Unlike most of PKD’s work, this was my first time reading The Three Stigmata of Palmer Eldritch. I wonder what my thoughts would have been a few decades ago had I gotten to it at the same time as the rest of his novels, but now I cannot help but admire what Dick achieved and how prescient he was, yet again.

The first achievement was to do with words what Satoshi Kon did with images in all of his works, Paprika most of all. Perspectives change and timelines shift mid-sentence, delirious hallucinations become matter-of-fact reality, all without losing the reader. This is only ocassionaly done for comedy; more often, the result is horror of the Lovecraftian kind — Eldritch is right there in the title. One can only imagine what Kon would have done with this book, or with Dick’s similarly reality-bending Ubik. I am, of course, not the first person to have made this observation.

The second was to see what the religion of conumerism will bring, decades before it become obvious to everyone else: alienation, blurred reality, despair. Their physical manifestations — (a metal hand, artifical eyes, deformed jaw — are the titular three stigmata. The Man in the High Castle had religious undertones; fitting for a book of its title, The Three Stigmata… brandishes a religious foghorn.

The third, unintentional achievement, was to bring into focus what I find particularly pernicious about LLMs: I get a visceral reaction, revulsion, to its common turns of phrase. Is this not a good thing, you ask? After all, it kept me off Xitter and most of Substack, which are now inundated with computer-generated text. But no, the revulsion is there even in texts written years ago: this has to be AI, I say to myself, only to see that the article was from 2018. Much like Dick’s protagonists who keep questioning their reality and see the Eldritch stigmata in everyone and everyhing, even themselves, long after exposure to the transcendental drug which is the book’s McGuffin, I have overcalibratted my bullshit detector to find fault in the most innocuous turns of phrase.

Worst of all: am I myself now writing things that someone will mistake for AI — instead of human — slop?

The titular “it” is enshitification, particularly of the “let’s digitize everything” type.

Next year will be a full decade since my initial board certification in oncology, and with that comes another set of multiple choice questions for quarterly completion. We can debate whether ABIM’s MOC scheme is fair — I think not — but still being the law of the land, it led me to think about board prep for the first time since 2018, when I completed my hematology boards.

Being an over-preparer (as people who finish medical school tend to be), I started looking into the size and cost of ASCO-SEP “ASCO” is the American Society of Clinical Oncology. “SEP” stands for “Self-Evaluation Program”. “ASCO-SEP” was something oncology fellowship programs gave to their trainees free of charge some time during their second or third year of fellowship to get them ready for the board exam. This was less from the goodness of their hearts and more because fellowships were graded — and to the best of my knowledge still are — on the percent of their graduates who pass the boards on the first attempt. A rate lower than around 80% would raise all sorts of flags and could lead to audits, suspensions and even closures. So, mid and low-tier programs would overselect on good test takers during fellowship match season, with interesting consequences (the discussion of which is better left for some other time). and was dismayed to learn that it is no longer a physicial book published every 3 or so years which one could use as a reference, doorstop or paper weight long after passing the boards, but rather a 12-month digital subscription with no option for a print copy. You would think that ditching print would lead to all sorts of dematerialization efficiencies — no typesetting, no printing, storage, etc — that could potentially lower the price and make it more affordable for everyone. Alas, if there were any efficiencies to begin with, they didn’t trickle down to the end-user: the cost of subscription for members if $550. And did I mention it was only for a year? Enshittification in action.

ASCO’s quirky sibling is ASH, the American Society of Hematology, which publishes ASH-SAP. “SAP” is for “Self-Assessment Program”, and the fact that they chose different acronyms for the same thing tells you much about the world of medicine. It is a smaller organization with fewer members yet it managed to put out a print copy for $60 over the digital-only offering — a more than fair price for a textbook. This is not the first time ASH has been on the right side of history.

So if anyone knows anyone in the ASCO leadership, please nudge them over to the ASH approach. Maybe you can mention ASH-SAP explicitly and let mimetic forces do their magic. And if you can influence decisions at ASH, whatever you do don’t highlight that ASCO-SEP is digital-only and please don’t talk about efficiencies, lockup and similar matters lest hematologists get any wrong ideas.

This is a sculpture of a single translucent disk and some cleverly positioned spotlights. Made in 1969 by Robert Irwin and now at the Hirshhorn Museum in DC, it reminded me, of all things, of a Reddit thread.

• Branko Milanović: To work or not to work. A modern economic take on the Red Queen’s race of capitalism. Pairs well with this question from Alex McCann.
• Alex McCann: The Case for Active Optimism. Speaking of! Yes, let’s extrapolate the transitions from agranian to industrial to information societies into this new transition to the society of slop (SoS). I still worry that those required levels of civic vigilance that we are not currently able to muster (and arguable failed at even as moved from industry to information, hence our current predicament).
• Derek Sivers: Offline 23 hours a day. A palate cleanser before the next course.
• Harry Crane: When Prediction Markets Don’t Predict: The Khamenei Resolution Debacle. Crane is a semi-professional gambler and views these new gambling devices rather favorably (see: name of his blog) but even he bristled at what happened here. There is also a follow-up.
• Sara Talpos and Michael Schulson for Undark: Do America’s Top Health Research Officials Stick Around Too Long? Yes, with interesting caveats. (ᔥJim Olds, who makes an appearance)

In addition to the categories listed on the blogroll my RSS reader has one labeled “New” which acts as a saucer for my feed subscriptions. I end up deleting quite a few of these — the post that got me interested may not be representative of the whole thing Which brings up an interesting question of whether or not blogs are ergodic. Let that be an excercise for the reader. — but some do move on. Below are a few of those.

Stories & Journals

• Weird and Deadly Interesting by Ahmet Alphan Sabancı, “a critical futurist, writer, journalist and activist”.

Economy & Finance

• Citation Needed by Molly White, “a researcher, software engineer, and prominent critic of cryptocurrencies and blockchain-based projects”.

Reading & Writing

• Note to Self by Gina Trapani, “a writer and programmer based in New York City”.

Science & Medicine

• Aaron Cheng, MD by Aaron Cheng, “a classical hematologist and clinical investigator”.

Philosophy & Religion

• Heavy Machinery by Mike Pepi, “a cultural critic”.

Hardware & Software

• Tonsky.me by Nikita Prokopov, “Software Engineer with a vast open-source portfolio and strong UI/UX background.”
• nickschaden by Nick Schaden, “an engineering manager and creative technologist”.
• journal.stuffwithstuff.com by Bob Nystrom, a “programming language developer at Google working on Dart, ex-game developer at EA, UI nerd, author of ‘Game Programming Patterns’ and ‘Crafting Interpreters’”.
• Disconnect by Paris Marx, who " hosts the award-winning Tech Won’t Save Us podcast and is the author of Road to Nowhere: What Silicon Valley Gets Wrong about the Future of Transportation."
• karpathy by Andrej Karpathy, “AI researcher”.

An honorable mention goes to the Bear Blog Discovery feed which will forever remain in the “New” category as new blogs keep bubbling up. That feed is also the reason “Hardware & Software” blogs overrepresented in the above list. My preferred platform, micro.blog, also has a Discovery feed, but since it tends to promote micro posts (duh) it is there more to find new people to follow on micro.blog itself rather than the feed reader.

So, any pointers to non-technical blog chains and other discovery mechanisms would be much appreciated!

• Aaron Cheng: On the emotional weight of a life in medicine. Thoughts of a newly-mintend hematologist which act as a good counterbalance to the popular fictional accounts. Feel free to peruse the few pre-2017 posts from the Infinite Regress archive for my own thoughts from that period.
• Fred Vogelstein: Enveda’s drugs from plants will turn pharma upside down. This is what Ruxandra Teslo warned us about a few months back.
• Joseph Howlett for Quanta Magazine: The Man Who Stole Infinity. On Georg Cantor, plagiarist. It does cause one to become more cynical, as we keep discovering that high-profile scientists built their reputiations on the backs of people with more scrupules and less need for attention. Taleb’s minority rule applied to sociopaths.
• Adam Mastroianni: The one science reform we can all agree on, but we’re too cowardly to do. It is to abolish for-profit scientific publishers, and I am all for it. But, people being people, I do not have high hopes that this prisoners' dilemma will have a positive outcome.

We went to the Hirshhorn Museum to see their Basquiat X Banksy exhibit, stayed for this magnificently decorated room by Laurie Anderson. She spent more than two weeks working 10-hour days to paint it in 2021, when she was 74 years old, and you can see the experience seep through the walls.