domain:mattlakeman.org
MadMonzer
Epstein Files must have done something really awful for so many libs to want him released.
8hr ago
Are you serious that there have been no domestic Irish issues that were the Current Thing in Ireland at any point in the last decade? (I agree Brexit and COVID had pretty large domestic impacts, such that being the Current Thing in Ireland is reasonable).
Domestic issues that have been the Current Thing in the UK over that time period include Brexit (obviously), COVID (obviously), ongoing uncovering of cold case paedo scandals, Partygate, Trussonomics, and small boat immigration.
fujiters
8hr ago
When I read it around age 17 (circa 2002), I found it really invigorating. I got a kick out of the detailed detours (especially the footnotes) and it struck me as novel and true. I reread it 2-3 years ago and it was a bit of a slog (though I still finished it--I just wasn't excited each time I picked it up). Sometimes you have to be in the right place in life for a book to speak to you, and sometimes you've already seen the tricks that make a book notable that the charm wears off.
I no longer feel compelled to continue reading books that don't hold my interest though. Give it 100 pages. It should be clear at that point if it currently resonates with you.
MadMonzer
Epstein Files must have done something really awful for so many libs to want him released.
8hr ago
Yes - I was surprised that the line on MAGA Twitter was "Trump woz robbed" and not to congratulate Machado and make hay out of her anti-leftist status (which she was very much up for), possibly along with a call for Trump to be nominated next year for the Gaza ceasefire. (If it holds, he may have actually earned a Nobel Peace Prize. If it doesn't, given the history, he has definitely earned a Nobel Peace Prize).
Trump himself went for the pro-Machado approach, so I don't know why the number of Trump sycophants posting "Trump woz robbed" were doing it. Obvious candidate theories include King Canute's courtiers tier more-royalist-than-the-King competitive uber-sycophancy, back-channel co-ordination to give Trump himself plausible deniability that he was having a bitchfest by proxy about not winning it, and failure of the administration to co-ordinate with its supporters on MAGA Twitter.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
8hr ago
Verapamil is a calcium channel blocker, and a good option. I don't recall off the top of my head whether it's superior to something like metoprolol, but it is very reasonable to prescribe.
They did, in Japanese lol. Broadly they said, "Look, just don't worry about it. Do whatever exercise you like - it won't help but it won't make things worse. In practice go on living your life the same as ever." Which is... nice and all, and better than the alternative, but somehow less reassuring than 'eat salad, never let your heart get above 160, and we want you to wear a 24h ECG once a year' or whatever. I try not to think about it too much, or else I will turn into a hypochondriac
I'm sorry, I had to laugh. This is a good reminder that patients are not made alike, some of us need gentle reassurance, others desire bright lines in the sand. In all honesty, I think telling someone not to let their HR cross 160 either won't work or will be counterproductive. The anxiety of watching it maybe go to 140 might easily cause it to spike.
Something like an Apple Watch with ECG tracking might be good just for the peace of mind. I told my dad to get one, and even offered to pay. Unfortunately, despite getting a heart disease so rare it was until recently thought to only happen to the Japanese (coincidence?), he's proof that doctors make bad patients.
If you want to DM me the exact diagnosis, I can probably give you better advice, but I am still a psychiatry resident and I am blissfully forgetting everything about cardiology other than measuring QTc elongation on a trace.
It seems to be genetic (at least one of my elderly relatives used to have it I think) and to die down as you get older.
If they lived to be elderly, don't you think that's a good sign?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
8hr ago
That is unfortunate. I shared your feedback, and it acknowledges it as an important omission and also provided additional configuration options it missed the first go around:
https://chatgpt.com/share/68ecf793-909c-800b-b56f-cedc5c798eaf
The_Nybbler
If you win the rat race you're still a rat. But you're also still a winner.
8hr ago
I'm in the suburbs and I can get my groceries delivered also, though the charge is $15. Density doesn't make delivery viable; it reduces the area in which delivery is viable. When I can order shit from China for $11 (even after everything Trump has done) you know you don't need a dense city to do delivery. Though I admit it wouldn't be viable to do perishables that way.
Corvos
8hr ago
I do note that the main article currently on the English language section of Yomiuri, a Japanese paper, is about Gaza.
CertainlyWorse
No one is coming. It's just you.
8hr ago
I don't have a direct reply, but I'm going to piggy back off this post because I'd written up a related issue. I’d like to look at the prisoner exchange ratio.
We’ve looked at this issue various times before on The Motte, with amazement at the disparate ratio of prisoners being exchanged on each side, and the risks involved in releasing terrorists freedom fighters in a prisoner exchange only to have the prisoners commit attacks on Israel in the future.
This time its 20 Israeli hostages against a list of 1900 Palestinian prisoners.
One way of looking at this is that it’s a release of ‘Prisoners of War’ and that all POWs are released at the cessation of hostilities. Except that the hostages were civilians deliberately taken as.. well as hostages, to prevent military advancement and also as leverage in negotiations such as this peace deal.
In addition, the list of 1900 is not limited to ‘POWs’ captured during the latest war, but includes 250 other terrorists freedom fighters that have attacked Israel prior to the current war)
If this peace plan doesn’t hold then Hamas would have bolstered its force by almost 2000 fighters, not for this war, but the future wars to come.
I don't blame Trump and other peacemakers for trying and I am a fan of lasting peace, but this exchange ratio has always been a bugbear of mine and I don't think I'm alone. At a minimum they should stagger out the prisoner release with the 250 non-POWs to be released after the peace holds for 5+ years.
The_Nybbler
If you win the rat race you're still a rat. But you're also still a winner.
8hr ago
She's been around forever, but was still having major exhibitions last year. Her connection to woke/leftism is mostly through her association with Hillary Clinton campaign chair John Podesta.
I've got a tab of verapamil, which is similar to a beta blocker. In practice they've usually died down quickly enough that I don't have time to fetch and take it, which is good.
Did the surgeons or cardiologists not give advice regarding lifestyle modifications or exercise tolerance?
They did, in Japanese lol. Broadly they said, "Look, just don't worry about it. Do whatever exercise you like - it won't help but it won't make things worse. In practice go on living your life the same as ever." Which is... nice and all, and better than the alternative, but somehow less reassuring than 'eat salad, never let your heart get above 160, and we want you to wear a 24h ECG once a year' or whatever. I try not to think about it too much, or else I will turn into a hypochondriac.
It seems to be genetic (at least one of my elderly relatives used to have it I think) and to die down as you get older.
FtttG
9hr ago
I explicitly stated that I don't think the Israel-Palestine conflict will come to a complete end any time soon, so I don't know why you're pointing that out. It doesn't seem like a productive contribution to the discussion.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9hr ago
Had keyhole surgery (catheter ablation) a couple of years back when it flared up to multiple several-minute bouts of 180bpm a day. Much better now, only once every few months, but I live in fear of it getting worse and needing surgery again. Realistically could be a lot worse but it's made me risk-averse in a way I dislike.
Now that is far more serious than I'd like. Did they not give you beta blockers for as-required symptomatic relief? Did the surgeons or cardiologists not give advice regarding lifestyle modifications or exercise tolerance? This is far out of my wheelhouse, but I don't want you to be unduly anxious, even if you are right to worry.
Cool! That's today to Weds, or next week?
Next week! I'll DM you closer, once I know the exact dates.
Best of luck!
Thank you again!
greyenlightenment
investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...
9hr ago
Has there ever been a Middle East deal what wasn't 'cautiously optimistic'. Things can pop off at any moment. There was a long stretch of peace following the death of Yasser Arafat, so who knows..
functor
9hr ago
The Palestine situation is not over. Israel is continuing to oppress Christians, is continuing to occupy parts of the west bank, is continuing its war in Syria and is continuing its meddling in other country's policies. AIPAC's absurd meddling hasn't gone away. The US is still wasting billions and billions on Israeli interests in the middle east and Israel is still making it hard for refugees to return from Europe.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9hr ago
If you know the right prompt, you can get the models to leak OAI's profile of you. That includes usage stats. I believe I'm now at 95%+ GPT-5T usage, and almost zero for plain 5. The only time I use it is by accident, when the app "forgets" that I chose 5T in the model picker.
For any problem where you need even a modicum of rigor, I can't see a scenario where I wouldn't pick 5T over 5. If I need an instant answer, I use Claude. The free tier lets you use 4.5 Sonnet without reasoning, but it's still solid.
I will admit that I have barely used 5, because I gave it a few tries, found it barely better than 4o, and never touched it again. I just like 5T too. It has a bit of o3 in it, even if not quite as autistic. I really appreciate the lack of nonsense or sycophancy. 5 is far from the Pareto frontier on any aspect I care about.
OracleOutlook
Fiat justitia ruat caelum
9hr ago
Environmentalism vs Reindustrialzation in the US. For Military purposes we need to reshore rare earth refinement. This will undoubtedly lead to some desert in Nevada getting radiated and risk the extinction of some heretofore undiscovered species of jackalope.
Alternatively, bringing freedom and democracy to Venezuela. The latest Nobel Peace Prize winner was practically begging Trump for it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9hr ago
Thank you.
I’m curious about these medical exams and studying. Are there some candidates you’ve met that can just ace them without studying, based solely on general medical knowledge and above average recollection from both medical school and hands-on training in the years before their specialist qualification? Or is it like some legal qualifications, where even a towering intellect needs to rote memorize that the answer is a section 37 part 3 form and not a part 4 and that a certain period is 13 working days and not 12?
I don't think that it is possible to pass just about any medical exam with zero studying, in the literal sense. But I definitely know or have heard of people who can get by with much less of it in the way of "total hours of effort". The very best young doctors I know (in terms of academic performance and successful entry into difficult specialties) were both very smart and very hardworking.
There are people who have retained far more than I did from med school, which definitely came in handy for them. I wasn't the most motivated of candidates back then (because my performance didn't matter as long as I passed, and I only ever failed one minor exam in the last decade), but I put far more effort into career-defining or gatekeeping exams later.
For example, the very first exam a foreign doctor needs to clear to get a license to practice in the UK is the first PLAB exam. It was always oriented around a UK curriculum, but now is/will be entirely subsumed into the same British end-of-medschool exam that is the UKMLA. A British med student would have a very significant innate advantage simply because that's their default curriculum, whereas a foreign grad would need to learn additional information about UK guidelines (holding all else equal, which I will happily grant isn't true, British med students are very good on average).
Once the PLABs were done, I had to give another exam called the MSRA, where the advantages for the locals diminish. The exam has roughly the same core topics as the PLAB/UKMLA, but will drill much harder into the nitty-gritty details. These details aren't comprehensively covered in med school, so that's when your own effort begins to come through.
The next step is usually the membership exams of one of the Royal Colleges. In my case, the MRCPsychs. At that point you are well beyond "innate" or general knowledge. Almost everything is new.
Not all RC exams are made alike:
Something like the MRCPsych Paper A heavily rewards rote memorization. There's no exam where it isn't important, but some others will test your practical and critical thinking skills harder than others.
Or is it like some legal qualifications, where even a towering intellect needs to rote memorize that the answer is a section 37 part 3 form and not a part 4 and that a certain period is 13 working days and not 12?
You would have to be God to derive medicine from first principles. For mere humans, no matter how smart, there's no choice but to resort to empiricism and knowing what works. Medicine, for all its scientific underpinnings, remains a deeply empirical and at times atheoretical field.
For example, why do antipsychotics increase the risk of pneumonia? Nobody knows. Why do clozapine and olanzapine cause the most weight gain (within antipsychotics)? Fuck knows. There is no logical chain that leads from the pharmacology of clozapine to it causing more weight gain than ziprasidone. We only know these things through observation.
The exam questions reflect this reality. They do not ask you to model the interaction of dopamine antagonists with hypothalamic appetite centers. They ask: "Which of the following drugs is most associated with weight gain?" This is not a test of your reasoning. It is a test of your internal lookup table. You either pass the herblore skill check or you don't.
And that is a good question. It's information that is in some way relevant to clinical practice.
Freud's nonsense isn't. Neither is Monkey Business. I don't know why I need to learn the name of the dude who invented modern antipsychotics, or why I'm being asked that. Yet those make up an unfortunate amount of the syllabus.
Corvos
9hr ago
I will probably be in London sometime between Monday to Wednesday next week
Cool! That's today to Weds, or next week?
I presume you've gotten that looked at? My impression is probably anxiety, and CBT or the drugs would help if that's the case. Maybe even just a beta-blocker for symptomatic relief if it gets bad.
Had keyhole surgery (catheter ablation) a couple of years back when it flared up to multiple several-minute bouts of 180bpm a day. Much better now, only once every few months, but I live in fear of it getting worse and needing surgery again. Realistically could be a lot worse but it's made me risk-averse in a way I dislike.
That's true. This exam isn't the end of the world if I fail, just £500 I won't be getting back. But I do very much want to pass it in one go - deferring it is an option, but I'll only be getting busier in the future and I'm already a bit overdue for an attempt.
To moan in general, the exam is designed by sadists, with much of it of limited/negative utility in actual psychiatric practice. But I am not credentialed enough to be consulted on such topics, so I'm dealing with it. It's also pointlessly hard, but eh, I can manage that too.
Good to hear that it's not do-or-die, at least. Worst comes to the worst, spreading the study out over a longer period will make you much more likely to retain the knowledge.
Best of luck!
Corvos
9hr ago
GPT-5T is incredibly smart
Do you find it reliably better than default 5? It seems to me that it's rather over-done and prone to skip ahead to something that is not necessarily what I want, rather than answering the specific query and working through with me as I prefer.
sun_the_second
could survive a COD lobby and a gay furry discord server
9hr ago
What was stopping him before? Israel had already been accused numerous times of being callous to their hostages' safety, Hannibal Doctrine etc.
Stefferi
Chief Suomiposter
9hr ago
There is also some irony, or possibly some future culture war conspiracy theories, about how this will not get Trump a noble peace prize, since they announced that late last week.
This led to some incredibly stupid discussions I've seen with both leftists and rightists assuming that the Machado selection was some sort of a woke Yass Queen finger in the eye towards Trump instead of doing just the barest amount of Googling to recognize that this was very much in the line with the Trump admin foreign policy goals, ie. getting rid of Maduro, which was then confirmed with Machado going out of her way to congratulate and give credit to Trump after the selection.
orthoxerox
If you can read this, you're using a custom theme
9hr ago
What will stop Netanyahu from attacking the Strip again? Now that there are no hostages he can just turn it into fine rubble. It's not like American military and intelligence aid to Israel will stop if he does that.
Thank you for the detailed, succinct write-up. I intended to make a top-level post using the presumptive end of the current Gaza conflict as a jumping-off point to ask a much broader question, namely:
What will the next Current Thing™ be?
In May of last year, I argued that media minutes, column inches and the forefronts of public consciousness follow a Pareto distribution, in which one issue clearly dominates at the expense of all others. In Ireland (and presumably a significant chunk of the Anglosphere and also the entire world), a list of these "primary" issues over the past decade or so looked as follows:
- Brexit (June-November 2016; intermittently recurs as a secondary topic whenever there's a lull in one of the subsequent primary topics)
- Donald Trump election and presidency (November 2016-March 2020)
- Covid (March 2020-January 2022)
- George Floyd/BLM protests (May 2020-September 2020) [I'm cheating a little bit; while the protests were ongoing they seemed to take up exactly as much space in the discourse as Covid, then after they died down Covid returned as the sole current thing)
- Russia-Ukraine war (February 2022-October 2023)
- Israel-Gaza war (October 2023-present)
I'm not saying the Israel-Palestine conflict is permanently over: as a cold conflict which periodically goes hot for 77 consecutive years, it would be very impressive indeed if the imminent cessation of hostilities represented a decisive end to the conflict. But I do think there's a very good chance that it stops being the "primary" issue that dominates the discourse, and retreats to the status it occupied prior to October 7th, 2023. Diehards will still emblazon their balconies with Palestine flags, you have not heard "from the river to the sea" for the last time, there will be periodic calls to boycott and divest — but it will go back to being a page 4 story. I strongly suspect that the era of copycat attacks on random Jewish civilians in First World nations has come to an end.
Which invites the obvious question: what will the next Current Thing™ be?
Playing the game on Easy Mode, and the answer might be that something which was a secondary issue for the last two years now jumps forward to become the pack leader in the Pareto distribution. Sometimes the easy, obvious answer is the correct one: activists had been complaining about police mistreatment of black Americans for years prior to the murder of George Floyd, and Putin's invasion of Ukraine could not have come as a complete surprise to anyone with even the most passing familiarity with the geopolitics of the region. In this framing, obvious candidates for the next Current Thing™ include AI, the ongoing debate about immigration from the global south, and Orange Man Bad. In the latter case, it's entirely possible that all of the "ceasefire now" people will quickly realise that their moment in the limelight has passed, exchange their keffiyehs for black bloc and get back to partying like it's 2017.
Playing the game on Hard Mode, the answer might be something completely unexpected. In January 2020, who among us could have foreseen that a virus in Wuhan (whether from a lab or a wet market) would determine the course of our lives for pretty much the duration of March 2020-December 2021? In this light, do any of you have candidates in mind for dark horse black swan events which could dominate the discourse for the next two years or so?
Unless the two of you have an excellent relationship built on truth telling and open feedback, yes
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