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.

Are these the two Americas everyone keeps telling me about?

Writes Kate Lindsay in The Atlantic:

Today’s teens are similarly wary of oversharing. They joke on TikTok about the terror of their peers finding their parents’ Facebooks. Stephen Balkam, the CEO of the nonprofit Family Online Safety Institute, says that even younger children might experience a “digital coming-of-age” and the discomfort that comes with it. “What we’ve seen is very mature 10-, 11-, 12-year-olds sitting down with their parents, going, ‘Mom, what were you thinking?’” he told me.

This is exactly the kind of scenario I had in mind when our now-almost–11-year-old was just born. It took a tiny bit of convincing, but neither I nor my spouse had posted any baby photos since then; who knows, the lack of dopamine hits may have contributed to neither of us having much of a presence on Facebook or Instagram.

And before I start patting myself on the back, there are of course negative consequences in that old friends and distant family members back in Serbia probably have no idea what any of our children look like, thereby lessening their psycho-social connections, etc. But that is something a visit or two to the old country will, hopefully, heal.

The first article I ever saved to Instapaper — 11 years ago, three years after it was created and quite some time before it turned into my personal graveyard of text — was AOL Hell from the now defunct The Faster Times The link is to the Wikipedia entry which, strangely, says that as of February 2018 the url belonged to someone in Serbia. An odd coincidence.. The titular hell is the one AOL created for the employees producing content for its text mill. Writes Oliver Miller:

My “ideal” turn-around time to produce a column started at thirty-five minutes, then was gradually reduced to half an hour, then twenty-five minutes. Twenty-five minutes to research and write about a show I had never seen — and this twenty-five minute period included time for formatting the article in the AOL blogging system, and choosing and editing a photograph for the article. Errors were inevitably the result. But errors didn’t matter; or rather, they didn’t matter for my bosses.

This is, in fact, why AI will destroy the Web as we know it. And if you have any doubts about the outcome of Large Language Models being set loose on the internet, well, AOL wanted to do it even before it was trivial, destroying a few humans in the process:

The document reveals the same attitude that the bosses at the old Ford Motors factory had, when the assembly line was first introduced. Every week or so, the assembly-line was sped up; incrementally, barely noticeably, but the increase had a staggering, cumulative effect, and soon, those workers who couldn’t keep up found themselves standing by the wayside. If AOL could find a good way for machines to write about Lady Gaga, they would almost certainly fire the writers who remain.

They now have the machines, folks… They have the machines.

Mr. Miller can now be found on Medium, writing poetry.

And in some positive news — can you imagine those still exist? — the US Food and Drug Agency has issued their draft guidance on decentralized trials (PDF download). America is playing catch-up with the UK in this regard, but better late than never!