This morning’s story in The Washington Post on a slow-rolling climate disaster has this as the subtitle:

Maryland’s iconic Smith Island faces one of the nation’s most dire forecasts for rising seas, but real estate is booming

In the story we learn that the “booming” real estate market means that

More homes have sold on Smith Island in the last three years than in the previous 11 combined, according to sales data.

…

Woutila and Pueschel lived in the Baltimore suburbs for years, but she always dreamed of living on a sailboat and he of owning waterfront property. As they scouted real estate listings, they hit upon a marshy plot in the middle of the Chesapeake: Smith Island.

Waterfront homes run roughly from $100,000 to $200,000 — far less than most spots on the mainland — so it was one of the few places that fit the couple’s budget. In comparison, a two-bedroom condo on the water in Annapolis recently sold for $530,000 and a small home near a dock in Shady Side, Md., went for $360,000.

Framing is everything: a journalist’s “real estate boom” is a thinking person’s exodus.

Suitcase words are imprecise, mealy-mouthed pieces of verbal dreck whose purpose is to rouse emotion while masquerading as vectors of information. ⊕ Yes, yes, this is itself an emotional reaction, and they can indeed be useful — follow the link to read how and why — but most suitcase words are useful for thought and dialogue in the same way that semi-automatic rifles are useful for pest control: caveat usor. Oncology is full of them — from immunotherapy to survival — but all examples I encountered there came to me fully packed, zippers bursting, ready to confuse. Live long enough, however, and you will see a suitcase word being formed in front of your eyes as you stare in horror, incapable to do anything but mourn the sacrifice off a perfectly adequate concept to the gods of sophism.

Take “gaslighting”. The term — this may be common knowledge by now, but it is worth repeating — comes from the 1944 American movie Gaslight ⊕ Or maybe the 1940 British movie, or the 1938 British play — who knows? in which the husband of an heiress drives her insane by way of psychosocial manipulation — Wikipedia’s example is his secretly dimming and brightening the indoor gas-powered lighting but insisting that she is imagining it, making her think she is going insane. Note that there are three aspects to the original gaslighting:

1. The manipulator originates the stimulus that is to be misinterpreted;
2. The manipulator questions the victim’s initial interpretation, despite agreeing with it, or knowing it to be correct;
3. The manipulator’s intention for doing this is to “drive the victim insane”, i.e. question everything else about their reality.

And let’s all agree that intentionally pushing someone into psychosis is a very bad thing indeed. The emotional reaction to the action of gaslighting is therefore deservedly negative, more so than plain old lying, bulshitting, or scheming for a different purpose.

The first aspect of gaslighting dropped off early on. The very first mention ⊕ The link is to the Internet Archive version of a most excellent writeup on its etymology, now behind a paywall. of the term as a verb went “It is also popularly believed to be possible to “gaslight” a perfectly healthy person into psychosis by interpreting his own behavior to him as symptomatic of serious mental illness”, which eliminated number 1 but strengthened the criteria for number 2: to be the gaslighter you should not only question the interpretation, but you yourself should interpret it as a sign or symptom of breakdown. Undeniably bad! And for decades the word lived quietly in psychotherapy circles as a helpful shorthand for a type of behavior, usually from an abusive spouse.

Then 2016 happened, and everyone is gaslighting everyone else: politicians are doing it to their voters, doctors to their patients, and parents to their children, when in fact what they are doing, respectively, is bulshitting, misdiagnosing, and following guidelines you don’t agree with.

And all this is in writing, supposedly the more formal of the methods of communication. In everyday speech, gaslighting gets thrown left and right for any behavior with which people disagree, and has become a stand-in for lying, bullshitting, or just plain old making me feel bad. Note that in each case you can see a kernel of a connection with actual gaslighting — usually it is the questioning part — but the supposed gaslighter’s questioning is genuine, and/or the intent behind the questioning is — possibly misdirected but also genuine — care for the wellbeing of their “victim”.

So, whenever I hear or read the word now I have to stop, think, and unpack it. What is the actual process it is trying to describe? Would a different word better describe that process without implying things that aren’t true? ⊕ All good things to do when encountering any suitcase word. This is why I am slightly skeptical of speed reading. Did whoever (mis)used the word know its original meaning and broaden it to creatively express themselves, or did they have an agenda? Dismissing any argument which uses it would be the easy thing to do, and as most easy things also wrong: while its imprecise use may make me think slightly less of the person using it, they may still be making a valid point.

None of this is news: therapists have raised concerns about the misuse of the word and explained the issue much more eloquently than I just did, but also not as concisely, so if this piqued your interest this article quoting a few of them would be a good next stop.

Martin Gurri, a Cuban-born CIA analyst turned “public intellectual”:

And for those of you who love to sneer at “consumerism,” let me repeat a story I have told before. A Cuban woman, a recent refugee, entered a supermarket in Miami and proceeded to burst into tears. Surrounded by such a dazzling display of goods, her heart broke, she said, when she thought of the people she had left behind in Cuba, who had so little.

But, why do the people in Cuba have so little, Martin, why?

Snark aside, his perspective on being an immigrant to the United States is close to mine; the entire column is worth your time.

Vulture: Spider-Verse Artists Say Working on the Sequel Was ‘Death by a Thousand Paper Cuts’:

“Phil [Lord] does have good ideas. He speaks creatively really well, and listening to Phil can be inspiring. But the process is not inspiring.”

Sure, if it were that easy then everyone would do it, but there are no excuses for making people around you feel tiny.

I have always admired prolific writers like Matthew Yglesias and Scott Alexander — both now on Substack, and not by accident — for their ability to produce tens of thousands of words daily, ⊕ My admiration being tampered somewhat by ChatGPT and other LLMs, which are about as intellectually and factually rigorous as Alexander, and slightly less so than Yglesias; some sacrifices do have to be made in the name of productivity. on top of the random bite-sized thoughts posted on social media. There are only so many words I can read and write in a day, and for the better part of the last year, my language IO has been preoccupied by helping clean, analyze, interpret, and write up the results of a single clinical trial, which are now finally out in The Lancet Neurology. ⊕ Yes, my highest impact factor paper to date is in a neurology journal. Go figure.

The paper is about our clinical trial which used the body’s own immune system to treat autoimmune disease — and a particular one at that, myasthenia gravis — via technology that up until now has only been used against cancer (CAR T cells). It has made a decent impact since it came out less than two days ago. It got a write-up in The Economist, for one. Endpoints News as well. Evaluate Vantage got the best quote — it is at the very end of the article. And there is a whole bunch of press releases: from National Institutes of Health, University of North Carolina, Oregon Health and Sciences University, and of course Cartesian Therapeutics.

What went on yesterday reminded me that Twitter is not going anywhere any time soon: all of the above releases were to be found only there, not on a Mastodon instance, the journal’s own media metrics do not — and can not, at least not easily — trawl the Fediverse for hits, and I can’t just type in “Descartes–08”, “myasthenia gravis CAR-T”, or “Cartesian” into a Mastodon search box and get anything of relevance. ⊕ One could, of course, argue that you wouldn’t get anything of relevance on Twitter either, most of the discussion consisting of people who have barely read the tweet, let alone the article. And one would be correct. And while most of the non-Web3/crypto tech world has moved out, it looks like people in most other fields, from medicine to biotechnology to the NBA commentariat, are maintaining substantial Twitter presence.

This will, of course, have no impact on my commitment to staying out of the conversation to the extent possible while maintaining a semi-regular schedule of 500-character posts, which may now, IO bandwidth having opened up, become a tiny bit longer. Thank you for reading!

Chris Arnade’s travelogue from Senegal (Part 1, Part 2) is well worth your time, especially if you can also spare a minute to read Tyler Cowen’s notes from Kenya and a Masai village. To put the two in (somewhat uncharitable) contrast:

This past weekend there was a conference at the fanciest resort in Dakar, the one with its own golf course. The title was something like, “Solving all of Africa’s problems, 2023!” and representatives of various global non-profits, charities, and NGOs were flown in to spend four days talking about what Africa needs. Presumably something only they and their friends can offer.

Verus:

Kenya Is Poised to Become the ‘Singapore of Africa’

Tyler Cowen had a “fireside chat” about Effective Altruism. Every trade conference I go to has “fireside chats” with “industry leaders”.

The fireside chats were a series of evening radio addresses given by Franklin D. Roosevelt, the 32nd President of the United States, between 1933 and 1944. […] On radio, he quelled rumors, countered conservative-dominated newspapers, and explained his policies directly to the American people. His tone and demeanor communicated self-assurance during times of despair and uncertainty.

Gotcha.

Washington Post’s Katherine Ellison on the striking decrease in mortality from lung and breast cancer in the US:

There are many and varied explanations for the progress, says Memorial Sloan Kettering oncologist Larry Norton, including “better early diagnosis, better imaging, better blood tests, better preventive measures and better treatments, including precision medicine with gene-profiling of patients’ tumors.”

The rest of the article focuses on treatments — immunotherapy in particular — ⊕ And yes, of course dostarlimab was mentioned. Once a darling, always a darling. and cancer survivorship, but in discussing decreasing deaths from lung and breast cancer the article missed an opportunity for some education in cancer epidemiology.

The two sources chosen to present these data, ASCO’s cancer.net for lung and Breastcancer.org for breast are lacking in two ways: they are an impenetrable wall of text without much context, and they both have an agenda. Now, it happens that I agree with ASCO’s agenda — I am a dues-paying member — and don’t know enough Breastcancer.org to form an opinion, but neutral parties they are not. If only there was a tax-funded, publicly available database which could help us visualize trends in cancer statistics.

Now it so happens that the CDC maintains such a database, with its very on visualization tools, and it is exactly what we need. It will even make your PowerPoint slides for you! And yes, deaths from both lung and breast cancer have been steadily decreasing for the past two decades.

But is it because of better prevention, early diagnosis, more effective treatments, or all three? Looking at cancer incidence — the number of newly diagnosed cases per year — may help some. Better prevention would lead to decreased incidence, early detection would lead to an increase, a combination of the two may cancel each other out leading to a flat line, and any change in treatments would not affect it at all.

A slight initial dip in female breast cancer incidence followed by an even slighter increase make me think that early detection — all those mammograms — is superimposed on better prevention. The case is less ambiguous for lung cancer: the incidence is plummeting. In both cases, “prevention” was initiated by the 1964 Surgeon General’s report on tobacco smoke which led to massive anti-smoking campaigns from the 1970s onwards. The results weren’t immediately obvious — not having to air out all your clothes after a night out notwithstanding — but cancer rates started dropping after 20 years, and 50 years later we are reaping the full benefits.

Note that in lung cancer the mortality slope is steeper than the incidence slope. And while this may be explained by early detection and better treatments, it is possible that at least some of the improvement over newly diagnosed lung cancers is due to non-smoking associated lung cancer being generally less aggressive and occurring in younger and healthier people than tobacco-associated cancers. What could help unravel these different components — and highlight the increasing importance of cancer survivor healthcare — would be a prevalence curve: how many people in the United States are currently living with a particular cancer. Alas, those data are not available.

If you thought interpreting those four curves was interesting, do go back to the CDC database and check out the incidence and mortality curves for thyroid cancer — that poster child of over-diagnosis — and prostate cancer, the incidence of which fluctuates ever which way with changing screening recommendations but with mortality marching downwards for the last 20 years.

You won’t see me link to ESPN too many times, so enjoy (emphasis mine):

“If you want to be a success, you need a couple years,” Jokic said after Monday’s title game. "You need to be bad, then you need to be good, then when you’re good you need to fail, and then when you fail, you’re going to figure it out.

“There is a process – there are steps that you need to fill – and there are no shortcuts. It’s a journey, and I’m glad that I’m part of the journey.”

This is, of course, true in absolutely every field of human endeavor, but in too many of those fields any failure, let alone failing repeatedly, is just not an option. And we are all worse for it.

Writes the Washington Post:

Fein was rehired by one of his clients, who wasn’t pleased with ChatGPT’s work. But it isn’t enough to sustain him and his family, who have a little over six months of financial runway before they run out of money.

Now, Fein has decided to pursue a job that AI can’t do, and he has enrolled in courses to become an HVAC technician. Next year, he plans to train to become a plumber.

“A trade is more future-proof,” he said.

CGP Gray’s Humans Need Not Apply video is eight years old, but has never been more relevant. Leaning towards a profession more rooted in the physical world is a good instinct to have, for now.