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.

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

From oil to attention.

Oil has been the most important commodity for a century. It's sparked wars. Pearl Harbor was a preemptive strike to guarantee Japanese access to Indonesian oil, and it made desert tribes rich. Oil's heyday is over. From oil to attention.

We talked about an information economy. In an age of abundant information, what's scarce? Attention. Scale of the world's largest enterprises, wealth of its richest people, and power of governments all stem from attention extraction, monetization, and custody.

Attention-grabbing isn't new. Humans have competed for attention and turned content into wealth since Aeschylus' Oresteia. The internal combustion engine, industrial revolutions in mechanization and plastics, and the emergence of a mobile Western lifestyle boosted oil. Digitization has put wells in pockets, on automobile dashboards, and on kitchen counters, drilling for attention.

The most valuable firms are attention-seeking enterprises, not oil companies. Big Tech dominates the top 4. Tech and media firms are the sheikhs and wildcatters who capture our attention. Blood will flow as the oil economy rises.

Attention to Detail

More than IT and media companies compete for attention. Podcasting is a high-growth, low-barrier-to-entry chance for newbies to gain attention and (for around 1%) make money. Conferences are good for capturing in-person attention. Salesforce paid $30 billion for Slack's dominance of workplace attention, while Spotify is transforming music listening attention into a media platform.

Conferences, newsletters, and even music streaming are artisan projects. Even 130,000-person Comic Con barely registers on the attention economy's Richter scale. Big players have hundreds of millions of monthly users.

Supermajors

Even titans can be disrupted in the attention economy. TikTok is fracking king Chesapeake Energy, a rule-breaking insurgent with revolutionary extraction technologies. Attention must be extracted, processed, and monetized. Innovators disrupt the attention economy value chain.

Attention pre-digital Entrepreneurs commercialized intriguing or amusing stuff like a newspaper or TV show through subscriptions and ads. Digital storage and distribution's limitless capacity drove the initial wave of innovation. Netflix became dominant by releasing old sitcoms and movies. More ad-free content gained attention. By 2016, Netflix was greater than cable TV. Linear scale, few network effects.

Social media introduced two breakthroughs. First, users produced and paid for content. Netflix's economics are dwarfed by TikTok and YouTube, where customers create the content drill rigs that the platforms monetize.

Next, social media businesses expanded content possibilities. Twitter, Facebook, and Reddit offer traditional content, but they transform user comments into more valuable (addictive) emotional content. By emotional resonance, I mean they satisfy a craving for acceptance or anger us. Attention and emotion are mined from comments/replies, piss-fights, and fast-brigaded craziness. Exxon has turned exhaust into heroin. Should we be so linked without a commensurate presence? You wouldn't say this in person. Anonymity allows fraudulent accounts and undesirable actors, which platforms accept to profit from more pollution.

FrackTok

A new entrepreneur emerged as ad-driven social media anger contaminated the water table. TikTok is remaking the attention economy. Short-form video platform relies on user-generated content, although delivery is narrower and less social.

Netflix grew on endless options. Choice requires cognitive effort. TikTok is the least demanding platform since TV. App video plays when opened. Every video can be skipped with a swipe. An algorithm watches how long you watch, what you finish, and whether you like or follow to create a unique streaming network. You can follow creators and respond, but the app is passive. TikTok's attention economy recombination makes it apex predator. The app has more users than Facebook and Instagram combined. Among teens, it's overtaking the passive king, TV.

Externalities

Now we understand fossil fuel externalities. A carbon-based economy has harmed the world. Fracking brought large riches and rebalanced the oil economy, but at a cost: flammable water, earthquakes, and chemical leaks.

TikTok has various concerns associated with algorithmically generated content and platforms. A Wall Street Journal analysis discovered new accounts listed as belonging to 13- to 15-year-olds would swerve into rabbitholes of sex- and drug-related films in mere days. TikTok has a unique externality: Chinese Communist Party ties. Our last two presidents realized the relationship's perils. Concerned about platform's propaganda potential.

No evidence suggests the CCP manipulated information to harm American interests. A headjack implanted on America's youth, who spend more time on TikTok than any other network, connects them to a neural network that may be modified by the CCP. If the product and ownership can't be separated, the app should be banned. Putting restrictions near media increases problems. We should have a reciprocal approach with China regarding media firms. Ban TikTok

It was a conference theme. I anticipated Axel Springer CEO Mathias Döpfner to say, "We're watching them." (That's CEO protocol.) TikTok should be outlawed in every democracy as an espionage tool. Rumored regulations could lead to a ban, and FCC Commissioner Brendan Carr pushes for app store prohibitions. Why not restrict Chinese propaganda? Some disagree: Several renowned tech writers argued my TikTok diatribe last week distracted us from privacy and data reform. The situation isn't zero-sum. I've warned about Facebook and other tech platforms for years. Chewing gum while walking is possible.

The Future

Is TikTok the attention-economy titans' final evolution? The attention economy acts like it. No original content. CNN+ was unplugged, Netflix is losing members and has lost 70% of its market cap, and households are canceling cable and streaming subscriptions in historic numbers. Snap Originals closed in August after YouTube Originals in January.

Everyone is outTik-ing the Tok. Netflix debuted Fast Laughs, Instagram Reels, YouTube Shorts, Snap Spotlight, Roku The Buzz, Pinterest Watch, and Twitter is developing a TikTok-like product. I think they should call it Vine. Just a thought.

Meta's internal documents show that users spend less time on Instagram Reels than TikTok. Reels engagement is dropping, possibly because a third of the videos were generated elsewhere (usually TikTok, complete with watermark). Meta has tried to downrank these videos, but they persist. Users reject product modifications. Kim Kardashian and Kylie Jenner posted a meme urging Meta to Make Instagram Instagram Again, resulting in 312,000 signatures. Mark won't hear the petition. Meta is the fastest follower in social (see Oculus and legless hellscape fever nightmares). Meta's stock is at a five-year low, giving those who opposed my demands to break it up a compelling argument.

Blue Pill

TikTok's short-term dominance in attention extraction won't be stopped by anyone who doesn't hear Hail to the Chief every time they come in. Will TikTok still be a supermajor in five years? If not, YouTube will likely rule and protect Kings Landing.

56% of Americans regularly watch YouTube. Compared to Facebook and TikTok, 95% of teens use Instagram. YouTube users upload more than 500 hours of video per minute, a number that's likely higher today. Last year, the platform garnered $29 billion in advertising income, equivalent to Netflix's total.

Business and biology both value diversity. Oil can be found in the desert, under the sea, or in the Arctic. Each area requires a specific ability. Refiners turn crude into gas, lubricants, and aspirin. YouTube's variety is unmatched. One-second videos to 12-hour movies. Others are studio-produced. (My Bill Maher appearance was edited for YouTube.)

You can dispute in the comment section or just stream videos. YouTube is used for home improvement, makeup advice, music videos, product reviews, etc. You can load endless videos on a topic or creator, subscribe to your favorites, or let the suggestion algo take over. YouTube relies on user content, but it doesn't wait passively. Strategic partners advise 12,000 creators. According to a senior director, if a YouTube star doesn’t post once week, their manager is “likely to know why.”

YouTube's kevlar is its middle, especially for creators. Like TikTok, users can start with low-production vlogs and selfie videos. As your following expands, so does the scope of your production, bringing longer videos, broadcast-quality camera teams and performers, and increasing prices. MrBeast, a YouTuber, is an example. MrBeast made gaming videos and YouTube drama comments.

Donaldson's YouTube subscriber base rose. MrBeast invests earnings to develop impressive productions. His most popular video was a $3.5 million Squid Game reenactment (the cost of an episode of Mad Men). 300 million people watched. TikTok's attention-grabbing tech is too limiting for this type of material. Now, Donaldson is focusing on offline energy with a burger restaurant and cloud kitchen enterprise.

Steps to Take

Rapid wealth growth has externalities. There is no free lunch. OK, maybe caffeine. The externalities are opaque, and the parties best suited to handle them early are incentivized to construct weapons of mass distraction to postpone and obfuscate while achieving economic security for themselves and their families. The longer an externality runs unchecked, the more damage it causes and the more it costs to fix. Vanessa Pappas, TikTok's COO, didn't shine before congressional hearings. Her comms team over-consulted her and said ByteDance had no headquarters because it's scattered. Being full of garbage simply promotes further anger against the company and the awkward bond it's built between the CCP and a rising generation of American citizens.

This shouldn't distract us from the (still existent) harm American platforms pose to our privacy, teenagers' mental health, and civic dialogue. Leaders of American media outlets don't suffer from immorality but amorality, indifference, and dissonance. Money rain blurs eyesight.

Autocratic governments that undermine America's standing and way of life are immoral. The CCP has and will continue to use all its assets to harm U.S. interests domestically and abroad. TikTok should be spun to Western investors or treated the way China treats American platforms: kicked out.

So rich,

Product game mindsets? How do these vary from Project mindset?

1950s spawned the Iron Triangle. Project people everywhere know and live by it. In stakeholder meetings, it is used to stretch the timeframe, request additional money, or reduce scope.

Quality was added to this triangle as things matured.

Quality was intended to be transformative, but none of these principles addressed why we conduct projects.

Value and benefits are key.

Product value is quantified by ROI, revenue, profit, savings, or other metrics. For me, every project or product delivery is about value.

Most project managers, especially those schooled 5-10 years or more ago (thousands working in huge corporations worldwide), understand the world in terms of the iron triangle. What does that imply? They worry about:

a) enough time to get the thing done.

b) have enough resources (budget) to get the thing done.

c) have enough scope to fit within (a) and (b) >> note, they never have too little scope, not that I have ever seen! although, theoretically, this could happen.

Boom—iron triangle.

To make the triangle function, project managers will utilize formal governance (Steering) to move those things. Increase money, scope, or both if time is short. Lacking funds? Increase time, scope, or both.

In current product development, shifting each item considerably may not yield value/benefit.

Even terrible. This approach will fail because it deprioritizes Value/Benefit by focusing the major stakeholders (Steering participants) and delivery team(s) on Time, Scope, and Budget restrictions.

Pre-agile, this problem was terrible. IT projects failed wildly. History is here.

Value, or benefit, is central to the product method. Product managers spend most of their time planning value-delivery paths.

Product people consider risk, schedules, scope, and budget, but value comes first. Let me illustrate.

Imagine managing internal products in an enterprise. Your core customer team needs a rapid text record of a chat to fix a problem. The consumer wants a feature/features added to a product you're producing because they think it's the greatest spot.

Project-minded, I may say;

Ok, I have budget as this is an existing project, due to run for a year. This is a new requirement to add to the features we’re already building. I think I can keep the deadline, and include this scope, as it sounds related to the feature set we’re building to give the desired result”.

This attitude repeats Scope, Time, and Budget.

Since it meets those standards, a project manager will likely approve it. If they have a backlog, they may add it and start specking it out assuming it will be built.

Instead, think like a product;

What problem does this feature idea solve? Is that problem relevant to the product I am building? Can that problem be solved quicker/better via another route ? Is it the most valuable problem to solve now? Is the problem space aligned to our current or future strategy? or do I need to alter/update the strategy?

A product mindset allows you to focus on timing, resource/cost, feasibility, feature detail, and so on after answering the aforementioned questions.

The above oversimplifies because

Leadership in discovery

Project managers are facilitators of ideas. This is as far as they normally go in the ‘idea’ space.

Business Requirements collection in classic project delivery requires extensive upfront documentation.

Agile project delivery analyzes requirements iteratively.

However, the project manager is a facilitator/planner first and foremost, therefore topic knowledge is not expected.

I mean business domain, not technical domain (to confuse matters, it is true that in some instances, it can be both technical and business domains that are important for a single individual to master).

Product managers are domain experts. They will become one if they are training/new.

They lead discovery.

Product Manager-led discovery is much more than requirements gathering.

Requirements gathering involves a Business Analyst interviewing people and documenting their requests.

The project manager calculates what fits and what doesn't using their Iron Triangle (presumably in their head) and reports back to Steering.

If this requirements-gathering exercise failed to identify requirements, what would a project manager do? or bewildered by project requirements and scope?

They would tell Steering they need a Business SME or Business Lead assigning or more of their time.

Product discovery requires the Product Manager's subject knowledge and a new mindset.

How should a Product Manager handle confusing requirements?

Product Managers handle these challenges with their talents and tools. They use their own knowledge to fill in ambiguity, but they have the discipline to validate those assumptions.

To define the problem, they may perform qualitative or quantitative primary research.

They might discuss with UX and Engineering on a whiteboard and test assumptions or hypotheses.

Do Product Managers escalate confusing requirements to Steering/Senior leaders? They would fix that themselves.

Product managers raise unclear strategy and outcomes to senior stakeholders. Open talks, soft skills, and data help them do this. They rarely raise requirements since they have their own means of handling them without top stakeholder participation.

Discovery is greenfield, exploratory, research-based, and needs higher-order stakeholder management, user research, and UX expertise.

Product Managers also aid discovery. They lead discovery. They will not leave customer/user engagement to a Business Analyst. Administratively, a business analyst could aid. In fact, many product organizations discourage business analysts (rely on PM, UX, and engineer involvement with end-users instead).

The Product Manager must drive user interaction, research, ideation, and problem analysis, therefore a Product professional must be skilled and confident.

Creating vs. receiving and having an entrepreneurial attitude

Product novices and project managers focus on details rather than the big picture. Project managers prefer spreadsheets to strategy whiteboards and vision statements.

These folks ask their manager or senior stakeholders, "What should we do?"

They then elaborate (in Jira, in XLS, in Confluence or whatever).

They want that plan populated fast because it reduces uncertainty about what's going on and who's supposed to do what.

Skilled Product Managers don't only ask folks Should we?

They're suggesting this, or worse, Senior stakeholders, here are some options. After asking and researching, they determine what value this product adds, what problems it solves, and what behavior it changes.

Therefore, to move into Product, you need to broaden your view and have courage in your ability to discover ideas, find insightful pieces of information, and collate them to form a valuable plan of action. You are constantly defining RoI and building Business Cases, so much so that you no longer create documents called Business Cases, it is simply ingrained in your work through metrics, intelligence, and insights.

Product Management is not a free lunch.

Plateless.

Plates and food must be prepared.

In conclusion, Product Managers must make at least three mentality shifts:

1. You put value first in all things. Time, money, and scope are not as important as knowing what is valuable.

2. You have faith in the field and have the ability to direct the search. YYou facilitate, but you don’t just facilitate. You wouldn't want to limit your domain expertise in that manner.

3. You develop concepts, strategies, and vision. You are not a waiter or an inbox where other people can post suggestions; you don't merely ask folks for opinion and record it. However, you excel at giving things that aren't clearly spoken or written down physical form.

Most productive people are habitual.

Early in the day, do important tasks.

In his best-selling book Eat That Frog, Brian Tracy advised starting the day with your hardest, most important activity.

Most individuals work best in the morning. Energy and willpower peak then.

Mornings are also ideal for memory, focus, and problem-solving.

Thus, the morning is ideal for your hardest chores.

It makes sense to do these things during your peak performance hours.

Additionally, your morning sets the tone for the day. According to Brian Tracy, the first hour of the workday steers the remainder.

After doing your most critical chores, you may feel accomplished, confident, and motivated for the remainder of the day, which boosts productivity.

Develop Your Essentialism

In Essentialism, Greg McKeown claims that trying to be everything to everyone leads to mediocrity and tiredness.

You'll either burn out, be spread too thin, or compromise your ideals.

Greg McKeown advises Essentialism:

Clarify what’s truly important in your life and eliminate the rest.

Eliminating non-essential duties, activities, and commitments frees up time and energy for what matters most.

According to Greg McKeown, Essentialists live by design, not default.

You'll be happier and more productive if you follow your essentials.

Follow these three steps to live more essentialist.

Prioritize Your Tasks First

What matters most clarifies what matters less. List your most significant aims and values.

The clearer your priorities, the more you can focus on them.

On Essentialism, McKeown wrote, The ultimate form of effectiveness is the ability to deliberately invest our time and energy in the few things that matter most.

#2: Set Your Priorities in Order

Prioritize your priorities, not simply know them.

“If you don’t prioritize your life, someone else will.” — Greg McKeown

Planning each day and allocating enough time for your priorities is the best method to become more purposeful.

#3: Practice saying "no"

If a request or demand conflicts with your aims or principles, you must learn to say no.

Saying no frees up space for our priorities.

Place Sleep Above All Else

Many believe they must forego sleep to be more productive. This is false.

A productive day starts with a good night's sleep.

Matthew Walker (Why We Sleep) says:

“Getting a good night’s sleep can improve cognitive performance, creativity, and overall productivity.”

Sleep helps us learn, remember, and repair.

Unfortunately, 35% of people don't receive the recommended 79 hours of sleep per night.

Sleep deprivation can cause:

• increased risk of diabetes, heart disease, stroke, and obesity

• Depression, stress, and anxiety risk are all on the rise.

• decrease in general contentment

• decline in cognitive function

To live an ideal, productive, and healthy life, you must prioritize sleep.

Follow these six sleep optimization strategies to obtain enough sleep:

• Establish a nightly ritual to relax and prepare for sleep.

• Avoid using screens an hour before bed because the blue light they emit disrupts the generation of melatonin, a necessary hormone for sleep.

• Maintain a regular sleep schedule to control your body's biological clock (and optimizes melatonin production)

• Create a peaceful, dark, and cool sleeping environment.

• Limit your intake of sweets and caffeine (especially in the hours leading up to bedtime)

• Regular exercise (but not right before you go to bed, because your body temperature will be too high)

Sleep is one of the best ways to boost productivity.

Sleep is crucial, says Matthew Walker. It's the key to good health and longevity.

Writing for readers:

14 years of daily writing.

I post practically everything on social media. I authored hundreds of articles, thousands of tweets, and numerous volumes to almost no one.

Tens of thousands of readers regularly praise me.

I despised writing. I'm stuck now.

I've learned what readers like and what doesn't.

Here are some essential guidelines for writing with impact:

Readers won't understand your work if you can't.

Though obvious, this slipped me up. Share your truths.

Stories engage human brains.

Showing the journey of a person from worm to butterfly inspires the human spirit.

Overthinking hinders powerful writing.

The best ideas come from inner understanding in between thoughts.

Avoid writing to find it. Write.

Writing a masterpiece isn't motivating.

Write for five minutes to simplify. Step-by-step, entertaining, easy steps.

Good writing requires a willingness to make mistakes.

So write loads of garbage that you can edit into a good piece.

Courageous writing.

A courageous story will move readers. Personal experience is best.

Go where few dare.

Templates, outlines, and boundaries help.

Limitations enhance writing.

Excellent writing is straightforward and readable, removing all the unnecessary fat.

Use five words instead of nine.

Use ordinary words instead of uncommon ones.

Readers desire relatability.

Too much perfection will turn it off.

Write to solve an issue if you can't think of anything to write.

Instead, read to inspire. Best authors read.

Every tweet, thread, and novel must have a central idea.

What's its point?

This can make writing confusing.

️ Don't direct your reader.

Readers quit reading. Demonstrate, describe, and relate.

Even if no one responds, have fun. If you hate writing it, the reader will too.