From “COMMON PROVERBS AS VIDEO GAME TUTORIALS” in McSweeney’s:
Notice how after you consumed the Cake, the Cake is no longer in your inventory.
Asides are a microblog of shared links and quick thoughts.
They're on the main page but also all collected here.
Think of it like a Twitter feed without the awfulness.
From the short essay, “Energy Makes Time,” by Mandy Brown:
But there’s something else I want to suggest here, and it’s to stop thinking about time entirely. Or, at least, to stop thinking about time as something consistent. We all know that time can be stretchy or compressed—we’ve experienced hours that plodded along interminably and those that whisked by in a few breaths. We’ve had days in which we got so much done we surprised ourselves and days where we got into a staring contest with the to-do list and the to-do list didn’t blink. And we’ve also had days that left us puddled on the floor and days that left us pumped up, practically leaping out of our chairs. What differentiates these experiences isn’t the number of hours in the day but the energy we get from the work. Energy makes time.
The what is sometimes even more important than the how much.
From the free ebook A Manifesto for Applying Behavioral Science from the UK’s Behavioural Insights Team:
The other concern is that [behavorial science] theories can make specific predictions, but they are disconnected from each other – and from a deeper, general framework that can provide broader explanations (like evolutionary theory, for example). The main way this issue affects behavioral science is through heuristics and biases. Examples of individual biases are accessible, popular, and how many people first encounter behavioral science. These ideas are incredibly useful, but have often been presented as lists of standalone curiosities, in a way that is incoherent, reductive, and deadening. They can create overconfident thinking that targeting a specific bias (in isolation) will achieve a certain outcome.
Cognitive biases and mental models make for great blog posts but are really hard to put into practice as an individual or effectively guide policy as an organization.
For further reading, try Nudge (the new/final edition was just released in 2021).
In a similar vein to our recent discussion of radiology practice and game theory, this is from Andrew K. Moriarity’s new article in JACR, “Pirate Practice”:
Employed sailors could count on the guarantee of agreed-upon pay in return for work performed. However, each pirate must be primarily motivated to ensure group success by their own self-interest because each endeavor lasted only as long cooperation maximized profits over expenses.
[…]
In considering the cooperation needed among individuals for a successful voyage to keep moving forward, perhaps Jack Sparrow was right to conclude that “not all treasure is silver and gold, mate.”
Humans–with some incredible diligence and lots of practice–can do such fascinating things.
Pretty unreal.
Hold in the back of your mind the notion that someday you’re gonna write a book. You don’t have to write it this year. Meanwhile, writing begets writing. Just get into some kind of situation where you are writing, and if it’s some various thing you’re publishing online, it’s still grist to the mill.
Legendary nonfiction writer John McPhee in an interview with GQ at the tender age of 92. For further reading, see Draft No. 4.
From Tanner Greer’s The Scholar’s Stage:
The professionalization of intellectual pursuit is another problem. Melville would never have written Moby Dick if he had spent years enrolled in an MFA program instead of spending years at sea. Men and women who in past ages would have observed humanity up close (or at least who would have been forced through a broad but rigorous education in classics) instead cloister themselves in ivory towers. Their intellectual energy is channeled into ever more specialized academic fields and cautiously climbing a bureaucratic and over-managed academic ladder. Could that social scene ever produce a great work?
Great reporting by Cezary Podkul in ProPublica (and amazing perseverance by Dr. Shteynshlyuger):
A powerful lobbyist convinced a federal agency that doctors can be forced to pay fees on money that health insurers owe them. Big companies rake in profits while doctors are saddled with yet another cost in a burdensome health care system.
“Our Economy Is Being Plundered By Wall Street Elites” is fantastic discussion of private equity in America on the Wealthion Podcast. It’s an interview with Gretchen Morgenson, Pulitzer-prize winning author of the new bestselling These Are the Plunderers: How Private Equity Runs―and Wrecks―America. If you’ve been wanting to learn more about the industry but haven’t had the time, this is a great introduction.
I’ll be giving the keynote at the FSU College of Medicine’s Business & Medicine Symposium in Tallahassee this Saturday. If you’re a student there, make sure to come say hi during the morning coffee or lunch after!
On my brief perusal, the eBook for Undergraduate Education in Radiology (developed by the European Society of Radiology) seems like a great and entirely free first radiology book for medical students and first-year residents. In particular, the sections I looked at included a great first pass of high-yield anatomy. Strongly recommended.
How amazing does this new retro NES-themed mechanical keyboard look?
And an included separate pad with two huge programmable buttons?
That’s a great way to toggle dictation or almost have fun navigating Epic.
$39 billion of student loans were forgiven tax-free this month.
If you have any FFEL, Perkins, or Health Education Assistance Loan (HEAL) Program loans, please check out the IDR Waiver FAQ. You have until the end of 2023 to do a Direct Consolidation to make those loans eligible for loan forgiveness programs and count previous payments without resetting the clock.
Filed under things I really want but for way, way cheaper: Project E Ink’s “$2500 e ink art piece that displays daily newspapers on your wall.”
From MONETIZING MEDICINE: PRIVATE EQUITY AND COMPETITION IN PHYSICIAN PRACTICE MARKETS, a report by the American Antitrust Institute:
Price increases associated with PE acquisitions are exceptionally high where a PE firm controls a competitively significant share of the local market. When we focus our analysis on markets where a single PE firm controls more than 30% of the market, we find further elevated prices associated with PE acquisitions in each of the 3 specialties with statistically significant results, for gastroenterology (18%), obstetrics and gynecology (16%), and dermatology (13%).
Discussed in the NYTimes here.
Jeff Goldsmith in “What Can We Learn from the Envision Bankruptcy?“:
Strategically, the Envision bankruptcy raises anew the question of whether there are economies of scale, and investment returns to scaling, in healthcare. Certainly the conventional wisdom argued that large firms like Envision had the ability to recruit and retain clinicians across vast geographies, and negotiating power with the large insurers that increasingly dominate key insurance sectors like Medicare Advantage and Managed Medicaid.
Envision’s demise strongly suggests that the power balance-both political and economic- has tipped decisively in the direction of payers like United. Rising interest rates, the increasing scarcity of clinicians as workaholic baby boom vintage docs and deepening financial challenges for the ultimate customers of many of these companies, namely hospitals, suggest that we may have reached an inflection point in the viability of many private equity physician care models, with their 4-7 year holding periods and a succession of owners. Current owners might find it increasingly difficult to exit their positions.
CEO’s Skill Set Transferable To Any Job That Requires Dumbass To Receive Big Salary: “I have the incompetence necessary to effortlessly transition into a role at any company that yields a seven-figure income.”
The Department of Justice said the defendants allegedly defrauded programs used to take care of elderly and disabled people, and in some cases used the ill-gotten money to buy exotic cars, jewelry and yachts.
RadPartners is desperately trying to raise capital to pay off its debts via another round of equity funding (i.e. creating and selling new shares of preferred stock).
If successful, this would dilute the value of shares held by current shareholders (historically, ~40% of the company was owned by current or former RP radiologists). In reality, I have a tough time imagining any large investors putting enough good money into something predicted to go bankrupt within the next two years to shift the course of the Titanic.
Indisputable authorship ordering method:
Reviewer 2 should have blocked this for not specifying the version used (N64? Melee? Brawl? This is science!).
The pull of these forces left many doctors anguished and distraught, caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”
Not only are clinicians feeling betrayed by their leadership,” she says, “but when they allow these barriers to get in the way, they are part of the betrayal. They’re the instruments of betrayal.”
Graduating medical students: if you haven’t already begun, it’s around time to consolidate your federal student loans. The benefits are discussed in this chapter from my (free) book. While you’re at it, you should also probably read the whole thing.
2. Being enthusiastic is worth 25 IQ points.
12. Pros are just amateurs who know how to gracefully recover from their mistakes.
These gems from the original 68 bits of unsolicited advice have joined more of Kevin Kelly’s wisdom in a new book containing 450.
Hi! I’ve been wanting to revamp my site for years, but some mandatory security updates have forced my hand, so now we’re in the middle of frantic unplanned unavoidable total website redesign (oops)!
Please excuse any quirks as I work on this in my copious free time.
Speaking of physician shortages, Tennessee just became the first state to pass legislation allowing international medical graduates to obtain licensure and practice independently without completing a U.S. residency program. Bryan Carmody breaks it down.
From Elisabeth Rosenthal’s (author of An American Sickness) “Denials of health-insurance claims are rising — and getting weirder“:
An insurer’s letter was sent directly to a newborn child denying coverage for his 4th day in a neonatal intensive-care unit. “You are drinking from a bottle,” the denial notification said, and “you are breathing on your own.” If only the baby could read.
The final trailer for the Super Mario Bros. movie dropped, and it looks like it might be the rare (only?) (did you like the Sonic movie?) video game movie that hits the important game notes for enjoyable fan service while also looking like a decent movie.
Our family is genuinely looking forward to seeing this one.
From “Nobody Has My Condition But Me” by Beverly Gage in The New Yorker:
Plus, the longer you stay on it the harder it becomes to stop. Prednisone is sometimes referred to as “the Devil’s Tic Tac”: cheap and available and effective, but at potentially scorching long-term costs.
Great term.
I always find it interesting that The New Yorker changes the titles of its stories for the internet so often. In print, this personal essay was titled “One of a Kind.”
For those who want to listen for almost an hour about PE in radiology, the current radiologist shortage, and navigating the job market, I was on the BackTable VIR podcast.
From the very pleasant small corner (seriously, just check out the comments!) of the internet that is author George Saunders’ substack, Story Club, answering a question about finding a mentor:
One of the things I’ve come to love about this Story Club community is its generosity. From where I sit, it feels like people show up here with the right attitude for any artistic endeavor, which is, “I bet there’s something for me to learn here.” This doesn’t mean that the person doesn’t already know quite a lot. But she has reverence for the importance and difficulty of the task and knows at some level that showing up in a curious, humble, friendly spirit, she’s more likely to return home with something of value.
If that’s not wisdom for approaching just about anything, I don’t know what is.
There is something to be said about a truly disastrous meal, a meal forever indelible in your memory because it’s so uniquely bad, it can only be deemed an achievement. The sort of meal where everyone involved was definitely trying to do something; it’s just not entirely clear what.
I’m not talking about a meal that’s poorly cooked, or a server who might be planning your murder—that sort of thing happens in the fat lump of the bell curve of bad. Instead, I’m talking about the long tail stuff – the sort of meals that make you feel as though the fabric of reality is unraveling. The ones that cause you to reassess the fundamentals of capitalism, and whether or not you’re living in a simulation in which someone failed to properly program this particular restaurant. The ones where you just know somebody’s going to lift a metal dome off a tray and reveal a single blue or red pill.
I’m talking about those meals.
This piece from The Everywhereist is perhaps the most enjoyable romp of a restaurant review since Peter Wells pilloried Guy Fieri’s Times Square restaurant back in 2012.
As we near the end of the residency interview season, a choice quotation from “Surely You’re Joking, Mr. Feynman!”: Adventures of a Curious Character:
So I have just one wish for you—the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity. May you have that freedom.
From the original UK version of Adam Kay’s This is Going to Hurt: Secret Diaries of a Medical Resident:
Asked to review a patient in labour ward triage and repeat a PV as the midwife is uncertain of her findings. Her findings were of cephalic presentation with cervix 1 cm dilated. My findings are of breech presentation, cervix 6 cm dilated. I explain to mum that baby is bottom-down and the safest thing to do is to deliver by caesarean section. I don’t explain to mum which part of the baby the midwife has just stuck her finger in to 1 cm dilatation.
Good medical humor is rare.
Morgan Housel, author of the excellent The Psychology of Money, writing “a few rules”:
Being good at something doesn’t promise rewards. It doesn’t even promise a compliment. What’s rewarded in the world is scarcity, so what matters is what you can do that other people are bad at.
A corollary: Being good at doing (or even just willing to do) what other people don’t want to do can take you far.
“The world needs you at the party starting real conversations, saying, ‘I don’t know,’ and being kind.”
From David Roth’s The New Republic piece, “American Psycho,” an absolutely scathing brief profile of Jared Kushner’s role in unquestionable pandemic mismanagement:
So here we have Kushner, a powerful special adviser with no meaningful expertise in public health or epidemiology, using a breathtakingly specious chart produced by an economist who’d flubbed the biggest prediction he’d ever made—all as a justification for the federal government to do less to confront a rampaging pandemic. While the Trump years have offered many such crystalline and bottomless moments of executive abandonment, this one felt uniquely Jared. The collaboration is what makes it—a legacy figure in the field of elite ineptitude, delivering the old egregiousness in a style optimized for the vacuous new avatar of elite incompetence. The gilded tools of one generation of catastrophic conservative governance pass into the soft and clammy hands of the next. If it weren’t for all those people dying, it would be beautiful.
From “Physicians Get Addicted Too,” an Atlantic story about opiates and addiction in West Virginia:
“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”
Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”
Genetics, the environment, adversity, and perseverance—all in this short documentary from The Atlantic:
Standard Ebooks is an awesome long overdue idea:
Standard Ebooks is a volunteer driven, not-for-profit project that produces lovingly formatted, open source, and free public domain ebooks.
Ebook projects like Project Gutenberg transcribe ebooks and make them available for the widest number of reading devices. Standard Ebooks takes ebooks from sources like Project Gutenberg, formats and typesets them using a carefully designed and professional-grade style guide, lightly modernizes them, fully proofreads and corrects them, and then builds them to take advantage of state-of-the-art ereader and browser technology.
What a great project.
It’s surprising to me that people would question that obesity would have a negative effect on the brain, because it has a negative effect on so many other bodily systems,” he says, adding, “why would the brain be spared?”
– Terry Davidson, director of the Center for Behavioral Neuroscience at American University in Washington, D.C, speaking to NPR about new research concerning obesity’s effects on memory.
Alan Kay on Xerox’s culture back when it was killing it:
A few principles:
1. Visions not goals
2. Fund people not projects — the scientists find the problems not the funders. So, for many reasons, you have to have the best researchers.
3. Problem Finding — not just Problem Solving
4. Milestones not deadlines
5. It’s “baseball” not “golf” — batting .350 is very good in a high aspiration high risk area. Not getting a hit is not failure but the overhead for getting hits.
Doesn’t that sound so healthy and reasonable? Of course, it didn’t last: profit needs and fear can easily trump ingenuity, hard work, teamwork, and progress.
We don’t really fund scientists in the public sector; we fund projects. And outside of politically expedient “moonshots,” we’ve curbed our visions in favor of concrete achievable goals with deadlines.
When people criticize or respond negatively to me, usually they’re responding to this character that they’re seeing on TV called Barack Obama, or the office of the presidency, or the White House and what that represents. So, you don’t take it personally. You understand that if people are angry that somehow the government is failing, than they are going to look to the guy who represents government.
Barack Obama talking with Ta-Nehisi Coates for The Atlantic.
This is of course not limited to elected officials. Every person can function as a representative of their organization or profession. It happens to doctors every day because healthcare is broken. It can even happen to the CEO of United Airlines.
Von Hippel offers two pieces of wisdom regarding self-deception: “My Machiavellian advice is this is a tool that works,” he says. “If you need to convince somebody of something, if your career or social success depends on persuasion, then the first person who needs to be [convinced] is yourself.” On the defensive side, he says, whenever anyone tries to convince you of something, think about what might be motivating that person. Even if he is not lying to you, he may be deceiving both you and himself.
The stealth battle between hospitals and insurers over bills for each hospitalization, office visit, test, piece of equipment and procedure is costly for us all. Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund. That compares with 16 percent in England and 12 percent in Canada.
NYTime’s Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much.
- General Tso was a real general
- His chicken was a dish actually created by a Taiwanese chef and isn’t a bastardized American creation.
Chef Peng Chang-kuei, the inventor of General Tso’s chicken, just passed away at the age of 98.
John Oliver turns his incisive gaze on scientific studies:
Fantastic as always, with some great “TODD” talks too.
The Scope is a new free weekly medicine newsletter that distills down some highlights from the major journals (NEJM, JAMA, etc) in plain English with a dose of context and light analysis. I’ve added it to my newsletter subscriptions, which also includes The New Yorker Minute (which reads the New Yorker so you don’t have to, recommending which parts are worth your time, and which I also love). The Scope is published on Fridays by a group of Columbia medicine residents and makes a great 2-minute light read for medical students, residents, and anyone who wants something in between reading journals all the time and waiting for something to be misinterpreted by the mainstream media.
Just in time for Valentine’s day, Priceonomics discusses the history of the highly anatomically incorrect heart symbol.
This awesome comic explains gravitational waves and the amazing experiment that detected/detects them. Einstein was right again!
Dr. Daniela K Lamas, writing in the NYTimes:
My patient gave me a thumbs-up. I wished that I had known him better. “Cheers,” he said.