Trolling for a wealthier world

By: Omar Metwally, MD
University of California, San Francisco

“No,” said the priest, “you don’t need to accept everything as true, you only have to accept it as necessary.” “Depressing view,” said K. “The lie made into the rule of the world.”  – The Trial (Franz Kafka)


To understand what motivates people to create and share knowledge.


Larry, is a cafe owner on a mission to brew the world’s best cup of coffee.
Larry’s on a mission to brew the world’s best coffee

The Cast:

Roy Bender:  Australian-American physician who invented Roy’s Retractable Needle in 1990. His patents in Australia, America, and Germany brought him great success and have since expired.  

Dr. Roy Bender enjoying his patents’ success

Ernesto Bernal: Ernesto is an altruistic Mexican inventor whose outrage at the cost of American “Epi Pens” (life-saving medical devices used to treat potentially fatal allergic reactions by delivering epinephrine into the thigh muscles) inspired him to invent Ernie’s Excellent Pen. Ernie’s Excellent Pen uses the technology behind Roy’s Rectractable Needle to make this life-saving medication more affordable for patients.

Dr. Ernesto Bernal building “Ernie’s Excellent Pen”

Dr. Xu: Chinese scientist looking for a way out of a dead-end postdoc. He spends a lot of time trolling websites like reddit in between experiments.

Dr. Xu, Full-time redditor, part-time postdoc

Dr. Chang: Chinese scientist who invented China Pen in 2005, her own version of the epi pen. Dr. Chang, a brilliant scientist without business aspirations, quickly forgot about her invention and moved on to other research projects. She and Dr. Xu were postdocs together and longtime friends. 

Dr. Chang mentoring her student

Part I

Looking for inspiration for his next big invention to save him from a stagnant postdoc, Dr. Xu browses the blackswan network, a database of inventions and ideas, on a quiet afternoon in his lab. He likes the website because it’s like a nerdy version of reddit, a website that has occupied a lot of his time recently. While browsing blackswan he stumbles upon Ernie’s Excellent Pen (a medical device built using Roy’s Retractable Needle), which immediately reminds him of his old friend’s China Pen. He creates an “attribution” on the blockchain, an association between two devices/components, that looks like:

To a human, this attribution looks something like:
[Appraiser's (Dr. Xu's) Ethereum address, Resource1* (Roy's Retractable Needle), Resource2* (Dr. Chang's China Pen), Timestamp, Transaction Handle]

To a machine, this same attribution might look like:
[0x6060604052341561000f576, Qmt3z9320ba, Qz429ccr082, 1508029285, 0xc6a493eb108266c548906c8b]

This attribution allows others to see that Roy’s Retractable Needle and the China Pen are related to one another. Others can “upvote” this association as a useful one and create their own associations (so that Dr. Xu can learn about related inventions which he wouldn’t have otherwise encounter). For someone on the hunt for the next big idea, this is a great way to find inspiration and learn about what others are building. All community members can vote on how useful an attribution is and can create their own attributions.

*As a side note, resources are named something like Qmt3z9320ba , and these names also function as locations (addresses) of files with detailed information about each invention, including schematic drawings and textual descriptions. If any of the files to which these addresses point are modified, the entire address changes — one way to make sure each timestamp accurately reflects the information with which it’s associated. 

Part II

Larry owns a hip cafe in Tel Aviv and has invented many gadgets on his quest to brew the perfect cup of coffee. As he sips on a cup of coffee and browses the blackswan network, inspiration strikes, and he has a new idea for a modified French press that could be built using the spring-loaded mechanism underlying Roy’s Retractable Needle. Larry draws up some sketches and a description of how his Better Coffee Press would work and confidently uploads the information to the blackswan network. He doesn’t need to worry about someone else claiming ownership of his ideas because there’s a timestamped record of this information on the blackswan network. 

Part III

The owner of Oakland Standard, a manufacturer in Oakland, California, discovers Larry’s sketches a week later and calls him in his cafe. He loves the idea, he tells Larry, and wants to bring his product (Better Coffee Press) to the U.S. market. One of Oakland Standard’s designers suggests using a slightly modified component from Ernie’s Excellent Pen (Larry’s never heard of Ernie or his epi pen, but he likes Oakland Standard’s suggestion). Larry seals the deal with Oakland Standard. 

Oakland Standard eventually takes the product to market, and it’s a hit among hipsters and coffee connoisseurs across the U.S.. After Oakland Standard (and Larry) make their millions, the design for Better Coffee Press appears on the blackswan network around the same time that the patent is published and viewable on Google Patents and the US Patent and Trademark Office website:

Type: device
Name: Better Coffee Press
Function: hand-operated coffee brewing device
Content-addressed hash: Qbb4a27e6783
Author1: Larry Bucks
Timestamp: 1601036650
Classifier1: Food and Beverage
Classifier2: Brewing System

Part IV

Dr. Xu is having another rough day in his lab. He heard about the Better Coffee Press on reddit and bought one so he can brew coffee in between experiments. As soon as his coffee press arrives in the mail, Dr. Xu brews his first cup of coffee, sets his laptop on his lab bench, and pulls up a stool. Sipping an extraordinarily delicious cup of coffee, he admires the technical genius of this new coffee press and begins dismantling the gadget. As he takes apart the coffee press, he records the following attributions (logical associations between the coffee press and its underlying components) on his quest for inspiration for his own inventions:

Human version:
[Appraiser's (Dr. Xu's) Ethereum address, Resource1 (Roy's Retractable Needle), Resource2 (Larry's Better Coffee Press), Timestamp, Transaction Handle]

Machine version:
[0x6060604052341561000f576, Qmt3z9320ba, Qbb4a27e6783, 1508029285, 0xa8e493eb108266c548906331]

[Appraiser's (Dr. Xu's) Ethereum address, Resource1 (Ernie’s Excellent Pen), Resource2 (Larry's Better Coffee Press), Timestamp, Transaction Handle]

[0x6060604052341561000f576, Qz429ccr082, Qbb4a27e6783, 1508029285, 0xd8a493eb106206a448906257]

Part V

Oakland Standard sells tens of millions of dollars worth of the Better Coffee Press, and Larry makes a fortune in licensing fees. Meanwhile, Roy, Ernie, and Dr. Chang have also made millions — in tokens.

Whenever blackswan community members like Dr. Xu appraise information by creating and voting on the quality of attributions, inventors like Roy, Ernie, and Dr. Chang receive tokens on the blackswan network. 

But why would anyone care about earning tokens when they could earn real money like Larry and Oakland Standard? Aren’t these tokens just monopoly money? Larry and Oakland Standard earned their wealth by operating within the intellectual property systems of each respective country where they manufactured and sold the Better Coffee Press. They had the financial resources to pay intellectual property attorneys tens of millions of dollars in fees to draft and review contracts, and even more to enforce their patents by taking infringers to court.

But what about all the smart people out there who don’t have the same access to intellectual property attorneys and millions of dollars in investment capital? 

Larry may be a clever capitalist, but he also sees the value of the novel economy emerging around the blackswan network. As he sips on a cup of coffee, Larry is already planning his next big venture. He announces on his cafe’s website that he’s on a quest to build an even better coffee brewing system and drafts an Ethereum contract that will award $5 million to all the tinkerers out there who make the most meaningful intellectual contributions to his future invention. Larry types up his Ethereum contract, buys $5 million worth of Ether, and sends these funds to be held in digital escrow. He then creates this entry for his future invention on the blackswan network, which he calls Best Coffee Press:

Type: device Name: Best Coffee Press 
Function: hand-operated coffee brewing device that keeps coffee warm and serves up to 6 people 
Content-addressed hash: Qzt7w201e55j 
Author1: Larry Bucks 
Timestamp: 1720015640 
Classifier1: Food and Beverage 
Classifier2: Brewing System

Part VI

One year and many blockchain transactions later, new records of device components and devices have been created on the blackswan network, new attributions have been made, and millions of makers have earned tokens for their contributions. Larry has also amassed a personal fortune as a result of his second contract with Oakland Standard to manufacture and sell his latest invention, Best Coffee Press. 

Larry’s smart contract then distributes the $5 million that have been held in escrow for the past year to 280 inventors on the blackswan network whose work has contributed to the creation and success of Best Coffee Press. Rather than dividing $5 million equally among 280 people (each receiving $17,857.14), Larry wrote his contract to reward inventors proportionally to their contributions; the more frequently a device or component appears in the blockchain in the form of attributions (as they relate to Best Coffee Press), the greater those inventors’ piece of the $5 million pie. 

While making his own personal fortune (and bringing wealth to Oakland Standard, teams of attorneys, factory workers, and international governments), Larry also brought wealth to 280 inventors who would not have otherwise contributed to or benefitted from Larry’s success he had operated solely under existing systems of information disclosure, such as the US Patent and Trademark Office. Through his foresight in adopting the blackswan network, Larry was able to create his Best Coffee Press in half the time it took to create his less innovative (and less successful) Better Coffee Press.

One of Larry’s childhood friends, now a famous Professor of Medicine, read a newspaper article about Larry and came to visit his old friend in his cafe. 

Larry greeted his old friend with a warm hug and insisted on brewing the best cup of coffee for him using his latest invention. As they enjoyed what Prof. Grossman admitted was truly the best cup of coffee he had ever tasted and watched people hurrying beyond the cafe’s windows, Prof. Grossman began, “I’ve heard of billionaires who’ve made fortunes building monopolies…but a billionaire who’s made fortunes by dismantling monopolies?”

Larry pouring coffee for his childhood friend

Larry’s face wrinkled with laughter. “Most people think that wealth can be made only at others’ expense,” he answered. “The secret is, the more you give, the more you get. And here I’ve found a way to do just that.”

“From a certain point onward there is no longer any turning back. That is the point that must be reached.” ― The Trial (Franz Kafka)

How to connect 3+ Ethereum nodes in a private Ethereum network.

How to create a private Ethereum Network, Part Deux

By: Omar Metwally, MD

Background and Prerequisites:  This tutorial picks up where part one (“How to create a private Ethereum network”) left off.


Numerous people have asked me how to connect 3+ nodes in a private network after reading my previous tutorial. There are scripts out there that will pseudo-automate the process, but I believe in understanding the fundamentals and building it yourself from the ground-up without obfuscating layers between you and your network. Many people got hung up on obtaining a machine’s enode address (basically your Ethereum client’s public key) using the bootnode application. Depending on which machine you’re running and how you installed geth (the Go Ethereum client), chances are you don’t have bootnode installed. I realized that most people out there are not running Linux machines like me and therefore are getting stuck here.

The good news is that creating a network with any number of peers is possible without having to install bootnode.

A crucially important difference between private Ethereum networks and the main Ethereum network

is that, unlike the main Ethereum network (where real money is used to power the Ethereum supercomputer, create contracts, and move money around the network), private Ethereum networks do not automatically let anyone join the network. In a private network, each peer must identify all other peers to which it wants to connect. In networking parlance, a node becomes a peer when it connects to a fellow node.

Nodes are identified via enode addresses, which are basically public keys.

To illustrate how to create a private network with 3+ nodes, I’ll use the private blackswan network I created to run one of our projects, called DDASH (Distributed Data Sharing Hyperledger). You’re welcome to follow along and join the blackswan network or take notes and create your own private network.

Step 1: Create a genesis block 

All peers must use the exact same genesis block specified by genesis.json:


For more information about the contents of this file, see my previous tutorial.

The exactly location of the genesis.json file will probably differ on your machine, depending on your operating system and how you installed geth.

Step 2: Clear old chain data

This will allow you to start from a blank slate and is necessary whenever you change the genesis block because you can’t merge two chains with different genesis blocks.

rm -r /Users/omarmetwally/Desktop/blackswan/data/geth

Step 3: Reinitialize the genesis block 

Again, this needs to be done on each node.

geth --datadir=/Users/omarmetwally/Desktop/blackswan/data init /Users/omarmetwally/Desktop/blackswan/genesis.json

Step 4: Discover each node’s enode address

To create a private network, each machine needs to know every other machine’s address.

geth --verbosity 1 --datadir=/Users/omarmetwally/blackswan/data console

Then type in:

> admin.nodeInfo

Copy the enode address, including quotation marks. It will look something like this (without the ellipsis):


Step 5: Create the static-nodes.json file on each node

This step is critical and a common point of failure for many people creating a private Ethereum network. This file identifies other network peers using their enode addresses. Create a file called static-nodes.json in the local geth data directory of each node, and paste the enode of every peer in your private network, such that it looks something like:





Note the quotation marks, the commas, and the format:  enode@ip_address:port.

Save this file as static-nodes.json in your local geth data directory, which in my case is:


Step 6: Launch your private network.

Run this command on each node

geth --verbosity 2 --datadir=/Users/omarmetwally/Desktop/blackswan/data --networkid 4828 --port 30303 --rpc -rpcport 8545 --etherbase "0xYourEthereumAddress" console

The flags in the above command are important.


The blackswan network id is 4828, but your own private network will contain its own identifying network id which you should create to be unique.


How much information geth will spew, which can help with troubleshooting or be too much unnecessary information cluttering your screen.


This must correspond to your own local geth data directory. You will not get a helpful error message if this does not correspond to a real directory on your machine, so be careful here.


This is your Ethereum address on the private network.

rpcport and port 

The port and rpcport flags are networking parameters which I will not get into here. Make sure that your firewall will not block the ports you’re trying to use, and be careful when opening your machine to the outside world. Be very careful when exposing the RPC API to the outside world to prevent theft of real Ether and loss of real money! Any real Ether you might own should be kept completely separate from your development environment.

Step 7: Mining on your private network

Mine Ether by running:

geth --verbosity 4 --datadir /Users/omarmetwally/Desktop/blackswan/data --networkid 4828 --port 30303 --etherbase "0xYourEthereumAddress" --mine --minerthreads=1 

Then open a new Terminal window (if you’re using a Mac) or new Terminal tab (Ctrl-tab) and check your balance:

geth attach /Users/omarmetwally/Desktop/blackswan/data/geth.ipc console

> web3.eth.getBalance(web3.eth.accounts[0])

You should see your account balance increase fairly quickly as you mine.

Connecting to blackswan

If you’d like to connect to the private blackswan network, for example to use DDASH or deploying/testing your own contracts easily and freely, please email your request to:  


Royd Carlson’s (UC Berkeley) feedback was instrumental in conceiving this article. The comments and emails I receive from readers of this blog help make these articles relevant to the Ethereum community .

Knowledge is power, and my goal is to empower the readers of this blog with the information necessary to create blockchain applications with the potential to re-program institutions, level playing fields, and take a huge step toward more democratic societies. I’m humbled to welcome visitors to this blog, especially from nations where access to and dissemination of  knowledge is much more difficult than we sometimes take for granted in the Western world.

“…the poor catch up with the rich to the extent that they achieve the same level of technological know-how, skill, and education, not by becoming the property of the wealthy.”  (Thomas Piketty, Capital in the Twenty-First Century)

On the economics of knowledge creation and sharing

Omar Metwally, MD
University of California, San Francisco
First Draft


This work bridges the technical concepts underlying distributed computing and blockchain technologies with their profound socioeconomic and sociopolitical implications, particularly on academic research and the healthcare industry. Several examples from academia, industry, and healthcare are explored throughout this paper. The limiting factor in contemporary life sciences research is often funding: for example, to purchase expensive laboratory equipment and materials, to hire skilled researchers and technicians, and to acquire and disseminate data through established academic channels. In the case of the U.S. healthcare system, hospitals generate massive amounts of data, only a small minority of which is utilized to inform current and future medical practice. Similarly, corporations too expend large amounts of money to collect, secure and transmit data from one centralized source to another. In all three scenarios, data moves under the traditional paradigm of centralization, in which data is hosted and curated by individuals and organizations and of benefit to only a small subset of people.

1. Introduction

In its current siloed state, data is a liability rather than an asset. The value of data depends on its quantity and quality. Organizations, including corporations, government, and academia, have few incentives to share data outside the context of selling it. For instance, advertisers use data procured  from individuals’ browsing history and social media use (via internet service providers, social media and search engines) to create detailed profiles of individuals’ online behavior and spending habits and more effective sell products to unknowing consumers. While this paradigm fits naturally into a capitalistic society, these economics of data collection and transfer do not facilitate the generation or sharing of knowledge in the academic setting.

A typical university-based research group depends upon external funding to support its research activities. These funds often originate from governmental bodies, philanthropic organizations, or corporations and are difficult to secure [1]. Only a small minority of tenure track scientists ever becomes principal investigators, and a lab that is productive today can become defunct tomorrow if its principal investigator is unable to secure funding for laboratory equipment and supplies such as microscope parts, reagents, and to compensate technicians and trainees [2]. Principal investigators spend a majority of their time writing grant applications rather than participating directly in the process of knowledge generation [3].

It is often said that publications are the currency of academia. The maxim “publish or perish” applies to most research groups, whose work culminates in peer-reviewed publications with publication fees commonly amounting to several thousand dollars [4]. Moreover, these peer-reviewed publications are heavily biased toward so-called “positive results,” in which mathematical correlations between variables are described [5]. The vast majority of data produced by scientific researchers do not refute the null hypothesis; in a best case scenario, they are deemed “negative results,” and are discarded; in a worst case scenario, they are data that can’t be replicated, verified, or are outright fraudulent [6]. The result is the modern-day academic machinery. This severely flawed system, a victim of many conflicting economic forces, results in a tremendously inefficient workflow in which most grant money is wasted in the form of negative, and therefore unpublishable, results. Principal investigators spend a majority of their time trying to secure funding. The ultimate winner is the $10 billion business of academic publishing [6]. In this reality, data with the potential to produce vast knowledge is rendered into a vastly wasted opportunity to exponentially build on communities’ resources. Individuals’ roles are minimized by the centralization of resources in the hands of a privileged few.

2. Background

While the term “blockchain” has been touted to near-hysteria in popular media in the context of initial coin offerings and get-rich-quick schemes, an understanding of this data structure’s logic reveals the tremendous and fascinating socioeconomic implications of storing data on blockchain. In its most simplified form, a blockchain is a ledger [7]. The reason for blockchain’s natural association with financial derivatives lies in its ability to mathematically prove the authenticity of data and demonstrate proof of stake and proof of work [8].

The starting port for these use cases is the typical consumer, who is separate from (and often completely unaware of) the data collected about him or her. For instance, a customer’s online behavior is collected and used to up-sell the customer as much as algorithmically possible [9]. Customers have  nothing to gain (and a few thousand dollars each year in extra spending to lose) from such data, which companies can sell to data brokers and merchants [10]. Analogously, the majority of taxpayers have no access to — and oftentimes no way to directly benefit from — publications funded through research that ends up property of academic journals [11, 12].

2.1 Case Study: Proof of Stake

Consider a research lab living from grant to grant, sifting through negative results to find crumbs of publishable positive results. If its lab notebooks were stored in the form of a blockchain, every experiment conducted, every machine learning model and dataset, and every clinical trial would generate data that lives on the blockchain as a cryptographic asset. Also referred to as “coins” and “tokens,” these cryptographic assets have inherent value because they are perfect receipts of the existence and transfer of data [13]. Never before in history has such a perfect ledger existed [14, 15]. On the blockchain, a relatively worthless set of negative results generated by a research lab becomes, when combined with negative results from thousands of other research groups, a trove of extremely valuable scientific data which can be traced to its owners whenever and however it is utilized. This large collection of negative results can become the source of unexpected positive results.

Moreover these blockchain-hosted data take on a new life as a financial derivative [16, 17]. These cryptographic assets, perfect receipts of the creation and movement of knowledge, can be traded by third-parties analogously to the way a company’s common stock is bought and sold on private and public marketplaces, albeit without the same regulations and on a different scale [13]. These tokens enable individuals, small and large groups alike to be compensated for their services in ways that are impractical or impossible in traditional economies [18]. Rather than relying on the slow and inefficient process of securing funding through grants, research labs can codify contracts on the blockchain to allow third-parties to bid for services and products rendered, on the metadata (what kind of knowledge research labs generate through their scholarly activities), and allow third-parties to become stakeholders in a research group’s success by directly benefitting from these research activities. For instance, if I believe that a particular group is contributing to science and society in a positive way, I can economically support this group by donating computing power and electrical energy to support the integrity of their lab notebook-turned-ledger, or by trading fiat for tokens representing proof of stake in their scholarly activities. What are today opportunities exclusive to accredited investors and institutions will become abundant opportunities for individuals to influence how perceived value circulates through society.

2.2 Case Study: Proof of Work

Consider the United States healthcare system, which still excludes millions of Americans from access to healthcare and financially ruins even more [19, 20]. Insurance companies are able to impose high premiums simply because they can. This is the logic of a capitalistic society, and insurance companies alone enjoy the benefits of owning valuable health data to their fullest extent — at the expense of those whose health data was collected [20, 21]. Imagine, on a smaller scale, a radiology group that puts a copy of every imaging study they do on a blockchain, along with a timestamp, a description of which type of study was done, and why it was performed. In doing so, data that would have otherwise been discarded can be engaged with by third-parties while directly benefiting the radiology group as well. For instance, grassroots-based health insurance co-ops could emerge from these sources of data which are otherwise privy to insurance companies, to the benefit of health consumers, who can undergo imaging studies and receive other healthcare services at a fraction of current costs. Information about which studies are performed — where, by whom, and why, and the result of those studies, can be used to lower healthcare costs while improving health outcomes, rather than raise healthcare costs and increasing profits.

One question that naturally arises, especially in the context of current centralized data paradigms, is: why would healthcare providers be incentivized to make public valuable data that is routinely used by corporations and insurance companies to maximize profits? One powerful force driving healthcare costs upward is the process through which health providers bill patients via insurance companies. Whether ordering relatively common drugs or expensive therapeutics or procedures, healthcare systems rely on administrators whose role is to submit authorization requests to insurance companies for approval to prescribe therapeutics on their patients’ behalf [22]. When a service is rendered in the hospital or in a clinic, a healthcare team is reimbursed a fraction of the amount they bill for, creating a cat and mouse game in which providers continuously bill as high as possible for services rendered with the expectation that they will only receive a fraction of what they bill for, and in which insurance companies place limitations on which drugs and services this will pay for and how much of the cost they will cover [23]. Blockchain would provide an end to this cat-and-mouse game and create a race to the bottom for healthcare costs, through price transparency and elimination of bloated administrative layers that handle authorization requests and billing, while creating a race to the top for healthcare outcomes as this ledger of health services and outcomes would be publicly accessible on a blockchain. Simultaneously, healthcare providers can immediately receive payment for services rendered, and although individual payments may be less, overall profits would increase because payments would arrive immediately and there would be no need for entire departments of administrators whose entire role is to maximally inflate bills sent to insurance companies (and patients, insured and uninsured) and to see these bills through collection.

2.3 Informing current and future medical practice

We may well already have all the knowledge we need to cure many illnesses currently considered incurable [24]. We may well have all the data we need to create intelligent machines that can interpret CT scans, diagnose disease, and synthesize drugs to cure any condition. The reason this knowledge hasn’t culminated in more rapid advancement in healthcare and science is that information is fragmented into pieces, siloed, and ultimately rendered worthless data. Blockchain allows transparent access to data. It would be naive to imply that a data structure will cure society of all its ailments. However blockchain allows data to culminate into extremely valuable information, once at the disposal of a powerful few, now to the benefit of all who become stakeholders by contributing to, interacting with, and propagating data.

3. The need for a ledger of scholarly assets

The need for this project, a protocol for the hosting and sharing of data on a distributed network (“Distributed Data Sharing Hyperledger,” or DDASH), arises from the observations by the above examples, as well as the observation that numerous research groups at UCSF and other academic institutions are working in parallel in their endeavors to create knowledge with little synergistic interaction [25]. How would research group A at UCSF Medical Center know that research group B at the University of Michigan is working to answer the same scientific questions, for instance? Without a transparent glimpse into which resources an organization owns and how they are being used and shared, both research groups miss opportunities for synergistic collaboration, within and among organizations.

Those acquainted with the politics of contemporary academia will be quick to raise several criticisms. Working within the current reality of Google, the most comprehensive collection of information known to humanity as of September 2017, why can’t research groups A and B simply host their digital assets — data and knowledge gleamed from this data — on websites or public databases? And if groups A and B are competing to be the first to publish in academic journals and competing to drink from the same pools of grant funding, why would any research group benefit by sharing the results of experiments that were costly to run before they can reap the benefits of publication and intellectual property [26]? The answer is in blockchain’s ability to capture proof of work and proof of stake in a network’s digital assets. There is nothing to stop a competing research group from stealing these data and benefiting at their competitors’ expense. Hosting data in the form of knowledge on a blockchain elegantly solves this problem through irrefutable mathematical proof of data ownership, transfer, and authenticity [27].

Turn data into digital assets using Ethereum and IPFS

3.1 Distributed Data Sharing Hyperledger (DDASH)

DDASH (link to open source Github repository) is a ledger of scholarly data and knowledge produced by life science, informatics, and clinical researchers at UCSF and other academic institutions. The need for this project arises from the negative impact of data siloing, competition, and counterproductive financial incentives in the academic world on the creation and sharing of knowledge. Concretely, researchers can host data — datasets, experimental results, and machine learning models, among other examples of scholarly knowledge — on the distributed InterPlanetary Filesystem (IPFS) network and record the location of these assets on an Ethereum-based blockchain, along with a description of the asset, when it was created, and who has privileges to access the data.

3.2 Network Architecture

We believe that the IPFS protocol’s combination of security and speed is well suited for this application. IPFS uses content-based addressing, in which a hashing function determines a file’s network address based on the file’s contents [28]. Storing data in the form of a directed acyclic diagram (in this case, a Merkle DAG) results in trees that can be efficiently traversed and queried. IPFS is a peer-to-peer network in which data is continuously circulating through network participants’ machines which are running the client software. Data are rendered permanent by virtue of content-based addressing and persistent by virtue of its peer-to-peer architecture, and data are rapidly accessible without the bottlenecks that Internet Protocol imposes.

3.3 Blockchain as a ledger

The blockchain functions as a decentralized ledger of digital resources and the movement of these resources throughout the network. As the DDASH protocol is formalized, more robust mechanisms for associating IPFS hashes with the owner of the resource and the permissions granted by the owner are necessary. Currently the DDASH protocol accounts for the following elements:

  • IPFS content-addressed hash, which defines the location of an asset on the IPFS network
  • The owner’s public key fingerprint
  • The public key fingerprints of users authorized to access the resource, or a designation as “public”
  • Timestamp

In its current form, DDASH interfaces between the IPFS network and the Ethereum blockchain. One can conceive an alternative version of the DDASH protocol that seamlessly integrates a ledger-based indexing and permission management system, using for example IPFS’s native public and private keys and a native IPFS ledger. Keeping the networking architecture separate from the blockchain has tangible advantages, however, including the versatility of allowing users to create digital assets using any permutation of blockchains, private and public.

3.4 Security

DDASH allows users to manage access to privileged resources using public-key encryption. Public-key encryption allows users to identify themselves on the network using a verifiable public key, which can be used to encrypt resources such that they can only be unencrypted using a  corresponding private key accessible exclusively to the intended recipient. Future versions of the DDASH protocol may feature ways to host resources on private clusters and manage access to these clusters on the blockchain. In doing so, resources are secured by limiting the movement of certain data to a subset of the swarm (network peers), and through a second layer of encryption. This not only allows data to move much more quickly through a network, it also greatly enhances security compared to the antiquated paradigm of data hosted on centralized, and therefore inherently vulnerable, servers. Common sources of wasted IT budgets and wasted productivity, such as forgotten, cracked and stolen passwords, or easily-intercepted HTTP network traffic, are obviated by virtue of the DDASH protocol. What stands between the theoretical underpinnings of this protocol and its implementation in academic centers and healthcare systems is not a question of the feasibility of this technology, but rather, whether legislation governing health information and computing will keep up with emerging trends in computing. Catastrophic beaches of sensitive consumer information, such as the Equifax data breach, have become regular occurrences and urgent reminders of the shortcomings of our antiquated Internet Protocol and undeserved trust in institutions that centralize large amounts of highly sensitive data at individuals’ expense [29].

3.5. DDASH Repository

DDASH is hosted as an open source repository at

We intend for this nascent project to illustrate the concepts and the larger vision outlined here while serving as a starting point for a formalized protocol for hosting and interacting with distributed digital assets. We made this a public repository early in the conception of this project in order to allow the codebase to benefit from the technical expertise and creativity of the open source community, and to allow the project to benefit from the rapid and exciting evolution in computing paradigms driven by the blockchain and distributing computing communities.

4. Using DDASH

DDASH currently runs on the blackswan private Ethereum network at It benefits from the open source work produced by the, and py-ipfs communities.

The Go Ethereum, and py-ipfs Python packages are all prerequisite. The instructions here are for machines running Ubuntu 16.04. A Ethereum node must be connected to the blackswan private network and possess the ability to lock/unlock accounts to send transactions.

4.1 Directory Structure

Start by creating these directories:

mkdir /home/omarmetwally/blackswan
mkdir /home/omarmetwally/blackswan/gnupg
mkdir /home/omarmetwally/blackswan/data

4.2 Genesis Block

To connect to the blackswan network, you’ll need to use the same genesis block defined in genesis.json (see the Github repository). Move this file to /home/omarmetwally/blackswan/ and set your genesis block (you only need to do this once, and you need to install the Ethereum go client geth and Ethereum developer tools first):


geth --datadir=/home/omarmetwally/blackswan/data init /home/omarmetwally/blackswan/genesis.json

bootnode --genkey=boot.key

bootnode --nodekey=boot.key 

4.3 Go Ethereum client and IPFS daemons

In order to use the and ipfs wrappers, you’ll need to run geth and ipfs daemons in the background, respectively:

geth --verbosity 1 --datadir /home/omarmetwally/blackswan/data --networkid 4828 --port 30303 --rpcapi="db,eth,net,web3,personal,web3" --rpc --rpcport 8545  console 

Be very careful when enabling RPC while your accounts are unlocked. This can lead to Ethereum wallet attacks, hence the recommendation to keep your development environment completely separate from any real Ether you might own.

The above command starts the go Ethereum client on your local machine and attempts to connect to the blackswan server at Remember to set your genesis block according to the above directions. Trying to join this network with a different genesis block (such as the default genesis block) will not work.

Then open a new terminal window or tab and start the ifps daemon:

ipfs daemon

4.4 DDASH command line interface

Once your Ethereum and IPFS nodes are running, your account is unlocked, and you can interact with both clients, start the DDASH command line interface (CLI):


    ::: Distributed Data Sharing Hyperledger :::

    Welcome to the DDASH Command Line Interface.

[1]   ddash> sanity check
      IPFS and geth appear to be running.
[2]   ddash> set directory /home/omarmetwally/blackswan/gnupg
[3]   ddash> new key
[4]   ddash> show keys
[5]   ddash> use key 0
[6]   ddash> show accounts
[7]   ddash> use account 0
[8]   ddash> set recipient your_recipient's_pubkey_id 
[9]   ddash> set file /path/to/clinical/trial/data.csv
[10]  ddash> encrypt
[11]  ddash> upload
[12]  ddash> checkout QmUahy9JKE6Q5LSHArePowQ91fsXNR2yKafTYtC9xQqhwP

The above commands:
1. check if IPFS daemon and Go Ethereum client are running
2. specify working directory (need to have read/write permission)
3. generate a new PGP keypair
4. list all PGP keypairs on your machine
5. uses the first (index 0) keypair as your identity
6. list Ethereum accounts
7. specify index of Ethereum account to use for transactions
8. specify an intended recipient's public key
9. upload the file to IPFS and create transaction containing the hash, user id of the person who uploaded the file, and recipient's public key id (or "public" indicating that it's not encrypted).
10. encrypt file from step 9 using public key from step 8
11. upload file from step 9 to IPFS network
12. check blockchain using IPFS hash as handle


4.5 Mining on the blackswan Ethereum network

Mining difficulty is currently relatively easy (1e6) on the blackswan network. Mine Ether by running:

geth --verbosity 4 --datadir /Users/omarmetwally/Desktop/blackswan/data --networkid 4828 --port 30303 --rpc 8545  --mine console


5. Acknowledgements

I’m grateful to my mentor, Dr. David Avrin (UCSF) for his belief in this vision and for his unwavering support. My colleagues, Dr. Michael Wang and Dr. Steven Chan, provided formative feedback during the conception of these ideas. Steven Truong (UC Berkeley) inspired me with his technical creativity. Visionaries such as Vitalik Buterin and Juan Benet, and many brilliant minds contributing to the open source communities they inspired, conceived the technical underpinnings which are allowing these concepts to grow into powerful tools which I believe will transform and modernized academic research. 

6. References

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  2. Bohannon J. “Want to be a PI?”Science. June 2 2014. Accessed: 11 September 2017.
  3. Kaplan K. “A roll of the dice.” Nature 479, 433-435 (2011). doi:10.1038/nj7373-433.
  4. Van Noreen R. “Open access: the true cost of science publishing.” Nature. 27 March 2013. Accessed: 11 September 2017. Available:
  5. World Health Organization. “WHO Statement on public disclosure of clinical trial results.” Published: 9 April 2015. Accessed: 11 September 2017. Available:
  6. Ionnidis JP. “Why most published research findings are false.” PLoS Medicine Published: 30 August 2005. Accessed: 11 September 2017. Available:
  7. Narayan A et al. Bitcoin and cryptocurrency technologies. Princeton University Press, 19 July 2016.
  8. Narayan A and Clark J. “Bitcoin’s academic pedigree.” ACM Vol 15:14, 29 August 2017. doi: 10.1145/3134434.3136559
  9. Keyes D. “Amazon looks to gain a machine learning advantage.” Business Insider. Published: 8 September 2017. Accessed: 11 September 2017. Available:
  10. Federal Trade Commission. “Data Brokers: A Call for Transparency and Accountability.” Published: May 2014. Accessed: 11 September 2017. Available:
  11. Kimbrough, Julie L., and Laura N. Gasaway. “Publication of government-funded research, open access, and the public interest.” Vand. J. Ent. & Tech. L. 18 (2015): 267.
  12. California State Department of Public Health. “California Taxpayer access to publicly funded research act (Assembly Bill No. 609).” Published: 29 September 2014. Accessed: 11 September 2017. Available:
  13. Nakamoto, S. “Bitcoin: A peer-to-peer electronic cash system.” Satoshi Nakamoti Institute. Published: 31 October 2008. Accessed: 11 September 2017. Available: .
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  19. Centers for Disease Control and Prevention. “Health Insurance Coverage.”
  20. Metwally O. “Building smart contract-based health insurance.” Published: 30 June 2014.
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  22. California Department of Health and Human Services. “Treatment Authorization Request.”
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  29. Gressen S (Federal Trade Commission). “The Equifax Data Breach: What to Do.” Published: 8 September 2017. Available:

Healthcare on the Ethereum Blockchain

Since Ethereum’s conception, I’ve dreamed of a blockchain-based healthcare services economy and presented the idea at BitTorrent’s headquarters 3 years ago. It’s also taken me that long to conceive of a concrete study of this protocol’s readiness for the limelight. With Ethereum’s adoption by a number of blue chip companies, including JP Morgan and Microsoft, its inevitability is clear. While still unreachably abstract to many people, I believe that healthcare’s state of disarray is a perfect environment to test the waters. As I get ready to start a Clinical Informatics fellowship at UCSF Medical Center, I’m prototyping such a blockchain-based health services marketplace and would like to humbly present the proposal to the Ethereum community for its feedback.

Pricing for healthcare services is currently based on prices determined by insurance companies’ ability to negotiate price points with groups of healthcare providers, individual providers, and healthcare systems. The lack of a true free market, and insurance companies’ administrative overhead, contribute to inflated prices for healthcare services across the board. [Figure 1: Health services marketplace in the blockchain era]


Figure 1: Health services marketplace in the blockchain era. Red text indicates how things work presently. Green indicates how things might work in a health services economy founded on the Ethereum blockchain. Notice the absence of insurance companies in the latter, hypothetical scenario. Their role has yet to be determined. I use laboratory testing as an example, but this would apply to imaging studies, office visits, surgical procedures, and consultations.


Enter Ethereum, a next-generation blockchain protocol for automatically executing “smart contracts.” Autonomously executed contracts obviate the need for escrow, attorneys, and administrators. Like Bitcoin’s protocol, Ethereum is a distributed blockchain that is open source, not owned by anyone, and runs off any and all computers running the client software. Ethereum’s novelty – and power – lies in the fact that it’s a Turing-complete system. Ethereum, unlike Bitcoin has mechanisms for executing logic, so smart contracts can be written by anyone, hosted on the Ethereum blockchain, and anyone in the world can interact with these contracts with the endpoint of manipulating data and moving money in the form of Ether (also a cryptocurrency).

So why not harness the Ethereum protocol to create a distributed, open source healthcare marketplace? Without administrative overhead (which accounts for the majority of an insurance company’s expenses, which are then passed on to patients and healthcare systems) and with the freedom for any provider of healthcare services to bid for a service (imaging, lab testing, consultations, procedures…), I hypothesize that the cost of healthcare services will be reduced to approximately 10% of its current artificially inflated price. Further contributing to cost and redundancy of healthcare expenditures is data siloing, the isolation of data on servers without APIs to set them free. Many healthcare providers will agree that it’s often much easier to repeat an expensive study than obtain records of that same procedure performed at an outside hospital (even if the study was just performed hours or days ago, and oftentimes, even if the study was performed at an affiliated hospital!). Ethereum’s distributed blockchain is a global ledger of everyone’s health information. I predict that sound security protocols, which need to be developed with healthcare’s unique needs in mind, will necessitate the use of biometric data to associate data on the blockchain with individuals.

So, how can we test the former hypothesis, that Ethereum can reduce the cost of healthcare services to 10% of their current prices?

I propose simulating such a bidding system to start collecting data on the free market prices Ethereum will foster by surveying physicians based in the community, as well as groups contracting with academic medical centers. If I survey Dr. Roentgen, Dr. Tomo, and Dr. Houndsfield (and a few hundred other radiologists) asking them if they would accept $X cash payment for imaging study A, B, or C (e.g. chest x-ray, mammogram, brain MRI…) performed STAT, tomorrow, or next month, we will start to approach theoretical market price for these studies.

If you are a fellow Ethereum developer or are otherwise interested in collaborating in the spirit of establishing healthcare as a human right on the Ethereum blockchain, please send me a line! I’m dreaming up experiments and am seeking partners in code.

Portland smoke

[Daydreaming in Portland]

Omar Metwally, MD

Sunday April 30th, 2017

Portland, Oregon


Doctor will work for Ether: Decentralized autonomous health insurance

Once Upon a Time a young man named Vitalik Buterin presented the concept of “Ethereum” to the cryptocurrency community. Vitalik became a Thiel Fellow and persuaded the world that there’s a better way to write laws, organize ourselves politically, and conduct transactions using a Turing-complete language built on the blockchain.

I would have never imagined, when I began developing on the Ethereum platform, that the concept of a decentralized autonomous organization (DAO) would make popular media headlines so soon. This is the start of something remarkable.

When I presented my vision for decentralized autonomous health insurance in June 2014 at the BitTorrent headquarters, Chris Peel, the founder of the Ethereum Bay Area Meetup, asked me how I would realize my vision. “Well…” I began, “operating health insurance is a big undertaking!” I said, scratching my head. Two years later, the time for a better way to insure our health and pay for health services is here. By cutting out the middle people, Ethereum-powered smart contracts and DAOs promise to dramatically reduce the cost of health services. Why should most of our outrageously over-priced health insurance premiums feed bloated corporations and their executives?

Ancient Chinese physicians practiced preventive medicine par excellence. In ancient China, physicians were compensated when their patients enjoyed good health, not when they grew ill – the opposite of our reactive, fee for service-based health system. Ethereum is our opportunity to end the healthcare crisis, and it’s incumbent on us to carry forth this effort.


Send me a line at

Omar Metwally MD