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

He’s not the President. Stop treating him like one.

Elon Musk tweeted from Qatar, where he was watching the World Cup Final with Jared Kushner.

Musk's subsequent Tweets were as normal, basic, and bland as anyone's from a World Cup Final: It's depressing to see the world's richest man looking at his phone during a grand ceremony. Rich guy goes to rich guy event didn't seem important.

Before Musk posted his should-I-step-down-at-Twitter poll, CNN ran a long segment asking if it was hypocritical for him to reveal his real-time location after defending his (very dumb) suspension of several journalists for (supposedly) revealing his assassination coordinates by linking to a site that tracks Musks private jet. It was hard to ignore CNN's hypocrisy: It covered Musk as Twitter CEO like President Trump. EVERY TRUMP STORY WAS BASED ON HIM SAYING X, THEN DOING Y. Trump would do something horrific, lie about it, then pretend it was fine, then condemn a political rival who did the same thing, be called hypocritical, and so on. It lasted four years. Exhausting.

It made sense because Trump was the President of the United States. The press's main purpose is to relentlessly cover and question the president.

It's strange to say this out. Twitter isn't America. Elon Musk isn't a president. He maintains a money-losing social media service to harass and mock people he doesn't like. Treating Musk like Trump, as if he should be held accountable like Trump, shows a startling lack of perspective. Some journalists treat Twitter like a country.

The compulsive, desperate way many journalists utilize the site suggests as much. Twitter isn't the town square, despite popular belief. It's a place for obsessives to meet and converse. Journalists say they're breaking news. Their careers depend on it. They can argue it's a public service. Nope. It's a place lonely people go to speak all day. Twitter. So do journalists, Trump, and Musk. Acting as if it has a greater purpose, as if it's impossible to break news without it, or as if the republic is in peril is ludicrous. Only 23% of Americans are on Twitter, while 25% account for 97% of Tweets. I'd think a large portion of that 25% are journalists (or attention addicts) chatting to other journalists. Their loudness makes Twitter seem more important than it is. Nope. It's another stupid website. They were there before Twitter; they will be there after Twitter. It’s just a website. We can all get off it if we want. Most of us aren’t even on it in the first place.

Musk is a website-owner. No world leader. He's not as accountable as Trump was. Musk is cable news's primary character now that Trump isn't (at least for now). Becoming a TV news anchor isn't as significant as being president. Elon Musk isn't as important as we all pretend, and Twitter isn't even close. Twitter is a dumb website, Elon Musk is a rich guy going through a midlife crisis, and cable news is lazy because its leaders thought the entire world was on Twitter and are now freaking out that their playground is being disturbed.

I’ve said before that you need to leave Twitter, now. But even if you’re still on it, we need to stop pretending it matters more than it does. It’s a site for lonely attention addicts, from the man who runs it to the journalists who can’t let go of it. It’s not a town square. It’s not a country. It’s not even a successful website. Let’s stop pretending any of it’s real. It’s not.

Japan's startup challenge: 7 reasons

Every day, another Silicon Valley business is bought for a billion dollars, making its founders rich while growing the economy and improving consumers' lives.

Google, Amazon, Twitter, and Medium dominate our daily lives. Tesla automobiles and Moderna Covid vaccinations.

The startup movement started in Silicon Valley, California, but the rest of the world is catching up. Global startup buzz is rising. Except Japan.

644 of CB Insights' 1170 unicorns—successful firms valued at over $1 billion—are US-based. China follows with 302 and India third with 108.

Japan? 6!

1% of US startups succeed. The third-largest economy is tied with small Switzerland for startup success.

Mexico (8), Indonesia (12), and Brazil (12) have more successful startups than Japan (16). South Korea has 16. Yikes! Problem?

Why Don't Startups Exist in Japan More?

Not about money. Japanese firms invest in startups. To invest in startups, big Japanese firms create Silicon Valley offices instead of Tokyo.

Startups aren't the issue either. Local governments are competing to be Japan's Shirikon Tani, providing entrepreneurs financing, office space, and founder visas.

Startup accelerators like Plug and Play in Tokyo, Osaka, and Kyoto, the Startup Hub in Kobe, and Google for Startups are many.

Most of the companies I've encountered in Japan are either local offices of foreign firms aiming to expand into the Japanese market or small businesses offering local services rather than disrupting a staid industry with new ideas.

There must be a reason Japan can develop world-beating giant corporations like Toyota, Nintendo, Shiseido, and Suntory but not inventive startups.

Culture, obviously. Japanese culture excels in teamwork, craftsmanship, and quality, but it hates moving fast, making mistakes, and breaking things.

If you have a brilliant idea in Silicon Valley, quit your job, get money from friends and family, and build a prototype. To fund the business, you approach angel investors and VCs.

Most non-startup folks don't aware that venture capitalists don't want good, profitable enterprises. That's wonderful if you're developing a solid small business to consult, open shops, or make a specialty product. However, you must pay for it or borrow money. Venture capitalists want moon rockets. Silicon Valley is big or bust. Almost 90% will explode and crash. The few successes are remarkable enough to make up for the failures.

Silicon Valley's high-risk, high-reward attitude contrasts with Japan's incrementalism. Japan makes the best automobiles and cleanrooms, but it fails to produce new items that grow the economy.

Changeable? Absolutely. But, what makes huge manufacturing enterprises successful and what makes Japan a safe and comfortable place to live are inextricably connected with the lack of startups.

Barriers to Startup Development in Japan

These are the 7 biggest obstacles to Japanese startup success.

1. Unresponsive Employment Market

While the lifelong employment system in Japan is evolving, the average employee stays at their firm for 12 years (15 years for men at large organizations) compared to 4.3 years in the US. Seniority, not experience or aptitude, determines career routes, making it tough to quit a job to join a startup and then return to corporate work if it fails.

1. Conservative Buyers

Even if your product is buggy and undocumented, US customers will migrate to a cheaper, superior one. Japanese corporations demand perfection from their trusted suppliers and keep with them forever. Startups need income fast, yet product evaluation takes forever.

1. Failure intolerance

Japanese business failures harm lives. Failed forever. It hinders risk-taking. Silicon Valley embraces failure. Build another startup if your first fails. Build a third if that fails. Every setback is viewed as a learning opportunity for success.

4. No Corporate Purchases

Silicon Valley industrial giants will buy fast-growing startups for a lot of money. Many huge firms have stopped developing new goods and instead buy startups after the product is validated.

Japanese companies prefer in-house product development over startup acquisitions. No acquisitions mean no startup investment and no investor reward.

Startup investments can also be monetized through stock market listings. Public stock listings in Japan are risky because the Nikkei was stagnant for 35 years while the S&P rose 14x.

5. Social Unity Above Wealth

In Silicon Valley, everyone wants to be rich. That creates a competitive environment where everyone wants to succeed, but it also promotes fraud and societal problems.

Japan values communal harmony above individual success. Wealthy folks and overachievers are avoided. In Japan, renegades are nearly impossible.

6. Rote Learning Education System

Japanese high school graduates outperform most Americans. Nonetheless, Japanese education is known for its rote memorization. The American system, which fails too many kids, emphasizes creativity to create new products.

1. Immigration.

Immigrants start 55% of successful Silicon Valley firms. Some come for university, some to escape poverty and war, and some are recruited by Silicon Valley startups and stay to start their own.

Japan is difficult for immigrants to start a business due to language barriers, visa restrictions, and social isolation.

How Japan Can Promote Innovation

Patchwork solutions to deep-rooted cultural issues will not work. If customers don't buy things, immigration visas won't aid startups. Startups must have a chance of being acquired for a huge sum to attract investors. If risky startups fail, employees won't join.

Will Japan never have a startup culture?

Once a consensus is reached, Japan changes rapidly. A dwindling population and standard of living may lead to such consensus.

Toyota and Sony were firms with renowned founders who used technology to transform the world. Repeatable.

Silicon Valley is flawed too. Many people struggle due to wealth disparities, job churn and layoffs, and the tremendous ups and downs of the economy caused by stock market fluctuations.

The founders of the 10% successful startups are heroes. The 90% that fail and return to good-paying jobs with benefits are never mentioned.

Silicon Valley startup culture and Japanese corporate culture are opposites. Each have pros and cons. Big Japanese corporations make the most reliable, dependable, high-quality products yet move too slowly. That's good for creating cars, not social networking apps.

Can innovation and success be encouraged without eroding social cohesion? That can motivate software firms to move fast and break things while recognizing the beauty and precision of expert craftsmen? A hybrid culture where Japan can make the world's best and most original items. Hopefully.

Great technology opens up an universe of possibilities.

Need a friend? WhatsApp, Telegram, Slack, etc.

Traveling? AirBnB, Expedia, Google Flights, etc.

Money transfer? Use digital banking, e-wallet, or crypto applications

Products inspire us. How do we become great?

I asked product managers in my network:

What does it take to be a great product manager?

52 product managers from 40+ prominent IT businesses in Southeast Asia responded passionately. Many of the PMs I've worked with have built fantastic products, from unicorns (Lazada, Tokopedia, Ovo) to incumbents (Google, PayPal, Experian, WarnerMedia) to growing (etaily, Nium, Shipper).

TL;DR:

• Soft talents are more important than hard skills. Technical expertise was hardly ever stressed by product managers, and empathy was mentioned more than ten times. Janani from Xendit expertly recorded the moment. A superb PM must comprehend that their empathy for the feelings of their users must surpass all logic and data.

• Constant attention to the needs of the user. Many people concur that the closer a PM gets to their customer/user, the more likely it is that the conclusion will be better. There were almost 30 references to customers and users. Focusing on customers has the advantage because it is hard to overshoot, as Rajesh from Lazada puts it best.

• Setting priorities is invaluable. Prioritization is essential because there are so many problems that a PM must deal with every day. My favorite quotation on this is from Rakuten user Yee Jie. Viki, A competent product manager extinguishes fires. A good product manager lets things burn and then prioritizes.

This summary isn't enough to capture what excellent PMs claim it requires. Read below!

What qualities make a successful product manager?

Themed quotes are alphabetized by author.

Embrace your user/customer

Aeriel Dela Paz, Rainmaking Venture Architect, ex-GCash Product Head

Great PMs know what customers need even when they don’t say it directly. It’s about reading between the lines and going through the numbers to address that need.

Anders Nordahl, OrkestraSCS's Product Manager

Understanding the vision of your customer is as important as to get the customer to buy your vision

Angel Mendoza, MetaverseGo's Product Head

Most people think that to be a great product manager, you must have technical know-how. It’s textbook and I do think it is helpful to some extent, but for me the secret sauce is EMPATHY — the ability to see and feel things from someone else’s perspective. You can’t create a solution without deeply understanding the problem.

Senior Product Manager, Tokopedia

Focus on delivering value and helping people (consumer as well as colleague) and everything else will follow

Darren Lau, Deloitte Digital's Head of Customer Experience

Start with the users, and work backwards. Don’t have a solution looking for a problem

Darryl Tan, Grab Product Manager

I would say that a great product manager is able to identify the crucial problems to solve through strong user empathy and synthesis of insights

Diego Perdana, Kitalulus Senior Product Manager

I think to be a great product manager you need to be obsessed with customer problems and most important is solve the right problem with the right solution

Senior Product Manager, AirAsia

Lot of common sense + Customer Obsession. The most important role of a Product manager is to bring clarity of a solution. Your product is good if it solves customer problems. Your product is great if it solves an eco-system problem and disrupts the business in a positive way.

Edward Xie, Mastercard Managing Consultant, ex-Shopee Product Manager

Perfect your product, but be prepared to compromise for right users

AVP Product, Shipper

For me, a great product manager need to be rational enough to find the business opportunities while obsessing the customers.

Janani Gopalakrishnan is a senior product manager of a stealth firm.

While as a good PM it’s important to be data-driven, to be a great PM one needs to understand that their empathy for their users’ emotions must exceed all logic and data. Great PMs also make these product discussions thrive within the team by intently listening to all the members thoughts and influence the team’s skin in the game positively.

Director, Product Management, Indeed

Great product managers put their users first. They discover problems that matter most to their users and inspire their team to find creative solutions.

Grab's Senior Product Manager Lakshay Kalra

Product management is all about finding and solving most important user problems

Quipper's Mega Puji Saraswati

First of all, always remember the value of “user first” to solve what user really needs (the main problem) for guidance to arrange the task priority and develop new ideas. Second, ownership. Treat the product as your “2nd baby”, and the team as your “2nd family”. Third, maintain a good communication, both horizontally and vertically. But on top of those, always remember to have a work — life balance, and know exactly the priority in life :)

Senior Product Manager, Prosa.AI Miswanto Miswanto

A great Product Manager is someone who can be the link between customer needs with the readiness and flexibility of the team. So that it can provide, build, and produce a product that is useful and helps the community to carry out their daily activities. And He/She can improve product quality ongoing basis or continuous to help provide solutions for users or our customer.

Lead Product Manager, Tokopedia, Oriza Wahyu Utami

Be a great listener, be curious and be determined. every great product manager have the ability to listen the pain points and understand the problems, they are always curious on the users feedback, and they also very determined to look for the solutions that benefited users and the business.

99 Group CPO Rajesh Sangati

The advantage of focusing on customers: it’s impossible to overshoot

Ray Jang, founder of Scenius, formerly of ByteDance

The difference between good and great product managers is that great product managers are willing to go the unsexy and unglamorous extra mile by rolling up their sleeves and ironing out all minutiae details of the product such that when the user uses the product, they can’t help but say “This was made for me.”

BCG Digital Ventures' Sid Narayanan

Great product managers ensure that what gets built and shipped is at the intersection of what creates value for the customer and for the business that’s building the product…often times, especially in today’s highly liquid funding environment, the unit economics, aka ensuring that what gets shipped creates value for the business and is sustainable, gets overlooked

Stephanie Brownlee, BCG Digital Ventures Product Manager

There is software in the world that does more harm than good to people and society. Great Product Managers build products that solve problems not create problems

Experiment constantly

Delivery Hero's Abhishek Muralidharan

Embracing your failure is the key to become a great Product Manager

DeliveryHero's Anuraag Burman

Product Managers should be thick skinned to deal with criticism and the stomach to take risk and face failures.

DataSpark Product Head Apurva Lawale

Great product managers enjoy the creative process with their team to deliver intuitive user experiences to benefit users.

Dexter Zhuang, Xendit Product Manager

The key to creating winning products is building what customers want as quickly as you can — testing and learning along the way.

PayPal's Jay Ko

To me, great product managers always remain relentlessly curious. They are empathetic leaders and problem solvers that glean customer insights into building impactful products

Home Credit Philippines' Jedd Flores

Great Product Managers are the best dreamers; they think of what can be possible for the customers, for the company and the positive impact that it will have in the industry that they’re part of

Set priorities first, foremost, foremost.

HBO Go Product Manager Akshay Ishwar

Good product managers strive to balance the signal to noise ratio, Great product managers know when to turn the dials for each up exactly

Zuellig Pharma's Guojie Su

Have the courage to say no. Managing egos and request is never easy and rejecting them makes it harder but necessary to deliver the best value for the customers.

Ninja Van's John Prawira

(1) PMs should be able to ruthlessly prioritize. In order to be effective, PMs should anchor their product development process with their north stars (success metrics) and always communicate with a purpose. (2) User-first when validating assumptions. PMs should validate assumptions early and often to manage risk when leading initiatives with a focus on generating the highest impact to solving a particular user pain-point. We can’t expect a product/feature launch to be perfect (there might be bugs or we might not achieve our success metric — which is where iteration comes in), but we should try our best to optimize on user-experience earlier on.

Nium Product Manager Keika Sugiyama

I’d say a great PM holds the ability to balance ruthlessness and empathy at the same time. It’s easier said than done for sure!

ShopBack product manager Li Cai

Great product managers are like great Directors of movies. They do not create great products/movies by themselves. They deliver it by Defining, Prioritising, Energising the team to deliver what customers love.

Quincus' Michael Lim

A great product manager, keeps a pulse on the company’s big picture, identifies key problems, and discerns its rightful prioritization, is able to switch between the macro perspective to micro specifics, and communicates concisely with humility that influences naturally for execution

Mathieu François-Barseghian, SVP, Citi Ventures

“You ship your org chart”. This is Conway’s Law short version (1967!): the fundamental socio-technical driver behind innovation successes (Netflix) and failures (your typical bank). The hype behind micro-services is just another reflection of Conway’s Law

Mastercard's Regional Product Manager Nikhil Moorthy

A great PM should always look to build products which are scalable & viable , always keep the end consumer journey in mind. Keeping things simple & having a MVP based approach helps roll out products faster. One has to test & learn & then accordingly enhance / adapt, these are key to success

Rendy Andi, Tokopedia Product Manager

Articulate a clear vision and the path to get there, Create a process that delivers the best results and Be serious about customers.

Senior Product Manager, DANA Indonesia

Own the problem, not the solution — Great PMs are outstanding problem preventers. Great PMs are discerning about which problems to prevent, which problems to solve, and which problems not to solve

Tat Leong Seah, LionsBot International Senior UX Engineer, ex-ViSenze Product Manager

Prioritize outcomes for your users, not outputs of your system” or more succinctly “be agile in delivering value; not features”

Senior Product Manager, Rakuten Viki

A good product manager puts out fires. A great product manager lets fires burn and prioritize from there

acquire fundamental soft skills

Oracle NetSuite's Astrid April Dominguez

Personally, i believe that it takes grit, empathy, and optimistic mindset to become a great PM

Ovo Lead Product Manager Boy Al Idrus

Contrary to popular beliefs, being a great product manager doesn’t have anything to do with technicals, it sure plays a part but most important weapons are: understanding pain points of users, project management, sympathy in leadership and business critical skills; these 4 aspects would definitely help you to become a great product manager.

PwC Product Manager Eric Koh

Product managers need to be courageous to be successful. Courage is required to dive deep, solving big problems at its root and also to think far and dream big to achieve bold visions for your product

Ninja Van's Product Director

In my opinion the two most important ingredients to become a successful product manager is: 1. Strong critical thinking 2. Strong passion for the work. As product managers, we typically need to solve very complex problems where the answers are often very ambiguous. The work is tough and at times can be really frustrating. The 2 ingredients I mentioned earlier will be critical towards helping you to slowly discover the solution that may become a game changer.

PayPal's Lead Product Manager

A great PM has an eye of a designer, the brain of an engineer and the tongue of a diplomat

Product Manager Irene Chan

A great Product Manager is able to think like a CEO of the company. Visionary with Agile Execution in mind

Isabella Yamin, Rakuten Viki Product Manager

There is no one model of being a great product person but what I’ve observed from people I’ve had the privilege working with is an overflowing passion for the user problem, sprinkled with a knack for data and negotiation

Google product manager Jachin Cheng

Great product managers start with abundant intellectual curiosity and grow into a classic T-shape. Horizontally: generalists who range widely, communicate fluidly and collaborate easily cross-functionally, connect unexpected dots, and have the pulse both internally and externally across users, stakeholders, and ecosystem players. Vertically: deep product craftsmanship comes from connecting relentless user obsession with storytelling, business strategy with detailed features and execution, inspiring leadership with risk mitigation, and applying the most relevant tools to solving the right problems.

Jene Lim, Experian's Product Manager

3 Cs and 3 Rs. Critical thinking , Customer empathy, Creativity. Resourcefulness, Resilience, Results orientation.

Nirenj George, Envision Digital's Security Product Manager

A great product manager is someone who can lead, collaborate and influence different stakeholders around the product vision, and should be able to execute the product strategy based on customer insights, as well as take ownership of the product roadmap to create a greater impact on customers.

Grab's Lead Product Manager

Product Management is a multi-dimensional role that looks very different across each product team so each product manager has different challenges to deal with but what I have found common among great product managers is ability to create leverage through their efforts to drive outsized impacts for their products. This leverage is built using data with intuition, building consensus with stakeholders, empowering their teams and focussed efforts on needle moving work.

NCS Product Manager Umar Masagos

To be a great product manager, one must master both the science and art of Product Management. On one hand, you need have a strong understanding of the tools, metrics and data you need to drive your product. On the other hand, you need an in-depth understanding of your organization, your target market and target users, which is often the more challenging aspect to master.

M1 product manager Wei Jiao Keong

A great product manager is multi-faceted. First, you need to have the ability to see the bigger picture, yet have a keen eye for detail. Secondly, you are empathetic and is able to deliver products with exceptional user experience while being analytical enough to achieve business outcomes. Lastly, you are highly resourceful and independent yet comfortable working cross-functionally.

Yudha Utomo, ex-Senior Product Manager, Tokopedia

A great Product Manager is essentially an effective note-taker. In order to achieve the product goals, It is PM’s job to ensure objective has been clearly conveyed, efforts are assessed, and tasks are properly tracked and managed. PM can do this by having top-notch documentation skills.

Sundar Pichai unveiled Simplicity Sprint at Google's latest all-hands conference.

To boost employee efficiency.

Not surprising. Few envisioned Google declaring a productivity drive.

Sunder Pichai's speech:

“There are real concerns that our productivity as a whole is not where it needs to be for the head count we have. Help me create a culture that is more mission-focused, more focused on our products, more customer focused. We should think about how we can minimize distractions and really raise the bar on both product excellence and productivity.”

The primary driver driving Google's efficiency push is:

Google's efficiency push follows 13% quarterly revenue increase. Last year in the same quarter, it was 62%.

Market newcomers may argue that the previous year's figure was fuelled by post-Covid reopening and growing consumer spending. Investors aren't convinced. A promising company like Google can't afford to drop so quickly.

Google’s quarterly revenue growth stood at 13%, against 62% in last year same quarter.

Google isn't alone. In my recent essay regarding 2025 programmers, I warned about the economic downturn's effects on FAAMG's workforce. Facebook had suspended hiring, and Microsoft had promised hefty bonuses for loyal staff.

In the same article, I predicted Google's troubles. Online advertising, especially the way Google and Facebook sell it using user data, is over.

FAAMG and 2nd rung IT companies could be the first to fall without Post-COVID revival and uncertain global geopolitics.

Google has hardly ever discussed effectiveness:

Apparently openly.

Amazon treats its employees like robots, even in software positions. It has significant turnover and a terrible reputation as a result. Because of this, it rarely loses money due to staff productivity.

Amazon trumps Google. In reality, it treats its employees poorly.

Google was the founding father of the modern-day open culture.

Larry and Sergey Google founded the IT industry's Open Culture. Silicon Valley called Google's internal democracy and transparency near anarchy. Management rarely slammed decisions on employees. Surveys and internal polls ensured everyone knew the company's direction and had a vote.

20% project allotment (weekly free time to build own project) was Google's open-secret innovation component.

After Larry and Sergey's exit in 2019, this is Google's first profitability hurdle. Only Google insiders can answer these questions.

• Would Google's investors compel the company's management to adopt an Amazon-style culture where the developers are treated like circus performers?

• If so, would Google follow suit?

• If so, how does Google go about doing it?

Before discussing Google's likely plan, let's examine programming productivity.

What determines a programmer's productivity is simple:

How would we answer Google's questions?

As a programmer, I'm more concerned about Simplicity Sprint's aftermath than its economic catalysts.

Large organizations don't care much about quarterly and annual productivity metrics. They have 10-year product-launch plans. If something seems horrible today, it's likely due to someone's lousy judgment 5 years ago who is no longer in the blame game.

Deconstruct our main question.

• How exactly do you change the culture of the firm so that productivity increases?

• How can you accomplish that without affecting your capacity to profit? There are countless ways to increase output without decreasing profit.

• How can you accomplish this with little to no effect on employee motivation? (While not all employers care about it, in this case we are discussing the father of the open company culture.)

• How do you do it for a 10-developer IT firm that is losing money versus a 1,70,000-developer organization with a trillion-dollar valuation?

When implementing a large-scale organizational change, success must be carefully measured.

The fastest way to do something is to do it right, no matter how long it takes.

You require clearly-defined group/team/role segregation and solid pass/fail matrices to:

• You can give performers rewards.

• Ones that are average can be inspired to improve

• Underachievers may receive assistance or, in the worst-case scenario, rehabilitation

As a 20-year programmer, I associate productivity with greatness.

Doing something well, no matter how long it takes, is the fastest way to do it.

Let's discuss a programmer's productivity.

Why productivity is a strange term in programming:

Productivity is work per unit of time.

Money=time This is an economic proverb. More hours worked, more pay. Longer projects cost more.

As a buyer, you desire a quick supply. As a business owner, you want employees who perform at full capacity, creating more products to transport and boosting your profits.

All economic matrices encourage production because of our obsession with it. Productivity is the only organic way a nation may increase its GDP.

Time is money — is not just a proverb, but an economical fact.

Applying the same productivity theory to programming gets problematic. An automating computer. Its capacity depends on the software its master writes.

Today, a sophisticated program can process a billion records in a few hours. Creating one takes a competent coder and the necessary infrastructure. Learning, designing, coding, testing, and iterations take time.

Programming productivity isn't linear, unlike manufacturing and maintenance.

Average programmers produce code every day yet miss deadlines. Expert programmers go days without coding. End of sprint, they often surprise themselves by delivering fully working solutions.

Reversing the programming duties has no effect. Experts aren't needed for productivity.

These patterns remind me of an XKCD comic.

Programming productivity depends on two factors:

• The capacity of the programmer and his or her command of the principles of computer science

• His or her productive bursts, how often they occur, and how long they last as they engineer the answer

At some point, productivity measurement becomes Schrödinger’s cat.

Product companies measure productivity using use cases, classes, functions, or LOCs (lines of code). In days of data-rich source control systems, programmers' merge requests and/or commits are the most preferred yardstick. Companies assess productivity by tickets closed.

Every organization eventually has trouble measuring productivity. Finer measurements create more chaos. Every measure compares apples to oranges (or worse, apples with aircraft.) On top of the measuring overhead, the endeavor causes tremendous and unnecessary stress on teams, lowering their productivity and defeating its purpose.

Macro productivity measurements make sense. Amazon's factory-era management has done it, but at great cost.

Google can pull it off if it wants to.

What Google meant in reality when it said that employee productivity has decreased:

When Google considers its employees unproductive, it doesn't mean they don't complete enough work in the allotted period.

They can't multiply their work's influence over time.

• Programmers who produce excellent modules or products are unsure on how to use them.

• The best data scientists are unable to add the proper parameters in their models.

• Despite having a great product backlog, managers struggle to recruit resources with the necessary skills.

• Product designers who frequently develop and A/B test newer designs are unaware of why measures are inaccurate or whether they have already reached the saturation point.

• Most ignorant: All of the aforementioned positions are aware of what to do with their deliverables, but neither their supervisors nor Google itself have given them sufficient authority.

So, Google employees aren't productive.

How to fix it?

• Business analysis: White suits introducing novel items can interact with customers from all regions. Track analytics events proactively, especially the infrequent ones.

• SOLID, DRY, TEST, and AUTOMATION: Do less + reuse. Use boilerplate code creation. If something already exists, don't implement it yourself.

• Build features-building capabilities: N features are created by average programmers in N hours. An endless number of features can be built by average programmers thanks to the fact that expert programmers can produce 1 capability in N hours.

• Work on projects that will have a positive impact: Use the same algorithm to search for images on YouTube rather than the Mars surface.

• Avoid tasks that can only be measured in terms of time linearity at all costs (if a task can be completed in N minutes, then M copies of the same task would cost M*N minutes).

In conclusion:

Software development isn't linear. Why should the makers be measured?

Notation for The Big O

I'm discussing a new way to quantify programmer productivity. (It applies to other professions, but that's another subject)

The Big O notation expresses the paradigm (the algorithmic performance concept programmers rot to ace their Google interview)

Google (or any large corporation) can do this.

1. Sort organizational roles into categories and specify their impact vs. time objectives. A CXO role's time vs. effect function, for instance, has a complexity of O(log N), meaning that if a CEO raises his or her work time by 8x, the result only increases by 3x.

2. Plot the influence of each employee over time using the X and Y axes, respectively.

3. Add a multiplier for Y-axis values to the productivity equation to make business objectives matter. (Example values: Support = 5, Utility = 7, and Innovation = 10).

4. Compare employee scores in comparable categories (developers vs. devs, CXOs vs. CXOs, etc.) and reward or help employees based on whether they are ahead of or behind the pack.

After measuring every employee's inventiveness, it's straightforward to help underachievers and praise achievers.

Example of a Big(O) Category:

If I ran Google (God forbid, its worst days are far off), here's how I'd classify it. You can categorize Google employees whichever you choose.

The Google interview truth:

O(1) < O(log n) < O(n) < O(n log n) < O(n^x) where all logarithmic bases are < n.

O(1): Customer service workers' hours have no impact on firm profitability or customer pleasure.

CXOs Most of their time is spent on travel, strategic meetings, parties, and/or meetings with minimal floor-level influence. They're good at launching new products but bad at pivoting without disaster. Their directions are being followed.

Devops, UX designers, testers Agile projects revolve around deployment. DevOps controls the levers. Their automation secures results in subsequent cycles.

UX/UI Designers must still prototype UI elements despite improved design tools.

All test cases are proportional to use cases/functional units, hence testers' work is O(N).

Architects Their effort improves code quality. Their right/wrong interference affects product quality and rollout decisions even after the design is set.

Core Developers Only core developers can write code and own requirements. When people understand and own their labor, the output improves dramatically. A single character error can spread undetected throughout the SDLC and cost millions.

Core devs introduce/eliminate 1000x bugs, refactoring attempts, and regression. Following our earlier hypothesis.

The fastest way to do something is to do it right, no matter how long it takes.

Conclusion:

Google is at the liberal extreme of the employee-handling spectrum

Microsoft faced an existential crisis after 2000. It didn't choose Amazon's data-driven people management to revitalize itself.

Instead, it entrusted developers. It welcomed emerging technologies and opened up to open source, something it previously opposed.

Google is too lax in its employee-handling practices. With that foundation, it can only follow Amazon, no matter how carefully.

Any attempt to redefine people's measurements will affect the organization emotionally.

The more Google compares apples to apples, the higher its chances for future rebirth.