If you’re called on to give a talk or presentation, the biggest trap to avoid is the most common: Decide that you need to be just like a professional presenter, but not quite as good. Being a 7 out of 10 at professional presenting is a mistake. Better to stay home and send a memo.
Outcomes are broader, and include any change in health that are considered important enough to measure in a patient (such as “overall survival” — the amount of time between enrolling onto the trial and death, or “quality of life” — a certain score on a specified scale that a patient fills out or the doctor performs).
Endpoints are more specific than outcomes, consider the whole study population instead of individual patients, and need to have a precisely defined way of measurement and time points when they are measured (e.g. “median overall survival”, “3-year overall survival rate”, and “5-year overall survival rate” are three different endpoints that are different ways of aggregating and evaluating the same individual patient outcome — overall survival).
It reminds me of the confusion between efficacy and effectivness, only it’s worse: there is no agreed-upon text that describes the distinction, so it is a really terminological free-for-all. Indeed, what I wrote above may end up not being true — caveat lector! As always, it is always best to ask people to clarify what they meant when they said this or that. Regardless, if someone tells you that “overall survival” (or, worse yet, “survival”) was the primary endpoint, it clearly can’t be the case. Endpoints need to be more specific than that.
Surrogate outcomes and surrogate endpoints are those which are stand-ins for what we actually care about.
Here is a good video on surrogate endpoints in oncology.E.g. when we give chemotherapy to someone with cancer, we do it so that they would live longer and/or better. However, it is quicker and easier to measure if the tumor shrinks after chemotherapy (i.e. “responds” to treatment), and we believe that the tumor shrinking will lead to the patient living longer or better (which may not necessarily be the case!), so we use the response as a surrogate outcome for survival and quality of life (by how much did the tumor shrink? was it a complete or a partial response according to pre-specified criteria?). Study level surrogate endpoints would be the overall response rate, partial response rate, complete response rate, etc.
We have created so much confusion here that it is a small miracle we can communicate amongst ourselves at all.
At certain data volumes and distances, the pigeon is a quicker option for large swaths of rural America, where internet speeds can lag far behind the national average.
And not just rural America. As I write this from the nation’s capital, speedtest.net reports 24 Mbps up. Federal agencies should bring back pigeons for sending large files back and forth.
November 9, 2023
In my notes from Honolulu I downplayed how much better the food was there — for the price you pay — compared to what you can get back home.
Case in point: returning from Diamond Head (an easy trek, highly recommended) we took a Lyft ride back to our hotel. The driver, “L.J.”, turned out to be Ljubiša from Novi Sad, Serbia. Needless to say, we had a good conversation, which led to food, which let to us making a pit stop at “the best doughnut place on the island”. Selling Portuguese doughnuts, of all things.
The box, the interior, and the signage all screamed mid-century modern. Looking at when it was openned, it checks out.
I don’t know if they were the best on the island, but they were better than anything we’ve had in DC in our seven years here!
They are converting a modern office building into condos a few blocks down from my apartment, and by the looks of it they may as well have torn everything down and built it anew. I hope they will do that will all the brutalist federal garbage downtown, the FBI building first. Meanwhile, the late 19th-early 20th century townhouses scattered around DC have been switching seamlessly from commercial to residential and back for a hundred years now for little to no cost.
Optimization and scale: they work great, until they don’t. Just ask a salaried physician working for a conglomerate in the medical-industial complex, a large-scale operation which is being optimized to death (sadly not its own, but that of its component parts — patients and health care workers alike). All those large reptiles and mammals are extinct for a reason.
What goes for biology, architecture, and logistics also goes for industry, and if there is one hyper-optimized massive-scale operation around, it’s Apple’s iPhone production. If and when its production chain comes toppling down, it will not be a black or a gray swan event, it will be snow-white, which is why I suspect (or, as an iPhone user, hope) they have contingencies.
And in practicing what I preach, I have slowly been transitioning away from GTD levels of hyper-productivity and into a 40,000 weeks mindset. Whether this is a sign of wisdom, experience, or just plain old age, well, who is to say? Why not all three?
Two blog posts of the old-school kind, as in people writing in depth about things they love:
And both out on the same day (I’m behind on my feeds!)
November 7, 2023
🏀 Two weeks in, and the Nuggets are at 7–1, the Wizards at 1–5. So no, I wasn’t joking.
The holiday season starts as soon as I get my first email from the Wikimedia Foundation, reminding me that “last year, you donated x dollars…”. And those emails work, despite some recent made-upcontroversies. Wikipedia is the wonder of the modern world.
It was better than the average Netflix series — which isn’t saying much — but also has a better than average time travel story line, so definitely recommended. The premise, which you get from the promo, is that the same dead body shows up in the same London alley in four different time periods; the following few bullet points have mild spoilers, so, caveat lector:
In the way it deals with travel through time it most directly resembles Predestination (2014), and if I were to directly compare the two I would say that Bodies makes the point that both of them are attempting to make in a much better way, and adds a few more points that are as important if not more so.
And yet there is still a plot hole, and of course the plot hole — as in Predestination — has to do with biology. Either writers of science fiction can’t quite grasp how chaotic life is, or are hoping that the general public doesn’t so that they can prove their point.
You may think, as the story takes its second-to-last turn, that it poo-pooed its own premise, and I had this sinking feeling that we were in Back to the Future land, but this was ultimately unfounded. Whew.
We are much further away from World War 2 than WW2 was from the Victorian period, and it is one thing to read about progress and stagnation and yet another to see what a person born in the 1870s–1880s experienced in their lifetime.
There is mercifully little of the future in this series, but what little of it there is serves as an excellent example of humans being better at creating the future than imagining it.
There is a “Deutsch particle” in Bodies, and it ties with Hofstadter’s Spiderverse… mention as my favorite meta/physical Easter egg, which is, admittedly, a rather narrow category.
I haven’t read the graphic novel the show was based on, but I much preferred its stylistic choices in how it showed its roots than those that Watchmen (2009) or The Sandman (2022) took. However, Watchmen (2019) is still five heads and ten shoulders above everything else.
