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Good ideas need to outlive the old guard

09.25.20 // Miscellany

Nobel-prize winning physicist Max Planck argued in his autobiography that change takes time because good ideas need enough staying power to outlive their detractors:

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it…An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarized with the ideas from the beginning: another instance of the fact that the future lies with the youth.

Clearly not always true, but it’s so broadly applicable a principle that it’s worth adding to your library of mental models.

Frozen Meat: A New Standard for COVID-19 Research

09.23.20 // Miscellany

As a physician, I mostly read medical journals. I also occasionally read economics and psychology literature, usually because they are frequently cited in popular books for laypersons.

But I don’t normally read business or communications literature.

That is until I saw this paper about frozen meat company Steak-umm’s surprisingly awesome Twitter account:

I haven't actually read this, but I can tell from the title it's better than most of the COVID-19 preprints I've seen in medical journals. https://t.co/ScgobNBfGn

— Ben White, MD (@benwhitemd) September 18, 2020

The title of the paper is too good to ignore. Anytime you can employ the phrase “frozen meat” in a way that only might be ironic is a communications victory from my perspective.

To give you an example of what the content Steak-umm generated to become worthy of intense positive scrutiny:

friendly reminder in times of uncertainty and misinformation: anecdotes are not data. (good) data is carefully measured and collected information based on a range of subject-dependent factors, including, but not limited to, controlled variables, meta-analysis, and randomization

— Steak-umm (@steak_umm) April 7, 2020

and then…

we're a frozen meat brand posting ads inevitably made to misdirect people and generate sales, so this is peak irony, but hey we live in a society so please make informed decisions to the best of your ability and don't let anecdotes dictate your worldview ok

steak-umm bless

— Steak-umm (@steak_umm) April 7, 2020

From “Frozen Meat Against COVID-19 Misinformation: An Analysis of Steak-Umm and Positive Expectancy Violations“:

To examine another possible factor contributing to the success of Steakumm’s response to the pandemic, we analyze the case through the lens of expectancy violations theory (Burgoon & Jones, 1976), which predicts how individuals will respond when others communicate in unexpected ways. Although expectancy violations can be positive or negative depending on the situation, research has shown that positive expectancy violations resulting in positive communication appraisals and outcomes can happen when publics are pleasantly surprised by an entity’s communication (e.g., Yim, 2019).

Sometimes beautiful, sometimes terrible—but it’s always an interesting world we live in.

Sociopaths need data too

09.01.20 // Miscellany, Reading

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

08.26.20 // Miscellany

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

08.24.20 // Medicine, Miscellany

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.


I did a brief interview with the folks at Elite Medical Prep about my Free 120 explanations 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.

// 08.19.20

The Trajectory of American Education

08.03.20 // Miscellany

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.

Guesting on Doctor Money Matters

07.09.20 // Finance, Miscellany

Another pre-pandemic podcast recording is out this week, this one discussing student loans (and some other stuff) on the excellent Doctor Money Matters. Check it out on your favorite podcast app and give Dr. Patel a nice review. We covered some good stuff!

Now that I keep mentioning my next book in progress on all of these shows I really need to sit down and finish it…

Talking about Life, Finance, and Student Loans

06.24.20 // Finance, Miscellany

I recorded an episode of Dave Denniston’s Freedom Formula for Physicians Podcast earlier this year and it’s up this week. I had fun, and we actually covered a lot more personal stuff compared to my usual writing.

You can listen here (or on your favorite podcast app—I recommend Overcast).

The Machinery of Skepticism

06.16.20 // Miscellany

Carl Sagan, famous astronomer and author of Contact and Cosmos (among others), writing about “The Burden of Skepticism” way back in 1987:

It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble. If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful ideas from the worthless ones. If all ideas have equal validity then you are lost, because then, it seems to me, no ideas have any validity at all.

Some ideas are better than others. The machinery for distinguishing them is an essential tool in dealing with the world and especially in dealing with the future.

That summarizes so much.

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