Author Archives: Jake Seliger

Uncomfortable truth: How close is “positivity culture” to delusion and denial?

June 24, 2024 By in cancer, Culture, Essays Tags: , , 3 Comments

“Positivity culture” is tricky to define but easy to feel, especially for someone like me, whose fatal cancer diagnosis elicits many responses rooted in the desire to evade the discomfort of imminent mortality or to seek false control because true control is out of reach. I notice positivity culture in responses from friends, family, strangers, and strangers on the Internet who say “look at the bright side” or “other people have it worse” or “you are lucky in some ways.” It’s the people who say I should stifle or cut off “negativity.” Though those people are not wholly wrong, they’re also missing a lot.

Positivity culture is adjacent to therapy culture, which I’m also ambivalent about: therapy is useful to some people in some circumstances, but for many it’s become a crutch and, often, a form of narcissistic dysfunction that denies true obligation to other people, as therapy itself becomes a replacement for authentic relationships and family. Real friendships and relationships aren’t about what happens when things are happy and convenient; they’re about what happens during difficulty, strife, and inconvenience. Who are you when things get hard? “Plenty of People Could Quit Therapy Right Now: Except in rare cases, treatment shouldn’t last forever” says:

There’s reason to believe that talk therapy in the absence of acute symptoms may sometimes cause harm. Excessive self-focus—easily facilitated in a setting in which you’re literally paying to talk about your feelings—can increase your anxiety, especially when it substitutes for tangible actions.

Therapy can promote self-absorbed navel-gazing. It’s like people who read too much and do too little: there’s an optimal amount of reading, which is less than I did in my teens or twenties. Too little, and a person is ignorant and not adequately benefiting from the learning of others. Too much, and a person is inert, without a perspective and drive of his own, too mired in the words of others. Some positive encouragement is good, particularly when depression leads to inaction and further problems. Too much is denial. Balance can be hard, but I see a default to excess, false cheerfulness.

“Why Positivity Culture is A Problem” is stashed behind a paywall now, but its author identifies cultural tendencies similar to those I’ve noticed. Another, congruent view is articulated in “The Opposite of Toxic Positivity: ‘Tragic optimism’ is the search for meaning during the inevitable tragedies of human existence, and is better for us than avoiding darkness and trying to ‘stay positive.’” “Tragic optimism” seems to me close to a stoic attitude, which admits sadness into life without being dominated by sadness. Look, I like optimism. Being around optimists is often more fun than being around dour pessimists. I just don’t want optimism to bleed into folly or inanity. The lines are blurry.

Gratitude is good. Having some perspective is good, even though I’m not sure what “having perspective” means. From a sufficiently cosmic perspective, our lives can look kind of pointless and meaningless, which seems bad, and maybe it’s better to imbue life with a meaning that doesn’t intrinsically exist. Maybe the optimal amount of perspective is as tricky a line as the right amount and kind of positivity.           

I recently read “The Optimists Ended up in Auschwitz.” As you can infer from the title, the people who looked on the bright side didn’t flee Germany in the 1930s, and the people who were less convinced of the goodness of the mob ran, survived, and passed on their genes. Optimism is often but not always warranted, and pessimism exists because bad things do in fact happen, and, if we ignore them, we can die.

Too much catastrophizing seems just as bad as putting a happy spin on everything. If you always, then you stand still as the problem runs over you. When I first had pain on my tongue, I thought I’d bitten it. Bess identified nothing abnormal on the tongue’s surface, and so it seemed reasonable to wait and see if it improved instead of giving into hypochondria and rushing to the hospital like the patients Bess sees in the ER every time they feel a small twitch or twinge. The pain continued, and I saw a strange patch of skin on my tongue, and that stimulated me to act (albeit too slowly). During my most recent infusion of PDL1V, I talked to a guy who said he noticed pimple-size mass erupt on his hip, and over weeks it grew to the size of a saucer. His response to that and other symptoms was apparently to see a chiropractor and acupuncturist. I found his story baffling, though I know from listening to doctors’ stories that denial is powerful.[1]

When someone pitches positivity to me, I know there’s a kind of self-interest lurking in the pitch.[2] Most of us prefer to hang out with someone who’s upbeat to someone who is dour. Yet negative people are often funnier—better able to see life’s absurdities, which is to say human absurdity. I’ve gotten a lot of positive feedback on the humor in my cancer writing, and that humor germinates, I think, in my cantankerous side. It’s not that I actively try to cultivate cantankerousness—I’m no Larry David[3]—but I have to notice the negative, often absurdist facets of the healthcare system. At the same time, emotional honesty compels me to speak, maybe too voluminously, about the pain of premature death for those left behind. That pain just sucks. There’s no compensating wisdom. Occasionally, the more things suck, the better fodder they are for dark humor. That’s sometimes life. Bess reassures me that, when I think some of the things coming out of my mouth—or usually, keyboard— are “too dark,” I should just ask her to repeat some of what emergency healthcare workers say on a near-daily basis and I’ll be in excellent company.

In the U.S., we’re bad at dealing with things that just suck. Pain and adversity often teach nothing except how to access the angry, petty aspects of our natures. A friend recommended It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand by Megan Devine; the book is useful, though it should really be a 5,000- or 10,000-word article.[4] It starts: “The way we deal with grief in our culture is broken.” How so? Devine says: “Platitudes and advice, even when said with good intentions, came across as dismissive, reducing such great pain to greeting card one-liners.” The intentions are good, but they misfire because “Our culture sees grief as a kind of malady: a terrifying, messy emotion that needs to be cleaned up and put behind us as soon as possible.” Sometimes life is terrifying and messy—themes Bess often describes in her work as an ER doc[5]— and Devine argues that grief often can’t be assuaged, except perhaps by time; although “most people approach grief as a problem to be solved,” grief is often not solvable at all, let alone in the short term. The perspective that grief, an inevitable part of the human experience for everyone except sociopaths, is a “problem” is itself a large part of the problem. Get a fundamental cultural supposition wrong and everything that follows is going to feel wrong.

Instead, Devine says grief is deeply felt, and often continues to be felt for longer than it “should be” (however long that is), and often the best thing for friends and family to do is nothing but sit and be present. I guess they can stand and be present, too. Most of us are uncomfortable and impatient with grief, so the advice to buck up, move past it, stay positive, etc., is really about making the person speaking feel better—not the griever. According to Devine, “Even our clinicians are trained to see grief as a disorder rather than a natural response to deep loss.” The commonplaces people say are detrimental, not helpful, in Devine’s model: “Platitudes and cheerleading solve nothing. In fact, this kind of support only makes you feel like no one in the world understands.” Is it true support? When friends and family inadvertently reach for clichés, the effect is the opposite.

Sometimes things happen for no discernible reason. Sometimes things happen and there is nothing to be learned from them. I for one think I’ve learned nothing from having cancer or losing my tongue, apart from the obvious, like “both suck.” Neither has made me stronger, better, more empathetic, or anything else positive. I’m not a better person. I don’t appreciate life more. People have told me my writing about my experience is helping other people, which is good, but writing about my illness has taught me that I’d prefer to be writing about something else in order to help people. It’s all bad, no good. I’d prefer not to have whatever wisdom pain might impart. Devine says: “As a culture, we don’t want to hear that there are things that can’t be fixed. As a culture, we don’t want to hear that there is some pain that never gets redeemed.” Instead, we want people to be positive and look on the bright side, even when both are lies.

Devine says that “Talking with people in new grief is tricky. During the first year, it’s so tempting to say that things get better.” There’s sometimes some truth to this: things are better for me right, now, today, than they were in June to August 2023. But they’re forever going to be worse than they were before cancer. To claim otherwise is not to put a positive spin on things; it’s to be willfully delusional. Positivity easily shades into delusion. “There are some events that happen in life that cause people to cross a threshold that forever changes them, whether they seek out their transformation or not.” I like that Devine is willing to imply that transformation can be bad. Sometimes there isn’t compensation for suffering. Sometimes suffering is, tautologically, just suffering. Not everything is meaningful and trying to impose meaning on it—or trying to impose meaning on it for the person experiencing it, so that you can feel that, should the same happen to you, it would be meaningful and not just arbitrary and terrifying—can backfire.

Being sad or unhappy or similar is telling us something. Sometimes it’s telling us to change. Sometimes it’s telling us something else, I think. Sometimes the feeling is just wrong, as is our potentially myopic interpretation of a situation, and, when a feeling is wrong, that’s when positivity culture may help. But negativity isn’t always wrong or pathological, and improvements come from realizing something is not going right and then fixing it. Or recognizing that something can’t be fixed, and the time is now to sit with the unhappiness.

To reiterate, I’m not against positivity and, like most people, I’d prefer most of the time to be around positive people than negative ones. But I also prefer to be around truthful, accurate people more than the delusionally optimistic, and though I can’t firmly mark the line between them, I know it when I see it. I appreciate what the friends who tell me to excise the negative are saying, even when I don’t follow their suggestions. Sliding into darkness and then the void is easy. Many aspects of my life do in fact suck, particularly compared to my life before the cancer diagnosis. Perhaps paradoxically, part of what’s allowed me to keep going is to acknowledge and be honest about what is going wrong, while trying to focus on the things that remain that are going right: mostly my relationships with other people, Bess, and still being able to write and contribute. Seeing that there are things to live for doesn’t negate or cushion the blows from the things that make living awful and hard, but neither do the things that have made me consider auto-termination negate the things that are still good.

The worst parts of the positivity people are the ones who reject sickness, setback, and ailment altogether—the “fair-weather friends” of cliché. The people who are “friends” with you, but when something slightly inconvenient comes along, they don’t want to hear about it—they’re obviously not friends, not in any significant sense of the word.

Sitting with someone who is ill, talking about it frankly, and the new challenges and fears it creates, puts the sitter in a position of closeness with the ill person, and therefore closeness with that person’s illness or loss. “If it’s happening to this guy, it could happen to me,” those clinging to the security blanket of positivity culture seem to be thinking. But, even for those who aren’t made uncomfortable by the thought of their own fragility, listening to someone’s personal experience with illness establishes a kind and depth of intimacy most people just aren’t really interested in. We’re a culture of surface, not depth. We more frequently say, “Hey, how’re you doing?” to people while we’re actively in transit, unable and unwilling to stop and hear a real answer. “I’m fine,” is rarely the truth, but it’s easy to imagine the discomfort we’d cause by answering, “My marriage is on the rocks and I’m worried about my last performance review, I could really use a friend to talk with over coffee.” We know the person asking doesn’t really want to know. I’m fond of saying in response to “How’re you doing?” that “I’m dying, which is painful and quite bad. How are you?”[6] Positivity culture is often a canned response to deflect and discourage real conversation. It’s a cutoff in the guise of the curative powers of pretend. It’s faux-connection. It’s bullshit. And our conversations are already infused with too much bullshit. I’ve already imposed a moratorium on banalities. Bullshit might be considered banalities’ equally useless relational first cousin.

Everything is not fine, not all the time. Not for me. Not for you. Though the gradations of “not fine” vary, shutting our eyes against the inevitable instead of finding a way to weave it into our lives, use it to forge connections with other equally fragile human beings, and use that knowledge to generate connection, is shutting our eyes against our own humanity. Sometimes a seemingly sunnier, happier perspective is an alienating, temporarily comforting lie.

The Buddhists have a meditation on death called “Maranasati.” You lie there for a while and dwell on the fact that, barring technological innovation like the Singularity, you’re going to bite it one day. You stop deluding yourself that you’re not a part of the human condition. Like many worthwhile things, Maranasati isn’t meant to be comfortable, even if you pay $30 to be led through the meditation in a fancy downtown LA yoga studio smelling of Frankincense and populated by flexible twenty-somethings who inspire thoughts very different than those of meeting your untimely end. Sometimes embracing the uncomfortable brings a paradoxical comfort, and sometimes embracing what appears to be comfort is just wallowing in bullshit.

If you’ve gotten this far, consider the Go Fund Me that’s funding ongoing care.

[1] His story was also garbled and nonsensical, and I didn’t have the energy to seek real clarification.

[2] Often unconsciously.

[3] Larry David, and other comedians, being interesting examples of people who other people like to hang around typically because of their generative negativity.

[4] The excessively length and repetitiveness is a symptom of the publishing industry’s pathologies, but that’s a rant for some other time.

[5] On the flight to Manifest, the nerd conference associated with the Manifold prediction markets, Bess and I sat near a guy who works as some kind of project manager for constructing data centers. He said he likes working on buildings because the process is so much cleaner and neater than working on or with humans. Working in the ER might melt his mind, since so much of it is the antithesis of clean or neat.

[6] Bess has a half-finished essay on this tendency, and the tendency of people not to listen. When I answer in a chirpy voice, “I’m dying, which is pain and quite bad,” some people go, “That’s great man, good to hear it.” Listening is a rare skill.

Links: The need to lower housing costs, deep reading, and a strep vaccine

June 16, 2024 By in Links Tags: Leave a comment

* “Market-rate housing will make your city cheaper.” Obvious, but one sees many, even generally smart people, blaming everything under the sun apart from supply restrictions. Overall, “Americans Are Mad About All the Wrong Costs”—we should be wrong about housing costs, because housing costs are the biggest part of most people’s budgets. Yet we’re getting what we’ve voted for, for decades: we oppose new housing anywhere near us, and then costs rise. I’ve read claims that voters are like children, unhappy when the things we collectively vote for come to pass and harm us in predictable ways.

* “Deep Reading Will Save Your Soul: Real learning has become impossible in universities. DIY programs offer a better way.” To me the hardest part is finding books worth reading deeply. Most classics I find unsatisfying.

* “You Can Thank Private Equity for That Enormous Doctor’s Bill” (wsj, $). Consolidation in healthcare is an underrated problem. Oligopolies are sprouting while regulators are asleep. Hospitals and insurance companies have great lobbyists.

* The U.S. has not pursued wise nuclear policy.

* Could a vaccine eliminate or dramatically reduce strep throat? One of these truly important things that gets subsumed beneath the typical, not-important headlines.

* “Deterring a Taiwan Invasion: There might still time to stave off WWIII.” Also: “Taiwan is the new Berlin.”

* “People Unlike Me: Political ideologies tend to suit the people who promote and believe them, and not suit others. This makes governance difficult.” A useful admission that policies good for one group (like drug liberalization) may be bad for others (like people with poor conscientiousness or impulsiveness issues).

* “Rejecting GMOs hinders human progress and keeps the poor hungry.” Obvious, and yet here we are.

* “More Crowding, Fewer Babies: The Effects of Housing Density on Fertility.” On especially the failure to build spacious multi-family.

* Arguments for parent control of education.

* Claim that “China Is Losing the Chip War: Xi Jinping picked a fight over semiconductor technology—one he can’t win.” I don’t know enough to evaluate this for truth.

* “Putin Is Running Out of Time to Achieve Breakthrough in Ukraine.” Good.

* “Do grant proposal texts matter for science funding decisions? A field experiment.” Maybe not that much.

Manifest, the Manifold Markets nerd festival

June 13, 2024 By in cancer, Cities, Culture Tags: , , , , , 3 Comments

Bess and I went to Manifest, which bills itself as “A festival for forecasting and prediction markets,” a description that may technically be true but fails to capture the spirit; to my eye and experience, it’s maybe more accurately stated as “Substack and Twitter live” or “a mixture of festival-conference-party-Burning-Man for nerds with many interests to show up and enjoy each other’s company.” Which is just to the temperament of Bess and me (though I’m still on a legacy WordPress platform; a year ago I thought about switching to Substack but didn’t because I thought I’d not be alive long enough for the switch to matter). Bess excitedly exclaimed it to be “Nerd Camp!” with a sort of takes-one-to-know-one gleam in her eye.

There’s something about seeing people in real life that makes me bearish on efforts to build the metaverse, which may be an improvement on text / audio / video but still don’t seem likely to replace live in-person interactions. Meeting in real life creates a kind of vividness and immediacy that online doesn’t (yet) create, and Manifest does just that. I recognized a huge number of people whose Substacks I’ve commented on and whose tweets I’ve replied to. A lot of people in turn recognized Bess and me, for our writing about the FDA killing people via inaction. Manifest attendees manifested a kind of earnestness that a better world is possible, that data should guide actions, that one should change one’s mind in the face of new evidence, and that what initially seems to be true may not be true. Those are all useful traits in getting past the FDA’s PR (something like: “we keep you safe from predatory drug companies”) and into the FDA’s substance (something like: “we don’t care if people are dying while our process runs; our process needs to run”). Nerd Camp was filled with people who believe that a good future is based on better predictions, and better predictions take both knowledge and calculated risk. No risk, no future: at least not a future that circumvents stagnation, and certainly not a future I am in.

The vast majority of the world’s information and ideas aren’t written down or otherwise recorded. It or they exist in people’s head and are expressed verbally. Gatherings of smart people don’t seem like they’re likely to be obsolete soon, which might qualify as bearish on AI. A humorous conspiracy theory called “Dead internet theory” claims that “the internet now consists mainly of bot activity and automatically generated content manipulated by algorithmic curation, minimizing organic human activity.” Manifest is an existence proof of the opposite, a real-life CAPTCHA: the people writing Substacks and making podcasts are gathered in one place. Would the people be the same as their online personas? Could they be better? One guy recognized my nametag and was like: “Hey, you’re the guy who lived!” Bess and I laughed.

Every single person Bess and I talked to was substantive, curious, and interesting, with the middle term being especially important. Given my lack of tongue, a common non-verbal reaction I get in everyday life is the other person thinking: “Why is the retard trying to get my attention?” I could use a more politically correct term, but I get the impression that that’s the one running in their mind. Anyway, I sensed none or almost none of that, despite being in fact very hard to understand. It’s a little like having a heavy foreign accent that no one else has; I’ve noticed that people who work in the tech industry, where people commonly show up from all over, are on average better at understanding me. I now do poorly at conferences yet I’m glad to have made Manifest. Bess observes that there is an assumption of competency at Manifest. Yes, many people had read us, but certainly not all. Everyone there, regardless of age or gender, was approaching interactions from a place of assumed reciprocal intelligence. Maybe this is what it’s like when everyone in a room acknowledges theory of mind. Or maybe it was from the sort of temporary tribalism conferences can create: “I think may people in this room are smart, therefore I am smart, therefore I, and everyone here, is part of this smart group of people.” Whatever it is, it’s a great way to approach a weekend.

One person said that she feels like everyone is somewhat autistic, and all conversation is in the form of parallel, consensual info-dump, or nothing. To me, greater informational content is great. A friend of ours met us on Sunday night, and she described it as a “carnival of the neurodivergent.” To which I say: great!

AI was a big issue there, and there seemed to be more people working on advancing AI than there were people working to advancing what’s sometimes called AI safety. The accelerationists and safetyists would be in the same room, sometimes debating each other, sometimes not. It’s interesting how discontinuous the AI contingent, whether safety or accelerationist, think the near future is going to be.

I’m undoubtedly not the first to contrast, on the one hand, claims of unique historical discontinuity from AI changing the world with, on the other hand, the stasis evident in the physical plant of Berkeley and other Bay Area cities. Bay Area cities have built hardly anything since the ‘70s, if not earlier. Infrastructure is ancient and rundown (including housing, roads, transit). We’re going to build the future in every respect, except for the physical world in which all the AI programmers live. Not even the many billionaires of the Bay Area have managed to build modern subways. Yet there is some upside to not having built “modern” infrastructure when that “infrastructure” consists of stroads and parking lots. Berkeley is still a walking or biking town, and Bess and I walked more than I have since the surgery in May 2023.

On a personal level, Manifest was amazing because it’s the first time since losing my tongue that Bess and I have gone anywhere or done much primarily for fun. Cancer treatment and cancer-related disability have dominated my life in the last year. Manifest first got on my radar when Austin Chen (co-founder of Manifold, the prediction market) emailed me in March. I looked at the Manifest website and thought: “This sounds awesome.” Bess is less keyed into Internet nerds than I am, and I had to try to explain to her who many of these people are; it’s a bit like a European trying to explain soccer to an American, or, worse, an American trying to explain American football to a European.[1] But she was happy at the prospect of going somewhere that isn’t a hospital and doing something that isn’t treatment.[2] We’ve lived in Arizona for four years and found few of our people here.[3] We’d probably have been better served moving to Austin, but the market for ER doctors is worse there, and we didn’t realize that headlines like “Apartment rents plummet in Austin” due to new housing construction would become common, while Arizona governor Katie Hobbs would veto housing bills designed to increase supply. Crazy! Anyway, most Manifest attendees appeared to be from California, but a significant number were from Austin.

If me going to Manifest had been a Manifold prediction market, the probability would’ve gone up and, mostly down, between me learning about the conference months before and getting there. Much had to go well, in a year and a half where almost nothing has gone well, that, despite booking plane tickets and a place to stay, I wouldn’t have placed a large-value bet on myself. In April I was terribly sick: tumors popped from the left side of my neck, making both Bess and me wonder if I’d live until May. On April 15 I began treatment with Seagen’s PDL1V, and the second dose of PDL1V on April 22 generated numerous adverse side effects. That week I also got some radiation therapy to try and counter the neck tumors. The good news is that the neck tumors necrosed and exited through a hole in the skin. The bad news is that I felt like garbage between April 22 to May 6, with side effects that challenged my ability to remain on treatment. But a new, extensive drug regimen helped me stay the course.

Then, last week, on Sunday, June 2, I noticed pain from the right side of my neck. Looking at it showed an unhappy red splotch—an infection. I started Keflex, an antibiotic, and hoped it would resolve the infection in time. Bess, doing what doctors do, poked at it (despite my protestations) and got some pus out. Unfortunately, I packed the Keflex in a suitcase with my Vitamix, checked the suitcase on the way to treatment to Utah, and then Southwest left the suitcase in Phoenix, which touched off predictable problems and resolutions. By Thursday I hoped I was well enough to fly, and that I wouldn’t need to upgrade from Keflex to Augmentin; the latter is like napalming one’s GI tract. Every morning during the conference, I wound up having to fight some gnarly GI problems, but I managed to get to Manifest by about noon. I managed to defy the implicit odds.

Lighthaven, the venue, was great, and the fridges well-stocked with Soylent, and I also saw pouches of Maya Kaimal Indian food. I didn’t know the specific brand name of Maya Kaimal, but I have some of them in my apartment and so could check. I saw a couple of Framework laptops, too, despite having seen just a few of them in the wild.

If I’m alive this time next year I’ll go back!

Other Manifest commentary:

  • Theo Jaffee has a good podcast and wrote “Manifest Manifested: One of the best weekends of my life at the best conference in the world.” I look to be older than him and while I thought it great, “one of the best weekends of my life” is a high bar. Then again, I don’t know what his life experiences have been or, more importantly, what happened at the Saturday night after-party which went till about 4a.m.
  • Robin Hanson calls it “probably my most pleasant event of the last year, since last year’s Manifest. :)”. With Robin, I feel like “pleasant” might be a slightly suspect word!
  • Bryne Hobart’s generalization of conference-going is behind a paywall, but he says that “The conference solves for specialization by inviting people around whom useful micro-subcultures nucleate, and it synthesizes high real estate prices by charging an entry fee (and plane tickets plus hotels are also going to have the same economic effect; they make time more expensive, so they raise the relative value of the highest-utility interactions)” and “Five minutes of in-person conversation create a more tangible sense of who someone is than years of occasional emailing, even if the emails are a better representation of their mental models. So future discussions are higher-bandwidth.” I’d not read until after writing a draft of the rest of this essay, I will add.
  • Tracing Woodgrains, someone I’d not heard of before but who appears to have some Internet microcelebrity, on Manifest: “For much of my life, I have poured my attention into tough-to-explain solitary pursuits, finding myself often sitting in quiet corners on the fringes of gatherings wondering if they’re worth the effort. Not so last weekend.” Woodgrains seems to have had an interesting life so far.
  • Bess says: “I will 100% return to nerd camp with you next year.” She is also looking forward to maintaining real-world connections via the internet.

[1] Which I’ve attempted, although not very successfully: I find American football tedious.

[2] Bess loudly and adamantly denies this characterization. “I think I know who Scott Alexander and Nate Silver are,” she squawks, like a penguin who wants a fish. “And I have a Substack!” Now she’s glaring at me. Now she’s explaining that she has never been able to understand the rules of football but is at least starting to understand the principles of writing for the internet as I’ve explained them. And she reads. Now she’s harrumphing, but is returning to continue editing this essay, so I must not be entirely off base. 

[3] “Why stay, then?” you may justifiably ask. Jobs, family, and then me getting cancer all make moving impractical, and the gains from moving lower than they’d be if I were well.

Links: Bad news about chestnuts, YIMBYism in Congress, and more!

June 7, 2024 By in Links Tags: Leave a comment

* “Cancer Is Capsizing Americans’ Finances. ‘I Was Losing Everything.’ Higher drug prices, rising out-of-pocket costs and reduced incomes create economic strain for many patients” (wsj, $). Don’t I know it: the time taken by treatment combined with fatigue and exhaustion are murderous to real work, and even to thinking. The side effects of many cancer treatments are themselves so deleterious.

* Turns out that Darling 58, the newly modified chestnut tree that was supposed to be resistant to chestnut blight, is actually Darling 54, which is not so resistant. And so now progress in restoring the American chestnut has been set back years, if not decades.

* “Why a California Plan to Build More Homes Is Failing: Only a few dozen people have built housing under a law allowing them to construct duplexes alongside single-family houses” (wsj, $). It’s notable how few people say things like: “I want my city or state to be governed like California.”

* New Framework laptops are out, with new Intel processors. Framework laptops are famous because they’re designed to be modular, and with easily replaced parts. My big complaint so far is that they don’t offer an OLED screen option, but for a “big complaint,” it’s minor.

* Cold War 2 update. It still seems like hardly anyone is taking this seriously, and building new stuff in the U.S. remains maddeningly difficult.

* “Protesting the Decline of Reading.” Good luck!

* “Is Congress having its YIMBY moment?” Let’s hope so. YIMBYism should transcend left and right, too; shouldn’t we all want affordable housing? Maybe “A New Centrism Is Rising in Washington: Call it neopopulism: a bipartisan attitude that mistrusts the free-market ethos instead of embracing it.” I wouldn’t quite agree with the framing, but it is obvious that China is gearing up to attack Taiwan, and that requires thinking differently about a lot—China might not actually pull the trigger (Xi shouldn’t), but it’s putting itself in position to do so.

* “The solar industrial revolution is the biggest investment opportunity in history.” Optimistic, but not necessarily wrong.

* “How Putin hijacked Austria’s spy service — and is now gunning for its government.” It seems insane to me that Austrians don’t mind this, and that Hungarians don’t seem to mind Orban’s love of the Kremlin, or that parts of the American right are interested in taking orders from Moscow.

* How Matt Yglesias went from left to center-left.

* “‘He couldn’t wait to join’: thousands of young Russians die in Ukraine war.” Putin is destroying Russia and Ukraine, which one say see more explicitly in “Not Enough Russians: Russia’s population has been in decline for years, and the war in Ukraine has made matters worse.” For decades if not centuries, the smartest thing Russians could do was get out of Russia. That’s still true today.

* Why the State Department’s intelligence agency—the INR—may be the best in DC.

* “America’s Military Is Not Prepared for War — or Peace.”

* School choice has been wildly successful in Florida.

The Williams Cancer Clinic treatment costs, and how much another day is worth

June 5, 2024 By in cancer, Essays, Personal Tags: , , 4 Comments

Most of the “alternative” cancer care groups are quacks and charlatans pitching dubious diets, but “most” is not “all” and an outfit in Mexico called “The Williams Cancer Institute” caught my attention because they’re offering legitimate treatment—for example, they’ll inject legitimate immunotherapy agents like Opdivo straight into tumors.[1] They’ll also perform Pulsed Electric Field (PEF) ablation, which has some research showing potential efficacy; PEF may stimulate tumor antigen release in a way that allows immunotherapies to identify the tumor antigens and thus attack the tumors themselves. The possibility of tumor response from PEF and immunotherapy is real, as opposed to the “eat our special diet” people, or the “energy” healing people, or the homeopathy people.[2]

In “The financial costs of healthcare costs, or, is keeping me alive worth it?”, I wrote about whether from a society-wide perspective the care I’ve been consuming passes a reasonable cost-benefit analysis. But that essay primarily assumes a system in which health insurance or a public healthcare system is paying—I’ve also faced the question more concretely, because the Williams Institute is in Mexico and all payments are cash. Is $200,000 for treatment that would probably not cure me worthwhile?

Continue reading →

Links: How to get to more housing, Chinese electric cars are good, trade wars, and more!

May 30, 2024 By in Links Tags: 2 Comments

* “Are single-staircase buildings the new accessory dwelling units (ADUs)?” The basic goal is to figure out all the legal impediments to housing abundance and knock them all over.

* “I Went To China And Drove A Dozen Electric Cars. Western Automakers Are Cooked.” It’s notable that this story is actually important, and yet barely reported in the media.

* “No One Knows What Universities Are For: Bureaucratic bloat has siphoned power away from instructors and researchers.” A process that has been underway for decades and that is now largely complete.

* “Your friends are not a representative sample of public opinion: It’s not just Republicans who are at risk of epistemic closure.”

* “China Has Gotten the Trade War It Deserves.”

* “Parking Reform Legalized Most of the New Homes in Buffalo and Seattle.” It’s a good start. Along similar lines, “Let a thousand skyscrapers bloom.” Obvious, and yet still strangely contentious.

* “It’s 2024 and Drought is Optional.” We can solve a lot of problems with technology, if we choose to. The tragedy is choosing not to, and choosing stasis over abundance.

* “Reasons America is headed for a more conservative decade.”

* The Demographic Roots of American Power.

* Are self-driving cars the beginning of the end of private cars? One can only hope. I routinely take Waymo in Phoenix and it’s great.

Chemo versus carrots: When we don’t have true control, we seek faux control through what we eat

May 28, 2024 By in cancer, Essays, Personal Tags: , , 4 Comments

Get cancer[1] and you’ll be inundated with advice about food, most wrong and much contradictory: avoid sugar; processed food kills; meat promotes cancer; ketogenic diets are incompatible with cancer; milk is dangerous; milk is healing; cancer is impeded by vegetables; honey is good; tea is safe; coffee is dangerous; tumors like Adderall. I think people latch onto diet-based advice, like they do prayer, as a mechanism of control, even if the mechanism is faulty, in a situation where any control is highly medical and scientific and thus beyond the typical person’s abilities. Today, the most common form of nutrition advice is to avoid sugar, even though no evidence suggests that a low-sugar diet will eliminate or reduce cancer (“cutting out all sugars doesn’t actually fight existing tumors”)[2]. Sure, it’d be nice if one could follow a particular diet advice in order to eliminate tumors. “It’d be nice” is not the same as “it is true.”

There’s a human tendency to crave control even if craving control isn’t well correlated with true control over a chaotic, uncertain world. One sees this, for example, in people who erroneously think driving is safer than flying—a driver has some control, but, on a per-mile basis, flying is way safer. We imagine that that we’ll evade the drunk driver, the woman distracted by her smartphone, the dude yelling at his kids. In reality, we don’t control the cars and distracted drivers around us. By contrast, no amateurs fly large planes, the pilots are sober experts, and the FAA extensively digs into any crash to figure out how to prevent the same thing from happening again.

We collectively (and bizarrely, in my view) accept 40,000+ car fatalities every year in the U.S. alone. To me this is insane, but I’m the weirdo in that most people don’t think statistically and accept the fact that people they know and sometimes will be seriously hurt or killed in car crashes. In Sweden, however, there’s an effort to understand the factors underlying serious car crashes, and, because of that effort, “Today, Sweden has some of the lowest rates of road traffic fatalities in the world.” In the U.S. and much of the world, we tend to blame individual drivers, instead of systems; systems, however, can (and should) be improved. In Sweden, “officials were no longer allowed to design roads for idealised drivers who never became distracted or exceeded the speed limit. They had to make roads for real people who made mistakes.” Drivers still drive, but the roads are built to limit the ability of people to kill and maim one another. Real control happens at the level of the system.

I’m not saying striving for control is bad; given the frantic, relentless efforts Bess and I have put into keeping me alive, it’d be peculiar and hypocritical if I did. Striving for greater control is good, but grasping at illusions is not, particularly if those illusions are deleterious to the desired outcome, like, for me, staying alive via clinical trials. Individuals influence their cancer risks; not smoking, or not smoking much, is an obvious way. And it is true that high sugar intake is a risk factor for developing cancer. Once someone has cancer, though, eating sugar (or not), or eating meat (or not) isn’t going to affect the cancer’s course. What will is the usual: surgery, chemotherapy, radiation therapy, oncology treatments (like the bispecific antibody I got, or the antibody drug conjugate (ADC) I’m on now). I’ve been on a low-sugar diet for more than a decade, and that didn’t stop a squamous cell carcinoma from growing in my tongue. There’s a correlation between a low-sugar diet and avoiding cancer, but it’s far from r = 1.0.

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The one-year anniversary of my total glossectomy

May 25, 2024 By in cancer, Essays, Personal 7 Comments

One year ago today, I went into surgery expecting that I’d lose half my tongue to a squamous cell carcinoma recurrence. The evening before, Bess and I got legally married;[1] it was a short, but charming, crash ceremony. I say “crash ceremony” because we wanted to marry before surgery, and on afternoon of May 24 I learned a spot had opened for the next day. It was only luck—if you could call any part of this story “lucky”—that Bess and I had picked up our marriage license a few days earlier, expecting to wed sometime before the planned surgery date of June 8 or 9.  

The tumor itself has only been confirmed on May 11: I got a “hot” PET scan on April 26. Mayo Phoenix initially scheduled follow-up CT scans a few weeks later to figure out what was going on, but Dr. Hinni, the ENT surgeon at Mayo who saved my life, did not like that delay (he dislikes any delay, a trait which has likely saved my life on several occasions) and ordered them stat, so on May 1 I went in to find out whether I was likely to live or die.

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Links: Building smarter, an Epstein-Barr vaccine, you get what you want in the media, and more!

May 22, 2024 By in Links Tags: Leave a comment

* “Exit Strategy: The Case for Single-Stair Egress.” One of these policies that seems minor but is in fact important to human flourishing.

* “How to Build a $20 Billion Semiconductor Fab.” It’s hard.

* “Lithium-free sodium batteries exit the lab and enter US production.” Good if true.

* “The positive case for Joe Biden.” Arguments rarely heard, and it’s largely about policy, unlike the identity and horse-race nonsense that predominates what passes for coverage. This is interesting too: “Biden led by 49 points among voters who relied on newspapers.” By contrast, “Among voters who rely on social media, Trump led by four points. Among voters who rely on cable news, Trump led by eight. Voters who get their news from YouTube and Google favor Trump by 16 points.” Many if not most people have poor epistemology, and, as Bryan Caplan argues in The Myth of the Rational Voter, most people don’t bear direct costs for that.

* Debugging tech journalism. Like most journalism, there’s a strong pull, driven by audience interest, in negativity and salaciousness. We get what we ask for, which is consistent with the links immediately above this one.

* The importance of your coaching tree.

* The Austin, TX freeway expansion and the ills of induced demand.

* Dmitri Alperovitch on the New Cold War with China. Grim but also important.

* Argument that supernormal returns to real estate are over. I’d probably bet against this, at least for high-productivity cities, because I think knowledge-spillover effects from in-person proximity are likely to continue, and are not likely to be replicated from working at home. The best argument against my view is self-driving cars: self-driving cars will obviate the need for most parking lots, which will open huge amounts of existing urban / suburban land to development, which should reduce prices. What we think of as “the age of the car” is really “the age of the parking lot.”

* Eli Dourado on sociopolitical collapse. The bits about the complexity ratchet are notable. Still, I don’t think any “civilizations” have collapsed in the ways he’s describing since the Industrial Revolution, though there are ways to imagine this now (nuclear weapons, pandemics).

* “The problem is that in his search for teachable moments, his memoir acquires the cardboard tone of a middling opinion column.” A fun takedown, full of quotable insults.

* “Is the backlash to universities becoming real? Taxpayers, politicians, and employers are realizing that campus leftism has gone too far. The question is whether it’s too late to stop it.” Maybe.

* “Revolution of the Broletariat: From the christ-like resurrection of america’s frat boy to the chad-ification of tech, anti-masculinity is over; chad maximalism has arrived.” Maybe? Entertaining, though not sure I buy it.

* FDA approves initial clinical trial for an Epstein-Barr Virus (EBV) vaccine. EPV is probably much worse than is commonly realize.

In which the antibody-drug conjugate (ADC) PDL1V shrinks the tumors in my neck and buys me more time

May 20, 2024 By in Essays, Personal Tags: , , , 3 Comments

In March I learned that the previous clinical trial I’d been on, petosemtamab, had stopped working, and the tumors in my neck were an average of 20% bigger: a lot of growth in an ominously small space. That news set off a furious, exhausting, consuming effort to find the next clinical trial; pick the right one, and I’d get more time with Bess. Pick wrong, and die. The eventual answer was PDL1V, a Seagen-Pfizer antibody-drug conjugate (ADC) that has caused and is causing a lot of side effects—but it’s also working. On April 4 and 5 I got CT scans to qualify for the PDL1V trial, and the CT scans were ugly: the radiologist reported “Progression of disease including tumor interval enlargement and increased extent” and found “enhancement” or “worsening” in every tumor, as well as some lymph nodes. Two large lumps grew from the left side of my neck and jaw. Every day, I felt worse, and headaches began in the last week of March or first week of April. I wasn’t sure whether I’d make it to the next treatment. In mid-March, Bess and I debated whether I should get a round of systemic chemotherapy in order to increase the probability of me living long enough to reach the next treatment. PDL1V, however, requires no more than two previous lines of systemic therapy, and we learned that Seagen-Pfizer would consider an extra round of chemo, even the same chemo that I received in August and September 2023, as a new “line” of therapy—rendering me ineligible for PDL1V.

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