or, how I spread monkeypox and got it myself.

This story contains nsfw (not safe for wife) stuff and shouldn't be read if you're under 18 or think I'm a newborn angel. After the opening, it's broken into three sections: a chronological explanation of my disease course, my ideas, and what I plan to do next.

Your journey awaits.

As early as mid-may, I was waltzing around the lab talking about monkeypox, a rare tropical disease with an inaccurate name. Monkeys are not its primary animal reservoir. It caused an outbreak among men who have sex with men across Europe, with unprecedented levels of person-to-person transmission. European health authorities speculated that the virus spread at raves and parties and was easily transferred through intimate, mainly sexual, contact. I had already read the nejm article about the first confirmed monkeypox patient in the u.s. and shared the photos on social media so people knew what to look for. The cdc information page only included 4 photographs of monkeypox lesions that looked like they were captured on a motorola razr.

I warned my ex-boyfriend about monkeypox. Monkeypox? responded.

Mom, I'm afraid about monkeypox. What's monkeypox?

My therapist is scared about monkeypox. What's monkeypox?

Was I alone? A few science gays on Twitter didn't make me feel overreacting.

This information got my gay head turning. The incubation period for the sickness is weeks. Many of my social media contacts are traveling to Europe this summer. What is pride? Travel, parties, and sex. Many people may become infected before attending these activities. Monkeypox will affect the lgbtq+ community.

Being right always stinks. My young scientist brain was right, though. Someone who saw this coming is one of the early victims. I'll talk about my feelings publicly, and trust me, I have many concerning what's occurring.

Part 1 is the specifics.

Wednesday nights are never smart but always entertaining. I didn't wake up until noon on june 23 and saw gay twitter blazing. Without warning, the nyc department of health announced a pop-up monkeypox immunization station in chelsea. Some days would be 11am-7pm. Walk-ins were welcome, however appointments were preferred. I tried to arrange an appointment after rubbing my eyes, but they were all taken. I got out of bed, washed my face, brushed my teeth, and put on short shorts because I wanted to get a walk-in dose and show off my legs. I got a 20-oz. cold brew on the way to the train and texted a chelsea-based acquaintance for help.

Clinic closed at 2pm. No more doses. Hundreds queued up. The government initially gave them only 1,000 dosages. For a city with 500,000 LGBT people, c'mon. What more could I do? I was upset by how things were handled. The evidence speaks for itself.

I decided to seek an appointment when additional doses were available and continued my weekend. I was celebrating nyc pride with pals. Fun! sex! * ‍

On tuesday after that, I felt a little burn. This wasn't surprising because I'd been sexually active throughout the weekend, so I got a sti panel the next day. I expected to get results in a few days, take antibiotics, and move on.

Emerging germs had other intentions. Wednesday night, I felt sore, and thursday morning, I had a blazing temperature and had sweat through my bedding. I had fever, chills, and body-wide aches and pains for three days. I reached 102 degrees. I believed I had covid over pride weekend, but I tested negative for three days straight.

STDs don't induce fevers or other systemic symptoms. If lymphogranuloma venereum advances, it can cause flu-like symptoms and swollen lymph nodes. I was suspicious and desperate for answers, so I researched monkeypox on the cdc website (for healthcare professionals). Much of what I saw on screen about monkeypox prodrome matched my symptoms. Multiple-day fever, headache, muscle aches, chills, tiredness, enlarged lymph nodes. Pox were lacking.

I told my doctor my concerns pre-medically. I'm occasionally annoying.

On saturday night, my fever broke and I felt better. Still burning, I was optimistic till sunday, when I woke up with five red splotches on my arms and fingertips.

As spots formed, burning became pain. I observed as spots developed on my body throughout the day. I had more than a dozen by the end of the day, and the early spots were pustular. I had monkeypox, as feared.

Fourth of July weekend limited my options. I'm well-connected in my school's infectious disease academic community, so I texted a coworker for advice. He agreed it was likely monkeypox and scheduled me for testing on tuesday.

nyc health could only perform 10 monkeypox tests every day. Before doctors could take swabs and send them in, each test had to be approved by the department. Some commercial labs can now perform monkeypox testing, but the backlog is huge. I still don't have a positive orthopoxvirus test five days after my test. *My 12-day-old case may not be included in the official monkeypox tally. This outbreak is far wider than we first thought, therefore I'm attempting to spread the information and help contain it.

*Update, 7/11: I have orthopoxvirus.

I spent all day in the bathtub because of the agony. Warm lavender epsom salts helped me feel better. I can't stand lavender anymore. I brought my laptop into the bathroom and viewed everything everywhere at once (2022). If my ex and I hadn't recently broken up, I wouldn't have monkeypox. All of these things made me cry, and I sat in the bathtub on the 4th of July sobbing. I thought, Is this it? I felt like Bridesmaids' Kristen Wiig (2011). I'm a flop. From here, things can only improve.

Later that night, I wore a mask and went to my roof to see the fireworks. Even though I don't like fireworks, there was something wonderful about them this year: the colors, how they illuminated the black surfaces around me, and their transient beauty. Joyful moments rarely linger long in our life. We must enjoy them now.

Several roofs away, my neighbors gathered. Happy 4th! I heard a woman yell. Why is this godforsaken country so happy? Instead of being rude, I replied. I didn't tell them I had monkeypox. I thought that would kill the mood.

By the time I went to the hospital the next day to get my lesions swabbed, wearing long sleeves, pants, and a mask, they looked like this:

I had 30 lesions on my arms, hands, stomach, back, legs, buttcheeks, face, scalp, and right eyebrow. I had some in my mouth, gums, and throat. Current medical thought is that lesions on mucous membranes cause discomfort in sensitive places. Internal lesions are a new feature of this outbreak of monkeypox. Despite being unattractive, the other sores weren't unpleasant or bothersome.

I had a bacterial sti with the pox. Who knows if that would've created symptoms (often it doesn't), but different infections can happen at once. My care team remembered that having a sti doesn't exclude out monkeypox. doxycycline rocks!

The coworker who introduced me to testing also offered me his home. We share a restroom, and monkeypox can be spread through surfaces. (Being a dna virus gives it environmental hardiness that rna viruses like sars-cov-2 lack.) I disinfected our bathroom after every usage, but I was apprehensive. My friend's place has a guest room and second bathroom, so no cross-contamination. It was the ideal monkeypox isolation environment, so I accepted his offer and am writing this piece there. I don't know what I would have done without his hospitality and attention.

The next day, I started tecovirimat, or tpoxx, for 14 days. Smallpox has been eradicated worldwide since the 1980s but remains a bioterrorism concern. Tecovirimat has a unique, orthopoxvirus-specific method of action, which reduces side effects to headache and nausea. It hasn't been used in many people, therefore the cdc is encouraging patients who take it for monkeypox to track their disease and symptoms.

Tpoxx's oral absorption requires a fatty meal. The hospital ordered me to take the medication after a 600-calorie, 25-gram-fat meal every 12 hours. The coordinator joked, "Don't diet for the next two weeks." I wanted to get peanut butter delivered, but jif is recalling their supply due to salmonella. Please give pathogens a break. I got almond butter.

Tpoxx study enrollment was documented. After signing consent documents, my lesions were photographed and measured during a complete physical exam. I got bloodwork to assess my health. My medication delivery was precise; every step must be accounted for. I got a two-week supply and started taking it that night. I rewarded myself with McDonald's. I'd been hungry for a week. I was also prescribed ketorolac (aka toradol), a stronger ibuprofen, for my discomfort.

I thought tpoxx was a wonder medicine by day two of treatment. Early lesions looked like this.

however, They vanished. The three largest lesions on my back flattened and practically disappeared into my skin. Some pustular lesions were diminishing. Tpoxx+toradol has helped me sleep, focus, and feel human again. I'm down to twice-daily baths and feeling hungrier than ever in this illness. On day five of tpoxx, some of the lesions look like this:

I have a ways to go. We must believe I'll be contagious until the last of my patches scabs over, falls off, and sprouts new skin. There's no way to tell. After a week and a half of tremendous pain and psychological stress, any news is good news. I'm grateful for my slow but steady development.

Part 2 of the rant.

Being close to yet not in the medical world is interesting. It lets me know a lot about it without being persuaded by my involvement. Doctors identify and treat patients using a tool called differential diagnosis.

A doctor interviews a patient to learn about them and their symptoms. More is better. Doctors may ask, "Have you traveled recently?" sex life? Have pets? preferred streaming service? (No, really. (Hbomax is right.) After the inquisition, the doctor will complete a body exam ranging from looking in your eyes, ears, and throat to a thorough physical.

After collecting data, the doctor makes a mental (or physical) inventory of all the conceivable illnesses that could cause or explain the patient's symptoms. Differential diagnosis list. After establishing the differential, the clinician can eliminate options. The doctor will usually conduct nucleic acid tests on swab samples or bloodwork to learn more. This helps eliminate conditions from the differential or boosts a condition's likelihood. In an ideal circumstance, the doctor can eliminate all but one reason of your symptoms, leaving your formal diagnosis. Once diagnosed, treatment can begin. yay! Love medicine.

My symptoms two weeks ago did not suggest monkeypox. Fever, pains, weariness, and swollen lymph nodes are caused by several things. My scandalous symptoms weren't linked to common ones. My instance shows the importance of diversity and representation in healthcare. My doctor isn't gay, but he provides culturally sensitive care. I'd heard about monkeypox as a gay man in New York. I was hyper-aware of it and had heard of friends of friends who had contracted it the week before, even though the official case count in the US was 40. My physicians weren't concerned, but I was. How would it appear on his mental differential if it wasn't on his radar? Mental differential rhymes! I'll trademark it to prevent theft. differential!

I was in a rare position to recognize my condition and advocate for myself. I study infections. I'd spent months researching monkeypox. I work at a university where I rub shoulders with some of the country's greatest doctors. I'm a gay dude who follows nyc queer social networks online. All of these variables positioned me to think, "Maybe this is monkeypox," and to explain why.

This outbreak is another example of privilege at work. The brokenness of our healthcare system is once again exposed by the inequities produced by the vaccination rollout and the existence of people like myself who can pull strings owing to their line of work. I can't cure this situation on my own, but I can be a strong voice demanding the government do a better job addressing the outbreak and giving resources and advice to everyone I can.

lgbtqia+ community members' support has always impressed me in new york. The queer community has watched out for me and supported me in ways I never dreamed were possible.

Queer individuals are there for each other when societal structures fail. People went to the internet on the first day of the vaccine rollout to share appointment information and the vaccine clinic's message. Twitter timelines were more effective than marketing campaigns. Contrary to widespread anti-vaccine sentiment, the LGBT community was eager to protect themselves. Smallpox vaccination? sure. gimme. whether I'm safe. I credit the community's sex positivity. Many people are used to talking about STDs, so there's a reduced barrier to saying, "I think I have something, you should be on the watch too," and taking steps to protect our health.

Once I got monkeypox, I posted on Twitter and Instagram. Besides fueling my main character syndrome, I felt like I wasn't alone. My dc-based friend had monkeypox within hours. He told me about his experience and gave me ideas for managing the discomfort. I can't imagine life without him.

My buddy and colleague organized my medical care and let me remain in his home. His and his husband's friendliness and attention made a world of difference in my recovery. All of my friends and family who helped me, whether by venmo, doordash, or moral support, made me feel cared about. I don't deserve the amazing people in my life.

Finally, I think of everyone who commented on my social media posts regarding my trip. Friends from all sectors of my life and all sexualities have written me well wishes and complimented me for my vulnerability, but I feel the most gravitas from fellow lgbtq+ persons. They're learning to spot. They're learning where to go ill. They're learning self-advocacy. I'm another link in our network of caretaking. I've been cared for, therefore I want to do the same. Community and knowledge are powerful.

You're probably wondering where the diatribe is. You may believe he's gushing about his loved ones, and you'd be right. I say that just because the queer community can take care of itself doesn't mean we should.

Even when caused by the same pathogen, comparing health crises is risky. Aids is unlike covid-19 or monkeypox, yet all were caused by poorly understood viruses. The lgbtq+ community has a history of self-medicating. Queer people (and their supporters) have led the charge to protect themselves throughout history when the government refused. Surreal to experience this in real time.

First, vaccination access is a government failure. The strategic national stockpile contains tens of thousands of doses of jynneos, the newest fda-approved smallpox vaccine, and millions of doses of acam2000, an older vaccine for immunocompetent populations. Despite being a monkeypox hotspot and international crossroads, new york has only received 7,000 doses of the jynneos vaccine. Vaccine appointments are booked within minutes. It's showing Hunger Games, which bothers me.

Second, I think the government failed to recognize the severity of the european monkeypox outbreak. We saw abroad reports in may, but the first vaccines weren't available until june. Why was I a 26-year-old pharmacology grad student, able to see a monkeypox problem in europe but not the u.s. public health agency? Or was there too much bureaucracy and politicking, delaying action?

Lack of testing infrastructure for a known virus with vaccinations and therapies is appalling. More testing would have helped understand the problem's breadth. Many homosexual guys, including myself, didn't behave like monkeypox was a significant threat because there were only a dozen instances across the country. Our underestimating of the issue, spurred by a story of few infections, was huge.

Public health officials' response to infectious diseases frustrates me. A wait-and-see approach to infectious diseases is unsatisfactory. Before a sick person is recognized, they've exposed and maybe contaminated numerous others. Vaccinating susceptible populations before a disease becomes entrenched prevents disease. CDC might operate this way. When it was easier, they didn't control or prevent monkeypox. We'll learn when. Sometimes I fear never. Emerging viral infections are a menace in the era of climate change and globalization, and I fear our government will repeat the same mistakes. I don't work at the cdc, thus I have no idea what they do. As a scientist, a homosexual guy, and a citizen of this country, I feel confident declaring that the cdc has not done enough about monkeypox. Will they do enough about monkeypox? The strategic national stockpile can respond to a bioterrorism disaster in 12 hours. I'm skeptical following this outbreak.

It's simple to criticize the cdc, but they're not to blame. Underfunding public health services, especially the cdc, is another way our government fails to safeguard its citizens. I may gripe about the vaccination rollout all I want, but local health departments are doing their best with limited resources. They may not have enough workers to keep up with demand and run a contact-tracing program. Since my orthopoxvirus test is still negative, the doh hasn't asked about my close contacts. By then, my illness will be two weeks old, too long to do anything productive. Not their fault. They're functioning in a broken system that's underfunded for the work it does.

*Update, 7/11: I have orthopoxvirus.

Monkeypox is slow, so i've had time to contemplate. Now that I'm better, I'm angry. furious and sad I want to help. I wish to spare others my pain. This was preventable and solvable, I hope. HOW?

Third, the duty.

Family, especially selected family, helps each other. So many people have helped me throughout this difficult time. How can I give back? I have ideas.

1. Education. I've already started doing this by writing incredibly detailed posts on Instagram about my physical sickness and my thoughts on the entire scandal. via tweets. by producing this essay. I'll keep doing it even if people start to resent me! It's crucial! On my Instagram profile (@kyleplanckton), you may discover a story highlight with links to all of my bizarre yet educational posts.

2. Resources. I've forwarded the contact information for my institution's infectious diseases clinic to several folks who will hopefully be able to get tpoxx under the expanded use policy. Through my social networks, I've learned of similar institutions. I've also shared crowdsourced resources about symptom relief and vaccine appointment availability on social media. DM me or see my Instagram highlight for more.

3. Community action. During my illness, my friends' willingness to aid me has meant the most. It was nice to know I had folks on my side. One of my pals (thanks, kenny) snagged me a mcgriddle this morning when seamless canceled my order. This scenario has me thinking about methods to help people with monkeypox isolation. A two-week isolation period is financially damaging for many hourly workers. Certain governments required paid sick leave for covid-19 to allow employees to recover and prevent spread. No comparable program exists for monkeypox, and none seems to be planned shortly.

I want to aid monkeypox patients in severe financial conditions. I'm willing to pick up and bring groceries or fund meals/expenses for sick neighbors. I've seen several GoFundMe accounts, but I wish there was a centralized mechanism to link those in need with those who can help. Please contact me if you have expertise with mutual aid organizations. I hope we can start this shortly.

4. lobbying. Personal narratives are powerful. My narrative is only one, but I think it's compelling. Over the next day or so, i'll write to local, state, and federal officials about monkeypox. I wanted a vaccine but couldn't acquire one, and I feel tpoxx helped my disease. As a pharmacologist-in-training, I believe collecting data on a novel medicine is important, and there are ethical problems when making a drug with limited patient data broadly available. Many folks I know can't receive tpoxx due of red tape and a lack of contacts. People shouldn't have to go to an ivy league hospital to obtain the greatest care. Based on my experience and other people's tales, I believe tpoxx can drastically lessen monkeypox patients' pain and potentially curb transmission chains if administered early enough. This outbreak is manageable. It's not too late if we use all the instruments we have (diagnostic, vaccine, treatment).

*UPDATE 7/15: I submitted the following letter to Chuck Schumer and Kirsten Gillibrand. I've addressed identical letters to local, state, and federal officials, including the CDC and HHS.

I hope to join RESPND-MI, an LGBTQ+ community-led assessment of monkeypox symptoms and networks in NYC. Visit their website to learn more and give to this community-based charity.

How I got monkeypox is a mystery. I received it through a pride physical interaction, but i'm not sure which one. This outbreak will expand unless leaders act quickly. Until then, I'll keep educating and connecting people to care in my neighborhood.

Despite my misgivings, I see some optimism. Health department social media efforts are underway. During the outbreak, the CDC provided nonjudgmental suggestions for safer social and sexual activity. There's additional information regarding the disease course online, including how to request tpoxx for sufferers. These materials can help people advocate for themselves if they're sick. Importantly, homosexual guys are listening when they discuss about monkeypox online and irl. Learners They're serious.

The government has a terrible track record with lgtbq+ health issues, and they're not off to a good start this time. I hope this time will be better. If I can aid even one individual, I'll do so.

Thanks for reading, supporting me, and spreading awareness about the 2022 monkeypox outbreak. My dms are accessible if you want info, resources, queries, or to chat.

y'all well

kyle

Many of us have struggled for years to master a second language (in my case, English). Because (at least in my situation) we've always used an input-based system or method.

I'll explain in detail, but briefly: We can understand some conversations or sentences (since we've trained), but we can't give sophisticated answers or speak fluently (because we have NOT trained at all).

What exactly is input-based learning?

Reading, listening, writing, and speaking are key language abilities (if you look closely at that list, it seems that people tend to order them in this way: inadvertently giving more priority to the first ones than to the last ones).

These talents fall under two learning styles:

• Reading and listening are input-based activities (sometimes referred to as receptive skills or passive learning).

• Writing and speaking are output-based tasks (also known as the productive skills and/or active learning).

What's the best learning style? To learn a language, we must master four interconnected skills. The difficulty is how much time and effort we give each.

According to Shion Kabasawa's books The Power of Input: How to Maximize Learning and The Power of Output: How to Change Learning to Outcome (available only in Japanese), we spend 7:3 more time on Input Based skills than Output Based skills when we should be doing the opposite, leaning more towards Output (Input: Output->3:7).

I can't tell you how he got those numbers, but I think he's not far off because, for example, think of how many people say they're learning a second language and are satisfied bragging about it by only watching TV, series, or movies in VO (and/or reading a book or whatever) their Input is: 7:0 output!

You can't be good at a sport by watching TikTok videos about it; you must play.

“being pushed to produce language puts learners in a better position to notice the ‘gaps’ in their language knowledge”, encouraging them to ‘upgrade’ their existing interlanguage system. And, as they are pushed to produce language in real time and thereby forced to automate low-level operations by incorporating them into higher-level routines, it may also contribute to the development of fluency. — Scott Thornbury (P is for Push)

How may I practice output-based learning more?

I know that listening or reading is easy and convenient because we can do it on our own in a wide range of situations, even during another activity (although, as you know, it's not ideal), writing can be tedious/boring (it's funny that we almost always excuse ourselves in the lack of ideas), and speaking requires an interlocutor. But we must leave our comfort zone and modify our thinking to go from 3:7 to 7:3. (or at least balance it better to something closer). Gradually.

“You don’t have to do a lot every day, but you have to do something. Something. Every day.” — Callie Oettinger (Do this every day)

We can practice speaking like boxers shadow box.

Speaking out loud strengthens the mind-mouth link (otherwise, you will still speak fluently in your mind but you will choke when speaking out loud). This doesn't mean we should talk to ourselves on the way to work, while strolling, or on public transportation. We should try to do it without disturbing others, such as explaining what we've heard, read, or seen (the list is endless: you can TALK about what happened yesterday, your bedtime book, stories you heard at the office, that new kitten video you saw on Instagram, an experience you had, some new fact, that new boring episode you watched on Netflix, what you ate, what you're going to do next, your upcoming vacation, what’s trending, the news of the day)

Who will correct my grammar, vocabulary, or pronunciation with an imagined friend? We can't have everything, but tools and services can help [1].

Lack of bravery

Fear of speaking a language different than one's mother tongue in front of native speakers is global. It's easier said than done, because strangers, not your friends, will always make fun of your accent or faults. Accept it and try again. Karma will prevail.

Perfectionism is a trap. Stop self-sabotaging. Communication is key (and for that you have to practice the Output too ).

“Don’t forget to have fun and enjoy the process.” — Ruri Ohama

[1] Grammarly, Deepl, Google Translate, etc.

ZERO GRACE/ZERO MALICE

Amazon's purchase of One Medical could speed up American healthcare

The U.S. healthcare industry is a 7-ton seal bleeding at sea. Predators are circling. Unearned margin: price increases relative to inflation without quality improvements. Amazon is the 11-foot megalodon with 7-inch teeth. Amazon is no longer circling... but attacking.

In 2020 dollars, per capita U.S. healthcare spending increased from $2,968 in 1980 to $12,531. The result is a massive industry with 13% of the nation's workers and a fifth of GDP.

Doctor No

In 40 years, healthcare has made progress. From 73.7 in 1980 to 78.8 in 2019, life expectancy rose (before Covid knocked it back down a bit). Pharmacological therapies have revolutionized, and genetic research is paying off. The financial return, improvement split by cost increases, is terrible. No country has expense rises like the U.S., and no one spends as much per capita as we do. Developed countries have longer life expectancies, healthier populations, and less economic hardship.

Two-thirds of U.S. personal bankruptcies are due to medical expenses and/or missed work. Mom or Dad getting cancer could bankrupt many middle-class American families. 40% of American adults delayed or skipped needed care due to cost. Every healthcare improvement seems to have a downside. Same pharmacological revolution that helped millions caused opioid epidemic. Our results are poor in many areas: The U.S. has a high infant mortality rate.

Healthcare is the second-worst retail industry in the country. Gas stations are #1. Imagine walking into a Best Buy to buy a TV and a Blue Shirt associate requests you fill out the same 14 pages of paperwork you filled out yesterday. Then you wait in a crowded room until they call you, 20 minutes after the scheduled appointment you were asked to arrive early for, to see the one person in the store who can talk to you about TVs, who has 10 minutes for you. The average emergency room wait time in New York is 6 hours and 10 minutes.

If it's bad for the customer, it's worse for the business. Physicians spend 27% of their time helping patients; 49% on EHRs. Documentation, order entry, billing, and inbox management. Spend a decade getting an M.D., then become a bureaucrat.

No industry better illustrates scale diseconomies. If we got the same return on healthcare spending as other countries, we'd all live to 100. We could spend less, live longer and healthier, and pay off the national debt in 15 years. U.S. healthcare is the worst ever.

What now? Competition is at the heart of capitalism, the worst system of its kind.

Priority Time

Amazon is buying One Medical for $3.9 billion. I think this deal will liberate society. Two years in, I think One Medical is great. When I got Covid, I pressed the One Medical symbol on my phone; a nurse practitioner prescribed Paxlovid and told me which pharmacies had it in stock.

Amazon enables the company's vision. One Medical's stock is down to $10 from $40 at the start of 2021. Last year, it lost $250 million and needs cash (Amazon has $60 billion). ONEM must grow. The service has 736,000 members. Half of U.S. households have Amazon Prime. Finally, delivery. One Medical is a digital health/physical office hybrid, but you must pick up medication at the pharmacy. Upgrade your Paxlovid delivery time after a remote consultation. Amazon's core competency means it'll happen. Healthcare speed and convenience will feel alien.

It's been a long, winding road to disruption. Amazon, JPMorgan, and Berkshire Hathaway formed Haven four years ago to provide better healthcare for their 1.5 million employees. It rocked healthcare stocks the morning of the press release, but folded in 2021.

Amazon Care is an employee-focused service. Home-delivered virtual health services and nurses. It's doing well, expanding nationwide, and providing healthcare for other companies. Hilton is Amazon Care's biggest customer. The acquisition of One Medical will bring 66 million Prime households capital, domain expertise, and billing infrastructure. Imagine:

"Alexa, I'm hot and my back hurts."

"Connecting you to a Prime doctor now."

Want to vs. Have to

I predicted Amazon entering healthcare years ago. Why? For the same reason Apple is getting into auto. Amazon's P/E is 56, double Walmart's. The corporation must add $250 billion in revenue over the next five years to retain its share price. White-label clothes or smart home products won't generate as much revenue. It must enter a huge market without scale, operational competence, and data skills.

Current Situation

Healthcare reform benefits both consumers and investors. In 2015, healthcare services had S&P 500-average multiples. The market is losing faith in public healthcare businesses' growth. Healthcare services have lower EV/EBITDA multiples than the S&P 500.

Amazon isn't the only prey-hunter. Walmart and Alibaba are starting pharmacies. Uber is developing medical transportation. Private markets invested $29 billion in telehealth last year, up 95% from 2020.

The pandemic accelerated telehealth, the immediate unlock. After the first positive Covid case in the U.S., services that had to be delivered in person shifted to Zoom... We lived. We grew. Video house calls continued after in-person visits were allowed. McKinsey estimates telehealth visits are 38 times pre-pandemic levels. Doctors adopted the technology, regulators loosened restrictions, and patients saved time. We're far from remote surgery, but many patient visits are unnecessary. A study of 40 million patients during lockdown found that for chronic disease patients, online visits didn't affect outcomes. This method of care will only improve.

Amazon's disruption will be significant and will inspire a flood of capital, startups, and consumer brands. Mark Cuban launched a pharmacy that eliminates middlemen in January. Outcome? A 90-day supply of acid-reflux medication costs $17. Medicare could have saved $3.6 billion by buying generic drugs from Cuban's pharmacy. Other apex predators will look at different limbs of the carcass for food. Nike could enter healthcare via orthopedics, acupuncture, and chiropractic. LVMH, L'Oréal, and Estée Lauder may launch global plastic surgery brands. Hilton and Four Seasons may open hospitals. Lennar and Pulte could build "Active Living" communities that Nana would leave feet first, avoiding the expense and tragedy of dying among strangers.

Risks

Privacy matters: HIV status is different from credit card and billing address. Most customers (60%) feel fine sharing personal health data via virtual technologies, though. Unavoidable. 85% of doctors believe data-sharing and interoperability will become the norm. Amazon is the most trusted tech company for handling personal data. Not Meta: Amazon.

What about antitrust, then?

Amazon should be required to spin off AWS and/or Amazon Fulfillment and banned from promoting its own products. It should be allowed to acquire hospitals. One Medical's $3.9 billion acquisition is a drop in the bucket compared to UnitedHealth's $498 billion market valuation.

Antitrust enforcement shouldn't assume some people/firms are good/bad. It should recognize that competition is good and focus on making markets more competitive in each deal. The FTC should force asset divestitures in e-commerce, digital marketing, and social media. These companies can also promote competition in a social ill.

U.S. healthcare makes us fat, depressed, and broke. Competition has produced massive value and prosperity across most of our economy.

Dear Amazon … bring it.

Most crypto is probably too.

The goals of Web 3 and the metaverse are admirable and attractive. Who doesn't want an internet owned by users? Who wouldn't want a digital realm where anything is possible? A better way to collaborate and visit pals.

Companies pursue profits endlessly. Infinite growth and revenue are expected, and if a corporation needs to sacrifice profits to safeguard users, the CEO, board of directors, and any executives will lose to the system of incentives that (1) retains workers with shares and (2) makes a company answerable to all of its shareholders. Only the government can guarantee user protections, but we know how successful that is. This is nothing new, just a problem with modern capitalism and tech platforms that a user-owned internet might remedy. Moxie, the founder of Signal, has a good articulation of some of these current Web 2 tech platform problems (but I forget the timestamp); thoughts on JRE aside, this episode is worth listening to (it’s about a bunch of other stuff too).

Moxie Marlinspike, founder of Signal, on the Joe Rogan Experience podcast.

Source: https://open.spotify.com/episode/2uVHiMqqJxy8iR2YB63aeP?si=4962b5ecb1854288

Web 3 champions are premature. There was so much spectacular growth during Web 2 that the next wave of founders want to make an even bigger impact, while investors old and new want a chance to get a piece of the moonshot action. Worse, crypto enthusiasts believe — and financially need — the fact of its success to be true, whether or not it is.

I’m doubtful that it will play out like current proponents say. Crypto has been the white-hot focus of SV’s best and brightest for a long time yet still struggles to come up any mainstream use case other than ‘buy, HODL, and believe’: a store of value for your financial goals and wishes. Some kind of the metaverse is likely, but will it be decentralized, mostly in VR, or will Meta (previously FB) play a big role? Unlikely.

METAVERSE

The metaverse exists already. Our digital lives span apps, platforms, and games. I can design a 3D house, invite people, use Discord, and hang around in an artificial environment. Millions of gamers do this in Rust, Minecraft, Valheim, and Animal Crossing, among other games. Discord's voice chat and Slack-like servers/channels are the present social anchor, but the interface, integrations, and data portability will improve. Soon you can stream YouTube videos on digital house walls. You can doodle, create art, play Jackbox, and walk through a door to play Apex Legends, Fortnite, etc. Not just gaming. Digital whiteboards and screen sharing enable real-time collaboration. They’ll review code and operate enterprises. Music is played and made. In digital living rooms, they'll watch movies, sports, comedy, and Twitch. They'll tweet, laugh, learn, and shittalk.

The metaverse is the evolution of our digital life at home, the third place. The closest analog would be Discord and the integration of Facebook, Slack, YouTube, etc. into a single, 3D, customizable hangout space.

I'm not certain this experience can be hugely decentralized and smoothly choreographed, managed, and run, or that VR — a luxury, cumbersome, and questionably relevant technology — must be part of it. Eventually, VR will be pragmatic, achievable, and superior to real life in many ways. A total sensory experience like the Matrix or Sword Art Online, where we're physically hooked into the Internet yet in our imaginations we're jumping, flying, and achieving athletic feats we never could in reality; exploring realms far grander than our own (as grand as it is). That VR is different from today's.

https://podcasts.google.com/feed/aHR0cHM6Ly9leHBvbmVudC5mbS9mZWVkLw/episode/aHR0cHM6Ly9leHBvbmVudC5mbS8_cD00MzM?hl=en&ved=2ahUKEwjH5u6r4rv2AhUjc98KHeybAP8QjrkEegQIChAF&ep=6

Ben Thompson released an episode of Exponent after Facebook changed its name to Meta. Ben was suspicious about many metaverse champion claims, but he made a good analogy between Oculus and the PC. The PC was initially far too pricey for the ordinary family to afford. It began as a business tool. It got so powerful and pervasive that it affected our personal life. Price continues to plummet and so much consumer software was produced that it's impossible to envision life without a home computer (or in our pockets). If Facebook shows product market fit with VR in business, through use cases like remote work and collaboration, maybe VR will become practical in our personal lives at home.

Before PCs, we relied on Blockbuster, the Yellow Pages, cabs to get to the airport, handwritten taxes, landline phones to schedule social events, and other archaic methods. It is impossible for me to conceive what VR, in the form of headsets and hand controllers, stands to give both professional and especially personal digital experiences that is an order of magnitude better than what we have today. Is looking around better than using a mouse to examine a 3D landscape? Do the hand controls make x10 or x100 work or gaming more fun or efficient? Will VR replace scalable Web 2 methods and applications like Web 1 and Web 2 did for analog? I don't know.

My guess is that the metaverse will arrive slowly, initially on displays we presently use, with more app interoperability. I doubt that it will be controlled by the people or by Facebook, a corporation that struggles to properly innovate internally, as practically every large digital company does. Large tech organizations are lousy at hiring product-savvy employees, and if they do, they rarely let them explore new things.

These companies act like business schools when they seek founders' results, with bureaucracy and dependency. Which company launched the last popular consumer software product that wasn't a clone or acquisition? Recent examples are scarce.

Web 3

Investors and entrepreneurs of Web 3 firms are declaring victory: 'Web 3 is here!' Web 3 is the future! Many profitable Web 2 enterprises existed when Web 2 was defined. The word was created to explain user behavior shifts, not a personal pipe dream.

Origins of Web 2: http://www.oreilly.com/pub/a/web2/archive/what-is-web-20.html

One of these Web 3 startups may provide the connecting tissue to link all these experiences or become one of the major new digital locations. Even so, successful players will likely use centralized power arrangements, as Web 2 businesses do now. Some Web 2 startups integrated our digital lives. Rockmelt (2010–2013) was a customizable browser with bespoke connectors to every program a user wanted; imagine seeing Facebook, Twitter, Discord, Netflix, YouTube, etc. all in one location. Failure. Who knows what Opera's doing?

Silicon Valley and tech Twitter in general have a history of jumping on dumb bandwagons that go nowhere. Dot-com crash in 2000? The huge deployment of capital into bad ideas and businesses is well-documented. And live video. It was the future until it became a niche sector for gamers. Live audio will play out a similar reality as CEOs with little comprehension of audio and no awareness of lasting new user behavior deceive each other into making more and bigger investments on fool's gold. Twitter trying to buy Clubhouse for $4B, Spotify buying Greenroom, Facebook exploring live audio and 'Tiktok for audio,' and now Amazon developing a live audio platform. This live audio frenzy won't be worth their time or energy. Blind guides blind. Instead of learning from prior failures like Twitter buying Periscope for $100M pre-launch and pre-product market fit, they're betting on unproven and uncompelling experiences.

NFTs

NFTs are also nonsense. Take Loot, a time-limited bag drop of "things" (text on the blockchain) for a game that didn't exist, bought by rich techies too busy to play video games and foolish enough to think they're getting in early on something with a big reward. What gaming studio is incentivized to use these items? Who's encouraged to join? No one cares besides Loot owners who don't have NFTs. Skill, merit, and effort should be rewarded with rare things for gamers. Even if a small minority of gamers can make a living playing, the average game's major appeal has never been to make actual money - that's a profession.

No game stays popular forever, so how is this objective sustainable? Once popularity and usage drop, exclusive crypto or NFTs will fall. And if NFTs are designed to have cross-game appeal, incentives apart, 30 years from now any new game will need millions of pre-existing objects to build around before they start. It doesn’t work.

Many games already feature item economies based on real in-game scarcity, generally for cosmetic things to avoid pay-to-win, which undermines scaled gaming incentives for huge player bases. Counter-Strike, Rust, etc. may be bought and sold on Steam with real money. Since the 1990s, unofficial cross-game marketplaces have sold in-game objects and currencies. NFTs aren't needed. Making a popular, enjoyable, durable game is already difficult.

With NFTs, certain JPEGs on the internet went from useless to selling for $69 million. Why? Crypto, Web 3, early Internet collectibles. NFTs are digital Beanie Babies (unlike NFTs, Beanie Babies were a popular children's toy; their destinies are the same). NFTs are worthless and scarce. They appeal to crypto enthusiasts seeking for a practical use case to support their theory and boost their own fortune. They also attract to SV insiders desperate not to miss the next big thing, not knowing what it will be. NFTs aren't about paying artists and creators who don't get credit for their work.

South Park's Underpants Gnomes

NFTs are a benign, foolish plan to earn money on par with South Park's underpants gnomes. At worst, they're the world of hucksterism and poor performers. Or those with money and enormous followings who, like everyone, don't completely grasp cryptocurrencies but are motivated by greed and status and believe Gary Vee's claim that CryptoPunks are the next Facebook. Gary's watertight logic: if NFT prices dip, they're on the same path as the most successful corporation in human history; buy the dip! NFTs aren't businesses or museum-worthy art. They're bs.

Gary Vee compares NFTs to Amazon.com. vm.tiktok.com/TTPdA9TyH2

We grew up collecting: Magic: The Gathering (MTG) cards printed in the 90s are now worth over $30,000. Imagine buying a digital Magic card with no underlying foundation. No one plays the game because it doesn't exist. An NFT is a contextless image someone conned you into buying a certificate for, but anyone may copy, paste, and use. Replace MTG with Pokemon for younger readers.

When Gary Vee strongarms 30 tech billionaires and YouTube influencers into buying CryptoPunks, they'll talk about it on Twitch, YouTube, podcasts, Twitter, etc. That will convince average folks that the product has value. These guys are smart and/or rich, so I'll get in early like them. Cryptography is similar. No solid, scaled, mainstream use case exists, and no one knows where it's headed, but since the global crypto financial bubble hasn't burst and many people have made insane fortunes, regular people are putting real money into something that is highly speculative and could be nothing because they want a piece of the action. Who doesn’t want free money? Rich techies and influencers won't be affected; normal folks will.

Imagine removing every $1 invested in Bitcoin instantly. What would happen? How far would Bitcoin fall? Over 90%, maybe even 95%, and Bitcoin would be dead. Bitcoin as an investment is the only scalable widespread use case: it's confidence that a better use case will arise and that being early pays handsomely. It's like pouring a trillion dollars into a company with no business strategy or users and a CEO who makes vague future references.

New tech and efforts may provoke a 'get off my lawn' mentality as you approach 40, but I've always prided myself on having a decent bullshit detector, and it's flying off the handle at this foolishness. If we can accomplish a functional, responsible, equitable, and ethical user-owned internet, I'm for it.

Postscript:

I wanted to summarize my opinions because I've been angry about this for a while but just sporadically tweeted about it. A friend handed me a Dan Olson YouTube video just before publication. He's more knowledgeable, articulate, and convincing about crypto. It's worth seeing:

This post is a summary. See the original one here.

The human brain is amazing. As more scientists examine the brain, we learn how much it can store.

The human brain has 1 billion neurons, according to Scientific American. Each neuron creates 1,000 connections, totaling over a trillion. If each neuron could store one memory, we'd run out of room. [1]

What if you could store and access more info, freeing up brain space for problem-solving and creativity?

Build a second brain to keep up with rising knowledge (what I refer to as a Digital Brain). Effectively managing information entails realizing you can't recall everything.

Every action requires information. You need the correct information to learn a new skill, complete a project at work, or establish a business. You must manage information properly to advance your profession and improve your life.

How to construct a second brain to organize information and achieve goals.

What Is a Second Brain?

How often do you forget an article or book's key point? Have you ever wasted hours looking for a saved file?

If so, you're not alone. Information overload affects millions of individuals worldwide. Information overload drains mental resources and causes anxiety.

This is when the second brain comes in.

Building a second brain doesn't involve duplicating the human brain. Building a system that captures, organizes, retrieves, and archives ideas and thoughts. The second brain improves memory, organization, and recall.

Digital tools are preferable to analog for building a second brain.

Digital tools are portable and accessible. Due to these benefits, we'll focus on digital second-brain building.

Brainware

Digital Brains are external hard drives. It stores, organizes, and retrieves. This means improving your memory won't be difficult. 

Memory has three components in computing:

Recording — storing the information

Organization — archiving it in a logical manner

Recall — retrieving it again when you need it

For example:

Due to rigorous security settings, many websites need you to create complicated passwords with special characters.

You must now memorize (Record), organize (Organize), and input this new password the next time you check in (Recall).

Even in this simple example, there are many pieces to remember. We can't recognize this new password with our usual patterns. If we don't use the password every day, we'll forget it. You'll type the wrong password when you try to remember it.

It's common. Is it because the information is complicated? Nope. Passwords are basically letters, numbers, and symbols.

It happens because our brains aren't meant to memorize these. Digital Brains can do heavy lifting.

Why You Need a Digital Brain

Dual minds are best. Birth brain is limited.

The cerebral cortex has 125 trillion synapses, according to a Stanford Study. The human brain can hold 2.5 million terabytes of digital data. [2]

Building a second brain improves learning and memory.

Learn and store information effectively

Faster information recall

Organize information to see connections and patterns

Build a Digital Brain to learn more and reach your goals faster. Building a second brain requires time and work, but you'll have more time for vital undertakings. 

Why you need a Digital Brain:

1. Use Brainpower Effectively

Your brain has boundaries, like any organ. This is true while solving a complex question or activity. If you can't focus on a work project, you won't finish it on time.

Second brain reduces distractions. A robust structure helps you handle complicated challenges quickly and stay on track. Without distractions, it's easy to focus on vital activities.

2. Staying Organized

Professional and personal duties must be balanced. With so much to do, it's easy to neglect crucial duties. This is especially true for skill-building. Digital Brain will keep you organized and stress-free.

Life success requires action. Organized people get things done. Organizing your information will give you time for crucial tasks.

You'll finish projects faster with good materials and methods. As you succeed, you'll gain creative confidence. You can then tackle greater jobs.

3. Creativity Process

Creativity drives today's world. Creativity is mysterious and surprising for millions worldwide. Immersing yourself in others' associations, triggers, thoughts, and ideas can generate inspiration and creativity.

Building a second brain is crucial to establishing your creative process and building habits that will help you reach your goals. Creativity doesn't require perfection or overthinking.

4. Transforming Your Knowledge Into Opportunities

This is the age of entrepreneurship. Today, you can publish online, build an audience, and make money.

Whether it's a business or hobby, you'll have several job alternatives. Knowledge can boost your economy with ideas and insights.

5. Improving Thinking and Uncovering Connections

Modern career success depends on how you think. Instead of overthinking or perfecting, collect the best images, stories, metaphors, anecdotes, and observations.

This will increase your creativity and reveal connections. Increasing your imagination can help you achieve your goals, according to research. [3]

Your ability to recognize trends will help you stay ahead of the pack.

6. Credibility for a New Job or Business

Your main asset is experience-based expertise. Others won't be able to learn without your help. Technology makes knowledge tangible.

This lets you use your time as you choose while helping others. Changing professions or establishing a new business become learning opportunities when you have a Digital Brain.

7. Using Learning Resources

Millions of people use internet learning materials to improve their lives. Online resources abound. These include books, forums, podcasts, articles, and webinars.

These resources are mostly free or inexpensive. Organizing your knowledge can save you time and money. Building a Digital Brain helps you learn faster. You'll make rapid progress by enjoying learning.

How does a second brain feel?

Digital Brain has helped me arrange my job and family life for years.

No need to remember 1001 passwords. I never forget anything on my wife's grocery lists. Never miss a meeting. I can access essential information and papers anytime, anywhere.

Delegating memory to a second brain reduces tension and anxiety because you'll know what to do with every piece of information.

No information will be forgotten, boosting your confidence. Better manage your fears and concerns by writing them down and establishing a strategy. You'll understand the plethora of daily information and have a clear head.

How to Develop Your Digital Brain (Your Second Brain)

It's cheap but requires work.

Digital Brain development requires:

Recording — storing the information

Organization — archiving it in a logical manner

Recall — retrieving it again when you need it

1. Decide what information matters before recording.

To succeed in today's environment, you must manage massive amounts of data. Articles, books, webinars, podcasts, emails, and texts provide value. Remembering everything is impossible and overwhelming.

What information do you need to achieve your goals?

You must consolidate ideas and create a strategy to reach your aims. Your biological brain can imagine and create with a Digital Brain.

2. Use the Right Tool

We usually record information without any preparation - we brainstorm in a word processor, email ourselves a message, or take notes while reading.

This information isn't used. You must store information in a central location.

Different information needs different instruments.

Evernote is a top note-taking program. Audio clips, Slack chats, PDFs, text notes, photos, scanned handwritten pages, emails, and webpages can be added.

Pocket is a great software for saving and organizing content. Images, videos, and text can be sorted. Web-optimized design

Calendar apps help you manage your time and enhance your productivity by reminding you of your most important tasks. Calendar apps flourish. The best calendar apps are easy to use, have many features, and work across devices. These calendars include Google, Apple, and Outlook.

To-do list/checklist apps are useful for managing tasks. Easy-to-use, versatility, budget, and cross-platform compatibility are important when picking to-do list apps. Google Keep, Google Tasks, and Apple Notes are good to-do apps.

3. Organize data for easy retrieval

How should you organize collected data?

When you collect and organize data, you'll see connections. An article about networking can assist you comprehend web marketing. Saved business cards can help you find new clients.

Choosing the correct tools helps organize data. Here are some tools selection criteria:

• Can the tool sync across devices?

• Personal or team?

• Has a search function for easy information retrieval?

• Does it provide easy data categorization?

• Can users create lists or collections?

• Does it offer easy idea-information connections?

• Does it mind map and visually organize thoughts?

Conclusion

Building a Digital Brain (second brain) helps us save information, think creatively, and implement ideas. Your second brain is a biological extension. It prevents amnesia, allowing you to tackle bigger creative difficulties.

People who love learning often consume information without using it. Every day, they postpone life-improving experiences until they're forgotten. Useful information becomes strength. 

Reference

[1] ^ Scientific American: What Is the Memory Capacity of the Human Brain?

[2] ^ Clinical Neurology Specialists: What is the Memory Capacity of a Human Brain?

[3] ^ National Library of Medicine: Imagining Success: Multiple Achievement Goals and the Effectiveness of Imagery