As heard at the NIH IRB retreat, which I sadly had to miss:

“For the incredible gift of looking at the most chaotic study designs and effortlessly deciphering their hidden meaning, this goes to Milos Miljkovic!”

Not into sharing accolades here, but I’m super-proud of this one.

A few days ago I wrote about a decade-old medical experience with parallels to modern tech. Today I have a recent story from home with parallels to medicine.

We have an indor fountain in our fancy new home, ⊕ [Note: The story of how we ended up in a house some two levels of fancifullness above our needs and wants deserves a separate post, maybe a whole series of posts. ] a thin slab of rock over which water runs in a smooth sheeth.

Problem one: when the water tank is full the fountain is nearly silent. In the dry Colorado air, it is full for a day or two at most, after which it becomes an increasingly annoying drip-drip-dripapalooza.

Problem two: you can’t fill a fountain with plain tap water, unless you want to clog the pipes with sediment. No, you need it to be deionized, at least aquarium-grade, preferably distilled.

Problem three: the only place that will refill a 3 gallon bottle of deinozed water near us is Whole Foods, which during my time in the US went from the third great Wonder of Capitalism (Costco being number one, TJ’s number two) to a soul-sucking dump. I was not about to make twice-weekly trips to Whole Foods a family ritual.

So, we got ourselves a home deionizer that hooked up to our laundy room’s faucet and produced 3 gallons of fountain-ready water — along with around 4 gallons of waist water; it is not a terribly efficient system — in about 45 minutes and at fractions of a penny per gallon. Waste tube goes into the sink, output tube goes into the 3 gallon bottle. What could go wrong?

Well you could leave it unattended for too long is what could go wrong, and it did, I did, within a few weeks of my installing it. One moment you are turning on the laundry room faucet before dinner thinking the length of an evening family meal is just enough for the bottle to fill up, the next you are sitting at your computer finishing up slides for next day’s lecture when you are startled by your wife’s loud, anxious, not really panicked but certainly urgent question from two stories down of why there was water drip-drip-dripping from the recessed light fixture onto the glass cooktop.

Not 10 seconds had passed from the downstairs yelp to my running to the laundry room and turning off the faucet. There wasn’t that much water on the floor, and none at all under the washer and dryer which were mercifully elevated with the tiles underneath clearly visible. However much water went over, and from the timing of everything it could have been up to 4 gallons, must have quickly found its way down under the floor, which was also the kitchen ceiling. But whatever damage there was, it had already happened. There was nothing to do but survey it, right?

Wrong. The process of surveying included climbing onto the kitchen island, as the recessed lights were right above it an inaccesible by ladder. On the island was also a stove. With a glass cooktop. Which I was very careful not to put pressure on getting onto the island, because of course the glass was fragile and not meant to be stomped on. But for one of the two lights, which ended up not being a conduit for the drips, I had to — oh so very gently — lay my knee onto the stove so that I could have a better grasp of the trim. Relieved that there was no water underneath, I quickly turned to the other one, behind me, bending my knee ever so slightly in the process, hearing a gentle click down below.

So that is the story of how our attempt to boycott MacKenzie Scott’s husband led to an $850 cooktop repair bill but — mercifully — no substantial water damage. Squint hard enough and you will also see a story of medical misadventures, chasing one fix with another for a problem of your own making until you make a critical mistake.

Like the time someone had a thyroid ultrasound to screen for cancer — please, don’t ever do this — and found a few thyroid nodules, benign under a microscope, but also a plump lymph node in the neck. That one was also biopsied, the result being some scar tissue and a piece of muscle so it may not have been as plump as the sonographer had thought, which should have provided reassurance but instead only prompted some to ask how we could tell that the person — let’s not call them a patient as there was never anything wrong with them — didn’t truly have lymphoma? I would argue that their probability of having it would be the same as anyone else’s, the suspicious lymph node being a nothingburger, but in the great game of Cover Your Ass someone else decided to scan the patients whole body, leading to a bonanza of incidental findings of the kind you would suspect to see in a 60-year-old smoker, with so many radiographic ghosts in which to stick a needle, maybe miss, maybe cause bleeding or infection.

But hey, at least we did something.

My quarterly Now page update is up. Nothing’s new and everything is, depending on your point of view.

I did it. I used overmorrow in a progress note today.

Doing my part to bring it back.

PSA: there is a word for “the day after tomorrow”. It’s overmorrow, and it’s almost 500 years old. Let’s bring it back!

And “the day before yesterday” is ereyesterday, in case you were wondering.

Remember when I mentioned paying movers was some of the smartest money you could spend. Well, I should have added paying someone to assemble large IKEA furniture, and then I should have followed that advice. Good lord…

Stress-free moves don’t exist. But for less stress, get professional movers from a reputable company, if you can afford it. Yes, packing too. Especially packing.

Yes, we have started the move today, Day 1 of who knows how many.

Here is some child-rearing equipment that we only began using the fourth time around:

Glass bottles, like Philips Avent. We used Playtex disposable liners before and now regret it: what we got in convenience was not worth the cost in money, raw materials, and potential plastics exposure. Our biggest fear going into it was having glass shards all over the house from my sleepily mishandling a bottle at 3am. But no breakages yet! These Avent bottles are quite sturdy — I would expect them to chip the kitchen counter sooner than crack — yet not as heavy as you’d expect for something so robust.

One-piece silicone pacifiers, like these from NUK. We have progressively used them less for each of our children — one gets more used to an occasional nocturnal gasp or scream as time goes on, though of course here I speak solely for myself as I know that a certain someone in our house would violently disagree — so I suspect our infant will soon stop needing his, but as he has the nasty habit of trying to put the entire thing in his mouth not having sharp plastic edges is much appreciated; not have any plastic there at all even more so.

Zip-up onesies, like you can now find practically everywhere. In years past most zippers were too uncomfortable and the risk of accident too high so we opted for snap-ons, which could be found in about equal proportion at a Babies"R"Us. Not any more: in the zipper versus snap-on wars, the zipper won handily. Thankfully, they seem a lot more comfortable, with cushioning, double zipping and what not. They are also faster to put on than snap-ons, which required figuring out the sometimes bewildering pairing of snaps.

And here are some old favorites which remain in use:

OXO bottle cleaners, like these here. They used to come in fun colors like seaweed green and teal. Alas, now that it’s mostly millennials who are parenting it only comes in gray. As a geriatric millennial, I condemn this bias against color.

The 360° sippy cups, mostly from Munchkin. Sucking liquids through a straw is for people with lockjaw or those recovering from dental surgery and most other sippy cups are elaborate ways of hiding that straw. Not these beauties, which unlike the OXO brushes above come in a million color combinations.

A large, rickety stroller, like those from Baby Trend or Graco. They are big, robust, and able to carry much more weight than those sleek metal and faux-leather vehicles I usually see around DC. They also come at one third of the price. Yes, this may have to do with the fact that it’s not our first rodeo and have long ago crossed into the zone of no fear, no embarrassment, nothing to prove.

And then there are things that are popular now but you just know will disappear in the blink of an eye. Looking at you, Snoo, you subscription-peddling, FDA-defrauding sack of technofeudalist grift.

A quarterly update to my Now page is in. For more like it, check out Derek Sivers’ nownownow.com.

In his latest essay, “How to Earn a Billion Dollars”, Paul Graham does his best impression of a condescending prick while trying to explain that it is possible to have a billion dollars without cheating. This was in response to Alexandra Ocasio-Cortez’s comment that:

There’s a certain level of wealth and accumulation that is unearned. You can’t earn a billion dollars. You just can’t earn that. You can get market power, you can break rules, you can abuse labor laws, you can pay people less than what they’re worth, but you can’t earn.

This is my interpretation of Ocasio-Cortez’s words: no one deserves to have one billion dollars of their own. You can get to them by ways both lawful — underpaying your workers, abusing labor laws, etc. — and, of course, unlawful, but you can’t earn them. Somewhere on your path to a billion, in fact in too many places to count, you will have broken a moral, ethical, personal or public standard, sold your soul piece by piece, through acts diabolical when written down and thought about for more than a moment but which tend to go down smoothly, like nothing at all, just doing regular business as taught and practiced by people like Graham. No one described it better than C.S. Lewis in his essay “The Inner Ring” and, more viscerally, in the third book of his space trilogy.

This is how Paul Graham seems to have interpreted those same words: it is impossible to have one billion dollar net worth without cheating. He then uses basic math — start with a few measly million, grow it at 93% per month, see magic happen — to show that no, it is mathematically impossible not to get to a billion with that kind of growth. The only reason you are not a billionaire is that you are not trying hard enough, not producing the magical technology that will get you to a 93% monthly growth rate. Left unsaid, for this was initially a talk he gave at the Oxford Union debate society, are the many assumptions that are to me unpalatable but to Graham either so common that they have become like water or equally unpalatable and therefore hidden deep in his hindbrain. I can’t tell which is worse.

Assumption one: growth is a universal good. Without even going into what it is that you are growing (gambling, recreational drugs, surveillance systems, etc) the easiest way to grow a thing good or bad is to provide more to the customer than what they are paying. If I gave people a dollar for every quarter they spend my growth would be through the roof! Normally you grow because the perceived value to the customer is greater than the monetary one, but we are long past that. Getting thousands of dollars worth of tokens for a $200 per month subscription is the latest iteration, but Uber did it before on wheels, as have many companies before and since. Welcome to step one of enshittification.

Assumption two: to the founder go the spoils. Well, not just the founder — spare the thought for the investor — but notice how it goes without saying that by getting the company to a billion dollar valuation it is the founder who would become the billionaire. You see in this kind of thinking one of the reasons why CEOs, board members and investors are so enthusiastic about AI: widespread implementation would absolve them of the moral injury they get by shafting their workers. Well, those who still have morals to be injured.

Assumption three: these are not, I repeat — not — shark-infested waters. The second assumption is that the workers should be happy with their salary and a few lottery-ticket options, and that only a handful of people, the founders, should get a lion’s share of the company. The third is that the financial ecosystem will let the founders keep the money. Alas, from banking and legal fees to business partners and investors claiming their share, our newly not poor founder may find herself in an Old Man and the Sea situation. This is much more common in biotech where the academic founders regularly get mere crumbs once they cede most business to people presenting themselves as the adults in the room.

Assumption four: all assets are equal when it comes to net worth. The Internet has been flush with graphic depictions of what one trillion dollars means in physical terms — even one of my favorite popular science outlets was in on it — without stopping to think whether Elon Musk actually has access to that kind of money. Founder shares are particularly susceptible to melting down once the founder starts liquidating them, so the answer is no, Musk would not be able to get his one trillion and lock them in a vault Scrooge McDuck-style. Which is fine, as long as you can buy, borrow, die, but then what have you “earned”, exactly? The right to cheap credit and no taxation?

Assumption five: to be a billionaire, you have to want it. This one is in fact the correct assumption! There are no accidental billionaires, though not for the reason you think. You can be purposeful and diligent in building a great business; alas this is not sufficient. Mr. Market won’t just hand you gobs of money after it sees what you have done, no, you have to absolutely want to be a billionaire, make those small sales of your soul, shaft the workers, avoid the sharks and buy into the lifestyle. Balk at any one of those steps and wham, even if the number of whatever tracker you use gets to ten figures you won’t stay there for long. Well, conditional on inflation being under control, or soon enough we will all be billionaires!

There are many, many people in the tech and biotech circles who could have become billionaires but haven’t, and kudos to them! They tend to be silent, but Jeff Atwood comes to mind as an exceedingly decent human being who is also unusually outspoken and kudos to him. Whether there are even more people who would desperately want to be billionaires but can’t — or aren’t yet — I cannot say for certain, though my brief exposure to the ecosystem tells me that the answer is sadly yes.