Yes, investigator-initiated clinical trials take time. But rather than back-patting and boasting about how it can still be done despite the setbacks, why not propose solutions for how to speed them up? I made a few off-the-cuff suggestions but you can also find serious efforts on that front.

If you say that “$1 of research investment yields $5 in returns to the economy” — as some do — but then clarify that under those $5 you have a lot of laboratory-building and infrastructure-supporting — as some did — what point exactly are you trying to make? As ever, there is much wisdom in r/Jokes.

A major entry in the Annals of Zombie Medicine must be screening for prostate cancer in men age 70 and above. Recent events had Nassim Taleb asking whether one could detect aggressive prostate cancer early, and one could, but… Indeed, this kind of screening has been singled out as something not to do for more than a decade, and yet:

Prostate screening in men ≥70 has not reached a 50% reduction in use since the 2012 guideline release.

Meanwhile, a full one-third of adult Americans is not doing the kinds of screening that are recommended, probably because they involve poop.

After finishing The Space Trilogy I was wondering which of C.S. Lewis’s many books I should read next. Well, Kyla Scanlon has just nudged me in the right direction with her Economic Lessons from the Screwtape Letters:

In Screwtape, evil doesn’t arrive through fire and fury. It creeps in through ease, comfort, and optimization. Screwtape wants to nudge people into passivity as a way of capturing their souls. Let them scroll. Let them spend. Let them smooth away all friction until they wake up hollow and can’t remember why.

Sounds about right.

Speaking of Gioia, I love his work, his most recent article is just wonderful, and I absolutely share his view on techno optimism… but blogging from Substack makes things a bit awkward.

📚 Thinking With Tinderbox continues to pay dividends, even though I am not learning anything about the app’s mechanics. One of the footnotes led me to About This Particular Outliner and its parent, ATP Macintosh and now I am thinking about the greatness of pre-2016 Internet. Quite the rabbit hole.

Finally, a definition of “paradigm” I can understand:

So let’s get clear: a paradigm is made out of units and rules. It says, “the part of the world I’m studying is made up of these entities, which can do these activities.”

In this way, doing science is a lot like reverse-engineering a board game. You have to figure out the units in play, like the tiles in Scrabble or the top hat in Monopoly. And then you have to figure out what those units can and can’t do: you can use your Scrabble tiles to spell “BUDDY” or “TREMBLE”, but not “GORFLBOP”. The top hat can be on Park Place, it can be on B&O Railroad, but it can never inside your left nostril, or else you’re not playing Monopoly anymore.

From Adam Mastroianni, and the rest of the article is even better.

Two good travel-adjacent articles that recently came out:

• Why travel didn’t bring the world together from FT’s Janan Ganesh (that is a gift link)
• Is it Euro-poor, or Ameri-poor? from Chris Arnade

Here is Ganesh:

Travel is enormous fun. Besides that, it can be an educational top-up, if you arrive in a place with a foundation of reading. (And if you don’t over-index whatever you happen to observe in person.) But a connecting experience? A reminder of the essential oneness of humankind? If it were that, we should have expected national consciousness to recede, not surge, in the age of cheap flights, a dissolved Iron Curtain and a China that became porous in both directions. 

To explain this away, some will insist on the difference between crass “tourism” and real “travel”. Please. This has become a class distinction, nothing more, like that between “expats” and “immigrants”.

And here is Arnade:

It is primarily we intellectuals and elites who culture shop, picking and choosing what works best for us. That’s true in Europe and the US, where each group of elites is inoculated from the least admirable qualities. Well-to-do Americans can escape the banal landscapes, either through travel or by living in the exclusive US neighborhoods that share European qualities, and find belonging in communities formed from their careers that cross national and cultural boundaries. Highly motivated Europeans can move to America, or work in a large corporation and escape European provincialism, while not giving up the aesthetic and communal benefits it offers.

It is the ‘normies,’ working-class, back-row, or whatever you want to call them, who make up the vast majority of citizens, that are tethered to live within their culture. That isn’t who is engaged in this debate, but it is who it should be about, not us cultural chameleons.

I am writing this from Zürich where I have spent a lovely spring day flaneuring in between business meetings. So, yes.

Today in titles that trigger me: Where is the YIMBY movement for healthcare?.

YIMBY is too simplistic of a concept to be easily applied to healthcare. It relies on a single dimension — how easy is it to build housing — and any proposed policy can be easily placed on the NIMBY/YIMBY spectrum. And since everyone can agree on where a particular policy lies on that spectrum, creating alliances is easy.

No such luck for American healthcare, where there are many dimensions: accessibility of new procedures (clinical trial YIMBYism), accessibility of approved treatments (insurance YIMBYism), accessibility of healthcare providers (practitioner YIMBYism), accessibility of MDs in particular (doctor YIMBYism)… And even there it is not clear what the YIMBY-equivalent stance would be. Does clinical trial YIMBYism mean you want more trials, quicker trials, or just more drug approvals and doing away with trials entirely? If you are a doctor YIMBYist, do you want to increase the number of medical schools? Residency and fellowship slots? Enable more foreign medical graduates to enter practice? All of the above? But then how do you deal with practitioner YIMBYists, who want to do away with most doctors altogether and delegate most work to physician assistants, nurse practitioners and, at the end of the line, large language models?

There is not a single person in America who would say its healthcare system is working, and yet it is clear why there is no unified front on how to fix it.

To be clear, I quite like the ideas brought up in that leading article. The five sample issues it names — breakdown of the direct doctor/patient relationship, unclear fees for service, frequent insurance switching, no room for insurer creativity, too much money spent on end-of-life care — are spot on. ⊕ If I had to pick one thing where I would want to be a YIMBYist, it is to remove any direct influence of the federal budget on healthcare. A large pot of money leads to hypertrophy of every other part of the system which down the line lead to many of the issues above. But is that really a YIMBY attitude?But alas the issues in question are too complex to be boiled down to a YIMBY-equivalent jingo, and to emphasize that point the article has an addendum linking to a 10,000-word report on the topic which at a glance seems to be raising the right points but I couldn’t really tell you since I have a day job that doesn’t leave much time for reading 10,000-word policy papers.

(↬Ruxandra Teslo)

It took me four years to drop my Apple Watch habit, but drop it I did. Goodbye, constant notifications. Farewell, nudges to breathe and to stand up and to convert my walk to the grocery store into “an activity”. I will hardly miss you, phantom vibrations and the pale white band around my wrist. You were good for heart rate and pace tracking, and for that you can still sit in the drawer, awaiting my next run.

The de-watchification of my everyday life began a few months ago when I forgot to take it off the charger after leaving it there for the night. This in itself was an aberration as I tended to keep it on at bedtime for sleep tracking ⊕ The number of times I checked the results of this tracking is, of course, zero. This is also how many valuable insights on my sleep patterns I received from Apple’s Fitness app. and only charge it for a half-hour in the morning. I failed to notice a change on that first watchless day, or on subsequent days. A $30 Casio — itself an indulgence since similar performance could be had for under $10 — gave time just as well and did not require charging. With luck, I may eventually get to cleaning and repairing a slightly more substantial timepiece I got some 20 years ago, victim of an inept shopping mall jeweler trying to replace its battery.

This is not the only way I tried to introduce more friction into my life — see the iPhone dumb-down of a few months ago. Kyla Scanlon’s latest article, ⊕ If you haven’t yet checked out Kyla’s blog, please do so now. It is for economy and finance what Ruxandra Teslo’s blog is for biology. The Most Valuable Commodity in the World is Friction, outlines the reasons why one should think about more friction better than I ever could. There is a clear distinction between the frictionless digital and the friction-full physical world, only the frictionlessness of the digital realm is largely an illusion, a sleigh of hand, for:

… we have a world where friction gets automated out of experiences, aestheticized in curated lifestyles, and dumped onto underfunded infrastructure and overworked labor. The effort doesn’t disappear; it just moves.

It was easy enough to nod my head in agreement for I thought of this every time I ordered my groceries to be delivered. But in Apple Watch’s nudge economy the underfunded infrastructure was my calendar and the overworked labor was me.