October 7, 2026

But how will it happen?

A propos of nothing in particular, a memory came back to me this morning. I was a first year — more precisely, first month — oncology fellow at the National Cancer Institute, and had the dubious honor of having bone marrow transplants as my first rotation. This was back when NCI did not require proof of legal residency to enter the campus, so we had quite a few referrals from all around the country for people who otherwise would never have been able to afford one. These were clinical trials of bone marrow transplants, but the risks of the research procedure — whether to use drug A or drug B, bot approved, to prevent graft versus host disease — were minor compared to the risks of a standard full-on allogeneic transplant, so before you think “but isn’t this undue influence?” let me reassure you that, for the most part, it was not.

Anyway, one of these patients was a young woman with Burkitt lymphoma not responding to any chemotherapy you threw at it. I saw her in clinic early on during the rotation and despite having this rapidly progressing cancer didn’t look all that bad. She had just finished the last round of Hail Mary chemotherapy meant to control the disease before the transplant so had to wait a couple of weeks before being eligible for the trial, and so she went home somewhere in the Midwest to be with her family during this “washout period”.

She did come back, with a portruding belly and a hollowed out face, both of those tells that the lymphoma did not care an iota about any hail marys her doctors threw at it. Her labs, from blood counts to kidney and liver function, looked great, but true enough her PET scan had more areas lighting up than not, lymphoma everywhere.

In most other places this would have prompted a discussion about hospice and end-of-life care, but not at the NIH. She was admitted to the largest research hospital in the world to get some more chemo followed by, let’s hope, the life-saving transplant.

So I got to see her and talk about her at rounds each morning, and each morning that I saw her, belly stil protruding, face still hollow, I’d paint an uggly picture and at first hint then overtly ask, what were we doing here and why wasn’t she already in hospice?

One of those mornings, the inpatient attending who was by the luck of the draw also the primary investigator of the clinical trial she was supposed to be in had enough. All of her organs were functioning. She didn’t have an infection. The cells will be ready in a few days. “What exactly do you think will be the mechanism of her demise?”, he asked, and the phrase struck me as so out of touch that I remembered it to this day. This was a scientist first, maybe a great scientist, asking the question, but a piss-poor doctor.

The point of much of medicine is that we have no clue what the exact mechanism of someone’s demise will be, but we have seen enough and read enough to know that a quick demise was the most likely outcome. There were many things that could have gone wrong at any second: tumor eroding into a large blood vessel causing her to exsanguinate; massive infection taking over after her bone marrow was completely wiped out by our chemotherapy and her lymphoma combined; a large blood clot clogging up her lung’s blood vessels… It was a long list and I wasn’t a fortuneteller, so I shrugged my shoulders and moved on. She died a few weeks after I left the inpatient BMT service.

So anyway, when people ask how exactly the AI bubble will burst, in a way that’s challenging the very idea that it is a bubble that may burst, I remember this patient, shrug, and move on.

October 6, 2026

☕ Trader Joe’s is one of the Great Wonders of Capitalism, up there with Costco, [Note: It is worth remembering that capitalism of Adam Smith has, in fact, been a great net good for humanity. The problem of our time is not capitalism. It is greedy dumbasses doing stupid shit for ever-more money. ] but the only coffee you can buy there is an over-roasted mess. Last week was the third time I bought a bag of medium roast beans — different origin each time — and again, the beans were shinier than a teenager’s moon face.

Shiny beans aren’t inherently bad, if you like a dark roast. But putting them in a bag labeled “medium roast” is malpractice. Why, TJ’s? Why?

By the way, try doing a web search for “why are some coffee beans shiny?” and you will be hit with row after row of slop, high-altitude brewing style. The Internet died in 2016, the internet is dying as I type this.

October 4, 2026

🍿 Dungeons & Dragons: Honor Among Thieves (2023) was better than it had any right to be. You can figure out within minutes whether people know, understand and love the IP they are trying to bring to the screen, and boy does it show here. Pitch perfect family fun.

October 2, 2026

📚 Finished reading: "The Reverse Centaur's Guide to Life After AI" by Cory Doctorow.

The book is a quick read if you are familiar with Doctorow’s other writings, and/or have listened to a few of his interviews. He is nothing if not consistent and, in the case of AI, consistently correct.

Style

You may, if you feel particularly carmudgeonly, argue that this is a book that could have been a blog post. You would be off by only a degree: each chapter does in fact resemble a piece or three from Pluralistic, his decades-old blog. You may notice that each daily article there starts off with an appropriate picture collage of Doctorow’s own making. “Reverse Centaur’s Guide” is his blog post collage. But he is so good at hiding the seams.

Substance

No arguments there. AI of the day, which is to say LLMs, are a real technology with real uses that is overhyped beyond any reason. Unless Anthropic and/or OpenAI do great a general supper-intelligence — which they won’t — we will witness (if we are lucky) or suffer their fall.

There are now material ways in which LLMs have improved my life.

At work, it is mostly by transcribing the first patient visits so that I can focus on listening to the person in front of me rather than scribbling in a notepad or staring at a screen while nodding my head pretending I am paying attention. [Note: It is not that you get worse at multitasking with age, it is that you realize you were never particularly good at it so you stop pretending. ] Occassionally, for someone recently discharged and with a million notes, tests, and imaging data in the aftermath of their hospitalization, I may use EPIC’s crude but useful built-in summarization tool. I will even use OpenEvidence in preparation for a visit, but I maintain that free and unrestricted search through NCCN, NEJM and JAMA archives would have yielded the same result, and with fewer linguistics tics.

Personally, I have barely moved from my original use case, which was solving household problems. Having installed Meta’s Muse, sandboxed, locked out of any personal information, I do understand agents have their uses:

In other words, infrastructure-of-life stuff, the exact opposite of what the big mind of Muse espoused. Plans for self-hosting are in progress.

If your reaction to the above was largely negative, you should read the book. Doctorow makes a much better case than I ever could for why it is not morally abhorent to use this new technology. After all, are you boycotting the interstate system because Hitler championed the first autobahn?

September 29, 2026

May I propose “BSI”, for Bullshit Intelligence?

September 27, 2026

🍿️ Ferris Bueller’s Day Off (1986) was available on Apple TV and heavily referenced in Ted Lasso, and not having watched it before it was a natural choice for the family’s Saturday night viewing.

September 26, 2026

🍿️ The Dead Don’t Die (2019) looked exactly like you would imagine a zombie movie made by Jim Jarmusch to look, especially if you knew that he spent his childhood watching matinee double features. Not his greatest, but it hit the right spot: between the fracking references (the apocalypse came about because some brilliant minds decided to frack the Earth’s poles), Murray and Driver’s deadpanning, Tilda Swinton’s out-of-this-world turn and the Iggy Pop cameo, there was much to love.

🍿️ The Last House (2026) was pitched, or so I would like to imagine, as a blend of Home Alone and a Lovecraftian apocalypse. Instead of Macaulay Culkin you get a whole picture-perfect nuclear family; Joe Pesci becomes Cthulhu. No surprise, then, that the ending is a soppy, schmaltzy mess.

📚️ Six Memos for the Next Millennium by Italo Calvino helped me clarify why I liked some authors and not others. [Note: Incidentally, M. John Harrison’s latest book is on the short list for the Booker prize this year. I eagerly await October 13 and its US debut. ] There are in fact five memos, named in order Lightness, Quickness, Exactitude, Visibility and Multiplicity. The final one, Consistency, was not to be: Calvino died, aged 61, before finishing.

September 15, 2026

Dictated the first draft of this from an Index 01. Integration with Micro.blog isn’t there yet but at some point I might be “writing” blog posts with only my left index finger.