• I used to say Maryland was the best U.S. state. I’d like to change that to the best continental state. I don’t know about the rest of Hawai’i but Maui is spectacular. That 50th star should be gold.
• This is why: there are so many things to do on the island that many visitors get a FOMO-induced urge to do as much as possible. That leaves the wonderful beaches mostly empty during the weekdays, when the locals are working, and quite bearable (compared to the Montenegrin beaches of my youth) on weekends.
• There are at least five kid-friendly beaches within a 5-minute drive from our condo. One is a go-to for snorkeling, one if full of sea turtles for those who enjoy swimming around them (which should be everyone with a heart), one is looong, peaceful, with shallow water no waves, excellent shade, and also an occasional turtle (swimming with sea turtles naturally being better when you didn’t even expect to find them).
• “The road to Hana” would be a great find if you had some business to do in Hana, then stumbled into seeing a few waterfalls and making a pit stop at a black sand beach. It’s overrated otherwise, and the poor residents of Hana and central Maui have to deal with droves of slow-moving tourist vehicles looking for the next instagrammable moment.
• Hana highway is also the home to the best vegan ice cream I’ve ever had, so there’s that.
• No, I’m not vegan. Kalua pork is too good.
• Each new state I visit means I get to learn more about American exceptionalism. The story of Hawai’i’s annexation taught me that it’s OK for a private corporation to hold the ruler of an independent nation hostage in order to control the said nation’s resources, as long as the corporation is American and the nation is not European.
• Yes I’ll keep writing Hawai’i.
• It’s also OK to ban the native language and culture well into the 20th century. Safeway came to the islands well before the Hawaiian language was legal again.
• Having said that, there is now also a Walmart and — crucially — a Costco on Maui. Prices are the same or lower than in D.C. That is how you conquer a nation, Serbia.

This is all about work email. I have succeeded in transferring most personal communication to Slack, iMessage, and WhatsApp, with a sprinkling of Skype for the grandparents. The sole holdout is Dad, who insists on emailing me links to Serbian tabloid news, child rearing advice, and recipes.

Inbox Zero is a great idea in its original form: live you life and write your emails in a way that solicits as few return emails to you as possible. It means giving some thought to what you put in your responses, and being clear and definitive about them. It doesn’t mean mindlessly deleting or archiving everything or, even worse, sending out half-baked replies just to pass on the baton when you’ll get a dozen of them in return.

I only check email twice a week day and once on a weekend, and with the explicit intent to clean out the inbox (unless when on service or when I’m the primary attending for a sick inpatient). Never check email “just to see what’s there” unless you have the time and the means to do something about whatever you’ll find. More than once in the past I was left to sour over an unexpected administrative roadblock or a non-urgent patient care calamity during a family event, when I could have just as easily waited for Monday morning.

When scheduling meetings: Doodle (or your preferred equivalent) for more than three people, email is fine for 1 or 2. If using email and I’m scheduling, proposed times, location, and a tentative agenda are all in the initial email. If I’m responding to a meeting request I try to put all of those in my reply, but that also depends on who’s requesting.

I thank in advance, not after the fact, and rarely send emails whose sole purpose is to give thanks.

If I get an unsolicited and unexpected email from someone I don’t know but that’s not obviously a mass posting, I wait for the second one. Most times it never arrives.

If the email looks like it came from a template it gets deleted without being read.

If I am cc’d on an email chain with many recipients and not directly called out, I archive and wait it out. The only exception is when I know that one or two replies from me would be able to end the game of email chicken that these chains tend to become.

The few times that I didn’t follow these guidelines, I came to regret it (confirmation bias warning!). I’m sure plenty of people don’t give it a second thought and go by just fine. But they probably don’t work in health care.

Update: Out of Office messages are equally important, and covered well here. My own recent OoO message was as explicit as it could get without using profanity, and hopefully conveyed the sentiment that no, I won’t be checking messages at all.

1. Plenary Session. Many friends and coworkers are amazed that anyone would voluntarily subject themself to Vinay Prasad‘s tirades, but his podcast is well-behaved and a pleasure to listen. The monologues are better than the interviews, which is to be expected: he’s been monologuing his whole life and interviewing for less than a year. And yes, some of his guests/collaborators need too much coaxing, but sock puppets only reinforce the national meeting atmosphere that the name evokes.
2. Conversations with Tyler. Still great. You can start at the beginning, or with the one with Daniel Kahneman, but start somewhere. Most are excellent and all are good, even the ones you wouldn’t guess from the interviewee’s name and bio.
3. The Knowledge Project. Farnham Street/F.S. has gotten some good press, and for good reason. It’s self-improvement for people allergic to the self-improvement label.
4. Revisionist History. Yet to listen to the latest season, but I can’t see it going badly. Malcolm Gladwell is a pro.
5. The Glass Canon Podcast. In the absence of a regular gaming night (never schedule a campaign around three doctors’ schedules), I listen to other people playing tabletop RPGs. No better entertainment, I say.

The world in general, and the US in particular, is spending too much on goal-directed, targeted biomedical research while undervaluing both applied and theoretical physics. Picture Leonardo da Vinci drawing helicopters: that’s the modern-day cancer researcher. The universal cure for cancer — and there should be one, if humanity survives long enough to create it — will not come from an NIH grant. If grants are involved at all, it will be something initially funded by the National Science Foundation. The current system of funding (government, non-profit, biotech, you name it) is broken, and if you account for the opportunity cost it is a complete disaster. Each of these statements deserves at least a paragraph, but I am saving my carpal tunnels for a manuscript, an LOI, and a couple of protocols (oh, the irony).

In the meantime, a few things physician-scientists should do for the overall good: * find causes and create better prevention strategies, because a look at the SEER database will tell you that it’s not just bad luck; * eliminate barriers for administration of known curative therapies world-wide (do we really want to leave this to politicians and economists?); * ensure rapid and honest evaluation of the many new treatments, procedures, and diagnostic/prognostic methods coming out of the biomedical behemoth.

How beneficial any of this would be for one’s career is a different question altogether, but let’s not get into incentives because RSI. I am also very open to opposing opinions, since my being wrong would make my life easier.

Serbia’s public broadcaster, RTS (that’s PTC in cyrillic) has a good chunk of its archive spread across multiple YouTube channels, and it is magnificent (this one in particular).

Observe the 1960s-1990s televised plays and TV dramas. I still have vivid memories of watching one particular product the first time it aired, about a Serbian family keeping in touch with their ex-pat relatives in Germany via VHS tapes. Replace camcorders with smart phones and speed up the timeline to account for the internet, and it could have been shot today. Technology changes, people don’t.

My favorite childhood TV show hasn’t aged well at all; then again has anything from the ‘90s? If you consider most of it was made during a civil war and in a time of hyperinflation it is actually quite good. What was 90210’s excuse? Better kids’ shows have been made in Serbia both before and after.

Best for last: the celebration of hard core nerddom that is Serbia’s longest-running quiz show, important enough to have its own channel. It starts with anagrams and math problems, makes a detour to Mastermind, then finishes off with three different ways to test for trivia. Jokes about the autism spectrum would be writing themselves if this were an American show, but it’s not, and (before I left, at least) Serbian viewers still had some admiration for the participants. It is all very serious and competitive, and has been on the air every weekday for the last 24 years. (A political side-note: this does not mean Serbia is free from anti-intellectualism, quite the opposite in fact. Some combination of militant anti-intellectuals, gas-lighters, and proponents of economic/financial scientism has been in positions of power since the early 90s. There are no lessons here, just observations).

For better or worse, the American system of government is strong. Those who say otherwise have a financial interest in people thinking the opposite.

Culturally, US has more similarities with Iran than with Saudi Arabia, even if you count religion and religiosity as part of culture. The Christian right is working hard to make them even more similar.

Though still quite hard, it’s easier for a high-skilled immigrant to come to America than to any other country in the world. Comparison is even more favorable for low-skilled and unskilled immigrants. For all of them, quality of life, acceptance, and protection they get are better than anywhere else.

The randomness of the Green Card lottery process is a feature not a bug.

Reading the non-fiction sections of The New Yorker, The Atlantic, and whatever their conservative equivalents are, is good for generating fake insight but ultimately pointless. The Economist is useful for a tiny segment of the population but lets be real: if you’re reading this you are not it.

The only useful section in the daily newspapers is Local. Maybe Sports, if you are into that sort of thing, but professional and college sports are a scam so stick with the amateur leagues.

TSA agents and airline personnel are nice people but some passengers check out their brains at the curb and make everyone’s lives less pleasant.

Apple hardware products are underpriced for what you get but do you actually need what they offer? This doesn’t include the AirPods, which are the best thing Apple has made in the last 20 years and still underpriced; though they unfortunately resemble in both name and appearance a mind control method from Doctor Who S2 and paired with a smart phone are not far from it.

The world doesn’t need another IPA. America needs more tripels.

This is all coming from a non-immigrant resident alien with no expertise in politics, international law, transportation, or technology. I do know beer though.

(voices as in podcasts, not a psychotic episodes)

• Conversations with Tyler: I much prefer this over his mostly spartan, often cryptic, and always clueless about things medical blog Marginal revolution. Cowen‘s interview style brings out the best from people; it is also a good and rare example of clear thinking. Compare and contrast his chat with Malcolm Gladwell and Patrick Collison’s chat with Cowen: when answering, Gladwell uhms and ahhs and changes direction mid-sentence; Cowen pauses for a half-second, then produces paragraphs of prose that could have been lifted right out of an encyclopedia. Not to belittle Gladwell — for one, I’d be even worse (as anyone who had to finish my sentences for me can confirm); and two, he is responsible for
• Revisionist history: He had me at Food Fight. Gladwell embraces and owns his Well, actually kind of story-telling — even the show’s name is a big Well, actually to the Gladwell-haters. And good for him, because the stories are marvelous in both topic and style, and make me want to read his books again.
• Sources and methods: Two ex-spies talk about learning and cognition. They are still in intelligence-gathering mode, interviewing guests you‘re unlikely to hear anywhere else. It’s how I learned about Tinderbox (and you can too).
• America the bilingual: One part pep-talk to encourage the pre-1990s waves of immigrants to America to take up a second language, one part advice to parents raising multilingual children. The latter validated my plan to ~~save money~~ strengthen the offspring’s Serbian by shipping them across the Atlantic to spend some quality time with the grandparents.
• Novel targets: Finishing of the list of men talking to each other is the best oncology podcast I’ve come across. It may be heavily slanted towards immunotherapy, and not zealous enough in dampening the hype, but it tries.

I have cut my commute down to 40 minutes door-door (from ~2 hours), 25 of which are walking, and we only have to pay 1.69 times the rent. Yay?

Some observations about our new neighborhood from a Serbian/European/Baltimorean transplant.

Dogs are everywhere.

Runners and cyclists too.

And a couple of homeless people. One seems to have staked out a bench I pass by every day.

Very few children. Assuming all the little Audreys and Maddisons are attending their ballet lessons, or whatnot.

Restaurants with street seating. It’s like I’m back in Belgrade. Alas, most of them serve nothing but greasy American classics, only they call it Southern-style and put even more grease.

Are people who eat at these places the same ones doing all the running?

Why do two different streets in the same neighborhood have the exact same name? If you put a super-block that cuts a road in half, does it not make sense to rename one of them?

Safeway is a dump.

The title may remind you of Marginal revolution. That’s on purpose. Go read it.

What better way to spend a Sunday morning than setting up a home server while watching Wimbledon finals?

Congratulations, Andy.

Old (1999), but still good.

When I was a house officer and installing one of the first right-heart catheters, the machine that showed intrapulmonic arterial pressures was enormous and was equipped with strain gauges rather than computer chips. Making it work was difficult. After the line was in, the attending, the nurse, and I tried desperately to adjust the machine to show the pulmonary arterial pressure waves. We could not get them. The line on the screen remained flat. We manipulated toggle switches and strain gauges for about 15 minutes. Nothing. Finally, I glanced at the patient: He was dead.

The story that follows is even better.