Unlike most of PKD’s work, this was my first time reading The Three Stigmata of Palmer Eldritch. I wonder what my thoughts would have been a few decades ago had I gotten to it at the same time as the rest of his novels, but now I cannot help but admire what Dick achieved and how prescient he was, yet again.

The first achievement was to do with words what Satoshi Kon did with images in all of his works, Paprika most of all. Perspectives change and timelines shift mid-sentence, delirious hallucinations become matter-of-fact reality, all without losing the reader. This is only ocassionaly done for comedy; more often, the result is horror of the Lovecraftian kind — Eldritch is right there in the title. One can only imagine what Kon would have done with this book, or with Dick’s similarly reality-bending Ubik. I am, of course, not the first person to have made this observation.

The second was to see what the religion of conumerism will bring, decades before it become obvious to everyone else: alienation, blurred reality, despair. Their physical manifestations — (a metal hand, artifical eyes, deformed jaw — are the titular three stigmata. The Man in the High Castle had religious undertones; fitting for a book of its title, The Three Stigmata… brandishes a religious foghorn.

The third, unintentional achievement, was to bring into focus what I find particularly pernicious about LLMs: I get a visceral reaction, revulsion, to its common turns of phrase. Is this not a good thing, you ask? After all, it kept me off Xitter and most of Substack, which are now inundated with computer-generated text. But no, the revulsion is there even in texts written years ago: this has to be AI, I say to myself, only to see that the article was from 2018. Much like Dick’s protagonists who keep questioning their reality and see the Eldritch stigmata in everyone and everyhing, even themselves, long after exposure to the transcendental drug which is the book’s McGuffin, I have overcalibratted my bullshit detector to find fault in the most innocuous turns of phrase.

Worst of all: am I myself now writing things that someone will mistake for AI — instead of human — slop?

The titular “it” is enshitification, particularly of the “let’s digitize everything” type.

Next year will be a full decade since my initial board certification in oncology, and with that comes another set of multiple choice questions for quarterly completion. We can debate whether ABIM’s MOC scheme is fair — I think not — but still being the law of the land, it led me to think about board prep for the first time since 2018, when I completed my hematology boards.

Being an over-preparer (as people who finish medical school tend to be), I started looking into the size and cost of ASCO-SEP “ASCO” is the American Society of Clinical Oncology. “SEP” stands for “Self-Evaluation Program”. “ASCO-SEP” was something oncology fellowship programs gave to their trainees free of charge some time during their second or third year of fellowship to get them ready for the board exam. This was less from the goodness of their hearts and more because fellowships were graded — and to the best of my knowledge still are — on the percent of their graduates who pass the boards on the first attempt. A rate lower than around 80% would raise all sorts of flags and could lead to audits, suspensions and even closures. So, mid and low-tier programs would overselect on good test takers during fellowship match season, with interesting consequences (the discussion of which is better left for some other time). and was dismayed to learn that it is no longer a physicial book published every 3 or so years which one could use as a reference, doorstop or paper weight long after passing the boards, but rather a 12-month digital subscription with no option for a print copy. You would think that ditching print would lead to all sorts of dematerialization efficiencies — no typesetting, no printing, storage, etc — that could potentially lower the price and make it more affordable for everyone. Alas, if there were any efficiencies to begin with, they didn’t trickle down to the end-user: the cost of subscription for members if $550. And did I mention it was only for a year? Enshittification in action.

ASCO’s quirky sibling is ASH, the American Society of Hematology, which publishes ASH-SAP. “SAP” is for “Self-Assessment Program”, and the fact that they chose different acronyms for the same thing tells you much about the world of medicine. It is a smaller organization with fewer members yet it managed to put out a print copy for $60 over the digital-only offering — a more than fair price for a textbook. This is not the first time ASH has been on the right side of history.

So if anyone knows anyone in the ASCO leadership, please nudge them over to the ASH approach. Maybe you can mention ASH-SAP explicitly and let mimetic forces do their magic. And if you can influence decisions at ASH, whatever you do don’t highlight that ASCO-SEP is digital-only and please don’t talk about efficiencies, lockup and similar matters lest hematologists get any wrong ideas.

iCloud on the web is surprisingly good. The only thing missing is iMessage, which should have been there instead of the never-used Invites app. It feels like it was created just to fill up that spot in the 4x3 rectangle.

AI is currently entering our civilization as a synthetic, dazzling image of a fire projected on a wall, and the tech people are saying “look, it’ll cook everything and keep you warm” as you stand wearing mittens holding a raw steak. Meanwhile, you watch those same people drown the embers of the ancestral hearth fire, around which you once gathered with your family while the chowder-pot simmered, with gallons of freezing water.

There also needs to be accountability: Sam Altman and Mark Zuckerberg should go to prison. I’m not even sure for what, but these men are clearly the kind of person the world’s folkloric traditions warn us about, demonic and hollow, a threat to the social order. We need deterrence, because right now people look up to these guys and aspire to be like them.

AI serves as a source of cheap and “good enough” intellectual and emotional labor. Since we increasingly don’t provide that stuff to each other through systems because they have been plundered by rich people, AI plays an important social role. It is to thinking and feeling what McDonald’s is to eating.

If we’re living in a crisis of loneliness, bad mental health, and plummeting media literacy, then the arts are the number-one thing that can help solve those issues.

Here is Walker’s article, and here is the Slop Tax proposal from one Mike Pepi, whose Substack-hosted blog posts are delightfully short.

After reading Apple in China and deciding to decouple from Apple, I started asking Google Gemini how to replace my favorite MacOS apps with their Linux equivalents. I have been a vim person from way back but always had Emacs org-mode in the back of mind so a replacement for OmniFocus came first. Replacing MailMate with mu4e — another Emacs addon — was a close second.

Once you learn about the Emacs hammer everything starts looking like a nail, including blog post management. My blogging tool of choice on MacOS is Daniel Jalkut’s MarsEdit, and my experience with mu4e made me think a similar approach could work with micro.blog’s APIs. Now, I know nothing about those APIs nor about Lisp, which is the Emacs scripting language of choice. But Gemini was fluent in both, so it was trivial to instruct it!

It took two tries for each of the main functions I had in mind (full text search, tagging auto-complete, quick copying of the published URL, easy image attachment) but also to get the basic look and feel right, emoji being the most challenging to implement correctly. Even with all that I spent less than 3 hours to have more or less in shape for using and sharing. The single leftover feature, drafts, I don’t use often enough to spend even a few minutes on, but I may get to it at some point.

Microbe.el is available on GitHub. Note that it is completely LLM-generated (Google Gemini) so please approach it with some caution, but also do with it as you please. Many thanks to Manton Reece for creating and stewarding micro.blog and making it as open as it is. Thanks also to Daniel Jalkut for making MarsEdit.

• Chris Arnade: What Holds America Together?

The best description of the conundrum America is in and the future of the American dream I have seen, accounting for the difference between “thin” (superficial) and “thick” culture. Good bit about immigration too:

Our tolerance for thin differences is also why immigration works better here than in other countries. That is especially true of front-row immigrants (highly educated), since they are leaving cultures they didn’t fit into at a thick level (entrepreneurial). They have self selected for being a natural American, at a thick level.

My own thoughts about and experience with immigration and the American dream match the above.

• Jessica Hullman: Living the metascience dream (or nightmare) with AI for science.

AI begets AI, as previously noted. Papers will be “safer”. Nuance will be lost. The comments to the post are just as enlightening.

• Paris Marx: Sam Altman’s anti-human worldview.

No nuance here either. Altman is so unabashedly anti-human that any of his public appearances are right out of a CS Lewis essay or story.

• Terry Godier: Current.

A new RSS reader ⊕ ↬John Gruber which I am yet to check out. I do like the idea behind it, which tries to tame Dave Winer’s river of news a full two decades after he described the concept. I am less enthusiastic about the website copy: there is so much of it, and it is written in just such a way that it smells strongly of LLM assistance. I don’t think I mind it that much — though my skin still crawls when I see a “not this but that” phrase — and will chalk it up to the font-overload era of 1990s computing when we were just figuring out how to use the many typefaces available.

• Rebecca Robbins and Gina Kolata for the NYT: Grail’s Cancer Detection Test Fails in Major Study. Some of my earliest tweets — now protected, so apologies for linking if you haven’t already followed me — were about Grail and why their project to screen healthy people for early signs of cancer would likely fail. Nine years and billions of dollars later…
• Peter Bonate: Drugs Explained. A layperson’s primer on drug development from a pharmacologist, available on GitHub.
• Colin Gorrie: How far back in time can you understand English?. One thousand years of the English language in one blog post.
• Joel Hawksley: How I built Timeframe, our family e-paper dashboard. It was quite the journey, interrupted by the Boulder County Marshall Fire which burned down more than a thousand buildings in late 2021. “On the night of December 31–January 1, heavy snowfall put an end to the fire.”
• ConchCat: I accidentally ate lunch with a cult. The cult in question is Twelve Tribes, accused of exploiting its followers as free labor, along with assorted abuses of women and children. But the sandwiches were good!

It took me less that two hours with Google Gemini to create microblog.el, a micro.blog manager for Emacs which can edit old posts, create new ones (even with images), auto-complete tags and perform lightning-fast full text search. What a time to be alive!

Update: It’s out on GitHub!

Part 2 of my Apple decoupling is not ready just yet, but I couldn’t wait to share this preview of my (and Google Gemini’s) micro.blog editing client. I am writing this in the browser as image attachment is not yet fully baked, but it can download and edit existing posts just fine.

Emacs FTW!

Update: It’s out on GitHub!

• Martha Lane Fox: The Price of initiative just collapsed. On the lag between invention and implementation, from printing press to AI.
• Scott Shambaugh: An AI Agent Published a Hit Piece on Me. A taste of what’s possible, with follow-up.
• Steve Blank: You Only Think They Work For You. About contracted service providers. The article is about public relations, but applies just as well to contract research organizations (CROs) and these complex dynamics are part of the reason clinical trials are so expensive.
• Andrew Gelman: The 80% power lie. A clear example of why frequentist statistics, so favored by conservative regulators, institutional review boards and scientific review committees, are more often than not based on false assumptions.
• Dr. Drang: Chinese New Year and Ramadan. The pseudonymous doctor often shifts between programming and scripting languages, from R through Python to Mathematica which coincidentally matches my own amateur programmer journey. For this post he used Emacs Lisp and I am very much interested in Emacs and Lisp right now due to recent experimentation with Linux. Saliency FTW.