Digital Exhaust #190

AI paternalism, universal menstrual leave, and the metaverse circles the drain

You’ve opened Digital Exhaust, a 33 charts weekly digest. Browse below the big button for compelling stuff. As usual, the letter has a tech focus with attention to humans.

Resident calls for a pause on unionization

Despite being the most highly compensated residents in the U.S, Mass General trainees want to organize. Once part of an elite professional strata of medicine, these young, Harvard-trained postgrad physicians now identify as line workers — like Starbucks baristas. Not a judgment. Just a sad reality.

Interesting perspective in StatNews from a Mass General ortho resident making the case to pause and think rather than reflexively jump on the line.

Unreal. More money than I could ever have dreamed of in residency, and the privilege of being trained by some of the smartest minds in medicine. I can only imagine other trainees in different parts of the country or world who would kill to be in their positions.

And I have to wonder how the Hell we got to this? What is going on?

+ Apparently, postdoctoral researchers are also unionizing.

Sam Altman opens up about AI

In an MIT interview with Lex Fridman, OpenAI’s Sam Altman discloses there is no GPT5 in the works, and addresses the call for a universal halt on AI development. Interesting to watch this young guy spur a shift in human civilization not seen since The Enlightenment.

Few realize how big all of this really is.

The signals are talking - Is the metaverse circling the drain?

Major retailers are walking back their ‘metaverse strategy.’ Walmart, Disney and others are pulling the plug on the apparently waning Second Life knock-off. And to make matters worse, Meta’s metaverse division lost over $4 bn in the fourth quarter of last year.

Big thinker Benedict Evans on Twitter:

Conversation from a long time ago…

"What kind of people visited our Second Life experience?"

"Well, about a third were our employees, a third were employees at our competitors, and a third were consultants and analysts..."

The easiest way to mismanage a technology is to misunderstand it

Jaron Lanier, one of the great visionaries of tech, on ‘controlling’ AI.

Pharmabro’s GPT advice line

Pharmabro, Martin Shkreli, “the West’s most punchable man (oh, ok, but definitely top 20) is back to SAVE MEDICINE with, er, a $20 a month subscription service that lets you ask what I presume is a custom-trained GPT medical questions and receive infinite medical ‘advice’ on demand.”

Shkreli’s site, Dr Gupta, is here for those willing to swipe their card. And how did he come up with the name, ‘Dr. Gupta’?

Raging strep

Epic Research identified 3.3 million strep throat infections across 982 million encounters (not a typo - not The Onion) from January 2017 to February 2023. As of February 2023, strep throat encounters increased to a rate nearly 30% greater than the previous peak seen in February 2017.

Percentage of strep encounters by age

Great explainer behind the paywall at Nature. One theory is that lack of exposure to group A Streptococcus (strep A) during lockdowns at the height of the COVID-19 pandemic means that young children lack immunity against the bacteria.

As I always say, the Epic Research data is just mind-blowing. I’m surprised more folks don’t talk about or reference it…

Neologism of the week: AI paternalism

Picked up in the MIT Tech Review. As AI infiltrates healthcare, researchers are seeing a rise in what’s known as AI paternalism. Paternalism in medicine has been problematic since the dawn of the profession. But now, doctors may be inclined to trust AI at the expense of a patient’s own lived experiences, as well as their own clinical judgment.

Why innovate in healthcare?

In the past few months, the founders of Instacart, Spotify, and Coinbase have all started new healthcare companies. But why are these seasoned tech founders jumping into tech-driven healthcare? Andreessen unpacks it.

Not sure if this is was intended for The Onion, but this monolithic venture firm is selling healthcare because ‘it’s the right thing to do.’ Hilarious.

And while margins are nice, mission is nicer. When you think about the limited number of days you have on this planet and the insane number of hours you’ll pour into building a startup, wouldn’t it be great if you were working on something that really mattered? You don’t have to be a doctor or cancer researcher to save lives. A company detecting medical errors or helping people afford medical care might save countless lives.

Universal menstrual leave

An opinion piece in Undark that builds a compelling case for universal menstrual leave.

Elon Musk pays for Stephen King’s blue checkmark to make it cool again

Twitter took away blue checkmarks from legacy verified accounts this week, but Stephen King, William Shatner, and LeBron James' checkmarks are hangin’ on.

I subscribed very early on to test the editing feature but canceled after two weeks. I’m not paying a cent but can’t make the check go away. Maybe Elon thinks I’m cool like William Shatner. Or maybe there are no employees to address my service request.

Drunk Lab

Wondering if I’ve got any Digital Exhaust vet subscribers who can confirm that this is even possible? — “Vets in the UK scrambled to save the life of an alcoholic labrador retriever that had become addicted to booze because its late owner kept leaving his drinks outside overnight.” Seems plausible.

I suspect my discerning Australian Cobberdogs won’t drink New Zealand Sauv, so they’re safe. I think.

The fate of Einstein’s brain

When Albert Einstein died of an aortic aneurysm on April 18, 1955, the Princeton Hospital pathologist on duty, Thomas Harvey, removed the great man’s brain. Harvey, acting without the family’s permission, seemed to think the brainiac’s grey matter would reveal the anatomy of genius—if only somebody could uncover it. | JSTOR

Great quote: Sense making as the new leadership challenge

This is one of my fav quotes from Finnish management guru, Esko Kilpi. It captures the core challenge of healthcare leaders — the tension between technological advancement and our ability to keep pace as organizations. As leaders we are evolving as sense makers in a world changing faster than most of us can keep up.

The fundamental problem today: the speed embedded in our institutional frameworks vs. the speed of technological change. The key management capability is not being in control, but to participate and influence the formation of sense making and meaning. It is about creating a context that enables connectedness, interaction and trust between people.

I’m hiring 149 amazing pediatric subspecialists in Austin, Texas

I’m almost halfway there. Working long days on the phone and hardhat touring candidates, but I still need your help. If you know pediatric subspecialty talent interested in moving to Austin, Texas to work in our beautiful new 650 million dollar children’s hospital, please have them reach out to me at bsvartab@texaschildrens.org. We’re out on the edge of the Texas Hill Country and it’s going to be amazing. So far, we’ve shaped a crazy-good team of innovators, rabble rousers, starters and shapers.

Substack notes

When I have the time to come up for air, I’ll get into the new Substack notes. So watch you inbox….

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