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

• The only reason I bought and read this book was the excerpt published in the Atlantic which noted some parallels between 1990s' Balkans and 2010s', well, the world, which I was already mulling in my head. Turns out that's the best part of the book.
• The rest is uneven. Holbrooke was a slime ball of a human and his accomplishments were nil, yet Packer still manages to make the book into a hagiography. Which I guess is an accomplishment.
• Did Holbrooke truly think that his memos would change the world? In the Gervais Principle hierarchy, he was a clueless posing as a sociopath.
• Packer’s account of the Dayton negotiations confirms that the only reason a deal was made was that Milošević wanted it at any cost. The agreement was for Holbrooke to mess up, and he almost did, multiple times.
• There is mention of HBO buying rights to make a show out of Holbrooke's account of the Bosnian was. I haven't read "To End a War", but I like the idea of the Dayton negotiations being the centerpiece of a mini-series, with flash backs to each individual warlord's (and Dick's) messy history. Someone please give the idea to Damon Lindelof after he's done with Watchmen.

Written by George Packer, 2019

1. Malcolm Gladwell tries to explain the death of Sandra Bland by the way of the Hitler-Chamberlain meetings, Cuban double-agents, college student alcohol culture, an episode of Friends, and Sylvia Plath’s suicide by gas oven. Huh?
2. The pieces actually fit, and — a few abrupt interludes aside — the story flows nicely. His previous books were also stories and not scientific review articles, which people tend to forget, but this one more so than others. Which is good, since people tend to misunderstood him for a Pinkeresque academic with pop culture pretensions rather than a journalist having fun.
3. A single point of disagreement: his portrayal of Ferguson, MO police as misapplies of hot spot policing rather than racketeers rang false to my layman ears.
4. Gladwell has become a podcaster, and it shows in how the book is structured: it reads like a podcast script. I haven’t listened to the audio version, but this may be the one case of a non-fiction book that is better listened than read.
5. But if you don’t have the actual book, you won’t get to read the extensive notes, on of which directly refutes a whole chapter of Blink. Another is an excellent parallel between indiscriminate police searches and cancer screening tests. Too bad he didn’t use actual footnotes (but then people would also complain, see no.2).

Written by Malcolm Gladwell, 2019