phobosanomaly

Medical errors kill around a quarter-million people a year. Third-leading cause of death.

Anderson JG, Abrahamson K. Your Health Care May Kill You: Medical Errors. Stud Health Technol Inform. 2017;234:13-17. PMID: 28186008.

https://pubmed.ncbi.nlm.nih.gov/28186008/

Medical residents are capped at 80 hours per-week making around $50k/year, and this is sold as some sort of breakthrough over the previous system where they were working well-in-excess of those 80/week for years during their residency.

What is normalized in the healthcare system is beyond insane.

> care team

You used this phrase, and I like it.

I see this as the core of the problem, and I might just be re-phrasing what you are saying.

I risk veering off into politics here, and I don't really want to, but I do think that the profit-centered healthcare system in the United States creates this separation of people who should really be consolidated into a single team. There should be a team of people working together: Dieticians, physicians, etc.

But, in my experience, everything is siloed pretty bad. Physicians work for one company, the dieticians work for another. Everybody is divorced from one-another. Nobody is part of a consolidated team.

Ideally, you would have both a PCP, and a dietician that you could consult, both of whom are part of a team, share the same medical records system, talk to each other over lunch, etc.

Let the doctors do the doctor part. Let the dieticians do the dietician part. Let them both work together for the benefit of the patient. But, integrate them into the same system.

Maybe this just isn't the type of problem we should be looking towards a physician to address? They spend at least seven years in school learning to handle certain types of problems that can be addressed with certain types of solutions.

Perhaps this type of thing (lifestyle issues) is more in the wheelhouse of a dietician or a lifestyle coach who has a different type of training.

If you have sepsis, a dietician probably wouldn't be the safest bet. If you have lifestyle issues with diet and exercise, maybe a physician wouldn't be the safest bet.

You can enjoy the intellectual challenge of what you do, while understanding that the political context of it is bullshit.

They're patriotically serving their country doing an intellectually challenging job.

If you compare it to what many intelligent individuals wind up getting stuck doing in other developing countries it's a pretty awesome opportunity.

Sounds plausible, but is there any sort of evidence or indication that this is happening?

It could just be that you need a nap. I used to do a basic powerlifting routine in the morning, and my brain would get progressively slower and slower until noon when I took a nap.

It was like hitting the reset button and I was fine for the rest of the day.

Yeah, it's literally paying someone to follow you around all day and control what you put in your mouth. There's no guy in spandex telling me not to buy those Reese's Pieces at 7/11 when I'm bored on a Sunday.

I see this as exacerbated by the lack of anywhere to go and do work for people stuck in quarantine.

Some people despise work-from-home in it's current manifestation, but might not hate it at all if they could rent a quiet coworking space near their gym or something. Instead everybody's stuck at home, so the people who don't necessarily enjoy being at home all day are losing their minds.

I had a boss who finished an online master's degree on his train commute every day.

It was a good way for him to timebox the work, and stay consistent day-in-day-out without having to burn through a ton of self-discipline.

It really depends on the curve. Weed-out classes are famous for having extremely aggressive curves. You can be perfectly smart, be intellectually curious, and have a great grip on the material, but due to the competitiveness wind up with grades too low for, say, medical school. You need those A's and A+'s in the early courses to pad your GPA so that you can take the hit from taking harder more intellectually-demanding courses later-on if you're in a demanding major.

A potentially brilliant scientist isn't necessarily the best at memorizing every single idiosyncratic, arcane detail that the professor uses to differentiate an A+ from a B.

I got some pretty darn good grades in undergrad, and whenever I explained to a research PI how the sausage was made they were pretty disgusted by it, because it involves zero intellectual curiosity. Just dissecting and memorizing massive amounts of minute details from the lecture that have zero relevance to the real world. I didn't get those grades because I was the smartest guy in the class (I wasn't by a long-shot), I got them because I was a machine that resided in the same cubicle on the second-floor of the science library 7 days/week. There are plenty of people with lower grades than I got who would be magnificent surgeons or scientists. But, that GPA is a huge gatekeeper to those professions.

For example, the infamous med school STEP 1 exam is going pass/fail next year, because students have stopped caring about learning about how to practice medicine in the real world, and have started grinding thousands of ANKI cards every day to memorize infinite details about weird autosomal recessive diseases that like 4 people on the planet have, and game the test. The curve is tight, and performance on the test has stopped reflecting ability to actually perform the jobs the test is gatekeeping for.

That requires lots of risk that may not be feasible to students funding their education with debt, and with skills in spaces that have regulatory overhead.

Many community colleges offer excellent programs for later-in-life learners to get them up to speed on things like math and writing skills.

You can use community college to go from being a college dropout to transferring into Berkeley. It's important that we preserve those mechanisms for social mobility.

I would make the case that it's like running a program on a PC with an unknown codebase.

If you don't have access to the source code, and you're just watching the program running, it's this magical thing that behaves in a way you're not entirely sure of. The software architecture is filtered through the UI, and so you can't be 100% sure exactly what's going on in there.

But, at the end of the day, regardless of the zeroes and ones, it's all just electricity flowing through logic gates on a silicon chip.

The program may mimic consciousness (and be indistinguishable from it in a practical sense - in which case, is it not conscious?), it may talk to you, it may display fantastical images, but at its heart is a silicon chip made of logic gates.

So, consciousness in a living thing may be something mystical and intangible when you're observing it, but drill a hole in the skull and biopsy the tissue, and it's just a collection of carbon, hydrogen, nitrogen, oxygen, and phosphorus molecules arranged in a particular structure that conveys electrical patterns.

Similarly, I can eat a sandwich and it's somehow turned into me and that's magical. But if I open a biochem textbook it starts looking less like magic, and more like a complex interplay of biochemical pathways. I can administer some carbon triple-bonded to nitrogen and boom the pathways grind to a halt. I can administer a molecule with a ring structure and a nitrogen and a methyl group, and boom it ramps into overdrive.

I think that the word consciousness is part of the problem. It's a tremendously vague and ephemeral word. It comprises personality, memory, behavior, etc., all of which are variables that can be pharmacologically and electrically manipulated.

Reality itself, well, iono. I'm sure they have a pill for that.

Are you arguing for the existence of an intangible soul?

I mean, it's all chemicals, right? It's chemicals all the way down.

Neurotransmitters secreted by lipid-bound sacs (cells) packed with protein and sugar, arranged in vicinity of each other based on chemical and electrical (chemical influx/action potential) pulses.

We abstract the chemistry from a machine-code level (raw, chaotic, biochemistry) up to medicine's version of brain C++ (neuroscience), and then brain Python (psychology).

And, so, sure, maybe mental illness isn't simple chemistry (only a matter of one or two neurotransmitters a little off-kilter), but everything happening in your brain right now is chemistry, and so deviations from normal must therefore be a matter of chemistry.

I would argue that calling it an imbalance or whatever is just a matter of semantics, but everything we see, and are, and do, and perceive is chemistry and changes in the chemistry (imbalances, whatever you want to call it) influence everything we see, and are, and do, and perceive.

At a low level with current technology, we can tweak individual neurotransmitters pharmacologically (SSRI). With things like CBT we can try to tweak the chemistry in a more complex manner, and at a higher level of abstraction (changing wiring of chemical and electro-chemical synapses via chemically-mediated long-term potentiation/depression).

So, I want to try to make the argument that it's less a matter of whether you address chemical imbalances or not, but rather at what level of abstraction you address the chemical imbalances.

I'm genuinely not trying to be a pedantic douchebag. I'm just trying to argue that it's all the same shit, just at different levels of abstraction.

Out of curiosity, what is it that gets you before you go to sleep? What is running through your mind when you experience the panic attack? (I mean, not specifics, but in a general sense.)

I've had panic attacks during loosely-structured periods in my life where sitting in the shower after waking up in the morning and having to decide what to do with that day was absolutely overwhelming. Sometimes when you have a lot going on and you're under a lot of stress there's a lot of pressure associated with deciding how best to allocate your time.

In contrast, I find a relative peace at 3am, since it's merely a continuation of what I had been doing earlier that day. I'm in a groove, and there's no major decisions to make regarding my resource allocation.

Waking up is absolutely one of my least favorite parts of the day. It comes with a tremendous burden, especially when living alone and not having a fixed schedule or a boss.

Your point about interests is interesting.

What would you consider an interest that would catch your attention?

If hiking is an activity, then would the interest be 'getting outdoors.'

> Birth control and condoms have been widely available for one billion years at this point.

Many, many women prefer not to use birth control (for a variety of reasons), and many men find that the decreased sensation from condoms doesn't make the experience worth all of the effort.

As a result, after going through a few pregnancy scares, sex may just not be worth the trouble. Especially if you're not past a threshold of attractiveness and have to put in a ton of effort to be able to have that sex in the first place.

If sex is going to wind up being only a marginally-pleasurable activity that requires an enormous amount of effort to secure and is accompanied by regular pregnancy scares, then why bother?

Fuck the species. Why not just smoke some week, sip a beer, and play videogames with your buddies (guys or gals)? Sounds like a much better way to spend an evening to me!

The implication of the data used to generate the graph that the article is focused on is that young females are having more sex than young males.

"Americans overall are having less sex than they used to. Young people, in particular young men, appear to be driving this trend."

"As per the chart below, the percentage of young women who hadn't had sex in the previous year increased as well, though not nearly as much as it did for men."

They might not know that they're part of a harem if they're struck by the man's good looks and there's asymmetric information.

I mostly just fill my time with work and hobbies. The rest of the time I spend alone with myself.

Doesn't fill the mental needs, but you just get better at suppressing them over the years.

Would be nice to meet someone who shared my interests and take on life, but the only ones I've found don't find me particularly attractive or already got snatched up. And what's the point of starting a relationship with someone who doesn't share your interests and take on life? Fear of dying alone? That doesn't seem to me to be a good enough reason.

Eh, well, dying alone doesn't seem too bad in an era where you can literally pursue any fascinating hobby you want with relatively low startup costs (FPV drones, dirt bikes, rock climbing, backpacking around the world, you name it).

I think you raise a really interesting point with this, and I want to offer a counterexample that I managed to come up with.

So, yes you can make an FGC-9 in your garage. Fair enough.

But are the barriers to manufacturing one in the garage sufficient to significantly reduce proliferation?

So, my example is the widespread absence of fully-automatic weapons in U.S. crime. Any schmuck with a lathe and a milling machine in the garage can crank out fully-automatic sub guns like it's Christmas in Sarajevo in 1993. But nobody does. You only very rarely hear about full-auto being used in the commission of crimes. Why? Perhaps the illegality, expense, and manufacturing hurdles (however small they might be) are just good enough to prevent meaningful proliferation in the way we see with semi-autos today.

The ammo thing is an interesting point too. I would think one of the biggest hurdles would be to homebrew ammo that was clean-burning enough not to immediately jam something like an FGC-9 in small calibers. I looked into cartridge case manufacturing and I guess there's a brass drawing process or something. I wonder how difficult it would be to base a design around CNC machined cartridge cases instead?

One thing is, you have to subtract bolt guns, and bolt gun calibers from circulating firearm and ammunition totals. That should cut the number down quite significantly.

The guns wouldn't instantaneously disappear overnight in this scenario. It would take 10-20 years to see a sizeable impact.

I have an interesting quote related to the UK and gun laws:

Gun deaths remain extremely rare in Britain, and very few people, even police officers, carry firearms. But the growing presence of American weapons on the streets, which has not previously been widely reported, comes as serious violent crime, like murders and stabbings, has risen sharply.

https://www.nytimes.com/2020/08/12/world/europe/handguns-smu...

So, hey, U.S. firearms restrictions might have some very positive outcomes for the U.K. (and Mexico as well).

I'd love if you could share an article about that firearms rental operation, how prevalent those weapons actually are, and if they're coming in from the United States.

Through buyback programs and legal penalties for possession, the amount of weapons in meaningful circulation would likely decrease substantially over a period of years.

As that process occurred, the value of the weapons would spike as scarcity took hold, and tactically-useful firearms (e.g. semi-auto) would become expensive on the black market. This would mean that criminals would need to be far more judicious with how they carried and used them.

It is very plausible that this scarcity effect would lead to a meaningful reduction in the possession and use of firearms by low-level street criminals, which would also by extension lead to a reduction in levels of firearms-related homicide, assault, and intimidation.

A low-level narcotics broker is less likely to carry around a Glock that costs $10,000 (which they have to dump off of a bridge or in a storm drain every time it's used in a homicide), than they are to carry around a black-market stolen Glock that cost $600.

I'd like to riff off of the above poster's great comment.

Even taking an inexpensive trip through Mexico by bus (Autobuses ADO) and staying in hostels might effectively hit a 'reset' button.

If you've already had COVID, you don't have to worry about that, and climbing a few ancient pyramids, eating fried lime/salt crickets, and being surrounded by new sights, smells, and sounds at the tianguis might yank you out of your fog.

Americans are pissed about a lot of the things we see around us, yet we also have a political system that, were all of us involved, would likely provide the means to fix many of those things.

If you ask an American about, say, the problem of homelessness they will tell you it is awful, and there are more people living in tents, and etc. etc.

But, the overwhelming majority of people will not lift a finger to get involved in either nonprofit or public-sector solutions in any meaningful hands-on way.

So, we're upset about everything and simultaneously unwilling to put in a collective effort to fix any of it (even though we know we could if we really tried - we were raised on the idea of American exceptionalism after-all). I think that produces a sort of cognitive dissonance throughout the population. We know these problems are tractable, we know we're capable of solving them, but we also know we're not going to do a damn thing about them.

The origins of the cognitive dissonance can perhaps can be attributed to the strong mythologic narrative of individualism in the country running up against the erosion of community, the income gap, the increasing complexity of the problems we face, and the inadequacy of out K-12 education system to prepare students to function competitively in the 21st century.

If you're into that kind of thing, I highly recommend William T. Vollmann's Imperial.

There are two kinds of reading. Reading that is hard and reading that is easy.

Nobody who reads 100 books a year (or even 50 as the author cops to) is reading anything particularly difficult. It's either fluff self-help, or fiction that vacuums your attention in, or a medium article by some MBA blown up to 250 pages by a publisher, or something you should be listening to as an audiobook on your commute. Look at what the author of the article is reading! Come on, this stuff is embarrassingly easy. It sure as hell ain't Knuth.

I'm an advocate of reading about 6-8 books per-year, and it is miserable. About 300 pages into a nonfiction technical book and I'm pacing around the kitchen island, djent in the headphones cranked up to 1,000, jaw clenched on my nicotine gum, 12 cups of coffee playing chicken with my guts, muttering to myself, scribbling nonsensical notes in the margin. Miserable.

It sucks. I absolutely hate it. I don't understand 30% of the goddamn thing. But, I learn a hell of a lot.

So, I strongly distrust anyone who brags about reading, and I listen closely to anyone who bitches and moans and complains, but slogs their way through a small number of serious, technical, nonfiction books per-year. The difference between reading SICP and reading Simon Sinek is immeasurable.