So it looks like the new Pokemon game is buggy as hell. This brings back fond memories of TES II: Daggerfall which way nearly unplayable when it first came out but after a half-dozen or so patches became my favorite game of all time.

Today I found, via a (paywalled) Janan Ganesh article, an hour-long conversation between Cormac McCarthy and David Krakauer. Krakauer is an evolutionary biologist at the Santa Fe Institute, where McCarthy spent some time writing. I could watch ten hours of this.

There is a good overview of the two ways Micro.blog can interact with Mastodon, from @pmcconnell. I much prefer the full integration (Option 2 in the text), but it looks like only Option 1 completely matches the formatting. Is that a bug or a technical limitation?

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.

• Avoid, if at all possible, eating in a random downtown restaurant. This is especially true for the National Mall, but also near large hotels — Woodley Park with nearby Omni Shoreham and the Marriott comes to mind. There is a line of restaurants there which sound suspiciously like some other, more well known DC establishments: Mayahuel for Oyamel, District Kitchen for District Commons, that kind of thing.
• There is good food to be had, for sure, but it is still overpriced.
• The best food at any price is outside of the beltway, usually in strip malls.
• Yes, sometimes you need to pay for the “good” attractions, but not in DC! The best stuff is free and unless you want to go to a specific gallery or museum (The Phillips collection is worth visiting) you can easily spend a week just going through the Smithsonian museums and free parks.
• Speaking of parks: Kennilworth Aquatic Gardens and Brookside Gardens are two (free) family favorites, and underrated.
• Two favorites that you do have to pay for: the Hillwood estate, which was Marjorie Merriweather-Post’s home and now an exhibit of (mostly pre-revolutionary Russian, including Faberge eggs) art with a small-ish but beautiful garden; and the Dumbarton Oaks museum and garden, which is so large that is bordering on unseemly considering its Georgetown location.
• But the best — and free — experience would be just to walk around areas that aren’t the Mall, around Dupont and Logan Circles on a spring afternoon when trees are in blossom, or down U Street/Shaw on a Friday evening, both unforgettable experiences in their own ways.

My first contact with GTD was through 43folders nearly two decades ago, and I haven’t looked back since. A few things did change since then. One adjustment was procedural, going from the DIY planner, I hope this is the right link. Far from being an eternal archive, the web churns at the speed of internet startups. through hipster PDA and Things to, ultimately, OmniFocus. And through the magic of personal blogs I know that the 7-year anniversary of my OmniFocus run is coming up. Tempus fugit. The bigger change was to the arguably most important part of GTD, the weekly review, onto which I added three lists that I glance at weekly and read and update at least quarterly. These are:

• The root commitment document, as suggested by Cal Newport.
• Privileged principles, described by Russ Roberts in his book Wild Problems.
• Favorite problems, which Tiago Forte mentions in his otherwise forgettable Building a Second Brain.

The root commitment document requires little elaboration as Newport himself gave clear instructions on what it was and how to go about making one. I view it as a contract with myself on which routines I should follow and how much flexibility I have in executing them. Through lockdowns and job changes it went from 1000 to 250 to fewer than 200 words now. Brevity matters. ⊕ Wrote he, in the third paragraph of what was supposed to be a 280-character post.

Privileged principles I use as simple heuristics, a hierarchical list of priorities phrased as “I am the kind of person who…” never picks their nose, let’s say, as a pure hypothetical. They do come in handy in those moments of distraction when ambient noise is high and willpower is low. At a higher level — and this is how Roberts intended them to work — having principles you value above others works wonders to reason through seemingly difficult choices.

Favorite problems I intuitively figured out by myself, but formalizing them was an improvement. Whereas privileged principles are what is top of mind when making decisions, favorite problems are top of mind when reading books and articles, watching lectures, etc, especially when those are not tied to a specific project. ⊕ Although, really, if a project you are working on isn’t tied to a favorite problem of yours, why are you doing it at all? There are many reasons why a paper on, let’s say, differences in T-cell development between mice, rats, and humans, may be interesting to someone, but your attention may be focused on different parts depending on your interests. Are you reading about a phase 3 clinical trial in atrial fibrillation because you are an electrophysiologist, a general cardiologist, a patient with a-fib, or a researcher interested in clinical trials in general? And if you are a lawyer, why are you reading it at all? Reasons for reading are not always clear, and if anything, knowing what your favorite problems are helps tremendously with triage.

So these are the three lists that aren’t necessarily part of GTD — heck, the first one may not even be a list at all — but which through trial and error I ended up integrating in my weekly review. I’m sure there are many more.

🎙️ Two recent episodes of EconTalk reminded me why it was the best podcast around:

• Devon Zuegel on Inflation, Argentina, and Crypto brought back memories of living with hyperinflation in 1990s Serbia
• Roland Fryer on Educational Reform was simultaneously frustrating and fun

☕️ After a few decades of making coffee with various techniques (including a dual boiler ECM Synchronika) I realized that:

• Roast level and freshness: huge!
• Brew method and grind level: important, but not as much as the above.
• Burr v. blade, water temp, filter type: meh.