Infinite Regress

Saturday links, biotech and medicine

Sat, 15 Aug 2026 15:59:58 -0600

Saloni Dattani: Every disease is a policy failure. A good overview of how far we’ve come in treating many diseases, but also a thoroughly depressing perspective and one that I can’t endorse. It’s like saying “poverty is a policy failure.” No. Poverty and disease are the default state of the human condition. We should celebrate and cherish each step away from them; beating ourselves up over our imperfections in eliminating them is the road to madness.
Hugh Rienhoff for the FT: Biotech VCs have become like bankers and we might all pay the price. With the above in mind, I think we can agree that financialization of drug development has brought asymmetric returns to the parties involved, and the closer you are to the actual science the further you are from the rewards. The bankers always win.
Rahul Parikh and Jonathan Mates for Nautilus: The Trouble with Cancer Screening. There is a school of thought which views information as the ultimate good: the more you have the better. Here is a nice example of when that may not be the case. A pox on every doctor who sends out a screening PSA without first discussing it with their patient.

Sat, 15 Aug 2026 15:48:02 -0600

This chart is a close relative to “you are not stuck in traffic, you are the traffic.” Marginal Revolution comments, as usual, have it right; the actual chart title doesn’t.

Thu, 13 Aug 2026 22:56:30 -0600

“How can you not like Ted Lasso?” I asked my 9-year old daughter.

“Because we’re not middle-aged people.”

Fair.

Wednesday links, wise old men edition

Wed, 12 Aug 2026 15:29:01 -0600

Tom Peteet: Do You Speak Creatinine or Cystatin C? Some good advice for internists from an internist here. Peteet used to have a blog, but now of course there is a Substack page which is slowly transforming into a social media platform. I hate it.
Nassim Nicholas Taleb: The Book is a Book, not Disembodied Information. Here is another person who abandoned writing blog posts (and books!) for social media. I hope this article is a sign his new book is coming along.
Hollywood Gadfly (pseud.): “Can We Make the Villain a White Guy?” As much as I agree with the praise this pseudonymous gadfly heaps on The Wire and other Golden Age shows, I kind of disagree with the premise. There are in fact too few modern movies where there are clear-cut and unambiguous heroes and villains. Everyone has a dark side, and/or conflicting motives, and/or skeletons, etc. Even Saturday morning cartoons — or their 2020s equivalent on YouTube — have become too complex. Won’t somebody think of the children?
Oliver Burkeman: Let’s stop talking about A.I. Oh how I wish we did. Burkeman too, but there he is, writing about it. D’oh.
Ernie Smith: Vibe-Coded Flattery. About sloppy spam and some recent developments. Ted Gioia has also been getting email. I keep getting slop-ridden offers to host various academics with low to mid-tier publications on my Serbian-only podcast. What a time to be alive.

Monday links, told-you-so

Mon, 10 Aug 2026 15:17:50 -0600

John Gruber: Retraction: The App Store Rejection of the Week That Was, in Fact, a Correct Rejection. Count me among those unsurprised that a purveyor of slop — fine artisanal slop, but slop nevertheless — was not an upstanding citizen. I am surprised that Gruber’s bullshit detector wasn’t better calibrated.
Henry Farrel and Dan Wang for the FT: Does Silicon Valley dream of Philip K Dick? Oh yes it does, and now my impression got some confirmation bias from a professor at Johns Hopkins and … Dan Wang? This Dan Wang? My impression of him has declined even in the months after reading Breakneck — more on that some other time — but can’t argue with him here.
Janan Ganesh for the FT: The exciting boring decade. On one hand yes, things are not as bad as we think. On the other, our physical senses are more calibrated to the rate of change than change itself so why not our internal senses too?
J.R. Duren for the Independent: A terminal cancer drug was priced at $13,000 — but he found the same medication for $40 on Mark Cuban’s website. You mean to say that drug companies are, for the most part, pulling these prices out of thin air? I tend to agree.
Dan Kagan Kans for New York magazine: He Was Right About AI. What About the Fate of Mankind? What the article says one Hans Moravec was right about back in 1988 was “the arrival on earth of human-level artificial intelligence in 40 years.” So I would clarify the headline to read that he may be right about AI in a couple of years, but LLMs are still closer to chess-playing algorithms than humans.

Sun, 09 Aug 2026 22:37:52 -0600

🍿 22 Jump Street (2014) was even better than its predecessor, with the best credit sequence in recent memory. I do hope they don’t skip medical school.

Sat, 08 Aug 2026 21:09:03 -0600

PSA: there is a word for “the day after tomorrow”. It’s overmorrow, and it’s almost 500 years old. Let’s bring it back!

And “the day before yesterday” is ereyesterday, in case you were wondering.

But do you really know what's in your app?

Fri, 07 Aug 2026 13:12:21 -0600

Apple rejected an astronomy app from the iOS App Store because “it was astrology”. When the author appealed, Apple doubled down because “We understand that the app includes a live tarot reading feature.” Ridiculous, right?

Well. The author in question is Terry Godier, and while I understand that he has gained quite the following in recent months, I am not a fan. He is unabashedly pro undisclosed AI writing, having conjured — “written” would be inappropriate in this context — a whole essay on large language models being a whole new communication technology. Trigger warning for those sensitive to LLM-ese.

The app, “Dark Hours”, was supposed to be an iOS-native version of this website. It has some truly useful information on the quality of the night sky for stargazing at any given location. It also has the tells of AI generation: too wordy — or overly verbose, if you prefer LLM talk — in some places, too technical in others. Many small digits scattered around the screen. It even manages to fit a this-not-that in what should be a technical explanation.

I have nothing against using LLMs as a coding aide. Dave Weiner sings Claude praises daily in his blog, while being realistic about its limits. Half of the ATP Podcast is an advertisement both paid and unpaid for OpenAI and Anthropic. The creator of Pedometer++, Widgetsmith and many other apps, “Underscore” David Smith, had a good post on his use cases. If you look at their products you could never tell that they were “made by” AI, because they weren’t. If any of them has ever made a fully “vibe-coded” app, they have yet to publish it under their name.

But then if you do fully vibe-code an app, and I am not a programmer so professionals please chime in, can you and do you vet every single line of code? “Live tarot reading” is a weird mistake for a human reviewing an app to make, unless there is a live tarot reading advertisement (or, why not, full functionality) somehow baked into the thousands of lines of code. Stranger things have happened than an app behaving differently depending on the IP address, though they usually try to hide something from the App Store reviewers, not show it to them.

All this to say, the story smells and I’d withhold judgement until we have more information. Unless, of course, it was Apple using automated LLM-based review even in the appeal process, in which case: a plague on all their houses.

Fri, 07 Aug 2026 12:34:57 -0600

📺 Only Murders in the Building, Season 5 declined in quality by quite a bit near the middle, enough to have me stop watching. Good thing we are a family of completionistis, because the show picked up steam and pulled off one of the best endings of the run. I for one cannot wait to see the crew in London, schmoozing with all the British guest stars.

Thursday links, Lovecraftian

Thu, 06 Aug 2026 11:18:38 -0600

Adam Mastroianni: Incentives are for losers. With a reference to Dagon, a short story in which a man goes insane after seeing a weird fish. Mastroianni equates the fish to our unchecked and unquestioned assumptions which would fall apart after a bit of scrutiny but few of us are aware that it exists and even fewer dare examine it. I haven’t seen the fish as much as felt its slimy yet at the same time oddly rough scales while flailing around blindly and even that was enough to, erm, seek other opportunities.
Bobby Derie: Pre-Code Lovecraftian Horror Comics. ⊕ [Note: ↬Bruce Sterling on Mastodon. ] in which “The Horror of the Seas” is mentioned among many others, a 1942 comic which copied generously from The Shadow over Innsmouth. This whole blog is a treasure: where else could you find a review of “Relatione del Reame di Congo”, the 1591 (sic!) account of Portuguese missionaries’ voyage to Africa which was transcribed into Italian and published by Filippo Pigafetta, then translated to German in 1597 and — here comes the Lovecraftian connection — adorned with engravings horrific enough to deserve a mention in The Picture in the House?
Alberto Alcaraz Escarcega: The Racial Imaginaries of H. P. Lovecraft. A terrifically-sourced exhibition/essay on just how much of a racist Lovecraft was (answer: very very racist, over and above what was considered “normal” at the time) and how it affected his work (answer: they are inseparable; without it there would be no diversity horror of The Horror at Red Hook or the genetic horror of the above-mentioned shadow over Innsmouth). Lovecraft died in 1937 at 46, so he lived long enough to overlap with Hitler. This led to some incredible quotes from his many letters to friends and family, such as:

the crazy thing is not what Adolf wants, but the way he sees it & starts out to get it. I know he’s a clown, but by god, I like the boy!

Yikes! I do wonder what he would have made of Lovecraft Country.

Wed, 05 Aug 2026 21:56:00 -0600

🎙️ For all the complaints I had about ASCO’s oncology podcasts, I must admit not all professional societies are as bad. Hemetalks from ASH has much more fluid dialogue and more interesting topics. They even had a patient come in to talk about their experience going through a workup. Recommended!

Tuesday links, quick hits

Tue, 04 Aug 2026 14:09:56 -0600

Gita Jackson: I Am Here To Defend The Noble Action Movie From The Classicist Emily Wilson. Wilson being the most recent translator of the Odyssey and also the author of this takedown of Nolan’s movie, confusingly titled The Odyssey ⊕ [Note: One of these days I should ask a native speaker of English to explain to me, if they may, like I were a five-year-old, what rhyme or reason if any these authors are following as they pepper their titles with articles both definite and not. ] . Not having seen the movie or read her translation I tend to side with Jackson here if for no other reason then to fight academic overreach.
Ted Gioia: How to Lose $35 Billion with Philosophy. Making fun of effective altruists is like shooting fish in a barrel, but they do make it so easy.
lepetitg (pseud?): ikea complexity index. ⊕ [Note: ᔥAndy Baio ] How long will it take to assemble that IKEA shelf? I wish I had this three weeks ago!
Dr. Drang (pseud): My rules for using spreadsheets. The number one rule is “Don’t!”, but then of course there are exceptions. This is one of the biggest sins of clinical trial analysis, particularly for investigator-initiated trials: a shadow database apart from any eCRFs, run exclusively in Excel, a nightmare to analyze and verify. All those trial write-ups in JCO and JAMA Oncology are, I am sure, riddled with errors.

Heads we win, tails you lose, fracking edition

Mon, 03 Aug 2026 12:02:16 -0600

If you have followed this blog long enough you will know that I am an unabashed fan of the life and work of Nassim Nicholas Taleb, pugilistic social media presence and all. There is no simple way to summarize why — this post from the economist Branko Milanović is as good of an attempt as any — and reducing his Incerto series of books to a collection of One-Neat-Tricks (Ergodicity! Lindy! Skin in the game!) would not do them justice.

Having said that, here is One Neat Trick: when deciding to act, think about the best-case and the worst-case scenarios and try to pick one with known and limited downside and a potentially unlimited upside. The classic example here is buying stock options: for pennies on the dollar you purchase the right to buy stock at a certain price by a certain date. If the stock costs less than that price by the time it expires your only loss is the price of the option. But in the unlikely but possible case it skyrockets, you can pocket a good chunk of change. ⊕ [Note: People misunderstand this as Taleb recommending that people from all walks of life go into options trading. Far from it. In fact, one thing he said at my first RWRI years ago which has served me well is that if you are not a professional trader and you earn money from a different profession, your priority should be capital preservation, not generation. ]

The flipside and what you should definitely not do is selling uncovered stock options. Yes, most of them will expire and be worthless and you will get to keep the modest steady income derived from the selling price. But in the unlikely but possible case it skyrockets, and you don’t actually own those stocks — that’s the “uncovered” part, and yes people actually do that — you will need to purchase them on the open market at that very high price. D’oh.

Rarely are real-life choices this clear. You usually have to pick between several bad options with the same limited upside and different downsides. Case in point — and we are finally getting to the point of the title — is what the Colorado town of Erie has to deal with. Some houses in Erie are yards away from the Draco pad, one of several new fracking projects slithering around Denver. The city council was initially against it, then one member did an about turn, changed his vote, and allowed the sale of mineral and oil rights “for up to $35 million over the next two decades” along with some 160 acres of land previously used for drilling.

Quoth the Mayor, Andrew Moore: “So when we get to the point of, ‘Hey, the state approved this’ — I can’t change that,” Moore said. “But I think we need to work to get as much as we possibly can for Erie.”

In case you missed it, his thinking was that the state approved it already, drilling is down in the next-door Weld County and Erie can’t stop it, so they might as well get something out of it, like keeping the 10/10 elementary school and building up some more of the infrastructure. The downside is that it is and the upside looks good, so what’s wrong with that?

Well, if you stopped to think about it for more than a millisecond a question may come to mind: why on Earth would a publicly traded company give anything to the town if they were going to drill and get the oil anyway, There Will Be Blood-style? Out of the goodness of their corporate hearts? Please.

First, the upside is not what it seems. This is from yesterday’s Denver Post:

Under the agreement negotiated by Owens, Erie would receive a $4.5 million upfront payment and 3% royalty interest for the life of the project, which the town projected at the time of the council’s vote could range from $19 million to $31 million. The royalties wouldn’t kick in until SM Energy has recovered 200% of its cost to develop Draco.

$4.5 million is significantly less than $35M, as there are no guarantees whatsoever that any royalties would be paid out: those development costs can skyrocket, particularly when it’s the company itself estimating how much everything cost. Fungible accounting ftw.

Worse yet, by selling their rights I can only assume that the townsfolk are giving up the opportunity to sue the company for any untoward consequences of pumping millions of gallons of pressurized fluid into a landscape pockmarked with old oil and gas wells. Paying the town $4.5 million to not have to think about would be a steal, and easily defensible to even the stingiest of the board members.

So these are the two bad, ugly, abysmal choices put forth: take the $4.5M upside in return for the unlimited downside if and when things go wrong and there is no one to hold liable; or don’t take anything but lawyer up and reserve the right to block everything in courts at the first sign of trouble while also getting some money for potential damages.

My choice would be preservation, but then one of the big reasons we are in Denver and not north of it is that we didn’t want to make choices like that.

Sat, 01 Aug 2026 09:04:18 -0600

🍿 Backrooms (2026) was the horror movie Wes Anderson would have made if he made horror movies and forgot everything he knew about plot. Fortunately, the plot was not the point — the physicality of the set and special effects more than make up for it.

Thu, 30 Jul 2026 15:48:44 -0600

I am shocked — shocked! — to find a zoomer “AI investor” caught swimming naked at the first turn of the tide:

Aschenbrenner, who had no previous trading experience before starting the fund, worked for the FTX Future Fund, the philanthropic arm of Sam Bankman-Fried’s empire before it collapsed in late 2022. He later joined OpenAI’s “Superalignment” team before being fired over an alleged leak.

With such an illustrious pedigree, how could things have possibly gotten so wrong so quickly?

And in the unlikely case you were still wondering if there was an AI bubble, even FT called it.

Wed, 29 Jul 2026 22:49:23 -0600

🍿 The Dink (2026) was a goofy blast. I knew absolutely nothing about pickleball beforehand and know marginally more having seen the movie. It still seems kind of dumb — why don’t they just take up badminton? — and therefore the perfect centerpiece for a Dodgeball/Blades of Glory-style farce.

Tue, 28 Jul 2026 22:39:08 -0600

PSA: when making tiramisu from scratch, do not — I repeat, do not — use mascarpone from Whole Foods unless you are really into tiramisoup.

Tuesday links, AI-bent

Tue, 28 Jul 2026 10:57:48 -0600

Venkatesh Rao: Cognitive Farmsteading. From the man who came up with premium mediocre (2017), the cozyweb (2019), and the Internet of beefs (2020) here is another tone-setting phrase. He spent the better part of this decade working on sloptraptions (guess who his co-author is there) so I lost interest, but this article is fully Rao in every sense, even if his preferences in AI use — discussed in the article — are far, far removed from my own.
Cory Doctorow: Discernment. Doctorow’s preferences, on the other hand, match mine to a T, spell checking and all (would a regular spellchecker note the missing greater-than sign in my Hugo notation?) What I don’t yet have is my very own on-device chatbot — have you seen the RAM prices these days? — but that is coming, with or without the bubble bursting.
Debbie Millman: If You’re Over 40, You’re Ready to Use A.I. The thesis is in the title, and it is downright stupid. Persons over a certain age — 65? 75? I don’t know for sure and there are individual differences but it is in that ballpark — have no chatbot immunity or capacity for discernment (see above) and from my experience account for 95% of slop being unintentionally shared around the Internet.
Lila Shroff for The Atlantic: America Is Headed Toward the Infinite Workweek. Headed towards or pushed?

In Silicon Valley, engineers assign their agents tasks to complete overnight, and then check the results even before their morning coffee. Some are staying up late: “The opportunity cost of going to sleep is too high,” the billionaire venture capitalist Marc Andreessen said on The Joe Rogan Experience last month. “If you go to sleep, you won’t be with your 20 AI coding agents.”

This Andreessen guy sounds like a grade-A asshole.

Colorado has a fracking problem

Mon, 27 Jul 2026 00:19:49 -0600

Noelle Phillips for The Denver Post, my new weekend paper now that we are out of the Financial Times’ distribution zone: Colorado’s oil and gas regulators studied health problems tied to drilling. Critics ask: Why will nothing change?

The headline does not scream riveting reading, so before you click here is a short story about our family’s recent journey that may put it in context.

We moved to Colorado in great part for more space and an opportunity to spend more time outdoors. The small towns north and northwest of Denver, in Boulder Valley County, were particularly appealing: great schools, kind-of affordable houses — their proximity to billionaire-laden Boulder got them within striking distance of DC — close enough to the foothills that a trip in the mountains does not take a full day of planning yet far enough that mountain fires should not be as big of a concern. [Note: Here, too, a caveat. There has in fact been a major fire in the area, not from wood but rather acres of dry grass in the open spaces people here are so proud of. Can’t escape climate change. ] Also a quick, non-trafficjammed commute to my new place of work northeast of Denver. What’s not to love? In fact, every single person with whom we shared our great plans nodded in agreement and expressed the appropriate mix of pleasure and envy.

So that was where we hoped to settle initially and that was where our super-kind, super-accommodating realtor showed us on our first few tours. We even made an offer, which was — and I will foreshadow with a thankfully! here — outbid. Then we noticed that another property we looked at, and got within a couple of heartbeats of making an an offer, a property whose backyard looked into one of those open spaces Coloradans are so proud of, also had some heavy machinery in that open space, digging a hole wider than it was deep but unsettlingly large in both dimensions, yellow caution tape all around it. What’s that, I asked? Oh, it’s just an old oil well being decommissioned and the company doing it found contaminated soil, probably a leak from who knows when, so they are now digging around and testing until they’ve cleaned out all the contaminants — like a Mohs procedure — before they finally plug it. People make it out to be a bigger deal than it is. Probably why the price is so good! Anyway, you can read more about it online.

And so we did. And as we did, our great plans for a big move to the wide open spaces of Colorado began to unravel.

A thing about the state that may or may not be common knowledge but it was news to us: it is full of oil and gas. The Wattenberg Gas Field is one of the largest in the US and still being exploited. Go to Colorado Energy & Carbon Management Commission’s interactive map of wells, and you will see the striking density of them at Denver and Boulder’s doorsteps, and more wells than you’d expect in the city limits. For a great overview of the Colorado gas well situation check out a substack newsletter aptly named What the Frack?. Aptly, because 99% of Colorado’s oil and gas production comes from fracking.

In fact, a quick Internet search led us to the reason why that abandoned backyard oil well was being capped and, oops, found to have been contaminating the surrounding soil for who knows how long. There will soon be a whole lot of fracking underneath Boulder Valley, courtesy of the neighboring and significantly less crunchy Weld County, which gave a permit for some crafty oilmen to perform a real-life milkshake maneuver. The Draco Pad website described where in Weld County some 26 holes will be made. Tucked in a tiny thumbnail at the bottom of the page is a depiction of what will happen underground: one of the longest horizontal drilling operations ever attempted, going for 5 miles, well into Boulder Valley County and underneath many residential neighborhoods, schools, hospitals, etc.

Another well-named website, Erie Protectors, goes into much detail for why this is a Bad Thing Indeed, even not taking into account the fact that the wells themselves will be less than the mandatory 2,000 feet away from houses (which is kind of a big deal — why even have a state law if you won’t enforce it). An important observation they make, and the reason why those oilmen felt the obligation — or was it a mandate from the local government? — to plug the abandoned wells was that there will be a lot of pressurized liquid going through those bore holes, and who knows what may pop and when, plugged or not.

Oh, and did I mention the University of Colorado study from last year — available to us during all this searching and the reason why that Denver Post article exists — which noted increased risk of childhood leukemia for those living within 8 miles of a well? But then, it doesn’t take a rigorous scientific study to understand what my grandmother (or, in the absence of a grandmother, Nassim Taleb) could have told you: avoid living close to fume-spewing industries of any kind to avoid risks known and unknown.

If ever there was a reason for a hematologist/oncologist and a pulmonologist with four children, one of whom was still an infant, to give up on an area and settle for less space and no backyard in significantly more urban parts of Denver proper, well, this was it! There is another short story about how we finally found the right place, with a couple of detours on the way, but let’s leave that for another time.

You may now, if you haven’t already, click through and read the article, because it discusses the aftermath of those results coming out.

What happened after the study was what the oil industry, like the tobacco industry before it, loves. There was a committee. It reviewed that and 2 more studies and came to the tepid conclusion that more research needs to be done, and that no changes shall be made to Colorado’s drill permit process. You know, the same process that allowed 26 wells to be drilled less than 2,000 feet from people’s homes, then under more homes, schools, hospitals, etc, etc. To quote the Post, “oil and gas industry representatives welcomed the review, saying it is important for Colorado regulators to follow science.”

Yes, yes, of course. If the science can’t tell us which cigarette, nay, which puff of the cowboy killer caused your lung tumor, well then, can we even say that smoking causes cancer? Show us the atom of benzene that got into your child’s bone marrow to cause her leukemia and we will shut this plant down, the Colorado oilmen — those champions of science — might cry.

How did it come to this?

Well first of all, didn’t you hear how important fracking was? Just in the last few months Tyler Cowen, Ed Conway and The New York Times noted this, that last one putting an accent on the Democratic Party establishment not being too keen on fighting oil and gas anymore.

Second, so many of those schools being drilled under are paid for by oil and gas! This is as true in Colorado as it is in Texas although unlike the astroturfed Colorado data the local reporting from Amarillo, Texas gives more color on how fickle that funding can be.

Third, There Is No Alternative (↬ Cory Doctorow).

Fourth, we are all human and would rather not advertise anything nefarious going on that may decrease their property values even when they couldn’t do anything about it and take the brunt of the risk. Why, this oil well here is part of regular infrastructure, just like telephone poles and traffic lights, don’t you know?

Fifth, there was in fact huge uproar about most of these projects during the permitting phase — the above mentioned What the Frack? newsletter has written about some of it — but it has had no effect. As long as the 2,000 foot-ish setback was followed and the oilmen could say with a straight face that, as far as they knew, what they did had no ill effects on human health if all the safety procedures are followed, asterisk asterisk, the permits were granted.

Sixth, even if something bad did happen, some of these oilmen run fly-by operations that are worse than Washington DC residential construction LLCs. By the time a well is found to have done damage the company that drilled it is long gone and there is no one to sue. Why did you think there were so many abandoned wells out there?

In short, plenty of reasons, none of them good.

Reason number seven hits close to home. When Rio Tinto wanted to mine for lithium in western Serbia the country was in an uproar. Never mind that the EU is very much for establishing a wholly European-based battery supply chain. Never mind that the contracts with the government were already signed. Years have passed and there is still no mine. I suspect this is because Serbia is an already small and ever-shrinking country with limited resources. Screw up one river system with mining detritus and there aren’t that many more left to go around. Screw up each and every one, and you don’t have another country to go to.

Not so with Americans, who will always have Yellowstone and other national parks to keep in reserve. The country is so vast with so much unspoiled wilderness that there is the illusion of abundance. The problem with national parks of course is that they have no houses, schools, hospitals, or really anything that would qualify as residential infrastructure. Far from ideal for a family, and even singles may have trouble settling in unless they are the Ted Kaczynski and/or Waldenponding types. Look at where people actually want to live, and you will find issue after man-made issue, created by greedy bastards, allowed in part because people who should know better thought they could always go somewhere else after the check clears.

With greed again becoming good, I have a sinking feeling that most American cities already have — or are soon to get — their own version of this fracking problem.

Saturday links, old and new

Sat, 25 Jul 2026 09:35:08 -0600

Gillian Tett for the FT: Welcome to the era of financial candyfloss. ⊕ [Note: Gift link, if you click on time. ] It is the perfect metaphor for American finance: spinning thin and devalued real properties into mounds of tooth-decaying fluff. You know things are bad when it comes not from the Guardian but from a seasoned Financial Times columnist.
Brett Murphy for USA Today: Rigged. ⊕ [Note: ᔥCorey Doctorow ] An exhaustively sourced, dramatically illustrated, harrowing story about truck drivers working as slave labor, from 2017. If only there were a mechanism by which the richest, most prosperous country in the world could control this and similar excesses of a greedy minority.
Alice Fleerackers for Nautilus: When Stupid Was a Diagnosis. On the plight of people with intellectual disabilities. In some ways, the 1700s were better to most of them than even now, or rather, they were equally cruel and bad to everyone regardless of their mental prowess. Then came the oh so ironically named Enlightenment.
David Tuller: Trial By Error: No Benefits for Multidisciplinary Rehabilitation in New ME/CFS Study. “ME/CFS” stands for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and it seems to be the consequence of viruses playing havoc with people’s immune systems, which leads to their autonomous nervous systems being out of whack. Many of you may not remember, but there was a big viral infection going around 5-6 years ago that left everyone exposed all at once, which led to an explosion of these cases in absolute terms, though in terms of percentages it is thankfully still a vanishingly small fraction. Sadly, you can’t rehabilitate your way out of this particular organic problem, and it puts many young and otherwise healthy people out of commission. If only there was a mechanism to fund more basic research.
Davide Gioia: Wildlife on the Planet Furaha by Gert van Dijk. A book review. The book in question is an alternative evolutionary history, richly illustrated, from a professor of neurology at Leiden University. An instant pre-order for me, and it is coming out next week in the US!

The slop we share

Fri, 24 Jul 2026 12:52:10 -0600

Now that I am back in clinic full-time I have tried and failed to pick up on the more clinical podcasts. Both ASCO and ASH have their podcast series, but they are all so formal and scripted you can see the teleprompter scrolling in front of the speakers’ eyes.

One potentially bright note could have been Cancer Stories, which are spoken versions of Journal of Clinical Oncology’s Art of Oncology article series. Note the past tense; I have a longstanding antipathy towards “narrative medicine”, a mode of fiction in which doctors combine patient stories, or present a single patient’s story anonymously, to make a point. The fallen king of narrative medicine was the neurologist Oliver Sacks, and look at how that turned out. Social media are of course an even more fertile ground for this kind of fakery; I won’t go into the X, Bluesky, Mastodon, TikTok and YouTube accounts that are completely full of it, but there is a lot of content out there and all of it — all of it — is bullshit.

So I was hoping that these stories being published in a peer-reviewed journal would at least be closer to the truth. And I’m not saying they are not, an inch or two closer, with cases not being invented out of whole cloth. What I am saying is that JCO editors are incapable of recognizing AI slop and the very first story I listened to was full of it.

It was disconcerting to hear a professional voice narrate The Liver We Share in the April edition of the podcast. In the story, BU medical student Ryan Wexler writes about his experience as a living donor to his then-fiance now-wife who needed a new liver. Quoth Wexler: “When I learned I was a match, relief arrived not as joy, but as quiet permission to hope.” The hope was justified, for everything went well: “Her recovery, and our journey as a whole, bears little resemblance to the decisive triumph I once imagined. It is quieter, ongoing, and more powerful for it.” Yes, yes, so much quiet. Other empty metaphors and nonsensical turns of phrase abound.

Did Wexler feel bad, I wondered, when the completely credulous host and a great hematologist Mikkael Sekeres — a pre-AI book author I should add — asked him probing questions about his mental state and the specific words he used in the essay? Couldn’t you see through the AI bullshit, Mikkael, I wanted to scream out. He is a bit older than me so maybe there is an age cutoff at which people can no longer detect the slop? At least one of my parents and one in-law don’t have a clue, as they keep forwarding sloppy Instagram links despite my not having an account for more than a decade.

In any case, no, peer review is no protection against bullshit and I will not be exposing myself to any more of it. End of rant.

You can have a "fail fast" mentality and you can have a low failure rate as a target, but you can't have both

Fri, 24 Jul 2026 11:49:08 -0600

Derek Lowe is scandalized by the fact that 9 out of 10 drugs that get to a first-in-human trial don’t get approval or, to use some jargon, a clinical failure rate (CFR) of 91% per year. He quotes a recent paper which followed CFR over the last six decades ⊕ [Note: Just to make things confusing, the paper itself calls this percentage “clinical attrition” but Lowe rebrands it to a CFR. Let’s for the sake of consistency stick with the latter, although a pedant may question whether that statistic truly is a rate. ] and noted that it was improved somewhat in the 1970s and 1980s — down to about 80% — but was consistently at or above 88% in every other decade analyzed.

Both the paper and Lowe present this as a Bad Thing. Here is a direct quote from Lowe:

But let’s think about that 91% failure rate for a moment. When I bring this up in presentations, I invite the audience to consider what the auto industry would look like if 91% of new car designs proved unable to roll out of the factory, or if 91% of new airliner models were unable to leave the ground - and if you only found that out after spending all the R&D money to build them at full size and trying to fly them. No cutting-edge restaurant could survive if 91% of its innovative dishes proved inedible or outright poisonous. What other industries operate under these bizarre conditions?

Sounds scary! The paper has a different and a somewhat less alarming spin: see how bad our preclinical testing is if so many of the drug candidates don’t make it to approval for reasons of biology. If there are bad side effects, or the drug doesn’t make it to the targeted tissue, or the liver destroys it too quickly, should we not have picked that up in cell culture or animal testing? Should we not focus our resources on developing more human-relevant preclinical tools, and maybe call them New Approach Methodologies (NAMs)?

At this point in the story I should mention that the paper in question, titled “Need for NAMs: A systematic evidence synthesis revealing over half a century of drug development failure”, was published in NAM Journal. Holy motivated reasoning, Batman.

So now let’s look at the counterfactual: what if the increased CFRs from 1980s to today came by design, from the realization by drug developers that preclinical testing isn’t the greatest at predicting toxicity and is completely useless when it comes to efficacy, so why not just get drugs to clinical as quickly as possible and be as quick in cutting them? My go-to paper outlining this philosophy is one from 2010 which a team from Eli Lilly — as successful at developing drugs as they come — published in Nature Reviews Drug Discovery. To pick out two key points from their above-the-paywall outline:

Reducing late-stage (Phase II and III) attrition rates and cycle times during drug development are among the key requirements for improving R&D productivity.

To achieve the necessary increase in R&D productivity, R&D investments, both financial and intellectual, must be focused on the ‘sweet spot’ of drug discovery and early clinical development, from target selection to clinical proof-of-concept.

Which is to say: since Phase II and especially Phase III trials are an order of magnitude more expensive than Phase Is, let’s quickly do what we must to get drugs into clinic, gather early human data, then make an informed decision. If that makes an arbitrary number go up, so be it.

You can see why the de-emphasis of preclinical efficacy data could have made some lab people unhappy, which I guess is why we now have a journal called NAM. Or was it ‘Nam?

Of course, there are tradeoffs everywhere, and the big tradeoff in the “fail fast” school of drug development is that you are tying your faith, financial and otherwise, to the health care system and contributing to the health care ouroboros. The one where Americans pay so much for health care because drugs are so expensive to develop, and drugs are so expensive to develop because health care in America is generally so expensive. But of course, no one is obligated to run their early-stage trials in the US.

Health care is a human right, even in America

Thu, 23 Jul 2026 15:02:27 -0600

Vinay Prasad asks whether health care is a human right and, using some convoluted mental gymnastics, answers no with a disturbingly LLM-like turn of phrase:

Health care, as it is practiced in 2026 America, is not a human right. It’s a tax penalty on our ignorance and wishful thinking.

This is bullshit, in the classical sense. Not to psychoanalyze Vinay ⊕ [Note: The house style over here at Infinite Regress is to default to last names for any and all persons mentioned. I will on occasion make an exception for friends, which is indeed the case here. ] but this is what years of pandering to your ticket-paying audience will do to you: lose common sense.

To be pedantic, the Universal Declaration of Human Rights specifically mentions the right to health, i.e., a minimum standard of health to which everyone is entitled. The minimum standard in America is prescribed by a single law, EMTALA, which guarantees the right to emergency treatment for those who seek it. It is a floor low enough to qualify as a basement — pathetic for one of the richest nations in the world — but it is nevertheless a floor. Should the minimal standard also involve immunization and the few disease screening programs that are known to be beneficial? Yes! But they are not yet a right in the US. As I’ve noted before, I don’t think it should include the largely superfluous annual “wellness visits”. But if that’s what it takes for immunizations and screening to happen, fine.

But that’s not the bee in Vinay’s bonnet. Rather, he takes issue with the totality of American health care — who doesn’t? — and makes the case for that particular Lovecraftian horror not being a human right. Well, duh.

Cthulhuian or not, there is one good thing about the system: its extraordinarily high ceiling. This is still the place to be for getting the latest and greatest medical treatment, whether in a large academic medical center or a small community hospital, contingent on the doctors in either place knowing what they’re doing. Most stories Americans tell of their exposure to European health care are about how quickly and cheaply minor procedures are performed. Not told are stories of patients with metastatic cancer or autoimmune disease who are waitlisted for getting immunotherapy or other biologics. Or those with debilitating arthritis waiting months for a hip replacement.

With the high ceiling comes some extra girth in the middle, where there are many unnecessary treatments given and diagnostic procedures performed that Vinay rallies against. For good reason! But how you come from Ending Medical Reversal to proclaiming that health care is not a human right is beyond my comprehension.

Cory Doctorow's dickover remedies

Wed, 22 Jul 2026 15:39:36 -0600

As described here:

Use browsers not apps.
Use Firefox or, if you are concerned about their recent turn, at least a Mozilla and not Chromium-based browser.
Hit ctrl-alt-r for Reader mode (Cmd-alt-R on MacOS). ⊕ [Note: Per Doctorow: Firefox tries to guess whether a given page should have a Reader Mode option based on its layout. This sometimes blocks Reader Mode on pages that badly need it. You can force Firefox to always allow you to try Reader Mode by going to “about:config” in your location bar, then searching for “reader.parse-on-load.force-enabled” and toggling it to “true”. If you switch to Reader Mode and the page breaks, you can switch back by hitting ctrl-alt-r again. ] Sometimes, reloading the page while in reader mode works.
If reader mode doesn’t work, try the Kill Sticky bookmarklet. That’s the second line of defence.
However, Kill Sticky requires you to hit the bookmarklet every time you are on the same web page. For a more permanent solution, try Adblock plus. With that extension on, right-clicking will show a “Block Element…” option to the context menu.
If all of that fails, try the Remove Paywall website or browser extension.

Looks exhausting, no? We have come to the Red Queen’s Race stage of the Internet. And as a reminder, this is a dickover.

Tuesday links bonanza and more than one reminiscence

Tue, 21 Jul 2026 20:39:03 -0600

Craig Coben for the FT: SpaceX and the myth of independent Wall St research.

On my first encounter with Wall Street analysts I also wondered what they were for. Here is Coben’s take:

It is possible some retail investors may follow the research ratings, but in my experience the audience that matters most is the company itself. Management teams appreciate reports seeing their narrative endorsed in a report carrying the logo of a major bank. Flattery takes you a long way in finance, as it does in life.

And in turn management teams may, if the analysis reflects what they believe is the true and right way to talk about the company, prioritize that particular bank to be on the left side, or the upper right corner, or the bottom third paragraph of the second-to-last-page, of the term sheet. And if you have no idea what that last part was supposed to mean, I envy you, truly.

Gideo Rachman, also for the FT: My journey down the rabbit hole at the Conspiracy World Cup.

One of my earliest memories of conspiratorial thinking was when I was in 7th grade and flunked a state-wide English language competition. ⊕ [Note: Worry not, I returned the following year and won 1st place, which was ultimately worth diddly squat except for bragging rights. Oh, and some family lore, for my now-wife’s best friend placed second and apparently told her stories about me. ] Upon return to school, a certain teacher who was generally decent huddled with me and asked me for “the scoop”, meaning for the shenanigans that must have went on for me not to get an awarded. The scoop was that I spent the night before playing something — from the years when it went on the most likely culprit is Quest for Glory: Shadows of Darkness — though of course that’s not what I told him. Which is to say, when Alfie Haaland, the father of Norway’s star centre-forward, Erling, had sarcastically congratulated the referee on England’s victory, I knew exactly where he was coming from.

Corey Doctorow: Deranged billionaires and their syndromes.

Good to see that Tyler Cowen’s verbal tick caught Doctorow’s attention:

Today, these Renfields clutch their pearls at the “demonization” of the ultra-rich, calling it “billionaire derangement syndrome.” But the only “billionaire derangement syndrome” that matters is the syndrome that affects billionaires and convinces them that they are above any discipline or rules.

Oh snap.

Matt Webb: Frozen 2 should be rated R.

On how movie stakes have become too high. I agree! Where are this generation’s Harold & Kumar?

Ernie Smith: The Terminus.

On the beginnings and endings of interstate highways. This has been on my mind recently, as I drive up I-25 past the exits to I-70, thinking that, hey, I know exactly where I-70 starts (or ends?): right on the I-695 Baltimore beltway. And to think it goes straight this far out west… Well, except for that little infamous break in Pennsylvania.

Aidan Walker: vultures feeding their young.

“If you literally educate children, care for patients, clean up the environment, or do something like that, you aren’t a looter — but your boss probably is, your boss’s boss definitely is, and you’re part of a dying breed.” No notes there.

Quico Toro: Natural experiments prove phytoplankton carbon removal works.

Going straight to the quote:

In reality, any program to intentionally add nutrients to nutrient-deprived oceans would be considerably less dangerous than any of these natural analogs. Fires, volcanoes, icebergs and vents just dump crap into the ocean willy-nilly, with no plan, no environmental monitoring, no environmental impact assessment, nothing. Nature does this in precisely the kind of blind, reckless, unthinking way that skeptics fear in people, and even then there’s no evidence of harm.

Let spotting the cognitive error here be an exercise for the Reader.

Simon Park: Reviving a 15-year-old netbook with Arch Linux.

Hey, I had that exact model back in 2008 and the little guy traveled the world with me back then, from Barcelona and Naples to Bangkok and Kho Samui. Not proud of the fact, but that 1024x600 pixel WSVGA screen is where I first saw Season 4 of The Wire. I even took it with me to the US, so it’s been on as many continents as I have. And wouldn’t you know it, I kept it through all these years, hoping for a good opportunity to resuscitate it. Which is to say: I know what I’m doing this weekend!