Infinite Regress

Another year, another move

Miloš Miljković — Sun, 11 Dec 2022 14:39:00 -0500

The last post in here, my review of Luck, was 4 months ago. Since then I’ve realized micro.blog is a better place for short-form writing, hence the silence.¹

The thing is, micro.blog is also better for longer essays, and the Tufte theme which enables margin notes and sidenotes instead of footnotes is an absolute delight. So, I have moved all of my writing there, which is easy to see, the last post on here being 4 months old.

Worry not, Infinite Regress will remain frozen in time until I convert it into something more cohesive — digital garden seems to be the preferred term — about meta-science and meta-medicine, which will be a fun thing to do in retirement.

There is also a new landing page and even a Mastodon account, but that’s beside the point. ↩

Everything Everywhere All at Once 👍

Miloš Miljković — Thu, 11 Aug 2022 17:41:00 -0400

Turning Red for adults. It works.

Luck 👎

Miloš Miljković — Mon, 08 Aug 2022 11:45:00 -0400

Trite and predictable, with stilted animation, convoluted storytelling, and a general feeling of awkwardness that drowns the few good early scenes. We were re-watching Ratatouille for what feels like the 56th time last weekend and it is ridiculous how much better it is in every respect despite being 15 years older. Luck… will not be getting a re-watch.

Notes from Asheville

Miloš Miljković — Sat, 25 Jun 2022 10:02:00 -0400

A town that has more art deco than brutalism — the largest piece of concrete in sight was a modestly sized skate park — is my kind of town. It is at once frozen in time (picture unsupervised tweens riding bicycles and scooters down a quiet tree-lined street) and progressive (in the American sense of having more crystal shops than chain stores and more rainbows than stars’n’stripes posted on storefronts). It is also, for someone who has spent the last 12 years in the Baltimore-DC area, noticeably white, but note more so than would be expected from any place in North Carolina.¹

Biltmore is as impressive as you would expect a 250-room house to be, but also shows how much better our lives are compared to the richest of the early 20th century rich. Yes, your 23,000-book library with wall-to-wall and floor-to-ceiling bookcases is beautiful, but even a person living on the street has access to more books than that from a device in their pocket. Never mind the demands of heating, cleaning, and maintaining the beast. No wonder then that the owners turned it into an amusement park instead of continuing to live there.

A few more observations:

Farm Burger is a Southern fast food chain a few notches above Shake Shack that in addition to pretty good beef and incredible vegan burgers also serves roasted bone marrow. The only thing missing was sweetbreads.
There are too many hills for it to be a biking town yet there were many people on bicycles. Having mostly narrow, slow-traffic streets downtown helps.
There are not one but two interstate highways that bisect the city, but unlike Baltimore’s idiotic I-83 that destroyed many neighborhoods and ruined the city’s walkability, there are plenty of ways to cross the I-240 on foot. Here, having hills actually helped as the highway is in many places nestled between two slopes.
Its largest neighbors are Knoxville (approx. 2 hours away), Charlotte (same) and Atlanta (3 and a half). That is… too far away for too little, perhaps?
But was the 7+ hour drive from DC worth it? Hell, yes.

The same cannot be said about another picture-perfect town, Frederick, which is distinctly unlike its home state of Maryland. Note, however, that only one of these two states had segregation of some kind in this century. ↩

Calculated Risks

Miloš Miljković — Mon, 30 May 2022 08:52:00 -0400

To get yourself in the right frame of mind before reading this book, try watching a few optical illusion videos. There is no reason to think our visual cortex is any dumber than the rest of the brain — in fact, quite the opposite. That our inference can be so easily fooled in a domain which is supposedly our strong suit is humbling.

Our statistical inference is even worse, so a short book or two on statistical numeracy should be in everyone’s library. Gerd Gigerenzer’s Calculated Risks can be that book for most people. The assumption, easily defensible, is that “most people” will get more use out of understanding frequentist rather than Bayesian probability. After all, most probabilities people are bombarded with — your chance of dying from breast cancer with and without screening, the chance of your neighbor being the killer given a positive DNA match (you know, the day-to-day stuff) — is frequentist.¹

The only reservation to wholeheartedly recommending Calculated Risks to everyone is that it falls into the category of “blog post books”, if you believe that most non-fiction books should, in fact, have been just blog posts. Or, since blogs are out of vogue, a 15-minute YouTube video may do. Or perhaps a single sentence: use natural instead of relative frequencies (e.g. 1 in 10.000 instead of 0.01%). Let your faulty cortex fill in the rest.

It’s Bayesian companion could be The Scout Mindset. ↩

Bullshit Jobs

Miloš Miljković — Sun, 29 May 2022 16:54:00 -0400

A massively biased and, ultimately, underwhelming account of jobs that even people performing them think shouldn’t exist. It is biased because David Graeber’s sole source of information — beside his own flowering mind — were his Twitter followers. More precisely: his followers’ self-imolations in prose sparked by the short essay which popularized the term. So you get not only a self-selected sample of young middle-class professionals discontent with their jobs, but also the attempts of that sample to connect with their anarchist idol. A fun game to play while plodding through these accounts — accounts which, by the way, take a full half of the book — is to spot the embelishments. There are many, and some even Graeber marks as such.

As for underwhelming, well, the book’s purely descriptive nature wouldn’t be so bad if it weren’t skin-deep. Graeber comes frustratingly close to asking some interesting questions;¹ alas, that would have required too much research. Instead we got fan mail copypasta and cheap digs at the corporate culture. So it goes…

In no particular order: Should we be worried about AI taking our livelihoods if most jobs are irrelevant anyway? How much of what doctors do is bullshit, and are they aware of it? Is the private sector just as bad as the government in real-to-bullshit job ratio, or are some companies better than others, and is that reflected in their market value? Are there any signs of de-bullshitization in countries that experimented with Universal Basic Income? ↩

A World Without Email

Miloš Miljković — Sat, 21 May 2022 09:41:00 -0400

Cal Newport’s new book goes well with David Graber’s Bullshit Jobs (about which more to come). Newport may have in fact provide a good, if partial, answer to one of Graber’s main questions — why have jobs that workers themselves see as useless proliferated in the last 50 years? No, it isn’t just email, but rather this: supporting structures of large institutions (think IT, HR, accounting, etc) have taken a life of their own and behave as if their own performance metrics — rather than the instituion’s primary reason for being — are all that matters. Enter thousands of survey requests, daily updates, weekly newsletters, calls for feedback… from dozens of departments all shouting about their contribution to the “core mission”.

So one way to get out of email hell is to work at a smaller place, having anyone completely dedicated to human resources being a good surrogate for being too large. But even that won’t completely save you: as long as you work in a team there will be need for internal communication, and as long as the primary mode of that communication is via email, the hyperactive hivemind — Newport’s preferred phrase — will ensue. Much of the book talks about how this came to be, and how to avoid it. While none of it is revolutionary (some of it even covered on this very blog, twice!), it did point me to Asana, Trello, and other collaborative task/project management apps with file storage and messaging capabilities as good alternatives that I tended to disregard.

As for external communication, well, if the email is longer than five sentences, better make it into a call, preferably the old-fashioned kind.

A World Without Email could easily have fit into the blog post in book form category but for the need to persuade key people that too much email is in fact a bad thing, said people being ones with power to save their employees from email hell yet not being aware that their employees need saving, as they themselves tend to be protected form the onslaught with layers and layers of administrative assistants¹. Judging from the reception in the types of newspapers “key people” tend to read, he has their attention.

On-demand administrative assistants for the regular schmoes being another one of Newport’s proposed solutions. I remain sceptical. ↩

The Demon-Haunted World

Miloš Miljković — Sat, 07 May 2022 18:35:00 -0400

How times change. What in the 1990s was fluff about the importance of learning, thinking, free speech, and civility for America’s continued progress now bounces between prophetic and controversial.

Of course, it wasn’t fluff. It was as true then as it is now, only this time there is no background hum of optimism to drown out the warning sirens. The country, subsumed by ignorance left, right and center — each stupid in their own way — went from being haunted by Demons to being run by them. We are living through Carl Sagan’s nightmare, brains turned off, phones in hand, fingers at the ready. So it goes.

Understanding Nonlinear Dynamics

Miloš Miljković — Sun, 27 Mar 2022 18:30:00 -0400

It is a good thing for intellectual humility — particularly in middle age into which yours truly has stepped a few years ago¹ — to open an undergraduate textbook for a field that is just outside one’s area of expertise. A series of reviews on gene regulatory networks led me down a rabbit hole of vector fields and attractor states that was interesting-yet-unscrutable enough to get me to Understanding Nonlinear Dynamics.

It is very much a textbook, info-boxes, end-of-chapter exercise, and all. It also presupposes a grasp of mathematics which I may have had just out of high school but have long since lost. This is fine: at Mortimer Adler’s suggestion I zipped past the equations and derivations, deciding to trust the authors that they are indeed correct, and went to the meat. Which, in nonlinear dynamics, as a nice bonus, also has pretty pictures of fractals and vector fields. Alas, not as artistic as Charles Waddington’s, but nevertheless striking.

What surprised me the most was how much of the field resulted from mathematicians fiddling around with parameters to see what happens. Going to a textbook to learn this was overkill — the Wikipedia article on experimental mathematics may serve the purpose just as well — but knowing the context does make it memorable. There is a pleasing symmetry here: mathematics is usually thought of as purely theoretical, yet its most interesting aspects, Lorenz attractors to Wolfram’s (not so) “new kind of science”, have relied on experimentation. Biology has been purely experimental ever since Watson and Crick, aborted attempts at theoretical biology notwithstanding, and was even a decade ago producing more data than it can handle. Would it not be neat if the answer to this biological data overload wasn’t machine learning but instead a framework for theoretical biology? If there was one, nonlinear dynamics would play a big part.

What constitutes “middle age” in the 2020s is a matter of some debate. Is it a matter of birth date, life style, state of mind, a combination thereof? Taking the last thing first: I have been in a middle age state of mind since I was twelve; am as much of a 2.5-child nuclear family man as a geriatric millennial can be; and am well into the third quintile of life, as foretold by the life expectancy tables for a man of my age. No red convertibles planned for purchase, though a new decked-out Mac Pro — once it comes out — would probably cost just as much and is something I would actually consider having. ↩

Station Eleven 👍

Miloš Miljković — Thu, 24 Mar 2022 07:45:00 -0400

It was a brave move, to release a TV show/limited series set in the aftermath of a world-ending respiratory virus pandemic right at the tail end of covid. Good thing that the execution was flawless, from the dream-like cinematography,¹ through casting, to Satoshi Kon-like editing. Notes of Watchmen, too, in how the source material is to be taken seriously but not literally when converting a book into something else.

Importantly, Station Eleven is set in, but is not about, a post-apocalyptic Earth, in much the same way Titanic was set in, but was not about, a sinking ship. Less romantic love and more parent/guardian/child love/hate relationships here, which is why it takes 9+ hours instead of 3+ to tell the story; but a full, rich, meaningful story is told, and told well. Kudos.

Almost every shot reminded me of the dream sequences from The Leftovers, which were in fact its best part. And it is here that I realize with horror that I never wrote about The Leftovers, which is in my all-time top 5. A rewatch and a writeup are due. ↩

Back to microblogging

Miloš Miljković — Sun, 20 Mar 2022 10:10:00 -0400

A brief experiment with Drummer reminded me how fun it was to write short, untitled, tweet-like posts throughout the day without having to be exposed to social networks. Drummer itself was too high-maintenance for the 2020s me, but Micro.blog is a (paid) service whose focus is — and the name does give it away — short, untitled, tweet-like posts with a light layer of social networking.

Which is to say, my old domain is now resurrected as a micro blog with a snazy Edward Tufte-inspired design. The RSS you get there should include updates from this blog, so subscribe to either but not both.

Turning Red 👍

Miloš Miljković — Tue, 15 Mar 2022 14:12:00 -0400

Bao meets The Mitchells… to produce something less artistic then either, but at least fun to watch. Mid-March release sounds about right.

Where Good Ideas Come From

Miloš Miljković — Sun, 13 Mar 2022 09:49:00 -0400

There is no clearer sign of us entering a new era than reading a book from 2010. Not so long ago, wide-eyed journalists still described the Internet — note the capitalization¹ — as a force for good, an incubator of ideas whose capacity to connect people will lead to an exponential growth of innovation and prosperity. If one was to build a case against journalisitc blindness to externalities, Where Good Ideas Come From would make for a good exhibit.

The case against journalistic ignorance of patent law, too. The author, Steven Johnson, describes patents as means of rewarding inventors — and surely we can find a better way to reward them than a device that restricts the all-important distribution of knowledge. Only, that is not why the patent system was introduced, as described clearly if not succinctly by Vannevar Bush. Why a science journalist would straw-man a crucial factor of western technological superiority before attacking it is beyond the scope of this brief review.

The third feather in Johnson’s cap of muddled thinking is his conflation of discoveries and inventions, putting both under the broad category of “ideas”. The problem with that is apparent in the last few chapters of the book, where a series of 2x2s of ideas distributed according to the number of people involved (individual versus networked) and whether the enterprise is commercial (market versus non-market) “proves” Johnson’s case that non-market networked operations are superior, and should be supported above others. After all, from the 1800s onwards, most of the dots have been in their quadrant!

But here is a random² sample of the 54 ideas listed in the non-market/networked quadrant: electron, RNA splicing, chloroform, cell differentiation, EKG, cosmic rays, universe accelerating, genes and chromosomes, atoms form molecules, radiocarbon dating. Only one of those ten, EKG, is now a physical product being sold and used. Two more, RNA splicing and radiocarbon dating, are methods that could be commercialized. Those three I would describe as inventions, and all three have a rather limited scope of use. Everything else are discoveries, telling us things about how the world works but not directly improving our lives in any meaningful way, other than satisfying our thirst for knowledge.

Now here are 7 ideas randomly selected from the 35 listed in the market/networked quadrant: contact lenses, washing machine, plastic, elevator, steel, television, radio. If Johnson’s quadrants prove anything, it is that having market forces involved is strongly associated with invention. We can, of course, discuss the direction of that particular arrow, and whether markets co-opt inventions they deem useful rather than actually developing them. The distinct lack of inventions in parts of the world where market forces aren’t in play hints at my preferred answer.

Having said that, there are some good ideas in this book about good ideas. One of them, the adjacent possible, a mental model for both discovery and invention, is also the name Johnson now uses for his (rather … good) newsletter. That is the concept that made me remember the book fondly after my initial reading, 10 years ago, and it is the newsletter that made me re-read it. And a good thing too — because even though the book is the same, both I and the world have changed enough to make it irrelevant. It won’t be in my re-read list.

Also note that the Chicago Manual of Style and the Associated Press both revised their stylization to lowercase in 2016, Year Zero of the New Era. This was not, of course, the year’s only notable event. ↩
Randomization was performed by my hovering a pencil above the page and dropping it with eyes closed. If the pencil hit an empty space, the first idea straight down from the spot was chosen regardless of distance. ↩

The French Dispatch 👍

Miloš Miljković — Thu, 03 Mar 2022 13:07:00 -0500

The Wes Andersoniest of all Wes Anderson movies, at least the live action ones. Every frame is a painting here, or a New Yorker front page, and in that regard this is also his most artful work. But The Grand Budapest Hotel is still a better movie.

Pieces of the Action

Miloš Miljković — Wed, 23 Feb 2022 07:20:00 -0500

Old men and their tales are good for many things: knowledge, inspiration, amusement, and, occasionaly, ridicule. Vannevar Bush provides all four in this series of (mostly war) stories about innovation and how to kill it. The anecdotes are loosely grouped into themes, and are even more loosely chronologically arranged; an opportunity for a joke, a pun, or a humble-brag trumps any attempt at organization. The feeling is very much like sitting crossed-legged on the carpet next to your grandfather’s airmchair as he — pipe in one hand, tumbler of scotch in the other — spins you a yarn.

Quite a yarn, though. Bush spent time as a leader in academia, government, and industry, in that order, and has good and bad things to say about all three. His preference is for strict hiearchy; his favorite part of government is the military, his most hated subordinates are those who don’t follow chain of command. One doesn’t win a World War without gaining some appreciation for epaulets and funny hats, I suppose.

That said, his is the most convincing case for patents that I’ve come across: they should be seen as a way to secure a return on investment for the venture capital, not a monetary incentive for the inventor. Having a few patents in his name, he knows an idea by itself is worthless without the resources to implement it, resources which won’t come unless there is a guarantee someone else won’t be able to come and lift the final product, bypassing the costly process development. Fifty years after this clear and concise explanation, people still make the mistake of describing patents as rewards (more on Steve Johnson’s book — which if we are being pedantic came out 40-some years after Pieces of the Action — some other day).

So an intelligent, wise, industrious man in the twilight of his career retells his life’s story — all well and useful — but he also gives some predictions: that American politicians are becoming more leader-like and that we should expect to see even more leadership in high-quality politics in the coming days, possibly thanks to that new darling of American intellectuals, the television set. Pieces of the Action came out in 1970, two years before the Watergate break-in and four years before Nixon’s resignation. The difference between metaphorical peaks and real ones is that you don’t know you are on the former until you are well on your way down, and if you spent your life inventing the modern world, running corporations and fighting Nazis, the way down is hard to imagine.

January reading

Miloš Miljković — Tue, 01 Feb 2022 14:10:00 -0500

The Scout Mindset by Julia Galef
Four Thousand Weeks by Oliver Burkeman
Twilight of Democracy by Anne Applebaum
How to Live by Derek Sivers (the only one in the list I may re-read)
Safe Haven by Mark Spitznagel

So far so good. If the first month is anything to go by, I will have the 2022 reading list licked by September.

Safe Haven

Miloš Miljković — Mon, 31 Jan 2022 13:51:00 -0500

My infatuation with Karl Popper’s philosophy of science didn’t survive actual experience in the lab, which was far messier and more nuanced than the strict Austrian hypothesis falsification workflow Popper described. What, then, to make of this book, which is Popperian science applied to financial risk mitigation? It makes sound and persuasive arguments, but then again so did Popper when discussing general scientific progress.

In the dilemma also lies the answer — unlike Popper, who never conducted practical research, Mark Spitznagel is investor first, philosopher of finance last. He needed a framework to impart his wisdom and Popper’s served nicely, though I suspect just as much knowledge transfer would have occurred had he used verse.

How to Live

Miloš Miljković — Wed, 26 Jan 2022 15:40:00 -0500

Continuing the “How to…” series, we’ve come to the pinnacle of self-help schlock… or so I thought. How to Live is a good book. So good, in fact, that I plan on ordering a half-dozen or so copies to give out as birthday presents throughout the year.

“Please read slowly. One line at a time. ” says the preface. And it is the perfect advice, for what follows are pithy comments on life grouped into chapters by predominant mood. “Be independent” advises Chapter One, “Commit”, retorts the second; the chapters are internally consistent but mutually conflicted, if not exclusive.

So here is what happens: you will start reading a chapter with an agreeable-sounding name, nodding along in the beginning, until a turning point comes where that particular line of thinking is brought to (what you think are) extremes only found on BBSs, internet forums, and private Facebook groups. Or you may start the chapter by shaking your head in disagreement only to find a line, or two, or ten that are actually quite sensible, for you, at that particular moment in time.

Some savvy operator — a pioneer, the author Derek Sivers might call them in what is the only trollish chapter of the book — could have created a speaking gig, an LLC, or maybe even a cult based on what’s here. Lucky for us that he didn’t: you can order the book online in hardcover, paperback, and many electronic formats.

Twilight of Democracy

Miloš Miljković — Fri, 21 Jan 2022 13:59:00 -0500

Confesions of a neocon boomer, horrified with what her generation has wrought upon the world. That it is written without a hint of irony makes it all the more amusing.

We really did have everything, didn’t we?

Four Thousand Weeks

Miloš Miljković — Wed, 19 Jan 2022 14:43:00 -0500

The subtitle is Time management for mortals, but Making peace with middle age would not be too off the mark. Don’t waste your life micromanaging workplace minutia while waiting for the conditions to be right to start working on what’s important to you. Just do it.

The Nike slogan echoing throughout is not the most GenX thing about it either.

There is an important point there, but I can’t help thinking it could have been made without denigrating other books on time management. From Stephen Covey’s ladders against the wrong wall to David Allen’s 50,000-foot view, most systems have a way of reminding you about the big picture — though only as a footnote and without fancy diagrams so no wonder there are some who miss it. Good thing there is now a whole book about the big picture to add to your workflow.

The Scout Mindset

Miloš Miljković — Tue, 18 Jan 2022 13:03:00 -0500

A brisk account of mental models and cognitive techniques to get you out of idea-defending and into idea-falsifying mode, or from solider to scout mindset, to use the author’s terminology. Soldiers care about status and will use evidence and rhetoric to shore up their established position; scouts care about reality, and will use evidence and rhetoric to seek out and build a better and more trustworthy map.

Yes, we could all do with some more of the scout mindset in our lives — the easiest person to fool being ourselves and all that. It is too bad, then, that people most likely to read and internalize the book are already the most scout-like among their friends. Back in early 2020 many a scout asked for more evidence and even went looking while others were digging ditches and building barricades; they are still pariahs.

Being a scout is a lonely endeavor. No surprise, then, that most humans actively avoid becoming one.

How to Speak and How to Listen

Miloš Miljković — Thu, 06 Jan 2022 07:57:00 -0500

Continuing my streak of self-help indulgence, I decided to re-read Mortimer Adler’s less known work, the one about speaking and listening.¹ Parts of the book aged rather poorly.

Lamenting the decline of liberal arts colleges — decline of the 1980s, not the deep dive that was yet to come — he offers some words of self-praise about teaching marketing executives on the importance of ethos, pathos, and logos in controling people’s actions and minds. Oh, how professioral he must have looked — my mind brings up images of a bespectacled jowly professor in a tweed suit; the internet agrees with my assessment and even adds a pipe — educating these know-nothings on the works of Demosthenes. Oh, how tragic is the path to which he led them, and the world.

But I kid. Mortimer Adler the man had little to do with the attention economy of days present, but his ponderings on how to be a good dinner host, impress CEOs of Fortune 500 companies, and rile up a crowd to do your bidding are a good example of the tango mortale that academia played with industry in the mid-to-late 20th century. And we are all worse for it.

The best-known one being How to Read a Book, which is good despite itself and its author’s pretentiousness. ↩

One last thing about Don’t Look Up

Miloš Miljković — Wed, 05 Jan 2022 18:06:00 -0500

After two failed attempts to explain why exactly I wasn’t thrilled with Adam McKay’s Netflix movie — brevity will only get you so far — I found this review by Scott Alexander to perfectly capture my doubts about the movie’s message. I agree with Alexander only about 60% of the time, but I can agree with 100% of his review.

How to Think

Miloš Miljković — Tue, 04 Jan 2022 09:08:00 -0500

The subtitle, “A Survival Guide for a World at Odds”, is closer to what the book really is: not a manual for thinking, but rather a set of instructions for responsible use of, and participation in, social media circa late 2010s. As such it is quite useful, skipping briskly in its 100-some pages from Kahneman and Tversky’s Systems 1 and 2, through Kevin Simler’s Elephant in the Brain, to a few online anecdotes of people changing their minds after communicating with the other side — whatever the “other side” was in their particular front of the culture wars.

Left unsaid is why you would want to throw your hat into the social media ring anyway. The author Alan Jacobs has himself all but abandoned Twitter and seems to have limited his online presence to a one-way, comment-less blog. Jacobs may have correctly framed thinking as inherentialy social, but social media as they are just 4 years after the book’s publication are decidedly not the best medium for thinking.

The Dawn of Everything: A New History of Humanity

Miloš Miljković — Mon, 03 Jan 2022 12:36:00 -0500

The book that Sapiens¹ wished it could be: an honest, academically rigorous, intellectually stimulating, fun overview of archeology’s current understanding of prehistory, and an exploration of the reasons why the popular view has become so divergent from the professional.

I won’t pretend to have digested all 700 pages after one read, but a few mental models popped up immediately.

The first is the importance of play: there is some evidence — and much hypothesizing — that at least some of the modern societal setup came about as a result of play. Pretend-kings of annual feasts may have, at some point, decided to be true rulers. The first use of clay modeling was to build toys, not pottery. And to extrapolate to the more recent past: powerful graphics cards built for photo-realistic video games are now mostly used for cryptocurrency mining. The outcomes don’t always need to be good!

That is another important point: the book dismantles the myth of linear progress and replaces it with a theory of multiple (social) worlds in which some may be more suitable at different times for different populations, but none could be called universally “better” than others. We are in dicey territory here, because one of the authors — the late David Graeber — was a well-known activist for anarchism and you’ll have a hard time finding a review of The Dawn of Everything which doesn’t try to frame it as some sort of a call to anarchy. But it is hardly the first book published in the last five years to point out some of the deficiencies of the current state of affairs, while pointing out that social experimentation was the modus operandi for most of human (pre)history.

The how of our mistaken ideas of the neolithic leads to another important mental model: premature codification of hypotheses as facts. The chain of events leading from Rousseau’s essay on the mythical Noble Savage to historians mistaking it for actual history echoes many of the medical myths with which I am more familiar, from iron-rich spinach to fever-causing atelectases. Most fields of human endevor won’t let facts get in the way of a good story.

My own field being as far away from archeology as you can get, I had to ask the one “real” archeologist I knew — with recent field-work experience in Europe and the Eastern Mediterranean — what she thought of the facts in this book. And, somewhat surprisingly, she saw nothing new, controversial, or groundbreaking in any of the stated facts. For what it’s worth, an anonymous Amazon review from someone claiming to be an expert in the field confirms this. This is important: we can argue about interrpretation — and unlike some popular historians the authors here clearly mark the parts where they are telling a story more than stating facts — but the truth about how much we know should not be in doubt.

Meanwhile, professional book reviewers, quick to judge, easy to confuse, attention spans short, don’t know what to make of any of it: as sure a sign as any that The Dawn of Everything is a true masterpiece.

Reading my review of the Sapiens I realize I fell prey to the reverse form of Gell-Mann amnesia: suffering through Harari’s other book, Homo Deus, should have made me revise my opinion of Sapiens right away, and not wait for Graeber and Wengrow to put things right. ↩

22 books for 2022

Miloš Miljković — Sun, 02 Jan 2022 21:05:00 -0500

This is the bare minimum of non-medical books I should read this year. The last two years were abysmal in that regard, and I look forward to making excuses for why 2022 was no different.

The Scout Mindset (Julia Galef)
How to Live (Derek Sivers)
Understanding Nonlinear Dynamics (Daniel Kaplan and Leon Glass)
Light (M. John Harrison)
Safe Haven (Mark Spitznagel)
Pieces of the Action (Vannevar Bush)
The Demon-Haunted World (Carl Sagan)
Where Good Ideas Come From (Steven Johnson)
Calculated Risks (Gerd Gigerenzer)
Making Things Work (Yaneer Bar-Yam)
The Morning Star (Karl Ove Knausgaard)
Alexander Hamilton (Ron Chernow)
Where Law Ends (Andrew Weissmann)
The Fifth Risk (Michael Lewis)
Checkpoint Charlie (Ian MacGregor)
Checkmate in Berlin (Giles Milton)
The Complacent Class (Tyler Cowen)
Craft Coffee: A Manual (Jessica Easto)
The Complete Father Brown Stories (G. K. Chesterton)
Foucault’s Pendulum (Umberto Ecco)
Scientific Freedom: The Elixir of Civilization (Donald W. Braben)
Adventures of a Computational Explorer (Stephen Wolfram)

A Swim in a Pond in the Rain

Miloš Miljković — Sun, 02 Jan 2022 10:28:00 -0500

George Saunders is a modern master of the short story, so when he offers his thoughts on masters of old — all of them Russian — you’d better take it. Even if, like myself, you have no intention of ever writing short stories for a living or for personal enjoyment, it will greatly enhance your appreciation of the craft.

Science and scientism

Miloš Miljković — Sat, 01 Jan 2022 09:36:00 -0500

A big reason Don’t Look Up didn’t sit right with me was its simplistic view of the scientific consensus. “Listen to the goddamn qualified scientists…” bellows Ariana Grande paternalistically.

Meanwhile, qualified scientists from reputable institutions of higher education act as petty and vindictive prima donnas. The linked article is one scientist’s story of having to suffer through years of academic harassment for publishing a paper that rubbed some of her fellow researchers the wrong way. From the abstract:

A naïve researcher published a scientific article in a respectable journal. She thought her article was straightforward and defensible. It used only publicly available data, and her findings were consistent with much of the literature on the topic. Her coauthors included two distinguished statisticians. To her surprise her publication was met with unusual attacks from some unexpected sources within the research community. These attacks were by and large not pursued through normal channels of scientific discussion. Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work.

Goddamn scientists indeed.

Happy New Year

Miloš Miljković — Sat, 01 Jan 2022 08:46:00 -0500

Infinite Regress HQ wishes a Happy New 2022 to all those who celebrate.¹

By the time this gets published, it will be January 1, 2022 in all time zones. The earliest someone has wished me a Happy New Year this season was mid-December (!?). Yes, yes, we won’t see each other until the next year, but let’s see the old year out the door before celebrating the new one. I’m superstitious like that. ↩

Encanto 👍

Miloš Miljković — Fri, 31 Dec 2021 23:54:00 -0500

An unexpected diversion that is all heart and no plot — not the most terrible thing in the world, but far from the year’s best animated movie.

Newsletters of note

Miloš Miljković — Fri, 31 Dec 2021 15:35:00 -0500

Most of these also make an appearance on my list of blogs. All are recommended, though some of the more prolific ones are best consumed in moderation.

Influence

Miloš Miljković — Wed, 29 Dec 2021 12:49:00 -0500

Similarly to Peter Thiel’s key question in Zero to One, Influence revolves around a list of seven: the seven heuristics our System 1 has accepted as a sign that we can agree to something automatically — what Robert Cialdini calls the Click, run response. Actors both nefarious and benign may use them to get wat they want from us. But of course, it works both ways: we can’t learn defense against the dark arts without picking up some of those dark arts ourselves.

As chance would have it, my finishing the book coincided with a family trip to Las Vegas where all of the principles were tried on us in an attempt to sell us a time share scheme. We got our initial hotel room stays at a well-known and renowned hotel chain (authority) at a discount (reciprocity); the sellers wanted to ingratiate with us with a wink here and a compliment there (liking), citing that she, too, was bilingual and raising a bilingual child (unity); we were taken to a room fool of other potential buyers and witnessed one occasion of a 14,000 point plan being sold (social proof); we had only that day to decide on whether we should buy into this once-in-a-lifetime opportunity (scarcity), and we kept being reminded how much we spent on vacations anyway (commitment and consistency).

They were good, but the book was better: we thanked them for the offer and graciously declined. It was a $15 investment that saved us tens of thousands of dollars in frivolous expenses. Well worth an ocassional re-read.

Don’t Look Up 👎

Miloš Miljković — Tue, 28 Dec 2021 14:32:00 -0500

Netflix has a corrupting influence on film makers. Could it be that good art needs constraints?

Witness Don’t Look Up: a two and a half hour movie in which everything is at stake yet nothing happens. As a government farce, it is worse than Burn After Reading; as a disaster movie, it is worse than even Armageddon; and it is much, much worse than Dr. Strangelove by any criteria.

If it was meant to portray our response to Covid it did a terrible job, painting science as all-knowing and the political-buisness cabal as less coherent than your average B-grade movie villain. Spolier alert: (almost) everyone dies at the end, and you (mostly) won’t care.

Good soundtrack, though.

Goodbye, Drummer (for now)

Miloš Miljković — Tue, 28 Dec 2021 12:20:00 -0500

Drummer is an online outliner that enables quick, easy, and near real-time posting of text both long form and short — what we used to call blogs back in the good old days of two years ago. Dave Winer created it for his own purposes, but it works beautifuly with just your Twitter account as a login. Here is my page.

As things are still very much in progress, Dave recommended doing daily backups. Sadly, I didn’t, and as of today’s updates a few weeks’ worth of half-baked notes are wiped out from the Drummer server (but thankfully not from the website they helped create). That’ll teach me.

Since posting to that page is on hold until everything is back in order, expect more — dare I say daily — updates here. Managing markdown files is not nearly as intutitive or pleasant to use as Dave’s outliner, but he seemes to be working on an OPML to markdown converter. That will be well worth the wait.

Zero to One

Miloš Miljković — Sat, 25 Dec 2021 11:48:00 -0500

Peter Thiel’s thoughts about startups, which I presume every founder past, present, and future has read and internalized.

But I jest. Browse Twitter and you’ll see his seven fairly simple principles of running a successful startup abused, ignored, and misinterpreted, particularly in biotech.

Instead of building a technology that will be useful 20 years from now — the durability factor — technologies are made to solve problems of 20 years ago. Layering optical character recognition, artificial intelligence and machine learning over the cruft of hand-written notes faxed back and forth between doctors’ offices comes to mind. Compare and contrast to mRNA vaccines, a technology created more than a decade ago to treat today’s pandemic.

Instead of developing drugs and other treatments with at least 10 times the effect size of current standards of care — principle of technology — the regulatory agencies and markets are overwhelmed by me-too drugs whose marginal benefit requires mammoth trials for any chance of detection.

Instead of vertical integration and ownership of drug discovery, manufacturing, clinical operations and biomarker development within the same organization, with positive feedback loops between all the factors leading to a faster pace — the team prinicple — we get ghost companies made of slide decks and good wishes whose only tangible impact on the world is achieved via Contract Research Organizations.

I could go on: the principles of timing, monopoly, and distribution are also violated early and often in a biotech startup’s lifetime. But then I’d be breaking a principle myself, that of the secret.

Voices in my head, 2022

Miloš Miljković — Sat, 25 Dec 2021 10:50:00 -0500

Listen to podcasts long enough and you are bound to develop tastes. After 15-some years, mine are these: conversations over stories, with minimal to no editing, and lasting no longer than a couple of hours per episode. Even within these constraints, the list of podcasts I could listen to is near-infinite. Yet these are the few to which I keep returning:

Omnibus, which survived John Roderick’s attempted cancelation to continue providing two poorly-researched topics per week. Highlights of 2021: Mobile Jubilees, The Bottle Conjuror, Officials General, Merkins (yes, those), and The Phantom of New Guinea in which the curious popularity of an obscure Canadian detective show in Serbia makes an appearance.
EconTalk, which continues to be the best general-interest interview show for people who’d rather avoid snake oil salesmen. Highlights of 2021: Dana Giola on poetry (which is in fact the best episode of 2021), Julia Galef on her book Scout Mindset (which I am yet to read, but oh well), Anja Shortland on lost art, Bret Devereaux on ancient Greece and Rome, and Johann Hari on lost connections (which reminded me of a particularly sad episode from my tenure as a heme/onc attending).
Healthcare Unfiltered is the first new healthcare-related podcast I’ve started listening in years. Chadi Nabhan is a good interviewer with an even better access to relevant guests, particularly when he attempts to bring together both sides of a twitter-heated medical debate. Highlights of 2021: Bishal Gyawali on clinical trial design, Aaron Goodman and Matt Wilson on CNS prophylaxis for DLBCL, Barbara Pro and Mehdi Hamadani on PTCL, Mikkael Sekeres and David Steensma on mid-career transition, and Aaron Goodman versus the world, supposedly about randomized clinical trials.
Plenary Session was back on my playlist this year, and mostly Covid-free. Highlights of 2021: Chris Booth, Adam Cifu, Manni Mohyuddin, Bapu Jena, and again Aaron Goodman (who should really start his own podcast instead of squatting in other people’s).
The VPZD Show is the one about Covid. Prasad and Damania have their hearts in the right place and fairly sharp minds; they can evaluate evidence on merits and are willing to admit past mistakes. Without mourning days past when these characteristics were more common — because in fact they weren’t — I’ll just note that in times like these, they are essential. Highlights of 2021 include the entirety of the show, which has only just started.

Previous editions: 2021 — 2020 — 2019 — 2018 — The one where I took a break from podcasts — The very first one

Dune (2021) 👍

Miloš Miljković — Sat, 23 Oct 2021 12:59:00 -0400

The 1984 version showed that making a good movie out of a 700-page tome is a complex problem that can’t be solved in 2 hours 17 minutes on a $40M budget. It took 20 minutes and $50M more than that for Denis Villeneuve to cover just half of what Lynch attempted, but the end result is so much better. The story is what it is — between the book, the movie, the TV show, and the game I now know it by heart — but the casting, the pace, cinematography, score, the movieness of it, are all pitch perfect. A cross between Mad Max: Fury Road and Star Wars, noted our perceptive nine-year-old somewhere around the 30-minute mark. Yes, and more like this, please!

Viewing notes: we saw it on a 120” screen with a 5.1 surround system. If you have anything less at home I’d strongly recommend going to a movie theater. Yes, it’s nice that it is available for streaming on day 1, but you would be doing a disservice both to the movie and to yourself seeing it on a postage stamp. \</privilege>

The Mysterious Benedict Society 👍

Miloš Miljković — Tue, 19 Oct 2021 11:21:00 -0400

A Disney+ TV show that WoG followers would like. Villains are IYI vegans who live in modernist buildings and make children live by absurd and contradictory rules that only give an appearance of freedom (“You are free to go wherever you like, as long as you stay on the path”, to paraphrase one). Our heroes, both children and adults, are messy but resourceful, at home in both a Georgian mansion and the wilderness of (I assume, though it’s never specified) the Pacific Northwest.

It starts in a picturesque costal town right off of Townscaper. By the third episodes the children are stuck in a nightmareish brutalist school that is all acute angles and ‘70s orange-white plastic furniture — not nearly as pretty to look at, but the puzzle-of-the-day aspect makes every episode worthwhile. It ends with most of the loose ends tied up but with promises of more to come. And Tony Hale is in almost evey scene. What’s not to love?

A brief chronology of my employment

Miloš Miljković — Mon, 18 Oct 2021 11:46:00 -0400

1994: Fifth grade; I am charged with editing the school newspaper. There is an Intel 386 PC at home that is about to be upgraded to a 486 and do something more than run Lands of Lore.
1996: Seventh grade; I typeset a book of poems¹. The school newspaper becomes the school magazine — in layout only; the publishing schedule remains haphazard — as I upgrade from Word 6.0 to QuarkXPress
2000: High school starts again after a freshman year interrupted by NATO bombing. I make the town library’s official website. It is a php hack job laid out in tables instead of the newfangled and to me unknown CSS; it still wins an award.
2002-2008: Med school; I typeset a book here and there and occasionally help out with the library website.
2009: Teaching assistant, Institute for histology and embryology, Belgrade School of Medicine.
2010: Resident, Internal medicine, JHU/Sinai, Baltimore MD.
2013: Chief resident, Internal medicine, as above; I understand the benefits of not being invited to a meeting.
2014: Clinical fellow, hematology/oncology, National Cancer Institute, Bethesda MD.
2016: As above, but also Chief fellow ex tempore for the joint NCI/NHLBI fellowship; my hatred of poorly-run meetings intensifies.
2017: Staff clinician, later to be renamed Assistant research physician, Clinical Trials Team, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda MD; the 1994 me marvels at the word salad trailing the title.
2021: Chief Medical Officer, Cartesian Therapeutics.

Someone else’s, to be clear. ↩

CODA 👍

Miloš Miljković — Mon, 11 Oct 2021 16:50:00 -0400

A few notches below Little Miss Sunshine, a movie of a similar sensibilities. Some changes might have improved it — e.g. why does Ruby end up at high-school choir practice because of a boy, and not because of her love of singing? — but none of it can correct the one huge flaw, which is that conflict between Ruby’s supporting her family by providing free ASL interpreter services and Ruby’s becoming a strong independent young woman is a zero-sum game which will end up in either financial hardship or broken dreams.

But, you know, the music was nice.

The Mare of Easttown 👍

Miloš Miljković — Wed, 08 Sep 2021 06:38:00 -0400

The Mare of Easttown is the best dead-girl-in-a-sad-town TV show to come out of the US since Twin Peaks. To be clear, the 30-some years that separate them still have many good shows of the genre, but none were American. When they weren’t busy churning out the millionth iteration of CSI, Americans could only muster pale copies of what came out of Britain and Scandinavia, with characters and plots lifted wholesale and Northern European sentiments crammed oddly into New England toponyms.

The Mare takes its setting more seriously, and not just with flannel shirts, odd accents, and dozens of bottles of Yuengling and Rolling Rock drunk per episode. You quickly learn that the town is not all that bad: it has decent homes, an upscale college and high school, and a pretty good sense of community. It’s the people who are sad, each in their own way and for their own reasons, with the titular Marianne the saddest of them all, and the show mostly dedicated to exploring how and why this happened.

There is also a murder or two, some kidnappings, and an action scene that brought back some of the best moments of The Silence of the Lambs. A few of the cliffhangers were the murder mystery equivalent of a jump scare, but that can be forgotten because the show manages to pull off a successful double-twist ending that is both reasonable and unexpected.

Ultimately, if a show is good enough for Kate Winslet to be in, it’s more than good enough for me to watch.

The White Lotus 👍

Miloš Miljković — Thu, 26 Aug 2021 07:15:00 -0400

Two parts lifestyle porn one part sociologic study of intergenerational struggle, with a smidgen of mystery to whet your appetite and make you think there is more there there than it actually is, though what is there is still pretty good if not exactly a Knives Out caliber of crime comedy.¹

But oh my that soundtrack.

And it is here that I realize I never wrote about Knives Out, which would have been the movie of the year had it not come out in 2019, a good year for movies in an otherwise mediocre decade. So here is my review: it is outstanding, go see it (👍). ↩

How I handle meetings (which most certainly is not how everyone should, but again, may be useful to some)

Miloš Miljković — Fri, 06 Aug 2021 08:15:00 -0400

It is easier than ever to organize and attend a meeting, which should scare the living daylights out of anyone who doesn’t organize or attend meetings for a living. It used to be that only middle management had to deal with a series of 90-minute meetings all 15 minutes apart in which they had no specific role, which had no effect on their task list, and which left them no better off than they’d be if they had just read the minutes.

We are all middle management now.

My own experience with middle management was during chief residency and I learned quickly that the more administrative aspects of it just weren’t for me. But I also learned a few coping strategies, modified below for the video conferencing age.

A short ad-hoc meeting is better than a long email thread. Email is a brilliant technology, but it just wasn’t meant for frequent back and forth between any number of people. It always amazes me when someone sends an email with five direct recipients and ten more addresses cc’ed, and then expects to have a productive conversation. Pre-2020 the excuse would have been that everyone was too far apart to attend a meeting, whether in another time zone or in a different building on campus. No longer.¹
A short standing meeting is even better than an ad-hoc one. Few things in any line of work need someone’s immediate and undivided attention. Issues can usually wait: if one project is on hold because a decision needs to be made, there will be others to work on. If they can wait a full week, why not batch them and bring them up with your boss/employees/co-workers/contractors at a weekly meeting. If they can’t wait for more than a day, make it into a short daily meeting held at a set time. We have these meetings all the time in medicine — we call them rounds, and they have worked well for more than a century.
Frequent short meetings are better than infrequent long ones. Setting one up used to be hard logistically: from booking the right sized room on time to making sure the timing works out for everyone — not to mention having to include a buffer for getting to the conference room and setting up AV. With that much overhead for a meeting of any length, of course the default was at least 60 minutes, if not a full hour and a half. Now even a 90-year-old can tap a link on their oversized phone to log onto that Zoom meeting while quarantining at home. The negligible cost of starting a meeting may mean they are more frequent, but it should also make them shorter. Much shorter.
One day full of meetings is better than all five weekdays broken up with just a few per day. When in meeting mode, it takes me at least 30 minutes to get my bearings back to doing other work. Mode switching is a fixed cost and it’s best done infrequently. I therefore have a day dedicated to meetings, and if I have any say whatsoever in when a meeting will be held I try to do it then.² If you need to have a meeting on a different day, try to have it as a bookend — morning and afternoon rounds are a good example of this.
Finish off a meeting with a task list and the designated person(s) for each task. You will probably have missed something, but that’s OK since you’re still at the meeting and others can fill in the gaps. Send off that list as an email to all attendees. Congratulations: you are now the meeting’s Most Valuable Attendee. If the meeting ends without anyone being able to come up with a single task, it should not have taken place. This is an important lesson. Take note of whomever called the meeting and try to avoid attending their meetings in the future.³
Bonus tip: If you are setting up a one-on-one meeting with me, and you are the one sending out a calendar invite, do enter both of our names in the meeting title. I have too many meetings with myself on the calendar and it’s getting hard to keep track.⁴

If you liked this, you may also enjoy my lukewarm take on handling email.

I believe Cal Newport wrote a whole book about this issue which is in my ever-growing To Read pile so this will remain just a belief for the foreseeable future. ↩
Wednesdays. ↩
This excludes staff meetings mandated by this or that accreditation agency, which turn into venting venues by design — though even then the tasks should be to set up smaller, more meaningful meetings to deal with concrete issues that may be brought up. ↩
My default name for those kinds of meetings is just “Milos <-> Person 2“. ↩

Notes from West Virginia

Miloš Miljković — Sat, 31 Jul 2021 09:03:00 -0400

It was the middle of another heat dome week, but the morning was cool enough to require long sleeves. The grass — freshly cut, of course — was covered in dew. In less than 20 minutes one could see sitting on the front porch: several hummingbirds battling around a feeder, two deer grazing just off the gravel driveway, a wild turkey, a rabbit, several blue jays and cardinals; I half-expected Snow White to skip down the forest path and burst into song.

The Broadband internet in West Virginia is not great, but it’s not terrible either. Why are there only 2 million people in this state?

The Mitchells vs. The Machines 👍

Miloš Miljković — Tue, 22 Jun 2021 07:30:00 -0400

Spider-verse meets Gravity falls, resulting in a completely unexpected delight that really is fun for the whole family. The animation is beautiful, the pace is fast, the humor earnest and often physical, and the story intentionally misses every opportunity for cynicism. The photogenic family next door with the perfect vacation photos really is that high-functioning, fit and smart.¹ Friends are there to support you, not tease you. The world doesn’t make fun of weirdness, it embraces it.

So, even though it premiered on Netflix, this is not your ordinary Netflix feature-length animation; it is actually good. It is also a triumph of believable character motivation and well-executed action sequences over a coherent plot. Thankfully, humans put much more weight on the former.

Some Eastern European cynicism is in order, though: given that these characters are voiced by John Legend and Chrissy Teigen, making them inauthentic frauds was never an option. ↩

Range — Why Generalists Triumph in a Specialized World

Miloš Miljković — Thu, 17 Jun 2021 07:30:00 -0400

At the very beginning, David Epstein presents a dichotomy: there are the super-specialists, who decide early on in their lives who they are and what they want to be, and put all of their time and energy into improving a narrow set of skills that make them competitive in a tightly-regulated field such as professional sports; and then there are the generalists, who try out different things here and there, learning across disciplines and using that knowledge to solve difficult — “wicked”, the book calls them — problems that don’t fall neatly into any category, but which are more and more common in our modern world full of complexities.

The model super-specialist is Tiger Woods, who picked up his first golf club as a toddler and won his first tournament at age six. Compare and contrast with the model generalist, Roger Federer, who dabbled in 11 different sports¹ before finally picking up the one that will make him famous at the ripe old age of (checks notes)… eight.

The rest is of the same cloth: light on arguments, heavy on emotion. The examples of hyper-specialization it gives are telling: oncologists specializing in cancer related to a single organ and interventional cardiologists.² Never mind that to get to any medical subspecialty one needs to go through more than 20 years of not so specialized schooling, sample different professional careers in college, then sample different physician specialties in medical school, and not reach the subspecialty until their early thirties at best. When did the supposed generalist Roger Federer start playing tennis, again?

So, the term “specialist” gets thrown around a lot without being precisely defined. Is it the narrowness of one’s current field that makes them a specialist? Or is it the path they took to get there? Regardless, we do know what makes a generalist: meandering from field to field until you find your niche, which will, ideally, use some of the knowledge and skills gained through all of that meandering. If you start as a stocker at Walmart, then work as a florist, hair stylist, hand model for a watch company, and end up as a short order cook at McDonalds, well that’s not much of a generalist story. Flip these around so that your final job is something more glamorous and you are the master of your profession who uses the Walmart work ethic, florist’s sense of proportion and beauty, Mickey D’s sense of urgency, and a hand model’s way with wrist movements to create a work of coiffured art. It’s the narrative and Texas sharpshooter fallacies combined.

Their friends confirmation and survivor bias also show up. Each chapter has a few stories hand-picked to showcase how a “generalist” solves problems that the “specialists” were stumped with. The generalist’s life story is then picked apart to showcase their versatility, though some at first do not appear to be so versatile. There are, unfortunately, no counterfactuals, and no going over the specialists’ biographies which would — I am fairly confident — be strikingly similar to those of the generalists.

Looking back at a life, your own or someone else’s, is very much like stargazing. There are a few set pieces — a marriage here, a near-death experience there — but for the most part the events are devoid of much meaning until we give it to them by imputing a causal relationship to something that is important ex post. Epstein picks out situations where a failing team of “specialists” — let’s take him at his word that they are, for their biographies are not presented and we are left wondering whether they, too, worked the summers in their family’s farm or had a brother in the concrete business or some such — well, where that team of maybe-specialists is rescued by a certified (by Epstein) generalist who expresses their generalissimo-ness via a string of anecdotes, the stars in my overwrought stargazing analogy.

There is a story to be told about narrowness of focus and the importance of not being a fachidiot. Epstein comes tantalizingly close to framing the problem as it should be framed: that specialty narrow-mindedness — no matter how you got to it — is dangerous and makes you a bad specialist and a worse human. Yet there is no mention of this wonderful German word in the book’s hundreds of pages. That’s too bad: Fachidiocracy would have been a better title.

Squash, skiing, wrestling, swimming, skateboarding, basketball, handball, tennis, table tennis, badminton, and soccer. ↩
Apropos interventional cardiologists, Epstein attributes the massive overuse of stents for dubious indications to the said specialists “getting so used to treating chest pain with stents … that they do so reflexively”. And not because of financial incentives? Interesting. ↩

Clearing the PDF log jam

Miloš Miljković — Sat, 05 Jun 2021 14:20:00 -0400

There is a crisis in medicine, but not the one you think:¹

I have a folder called Articles for them on my desktop. Which never gets opened. It is a like a black hole.
— Venkatraman Radhakrishnan (Venky) (@venkymd) November 15, 2020

90% of what I do on Twitter is email myself interesting articles I see Tweeted only to never be read.
— Aaron Goodman - “Papa Heme” (@AaronGoodman33) February 25, 2021

Reading primary literature is superior to press releases and tweets — it sounds so obvious, but not many physicians act on it. There no prizes to be won for not just following the KOLs², nor do you save any time. Quite the opposite: instead of a promoted tweet about the me-too drug de jour falling into your lap, you need to find a way to identify what’s worth your time reading, and also find time to actually read it — not a small achievement, as highlighted by the above tweets.

But then what? Sure, there is profit at the end of the rainbow in the form of useful knowledge, but merely reading a PDF may not result in any knowledge at all, let alone knowledge you can use. Or, as the underpants gnomes would put it:

I too had a backlog of unread PDFs once, spent so much time organizing files and folders, using this and that program to store the metadata³, trying out plain paper, a Kindle, an iPad or two, thinking it is how I was reading them that mattered and oh if only I could find the perfect setting, under the shade of an old oak tree perhaps, with some peace and quiet, a pen in one hand and a cup of coffe in the other, well, then the unread pile would melt away and all would be good in the world.

But reading is easy, if what you read is useful, entertaining, or both. For most people without visual impairments or dyslexia, the log jam is at Step 2. We don’t want to read our pile of PDFs because, in most post-GME circumstances, there isn’t a clear goal to reading them (lest you have superhuman memory).⁵ This is particularly true early on in your carreer, when you have nothing to hang your hat on mentally, and few connections to make between what you are reading and what you already know. Sure, you don’t need to keep track of the articles you’ve read if the only reason for reading is to pan them on Twitter. You do, however, want to summarize what you’ve read and save it for future use, be it in a lecture, article, grant proposal or a blog post. So if and when you find a fairly obscure but potentially important fact about this or that cellular pathway in a supplemental figure from a CNS-adjacent journal, and you memorize the fact for later use, and then a year or so later you do use it to make a figure for the background section of a clinical trial protocol, well, what you do not want happening in that case is to spend hours of your life trying to retrace your steps and figure out the original source when a fellow asks where you got the data.⁴

I wouldn’t be admitting to all that if I didn’t think I’ve found a solution. A few years ago, I replaced the unsustainable routine of just-in-time literature reviews for whatever I needed done with a robust knowledge management system — a GTD®⁶ for ideas, if you will. It got to a point where I can read at least one article every day and skim a few more, get the useful information out and into my app of choice⁷, and have all the information I need to write an editorial like this in a morning or two.

As with most of the things I do it is too personal and Rube Goldberg-y to be of use to anyone else, but it started with a forum post and a book, and if you’d like to turn your plate full of PDFs into something more usable may I recommend that you start with one or both of those and see how it goes. Could it be any worse than what you’re doing now?

And not only in medicine, of course. ↩
Key Opinion Leaders, the influencers of medicine before influencer became a real noun. Note that unlike the influencers of social media KOLs don’t use the #sponsored hashtag, though there is a hashtag equivalent. ↩
NB: if you write any sort of scholarly texts you will still need a reference manager, no matter what system of organizing PDFs themselves you choose. I recommend Zotero, lest your institution has a requirement for Endnote (which must have quite a salesforce, to so thoroughly insert their buggy, laggy, slob of a program into every academic crevice). ↩
Yes, this has happened to me. We do have good fellows. ↩
The clear exception here being board exam and MOC prep, where the goal is obvious and the sources of information are all spelled out. ↩
© David Allen Co. 2001. It is a good system though ↩
The app of choice before DEVONthink was Roam, which is a web service and a marvelous one at that, but unfortunately not much into encryption, privacy, and other things people dealing with confidential information like to have in the tools they use. ↩

Interstellar (2014) 👍

Miloš Miljković — Thu, 03 Jun 2021 07:30:00 -0400

Interstellar is many things: a mediocre sci-fi story, a timely study of sociopathy, a schmaltzy meandering about love conquering space and time, an excellent showcase of near-future space engineering, and, sadly, a big budget Hollywood movie that grossly underestimates its audience. Foreshadowing is one thing, having one astronaut do the punch-a-hole-though-a-folded-piece-of-paper schtick to another while they are in space on their way to a wormhole as part of a billion dollar secret mission… Well, that’s a whole new level of cringe.¹

Hollywood rears its head in many other places, most of all the needless addition of superficial suspense to things that don’t need added suspense. Because a father communicating with his estranged daughter through spacetime is not emotional enough, let’s also add a hick brother who doesn’t want her at the only place where communication is possible, and may kick her out at any moment. Decades are spent on trying to get humans off Earth, yet the big scientific breakthrough comes at the very last moments, as people are suffocating on the ground. While we are there: if the human civilization is capable of building a county-sized space habitat and the only problem is getting the thing off the ground, why not build it on Earth or under the sea, instead of using a few hundred frozen embryos as humanity’s only backup plan? But let’s not get into plot holes because, um, there are a few.

Which is to say that Interstellar is not an overwhelmingly good movie. The good, however, still outweighs the bad, especially for those willing to forgive all the pandering. The best of humanity is also the worst of it, and the best of American sci-fi in matters of technology also turns out to be some of the worst story-wise. So it goes…

I have yet to see Tenet but from what I have heard about its convoluted and unknowable plot, it is Christopher Nolan’s reactive formation to the many comments about oversimplifying and over-explaining that followed Interstellar. For an ever better example of a reactive formation see La La Land as Damien Chazelle’s response to Birdman winning the best movie Oscar over Whiplash and giving the Academy what it wants: more cotton candy navel-gazing. Ironic that the attempt also failed to win, this time to a better opponent. ↩

Mulan (2020) 👎

Miloš Miljković — Mon, 31 May 2021 10:00:00 -0400

There are too many things here that just don’t work: the acrobatics (cartoonish in a bad way), the believability (live action is less forgiving to cross-dressing, just ask Mrs. Doubtfire), and worst of all, the message, which comes straight from the Big State handbook of propaganda: a woman’s worth is in marriage and — maybe, under extraordinary circumstances — in her service to the country. Self-actualization is allowed, after much hemming and hawing, as long as you are actualizing yourself towards protecting the Empire.

Which is too bad, because the setup provided excellent opportunity for two badass female characters to unite against the common oppressor. Of course, uniting against anything would not have been received with open arms in Mulan’s intended market, said market working diligently towards exterminating threats foreign and domestic even as the movie was made.

One thing that did work was the matchmaker who really should get a show of her own. A Disney+ series of shorts with a match per episode, perhaps, culminating in helping Xianniang the witch find the man/woman/hawk of her life? Disney, you are welcome.

Cruella (2021) 👍

Miloš Miljković — Sun, 30 May 2021 08:30:00 -0400

Comparisons with Joker started the moment Cruella was announced, so let’s get that out of the way: Cruella was so much more fun to watch. Granted, it was a low bar to clear, Joker being about as much fun as watching a botched execution, but Cruella also has better acting, music, editing, and any technical category you can think of.¹

What it doesn’t have is much of a message, at least not one that hasn’t been covered already and in more detail by some other Disney or Disney-adjacent product. Killing your firstborn daughter is a bad idea? (Snow White) Villains are people too? (Maleficent) You know you’re in trouble message-wise when you have your titular character saying out loud the movie poster tagline. “Brilliant. Bad. A little bit mad.” looks great on a wall, sounds awkward coming out of a speaker.

I do, however, wish the camera could stay still for more than a milisecond. Just because you can make every shot glide doesn’t mean you should. This is true for every high-budget movie made in the past 10 years at least but particularly for Cruella, which between the costumes and the set design had potential for some iconic shots. I don’t expect the second coming of Barry Lyndon from a Disney franchise, but how about teaching the young audience to slow down and stay still for a moment? ↩

A promising young woman (2021) 👍

Miloš Miljković — Sat, 29 May 2021 13:15:00 -0400

Emerald Fennell, who wrote, directed, and co-produced A promising young woman, made many good choices when writing the screenplay. Let’s start with things not shown, like what Carrie Mulligan’s character¹, Cassie, does with all the men picking her up (or does she pick them?) under false pretenses. What is that red streak dripping down her arm walking home the morning after? Are the red, black, and blue notches she jots down with her gunner pen for each man a matter of convenience or a code for their fate? How much of a psycho is she?

Another good choice: the (never-shown!) sexual assault that underpins much of the plot is set in a medical school. Medical education selects for conformity, which is on one hand understandable (why fight windmills and ruin your chance for a secure and often lucrative income?) but on the other leads to willful blindness to many misdeeds.² Some may be surprised by the bad turns some seemingly good characters take by the end of the movie, but to anyone who’s gone to medical school it would have been true to personal experience. Parallels to other nice-guy professionals — lawyers, let’s say — draw themselves.

Yes, the movie is topical, drawing on current events, trending hashtags and rising fears. Thankfully, that doesn’t stop it from being damn good, and well worth a rewatch or two.

Carrie Mulligan is, of course, the best Dr. Who companion that never was, and an integral part of the best Dr. Who episode ever made. I wonder sometimes if Sally Sparrow and Larry Nightingale would really have been Doctor’s companions — or at least had a spinoff series of their own — if Mulligan hadn’t been such a great actress with other opportunities presenting themselves soon after Blink. ↩
During one memorable residency interview I (as the applicant, not the interviewer) was asked a question on (un)professionalism. My impromptu answer was about my own silence to a misdeed witnessed as a medical student in Serbia, with a young inpatient being kept in the dark about her diagnosis of advanced multiple myeloma, and us as students shrugging our collective shoulders as she peppered us with questions about bone health. Not my proudest moment as a med student, doctor, or a human being, but I ended up matching to that very program so, yay? Bad deeds rarely go unrewarded. ↩

Notes from the beach

Miloš Miljković — Sun, 23 May 2021 17:45:00 -0400

Southwest Florida is better for a short family vacation than Maui, conditional on the family not owning a private jet.
Florida sand is superior to Maryland and Delaware sand. For one, it doesn’t collapse as easily; second, it is much easier to clean; third, on Sanibel and Captiva islands it is mostly made of quartz and broken down shells and is there anything cooler than that?¹
More bird diversity makes for happier humans and while D.C. has a respectable population of birds, it doesn’t come close to Florida with the ospreys and the fish hawks, brown pelicans and roseate spoonbills, white ibises and snowy egrets, sanderlings and sandpipers, woodpeckers both pileated and downy, and not a robin in sight.²
Is it just me or is sunscreen really so much better now than it was 30 years ago? With UPF swimwear you need less of it anyway, and the little that you do need is easier to apply, lasts longer, and just works better than whatever smelly Coppertone slurry we used in the 90s.
Beach towels are useless.
Spending a week in a zip code with no Instacart, no DoorDash, no Uber or Lyft or ad hoc taxis of any kind was refreshing, but I wouldn’t recommend it long-term. Although there was still Amazon next-day delivery and plenty of UPS trucks, so not all was lost.
Physical books continue being better than e-books; the calculation will change for me as soon as e-book readers solve quick note entry — emphasis on quick.
Where are all the Nightingales is a great way to start the day, on or off the beach.

Sure, volcanic sand sounds cool, but have you tried washing off the glossy black detritus? Not to mention it is much sharper. ↩
Although maybe a few too many common grackles. ↩

Conspiracy — Peter Thiel, Hulk Hogan, Gawker, and the anatomy of intrigue

Miloš Miljković — Wed, 19 May 2021 08:20:00 -0400

Yes, real life is messy, yes, there is more stupidity than evil in the world, and no, there are no billionaire/vampire/reptile cabals running the show behind the curtains (if only). Yet individual humans do have needs, and some of those needs are secret, and when meeting a secret need involves more than one person, when each of those persons is tasked with keeping their role a secret, and when that role is exacting revenge, well then, you have a genuine conspiracy.

There have been many conspiracies in my lifetime, most of them having to do with Serbian politics: the conspiracy by the heads of Serbia and Croatia to break up Yugoslavia; the conspiracy by parts of the Serbian surveillance apparatus to overthrow Slobodan Milošević; the conspiracy by the Serbian mafia-political complex to assasinate the prime minister; the conspiracy by parties yet unknown to hide the numbers of Serbian Covid-19 victims… You cannot fault the average Serb for seeing conspiracies everywhere, and you can empathise at least a tiny bit for being sceptical of masks, vaccines, the existence of the virus itself.

The last time the average American was exposed to a big conspiracy that was named as such was in 1974, and it was so bungled and comically inept that you cannot fault them for thinking conspiracies are relegated to history books. This is what Ryan Holiday suggests in his book, while unravelling the conspiracy by Peter Thiel to secretly bankroll civil lawsuits against Gawker Media until they are bankrupt. But is this true? After all, weren’t Purdue Pharma, Ferguson PD, the 25th amendment gang, and the Capitol insurrectionists, to name a few, all involved in more or less successful conspiracies?

“The idea of a conspiracy,” Thiel is quoted saying in the book, “is linked with intentionality, with planning, working towards longer-term goals. In a world where you don’t have conspiracies maybe also those things disappear.” Holiday adds: “The truth is that Gawker already believed we lived in that world. And so do far too many people.”

I object to that evaluation of my fellow humans, because most people are well aware of the fact that we do indeed live in a world full of conspiracies. If the last few years have taught us anything, it is that people over-read them. But they are conspiracies perpetrated by multinational corporations, rouge state officials, the actual states, and, Holiday’s book now tells us, condescending billionaires.

Dune (1984) 👎

Miloš Miljković — Thu, 13 May 2021 07:40:00 -0400

It aged better in my mind than it did after a rewatch, the version in my mind being conflated with the book and the game. What it gains on the aesthetics it loses on the incoherent plot, which at the same time has too much exposition and leaves too much unexplained.¹ Also: Sting?!

You could say that this is a classic example of a long book being better suited to a TV show than a movie, but there was a TV show and it wasn’t much better. Maybe the new movie will be it? Or maybe HBO, Amazon, Netflix or Apple need to pour money into a serialized version, three of the four having a track record for funding good sci-fi.

Apparently, David Lynch didn’t have the final cut and had an hour of his movie chopped of by the studio. But since he had also ran out of money I doubt much could have been done to make the final battle decent, or the last third of the movie comprehensible. ↩

Shin Godzilla (2016) 👍

Miloš Miljković — Sat, 24 Apr 2021 09:00:00 -0400

Equal parts of man versus monster and man versus bureaucracy in this low-budget high-quality remake. Though googly-eyed, the monster is more alien, more menacing, and more destructive than the recent American version. So is the Japanese bureaucracy, which is, in the end, a bigger threat to the country than Godzilla will ever be.

Against sarcasm

Miloš Miljković — Wed, 21 Apr 2021 07:30:00 -0400

Everyone loves Ted Lasso, both the character and the show, in great part because he manages to be funny without being sarcastic. It reminds me of what made Frasier so good: that the writers never took the easy jokes. Smart humor is hard, smart humor without sarcasm is even harder.¹

The past few years have made me sarcarsm-intolerant. I can still appreciate professionally done satire — Stephen Colbert of the Colbert Report years comes to mind — but you, my Twitter friend, are no Stephen Colbert. Good satire takes some effort to create, but is easily understood. Casual sarcasm is the opposite: it is easy to say or write what you don’t mean, but recognizing sarcasm requires knowledge of the context, the author’s prior writings, the subject in question, and even then, often, it is missed. Queue the author’s indignation and musings on how the Twitter sheeple can’t recognize a joke, though sometimes the indignation itself can be self-consciously funny.

Uh oh, I guess I better be able to prove real fast that I was doing work on bats a few years back…. pic.twitter.com/abkBX2z0Xl
— Vinay Prasad MD MPH (@VPrasadMDMPH) May 17, 2020

The exchange above was notable for erecting a barrier between people who some time ago would have considered themselves part of the same ingroup.² If there is one thing sarcasm does well, it is to erect barriers between smaller and smaller groups until everyone is at a war of wits with everyone else. It turns a tool of communication capable of spreading great knowledge quickly into a French court-style spectacle for the masses, fueled by the algorithm.

Dropping sarcasm would not make the internet excruciatingly boring. Note @10kdiver of the Markov chain thread from the paragraph above, or @wrathofgnon, @Gwern, @craigmod, @BCiechaowski… all brilliant, not an ounce of sarcasm between them (half an ounce from Gwern, perhaps). There is in fact an infinite number of ways to be interesting online without being sarcastic, and sarcasm itself permeates the online life so much that it is, well, boring.

Offline, the distinction blurs between being sarcastic and having plausible deniability. Sarcasm may be the highest form of intellect in teenage years, where plausible deniability helps save face, but before the end of adolescence saving face quickly turns into gaslighting. Small wonder that the most sarcastic character on Friends was also the one to catfish a woman.³ So if there ever was a quick and easy litmus test, it is this: after the horrible year we’ve had, and a decade that was not much better, whom would you rather hang out with and who would you rather be: Ted Lasso or Chandler Bing.

This is also why in the great Seinfeld versus Frasier debate I will always choose Frasier. Don’t @ me. ↩
Yes, ingroups of days past still had factions and civil wars, but what used to be confined to the university cafeteria or the sparsely attended conference session is now right there for the world to see, and pile onto. Somewhat paradoxically, meatspace barriers are as ephemeral as an academic’s memory; online barriers, while not set in stone, are quite a bit more solid. The algorithm remembers. ↩
This is also one of many reasons why Friends will never be in contention for the best of anything, except maybe the best show to reveal the 90s to be the backwards decade it truly was. ↩

The Year Earth Changed (2021) 👍

Miloš Miljković — Tue, 20 Apr 2021 07:55:00 -0400

A soaring orchestral score. Drone shots of empty squares and promenades. Surveillance camera footage of animals running amok. Stuck onto this skeleton are a few soundbites of scientists explaining humanity’s inhumanity towards wildlife; redundant, but required to elevate this from a long Youtube video into a… long Youtube video with a Message.

Our towns (2021) 👍

Miloš Miljković — Mon, 19 Apr 2021 07:45:00 -0400

“Drone shots of oversaturated greenery zipping accross the screen to the rythm of athmospheric EDM” could describe almost any documentary made in the last decade, but “Our towns” has a note of localism that’s pleasing to my mind. The movie promises us stories of eight towns across the country that failed and/or bounced back. That is a tall order for a single town, life being complicated and things not falling neatly in line for a comprehensible narrative. Fortunately, the movie doesn’t even try to spin a story, giving us instead a few lessons: that local newspapers are important for the life of a community; that people want to live in neighborhoods from which they can walk to work, school, shops, and nature; that despite your best efforts, a decision from up above (to close a factory, move an interstate, etc) can ruin a town; and that small towns owe their prosperity — if they prosper at all — to the people who could have been anywhere else but chose to be there.

True, there is nothing there you wouldn’t know from reading Jane Jackobs, A Pattern Language, or even @WrathOfGnon tweets. But maybe just maybe this movie being on HBO and coming from a writer of The Atlantic means those ideas are seeping into circles that have so far preferred centralized planning.

Kong: Skull Island (2017) 👍

Miloš Miljković — Sun, 18 Apr 2021 06:50:00 -0400

Like Godzilla but with a better story, better scenery, better acting, and, yes, better monsters. A thoroughly fun movie that The Guardian critic hated. What’s not to love?

Godzilla (2014) 👍

Miloš Miljković — Sat, 17 Apr 2021 07:20:00 -0400

Having babies and toddlers in the house takes you out of the popular culture loop for a while, so I completely missed this challenger to the Marvel Cinematic Universe¹ when it came out. But now that the fourth installment is available for streaming and one of the said toddlers is of age to watch a PG-13 movie (i.e. almost 9), HBO Max is finally paying itself off.

Most Japanese versions of Gojira/Godzilla are in their hearts cinéma bureaucratique — you come for the thrill of monsters destroying Tokyo, you stay for the drama of humans battling red tape. There is no deeper layer to this American version — you come for the monsters and stay for the monsters, and you skip all the dialogue unless you’re into cringing. If there is a subtext to the movie it is this: most of the protagonists are highly competent US marines who fail to prevent giant monsters from destroying the liberal mecca that is San Francisco.

The monster battles truly are fun, though.

The MonsterVerse, apparently, which comes with its own official logo and everything. Surely there was also a slide deck full of charts pointing upwards 🚀 ↩

The Tree of Life 👍

Miloš Miljković — Fri, 19 Mar 2021 07:50:00 -0400

Samsara with a bit of a backstory and Jessica Chastain — perfect for the nights when you’re feeling pretentious¹ but don’t have four hours to spend on the Snyder Cut.

Directed by Terrence Malick, 2011.

Whereby I use “feeling pretentious” to mean more poetically inclined than usual, to the point of resembling a film student, liberal arts major or, God forbid, a creative writing professor, who for the most part don’t only have occasional bouts of pretentiousness but are, let’s be honest here, full-blown snobs. Indeed, the divisive reviews of this movie on IMDB map perfectly to the reviewer’s pretentiousness index on the day they viewed it (as in, if someone goes to see a Woody Allen movie and instead stumbles into The Tree of Life wouldn’t you expect them to leave a bad review, not being in the right mind set; also: of course the Cannes jury gave it their top award, since being in France AND going to a festival are both major pretentiousness boosters). ↩

What I learned on Twitter, week of 2/15/21

Miloš Miljković — Mon, 22 Feb 2021 08:30:00 -0500

Photo of the week: Mars, of course (this one is even better, but there’s something to being first)
Article of the week: Mars, of course
Video of the week: May as well be from Mars (this one too)
Gaming story of the week: There was supposed to be a Monkey Island movie, then Steven Spielberg asked for more monkeys and the thing fell apart. I’m heartbroken.
Meme of the week: Texas.

The Undoing 👎

Miloš Miljković — Tue, 16 Feb 2021 08:30:00 -0500

A mini-series is usually the better format for a book adaptation than a movie. Not so with HBO’s The Undoing. The stretched-out plot and meaningless flashbacks just barely fill out the six hours allotted. Twenty years ago it would have been an enjoyable 100-minute psycho-drama, also staring Nicole Kidman, Hugh Grant, and Donald Sutherland. With less Upper East Side lifestyle porn, perhaps, but also with fewer unnecessary scenes of violence.

It is difficult to understand why things didn’t work out, because the first episode — easily the best one of the show — had such promise. Squeeze the other five into Acts II and III, and you would get a much more engaging story. Sadly, it is only the three hundred million dollar flops that get do-overs these days.

What I learned on Twitter, week of 2/8/21

Miloš Miljković — Mon, 15 Feb 2021 09:15:00 -0500

Article of the week: Zeynep Tufekci on critical thinking (and a close second: Matthew Yglesias on controversial topics)
Thread of the week: Taleb gets Covid-19
Video of the week: John Mattick’s RNA lecture.
Internet service of the week: Radio Garden
Meme of the week: Psychology versus cognitive science

The Social Network 👍

Miloš Miljković — Sun, 14 Feb 2021 09:00:00 -0500

Aaron Sorkin doesn’t get Silicon Valley — case in point — so it is a small miracle that his screenplay about (The) Facebook’s origins works. The Sorkinized version of Mark Zuckerberg bears little resemblance to the real person, if old footage is anything to go by. Yet even this aloof and opportunistic cipher is more human than the soulless privacy-destroying corporate robot that the kind of people who like Sorkin — let’s call them New York Times readers — now see when they look at Zuckerberg.

Much has happened in the 10 years since the movie came out, the least of which is Facebook’s valuation going from $25 billion to $770 billion. I imagine a great deal of the story being depicted differently if it were shot today, including but not limited to the experience of the women involved, the entitlement of most of the protagonists, and Peter Thiel. In fact, with all those culture bombs strung out it’s unlikely it would even see the light of day in 2021, at least not as a David Fincher feature film. In 2010 it had felt too soon for a movie about an internet company that was barely out of infancy. From 2021 hindsight, making it so early seems to have been the right call.

What I learned on Twitter, week of 2/1/21

Miloš Miljković — Mon, 08 Feb 2021 07:30:00 -0500

Article of the week: Current landscape of immunotherapy trials in thoracic malignancies (and a completely unrelated bonus: How EU tripped in Covid-19 vaccine race)
Chart of the week: those vaccines do work.
Newsletter of the week: Culture Study and the diminishing returns of productivity culture (the French are laughing now aren’t they?)
Thread of the week: A baton-twirling champion meets David Letterman (video of the week is at the end of that thread)
Satire of the week: White history month

Chernobyl 👍

Miloš Miljković — Wed, 03 Feb 2021 08:15:00 -0500

Chernobyl became a last-minute entrant for the best show on TV of the 2010s, but it is apparent now that the 2020s are its decade. From governmental incompetence to criminal cover-ups to the bravery of regular humans, the parallels between a 1980s nuclear meltdown and a 2020s societal meltdown draw themselves. Being an 80s baby, I can only count my blessings that nuclear fallout isn’t self-replicating.

But I do hope I’m still around when Wuhan comes out.

What I learned on Twitter, week of 1/25/21

Miloš Miljković — Mon, 01 Feb 2021 08:00:00 -0500

Article of the week: MARIETTA
Meme of the week: Don’t take press releases seriously
Chart of the week: Vaccinations per 100,000 in Europe and Serbia is in the lead (?!)
Thread of the week: Skin in the game, the Serbian way (bonus: Venkatesh Rao is only now watching Community)
Satire of the week: Blue check homes

The Mandalorian, Season 2 👍

Miloš Miljković — Sat, 30 Jan 2021 09:00:00 -0500

The Mandalorian is still a series of fantastic action pieces connected by enough plot to make it interesting without requiring you to build your own crazy wall. It’s the good kind of mindless, now with some old favorites.

What I learned on Twitter, week of 1/18/21

Miloš Miljković — Mon, 25 Jan 2021 08:30:00 -0500

Thread of the week: Pandemic doomsaying
Article of the week: Controversy, what controversy?
Meme of the week: Research(yes, sure, there is also this)
Video of the week: Trams
RIP Mira Furlan

What a week…

The Goldfinch 👎

Miloš Miljković — Sun, 24 Jan 2021 09:00:00 -0500

There are pieces of several good movies in these two hours and 30 minutes but none of them last for very long and what’s in between isn’t very good. The novel it is based on has almost a thousand pages in paperback and not having read it I would still wager it would’ve been better served as a TV series than this overwrought film that is narratively, visually, and emotionally all over the place.

The longest stretch of coherence — our young semi-orphan Theo’s coming-of-age in a Nevadan subdevelopment with his new friend Boris — should have comprised the first two acts of a 90-minute three-act movie that would still have had enough different storylines to satisfy the early 2020s fad of too much plot (see also: Soul). This structure would both have prevented Nicole Kidman’s family of emotionally stunted ciphers from contaminating the movie, and given Finn Wolfhard’s adorable pretend-Russian accent more screen time.

Directed by John Crowley, 2019.

The Mandalorian, Season 1 👍

Miloš Miljković — Sat, 23 Jan 2021 09:00:00 -0500

There is a place in everyone’s life for mindless entertainment: things with which to amuse and delight your brain when it can’t handle anything more mentally taxing. But whereas mindfulness is always the same: complex, developing characters, plot twists, emotional range (yawn), there are many different ways to achieve mindlessness. Most shows take the easy route: if there is no “there” there, there is nothing to worry your mind about — just react to what’s in front of your eyes without worrying what came before or what will come after, football in the groin-style.

As you could have guessed from the thumbs up emoji in the title, The Mandalorian does it the hard way. It counts on the viewers’ familiarity with Star Wars and western movie tropes to do the mental work in the background without taxing the frontal cortex. There is a before and an after, but you’ve seen the before and can guess the after so you can focus on the here and the now of blasters firing away and villains monologuing themselves into a stalemate. Familiar but fresh, just what the brain needs after dealing with the stale strangeness of the last year.

What I learned on Twitter, week of 1/11/21

Miloš Miljković — Mon, 18 Jan 2021 08:20:00 -0500

Article of the week: Schrödinger’s cat bias
Thread of the week: Omega events
Blog post of the week (remember those?): L’éducation idéologique
Letter of the week (remember those?): Biden’s to Eric Lander
Video of the week: Warren Buffett’s house (bonus: wokeness overload)

Things I heard were good but was holding out for reasons unknown then wondered why I haven’t tried them sooner

Miloš Miljković — Sat, 16 Jan 2021 09:00:00 -0500

The Americans
The Mandalorian
Spider-Man: Into the Spider-Verse
Elena Ferrante’s Neapolitan Novels
Peter Thiel’s Zero to One
Sam Harris’s Waking Up app
Steven Wolfram’s Mathematica
The following Mac “productivity” apps: Omnifocus, Omnigraffle, DevonThink Pro, Tinderbox
Zettelkasten
Apple hardware
Electric bicycles
Birdwatching

Obviously, I recommend all of the above.

Things I used to like but now wonder what in the world I was thinking

Miloš Miljković — Sat, 16 Jan 2021 09:00:00 -0500

Social media
Gmail
Richard Dawkins and his “New Atheism”
Ayn Rand’s two books

There must be more, but I am good at suppressing.

Some observations on Covid-19 from recent personal experience

Miloš Miljković — Wed, 13 Jan 2021 08:45:00 -0500

A few hours before I developed symptoms I had a negative screening nasal swab. By the time I got a positive test three days later the symptoms were well on their way to resolving. Good thing I didn’t believe that first result.
What helped my not believing was that I had textbook Covid-19 which was moderate bordering on severe: fever 39.5°C (~103°F), chills, body aches, nasal congestion, rhinorhea, and a dry cough that was mild enough for me not to worry. But thankfully no anosmia.
Read the preceding paragraph again. The nasal swab done just before I developed all those symptoms (and arguably while having chills - though I didn’t know they were chills at the time) was negative. Covid-19 testing is no better or worse than any other clinical test we have, which is to say caveat medicus.
Considering our family’s practices I was surprised that it managed to get in and suspected it was one of the new strains. Lo and behold not 7 days later the UK strain was found in Maryland. I won’t know the sequence of the one that got me for a few more months, but I’d say it’s likely.
Said practices did contribute to containment, as there seemed to be no spread outside of the household (there is a small asterisk there which I will leave for another time).
The new strains being so much easier to get makes any delays in administering the vaccine that more deadly. This is hard to overstate: shots in arms now, doesn’t matter how and to whom.
Speaking of shots, I did get my first dose a few days before the likely exposure, and plan on getting the second one as scheduled if available.
Masks aren’t 100% effective, particularly in areas of high prevalence which is right now most of the world. The new strains shift the equilibrium even more. Holier-that-though memes about things being OK again if only people did what’s good for them (i.e. wore a mask) are misguided at best and quite likely counterproductive.
Another misguided effort: a DC health professional telling the sole member of a large family without a fever to use a separate bathroom, wear a mask at all times and open all the (quite tall) windows of their 1200 sq ft 7th floor apartment. Hard to tell if this was more comical or dangerous.
DC health professional’s misguided advice #2: to get everyone in the household tested. If mine was positive and four more people also have fevers do we really think they have something else? Why risk the tester’s exposure and waste reagents: count these people as positive and move on.
But as things stand right now, if these household members don’t get tested they don’t count as positive. How prevalent is this situation, I wonder? Even with test availability not being a bottleneck I’d multiply the current counts by at least 2, probably 3 to get the real number (and I’m sure there are epidemiologists who have a more scientific explanation for why we should be doing that anyway).
Symptoms in children seem to be no different than any other febrile viremia of childhood (and in fact may be slightly better as they didn’t seem to sap any of their energy, for better or worse). Does this make in-person school more or less safe? I can see both sides of the argument but if you thought children as asymptomatic carriers would be a big risk that risk is probably overblown as they do in fact get symptoms — they just won’t telegraph them.
And if you are worried about long-term effects of Covid-19 in children, well, sure, but how is that different from long-term effects of any febrile viremia of childhood? I’m sure our parenting style will ruin their prospects enough that Covid-19 will be just a drop in the bucket.
I have been getting lists of home remedies from people who should know better. This includes aspirin (as an anti-platelet agent, not an antipyretic), azithromycin (still!) zinc, turmeric, propolis. What I took: a little bit of APAP and a lot of H2O.
I have a new appreciation for the gig workers, who are the unsung heroes of the pandemic. Tip your Dasher.
2021 is certainly off to an interesting start.

National Treasure: Book of Secrets 👎👎

Miloš Miljković — Tue, 12 Jan 2021 08:30:00 -0500

The disaster continues. After making a mindless theme park out of liberal democracy, our daring trio of materialists sets their eyes on slavery, race relations, and American fascism. Did I say “set their eyes”? My mistake — I meant “completely ignore while protecting their Civil War ancestors’ honor and looting Native American treasure”.

A pox on everyone who was in this movie, Helen Miren inclusive.

What I learned on Twitter, week of 1/4/21

Miloš Miljković — Mon, 11 Jan 2021 13:00:00 -0500

Nature Methods method of the year (and deservedly so): spatially resolved transcriptomics
Transgenic myeloid cells (not the worst idea) from Siddhartha Mukherjee (uhmmmmm…)
Thread of the week: Adam Cifu doodles
Pile-on of the week: David Chapman on airmchair philosophy (and a bonus pile-on from last weeek)
Basketball is easy (when you’re Jokić)

National Treasure 👎

Miloš Miljković — Fri, 08 Jan 2021 08:00:00 -0500

In a museum exhibit dedicated to the fall of liberal democracy, National Treasure deserves to be played at the entrance, on loop; because the treasure in question isn’t freedom, nor equality, and no it’s not brotherhood either. It’s actual treasure, stolen from civilizations past, to be turned by our daring protagonists at the end of the movie into mansions and fast cars. That The Aristocats have a trigger warning on Disney+ and this consumerist anti-civilization piece of dreck doesn’t tells you all you need to know about the situational awareness of modern institutions.

Directed by Jon Turteltaub, 2004.

Day Seven

Miloš Miljković — Thu, 07 Jan 2021 08:00:00 -0500

Reading: VAV1 mutations contribute to development of T-cell neoplasms in mice, in addition to the two books I hope to finish this month.
Watching: A master contortionist.
Playing: The Dead South, a kids’ favorite.
Feeling: Quite well actually, considering.

Day Six

Miloš Miljković — Wed, 06 Jan 2021 07:45:00 -0500

Reading: T follicular helper phenotype predicts response to histone deacetylase inhibitors in relapsed/refractory peripheral T-cell lymphoma
Watching: Democracy in action, and freedom of speech. Both are good, no? OK, maybe not
Playing: Just One which is the perfect game to play with a precocious 8-year-old
Feeling: Feverish. Let’s hope it’s just the vaccine.

Day Five

Miloš Miljković — Tue, 05 Jan 2021 08:45:00 -0500

Reading: The Peripheral T-Cell Lymphomas: an Unusual Path to Cure
Watching: Vitalik Buterin talks to Tyler Cowen. I don’t understand why this only has 2k views
Playing: Season 2 of The Americans, and also its most excellent soundtrack
Feeling: Good about today. Tomorrow, not so much.

Day Four

Miloš Miljković — Mon, 04 Jan 2021 09:30:00 -0500

Reading: Edward Tufte’s website, in preparation for his new book which I will also read at some point this year, I hope
Watching: These Tinderbox video tutorials are an excellent introduction to a powerful application
Playing: Running with the Wolves at bedtime, on repeat. Don’t ask.
Feeling: Thankful that my parenting skills aren’t a trending topic on Twitter.

What I learned on Twitter, week of 12/28/20

Miloš Miljković — Mon, 04 Jan 2021 09:00:00 -0500

Video of the week: Arthur C Clarke has a few words about the future (Bonus: I see that the trailer for Half-Life 3 is out)
Taleb tweet of the week: Stakeholders (and a Taleb-adjacent tweet, I ordered all three)
App of the week: Drafts
Thread of the week: How to teach your daughter (no, it’s not that thread)
Happy New Year!

Day Three

Miloš Miljković — Sun, 03 Jan 2021 09:00:00 -0500

Reading: TCR and TCL1A collaboration in T-PLL, an article from late last year about T prolymphocytic leukemia, sometimes called T-CLL, both being misnomers.
Watching: Video of a hawk (or is it a falcon?) picking on a rat carcass on top of a traffic light in DC, courtesy of my wife. I’ll spare you the gory details.
Playing: Hunt a Killer, which is a birthday present I may finally get to since we are now 2 for 3 in rainy days this year.
Thinking: If I am typing this on the phone is it still considered writing?

Day Two

Miloš Miljković — Sat, 02 Jan 2021 08:45:00 -0500

Reading: My Name is Red and A Pattern Language, still. The beginning few chapters of the latter give the best explanation for why McMansions are a waste of space, with square foot upon square foot of single-use (or no-use!) space.
Watching: Season 1 of The Americans soon to be completed. Tough stuff.
Playing: Dark Souls III (or rather I will attempt to do so… the Elder Signs game went fine yesterday until the youngest decided sucking on monster tokens is great use of his time)
Eating: black beans (like most cooking websites this one too has SEO’d itself into parody, but it is a good recipe)
Thinking: Does birdwatching count as playing? Because with the gorgeous weather outside a walk in the woods will be in order.

Day One

Miloš Miljković — Fri, 01 Jan 2021 09:00:00 -0500

Read: Cell Biology by the Numbers online, My Name is Red and A Pattern Language offline. But American Registry of Pathology Expert Opinions: Recommendations for the diagnostic workup of mature T cell neoplasms is the only thing I’ll finish (and you can tell from the title it’s a page-turner)
Watch: Season 1 of The Americans and also this YouTube channel in the background, as one of the children is quite the car enthusiast.
Play: Elder Sign which is the perfect game to play on a rainy day, and what better way to welcome in the New Year than by fighting the Ancient Ones.
Eat: Leftovers from The Federalist Pig (or The Capitalist Pig, as a friend tends to mispronounce it constantly in what is quite the Freudian slip).
Think: How long can I keep this up? I give myself until the end of next week.

Corona 300

Miloš Miljković — Thu, 31 Dec 2020 08:15:00 -0500

March 7, 2020 was a Saturday. I woke up at 8am, which is as late as it gets, since the night before we watched Breathless and The Graduate back-to-back (the 1960s were a good decade for movies). Most of they was spent in visiting friends in downtown DC. They are a family of four in a tiny one-bedroom; we compared notes on where best to stash the extra flour, rice, pasta, and other staples¹ we stocked up on expecting the inevitable. The inevitable came that night as we were heading out, when Mayor Bowser announced in a late news conference that yes indeed Washington DC had its first confirmed case of Covid-19: a man with no recent travel and no confirmed exposures, which is to say, there was already community spread. We got back to our apartment and closed the door; the next time that apartment would be empty of people again, as it usually had been on weekends and later summer afternoons before the pandemic, was more than five months later.

That was 300 days ago to the day, and as my favorite columnist and fellow millennial Janan Ganesh astutely noted, there were no grand lessons that these 300 days gave me, unless you count confirmation that humans can muddle their way through anything as a lesson. Harambe may have been killed in 2016, but 2020 was his year: a tragic, sensless event where everyone is responsible but no one is to blame — though I may be an exception in thinking this, since 2020 was the year of confirmation bias, the year of suppressing the opposing view points, the year of shaming. To complicate matters some more, it was also the year when crackpots and idiots joined into the Grand Coalition of Stoopid, expressing some points of view that maybe ought to be suppressed, and doing some things for which maybe they should be ashamed. Harambe indeed.

I finished the last year with a post about the great things that happened to me personally as the world stagnated in the 2010s. In the spirit of this year, I’ll finish with a list of failures instead, and I’ll do my best not to make it into a thinly veiled list of successes:

I read far fewer books and watched far fewer movies than any year before.
I wrote far fewer (medical) articles than planned.
I wasted time on Twitter like never before (and, let’s hope, never again).
I dropped more projects than ever before, including piano lessons, learning a new language, speed-completing the Rubik’s cube, and running in cold weather, among many others.
I walked less than any other year since I started walking.²
I commuted more by car than ever since moving to DC.
I ordered more takeout than ever.
And the one that hurts the most: I did not finish a single video game, or even play anything for more than 15 minutes, unless you count Good Sudoku which is truly a masterpiece of design and the highlight of the year. Yes, the highlight.

Though not, funnily enough, toilet paper. ↩
This may be an exaggeration, but not by much. ↩

Soul 👍

Miloš Miljković — Tue, 29 Dec 2020 18:00:00 -0500

There are so many parallels between this movie and Wolfwalkers, which is just as well since they are the two main contenders for the 2021 Academy Awards. Both have masterfully innovative animation, but where Wolfwalkers looked back at the old texts and pre-renaissance perspective for inspiration and side-stepped into something new, Soul pushes La Linea and its own work to 11 with Terry, the best non-villain villain since the wind in Kiki’s Delivery Service.

Note also Trent Reznor’s notes bleeping and blooping away in the background. The soundtrack is another thing on par with Wolfwalkers. As you may have seen in the trailers and guessed from the title, most of the music in Soul is jazz, melded with ethereal electro-something.¹

Both fumble the narrative: Wolfwalkers’ story because it was predictable, Soul’s because incoherence. The presumed big conflict — man v. death — is deemphasized in favor of many small ones: art v. education, passion v. commitment, meaning v. nihilism, hippies v. bureaucrats, moments of inspiration v. the daily grind. It is just too much philosophizing, and this is coming from someone who has, from the age of six, been called a philosopher by exasperated adults.²

Not that the story is bad, it is just not as focused as its closest Pixar ancestor — Inside Out — another villain-less meditation on the internal lives of humans.³ Even so, it takes the top half of the Pixar pantheon, at least a few notches above Docter’s first movie, Up.⁴ Wish other studios put out things that were half as good this year.

Important to note here that I am tone-deaf. Don’t come to me for music advice. ↩
A more precise term would have been a sophist, but what did they know? ↩
Though in this case, sadly, not cats, dogs, and other animals. Do they not have souls, Pete? ↩
But not its openning sequence, which are still my favorite five minutes of animation and are now (gasp) eleven years old. ↩

What I learned on Twitter, week of 12/21/2020

Miloš Miljković — Mon, 28 Dec 2020 07:30:00 -0500

Preprint of the week: Single cell proteomics
Flowchart of the week: What sort of philosopher do you want to be?
Taleb-adjacent tweet of the week: Takeaways from Statistical Consequences of Thick Tails
Book recommendation of the week (also Taleb-adjacent): The Systems Bible
Spellcheck fail of the week: Serbian PM gets vaccine, mangles hashtag

Palm Springs 👍

Miloš Miljković — Sun, 27 Dec 2020 07:30:00 -0500

Take Groundhog Day, punch up the message to make it more on the nose, add a few scenes of awkward sex, finish with an after-credits sequence that chooses charm over consistency. It’s still a good movie, now oh so very millennial.

I didn’t hate it.

Directed by Max Barbakow, 2020.

Baby Driver 👍

Miloš Miljković — Thu, 24 Dec 2020 08:00:00 -0500

Remember that climactic scene in Shaun of the dead where they each take a pool stick and beat the zombie pub owner to his second death to the beat of Queens “Don’t stop me now”? You know, this one?¹ Well, Baby Driver is an entire movie made out of that scene — even Queen makes an appearance — only it’s guns instead of sticks and gangsters instead of zombies. Also, Atlanta, Georgia instead of London, England with a baby-faced youth instead of Simon Pegg, so only a third as charming though it’s an Edgar Wright film so still very charming indeed.

Trigger warning: the movie contains Kevin Spacey who first behaves like the rotten bastard we know he is but then goes and (spoiler alert) redeems himself. The movie does kill him off in a rather gruesome manner, if that’s any consolation. Did the writer/director know something we at the time didn’t?

Written and directed by Edgar Wright, 2017.

The actual beating doesn’t start until 1:05. ↩

Voices in my head, 2021

Miloš Miljković — Wed, 23 Dec 2020 11:00:00 -0500

If there is a theme to this year’s list it is the intentional omission of all things biomedical, which I hope is self-explanatory considering (waves around) all this.

Omnibus, wherein two nerds, one professional the other amateur discuss topics of great interest, including bad architecture, bad cinema, a bad sister, and a very bad husband. It is at once entertaining, educational, and en…titilating?
Lex Fridman Podcast, wherein the said Lex Fridman, an AI researcher from MIT, discusses history with Dan Carlin, programming with Chris Lattner, cryptocurrency with Vitalik Buterin, Joe Rogan with Joe Rogan, et cetera, et cetera. File under “good for exploring the back catalogue, not so much for regular weekly listending”, like so many others.
20 Macs for 2020, which is a weekly-ish countdown of notable Apple computers, with comments from notable Apple aficionados. Listen and appreciate how enthusiastic some people can be about some things.
Dithering, which is a — shock, horror — paid podcast, but one well worth your money and time if you know the two men responsible, Ben Thompson and John Gruber.
People I (mostly) admire, wherein an economist of some fame and with a good sense of humor talks to, well, people he (mostly) admires, including Ken Jennings of the first podcast on this list, and what a nice way to end it.

Previous editions: 2020 - 2019 - 2018 - The one where I took a break from podcasts - The very first one

Barry Lyndon 👍

Miloš Miljković — Tue, 22 Dec 2020 08:30:00 -0500

The camerawork alone makes it a timeless classic. It doesn’t hurt that the deliberate, slow pace is perfect for my increasingly middle-aged mind. Yes it runs for 3 hours, but I’ll take three hours of this

over two and a half hours of that well-known super hero franchise any time.

Directed by Stanley Kubrick, 1975.

What I learned on Twitter, week of 12/14/2020

Miloš Miljković — Mon, 21 Dec 2020 07:40:00 -0500

Why you shouldn’t store your data in Excel.
Article of the week: RCT of auto versus alloSCT as first-line consolidation in T-cell lymphoma.
Interview of the week: Miyamoto in the New Yorker.
Thread of the week: Lear linear algebra. Wolfram University has a good beginners’ course.
Photos of the week: so many good ones. Oh who am I kidding? It’s actually this one.

The Great British Baking Show, Season 8 👍

Miloš Miljković — Sat, 19 Dec 2020 09:00:00 -0500

Kelsey Grammer once said that Fraiser — the show, not the character — was so good because the writers and cast never went for the easy laughs, the jokes that came to mind right away. That’s what made it the best sitcom of the 1990s and still eminently watchable¹.

TGBBS goes for the easy jokes all the time but that’s OK because we watch it for the emotions it elicits in its competitors, judges, and us viewers, not for the triple-A-rated comedy. And here it does not go for the easy ones, the emotions that will arise any time competing humans are being judged: ridicule, shame, anger, rivalry, envy… You know, the ol’ staples of American reality TV. There is lots of sadness and frustration when a baker overproofs their sourdough, sure, but there is also friendship, compassion, empathy, and a kind of gentleness even when a steely-eyed judge ribs your rhubarb pie’s soggy bottom.

I am sure this wasn’t easy, particularly in a season in which early on one baker makes another drop their finished goods on the floor right before judging (anger hidden), a good baker leaves after a week of horrible performances in what was supposed to be their specialty (ridicule averted), and an oversized bakerette who tends to spill everything everywhere whilst making visually mediocre — though no doubt tasty — goods serves up a cake-shaped splodge in one of the last showstoppers (no shaming of any kind and there were plenty of kinds to think of in those moments). It was a trying year and the season could not have been easy to make. Yet, I can happily report that the baking tent and the hyper-green lawn it sits on continue being cynicism-free zones, making better people of its participants and viewers alike.

The absolute best, beating Seinfeld in a photo-finish and Friends by a mile. This is not a matter of opinion but an indisputable fact. ↩

What I learned on Twitter, week of 12/7/2020

Miloš Miljković — Mon, 14 Dec 2020 08:00:00 -0500

Chart of the week: Evolution of the alphabet. There was another good chart this week too, and probably more consequential.
Discussion of the week: Branko Milanović and Russ Roberts mostly on the Nobel prize
Letter of the week: Lunch is bad for me
Tech tip of the week: Uninstall Google Chrome and the malware that comes with it (bonus life tip of the week: Write better notes)
Thread of the week: The future of work(?)

Wolfwalkers 👍

Miloš Miljković — Mon, 14 Dec 2020 00:00:00 -0500

A predictable story, beautifully animated. It has the most straightforward plot of the Celtic triology¹ but also the most complex imagery and a soundtrack that equals the two prior films, making it the perfect Oscar contender. And even the simple A to B to C storyline allows for many different interpretations. Is it about man versus nature, town versus country, old versus young, masculine versus feminine, blue eyes versus green? Probably all of the above.

Side note: Wolfwalkers came out on AppleTV+, pretty much sealing its status as the new HBO. Still, it would be nice to see the animation in a theater next year, if any are left.

Which is to say The Secret of Kells, Song of the Sea, Wolfwalkers, and no I don’t think that’s the official title but that’s how I have it filed in my mind. ↩

What I learned on Twitter, week of 11/30/2020

Miloš Miljković — Mon, 07 Dec 2020 11:00:00 -0500

A depressing truth which reminded me that season 2 of the Leftovers is the best season of any show ever made.
Discussion of the week: Is “Finite and Infinite Games” a masterpiece or dangerously delusional (after reading the replies I favor the latter, and this is a good reason why)
Software of the week: CellPAINT-2.0, and I had to pick up my jaw off the floor after seeing what it can do (this tweet also made my jaw drop but for all the wrong reasons).
Article of the week: Shedding of viable SARS-CoV-2 after immunosuppressive therapy for cancer.
Thread of the week: David Steensma’s best one yet — A brief history of aspirin (bonus thread: Accidental renaissance photos)

What I learned on Twitter, week of 11/23/2020

Miloš Miljković — Mon, 30 Nov 2020 17:00:00 -0500

The nightmare continues. Novartis should ask for its money back.
Thread of the week: some RECOVERY trial updates. And if you prefer vaccines, there is a thread for that.
Tool of the week: SciTLDR. Turns your abstracts into tweetable one-liners. Not sure it’s a positive development but it’s interesting.
Taleb tweet/video of the week: discussing the Danish mask study with Yaneer Bar-Yam. Here is the paper if by some miracle you’ve missed it.
More Prince, less Covid-19, please.

Things for which I am thankfull, in no particular order

Miloš Miljković — Thu, 26 Nov 2020 11:20:00 -0500

A toddler’s giggle
A third-grader’s pout
Foam mat floor tiles
Child locks
Apple TV+, including but not limited to Ted Lasso, Tiny World, Mythic Quest, Fireball, and Wolfwalkers which even before being released has provided hours of entertainment for my children by the virtue of its most excellent trailer
Essential workers
A working internet connection, on weekday mornings in particular
My coworkers, each and every one
Overcast
Belgian beer, more specifically Duvel and Chimay Tripel (aka Chimay White)
Wireless buds, even though they remind me of that one episode of Doctor Who
Fresh towels
Reliable pens (this one too, and here’s a good mechanical pencil)
Good journalism
Blurred backgrounds (but I may soon start using these instead)
Physical mute buttons
Reliable cars
Fast pipelines
Thoughtful interviewers
Saturday afternoons when we’re all back from a long walk outside and tired enough to have a good appetite but not too tired to spend the evening doing something fun knowing there’s also Sunday to look forward to
Long sentences
Good endings

The Computer and the Brain

Miloš Miljković — Tue, 24 Nov 2020 18:00:00 -0500

At a hundred pages, a fifth of which is the preface, this is a slender book that compares the 1950s state of the art computer and neuroscience, but more importantly gives the answer to the burning question in oncology: how much are a few months of overall survival benefit worth? Well, if you are John von Neumann and you have boney metastasis from a cancer of unknown origin eating away first your energy and then your mental capacities while your are writing a series of lectures on how similar and different brains are from “modern-day”¹ computers, and you are way ahead of your time in thinking about both, well, the answer to that question is quite a lot. It is in fact an unthinkable loss that he died before he could even finish his writing, let alone hold the lectures.

It was also somewhat eerie to read about the comparison between humans and machines shortly after Apple announced its quite literally game-changing M1 processor. There is fierce competition among the big tech companies to build the Skynet of our universe, and as of last week Apple is winning.

i.e. 1950s, though apparently the architecture hasn’t changed at all, save for the size and number of the components. ↩

Enola Holmes 👎

Miloš Miljković — Mon, 23 Nov 2020 18:15:00 -0500

Netflix has a knack for producing empty calories, and Enola Holmes is not an exception. Pretty visuals, female empowerment, and decent to above-average acting can’t hide the blandness of its storyline nor the absence of any reasoning, deductive or otherwise.

It is, by the way, hard to think of Enola’s character as particularly empowered when the next three women in screen time order are her mother the polymath rebel, her friend the black martial arts teacher, and an aristocratic evil mastermind. Not to mention the brief appearance of a coitery of female anarchist geniuses. In Victorian London!¹ A bit too on the nose, maybe? To paraphrase the Incredibles, when everyone’s special, no one is.

What’s worse, there is a story where this particular cast of characters makes perfect sense in this particular setting, one where a downtrodden young woman — think female Oliver Twist — meets them in order to learn what’s possible. But Enola is built up to already be the self-reliant Victorian anti-lady. Running into even more of the same archetype on her way to saving the prince makes for boring and lazy storytelling. ↩

What I learned on Twitter, week of 11/16/2020

Miloš Miljković — Mon, 23 Nov 2020 09:00:00 -0500

USMLE Step 2 CS is now virtual. I am trying hard to find reasons for this other than the purely cynical and so far I’m failing.
ABIM has its issues too.
Idea management tools. I was using Roam Research this time last year and stopped as soon as it became clear privacy would always be an issue with an online-only tool.
Article of the week: Exceptional responders.
Taleb tweet of the week: Eggs!

What I learned on Twitter, week of 11/9/2020

Miloš Miljković — Mon, 16 Nov 2020 18:00:00 -0500

Remember how people blamed sugar for tumor growth? Well, they can now start blaming fat as well.
Life is complex.
Article of the week: super-spreader parties.
Taleb tweet of the week: if you are in six+ sigma territory time and again, your probability distribution is wrong.
Quote of the week: “Live your life honestly and make sure you are never caught”. Truly a quote for our times.

The Queen’s Gambit ♟👍 🎭👎

Miloš Miljković — Sun, 15 Nov 2020 10:00:00 -0500

It’s full of style, has excellent casting, and pretty good chess¹, which is enough to make it into an enjoyable but forgettable miniseries. If only they had put in as much effort and thought into character development as they did in Beth Harmon’s dresses…

I hear, never being much into chess, except that now thanks to the show I’m a paying member at chess.com and am very much looking forward to playing a few games with my own children once they’re old enough not to chew on the figures constantly. But I still think Twilight Struggle is the superior game. ↩

Ted Lasso 👍👍👍

Miloš Miljković — Sat, 14 Nov 2020 18:00:00 -0500

As long as I can remember¹, any protagonist of a movie or a TV show who wasn’t world-weary and cynical was either naïve, stupid, or both. In American popular culture, “good” people are the way they are only because they don’t understand how the world truly works. As side characters they are mostly comic relief. As protagonists they can only succeed through piercing the veil of ignorance — becoming worse people in the process — or by pure dumb luck. Ned Flanders, Forest Gump, Kimmy Schmidt all come to mind.

Not so with Ted Lasso, the only character in recent memory who is well aware that the world is harsh and that there are people out to get him², yet defaults to thinking the best of everyone he meets. He is still capable of mild deception in the service of punishing the wicked, but he can’t even punish someone without an endearing monologue on what he’s all about: being curious and not judgmental.

Being more curious and less judgemental would serve everyone well at any time, but never more so than this year, when everyone suspects the worst of everyone else. The default behavior is mistrust, the default sentiment cynicism. This show starts with plenty of both, yet they melt away under Lasso’s high-power beam of un-ironic and very self-aware goodness. If the 2000s were the decade of The Wire and the 2010s were the decade of the Game of Thrones, I wish, hope, pray that the 2020s turn out to be the decade of Ted Lasso.

Which is to say, mid to late 1980s. ↩
The show doesn’t hide who this is: all of England, save for two close friends. ↩

What I learned on Twitter, week of 11/2/2020

Miloš Miljković — Mon, 09 Nov 2020 08:00:00 -0500

Abolish time zones! (I’ve had this idea for a while, glad I wasn’t the only one)
Taleb on 538’s election model
Knowing the result ≠ counting all votes, legal or not
I finally understand Bayesian statistics.
RIP Sean Connery and Alex Trabek.

What I learned on Twitter, week of 10/26/2020

Miloš Miljković — Sun, 01 Nov 2020 17:00:00 -0500

David Bowie was a genius
Why telemedicine can’t replace in-person visits
Why I don’t write as much
Paper of the week: a review of hepatosplenic T-cell lymphoma
Thread of the week: the story of warfarin

Bonus: I may finally learn how many people actually read this blog.

What I learned on Twitter, week of 10/19/2020

Miloš Miljković — Mon, 26 Oct 2020 15:00:00 -0400

The known unknowns of Covid-19
The blue checkmark correlates with not distinguishing correlation from causation. (or does it actually cause the ignorance?)
Someone at DHS hasn’t thought through the second order effects of their stupendously inept J-1 policy change.
The best essay I read this week was written in 1944.
Zombie starfish and mutant crayfish. Halloween must be near.

What I learned on Twitter, week of 10/5/2020

Miloš Miljković — Sun, 11 Oct 2020 09:00:00 -0400

The true value of Twitter: one misspelled, 2-like post can lead you down some magnificent rabbit holes. Bonus: An introduction to mathematical oncology, which is part of this JCO compilation.
Median time from application submission to drug approval was 3.3 months (range 0.4 to 5.9 months) with real-time oncology review. Hard to get much faster than that, so why do some economists still want to speed up review?
Another top physician-scientist leaves academia for industry, and announces it in style.
Nassim Taleb doesn’t know that DOs and MDs are nowadays functionally equivalent but Twitter quickly sets him straight.
Thread of the week: Sarajevo assassination 1914 — what really happened.

What I learned on Twitter, week of 9/14/20

Miloš Miljković — Fri, 18 Sep 2020 17:30:00 -0400

It’s good to keep a list, else you forget there’s more to Twitter than outraged mobs misunderstanding sarcasm.

More tweets = more citations (says more about the academic enterprise than about Twitter if you ask me).
Vincent Rajkumar on the trials (haha) and tribulations of starting a randomized clinical trial in the US.
Should we add courses on dealing with medical insurance to the medical school curriculum? No.
The no-meeting crowd is good company to be in (as long as we don’t meet!)
World’s prettiest libraries (with only one clunker on the list).

Malignant

Miloš Miljković — Wed, 06 May 2020 08:30:00 -0400

These 250 pages on the many ways that cancer care in America is broken should be read by everyone with even a passing interest in oncology, and must be read by every heme/onc fellow or fellow-to-be. Malignant reminded me of the best days of my own fellowship, when the then-program director Tito Fojo would eviscerate an article — these tended to be poorly thought out phase 3 trials of one TKI or another that somehow made it to the New England Journal — with a few slides made at the last minute.¹ But this is not just a rehash of those lectures, nor is it the best of Prasad’s prolific Twitter feed, nor an overview of his billion meta-science articles and editorials. It is instead a series of lectures — enough to fill a semester — that takes bits and pieces of the above and adds quite a bit of new to make something better.

It is not the easiest of narratives to follow. This is understandable: cancer research, policy, and outcomes are as intertwined as the molecular pathways Prasad valiantly tried to avoid, and mapping their connections will inevitably result in a crazy wall. There are nominally four parts to the book with four chapters each, because you had to put it together somehow, and the parts make sense. Even so, more than once I was wondering what exactly a particular vignette had to do with where it was in the book, and wanted to put it somewhere else. But the feeling goes away quickly — Prasad’s style is entertaining, the puns are clever², and there isn’t a superfluous paragraph in site.

To that last point — if anything, the book is too short. My pet cancer peeve, the disconnect between bioplausability and reality, and the many misuses of animal models to inform clinical trials, was barely mentioned when it could’ve easily made a whole chapter. Same for grant mechanisms, which did get a page and a half — that one half is a figure — but left too many things unexplained and uncovered, particularly for the lay audience. And as to Prasad’s big advice that the federal government should take over running clinical trials from private companies, well, it’s nice to put some pie-in-the-sky proposals out there, but something that is so against the grain should be more fleshed out.³ Or maybe mention some more feasible proposals, in the line of Vincent Rajkumar’s plea to cut down the number of people with veto power over a randomized controlled trial. I could go on, but I’d rather not spend too much time on what can be refuted by a single sentence: “Write your own damn book”.

Written by Vinay Prasad, 2020

And I mean this quite literally: you could see him cropping screenshots two minutes before journal club. ↩
My favorite involves a marinating chicken and curry. ↩
There is, of course, the argument that someone who’s never run a clinical trial has no right to comment on the quality of those that are out there, nor to propose how they should be done. Rather than resorting to modern arguments against gatekeeping, I will echo my grandmother: I don’t have to lay eggs to know when there’s a rotten. ↩

My American decade

Miloš Miljković — Tue, 31 Dec 2019 10:08:00 -0500

The decade in which one’s three children are born will have to rank among the best ones ever, no matter what else happened. But then add marriage, a move to America¹, completing 25 years of training², getting a dream job, becoming an uncle — twice — and not to forget, starting this blog, and, well, it is hard to imagine things getting any better.

So yes, it has been a good ten years. Certainly better than any other ten-year span I’ve had. A good test would be imagining the ten-year-ago me learning the outcome of the single decision he’s made back in 2008 to go for residency training in the US of A instead of a PhD in Germany, and I’m not one to pee their pants from excitement but I do imagine myself coming close, even without knowing the counterfactual.

Is America the greatest country in the world? It was for me, at the time, even as a visitor³. And it may continue being so for decades to come; I don’t see any competitors coming close.⁴

Or was it an escape from Serbia? ↩
Thats 8 years of elementary school, 4 years of high school, 6 years of medical school, 4 years of residency — Chief year included — and 3 years of fellowship. ↩
Or rather a nonimmigrant alien of extraordinary ability, for now. ↩
And I’m looking. ↩

Watchmen, Season 1 👍

Miloš Miljković — Sun, 29 Dec 2019 12:24:00 -0500

The HBO show manages to be more like the comic book than the movie ever was, even though — or rather exactly because — it is nothing like the original while the movie was for the most part a literal shot-for-shot translation of the comic and therefore missed two things that made the comic great: 1. amplifying the anxiety of the day to intolerable levels, and 2. deconstructing its own medium.
Re: no 1, the original was all over the place time-wise but mostly set in the 80s and the perceived threat was nuclear holocaust. The movie came out in the mid-2000s, during the time of war against terror and existential angst, but was still set in the 80s and the threat again was nuclear holocaust — two beats already missed. The HBO series is all over the place time-wise but is for the most part set in 2019, and the perceived threat is white supremacy. Note the “perceived” and note that it takes some time for the real villains to be revealed.
Re: no 2, I’ll pick just one example although there are many. The original featured a comic book within the comic book. Of course, in a world in which super heroes are real, escapist media wouldn’t be doing its job just by featuring even more super heroes. So what kids get instead are pirates, and what you as a reader get are panels featuring ships at sea, pirate raids, and the like, interspersed with the “real” story, to great effect. The movie had… breaks in which it showed panels from that same pirate-themed comic book, with the same story line. Only because you’re not mixing two comic books but instead are interrupting a movie to show some drawings, it doesn’t work at all. The HBO series, brilliantly, has a TV show within a TV show, which is, again brilliantly, not pirate-themed. As to what it is, well, that’s one knock I’d have against the show because it’s trying to be cute and funny, and yes a parody docu-drama about super hero origins in the style of American Crime Story is cute and funny, but it’s not in the spirit of the original.
Another knock against the HBO series is that it coddles the audience, almost as if HBO got complaints about a few of its other shows being too obtuse. A dialogue line was foreshadowed 10 minutes ago in a different dialogue? Cut to the foreshadowing. Characters recognize a clue in something that occurred two episodes ago? Cut to that scene to remind you what happened. A character breaks an egg? Cut to them holding a different egg in a scene from the same episode. Why?
Yes, it’s petty criticism, but the show is so masterful in so many other ways that the tiny imperfections stick out. Also, it’s also easier for me to list the few things I didn’t like because everything else (Regina King! Jeremy Irons! Jean Smart! The kid actors! The two skinny white guys who I hope will team up for Season 2! The self-conscious wokeness. That soundtrack!) is pitch perfect.
A half-sequitur: everything I liked about Lost was put in there by Damon Lindelof, and everything bad about it came from JJ Abrams. I didn’t realize that at the time, but their work post-Lost speaks for itself.
It ties with Westworld Season 1 as the second-best season of the decade, but The Leftovers Season 2 is still my number 1.

Directed by Various, 2019

Voices in my head, 2020

Miloš Miljković — Mon, 23 Dec 2019 17:17:00 -0500

EconTalk with Russ Roberts is the best interview podcast I’ve listened to, period. Unlike Tyler Cowen Roberts focuses on an issue or two, not the personality being interviewed. He gives fewer if any passes. The effect is that I feel like I’m actually learning about the thing in question, not just getting acquainted with Cowen’s personality du jour. Whether any learning actually takes place at my advanced age is another matter.

My top 5 episodes: - Keith Smith on free market health care - Venkatesh Rao on Waldenponding - Adam Cifu on the case for being a medical conservative - Patrick Collison on innovation and scientific progress - Andrew McAfee on more from less

Honorable mentions: Cowen, Holiday, Hossenfelder, Bertaud

Conversations with Tyler are as good as ever. This year’s favorites: - Mark Zuckerberg and Patrick Collison - Margaret Atwood - Masha Gessen - Emily Wilson - Ezekiel Emanuel

(Note that the majority are episodes with women - Cowen has Roberts easily beaten here)

Breaking Smart with Venkatesh Rao I would recommend to anyone who’s enjoyed the above-linked interview Russ Roberts did with Rao on one of the better Breaking Smart essays. It’s 15-20 minutes of Rao performing mental stretching excercises, solo.

Plenary Session with Vinay Prasad is another podcast that shines with the solo performances, but the interviews aren’t half-bad either. That isn’t a surprise, since this year Prasad has talked to David Steensma, Frank Harrell, Adam Cifu, H. Gilbert Welch, and Clifford Hudis, among others. Sadly, the podcast still doesn’t have a proper website, so I can’t link to any of these episodes directly.

Capitalism, Alone

Miloš Miljković — Sun, 15 Dec 2019 10:45:00 -0500

A brief overview of the past, present, and future of capitalism by a Serbian-born and formerly World Bank-employed CUNY professor Branko Milanović, who specializes in income inequality.
Some parts hit closer to home than others, most of all the idea that you can have a welfare state, and you can have open borders, but that mixing the two is ill-advised. I am also well-acquainted with America’s indirect and informal immigrant tax, a version of which Milanović proposes as one of the solutions to the welfare/immigration dilemma. I am not a fan.
His big insight before this book was the elephant chart. Capitalism, Alone’s big idea is that communism may not have been the pinnacle of society that Marx and Engels had predicted, but rather a good way of transforming feudal agrarian societies into modern economies. Centralized planning and broad-stroke changes work well up to a point, but the production chains soon get too complex for communism, at which point the invisible hand steps in.
Second big insight: corruption is hard-wired into how a particular type of capitalism (which he calls “political”, in contrast to the Western “liberal meritocratic”) operates. This is supported by many a “liberal meritocratic capitalism” city and state, their financial services and real estate markets being dependent on the “political capitalism’s” dark money.
It was an easy read for this non-economist. Recommended.

Written by Branko Milanović, 2019

Our Man: Richard Holbrooke and the End of the American Century

Miloš Miljković — Sat, 23 Nov 2019 15:44:00 -0500

The only reason I bought and read this book was the excerpt published in the Atlantic which noted some parallels between 1990s’ Balkans and 2010s’, well, the world, which I was already mulling in my head. Turns out that’s the best part of the book.
The rest is uneven. Holbrooke was a slime ball of a human and his accomplishments were nil, yet Packer still manages to make the book into a hagiography. Which I guess is an accomplishment.
Did Holbrooke truly think that his memos would change the world? In the Gervais Principle hierarchy, he was a clueless posing as a sociopath.
Packer’s account of the Dayton negotiations confirms that the only reason a deal was made was that Milošević wanted it at any cost. The agreement was for Holbrooke to mess up, and he almost did, multiple times.
There is mention of HBO buying rights to make a show out of Holbrooke’s account of the Bosnian was. I haven’t read “To End a War”, but I like the idea of the Dayton negotiations being the centerpiece of a mini-series, with flash backs to each individual warlord’s (and Dick’s) messy history. Someone please give the idea to Damon Lindelof after he’s done with Watchmen.

Written by George Packer, 2019

The 2010s

Miloš Miljković — Tue, 12 Nov 2019 14:05:00 -0500

I started the decade childless and am ending it with three, so I have missed most of the 2010s’ pop culture. This includes the entire Transformers franchise and most of the Marvel Cinematic Universe (so, not much missed then?)

Film: “Get Out”
Blockbuster/action film: “Spider-Man: Into the Spider-Verse”
Album: “Hamilton”
Single: “Rolling in the Deep”
TV Show: “Veep”
Single Season: “The Leftovers” season 2
Book Fiction: “The Dark Forest” (or “Death’s End” if you count the publication of the first Chinese edition, but TDF is superior)
Book Non Fiction: “Antifragile”
Athlete of the Decade: The Đoković-Federer-Nadal trio, but if I had to pick one then obviously Đoković.

Movies and music were better in the 2000s, but oh what time to watch TV and follow tennis. It’s too early to judge the books (though it’s telling that my favorite was originally written in 2008).

Talking to Strangers

Miloš Miljković — Mon, 04 Nov 2019 07:17:00 -0500

Malcolm Gladwell tries to explain the death of Sandra Bland by the way of the Hitler-Chamberlain meetings, Cuban double-agents, college student alcohol culture, an episode of Friends, and Sylvia Plath’s suicide by gas oven. Huh?
The pieces actually fit, and — a few abrupt interludes aside — the story flows nicely. His previous books were also stories and not scientific review articles, which people tend to forget, but this one more so than others. Which is good, since people tend to misunderstood him for a Pinkeresque academic with pop culture pretensions rather than a journalist having fun.
A single point of disagreement: his portrayal of Ferguson, MO police as misapplies of hot spot policing rather than racketeers rang false to my layman ears.
Gladwell has become a podcaster, and it shows in how the book is structured: it reads like a podcast script. I haven’t listened to the audio version, but this may be the one case of a non-fiction book that is better listened than read.
But if you don’t have the actual book, you won’t get to read the extensive notes, on of which directly refutes a whole chapter of Blink. Another is an excellent parallel between indiscriminate police searches and cancer screening tests. Too bad he didn’t use actual footnotes (but then people would also complain, see no.2).

Written by Malcolm Gladwell, 2019

Scary Stories to Tell in the Dark 👎

Miloš Miljković — Sun, 03 Nov 2019 18:01:00 -0500

Things I found to be scarier than this movie:

“Cabin in the Woods”
“Coraline”
“Toy Story 3”
My father upgrading his Windows PC
My 2-year-old’s diaper
The thought that I have spent almost two hours watching this drek

That this was co-written and produced by Guillermo del Toro and directed by the same person who did The Autopsy of Jane Doe is not exactly mind-boggling, but certainly disappointing. I wonder what went wrong.

Directed by André Øvredal, 2019

Consider the Lobster

Miloš Miljković — Tue, 24 Sep 2019 08:07:00 -0400

A collection of essays from the man who wrote Infinite Jest, also known as the 20th century’s best 21st century book. Each one is near-to-completely brilliant and worthy of more thought than a one-line in an inconsequential blog post, but that won’t stop me:

Big red son is the one where he attends the AVN awards as a magazine correspondent. The more absurd things become, the more encyclopedic he gets. Yes it’s funny, but also existentialist and sad as only pornography can be.

Certainly the end of something or other, one would have to thing is long title to a short-ish review of a supposedly science fiction book by John Updike. He didn’t like it.
Some remarks on Kafka’s funnies from which probably not enough has been removed is exactly what it says it is. Having only high-school literature class-level acquaintance with Kafka, I can’t comment.
Authority and American usage is a review of a dictionary but also the 20th century’s (written in 1999) best 21st century essay, covering issues of political correctness, identity politics, race, alienation, and a brief history of the battle between prescriptivism and descriptivism for the hearts and minds of I don’t know who exactly, but what an exciting battle it is.
The view from Mrs. Thompson’s is about where he was on 9/11 (spoiler alert: he was at Mrs. Thompson’s).
How Tracey Austin broke my heart is the reason I’m even sadder than I should be about DFW not still being around, because an essay about the Federer-Đoković-Nadal tennis trio in general and the mental gymnastics going on in Novak Đoković’s head in particular would have been spectacular to read (although there has been a fairly successful attempt). Oh, and it’s also a review of a reasonably bad autobiography of the titular Ms. Austin, who is also a tennis player.
Up, Simba is DFW following McCaine’s failed 2000 attempt in the Republican primaries, wherein he shows just how walled away from the “real” world candidates were back then, how big of a gatekeeper the media world, and just why Twitter could have made all the difference.
Consider the lobster is where a travel essay for a cooking magazine from a food festival in Maine turns into an existential crisis and a call for veganism. It’s good
Host is so messed up by its formatting of footnotes (fortunately there is now a web version which more than makes up for it, and the original article published in The Atlantic was also easier to read, apparently, say people who were able to find it, and yes this should also have been a footnote) that it’s hard at first to appreciate how good of a story interspersed with thoughts on infotainment and talk radio it really is, and even though it was written more than a decade ago you can sort of see what it’s protagonist will eventually become in these troubling times.

Written by David Foster Wallace, 2007

It’s time to stop the foreign doctor kabuki

Miloš Miljković — Thu, 12 Sep 2019 07:46:00 -0400

Residency application season has just started. Many of the applicants, a few of whom I know in person, will be foreign medical graduates, or FMGs, meaning that they are doctors who want to work in the US but are not US citizens. Most FMGs, but not all, will also be international medical graduates — IMGs — meaning that they have graduated from a non-US medical schools. Something called the Education Commision for Foreign Medical Graduates, or ECFMG, acts as their medical school when interacting with most of the sprawling US bureaucracy. These are our personae dramatis, if you will.

Disclosure: I am both an FMG and an IMG, and first began working in the US on an ECFMG-sponsored J1 visa.

America is a net importer of physicians, that much should obvious to anyone who’s ever been in an American hospital. The country depends on FMGs to keep the system running, get the less lucrative specialties, work in underserved areas, etc. Not so obvious is that most FMGs get to America by lying; ICE-approved, foreign-government sponsored lying for sure, but lying nonetheless.

Here are the lies FMGs tell when they come in: that their country has a need for doctors of such-and-such specialty, and/or that their government is sending them to the US for training in the said specialty, and/or that at the end of training they will go back to their country of origin to work in the (sub)specialty they came in to obtain. Those are the three postulates of the J1 physician exchange visa, the very name of which is also a lie as there is no exchange taking place: foreign doctors do come in, but no American doctors come out.

The postulates are incompatible with reality, and imply foreign government competence that just isn’t there in second and third-world countries¹. Because over there, no one is keeping statistics on specialist needs, and if they are there is actually a surplus, and if there isn’t they wouldn’t be able to afford the (sub)specialists once they come back, and if they could then they would be chosen by party or family lines, and you wouldn’t want them in your hospitals anyway.

So to get a J1 visa FMGs need to obtain a letter from their Ministry of Health or equivalent stating the above (the postulates, not the actual truth; I’m sure that in some of those countries people have gone to prison for saying the truth). But is there a functioning Ministry of Health? Does anyone there know that the letter they are supposed to provide about lending a medical graduate and wanting them back is a piece of kabuki theater, and not a commitment to employ that person if and when they come back? And because this letter is supposed to come in a sealed envelope directly from the Ministry to ECFMG: does anyone there speak English? So here are all those FMGs whose main reason to emigrate to America may have been to escape their kleptocratic governments, being dragged into a game of Whom do I bribe next? and Which newspaper do I threaten them with?² by the rules of the country they were hoping was less crooked than their own.

Which is fine for America, because it doesn’t care as long as it gets its steady stream of MDs one way or another. Only it should care because 1) the amount of person-hours wasted is on par with if not greater than the amount spent writing grants, and that one’s a whopper, 2) it relinquishes control over a part of its healthcare to foreign governments, and 3) it introduces an air of subterfuge and deceit at the very beginning of the FMG-USA relationship. I would like to think this is an aberration to be fixed, and not a preview of things to come in other areas of governance.

The process was probably fine 50 years ago, when both demands of the medical system and the influx of foreign doctors were but a fraction of the current monstrosity, when USMLE was taken on paper if you had to take it at all, when it wasn’t so obvious to a non-aligned physician whether they should go to the US or USSR (or Yugoslavia, for that matter) to get more training. But healthcare has changed and so has the world: it’s time do drop the pretense of an exchange, America, and be honest about what’s going on here.

The transitioning and developing world, if you will. ↩
In 2019 the correct answer is, for most countries of this sort, None. ↩

Diagnosis 👎

Miloš Miljković — Tue, 20 Aug 2019 07:48:00 -0400

“Diagnosis” is a Netflix reality show first, a comment on American healthcare second, and Lisa Sanders’ medical show on crowdsourcing the diagnostic process a distant third. If you wanted to see more of what made her book and column great, like I did, well, tough luck: this ain’t it. Because — and this isn’t a surprise — most people with access to a tertiary medical center do get an adequate diagnosis. Those who are undiagnosed either lack access, or have a functional-slash-undiagnosable condition that ultimately doesn’t change much in their management.

Realizing this, the producers add a spin: the crowdsourcing they bring is also there for emotional support, connecting with people, getting different treatment recommendations. As if Facebook didn’t exist. If this show were a clinical trial, it would be a phase II with an unimpressive response rate but hey look at those bio markers we hadn’t initially planned on doing!

Warning: spoilers for Episode 1 ahead. I may get to the other ones, eventually.

Only the first episode half-lives up to its promise. A young woman from Las Vegas has a problem. Her local doctors don’t know the cause; I certainly didn’t, but could make a ballpark guess as to which type of a disorder it was and which subspecialist she should see. However, instead of giving her a referral to the nearest university medical center, the doctors flood her medical bills, and sue her for non-payment to boot. Only in America!

Enter Sanders: her NYT article gets a bunch of people across the world sending video suggestions as to the possible diagnosis. A medical student from Turin, Italy, offers a free work-up. Netflix, bless their hearts, films the patient and her partner flying to Italy to get it done, marveling at the wonders of a single payer system. I can only presume travel and boarding were paid for by the production team. But why not pay for a trip to San Francisco instead? Well, the skyline isn’t as dramatic as that of Turin; and it would rob Dr. Sanders of the opportunity to marvel how crowdsourcing brought the answer from half way across the world, literally.

In a nutshell: Because of No Insurance and TV Drama Makes Better Ratings, woman from Nevada flies to Italy — instead of driving to California — to get diagnosed with a rare medical condition.

To be continued…

In the land of outrage and snark

Miloš Miljković — Thu, 25 Jul 2019 08:33:00 -0400

Twitter brings out the worst in people. If your worst is not that bad then power to you, madam, but most of us need to spend an extraordinary amount of energy not to look like sociopaths, or should just stay away. More often than not I choose the latter.

There are good arguments for why you should be on Twitter from both doctors and civilians. On the opposite end there is a whole book dedicated to why you shouldn’t (full disclosure: I haven’t read the book, but did read two accompanying NYT Opinion pieces back before I realized NYT Opinion pieces weren’t worth my time). So clearly there are two opposing points of view, and while I’m sympathetic to the Twitter cheerleaders and their cause, my own experience makes me take pause. Here’s why:

1. No nuance

Note the “madam” reference in the opening paragraph. Here, I have space to explain what I meant: that a well-behaved user on Twitter was more likely to be a woman. An outrage-primed stranger on Twitter just glancing at the post could instead interpret it as an attempt to emasculate the well-behaved male readers. And I forget, is it still kosher to use madam to refer to women? Or is “females” the appropriate term now, never mind that it’s an adjective? At least using “kosher” is not considered cultural appropriation yet. Right?

I don’t like this lack of nuance for two reasons: because I recognize it in myself when I overreact to a tweet and have to stop myself from writing a snarky reply and because writing down short thoughts that are still coherent is much more time-consuming than writing run-on sentences like this one.

2. Ill will

Recall Justine Sacco and the delight with which a Twitter mob tracked her WiFi-less flight across the Atlantic. Twitter mobs are pure minority rule, wherein the minority has a high follower count with an incentive to mobilize them. It is vexing to see someone with 10,000+ followers retweeting — with a snarky comment, of course — a poorly worded tweet that had thus far garnered three likes and no other retweets. No matter the content of the original tweet, and often they’re deranged rantings of an anti-vaccer, doing it to a person with a hundred-fold lower followe count and a thousand-fold lower reach is unethical at best, and dare I say immoral too when the intent of the retweet is nothing more than virtue signaling.

Again, this kills my enthusiasm for Twitter in two ways: the time I spend self-censoring my Eastern European spent-a-decade-under-US-sanctions tendency towards sarcasm, and the time I spend reading, digesting, and ultimately dismissing these worthless posts.

3. Poisoned stream

But isn’t the great benefit of Twitter over mainstream media the ability to choose whom you follow? Yes, but: Twitter the company is doing its best to ruin that by showing you not only retweets, but also those tweets that people you are following liked, and a random tweet here or there that’s been getting attention (as in: a lot of replies, as in: this is probably controversial) which it thinks may cause you to engage (as in: join the conversation, as in: enter the fray). I am not making this up.

So even if you try to keep your time line completely professional and only follow other MDs who post only their high thoughts on the latest randomized trials in the area you’re interested in… Well, you can’t stop them from liking political posts, and you can’t stop Twitter from foisting its algorithm on you.

4. No country for slow thinkers

So what? Just ignore the noise. Cull your follow list to manage input, write quickly and don’t look back to speed up your output. I suspect that’s what many people who are good at Twitter do, and if you can do it too then power to you. What kills it for me is 1) the opportunity cost (as in: I’d rather spend time with my family, and 2) (and this is the main one) I. cannot. write. like. that. This was supposed to be a two-paragraph post written in the subway. Well clearly it’s not.

As I finish writing this, a scientist I’m following has retweeted the FCC chairman’s gripe about the latest Twitter redesign. An MD is retweeting pointless videos. Random biotech factoids fly by my screen, unwanted and uncared for.

The Royal Society and the Invention of Modern Science

Miloš Miljković — Thu, 04 Jul 2019 09:39:00 -0400

I’ve always assumed that much of the western scientific tradition is a series of That’ll-Do measures made by imperfect humans in imperfect circumstances. This monograph showed me just how imperfect were both the circumstances (the English civil war) and the humans (naive, vain, incestuous, sometimes all at once). And just how much like the present times was the whole scientific endeavor: even back then, with so much yet to be discovered, most published papers were trivialities, most scientists (and “scientists”) cared for status more than truth, and most research (and “research”) was left unheard and unread.

It’s not a mystery then why we have such a hard time changing the ways of the ancients when those ways were built out of sheep’s blood and luminescent meat. But then I realized: we don’t get the science we need, we get one that we deserve, and we’ve been deserving the same kind of science for centuries now.

Written by Adrian Tinniswood, 2019

The language of God

Miloš Miljković — Tue, 25 Jun 2019 19:54:00 -0400

Francis Collins is a physician scientist who after a particularly tough patient interaction went from being atheist to agnostic to evangelical Christian. He is also kind of my boss, and while I hope that fact is not influencing my opinion of his book, it probably is.
The books has two audiences: scientists prejudiced against (organized) religion, and Christians prejudiced against science, evolution in particular.
The message to the scientists is: read C.S. Lewis to find out more.
The message to the faithful: don’t be narrow in your reading of the Bible, it’ll come back to bite you. And also read C.S. Lewis.
The first few chapters read like Dr. Collins’ personal statement. Residency and fellowship applicants, take note.
The scientific parts are accurate and an easy read for me and probably for the target audience as well.
The parts on religion are vague, subjective, and rely too much on “trust me”.
The part where he turns a story of a sexual assault against his daughter into a story about his faith deserves a cringe, a face-slap, and a letter of apology in future editions.

Written by Francis S. Collins, 2007

The Theory of Everything 👎

Miloš Miljković — Fri, 14 Jun 2019 07:36:00 -0400

There are so many wasted opportunities in this movie that I hesitate to recommend it. Here is the raw material in more-or-less chronological order: an atheist theoretical physicist studying time, black holes, and the beginning of the universe falls in love with a devout wife, develops a catastrophic neurological condition, gets married and has children, becomes world-famous, gets a tracheotomy and can’t talk any more, gets a robotic voice, falls out of love, divorces, marries his nurse, denies suspicions of domestic abuse by the said nurse, divorces the nurse, reconciles with the first wife, never wins a Nobel prize and never will because it will take too much time for his theories to be proven correct.

With so many intertwined plot lines and obsession with time you would think this would be non-linear story, or better yet a series of reverse-chronological set pieces that covers the highlights in depth. What we get instead is a shallow, lukewarm love story carried entirely by the walking-to-debilitated transformation of Eddie Redmayne whose best actor Oscar is one of the better deserved. If you want to tell such a complex life story beginning-to-end, make it into a mini-series and put it up on Netflix.

Directed by James Marsh, 2014

Collapse: How Societies Choose to Fail or Succeed

Miloš Miljković — Sun, 09 Jun 2019 09:36:00 -0400

Jared Diamond’s Guns, Germs, and Steel is a book with a brilliant idea, adequately presented. Collapse is also presented adequately, for an undergrad ecology course textbook. The ideas aren’t lacking, but are dull, undefined, hard to follow, and boil down to this: it is hard for a society to survive in a harsh, isolated environment, and some places tend to become harsh and isolated once humans start overexploiting resources, so better be careful. He presents several past societies that thus failed (Easter Island, Anasazi, the Greenland Norse, etc.), several that survived, and gives some not entirely plausible accounts of current societies which may be on the brink of collapse (Montana, China, Rwanda).

Diamond likes to enumerate: there is a Five-point Framework for Societies’ Collapse, but also Ten (?) Reasons Why The Vikings Failed, Seven Ways the Hard Mining Industry is Ruining the Environment, and Fifteen Things to Do in Iceland. I made-up those last three numbers, because I couldn’t remember the actual ones — he likes to enumerate, but doesn’t like lists, so it doesn’t make for a very good textbook either.

Written by Jared Diamond, 2011

Get Out 👍

Miloš Miljković — Thu, 30 May 2019 07:36:00 -0400

Yes, I know I’m late to this.
Comedy and horror both work by playing with your expectations, so that a comedian made the best horror movie in decades is not a complete surprise.
A surprise is how good of a director Jordan Peel is: you could easily take 95% of the dialogue, and 80% of the acting, and make a comedy out of this. That it is so suspenseful and creepy is all from direction.
Speaking of creepy: Catherine Keener. Yikes.
Of course there was still some comedy gold — the surgery scene in particular (yes, I know it wasn’t meant to be funny).
Watch it at least twice. The second time, pay attention to Rose (i.e. Allison Williams, i.e. Marnie).
The 2018 best movie Oscar went to The Shape of Water. I thought it was a bad choice after watching Phantom Thread, but now it’s a travesty: Get Out was clearly the most deserving that year.

Directed by Jordan Peele, 2017

Dallas impressions

Miloš Miljković — Mon, 20 May 2019 14:15:00 -0400

Green, walkable, good coffee, plenty of people on the streets but not crowded. Who knew.
The Sixth Floor Museum at Dealey Plaza is very well put together, but it has a remarkable story going for it so it would have been hard to mess it up. Making the audio guide non-optional was a good choice. You can easily spend hours and hours in it: we spent 4.
Dining was good for the price, but I wasn’t blown away by quality at the randomly selected BBQ places. DC’s Federalist Pig was better than anything we’ve had in Dallas, and the Kalua pork we had on Maui was by far the best.
That last one may not have been a fair comparison, only having three days to check out the restaurant and spending one of three dinners trying out the impossible burger (which was OK, but I’ll take a well-made black bean burger over it any time).
There is a proper 7-days-a-week farmers’ market that would have reminded me of the one in my home town in Serbia if it weren’t so gentrified (as in, more artisanal coffee stands and hemp candles than produce).
The hipster breakfast place in downtown Dallas has blue tile and plastic chairs instead of reclaimed wood and old school benches, but don’t let that fool you: they do serve cortados.
Four stars, will come back.

This blog, now on Twitter

Miloš Miljković — Mon, 20 May 2019 14:05:00 -0400

I don’t like automated posts on personal Twitter accounts, so I’ve created one just for this blog: @8regress. It’s automatic and unmonitored.

As always, there is an RSS feed.

Upgrade 🤖

Miloš Miljković — Thu, 16 May 2019 07:02:00 -0400

A cheap (estimated budget $5,000,000) sci-fi movie that doesn’t look cheap. Its looks are a blessing and a curse: yes, the camera work is good and the actors are photogenic but what are supposed to be gritty run-down inner cities of the utopian/dystopian near-future look instead like HD-bloomed props of a glossy magazine photoshoot.

The story features drones, self-driving cars, moments of gender ambiguity, and — the title gives it away — upgraded humans. It is timely, but also kind of lazy; I would have preferred more time dedicated to the huge inequalities between the different flesh-and-blood humans rather than the more obvious AI versus humanity plot line.

But I like where the movies are going much better than TV: the barrier to entry for both the makers (again, $5 mil) and consumers (90 minutes on the couch) is low, potential payoffs high (Upgrade’s gross was double its budget, a pretty good return on investment), and with word-of-mouth traveling more quickly and easily than ever before the good ones are more likely if not guaranteed to get awareness. Upgrade is not as good as it gets, but it’s pretty good.

Directed by Leigh Whannell, 2018

Catch-22

Miloš Miljković — Mon, 13 May 2019 13:10:00 -0400

“I’d like this book more if it weren’t so…”

“If it weren’t so what?”

“If it weren’t so repetitive!”

“You would have liked this book more if it weren’t so repetitive.”

“Yes, that’s what I said. Also the book is kind of meandering and takes it’s time getting to…”

“What book?”

I much preferred Slaughterhouse-Five. This one just wasn’t for me.

Written by Joseph Heller, 1961

Things a Computer Scientist Rarely Talks About

Miloš Miljković — Mon, 06 May 2019 07:00:00 -0400

Those things are God and religion, and Donal Knuth discussed them in a series of lectures at Harvard, the transcripts of which make this book. The lectures amount to a Director’s Comment edition of another one of his books, 3:16, so if you’ve read that one your yield is sure to be higher than mine: I hadn’t. In 3:16, he makes a thorough analysis of verse 3:16 from each book of the Bible. So yes, that makes “Things a computer scientist…” a book containing lectures about a book that deals with books of The Book.

Knuth is religious and also a brilliant computer scientist, and he brings a programmer’s mind to the Bible. Alas, I don’t have the mind of a programmer: the only parts of the book I could follow and enjoy were those dealing with typography, another one of Knuth’s interests. It did raise my interest enough to look for a religious physician’s take on Christianity, and what do you know: the boss of my boss’s boss wrote one. It’s on the pile now, but not before I scratch my typographic itch.

Written by Donald E. Knuth, 2003

Maui

Miloš Miljković — Fri, 03 May 2019 07:10:00 -0400

I’m 12 and the family is taking a summer vacation in sunny Pomorie, Bulgaria. It’s on the Black Sea. The ~400-mile drive in my father’s VW Golf (Mk2) takes close to 12 hours, border check and an interlude in Sophia included. It feels longer: it’s a 3-door hatchback and I’m sharing the back seat with my brother and a suitcase. There are enough groceries in the trunk to last us a week.

We arrive in the early morning and look for a place to stay. Airbnb is 16 years away, but there are vacancy signs posted on private residences all around town. We find one that’s half-built: gray building blocks still visible on the outside and concrete stairs with no railings, but the rooms are actually quite nice and the apartment is self-contained. The owner-slash-proprietor is financing the finishing touches by renting it out. My father approves.

The weather is nice and the beach is crowded. I have a perpetual sunburn. We visit Burgas and Nessebar. Dad almost gets scammed out of all of our German marks by a street money changer. I get a photo taken with a yellow-white python around my neck. We eat at home and take evening strolls up and down what goes for a boardwalk in Pomorie. We ocasionally catch a glimpse of live music from accross a hedge. A few people climb a hillock to watch the concert. I try it once and climb right back down: do I want to spend the evening listening to a Boney M. tribute band?

The drive back through Bulgaria feels faster, but that’s because Dad is speeding. We get caught and the policeman pencils something in on a lemon-yellow card. The next time we stop for gas Dad tries to erase it. He succeeds but the card is now a paler yellow where the marking used to be. They notice this at the border and we stay an extra few hours until they let us through. But then we’re in Serbia and close to home and soon I’ll get back to playing Civilization II and Duke Nukem 3D and Quest for Glory IV so who cares what happened and how we got out of it?

It’s 2019 and I’m the Dad. The family is taking an early summer vacation in sunny Wailea. It’s on Maui. My wife and I take two new credit cards to get enough points to get three tickets for the four of us. A week before the trip we realize I can’t have a 35-pound toddler on me for two 5-hour flights and we buy the fourth ticket. The airline charges for food, so we stock up on snacks to bring on board; I have a Costco membership card in my wallet.

We are in a one-bedrom two-bathroom condo that is bigger than my family home in Serbia. A decorative bowl full of glass balls greets us in the hallway; a large ceramic vase is next to our bed. My wife glances at our jet-lagged toddler, then at me, and I spend the next half-hour lifting fragile items up on top of kitchen cabinets. I go to bed around midnight, which is 6am Eastern Time.

The condo sits next to a golf course and some tennis courts. I don’t play either. There are five beaches within 5 minutes’ driving distance. They are virtually empty save for one, which has a steady stream of snorklers and divers parading up and down. The Costco-chosen guidebook says it’s the best spot on Maui for snorkling lessons, but 18-month-olds can’t snorkle.

The older sibling collects seashells and runs away from waves and builds puddles for the younger one to jump on. She chats up the adults and can carry a conversation better than her dad. We all wear UPF shirts and go through five bottles of Coppertone. We visit Lahaina and Paia and Kihei. We eat at home and take evening strolls through beachside resorts. There are Luaus on every night. The one at the Marriott is there for all to see from a public walkway. It’s the one we attend one night — the pork is good. There is audience participation: children learn the hula, adults blow into a conch shell; one man proposes to his fiance while up on the stage, in front of all us people — it’s a bit corny.

We wake up at 3am and wake up the kids at 4 to drive up a mountain top to see the sunrise. It is 10°C and colder with wind chill, and the sunrise lasts for all of five minutes; the children are not impressed. The other 100 people looking at it seem quite happy. One man proposes to his fiance, on top of that inactive volcano, in front of all us people — it’s quite romantic.

We sign up for an 8-hour van ride up and down a rainforest highway. It takes 12 hours. We are sitting all the way in the back: the older one is sick but doesn’t vomit, the younger one doesn’t say anything but vomits twice. It’s mostly juice and water and doesn’t smell like acid at all so we wipe it up with tissues and wet wipes and don’t ask the driver to stop. The young couple in front of us asks for more air.

The last flight back is a red-eye and the younger one screams for the first hour of the last leg of the journey because i don’t let her play with the restroom faucet. The attendents are out serving drinks so we let her roll around in the back of the plane, head close to the emergency exit door which I eye nervously. They serve us apple juice which she drinks and falls asleep. The older one is excited: there is an Amazon delivery of one toy or another waiting for her back home. She is still tired enough to be sleeping when the plane catches turbulence — the last 3 hours are bumpy. I watch a movie and try to fall asleep.

Spider-Man: Into the Spider-Verse 👍

Miloš Miljković — Wed, 01 May 2019 15:40:00 -0400

I’m late to this, seeing as it’s already gotten a bunch of awards including one from the Academy, but wow. Everyone involved in making this should be proud of the work they’ve done. Having said that…:

Some action scenes (looking at you, final boss battle) are too fast-paced with too much unnecessary stuff going on in the background, just because they could.
PP’s death was… banal. Is this how he died in the comic book? Sheesh.
Auntie May should got over his death quickly too.
That’s not how a linear accelerator looks like or works (not on this Earth, at least).
But take note: I saw this on the back of an airplane seat during a red-eye flight with a sleeping offspring ramming her head into my flank every few minutes, and I still thought it was amazing. Five stars, will see again.

Directed by Bob Persichetti, Peter Ramsey, Rodney Rothman, 2018

Aquaman 🐠🐠🐠

Miloš Miljković — Tue, 30 Apr 2019 06:00:00 -0400

H.P. Lovecraft’s “The Dunwich Horror” makes an early appearance, foreshadowing some Cthulhu-inspired creatures our hero will first fight and then command. Sadly, the (very!) big baddie in Dunwich is Yog-Sothoth, not Cthulhu, so this also foreshadows a movie that has some good ideas but doesn’t quite get them all right.
One thing it did get right was a spectacular chase scene on the rooftops of Sicily that reminded me of the best moments of Assassin’s Creed and Uncharted. This is also one of the few places where the setting wasn’t obviously CGI (because it wasn’t).
Seriously, if your budget is $160,000,000 you should either just film a real sunset or have an obviously fake one as a statement. It looked like most above-ground scenes were shot in the Uncanny Valley.
William Defoe is a lifelong resident of the Uncanny Valley, no matter the movie.
Nicole Kidman has a good fight scene. The fight scenes in general were easy to follow and nicely choreographed.
Dolph Lundgren, huh? Good casting there, but I was hoping he’d have a nice fight as well
Jason Momoa can’t pull off the dumb muscle look they were going for at the beginning and the smartass one-liners don’t help. So his character’s arc is in costume more than psyche: shirtless, street clothes, Aquaman.
Speaking of which, that Aquaman costume came fresh off a corpse that had been simmering in the deep sea for millennia. But we already established that Aquaman had bad b.o. so that made it fine I guess?
The underwater villain was entirely predictable and boring. The human baddie was delightful and I look forward to seeing more of him and his equally delightful new companion in the sequel.
Nutshell review: Predictable but delightfully over-the-top.

Directed by

2018

Maui, more impressions

Miloš Miljković — Sun, 28 Apr 2019 13:55:00 -0400

Top four South Maui beaches, best one first: Po’olenalena, Keawakapu (a close second), Wailea (only in the afternoons), Mokapu.
Top guide book is Maui Revealed. NB: Hotel/lodging information is on their app (‎Hawaii Revealed), and that part of the app is free.
Top place for shopping is Paia, especially if you’re into that 21st century hippie aesthetic that’s popular with Instagram influencers these days (though mine being aware of it means it won’t be popular for much longer).
There is a notable absence of panhandlers. If there are any homeless, they are indistinguishable from a certain type of tourist. Locals are indifferent to appreciative of your business, but they don’t go out of their way to get you to pay for stuff (which is unlike any other tropical/Mediterranean island I’ve been to, but then again I haven’t been to many).
The sand sticks to anything and everything. There’s enough of it in the car that I’ll happily pay any extra cleaning fees the rental agency will surely charge.
Prices at low and mid-scale restaurants are same or just slightly higher than D.C. This does not bode well for D.C.
There are more veterinarian than human hospitals on Maui.
The one general hospital on the island is Keiser’s Maui Memorial Medical Center. It looks like they have a heme/onc service with an infusion center, so don’t think I haven’t thought about it.
Only two days left.

Maui first impressions

Miloš Miljković — Thu, 25 Apr 2019 13:52:00 -0400

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.

Foundation

Miloš Miljković — Wed, 24 Apr 2019 07:09:00 -0400

For someone who supposedly likes science fiction I’ve been late getting to Asimov’s best known works. That’s too bad, since 20 years ago I would have enjoyed the first book much more.

The literal title of the series could be The Decline and Fall of the Galactic Empire, and How to Survive It.
Amazon says “Foundation” is book three. It’s not: books 1 and 2 are prequels and if you read them as published, this is the rightful Book One (you’re not one of those people who shows their kids The Phantom Menace first, are you?)
The future has no women, save for a shrill daughter of a viceroy wedded off to a barbarian ruler. This is literally the only female character in a book that spans 80+ years and five star systems. I would not have noticed this 20 years ago.
The Empire’s degeneracy is most evident in its approach to culture and science: our ancestors knew more that we did so we’d better maintain the status quo and not let things get too much worse on our watch. Over a few centuries of such policies things inevitably get much worse. The premise is a good counterfactual to Tyler Cowen’s Stubborn Attachments.
The peak of science is neither interstellar travel nor advanced atomic energy: both of these survive the decline and continue to be used even by “barbarians”. What waits to be re-discovered is psychohistory (PH), an invention of Asimov’s which is to psychology what Newtonian physics is to quantum mechanics: an averaging out of individual variability in order to predict “future history”.
PH notably can’t predict actions of individuals, yet at critical moments it’s the individuals who make the critical decisions that make the PH predictions come true. Paradox? Irony? Both?
Also, for someone who keeps saying that PH can’t predict the future of an individual human, the inventor of PH is really good at predicting the future of individual humans. That’s neither paradox nor irony but rather bad plotting on Asimov’s part, but I’ll hold final judgment until the end of the series.

Written by Isaac Asimov, 1951

Homo Deus: A Brief History of Tomorrow

Miloš Miljković — Mon, 22 Apr 2019 15:00:00 -0400

This could have and should have been the wrap-up of Sapiens rather than a book of its own. The first two thirds are a rehash of the last few chapters of Sapiens, dealing with three different flavors of humanism (liberal, social, evolutionary) in more depth. Only the last third deals with predictions, the main one being that, the postulates of liberalism being incompatible with our current understanding of biology, two other candidate “religions” may replace it: techno-humanism (out of which springs Homo Deus) and dataism (wherein humans need not apply).

So far so good; unfortunately, his claims about the current state of affairs are supported by the thinnest of cobwebs, at least where medicine is concerned:

“It is highly likely that during your lifetime many of the most momentous decisions about your body and health will be taken by computer algorithms such as IBM’s Watson.”

It isn’t.

“Google, together with the drug giant Novartis, is developing a contact lens that checks glucose levels in the blood every few seconds by analysing the composition of tears.”

Not any more.

“Twentieth-century medicine aimed to heal the sick. Twenty-first-century medicine is increasingly aiming to upgrade the healthy.”

Is he referring to the “ADHD” epidemic? Anabolic steroid use? Medicine’s record of messing with the healthy has so far been abysmal, there are no indications that this will change, and there are plenty of sick that still need healing. It’s not medicine that wants the upgrading, it’s the Silicon Valley tech bros, for the most part.

Yes, it’s only medicine, but it’s the part I understand the most and his conjectures, deductions, and extrapolations fall flat on their face.

A darker prediction: the best minds of the West are too busy monetizing the unjustified optimism and hubris of the monied classes to work on the important problems. A breakthrough, when it comes, will be out of left field and from somewhere less regulated, less devoted to a good narrative, and more prone to experimentation for its own (rather than financial) sake. It is now indescribable but will in hindsight seem inevitable, which makes it a terrible subject for a book on future history but a terrific one for true science fiction.

Written by Yuval Noah Harari, 2018

The Making of the Atomic Bomb

Miloš Miljković — Tue, 02 Apr 2019 17:12:00 -0400

Fifty years and what feels like ten times as many people crammed into a story of physics, engineering, politics, psychology, diplomacy, and war. An awesome book about an awesome topic, and yes that’s how awesome was meant to be used.

I enjoyed the first half of the book, about the physics of it all, much more than the second. It has fewer characters, all of them characters, and has fewer parallel stories to tell. A whole chapter is devoted to a manuscript authorship dilemma: kudos to Rhodes for making it interesting.
Niels Bohr and Ernest Rutherford were some of those characters. So was Marie Curie: “How does it feel to be married to a genius, Mdm. Curie?” “I don’t know, ask my husband”. Indeed.
If there’s anything that I got from the second half, about engineering and deploying the thing, it’s that large projects are messy, costly, and never completely satisfying. But that’s kind of a given.
With all the firebombing (Dresden et al), and two atomic bombs top it off, how much worse must have the Allies behaved for their atrocities to be equal to those of the Nazis? Note that Stalin was an Ally.
I knew little of Oppenheimer before reading this except that he got into political trouble after Los Alamos. The book doesn’t go there, but every mention of him foreshadows his troubles to come. Which would be very confusing if I knew absolutely nothing about him, and was still kind of confusing with the little knowledge I had.
Soldiers were much more interesting to read about than politicians, and came out on top in almost every confrontation.
I know what I wrote about the second half of the book, but the last three chapters are easily the best, and the way Rhodes covered the actual bombing of Hiroshima was masterful.

This will probably be the best book I read this year.

Written by Richard Rhodes, 1986

Sapiens: A Brief History of Humankind

Miloš Miljković — Fri, 25 Jan 2019 15:16:00 -0500

A speedy overview of the past 70 some millennia of humanity. Self-aware without being modest about its proclamations. Very 2014 in its optimism to dread ratio, but with enough forewarning that things might slip at any moment that it doesn’t appear naïve when being read in 2019. A few observations:

The book’s main thesis is that civilization as we know it lies on many, many figments of our collective imagination: states, laws, human rights, religions, corporations, etc. The last hundred years have sped this up, pulling people apart from families and other tangible local communities and into fictive constructs such as nations, sports teams, organized religion, and other forms of fandom. Are Twitter and Facebook communities more or less real than these, and if more, are they why people have been having a hard time suspending their disbelief?
Many religions are poked, proded, and pulled apart by witty turns of phrase, but Harari turns dead serious whenever buddhism is discussed. Unlike christianity and islam, buddhism gets whole running paragraphs of in-depth explanation. Did the book need a religious disclaimer?
His go-to example for discussing nationalist myths is Serbia. It figures. Kudos for doing it respectfully.
Another thesis is that capitalism lives by using up future resources in form of credit, which in turn produces and enlarges those very same future (now present) resources. In addition to being a very Predestination way of seeing things, does that support or conflict with Tyler Cowen’s thesis in Stubborn Attachments that we tend to — but shouldn’t — discount the future? Maybe we (or capitalists, at least) are at the same time optimists by thinking the future will be better by default, but also saying to hell with it by using those perceived future benefits now, to the detriment of future people? To this non-economist modern capitalism looks like an underbaked ideology.
This is the best-looking and best-made soft cover edition of a non-fiction book I’ve ever read.

Written by Yuval Noah Harari, 2014

How I handle email (which is not how everyone should, but you may find some of these useful)

Miloš Miljković — Sun, 20 Jan 2019 09:15:00 -0500

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.

Flashpoint: Trieste

Miloš Miljković — Sat, 12 Jan 2019 21:38:00 -0500

A history of the Trieste kerfuffle between Tito and the Allies immediately following WW2, but also an overview of the many warring sides: Non-soviet Allies, the Soviets, Tito’s partisans (“Yugoslavs” but also sometimes “Slovenians” and “Croats”), Chetniks (“Serbs”), Ustashe (“Croats”), Italian communists, Italian fascists, Italian non-communist non-fascist partisans, and let’s not forget the Nazis. Whew… At least the French are out of the picture.

It’s biased towards the Americans and the British, but then that’s not surprising considering the author. All other sides being equally horrible — according to the book at least, and it’s a lazy though intellectually safe stance to make — it manages to be sort of objective but then in a lot of cases resorts to citing some not very objective secondary sources written in the background of a much bigger kerfuffle in the 1990s. Jennings is no Ron Chernow, and even less of a Robert Caro. The region needs someone of Cs’ tenacity and attention to detail to untangle even the footnotes of Balkan history like Trieste. I can’t imagine who would be able to tackle a Power Broker-like biography of Tito, but I’d be happy to read one.

Written by Christian Jennings, 2017

Titan: The Life of John D. Rockefeller, Sr.

Miloš Miljković — Fri, 28 Dec 2018 14:42:00 -0500

A biography of the Rockefeller patriarch. It’s a messy book, but then it was also a messy 97 year-long life. A few highlights:

He benefited from starting his business, unencumbered by monetary or ideological debt, just when one of the greatest technological leaps of human history occurred. What got him all that money was luck and ruthlessness more than business acumen (what others thought) and religious zeal/hand of God (what he thought). His subsequent mostly failed business ventures confirm this.
Even so, it is his religion that led him to become the world’s greatest philanthropist, and also set up a template for modern billionaires on how to donate most of their fortune formally and on a grand scale. Yay for religion, then?
Rockefeller’s company Standard Oil and other trusts emerged at a time when legislature couldn’t keep up with rapidly evolving technologies; by the time laws caught up, it didn’t matter. Private data and human attention are 21st century oil.
You also have corrupt politicians, populist presidents, and progressive and gender/racially sensitive (dare I say woke) but ineffective intelligentsia. It all seems very familiar.
A search for “John D Rockefeller” on youtube brings mostly conspiracy videos and hilarious reenactments. I did find one video of the man himself in which he looks eerily like my grandmother.

Written by Ron Chernow, 2004

Voices in my head, 2019 edition

Miloš Miljković — Fri, 21 Dec 2018 12:10:00 -0500

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.
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.
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.
Revisionist History. Yet to listen to the latest season, but I can’t see it going badly. Malcolm Gladwell is a pro.
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 drunkard’s walk: How randomness rules our lives

Miloš Miljković — Wed, 28 Nov 2018 11:37:00 -0500

An introduction to the normal distribution and to our incompetence in dealing with probability. Since it covers a different type of probability than “Fooled by randomness”, and only skims the heuristics and biases discussed at length in “Thinking, fast and slow”, it works well as a prologue to both books. This trio should be mandatory reading for premeds, by the way, with the rest of Taleb’s Incerto rounding out an advanced curriculum. They would for sure have served me better than the anemic statistics textbooks I had to plough through in the early ‘00s.

Written by Leonard Mlodinow, 2009

Buffet: The making of an American capitalist

Miloš Miljković — Tue, 27 Nov 2018 13:25:00 -0500

I’m glad the author, Roger Lowenstein, didn’t even attempt to appear impartial in this, Amazon’s most highly rated of Warren Buffett biographies. It’s the reverse of a Power Broker hit job: in the reprint afterword, Lowenstein is wistful about not getting more praise from Buffet while the aforementioned is signing the author’s personal copy at a conference. How wonderful it would be if our heroes loved us as much as we love them.

Granted, Buffet is an easy person to love, what with being an aw-shucks Midwestern pro-government regulation democrat who is modest, smart, and also one of the richest people in world. That he first earned his money off of America’s addiction to sugar and shopping, followed by tobacco and war, followed by decidedly inegalitarian buddy deals, all while neglecting his wife to the point of her leaving, and his children to the point of their becoming New Age musicians, just supports his claim to being the most American of all American heroes. Kudos.

Written by Roger Lowenstein, 2008

A Wrinkle in Time 👎

Miloš Miljković — Tue, 20 Nov 2018 17:07:00 -0500

So much wasted potential in this one. It could have been a great movie for both children and adults, a Labyrinth for the age of CGI and social justice. Instead, it’s a confused, hurried mess in which lots of Stuff happens for no good reason; a Michael Bay extravaganza for your middle-schooler. My daughter (6) liked it, but even she questioned a major plot point. “But, why did X become evil, daddy?” I’ve no idea, Honey, and I’m not sure the screenwriters gave it much thought either.

Such is the faith of many book adaptations; this one even more so, having had to pass through the Disney committee wringer. I haven’t read the book(s? That’s how much I know about the potential franchise) but I’ve read and watched enough fantasy to know that 1) your made-up world needs to have rules, and 2) if you break them, it better be for a good reason. The few week rules set in the Wrinkle’s first half are promptly broken at the half-time, with no explanation and nothing to replace them. Instead you get a holodeck of a planet, where anything can happen: hurricane in a haunted forest turns into a Stepford wives cul-de-sac turns into a crowded beach, and no there is nothing connecting those dots.

Which is too bad — each one of those scenes would’ve made a good episode for the second season of the unmade Wrinkle TV show, perfect for Disney’s new streaming service. Such a waste.

Directed by Ava DuVernay, 2018

Ending medical reversal

Miloš Miljković — Mon, 12 Nov 2018 10:23:00 -0500

The first thing I picked up after taking the hematology boards was this gem from Chicago’s medical royalty (Adam Cifu) and everyone’s favorite oncologist (this is of course a joke — you know that people hate your guts, Vinay).

I didn’t, and still don’t, care much for the title. It is ambiguous: if medical reversal means overturning an established practice that was based on weak to no evidence once stronger evidence comes along — usually in the form of a (multi-center, blinded) randomized controlled trial — why on earth would you want to end reversals? Well, the book is about how to stop those kinds of practices from becoming established in the first place, which would indeed end medical reversal, but an easier way to stop them and one that would be endorsed by most of industry and many researches would be to just not look. “Ending Medical Reversal the Hard Way” is therefore a more appropriate name.

Title aside, I agreed with pretty much everything they wrote, from reforming medical education, through stopping direct-to-consumer marketing and direct-to-academic (not their words) payments, to having more people participate in (simpler, cheaper, and fairer) randomized trials. I enjoyed their honesty and clear style, and wished my medical school had at least a passing resemblance to the one they proposed (if you thought US medical education leaned too much on basic science-oriented and was heavy in professorial mechanistic proclamations, try the average European med school). Granted, I work in a federal research hospital and focus on some of the rarest of the rare diseases; but that only makes me shake my head in disbelief more when my colleagues who specialize in breast or lung cancer, not to mention coronary artery disease and diabetes, randomize enormous numbers of patients to search for minute differences in surrogate outcomes.

Written by Vinayak Prasad and Adam Cifu, 2015

Stubborn Attachments

Miloš Miljković — Sat, 20 Oct 2018 09:10:00 -0400

This is as close to a “Rules for Life” book as we’ll get from Tyler Cowen, and if you’ve listened to his podcast or followed his blog what’s inside won’t surprise you — but it will make you think. Which is good: surprise is overrated anyway, and things that depend on it don’t do well on re-reading/watching/listening. I’ll be coming back to this one.

Cowen argues that growth is good even when it doesn’t benefit everyone all the time. There are things that can grow that you can’t measure (like happiness, life satisfaction, health, culture, feeling of superiority [I may be misremembering some of these]), so don’t focus on wealth only but instead on Wealth Plus. Also, distant future is just as important as the near future, so don’t sacrifice long-term prospects for short-term gains. Speaking of future, we can’t predict it, so even though tiny decisions can influence it in an oversized manner we should stop fretting over those and focus on the big picture: which is to chose policies that provide the greater sustained benefit sooner. Finally, common sense morality can usually steer you in the right direction, but if it feels like it’s not, remember everything else in the book and you should be all set.

That’s all well and good, except that I kept imagining someone from Serbia — currently a second-world European kakistocracy — living by the standards of this book. Hilarity ensued: for things would be included in Wealth Plus that Cowen hadn’t foreseen (the ability to redraw borders, to name one), and common sense morality would include good doses of nepotism, chauvinism, and the desire to cheat the state (yes, yes, I know, #notallserbs).

So the first thing that’s keeping this book from being great is that it can’t be universally applied — it was written by an American for his fellow Americans who have lost their way — and doesn’t explore, or even mention, the implications of his vague concepts of Wealth Plus and common sense morality being different around the world.

The second is that shortly after admitting that economists don’t have crystal balls (the twelve-year-old me would have loved to put parentheses around “crystal”), he goes on to compare hypothetical policies based on their projected rates of growth well into the future. It may be my lack of an economic background speaking, but how can those two go together?

But do read the book. After my first pass I can say it’s good, if not great. For me as a doctor the idea of delaying gratification for long-term gains felt familiar. The oncologist in me would add that inflicting harm for a known long-term benefit is also reasonable and depending on the alternatives even preferred. Of course, it took centuries of wading in the dark before medicine got to the point where it could with any certainty predict the outcome of its interventions. Are social sciences there yet?

Written by Tyler Cowen, 2018

Applied minds: how engineers think

Miloš Miljković — Fri, 07 Sep 2018 16:07:00 -0400

I wanted to like this book more than I actually did. The title is seductive for those of us who work with people’s very unengineered fleshy bits: would it help if we added some engineering tools to our mental toolbox? Well, maybe it would, but this book couldn’t help me find them, being more of an essay on why I should think like an engineer rather than an instruction manual on how.

Apparently, you need a lot anecdotes anecdotes to explain the Why; stories zip by so fast they gave me whiplash. There are too many narratives and not enough thoughts: instead of just buttressing the main point or two, the anecdotes take center stage, sprinkled with outlines of different ideas that never become central.

For a book about engineering, I expected better construction.

Written by Guru Madhavan, 2016

If on a winter’s night a traveler

Miloš Miljković — Sun, 15 Apr 2018 18:02:00 -0400

The book is almost forty years old but it could have been written yesterday. It is short, smart, punchy, and very, very meta. It also makes me want to learn Italian, though I understand William Weaver is a good translator.

Written by Italo Calvino, 1981

The death and life of great American cities

Miloš Miljković — Wed, 24 Jan 2018 18:30:00 -0500

Jane Jacobs loved Greenwich Village so much that she wrote a book about why that was and why more neighborhoods weren’t like it. She looked at other similar areas in Boston, Chicago, Philadelphia, etc. as well some failed ones, and gave a few guidelines on what was needed for safe, lively, and desirable city streets.

It has enough whimsical observations of city life to keep things interesting for its too-many—over 400—pages. E.g. on a city park’s homeless population:

Almost imperceptibly, like the hand of a clock, the raggle-taggle reception creeps around the circular pool at the center of the square. And indeed, it is the hand of a clock, for it is following the sun, staying in the warmth.

Or, comparing a safe-but-dirty city street to a desired but decidedly unsafe park:

The sidewalks were dirty, they were too narrow for the demands put upon them, and they needed shade from the sun. But here was no scene of arson, mayhem or the flourishing of dangerous weapons. In the playground where the night-time murder had occurred, things were apparently back to normal too. Three small boys were setting fire under a wooden bench. Another was having his head beaten against the concrete. The custodian was absorbed in solemnly and slowly hauling down the American flag).

It’s all quite lovely. But ultimately, it is an exercise in confirmation bias that misses as many essential points as it reveals. What was arguably the most devastating influence on American cities — Robert Moses — is but a misguided elderly official who, and kudos to him, knows his way around public funds. City planners like big, disruptive projects because of their bad (deductive!) reasoning, not because they give politicians photogenic ribbon-cutting ceremonies.

If you want to know why American cities are the way they are, better read The Power Broker.

Written by Jane Jacobs, 1961

The Last Jedi 👊

Miloš Miljković — Mon, 08 Jan 2018 10:16:00 -0500

Extraordinary set pieces strung together by the thinnest of plots, based on an absurd, sitcom-worthy failure to communicate. A particular subplot should have been spun off as a buddy cop movie.

The Ray-Luke-Kylo triangle should have been a bigger part of the movie, but then many of the new characters, the ones that aren’t white and/or men, would have nothing to do. Such are the problems of building on an old and popular franchise: you can’t both stay true to the roots and change with the times.

It has cute animals and looks good in 3D though, so Dora (5.4) approves.

Directed by Rian Johnson, 2017

What I believe that most people probably don’t (no data behind this, just the armchair)

Miloš Miljković — Wed, 27 Dec 2017 15:31:00 -0500

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.

Brush up on your Serbian

Miloš Miljković — Wed, 27 Dec 2017 07:42:00 -0500

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).

A few unpopular (in certain circles) opinions from a person who has no rights having them

Miloš Miljković — Sun, 24 Dec 2017 09:45:00 -0500

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 in my head, 2018 edition

Miloš Miljković — Sat, 23 Dec 2017 18:03:00 -0500

(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.

The hero with a thousand faces

Miloš Miljković — Wed, 07 Jun 2017 03:12:00 -0400

What you do is you take as many fairy-tales and myths and other stories as you can — Campbell is extraordinarily good at collecting them — then squint and trace out the patterns. Us humans are very good at finding patterns where none exist (just ask Percival Lowell), so it is no wonder that we end up with an overarching story, albeit disjointed, which is — of course it is — steeped in New Age monism.

Plot twist: unlike similar attempts in other arts, this one becomes wildly successful, serving as a template for other stories that end up following it more closely than any of the tales of old ever did (see Kevin Garvey’s literal and metaphorical travails for the most recent example). I like The Leftovers, so I would say The Hero… is a net benefit for the civilization. It just wasn’t for me.

Full disclosure: I stopped reading the book near the end of the first (of two) sections, the one about The Hero’s Journey. I therefore never got to the Cosmogonic cycle, and cannot comment. Do let me know if there was a surprise ending.

Written by Joseph Campbell, 2008

50/50 👍

Miloš Miljković — Sat, 06 May 2017 16:36:00 -0400

An oncologist(?), a psychologist, and a surgeon give master classes on unprofessional behavior while treating JGL and his unfortunately named tumor. Even though only one of the three was meant to look bad in the movie, they each break a fundamental rule of the doctor-patient relationship: don’t be a douchebag, don’t sleep with the patient, don’t tell them everything will be fine when you have no clue. Cut out the profanities, and you’d have a semester’s worth of medical ethics discussions.

Cut out the profanities, though, and you’ll miss half the movie. Seth Rogen — a dirty old man trapped inside Fozzy the Bear — does what he’s been doing ever since Judd Apatow found him, heart of gold included. Fortunately, 50/50 has better timing than anything to come out from the Apatow cringe factory, and even has a point.

Medical miscellanea: was the diagnosing physician a medical oncologist, neurologist, neurosurgeon, or an orthopedic surgeon? Likely not the first, else he wouldn’t give neoadjuvant cytarabine for a sarcoma, and probably not the latter two since another, overoptimistic MD does the actual surgery. Can a psychologist perform interviews for what she admits will be her PhD thesis without getting informed consent? How can a surgeon say with any certainty that “everything will be fine” minutes after performing what she admitted to be a difficult operation for a tumor with a relapse rate north of 50%. You know, the 50% that gave the movie its name.

Still, thumbs up.

Directed by Jonathan Levine, 2011

Doctor Strange 👎

Miloš Miljković — Wed, 26 Apr 2017 06:58:00 -0400

Inception for the Disney Franchise Age of American cinema. Trying to be deliberately inoffensive to a particular class of consumer, it dodges Mickeydom’s most glorious moments of cultural sensitivity only to fall on the sword of blandness. But credit where it is due — it takes talent to make a trippy 60s comic book that’s oddly relevant in today’s world of magic mystery turmoil into a boring, predictable, dull, uninspired, yawn-inducing, delta wave-producing, paint-by-numbers origin story.

And if you thought only the Strange-ness was fumbled you must not be a doctor, because his day job features the most laughable medicine this side of the Human Centipede. Though I shouldn’t complain too much — I imagine aerospace engineers cringe an order of magnitude more when watching any other Marvel miracle.

Thumbs down.

Directed by Scott Derrickson, 2016

Black Swan 👍

Miloš Miljković — Tue, 25 Apr 2017 07:17:00 -0400

Every ballet metaphor told and/or written by dancers, visualized: you don’t feel like a swan, you become one; competitiveness means murdering the competition; and liberating yourself from constraints is suicide. It is on the nose and at times painful to watch, but I would not expect anything else from the master of the afterschool special.

Portman is a pro: she gets you to swallow the banal white swan/black swan analogy whole, and ask for more, goes through every exercise in Aronofsky’s mental torture playbook like it’s nothing, and looks believably cool and composed until she believably isn’t. Watching her in this movie makes a certain trilogy an even bigger crime against directing.

Thumbs up.

Directed by Darren Aronofsky, 2010

Stoker

Miloš Miljković — Sat, 25 Mar 2017 10:59:00 -0400

Derivative drivel.

Directed by Chan-wook Park, 2013

La La Land

Miloš Miljković — Thu, 23 Mar 2017 18:49:00 -0400

A solid attempt in recreating musical films of old that succeeds in all the technical details — the cuts are smoother, the camera livelier, the sets more real — but fails in a thing that matters more: talent. Literally anyone (yes, anyone) from the cast of Hamilton would have been a better choice for Bigeye’s partner. Heck, Justin Timberlake would have made more sense, being a human being of actual musical ability, and if you are forcing me to recommend Curly for a role in your movie, your have miscalculated horribly.

The only way Gosling would possibly have made sense was if you were making a point that anyone could sing, but then don’t make the character a musician, and better don’t do that movie at all since it had already been done much better on TV 15 years ago by a man who knows his musicals. And this is clearly not what Chazelle was trying to do, what with him incorporating high-level bizarre dance numbers and movie-making subplots reminiscent of the greatest American movie ever made.

Emma Stone is a real jewel, though.

Directed by Damien Chazelle, 2016

Birdman

Miloš Miljković — Tue, 14 Mar 2017 16:54:00 -0400

A faux-continuos shot of a washed-up superhero movie star trying to stage a Broadway comeback. The way it plays with space and time is admirable, and the law company of Keaton, Norton & Stone does their job with perfection, but the subject matter is so far up Hollywood’s large intestine that Birdman should best be compared to another well-known continuous shot.

It is on-your-nose pretentious, and artsy by design, yet too loaded with contemporary references to become timeless. Its one deep message — the one about criticism — was much better stated, and with a more positive attitude, a decade ago in an animated film about a rat. Iñárritu must have made it on a dare.

Directed by Alejandro G. Iñárritu, 2014

Hacksaw Ridge

Miloš Miljković — Tue, 07 Mar 2017 07:07:00 -0500

An old-school paint-by-numbers war movie. Each kind of scene in it has a bar that’s been set long ago, and it doesn’t surpass any of them. Some are so high above it’s like they don’t exist. It does set some standards of its own, most notably for dehumanizing the enemy, who is never given more than 10 seconds of film at a time and always with a growling face straight out of a propaganda poster.

That is a shame. The story of Desmond Doss as told in 2016 deserves better than a WW2 also-ran and an illiterate journal article, for at least two reasons: he saved everyone he saw on the battlefield, American and Japanese; and no-one could get the number of people he helped straight, even as he was being given the Medal of Honor. Wondering how the other side thinks and feels, and sorting between truths, half-truths, and alt-truths are the themes of this decade, so it must have taken a lot of determination (or ignorance) on Braveheart’s part to ignore them so completely. Sort of like I’m ignoring Mel’s pet theme that wants to be central but can’t quite make it.

PS: Spiderman Jr. does his best doing Jimmy Stuart doing a pious army medic, and almost makes it. Vince Vaughn makes a good drill sergeant. This is not a failure of acting.

Directed by Mel Gibson, 2016

Kiss Kiss Bang Bang

Miloš Miljković — Mon, 06 Mar 2017 11:06:00 -0500

Neurotic burglar with a heart of gold meets neurotic gay private investigator for some neurotic fourth wall-breaking shenanigans. Ironman’s vintage post-rehab quips are supposed to be endearing, but turn the movie into an annoying Ally McBeal spinoff that’s even less sure of itself. Val Kilmer’s misshapen botoxed head mumbles through most of the lines, though his penis features in a memorable scene. There are many more gags that are just as good, but are connected by a not well thought-out metaphor (is it a home movie on a reel? on tape? is it just playing in Downey’s head?) to make a twisty-turney plot that’s meant not to be followed (not unlike this sentence).

Good thing Michele Monaghan is there to eat their lunch and make the movie watchable.

Directed by Shane Black, 2005

Moonlight

Miloš Miljković — Tue, 28 Feb 2017 06:53:00 -0500

A poem in three verses about introversion and grit that is also a story about a boy growing up black and gay and functionally parentless in a poor Florida neighborhood. Through symmetry, silence, and omission, that depressing premise — imagine having to be a teenager in Florida — never invokes depression. Compare and contrast to sad tales of straight white lower-middle class woes.

Since issues of identity, gender, and race are somewhat of a thing in this early 21st century, the movie is also a Rorschach test for its audience. A thousand opinion pieces bloomed in its wake, few of which as deep as a single scene, yet quite a bit more pretentious. Thousands more are to come in liberal arts colleges across the country, and deservedly so — many films tend to induce sympathy and elation in one particular group of people, awkwardness and shame in another, and this one time those two groups have flipped.

Directed by Barry Jenkins, 2016

Whiplash

Miloš Miljković — Sun, 26 Feb 2017 07:35:00 -0500

A.k.a. Whiplash: The Truth Behind the 10,000 Hour Rule.

Parker’s a young kid, pretty good on the sax, gets up to play at a cutting session, and he fucks it up. And Jones nearly decapitates him for it. And he’s laughed off stage. But the next morning, what does he do? He practices. And he practices, and he practices with one goal in mind: Never too be laughed at again. And a year later he goes back to the Reno and he steps up on that stage and he plays the best motherfucking solo the world has ever heard. So imagine if Jones just said “Well, that’s okay Charlie. That was alright. Good job.” Then Charlie thinks to himself “Well, shit. I did do a pretty good job.” End of story. No Bird. That, to me, is an absolute tragedy. But that’s just what the world wants now. People wonder why jazz is dying. I’ll tell you, man - and every Starbucks “jazz” album just proves my point, really - there are no two words in the English language more harmful than “good job”.

If delivering this dialogue gets you an award, how on Earth does writing it not also get you one? Never mind the precise shots, impeccable pace, midpoint that could have been a short movie on its own, and the adrenaline-surge-inducing ending that is musical, cinematic, and deeply philosophical all at once. Movies at their best.

Directed by Damien Chazelle, 2014

Arrival

Miloš Miljković — Sat, 25 Feb 2017 08:13:00 -0500

Flat characters cipher through a thinly plotted array of science fiction concepts which are new enough to the non-reading public to make the movie palatable on novelty alone. Since novelty may be the only thing that counts in what is bracketed as SciFi — look at Interstellar being undeservedly panned — a movie whose emotional range begins and ends with a side plot of a dying child now has a shot at the Academy Award. Also, and it feels wrong to even have to write this, there are other ways to elicit emotion in your audience than killing off children, dear movie-makers of 2016.

Respect where it is due: passing of Hawkeye as a plausible physicist — by having him not talk about physics the entire movie, but still — and floating the idea of world unification in anno domini 2017 are admirable feats. Not enough to offset the hours wasted on walking through a hallway and 80s-style montages, though.

Directed by Denis Villeneuve, 2016

Manchester by the Sea

Miloš Miljković — Thu, 23 Feb 2017 06:45:00 -0500

A dour movie about dour people living dour lives in a dour New England town. The camera is static and so are our hero’s faces. Long periods of voyeuristic shots of everyday life are punctuated by rare expressions of minimal emotion. Answers to all our questions are quickly revealed and dramatic tension never builds up.

That kind of direction is fine if you are talking about a man’s mid-life crisis, but disturbing when your movie involves three children burning to death. Is seeing a couple of good acting performances worth subjecting yourself to emotional trauma that doesn’t result in a meaningful message (and anything on stoicism of the Irish can hardly count if the Simpsons have already done it)?

Medical things of note: congestive heart failure is a diagnosis as broad as lower back pain (i.e. not a real diagnosis at all); would anyone not work it up further, never mind that it is in an otherwise healthy 40-something; and do they not have ICDs in Manchester, MA? Coach should not have died, least of all because without his death we wouldn’t have had this movie.

Directed by Kenneth Lonergan, 2016

Looper

Miloš Miljković — Sun, 19 Feb 2017 15:53:00 -0500

Although a movie that involves traveling through time, Looper is hardly a time-travel movie. Bruce Willis says as much when he brushes off any attempts to discuss the mechanics, implications, paradoxes, etc. for reasons of expediency. So, Primer, Predestination, or even Back to the Future II this ain’t. Groundhog Day is more like it, only with shotguns, telekinesis, and a far messier ending.

That’s unfortunate for me, since I prefer pure time-travel movies; and there isn’t enough — or any, really — Bill Murray in Looper to justify comparing it to that other category. JGL spends too much time pretending to be Willis, who in turn phones it in. Elevator/hallway action scenes are good, but don’t come close to the peak of the genre (or even the western take, which was fundamentally a feature-length interpretation of that one scene from Oldboy).

There is, in fact, nothing new to see here, and the movie feels as flat as the Kansas plain it is set in. The one interesting thing about it is that, in what is the complete opposite of the director’s previous movie, Looper might be better appreciated in a vacuum.

Directed by Rian Johnson, 2012

The Dark Forest

Miloš Miljković — Wed, 15 Feb 2017 07:04:00 -0500

Starts several years after The Three Body Problem and ends 200 years later, shortly after the first (brief, horrific) physical contact with alien technology. The future’s clean, white, Apple-y aesthetic was annoying enough for me not to feel too badly after it imploded, and the humans of the future were just as grating, but I assume that was one of the big points Liu wanted to make (that we are more closely related temporally than we are geographically or genetically, that is, not that Jony Ive is a future-human).

Another point: a book about humanity’s impending demise has a good quarter of it dedicated to one man’s delusions about art and love. Those passages end up being directly relevant to the plot, but if anything, that takes away from them.

Finally, the character who ends up being the book’s main proponent of historicism dies in the best standoff since the Gotham prisoners’ dilemma, which ends up being only the second-best of the many standoffs the book presents. It is a beautiful, self-referential standoff heaven.

Written by Cixin Liu, 2015

Miss Peregrine’s Home for Peculiar Children

Miloš Miljković — Sun, 12 Feb 2017 08:53:00 -0500

Stylized but not psychedelic, quirky but not disturbing, borrowed liberally from The Prisoner of Azkaban but with good effect. It’s one of Tim Burton’s better Tim Burton movies.

Yes, yes, the plot has holes, and some of the characters’ motivations are… peculiar (har har). The more important thing is this: after seeing it, Dora wanted to fly.

Directed by Tim Burton, 2016

While We’re Young

Miloš Miljković — Sat, 11 Feb 2017 07:27:00 -0500

The title fools you into thinking the movie’s central conflict is between youth and old age. Turns out, the generation gap is only a setup for the real fight — that of authentic versus fake. It culminates with (old, authentic) Ben Stiller neurotically rollerblading into Lincoln Center, hoping for a catharsis after he reveals to his documentary film-making giant of a father-in-law that (young, fake) Kylo Ren based parts of his own documentary on alt-facts.

“Things change”, replies Mr. Breitbart, minutes after giving a speech on honesty in filmmaking. “Different things matter now.”

A sadly prescient moment in a sadly prescient movie.

Directed by Noah Baumbach, 2014

Begin Again

Miloš Miljković — Tue, 07 Feb 2017 07:21:00 -0500

Keira Knightly pulls off the sweater-wearing, guitar-wielding singer-songwriter nicely. Adam Levin doesn’t pull off acting — good thing none was needed for his cipher of a character. Kathleen Keener and Mark Ruffalo reprise their roles from every other movie they made.

Fluffy, predictable, forgettable.

Directed by John Carney, 2013

Captain Fantastic

Miloš Miljković — Sun, 29 Jan 2017 07:26:00 -0500

The Little Miss Sunshine of the twenty-teens is a wet dream for a certain kind of liberal: a family that is smart, good-looking, self-reliant, and self-aware; in which the eight-year-old knows both the content and the significance of the Bill of Rights, and the eighteen-year-old has his pick of Ivy League schools but chooses to go to Namibia; in which a Lolita-reading teenager unironically asks what is Coca-Cola, and gets poison water as an answer; in which the fireside homeschool-assigned reading session (Guns, Germs, and Steel; Brothers Karamazov; The Fabric of the Cosmos) breaks for a family drum circle.

Sadly, mom kills herself while hospitalized for depression far away in New Mexico, a road trip ensues, thoughts, feelings, and inadequacies of their lifestyle are exposed. The setup is better than the second act, during which 1) the captain of the freshly single-parent household is predictably un-fantastic, and 2) the middle-crassness of his extended family is blown out of all proportion. The payoff is better — if nothing else, it will make its New Yorker-reading audience think.

Vigo Mortensen was, apparently, destined to be in this movie. The question is: wouldn’t it have been better — and truer to its message — as a book?

Directed by Matt Ross, 2016

How to write a thesis

Miloš Miljković — Sat, 28 Jan 2017 17:33:00 -0500

Umberto Eco’s rules and advice on how Italian university students of modest means should choose a relevant topic, conduct and organize research with limited resources, and format their final undergraduate thesis. Though created by and for someone in the humanities, much of it applies to all sciences — and the parts that don’t are at least entertaining.

It was written in 1977, revised in 1985, and revised again when translated to English for both cultural and temporal/technological adjustments. A translation to Serbian (which is, amazingly, freely available online) needed neither, as Serbia and Italy have similarly dysfunctional systems of higher education.

For a book whose most important section is the one on taking notes and organizing research, this edition has remarkably small margins and tight binding. No matter — it will feature prominently in the Acknowledgments section of my PhD thesis, if and when I finish it.

Written by Umberto Eco, 1977

They Came Together

Miloš Miljković — Thu, 26 Jan 2017 06:35:00 -0500

The difference between loving homage and gross parody can be subtle, and what the movie ends up being usually depends on whether the author(s) actually like the genre they are spoofing. It is an easy guess, for example, that Edgar Wright likes zombie apocalypses and buddy cop movies, or that Joss Whedon is into horror films.

The people who made this thing must truly hate romantic comedies. It doesn’t wink at rom-com tropes — it blows them out of all proportion, the acting is even cheesier, camera work blander. I could pick out clips for these, but its’s the entire movie. Moreover, the comedies it references are dated, going with When Harry Met Sally (1989), You’ve Got Mail (1998), and Notting Hill (1999) over the more recent and even more ridiculous Love Actually interconnected plot wannabes. And the jokes are just too obvious.

Making fun of something that is easy to make fun of is easy. Making a good movie that is also a parody is hard. They Came Together (ha ha) is a decent parody.

Directed by David Wain, 2014

The Autopsy of Jane Doe

Miloš Miljković — Mon, 23 Jan 2017 06:51:00 -0500

A haunted house movie where the house has a morgue in the basement (America is weird) and the ghost is lying on a stainless steel cart, all peaceful and symmetrical until a father-son team of coroners begins slicing into her. Roose Bolton is again to blame, in a way, but has more sense at the end of this one while leaving room for a sequel (The Autopsy 2: Richmond Horror, a working title that I just made up, so you can stop googling it).

It’s a nice—if short—ride that would be much scarier for those who never attended an autopsy, but between the pacing, the acting, and the near-absence of jump scares, it’s the best horror movie I’ve seen since It follows. It gets extra points for being truer to the genre—no hipster soundtracks here.

And no, you can’t put a think chunk of freshly brain under a microscope and see cells, much less figure out if a neuron is alive just by looking at it for 1.5 seconds. Brian Cox can sell anything, though.

Directed by André Øvredal, 2016

Brick

Miloš Miljković — Sat, 21 Jan 2017 08:00:00 -0500

Twenty-somethings here are playing SoCal high-schoolers who talk like they are on the set of The Maltese Falcon; but it’s not Bugsy Malone with a slightly older cast, and it’s not sort-of-like film noir, either. This is a film noir, complete with a Gordian knot of a plot, gritty textures half-concealed in darkness, and telegraphed archetypes (the loner, the vamp, the femme fatale).

The teenagers seem parentless—save for a comic relief scene or two featuring the mom of our archetypal kingpin serving the boys cookies and OJ—and the few other adults in the world treat them as equals. Clearly a fantasy, but you will have suspended your disbelief long before then.

It fares well when compared to the competition—but then, most of it had been made in the 1940s, so I wouldn’t call it a fair fight.

Directed by Rian Johnson, 2005

An Education

Miloš Miljković — Thu, 19 Jan 2017 11:38:00 -0500

The Worst Father in the World, here played by Alfred Molina, prefers wedding off his smart and ambitious underaged daughter (Sally Sparrow, 24 going on 16) to a 30-something con artist of means (a smirking Skarsgard), rather than financing her studying English at Oxford. It is the 1960s—why waste money on tuition if her only reason for attending university is to find a good husband?

She likes his opera-champaign-trips-to-Paris lifestyle, he likes that she speaks French and looks at him like a God, so it looks like a win-win-win as she abandons high school for an engagement ring. But if you hang around scammers you will get scammed, and soon she learns he has a wife, a son, and countless past jeunes femmes like her, some of whom ended up with child. A deus ex machina in the form of an English teacher does help her get into Oxford, and she lives long and well enough to be able to write the memoire that Nick Hornby turned into this screenplay.

Not a masterpiece, but serviceable as educational material for preteens. I hope Dora will grow up not to be as impressionable to sleazeballs.

Directed by Lone Scherfig, 2009

The Three Body Problem

Miloš Miljković — Wed, 18 Jan 2017 15:20:00 -0500

Written by an engineer, and reads like it. It uses a broad brush—with not much description or characterization—to explore such trivialities as life, reality, human perception, and humanity’s place in the universe.

Much of it has a sense of odd turning into familiar: the bloodshed of the Chinese Cultural Revolution projected onto the book’s pro-alien human factions and real world’s opposed-yet-alike movements; virtual realities inside a nesting doll of x-dimensional spaces that may themselves be virtual; environmental dangers, imagined and real.

Einstein supposedly pictured himself chasing a beam of light before developing his theories of relativity. Liu imagined standing on the surface of a planet quite unlike Earth to come to this book and its two siblings. Based on the first installment, I can tell that investing some time in the trilogy will be worth it.

Written by Cixin Liu, 2012

Children of Men

Miloš Miljković — Wed, 18 Jan 2017 14:41:00 -0500

Children of Men has aged well. Too well. Between Brexit, Zika, islamist fundamentalists, and police brutality, 2017 is much closer to the version of 2027 the movie portrays than what Cuaron could possibly have imagined while writing and directing it.

Brilliant long tracking shots include Juliane Moore’s bloody demise in a post-apocalyptic British mini-car, and Clive Owen’s race through a desolate seaside town-slash-rebellious refugee camp to find the only baby alive on Earth. A lot of the movie could now be described as a Twitch video, though back then first-person shooters were decidedly less realistic.

If this were Interstellar, Owen would have lived through the end and be reunited with a resurrected Moore. Fortunately, it is not.

Directed by Alfonso Cuaron, 2006

The culture that is Nortwest Washington DC

Miloš Miljković — Tue, 12 Jul 2016 11:17:00 -0400

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.

And the fiddling continues

Miloš Miljković — Sun, 10 Jul 2016 11:57:00 -0400

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

Congratulations, Andy.

→ Annals of internal medicine: Curiosity

Miloš Miljković — Tue, 08 Mar 2016 15:01:00 -0500

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.

Submitted without comment

Miloš Miljković — Tue, 23 Feb 2016 14:19:00 -0500

→ NYT: Cancer and Climate Change

→ Esquire: When the End of Human Civilization Is Your Day Job

→ Guardian: Sea levels rising at fastest rate in 2,800 years due to global warming, studies show

OK, one comment: do not buy any coastal properties.

Level up

Miloš Miljković — Thu, 18 Feb 2016 13:57:00 -0500

The next time someone asks me about books to read before residency, I will direct them here. You don’t have to be a medical trainee to benefit from these, but that period of anxious anticipation between match day and orientation is perfect for buffing your attributes.

How to read a book, by Mortimer J. Adler

What better way to start learning about learning than by reading a book about reading books?

The Farnam Street blog has a nice outline of the book’s main ideas. The same establishment is now hocking a $200 course on the same topic. It’s probably good, but at $10 the source material is slightly more affordable.

Getting things done, by David Allen

The first few months you will be neck-deep in scut work no matter what you do. After that, though, you will have to juggle patient care, research, didactics, fellowship/career planning, and piles of administrative drek—and that’s just inside the hospital. At the very least, this book will help you make time for laundry (and maybe some reading).

Thinking, fast and slow, by Daniel Kahneman

Superficially, similar knowledge to what is in these 400+ pages can be found in a few Wikipedia entries. But you would miss out on the how and why cognitive biases and heuristics are so important. Medicine and research are bias-driven endeavors, and not understanding them is not knowing real-world medicine.

Only three? Yes. If anything, the two and a half months between mid-March and July 1st won’t be enough to read them all with the attention they deserve. But you should try.

Podcast time

Miloš Miljković — Thu, 11 Feb 2016 14:16:00 -0500

Another year, another round of podcast recommendations:

No, it’s not your browser. The list is empty.

After 10 years of attaching electric appendages to my head using flimsy earhooks some call ear-phones, I have decided that one voice in my head at a time is quite enough, thank you, and that there are better ways to muffle the sounds of everyday existence than the nasal overtones of middle-aged white men.

Who will be crushed to lose me as a listener, I am sure.

I haven’t suddenly decided that they are all bad, mind you—I have spent cumulative months listening to them, so they must be good. The problem is, I like them too much.

Behold my modified CAGE questionnaire for podcasts:

Have you ever felt you needed to Cut down on your time spent listening to podcasts? Doing it right now.
Have people Annoyed you by criticizing your listening to podcasts at inappropriate times? Does my wife count as people? If so, then yes.
Have you ever felt Guilty about listening to a podcast instead of doing something else? You mean like sitting in the car 10 extra minutes after coming back home from work, waiting for an episode of Radiolab to finish? Umm…
Have you ever felt you needed to put on your headphones first thing in the morning (Eye-opener) to finish listening to last night’s podcast, or to get a head start on completing the unplayed list. “Felt like?” I do it all the time.

Aced it.

Granted, being mostly free, not too hard on your body, sometimes educational, and often entertaining, podcasts are not the worst thing in the world to be addicted to. But to be alone with your thoughts is exceedingly rare when there is a toddler in the house—rare enough that you do not want to spoil it by introducing external stimuli which make it impossible to string a chain of thought longer than the 30-second commercial break for Squarespace.

Farewell, voices. It was good while it lasted.

Storytellers

Miloš Miljković — Mon, 08 Feb 2016 13:15:00 -0500

Last week I shared a brief reflection on a tiny aspect of my commute. Please check it out it if you haven’t already, it is a quick read.

Wasn’t that nice? It started by introducing some old concepts in a new light—you knew about trains before, and maybe even knew there was a MARC Penn that line goes from Baltimore to DC, but probably didn’t know the specific trains and their timetables. Then it gave you a coherent explanation of a phenomenon you hadn’t known about before. This first caused slight, but not unpleasant, cognitive strain while you were figuring out what I writing about, followed by the small pleasure of an ah-hah moment once the pieces clicked.

It was a brain massage, if you will. It was also complete bull.

Not that anything I wrote was wrong, as far as I know, but I didn’t give many arguments for it being right, either. There were no ridership statistics or arrival times to back up my claims. And even if there were—I didn’t give any alternative hypotheses to explain the situation, nor reasons why those would be less likely than my own explanation. When you think about it, it was more of a brain Twinkie than a massage—all empty calories, with a fleeting feeling of fullness.

Welcome to 99.99999% of the written word, and to anything ever spoken out loud.

We like stories. They need to make a threshold amount of sense (this is why societies universally ostracize schizophrenics). They should contain an element of surprise (it is not that the 7:07 train would come later than the 7:23—twists like that do not surprise anyone any more—it is that it comes in much earlier because people think it wouldn’t). And they get bonus points if—as my last parenthetical implied—they paint the others as stupid or incompetent. There are many more checkboxes; more of them checked, the better the story.

Most professions are based on storytelling. Doctors tell different stories to their patients, each other, and themselves—as do most other scientists, to a different degree. Lawyers tell stories to their clients to make them believe they will craft good ones for the judge, jury, and the opposing side. Ask a marketer what makes a good commercial (spoiler: story).

Being a coal miner doesn’t involve telling stories. No one wants to be a coal miner.

Our minds prefer a good story over a true one, and will have us believe it more, too. However, the more boxes you see checked, the more suspicious you should be that someone manipulated the tale to make it more pleasurable, ergo memorable, ergo believable.

(So, if what you’ve just read made sense…)

If you are looking for an objective truth—or getting as close to it as possible—any medium that involves audio/visual queues will be an impediment. Sights and sounds stir up emotions, and emotions prime us to believe or not to believe. Pay attention to the background music in a documentary, or how the desk of that shifty lawyer they’re interviewing is a complete mess.

TV news is, of course, a joke—this is why comedy shows are becoming the most popular delivery form.

Written word has its own way of deceiving—anecdotes, incomplete data, misquotes, lazy references—all to make a better narrative. Just read anything by Malcolm Gladwell. And look at the time it takes to get to the bottom of just one tiny factoid in that story of the iron content in spinach. Finding truth is exhausting and exasperating, and people whose job it is to find it (hello, accountants) are way less fun than those who make stuff up. Mark Twain said it best:

A lie can travel half way around the world while the truth is putting on its shoes.

Misquoted? Most likely. Or is Huff Post wrong? It wouldn’t be the first time.

There is nothing in this post that bigger and better minds than my own haven’t written about already. But that’s a boatload of pages! Not many people have the time, discipline, and interest to read all that—and even if they did, they would keep making the same mistakes over again, as shown in several studies described in those same books (yes, yes, all studies are flawed; one windmill at a time, please). These things are hard-wired, and for a good reason—evolution doesn’t care for objective truths.

Or maybe it does. I don’t know, I’ve just made it up.

Also, this is happening

Miloš Miljković — Thu, 04 Feb 2016 06:56:00 -0500

Or it may happen, eventually, when I get to it. Probably close to the trial expiration date, if ever.

Sigh.

The 7:07 train dilemma

Miloš Miljković — Thu, 04 Feb 2016 06:36:00 -0500

Here is a screen grab of the the Marc Penn line southbound schedule.

Note train 415, departing Baltimore Penn at 7:00 (I get on at West Baltimore, so in my mind it’s the 7:07 train). Also note train 517—my 7:23, and the times they both arrive at Washington Union Station.

Is it ever worth taking the 7:07?

Well, actually, yes. Because:

Most commuters look at the schedule and make the same conclusion that you probably did: waking up at least 16 minutes earlier in the morning is not worth the 7 minute lead time you get in DC.
With that in mind, even if they leave early they don’t really rush to the 7:07; therefore significantly fewer people need to get in at each stop compared to the 7:23 and it usually gets to Union slightly ahead of time.
Because of more people waiting on the 7:23 it tends to limp along in the last few stops and doesn’t get to Union until 8:15 in the best of days.
The 15-20 minute difference does mean a lot if you have to use DC’s abysmal metro which gets crowded by the minute between 8 and 9.

These are the sorts of things you think about when your commute is almost two hours each way. If you would like to read more about extreme commuting (and who wouldn’t?), this old New Yorker article is a good place to start.

Yes, but why?

Miloš Miljković — Mon, 04 Jan 2016 13:47:00 -0500

This website is:

a public repository of articles, lectures, and other original works I authored or co-authored;
a place to repost comments, reviews, and recommendations I wrote on other sites (like Quora, Amazon, etc);
a place where my half-baked ideas and philosophizings go if I think them interesting enough for general consumption.

This last one is what gives me trouble. Ideally, if I think a topic is worth writing about, I should make the extra 3-day effort to gather references, edit it nicely, and have it published. But like the character in “The bridge on the Drina” who means to be the town chronicler but can never find an event worthy enough to write about, most subjects have me less excited the more I think about them. By the time I finish a blog post, then, I have no intention to revisit the matter.

This is an excellent filter against appearing foolish in print, but horrible for productivity.

Two solutions come to mind readily, with equal chances of failing—either stop posting the third category of articles altogether and start writing everything with an intention of publishing; or start writing even more with the hope that at least a small percentage of that will turn into something a journal would accept for publication.

The former is a set-up for procrastination, the latter—doing extra work in a hope to create material for even more work—oxymoronic . I will try both and see where I end up.

Locked in

Miloš Miljković — Sat, 02 Jan 2016 18:14:00 -0500

Two years ago, I haplessly expressed excitement about my task list manager of choice being updated soon.

Speaking of @culturedcode, looks like Things 3 is progressing nicely. Hope “more structure” is code for dependencies. pic.twitter.com/ctwycDyL1e
— Miloš Miljković (@Miljko) February 2, 2014

It hasn’t yet. Two iterations of iOS and an Apple Watch later, Things 3 is still not available, and I am becoming increasingly annoyed. Inside my mind, two kinds of costs—Ms. Sunken and Mr. Opportunity—are battling it out.

Mr. O has me thinking about time wasted on not being able to turn a next action into a project; or having to make too many taps to edit anything in the iOS app. And then I stress out even more contemplating all the features I don’t even know I’m missing out on—not wanting to find out about those is why I not dare read reviews of the competition.

Ms. S, meanwhile, is raising dread whenever I thinking about moving to Omnifocus, Taskpaper, or whatever the GTD app du jour is—knowing that I would be trading a set of known deficiencies for a potentially grater set of unfamiliar ones.

The mister and missus are irrational beings—even though Things 3 remains vaporware, there have been a few 2.x updates that iOS7-fied the experience—from going flat to adding extensions and notification center widgets. All that considered, I should not spend so much time thinking about an app.

And yet, it is 6pm on January 2, 2016, and instead of writing about getting back to the lab, finally finishing the PhD thesis, or being a haughty gastro-tourist in unseasonably warm New Orleans, I am being much too first-worldly for my Balkano-Serbian comfort.

Which I will add to the pile of absurd reasons for why I dislike Cultured Code.

Shonda Rhimes on work

Miloš Miljković — Tue, 17 Nov 2015 06:57:00 -0500

Work will happen 24 hours a day, 365 days of the year, if you let it. We are all in that place where we are all letting it for some reason, and I don’t know why.

Via Cal Newport’s blog

Can you post to a Pelican blog from iOS?

Miloš Miljković — Thu, 12 Nov 2015 12:33:00 -0500

It looks like you can, provided you have a server running somewhere. Mine is a 2013 MacBook Pro with a dying battery.

This one I’m writing in Drafts, which will then copy the post to a Dropbox folder monitored by Hazel. This should trigger a simple bash script that processes the markdown file and pushes the newly created html files to github.

Very Rube Goldberg-y, I know. I’ll try doing it from Editorial next.

Programming, meet medicine

Miloš Miljković — Fri, 14 Aug 2015 19:30:00 -0400

John Siracusa is a programmer. Merlin Man is a lifehack guru-cum-internet personality. If you are in a medical field, there is no particular reason you would know them.

They co-host a podcast that modestly has themselves as the subject matter. It is one of the best new podcasts this year, second only to CGP Grey’s (though with Road Work coming out this week, it may be a three-way tie). In this week’s episode, Siracusa had this to say about programmers (link to the audio here—it sounds better than it reads):

Plenty of people can espouse information telling some younger programmer “make sure you always call ‘srand’ before you call ‘rand’”, and they can easily tell you “don’t listen to that guy, you should not call ‘srand’ before you call ‘rand’”.

Neither one of them really understands it, because they can’t explain it. If that young programmer is saying “But why? But why? Why? How do these things work together? Explain it to me.” and they realize “Oh, I can’t explain it. All I have is this…”—it’s not a cargo cult, but it’s more like—”I have this practice that I’ve learned through supposed bitter experience that if I didn’t do this one time and something didn’t work, then I did do it, then it did work.” Very often in programming you can sort of learn that way where basically “I tried this one thing and it didn’t work, or this bug happened, then (I did) this other thing, and the bug was fixed”, and come away from that with a rule, or a heuristic, or something you think is an unwritten law without actually understanding the underlying…

Remind you of anything? In medicine, “cargo cult” is exactly
the term I would use. Programming’s saving grace is that it is a finite system created by humans, and—at least in theory—knowable. The human body is as black a box as it ever was—the only difference between now and the 1800s being a stronger flashlight.

So, programming clearly shares this with medicine: most of its practitioners don’t have a firm grasp of what they are doing, and don’t understand the underlying principles of their craft. Why, then, do we fool ourselves that adding programmers’ idiosyncracies to physicians’ by the way of electronic medical records, clinical decision support systems, and ultimately AI-run e-doctors, will somehow “fix” medicine instead of making it bad in a different way?

A yearly welcome

Miloš Miljković — Wed, 01 Jul 2015 07:42:00 -0400

July 1st is when most US residency programs let their new interns loose after a week of corporate compliance training and ACGME-mandated talks about burnout.

If you are a medical student or a new intern, read this.

And this short post of mine still applies.

In addition, remember that it is easy to become very cynical very quickly. That is not the best of defense mechanisms, but it is better than substance abuse, domestic violence, or suicidal ideation. So, if you have to be cynical, do it up the chain of command, not down or laterally. That way you will avoid preconditioning medical students, observers, and your fellow interns. The senior residents will either support you in your jadedness, or will get to feel smug when they tell you that you are too young for that much cynicism. Your attendings should, ideally, teach you why you are wrong—though the younger they are the more likely it is they will behave like senior residents. So it’s a win for everyone, really, unless someone dings you for lack of professionalism.

Also, please remember to eat.

The overhead

Miloš Miljković — Fri, 29 May 2015 08:39:00 -0400

There are many misnomers in American medical English. Patients walk into your clinic (from Greek kline, bed) to learn whether their scan was negative (good) or positive (bad). Those who have severe chronic pain may ask for their pain medicine (that relieve pain, not cause it), usually opioids. Some physicians would call them pain-seeking (though what they are seeking is relief). If they don’t get a prescription, they may rate their doctor poorly on a patient satisfaction survey, which is a big thing if you are into quality improvement. Quality improvement. There’s a misnomer.

Quality improvement in medicine is by definition limited to improving things you can measure, i.e. quantify, i.e. judge by criteria that are the ying to quality’s yang. Those measures may be valid or not, and may improve patients’ lives, longevity, etc. (or not) but they are not quality. Because they are measures. Numbers. You know, quantities.

The movement is dangerous in at least three ways. Firstly and most obviously, many of the things being measured haven’t been validated in prospective trials. They are either (poor) conjecture—like tight glycemic control for type II diabetics assumed to help because of good outcomes in type ones (since, you know, a skinny teenager and a morbidly obese 60-year-old are similar that way.) Or they came out of a corporate think-tank cocaine-fueled outside-the-box brainstorming session, like patient satisfaction scores¹.

Secondly, even if they were the best measures in the world, tying them to promotion and compensation would have the unintended consequence of having practitioners loose sight of all other aspects of medicine, including the patient. There are many accounts of how it can happen—this one from Dr. Centor comes readily to mind—but since (1) identifying and (2) addressing the patient’s actual problem is difficult to measure objectively, it is not one of the benchmarks.

And finally, wherever there are numbers and money, techniques will evolve to game the system. David Simon’s account of how this happens in law enforcement is applicable. Want fewer central line infections? Enact a policy not to draw blood cultures from central lines! Too many nosocomial urinary tract infections? Urinalyses on admission for everyone! Hospitals create teams with dozens of people whose only job is to find new and better ways to do this. And they have to—because everyone else is doing it. A depressing amount of time, money, and effort wasted because of pointless exercises of anonymous pencil-pushers.

This is how you get to a near 3000% increase in the number of hospital administrators over 30 years. I am sure they are all good people, with good salaries, but they are, for the most part, insignificant. An epiphenomenon induced by someone’s desire to turn healthcare into an industry, forgetting that the six sigma ideology that works so well for toaster ovens can’t be forced onto moist, squishy, and fragile humans.

Which is also a good working definition of quality improvement.

Some speculation on my end there. They might have been on LSD. ↩

Talk therapy

Miloš Miljković — Thu, 07 May 2015 10:06:00 -0400

“She makes the mistake of talking to patients.”

— Overheard from a fellow discussing the consult attending’s rounding habits

Is there such a thing as spending too much time with a patient? The question seems preposterous, when recent time motion studies showed that physicians in general, and residents in particular, clock embarrassingly few face-to-face minutes. The quote above was said with a wink and a nudge, but there are situations when it can be true, particularly if you talk to a patient—or get talked to—instead of having a conversation.

Two groups are at highest risk of talking too much—trainees and consultants. Many an internist remembers having to pick up the pieces after a consulting physician flew by the bedside to throw an unasked for opinion bomb. Think hematologists talking about insulin regimens, cardiologists about causes and treatment of back pain, or orthopedic surgeons about code status. “But one doctor said…” and a perplexed look is the usual outcome, more so if the consultant debated him or herself out loud.

Fellows are even more efficient sowers of confusion. Unlike some of their superiors, they still remember other fields well enough to a) have a valid opinion, and b) keep it to themselves. Where they are at highest risk for foot-in-mouth is the area of their future expertise—picking up just enough from the attendings to sound knowledgeable, yet not knowing enough to tell the patient what they don’t know. Even at later stages of training, a fellow’s best plan shared with the patient may tumble down when the attending gives a diametrically opposed recommendation. The common scenario is one in which there is no evidence, and clinical judgment rules. You can either not share your own view, or punctuate every conversation with “But we’ll see what my attending says.” More time wasted, and for nothing.

Patients themselves can be talkative, sometimes to their detriment. The reasons are many, and understandable: they have much to say about themselves—relevant to why they are in the hospital and not so much, they might not have anyone at home listening, they may have some level of delirium, dementia, or other cognitive disorder. Being able to identify such a person, and then knowing how to direct the conversation, is an unknown skill for most trainees and goes against today’s dogma of giving patients time to talk. No harm done to the chatty ones, but there are only so many hours in the day, and some of them should be spent thinking.

To be clear, we don’t have an epidemic of young doctors staying in the hospital until 2am while demented World War II veterans regail them with half-made up stories from Normandy. If only. But more isn’t always better, and physicians need to know when to speak up (to get their patient back on the topic), and when to stay quiet (not to overwhelm them with half-baked ideas).

Apple’s App Store rules, Dosegate edition

Miloš Miljković — Sat, 28 Feb 2015 10:04:00 -0500

First they came for the nerds.

Now they are coming for the doctors (see What’s New in Version 3.0.5). The makers of MedCalc, the best medical calculator app out there, explained what happend in detail¹. This was the rule they were supposedly infringing:

22.9 Apps that calculate medicinal dosages must be submitted by the manufacturer of those medications or recognized institutions such as hospitals, insurance companies, and universities.

Nevermind that many doctors view themselves as institutions—this is an idiotic rule. Is University of Baltimore, which has no biomedical science courses or programs, allowed to publish a drug dose calculator? Is GEICO?

The FDA has issued guidance for mobile medical apps. It specificaly allows calculators that use generally available formulas, and forbids apps which calculate radiation dosage, but does not mention drugs. Where, then, did this rule come from?

It is, of course, the same App store rules that allowed these pearls of quackery.

It’s madness, and it’s maddening.

Seeing that URL made me appreciate the developers even more. ↩

Statistics resources for clinicians

Miloš Miljković — Tue, 30 Dec 2014 13:33:00 -0500

Another week, another Quora question.

What is an online resource for learning statistics needed for clinicians explained in a language that could be understood by doctors?

There are many biostatistics courses available on Coursera. Living in Baltimore, I’m biased towards JHU’s offerings. “Case-Based Introduction to Biostatistics” by Dr. Scott Zeger is a good one. If you prefer text to video, here are three good resources:

An article: “A Review of Basic Biostatistics” by Kimberly Dukes and Lisa Sullivan (free PDF)
A short book: “The Science of the Art of Medicine” by Dr. John Brush (free, iBooks only)
A textbook: “Statistical Inference for Everyone” by Brian Blais (also free)

If I had to pick one, it would be Dr. Brush’s book. He is a cardiologist writing for other physicians in a language they can understand. Also, Dr. Lehman recommended it, which is more than good enough for me.

Why be a chief resident?

Miloš Miljković — Sat, 20 Dec 2014 11:54:00 -0500

For the first time since joining Quora, I found a question to which I can meaningfuly contribute. Thought you might like to see my answer.

Why would someone choose to be a chief resident (in internal medicine)?

Why indeed.

The cynical answers would be “out of a misguided sense of loyalty to your program”. The correct and not very useful answer is—it depends.

Most positions entail primarily administrative responsibilities, with some teaching and clinical duties, and a salary just slightly higher than that of a PGY-3. So, you can expect your patient care skills to languish unless you work on maintaining them, your teaching skills to be slightly improved—or at least no worse if you’ve had some prior experience—and your knowledge of hospital administration, people management, dealing with email, and making the most out of seemingly pointless meetings to go through the roof. If you have any interest in academic medicine, as a generalist and sub-specialist alike, this last skill set will be invaluable. It is also a stamp of approval of sorts for any fellowship program director looking at your CV if and when you apply.

You also have much more free time. Depending on how many chiefs your program has, it will be most or all weekends, and almost all federal holidays. This is a good time to study for the boards if you haven’t taken them already, write up the research you’ve been working on, or spend some time with your family (the chief’s maternity/paternity leave is usually more flexible, but that’s program-dependent).

The downsides: you will have one fewer year of attending-level salary, so if you have a large debt or other financial responsibilities think twice before saying yes; some friendships you made with the junior residents will be undone or temporarily put on hold, unless you are very careful about not playing favorites; you may lose some respect for your higher-ups, as it goes whenever you peek behind the curtain; you will need to develop a thick skin, if you don’t have one already. Some would say these last two are actually pluses. It depends.

Visa issues complicate the matter, but I won’t go into details—bureaucracy shouldn’t play a role in determining a career choice, and when there is will (your own as well as the program’s) there is a way to bypass any obstacles.

Hope this helps.

A few good pens

Miloš Miljković — Wed, 17 Dec 2014 12:55:00 -0500

Helping out Georgetown University fellows with their oncology consult service for a few days reminded me of how important it was to have at least three good pens with you at all times. By that, I don’t mean grabbing a handful of disposable Bics from a Staples shelf just because you know you will lose a lot—though you should certainly plan for theft and absent-mindedness. There are at least three different use cases you will face daily, and no pen will be ideal for all of them. I’ve tried out enough, and listened to plenty of podcasts on the topic, to be happy with my choices.

Role 1: The task keeper

My choice: Zebra Sarasa Push Clip Gel Ink Pen, 0.4 mm black
First runner-up: Uni Jetstream Standard Ballpoint Pen, 0.5 mm black
Honorable mention: Zebra Sarasa 3 Color Gel Ink Multi Pen, 0.5 mm

Intern or fellow, this will be your most-used pen—the one you pull out to quickly jot and check off to-dos, make note of pertinent lab values and vital signs, and write down other important bits of information. If you are anything like me or my colleagues, you will be doing this on the signout, or some other piece of paper packed with information you might need.

This is why your pen should be:

as thin as possible, since you’ll likely write on the margins, but
not too faint, so it wouldn’t blend in with the rest of the text,
quick to use, since you’ll have to pull it out during rounds, patient encounters, and other situations in which fiddling with the cap would lead to losing both time and the cap, and
affordable, since you will misplace one every couple of months.

For the first two, the Uni Jetstream wins hands-down. The tip is as smooth as a 0.5 mm can be. It doesn’t skip, spill, sploch, or splat. The price is right—just $2.99 on jetpens.com. It is the best-in-class for every thing save one.

Zebra Sarasa Push Clip is not too thin, but thin enough to be scratchy and slightly annoying. Even with that small flaw, I choose it before the Jetstream. Because of the clip. The wonderful, magical clip.

You see, after four years of rounding, the act of pulling out a pen becomes a reflex. You hear something important, you have a thought, you blink, and you have a pen in one hand and your Very Important Paper in the other. You write something down, you blink, and your hands are free again. You are one with the sign out, and the pen.

To do that, you must at all times know where those two things are. The Very Important Paper is hard to miss, but the pen needs to be not just in the same pocket, but in the same spot in your pocket at all times. For me, the whitecoat-less fellow, that’s the inside of my left front pants pocket. This requirement rules out any clipless pens—goodbye, disposable Bics—but the regular clips don’t fare too well either. Too tight a clip, and you spend too much time fiddling it into the spot you want. Too loose, and it’s easy to put in, and easy to lose.

Which is why the clip is magical. You open it wide on entrance, and clamp it shut once you have the pen where you want it. It won’t budge after hours of walking up and down the hospital stairs. And, unlike one of my Jetstreams, it will be very difficult to break.

Alas, it only comes in one color. This is enough for the mild-to-moderate inpatient workload of a fellow, but during internship I needed the typical gunner pen to stay organized. Zebra Sarasa 3 is the high-end guner pen—one color fewer, but with the Zebra clip. For me today, it is just too bulky, I default to black anyway, and I’d just get annoyed with it running out way before the other two. But for me four year ago, it would have been perfect.

Role 2: The note writer

My choice: Ohto Graphic Liner Needle Point Drawing Pen - 02, 0.5 mm black Runner-up: Pilot Petit1 Mini Fountain Pen - Fine Nib, any colour

As much as I appreciate the ammount of writing I can cram onto a sign out with a thin pen, using one to write in paper charts, or for making notes on an old H&P while seeing a patient, creates an unreadable mess. The faint black lines of your pen blend in with the small type and the gray ruled lines of the progress note. Also, you don’t need as quick an access—a morning note-writing session may seem hectic, but you are the one who initiates the process. A couple of seconds looking for the pen or opening the cap won’t make you lose any information.

The Ohto liner leaves a consistent, dark line, lasts for ages, and is the right size for me. The ink is water-proof and archival safe—which is what you want for a medico-legal document. There’s a cap you need to worry about, but I’ve yet to lose one. And at $2.50 it won’t be the end of the world if I do.

This role can also be filled by a nice fountain pen—and you’ll see some attendings using one. I have had horrible luck finding a fountain pen that I won’t be afraid spilling in my bag or pocket, and most cost too much to carry around the hospital while sleep-deprived. The Pilot Petit1 pens have the right price, nice nib, and are easy enough to use. But I’m still too scared to put it in my pocket.

Role 3: The backup

My choice: Uni-ball Signo DX UM-151 Gel Ink Pen

This is the one you sprinkle around the house to be there just in case. The one you give out to friends and colleagues. And the one you use if you lose any of the others. If you needed to have just one pen, this would be the one, since it’s both thin and dark. Not perfect for either notes or task lists, but good enough.

At slightly less than $2 per pen it is afordable enough, though if you just want something to give out to others—and don’t care about them or their fingers—you can get a box of 60 horrible little stick for the price of three Signos. I guess you can give those out to your enemies and watch them writhe in pain and frustration.

Bonus: A pencil case

My choice: Kokuyo Will Stationery Actic Mini Pencil Case

This is entirely optional, but it saved me a surprising amount of time. It comfortably fits 4-5 pens and refills, and has good build quality. If your bag is small or you don’t mind fishing around for the pen you want, you can certainly do without it.

How to say “I don’t know” like an intern

Miloš Miljković — Thu, 11 Dec 2014 10:38:00 -0500

A key skill to have during oral exams back in med school was never to admit not knowing. Avoid the areas you’re uncertain of, dodge the examiner’s field of expertise as much as you can, and never ever say “I don’t know”.

These sage words were passed on from generation to generation, propagated by everyone, including me. Only, this wasn’t what I or any of my friends actually thought. It was a poke at the climate of intellectual dishonesty at our school, not a guide to success in medicine.

Starting residency, though, flips the sarcasm switch somewhere and the funny guidelines become instructions to be followed verbatim. The knowledge in question is different—patient data instead of textbook medicine—but the idea is the same. Observe the modern American intern’s vocabulary:

Not that I know of (means I don’t know).
I wasn’t aware of that (means I didn’t know).
I don’t think it is (means I don’t know if it is).
I belive so (means I have no idea, but yeah, maybe).
It probably was (means I don’t have a clue but I did a D6 roll in my head and it was a 5).

I used all of the above, and more, during internship, but still get frustrated hearing it from others¹. If you are an intern, or anyone reporting patient data to a person above you in the pecking order, try using “I don’t know, but I can find out in a second” instead. Then start practicing your EMR skills to trully make it a second.

That makes me a liar and a hippocrite, yes, but at least I’m being honest about it. ↩

On medical euphemisms

Miloš Miljković — Mon, 03 Nov 2014 15:42:00 -0500

Observe George Carlin discussing how euphemisms are invading the English language:

I first heard a version of this years ago, back in Serbia, while I was still a med student. It hadn’t left much of an impression, but I can imagine myself nodding my head and thinking ha ha, yes, stupid Americans, ruining their own language, or something comparably obnoxious.

Well, I’ve, erm, matured since then. True, some euphemisms now inspire rage instead of vague amusement, like my two favorites:

“I just wanted to let you know” instead of “I’m telling you”, and its relatives “Please let me know”, and “Thank you for letting me know”. Physicians are particularly fond of this, for we are the gatekeepers of knowledge, and the only reason you know something is because we are letting you. Don’t worry though, it’s not just you, we say that to each other all the time.
“I don’t feel comfortable doing xyz” instead of “I don’t want to do xyz”, as mentioned here.

Most of them, though—particularly ones we use with patients—have a good reason to exist. The Radiolab segment which inspired this post made fun of “making someone comfortable” being used for dying ICU patients. Instead of… what, exactly? Euthanasia? There is a difference between giving someone drugs usualy meant for comfort—opioids, primarily—in order to kill them, and giving them opioids for pain and comfort knowing it may shorten their life.

Then there are turns of phrase used because they are euphemisms. “You should get your affairs in order”, “your time is becoming limited”, “at this point we should concentrate on quality of life, not quantity” are all ways of saying “I don’t know when you’ll die, but it will be soon, so start planning the funeral”. I am sure Mr. Carlin would appreciate getting it straight, but not every patient is as stoic. We can easily be more blunt if asked to do so, but you cannot un-hit a patient with a sledgehammer like that. So the default is to err on the side of softness.

Then again, most of the euphemisms we use with patients also make us more comfortable with the sitation. What I wrote above may then just be my rationalizing it away with a convenient it’s-best-for-the-patient mantra. In truth—to use another common phrase—euphemisitis is a multifactorial condition (as in, I have no idea what the reasons are, but it’s probably a little bit of everything).

It’s well-known that most common knowledge is false

Miloš Miljković — Sun, 21 Sep 2014 09:10:00 -0400

Did you hear the one about not prescribing angiotensin receptor blockers to patients with ACE inhibitor-induced angioedema? I’ve had heated debates with residents in my old clinic who did not want to even consider ARBs for a patient with worsening diabetic nephropathy who’s had lip swelling while on an ACE-I ten years ago.

Or the one about not giving these patients amlodipine, since there are two—yes, two—case reports on amlodipine-associated angioedema? Should we also stop giving them water?

Then there are shellfish allergies and iodine contrast, fever and atelectasis, morbid obesity and hypothyroidism… No matter how many studies show these associations to be too weak to be clinicaly significant, or just plain false, there will always be an attending somewhere giving them as his or her pearl of the day.

We need some medical mythbusting for physicians, not just the lay public.

How to spend a Monday morning train ride

Miloš Miljković — Sun, 21 Sep 2014 08:06:00 -0400

The GTD weekly review does a good of job keeping my task list managable, but not all tasks and projects are equal. It’s good to have a sense of when you might have time for deep thinking versus mindless task processing—-something GTD doesn’t trully account for. I had been doing a variant of weekly planning since high school, until internship destroyed any hope of having a daily, let alone weekly plan. It’s time to start again.

And if you are not following Cal Newport’s blog already, you should. The man is a machine.

No, there’s nothing wrong with your attention span

Miloš Miljković — Sun, 14 Sep 2014 08:57:00 -0400

After skimming through the fifth long-form article about the increase in bite-sized consumable writing made for the short-attention-span—-dare I say “millennial”—-crowd, I became scared for my own tenacity. Would the 15-year-old me, the one who had read the LotR cover to cover, be horrified by this balding humunculus with twice the age and—-if you’d believe the articles—-half the attention span?

No, he would not. I can write that with confidence of a man who has just burned through the first two Dark Tower books exclusively while riding the subway. Get in at Union Station, actually sit down to read at Gallery Place, blink and I’m done with a chapter or two and arriving at Bethesda.

Stephen King is a hell of a writer, you see, and most of what you can find online—-this blog post included—-is derivative crap at worst, well-written nonsense at best. My brain jumping from text to text was its way of saying Dude, why are you punishing me with this drivel? Just get us a good book. So I did, and the percieved length of my metro commute has decreased by two orders of magnitude. Which is a convoluted way of saying that time flies when you’re having fun¹.

But if you’ve never read a book in your life and are now devouring Buzzfeed like a horsefly in a manure factory—-sorry, there is no help. It is you.

See above re: quality of online writing. ↩

Which opioids are safe in kidney and liver failure?

Miloš Miljković — Fri, 12 Sep 2014 12:05:00 -0400

Many times during residency I looked for a table like this online. There weren’t any, so I decided to create one.

Ye’r welcome.

Source: Induru RR, et al. Managing Cancer Pain: Frequently Asked Questions. Cleveland Clinic Journal Of Medicine. 2011;78(7).

What is the evidence for that?

Miloš Miljković — Fri, 22 Aug 2014 06:27:00 -0400

This has become the mantra of every medical student, intern, and resident wanting to appear smart on rounds and conferences, of every attending intent on shooting down a team member’s suggestion. Five, ten years ago it might have have signaled genuine interest. Now it means, usually, “I don’t know anything about the subject, but I’m still calling you out on (what I think is) your BS. Here, look at me! I am evidence-based!”

No, nobody has posed me that question in quite a while, and I don’t remember ever asking it in any context¹. But, honestly, except for a few very well-known examples listed in this excellent post, you can find “evidence” in the medical literature to back up any claim. Off-the-cuff conversations during lectures and rounds are not the best place to dissect them, especially when one side has seniority.

Although I understand asking questions means showing interest, I’ve always preferred looking things up myself. This would make me appear either very smart or very dumb, depending on whatever subcontious impression I made on the person in the first few minutes of us meeting. Try to use the halo effect to your advantage. ↩

Farewell, Squarespace.

Miloš Miljković — Sun, 17 Aug 2014 12:03:00 -0400

Starting tomorrow, miljko.org will no longer be on Squarespace. Instead, it will be a Pelican-generated static site hosted free of charge on GitHub Pages.

Squarespace is an excellent service, for those who don’t have the knowledge, time, or ambition to muck around with self-hosted websites, but have enough readers to justify the $8/month subscription. My long commute gives me more time to play with Python, git, vim, etc, and the $96 renewal charge was due this month. It was an easy decision to make.

Having most of my posts saved as markdown files payed off, as it is currently impossible to get a clean conversion of old Squarespace articles to Pelican. Some links will be dead, some images temporarily unavailable, and the three of you reading this via RSS will need to resubscribe.

That is all.

Research during residency

Miloš Miljković — Fri, 25 Jul 2014 06:21:00 -0400

Of the three pillars of medicine, research is the most ellusive. Unless you are in an MD/PhD program—-not an option for most Europeans—-you will have other priorities in medical school. And unless your residency program has a built-in research year, the way most surgical residencies do, you will either be way too busy in a university or a large community program to do any research, or have plenty of free time in a lower volume community hospital that doesn’t have many research opportunities.

When I interviewed residents-to-be last year, my first thought on seeing a non-PhD applicant having 18 publications on his or her CV wasn’t “Wow, she is a research machine, we gotta have her”, but rather doubt that anyone could be that productive during medical school. More points subtracted for thinking the interviewers would be so gullible.

I graduated six years ago, far enough not to be able to give advice on how to do research as a medical student. The hows and whys are institution-specific, so anything I wrote would have to be in Serbian anyway. Residencies, though, are similar enough to each other that I do have some words of advice for new residents wanting to do Research! in a community hospital, university-affiliated or not.

Patient care trumps research. Unless you have already worked as an attending in another country before coming to the US for residency, don’t waltz in to your PDs office on day one asking about research opportunities. Prove yourself on the field first, then six months later, when you’re comfortable managing DVT prophylaxis, septic shock, and what not, start asking questions.
Get your own idea? Common wisdom says it is better to come up with your own question and start your own projects, since you will be more invested in the outcome. Well, yes, sort of. Unless it is a quick-and-dirty chart review you can do over a two-week vacation—-and even then there are IRB hoops you’d need to jump through to get anything done—-you will get your inexperienced self into the murky world of project management. Many brilliant ideas have died on the field of required signatures, ambiguous data points, and impossible-to-coordinate meetings. Which is why this next advice is important.
Find good mentors. Surrounding yourself with a few good people is orders of magnitude better than having many good ideas. Research topics come and go, as does our interest in different fields of medicine (yesterday’s apoptosis is today’s epigenetics is tomorrow’s something or other). It is unlikely that the research your started in residency will continue onward into fellowship, but the knowledge, skills, and general wisdom you pick up from your mentors should serve you well into your career. NB: don’t wait for someone to be “assigned” to you—-although that’s what many residency programs will do. Seek out people who match your character and who would be able to give you advice in at least three fields: patient care, research methodology, and research topics. This can be one person, or five. And if you find an awesome mentor who just isn’t doing any research right then, you can always write a review.
Is it Science! or quality improvement? ACGME is big on Quality! and Patient Safety! this year. Programs take notice. If you can present your interest as a quality improvement project rather than small-s-science, consider doing it. Not only does showing interest in quality improvement look good on a CV, your institution might have special funds for resident QI projects. A dedicated QI mentor is also a good resource, if you want a carreer as a Sith lor—-erm, hospital administrator.

Interest in research goes from I just want something on my CV so I could get a fellowship to When I grow up, I’ll have my own lab, but this applies to most people in most circumstances.

Down the vim rabithole

Miloš Miljković — Tue, 22 Jul 2014 06:28:00 -0400

Spending two hours each day on the train, offline and without distractions, gives me an excuse to go down various rabbit holes that a couple of months ago I would’ve thought nothing but time wasters. Starting to read the Dark Tower series—-I’m almost done with the Gunslinger—-is one of them. Re-learning vim—-if dabbling with it in high school 15 years ago counts as having learned it—-is another.

This episode of the Technical Difficulties podcast is what started it, followed by a blog post or two (nay, three) on the perfect setup. Now, I may or may not continue using vim as my primary writting tool—-I would have to figure out how to integrate it into my workflow—-but several things I picked up will always be useful:

git is an amazing tool for tracking changes that researchers should use more
don’t blindly edit stuff—-dotfiles in this particular case—-on your computer without understanding what those edits mean
Solarized should be your default color theme for anything
use your macro/keyboard shortcut app of choice (mine is Keyboard Maestro, you can just as easily—-but not as prettily—-use Better Touch Tools) to quickly position windows into quadrants, halves, thirds, etc.
there might not be much difference between bash and zsh if you are a beginner, but zsh has the cool customizable prompts

Yes, I am writing this in vim, previewing and exporting in Marked, then posting it manually to Squarespace. The only thing standing between me and a fancy-pants static website engine powering this blog is there being no internet access on MARC trains, and me being too cheap to get a $20-a-month personal hotspot from Spring. That is probably for the best.

June 2014, final tally

Miloš Miljković — Tue, 01 Jul 2014 16:44:00 -0400

4 books read: Ocean at the End of the Lane, Tenth of December, The Golem and the Jinn, Ubiq
2 books re-read: Getting Things Done, Mindfulness in Plain English
1 book half-way through: Embassytown
2 computer games completed: To the Moon, Bastion
3 tabletop games played: Dixit (3 sessions), Pandemic (2), Eldritch Horror (4)
1 used minivan purchased
1 article, 1 abstract submitted
61 km ran
1000+ toddler photos taken
0 tedious field trips made

NIH orientation started today. My commute is 90-plus minutes each way, and the first four months are mostly inpatient. I will have to wait until retirement for another run like this.

Goodbye, Sinai

Miloš Miljković — Sun, 22 Jun 2014 10:42:00 -0400

Four years ago today was my first day as an intern at Sinai. Yesterday was my last on Sinai’s payroll. I will miss it.

Won’t miss the fake flash mobs of Lifebridge Health, though.

Three tech tips for new interns

Miloš Miljković — Tue, 03 Jun 2014 07:15:00 -0400

The new intern class starts in less than a month. It’s easy enough to find advice on how to be well-organized, efficient, and likable. Here are some more tech-oriented tips I wish I knew back when I started.

Take photos and videos, with permission

Get an iPhone. Turn off Photo stream, or download a camera app that doesn’t automatically upload to it, like VSCOcam. When a physical exam finding is rare, stumps you, or is just cool to see, ask the patient about recording it. If you see an interesting or rare radiography image, save it. But please remove all personally identifiable information.

Useful for: appearing smart on rounds, observing disease course, creating informative slides, posters, and written case reports.

Keep track of things you are interested in

Your EMR will have a way to create custom patient lists. Use it. If you are into hematologic malignancies, eosinophilic esophagitis, MODY—or anything, really—keep track of all your patients who have it. If you don’t yet know what it is, keep a list of all the patients you found interesting and try to find a pattern.

Useful for: getting ideas for research and quality improvement projects, figuring out your career path.

Do not copy forward, copy/paste, or use templates and macros

I started my internship in 2010 so I can’t believe I’ll write this, but—back in the day before EMRs, we wrote our progress notes and H&Ps by hand. This meant reviewing the med list, vital signs, and labs each morning and writing down only the important stuff; completing and recording just those parts of the physical exam that had to be done; and writing a new assessment and plan each day. Well duh, isn’t that what interns should do?—you might naively ask, until your second or third day on the job when a helpful senior resident shows you how to shave minutes—minutes!—off your note-writing time by using some variant of copying forward, templates, or macros.

These tricks are a mental crutch, and a known cause of documentation errors. They might help your handicapped intern self the first few months on the job, but will then prevent you from thinking about what you are doing and writing. A thoughtful daily review of everyone’s medications and labs will turn into a quick glance over a two-page long list of 10-point single-spaced Courier New. Also, your typing speed will never improve if you only document by clicking.

Useful for: being a good, thoughtful doctor.

Managing photos with Transporter, Hazel, Picturelife, and Backblaze

Miloš Miljković — Thu, 29 May 2014 07:40:00 -0400

In the olden days, back when I could keep all my photos on Facebook, photo management was simple. I didn’t have that many to begin with; the ones I did have were grouped around events—birthdays, vacations, etc—and easily organized into albums. I also didn’t care much for privacy, or backups.

Then two things happened: iPhone 4S, and Dora. Every day became a photo-op, with two cameras in our pockets ready to shoot. The DSLR was still there for big trips and Dora’s modeling yet another outrageously expensive dress. This gave us:

hundred of new photos and hours of video each month coming from four different sources (our two iPhones, a Nikon DSLR, and friends with their own cameras);
no time to sort them;
more respect for privacy, but at the same time a need to share baby photos with everyone;
panic attacks whenever I thought about having to organize the mess of file names, formats, storage, and backup solutions.

We needed a good method to collect all the photos, organize them for easy access, retrieve them quickly for show-off purposes, and back them up both locally and in the cloud.

Having children usually comes at a point in your life when you care less about money and more about your time—though your progeny will do their best to relinquish you of both. The willpower-depleting effects of a toddler’s tantrum are also well-documented. No surprise then that many of the tools listed below have at some point sponsored a certain Mac-centric podcast that has destroyed many family budgets³. No regrets, though—it all works.

Collecting, with Transporter Sync

For simplicity’s sake, I like systems with multiple inputs to have one central gathering node. Unfortunately, our only desktop computer is a ridiculously noisy four-year-old Windows PC which sits in a usually occupied guest bedroom. The fans that buzz with the sound of a thousand bumblebees instantly disqualify it from a job as a media server, so I had to use my Macbook Pro. Thanks to Transporter Sync, that was easier than I thought possible for an SSD-only machine.

Transporter, similarly to Dropbox, has an iOS app that automatically uploads new photos to a predetermined folder. Unlike Dropbox, there is no monthly subscription—you pay once for the device, and keep using it as long as the hard drive is working. It can also act as a NAS-lite—having access to the folders kept only on the remote hard drive without them occupying the limited space of an SSD, through a Transporter Library folder.

Organizing, with Hazel

A folder full of unsorted cryptically named JPEGs and RAWs is less than useful when your parents want to see all the photos from that trip to Naples back in January.

Enter Hazel, the Swiss army knife of file automation. With the rules I’ve set up, it renames photos based on the date and time taken, tags them according to the device that took them, and moves them to the proper Year/Month subfolder. It does the same with our DSLR’s RAW files, placing them in a separate folder. Since the laptop only has 256 Gb, it moves any files older that three months to Transporter Library, the “special” folder kept only on the external hard drive.

We therefore have the last three months’ worth of photos and videos organized by year and month on the laptop, and our entire collection on the external Transporter hard drive.

Access, with Picturelife

In theory, we could get to all those photos using the Transporter iOS app, but we’re not a masochists. It’s slow, ugly, and not meant for browsing media.

Thank FSM for Picturelife! It sucks up all our new photos and videos from the Transporter—though we’ve excluded RAW files since we do have to pay for all that data²—presents them in a nice web and mobile app interface whenever we want it, and can pass them on to Facebook, Shutterfly, Flickr, or wherever else we choose. It will also, from time to time, send you a “this day in the past” email, with photos taken years ago. When you have as many unprocessed photos as we do, it is a great discovery mechanism.

Did I mention it can send photos to Shutterfly with just a couple of clicks? I still have flashbacks of the last holiday season, progress bar dragging glacially, the upload finishing just in time for me to miss the shipping deadline. Good times.

Backup, with Backblaze and SuperDuper!

Keeping everything on the Transporter and Picturelife as on-site/off-site backups would probably be enough for some. Unfortunately, counting on a VC-backed company that might at any point pull an Everpix to hold all our photos does not seem optimal⁴.

Which is way Backblaze and SuperDuper! keep copies of all those photos as a part of my general backup system¹. If you have a Mac and an extra external hard drive, you should also turn on Time Machine. This way, there are three local copies of all the photos, RAWs, and videos (Transporter, SuperDuper! image, Time Machine), a cloud backup of the same (Backblaze), and an easily-accessible collection of JPGs and videos (Picturelife).

Setting this up is neither cheap nor simple⁵, but it gives you quick and easy access to all your photos, has several levels of backup, and—most importantly—requires little effort to maintain.

Backblaze will back up the Transporter Library folder, since it doesn’t count as network-attached storage. It doesn’t back up NAS drives. ↩
We keep RAW files in a separate folder, one that’s not on Picturelife’s monitor list ↩
Which is why this post has affiliate links. ↩
That being said, Picturelife is the best of its kind and I strongly recommend it. ↩
I thought about illustrating it with a diagram of a Rube Goldberg machine. ↩

Just can’t get a break

Miloš Miljković — Sun, 18 May 2014 14:25:00 -0400

A combination of heavy rain, bad infrastructure, and even worse emergency preparedness¹ resulted in Serbia and Bosnia having the worst floods in more than a century.

Dozens are dead, and tens of thousands misplaced. Government officials are having nervous breakdowns on live TV, calling the flood “a Biblical catastrophe”—since touting vast water resources as your country’s main asset isn’t a hint as to what big disaster you should prepare for. In case you’re wondering, the Netherlands’ last big flood was in 1953.

And of course a high priest³ of the Serbian Orthodox Church blamed it on Gay Pride. Because religion².

If you have a couple of minutes, please use PayPal to donate to floodrelief@gov.rs, the official account of the Serbian diplomatic mission in Brussels. If your bank allows international wire transfers, you can give directly to the Serbian Red Cross. While no one we know is affected, my grandparents had to leave their home twice over the past 50 years because of floods. The support they and their neighbors received from the Red Cross on both occasions was invaluable.

No surprise there. This guy is the head of Serbia’s department for emergency response. ↩
Though I shouldn’t be that sarcastic, since the Orthodox Church is, in fact, trying to help. By praying for the rain to stop. ↩
Isn’t organized religion just an excuse for LARPing. ↩

A podcast a day

Miloš Miljković — Wed, 14 May 2014 15:52:00 -0400

Fun fact: The average Maryland to DC commute is the second longest in the US, right after New York. I should know. Mine will be 90+ minutes, come July 1st. Last week, while I was finishing paperwork at my new employer’s Bethesda offices, the looks people gave me went from incredulity to pity on seeing the Baltimore address on my driver’s license and hearing my explanation that no, since my wife is still at Sinai and usually just walks to work, we won’t move. It’s better for me to take one for the team, I’d say, than have both of us suffer hellish beltway traffic from some midway point.

I could write an essay on how taking one for the team is not entirely true, but the title of this post says “podcast”, and it’s already the second paragraph, so here is my point: My commute will be long. I will need to fill that time with something. Sometimes, that will be strangers talking into my ear about things I don’t understand. Here is my list of strangers, carefully curated after ten years of listening.

Monday: Mac Power Users

Comes out every Monday morning, like clockwork. Great for learning about new hardware, productivity apps, etc. but podcasts are not the best medium for going into the minutia of somebody’s workflow.

Tuesday: Back to Work

Go read this. Having Merlin Mann talk for an hour all by himself would be good enough, but Dan Benjamin—the other half of BTW—is the best podcast host in the business. By using a simple formula, it is easy to mathematically prove that their show is the best podcast ever created.

The first 30 or so minutes are laden with inside jokes and obscure references, but even that is fun after you are several episodes in.

Wednesday: Wait, wait…

It airs each Saturday, but I like alliteration, and there is nothing else good on Wednesdays. I was in Chicago once while it was being taped, but was too late to get a ticket. Now that Carl Kasell is retiring, it’s unlikely I’ll ever be at a live show. So it goes…

Thursday: The Talk Show

Daring Fireball is a better blog than TTS is a podcast—John Gruber and some of his guests tend to ramble—but you can get good insights on baseball and bourbon.

Friday: ATP

One word: Siracusa. There are two other co-hosts, whose main job is not to screw up too badly. They do it well.

Saturday: The Alton Browncast

The John Siracusa-slash-Bret Terpstra of food. Yes, Alton Brown is a national treasure.

The Sunday potpourri

This is the time for irregular shows, or ones that don’t always have something of interest. In order of preference:

Radiolab • Fact: this is the best radio show ever created, and an even better podcast.
The Incomparable • For geeks, by geeks. Or is it nerds?
This American Life • Any co-production with Planet Money is a must-listen. Otherwise formulaic.
Systematic • Hit-and-miss, though usually a hit.
Technical Difficulties • A tech DYI show with show notes better than some books.
CMD+Space • I only listen to it when an interesting guest is on, which is once every couple of months.
The Pen Addict • A podcast about pens.
JOP podcast • The only oncology podcast worth listening to; the medical podcast landscape is dreary.

To Cuba and back

Miloš Miljković — Wed, 30 Apr 2014 17:12:00 -0400

Finishing up our world tour/airplane passenger torture project¹ was a trip from Baltimore to Havana, via Cancun. Before you scream Embargo!, neither my wife nor I are American citizens. Our daughter is, but it is fortunately not illegal for US citizens to visit Cuba as long as they don’t spend any money there, at least according to America’s most esteemed journal of law, medicine and gastronomy.

If for whatever reason you want to travel to Cuba from the East coast, you might find our experience helpful.

The flight

We took the United flight from Dulles to Cancun, went through Mexican customs and immigration, then took the Cubana flight to Havana after checking in again. Inbound, layover time was more than 3 hours so we could have comfortably checked a bag or two for those large bottles of sunscreen and other essential liquids. The trip back, however, was tight at 1h 55min, so we decided not to risk waisting time at baggage claim, and only brought carry-ons.

In retrospect, it was half of a good move. On the way back, going through customs, immigration, then walking from Cancun’s Terminal 2 to Terminal 3 and checking in for the flight to Dulles is barely manageable in those 90-ish minutes after leaving the plane. However, we could—and should—have checked one of the carry-ons on the inbound flight, as sunscreen, diaper cream, and other toiletries are ridiculously expensive in Havana.

NB: You can easily walk from Cancun’s Terminal 2 Arrivals to Terminal 3 Departures (or 3 -> 2 inbound). There is a shuttle that leaves every 30 minutes and goes Parking -> T1 -> T2 -> T3 -> Parking. The Cancun airport staff told us it would take us 25 minutes to walk from T2 to T3—and that it would take the shuttle at least as much since it makes those other stops—but hey! there’s this van that magically appeared which would drive us to T3 for the low low price of $20. Google maps said it’s less than a kilometer between terminals 2 and 3 so we smiled politely and walked away. It took us—three adults with a carry-on and a large shoulder bag each, plus a toddler in tow—less than 10 minutes. Kudos to United for letting us skip the long check-in line and making it to our flight without issues.

Entry

Serbian citizens don’t require a visa, but Dora had only her US passport. We got her a visa in Cancun at check-in for 20 euros.

Cuban entry stamp is bright pink. They asked us before putting one in Dora’s passport, so I can only assume they occasionally get US citizens who’d rather not have their passports stamped for whatever reason (cough, cough). The visa also gets stamped, so there is still proof of entry.

There were no issues going back through Dulles. The customs form asks you which countries you visited on the trip, so we did write we were in Cuba. The immigration officer at Dulles just asked if we were bringing any cigars back with us—of course not, we hadn’t even smoked any while there!—and finished the fingerprinting in record time.

Money

Bring euros, and bring more than you expect. You can convert USD to convertible pesos (CUC) in any exchange office, but with their rates it’s better to change dollars to euros in your own bank, then change euros to CUC once in Cuba. Also, convert some CUC to the peso nacional (CUP), if only for the ridiculously cheap ice cream you can buy on the street.

As for how much to bring, count on at least $20/person/day, not including the room or the 25 CUC exit tax. This would cover lunch, dinner, and a daily trip to the beach or a visit to a museum, monument, etc. Since you cannot use American credit/debit cards anywhere on the island, it pays to take more than you think you would need.

Homestay

The highlight of the trip! We booked this room on homestay.com, and could not be happier with how it turned out. Centro Habana, the neighborhood it’s in, is definitely not for everyone—very safe, like the rest of Cuba, but also with dog poop and open trash cans everywhere you turn². Our casa particular was the opposite—clean, well-maintained, gaudy, but cute. Between our large air-conditioned room, the patio, and the open rooftop terrace, we could easily have spent a couple of days just hanging out there chatting with the friendly hosts.

Internet

Don’t count on being able to get online at any point. We tried checking in online a day before the trip back, but none of the Havana Vieja hotels we tried had any prepaid cards available. Even if they had, there are no printers to print a boarding pass. Unless you’re staying in a hotel, don’t even think about wi-fi. Just bring a good book or two.

So, if someone’s vacations response email tells you they’re going to Cuba, don’t count on them having any access, no matter what some self-important douche bag tells you.

Guidebooks

The only resource we used—and we used it multiple times per day—was the Havana Good Time iPhone app. Some of the information on working hours and prices is slightly outdated, but it is all still relevant, and it comes with an offline map of Havana that is—duh—much easier to carry around than the paper version.

Other DOs and DON’Ts

Do take the Havana tour double decker bus at least once.
Do go to the Revolution Museum—the clunky propagandist English translations alone are worth the 8 CUC admission fee.
Do try the excellent Coppelito ice cream.
Don’t waste an hour standing in line to pay for it with CUP—support their economy, and pay for it in hard currency like the tourist you’re pretending not to be.
Don’t give any CUC to street performers, especially the kind that chases you down the street with a guitar.
Do throw CUP at them.
Don’t drink the tap water.

The torture device being our 19-month-old girl—or rather, her vocal cords. ↩
I could say the same about the part of Naples we stayed in this January. In fact, with laundry out in the open and being able to peek into people’s living rooms from ground level it looked very much like Naples, just with wider streets. ↩

Get a journal article through your library proxy quickly with Alfred 2

Miloš Miljković — Tue, 14 Jan 2014 10:07:00 -0500

It is always a pain clicking on a link to a journal article only to hit a paywall. It’s doubly painful when I know I have institutional access via my library’s proxy server, but have to jump through hoops to get it: go to the library website, log in, copy and paste the article name or PMID into its PubMed search box, and finally download the PDF. Arduous, and—turns out—unnecessary.

Enter Alfred 2 workflows. Here’s a nice article I found on Twitter today. The NEJM link in the top right corner leads to an abstract, but I need a special archive subscription for the full PDF. No matter—I can just highlight the PMID and hit my special Alfred 2 keyboard combo:

Since I’m not already logged into the Welch library proxy, I hit a login wall. It’s nothing 1Password can’t solve, but you can also just type in your username and password yourself, like an animal.

And Bam! The ugly but magic button is where it should be. Your institution might have a prettier one.

To make it clear—this simple workflow will do a PubMed search of any selected text anywhere in OS X, all through your institutional proxy server. Finding an interesting reference while reading an article, highlighting its title, and hitting ^⎇⌘P to get to the PDF always feels like magic.

You can download the workflow here.

Why doctors shouldn’t use Google services

Miloš Miljković — Mon, 13 Jan 2014 05:40:00 -0500

If you have a Google+ account—and you might not be aware that you do—anyone using Gmail can now email you without knowing your address. You can disable this “feature” in the settings, but having it be opt-out shows yet again how little Google cares about privacy.

Not that there’s anything wrong with that—privacy is a relatively modern invention that younger generations might not care for as much as we do. But you should understand the implications of patients and random strangers being able to leave messages in your personal inbox. Suing P.,,,,,,kmmmmmqmmmdoctors is not a modern invention.

This is why I stopped using all Google services—search included—years ago. The company has become so large, with so many users, that it doesn’t need to cater to fringe interests. And for a business with billions of users, doctors are a fringe group—one that hates change-for-change’s-sake, having to [re-learn an interface][ n. Nnjm interface] “just because”, and not being the true customer¹.

Also, the number of people at Google who may access my data is huge. FastMail², my email provider of choice, has fewer than 10 employees. Gmail alone has hundreds. Not that anyone would be interested in me in particular, but if I ever inadvertently send or receive private patient information through my personal account, I’d rather as few people as possible see it.

Email is fine, but why abandon search? First, I have googled enough ailments and substances, common and obscure, that the add network thought I was an elderly female recovering heroin addict with more than one paraphilia. The adds I would get were in that sense appropriate. Second, because of SEO the only valuable page-one results I would get were Wikipedia entries. Everything else was a hodgepodge of useless Livestrong, Huffington post and five-pages-per-500-word-article-AND-behind-a-login-wall Medscape links. Duckduckgo and, yes, Bing at least help with the first problem while not making the second one any worse.

Google calendar is the only service I would consider using. It is fast, reliable, omnipresent and easy to use. There is, however, that constant nagging fear that they will find some way to integrate it with Google+ and yet again sacrifice functionality to force people into its circle³. This is why I use Apple’s iCloud calendar, its horrendous web interface and all.

Also: Reader. I use FeedWrangler now, but man.

Doctors’ concerns aside, Google is all set to become the network TV⁴ of the internet—large, bland, and largely not relevant to the people who are. It is already two-thirds of the way there.

This one in particular, as it keeps reminding me that doctors are second-class citizens in the tech world. Electronic health records are made with the billing departments in mind—we are there to provide content. Google services are created to sell adds—we are there to provide eyeballs. ↩
Yes, it’s an affiliate link. ↩
crickets ↩
Or Microsoft. ↩

The difference between being well and feeling well

Miloš Miljković — Fri, 03 Jan 2014 11:39:00 -0500

Marco Arment discovered an old article in The Atlantic pronouncing the triumph of New-Age medicine. It’s been a while since I’ve read it, but the introduction reminded me of what I thought was its biggest fault in reasoning:

… But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it.

Alternative medicine does not make patients well. It makes them feel well. The difference is huge.

Here are two graphs from an excellent free-to-access NEJM article that compared four methods of treating asthma: conventional medicine, placebo, sham acupuncture, and doing nothing¹. The first one shows how well the patients in each group felt after 2-4 weeks of treatment.

Ah ha! Conventional medicine was no better than sham (sham!) acupuncture, and both beat placebo inhalers. Alternative medicine wins! Or did conventional medicine lose? At the very least it’s a draw.

Not so fast. The second graphs shows the amount of objective improvement, measured in FEV1—the volume of air you exhale during the first second of breathing out:

If this were the common cold, it wouldn’t have been a big deal. But asthma is not the common cold. People die of it every day, not because they didn’t feel well—though being unable to breathe is doubtlessly uncomfortable—but because their airways were too tight to get any air out of the lungs.

This is why alternative medicine can be dangerous in the wrong hands, with the wrong patient. Improving quality of life is important, but so is curing disease.

Adding real acupuncture to the interventions would have made the study perfect. Some other time, perhaps. ↩

Starting the New Year with Slogger

Miloš Miljković — Wed, 01 Jan 2014 19:28:00 -0500

January 1st seemed to be a good day to install Brett Terpstra’s Slogger. Every night, its army of gnomes will go over my tweets, blog posts, completed to-dos, etc. and record them in a Day One journal entry. Not a replacement for a real journal, true, but better than anything I could do on my own.

It’s a Mac-only app that runs from the command line—not user friendly at all. Even so, the installation instructions are straightforward, with some caveats for the not-too-bright, like me:

Plugin configuration is done in each individual plugin.rb file, not slogger_config.
All config strings (URLs, file paths, usernames…) should be in quotes (“…”), even when in an array (i.e. in square brackets). The Twitter plugin instructions wrongly give an example without quotes.
The Instapaper plugin doesn’t work since RSS feeds for folders are no longer supported. I’m still not switching to Pocket.
You will need an IFTTT account to log your Facebook posts, using this recipe.
Instructions for logging RunKeeper activity are convoluted, but work.

Slogger’s default time for sucking in your data is 11:50pm, when my laptop is usually in sleep mode. The scheduler should still be smart enough to start the app on wake-up. Nevertheless, it’s one more reason for me to get a used Mac Mini. In 2015, perhaps.

Two podcasts, three doctors, one good show

Miloš Miljković — Sun, 29 Dec 2013 14:24:00 -0500

In the last two months, two of my must-listen podcasts, Systematic and Mac Power User, have had medical professionals on as guests. I don’t usually listen to medical podcasts—Twitter and saved PubMed searches are big enough firehoses—so I thought it would be interesting to hear how my more experienced colleagues use technology. Two of the three episodes were underwhelming, one was stellar.

It started with Brett Terprstra and Dr. Pamela Peeke on Systematic. She has several books targeted towards lay public, and the episode went in the same vein—broad advice on nutrition, well-being, etc. I cringed more than once, but that was to be expected—public health information relies on overplaying the risks and simplifying facts to the point of absurdity¹. The one thing I could agree with was how important meditation can be, as mindful meditation might decrease physician burnout. Negative points for not mentioning Mindfulness in Plain English as essential reading, though I haven’t read Dr. Peeke’s own recommendation, The Miracle of Mindfulness.

I had higher hopes for Episode 169 of MPU, since Katie Floyd’s and David Sparks’s guest, Dr. Jeffrey Taekman, has an excellent productivity blog. Alas, McSparky spent more than half of the show being fascinated by the minutiae of what doctors do. Which is better than what followed—long periods of uncomfortable silence while the unprepared guest clicked through every app in his menu bar to see if there is anything worth mentioning². There wasn’t.

Then another episode of Systematic came on, with Dr. Don Schaffner, a microbiologist³. It was outstanding. Brett was a better interviewer than David, and avoided getting too side-tracked by his guest’s interesting work. But ultimately, the show was good because Dr. Schaffner had useful tips and app recommendations that did not simply regurgitate the latest round of MPU/Mactories/Macdrifter/etc. sponsors. His paper review workflow gave me several ideas I will work on during the holiday downtime. He also suggested a promising contender in my quest to find headphones that will survive more than 8-12 months of intensive use.

One more thing for me to do during the downtime: promote Zotero. Between the developers fumbling Papers 3 and Mendeley being taken over by an evil corporation, Zotero coupled with a few extensions is the best reference manager on any platform. Coming in 2014.

Much like weather forecasts. ↩
OK, it was not total silence. You could hear Katie fuming in the background. ↩
PhD, not MD. Wonder if that explains why the show was better. ↩

Ten common residency idioms and phrases

Miloš Miljković — Wed, 25 Dec 2013 13:52:00 -0500

I don’t feel comfortable doing that.—I don’t know what you’re asking me to do (nurse to intern); I’m too lazy to do it (intern to resident); I think it’s a stupid idea and there’s no way you can make me do it (resident to attending); You’re not paying me enough to do this crap (attending to administration).
It’s a light elective—You don’t need to show up.
Needs to read more. (on a written evaluation)—I have no idea how much medicine this person knows. I barely know any myself.
The family is reasonable.—Family members don’t ask too many questions and will agree with anything you say.
The patient has xyz.—I’ve read in an old discharge summary that the patient has xyz, but have no idea how they established the diagnosis, what stage it is in, or what the hell xyz even is.
The head is normocephalic, atraumatic. Pupils are equal, round and reactive to light and accommodation. Sclearae are nonicteric.—If I were to report the physical exam I actually did it would take five nanoseconds, so take these fillers to make it seem like I’ve put in some effort.
Thank you for the thorough presentation.—Why did you waste my time with all that useless information?
That’s an outpatient work-up.—Administration is already breathing down my neck because of this patient’s length of stay and you’re worried about a mild anemia and a positive hemoccult!?
That’s her new baseline.—Her disease is worse and we don’t know why, so I guess she’s stuck with it.
Please let me know if you have any more questions.—This is the end of our conversation, so please stop talking. I shall now leave.

As a one-time interviewer and two-time interviewee…

Miloš Miljković — Wed, 18 Dec 2013 18:24:00 -0500

…to me, this looks flaky. Yes, Scott Adams (of-Dilbert-fame) is right in saying your best bet for success in life is being pretty good in several skills rather than trying to be the best ever in only one. So, a plan like this:

Step one: become a decent entrepreneur
Step two: become a decent MD
Step three: ???
Step four: profit!

might indeed be a good idea. However:

Medicine implies altruism. Entrepreneurship implies greed.
Programs want their residents to be 100% dedicated to medicine in general and the program in particular. Can you do that with a small business on the side?
Physicians in academia, i.e. those who conduct residency interviews, forgo 300k+ salaries so they could dedicate themselves to research and education. Are you sure telling them about your latest money-making scheme is a good idea?
As a resident, do you look at each patient as an opportunity to help them and learn from them, or to figure out how to build a business around them?

Residency programs exist to train physicians, not CEOs. Residency slots are already in short supply. Would program directors give a position to someone who is more likely to end up not practicing medicine at all?

30 iPad apps I use almost every day

Miloš Miljković — Tue, 03 Dec 2013 11:09:00 -0500

After 18 months of intensive use, here are some of the apps left standing on my iPad 3, sorted by category. I like to think I’m a semi-advanced user, so for some of them I have also listed simpler alternatives. It goes without saying that you should download all the free iWork and iLife apps.

Medicine

MKSAP 16

For: all medicine residents
Recommendation: strong
Price: free (if you bought online MKSAP access)

MKSAP question bank. No-brainer if you are studying for your internal medicine board or MOC exam. Less page-flipping and instant gratification. Unfortunately, it doesn’t allow you to highlighting or annotate the explanations. Also, it can’t make custom quizzes, can’t review unanswered/wrong questions, and doesn’t allow you to copy any of the text to your notes. Lot’s of cants, but it’s the only MKSAP app available. Free if you purchase the electronic version of MKSAP 16.

Download MKSAP 16 from the app store here.

ACP Guidelines

For: all interns
Recommendation: ok, sort of
Price: free

It seems like a good idea, and the content is great, but it is more of a branded PDF reader than anything else. Doesn’t have search or favorites, and you have to download each recommendation one by one. The download is fast, but good luck getting what you need without internet access. So, good for night-time reading, particularly if you’re an intern, but not a good POC tool.

Download ACP Guidelines from the app store here.

Stanford 25

For: everyone
Recommendation: just OK
Price: free

If you haven’t heard of Stanford 25 before, see this TED talk and see the blog. It’s another good, if ugly, night table app.

Download Stanford 25 from the app store here.

Productivity

Things for iPad (or Omnifocus)

For: everyone
Recommendation: strong
Price: $19.99 for Things, $39.99 for OmniFocus

Whether you’re a GTD fan or not, this or it’s more powerful and more expensive sibling OmniFocus are a must-have for anyone shuffling between more than two areas of responsibility. It still hasn’t been updated for iOS 7, but is very functional. Only two missing features for me, really: there are no nested tasks/dependencies, and you can’t filter by more than one tag.

I’ve been thinking about switching to OmniFocus, but this works well enough for me that the hassle of complete overhauling my system wouldn’t be worth it. Not to mention the >100$ price tag.

Download Things for iPad from the app store here. You can find OmniFocus for iPad here.

Boxer

For: everyone who gets more than 5 emails/day
Recommendation: strong
Price: $0.99

The best mail client on the iPad. Apple’s Mail.app was OK until I realized I spent way too much time scrolling through my list of 20 IMAP folders whenever I wanted to move an email. Boxer works with Gmail, IMAP and Exchange accounts, has smart email sorting, and integrates with Sanebox.

Download Boxer here

Dropbox

For: everyone
Recommendation: strong
Price: free

If you use Dropbox on your PC—and you must—then this is a no-brainer.

Download Dropbox for iOS from the app store here

iThoughts HD

For: nerds
Recommendation: OK
Price: $9.99 for either

I found Tony Buzan’s book on mind mapping as a first-year medical student and used the hell out of it for my biophysics, chemistry and genetics coursers. As the material got more complicated, shuffling huge stacks of A3 paper became unwieldy, so I went back to plain old Cornell notes for biochemistry et al. This app is what got me back to making maps, this time when writing review articles and planning out other research. Also good when contemplating the GTD 50,000 ft view.

Download iThoughts HD for iPad from the app store here. It’s prettier new cousin Mindnode 3 is available here

Calendars 5

For: all busy overachievers
Recommendation: ok
Price: $6.99

The default calendar used to be ugly and impractical. With iOS 7 it’s just the latter. This is a good replacement. Fantastical for iPad would be nice, though.

Download Calendars 5 from the app store here.

Drafts

For: advanced users
Recommendation: strong
Price: $3.99

Quick note-taking and automation rolled into one. I use it as the default inbox for anything and everything, mainly by appending a dump.txt file in my Dropbox. There is a separate iPhone version that is just as useful.

Download Drafts for iPad from the app store here.

Pinner

For: pack-rats
Recommendation: ok
Price: $1.99

Pinboard is an excellent almost-free bookmarking and discovery service. There are plenty of iPad clients available, but Pinner seemed to be the most cost-effective. I haven’t regretted the purchase.

Download Pinner from the app store here.

GW Mail

For: anyone who is forced to use GroupWise
Recommendation: meh
Price: $9.99

I have to use GroupWise email for work. This is the only decent client I found for iOS. Stopped looking for a replacement since my last day of residency is less than six months away.

Download GW Mail here

Reading

Reeder 2

For: serious feed readers
Recommendation: strong
Price: $4.99

I’ve been using RSS feeds since the days of Bloglines (circa 2001) and switched to Google reader after the first big redesign. It’s sad that Google decided to murder it instead developing its potential as a social service. Feed wrangler is a good replacement, Feedly is a free one. Reeder 2 is the best iPad feed reader there is, and works well with both.

Download Reeder for iPad from the app store here.

Instapaper

For: everyone who reads
Recommendation: strong
Price: $3.99

If you read any text that’s longer than 500 words with any regularity, you need a service that will keep track of the articles and remove all the annoying cruft surrounding the text. Instapaper is the first one of its kind, and the best way to read articles on it is on an iPad.

Download Instapaper for iOS from the app store here.

NextDraft

For: everyone
Recommendation: strong
Price: free

Ten good articles hand-picked by an expert hand-picker and delivered (almost) every weekday. My only source of news for the past six months.

Download NextDraft from the app store here

ReadQuick

For: dabblers
Recommendation: ok
Price: $4.99

The second book from Tony Buzan that I read was on speed reading. This app will flash words from any article you find online or in your Instapaper/Pocket queue one-by-one at a set rate. Good for those who are too lazy to swipe.

Download ReadQuick from the app store here

Writing

Day One

For: everyone
Recommendation: strong
Price: $4.99

A journaling app. I don’t use it for the Dear-Diary types of texts—though I have no doubt it would be perfect for that. Instead, I use it to keep an archive of meeting and lecture notes (usually started in Drafts and sent to Day One), with an occasional milestone in between. Feature request: multiple journals.

Download Day One for iOS from the app store here

Byword

For: beginner iPad writers
Recommendation: ok
Price: $4.99

If you want to write a long text on an iPad and don’t need automation, text expansion et al. then this is the app for you.

Download Byword for iOS from the app store here

Editorial

For: advanced users
Recommendation: strong
Price: $4.99

If you want to write a long text on an iPad and like mucking about with workflows, text snippets and Python scripts—which I most certainly do—this is your only choice on any platform. This will become essential next July when I start my long commute.

Download Editorial from the app store here

Social

Twitterific 5 or Tweetbot

For: everyone
Recommendation: meh… you might want to wait for the newest version of Tweetbot to come out
Price: $2.99 for Twitterrific, $2.99 for Tweetbot

If you are on Twitter—and if you are a physician you really should be—please get a decent iOS client. The official one is definitely not it. Tweetbot used to be until iOS 7 came and made it look and feel ancient. Twitterrific is a good—if slightly annoying—substitute, with the added benefit of being universal (i.e. iPhone and iPad with the same purchase). I’m using the old version of Tweetbot and waiting for the new one, since Twitterific tended to make a mess of my position in the stream.

Download Twitterrific 5 here and Tweetbot for iPad here

Facebook

For: everyone who uses Facebook (why?)
Recommendation: my wife likes it
Price: free

OK, I guess, if you’re into that sort of thing.

Download Facebook for iOS here

Skype

For: everyone away from family
Recommendation: OK
Price: free

This is the international default for long-distance communication, I guess. It gets choppy and drains the battery, but it’s the only thing my mom knows how to use so I’m stuck with it.

Download Skype for iPad here

Games

Letterpress

For: everyone who can spell
Recommendation: strong
Price: free (with in-app purchase)

An excellent turn-based word game. The only multiplayer game I play with any regularity. You need an in-app purchase if you want to play more than two games at the same time, but it’s well worth it. I have five going on right now.

Download Letterpress here

10000000

For: nerds
Recommendation: strong
Price: $1.99

Bejeweled meets a 2D RPG. Hours of fun, even when you get to 100000000000 or however many points.

Download 100000000 here

Aquaria

For: adventure gamers
Recommendation: strong
Price: $4.99

A 2D side-scrolling action-adventure game set under the sea. At my pace I will finish it in about two years, but it’s great even in 15-minute increments.

Download Aquaria for iOS here

Shopping

Deliveries

For: serious shoppers
Recommendation: strong
Price: $4.99

Forward an email containing a tracking number to a special email address. Boom, you can now track your package through this app, with push notifications if you’re into being interrupted whenever a case of -diapers- Wild Turkey is delivered to your front door.

Download Deliveries for iOS here

Eat24

For: serious eaters
Recommendation: OK
Price: free

Good app for ordering food in the Baltimore area. Don’t know about rest of the country.

Download Eat24 for iPad here

Hipmunk

For: world travelers
Recommendation: strong
Price: free (you pay for the plane ticket, though)

The best flight comparison engine there is. Find the most affordable and least annoying plane route. Also does hotel rooms, which I haven’t tried.

Download Hipmunk for iOS here

Entertainment

Netflix

For: everyone with a Netflix subscription
Recommendation: OK
Price: free

I have used this app exactly once, to watch a couple of episodes of Buffy the Vampire Slayer while waiting for an Amtrak train. Well worth it, though.

Download Netflix for iOS here

AppleTV Remote

For: everyone with an Apple TV
Recommendation: strong
Price: free

I don’t have my original remote any more. We assume Dora ate it. This app is even better, since you don’t have to muck around with the tiny remote buttons when entering your wifi password or searching Netflix.

Download AppleTV Remote here

comiXology

For: everyone who reads comics
Recommendation: strong
Price: free (the app, not the comics)

The only way to read comics on an iPad.

Download comiXology here

On RVUs, sort of

Miloš Miljković — Tue, 24 Sep 2013 15:01:00 -0400

They let us peek into the sausage factory last week.

Nominally, the lecture was about RVUs¹. An accountant type in a pinstripe suit explained why the government came up with the concept and how more RVUs translate to mo’ money for the hospital. Then he showed us a table. This is how much RVUs an average ophthalmologist makes in an hour. Here is an orthopedic surgeon. See here at the bottom? That’s an internist. This is how much you’re worth to us, scum².

Then there was a chart. This is the last fiscal year. This solid line here are monthly RVUs for an average hospitalist. The dotted line is for a single physician in the practice. See how it’s always above the solid line? That’s good. We love that person.

We had medical students and interns just three months into training listen to this. It was blood-curdling.

Not because the hospital organized the lecture, mind you. It is a very good thing they did it, and it is good for doctors in training to realize as early as possible in what kind of a healtcare system they are expected to work. What is frightening is that there needs to be an entity, let’s call it administration, which views the hospital as a production plant and physicians as line workers who need to maximize outputs, optimize efficiencies and do other newspeak claptrap.

Administration usually lies—appropriately—on the ground floor, far removed from that other sausage factory of actual patient care. It looks at pie charts and histograms and RVU tables and keeps coming up with new and exciting ways to increase production while wondering why those bumbling doctors at the bottom of the list can’t do whatever the top performing docs are doing to keep the hospital in the black.

It’s modern medicine, it’s complex, it’s expensive, it requires that level of organization and detachment—you might be tempted to say. Yes, you could indeed say that, if not for the lonely example of every other country in the developed world which does it differently than the US.

But never mind that. With all the shenanigans the Congress has been up to this week, that end of the equation is unlikely to change. What administrators should do—and I understand the banality of the following advice—is see real physicians interacting with real patients for at least and hour each week. Interns being bombarded by page after page—from critical to comical—while trying to figure out a 15-minute window to eat, get coffee and use the restroom⁴. Residents finishing a 24+ hour ICU shift that started with three codes and ended with a difficult end-of-life care discussion, with central lines placements and intern supervision—but no sleep—sprinkled in between. Attendings getting yelled at while trying to explain to family members why they need to pay for the medications out of pocket or bring their own³.

One hour. Each week. Mandatory. To put things in perspective.

Relative Value Units. ↩
Not his actual words. Actually, he sounded very apologetic when explaining it. Still stung though. ↩
Hello, observation status. ↩
At the same time? — a thought will come to them, to be quickly dismissed. ↩

On patient notes and busy interns

Miloš Miljković — Sun, 15 Sep 2013 00:00:00 -0400

Electronic patient notes, the way they stand now, are dangerous. As physicians wiser and more experienced than myself have noted, they are made for billing, not story-telling and communication between healthcare professionals; and as anyone with even basic literacy in the English language will notice as soon as they read one, they are a barely comprehensible, intelligible, muddled word salad that looks computer generated because, well, in most cases it is.

Why?

For one, they are ridiculously easy to create. Click on a checkbox and every admission note you start will come pre-populated with what the EMR thinks are the patient’s current home medications, prior surgical procedures and such. Have trouble accurately documenting the dozen medications your 72-year-old with systolic heart failure, diabetes, CKD and vascular dementia has? No big deal—the e-patient has at least something listed from an ER visit 9 months ago. You’ll make sure to go back to the admission note later and append it with the correct list when you get it from the family member tomorrow, right? Right.

They also save you from having to type. Click click click, and the review of systems is done. Too much clicking? There is a solution: spend 5 minutes to create a macro, and you will have all your common questions pre-answered as No on all the notes, shaving of seconds of additional clicking. Because asking all your patients the same questions and expecting identical answers is just plain common sense, amiright? Oh, and of course tachycardia is a symptom. It’s right there on the ROS list, waiting to be clicked.

Most of all, electronic notes are the one cure for writer’s block. While in the distant past¹ you had to spend agonizing minutes staring at a blank admission note trying to form a coherent story on why the patient came to be seen, and then try putting it down on paper down without feeling ashamed, you learn from EMR that it is OK to sign a medico-legal document that contains this brilliant turn of phrase:

The reason for visit is: pt missed hd, high bp, n/v. The course was: constant. The exacerbating factor was: none. The alleviating factor was: none.

But why? Medicine residents are, in general, all moderately-to-ridiculosuly smart and ambitious people who should know better.

Well, for starters, some of them don’t. Even in the olden days¹ you had a couple of interns who weren’t the best ever history-takers² and wrote poor-quality notes. Electronic notes, unfortunately, help them obfuscate their deficiencies. It is very easy to see in a one-page note how much useful information the resident has actually obtained. Not so much with computer-generated six-pagers.

Then there is your typical smart intern just finishing putting in orders for her fourth admission admission that day after discussing each one with the supervising resident, all while answering a barrage of pages about the 30 patients she is cross-covering. The first two admission notes are almost done—she has to updated the plan after talking with the resident—but the other two will have to wait until she updates the sign-out and hands off all the patients to the night float. This is arguably much more important than notes as it directly affects the care those newly admitted patients will get overnight, while the admission note is not really needed until the following day during morning rounds. She’s smart enough to prioritize.

She’s also smart enough to know what is expected of her. What she know about writing admission notes during residency she learned from her peers, particularly seniors—who concentrated on efficiency —and that lady at the billing department who gave a noon conference talk on the importance of complete documentation for coding. So The Man wants me to be efficient-yet-thorough, and then he gives me this electronic tool with auto-population, templates, macros and such. Hmmmmm…

Yes, she might get in trouble if her notes are so horrendously bad to significantly impede patient care. From my very limited experience this just does not happen. Or rather, if it does, appropriate documentation is a single bullet in the long list of areas of improvement during an M&M.

What to do?

Or in my program, six months ago. ↩↩
They would be the ones calling the patient “a poor historian”, and were usually correct, although not in the way they intended. Patients are the ones giving a (hi)story, the physician is the historian. ↩

Attending APDIM Chief Residents’ Meeting

Miloš Miljković — Mon, 29 Apr 2013 00:00:00 -0400

No regular programming here, but had there been any it would now have been interrupted due to my attending this year’s chief resident meeting. Which is in Disney World, of all places¹.

You can always follow me on twitter for the latest smart-ass comments.

Despite this, there have been worryingly few sightings of Mickey so far, and zero of Donald. ↩

Peeves

Miloš Miljković — Sun, 02 Dec 2012 22:45:00 -0500

I don’t care much for spelling or grammar. My native language, Serbian, has no concept of the former thanks to its being phonetic. As for the latter, few people in my home town and the surrounding area cared too much about it, flinging tenses, forms and declinations around carelessly. I proudly continue this tradition.

What gets to me is semantics. Misspelling tachypnoeic is unfortunate; saying that the patient’s head is normocephalic means either that it had grown a head of its own, or that the speaker had no idea what the word they were using signified¹.

So anyway, lots of big words and a sizable footnote just to introduce something I’ll likely be doing on a weekly basis—-complaining about today’s youth and their improper use of medical verbiage².

Carry on.

Never mind that an average internists sees an abnormality like dolichocephaly once every 10 years—-thus obliviating the need to say that someone’s head has a normal shape in each and every admission note. Not that most physicians would recognize dolichocephaly if and when they saw it. ↩
Lets pretend that my entire medical experience thus far does not consist of just over two years of IM residency. Also, English is not my primary language. ↩