Sociopaths need data too

I just finished John Carreyrou’s Bad Blood: Secrets and Lies in a Silicon Valley Startup, about the fall of Elizabeth Holmes and Theranos, the Silicon Valley Unicorn that pretended to be a pioneer in laboratory testing but was really just a purveyor of bloated promises and outright lies.

A sociopath is often described as someone with little or no conscience. I’ll leave it to the psychologists to decide whether Holmes fits the clinical profile, but there’s no question that her moral compass was badly askew. I’m fairly certain she didn’t initially set out to defraud investors and put patients in harm’s way when she dropped out of Stanford fifteen years ago. By all accounts, she had a vision that she genuinely believed in and threw herself into realizing. But in her all-consuming quest to be the second coming of Steve Jobs amid the gold rush of the “unicorn” boom, there came a point when she stopped listening to sound advice and began to cut corners. Her ambition was voracious and it brooked no interference.

A 19-year-old with a couple of semesters of chemistry under her belt suddenly knows enough science and engineering to demolish the scientific state of the art and maybe even the laws of physics when it comes to fluid dynamics. Even the products themselves kept pivoting as her original ideas were clearly impossible with the current state of technology and the people she brought in to do the actual work rotated through.

It’s bonkers, and it’s so telling that almost everyone investing was a tech billionaire or silicon valley VC with no understanding of science. A cult of personality has no business in healthcare without data. This was Holmes describing the Theranos lab process:

A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.

If you heard this in a pitch meeting, would you think future of medicine or middle school book report?

I remember the news when Theranos imploded and I think a lot of people fully embraced the schadenfreude. But reading the detailed story was just so depressing. You shouldn’t be able to run a science company while hiding all the research and data. You know, all the sciency stuff. That’s literally not how science works.

How many thousands upon thousands of hours of smart folks’ time was wasted trying to duct tape vaporware when they could have been making a substantive contribution to their fields. How much money was flushed for someone’s ambition?

Less Certainty, More Inquiry

Maria Konnikova, psychologist and rapid-onset Poker champion, relaying a story from her mentor and seasoned Poker champion, Erik Seidel:

Seidel doesn’t give me much in the way of concrete advice, and our conversations remain more theoretical than I would prefer. He focuses more on process than prescription. When I complain that it would be helpful to know at least his opinion on how I should play a hand, he gives me a smile and tells me a story. Earlier that year, he says, he was talking to one of the most successful high-stakes players currently on the circuit. That player was offering a very specific opinion on how a certain hand should be played. Erik listened quietly and then told him one phrase: “Less certainty. More inquiry.”

“He didn’t take it well,” he tells me. “He actually got pretty upset.” But Seidel wasn’t criticizing. He was offering the approach he’d learned over years of experience. Question more. Stay open-minded.

A good candidate for the second Golden Rule.

The Power of Pausing

Solitude on its own won’t give us knowledge and compassion—it depends how we use that time with ourselves. But it gives us the opportunity to listen to ourselves, to hear the ideas, inspiration, feelings, and reactions that arise, and hopefully to approach what arises with kindness and compassion even when the thoughts that come up are painful or unflattering.

Moments of pause are especially powerful when combined with gratitude and feelings of love. I had a medical school professor who struggled with the demands of being a mother, doctor, teacher, researcher, and administrator. Finding time to meditate or go on a retreat was a near impossibility for her, but whenever she washed her hands before seeing a patient, she would let the warm water run over her hands for a few extra seconds and think of something she was grateful for—the opportunity to be a part of the patient’s healing, the health of her family, the joy of teaching a student earlier that morning. She was one of the first people to teach me that the power of gratitude can be delivered in the smallest of moments . . . and those moments have the power to change how we see ourselves and the people around us.

If we ever forget the power of pausing, we need only remember the lesson of our heart. The heart operates in two phases: systole where it pumps blood to the vital organs and diastole where it relaxes. Most people think that systole is where the action is and the more time in systole the better. But diastole – the relaxation phase – is where the coronary blood vessels fill and supply life sustaining oxygen to the heart muscle itself. Pausing, it turns out, is what sustains the heart.

From former Surgeon General Dr. Vivek H. Murthy’s lovely book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.

When the pandemic first exploded earlier this year, I naively hoped that it would be a unifying enemy that would help us transcend our differences. That didn’t happen here at least. I think some fortunate people were able to pause, but pausing–like many things–is easier with privilege. When I look at the depressing state of community and political discourse, I think Murthy has it exactly right:

The great challenge facing us today is how to build a people-centered life and a people-centered world. So many of the front-page issues we face are made worse by—and in some cases originate from—disconnection. Many of these challenges are the manifestation of a deeper individual and collective loneliness that has brewed for too long in too many. In the face of such pain, few healing forces are as powerful as genuine, loving relationships.

A brief interview (about my Free 120 explanations)

I did a brief interview with the folks at Elite Medical Prep ages ago that went live today. I can’t believe I’ve been writing up explanations for the NBME practice materials for so long, but, well, I guess I have.

On a related note, if you’re in the market for personalized 1-on-1 tutoring, they’re a good group of folks. Tell them I sent you and they’ll give you $50 off when you purchase 5 hours or more.

The Trajectory of American Education

From “Our Educational Colonialism” by Chris Arnade:

Yet it is the kids sitting in middle row I have the deepest sympathy for because they are the most harmed, and the ones you hear the least about. They are mostly working class kids who don’t really fit into the back row because they are very disciplined, eager, and want do what they are told, and especially want to do the right thing. Which now means going off to college to better themselves, so they go off to college to better themselves, regardless of the cost.

They buy into our faux educational meritocracy the most, swallowing it hook, line, and sinker. They buy the dream peddled by every successful person they have ever run across or heard, from Obama down to the middle school guidance counselor: Education is the pathway to a successful and meaningful life.

So they apply for loans and eight years later that child is a young adult with 100K in debt working in a government bureaucracy five hundred miles away and missing the weekly family backyard BBQs.

When I researched the history of student loans, one of the most striking currents underlying our educational debt crisis is the sad fact that student loans basically function as a subsidy for universities paid as a crippling tax on a generation of young Americans.

Education is wonderful, so is bettering yourself by getting as much of it as possible. But done on your terms and because you want it for your reasons. Not because you, your community, and everyone else you know, is competing with the Chinese, or the Germans, or the Indians. So you have to take countless standardized tests so you can win a golden ticket to ship off to Princeton and hang with others who are good at taking standardized tests, to then be taught more stuff, to then go to grad school to learn even more stuff, so you might, if you are lucky, get to go to San Francisco and live in an a small room hundreds of miles from your family to start in a firm trading bonds, or helping Google sue someone, or running from teaching one introductory writing course at one school to another introductory oratory course at another school, or maybe so you can write papers for a non-profit funded by a billionaire arguing that we need more education. That isn’t good.

What we have now is a top-down educational system that intellectually strip mines America and humiliates everyone. What we need is a democratic educational system that provides pathways to dignified lives for everyone. That provides Shakespeare and differential topology to those who see the beauty of each, but also provides skills to those who would rather focus on things like music, mechanics, nursing, parenting, farming, or whatever.

Education is wonderful. But right now we have an educational arms race, and we’ve forced people to mortgage their brains and futures to get degrees that simply function as overpriced old-fashioned card punches: just a ticket to enter the workforce.