self_made_human
Kai su, teknon?
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
User ID: 454
self_made_human
Kai su, teknon?
10mo ago
What the hell is going on in Russia?
I've been following the Russo-Ukrainian war since the livestreaming of the first tank that spooked some poor border guard, and frankly speaking the whole affair has been great for calibrating my epistemics.
Did I expect the "3 days to Kiev" thing to work out? Yes. I thought Ukraine was fucked.
I was also wrong about the duration of the war, for reasons little more than vibes going off war exhaustion, I expected the fighting to wrap up in a year. Still going.
Did I expect the UA counteroffensive to be a success? Yes, I was sufficiently inundated with pro-Ukrainian memes and their anti-Russian counterparts that I thought the Russians would fold to a stiff breeze.
Turns out that attacking is a lot harder than defending, especially when the offensive was widely telegraphed and even your relatively incompetent adversary had plenty of time to prepare accordingly.
My takeaway from the above is that forecasting something as anti-inductive as war is incredibly difficult, and that's it far too easy to fall for a cheerleader effect. I wanted Ukraine to win, and badly, and not only was this desire reflected in the sources of news I peruse, but the sheer hatred for the Russian side was sufficient to bury most evidence of them ever doing anything right. The Just World fallacy is hard to avoid personally if all your sources of information fall prey to it.
On /r/CombatFootage, anything remotely pro-Russian, or even depicting their success without obvious bias, gets buried. While I'm fond of /r/NonCredibleDefense, its NAFO sympathies make a honest calibration impossible, and as the name suggests, its members aren't particularly focused on academic rigor or epistemics.
But with that said, the whole Wagner affair confuses me.
Prigozhin managed to get within 2 hours of Moscow, prompting a panicked evacuation, and then suddenly stopped and took his ball home.
What the fuck? In normal circumstances, I'd say he just signed his death warrant, is Putin really going to forgive him for his quasi-coup? Wagner shot down around 7 Russian aircraft in the process!
And there I was thinking Lukashenko was largely a lap dog, unable to exercise agency except when it came to desperately avoiding sending Belarusian troops to Ukraine since it would upend the only thing keeping his dictatorship going. How did he become powerful enough to mediate a truce between Prigozhin and Putin?
It's not like the dust has settled, even leaving aside more questionable rumors, I've seen footage of the VDV cartel-killing one of their own for expressing sympathies for Wagner. Even if Prigozhin himself manages to avoid most consequences of his actions, his men are going to be making their pants desert-camo'd.
So far, I've only come up with one model that I think reasonably fits the evidence, albeit it's more consistent with the era of warlords and medieval feudalism than what I expect to see even in a failed state today:
Prigozhin is actually loyal, or at least he thinks of himself that way, and came to believe that Putin, like the well-meaning Emperor kept in the dark by a coterie of eunuchs (Shoigu and Co), simply wasn't involved in the attempts by the Russian MOD to swallow up Wagner whole.
Thus, he embarked on his crusade more as a demonstration of his ability to perform a coup, rather than a genuine desire to do so. Like an indecisive general crossing the Rubicon, shaking his fist in the direction of Rome and then high-tailing it back.
Cause some chaos and embarrassment, but stopping before what he thinks the red lines are, namely an occupation of Moscow.
I'd also wager that Lukashenko has more agency and freedom than most suspect, or rather Putin's power has declined relatively, such that he can credibly offer to shelter Prigozhin and fend off the dogs.
As far as I can tell, his gambit only partially worked, because Shoigu hasn't gone anywhere, and Prigozhin ended up like a dog that finally caught that damn car but isn't sure what to do with it.
"Sure, let's try and Thunder Run to Moscow, I'm sure we'll run into some real resistance along the way, and we can both rattle sabres at each other and go home."
"Huh. This is awkward, everyone is just giving up and letting us walk right past them. Might as well shoot down a few helicopters, they're the only things that have directly engaged us."
"Uh.. We're about two hours away from Moscow. Now what?"
I'm not going to weight my assessment heavily since I claim no particular expertise, but I'm outlining it here for the more knowledgeable to poke at.
I'd like to see everyone at least attempt to make concrete predictions about the near future. Does Prig make it out of this alive and with his power base intact? Does Putin slip him some unusually heavy and radioactive teabags?
self_made_human
Kai su, teknon?
7mo ago
Trudeau accuses India in killing of Sikh leader on Canadian soil
First of all, I want to state that my epistemic status is huh, rather an informed opinion, but I struggle to think of anyone in a better position on The Motte to discuss this, so bear with me.
India has had its share of irredentists, separatists and good old fashioned terrorists over the years. You have the Maoists still lurking in the north east, playing hot and cold with the government via their jungle boogaloo. Islamic terrorism was a serious issue in 2010s, though it's died down. There were the Tamil Tigers down south, who proved a severe PITA for a decade or so, and then the Khalistanis, who have been largely neutered in-country but find refuge in the numerous, prosperous Sikh diaspora abroad.
The last two have had the dubious distinction of getting confirmed kills on two Indian Prime Ministers (relatives to boot).
Khalistan is the supposed homeland of the Sikh peoples, largely surrounding Punjab in the west. Unable to get it during the original Partition of India, they waged a brutal war against the Indian government for decades, peaking in the 70s and 80s. There were quite a few pogroms and riots, with Hindu on Sikh violence in the rest of India, and vice versa in their population centers.
These days, the movement is moribund within India itself, most young Sikhs don't really pay it any heed, and the older aren't the demographic to go planting bombs for the large part. Sikhs are well integrated into Indian society, and haven't had that consistent friction that the Muslims have had with their Hindu co-ethnics.
Not that you'd know this abroad. Much like IRA sympathizers hanging around in New Jersey bars, the exodus of Sikhs in the 70s and 80s ossified in amber a large migrant population with a grudge to bear against the Indian government.
I'd draw a distinction between these first-wave migrants, and a more recent influx of Sikhs who are drawn more by the prospects of making it big in Canada, or the West in general, rather than any real grievance.
While Khalistan is dead in the water, it's a popular rallying cry there, with Western governments treating it with a mixture of bemused tolerance and kid-gloves for fear of pissing off the strong Sikh voting bloc. Speaking ill of them is, from what I've heard, a surefire way of losing a narrow election, but they're otherwise model citizens and nobody wants to press the issue.
Now, Modi stands accused of the shooting of this dude sometime in June, when he was shot by unidentified gunmen in the parking lot of a gurdwara in Surrey. If there's more substance to the accusation, they haven't been made public, but the heads of state have met to hash it out.
From what I can tell, Modi's response was "we didn't do it, but if it happened, he had it coming", strongly protesting the accusations while demanding Canada be less lenient in harboring terrorists.
Modi also stands accused of the assassination in Lahore of another Khalistan leader, not that anyone particularly cared at the time, and that's just the usual India-Pakistan bhai-bhai at play.
That's the gist of it, on one hand, we have the fact that India has largely refrained from extraterritorial assassinations, certainly not to the degree that the US, Russia or Israel are fond of. I struggle to think of a single example, not that I'm an expert.
On the other, who the fuck else has a motive to whack the dude? I don't think relations between India and Canada are bad enough for the latter to make entirely unfounded accusations, and they've even roped in a few other countries like the UK and US to bring diplomatic pressure to bear. The Head of Foreign Intelligence for India was kicked out from Canada, and some bloke named Oliver Sylvester was the tit to that tat.
I'd wager 50% odds that India was responsible based on the balance of evidence, and I wonder if this will be a flash in the pan that peters out when the Sikhs are mollified, or if Canada really wants to pick a fight with an otherwise neutral/positively inclined major nation.
But if you're curious, this means zilch in terms of impact on Modi's popularity of home, you think supporters of a strongman are going to be mad when he strongmans? Even the libs over at /r/India who foam at the mouth at the sight of Modi are of the opinion he had it coming.
There are few places on the internet I've got more disdain for than RationalWiki. It's a cesspit, on the same tier as /r/Sneerclub. Even rdrama is at least funny and not nearly as malicious.
And it's also squatting on a perfectly good name for a wiki that could deal with actual rationality for one.
self_made_human
Kai su, teknon?
9mo ago
Race is far too predictive for me to give this real credence. I'm only racist because I seek to understand reality, and unfortunately reality is racist as hell.
It's rare indeed that a rational agent is worse off with additional Bayesian evidence, and as mentioned, race is very strong evidence.
It's certainly not everything, as even most HBD-ers would accept, but goddamn do theories for why the world looks the way it does fail utterly without considering it.
As far as I'm concerned, the policy of acknowledging both race and additional information you have about a person is strictly superior to doing the same but ignoring race. I'd be more concerned if a black doctor was treating me since I know about how much AA they receive, I'd be less concerned if the doctor publicized his SAT score or had other objective markers for performance like a specialization in a field where his race counts for nothing (I doubt that's the case in the US, but I could be wrong). This is where AA in general taints by association, said doctor could absolutely be someone who managed to get in without not so subtle nudges, but since they usually lack a way to prove it, they're automatically discounted in the eyes of a rational agent with no additional information.
To use your example of running into a young male in a hoody at night, yes you should be significantly more concerned if he was black, the stats don't lie. Certainly you should avoid being in that situation in the first place, but feel no shame about crossing the street well in advance.
self_made_human
Kai su, teknon?
3mo ago
Ah, good old gain of function research, the gift that keeps on giving.
Why did we have to end up in the dystopia (well, maybe) where most of the useful biotech/genetic engineering like germline editing, gene drives and the like are either stifled in the crib or slowed down to a crawl while something as insanely risky and largely useless like GOFR for lethality is legal and far too easy to do for even just CV padding?
The funniest part about this particular debacle is that the paper in question had a paragraph on ethical issues/IRB clearances, and the only thing it included was assent, from a Chinese military hospital, that the mice in question were treated humanely.
Right.
That's by far the biggest concern. The only concern worth noting.
I'd bash my head against a wall, but I'm already short on neurons to spare.
self_made_human
Kai su, teknon?
7mo ago
This move to use Bharat in internationally visible context can be seen as normalizing and laying the ground work to a full-on name change. The motivation behind is by some commentators impugned to be Hindutva, the ideology of, in the opinion of these commentators, of "othering" non-Hindu groups. The logic being that India being an English word privileges English speaking-Indian, but since they lack an Asabiyyah, this isn't as dangerous affirming the Hindu name, empowring Hindus who do not lack it.
Instead of framing this as a Hindus vs Everyone Else kind of deal, in my eyes it's more emblematic of another major cultural divide in India, namely the North vs the South.
North India is majority Hindi speaking, whereas the southern states speak Tamil, Telegu and the like instead.
The latter have long been peeved about the BJP government's* tendency to name new projects/initiatives with Hindi terms, or outright rename the old commonly established English ones. This is seen as a form of cultural imperialism or at least chauvinism, since it alienates people from the south who might not be fluent or even conversant in Hindi.
*To be fair, the INC did plenty of Hindi-washing too, the BJP just leans into it more and unapologetically so.
English, while a foreign language, is still the lingua franca for educated Indians, and while Hindi has become far more common in the youth born of non-Hindi speaking parents, many prefer to use a "neutral" language instead of one that implicitly preferences one regional language, which despite what some might claim, is far from universal.
Of course there's a bit of the 'ol alienation of Muslims afoot, but this is a topic that pisses off even the orthodox Hindu majority down south.
As far as I'm concerned, Bharat just sounds way worse than India, and there's no real reason for a switch beyond inflating Modi's ego.
I MADE IT
FUCK THE HATERS
Ahem. Sorry. Got a bit too hyped up, but I've gotta be my own hype man, it's 11 pm at the hospital.
@Throwaway05, @TheDag, @AhhhTheFrench, @faul_sname, @whoeveritmayfuckingconcern (there's a lot of people who've egged me on over the years, I'll get to you all):
I got a match offer in psychiatry! While Scotland might be a little bit on the dreary side, well, endless exams are even drearier.
I was in an awkward position. If I'd done a lot better, I'd be confident in an offer. If I'd done way worse, I could have washed my hands of it and resolved to grit my teeth to prep yet another year of my short life. But I did well, but not so good that I wasn't on tenterhooks.
Most British doctors don't match on their first try, barring the least craved options like GP.
But psychiatry went from having a competition ratio lower than 1, to 9:1.
The exam got ten times harder since I began planning for it. Doubled in the span of a year. Yet I beat it. Beat all the bastards.
No more wannabe psychiatrist, upgraded to shrink-in-training. Then, barring an act of Satan, a bona fide shrink and not a LARPer
I might hold the current offer in the (mildly vain) hope that I get an upgrade to somewhere less rural, but I'll still take it. (Hmm, it seems that the hold window is already over, it seems to be take it or leave it, but I'll still ask around)
Fuck yeah. Gonna drink a lot of scotch and fuck a lot of bitches. I'm getting out.
Now, it's shame I've got 9 hours left at work, and while its going to be a slow night, I'd rather not lose my Indian license by drinking on duty. That can wait till the morning.
I've been thinking about Indians today.
I guess someone has to.
What is going on in India with their leadership? Why are Indians so bad in India but ones that come hear and get a taste of American corporate structure so good? I know this is probably a best fit for the questions thread, but this legitimately puzzles me.
Filtering. Filtering. Almost there.. No, you've still got coffee grounds left over. Keep at it champ.
The average Indian who arrives in the US is not representative of a random sampling of the native population. I'd know, I am one (Indian that is, I haven't been in the States since the NY skyline was a tad bit different).
The number of would be immigrants is far larger than the number that get through. You're filtering for IQ, conscientiousness and a million other things, leaving aside differences in drive that can motivate someone to cross a couple oceans and establish themselves far from home. That's before even getting into sociocultural aspects.
Leadership is certainly a part of it, at least if you're imagining just taking the same group of people and transplanting them under new management. Indian managers, in India, suck ass. They're mostly stick and little carrot, when they're not sodomizing you with it. Our societal norms and governmental system, while not outright dysfunctional, are still glaringly suboptimal in many regards. Being an entrepreneur is god knows how many times easier in the States, and so is relying on talent and work ethic to pay dividends.
The worst part of India, as most Indians who've escaped would tell you, is all the other Indians. The systemic failings are so coup-complete that the best recourse for a talented Indian is to take his talent elsewhere.
This strict system of skimming off the top is how a country that has, the last time I checked reliable figures, an average IQ in the upper 70s or low 80s, manages to contribute the single most successful ethnic group in terms of average income in the US.
There are plenty of other HBD-related factors, IQ here is not distributed as it would be in a homogenous population. I have good reason to believe that the upper caste/Brahmins are smarter on average, and I'm not one myself, just a cut above what would count as so underprivileged that I'd get AA in India. Millennia of strict endogamy and self-selecting for intellectual pursuits does funny things, just look at the Jews (though they were forced into their role more than willing adopters). And these upper caste people are disproportionately likely to be immigrants to the US. Sadly the matter isn't remotely as well researched as HBD in the US, not that I'm not convinced by available evidence.
Presumably this also answers @sickamore 's question, so I'm not going to duplicate it.
I spent a distressingly long amount of time thinking that the US and the EU were peers, or that most people can be truly equanimous between them.
Then I saw that an electrician in the US often outearns a UK professor/doctor/senior engineer, owns a bigger house, has more cars, and can enjoy the breadth of half a continent, and a proper continent at that.
So what if the Euros have socialized healthcare? At least in the UK (not EU, I know), the NHS is absolutely swamped and gasping for breadth, with elective surgeries having waitlists months long, and if I wanted to have my ADHD diagnosis ratified, I have to settle for a two year waiting period for an NHS shrink, or spend upwards of 800 GBP like 2rafa said was typical for even a teleconsult from a private consultant.
Everything is smaller, and often just a bit shabbier there. Even I, someone who lives somewhere barely acceptable to modern sensibilities, can clearly see that and plan accordingly.
self_made_human
Kai su, teknon?
10d ago
If only all our trolls put in this much effort. Thumbs up for that alone.
self_made_human
Kai su, teknon?
4mo ago
I have little regard for the pedo-panic in the first place, and this is even more weaksauce compared to that.
If you're at the point where children doing entirely innocuous things, in modest clothing, is somehow a bad thing because you're worried some pedo will use it as jerkoff material, then we're at about the point where audio-visual recording of just about anyone and anything is off the table, and maybe even a ban on thinking about the children, you creep.
It also is entirely pointless to forbid it now, even for the ever illusive concerns of it ending up in AI training data. You don't think there's enough out there that people aren't making photorealistic artifical CSAM, in both photographic and video form? The cat is out of the bag, and while I'm sure there are some pedophiles who have a fetish for jailbait/"real" children, barring about 99.99% of parents from recording their kids and sharing it is so grossly overkill it's demented. You take a video of your daughter jumping on a trampoline and upload it on Insta? Well, about 6 frames can be construed as an "upskirt" shot, enjoy your ban. Discord is already banning people without recourse, including entire discord servers, if a single still image (that bald dude munching popcorn used as a reaction image), is shared, because their heuristics recognize it as a frame shared with a flagged CSAM video.
The reasonable solution, as far as I'm concerned, is to not care, or at least find something more concrete to worry about.
self_made_human
Kai su, teknon?
10mo ago
Nevertheless, it’s evident the author himself is skeptical. He spends a lengthy section of the book detailing how JBP himself collapsed into a highly dysfunctional and disorganized existence
Reality is not a morality play, it's perfectly possible for someone to vocally endorse the optimal strategy and yet have it fail them (or him fail it).
The benefits of low hanging fruit like working out, good grooming and fashion are so blatantly obvious that one man's failures do not derail them. I'm sure the author doesn't hold Jordan as the sole argument, but I still can't see it being true.
Improvement is the other strategy which deserves a response; and my response is that I’m far from convinced. The few instances in which I’ve had success with women have had an almost random quality to them, and have been seemingly unrelated to any obvious self-improvement project. Lately I’ve greatly improved both my wealth and general status, and yet success has been sorely lacking.
Scott drew attention to a semi-serious analogue to micromorts, micromarriages, as in an action that has a 1/millionth chance of getting you married. I posit that it's obvious that microfucks are a useful concept too, and that while you any individual act of self improvement cannot be guaranteed to lead to getting laid, they tend to add up over time if you're being diligent.
Handsome people are already born with a lot of (micro)fucks to give, but for the rest of us, we have to work to earn them. Very little guarantees getting laid, short of paying for it in cold hard cash, but it's still worth trying.
In my reply to Cjet, I elaborated on why, despite being significantly above average (at least compared to my peers), I have immense sympathy for incels and incel-adjacent people.
As such, while I wouldn't go as far as to call myself a Chad, I'm certainly further on that end of the spectrum than the other. I still have immense sympathy for incels/average dudes, because I had to deal with raging, all consuming libido for years, and still had dry spells afterwards. I look at the latter, and think "there but for for the grace of God go I". The Chads (and women) simply don't understand what torture that is, how corrosive it can be to your self esteem, even if most of your peers are in similar straits.
Frankly, if you’re having trouble with women as a young man – and I speak as a young man who has had much trouble with women – the problem is likely to get worse with age.
Others have already pointed out that women tend to prefer older men, at least in the age range when men are still desperately horny.
Last but not least, a question to open further discussion: what is the optimal strategy, both in general and in more detail (i.e. should you improve, and what aspect of yourself or your dating approach is most fruitful to improve?).
Firstly, you have to at least try at the "improvement" category. Go to the gym, dress better, get a nice haircut.
If you're extremely unlucky, then yes, this may not suffice, but I feel no qualms about endorsing it in general.
You are far less likely to improve things like height/intelligence/charisma. Some of that isn't outright impossible, since you can always do limb lengthening or keep on hitting the field till you brute force a pickup strategy that works. It's simply not productive.
That being said, it really is a numbers game. If you never try you'll never know, and modern men have a degree of shame and fear that is blatantly counterproductive when you don't have to live in a tribe with the same dozen women your entire life, who gossip about your pitiful failure to court them all. Hit on women goddammit!
Finally, avoid the apps, unless you're in the lucky 10% who get all the goods, in which case my advice isn't for you. For the majority of men, it's a painful, soul sucking process that only dents your self-esteem.
I am unusually good at both in-person flirtation and sliding into DMs, but the advice is still true for the average man. Women are far less picky face to face, and you get far more than a fleeting moment of her attention.
That about sums it up when it comes to general purpose advice, everything else must be tailored to your individual needs.
Addendum:
I'm not being facetious, but my (sweet and loving) girlfriend was looking over my shoulder while I write this post (of all the hundreds I've written lately!).
She would like to make the following statements, written by her own hand on my phone:
Do not listen to anything he said. Doesn't apply to most women. If I slide into her DM, don't expect to get anywhere. My boyfriend vastly overestimates his prowess in the matter of flirtation. He is a very nice man, and that is the 1sf and most important thing g. Women have a radar in detecting fake vs real. I was the one who asked him out, yes that does happen, but it was not because of the flirtatious attitude. Tbh, It was painful. Be yourself. Not everyone is suited to everyone. I can assure you, I like him way before he started flirting. Cause I thought we had a genuine connection and I cud talk to him. That is what we want I the end, someone to talk to, make a life with. Had I not liked him before, his flirting wud have been construed as creepy. So, find out what u like in a woman, and stick to that. Don't slide into peoples dm'z. I assure u, that is a full proof way of getting blocked.
Addendum to the addendum:
Thank you sweetie, of course you're right :*
(Quick, she's looking away!)
Ahem, I would like to add another point to my list of general advice.
Do not take dating advice from women.
I was actually the one who started flirting with her weeks before she even noticed, even if she was the one to ask me out on a date and the one who pulled me in for a kiss. Her mom called me handsome the day the two of them first saw me 😉
That's about it, I don't want to get too saccharine haha.
I am in two minds on the matter.
Primarily, I have strong libertarian sympathies. I would prefer, for myself, the absolute right to choose any procedure for any reason (personal finance and avoidance of externalities allowing), and my standards for informed consent are "I explained to you, quite simply, that there's always a potential for things to go wrong, and now that they did, that's unfortunate, but you knew what you were getting into".
Unfortunately, this does have negative consequences. I am mostly willing to accept that, but all else failing, I would at least hope for a formal certification of a person as a "sophisticated patient", in much the same way that the FTC declares certain people sophisticated investors and allows them them to indulge in high risk (and high reward!) activities that they deem too dangerous for gullible proles.
In practise, this is a de-facto standard doctors extend to other doctors under their care. The gynecologist we saw would normally refuse to insert an IUD in a nulliparous unmarried woman, but when my girlfriend and I could argue UKMEC guidelines with her and point out that the benefits outweighed the risks (even if not as much as oral contraception), she happily went for it. Similarly, I disagree with the old adage that "doctors make the worst patients".
Bullshit. Sure, a few people are inclined to think they know better than their treating physicians, but the majority, having both referred and been referred to, understand the limits of their competence and can also be relied on to actually know what you mean when rattling off the standard boilerplate, which usually makes normal eyes glaze over.
But this shouldn't be something winked-nudged for other doctors and allied health personnel. If I encounter someone who has done their research and seems generally intelligent, I sincerely wish I could hand out a pass that both indemnifies me from some medicolegal risk if they were to take less than ironclad advice, and also lets them access more experimental therapies without the headache of FDA waivers in terminal cases and so on.
A lot of people from these parts would qualify. Much of the griping about paternalism from doctors here and in adjacent parts of the internet arise from intelligent, often UMC people not realizing that they're not typical in terms of what a normal doctor encounters, and our default priors are heavily biased against accepting it when a patient excitedly advocates for an experimental therapy they read about online (in your case it might be legit, but it is more often a misreading of WebMD or, shudder a Tumblr blog for alternative medicine).
Usually, your doctor does know better. Though a good one should also recognize an informed patient.
I had a terrible day. Overworked, underpaid, but what was most painful was seeing a poor lady with metastatic gall bladder cancer that was all but 100% confirmed. Severely jaundiced and anorexic, multiple distant mets including to the spine, and unlikely to be worth anything but palliation.
Her family was adamant that the diagnosis be kept from her. In the UK, that would be flat out illegal unless I fastidiously document that the patient themselves declined to learn more about their diagnosis. But in India, and many other Asian countries, family members usually handle such matters, especially for old, poorly educated people who are unlikely to take the knowledge of their impending demise well.
"Is it a gallbladder stone?" She asked me hopefully while her family was off haggling with my supervising consultant. I was about to go into a painstaking explanation about her cancer, and did get well into it, but I was rapidly grabbed by her son and daughter and told to please not tell her she was about to die, and certainly not from cancer.
Luckily for me, I doubt she understood half of what I said, especially since my Hindi is only passable, and soon enough, I was tip-toeing around the sudden change in surgical plans and why, a patient with "cholecystitis" was going to be have both an ERCP and an FNAC of a supraclavicular node.
"But my neck is fine doctor! And my back hurts." The PET-CT showing avid uptake disagrees. Maybe the back pain was from a fall a few months back, her daughter prompts. Sure. Maybe. Maybe it's also the mets causing fragility fractures, I don't say.
"Is she going to get better? What does chemotherapy mean?" I get asked by the family, who have processed about 10% of what the senior surgeons have told them. Well, at least I don't have to lie that the sudden pivot to an ERCP will improve her jaundice and QOL if not her life expectancy by much. And you'd hope after 6 months here I'd know how to explain how chemo works. She developed SOB after the OP, ?PE, and I watched the bacon being made as my surgical consultant grabbed a passing CCM doctor (who made the mistake of walking through the ward) and they haggled over what tests met very strict criteria for cost-effectiveness. No ABG for you, a CXR and ECG? Yeah, they can afford it. She got better till she inevitably gets worse.
To add insult to injury, I had a mandatory communications training course that day. Aced it, of course, but I had to chuckle and groan at how divorced from reality much of it was. And then I face-palmed when the final quiz began asking questions about HIPAA, which is not a thing in India and not covered in the course itself, strongly suggesting the material had been designed by ripping off a US source, or perhaps the latter hadn't localized it particularly well. All the actual citations and foot notes should have made me sus in the first place.
Some people are dumb, or simply won't understand no matter how much you dumb things down. We avoid this truth, except where formal diagnosis of mental incompetence lets us firmly but gently usher demented grannies back into the chemo ward, and most importantly that this is true even for seemingly functional members of society.
That's about it. Any wonders I wish we could all be smarter so my chosen preference of letting everyone decide, for better or worse, about their health, would cost less in bodies and money? I'll still pay with mine.
self_made_human
Kai su, teknon?
4mo ago
Sigh. It seems it was inevitable that I'd have to get around to doing the unpleasant part of being a mod at some point, namely enforcing the rules and using my discretion in ambiguous situations. But I did sign up for it.
Please consider this a request, and a mild warning, not to speak this way.
So far, your comment has received 3 reports for being antagonistic, which it clearly seems to be to me. To an extent, antagonism is a forgivable sin, and I certainly plead guilty to being less than maximally polite on occasion.
However, what does draw my attention is that this, to me, represents an example of "waging the Culture War". There's no strict line in the sand here, the people discussing CW in the CW thread are almost always at least modest opinionated on the matter, and advocacy for one's beliefs is in no way disbarred.
I don't even particularly care that you call them trannies, I'm not one to police vocabulary where the word is entirely synonymous with more polite equivalents, even if it's pejorative. If someone insisted on calling Jews "Blood-drinking vampires", then I'd consider that to be an obvious infraction. Some of the other mods may well disagree, but I'm only me, and I have a degree of leeway here.
It might surprise you to learn that I happen to largely agree with you. I consider transgenderism, if not an outright mental illness in the strictest sense, to be highly comorbid with it. I wouldn't balk at calling many of them insane like you did. I have a soft spot for Kiwi Farms, Rdrama and the other untamed corners of the internet, and I'm glad they live to fight another day in an increasingly homogenous internet where the edges are sanded down and a relatively small but vocal minority tyrannizes the rest of us and slides the French Overton Window as fast as the rails allow.
That being said, I would prefer you be less antagonistic. You are allowed to be happy that attempts to deplatform a site that makes fun of transgender people backfire. You may enjoy schadenfreude. You may, assuming the rest of your comment doesn't continue to not contribute to the atmosphere/culture we seek to cultivate here, also call people trannies (or at least I won't mod you for that reason alone).
But the gestalt impression conveyed by your comment? Bad. Not conducive to the (ideal) spirit of even-tempered discussion of contentious topics. The problem with culture war fervor, schadenfreude, and pithy pejorative labels for the outgroup is that they tend to crowd out everything else, or at least foster a negative spiral if left unaddressed that leads to everyone else doing the same, and those looking for more polite and high quality debate crinkling their nose and leaving. We aren't rdrama, this is what we are trying to avoid here, and by including all three and not much else, this comment is not helping.
I'll leave it at that, it would take a trivial restatement of your comment to make it slip under the high threshold I hold for formal mod action, if not a reprimand. If you wish to consider this an attempt at censorship (and how can mod action not be?), then it's of tone and not content.
self_made_human
Kai su, teknon?
5mo ago
By pidgin do they mean the annoying tendency of the NZ government to sprinkle in Maori words in press releases?
self_made_human
Kai su, teknon?
7mo ago
Every few hours, when I get tired of sneaking a cheeky vape in the millions of bathrooms and liminal stairwells that litter my hospital, I'll head over to the back of the building, in a secluded, roped off area that's the de-facto smoker's haunt of the place.
An ankle height chain dangles at the approach, as do signs for, among other things, no parking, and an enjoinder against loitering because there's construction ongoing up above.
It might say something about the nature of the universe that the tripping hazard produced by that chain far outweighs that of the falling debris, when it exists. Not the prohibition on smoking, of course, but since you can't quite see the signs from there, everyone pretends they don't exist.
There's a quiet camaraderie at play, doctors huddling together for a chemical pick-me-up after a grueling day at work, a good chunk of which was spent admonishing their patients for the same indulgence they're engaging in.
Did I mention this is an oncology hospital, or at least department big enough to be a standalone one? I suppose that's relevant too.
You can see a combination of quiet guilt, resignation and combativeness in their eyes. Yes. We know this is bad for us. We know you know. What are you going to do about it? Not smoke? Perish the thought, and pass me another. How's that patient with COPD doing? Yeah, he won't quit, even if it kills him, and given that he's got end stage lung cancer with brain mets, we're half a mind to wheel him out, nebulizer in tow, for a couple to greet the last dawn of his life, and just the start of another for us.
I stand there puffing on my vape, experiencing an exceedingly mild, almost homeopathic sense of smugness and superiority. Look at them, burning out their lungs, huffing and puffing when I pass them on the stairwells, and for what, the same nicotine I get, without the stink and almost all of the drawbacks beyond a nicotine dependency?
The vape ban in India has been a disaster, and these are the consequences. I muse on the black comedy that is existence with a black coffee in hand, that the tobacco lobbyists in here got a final swing in by banning the cheaper, healthier alternative.
I ignore the occasional curious glance at my little electing facsimile, the incongruity of a cigarette with an usb port. I'm probably the only one. In turn, I ignore the shifty consultants who don't meet my eye, still harboring in their heart of hearts the feeling they need to do better and set an example for us all. I hear the promises, the whispered pacts to cut down together. They're still they're next week.
There's a bimodal distribution there, you can tell seniority both by how quick, hurried and clandestine their puffs are, all flash and smoke blown into dark corners, and then the blatant ones, the big shots without who the hospital would grind to a halt of PGs, Associate Consultants and RMOs left rudderless when the buck stops with them. They challenge each cig and any mildly curious passersby. Fuck you, even cancer thinks twice about taking me on, at least on the hospital premises.
And then the phones ring, cigarettes burn out, the last dregs of chai and coffee are downed. Paper cups laden with ashes find more corners to marinate in, and stubs are crushed by shoes beneath scrubs and we all go our merry ways. If there's hell to pay, at least we can afford it.
self_made_human
Kai su, teknon?
10mo ago
I'm really not the right guy for in-depth political analysis in India, but in the absence of anyone better I'll step up to the plate:
NE India is largely divorced from the rest of the country, by geography and ethnicity to boot. The majority of the tribes that live in those parts resemble the denizens of Myanmar, Tibet or Nepal more than other parts of India, but even that's belying the ethnolinguistic diversity lurking there. The tribes have their own concerns, with them often being at each others throats over historical grievances, religion, or an effort to get gibs.
In this case, it's the latter, one of the Hindu tribes once successfully lobbied to be granted privileged status affirmative action-wise, causing an uproar in their Christian counterparts, who are afraid of being squeezed out, or more cynically, just as eager to get their stamp of disprivilege and run with it. After all, the coveted Scheduled Tribe status comes with economic and political benefits, and everyone wants a piece.
The extremely hilly terrain means that regional powers dominate the region more than the central government would like, especially given many decades of Maoist insurgency that only relatively recently calmed down. The border with Myanmar is porous, although the majority of Rohingya ended up in Bangladesh instead of NE India, that's still a major point of contention today.
So one tribe is taking the fuck you, got mine approach, and the other wants to join in the fun, prompting violence and rioting. The Indian government loves to cut off Internet access if someone looks at them funny, so there's an information blackout in those parts.
Frankly, most of India doesn't give a shit, violence there is unlikely to percolate to the rest of the country. None of the parties are particularly sympathetic, this is textbook sectarian strife in the arsehole of India, we've seen worse and will likely see more of the same for a while now.
self_made_human
Kai su, teknon?
5mo ago
This graph should have everyone at Google shot, then shot again just to make sure they're dead.
self_made_human
Kai su, teknon?
5mo ago
And to be fair reading isnt all that interesting as an adult, let alone a kid.
I wouldn't be surprised hearing this from a rando on the street, but you're a regular on The Motte, all we ever do is read and argue haha.
It's still a foreign notion to me, I read voraciously the moment letters ceased to be arcane scribbles, I actually did the whole reading labels on shampoo bottles thing well before it became a meme. If I show up late to my own funeral, it'll be because I was reading the obituary..
self_made_human
Kai su, teknon?
7mo ago
Call me old fashioned but I prefer innocent till proven guilty in a court of law when it comes to punitive actions like suspending someone's income
self_made_human
Kai su, teknon?
10mo ago
Unrelated observation, but I think Community Notes is one of the few good things that have been added to Twitter of late.
I find myself surprised at how they debunk lots of viral content I previously accepted uncritically, which I guess is sort of the point. For recent example, the thread about the richest billionaire in Africa being trolled by some random Brazilian, and a picture purporting to show that the Threads logo looked like Homer Simpson's ear.
I suspect that if a similar version was implemented on Threads, they'd be far more leery of "hate-facts", which would kill most of the utility.
self_made_human
Kai su, teknon?
4mo ago
I wager it's more because he prizes staying in the good graces of his immediate social circle, if memory serves, the dude who happened to date (marry?) his non-binary ex Ozzy leaked private emails from Scott where he acknowledges his surreptitious belief in HBD, which is an unpopular stance to hold in the EA community (and partially taboo in Rat circles like LW). This would be obvious to anyone who read his OG blog, before SSC, covering his trip to provide medical aid to Haiti.
This isn't to deny that he probably didn't like the controversy from the NYT exposé, but from a more detached perspective, it didn't really do him any harm and a lot of good. He garnered a great deal of sympathy, even from his opponents, and his Substack made >250k annually shortly after he opened it. That is already median wage for a US doctor, and at this point I expect it's long eclipsed his regular income.
And he wasn't really susceptible to cancelation in the sense of being sacked and left unemployed, it takes quite a bit to do that to a doctor, and short of being struck off the register for gross malpractice, they have the option of doing private consultation or heading to places with good salaries but more flexible standards in who they hire.
Another reason I hold that opinion is because he still criticizes what might well be called essential elements of the PTB, such as calling for the FDA to be, if not delenda est, significantly reformed.
There are a horde of bots, most commonly plaguing Twitter and Reddit, that exist solely to note highly upvoted posts on certain topics, usually with an image attached, and then post listings of said image applied to merchandise.
Someone posts a popular webcomic? A dozen shifty online stores print it on a t-shirt. Piece of obscure fan art? It costs nothing to have an automated pipeline photoshop it onto shirts, mugs, patches and the like, many legitimate sellers use templates themselves. If the business is so kind as to deliver the goods when someone purchases them, they're usually putting out tiny print orders to third parties and don't have to worry about stock or depreciation, let alone intellectual property rights.
And these days, with AI image gen, it takes about all of a second to rustle up a picture of Current Thing, if one doesn't conveniently exist.
I think there's a decent chance that some bot came across the names of the kids in an online context and decided to spin up a few items that are nominally child-related, or maybe it misfired even worse and put them on furniture and pizza.
At the very least it's not going to be an online pedo ring, so everything else is much more likely.
After two months from my original application, and two weeks since they asked me for some rather absurd documents that I had to scramble to provide, including one I was supposed to have legally turned in to my government but still had a random scan lying around, the utter radio silence from the GMC had me mildly concerned.
I kept checking my inbox and their website for weeks hoping they'd at least inform me of my progress.
Imagine my surprise when I randomly checked today and it said I'm a fully licensed doctor with a license to practise. I feel both happy and underwhelmed, you'd think that was at least worth a congratulatory email!
But there it stands, proof that despite fucking up big time in my choice of med school, being incorrigibly lazy and depressed and then having to teach myself all the medicine I snoozed through, 6 months of working my ass off has provided proof that I meet the standards needed to be a respectable First World doctor. It's been a long time coming, and thank you to everyone who overwhelmed me with support along the way, even during the dark days when this all seemed a distant dream, a hallucination of a overworked and overwhelmed intern who felt that his white coat hung heavy as a shroud on an impostor's frame.
I did this. It was all me. Now onto greater things!
Apologetics for America
I'm a big fan of the United States. It's a big country. It's a safe country. The people are wealthy, kind, industrious, and have done more than their fair share of upholding the Pax Americana under which the majority of the world prospers, including those who would tear it down.
I would go so far as to say that I'd be significantly happier if I had been so lucky as to have been born in a counterfactual universe where my parents had emigrated there, even keeping all my myriad flaws like ADHD and depression.
It's a country that holds multitudes, and has had such a good track record of making good on its promise of embodying:
And then achieving the minor miracle of making the vast majority of them upstanding proud Americans regardless of caste and creed.
(To such an extent that it has lost the memetic immune system needed to assimilate some of the people who meet that criteria but are resilient to anything but force)
It is gorgeous. Even after the visiting the UK, a nation that even in its sclerosed and ailing state is significantly better than India, I found myself grossly disappointed at how small and dull the place was, compared to what I've seen of the States.
I count myself lucky to still have the memories of when I visited as a toddler, some of my earliest, a period I enjoyed so much that I came back home speaking English with an American accent when I hadn't even been conversant in the language when I left.
I stare at the reels and pictures posted on Insta by my friends studying there with ill-concealed envy. It looks so huge, so clean, so vibrant, so picturesque and unspoiled. Still a land where someone with innate talent, having landed with but a penny to his name, can ennoble himself through hard work, or at the very least his descendants.
If it were not for the fact that I'm currently ineligible to give the USMLE today, for no fault of my own, I'd bid adieu to my current aspirations for practising and settling in the UK. The latter is still better than India, but do you really need me to tell you how low a bar that is to beat?
I'm about as pro-American as it gets without driving a pickup truck with the stars-and-stripes hanging off it!
The people eat great food. They live in huge houses that appear outright intimidating to the rest of us. They can afford to waste gigaliters of water on a modestly appealing perennial grass and mostly not begrudge the expense.
They can travel visa free to most of the world, and act the fool there (can, not necessarily do, the worst I can say about most American tourists I've met is that they were rather underinformed about where they'd ended up), content in the knowledge that none but utter pariah states would dare raise a hand at them out of fear of Uncle Sam.
They earn salaries that make us all look like paupers. The median wage for a doctor in the US is $250k, fresh out of residency, whereas a senior consultant in the UK might be content to make half that. Indian doctors can only weep, especially lowly ones like me. Even my father, so talented in his surgical field that he'd be nationally famous if he was more fluent in English (instead just being regionally famous), makes only $50k PA at the very peak of his career, after a life of suffering and hustling so his sons would have to suffer and hustle just a bit less.
Even that seemingly colossal sum of money does not achieve the QOL a naive purchasing power calculation would suggest. Even billionaires here must be content to have their money only buy quick trips with their windows rolled up from only upper class enclave to the next.
The world, somewhat more multipolar than it once was, still wobbles unsteadily if you try and make it rotate around an axis not centered on America.
I'd give a lot to be there. I really would.
That is why it so severely vexes me that my girlfriend, a smart, intelligent and hard working woman who makes for an enviable partner to have at my side, holds a view of it so jaundiced you don't know whether to cry or laugh.
Like many Americans, she has had her perception of the States clouded by sheer propaganda that is more interested in cherrypicking out all of America's real problems, and when even all the real ones no longer suffice, concoct ones out of half-truths and whole-cloth to terrorize a broken primate brain that only notices the bad and becomes inured to the good, such that it no longer bears a resemblance to how fucking good they have it.
She stares at me like I'm mad when I tell her I've always wanted to live there, and the few warts on the face of the nation can't hide its timeless beauty.
She believes that abortion has been banned. When I protest otherwise and say that it's only a few states putting restrictions on it, and even then, just a few, she shakes in existential terror at the idea that there's a seething crowd coming for the rights of women, eager to snatch them all away. She thinks racism is a serious concern for hardworking and talented immigrants who speak fluent English, whereas you could put me in a room with a Confederate flag and I'd find a way to end up drinking beers and shooting AR-15s before dawn.
Did I mention she's terrified of gun violence, even if she could live a dozen lives in parallel and not get shot?
She categorically refuses to follow me if I wistfully make plans to find some route to make it there, be it fighting tooth and nail with my med school and the ECFMG to give me the right to at least try my luck, so that I can show them I meet even their high standards.
I'm at the point that I am seriously debating abandoning clinical medicine as a career, to upskill myself in medical ML, so that I have an easier route to the States that isn't gated behind a professional licensing exam I'm not allowed to give. I am still young. I am allowed to dream.
She's rather be middle class in the UK, unable to afford air-conditioning, living in a tiny house, watching our salaries erode into nothingness, and then, if Sunak successfully makes doctors into a thin wrapper for GPT-5, potentially resign ourselves to a life of mediocrity, or worse, come back to India with our tails between our legs where we'd have to settle for working shit jobs with longer hours and worse pay.
She's scared of paying the medical bills, when the kind of comprehensive coverage that two professionals making 500k together buys care beyond the dreams of the NHS. Perhaps not value for money, but value.
I criticize America all the time, but only because I love it. I want to gorge myself on cheeseburgers with ridiculous portion sizes, because even if I die fat, I die happy.
I cherish what the Founding Fathers built, a shining city built on a hill of negentropy and abundance, rising out of a swamp wherein dwell the majority of us, only a generation or two removed from near-Malthusian conditions. I would die to keep the barbarians away from the gates, if only because I want to cross them myself, as an esteemed guest if nothing else, hopefully to be one of their own.
I set out to write a post somewhat glorifying (fairly) America, and to invite others to submit arguments that would let my girlfriend see reason. It would seem I've inadvertently done all the heavy lifting, if not for the fact that I've marshaled all these arguments before her and still found them wanting.
I don't want to jump to the conclusion that the two of us are moral mutants who can never reconcile our preferences. I prefer to think that she's wrong about her fears, or weighs the wrong facts too heavily and the right ones not at all.
Help me convince her. I will find it hard to live with myself if I fail.
Oh, and Happy Fourth of July to you all, ye sons and daughters living several decades in the future, hailing from the nation from whose physical and mental toil most of the good things in the world come.
Wait, is it a bit late for that? Um, I blame timezones, pernicious and insidious things that they are.
Don't think I don't see the cracks in the pristine facade, the erosion of the meritocracy that made your country glorious. I simply think that if America wakes up and patches a few holes, it can earn the right to slumber again in peace for centuries hence.
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