The book that Sapiens ⊕ Reading my review of the Sapiens I realize I fell prey to the reverse form of Gell-Mann amnesia: suffering through Harari’s other book, Homo Deus, should have made me revise my opinion of Sapiens right away, and not wait for Graeber and Wengrow to put things right. wished it could be: an honest, academically rigorous, intellectually stimulating, fun overview of archeology’s current understanding of prehistory, and an exploration of the reasons why the popular view has become so divergent from the professional.

I won’t pretend to have digested all 700 pages after one read, but a few mental models popped up immediately.

The first is the importance of play: there is some evidence — and much hypothesizing — that at least some of the modern societal setup came about as a result of play. Pretend-kings of annual feasts may have, at some point, decided to be true rulers. The first use of clay modeling was to build toys, not pottery. And to extrapolate to the more recent past: powerful graphics cards built for photo-realistic video games are now mostly used for cryptocurrency mining. The outcomes don’t always need to be good!

That is another important point: the book dismantles the myth of linear progress and replaces it with a theory of multiple (social) worlds in which some may be more suitable at different times for different populations, but none could be called universally “better” than others. We are in dicey territory here, because one of the authors — the late David Graeber — was a well-known activist for anarchism and you’ll have a hard time finding a review of The Dawn of Everything which doesn’t try to frame it as some sort of a call to anarchy. But it is hardly the first book published in the last five years to point out some of the deficiencies of the current state of affairs, while pointing out that social experimentation was the modus operandi for most of human (pre)history.

The how of our mistaken ideas of the neolithic leads to another important mental model: premature codification of hypotheses as facts. The chain of events leading from Rousseau’s essay on the mythical Noble Savage to historians mistaking it for actual history echoes many of the medical myths with which I am more familiar, from iron-rich spinach to fever-causing atelectases. Most fields of human endevor won’t let facts get in the way of a good story.

My own field being as far away from archeology as you can get, I had to ask the one “real” archeologist I knew — with recent field-work experience in Europe and the Eastern Mediterranean — what she thought of the facts in this book. And, somewhat surprisingly, she saw nothing new, controversial, or groundbreaking in any of the stated facts. For what it’s worth, an anonymous Amazon review from someone claiming to be an expert in the field confirms this. This is important: we can argue about interrpretation — and unlike some popular historians the authors here clearly mark the parts where they are telling a story more than stating facts — but the truth about how much we know should not be in doubt.

Meanwhile, professional book reviewers, quick to judge, easy to confuse, attention spans short, don’t know what to make of any of it: as sure a sign as any that The Dawn of Everything is a true masterpiece.

This is the bare minimum of non-medical books I should read this year. The last two years were abysmal in that regard, and I look forward to making excuses for why 2022 was no different.

• The Scout Mindset (Julia Galef)
• How to Live (Derek Sivers)
• Understanding Nonlinear Dynamics (Daniel Kaplan and Leon Glass)
• Light (M. John Harrison)
• Safe Haven (Mark Spitznagel)
• Pieces of the Action (Vannevar Bush)
• The Demon-Haunted World (Carl Sagan)
• Where Good Ideas Come From (Steven Johnson)
• Calculated Risks (Gerd Gigerenzer)
• Making Things Work (Yaneer Bar-Yam)
• The Morning Star (Karl Ove Knausgaard)
• Alexander Hamilton (Ron Chernow)
• Where Law Ends (Andrew Weissmann)
• The Fifth Risk (Michael Lewis)
• Checkpoint Charlie (Ian MacGregor)
• Checkmate in Berlin (Giles Milton)
• The Complacent Class (Tyler Cowen)
• Craft Coffee: A Manual (Jessica Easto)
• The Complete Father Brown Stories (G. K. Chesterton)
• Foucault’s Pendulum (Umberto Ecco)
• Scientific Freedom: The Elixir of Civilization (Donald W. Braben)
• Adventures of a Computational Explorer (Stephen Wolfram)

George Saunders is a modern master of the short story, so when he offers his thoughts on masters of old — all of them Russian — you’d better take it. Even if, like myself, you have no intention of ever writing short stories for a living or for personal enjoyment, it will greatly enhance your appreciation of the craft.

Similarly to Peter Thiel’s key question in Zero to One, Influence revolves around a list of seven: the seven heuristics our System 1 has accepted as a sign that we can agree to something automatically — what Robert Cialdini calls the Click, run response. Actors both nefarious and benign may use them to get wat they want from us. But of course, it works both ways: we can’t learn defense against the dark arts without picking up some of those dark arts ourselves.

As chance would have it, my finishing the book coincided with a family trip to Las Vegas where all of the principles were tried on us in an attempt to sell us a time share scheme. We got our initial hotel room stays at a well-known and renowned hotel chain (authority) at a discount (reciprocity); the sellers wanted to ingratiate with us with a wink here and a compliment there (liking), citing that she, too, was bilingual and raising a bilingual child (unity); we were taken to a room fool of other potential buyers and witnessed one occasion of a 14,000 point plan being sold (social proof); we had only that day to decide on whether we should buy into this once-in-a-lifetime opportunity (scarcity), and we kept being reminded how much we spent on vacations anyway (commitment and consistency).

They were good, but the book was better: we thanked them for the offer and graciously declined. It was a $15 investment that saved us tens of thousands of dollars in frivolous expenses. Well worth an ocassional re-read.

Peter Thiel’s thoughts about startups, which I presume every founder past, present, and future has read and internalized.

But I jest. Browse Twitter and you’ll see his seven fairly simple principles of running a successful startup abused, ignored, and misinterpreted, particularly in biotech.

Instead of building a technology that will be useful 20 years from now — the durability factor — technologies are made to solve problems of 20 years ago. Layering optical character recognition, artificial intelligence and machine learning over the cruft of hand-written notes faxed back and forth between doctors' offices comes to mind. Compare and contrast to mRNA vaccines, a technology created more than a decade ago to treat today’s pandemic.

Instead of developing drugs and other treatments with at least 10 times the effect size of current standards of care — principle of technology — the regulatory agencies and markets are overwhelmed by me-too drugs whose marginal benefit requires mammoth trials for any chance of detection.

Instead of vertical integration and ownership of drug discovery, manufacturing, clinical operations and biomarker development within the same organization, with positive feedback loops between all the factors leading to a faster pace — the team prinicple — we get ghost companies made of slide decks and good wishes whose only tangible impact on the world is achieved via Contract Research Organizations.

I could go on: the principles of timing, monopoly, and distribution are also violated early and often in a biotech startup’s lifetime. But then I’d be breaking a principle myself, that of the secret.

At the very beginning, David Epstein presents a dichotomy: there are the super-specialists, who decide early on in their lives who they are and what they want to be, and put all of their time and energy into improving a narrow set of skills that make them competitive in a tightly-regulated field such as professional sports; and then there are the generalists, who try out different things here and there, learning across disciplines and using that knowledge to solve difficult — “wicked”, the book calls them — problems that don’t fall neatly into any category, but which are more and more common in our modern world full of complexities.

The model super-specialist is Tiger Woods, who picked up his first golf club as a toddler and won his first tournament at age six. Compare and contrast with the model generalist, Roger Federer, who dabbled in 11 different sports Squash, skiing, wrestling, swimming, skateboarding, basketball, handball, tennis, table tennis, badminton, and soccer. before finally picking up the one that will make him famous at the ripe old age of (checks notes)… eight.

The rest is of the same cloth: light on arguments, heavy on emotion. The examples of hyper-specialization it gives are telling: oncologists specializing in cancer related to a single organ and interventional cardiologists. ⊕ Apropos interventional cardiologists, Epstein attributes the massive overuse of stents for dubious indications to the said specialists “getting so used to treating chest pain with stents … that they do so reflexively”. And not because of financial incentives? Interesting. Never mind that to get to any medical subspecialty one needs to go through more than 20 years of not so specialized schooling, sample different professional careers in college, then sample different physician specialties in medical school, and not reach the subspecialty until their early thirties at best. When did the supposed generalist Roger Federer start playing tennis, again?

So, the term “specialist” gets thrown around a lot without being precisely defined. Is it the narrowness of one’s current field that makes them a specialist? Or is it the path they took to get there? Regardless, we do know what makes a generalist: meandering from field to field until you find your niche, which will, ideally, use some of the knowledge and skills gained through all of that meandering. If you start as a stocker at Walmart, then work as a florist, hair stylist, hand model for a watch company, and end up as a short order cook at McDonalds, well that’s not much of a generalist story. Flip these around so that your final job is something more glamorous and you are the master of your profession who uses the Walmart work ethic, florist’s sense of proportion and beauty, Mickey D’s sense of urgency, and a hand model’s way with wrist movements to create a work of coiffured art. It’s the narrative and Texas sharpshooter fallacies combined.

Their friends confirmation and survivor bias also show up. Each chapter has a few stories hand-picked to showcase how a “generalist” solves problems that the “specialists” were stumped with. The generalist’s life story is then picked apart to showcase their versatility, though some at first do not appear to be so versatile. There are, unfortunately, no counterfactuals, and no going over the specialists' biographies which would — I am fairly confident — be strikingly similar to those of the generalists.

Looking back at a life, your own or someone else’s, is very much like stargazing. There are a few set pieces — a marriage here, a near-death experience there — but for the most part the events are devoid of much meaning until we give it to them by imputing a causal relationship to something that is important ex post. Epstein picks out situations where a failing team of “specialists” — let’s take him at his word that they are, for their biographies are not presented and we are left wondering whether they, too, worked the summers in their family’s farm or had a brother in the concrete business or some such — well, where that team of maybe-specialists is rescued by a certified (by Epstein) generalist who expresses their generalissimo-ness via a string of anecdotes, the stars in my overwrought stargazing analogy.

There is a story to be told about narrowness of focus and the importance of not being a fachidiot. Epstein comes tantalizingly close to framing the problem as it should be framed: that specialty narrow-mindedness — no matter how you got to it — is dangerous and makes you a bad specialist and a worse human. Yet there is no mention of this wonderful German word in the book’s hundreds of pages. That’s too bad: Fachidiocracy would have been a better title.

Yes, real life is messy, yes, there is more stupidity than evil in the world, and no, there are no billionaire/vampire/reptile cabals running the show behind the curtains (if only). Yet individual humans do have needs, and some of those needs are secret, and when meeting a secret need involves more than one person, when each of those persons is tasked with keeping their role a secret, and when that role is exacting revenge, well then, you have a genuine conspiracy.

There have been many conspiracies in my lifetime, most of them having to do with Serbian politics: the conspiracy by the heads of Serbia and Croatia to break up Yugoslavia; the conspiracy by parts of the Serbian surveillance apparatus to overthrow Slobodan Milošević; the conspiracy by the Serbian mafia-political complex to assasinate the prime minister; the conspiracy by parties yet unknown to hide the numbers of Serbian Covid-19 victims… You cannot fault the average Serb for seeing conspiracies everywhere, and you can empathise at least a tiny bit for being sceptical of masks, vaccines, the existence of the virus itself.

The last time the average American was exposed to a big conspiracy that was named as such was in 1974, and it was so bungled and comically inept that you cannot fault them for thinking conspiracies are relegated to history books. This is what Ryan Holiday suggests in his book, while unravelling the conspiracy by Peter Thiel to secretly bankroll civil lawsuits against Gawker Media until they are bankrupt. But is this true? After all, weren’t Purdue Pharma, Ferguson PD, the 25th amendment gang, and the Capitol insurrectionists, to name a few, all involved in more or less successful conspiracies?

“The idea of a conspiracy,” Thiel is quoted saying in the book, “is linked with intentionality, with planning, working towards longer-term goals. In a world where you don’t have conspiracies maybe also those things disappear.” Holiday adds: “The truth is that Gawker already believed we lived in that world. And so do far too many people.”

I object to that evaluation of my fellow humans, because most people are well aware of the fact that we do indeed live in a world full of conspiracies. If the last few years have taught us anything, it is that people over-read them. But they are conspiracies perpetrated by multinational corporations, rouge state officials, the actual states, and, Holiday’s book now tells us, condescending billionaires.

At a hundred pages, a fifth of which is the preface, this is a slender book that compares the 1950s state of the art computer and neuroscience, but more importantly gives the answer to the burning question in oncology: how much are a few months of overall survival benefit worth? Well, if you are John von Neumann and you have boney metastasis from a cancer of unknown origin eating away first your energy and then your mental capacities while your are writing a series of lectures on how similar and different brains are from “modern-day”¹ computers, and you are way ahead of your time in thinking about both, well, the answer to that question is quite a lot. It is in fact an unthinkable loss that he died before he could even finish his writing, let alone hold the lectures.

It was also somewhat eerie to read about the comparison between humans and machines shortly after Apple announced its quite literally game-changing M1 processor. There is fierce competition among the big tech companies to build the Skynet of our universe, and as of last week Apple is winning.

These 250 pages on the many ways that cancer care in America is broken should be read by everyone with even a passing interest in oncology, and must be read by every heme/onc fellow or fellow-to-be. Malignant reminded me of the best days of my own fellowship, when the then-program director Tito Fojo would eviscerate an article — these tended to be poorly thought out phase 3 trials of one TKI or another that somehow made it to the New England Journal — with a few slides made at the last minute.¹ But this is not just a rehash of those lectures, nor is it the best of Prasad’s prolific Twitter feed, nor an overview of his billion meta-science articles and editorials. It is instead a series of lectures — enough to fill a semester — that takes bits and pieces of the above and adds quite a bit of new to make something better.

It is not the easiest of narratives to follow. This is understandable: cancer research, policy, and outcomes are as intertwined as the molecular pathways Prasad valiantly tried to avoid, and mapping their connections will inevitably result in a crazy wall. There are nominally four parts to the book with four chapters each, because you had to put it together somehow, and the parts make sense. Even so, more than once I was wondering what exactly a particular vignette had to do with where it was in the book, and wanted to put it somewhere else. But the feeling goes away quickly — Prasad’s style is entertaining, the puns are clever², and there isn’t a superfluous paragraph in site.

To that last point — if anything, the book is too short. My pet cancer peeve, the disconnect between bioplausability and reality, and the many misuses of animal models to inform clinical trials, was barely mentioned when it could’ve easily made a whole chapter. Same for grant mechanisms, which did get a page and a half — that one half is a figure — but left too many things unexplained and uncovered, particularly for the lay audience. And as to Prasad’s big advice that the federal government should take over running clinical trials from private companies, well, it’s nice to put some pie-in-the-sky proposals out there, but something that is so against the grain should be more fleshed out.³ Or maybe mention some more feasible proposals, in the line of Vincent Rajkumar’s plea to cut down the number of people with veto power over a randomized controlled trial. I could go on, but I’d rather not spend too much time on what can be refuted by a single sentence: “Write your own damn book”.

Written by Vinay Prasad, 2020

• A brief overview of the past, present, and future of capitalism by a Serbian-born and formerly World Bank-employed CUNY professor Branko Milanović, who specializes in income inequality.
• Some parts hit closer to home than others, most of all the idea that you can have a welfare state, and you can have open borders, but that mixing the two is ill-advised. I am also well-acquainted with America’s indirect and informal immigrant tax, a version of which Milanović proposes as one of the solutions to the welfare/immigration dilemma. I am not a fan.
• His big insight before this book was the elephant chart. Capitalism, Alone’s big idea is that communism may not have been the pinnacle of society that Marx and Engels had predicted, but rather a good way of transforming feudal agrarian societies into modern economies. Centralized planning and broad-stroke changes work well up to a point, but the production chains soon get too complex for communism, at which point the invisible hand steps in.
• Second big insight: corruption is hard-wired into how a particular type of capitalism (which he calls “political”, in contrast to the Western “liberal meritocratic”) operates. This is supported by many a “liberal meritocratic capitalism” city and state, their financial services and real estate markets being dependent on the “political capitalism’s” dark money.
• It was an easy read for this non-economist. Recommended.

Written by Branko Milanović, 2019