To all trainees who are smart and lazy: no, you are not getting away with it. Sure, you can creatively avoid responsibilities on your way to graduation, but it will burn many more bridges than you realize. Your teachers aren’t stupid.

Samuel G Rodriques ⊕ If you were looking for his blog’s RSS feed, you won’t find one listed. Thankfully, NetNewsWire was able to dig up the url. is an inventor, entrepreneur, and author of my favorite blog post so far this year:

Serious drug developers have long since learned not to trust animal models when it comes to predicting the efficacy of a treatment for most diseases.

And also:

There is a phenomenon that all biologists will be aware of, where after working on a new idea for 2 years, you one day come across a paper from 2008 and say, “oh my god, if only I had known this two years ago.” If we want biology to move fast, we need to figure out how to eliminate this phenomenon.

And:

In biology, until recently, it seemed like everyone wanted to be a professor or start a company, i.e., that the only high status thing you could do after your PhD was to become a manager.

Not sure I agree with his prescriptions, but the diagnosis is right!

Fad of the day: Longtermism.

Longtermism is an ethical stance which gives priority to improving the long-term future. It is an important concept in effective altruism and serves as a primary motivation for efforts to reduce existential risks to humanity.

This is how you reduce existenal risks to humanity: avoid ruin. The rest is gobbledygook meant to dazzle venture capitalists and other sources of funding.

…is $1.5 million.

A few days ago, The Washington Post wrote about two medical students who are also identical twins being accused of cheating. Their school, the Medical University of South Carolina, apparently doesn’t have anyone on staff who is both versed in statistics and willing to participate in an investigation. Enter paid consultants:

The university sent their test scores to a data forensics company, Caveon, which reported that the chances of two tests that similar being completed independently was “less than a person winning four consecutive Power Ball drawings.”

Invocation of forensics is the first red flag (see: Calculated Risks by Gerd Gigerenzer). Comparing any real-life probability ⊕ Rule of thumb: if what you are doing professionaly made it into xkcd you should stop doing it. to lottery is the second. The uncertanty of real-life probabilities has little to do with known odds of games of “chance”. Confusing the two leads to the ludic fallacy, or “misuse of games to model real-life situations”. Nassim Taleb, The Black Swan, 2007.

The twins, now lawyers, sued and won the said $1.5M. Good for them.

If you would like to hear more about what I’ve been up to professionally for the last year or so — and maybe learn something about cellular therapy for autoimmune diseases — this 30-minute webinar organized by the Myasthenia Gravis Foundation of America may be of interest.

OpenAI’s new chatbot produces paragraphs of text indistinguishable from what you can find in newsletters, blogs, or college essays. It even does (mediocre) poetry and regex.

Halloween came a month late this year.

Alan Jacobs about Amerian health-care, or what passes for it:

I think the first thing to understand about the American health-care system is this: some people lose money from illness, and some people make money from illness. Some people pay, and some people get paid.

…

I don’t think there are many doctors who consciously make medical decisions based on their lust for money. But I do think there are a great many doctors who go along with the incentives established by the system, without thinking about it too much or at all, because on some level they know that thinking about it could well lead to their losing money.

Of course, most people getting paid from the illness of others are not the doctors, the nurses, or the pharmacists. In fact, outside of lucrative procedure-based specialties — and there aren’t as many of those as a Top Docs glossy would make you think — most doctors, certainly most of those who deal with chronic medical conditions, have no idea how much treatments and tests they order actually cost.

This is, in fact, not a feature but a bug of the system, and one of its main ones. Most doctors work not for their patients, but for amorphous “health systems” graced with all the charm and efficiency of a lumbering bueracracy. They, in turn, deal not with the patients directly, but rather with medical insurance companies or, worse yet, “benefits managers” who insert themselves as mediators nominally there to simplify the process but instead further increasing its complexity. And presto, you now have a series of matryoshka dolls each doing its part to create the mother of all principal-agent problems.

Should the patients' perspective be the primary consideration in improving American health-care? Absolutely! But lets not fool ourselves into thinking that the mess we are in is due to doctors' priorities overwhelming everyone else’s.

Niall Ferguson in one of last year’s Conversations with Tyler:

The epistemic problem, as I see it is — Ian Morris wrote this in one of his recent books— which is the scenario? Extinction-level events or the singularity? That seems a tremendously widely divergent set of scenarios to choose from. I sense that — perhaps this is just the historian’s instinct — that each of these scenarios is, in fact, a very low probability indeed, and that we should spend more time thinking about the more likely scenarios that lie between them.

This is bananas thinking! ⊕ Probability space replacing the river in this well-known Talebism. If the probability space is 4 feet deep on average you don’t just wade into it as if every part is just 4 feet. You need to know the variance, and from Ferguson’s own telling it goes from unlimited upside to complete ruin.

Worse yet: Ferguson is confusing improbable with the impossible. ⊕ And also hasn’t heard of ergodicity, again courtesy of Taleb. Given a long enough time span, an extremely low-frequency event is a near-certainty. If you don’t believe me, how about a game of Russian roulette?

Is it because Ferguson is a historian? Everything he encounters professionally would have ex post likelihood of 100% so probability theory may not be his area of strength. Don’t ask a historian for predictions, I guess.

Prof. Devi Sridhar in The Guardian about the epidemic of missed cancer cases:

Early [cancer] diagnosis is important because it improves survival outcomes. In England, more than 90% of people survive bowel, breast and ovarian cancer for at least five years if diagnosed at the earliest stage. This allows treatment to start earlier, before the cancer has spread through the body. Yet even with a cancer diagnosis, the NHS is struggling to provide treatment within the current 62-day target time: 36% of patients waited longer than 62 days in England, 21% in Scotland and 43% in Wales. The main bottleneck is staff shortages, which the Covid-19 pandemic has made more acute. Again, this points to the need for investment in the NHS – in not just infrastructure, but also the workforce.

Prof. Sridhar is chair of global public health at the University of Edinburgh so I was surprised to see her make a basic error in epidemiological reasoning. “Early cancer diagnosis is important because it improves survival outcomes”, the paragraph begins, citing not original research but a comment in The Lancet which, yes, is a prestigious journal, Impact factor 202.731, which is ridiculously high. but calling on comments to back your claims without primary literature are level 0 data.

The Lancet article ⊕ There is a story here about going down rabbit holes due to poor citation practices — I once spent two days hunting for the primary reference to a single sentence for a letter in a journal nobody reads — that deservs a post of its one. One day., “Earlier diagnosis: the importance of cancer symptoms” does refer to a 2015 systematic review of 209 studies in the British Journal of Cancer — not as prestigious, you’ll notice Impact factor 9. — whose main conclusion was that the studies were of such varying quality that “Heterogeneity precluded definitive findings”.

The authors did speculate in the conclusion that they “believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers”. Which, fair enough, but: number one, that’s just like, your opinion, man; and number two: there is already a plethora of data about lead time bias fooling you into thinking your early detection prolongs survival when in fact all it did was make the person aware they had cancer for longer without making an iota of difference on when and of what they would die. ⊕ I base this claim purely on personal anecdote, where people “cured” of their lymphoma were reluctant to get a mammogram — a possible side effect of chest radiation — so they wouldn’t have the aura of cancer hang above them once again. Since this is a situation for which we know that when the cancer does occur, a so-called “secondary malignancy”, it is more aggressive than usual, they ended up doing it, and good for the patient! Yes, there are people who would rather know, but a good proportion — as this is a blog post and not a commentary in The Lancet I am going to allow myself some speculation here — possible more than half would rather not!

So what is going on here? Surely the chair of global public health at a well-known university knows about the lead time bias? The last three years made me question jumping to that conclusion right away, but let’s give some benefit of doubt. The key word here, I’m worried, is public health, a blunt-force instrument which does away with nuance in favor of broad if not deep messages and interventions. Sometimes these are terrifyingly successful: witness the eradication or near-eradication of infectious diseases, or my favorite — plummeting smoking rates in the United States after a public campaign and a flurry of lawsuits that saved more lives than all statins and chemotherapeutics put together. But the dangers of oversimplification are real, like the crusade to ban saturated fats in favor of simple processed sugars backfiring spectacularly. Caveat audiens.

So anyway, that’s why I don’t read newspaper coverage of medical matters, opinion pieces, or The Guardian.

In the late 1700s, America’s founding fathers had a fight over the best treatment for yellow fever, then sweeping though Philadelphia. Republicans preferred bloodletting and purges; Federalists took a more conservative approach.

If it’s any consolation, the country survived.