The Long Game 23: Making the West Great Again, Thinking Biases in Medicine, Propaganda, Building Utopia, Optimism
🧠 Consciousness, Hunting, Career Planning, Disaster Preparedness, Scientific method, Institutions, Legibility, and Much More!
Greetings from the Balkans 🌊
If you missed the past episodes, you could catch up here.
In this episode, we explore:
Thinking biases and medicine
Optimism as human capital
A big little idea called legibility
Stop wasting your career one year at a time
Let’s dive into it!
Saint Jerome Writing (aka Saint Jerome in His Study). c. 1605-1606, Caravaggio
🤨 Trust in Authority Figures
While reviewing the highlights I took from Deep Medicine by Eric Topol, one thing struck me. The impact of the cognitive biases that lead doctors to errors in diagnosis is staggering. It’s quite understandable, we know humans are subject to thinking biases, and there are 10,000 human diseases; not a single doctor can know them all.
Here are some of the biases at play:
Availability bias: doctors will diagnose according to the possibilities that are mentally available to them.
Recency bias: doctors deal with patients one at a time, so what a doctor recently saw can shape his future medical judgment — for example, doctors tend to see a rare disease everywhere, after being confronted with one patient that had it.
Rule-based thinking: for example, when cardiologists assume that a patient must be over the age of forty before they suspect a heart attack.
Overconfidence: Kahneman called this “endemic in medicine,” and this bias toward certainty happens a lot and is related to confirmation bias.
Misdiagnosis is a major problem in medicine, and it deserves our attention.
There are more than 12 million serious diagnostic errors each year in the United States alone, and most people will experience at least one diagnostic error in their lifetime.
In his book, Topol proposes many measures to improve medicine and go from “shallow medicine” to “deep medicine.” AI will have a major role to play, but in helping physicians, not replacing them.
On a patient-centric level, what can we do to avoid getting misdiagnosed? The first step is to acknowledge the problem and stop trusting authority figures blindly. Just as there are genius artists and bad ones, there are incredible doctors and bad ones. This first step is hard because it’s so comfortable to trust institutions without doing the work behind. Accepting that they can often fail changes your perspective, but that’s the sad reality.
Once you accept this fact, here’s a good list of questions to ask your doctor to increase your chance of getting the right one. If you can’t imagine asking these questions to your doctor, it’s probably not the right doctor.
Here are some of these questions:
Which conferences do you try to attend each year?
How much time, on average, do you spend per month staying informed of the latest research in medicine overall, such as reading broadly from journals like JAMA or NEJM?
How much time, on average, do you spend per month staying informed of the latest research in your areas of focus, such as specialty journals (e.g., lipidology, nutrition, exercise physiology)?
📈 Definite Optimism as Human Capital
This week I wanted to consider wellness from a different perspective. Wellness can mean many different things, and most of the time, people use this term to talk about the wellness industry and the practices used to feel better.
One of the most important and overlooked things to feel better and live a good life is optimism. It may sound weird at first, but after reading Dan Wang’s Definite Optimism as Human Capital, I can put words to a feeling I developed but didn’t know how to express.
The article explores the connection between optimism and economic growth, but the same concept could be applied to personal growth.
I wonder if economists overrate the easier-to-observe policy factors and under-theorize the idea that positive visions of the future drive long-term growth. To put it in a different way, I wish that they would consider definite optimism as human capital. In addition to education levels, human capital models should consider factors like optimism, imagination, and hope for the future.
We’ve already talked about optimism here because I believe it’s one of the keys to fix the major challenges of our century. I’m not talking about the contextual optimism; I’m talking about the philosophical one. In the words of Jason Crawford in Roots of Progress:
Descriptive optimism, for me, is highly contextual. It is situation-specific. I am mildly optimistic about our efforts against coronavirus. I am fairly pessimistic about US politics. Prescriptive optimism is deeply philosophical. It is a belief about the nature of life, intelligence, and agency. It is a moral attitude, a way of living.
All the discussions about wellness are important, but nothing will replace a sense of purpose and a personal mission. This, coupled with optimism, is the solution to both personal growth and economic growth.
So how do we get there? Dan Wang suggests that science fiction could and should play an instrumental role on this front. As I already tweeted, sci-fi movies took a pessimistic turn lately, and it doesn’t help society.
Alas, for some reason, science fiction movies have taken a bleak turn in the last few decades. The dominant mode in modern sci-fi movies is dystopia, and perhaps even nihilism. Today, the contrarian project is to present an earnest, joyful vision of the technological future. That kind of undertaking will invite mockery from commentators posting essays on Medium, but one can hope that younger, less jaded people will find attractive that daring imagination.
On a personal level, the single most impactful thing that happened to me was finding a cause I cared deeply about — health & longevity — and align my professional life to work on it.
If I needed to point at one parameter to work on that would greatly help the West, it would be to spark a sense of mission and an optimistic vision of the future to its citizens. Joseph Campbell wrote:
If you want to change the world, change the metaphor.
Here’s a suggestion to change the metaphor:
If I had funding and access to studio talent, I would reshoot a bunch of films. Elysium, with a focus on the logistics behind the smooth functioning of a satellite habitat. Ex Machina, featuring an artificial intelligence whose greatest desire is not acceptance in human society. Gravity, with greater marveling of space and the desire to explore, not the aftermath of random mechanical failure. Her, in which artificial intelligences decide to improve humanity, instead of migrating en masse to a higher spiritual plane. Star Wars with no wars and no Jedis—and therefore no Sith—that instead draws out the gains from interstellar exchange under oversight of the Trade Federation.
Instead of getting fixated on comparing ourselves to others and competing in the infinite rat race, dreaming of a better future and working on making it a reality is both a way to contribute to our civilization's progress and feel better.
And here’s how we could make it happen at scale:
It might be a good philanthropic undertaking to create exciting visions of the future. I humbly beg the various generous people who open up their pocketbooks to also consider funding culturally exciting projects. I’d like the altruistic millionaires and billionaires to step up funding of movies, books, World Fairs, murals, memes, whatever, to expand our imagination. More art, say, that depict societies of the future, like so much of what we had previously. Or focus the World Fairs to once again showcase applications of cutting-edge technologies. Or figure out how to make cool videos of industrial processes that people are happy to watch online.
The Martian, 2015 — one of the only optimistic sci-fi movie of the decade, by Ridley Scott
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🧠 Better Thinking
💭 A Big Little Idea Called Legibility
Legibility is a fascinating concept. In our attempts to improve the world we live in, we have to go through a phase where we make the world more legible.
Look at a complex and confusing reality, such as the social dynamics of an old city
Fail to understand all the subtleties of how the complex reality works
Attribute that failure to the irrationality of what you are looking at, rather than your own limitations
Come up with an idealized blank-slate vision of what that reality ought to look like
Argue that the relative simplicity and platonic orderliness of the vision represents rationality
Use authoritarian power to impose that vision, by demolishing the old reality if necessary
Watch your rational Utopia fail horribly
There are many examples of how “legibility” led to major problems. For example, new cities like Brasilia are unlivable (I would be curious to know how charter cities plan to overcome this challenge), and neatly divided farmland leads to poor soil qualities and hydrological challenges.
Understandably, we need to simplify the reality we live in if we want to achieve something, but what might help us is to understand that reality doesn’t have to be legible.
The deep failure in thinking lies is the mistaken assumption that thriving, successful and functional realities must necessarily be legible.
This approximative rationalization mistake appears to happen when people aren’t really immersed in the system they want to improve.
Complex realities turn this logic on its head; it is easier to comprehend the whole by walking among the trees, absorbing the gestalt, and becoming a holographic/fractal part of the forest, than by hovering above it.
It wouldn’t be correct to consider that the problem of legibility only comes from a lack of knowledge. I think we’ve all experienced this feeling of chaos when exploring an idea or during a project. It’s a very uncomfortable sensation, and our reflex is often to try to rationalize the situation quickly.
I suspect that what tempts us into this failure is that legibility quells the anxieties evoked by apparent chaos. There is more than mere stupidity at work.
The concept of legibility is key to think better about complex systems. On the state level and the personal level, the first step is to welcome the chaos and sit with it, as uncomfortable as it may be. Then, the quest for a better solution can start by keeping in mind that reality doesn’t always have to be legible.
If my conjecture is correct, then the High Modernist failure-through-legibility-seeking formula is a large scale effect of the rationalization of the fear of (apparent) chaos.
To conclude this point about legibility, I found this quote from Heidegger to be a beautiful way of talking about legibility:
Enframing does not simply endanger man in his relationship to himself and to everything that is. As a destining, it banishes man into that kind of revealing that is an ordering. Where this ordering holds sway it drives out every other possibility of revealing. — Heidegger
⚡️ Startup Stuff
🗑 How to Waste your Carrer, One Comfortable Year at a Time
This week I want to explore something a little bit different in this section. I came across an article that’s not directly related to building a startup but to career planning.
It started with this tweet:
The replies are a very interesting guide to avoid making big mistakes.
The most common mistake is that people stayed too long in a job they didn’t like.
The first idea that’s necessary to understand for the right career planning is that life is short, and spending it on things that don’t matter is a poor usage of this short time we have:
One heuristic for distinguishing stuff that matters is to ask yourself whether you'll care about it in the future. Fake stuff that matters usually has a sharp peak of seeming to matter. That's how it tricks you. The area under the curve is small, but its shape jabs into your consciousness like a pin.
Now, on a more practical side, this article puts the right words on a complex topic. The biggest takeaway from it is that “complacency is cancer.”
If you don't want your talent to go to waste - treat complacency like cancer.
Then, optimizing for learning is an excellent way not to waste time. For the people who want to assess whether it’s time for a change, the writer gives a framework to evaluate it that takes into account:
The bottom line here isn’t to say that quitting is always the good thing to do or that everyone should become an entrepreneur. The point is that time is short and that if you’re not doing something that lets the best version of you thrive, it might be smart to find a way to get there.
The classic counterpoint to this idea is that change comes with risks. I agree, but isn’t wasting a life doing things one don’t like a risk as well?
That's the equilibrium. The engineers get to write code and believe they run things. Engineering managers get very cushy jobs and believe they’re doing productive work. The machines keep running. Nobody is especially happy, but everyone is making a lot of money in exchange for doing little work, so there isn’t anything to complain about.
Last words on career planning, by Marc Andreessen:
The first rule of career planning: Do not plan your career.
The second rule of career planning: Instead of planning your career, focus on developing skills, and pursuing opportunities.
📚 What I Read
🚥 Propaganda as Signaling
Last week, I saw Paul Graham respond to a post on Chinese propaganda on Twitter:
His idea was that Chinese propaganda was obviously very poorly executed and that everyone will know that it’s pure propaganda.
It made me think of this paper that I read a few months ago called Propaganda as Signaling, and here’s the abstract:
Why do authoritarian governments engage in propaganda when citizens often know that their governments are propagandizing and therefore resist or ignore the messages? This paper proposes that propaganda is often not used for indoctrination of pro-regime values and attitudes, as is traditionally understood, but rather to signal the government’s strength in maintaining social control and political order. Consistent with the theory, analysis of a unique dataset shows that Chinese college students with more exposure to state propaganda in the form of ideological and political education are not more satisfied with China’s government system, but are more likely to believe that the regime is strong in maintaining social control, and less willing to participate in political dissent. Additional evidences supporting the theory are also briefly discussed
The idea is very interesting; propaganda is intended to make individuals fear the regime, not brainwash them.
Now everything makes more sense.
🌌 Building Utopia
I really enjoyed this series about the academic culture by Andre Marques-Smith, who spent 12 years in British academia before leaving for the private sector. I’ve mentioned the problems of science and academia in The Long Game 21 because it’s one of the origins of the stagnation of progress and innovation since the 1970s.
I didn’t stop believing in Utopia — instead, I realised it is not something to be found but to be built.
The series covers:
Hidden Power Networks
Time spent on grant-seeking activities
Too much hierarchy
Poor people and project management
📱 Build Institutions, Not Apps
“Silicon Valley likes to think they’re above politics while in fact, they’re below it.”
I found this piece by Mark Lutter to be particularly interesting. In it, he calls for more political involvement from the tech world.
Last fall I applied and had an interview at a prestigious accelerator. I told them the Charter Cities Institute helped draft regulations for Enyimba Economic City, a new city in Nigeria with a target population of 1.5m residents. Their response was, ‘so you’re consulting’. Unfortunately, we were not accepted to the accelerator. If they think writing the regulations governing a new city is consulting, perhaps it isn't surprising Silicon Valley can't figure out how to legalize housing.
In a 2006 report, the World Bank showed that the most valuable thing in a country is the rule of law you plant from which everything else sprouts. That’s why it’s so important for tech to get involved in politics.
Institution building is a political act and needs to be understood as such. Tech giants like Google have figured out how to lobby effectively for their own interests. However, that parochial view of protecting one’s domain is no longer enough. There instead needs to be a push, a demand, for a broader set of pro-innovation reforms.
The COVID-19 crisis is the perfect example to show that we can’t make abstraction of the political world, and it also showed how our institutions are poorly managed. It’s too important not to do anything.
Who is creating the Y Combinator for institution builders? Who is funding their intellectual development and empowering them with a network to execute it?
balajis.com @balajisCompiling a list of the official misinformation from press & state. - Flu is more serious - Travel bans are overreacting - Only Wuhan visitors at risk - Avoiding handshakes is paranoid - Virus is contained - Tests are available - Masks don't help What else?
💼 Hedge: A Greater Safety Net for the Entrepreneurial Age, by Nicolas Colin
I’ve read this book by Nicolas Colin, and I loved it. My favorite chapter was “Making the West Great Again,” where the author explores how the West could work its way to greatness once again.
In the context of the US being increasingly inward-looking and the rise of China, this question is going to define our future in Western countries. Some people think that the world that we have today is the world we're always going to have, but studying history shows that things happen gradually, then suddenly.
The two non-Chinese scenarios Colin explores are:
Europe forging ahead and tackling the new institutional challenges without relying on the US anymore — an uncertain scenario at best.
“Western tech industry realizes that its interests lie in managing a new Great Safety Net for the age of ubiquitous computing and networks—and that it shouldn’t wait for feeble Western governments to take the lead.”
🍭 Brain Food
🤐 What’s an industry secret in the field you work in?
I came across this Reddit thread, and I found the responses fascinating. Reading it is funny, scary, concerning, and insightful at the same time!
Here are some of my favorite replies:
The cheapest bottle of wine in the restaurant has the biggest markup.
If you're someone who purchases bulk nuts, grains, etc. Just know that those bins are probably rarely cleaned, and even when they are "cleaned", odds are they were just rinsed out/wiped down to look clean.
I used to be a bulk buyer at Whole Foods Market and when I took over our bulk department had no cleaning logs or sanitizing procedure. The bins had moths/insect colonies and mold in them. Our store was opened nearly 5 years prior.
I'm an attorney. The secret is shut the fuck up.
Former Bath and Body works associate here. The scents they “discontinue” will come back with a different name and new marketing. They’re just recycling the scents.
The industry leading software is about at least 10 years old at its core.
🎥 What I’m Watching
🔭 Richard Feynman on Scientific Method
A beautiful lecture from Richard Feynman. Society would greatly benefit from more people understanding the scientific method, its limits, and its implications.
🎙 Podcast Episodes of the Week
I really enjoyed this episode. Steven Rinella, an American outdoorsman, conservationist, writer known for translating the hunting and fishing lifestyle to a wide variety of audiences, explains why hunting is important and how to do it well.
If you’re anti-hunting, I would highly recommend making a little effort and listening to Steven talk about it. I understand that hunting can be a hot topic for people, but Steven is an example of hunting done the right way. On top of that, most of the funding to manage wildlife comes from hunting permits in the US, so no hunting means no funding for wildlife!
One activity I would love to start is archery, so if you know something about the topic, please let me know! 🏹
🔮 Scott Aaronson: Computational Complexity and Consciousness — Lew Fridman Podcast
This is an excellent episode with all the good questions about consciousness, living in a simulation, and theories of everything.
One idea that really made me think is that we may be very human-centric in defining intelligence and consciousness. For example, the Turing Test seems like a very human definition of intelligence, and we might be missing other forms of intelligence that we don’t have the tools to understand yet.
🔧 The tool of the Week
☣️ Harbor — Reimagining readiness for life's uncertain moments
Harbor is an app that makes disaster preparedness easy and accessible. I’ve been thinking about a product like this for a while. We talked about prepping in The Long Game 10, and I know many people find this ridiculous, but I won’t change my mind that the best way to face a problem is to be prepared.
The emotional component of disaster preparedness is the biggest deterrent to getting more people to think about it. Harbor makes it easy to understand the risks you’re facing and provides you with a clear action plan.
I haven’t tried the app yet, but I would love to do so.
🪐 Quote I'm Pondering
“If you want to build a ship, don’t drum up people together to collect wood and don’t assign them tasks and work, but rather teach them to long for the endless immensity of the sea.”
— Antoine de Saint-Exupéry
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