• David Li: lots of discourse on here recently on how to get FIH clinical data in US cheaper, faster, and more competitively with China. “One thing I have not seen folks talk about, which to me is the most obvious, is - wait for it - the intense competition that breeds insane levels of hard work in China.” From a clinical trial perspective, let’s not forget how receptive the audience is to clinical trials, and how deferential to the doctor/investigator’s opinion. (ᔥRuxandra Teslo)
• John Collison: Dave Ricks has been at @EliLillyandCo for 20% of its 150-year history. He came to the pub, poured his own Guinness, and gave us a 2-hour state of the pharma union. Fear not, there is also a YouTube video of the conversation.
• Michael Eisen: Needed a word, so I coined one. The word is chrysotactic — being drawn to gold, wealth, luxury, etc. — which is derived from Greek but I have to say that the Latin aurotaxis has a better ring to it. You will never guess to whom it relates.
• David Weigel: How Elon Musk’s Changes to X Made Our Discourse Far Stupider. This is not on X but rather an article in Talking Points Memo and I completely agree. And yet, people worth listening to continue using it and as long as that X is the only place where they write I will continue to follow. Perhaps.

• Cal Newport: Forget Chatbots. You Need a Notebook. Yes, Cal, if you are a maths professor working on a proof. I love putting my fountain pen to paper as much as anyone but they are not sufficient for any of the hats I wear.
• Eric Topol: Multilingualism and Extending Healthspan. Another thing I should nominally be for as it is positive reinforcement of my own (two languages) and my children’s education (3+ and counting), but no matter how many potential confounders these researchers adjusted for I am absolutely convinced that there are residual confounders behind these results. Learn languages for their own sake, not to “prolong healthspan” or to — what this study actually checks for — make some proteins in your blood go one way instead of another.
• Ezekiel Emanuel at al for the NYT: Make Medical School Three Years. Here is a statement I could get behind provided there is adequate rationale — that undergrad premed is sufficient for basic science knowledge, that it is essential to attain practical skills during postgraduate education as early as possible, that the fourth year of medical school is pure formality of one low-stakes elective after another since most students will have already matched. But no, the rationale here is financial, and that is purely idiotic. The high tuition is taken as a given and all steps stem from there. The authors should check their premises.

• Ruxandra Teslo: What will it take for AI to change drug discovery?. Producing boatloads of hypotheses won’t be enough, and would even set the field back. Good stuff. Again, China is eating America’s lunch here so something better change, and soon, but it is unlikely LLMs will be of immediate help.
• Chris Arnade: Asian style materialism. And if you think, well, maybe it is time for one civilization to sunset so that another one will rise, observations like Arnade’s should make you pause. The culture there seems rather bleak. And I consider him a rather impartial observer.
• Sarah Kliff for the NYT: The ‘Worst Test in Medicine’ is Driving America’s High C-Section Rate. It is about fetal HR monitoring, a particularly salient topic right now. It seems to be the Swan-Ganz catheter of obstetrics, thankfully much less invasive.
• Anish Koka on X: In the wake of the hubbub on novel promising gene therapy approval for Huntington’s disease, this video on the Sarepta debacle is a must watch. Can’t be… I am sure that everything was on the up-and-up.

• June 25, 2024: Inside the controversy over FDA’s recent gene therapy approval
• July 18, 2025: Analysts demand transparency after Sarepta’s roundabout disclosure of 3rd patient death
• July 18, 2025: FDA Requests Sarepta Therapeutics Suspend Distribution of Elevidys and Places Clinical Trials on Hold for Multiple Gene Therapy Products Following 3 Deaths
• July 30, 2025: Prasad Resigns From Top FDA Post Amid Fallout Over Sarepta Dispute.
• August 7, 2025: The Sarepta Scandal: Laura Loomer, Vinay Prasad, and the history of pharma’s latest attempt to reassert control at Trump’s FDA
• November 3, 2025: Sarepta’s Duchenne confirmatory trial fails, but biotech will ask FDA for full approval anyway

All this for drugs that cost millions of dollars per dose from a company with $2B in revenue. Neutral people in the know have their opinions too. Know me by my enemies indeed.

• Rusty Guinn: Conjuring Consent. Is ignorance, malice or cynicism behind ICE’s attempts to co-opt Lord of the Rings into their anti-immigration narrative? I would say it’s their propensity to bullshit, which matches Guinn’s cynicism take. See also: Guinn on the “woke right”.
• Neil Armstrong for the BBC: Slow Horses: The anti-James Bond that gets to the heart of Britishness. Written last year just after Season 4 started, but seeing as Season 5 was even better it is truer than ever.
• Tanner Garity: Kurt Vonnegut’s Advice for Making the Most of Your Day. Read this only for the exceptionally relevant story from Vonnegut’s 1995 interview with Inc., which isn’t the primary link because it lies behind a paywall. A Vonnegut quote from that interview: “The information superhighway will be two lanes loaded with tollgates, and it’s going to tell you what to look for.”
• Oliver Burkeman: You have to do the living yourself. In which Burkeman answers the question of “Isn’t there something I could do, some rule I could follow, such that if I obediently followed the rule, I wouldn’t have to show up for life, in all its uncertainty and riskiness and intensity, in quite such a full-on way? So I could sort of hang back, hide out, and take things a bit easier instead?” and of course the answer is no.

• Nassim Taleb breaks with Russ Roberts. I learned about EconTalk from Taleb, after he wrote it was the only podcast worth participating in as a guest. The two haven’t had any public exchanges in two years so this was not much of a surprise. I continued listening to EconTalk, though with mixed feelings.
• A podcast on AI and medical progress. It is four hours long and I have no time to listen but I may run the transcript through an LLM to get a summary and a false sense of knowledge and understanding.
• Where are the Mozarts of our time? On one hand I agree that too much of the “top talent” is “wasted on writing algorithms to move trades a quarter of a thousandth of a millisecond faster.” On the other hand, isn’t Lin Manuel Miranda the Mozart of our time?
• Why are doctors less respected? Because “optimizing performance” and “curing disease” are two different things entirely, and you can’t do both while also acting as the nanny nagging about car seats, guns in the household and other matters which have much to do with well-being but nothing with disease.
• What happened to Harvard? This is so confirmatory of everyone’s worst fears about the Ivy League schools that I remain skeptical.

• Kyla Scanlon for the NYT: It Is Trump’s Casino Economy Now. You’ll Probably Lose. Left unsaid is what fuels it: the self-reinforcing duo of greed and envy.
• Lily Lynch: The Curtain Falls on Aleksandar Vučić’s Foreign Policy “Balancing Act” I wish I could consider this good news. Alas, “king” Aleksandar’s reign was full of pathos and drama tinged with blood, so it is hard to see its end being any different.
• The anonymous person behind “Applied Divinity Studies”: Peter Thiel and the Antichrist. A brief defense of Peter Thiel including zingers like “Since technology can progress, it may eventually become powerful enough to kill everyone. But a force capable of regulating this technology would be at least as powerful, and stagnation comes with its own dangers”. What dangers, the essay doesn’t say. I suspect the biggest one is to Mr. Thiel’s pocketbook.
• Ernie Smith: The Sky Is Falling, The Web Is Dead. A deep dive into one analyst’s history of making false claims. Motivated reasoning is a powerful force, particularly when the motive is money.
• Daniel Kolitz for Harper’s Magazine: The Goon Squad. A scary story about a particular corner of the Internet. Warning: there are some graphic depictions of despair that may be distressing for people who have children and now have to worry about protecting them from the bottomless pits of porn. Make no mistake that this, too, is fueled by greed.

• Kaitlyn Tiffany for The Atlantic: A ‘Death Train’ Is Haunting South Florida. Dream of the next generation of railway turns into a bloodbath because Americans forgot that train tracks at grade level with other traffic is bad bad bad. So bad that Robert Moses tore down half of New York to fix it. But that was almost a century ago and we are a forgetfull species. (ᔥTyler Cowen)
• Tim Urban: Tales from Toddlerhood. An accurate account, and a particularly salient one for me right now. If you think the second baby gets ignored relative to the firstborn, wait until number three comes along. The main character syndrome of the oldest siblings is real (at least to those of us who are not).
• Lisa Woodley: The Year I Left Design. What happens when you let your career drift, and how to get it back on track. Applicable to more than design. (ᔥGina Trapani)
• James L. Olds: “What Grant Reviewers Actually Look For (and What They Ignore)”. He recommends storyboarding your grant proposals. I would trust his advice, but I also — and please don’t interpret this politically — get the urge to burn that system to the ground because it is a narrative fallacy-producing machine.
• Derek Lowe: mRNA Vaccines and Immuno-oncology: Good News. It seems that LNP-encased mRNA by itself, regardless of what it encodes, may imrove efficacy of immunotherapy for cancer as it “stirs up” the immune systen. Big (and indeed good!) if true. But Lowe ends the post, as he did many of the prior ones, with a tirade against the current HHS, NIH and FDA leadership for spreading doubts and fears about mRNA research, forgetting that (1) much of those doubts and fears were about “overstimulation” of the immune system and the related side effects, such as myositis, which the above (positive!) findings further stoke, and (2) the original mRNA research famously never received NIH funding and was indeed “fringe” science. There is raising of legitimate concerns and then there is performative posturing and Lowe’s writing has shifted firmly to the latter.
• Nick Maggiulli: All the Money, None of the Satisfaction. On people continuing to be stingy even after being firmly in the top 1% of income and wealth. I have recently heard a billionaire-several-times-over unironically start a sentence with “If I had money…” so I can confirm that this is a real phenomenon and some may indeed say that the reason they are billionaires is such a mindset, while the hoi polloi drink their $12 frapuccinos. And if those who can afford such beverages are the hoi polloi, what are the people who can not?

• From Ruxandra Teslo, a story of early retirees having to come out of retirement. I am not shedding tears.
• From an anonymous friend, a very good podcast with Dan Wang.
• From a West coast scientist, a commercial genetic test that can predict an embryo’s IQ. To be clear, I do think this is a test of intelligence but not in the way the company intended: their idea is moronic.
• From geneticist Sasha Gusev, an agreement about the above.
• From Brian Potter of the Institute For Progress, an excerpt from his book “The Origins of Efficiency” which clarifies why it costs more to repair things than to buy new ones. Surprisingly, he thinks this is good and wants to efficientize even more things!

• Adam Cifu: Goodharts Law and Medical School Admissions. A significant contributor to scientific slop is “research output” as requirement for fellowship, residency, and even medical school admissions. And yes, I am also a fan of the law.
• Paul Teirstein for WSJ: The Gatekeeper Driving Doctors From Medicine. On board certification, which now seems to have some powerful enemies so consider me conflicted.
• Jonathan D. Cohen and Isaac Rose-Berman for NYT: Gambling. Investing. Gaming. There’s No Difference Anymore. “There should be a line of separation,” Alexander Hamilton [wrote] in 1792, “between respectable stockholders … and mere unprincipled Gamblers.” As a side note, it is incredible how much sports betting has exploded in the 15 years I’ve been in the US. One of many ways America is looking more and more like Serbia, where seedy gambling outposts are now more common than grocery stores.
• Brian Potter: More on US Pedestrian Deaths. An update of a previously linked-to post, which raises more questions than answers. Allow me to be somewhat conspiratorial: could worse hospital care combined with increasing organ donation contribute to this increase? There have been 3,200 more pedestrian deaths in 2023 compared to 2009 and 8,393 more deceased donor donations according to OPTN. And then there is this.