keywords that you've compiled via research will drastically increase the success of your campaign. If you'd like to learn more about how to conduct effective keyword research, then I've linked an article from Dave Cheson of Kindlepreneur.com in today's episode transcript at well-storied.com slash marketing. With that said, your next step is to choose your bid. This is the price that you're willing to pay for clicks. So you're going to choose a bid for each keyword. Rather than using Amazon's suggested bid, I recommend selecting custom bid from the dropdown menu and setting a very low bid. Think something like 11 cents or 16 cents. Setting your bids low when creating your first ad campaign will help you build relevance within the Amazon advertising algorithm, which I'll explain in detail in the last section of today's episode. When adding keywords to your campaign, you can also choose your keyword match type from among three options. The first match type is broad, which means your ad may target any variation of keywords included within a keyword phrase. So if your keyword is steamy Regency romance novel, then selecting this option would allow your ad to target Regency romance or steamy romance novel. The second match type is phrase, which means your ad will only target the exact keyword phrase or sequence of words within a keyword phrase. So for example, steamy Regency romance novel may target steamy Regency romance, but not steamy romance novel, because you'd be cutting out that middle word. Finally, the third match type is exact. This means that your ad will only target the exact keyword or phrase that you enter. So for example, steamy Regency romance novel will only target steamy Regency romance novel. I prefer to select phrase and exact match types for my campaigns, since these options allow for moderate control over which shoppers see my ads. Step 10 is exclude negative keywords. This is an optional step. So in the next section, enter any keywords that you don't want your ad to target. You might enter keywords that would exclude shoppers searching exclusively for free books or for unrelated products that bear a similar title or author name. Step 11, add your custom text. If you opted to add custom sales copy to your ad, then your last step is to enter this text. You only have 150 characters, so use them wisely. What words would entice your ideal reader to dive into the pages of your story? If you're promoting fiction, then try utilizing your story's hook in your custom text. If you're writing nonfiction, use your custom text to identify the pain point that your book will help readers resolve. And finally, step 12, preview and launch your campaign. Review your ad in the previous section, checking for any grammar or spelling issues or other mistakes. If all looks good to go, select launch campaign to submit your campaign for review. Most campaigns are moderated within 48 hours, and if your ad is approved, then it should receive its first impressions within several days. Congratulations, you have now created your first Amazon book ad. It's important to note that marketing your book on Amazon is not a get rich quick scheme. Building relevance within the Amazon advertising algorithm takes time, which means you likely won't make much profit from your campaigns for several months or even upwards of a year. Why? Well, relevancy is the metric by which Amazon determines whether your campaigns are worth showing to shoppers. The greater your relevance, the more impressions your campaigns will receive, thus allowing you to scale your ads to make far more significant income. To build relevance, you need to prove to Amazon that your ads can generate a high CTR, that's click through rate, and a low ACoS, advertising cost of sale. In other words, if Amazon sees that a high percentage of shoppers are not only clicking on your ads, but buying the product you're promoting, then they'll increase the pull of shoppers who see your campaigns. The greater your ads reach, the more revenue your ad is likely to make. Building relevance doesn't happen overnight. Instead, you must use your early campaign data to hone all of the factors that feed into the effectiveness of your ad, your book's keywords, bid strategy, custom copy, book description, and even your book's cover. Setting high bids when running your first ad will earn your campaign a large number of impressions, but if you haven't targeted the best keywords or written the most effective sales copy, then your campaign will likely have a poor CTR and ACoS that kills your relevance within the Amazon advertising algorithm. Digging yourself out of a low relevancy rating is much harder than slowly building strong relevance in the first place. So be patient. Use the first six months of advertising as a learning experience. Review your campaign statistics frequently, identifying which keywords are resulting in clicks and sales. Create multiple campaigns to test different sets of keywords and sales copy and see what sticks. If your ads aren't performing well, despite strong keywords, then consider revamping your book's cover and description. Continue to study the data and hone your marketing strategy and you'll soon develop a powerful Amazon ad strategy that helps you reach new readers and grow your sales. Thank you for listening to today's episode of The Podcast Writer. I hope you found it helpful to your writing journey. If so, make sure to subscribe to the podcast so you never miss a new episode and to give the podcast a quick rating or review. Doing so goes a long way toward helping the podcast reach new writers and lets me know that you're enjoying what I'm creating. You can also give me a shout out directly on Instagram at christen underscore keeper. For additional guidance as you work to craft sensational novels and build your best writing life, be sure to head on over to www.well-storied.com where I share blog posts, workbooks, e-courses, and other helpful resources for writers. Again, that's W-E-L-L-S-T-O-R-I-E-D dot com. Thank you again for tuning into today's episode, my friend. Until next time, happy writing!


Hi, and welcome to this presentation on NCC 2022 and the Nathers tools. I'm Claire Wright, your host. I'd like to acknowledge the traditional learners of the lands on which we produce this presentation, The Nunnable Peoples, and the traditional learners of the land where you are viewing this presentation. I pay my respects to their elders past and present and recognize their culture as the longest living culture in the world. Today's presenter is Leone Wilson. Leone works in the team that manages the implementation of the Nationwide House Energy Rating Scheme, or Nathers. Her work involves overseeing the administration of the Nathers software tools and the related policy and governance aspects. Before we hand over to Leone, I'd like to cover off the learning outcomes for this presentation. After the session, the aim is that you'll have a better understanding of the relationship between the National Construction Code and Nathers and learn the following. First be able to describe the changes to NCC 2022 as they relate to Nathers. Interpret and understand some of the related NCC provisions and lastly identify when these provisions will be adopted. Now I'll hand you over to Leone who will take you through the content. Today I will be covering how the NCC and Nathers worked together for energy efficiency of homes. Starting with NCC 2022 changes related to Nathers, updates to Nathers because of these changes including the new whole of home changes and then information about adoption and where to find more. First I'm going to take you through the NCC 2022 changes and how they relate to Nathers. As you may be aware Australia's energy system is undergoing a fundamental transformation and managing energy demand is a critical part of this change. According to the International Energy Agency Sustainable Development scenario, energy efficiency represents more than 40% of the emissions reduction needed by 2040. There is a commitment to reduce Australia's greenhouse gas emissions to 43% below 2005 levels by 2030 and net greenhouse gas emissions to zero by 2050. The National Energy Transformation Partnership and supporting strategies will support collaborative efforts across governments, energy market bodies and others to increase the understanding of energy demand to inform energy planning and investment. The NCC and Nathers are playing an important role supporting this work and major transition. Changes to the NCC and Nathers were agreed by energy and building ministers last year as part of the trajectory for low energy buildings, a national plan for zero energy and carbon ready buildings. You may be aware that thermal ratings are increasing from 6 to 7 stars and a new whole of home energy rating which considers energy used by major appliances such as heating, cooling, hot water systems and pool and spar equipment as well as on-site energy produced via solar PV. Thermal bridging requirements are also new for the NCC 2022. So why the changes? Well poorly designed and constructed homes are wasting far too much energy. We can help avoid this by guiding better design and construction through increasing energy efficiency and minimum standards for new homes and apartments. This will reduce energy demand now and into the future for the entire life of the building. And for the first time Nathers is providing new information for households on what appliances have the biggest impact on their energy bills and carbon footprint. This all adds up to more comfortable homes with on-site energy generation and more energy efficient appliances with less need for heating and cooling and lower household energy bills. This brings me to how Nathers fits into the changes for NCC 2022. To start with the NCC performance requirements in NCC 2022 include a stringency increase to 7 star or equivalent as well as being expanded to cover energy usage. Nathers is still referenced as a deemed to satisfy or DTS pathway as normal but has also been included as a new DTS pathway for the new NCC whole of home performance requirement. You may have noticed the NCC has updated the clause references from previous years as well. So the references might be a little different than what you're used to. This flow chart shows how the Nathers compliance pathway for homes fits into NCC volume 2 and the relationship it has with the performance requirements. In NCC 2022 volume 2 all relevant clauses for the Nathers compliance option are consolidated into specification 42. The star ratings required in specification 42 clause S42C2 for heating and cooling loads have been changed to reflect the stringency increase for NCC 2022. The split heating and cooling load limits have been updated which is included in the next slide. S42C3 net equivalent energy usage is required if you will use house energy rating software i.e. Nata software to meet the newly introduced whole of home requirements. I'll discuss this shortly in the compliance options for the second performance requirement energy usage. Under S42C4 there are other DTS elemental provisions that need to be met besides Nata's star rating and heating and cooling load limits. These include requirements for how thermal insulation is installed and the need for a thermal break in some instances. This flow chart shows how the Nathers compliance pathway for individual apartments fits into NCC volume 1 and the relationship it has with the performance requirements. The Nathers pathway in NCC volume 1 is an existing compliance option and practically speaking the way it operates is broadly the same as under NCC 2019 with some minor changes consistent with the Nathers pathway in NCC volume 2. The stringency has increased to reflect the increase in house energy efficiency for NCC 2022. Nata's also now incorporates a whole of home rating tool that you can use when you are showing compliance with the energy usage performance requirement J1P3. Nata's whole of home provides a score out of 100 for an individual sole occupancy unit with the NCC requiring that each apartment achieve a score of no less than 50. As with NCC volume 2 the Nata's pathway by itself is not sufficient to show compliance with J1P3. You will still have to demonstrate elemental energy efficiency requirements for both air conditioning and ventilation including equipment servicing the apartment and lighting. This can be done through parts J6 and J7 which were known as J5 and J6 in 2019. For Class 1 buildings the NCC 2022 requires a minimum rating of seven stars to be achieved. Those some areas may be allowed to claim an additional credit. For example outdoor living areas in climate zones one and two may claim a half of a full star credit if certain conditions are met reducing the minimum rating to six or six and a half stars. There are also updated heating and cooling load limits that match the increased minimum star rating. The whole of home requirements are that you attain a rating of 60 out of 100. More details about the whole of home ratings are covered later in this presentation. There are some specific changes and updates to Class 2 buildings with an individual apartment requiring a rating of six stars but the average across the whole building is required to be seven stars. There are also updated heating and cooling load limits like Class 1 dwellings. For whole of home every apartment must rate at least 50. There is no building average for whole of home every apartment must meet the same target. Now I'm going to take you through how NATAS is supporting the recent changes to National Construction Code NCC 2022. The climate files that are used to calculate thermal star ratings for NATAS have been updated with more recent and accurate weather data. This is an important improvement to NATAS as the climate interacts with the design features of a building to determine the amount of heating or cooling needed to keep the house comfortable. The more accurate the climate data the better the information supplied to inform the building's design and features. The star bands which indicate the amount of energy used for each star rating have the potential to be impacted by the new climate files. As a result the star bands have been recalibrated to minimize any impacts. This recalibration ensures that no particular dwelling will be disproportionately impacted by the updated climate files. As a result the majority of dwellings will on average have no change to their star rating. Individual dwelling designs may show a small increase or decrease but the level of impact is well within the range of normal that is expected. The ABCB heating and cooling load limit standard for NATAS has also been updated for NCC 2022. The standard has slightly tougher load limits reflecting in part the NCC's increase from six to seven stars. The load limits also are adjusted to reflect the changes to NATAS' star bands. NATAS has also made some adjustments to improve awareness and accessibility of the standard for assessors and certifiers at key stages of the building design and approval process. NATAS software has been modified to look up the relevant load limit in the standard and alert assessors when a design is not meeting the requirements. The NATAS certificate has also been modified to show the relevant NCC split load limits next to the predicted heating and cooling loads of the rating. This approach will allow users of the certificate such as building certifiers to quickly assess whether the NCC load limits are met while also allowing them to consider local variations. The final accredited software tools will have the updated load limits. The thermal bridging requirements for residential buildings are also updated in NCC 2022 as thermal bridging can significantly reduce the effectiveness of insulation if it is not accounted for. Thermal bridging is the movement of heat across an object that is more conductive than the materials around it. This effect is more pronounced with metal frames. NATAS has worked with CSIRO to develop a thermal bridging capability that aligns with the NCC 2022 requirements. This includes applying thermal bridging to metal frame constructions and aligning them with their timber frame equivalents. Thermal bridging calculations will only apply to repeating metal frame elements, for example joists and studs, for floors, walls and ceilings. Default values will be used when the precise framing specifications are not provided. It is an NCC requirement that the thermally bridged metal frame constructions achieve the same thermal performance as similar timber frame constructions. To offset the negative effects of thermal bridging on the thermal performance in NATOS, other elements of the home's design can be improved. Please refer to the NATAS website for further information on thermal bridging. This includes a report with details of the thermal bridging research that was undertaken. NATAS software is being upgraded to support the new NCC energy efficiency requirements. We are working with commercial software providers to update and reaccredit tools for use as soon as possible. In the interim, assessors can use the endorsed beta tools to gauge the impact of updates and new inclusions and familiarize themselves with conducting whole-of-home assessments. Building for seven stars does not have to be costly or complicated. Simple design features and material choices can make a big difference to a home's energy efficiency and its energy rating. Correctly applying the principles of passive solar design will have the largest impact on a rating at the least cost to assist reaching the new seven star requirement. This includes building for the local climates and using sun control mechanisms to provide appropriate shade and solar access as required. This could be, for example, to let in the winter sun and block out the summer sun. Also correctly orientating the design and the zoning spaces so the main living areas have a northerly orientation will make a significant difference to a home's thermal performance and its star rating. Optimizing the size, location, operability and shading of glazing is another important consideration to take into account. This could be to enhance cross-ventilation or by strategically limiting glazing to the east and west orientations when appropriate. Improving the glazing is also something worth considering. NADAS includes both default and custom window options. Generally choosing default windows will usually result in a lower rating so we recommend switching to a custom window where all the specifications are known. This allows for greater accuracy. Consideration should also be given to the color of the roof, window frames and walls. Adding internal ceiling fans where appropriate and increasing the r-value of wall, floor and ceiling insulation can also assist in improving a rating. If you want some more tips on building for a seven star rating visit natas.gov.au forward slash fact sheets or your home.gov.au. In the second half of this session I will now cover the expansion of NADAS to perform whole of home assessments in more detail and how NADAS fits into the NCC 2022 changes. In line with government policy the NADAS team and industry have been working on expanding NADAS from assessing the thermal performance of buildings to assessing the whole system of energy use in the home. In a nutshell this means bringing appliances into NADAS. NADAS is now able to assess the impact of those appliance choices. As NADAS is a very common pathway used for demonstrating compliance with the energy efficiency requirements for the NCC the focus has been to align NADAS updates with the NCC 2022 scope. This means we have targeted the same fixed appliances that the code has referenced covering heating and cooling, heated water, lighting, pool and spa equipment and onsite generation. As I touched on earlier the thermal star rating will sit alongside the whole of home performance rating on the new NATO certificates. It is a score out of 100 which includes an assessment of the energy required for the whole home. These changes will help homeowners make decisions on the most energy efficient appliances and products to include in their new home. They also encourage home builders to consider the efficiency of the appliances they recommend to clients. NADAS assessments also help compare the performance of different home designs so clients can find the design best suited to their needs, the climate and their block. Using NADAS we easily see how the design meets or exceeds the minimum standards and ultimately design and build homes that have little to no energy bills. While not required by the NCC the NADAS administrator encourages using a NADAS accredited assessor and engaging them early on in the design process. This is so they can provide the best advice on how to design a home to reduce its heating and cooling needs and improve the whole of home rating if required. For example to improve the whole of home rating a NADAS accredited assessor might recommend using higher efficiency appliances while adding solar PV. Higher efficiency versions of the appliances that have been specified will simply use less energy and improve the rating. Likewise having solar means importing less energy from the grid and also allowing for credits for exports that help offset the energy use depending on where you are. If those aren't creating the change your clients want to see NADAS accredited assessor might advise switching to a different appliance technology if that's going to work for your client. Or they might suggest shifting some of the energy used during those expensive early evening peaks to a cheaper time. This can be done by facing some of the solar PV panels towards the west allowing the system to generate more electricity later in the day or by adding a battery. Just like in NADAS thermal assessments there are elements that you won't be able to change. This is because while there are things that are good for improving energy efficiency they are also very difficult for a building certified to check and enforce through their compliance checks. As an example occupant behavior has a large impact on energy consumption in a home. Taking shorter showers or turning on a heater at a lower temperature than what is assumed in NADAS will reduce energy usage. But this cannot be checked by certifier so will not be considered in this rating. We also need to make sure that ratings are consistent and there is a fair and level playing field for industry. This means that there are assumptions that need to be made so that we can compare different homes equally. So what do you need to do now to prepare for the energy efficiency changes? The next section of this presentation covers advice about transition and adoption dates. If in doubt we recommend that you check with your local building authority. We are also rolling out training for accredited assessors from this month. Sign up for sessions from March through to August. Right now all you need to do is keep an eye on the NADAS website and if you have not already done so sign up for our newsletter to access the latest information including software accreditation updates, assessor fact sheets with practical guidance on building for seven stars. The new ratings are supporting industry and consumers to design and build homes that meet minimum standards and exceed them if they wish. If you would like any more information please visit the websites listed on this slide. This is a big change for NADAS and cannot be done without the engagement and support from all of you. Thanks for that Leone. We hope everyone found that informative. That brings our presentation on the changes to NADAS and NCC 2022 to a close. Again if you want more information visit abcv.gov.au or nathears.gov.au. Thanks for watching.


Hi everyone, Joe for jaspyscasebrakes.com coming at you with 2020-2021 upper deck the cup hockey To box pick a team number 11 from jaspyscasebrakes.com It's gonna be one of these two boxes right here the final two boxes are In the store right now jaspyscasebrakes.com so check it out big thanks to the people who bought their teams straight up and pick your team 11 and Todd I think ended up with double last spot mojo with my Kings and And the caps the rest of the teams we put into a random number block Which we did in a separate video, but here are the results for that So it's a serial number break featuring Those those teams right there now. Let's see which side we're gonna do one two three four five six Five So we do the right side right here And this side we will say for break 12, which is in the site now Good luck everybody. Yep Kyle just in time To witness a little hockey. Good luck The next two boxes we pulled the teams and we put them into that serial number that random number block randomizer So be sure to Get your spots in that and we can run back in other two boxes Can't open this there we go And we run back to two boxes All right. All right. All right. Good luck 23 out of 249 Mika Zabinyad For the Rangers That's for Rob picked up the Rangers straight up. Yeah, that's that's what the crew were telling me Kyle That was a big hit last night. Let's see if we can find some more tonight Rookie Auto Patch Gustav Lindstrom 90 out of 249 Detroit that's gonna be for Joe Christian Now we got Joe Pavelski, that's a cool little patch there 20 out of 25 for Dallas John with the Stars John was the recipient of that big Jason Robertson from last night. Oh, these are cool the lamp lighters Maxim Lutinov I Like that die cut gold ink For the sharks that's gonna be For Joe Christian picked up the shark straight up This is actually not numbered if this was a number block team, we would have randomized it to one person in the break Just FYI next up is Peter Forsberg three out of 36 Three color patch and autograph for the Flyers That's Sean Gola with Philadelphia picked up the flyer straight up and back here is Nikolai Cazenio 001 out of 249 for San Jose Joe Christian sharp-looking cards here ladies and gentlemen. All right now second box and again another two box break in the store that's a In a full in a random number block filler So check that out Featuring 17 teams a lot. Good luck everyone. We've got Austin Matthews 164 out of 249 Toronto is a number block team So if you're not familiar with how that works We go by that digit right there number four So that'll be four That'd be for Rob and the number four We got a rookie auto patch gave the lardy 65 out of 249 for the Kings and that was Todd with my Kings last spot mojo Yeah, there you go go Kings go I think their next game is in a few days We're playing some really good hockey That's Todd Powell Jason Jaspy so you can holler at Jason. Who's gonna be on Instagram? tonight and tomorrow and Right here on YouTube Friday and Saturday There's Raiden there's Raiden Shen 86 out of 99 Nice patch nice auto signature materials goes to st. Louis 6 That's for Robert st. Louis 6 Nolan foot 30 out of 36 chemical composition Jersey is a number block team. That's 30 out of 35. So that goes to number zero Jeff with the number zero and we got some quad jerseys 20 out of 25 all capitals all going to Todd Powell We've got Nicholas Backstrom Ovechkin Kusunov John Carlson the last one here is Dylan Cousins buffalo 95 out of 249 That's El Guapo with Buffalo. There you go ladies and gentlemen This cup really nice stuff here lays Boys and girls really nice stuff. We can get another one going tonight. I would love it So let's knock out that last number block and let's make it happen. Thanks for watching everybody. I'm Joe I'll see you next time for the next hockey break


Raghuram. Create your heart Institute of Photography.


Live from Las Vegas, it's theCUBE, covering AWS re-invent 2018.  Okay, welcome back everyone. We're live here in Las Vegas with AWS Amazon Web Services re-invent our sixth year. I'm John Furrier, Dave Vellante, Dave, six years, two sets, people rolling out of the keynote, so much action. We got another day coming tomorrow. We've got two great guests here. We've got Dr. Vassi Philliman, who's the general manager of machine learning and AI at Amazon Web Services, and Dr. Taha Khas-Hauthut, senior leader at healthcare and AI at Amazon. Guys, welcome to theCUBE. Thank you so much. I'm so excited that you're here because I've been waiting to have this conversation. Dave and I have been, we just had analysis of the distractions and we got the stack around machine learning. So much value now coming online that's been in the works around AI and really mainly machine learning that's creating AI-like benefits. And he just had to spend a lot of time in his keynote, say almost a third of it, around AI-like capabilities and how Amazon integrates in, from chipsets with elastic inference, beautiful, it's just good stuff. So congratulations. So what does it mean? What does it mean for customers right now who want to kind of grok what's going on with Amazon and AI? Is it new sets of services coming online? Is it how long it's been in the works? Explain. Our mission at AWS has always been to take technologies that have been traditionally available for a few special technology companies and take that and make it available to all developers. And we've done that, I should say that we've done that fairly well when it comes to compute, when it comes to storage, when it comes to databases, analytics and we're doing the same thing for machine learning and AI. And what we're doing because it's a new field is we've got to innovate at three layers of our stack. So the bottom most layer, as you saw in the keynote earlier has to do with frameworks and infrastructure. So this is more for the people that fully understand how to deal with machine learning models and like to go in and tweak these models. The middle layer then is for everyday developers and data scientists. And that's sort of where SageMaker fits in. And finally at the top layer of the stack is where we have our application services. And this is meant for developers that don't want to get into the weeds of machine learning, but they still want to use, make use of all of these technologies to make their applications more smarter. So they get the insight benefits, get the insights out of the data without getting down on the weeds. Exactly. And people who want to get down on the weeds, they can get down and dirty with all this other stuff. Yeah. Think of that right? Yeah, and typically what we do at the top layer of the stack is we try and solve really hard problems. And so customers can now take advantage of it because we've solved it for them and they can just take that and integrate it into their application. Real quick, what was the hardest problem that you guys solved? I mean, traditionally speech recognition is a very hard problem. That's one of the hard problems. The other one is NLP, Natural Language Processing. But I would say speech recognition is probably a hard problem. We just launched streaming transcription so you can now transcribe live as somebody speaks. And of course you can connect it to translate and translate it as well live, so. Great for our Cupiders, looking forward to having that online. As a healthcare practitioner, how does this all apply to that industry? What kind of projects are you guys working on in that regard? Of course, yeah. So I mean, to Vasi's point is when I continue to innovate on behalf of the customers across all layers of the stack and machine learning, in particular this week we launched Amazon Comprehend Medical. Particularly in a hard problem where the majority of healthcare data is captured, conversation and observations in an unstructured format. So petabytes of data is stored across entire healthcare system that's in unstructured form. So to drive actionable insights and to be able to find the right elements to treat patients or to manage a population or even to do accurate billing, it's been really important that we can empower our customers with building blocks for them to build the right solutions to take advantage of that. So Amazon Comprehend Medical is able to understand the medical language and the context, similar to how clinicians understand the medical language and context. For example, if you're looking at a patient medical note, Amazon Comprehend Medical is able to with high accuracy extract medical conditions, medications, tests, procedures, being done on the patients as well as the relationship between those and understanding that context, that this condition and this treatment go together as well as the nuances. For example, a patient has no family history of X or there's no smoking history. All those are things in relation in the past or in the future or other members. And this is really what we're really proud about launching Amazon Comprehend Medical. Talk about how it works because healthcare has been a great field around where AI's old fashioned AI say, when I was doing it in the 80s, early 90s, ontologies were really popular and it's linguistics is kind of known. But now that, but you need a linguistics guru to do that. You mentioned streaming, the transcribe, you got metadata. How do you guys get this kind of benefit when the ball's moving so fast around these rapidly changing and verticals like healthcare?  So much data. How do you put the puzzle together? Let me first give you some context here. As you're probably aware at last re-invent, we launched Amazon Comprehend, right? Comprehend is a text analytics service. It helps you look into text and understand what's in there. We started out with general things that we could detect like people, places, things, sentiment, the language, the text is written in and so on. But when we started, customers have picked on it and they're using it a lot. But as they keep using it, they came back to us and said, hey, it's great that you guys have this, this, you're giving us the capability to understand general language, but some of our domains have some special language. Like jargon. Yeah, like take the legal domain, for example, right? It's got judges and defendants and very particular things that are very relevant to the legal domain. So they were asking us for a capability to sort of extend Comprehend to include their custom domain terms and phrases as well, right? So last week we actually launched a custom entities feature that allows them to bring in their custom domain into Comprehend so that Comprehend can be extended to include their domain. And so legal language is difficult to understand, but medical language, on the other hand, is even more harder to understand. Yeah, exactly. Acronyms, jargon, what does an entity look like, extracting that. And extracting entities is alone, misspells, right? But relating those entities together is super important because in one clinical note, you could have multiple drugs in there with different dosages, different frequencies. So you need to be able to relate those entities together, right? And that's the sort of thing that Comprehend Medical allows our customers to do to solve some really big issues. So you're doing a lot of that entity extraction under the covers. Is that right? How does it work? I mean, how does Comprehend and medical work? I mean, just out of the box, you have to train it. There's no training needed, no machine learning expertise needed. So the algorithm extracts these entities as well as the relationship between those entities. And then also extracts any attributes that might be related, such as negation or past and future, or what's anatomy of the body relates and whatnot. All that is done out of the box. And that's super important. You want to know whether the patients stop taking a medication, right? So negation, things like that. You want to know because that gives you the context. Just getting the terms alone doesn't really tell you much. Andy Jackson had a great video about the F1 analytics. Imagine having that for a person. You're not doing good right now, take a break. So I feel like we're kind of now scratching the surface of healthcare transformation. Think about the healthcare industry. For years, it's been compliance-driven, whether it's HIPAA, Affordable Care Act, EMR, and meaningful use. But the industry hasn't been dramatically transformed and disrupted and it kind of needs to be. How do you guys see that evolving? I feel like you're now beginning to see that sea change. And it's going to take a while. It's a high-risk business, obviously. But what's your sort of prognosis for that transformation and what's the vision as to the outcome? Yes, that's a really great question. I mean, one great thing that's happened over the last decade is the digitization of your medical record. So, and that's really wonderful because before it was all paper-based primarily, unless you were in acute setting. So now, the majority of the US, for example, and globally, there's this huge adoption and propagation of these electronic medical records. The issue there remains now when the majority of that data is observations and conversations as well as unstructured, that creates a different kind of roadblock for our customers. And this is what we're hoping for, service-like Amazon company and medical, that's HIPAA-eligible, meets a lot of the compliance or help our customer meet their compliance needs that we'll be able to remove the heavy lifting of this undifferentiated task about having a large amount of time being spent on analyzing this text and extracting very low, where now with Amazon company and medical, we'll be able to really fast track that and be able to elevate that. Hit the nail on the head on the undifferentiated heavy lifting. That's the ethos of DevOps. Exactly, yeah. Let me give you some stats actually. There are 1.2 billion medical documents that are generated every year in the US and 80% of them, it's unstructured text. So to make sense of that, it's going to enable our customers to do some really amazing things. One of the things, one of the use cases that we see is clinical trial recruitment. So Fred Hutchinson, which is one of the nation's top cancer research centers, they recruit patients for clinical trials. If you go to clinicaltrials.gov, you'll see like 290,450 clinical trials open and typically from history we know that most of these clinical trials don't end up recruiting, they don't end up meeting their recruiting goals because it's very hard to figure out which patients fit the clinical trial that you're actually trying to perform. So Comprehend Medical helps these customers to very quickly narrow it down. Yeah. Expand on the involvement of people in the community. You mentioned Fred Hutch, and Roach has also been involved from what I heard. Yeah. Who was involved in this project? It sounds like it was a collaboration. Think a minute to explain that. Right. It's very similar to a lot of other services that we put into the market. We collaborate a lot with customers. 90% of what we do is really coming from customers. So we've collaborated with people like Fred Hutch and some of the nation's top institutions to help us validate the service that we've built to actually make sure that it's meeting sort of the requirements for those use cases that they are thinking of. So we collaborate closely with them to get the service to where it is today and we announced it as generally available yesterday. Okay, so what's the use case? Oh, go ahead. Yeah, I can expand a little bit on that. So some of the customers as well, they use cases. We're talking anywhere from hospital systems that when I use or take advantage of their unstructured texts for things such as identify people who are for their followup appointments or stop in treatment or finding alternative routes to billers were trying to identify accurate procedures were done. They'd be account for all the procedures account for all the billing, which oftentimes is hidden in those unstructured texts and require a lot of manual process. And oftentimes the rules can't really scale to things such as clinical trials, recruitment. How can you, for example, in Fred Hutchinson Cancer Institute use case for identify a patient and match them to the right clinical trial. These patients oftentimes have hairy potters worth of clinical notes done on them and they'll launch you on a journey and to go from one institution, another, another and be able to really find it's no longer a needle in a haystack, it's like a needle at the bottom of Atlantic Ocean and then be able to really do that match from hours and months down to a few seconds and that's really the beauty about the service. John likes to talk about the 20 mile stair and I wonder if we could just look ahead. How far can we take AI and machine learning in healthcare and how far should we take it? And that may be a more specific question is as a practitioner, when do you think machines might make better diagnoses than doctors, if ever? How do you feel about that? Where do you see this all going? I think, I mean, the whole idea about machine learning, the beauty about it, I mean, similar to how the status scope was introduced, similar to how the thermometer was introduced in medicine, these are tools that we use to our advantage to really provide better care and better outcomes and that's really what we're, that's the mission that our health IT and customers and whatnot are really driving towards. Machine learning can do a lot of great things for routine things that human being can go and focus their attention to other things such as the Fred Hutchinson, instead of going and mining these diagnoses in amounts and amounts of data, machine learning will be able to identify that where the clinical staff can focus on care. And that's really what I think, I mean, over the next decade and so, we're going to see a lot of this advancement in these building blocks, as well as what Amazon's offering from forecasting and prediction, algorithms and whatnot, we'll be able to fine tune our capabilities to help customers achieve even precision medicine. It's real world impact because you're changing the workflow. I mean, someone's in the wrong line or the wrong process based upon their history. HIPAA requirements really cause a lot of this record sharing thing to be a problem from what we've been reporting over the years. It's kind of a solution to that. So if I move to a service, medical service, I get all that records with me, is this kind of how you see going and how does other regulations that are holding you back that are blockers, is that clear now? How does that solve the industry challenges of privacy? If you look at the healthcare system today, there are lots of inefficiencies in there, right? In the end, this is all about improving patient outcomes and making sure that we reduce costs. And that's what this boils down to. And these are tools that allow our customers to do exactly that. Well, guys, thanks for sharing this insight. Comprehend Medical is really awesome opportunity. So I think it's early days, day one, as you guys say. I think there's so much more that could be there. I'd love to see the industry, just from a personal, you know, society changes, just get out of the way of all these hurdles, get the data out there, expose the data, check the privacy box, would be good, right? This is going to change the game. Yeah, I mean, maybe we should say a little bit about the, how we built the service in terms of that, right? As you know, at AWS, security and privacy is number one for us, right? So this service is HIPAA-eligible. It's a stateless service. What that means is nothing gets stored. The data is not used to improve the models or anything like that. The only person that can actually see the data is the customer. He's got the keys. He's the only one that's sending the data to the endpoint and whatever he gets back, only he can decrypt it. So we've taken care to make sure that we can remove some of those hurdles that people have always been worried about. Well, doctors, thank you so much for sharing. Thank you so much. Thank you so much for having us here. All right, we are bringing you all the action here from AWS ReInvent. Again, as the compute power has increased, as software is written with new apps, AI is changing the game, of course theCUBE, and a lot of video. We're going to need some of these services to make these transcribes on the fly. Thanks for coming on, I really appreciate it. Thank you so much. Back with more after this short break. Thank you for your time. Thank you.


A film in three minutes, Cache. Michael Haneke is a filmmaker whose work is no stranger to the darker side of human nature. From sadistic teenage torture to the unnerving roots of Nazism, Haneke's career has solidified his reputation as one of Europe's greatest living film directors, with his 2005 thriller Cache, or Hidden in English, acting as one of the best examples of his craft. The story follows George, played by Daniel Ottoya, a successful middle-class television presenter whose cosy cosmopolitan life is interrupted by the arrival of several mysterious videotapes, tapes that show his Parisian home being filmed at different times of the day. As more tapes show up, they arrive with disturbing childlike drawings, drawings which force George to look back into his past and face a harrowing guilt from his childhood. Cache as a film works on two levels. The first is a taught psychological thriller where the realities of how a family would react to receiving such tapes on a daily basis steadily begin to cause conflict between George and his wife and son. The second level, and the one which director Haneke focuses on the most, is how George's guilt is a metaphor for France's recent colonial past, most directly referencing the 1961 Seine River massacre where dozens if not hundreds of French Algerians were beaten and drowned during the Franco-Algerian War. In Cache, George as a character represents the tensions that affluent white suburban France have to this day with the country's large North African population, as well as symbolising the collective amnesia that France as a nation has had over its colonial guilt. The relationship between George and a person he suspects is responsible for sending the tapes symbolises the stark divide both French populations have, a divide revealed slowly to us thanks to the magnificent performance from Autoyer who perfectly encapsulates a man having to confront a buried secret from his past. On what fascinates Haneke as a filmmaker, the director has said, I'm interested in seeing films that confront me with new things, with films that make me question myself, with films that help me to reflect on subjects that I hadn't thought about before, films that help me progress and advance, those are the kind of films that interest me. For me, personally, I think watching a movie that simply confirms my feelings is a waste of time. The film's ending is one that has stuck with me for many years after first viewing, providing us with no direct clarity on who may be responsible for sending the tapes to George, but it's in that same lack of clarity where Cache works best, leaving us as the viewer to ponder and develop our own ideas on who is responsible and why, forcing us to think instead of just spectate, not just on the mystery itself, but how, like George, we as citizens have to choose whether to face our country's violent past or pretend it can be hidden away, not for the victim's sake, but for the descendants of those responsible.


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