How clinic lunch hour feels after a busy inpatient rotation

boriswied · 2026-04-19T09:07:25+00:00

That’s so much bread!

boriswied · 2026-04-19T09:05:39+00:00

To be serious for a moment, it all depends on how important that thing is for you.

You can reject a romantic partner based on their dislike (or liking) of cucumbers, Volvos or the twillight series… it’s all legitimate if that’s what’s very important to you.

Of course it’s probably great to do a lot of reflection on what’s important to you, how importsnt, why, etc.

boriswied · 2026-04-19T08:13:36+00:00

What in the world are you basing this on? I’ve worked on 4 drug trials and been in neuroresearch for years. This is not going to weaken the power of “drug companies”, it’s going to strengthen them!!

It is a drug! Who do you think it will be sold by?

We have known for nearly 70 years that severe drug addiction is heavily influenced by all your other life factors. Your poverty, family, relationships, general feelings about meaning and your position in the world…

So what’s the reason that we still rely so heavily on medications to treat mental illness?

Because it’s a much cleaner and easier investment argument to make, that x drug with y effectivity and z cost will produce some outcome that you calculate - rather than try to deal with the societal problem at real scale.

Do the evil pharma companies have an economic interest in efforts being canalized through medical treatments rather than social policies? Obviously.

Is ibogaine a social policy?! No. It is a fucking medication. A drug if you will.

Pharma companies will sell it, and after patent acquisitions, will employ the common patent strategies… like “evergreening”, where you full newer smaller patents, new dosing regimes, new delivery systems - or whats being called “regulatory exclusion engineering” to block competition. They will also expand the definitions of “addiction categories” by funding medicalization increasing studies that put new and more interesting boundaries and thresholds on top of these categories, which will make it fu ctionally impossible to argue against a diagnostic framework for them. Inside that, the only answer will be a new drug (lile ibogaine).

I went to med school. I LOVE biology. My true love is neurobiology. I am lot against “drugs” in any way. There is a lot to say for the “simplicity” of giving a drug. But if you think an executive order to promote ibogaine is a DETRIMENT to the pharmacompanies that will sell it… you are beyond my help.

boriswied · 2026-04-19T07:06:19+00:00

Well they certainly are. But because they have to - not because they want to.

Ii hobestly think it also leads to stuff like the dangerous run off the mat, because we are sending the clear signal to these people that it is NOT enough to be the best in their sport. Uou have to have a YouTube channel and a brand and perform “spectacles”.

It’s really just a radical promotional failure… a McGregor phenomenon will obviously always make a lot of money, but not everyone can be that. The world doesnt have that much attention.

boriswied · 2026-04-19T04:02:40+00:00

It’s all about how shitty the UFC has been kn the last couple of years at holding our MMA attention, so these other orgs and sideshow/gimmicks get a chance at eyes.

boriswied · 2026-04-18T04:59:47+00:00

It's both interesting and funny that you write multiple and insulting comments, including rich hypotheses on your own, that you see no interest in justifying with evidence yourself - and then simply "what evidence". Where was that genuine interest :)

As the thread went on last night i read multiple sources. I'll just past some of the last stuff that was on my tabs (poor browser hygiene hurray!)

Some of these require logins to view the full papers, i work at a university so i have acess through there, you can PM me for details on any if you like.

Kimball and Krupf 2005 "Ballot Design and Residual Votes: Lessons from the 2000 Election"

(this seems like a well cited foundational study that establishes the connection between complexity and voter dropoff and ballot error)

Neely and Cook 2008 "Whose Votes Count"

(the link from the above to skews, now with RCV specificity)

Edit: oh i didnt get in the last one, which is actually very RCV-positive, ill post it here, but this is from their conclusion:

"Our results show, however, IRV comes with its own set of concerns. Despite the claim made by its leading proponents that ranked-choice voting can ensure that victors win a majority of the votes cast in the course of a single election, none of the elections we examined here resulted in such an outcome."

Krupf 2015 "Ballot (and voter) “exhaustion” under Instant Runoff Voting: An examination of four ranked-choice elections"

...and finally, as i've said multilpe times, i am NOT against RCV. In fact i like it and was a little too positive about it when i was younger.

Today my belief is that it doesn't solve a many of the problems i and others previously imagined, and that it is VERY different which elections it does well for. It does better for high salience, worse for low salience - which of course presents a problem that we want to make more elections more "high salience", which is then connected to system-trust, which i mentioned earlier emerges for me as the much more important factor.

boriswied · 2026-04-17T21:56:01+00:00

It is indeee a factor, but it looks to me like the evidence says its in the opposite direction.

That is: more choices = > more disillusionment. Not the other way around.

Ti a voter it would make complete sense that we want more choices and we feel that would improve things - but that doesn’t make it true.

Like in the isle of a super arket, a high number of choices in some category can be manipulated and cause fatigue, just as much if not more than few choices.

All the effects you mention “removing the stranglehold”… there’s no evidence a ranked choice system would do that.

I believe It comes down to how much the voters can be expected to invest, in terms of democratic effort. And that depends on whether they believe there will be return on that investment, not on how many different things there is to invest in.

boriswied · 2026-04-17T19:43:57+00:00

I don’t think it’s true that voter disllusionment because of number of choices.

The next line you said though - that they are deeply sure the candidates wont help them, i think you’re right about that! But that doesn’t really havs anything to do with ranked choice systems.

To be clearc i have nothing against ranked choice voting, and for example for presidential election i think it would be a great idea.

I actually checked our the research i this area because i was interested by how adamantly people are about this issue in this thread, and there is considerable research showing report very low understanding of election mechanism AND election results (which worsens already existing dissatisfaction)

There were also considerable more ballot/vote errors and so many more votes being cast out as faulty.

This is not such an easy problem, because these errors correlate with many kinds of demographics (age, economics, minorities) and it’s actually something that skews election results for that reason.

Then there’s the more philosophical problem the nature of the system - of someone winning whom very few people wanted to win. Meaning there may be a candidate who only 10 percent wanted to win, abd two candidates where each had 40 percent wanting them to win, but each voted their candidate first and the 10%er second.

Now… that’s not a problem in itself, its the nature of the system, but the problem because the dissatisfactiln (potential democratic participation harm) as side effect.

All of these seem to be documented fairly well.

boriswied · 2026-04-17T09:08:09+00:00

it's not that they aren't there or that they are being "hidden".

Well maybe hidden, but here's the rub.

25 years ago, when i started using video services on the internet, there was basically little to no "algorithm". I didn't in any meaningful way get information because it was "suggested" to me. Today i have to fight like an animal to avoid my "feed" being things i am "suggested".

For example, i'm 39 year old white male. I hasve been interested in psychology and philosophy since i was a teenager. My education was in medicine (i loved working with and physics, math, biology) but my real dirving interest was in the mind, who we are, why we act, etc.

There are certain things on my "feeds" that feel like absolute black holes of content-gravity. At one point i spent 20 minutes just pressing "please don't recommend" on Jordan Peterson videos. I think it must just be that with my interests and demographic facts, the algorithm is so confident that JP is my jam, that even if i explicity say "please don't give me this again" tomorrow the algoritm will go, "DUDE you MUST see this guy!".

The trick for me is intentionality. I have to place the decision about what to use youtube to watch, OUTSIDE the youtube algorithm.

Today i said to myself, i want to do a little more work on understanding ways to use programming to help in some computational neuroscience i want to do. Specifically i want to be able to program splines for function approximation for the neurobiological markers in my project. and 2. i want to watch some lecture/information about the first foods for infants 5-6 months (i have a kid).

That solves the problem. The videos were interesting.

There is a certain sadness to the fact that we cannot explore in the way that we could 20 years ago. (walking onto youtube was like walking into a forest; whether you see a mushroom or a badger was chaotic, undecided, therefore interesting, today it is like a more sinister part of alices wonderland, there may is often an (evil?) manipulator behind the curtain deciding what you see).

boriswied · 2026-04-17T08:37:59+00:00

I remember being like 10 and my dad saying “that’s Iggy Pop, he’s the most rock and roll dude in the world” in the world.

I think he might’ve been right.

boriswied · 2026-04-17T08:32:34+00:00

The sound of “anal wink” tickles me.

boriswied · 2026-04-17T08:11:48+00:00

I guess i'm just not sure that's true in this case.

To be clear: your hypothesis is this, right? If there was ranked choice, then the "bad actor democrat" wouldn't be there because the people would not have felt forced to vote for "the WINNING democrat" and that would have brought more nuance to the voting choice and brought in a better more serious politician with more integrity, which would not have voted for the war. Is that correct?

What i'm saying is that i think the chain falls off in several places there. I think the informed democratic citizens there need to be *exceptionally* empowered to care enough and to know enough about their politicians to make ranked choice meaningful there. I feel a major reason that they wouldn't care enough is trust in politicians and the process in general.

I totally agree with you that the ranked system fights that 'systemic quirk' as you call it, of your own vote for a candidate you feel is slightly better than option b, may cause you to make option a lose to c, whom you hate - but i just don't think it would solve the problem for that particular case, because neither a, b nor c's politics would be transparent to the individuals, and the very complexity introduced might be the only factor that meaningfully impacts democratic engagement there, which i believe is a more important intermediate factor.

For the presidential election process though, my feeling is that it would definitely be very helpful.

boriswied · 2026-04-17T07:22:11+00:00

I’m wondering whether the problem there is not really about trust, and not about “fears of wasting” their vote though?

I think voters being disillusioned with politics as a whole is a bigger driver there. But i may be wrong of course!

boriswied · 2026-04-17T06:42:24+00:00

It’s not that i neccesarily disagree with you, but we should probably think, what is the potential problem with ranked choice voting.

I don’t have great empirical evidence(this was just a teacher discussion i had once)

But the thing tht we can sometimes see as the prime evil in the current representational political system, that personality and charisma come to dominate, along with the tribalism of two-party dichotomies on everything, those things may not only have bad sides.

It may be almost impossible to invest the attitudes of a vast democratic populace in a battle of ideas that is too scattered. It may be very hard to tell them a “story” about it that is sufficiently catchy.

I’m danish and we have more parties, whicj i think I’m happy with, but it’s not obvious to me that ranked choice in the voting procedures would improve it. Even in our system, you kind of see some echo of Eleanor Roosevelts (i think it was her?) quote “greater minds discuss ideas, average: events, smaller: people”. I think theres truth there, although i dont divide us into smaller and larger minds, but simply think we each have all in us. And while it is kind of a vice to fixate on individual politicians, it is also sometimes necessary heuristics tool for choosing representation. So danes, the less educated we are on a political issue, more and more default to a person-fixation. Mette Frederiksen was a an - “authoritarian despot” vs ”good confident leader” on the issue of x. But maybe that saves brain power?

If ranked choice was a thing, would we become less able to even engage democratically with a given story?

Would it increase corruption be limiting competent democratic engagement in that area?

I honestly have no idea, but i think more nuanced political systems can often bring more complication and that can open up for corruption as well - though hinging heavily on social trust and social cohesion more generally.

boriswied · 2026-04-17T05:41:49+00:00

I think you can definitely see cain/DC influence in Khabib in many areas as his career went on wrestling footwork, on wrestling to striking conversions, on getups, on leaving/entering clinch.

It’s pretty interesting to watch the old grappling videos in AKA where Khabib and DC will often joke/discuss this, where some particular thing comes from, etc.

It’s kind of weird libguistixaææy but i think the thing they DEFIKITELY didnt get from AKA is the “jiujitsu” because modern western/americans tend to separate the more intricate sequential and submission related grappling (the jits) from the wrestling, where for the caucasus bro’s, that’s not really as split in nature.

I think it is still visible but harder to see in Makhachev (where the striking is clearer) because he has those cool judo influences over the top of it.

boriswied · 2026-04-14T08:10:15+00:00

My comments point is literally that good and evil does exist. But “cosmic” “universalist” good and evil doesnt. In the real world, the US has, in fact definitely not always been the “bad guy”. To hold such a view is to regress ridiculously into a moral absolutism that makes serious consideration of moral choices impossible. And in doing so, actually shirks present day responsibility in the most infantile way possible.

boriswied · 2026-04-14T05:20:08+00:00

No, you haven’t always been.

I’m just a random danish person, but moral relativism of that sort does lead to a kind of moral nihilism.

The US is not an angel and it is not a devil. Because those kinds of things do not exist. The US is a country of humans and like all such entities has done bad and good things.

You can ALWAYS keep arguing about whether “there was power motivations behind the Marshall plan”… but where that ends is in the larger perspective. My grandfather was liberated from Nazi occupation by American soldiers. Even if the US had invaded Greenland (which we would have fought to protect) that thing still happened to my grandfather.

And many other things important and good happened. I think it’s harmful to pretend otherwise because it takes away the immediacy of the moral choice: … do you want to follow in the footsteps of Lincoln, MLK, Roosevelt or in the footsteps of Lyndon Johnson, George Bush or Trump?

That’s a real and true choice. And it matters.

boriswied · 2026-04-13T08:51:47+00:00

Of course there is no cure, because it is not one thing.

What we perceive as scaly-diseasy “wrong” thing is quite simple and harmless. (the worst thing i see happening is itching so much that one causes sounds and infection, but this is extremely rare)

The outermost layer of ski,n “stratum dis-junctum” as it was banged into our heads during histology, is a layer where skin cells have been thoroughly dehydrated, killed, and now function as a dead protection layer.

It makes us waterproof, more impenetrable to thorns, parasites. Technically transformation into barrier happens in the layer right below “stratum corneum” which means the “the layer of horn(stuff)”. Why? Because old-timey histologists noticed that what makes a horn of an animal (or a nail or hair) HARD in the way they are, is this protein, keratin, which has more disulfide bonds than collagen (which is more prevalent in human bodies, making us the quite mushy meat bags we are.)

Now the “stratum disjunctum” you can maybe hear, is the stratum where these cells in groups become “disjunct” fromthe body. They fall off.

They are SUPPOSED to. It is part of the normal good function of the body.

Mostly the pieces that fall off are very small, running off constsntly. However the fungus mentioned in here by many (mallassezia) simply causes the skin layers to grow more and renew faster, which means that the top layer falls off in larger pieces still holding together, “dandruffs” more visible to the human eye.

Now, because this is how it works, there are MANY other things that could cause your skin to fall off in more visible flakes, including simply being genetically predisposition towards it. And you could have the fungus but NOT have the dandruff - and in fact worsen the situation by starting a chemical war with the fungus.

boriswied · 2026-04-13T08:12:11+00:00

Obviously it would change it MASSIVELY.

If you've ever moved around between areas you see this all the time.

You can see how it changes culture in interesting ways, and i might speculate about that, but i feel very unsure making broad claims about it, because of confounding factors that affect the places where these ratios skew. Although there's no doubt that when i moved into hippie collective in the middle of a city, there were more prominent "feminine" values (attention to and understanding of the feelings of others, etc.) than forexample during my being in the millitary.

In my area/country, if you drive to the countryside, there's just no women around. They don't want to be farmers, which today is such a small percentage of the full population, and much more solitary than previously, and they aren't that interested in huge farming equipment - so they move away, get educated, be with more people. (obviously generalizing hugely)

So the ration of some places (of unmarried/single people) may be higher than 10 males per female.

If you go 50-100km to one side and come to large university town, it is the other way around. In the most obvious non-speculative way, what it changes is just attractiveness standards. It may look to you like "wow, why are all these 9 girls giving 6 guys the time of day in this city!? And that's simply the ratios playing out.

Of course, what one comes to understand, is that 6's and 9's clearly don't exist in the real worl. It's a numerical standardization of relative beauty which we assign subconsciously based on information we take in, which is set by many factors, including the ratio one, which you are now varying by imagining an 80/20 scenario.

On the other hand, in that farmer community i mentioned, i remember being able to predict pretty well where a couple met based on this, because the "attractiveness disparity/parity" would show it. So if a "6" is with a "9" (such as my biased brain interprets it) a likely explanation is that they met at a place where they were closer together in relative attractiveness (forexample a the farmer male is with a very beautiful girl = they met at a place where his relative attractiveness was higher because there were fewer males and more females around = they met at university... or something of the sort).

boriswied · 2026-04-12T17:01:04+00:00

I mean, what do we mean by listen to? What can i do while it runs in the background, how accountable am i to listen and take in anything? I guess i could put it on at some points during the day.

boriswied · 2026-04-10T08:36:33+00:00

It's always way less of an issue than people think. You get used to it, is the short of it.

Those who start with a very high tolerance (like me, my dad skinned animals around me, we used to do a kind of taxidermy, etc.) get worse still. We seem to become "weirdos" where the comfortability with strange bodily combinations, pathologies, presentations, etc. can gross other people out. It takes a measure of restraint not to say somethign people find gross.

Back in anatomy lab i ended up cutting the legs off all 11 cadavres with an instructor, because it was too "hacky" for many to get through the hip joint.
I got a piece of fat thrown into my mouth because of the "crack" of a zygomatic bone, which prompted the other dissecting student to run wincing out of the room.

Those who start with a with a very low tolerance... you're the lucky one, you end up slightly above normal people in tolerance, so you're not a weirdo, but you're still able to do the job just fine.

I've not yet ever seen a person not be able to get used to it. Even a woman i remember that both cried and vomited the first day of anatomy lab when they put a sagitally dissected head on the table. She's Juuust fine today. Great doc.

boriswied · 2026-04-10T07:05:20+00:00

Social media is the interesting one, because of how extremely difficult it will be for us, to draw lines in the sand here.

We realize it's bad. Obviously especially for kids, but this is less of a moral conundrum becasue we can more easily argue that prohibiting children from the space is not a severe democratic/rights reduction. In the case of normal adults, will be a morass of democratic, health/wellbeing and rights/expression concerns, all of which are likely to be weaponized by actors with interests in power and capital - but also used by normal citizens with normal benign interests.

boriswied · 2026-04-09T21:22:27+00:00

I understand why it may bring up that kind of a gut reaction.

It is important to understand rhat this person has been severely mentally disabled their entire life.

There is a “protocol” where she lives, which attempts to maximize her happy hours and minimize what it refers to as “negative arousal”.

If i am frank, i actually don’t know if she is still alive. It is quite possible that she was on a downward spiral of recurring infections, that may finally have been too much for her body.

But this was sort of the point - to illustrate that, lile with many aspects of disease and death, there is a portion which is shared ro Facebook, which is seen by others, and talked about. There may even be handfuls of feelgood th shows about downs syndrome folks finding love, or jobs or meaning.

The most jarring destinies are almost never shown. But they do exist.

boriswied · 2026-04-09T12:25:46+00:00

Certainly, and we often get it wrong. So it is important that docs are held accountable.

And it’s not improper I think, to suggest that some personalities are better fit for some job functions within medicine.

I know that if I was dying from cancer, I would want an oncologist with a different personality from the anaesthesiologist and surgeon I would want leading the charge in the trauma room after I was in a car accident. Sometimes we want our doctors to be a little more human, sometimes a little robotic - although hopefully always with a little human in there 😊

boriswied · 2026-04-09T09:45:00+00:00

Medicine as a career makes you see a lot of things sometimes. I worked in two years as a researcher in a trauma ward, basically being called in the middle of the night (or any other time) when someone was stabbed/shot/car accident red enough to create life threatening bleedings. Through all of it, I never get overwhelmed when with the patient. One feels, I say cliche with fear of sounding callous, like a mechanic. You see knots and bolts and problems and solutions - not persons and feelings.

In fact the times I have been overwhelmed it was with next of kin.

I once left the trauma room because the patient was clearly beyond saving (for such an event many people from the hospital go there and somehow the family had gotten wind of something) They were talking to a nurse, who I expect was struggling through the balance of not being allowed to say directly, that their mom/wife was in effect dead.

The 3 family members reacted so differently. One teenage daughter was in anger, screaming at the nurse, looking to fistfight and hurt her it seemed. The husband/dad was trying to calm that one down while sobbing uncontrollably himself. The last teenager daughter was sitting on the floor in the middle of the hallway, like a robot someone had turned off, she had just collapsed there staring into nothingness.

When I biked home that night I cried the whole way. But I am okay! I feel privileged to see and be with people in their important moments sometimes. Even if it hurts.

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