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Maggie, Linus, Geoffrey, and the LS crew are reuniting for our second annual AI UX demo day in SF on Apr 28. Sign up to demo here! And don't forget tickets for the AI Engineer World's Fair — for early birds who join before keynote announcements!It's become fashionable for many AI startups to project themselves as “the next Google” - while the search engine is so 2000s, both Perplexity and Exa referred to themselves as a “research engine” or “answer engine” in our NeurIPS pod. However these searches tend to be relatively shallow, and it is challenging to zoom up and down the ladders of abstraction to garner insights. For serious researchers, this level of simple one-off search will not cut it.We've commented in our Jan 2024 Recap that Flow Engineering (simply; multi-turn processes over many-shot single prompts) seems to offer far more performance, control and reliability for a given cost budget. Our experiments with Devin and our understanding of what the new Elicit Notebooks offer a glimpse into the potential for very deep, open ended, thoughtful human-AI collaboration at scale.It starts with promptsWhen ChatGPT exploded in popularity in November 2022 everyone was turned into a prompt engineer. While generative models were good at "vibe based" outcomes (tell me a joke, write a poem, etc) with basic prompts, they struggled with more complex questions, especially in symbolic fields like math, logic, etc. Two of the most important "tricks" that people picked up on were:* Chain of Thought prompting strategy proposed by Wei et al in the “Chain-of-Thought Prompting Elicits Reasoning in Large Language Models”. Rather than doing traditional few-shot prompting with just question and answers, adding the thinking process that led to the answer resulted in much better outcomes.* Adding "Let's think step by step" to the prompt as a way to boost zero-shot reasoning, which was popularized by Kojima et al in the Large Language Models are Zero-Shot Reasoners paper from NeurIPS 2022. This bumped accuracy from 17% to 79% compared to zero-shot.Nowadays, prompts include everything from promises of monetary rewards to… whatever the Nous folks are doing to turn a model into a world simulator. At the end of the day, the goal of prompt engineering is increasing accuracy, structure, and repeatability in the generation of a model.From prompts to agentsAs prompt engineering got more and more popular, agents (see “The Anatomy of Autonomy”) took over Twitter with cool demos and AutoGPT became the fastest growing repo in Github history. The thing about AutoGPT that fascinated people was the ability to simply put in an objective without worrying about explaining HOW to achieve it, or having to write very sophisticated prompts. The system would create an execution plan on its own, and then loop through each task. The problem with open-ended agents like AutoGPT is that 1) it's hard to replicate the same workflow over and over again 2) there isn't a way to hard-code specific steps that the agent should take without actually coding them yourself, which isn't what most people want from a product. From agents to productsPrompt engineering and open-ended agents were great in the experimentation phase, but this year more and more of these workflows are starting to become polished products. Today's guests are Andreas Stuhlmüller and Jungwon Byun of Elicit (previously Ought), an AI research assistant that they think of as “the best place to understand what is known”. Ought was a non-profit, but last September, Elicit spun off into a PBC with a $9m seed round. It is hard to quantify how much a workflow can be improved, but Elicit boasts some impressive numbers for research assistants:Just four months after launch, Elicit crossed $1M ARR, which shows how much interest there is for AI products that just work.One of the main takeaways we had from the episode is how teams should focus on supervising the process, not the output. Their philosophy at Elicit isn't to train general models, but to train models that are extremely good at focusing processes. This allows them to have pre-created steps that the user can add to their workflow (like classifying certain features that are specific to their research field) without having to write a prompt for it. And for Hamel Husain's happiness, they always show you the underlying prompt. Elicit recently announced notebooks as a new interface to interact with their products: (fun fact, they tried to implement this 4 times before they landed on the right UX! We discuss this ~33:00 in the podcast)The reasons why they picked notebooks as a UX all tie back to process:* They are systematic; once you have a instruction/prompt that works on a paper, you can run hundreds of papers through the same workflow by creating a column. Notebooks can also be edited and exported at any point during the flow.* They are transparent - Many papers include an opaque literature review as perfunctory context before getting to their novel contribution. But PDFs are “dead” and it is difficult to follow the thought process and exact research flow of the authors. Sharing “living” Elicit Notebooks opens up this process.* They are unbounded - Research is an endless stream of rabbit holes. So it must be easy to dive deeper and follow up with extra steps, without losing the ability to surface for air. We had a lot of fun recording this, and hope you have as much fun listening!AI UX in SFLong time Latent Spacenauts might remember our first AI UX meetup with Linus Lee, Geoffrey Litt, and Maggie Appleton last year. Well, Maggie has since joined Elicit, and they are all returning at the end of this month! Sign up here: https://lu.ma/aiuxAnd submit demos here! https://forms.gle/iSwiesgBkn8oo4SS8We expect the 200 seats to “sell out” fast. Attendees with demos will be prioritized.Show Notes* Elicit* Ought (their previous non-profit)* “Pivoting” with GPT-4* Elicit notebooks launch* Charlie* Andreas' BlogTimestamps* [00:00:00] Introductions* [00:07:45] How Johan and Andreas Joined Forces to Create Elicit* [00:10:26] Why Products > Research* [00:15:49] The Evolution of Elicit's Product* [00:19:44] Automating Literature Review Workflow* [00:22:48] How GPT-3 to GPT-4 Changed Things* [00:25:37] Managing LLM Pricing and Performance* [00:31:07] Open vs. Closed: Elicit's Approach to Model Selection* [00:31:56] Moving to Notebooks* [00:39:11] Elicit's Budget for Model Queries and Evaluations* [00:41:44] Impact of Long Context Windows* [00:47:19] Underrated Features and Surprising Applications* [00:51:35] Driving Systematic and Efficient Research* [00:53:00] Elicit's Team Growth and Transition to a Public Benefit Corporation* [00:55:22] Building AI for GoodFull Interview on YouTubeAs always, a plug for our youtube version for the 80% of communication that is nonverbal:TranscriptAlessio [00:00:00]: Hey everyone, welcome to the Latent Space Podcast. This is Alessio, partner and CTO at Residence at Decibel Partners, and I'm joined by my co-host Swyx, founder of Smol AI.Swyx [00:00:15]: Hey, and today we are back in the studio with Andreas and Jungwon from Elicit. Welcome.Jungwon [00:00:20]: Thanks guys.Andreas [00:00:21]: It's great to be here.Swyx [00:00:22]: Yeah. So I'll introduce you separately, but also, you know, we'd love to learn a little bit more about you personally. So Andreas, it looks like you started Elicit first, Jungwon joined later.Andreas [00:00:32]: That's right. For all intents and purposes, the Elicit and also the Ought that existed before then were very different from what I started. So I think it's like fair to say that you co-founded it.Swyx [00:00:43]: Got it. And Jungwon, you're a co-founder and COO of Elicit now.Jungwon [00:00:46]: Yeah, that's right.Swyx [00:00:47]: So there's a little bit of a history to this. I'm not super aware of like the sort of journey. I was aware of OTT and Elicit as sort of a nonprofit type situation. And recently you turned into like a B Corp, Public Benefit Corporation. So yeah, maybe if you want, you could take us through that journey of finding the problem. You know, obviously you're working together now. So like, how do you get together to decide to leave your startup career to join him?Andreas [00:01:10]: Yeah, it's truly a very long journey. I guess truly, it kind of started in Germany when I was born. So even as a kid, I was always interested in AI, like I kind of went to the library. There were books about how to write programs in QBasic and like some of them talked about how to implement chatbots.Jungwon [00:01:27]: To be clear, he grew up in like a tiny village on the outskirts of Munich called Dinkelschirben, where it's like a very, very idyllic German village.Andreas [00:01:36]: Yeah, important to the story. So basically, the main thing is I've kind of always been thinking about AI my entire life and been thinking about, well, at some point, this is going to be a huge deal. It's going to be transformative. How can I work on it? And was thinking about it from when I was a teenager, after high school did a year where I started a startup with the intention to become rich. And then once I'm rich, I can affect the trajectory of AI. Did not become rich, decided to go back to college and study cognitive science there, which was like the closest thing I could find at the time to AI. In the last year of college, moved to the US to do a PhD at MIT, working on broadly kind of new programming languages for AI because it kind of seemed like the existing languages were not great at expressing world models and learning world models doing Bayesian inference. Was always thinking about, well, ultimately, the goal is to actually build tools that help people reason more clearly, ask and answer better questions and make better decisions. But for a long time, it seemed like the technology to put reasoning in machines just wasn't there. Initially, at the end of my postdoc at Stanford, I was thinking about, well, what to do? I think the standard path is you become an academic and do research. But it's really hard to actually build interesting tools as an academic. You can't really hire great engineers. Everything is kind of on a paper-to-paper timeline. And so I was like, well, maybe I should start a startup, pursued that for a little bit. But it seemed like it was too early because you could have tried to do an AI startup, but probably would not have been this kind of AI startup we're seeing now. So then decided to just start a nonprofit research lab that's going to do research for a while until we better figure out how to do thinking in machines. And that was odd. And then over time, it became clear how to actually build actual tools for reasoning. And only over time, we developed a better way to... I'll let you fill in some of the details here.Jungwon [00:03:26]: Yeah. So I guess my story maybe starts around 2015. I kind of wanted to be a founder for a long time, and I wanted to work on an idea that stood the test of time for me, like an idea that stuck with me for a long time. And starting in 2015, actually, originally, I became interested in AI-based tools from the perspective of mental health. So there are a bunch of people around me who are really struggling. One really close friend in particular is really struggling with mental health and didn't have any support, and it didn't feel like there was anything before kind of like getting hospitalized that could just help her. And so luckily, she came and stayed with me for a while, and we were just able to talk through some things. But it seemed like lots of people might not have that resource, and something maybe AI-enabled could be much more scalable. I didn't feel ready to start a company then, that's 2015. And I also didn't feel like the technology was ready. So then I went into FinTech and kind of learned how to do the tech thing. And then in 2019, I felt like it was time for me to just jump in and build something on my own I really wanted to create. And at the time, I looked around at tech and felt like not super inspired by the options. I didn't want to have a tech career ladder, or I didn't want to climb the career ladder. There are two kind of interesting technologies at the time, there was AI and there was crypto. And I was like, well, the AI people seem like a little bit more nice, maybe like slightly more trustworthy, both super exciting, but threw my bet in on the AI side. And then I got connected to Andreas. And actually, the way he was thinking about pursuing the research agenda at OTT was really compatible with what I had envisioned for an ideal AI product, something that helps kind of take down really complex thinking, overwhelming thoughts and breaks it down into small pieces. And then this kind of mission that we need AI to help us figure out what we ought to do was really inspiring, right? Yeah, because I think it was clear that we were building the most powerful optimizer of our time. But as a society, we hadn't figured out how to direct that optimization potential. And if you kind of direct tremendous amounts of optimization potential at the wrong thing, that's really disastrous. So the goal of OTT was make sure that if we build the most transformative technology of our lifetime, it can be used for something really impactful, like good reasoning, like not just generating ads. My background was in marketing, but like, so I was like, I want to do more than generate ads with this. But also if these AI systems get to be super intelligent enough that they are doing this really complex reasoning, that we can trust them, that they are aligned with us and we have ways of evaluating that they're doing the right thing. So that's what OTT did. We did a lot of experiments, you know, like I just said, before foundation models really like took off. A lot of the issues we were seeing were more in reinforcement learning, but we saw a future where AI would be able to do more kind of logical reasoning, not just kind of extrapolate from numerical trends. We actually kind of set up experiments with people where kind of people stood in as super intelligent systems and we effectively gave them context windows. So they would have to like read a bunch of text and one person would get less text and one person would get all the texts and the person with less text would have to evaluate the work of the person who could read much more. So like in a world we were basically simulating, like in 2018, 2019, a world where an AI system could read significantly more than you and you as the person who couldn't read that much had to evaluate the work of the AI system. Yeah. So there's a lot of the work we did. And from that, we kind of iterated on the idea of breaking complex tasks down into smaller tasks, like complex tasks, like open-ended reasoning, logical reasoning into smaller tasks so that it's easier to train AI systems on them. And also so that it's easier to evaluate the work of the AI system when it's done. And then also kind of, you know, really pioneered this idea, the importance of supervising the process of AI systems, not just the outcomes. So a big part of how Elicit is built is we're very intentional about not just throwing a ton of data into a model and training it and then saying, cool, here's like scientific output. Like that's not at all what we do. Our approach is very much like, what are the steps that an expert human does or what is like an ideal process as granularly as possible, let's break that down and then train AI systems to perform each of those steps very robustly. When you train like that from the start, after the fact, it's much easier to evaluate, it's much easier to troubleshoot at each point. Like where did something break down? So yeah, we were working on those experiments for a while. And then at the start of 2021, decided to build a product.Swyx [00:07:45]: Do you mind if I, because I think you're about to go into more modern thought and Elicit. And I just wanted to, because I think a lot of people are in where you were like sort of 2018, 19, where you chose a partner to work with. Yeah. Right. And you didn't know him. Yeah. Yeah. You were just kind of cold introduced. A lot of people are cold introduced. Yeah. Never work with them. I assume you had a lot, a lot of other options, right? Like how do you advise people to make those choices?Jungwon [00:08:10]: We were not totally cold introduced. So one of our closest friends introduced us. And then Andreas had written a lot on the OTT website, a lot of blog posts, a lot of publications. And I just read it and I was like, wow, this sounds like my writing. And even other people, some of my closest friends I asked for advice from, they were like, oh, this sounds like your writing. But I think I also had some kind of like things I was looking for. I wanted someone with a complimentary skillset. I want someone who was very values aligned. And yeah, that was all a good fit.Andreas [00:08:38]: We also did a pretty lengthy mutual evaluation process where we had a Google doc where we had all kinds of questions for each other. And I think it ended up being around 50 pages or so of like various like questions and back and forth.Swyx [00:08:52]: Was it the YC list? There's some lists going around for co-founder questions.Andreas [00:08:55]: No, we just made our own questions. But I guess it's probably related in that you ask yourself, what are the values you care about? How would you approach various decisions and things like that?Jungwon [00:09:04]: I shared like all of my past performance reviews. Yeah. Yeah.Swyx [00:09:08]: And he never had any. No.Andreas [00:09:10]: Yeah.Swyx [00:09:11]: Sorry, I just had to, a lot of people are going through that phase and you kind of skipped over it. I was like, no, no, no, no. There's like an interesting story.Jungwon [00:09:20]: Yeah.Alessio [00:09:21]: Yeah. Before we jump into what a list it is today, the history is a bit counterintuitive. So you start with figuring out, oh, if we had a super powerful model, how would we align it? But then you were actually like, well, let's just build the product so that people can actually leverage it. And I think there are a lot of folks today that are now back to where you were maybe five years ago that are like, oh, what if this happens rather than focusing on actually building something useful with it? What clicked for you to like move into a list and then we can cover that story too.Andreas [00:09:49]: I think in many ways, the approach is still the same because the way we are building illicit is not let's train a foundation model to do more stuff. It's like, let's build a scaffolding such that we can deploy powerful models to good ends. I think it's different now in that we actually have like some of the models to plug in. But if in 2017, we had had the models, we could have run the same experiments we did run with humans back then, just with models. And so in many ways, our philosophy is always, let's think ahead to the future of what models are going to exist in one, two years or longer. And how can we make it so that they can actually be deployed in kind of transparent, controllableJungwon [00:10:26]: ways? I think motivationally, we both are kind of product people at heart. The research was really important and it didn't make sense to build a product at that time. But at the end of the day, the thing that always motivated us is imagining a world where high quality reasoning is really abundant and AI is a technology that's going to get us there. And there's a way to guide that technology with research, but we can have a more direct effect through product because with research, you publish the research and someone else has to implement that into the product and the product felt like a more direct path. And we wanted to concretely have an impact on people's lives. Yeah, I think the kind of personally, the motivation was we want to build for people.Swyx [00:11:03]: Yep. And then just to recap as well, like the models you were using back then were like, I don't know, would they like BERT type stuff or T5 or I don't know what timeframe we're talking about here.Andreas [00:11:14]: I guess to be clear, at the very beginning, we had humans do the work. And then I think the first models that kind of make sense were TPT-2 and TNLG and like Yeah, early generative models. We do also use like T5 based models even now started with TPT-2.Swyx [00:11:30]: Yeah, cool. I'm just kind of curious about like, how do you start so early? You know, like now it's obvious where to start, but back then it wasn't.Jungwon [00:11:37]: Yeah, I used to nag Andreas a lot. I was like, why are you talking to this? I don't know. I felt like TPT-2 is like clearly can't do anything. And I was like, Andreas, you're wasting your time, like playing with this toy. But yeah, he was right.Alessio [00:11:50]: So what's the history of what Elicit actually does as a product? You recently announced that after four months, you get to a million in revenue. Obviously, a lot of people use it, get a lot of value, but it would initially kind of like structured data extraction from papers. Then you had kind of like concept grouping. And today, it's maybe like a more full stack research enabler, kind of like paper understander platform. What's the definitive definition of what Elicit is? And how did you get here?Jungwon [00:12:15]: Yeah, we say Elicit is an AI research assistant. I think it will continue to evolve. That's part of why we're so excited about building and research, because there's just so much space. I think the current phase we're in right now, we talk about it as really trying to make Elicit the best place to understand what is known. So it's all a lot about like literature summarization. There's a ton of information that the world already knows. It's really hard to navigate, hard to make it relevant. So a lot of it is around document discovery and processing and analysis. I really kind of want to import some of the incredible productivity improvements we've seen in software engineering and data science and into research. So it's like, how can we make researchers like data scientists of text? That's why we're launching this new set of features called Notebooks. It's very much inspired by computational notebooks, like Jupyter Notebooks, you know, DeepNode or Colab, because they're so powerful and so flexible. And ultimately, when people are trying to get to an answer or understand insight, they're kind of like manipulating evidence and information. Today, that's all packaged in PDFs, which are super brittle. So with language models, we can decompose these PDFs into their underlying claims and evidence and insights, and then let researchers mash them up together, remix them and analyze them together. So yeah, I would say quite simply, overall, Elicit is an AI research assistant. Right now we're focused on text-based workflows, but long term, really want to kind of go further and further into reasoning and decision making.Alessio [00:13:35]: And when you say AI research assistant, this is kind of meta research. So researchers use Elicit as a research assistant. It's not a generic you-can-research-anything type of tool, or it could be, but like, what are people using it for today?Andreas [00:13:49]: Yeah. So specifically in science, a lot of people use human research assistants to do things. You tell your grad student, hey, here are a couple of papers. Can you look at all of these, see which of these have kind of sufficiently large populations and actually study the disease that I'm interested in, and then write out like, what are the experiments they did? What are the interventions they did? What are the outcomes? And kind of organize that for me. And the first phase of understanding what is known really focuses on automating that workflow because a lot of that work is pretty rote work. I think it's not the kind of thing that we need humans to do. Language models can do it. And then if language models can do it, you can obviously scale it up much more than a grad student or undergrad research assistant would be able to do.Jungwon [00:14:31]: Yeah. The use cases are pretty broad. So we do have a very large percent of our users are just using it personally or for a mix of personal and professional things. People who care a lot about health or biohacking or parents who have children with a kind of rare disease and want to understand the literature directly. So there is an individual kind of consumer use case. We're most focused on the power users. So that's where we're really excited to build. So Lissette was very much inspired by this workflow in literature called systematic reviews or meta-analysis, which is basically the human state of the art for summarizing scientific literature. And it typically involves like five people working together for over a year. And they kind of first start by trying to find the maximally comprehensive set of papers possible. So it's like 10,000 papers. And they kind of systematically narrow that down to like hundreds or 50 extract key details from every single paper. Usually have two people doing it, like a third person reviewing it. So it's like an incredibly laborious, time consuming process, but you see it in every single domain. So in science, in machine learning, in policy, because it's so structured and designed to be reproducible, it's really amenable to automation. So that's kind of the workflow that we want to automate first. And then you make that accessible for any question and make these really robust living summaries of science. So yeah, that's one of the workflows that we're starting with.Alessio [00:15:49]: Our previous guest, Mike Conover, he's building a new company called Brightwave, which is an AI research assistant for financial research. How do you see the future of these tools? Does everything converge to like a God researcher assistant, or is every domain going to have its own thing?Andreas [00:16:03]: I think that's a good and mostly open question. I do think there are some differences across domains. For example, some research is more quantitative data analysis, and other research is more high level cross domain thinking. And we definitely want to contribute to the broad generalist reasoning type space. Like if researchers are making discoveries often, it's like, hey, this thing in biology is actually analogous to like these equations in economics or something. And that's just fundamentally a thing that where you need to reason across domains. At least within research, I think there will be like one best platform more or less for this type of generalist research. I think there may still be like some particular tools like for genomics, like particular types of modules of genes and proteins and whatnot. But for a lot of the kind of high level reasoning that humans do, I think that is a more of a winner type all thing.Swyx [00:16:52]: I wanted to ask a little bit deeper about, I guess, the workflow that you mentioned. I like that phrase. I see that in your UI now, but that's as it is today. And I think you were about to tell us about how it was in 2021 and how it may be progressed. How has this workflow evolved over time?Jungwon [00:17:07]: Yeah. So the very first version of Elicit actually wasn't even a research assistant. It was a forecasting assistant. So we set out and we were thinking about, you know, what are some of the most impactful types of reasoning that if we could scale up, AI would really transform the world. We actually started with literature review, but we're like, oh, so many people are going to build literature review tools. So let's start there. So then we focused on geopolitical forecasting. So I don't know if you're familiar with like manifold or manifold markets. That kind of stuff. Before manifold. Yeah. Yeah. I'm not predicting relationships. We're predicting like, is China going to invade Taiwan?Swyx [00:17:38]: Markets for everything.Andreas [00:17:39]: Yeah. That's a relationship.Swyx [00:17:41]: Yeah.Jungwon [00:17:42]: Yeah. It's true. And then we worked on that for a while. And then after GPT-3 came out, I think by that time we realized that originally we were trying to help people convert their beliefs into probability distributions. And so take fuzzy beliefs, but like model them more concretely. And then after a few months of iterating on that, just realize, oh, the thing that's blocking people from making interesting predictions about important events in the world is less kind of on the probabilistic side and much more on the research side. And so that kind of combined with the very generalist capabilities of GPT-3 prompted us to make a more general research assistant. Then we spent a few months iterating on what even is a research assistant. So we would embed with different researchers. We built data labeling workflows in the beginning, kind of right off the bat. We built ways to find experts in a field and like ways to ask good research questions. So we just kind of iterated through a lot of workflows and no one else was really building at this time. And it was like very quick to just do some prompt engineering and see like what is a task that is at the intersection of what's technologically capable and like important for researchers. And we had like a very nondescript landing page. It said nothing. But somehow people were signing up and we had to sign a form that was like, why are you here? And everyone was like, I need help with literature review. And we're like, oh, literature review. That sounds so hard. I don't even know what that means. We're like, we don't want to work on it. But then eventually we were like, okay, everyone is saying literature review. It's overwhelmingly people want to-Swyx [00:19:02]: And all domains, not like medicine or physics or just all domains. Yeah.Jungwon [00:19:06]: And we also kind of personally knew literature review was hard. And if you look at the graphs for academic literature being published every single month, you guys know this in machine learning, it's like up into the right, like superhuman amounts of papers. So we're like, all right, let's just try it. I was really nervous, but Andreas was like, this is kind of like the right problem space to jump into, even if we don't know what we're doing. So my take was like, fine, this feels really scary, but let's just launch a feature every single week and double our user numbers every month. And if we can do that, we'll fail fast and we will find something. I was worried about like getting lost in the kind of academic white space. So the very first version was actually a weekend prototype that Andreas made. Do you want to explain how that worked?Andreas [00:19:44]: I mostly remember that it was really bad. The thing I remember is you entered a question and it would give you back a list of claims. So your question could be, I don't know, how does creatine affect cognition? It would give you back some claims that are to some extent based on papers, but they were often irrelevant. The papers were often irrelevant. And so we ended up soon just printing out a bunch of examples of results and putting them up on the wall so that we would kind of feel the constant shame of having such a bad product and would be incentivized to make it better. And I think over time it has gotten a lot better, but I think the initial version was like really very bad. Yeah.Jungwon [00:20:20]: But it was basically like a natural language summary of an abstract, like kind of a one sentence summary, and which we still have. And then as we learned kind of more about this systematic review workflow, we started expanding the capability so that you could extract a lot more data from the papers and do more with that.Swyx [00:20:33]: And were you using like embeddings and cosine similarity, that kind of stuff for retrieval, or was it keyword based?Andreas [00:20:40]: I think the very first version didn't even have its own search engine. I think the very first version probably used the Semantic Scholar or API or something similar. And only later when we discovered that API is not very semantic, we then built our own search engine that has helped a lot.Swyx [00:20:58]: And then we're going to go into like more recent products stuff, but like, you know, I think you seem the more sort of startup oriented business person and you seem sort of more ideologically like interested in research, obviously, because of your PhD. What kind of market sizing were you guys thinking? Right? Like, because you're here saying like, we have to double every month. And I'm like, I don't know how you make that conclusion from this, right? Especially also as a nonprofit at the time.Jungwon [00:21:22]: I mean, market size wise, I felt like in this space where so much was changing and it was very unclear what of today was actually going to be true tomorrow. We just like really rested a lot on very, very simple fundamental principles, which is like, if you can understand the truth, that is very economically beneficial and valuable. If you like know the truth.Swyx [00:21:42]: On principle.Jungwon [00:21:43]: Yeah. That's enough for you. Yeah. Research is the key to many breakthroughs that are very commercially valuable.Swyx [00:21:47]: Because my version of it is students are poor and they don't pay for anything. Right? But that's obviously not true. As you guys have found out. But you had to have some market insight for me to have believed that, but you skipped that.Andreas [00:21:58]: Yeah. I remember talking to VCs for our seed round. A lot of VCs were like, you know, researchers, they don't have any money. Why don't you build legal assistant? I think in some short sighted way, maybe that's true. But I think in the long run, R&D is such a big space of the economy. I think if you can substantially improve how quickly people find new discoveries or avoid controlled trials that don't go anywhere, I think that's just huge amounts of money. And there are a lot of questions obviously about between here and there. But I think as long as the fundamental principle is there, we were okay with that. And I guess we found some investors who also were. Yeah.Swyx [00:22:35]: Congrats. I mean, I'm sure we can cover the sort of flip later. I think you're about to start us on like GPT-3 and how that changed things for you. It's funny. I guess every major GPT version, you have some big insight. Yeah.Jungwon [00:22:48]: Yeah. I mean, what do you think?Andreas [00:22:51]: I think it's a little bit less true for us than for others, because we always believed that there will basically be human level machine work. And so it is definitely true that in practice for your product, as new models come out, your product starts working better, you can add some features that you couldn't add before. But I don't think we really ever had the moment where we were like, oh, wow, that is super unanticipated. We need to do something entirely different now from what was on the roadmap.Jungwon [00:23:21]: I think GPT-3 was a big change because it kind of said, oh, now is the time that we can use AI to build these tools. And then GPT-4 was maybe a little bit more of an extension of GPT-3. GPT-3 over GPT-2 was like qualitative level shift. And then GPT-4 was like, okay, great. Now it's like more accurate. We're more accurate on these things. We can answer harder questions. But the shape of the product had already taken place by that time.Swyx [00:23:44]: I kind of want to ask you about this sort of pivot that you've made. But I guess that was just a way to sell what you were doing, which is you're adding extra features on grouping by concepts. The GPT-4 pivot, quote unquote pivot that you-Jungwon [00:23:55]: Oh, yeah, yeah, exactly. Right, right, right. Yeah. Yeah. When we launched this workflow, now that GPT-4 was available, basically Elisa was at a place where we have very tabular interfaces. So given a table of papers, you can extract data across all the tables. But you kind of want to take the analysis a step further. Sometimes what you'd care about is not having a list of papers, but a list of arguments, a list of effects, a list of interventions, a list of techniques. And so that's one of the things we're working on is now that you've extracted this information in a more structured way, can you pivot it or group by whatever the information that you extracted to have more insight first information still supported by the academic literature?Swyx [00:24:33]: Yeah, that was a big revelation when I saw it. Basically, I think I'm very just impressed by how first principles, your ideas around what the workflow is. And I think that's why you're not as reliant on like the LLM improving, because it's actually just about improving the workflow that you would recommend to people. Today we might call it an agent, I don't know, but you're not relying on the LLM to drive it. It's relying on this is the way that Elicit does research. And this is what we think is most effective based on talking to our users.Jungwon [00:25:01]: The problem space is still huge. Like if it's like this big, we are all still operating at this tiny part, bit of it. So I think about this a lot in the context of moats, people are like, oh, what's your moat? What happens if GPT-5 comes out? It's like, if GPT-5 comes out, there's still like all of this other space that we can go into. So I think being really obsessed with the problem, which is very, very big, has helped us like stay robust and just kind of directly incorporate model improvements and they keep going.Swyx [00:25:26]: And then I first encountered you guys with Charlie, you can tell us about that project. Basically, yeah. Like how much did cost become a concern as you're working more and more with OpenAI? How do you manage that relationship?Jungwon [00:25:37]: Let me talk about who Charlie is. And then you can talk about the tech, because Charlie is a special character. So Charlie, when we found him was, had just finished his freshman year at the University of Warwick. And I think he had heard about us on some discord. And then he applied and we were like, wow, who is this freshman? And then we just saw that he had done so many incredible side projects. And we were actually on a team retreat in Barcelona visiting our head of engineering at that time. And everyone was talking about this wonder kid or like this kid. And then on our take home project, he had done like the best of anyone to that point. And so people were just like so excited to hire him. So we hired him as an intern and they were like, Charlie, what if you just dropped out of school? And so then we convinced him to take a year off. And he was just incredibly productive. And I think the thing you're referring to is at the start of 2023, Anthropic kind of launched their constitutional AI paper. And within a few days, I think four days, he had basically implemented that in production. And then we had it in app a week or so after that. And he has since kind of contributed to major improvements, like cutting costs down to a tenth of what they were really large scale. But yeah, you can talk about the technical stuff. Yeah.Andreas [00:26:39]: On the constitutional AI project, this was for abstract summarization, where in illicit, if you run a query, it'll return papers to you, and then it will summarize each paper with respect to your query for you on the fly. And that's a really important part of illicit because illicit does it so much. If you run a few searches, it'll have done it a few hundred times for you. And so we cared a lot about this both being fast, cheap, and also very low on hallucination. I think if illicit hallucinates something about the abstract, that's really not good. And so what Charlie did in that project was create a constitution that expressed what are the attributes of a good summary? Everything in the summary is reflected in the actual abstract, and it's like very concise, et cetera, et cetera. And then used RLHF with a model that was trained on the constitution to basically fine tune a better summarizer on an open source model. Yeah. I think that might still be in use.Jungwon [00:27:34]: Yeah. Yeah, definitely. Yeah. I think at the time, the models hadn't been trained at all to be faithful to a text. So they were just generating. So then when you ask them a question, they tried too hard to answer the question and didn't try hard enough to answer the question given the text or answer what the text said about the question. So we had to basically teach the models to do that specific task.Swyx [00:27:54]: How do you monitor the ongoing performance of your models? Not to get too LLM-opsy, but you are one of the larger, more well-known operations doing NLP at scale. I guess effectively, you have to monitor these things and nobody has a good answer that I talk to.Andreas [00:28:10]: I don't think we have a good answer yet. I think the answers are actually a little bit clearer on the just kind of basic robustness side of where you can import ideas from normal software engineering and normal kind of DevOps. You're like, well, you need to monitor kind of latencies and response times and uptime and whatnot.Swyx [00:28:27]: I think when we say performance, it's more about hallucination rate, isn't it?Andreas [00:28:30]: And then things like hallucination rate where I think there, the really important thing is training time. So we care a lot about having our own internal benchmarks for model development that reflect the distribution of user queries so that we can know ahead of time how well is the model going to perform on different types of tasks. So the tasks being summarization, question answering, given a paper, ranking. And for each of those, we want to know what's the distribution of things the model is going to see so that we can have well-calibrated predictions on how well the model is going to do in production. And I think, yeah, there's some chance that there's distribution shift and actually the things users enter are going to be different. But I think that's much less important than getting the kind of training right and having very high quality, well-vetted data sets at training time.Jungwon [00:29:18]: I think we also end up effectively monitoring by trying to evaluate new models as they come out. And so that kind of prompts us to go through our eval suite every couple of months. And every time a new model comes out, we have to see how is this performing relative to production and what we currently have.Swyx [00:29:32]: Yeah. I mean, since we're on this topic, any new models that have really caught your eye this year?Jungwon [00:29:37]: Like Claude came out with a bunch. Yeah. I think Claude is pretty, I think the team's pretty excited about Claude. Yeah.Andreas [00:29:41]: Specifically, Claude Haiku is like a good point on the kind of Pareto frontier. It's neither the cheapest model, nor is it the most accurate, most high quality model, but it's just like a really good trade-off between cost and accuracy.Swyx [00:29:57]: You apparently have to 10-shot it to make it good. I tried using Haiku for summarization, but zero-shot was not great. Then they were like, you know, it's a skill issue, you have to try harder.Jungwon [00:30:07]: I think GPT-4 unlocked tables for us, processing data from tables, which was huge. GPT-4 Vision.Andreas [00:30:13]: Yeah.Swyx [00:30:14]: Yeah. Did you try like Fuyu? I guess you can't try Fuyu because it's non-commercial. That's the adept model.Jungwon [00:30:19]: Yeah.Swyx [00:30:20]: We haven't tried that one. Yeah. Yeah. Yeah. But Claude is multimodal as well. Yeah. I think the interesting insight that we got from talking to David Luan, who is CEO of multimodality has effectively two different flavors. One is we recognize images from a camera in the outside natural world. And actually the more important multimodality for knowledge work is screenshots and PDFs and charts and graphs. So we need a new term for that kind of multimodality.Andreas [00:30:45]: But is the claim that current models are good at one or the other? Yeah.Swyx [00:30:50]: They're over-indexed because of the history of computer vision is Coco, right? So now we're like, oh, actually, you know, screens are more important, OCR, handwriting. You mentioned a lot of like closed model lab stuff, and then you also have like this open source model fine tuning stuff. Like what is your workload now between closed and open? It's a good question.Andreas [00:31:07]: I think- Is it half and half? It's a-Swyx [00:31:10]: Is that even a relevant question or not? Is this a nonsensical question?Andreas [00:31:13]: It depends a little bit on like how you index, whether you index by like computer cost or number of queries. I'd say like in terms of number of queries, it's maybe similar. In terms of like cost and compute, I think the closed models make up more of the budget since the main cases where you want to use closed models are cases where they're just smarter, where no existing open source models are quite smart enough.Jungwon [00:31:35]: Yeah. Yeah.Alessio [00:31:37]: We have a lot of interesting technical questions to go in, but just to wrap the kind of like UX evolution, now you have the notebooks. We talked a lot about how chatbots are not the final frontier, you know? How did you decide to get into notebooks, which is a very iterative kind of like interactive interface and yeah, maybe learnings from that.Jungwon [00:31:56]: Yeah. This is actually our fourth time trying to make this work. Okay. I think the first time was probably in early 2021. I think because we've always been obsessed with this idea of task decomposition and like branching, we always wanted a tool that could be kind of unbounded where you could keep going, could do a lot of branching where you could kind of apply language model operations or computations on other tasks. So in 2021, we had this thing called composite tasks where you could use GPT-3 to brainstorm a bunch of research questions and then take each research question and decompose those further into sub questions. This kind of, again, that like task decomposition tree type thing was always very exciting to us, but that was like, it didn't work and it was kind of overwhelming. Then at the end of 22, I think we tried again and at that point we were thinking, okay, we've done a lot with this literature review thing. We also want to start helping with kind of adjacent domains and different workflows. Like we want to help more with machine learning. What does that look like? And as we were thinking about it, we're like, well, there are so many research workflows. How do we not just build three new workflows into Elicit, but make Elicit really generic to lots of workflows? What is like a generic composable system with nice abstractions that can like scale to all these workflows? So we like iterated on that a bunch and then didn't quite narrow the problem space enough or like quite get to what we wanted. And then I think it was at the beginning of 2023 where we're like, wow, computational notebooks kind of enable this, where they have a lot of flexibility, but kind of robust primitives such that you can extend the workflow and it's not limited. It's not like you ask a query, you get an answer, you're done. You can just constantly keep building on top of that. And each little step seems like a really good unit of work for the language model. And also there was just like really helpful to have a bit more preexisting work to emulate. Yeah, that's kind of how we ended up at computational notebooks for Elicit.Andreas [00:33:44]: Maybe one thing that's worth making explicit is the difference between computational notebooks and chat, because on the surface, they seem pretty similar. It's kind of this iterative interaction where you add stuff. In both cases, you have a back and forth between you enter stuff and then you get some output and then you enter stuff. But the important difference in our minds is with notebooks, you can define a process. So in data science, you can be like, here's like my data analysis process that takes in a CSV and then does some extraction and then generates a figure at the end. And you can prototype it using a small CSV and then you can run it over a much larger CSV later. And similarly, the vision for notebooks in our case is to not make it this like one-off chat interaction, but to allow you to then say, if you start and first you're like, okay, let me just analyze a few papers and see, do I get to the correct conclusions for those few papers? Can I then later go back and say, now let me run this over 10,000 papers now that I've debugged the process using a few papers. And that's an interaction that doesn't fit quite as well into the chat framework because that's more for kind of quick back and forth interaction.Alessio [00:34:49]: Do you think in notebooks, it's kind of like structure, editable chain of thought, basically step by step? Like, is that kind of where you see this going? And then are people going to reuse notebooks as like templates? And maybe in traditional notebooks, it's like cookbooks, right? You share a cookbook, you can start from there. Is this similar in Elizit?Andreas [00:35:06]: Yeah, that's exactly right. So that's our hope that people will build templates, share them with other people. I think chain of thought is maybe still like kind of one level lower on the abstraction hierarchy than we would think of notebooks. I think we'll probably want to think about more semantic pieces like a building block is more like a paper search or an extraction or a list of concepts. And then the model's detailed reasoning will probably often be one level down. You always want to be able to see it, but you don't always want it to be front and center.Alessio [00:35:36]: Yeah, what's the difference between a notebook and an agent? Since everybody always asks me, what's an agent? Like how do you think about where the line is?Andreas [00:35:44]: Yeah, it's an interesting question. In the notebook world, I would generally think of the human as the agent in the first iteration. So you have the notebook and the human kind of adds little action steps. And then the next point on this kind of progress gradient is, okay, now you can use language models to predict which action would you take as a human. And at some point, you're probably going to be very good at this, you'll be like, okay, in some cases I can, with 99.9% accuracy, predict what you do. And then you might as well just execute it, like why wait for the human? And eventually, as you get better at this, that will just look more and more like agents taking actions as opposed to you doing the thing. I think templates are a specific case of this where you're like, okay, well, there's just particular sequences of actions that you often want to chunk and have available as primitives, just like in normal programming. And those, you can view them as action sequences of agents, or you can view them as more normal programming language abstraction thing. And I think those are two valid views. Yeah.Alessio [00:36:40]: How do you see this change as, like you said, the models get better and you need less and less human actual interfacing with the model, you just get the results? Like how does the UX and the way people perceive it change?Jungwon [00:36:52]: Yeah, I think this kind of interaction paradigms for evaluation is not really something the internet has encountered yet, because up to now, the internet has all been about getting data and work from people. So increasingly, I really want kind of evaluation, both from an interface perspective and from like a technical perspective and operation perspective to be a superpower for Elicit, because I think over time, models will do more and more of the work, and people will have to do more and more of the evaluation. So I think, yeah, in terms of the interface, some of the things we have today, you know, for every kind of language model generation, there's some citation back, and we kind of try to highlight the ground truth in the paper that is most relevant to whatever Elicit said, and make it super easy so that you can click on it and quickly see in context and validate whether the text actually supports the answer that Elicit gave. So I think we'd probably want to scale things up like that, like the ability to kind of spot check the model's work super quickly, scale up interfaces like that. And-Swyx [00:37:44]: Who would spot check? The user?Jungwon [00:37:46]: Yeah, to start, it would be the user. One of the other things we do is also kind of flag the model's uncertainty. So we have models report out, how confident are you that this was the sample size of this study? The model's not sure, we throw a flag. And so the user knows to prioritize checking that. So again, we can kind of scale that up. So when the model's like, well, I searched this on Google, I'm not sure if that was the right thing. I have an uncertainty flag, and the user can go and be like, oh, okay, that was actually the right thing to do or not.Swyx [00:38:10]: I've tried to do uncertainty readings from models. I don't know if you have this live. You do? Yeah. Because I just didn't find them reliable because they just hallucinated their own uncertainty. I would love to base it on log probs or something more native within the model rather than generated. But okay, it sounds like they scale properly for you. Yeah.Jungwon [00:38:30]: We found it to be pretty calibrated. It varies on the model.Andreas [00:38:32]: I think in some cases, we also use two different models for the uncertainty estimates than for the question answering. So one model would say, here's my chain of thought, here's my answer. And then a different type of model. Let's say the first model is Llama, and let's say the second model is GPT-3.5. And then the second model just looks over the results and is like, okay, how confident are you in this? And I think sometimes using a different model can be better than using the same model. Yeah.Swyx [00:38:58]: On the topic of models, evaluating models, obviously you can do that all day long. What's your budget? Because your queries fan out a lot. And then you have models evaluating models. One person typing in a question can lead to a thousand calls.Andreas [00:39:11]: It depends on the project. So if the project is basically a systematic review that otherwise human research assistants would do, then the project is basically a human equivalent spend. And the spend can get quite large for those projects. I don't know, let's say $100,000. In those cases, you're happier to spend compute then in the kind of shallow search case where someone just enters a question because, I don't know, maybe I heard about creatine. What's it about? Probably don't want to spend a lot of compute on that. This sort of being able to invest more or less compute into getting more or less accurate answers is I think one of the core things we care about. And that I think is currently undervalued in the AI space. I think currently you can choose which model you want and you can sometimes, I don't know, you'll tip it and it'll try harder or you can try various things to get it to work harder. But you don't have great ways of converting willingness to spend into better answers. And we really want to build a product that has this sort of unbounded flavor where if you care about it a lot, you should be able to get really high quality answers, really double checked in every way.Alessio [00:40:14]: And you have a credits-based pricing. So unlike most products, it's not a fixed monthly fee.Jungwon [00:40:19]: Right, exactly. So some of the higher costs are tiered. So for most casual users, they'll just get the abstract summary, which is kind of an open source model. Then you can add more columns, which have more extractions and these uncertainty features. And then you can also add the same columns in high accuracy mode, which also parses the table. So we kind of stack the complexity on the calls.Swyx [00:40:39]: You know, the fun thing you can do with a credit system, which is data for data, basically you can give people more credits if they give data back to you. I don't know if you've already done that. We've thought about something like this.Jungwon [00:40:49]: It's like if you don't have money, but you have time, how do you exchange that?Swyx [00:40:54]: It's a fair trade.Jungwon [00:40:55]: I think it's interesting. We haven't quite operationalized it. And then, you know, there's been some kind of like adverse selection. Like, you know, for example, it would be really valuable to get feedback on our model. So maybe if you were willing to give more robust feedback on our results, we could give you credits or something like that. But then there's kind of this, will people take it seriously? And you want the good people. Exactly.Swyx [00:41:11]: Can you tell who are the good people? Not right now.Jungwon [00:41:13]: But yeah, maybe at the point where we can, we can offer it. We can offer it up to them.Swyx [00:41:16]: The perplexity of questions asked, you know, if it's higher perplexity, these are the smarterJungwon [00:41:20]: people. Yeah, maybe.Andreas [00:41:23]: If you put typos in your queries, you're not going to get off the stage.Swyx [00:41:28]: Negative social credit. It's very topical right now to think about the threat of long context windows. All these models that we're talking about these days, all like a million token plus. Is that relevant for you? Can you make use of that? Is that just prohibitively expensive because you're just paying for all those tokens or you're just doing rag?Andreas [00:41:44]: It's definitely relevant. And when we think about search, as many people do, we think about kind of a staged pipeline of retrieval where first you use semantic search database with embeddings, get like the, in our case, maybe 400 or so most relevant papers. And then, then you still need to rank those. And I think at that point it becomes pretty interesting to use larger models. So specifically in the past, I think a lot of ranking was kind of per item ranking where you would score each individual item, maybe using increasingly expensive scoring methods and then rank based on the scores. But I think list-wise re-ranking where you have a model that can see all the elements is a lot more powerful because often you can only really tell how good a thing is in comparison to other things and what things should come first. It really depends on like, well, what other things that are available, maybe you even care about diversity in your results. You don't want to show 10 very similar papers as the first 10 results. So I think a long context models are quite interesting there. And especially for our case where we care more about power users who are perhaps a little bit more willing to wait a little bit longer to get higher quality results relative to people who just quickly check out things because why not? And I think being able to spend more on longer contexts is quite valuable.Jungwon [00:42:55]: Yeah. I think one thing the longer context models changed for us is maybe a focus from breaking down tasks to breaking down the evaluation. So before, you know, if we wanted to answer a question from the full text of a paper, we had to figure out how to chunk it and like find the relevant chunk and then answer based on that chunk. And the nice thing was then, you know, kind of which chunk the model used to answer the question. So if you want to help the user track it, yeah, you can be like, well, this was the chunk that the model got. And now if you put the whole text in the paper, you have to like kind of find the chunk like more retroactively basically. And so you need kind of like a different set of abilities and obviously like a different technology to figure out. You still want to point the user to the supporting quotes in the text, but then the interaction is a little different.Swyx [00:43:38]: You like scan through and find some rouge score floor.Andreas [00:43:41]: I think there's an interesting space of almost research problems here because you would ideally make causal claims like if this hadn't been in the text, the model wouldn't have said this thing. And maybe you can do expensive approximations to that where like, I don't know, you just throw out chunk of the paper and re-answer and see what happens. But hopefully there are better ways of doing that where you just get that kind of counterfactual information for free from the model.Alessio [00:44:06]: Do you think at all about the cost of maintaining REG versus just putting more tokens in the window? I think in software development, a lot of times people buy developer productivity things so that we don't have to worry about it. Context window is kind of the same, right? You have to maintain chunking and like REG retrieval and like re-ranking and all of this versus I just shove everything into the context and like it costs a little more, but at least I don't have to do all of that. Is that something you thought about?Jungwon [00:44:31]: I think we still like hit up against context limits enough that it's not really, do we still want to keep this REG around? It's like we do still need it for the scale of the work that we're doing, yeah.Andreas [00:44:41]: And I think there are different kinds of maintainability. In one sense, I think you're right that throw everything into the context window thing is easier to maintain because you just can swap out a model. In another sense, if things go wrong, it's harder to debug where like, if you know, here's the process that we go through to go from 200 million papers to an answer. And there are like little steps and you understand, okay, this is the step that finds the relevant paragraph or whatever it may be. You'll know which step breaks if the answers are bad, whereas if it's just like a new model version came out and now it suddenly doesn't find your needle in a haystack anymore, then you're like, okay, what can you do? You're kind of at a loss.Alessio [00:45:21]: Let's talk a bit about, yeah, needle in a haystack and like maybe the opposite of it, which is like hard grounding. I don't know if that's like the best name to think about it, but I was using one of these chatwitcher documents features and I put the AMD MI300 specs and the new Blackwell chips from NVIDIA and I was asking questions and does the AMD chip support NVLink? And the response was like, oh, it doesn't say in the specs. But if you ask GPD 4 without the docs, it would tell you no, because NVLink it's a NVIDIA technology.Swyx [00:45:49]: It just says in the thing.Alessio [00:45:53]: How do you think about that? Does using the context sometimes suppress the knowledge that the model has?Andreas [00:45:57]: It really depends on the task because I think sometimes that is exactly what you want. So imagine you're a researcher, you're writing the background section of your paper and you're trying to describe what these other papers say. You really don't want extra information to be introduced there. In other cases where you're just trying to figure out the truth and you're giving the documents because you think they will help the model figure out what the truth is. I think you do want, if the model has a hunch that there might be something that's not in the papers, you do want to surface that. I think ideally you still don't want the model to just tell you, probably the ideal thing looks a bit more like agent control where the model can issue a query that then is intended to surface documents that substantiate its hunch. That's maybe a reasonable middle ground between model just telling you and model being fully limited to the papers you give it.Jungwon [00:46:44]: Yeah, I would say it's, they're just kind of different tasks right now. And the task that Elicit is mostly focused on is what do these papers say? But there's another task which is like, just give me the best possible answer and that give me the best possible answer sometimes depends on what do these papers say, but it can also depend on other stuff that's not in the papers. So ideally we can do both and then kind of do this overall task for you more going forward.Alessio [00:47:08]: We see a lot of details, but just to zoom back out a little bit, what are maybe the most underrated features of Elicit and what is one thing that maybe the users surprise you the most by using it?Jungwon [00:47:19]: I think the most powerful feature of Elicit is the ability to extract, add columns to this table, which effectively extracts data from all of your papers at once. It's well used, but there are kind of many different extensions of that that I think users are still discovering. So one is we let you give a description of the column. We let you give instructions of a column. We let you create custom columns. So we have like 30 plus predefined fields that users can extract, like what were the methods? What were the main findings? How many people were studied? And we actually show you basically the prompts that we're using to

All four of my children were born at home. I feel extremely fortunate about this - they should too. Four wonderful experiences. I will forever be in debt to Louisa and Jolie.When, twenty-four years ago, my then wife, Louisa, told me she wanted to give birth to our first child at home, I thought she was off her rocker, but I gave her my word that we would at least talk to a midwife, and we did just that. Within about five minutes of meeting Tina Perridge of South London Independent Midwives, a lady of whom I cannot speak highly enough, I was instantly persuaded. Ever since, when I hear that someone is pregnant, I start urging them to have a homebirth with the persistence of a Jehovah's Witness or someone pedalling an upgrade to your current mobile phone subscription. I even included a chapter about it in my first book Life After the State - Why We Don't Need Government (2013), (now, thanks to the invaluable help of my buddy Chris P, back in print - with the audiobook here [Audible UK, Audible US, Apple Books]).I'm publishing that chapter here, something I was previously not able to do (rights issues), because I want as many people as possible to read it. Many people do not even know home-birth is an option. I'm fully aware that, when it comes to giving birth, one of the last people a prospective mum wants to hear advice from is comedian and financial writer, Dominic Frisby. I'm also aware that this is an extremely sensitive subject and that I am treading on eggshells galore. But the word needs to be spread. All I would say is that if you or someone you know is pregnant, have a conversation with an independent midwife, before committing to having your baby in a hospital. It's so important. Please just talk to an independent midwife first. With that said, here is that chapter. Enjoy it, and if you know anyone who is pregnant, please send this to them.We have to use fiat money, we have to pay taxes, most of us are beholden in some way to the education system. These are all things much bigger than us, over which we have little control. The birth of your child, however, is one of the most important experiences of your (and their) life, one where the state so often makes a mess of things, but one where it really is possible to have some control.The State: Looking After Your First BreathThe knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process.Suzanne Arms, authorThere is no single experience that puts you more in touch with the meaning of life than birth. A birth should be a happy, healthy, wonderful experience for everyone involved. Too often it isn't.Broadly speaking, there are three places a mother can give birth: at home, in hospital or – half-way house – at a birthing centre. Over the course of the 20th century we have moved birth from the home to the hospital. In the UK in the 1920s something like 80% of births took place at home. In the 1960s it was one in three. By 1991 it was 1%. In Japan the home-birth rate was 95% in 1950 falling to 1.2% in 1975. In the US home-birth went from 50% in 1938 to 1% in 1955. In the UK now 2.7% of births take place at home. In Scotland, 1.2% of births take place at home, and in Northern Ireland this drops to fewer than 0.4%. Home-birth is now the anomaly. But for several thousand years, it was the norm.The two key words here are ‘happy' and ‘healthy'. The two tend to come hand in hand. But let's look, first, at ‘healthy'. Let me stress, I am looking at planned homebirth; not a homebirth where mum didn't get to the hospital in time.My initial assumption when I looked at this subject was that hospital would be more healthy. A hospital is full of trained personnel, medicine and medical equipment. My first instinct against home-birth, it turned out, echoed the numerous arguments against it, which come from many parts of the medical establishment. They more or less run along the lines of this statement from the American College of Obstetrics and Gynaecology: ‘Unless a woman is in a hospital, an accredited free-standing birthing centre or a birthing centre within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.'Actually, the risk of death for babies born at home is almost half that of babies born at hospital (0.35 per 1,000 compared to 0.64), according to a 2009 study by the Canadian Medical Association Journal. The National Institute for Health and Clinical Excellence reports that mortality rates are the same in booked home-birth as in hospitals. In November 2011 a study of 65,000 mothers by the National Perinatal Epidemiology Unit (NPEU) was published in the British Medical Journal. The overall rate of negative birth outcomes (death or serious complications) was 4.3 per 1,000 births, with no difference in outcome between non-obstetric and obstetric (hospital) settings. The study did find that the rate of complications rose for first-time mums, 5.3 per 1,000 (0.53%) for hospitals and 9.5 per 1,000 (0.95%) for home-birth. I suspect the number of complications falls with later births because, with experience, the process becomes easier – and because mothers who had problems are less likely to have more children than those who didn't. The Daily Mail managed to twist this into: ‘First-time mothers who opt for home birth face triple the risk of death or brain damage in child.' Don't you just love newspapers? Whether at home or in the hospital there were 250 negative events seen in the study: early neonatal deaths accounted for 13%; brain damage 46%; meconium aspiration syndrome 20%; traumatic nerve damage 4% and fractured bones 4%. Not all of these were treatable.There are so many variables in birth that raw comparative statistics are not always enough. And, without wishing to get into an ethical argument, there are other factors apart from safety. There are things – comfort, happiness, for example – for which people are prepared to sacrifice a little safety. The overriding statistic to take away from that part of the study is that less than 1% of births in the UK, whether at hospital or at home, lead to serious complications.But when you look at rates of satisfaction with their birth experience, the numbers are staggering. According to a 1999 study by Midwifery Today researching women who have experienced both home and hospital birth, over 99% said that they would prefer to have a home-birth in the future!What, then, is so unsatisfying about the hospital birth experience? I'm going to walk through the birthing process now, comparing what goes on at home to hospital. Of course, no two births are the same, no two homes are the same, no two hospitals are the same, but, broadly speaking, it seems women prefer the home-birth experience because: they have more autonomy at home, they suffer less intervention at home and, yes, it appears they actually suffer less pain at home. When mum goes into labour, the journey to the hospital, sometimes rushed, the alien setting when she gets there, the array of doctors and nurses who she may never have met before, but are about to get intimate, can all upset her rhythm and the production of her labour hormones. These aren't always problems, but they have the potential to be; they add to stress and detract from comfort.At home, mum is in a familiar environment, she can get comfortable and settled, go where she likes and do what she likes. Often getting on with something else can take her mind off the pain of the contractions, while in hospital there is little else to focus on. At home, she can choose where she wants to give birth – and she can change her mind, if she likes. She is in her own domain, without someone she doesn't know telling her what she can and can't do. She can change the light, the heating, the music; she can decide exactly who she wants at the birth and who ‘catches' her baby. She can choose what she wants to eat. She will have interviewed and chosen her midwife many months before, and built up a relationship over that time. But in hospitals she is attended by whoever is on duty, she has to eat hospital food, there might be interruptions, doctors' pagers, alarms, screams from next door, whirrs of machinery, tube lighting, overworked, resentful staff to deal with, internal hospital politics, people coming in, waking her up, and checking her vitals, sticking in pins or needles, putting on monitor belts, checking her cervix mid-contraction – any number of things over which mum has no control. Mums who move about freely during labour complain less of back pain. Many authorities feel that the motion of walking and changing positions can even enhance the effectiveness of the contractions, but such active birth is not as possible in the confines of many hospitals. Many use intravenous fluids and electronic foetal monitors to ensure she stays hydrated and to record each contraction and beat of the baby's heart. This all dampens mum's ability to move about and adds to any feelings of claustrophobia.In hospital the tendency is to give birth on your back, though this is often not the best position – the coccyx cannot bend to help the baby's head pass through. There are many other positions – on your hands and knees for example – where you don't have to work against gravity and where the baby's head is not impeded. On your back, pushing is less effective and metal forceps are sometimes used to pull the baby out of the vagina, but forceps are less commonly used when mum assumes a position of comfort during the bearing-down stage.This brings us to the next issue: intervention. The NPEU study of 2011 found that 58% of women in hospital had a natural birth without any intervention, compared to 88% of women at home and 80% of women at a midwife-led unit. Of course, there are frequent occasions when medical technology saves lives, but the likelihood of medical intervention increases in hospitals. I suggest it can actually cause as many problems as it alleviates because it is interruptive. Even routine technology can interrupt the normal birth process. Once derailed from the birthing tracks, it is hard to get back on. Once intervention starts, it's hard to stop. The medical industry is built on providing cures, but if you are a mother giving birth, you are not sick, there is nothing wrong with you, what you are going through is natural and normal. As author Sheila Stubbs writes, ‘the midwife considers the miracle of childbirth as normal, and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble; if he leaves it alone, it's a miracle.'Here are just some of the other interventions that occur. If a mum arrives at hospital and the production of her labour hormones has been interrupted, as can happen as a result of the journey, she will sometimes be given syntocinon, a synthetic version of the hormone oxytocin, which occurs naturally and causes the muscle of the uterus to contract during labour so baby can be pushed out. The dose of syntocinon is increased until contractions are deemed normal. It's sometimes given after birth as well to stimulate the contractions that help push out the placenta and prevent bleeding. But there are allegations that syntocinon increases the risk of baby going into distress, and of mum finding labour too painful and needing an epidural. This is one of the reasons why women also find home-birth less painful.Obstetricians sometimes rupture the bag of waters surrounding the baby in order to speed up the birthing process. This places a time limit on the labour, as the likelihood of a uterine infection increases after the water is broken. Indeed in a hospital – no matter how clean – you are exposed to more pathogens than at home. The rate of post-partum infection to women who give birth in hospital is a terrifying 25%, compared to just 4% in home-birth mothers. Once the protective cushion of water surrounding the baby's head is removed (that is to say, once the waters are broken) there are more possibilities for intervention. A scalp electrode, a tiny probe, might be attached to baby's scalp, to continue monitoring its heart rate and to gather information about its blood.There are these and a whole host of other ‘just in case' interventions in hospital that you just don't meet at home. As childbirth author Margaret Jowitt, says – and here we are back to our theme of Natural Law – ‘Natural childbirth has evolved to suit the species, and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences.'At home, if necessary, in the 1% of cases where serious complications do ensue, you can still be taken to hospital – assuming you live in reasonable distance of one.‘My mother groaned, my father wept,' wrote William Blake, ‘into the dangerous world I leapt.' We come now to the afterbirth. Many new mothers say they physically ache for their babies when they are separated. Nature, it seems, gives new mothers a strong attachment desire, a physical yearning that, if allowed to be satisfied, starts a process with results beneficial to both mother and baby. There are all sorts of natural forces at work, many of which we don't even know about. ‘Incomplete bonding,' on the other hand, in the words of Judith Goldsmith, author of Childbirth Wisdom from the World's Oldest Societies, ‘can lead to confusion, depression, incompetence, and even rejection of the child by the mother.' Yet in hospitals, even today with all we know, the baby is often taken away from the mother for weighing and other tests – or to keep it warm, though there is no warmer place for it that in its mother's arms (nature has planned for skin-to-skin contact).Separation of mother from baby is more likely if some kind of medical intervention or operation has occurred, or if mum is recovering from drugs taken during labour. (Women who have taken drugs in labour also report decreased maternal feelings towards their babies and increased post-natal depression). At home, after birth, baby is not taken from its mother's side unless there is an emergency.As child development author, Joseph Chilton Pearce, writes, ‘Bonding is a psychological-biological state, a vital physical link that coordinates and unifies the entire biological system . . . We are never conscious of being bonded; we are conscious only of our acute disease when we are not bonded.' The breaking of the bond results in higher rates of postpartum depression and child rejection. Nature gives new parents and babies the desire to bond, because bonding is beneficial to our species. Not only does it encourage breastfeeding and speed the recovery of the mother, but the emotional bonding in the magical moments after birth between mother and child, between the entire family, cements the unity of the family. The hospital institution has no such agenda. The cutting of the umbilical cord is another area of contention. Hospitals, say home-birth advocates, cut it too soon. In Birth Without Violence, the classic 1975 text advocating gentle birthing techniques, Frederick Leboyer – also an advocate of bonding and immediate skin-to-skin contact between mother and baby after birth – writes:[Nature] has arranged it so that during the dangerous passage of birth, the child is receiving oxygen from two sources rather than one: from the lungs and from the umbilicus. Two systems functioning simultaneously, one relieving the other: the old one, the umbilicus, continues to supply oxygen to the baby until the new one, the lungs, has fully taken its place. However, once the infant has been born and delivered from the mother, it remains bound to her by this umbilicus, which continues to beat for several long minutes: four, five, sometimes more. Oxygenated by the umbilicus, sheltered from anoxia, the baby can settle into breathing without danger and without shock. In addition, the blood has plenty of time to abandon its old route (which leads to the placenta) and progressively to fill the pulmonary circulatory system. During this time, in parallel fashion, an orifice closes in the heart, which seals off the old route forever. In short, for an average of four or five minutes, the newborn infant straddles two worlds. Drawing oxygen from two sources, it switches gradually from the one to the other, without a brutal transition. One scarcely hears a cry. What is required for this miracle to take place? Only a little patience.Patience is not something you associate with hospital birth. There are simply not the resources, even if, as the sixth US president John Quincy Adams said, ‘patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish'. The arguments to delay the early cutting of the cord (something not as frequent in hospitals as it once was) are that, even though blood going back to the placenta stops flowing – or pulsing – non-pulsing blood going from the placenta into baby is still flowing. After birth, 25–35% of baby's oxygenated blood remains in the placenta for up to ten minutes. With the cord cut early, baby is less likely to receive this blood, making cold stress, infant jaundice, anaemia, Rh disease and even a delayed maternal placental expulsion more likely. There is also the risk of oxygen deprivation and circulatory shock, as baby gasps for breath before his nasal passages have naturally drained their mucus and amniotic fluid. Scientist W. F. Windle has even argued that, starved of blood and oxygen, brain cells will die, so cutting the cord too early even sets the stage for brain damage.Natural birth advocates say it is vital for the baby's feeding to be put to the breast as soon as possible after birth, while his sucking instincts are strongest. Bathing, measuring and temperature-taking can wait. Babies are most alert during the first hour after birth, so it's important to take advantage of this before they settle into that sleepy stage that can last for hours or even days.Colostrum, the yellow fluid that breasts start producing during pregnancy, is nature's first food. is substance performs many roles we know about and probably many we don't as well. Known as ‘baby's first vaccine', it is full of antibodies and protects against many different viruses and bacteria. It has a laxative effect that clears meconium – baby's black and tarry first stool – out of the system. If this isn't done, baby can be vulnerable to jaundice. Colostrum lines baby's stomach ready for its mother's milk, which comes two or three days later, and it meets baby's nutritional needs with a naturally occurring balance of fat, protein and carbohydrate. Again, with the various medical interventions that go on in hospitals, from operations to drug-taking to simply separating mother and baby, this early breast-feeding process can easily be derailed. Once derailed, as I've said, it's often hard to get back on track. I am no scientist and cannot speak with any authority on the science behind it all, but I do know that nature, very often, plans for things that science has yet to discover.Once upon a time, when families lived closer together and people had more children at a younger age, there was an immediate family infrastructure around you. People were experienced with young. If mum was tired, nan or auntie could feed the baby. Many of us are less fortunate in this regard today. With a hospital, you are sent home and, suddenly, you and your partner are on your own with a baby in your life, and very little aftercare. When my first son was born I was 30. I suddenly realized I had only held a baby once before. I was an only child so I had never looked after a younger brother or sister; my cousins, who had had children, lived abroad. Suddenly there was this living thing in my life, and I didn't know what to do. But, having had a home-birth, the midwife, who you already know, can you give you aftercare. She comes and visits, helps with the early breastfeeding process and generally supports and keeps you on the right tracks.It's so important to get the birthing process right. There are all sorts of consequences to our health and happiness to not doing so. And in the West, with the process riddled as it is with intervention, we don't. We need to get birth out of the hospital and into an environment where women experience less pain, lower levels of intervention, greater autonomy and increased satisfaction.A 2011 study by a team from Peking University and the London School of Hygiene found that, of 1.5 million births in China between 1996 and 2008, babies born in hospitals were two to three times less likely to die. China is at a similar stage in its evolutionary cycle to the developed world at the beginning of the 20th century. The move to hospitals there looks inevitable. Something similar is happening in most Developing Nations.In his book A History of Women's Bodies, Edward Shorter quotes a doctor describing a birth in a working-class home in the 1920s:You find a bed that has been slept on by the husband, wife and one or two children; it has frequently been soaked with urine, the sheets are dirty, and the patient's garments are soiled, she has not had a bath. Instead of sterile dressings you have a few old rags or the discharges are allowed to soak into a nightdress which is not changed for days.For comparison, he describes a 1920s hospital birth:The mother lies in a well-aired disinfected room, light and sunlight stream unhindered through a high window and you can make it light as day electrically too. She is well bathed and freshly clothed on linen sheets of blinding whiteness . . . You have a staff of assistants who respond to every signal . . . Only those who have to repair a perineum in a cottars's house in a cottar's bed with the poor light and help at hand can realize the joy.Most homes in the developed world are no longer as he describes, if they ever were, except in slums. It would seem the evolution in the way we give birth as a country develops passes from the home to the hospital. It is time to take it away from the hospital.Why am I spending so much time on birth in a book about economics? The process of giving birth is yet another manifestation of this culture of pervasive state intervention. (Hospitals, of course, are mostly state run.) It's another example of something that feels safer, if provided by the state in a hospital, even if the evidence is to the contrary. And it's another example of the state destroying for so many something that is beautiful and wonderful.What's more, like so many things that are state-run, hospital birth is needlessly expensive. The November 2011 study of 65,000 mothers by the National Perinatal Epidemiology Unit looked at the average costs of birth in the NHS. They were highest for planned obstetric unit births and lowest for planned home-births. Here they are:* £1,631 (c. $2,600) for a planned birth in an obstetric unit * £1,461 (c. $2,340 for a planned birth in an alongside midwifery unit (AMU)* £1,435 (c. $2,300) for a planned birth in a free-standing midwifery unit (FMU)* £1,067 (c. $1,700) for a planned home-birth.Not only is it as safe; not only are people more satisfied by it; not only do the recipients receive more one-to-one – i.e. better – care; home-birth is also 35% cheaper. Intervention is expensive.So I return to this theme of non-intervention, whether in hospitals or economies. It often looks cruel, callous and hard-hearted; it often looks unsafe, but, counter-intuitively perhaps, in the end it is more human and more humane.When you look at the cost of private birth, the argument for home-birth is even more compelling. Private maternity care is expensive. For example, in summer 2012, a first birth at the Portland Hospital in London costs £2,880 (about $4,400) for a normal delivery and £3,790 (about $5,685) for an elective caesarean and for the first 24 hours of care. Additional nights in a standard room cost around £1,000 (about $1,500). You also have to allow for the fees charged by your private consultant obstetrician, which might be £3,000–£4,000 ($4,500– $6,000). So, in total, a private birth at a hospital such as the Portland could cost £7,500–£10,000 ($10–$15,000). There will be some saving if you opt for a ‘midwife-led delivery service' or ‘midwife-led care'. In this instance, you will still have a named obstetrician, but he or she will see you less often, and the birth may be ‘supported by an on-call Consultant Obstetrician'. London midwives charge £2,500–£4,000 (c. $4–6,000) for about six months of care from early pregnancy to a month after birth. The comparative value is astounding, I would say.To have a planned home-birth on the NHS is possible, but can be problematic to arrange, depending on where you are based. Most people, after they have paid taxes, do not now have the funds to buy a private home-birth, so they are forced into the arms of government health care, such is the cycle at work.I was first introduced to the idea of home-birth by my ex-wife, Louisa, something for which I will forever be grateful. She hated hospitals due to an earlier experience in her life and only found out about alternatives thanks to the internet. I, as well as my friends and family, thought Louisa was insane. But she insisted. And she was right to.Our first son was actually two weeks and six days late. Because he was so late, we were obliged to go to the hospital, which we did, after two weeks and five days. We were kept waiting so long in there, we decided to go and persuaded an overworked nurse that we were fine to go and we left. The confused nurse was glad to have one less thing to think about. The next day Samuel was born: a beautiful and wonderful experience that I will never forget, one of the happiest days of my life – exactly as nature intended.Simply talking to people that have experienced both home-birth and hospital birth, or reading about their experiences, the anecdotal evidence is compelling. Home-birth may not be for everyone – I'm not suggesting it is. Birthing centres seem a good way forward. But a hospital birth should only be for emergencies. Childbirth is a natural process that no longer requires hospitalization, except in those 1% of situations where something goes seriously wrong. If it does go wrong and there is an emergency, call an ambulance and be taken to hospital – that is what they are for.Returning to the original premise of Natural and Positive Law, it's pretty clear which category hospital birth falls into. Hospitals do things in the way that they do because of the pressures they are under, not least the threat of legal action should some procedural failure occur. Taking birth back home and away from the state reduces the burden of us on it and of it on us.Life After the State - Why We Don't Need Government (2013) is now back in print - with the audiobook here: Audible UK, Audible US, Apple Books. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.theflyingfrisby.com/subscribe

Krishna spoke about the inverted tree of life where human beings are bound by roots hanging downwards and these roots are nothing but karmas (actions). Krishna immediately gives a solution to come out of this bondage and advises us to use the 'axe of non-attachment' (15.3). Non-attachment is one of the foundational principles of the Bhagavad Gita. On many occasions, Krishna has referred to this aspect. Broadly, we have attachments with people, things, feelings, thoughts and beliefs. In the case of our beliefs, many of them are based on unscientific myths, irrational and unverified facts etc. Using the quality of 'questioning', which was given by Krishna to be a good learner, one can attain non-attachment to them. When we are told about non-attachment, one tends to gravitate towards detachment or even hatred. That's why Krishna categorically told us to drop hatred. One finds it very difficult to shed attachment as it has been nurtured by us for a long time and thus becomes a part of us. The underlying message is to drop the sense of attachment but not destroy things or relationships. In fact, it is doing one's best in any given situation without the sense of attachment. Krishna says, "The true nature of this ashvatta (pipal) tree, its beginning, its end, and its modes of continuity -none of these are understood by ordinary men. Using a strong axe of detachment, one must cut it down and search out the base of the tree, which is the Supreme Lord, from whom streamed forth the activity of the universe a long time ago. Upon taking refuge in HIM, one will not return to this world again" (15.3 and 15.4). Once one is armed with the axe of non-attachment, the search begins for the base of the tree -the Supreme Lord or Paramatma.

This week, Amanda Montell (linguist and bestselling author of Cultish) is back on the pod for the first time since the LuLaRoe deep dive. This time, they're discussing Amanda's new book (out April 9) called The Age of Magical Overthinking, which explores our cognitive biases and the power, disadvantages, and highlights of magical thinking. Broadly defined as the belief that one's internal thoughts can affect unrelated events in the external world, the book (and this episode) examines topics like celebrity worship, manifesting babes, therapy speak, toxic relationships, weaponized nostalgia, conspiracy theories, and other categories where our inner mental gymnasts are doing the most to justify our behavior. Enjoy!SUPPORT OUR SPONSORSOrder Kate's NYT Bestselling book, One in a Millennial here!Right now, BÉIS (base) is offering our listeners 15% off your first purchase by visiting BEISTRAVEL.com/BETHEREINFIVE. Go to BEISTRAVEL.com/BETHEREINFIVE for 15% off your first purchase.Get 20% off your first order when you go to LIQUID-IV.COM and use code BETHEREINFIVE at checkout. That's 20% off your first order when you shop better hydration today using promo code BETHEREINFIVE at LIQUID-IV.COM.Get 10% off your first order sitewide with code BETHEREINFIVE at OSEAMalibu.com. You'll get free samples with every order, and free shipping on orders over $60.Get 25% off your first month for a limited time at ritual.com/BETHEREINFIVE. Start Ritual or add HyaCera to your subscription today. That's ritual.com/BETHEREINFIVE for 25% off.

All four of my children were born at home. I feel extremely fortunate about this - they should too. Four wonderful experiences. I will forever be in debt to Louisa and Jolie.When, twenty-four years ago, my then wife, Louisa, told me she wanted to give birth to our first child at home, I thought she was off her rocker, but I gave her my word that we would at least talk to a midwife, and we did just that. Within about five minutes of meeting Tina Perridge of South London Independent Midwives, a lady of whom I cannot speak highly enough, I was instantly persuaded. Ever since, when I hear that someone is pregnant, I start urging them to have a homebirth with the persistence of a Jehovah's Witness or someone pedalling an upgrade to your current mobile phone subscription. I even included a chapter about it in my first book Life After the State - Why We Don't Need Government (2013), (now, thanks to the invaluable help of my buddy Chris P, back in print - with the audiobook here [Audible UK, Audible US, Apple Books]).I'm publishing that chapter here, something I was previously not able to do (rights issues), because I want as many people as possible to read it. Many people do not even know home-birth is an option. I'm fully aware that, when it comes to giving birth, one of the last people a prospective mum wants to hear advice from is comedian and financial writer, Dominic Frisby. I'm also aware that this is an extremely sensitive subject and that I am treading on eggshells galore. But the word needs to be spread. All I would say is that if you or someone you know is pregnant, have a conversation with an independent midwife, before committing to having your baby in a hospital. It's so important. Please just talk to an independent midwife first. With that said, here is that chapter. Enjoy it, and if you know anyone who is pregnant, please send this to them.We have to use fiat money, we have to pay taxes, most of us are beholden in some way to the education system. These are all things much bigger than us, over which we have little control. The birth of your child, however, is one of the most important experiences of your (and their) life, one where the state so often makes a mess of things, but one where it really is possible to have some control.The State: Looking After Your First BreathThe knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process.Suzanne Arms, authorThere is no single experience that puts you more in touch with the meaning of life than birth. A birth should be a happy, healthy, wonderful experience for everyone involved. Too often it isn't.Broadly speaking, there are three places a mother can give birth: at home, in hospital or – half-way house – at a birthing centre. Over the course of the 20th century we have moved birth from the home to the hospital. In the UK in the 1920s something like 80% of births took place at home. In the 1960s it was one in three. By 1991 it was 1%. In Japan the home-birth rate was 95% in 1950 falling to 1.2% in 1975. In the US home-birth went from 50% in 1938 to 1% in 1955. In the UK now 2.7% of births take place at home. In Scotland, 1.2% of births take place at home, and in Northern Ireland this drops to fewer than 0.4%. Home-birth is now the anomaly. But for several thousand years, it was the norm.The two key words here are ‘happy' and ‘healthy'. The two tend to come hand in hand. But let's look, first, at ‘healthy'. Let me stress, I am looking at planned homebirth; not a homebirth where mum didn't get to the hospital in time.My initial assumption when I looked at this subject was that hospital would be more healthy. A hospital is full of trained personnel, medicine and medical equipment. My first instinct against home-birth, it turned out, echoed the numerous arguments against it, which come from many parts of the medical establishment. They more or less run along the lines of this statement from the American College of Obstetrics and Gynaecology: ‘Unless a woman is in a hospital, an accredited free-standing birthing centre or a birthing centre within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.'Actually, the risk of death for babies born at home is almost half that of babies born at hospital (0.35 per 1,000 compared to 0.64), according to a 2009 study by the Canadian Medical Association Journal. The National Institute for Health and Clinical Excellence reports that mortality rates are the same in booked home-birth as in hospitals. In November 2011 a study of 65,000 mothers by the National Perinatal Epidemiology Unit (NPEU) was published in the British Medical Journal. The overall rate of negative birth outcomes (death or serious complications) was 4.3 per 1,000 births, with no difference in outcome between non-obstetric and obstetric (hospital) settings. The study did find that the rate of complications rose for first-time mums, 5.3 per 1,000 (0.53%) for hospitals and 9.5 per 1,000 (0.95%) for home-birth. I suspect the number of complications falls with later births because, with experience, the process becomes easier – and because mothers who had problems are less likely to have more children than those who didn't. The Daily Mail managed to twist this into: ‘First-time mothers who opt for home birth face triple the risk of death or brain damage in child.' Don't you just love newspapers? Whether at home or in the hospital there were 250 negative events seen in the study: early neonatal deaths accounted for 13%; brain damage 46%; meconium aspiration syndrome 20%; traumatic nerve damage 4% and fractured bones 4%. Not all of these were treatable.There are so many variables in birth that raw comparative statistics are not always enough. And, without wishing to get into an ethical argument, there are other factors apart from safety. There are things – comfort, happiness, for example – for which people are prepared to sacrifice a little safety. The overriding statistic to take away from that part of the study is that less than 1% of births in the UK, whether at hospital or at home, lead to serious complications.But when you look at rates of satisfaction with their birth experience, the numbers are staggering. According to a 1999 study by Midwifery Today researching women who have experienced both home and hospital birth, over 99% said that they would prefer to have a home-birth in the future!What, then, is so unsatisfying about the hospital birth experience? I'm going to walk through the birthing process now, comparing what goes on at home to hospital. Of course, no two births are the same, no two homes are the same, no two hospitals are the same, but, broadly speaking, it seems women prefer the home-birth experience because: they have more autonomy at home, they suffer less intervention at home and, yes, it appears they actually suffer less pain at home. When mum goes into labour, the journey to the hospital, sometimes rushed, the alien setting when she gets there, the array of doctors and nurses who she may never have met before, but are about to get intimate, can all upset her rhythm and the production of her labour hormones. These aren't always problems, but they have the potential to be; they add to stress and detract from comfort.At home, mum is in a familiar environment, she can get comfortable and settled, go where she likes and do what she likes. Often getting on with something else can take her mind off the pain of the contractions, while in hospital there is little else to focus on. At home, she can choose where she wants to give birth – and she can change her mind, if she likes. She is in her own domain, without someone she doesn't know telling her what she can and can't do. She can change the light, the heating, the music; she can decide exactly who she wants at the birth and who ‘catches' her baby. She can choose what she wants to eat. She will have interviewed and chosen her midwife many months before, and built up a relationship over that time. But in hospitals she is attended by whoever is on duty, she has to eat hospital food, there might be interruptions, doctors' pagers, alarms, screams from next door, whirrs of machinery, tube lighting, overworked, resentful staff to deal with, internal hospital politics, people coming in, waking her up, and checking her vitals, sticking in pins or needles, putting on monitor belts, checking her cervix mid-contraction – any number of things over which mum has no control. Mums who move about freely during labour complain less of back pain. Many authorities feel that the motion of walking and changing positions can even enhance the effectiveness of the contractions, but such active birth is not as possible in the confines of many hospitals. Many use intravenous fluids and electronic foetal monitors to ensure she stays hydrated and to record each contraction and beat of the baby's heart. This all dampens mum's ability to move about and adds to any feelings of claustrophobia.In hospital the tendency is to give birth on your back, though this is often not the best position – the coccyx cannot bend to help the baby's head pass through. There are many other positions – on your hands and knees for example – where you don't have to work against gravity and where the baby's head is not impeded. On your back, pushing is less effective and metal forceps are sometimes used to pull the baby out of the vagina, but forceps are less commonly used when mum assumes a position of comfort during the bearing-down stage.This brings us to the next issue: intervention. The NPEU study of 2011 found that 58% of women in hospital had a natural birth without any intervention, compared to 88% of women at home and 80% of women at a midwife-led unit. Of course, there are frequent occasions when medical technology saves lives, but the likelihood of medical intervention increases in hospitals. I suggest it can actually cause as many problems as it alleviates because it is interruptive. Even routine technology can interrupt the normal birth process. Once derailed from the birthing tracks, it is hard to get back on. Once intervention starts, it's hard to stop. The medical industry is built on providing cures, but if you are a mother giving birth, you are not sick, there is nothing wrong with you, what you are going through is natural and normal. As author Sheila Stubbs writes, ‘the midwife considers the miracle of childbirth as normal, and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble; if he leaves it alone, it's a miracle.'Here are just some of the other interventions that occur. If a mum arrives at hospital and the production of her labour hormones has been interrupted, as can happen as a result of the journey, she will sometimes be given syntocinon, a synthetic version of the hormone oxytocin, which occurs naturally and causes the muscle of the uterus to contract during labour so baby can be pushed out. The dose of syntocinon is increased until contractions are deemed normal. It's sometimes given after birth as well to stimulate the contractions that help push out the placenta and prevent bleeding. But there are allegations that syntocinon increases the risk of baby going into distress, and of mum finding labour too painful and needing an epidural. This is one of the reasons why women also find home-birth less painful.Obstetricians sometimes rupture the bag of waters surrounding the baby in order to speed up the birthing process. This places a time limit on the labour, as the likelihood of a uterine infection increases after the water is broken. Indeed in a hospital – no matter how clean – you are exposed to more pathogens than at home. The rate of post-partum infection to women who give birth in hospital is a terrifying 25%, compared to just 4% in home-birth mothers. Once the protective cushion of water surrounding the baby's head is removed (that is to say, once the waters are broken) there are more possibilities for intervention. A scalp electrode, a tiny probe, might be attached to baby's scalp, to continue monitoring its heart rate and to gather information about its blood.There are these and a whole host of other ‘just in case' interventions in hospital that you just don't meet at home. As childbirth author Margaret Jowitt, says – and here we are back to our theme of Natural Law – ‘Natural childbirth has evolved to suit the species, and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences.'At home, if necessary, in the 1% of cases where serious complications do ensue, you can still be taken to hospital – assuming you live in reasonable distance of one.‘My mother groaned, my father wept,' wrote William Blake, ‘into the dangerous world I leapt.' We come now to the afterbirth. Many new mothers say they physically ache for their babies when they are separated. Nature, it seems, gives new mothers a strong attachment desire, a physical yearning that, if allowed to be satisfied, starts a process with results beneficial to both mother and baby. There are all sorts of natural forces at work, many of which we don't even know about. ‘Incomplete bonding,' on the other hand, in the words of Judith Goldsmith, author of Childbirth Wisdom from the World's Oldest Societies, ‘can lead to confusion, depression, incompetence, and even rejection of the child by the mother.' Yet in hospitals, even today with all we know, the baby is often taken away from the mother for weighing and other tests – or to keep it warm, though there is no warmer place for it that in its mother's arms (nature has planned for skin-to-skin contact).Separation of mother from baby is more likely if some kind of medical intervention or operation has occurred, or if mum is recovering from drugs taken during labour. (Women who have taken drugs in labour also report decreased maternal feelings towards their babies and increased post-natal depression). At home, after birth, baby is not taken from its mother's side unless there is an emergency.As child development author, Joseph Chilton Pearce, writes, ‘Bonding is a psychological-biological state, a vital physical link that coordinates and unifies the entire biological system . . . We are never conscious of being bonded; we are conscious only of our acute disease when we are not bonded.' The breaking of the bond results in higher rates of postpartum depression and child rejection. Nature gives new parents and babies the desire to bond, because bonding is beneficial to our species. Not only does it encourage breastfeeding and speed the recovery of the mother, but the emotional bonding in the magical moments after birth between mother and child, between the entire family, cements the unity of the family. The hospital institution has no such agenda. The cutting of the umbilical cord is another area of contention. Hospitals, say home-birth advocates, cut it too soon. In Birth Without Violence, the classic 1975 text advocating gentle birthing techniques, Frederick Leboyer – also an advocate of bonding and immediate skin-to-skin contact between mother and baby after birth – writes:[Nature] has arranged it so that during the dangerous passage of birth, the child is receiving oxygen from two sources rather than one: from the lungs and from the umbilicus. Two systems functioning simultaneously, one relieving the other: the old one, the umbilicus, continues to supply oxygen to the baby until the new one, the lungs, has fully taken its place. However, once the infant has been born and delivered from the mother, it remains bound to her by this umbilicus, which continues to beat for several long minutes: four, five, sometimes more. Oxygenated by the umbilicus, sheltered from anoxia, the baby can settle into breathing without danger and without shock. In addition, the blood has plenty of time to abandon its old route (which leads to the placenta) and progressively to fill the pulmonary circulatory system. During this time, in parallel fashion, an orifice closes in the heart, which seals off the old route forever. In short, for an average of four or five minutes, the newborn infant straddles two worlds. Drawing oxygen from two sources, it switches gradually from the one to the other, without a brutal transition. One scarcely hears a cry. What is required for this miracle to take place? Only a little patience.Patience is not something you associate with hospital birth. There are simply not the resources, even if, as the sixth US president John Quincy Adams said, ‘patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish'. The arguments to delay the early cutting of the cord (something not as frequent in hospitals as it once was) are that, even though blood going back to the placenta stops flowing – or pulsing – non-pulsing blood going from the placenta into baby is still flowing. After birth, 25–35% of baby's oxygenated blood remains in the placenta for up to ten minutes. With the cord cut early, baby is less likely to receive this blood, making cold stress, infant jaundice, anaemia, Rh disease and even a delayed maternal placental expulsion more likely. There is also the risk of oxygen deprivation and circulatory shock, as baby gasps for breath before his nasal passages have naturally drained their mucus and amniotic fluid. Scientist W. F. Windle has even argued that, starved of blood and oxygen, brain cells will die, so cutting the cord too early even sets the stage for brain damage.Natural birth advocates say it is vital for the baby's feeding to be put to the breast as soon as possible after birth, while his sucking instincts are strongest. Bathing, measuring and temperature-taking can wait. Babies are most alert during the first hour after birth, so it's important to take advantage of this before they settle into that sleepy stage that can last for hours or even days.Colostrum, the yellow fluid that breasts start producing during pregnancy, is nature's first food. is substance performs many roles we know about and probably many we don't as well. Known as ‘baby's first vaccine', it is full of antibodies and protects against many different viruses and bacteria. It has a laxative effect that clears meconium – baby's black and tarry first stool – out of the system. If this isn't done, baby can be vulnerable to jaundice. Colostrum lines baby's stomach ready for its mother's milk, which comes two or three days later, and it meets baby's nutritional needs with a naturally occurring balance of fat, protein and carbohydrate. Again, with the various medical interventions that go on in hospitals, from operations to drug-taking to simply separating mother and baby, this early breast-feeding process can easily be derailed. Once derailed, as I've said, it's often hard to get back on track. I am no scientist and cannot speak with any authority on the science behind it all, but I do know that nature, very often, plans for things that science has yet to discover.Once upon a time, when families lived closer together and people had more children at a younger age, there was an immediate family infrastructure around you. People were experienced with young. If mum was tired, nan or auntie could feed the baby. Many of us are less fortunate in this regard today. With a hospital, you are sent home and, suddenly, you and your partner are on your own with a baby in your life, and very little aftercare. When my first son was born I was 30. I suddenly realized I had only held a baby once before. I was an only child so I had never looked after a younger brother or sister; my cousins, who had had children, lived abroad. Suddenly there was this living thing in my life, and I didn't know what to do. But, having had a home-birth, the midwife, who you already know, can you give you aftercare. She comes and visits, helps with the early breastfeeding process and generally supports and keeps you on the right tracks.It's so important to get the birthing process right. There are all sorts of consequences to our health and happiness to not doing so. And in the West, with the process riddled as it is with intervention, we don't. We need to get birth out of the hospital and into an environment where women experience less pain, lower levels of intervention, greater autonomy and increased satisfaction.A 2011 study by a team from Peking University and the London School of Hygiene found that, of 1.5 million births in China between 1996 and 2008, babies born in hospitals were two to three times less likely to die. China is at a similar stage in its evolutionary cycle to the developed world at the beginning of the 20th century. The move to hospitals there looks inevitable. Something similar is happening in most Developing Nations.In his book A History of Women's Bodies, Edward Shorter quotes a doctor describing a birth in a working-class home in the 1920s:You find a bed that has been slept on by the husband, wife and one or two children; it has frequently been soaked with urine, the sheets are dirty, and the patient's garments are soiled, she has not had a bath. Instead of sterile dressings you have a few old rags or the discharges are allowed to soak into a nightdress which is not changed for days.For comparison, he describes a 1920s hospital birth:The mother lies in a well-aired disinfected room, light and sunlight stream unhindered through a high window and you can make it light as day electrically too. She is well bathed and freshly clothed on linen sheets of blinding whiteness . . . You have a staff of assistants who respond to every signal . . . Only those who have to repair a perineum in a cottars's house in a cottar's bed with the poor light and help at hand can realize the joy.Most homes in the developed world are no longer as he describes, if they ever were, except in slums. It would seem the evolution in the way we give birth as a country develops passes from the home to the hospital. It is time to take it away from the hospital.Why am I spending so much time on birth in a book about economics? The process of giving birth is yet another manifestation of this culture of pervasive state intervention. (Hospitals, of course, are mostly state run.) It's another example of something that feels safer, if provided by the state in a hospital, even if the evidence is to the contrary. And it's another example of the state destroying for so many something that is beautiful and wonderful.What's more, like so many things that are state-run, hospital birth is needlessly expensive. The November 2011 study of 65,000 mothers by the National Perinatal Epidemiology Unit looked at the average costs of birth in the NHS. They were highest for planned obstetric unit births and lowest for planned home-births. Here they are:* £1,631 (c. $2,600) for a planned birth in an obstetric unit * £1,461 (c. $2,340 for a planned birth in an alongside midwifery unit (AMU)* £1,435 (c. $2,300) for a planned birth in a free-standing midwifery unit (FMU)* £1,067 (c. $1,700) for a planned home-birth.Not only is it as safe; not only are people more satisfied by it; not only do the recipients receive more one-to-one – i.e. better – care; home-birth is also 35% cheaper. Intervention is expensive.So I return to this theme of non-intervention, whether in hospitals or economies. It often looks cruel, callous and hard-hearted; it often looks unsafe, but, counter-intuitively perhaps, in the end it is more human and more humane.When you look at the cost of private birth, the argument for home-birth is even more compelling. Private maternity care is expensive. For example, in summer 2012, a first birth at the Portland Hospital in London costs £2,880 (about $4,400) for a normal delivery and £3,790 (about $5,685) for an elective caesarean and for the first 24 hours of care. Additional nights in a standard room cost around £1,000 (about $1,500). You also have to allow for the fees charged by your private consultant obstetrician, which might be £3,000–£4,000 ($4,500– $6,000). So, in total, a private birth at a hospital such as the Portland could cost £7,500–£10,000 ($10–$15,000). There will be some saving if you opt for a ‘midwife-led delivery service' or ‘midwife-led care'. In this instance, you will still have a named obstetrician, but he or she will see you less often, and the birth may be ‘supported by an on-call Consultant Obstetrician'. London midwives charge £2,500–£4,000 (c. $4–6,000) for about six months of care from early pregnancy to a month after birth. The comparative value is astounding, I would say.To have a planned home-birth on the NHS is possible, but can be problematic to arrange, depending on where you are based. Most people, after they have paid taxes, do not now have the funds to buy a private home-birth, so they are forced into the arms of government health care, such is the cycle at work.I was first introduced to the idea of home-birth by my ex-wife, Louisa, something for which I will forever be grateful. She hated hospitals due to an earlier experience in her life and only found out about alternatives thanks to the internet. I, as well as my friends and family, thought Louisa was insane. But she insisted. And she was right to.Our first son was actually two weeks and six days late. Because he was so late, we were obliged to go to the hospital, which we did, after two weeks and five days. We were kept waiting so long in there, we decided to go and persuaded an overworked nurse that we were fine to go and we left. The confused nurse was glad to have one less thing to think about. The next day Samuel was born: a beautiful and wonderful experience that I will never forget, one of the happiest days of my life – exactly as nature intended.Simply talking to people that have experienced both home-birth and hospital birth, or reading about their experiences, the anecdotal evidence is compelling. Home-birth may not be for everyone – I'm not suggesting it is. Birthing centres seem a good way forward. But a hospital birth should only be for emergencies. Childbirth is a natural process that no longer requires hospitalization, except in those 1% of situations where something goes seriously wrong. If it does go wrong and there is an emergency, call an ambulance and be taken to hospital – that is what they are for.Returning to the original premise of Natural and Positive Law, it's pretty clear which category hospital birth falls into. Hospitals do things in the way that they do because of the pressures they are under, not least the threat of legal action should some procedural failure occur. Taking birth back home and away from the state reduces the burden of us on it and of it on us.Life After the State - Why We Don't Need Government (2013) is now back in print - with the audiobook here: Audible UK, Audible US, Apple Books. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.theflyingfrisby.com/subscribe

The Herle Burly was created by Air Quotes Media with support from our presenting sponsor TELUS, as well as CN Rail.Greetings, you curiouser and curiouser Herle Burly-ites! We've got a Finance Minister in the house. The Honourable Peter Bethlenfalvy, Minister of Finance for Ontario, is our guest today.He earned his Masters of Business Administration from McGill University, and Masters of Political Science from U of T. Prior to politics, he had a long and successful career in business and finance, holding senior roles at CST Consultants, Manulife Financial and TD Securities.Minister Bethlenfalvy was first elected to the legislature in 2018. In Premier Ford's first cabinet, he was appointed President of the Treasury Board, and succeeded Rod Phillips in the finance portfolio on the last day of 2020.And, you may have heard, he's been in the news lately, releasing the province's 2024 budget just 8 days ago, “Building a better Ontario”. That's what we're talking about today. Broadly, how does Minister Bethlenfalvy and the Ford government plan to deliver on that promise? We'll talk investments in housing and infrastructure. Economic growth. Clean energy and public services. And more.Thank you for joining us on #TheHerleBurly podcast. Please take a moment to give us a rating and review on iTunes, Spotify, Stitcher, Google Podcasts or your favourite podcast app.Watch episodes of The Herle Burly via Air Quotes Media on YouTube.

Speaker: Mislav Matejka, CFA, Head of Global Equity Strategy In terms of leadership, US and Japan are ahead of other markets ytd, Growth is outperforming Value and large caps are again beating small, in all key regions. We continue to believe that this style of leadership will broadly stay the case for a while longer, until there is a break, or a reset, in the cycle. For Value, commodities, low Quality, small caps, EM or International stocks to begin leading more sustainably one needs to see a reflationary backdrop, in our view, but we could have the opposite. Within this, we have recently taken profits on US vs Eurozone OW, as the Eurozone risk-reward has improved, in our view. Among other, Eurozone valuations appear very attractive, relative growth momentum could be bottoming out and ECB could start moving ahead of the Fed, which would be very atypical. We also have a tactical buy on China given extreme cheapness and UW positioning by most investors. Broadly, JPM Fixed Income's call is that bond yields are fundamentally set to move lower in 2H, but we note a pickup in inflation swaps, as well as the outright negative term premia for bonds again, which suggests that there is a lot of complacency in the bond market with respect to the inflation risk. Consequently, the gap that has opened up ytd between Fed futures and the equity market is getting wider. Equities rallied almost 30% from last October lows, driven in Nov-Dec by the expectation of a Fed pivot, but these projections have fully reversed back to October low levels. Equities are ignoring the most recent pivot of a pivot, which might be a mistake. The assumption that the market is likely making here is one of growth acceleration coming to the rescue in 2H. In this regard, we note that earnings projections for 2024 are still not moving up. Regionally, Japan is staying our top pick, continuing our 2023 preference. This podcast was recorded on 31 March 2024. This communication is provided for information purposes only. Institutional clients can view the related report at https://www.jpmm.com/research/content/GPS-4662999-0 for more information; please visit www.jpmm.com/research/disclosures for important disclosures. © 2024 JPMorgan Chase & Co. All rights reserved. This material or any portion hereof may not be reprinted, sold or redistributed without the written consent of J.P. Morgan. It is strictly prohibited to use or share without prior written consent from J.P. Morgan any research material received from J.P. Morgan or an authorized third-party (“J.P. Morgan Data”) in any third-party artificial intelligence (“AI”) systems or models when such J.P. Morgan Data is accessible by a third-party. It is permissible to use J.P. Morgan Data for internal business purposes only in an AI system or model that protects the confidentiality of J.P. Morgan Data so as to prevent any and all access to or use of such J.P. Morgan Data by any third-party.

Broadly speaking, the traditionally conceptualized mid-twentieth-century Civil Rights Movement and the newer #BlackLivesMatter Movement possess some similar qualities. They both represent dynamic, complex moments of possibility and progress. They also share mass-based movement activities, policy/legislative advocacy, grassroots organizing, and targeted media campaigns. Innovation, growth, and dissension—core aspects of movement work—mark them both. Crucially, these moments also engender aggressive, repressive, multilevel responses to these assertions of Black humanity. From Rights to Lives: The Evolution of the Black Freedom Struggle (Vanderbilt UP, 2024) critically engages the dynamic relationship between these two moments of liberatory possibility on the Black Freedom Struggle timeline. The book's contributors explore what we can learn when we place these moments of struggle in dialogue with each other. They grapple with how our understanding of the postwar moment shapes our analysis of #BLM and wherein lie the discontinuities, in order to glean lessons for future moments of insurgency. Learn more about your ad choices. Visit megaphone.fm/adchoices

Broadly speaking, the traditionally conceptualized mid-twentieth-century Civil Rights Movement and the newer #BlackLivesMatter Movement possess some similar qualities. They both represent dynamic, complex moments of possibility and progress. They also share mass-based movement activities, policy/legislative advocacy, grassroots organizing, and targeted media campaigns. Innovation, growth, and dissension—core aspects of movement work—mark them both. Crucially, these moments also engender aggressive, repressive, multilevel responses to these assertions of Black humanity. From Rights to Lives: The Evolution of the Black Freedom Struggle (Vanderbilt UP, 2024) critically engages the dynamic relationship between these two moments of liberatory possibility on the Black Freedom Struggle timeline. The book's contributors explore what we can learn when we place these moments of struggle in dialogue with each other. They grapple with how our understanding of the postwar moment shapes our analysis of #BLM and wherein lie the discontinuities, in order to glean lessons for future moments of insurgency. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/african-american-studies

Broadly speaking, the traditionally conceptualized mid-twentieth-century Civil Rights Movement and the newer #BlackLivesMatter Movement possess some similar qualities. They both represent dynamic, complex moments of possibility and progress. They also share mass-based movement activities, policy/legislative advocacy, grassroots organizing, and targeted media campaigns. Innovation, growth, and dissension—core aspects of movement work—mark them both. Crucially, these moments also engender aggressive, repressive, multilevel responses to these assertions of Black humanity. From Rights to Lives: The Evolution of the Black Freedom Struggle (Vanderbilt UP, 2024) critically engages the dynamic relationship between these two moments of liberatory possibility on the Black Freedom Struggle timeline. The book's contributors explore what we can learn when we place these moments of struggle in dialogue with each other. They grapple with how our understanding of the postwar moment shapes our analysis of #BLM and wherein lie the discontinuities, in order to glean lessons for future moments of insurgency. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Broadly speaking, the traditionally conceptualized mid-twentieth-century Civil Rights Movement and the newer #BlackLivesMatter Movement possess some similar qualities. They both represent dynamic, complex moments of possibility and progress. They also share mass-based movement activities, policy/legislative advocacy, grassroots organizing, and targeted media campaigns. Innovation, growth, and dissension—core aspects of movement work—mark them both. Crucially, these moments also engender aggressive, repressive, multilevel responses to these assertions of Black humanity. From Rights to Lives: The Evolution of the Black Freedom Struggle (Vanderbilt UP, 2024) critically engages the dynamic relationship between these two moments of liberatory possibility on the Black Freedom Struggle timeline. The book's contributors explore what we can learn when we place these moments of struggle in dialogue with each other. They grapple with how our understanding of the postwar moment shapes our analysis of #BLM and wherein lie the discontinuities, in order to glean lessons for future moments of insurgency. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/american-studies

Broadly speaking, the traditionally conceptualized mid-twentieth-century Civil Rights Movement and the newer #BlackLivesMatter Movement possess some similar qualities. They both represent dynamic, complex moments of possibility and progress. They also share mass-based movement activities, policy/legislative advocacy, grassroots organizing, and targeted media campaigns. Innovation, growth, and dissension—core aspects of movement work—mark them both. Crucially, these moments also engender aggressive, repressive, multilevel responses to these assertions of Black humanity. From Rights to Lives: The Evolution of the Black Freedom Struggle (Vanderbilt UP, 2024) critically engages the dynamic relationship between these two moments of liberatory possibility on the Black Freedom Struggle timeline. The book's contributors explore what we can learn when we place these moments of struggle in dialogue with each other. They grapple with how our understanding of the postwar moment shapes our analysis of #BLM and wherein lie the discontinuities, in order to glean lessons for future moments of insurgency. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/politics-and-polemics

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/public-policy

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/technology

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/law

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/science-technology-and-society

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/book-of-the-day

Our privacy is besieged by tech companies. Companies can do this because our laws are built on outdated ideas that trap lawmakers, regulators, and courts into wrong assumptions about privacy, resulting in ineffective legal remedies to one of the most pressing concerns of our generation. Drawing on behavioral science, sociology, and economics, Ignacio Cofone challenges existing laws and reform proposals and dispels enduring misconceptions about data-driven interactions. This exploration offers readers a holistic view of why current laws and regulations fail to protect us against corporate digital harms, particularly those created by AI. Cofone then proposes a better response: meaningful accountability for the consequences of corporate data practices, which ultimately entails creating a new type of liability that recognizes the value of privacy. Jake Chanenson is a computer science Ph.D. student and law student at the University of Chicago. Broadly, Jake is interested in topics relating to HCI, privacy, and tech policy. Jake's work has been published in top venues such as ACM's CHI Conference on Human Factors in Computing Systems.

Listen to ASCO's Journal of Clinical Oncology essay, “Knuckleheads” by Dr. Timothy Gilligan, Vice Chair for Education at the Cleveland Clinic Taussig Cancer Institute. The essay is followed by an interview with Gilligan and host Dr. Lidia Schapira. Gilligan emphasizes the importance of partnering with his patients to understand what they are going through and their reason for rejecting recommended treatment.   TRANSCRIPT Narrator: Knuckleheads by Tmothy D. Gilligan, MD, FASCO (10.1200/JCO.24.00160) I was in tumor board when I first heard about him. One of my former colleagues referred to patients like this as knuckleheads, patients who were interfering with our plan to treat their cancer. He needed chemotherapy. He kept refusing. He was going to be referred to me so that I could talk some sense into him. Preparing to go into the examination room, I realized I was getting ready to use my medical knowledge to try to make him consent to chemotherapy. After all, that is what he needed. If only he would listen to me. I paused and remembered what my mentors had taught me about forming effective relationships with patients and about the communication skills that could engender trust and a feeling of connection. I remembered one of them saying to me “Every time I open my mouth, I risk making things worse.” So I committed to listening and curiosity and humility and entered the room. He had a curable cancer. There was so much at stake. “What have the other doctors been telling you about what's going on?” I asked. He said he had been told that his cancer had come back and that he needed chemotherapy now. That additional surgery wasn't an option. “I heard that you had some concerns about chemotherapy,” I said. “Yes, I want to delay it until the fall,” he said. “Tell me about that,” I responded. So I got to hear his story. He was a single father with several school-aged children. His wife had recently left him for another man and said a lot of hurtful things on the way out the door. She no longer wanted to be a mother and only saw the kids 1 or 2 days a month. His oldest child was in crisis and struggling in school. The patient was a construction worker who could only work during the warmer months and would be unemployed all winter. As a seasonal worker, he was not eligible for unemployment benefits. He was the sole breadwinner for his family. It was now summer. If he stopped working for 3 months to receive chemotherapy, he would not be able to support his family and had no way to make it up during the winter. Not really the story of a knucklehead, of another man refusing to take care of himself. It all seemed so unfair to me that I wanted to cry, to have all this land on him at once—cancer, abandonment, a child in crisis, financial instability. He was overwhelmed. I let him know that I saw that, that I was moved by it. We talked about his cancer and what we would expect to happen if it was treated and what would happen if it was not. He wondered if maybe we could wait 2 weeks and get another scan to see how quickly things were progressing. Medically this seemed safe, and I agreed to his plan. And with the help of the social worker on our team, we started marshalling resources that day to make it more feasible to get him through treatment, which he agreed to begin a few weeks later. He completed the course of chemotherapy, and he has most likely been cured. He reminded me of another patient I had, an African American woman who had been referred to me by one of my only African American colleagues in my work setting. She had bladder cancer. When reviewing her chart, I noticed that she had been diagnosed 2 years earlier at a different hospital and refused treatment. The chart said that she needed to take care of her children and declined curative surgery for that reason. It seemed like an odd logic to me. Another knucklehead refusing to comply with our plan? When I went into the room, she clearly did not trust me. I saw skepticism in every aspect of her behavior and wondered whether it was my whiteness that triggered it. I remembered my mentor's words about the risk of opening my mouth when I was not yet sure to whom I was speaking. So I listened, paying attention and waiting for an opening. Eventually she said, “You know, I was actually diagnosed 2 years ago.” “Yes, I saw that in your chart. I was wondering what happened.” “Well, I was all set for surgery. And when they were evaluating me for it, this anesthesiologist came into the room. And she stood there looking at me like I was a piece of dirt. And she wouldn't answer my questions. And I said to myself, I'm not letting her take care of me.” “Was that racism?” I asked her. “Yes, it was,” she said. “It sounds like racism,” I said. “I know it when I see it,” she said. After that, there was a striking shift away from the skepticism I had felt from her earlier in the visit. We talked through her treatment options. We set her up to see a radiation oncologist and a urologist who did radical cystectomies. When I called her at home after those visits to see how they went, I heard that the radiation oncologist had won her trust. The urologist had not. “It felt like he couldn't wait to wheel me off to the operating room,” she told me. So she choose bladder preservation with chemotherapy and radiation. It turned out that she was a foster mother and was deeply devoted to her foster children. She wanted to be there for them. They were not a reason to decline life-saving medical care. And we talked about them at every visit as she made her way through treatment. She, too, seems to have been cured, despite the delay. What surprised me about these two patients is that no one seems to have heard their stories during their initial encounters with the health care system. The only story that was heard was the story of the tumor, the focus of our tumor boards. And yet it only became possible to treat them when we learned their human story. I wonder whether tumor board is the best name for the conferences that bear that moniker. Does the name predispose us to focus on the disease rather than the person? And while I did get to hear the stories of these two patients, it made me wonder how often I have failed to do so with others on days when I was not being so careful. What was it that led them to choose treatment? Human decision making is complex and influenced by many factors. I tried to see these two patients and to hear them and to make a connection. I cannot know for sure what made the difference. This is what I do know: I am not entitled to my patients' trust. It is something I have to earn each time I walk into the room. One way to earn it is to listen and to be responsive to what I hear. I try to remember where the locus of control lies. It is their life, it is their illness, and it is their decision. I can advise them and help them understand their options. Together, we can explore what is most important to them. But I do not get to tell them what to do. If they decline to follow sound medical advice, maybe there is something important that I do not know. If I stop talking, maybe they will tell me.   Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we are joined by Dr. Timothy Gilligan, who is Vice Chair for Education at the Cleveland Clinic Taussig Cancer Institute. In this episode, we'll be discussing his Art of Oncology article, "Knuckleheads."  At the time of this recording, our guest has no disclosures.  Tim, welcome to our podcast, and thank you for joining us.   Dr. Timothy Gilligan: Thank you so much for having me. I'm really happy to be here.   Dr. Lidia Schapira: It's my pleasure. Let's start by talking a little bit about the purpose of writing and publishing this article that, to me as a reader, has a direct message for our colleagues in oncology. Tell us a little bit about the motivation and the intention.   Dr. Timothy Gilligan: So I think there are two pieces to it. One actually was feedback that I heard from medical students, and we would talk to them about their experiences in the hospital with regard to bias and related issues. One of my hats that I wear is I'm a DEI officer for graduate medical education, so I'm involved in that work. We heard two major complaints from students, and one of them was that they heard doctors, whether they were attendings or residents or interns, speaking about patients disrespectfully. And the big kind of ‘aha moment' for me was realizing that we kind of get indoctrinated into this world where we sometimes let off steam by speaking about our patients in disrespectful ways. And I remembered when I was a junior attending, a senior attending, handing off a patient to me, saying, "Good luck with her. She's crazy." And I was so used to that language that I didn't pay that much attention to it, but I actually ended up forming a very good relationship with that patient.  But after I heard that feedback from the medical students about how it really upset them that we're taking care of these people, and sometimes outside the room, we use language that isn't really respectful. It's not that it was mean, necessarily, but it was less respectful than you'd like it to be if it was someone like your mom or your loved one, your brother, or whatever. And so I started really listening to that, and I tried to pay attention. Did I do that? And could I stop doing it if I did? So that was one piece of this. But the other thing that really motivated me is that the first story that I tell in this article really was my favorite patient of 2023, because I actually felt like, by taking an extra effort to really get to know the person, I was actually able to really get a better outcome for the patient. And when we got him through treatment and he was cured, it felt like such a win.   Dr. Lidia Schapira: Let's pause for a moment and just talk a little bit about the student's comment, because when I just saw the title of the article, I felt a little stung, like, how can we even be using this word to refer to a patient? Tell us a little bit about that. You are the most attentive, respectful clinician that I know, and you publish an article with a word that a colleague described the patient, and to me, it just doesn't pass the bar.   Dr. Timothy Gilligan: Yeah, well, it's funny, because, actually, the person I heard use this language is one of my favorite doctors and is really an amazing doctor. And so good people can use language like that, and I think we need to stop. But I almost used it affectionately because I learned a lot from this doctor. And as the doctor actually had very, very high clinical standards, and I admired that about them. But I'm an expert in testicular cancer. And sort of the word on the street among doctors who test testicular cancers is that the challenge is you have these men in their 20s who don't take their health care seriously and they won't follow your advice. And so they get referred to as "knuckleheads," which is not a word we should be using. But that's where I came from. I didn't make that up. It's a word I had heard in my practice.   Dr. Lidia Schapira: Let's talk a little bit about why you were called in to see this patient. He refused therapy and you were called in to go and have the conversation that will make him accept therapy because refusal of therapy seems unreasonable. Help us understand a little bit about how somebody should think about a patient who refuses therapy. Broadly, it seems your advice is to go in and get the story, and the story will explain things many times, but tell us a little bit more about that.   Dr. Timothy Gilligan: Yeah. The patient was sent to me because I'm the local expert in testicular cancer. And the thought was that the oncologist could get the patient to go along with the treatment that was recommended. And I realized shortly before I went into the room, I was all geared up to marshal all the evidence and all the facts and to explain to him why he needed treatment no matter what. And I remember when I was in training a surgeon, once I was in the room with them, I was talking to a patient and the patient was talking about how complicated it was to get through the treatment. And the surgeon said to the patient, "Well, you know, right now the only thing that matters is your cancer." And I remember thinking, well, that actually may not be true because people have lives. They have to pay their bills, they have a job, they have a family, they have kids they're worried about. For us, it's easy to say ‘your cancer is the only thing you need to worry about,' but often it's not. And so I think what helped me with the patient was to sort of pause before I went into the room and think, what's the story here? What don't I know yet that I need to know? And how can I find it out?   Dr. Lidia Schapira: And you tell the reader that you relied on advice you'd received from an attending years before, that also warned you that if you say too much, you could be making things worse. If you open your mouth, you could potentially contribute to whatever the tension was that had created this impasse to begin with. So you slowly sort of let the patient tell you the story and you're drawn in. Tell us a little bit about what it feels like to be drawn into this patient's story, somebody who had already been labeled as being perhaps difficult or refusing a life-saving therapy.   Dr. Timothy Gilligan: Well, honestly, I ended up being really surprised. And I think the issue you're talking about that what it reminds me of is when I was early in my career, I found it very confusing that I would have patients who really loved me and was glad I was their doctor, but then there'd be some patients who it felt like they didn't really love me and they wish they had someone else as a doctor. And I tried to figure out, like, I'm doing the same thing. Why am I getting such different reactions? Then, of course, the obvious explanation is I'm seeing all these different people who want different things. And I think going into the room with this sense of, before I say anything, I need to figure out who I'm talking to, because a given approach will work with one person but not with another. And if I can figure out who's who and tailor my approach to the individual, I can have much more success. And so it got me in the habit of trying to really start with listening and listening and watching. When I work with fellows, what I try to get them to do is just really observe carefully. So rather than put their energy into talking, put their energy into watching and listening and figuring out: “Who is this person? What kind of day are they having? What do they need from me? How can I be helpful to them? How can I speak to them in a way that they'll feel like I'm on their side and they can trust me and I respect them?” and all of that. And so the shorthand for me is to go into the room with curiosity and find out, who is this person? And I figured that out not by talking, but by listening to them. That's how I got him to tell me his stories. I just asked him, like, "I hear you don't want chemotherapy. Tell me what's going on." Then I heard this whole story.   Dr. Lidia Schapira: And his story is heartbreaking.   Dr. Timothy Gilligan: It is.   Dr. Lidia Schapira: He's been abandoned by his wife. He's got to support the kids. He's got to work in the summer. And it's not that he doesn't want to live. He just doesn't see a choice here. And you say in the article briefly that you were moved by the story, and tell us a little bit more about what happens to you when you're moved by a story.   Dr. Timothy Gilligan: I became a little bit emotional. I don't think I really cried, but I paused for a moment to kind of catch myself. I think particularly I brought a social worker into the room to help with what was going on and the nurse I work with closely. And I told them the story. I actually thought that ended up being effective. It wasn't really something I had planned, but I wanted to get them up to speed and I didn't want to make him tell the story again. And so I told his story to them and I thought what was effective about that was, first of all, it let him know I really heard it and I got it. And it wasn't the story of the medical facts, it was the whole story. But when I told it, I realized what a sad story it was and how unfair.   Dr. Lidia Schapira: So, Tim, let's talk a little bit about that. In the course of the work that we do, we are deeply moved and touched by the stories of the people that we treat, the people whose diagnoses we are experts in. But their lives are really their own and they share things that are incredibly intimate with us. So tell us a little bit about how you have, over the course of your career and as self-aware as you are, dealt with the emotional load.   Dr. Timothy Gilligan: The other thing I tell fellows is I think it's really important to have hobbies outside of medicine. I think you have to find a way to recharge your batteries. But if you don't care, if you try to protect yourself by not caring, then you're missing out on the meaning of the work.  I have a short anecdote I can share that really had a big impact on me. When I was in my first years of attending, I was treating a man with testicular cancer. And we tried and tried and tried to cure him and kept thinking we were going to be able to, but his tumor ended up being really very resistant to treatment and eventually it was not curable. And he was in the ICU. I think he had an infection, this complication from treatment, but it really was game over at that point. It was appropriate, medically appropriate, to withdraw care. We were just going to torment him to keep him on life support longer. And I went to the meeting with his mother and his sister and this attending who had supervised me, who I admired greatly, one of the people who changed me when I was an intern and I was in the ICU, so he's the ICU attending. I'm there as the oncologist, I'm kind of running the family meeting and I tell them I don't think there's anything more we can do medically, and it's time to withdraw life support. And I started to cry, and I felt really embarrassed because here's this attending who I admired so much, and gosh, Tim Gilligan can't even keep it together in a family meeting. And I felt a little embarrassed. But I really cared about this patient. I'd known him for a year and a half, and the family agreed, and withdrew life support and he passed away. And I ran into his sister about six months later, nine months later in the grocery store while shopping, and we talked for a little bit, and she said that what made them feel okay about withdrawing life support was the fact that I cried.   Dr. Lidia Schapira: It's a beautiful story, and thank you for sharing that. We often talk about the therapy of connecting with a patient, but connecting means connecting at an emotional level. And it's sort of disingenuous to think that we can do that without feeling and personally being affected by that.  When I was training, Tim, before we formally taught communication skills or integrated palliative care and talked about self-care, the advice I got from my attending was that you just go for a run as a way of recuperating. And I remember from a prior interview I did with you that you like to play tennis. Do you go for a run? Do you play tennis? And do you have any other advice for colleagues, especially junior colleagues who are just entering this field and realizing that connection means engagement. And engagement may mean loss and grief because we care.   Dr. Timothy Gilligan: So I do still play tennis. And what I love about tennis is that I can't think about anything else when I'm trying to hit a tennis ball. It's the best I can do. I can't meditate. But tennis is like meditation for me because I'm not obsessed with winning or losing. I do try to play good tennis. I like to hit a good ball, and that requires a lot of attention and a lot of focus, so it gets my head out of it. And then I also just think the stress relief. I mean, I can be aggressive on the tennis court in a way that's not socially acceptable to be aggressive elsewhere. I can hit that ball as hard as I can and not do any harm to anybody. So I think that stress release is really important. I think exercise, the benefits of running. I mean, there are so many benefits, psychologically and emotionally, to exercise and really being in your body. So I think some way of recharging your batteries. And what I worry is that sometimes you get this model of keeping our distance, our professional boundaries, and not get in too deep, not caring too much. And I actually think, as I said before, that the meaning of this work is caring and connecting. And so then if you're going to be drained in some ways, you have to figure out how to fill yourself back up. The risk is that there's a sort of ethic in medicine where you give everything to your job. But you burn out if you do that. So it's the feeling that it's okay to go play tennis, it's okay to go for a run. It's okay to read poetry or meditate or cook or do whatever it is that refills your tank. I think it's so important in this work to prioritize that and make room for it. Let's not take pride in being a workaholic and working all the time. What I have observed is that those people become less effective as physicians, at least in terms of the humanism of it.   Dr. Lidia Schapira: I couldn't agree with you more.  I'm wondering if you can also tell us a little bit about how you think storytelling and narratives in oncology can also help create a thoughtful and more supportive community. And that's a lot of what we do here in publishing some of these stories.   Dr. Timothy Gilligan: Yeah, it's a great question, and an important one. I'm not going to say anything original here, but I believe very strongly, as many people have written, we understand our lives as stories. We understand narratives. We organize ourselves around stories to a large extent. And one of the things I think that is a powerful question to ask myself often in life is, “Am I telling myself a story? Is that the best story? Are there other versions of that story that may be more true, or other stories that are equally true that may enrich my understanding of something?" And so I think storytelling is complicated. Sometimes we tell ourselves false stories. Sometimes we tell ourselves moving stories. But I think one of the things that we see in this work is that life has sadness in it and life has loss in it, and the solution isn't to hide from it or protect ourselves from it, but I think just to see the best part of the human experience and sometimes the deep meaning in it. And one of the beautiful things all of us in oncology see with some patients, not all patients is how, when faced with a life crisis, is the sudden clarity about what really matters. And oftentimes relationships deepen and people appreciate the beauty of their connections with others. Diving in and really hearing these stories, getting to know our patients as people is where the richness of the work is. And that's why people go into oncology. When you read applications from residents who want to be fellows, most of them talk about how moved they were working with cancer patients. And I think hearing their stories is a part of that work. And if we stop doing that, we are missing out on what actually made us go into the work in the first place.   Dr. Lidia Schapira: And that's one of the things that struck me about your narrative in that it's not just a lesson in communication or a plea for listening to patients and treating them humanely, even when they seem to refuse therapy, but that you actually talk about being moved and bringing yourself into this and taking the time to connect with the patients. In addition to the fact that in the two cases that you describe here, by doing that, you actually solve the puzzle. You figured out why it was that they either delayed or seemed to have refused treatment when, in fact, both of these people very much wanted to live and had a lot to live for.   Dr. Timothy Gilligan: Yes, that's right. The second case was a much less typical one for me. What was interesting for me about that was that it was the first time I really brought the issue of race and racism into a conversation with a patient. I struggle with that because I know from the medical literature and I know from talking to people I know, as well as patients I've taken care of, that people do encounter sexism, racism, and other forms of bias in healthcare, and we are often scared to talk about it. The reason I wanted to write about that case was that the patient really handed it to me on a platter. She couldn't have made it easier for me to name it. And it was amazing to me how it transformed the interview after I named it. I went from being treated like there's no trust. I tell you, it felt very antagonistic interview up until that moment. And then suddenly we connected. And that was interesting because when she was walking out the door - I didn't put this in the essay - she looked at me and she said, "Now I know why I was referred to see you."   Dr. Lidia Schapira: What a wonderful, wonderful endorsement. I'm sure that made you feel very good. How do you use your experience and the knowledge that you have accrued over years now of practice to teach your students, residents, fellows, and even your peers to be present, to call out injustice, to form important therapeutic alliances with patients? How do you actually do that every day?   Dr. Timothy Gilligan: I don't think it's easy. I think the easier part of it is to enter the room with curiosity and to be attuned to the fact that there are things that you don't know yet that we need to know, that the patient is an expert in their own experience and the patient is an expert in their own body. And if we go in with that humility, that we have medical expertise and they have expertise in their own self and their own lives, that we can work together as a team and try to break down some of the power differential. I think that helps a lot. I think there are certain questions that can be helpful to ask like, "What has your experience in the healthcare system been?" Because oftentimes, we assume one thing, and the patient's experience has been very different.  I've been influenced recently by work in trauma-informed care. A shorthand sentence for trauma-informed care is that we shouldn't ask, "What's the matter with you?" We should ask, "What happened to you?" And then if a patient is acting in a way that seems odd or difficult to explain, or simply difficult to put up with, we might ask ourselves, "What happened to them that this behavior actually does make sense?” And that if we approach it with sympathy and hear their story, we can work with them more effectively. It doesn't mean we should put up with intolerable behavior, but that oftentimes the behavior or the decision-making starts to make sense if we get more information and find out more and come in with a less judgmental attitude and more curious attitude. It's hard, and I don't have a simple answer, but I do think those tools, curiosity, listening, humility, and recognizing that the patient is a different person with a different experience of the way they are navigating through the world, even if it doesn't make sense to us, does make sense given what their experience has been.   Dr. Lidia Schapira: Tim, I certainly appreciate and am so glad that you continue to think about these problems, that you write about them, and that you make it sound simple for us to connect with our own sense of vocation and to try to bring everything to the bedside, not just a list of new therapies. So thank you for that, and thank you for sending your work to us.   Dr. Timothy Gilligan: Thank you for having me today. It's been a pleasure talking to you.   Dr. Lidia Schapira: And with that, until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts.     The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.     Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio:  Dr. Timothy Gilligan is Vice Chair for Education at the Cleveland Clinic Taussig Cancer Institute.

The looming axis of China, Russia and Iran threatens to destabilise the global order, such as it is. Populations across the world are continually immiserated under tyrannical regimes. The impending race for leadership of the free world orbits a pair of hoary ignorami whose antiquity and indeed place in history may best be described as "antediluvian". The abiding "we don't know" around artificial intelligence accommodates the calamitous continuum of widespread unemployment to total nuclear holocaust. Social media pollutes the mind, body and soul of what approaches an entire species. The cost of living condemns a generation+ to treadmillity. And nuance, conversation, art, tolerance and intellectual maturity are generally plunging into obsolescence. And so it's never been more acutely vital that you care about what Jordan and I think about the 2023 Doctor Who specials. Otherwise, "they" win. We used to agree on who "they" were, whoever they were. That is no longer the case. So just pick your side and whatever antagonises it... that's the "they". And they will win in the face of stark, unclicking indifference. And fear not, the content of the 'cast isn't as dour. It's pretty overcast as I'm writing this and were the Sun to peek out from behind a cloud for a couple of minutes, I'm sure I'd sing the praises of something I like in this world if I could summon the energy to ponder the matter for a good while. On this episode, Jordan and I discuss the fifth season of Fargo, The Holdovers, Poor Things and Doctor Who, and debut a new segment that isn't really too dissimilar from what we usually do. Enjoy!

GUEST: ANDREW DeBARTOLO, Director of Operations, Liberty Coalition CanadaTo borrow a popular term today, the United States is in “transition”. Whereas the nation once “identified” as a broadly Christian nation (the Declaration of Independence refers multiple times to the Christian God), a real transition (in contrast to the imagined transitions and marriages of the transvestite/homosexual movement) has and is taking place to a present-day post-Christian, neo-pagan nation, where Satanic statues are displayed in state capitol buildings and a reworked Marxist-based, anti-Christian religion of woke-ism has captured many minds and all institutions.How and why has this happened in a nation so known for and influenced by Christianity? Is it…Infiltration of nefarious forces (e.g. globalists and Marxists)?Leavening principle of sin over time?Compromising churches exerting less influence?Christians unengaged from culture and politics?Judgment of God “giving over” the nation to unrestrained sinfulness (Rom. 1)?Whatever the reasons—and no doubt there are more—here we are in our present state of depravity and foolishness (i.e. thinking and living as if there is no God).So what should Christians do now? Broadly speaking, there are three general responses:FAITHFULNESS: A primary focus on personal sanctification, family discipleship, and the local church, along with some civil engagement such as voting, running for public office, and supporting organizations that advocate for Christian-based policies. Example: G3 Ministries, John MacArthurACTIVISM: a more muscular posture that aims for spiritual and cultural change, including local church advocacy in politics and issues, on-the-street confrontation of sin, and a willingness to unite across theological divides to accomplish political objectives. Example: Turning Point USA, Charlie Kirk.DOMINION: the belief that Christ reigns over all and thus a mandate that institutions and society be reclaimed, possibly by force if necessary, to reflect overtly Christian laws and magistrates. Example: full-throated Christian Nationalists, some in New Apostolic ReformationWhich response most honors God and the example His Son and His disciples set? Join us this weekend on The Christian Worldview as Andrew DeBartolo, Director of Operations for Liberty Coalition Canada, describes what is occurring in his country and ours and what he believes Christians should do.

This Sunday, we're unveiling our new survey (the first of its kind at Jarrard), which sought the opinion of more than 1,000 adults across the country about their perception of post-acute models of care and private equity's role in healthcare. Over the past decade, industry segments such as urgent care clinics and post-acute rehabilitation have evolved from emergent trends to mainstream components of care delivery. And in parallel, the involvement of private investors in healthcare has grown. With this survey, we aimed to understand consumers' baseline views of these care delivery and business models, particularly in an era of eroding trust in healthcare institutions. In this week's High Stakes podcast, we speak with Jarrard Vice President, Health Services Dan Schlacter about some of the survey's headline takeaways. As one of the co-developers of the questionnaire, Schlacter sheds light on the implications of these insights. Key points: Broadly speaking, consumers' perspectives on PE and “alternative” sites of care are not limited to leaders within those sectors. This survey is also relevant to hospital/acute care decision makers, particularly to understand which models or care people trust (and don't trust) in the context of potential partnerships. That said, one significant takeaway is everybody has room to improve. In Schlacter's words, “there's not a whole lot of trust out there to begin with.” Remaining up to speed with the various levels of trust across the industry provides a valuable innovation and partnership playbook for leaders of every stripe. It can also help them retain, or gain, the coveted trust of key stakeholders when it counts the most. Speaking of “levels of trust”… government lawmakers and regulators are at the bottom of the barrel. At the same time, they have the power and jurisdiction to manifest change. Rather than doing so with an iron-fisted regulatory mindset, the public's low view of these groups is an opportunity to adopt a partnership mindset between the government and private sector. Regulators can recognize that healthcare innovators, including investors, are driving positive change in the industry, and they can foster a supportive relationship to help accelerate new care models, ideas and partnerships that improve healthcare for everyone.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Bias-Augmented Consistency Training Reduces Biased Reasoning in Chain-of-Thought, published by miles on March 11, 2024 on The AI Alignment Forum. [Twitter thread] I'm not going to add much additional commentary at the moment and will just let people check out the paper! But to give a bit more context: This paper is building off prior work we have done showing that chain-of-thought explanations can be misleading, which I wrote about on the alignment forum here. Broadly, this work fits into the process-based oversight agenda (e.g., here). Consistency training/evaluation also fits into scalable oversight: Evaluating consistency may be easier than evaluating a model's reasoning or final predictions directly (e.g., also explored here). Abstract: While chain-of-thought prompting (CoT) has the potential to improve the explainability of language model reasoning, it can systematically misrepresent the factors influencing models' behavior--for example, rationalizing answers in line with a user's opinion without mentioning this bias. To mitigate this biased reasoning problem, we introduce bias-augmented consistency training (BCT), an unsupervised fine-tuning scheme that trains models to give consistent reasoning across prompts with and without biasing features. We construct a suite testing nine forms of biased reasoning on seven question-answering tasks, and find that applying BCT to GPT-3.5-Turbo with one bias reduces the rate of biased reasoning by 86% on held-out tasks. Moreover, this model generalizes to other forms of bias, reducing biased reasoning on held-out biases by an average of 37%. As BCT generalizes to held-out biases and does not require gold labels, this method may hold promise for reducing biased reasoning from as-of-yet unknown biases and on tasks where supervision for ground truth reasoning is unavailable. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org.

The Nasdaq Composite sank to a two-week low as technology companies led a broad sell-off ahead of Fed chair's testimony.Important DisclosuresInformation on this site is for general informational purposes only and should not be considered individualized recommendations or personalized investment advice. The type of securities and investment strategies mentioned may not be suitable for everyone. Each investor needs to review a security transaction for his or her own particular situation. All expressions of opinion are subject to change without notice in reaction to shifting market, economic and geo-political conditions.Data contained herein from third-party providers is obtained from what are considered reliable sources. However, its accuracy, completeness or reliability cannot be guaranteed.All corporate names are for illustrative purposes only and are not a recommendation, offer to sell, or a solicitation of an offer to buy any security.Investing involves risk, including loss of principal.Past performance is no guarantee of future results.The Schwab Center for Financial Research is a division of Charles Schwab & Co., Inc.Apple Podcasts and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries.Google Podcasts and the Google Podcasts logo are trademarks of Google LLC.Spotify and the Spotify logo are registered trademarks of Spotify AB.

------------------Support the channel------------ Patreon: https://www.patreon.com/thedissenter PayPal: paypal.me/thedissenter PayPal Subscription 3 Dollars: https://tinyurl.com/ybn6bg9l PayPal Subscription 5 Dollars: https://tinyurl.com/ycmr9gpz PayPal Subscription 10 Dollars: https://tinyurl.com/y9r3fc9m PayPal Subscription 20 Dollars: https://tinyurl.com/y95uvkao   ------------------Follow me on--------------------- Twitter: https://twitter.com/TheDissenterYT   This show is sponsored by Enlites, Learning & Development done differently. Check the website here: http://enlites.com/   Dr. Suthan Krishnarajan is Associate Professor in Political Science at Aarhus University. His research agenda seeks to understand and explain political regime instability. Broadly speaking, a political regime is the rules that determine who can access power, and how, in a given country. In democracies, leaders are chosen in competitive, free, and fair elections; in autocracies, leaders access power through alternative means. In his research, he examines why such regimes sometimes endure and at other times break down. I do so from three traditional disciplines in political science: comparative politics, public opinion, and international relations.   In this episode, we talk about regime instability in democracies and autocracies. We start by defining democracy. We talk about how people from democratic support. We discuss if citizens in Western democracies support democracy, and how satisfied they are with it. We talk about when people support undemocratic behavior, and how they rationalize it. We discuss evidence-based interventions to improve citizens' democratic values. We discuss if national elections are unequivocally good for people's satisfaction with democracy. We talk about factors that lead to democratic breakdown, including economic crises. Finally, we discuss how autocratic leaders deal with regime instability and coup attempts. -- A HUGE THANK YOU TO MY PATRONS/SUPPORTERS: PER HELGE LARSEN, JERRY MULLER, HANS FREDRIK SUNDE, BERNARDO SEIXAS, OLAF ALEX, ADAM KESSEL, MATTHEW WHITINGBIRD, ARNAUD WOLFF, TIM HOLLOSY, HENRIK AHLENIUS, FILIP FORS CONNOLLY, DAN DEMETRIOU, ROBERT WINDHAGER, RUI INACIO, ZOOP, MARCO NEVES, COLIN HOLBROOK, PHIL KAVANAGH, SAMUEL ANDREEFF, FRANCIS FORDE, TIAGO NUNES, FERGAL CUSSEN, HAL HERZOG, NUNO MACHADO, JONATHAN LEIBRANT, JOÃO LINHARES, STANTON T, SAMUEL CORREA, ERIK HAINES, MARK SMITH, JOÃO EIRA, TOM HUMMEL, SARDUS FRANCE, DAVID SLOAN WILSON, YACILA DEZA-ARAUJO, ROMAIN ROCH, DIEGO LONDOÑO CORREA, YANICK PUNTER, CHARLOTTE BLEASE, NICOLE BARBARO, ADAM HUNT, PAWEL OSTASZEWSKI, NELLEKE BAK, GUY MADISON, GARY G HELLMANN, SAIMA AFZAL, ADRIAN JAEGGI, PAULO TOLENTINO, JOÃO BARBOSA, JULIAN PRICE, EDWARD HALL, HEDIN BRØNNER, DOUGLAS FRY, FRANCA BORTOLOTTI, GABRIEL PONS CORTÈS, URSULA LITZCKE, SCOTT, ZACHARY FISH, TIM DUFFY, SUNNY SMITH, JON WISMAN, DANIEL FRIEDMAN, WILLIAM BUCKNER, PAUL-GEORGE ARNAUD, LUKE GLOWACKI, GEORGIOS THEOPHANOUS, CHRIS WILLIAMSON, PETER WOLOSZYN, DAVID WILLIAMS, DIOGO COSTA, ANTON ERIKSSON, CHARLES MOREY, ALEX CHAU, AMAURI MARTÍNEZ, CORALIE CHEVALLIER, BANGALORE ATHEISTS, LARRY D. LEE JR., OLD HERRINGBONE, MICHAEL BAILEY, DAN SPERBER, ROBERT GRESSIS, IGOR N, JEFF MCMAHAN, JAKE ZUEHL, BARNABAS RADICS, MARK CAMPBELL, TOMAS DAUBNER, LUKE NISSEN, KIMBERLY JOHNSON, JESSICA NOWICKI, LINDA BRANDIN, NIKLAS CARLSSON, GEORGE CHORIATIS, VALENTIN STEINMANN, PER KRAULIS, KATE VON GOELER, ALEXANDER HUBBARD, BR, MASOUD ALIMOHAMMADI, JONAS HERTNER, URSULA GOODENOUGH, DAVID PINSOF, SEAN NELSON, MIKE LAVIGNE, JOS KNECHT, ERIK ENGMAN, LUCY, YHONATAN SHEMESH, AND MANVIR SINGH! A SPECIAL THANKS TO MY PRODUCERS, YZAR WEHBE, JIM FRANK, ŁUKASZ STAFINIAK, TOM VANEGDOM, BERNARD HUGUENEY, CURTIS DIXON, BENEDIKT MUELLER, THOMAS TRUMBLE, KATHRINE AND PATRICK TOBIN, JONCARLO MONTENEGRO, AL NICK ORTIZ, AND NICK GOLDEN! AND TO MY EXECUTIVE PRODUCERS, MATTHEW LAVENDER, SERGIU CODREANU, BOGDAN KANIVETS, ROSEY, AND GREGORY HASTINGS!

“I can't stress enough how often I get questions about, ‘Is this the paclitaxel doing this? Is this the docetaxel doing this?' And coming up with strategies to kind of help get our patients through with supportive care is important. It's a really big opportunity for pharmacists and our nurses to really provide it and help our patients get through and show the knowledge that we have and to help them,” Dane Fritzsche, PharmD, BCOP, oncology informatics pharmacist at the Fred Hutchinson Cancer Center and University of Washington Medicine in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the plant alkaloid drug class. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by February 16, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome:  Learners will report an increase in knowledge related to plant alkaloids. Episode Notes  Complete this evaluation for free NCPD. Oncology Nursing Podcast series: Pharmacology 101 Cancer Symptom Management Basics Oncologic Emergencies 101 ONS courses: ONS/ONCC Chemotherapy Immunotherapy Administration Certificate™ ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook Clinical Journal of Oncology Nursing articles: Vincristine Minibag Administration: A Quality Improvement Project to Minimize Medical Errors Taxane-Induced Peripheral Neuropathy: Objective and Subjective Comparison Between Paclitaxel and Docetaxel in Patients With Breast Cancer Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center Extremity Cooling: A Synthesis of Cryotherapy Interventions to Reduce Peripheral Neuropathy and Nail Changes From Taxane-Based Chemotherapy ONS Huddle Card: Plant Alkaloids ONS Symptom Interventions and Guidelines ONS Voice article: Chemo-Induced Peripheral Neuropathy May Have a Link With Vitamin D Deficiency Hematology/Oncology Pharmacy Association patient education IV Cancer Treatment Education Sheets ChemoCare To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From This Episode “An alkaloid is an organic compound, so think carbon-based ring structure. The only thing special about alkaloid is that it has to contain at least one nitrogen atom.” TS 1:43 “Plant alkaloids are just alkaloids derived from plants itself, so think like the roots, stems, leaves, bark, and things like that. Each of these agents we'll discuss today are unique, but broadly speaking, all of them are extracted, at least when they were first discovered, from a plant source. And they are typically biosynthesized by these plants for defensive purposes.” TS 2:01 “Broadly speaking, [plant alkaloids] are cell cycle–specific agents. They do, depending on the compound, impact different parts of the cell cycle. Topoisomerase inhibitors is an example, so think irinotecan, which is a topoisomerase I inhibitor. There's topoisomerase II inhibitors, like etoposide being a good example. These impact the S phase in your cell cycle, so the synthesis of the DNA. Topoisomerase kind of helps unwind DNA and stabilize that as it's being replicated.” TS 3:36 “Again, these plant alkaloids kind of fall into your typical chemotherapy side effects, so we're thinking rapidly dividing cells. Our bone marrow—so is it lowering our red blood cells, our white blood cells, our platelets? And then it can also affect our GI [gastrointestinal] tract, whether it causes diarrhea in some cases; in some other cases, it can actually cause the other way and cause severe constipation. And then a lot of these agents do lead to hair loss.” TS 5:28 “The last thing I want to touch on with paclitaxel is neuropathy, or your pins and needles, tingling in the tips of your hands and toes. That is the most common one. That's a sensory neuropathy. But we also can see motor neuropathies with this agent, where the patients start to struggle with their fine motor skills, like buttoning shirts, using pencils, things like that. This is a cumulative dose effect with paclitaxel. So if patients are on multiple, multiple, multiple cycles, we definitely start to ask, you know, how that's going. And we expect at some point this is going to become an issue as therapy continues.” TS 9:26 “The last class we are going to touch on for more agent specifics is our vinca alkaloids. I think the biggest takeaway and something that was just kind of hammered into my brain during residency and during pharmacy school is that these agents should never be in a syringe, and that's because they are fatal if they're accidentally given intrathecally.” TS 11:41 Neuropathy-wise, it's challenging, and it's something that throughout my whole career with patient care, it constantly comes up. And there's really no one great solution to it. There's many different guidelines out there and papers out there that recommend some stepwise approaches. At the end of the day, too, we have to think about, what are our goals with our patients? How much is this limiting? TS 16:44 “Unfortunately, these hypersensitivity reactions are somewhat routine because we have lots of patients getting these medications, and they're not uncommon, like you said. It's really just that team-based approach. And since they are routine, we're all pretty comfortable at handling these.” TS 22:51 “I've always appreciated just our team-based collaboration. My clinical nurse coordinators that I worked with very closely are all kind of our number-one go-to for our patients. So I mentioned anything that's happening, any questions you have, reach out to your doctors or nurse here. They know everything. And when they don't know everything, then they know who to reach out to.” TS 28:59 “You have to remember a lot of these agents have very agent-specific side effects. So don't just think you know them all just because you know it's a plant alkaloid. Remember and do your due diligence and dive into each drug.” TS 33:27

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Estimates on expected effects of movement/pressure group/field building?, published by jackva on February 15, 2024 on The Effective Altruism Forum. It seems relatively uncontroversial within EA-grantmaking that field building (and the building of societal pressure groups?) is an effective strategy to induce long-run changes. E.g. a resource frequently referenced in discussions is Teles's "The Rise of the Conversative Legal Movement" as an existence proof for a very large long-run impact of philanthropic money. I am curious whether anyone has done systematic work on using this and other evidence to (1) estimate expected effects (2) base rates of success or (3) anything else of that sort that would inform how we can think about the average (a) tractability and (b) impact of such efforts? Luke Muehlhauser's work on early-movement growth and field-building comes closest, reviewing historical case studies and generally giving the impression that intentional movement / field acceleration is (a) possible, (b) not rocket science (things one would expect to work do work), and (c) can be quite meaningful (playing a major role in shaping and/or accelerating fields). But it doesn't offer much in terms of relative tractability or effectiveness vis-a-vis other interventions, such as funding existing think tanks to do Beltway-style policy advocacy or other surgical interventions that we do a lot of. Broadly, I am trying to understand how to compare funding such work to more surgical interventions, so I am interested both in absolute estimates but also relative comparisons. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: My lifelong pledge to give away 10% of my income each year (and where I donated in 2023), published by James Özden on February 13, 2024 on The Effective Altruism Forum. Note: Cross-posted from my blog. There is probably not much new here for long-time members of the EA community, some of whom have been giving 10%+ of their income for over a decade. However, I thought it might be interesting for newer EA Forum readers, and for folks who are more left-wing/progressive than average (like me), to see what arguments are compelling to someone of that worldview. In November 2022, I took the Giving What We Can pledge to give away 10% of my pre-tax income, to the most effective charities and opportunities, for the rest of my life. I'm very proud of taking the pledge, and feel great about finishing my first full year! I wanted to share some thoughts on how it's been for me, as well as some concrete places I donated to. Broadly, I feel like I've been committed to doing the most good ( whatever that means) for several years now, but it took some time for me to get going with my donations. One big factor is that I haven't been earning too much, especially when I was working full-time with Animal Rebellion/Extinction Rebellion, where people used to get paid between £400-1000 per month. Otherwise, I thought it would be a significant financial burden, even when my salary increased, that would make it difficult for me to build a financial safety net. But primarily, it's a reasonably big commitment, so I think taking some time to stew on it can be useful. Despite this, I've been surprised by how quickly the Giving What We Can (GWWC) pledge has become a part of my identity. Now, I'm so happy that I've pledged, and feel amazing that I'm able to support great projects to improve the world (you can tell because I'm already preaching about it - sorry not sorry). Importantly, I don't think donating is the only way for people to improve the world, and not necessarily the most impactful. But, I don't see it as an either/or, but rather a both/and. Simply, I don't think the decision is whether to dedicate your career to highly impactful work OR dedicate your free time (or career) to political activism OR donate some proportion of your income to effective projects. Rather, I think one can both pursue a high-impact career and give a lot, as donating often gives you the ability to have a huge impact with relatively little time investment. Tangibly, I've probably spent between 5-10 hours to donate around £3,000 this year, which I think will have a lot of positive impact with a relatively small time investment on my side (this was helped partially with the use of expert funds and my prior knowledge in a given area, but more on that later). However, I want to speak about some of the key points that convinced me to give 10% of my income for the rest of my life, namely: I am better off than 98% of the world, for no great reason besides that I grew up in a wealthy country, and it is a huge travesty if I don't use some percentage of this luck to help others. Donations can have very meaningful impacts on the issues I care about, often far more than other lifestyle choices I might be already making. I think the world would be a much better place if everyone was committed to giving some of their income/wealth, and there's no reason why it shouldn't start with me. (If you just want to see where I donated to in 2023, skip to the bottom). Why I decided to take the pledge Most people reading this are in the top 5% of wealth globally, and we should do something about it As someone who has been fairly engaged in progressive political activism, I often hear lots of comments attributing some key problems in the world, whether it's climate change, inequality or poverty, to the richest 1%. However, I think most peopl...

The landscape of conservative political discourse is continuously shaped and reshaped by pivotal events and figures, both past and current. In the following article, we delve into several key conversations that frequently animate conservative circles, including Russia's historical narrative, reflections on the COVID-19 response, and the ongoing debate surrounding the binary nature of gender. Recent high-profile interviews like Tucker Carlson's with Vladimir Putin have brought the Russian perspective into the limelight. While these interactions provide a stage for Russia to articulate its viewpoint on historical matters, critics often perceive such discussions less as genuine diplomacy and more as aggressive posturing. From Russia's standpoint, their history cannot be disentangled from the present, particularly regarding their relationships and tensions with neighboring nations. The disbursement of foreign aid by American legislators, particularly towards countries of strategic interest like Ukraine, Israel, and Taiwan, raises vibrant discussions regarding the prioritization of international versus domestic interests. The conservative perspective often leans towards skepticism about the effectiveness and accountability of such substantial financial support to foreign nations. There's an undercurrent of thought questioning the prudence of involving the U.S. in conflicts that may not directly impact national security or the well-being of American citizens. On a more localized level, the unique nature of legislative sessions and the role of conservative leadership during such periods is an area of keen interest. The philosophy that government should be limited and intentional in its actions resonates with the conservative discourse. Hence, a quiet legislative year is not inherently troubling; it may reflect a considered approach where not acting is deemed preferable to acting without clear conservative objectives. Such perspectives emphasize the belief in strategic governance that is truly in service of conservative principles, rather than in the interests of political expediency. Tax legislation remains a prominent subject for conservative policymakers who discern the implications of fiscal policies on economic competitiveness. While large-scale tax reforms like the Tax Cuts and Jobs Act draw considerable attention and debate, it is the more nuanced, smaller-scale changes that often play crucial roles in shaping fiscal policy. At a state level, legislation that may appear minor can have significant impacts, driving greater efficiency and competitiveness without drawing the spotlight. In Iowa, lawmakers have introduced multiple pro-taxpayer constitutional amendments. These amendments can provide long-term stability by preventing future legislative bodies from easily overturning established fiscal safeguards. Broadly speaking, such amendments necessitate widespread support, reflecting a collective consensus on fundamental fiscal management principles. The introduction and potential ratification of these amendments evidence the steady work within state legislatures aimed at refining and fortifying the fiscal frameworks. These efforts go beyond the day-to-day policymaking and offer a perspective that is strategic in scope, seeking to instill enduring policies that support prudent financial governance.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: On Dwarkesh's 3rd Podcast With Tyler Cowen, published by Zvi on February 4, 2024 on LessWrong. This post is extensive thoughts on Tyler Cowen's excellent talk with Dwarkesh Patel. It is interesting throughout. You can read this while listening, after listening or instead of listening, and is written to be compatible with all three options. The notes are in order in terms of what they are reacting to, and are mostly written as I listened. I see this as having been a few distinct intertwined conversations. Tyler Cowen knows more about more different things than perhaps anyone else, so that makes sense. Dwarkesh chose excellent questions throughout, displaying an excellent sense of when to follow up and how, and when to pivot. The first conversation is about Tyler's book GOAT about the world's greatest economists. Fascinating stuff, this made me more likely to read and review GOAT in the future if I ever find the time. I mostly agreed with Tyler's takes here, to the extent I am in position to know, as I have not read that much in the way of what these men wrote, and at this point even though I very much loved it at the time (don't skip the digression on silver, even, I remember it being great) The Wealth of Nations is now largely a blur to me. There were also questions about the world and philosophy in general but not about AI, that I would mostly put in this first category. As usual, I have lots of thoughts. The second conversation is about expectations given what I typically call mundane AI. What would the future look like, if AI progress stalls out without advancing too much? We cannot rule such worlds out and I put substantial probability on them, so it is an important and fascinating question. If you accept the premise of AI remaining within the human capability range in some broad sense, where it brings great productivity improvements and rewards those who use it well but remains foundationally a tool and everything seems basically normal, essentially the AI-Fizzle world, then we have disagreements but Tyler is an excellent thinker about these scenarios. Broadly our expectations are not so different here. That brings us to the third conversation, about the possibility of existential risk or the development of more intelligent and capable AI that would have greater affordances. For a while now, Tyler has asserted that such greater intelligence likely does not much matter, that not so much would change, that transformational effects are highly unlikely, whether or not they constitute existential risks. That the world will continue to seem normal, and follow the rules and heuristics of economics, essentially Scott Aaronson's Futurama. Even when he says AIs will be decentralized and engage in their own Hayekian trading with their own currency, he does not think this has deep implications, nor does it imply much about what else is going on beyond being modestly (and only modestly) productive. Then at other times he affirms the importance of existential risk concerns, and indeed says we will be in need of a hegemon, but the thinking here seems oddly divorced from other statements, and thus often rather confused. Mostly it seems consistent with the view that it is much easier to solve alignment quickly, build AGI and use it to generate a hegemon, than it would be to get any kind of international coordination. And also that failure to quickly build AI risks our civilization collapsing. But also I notice this implies that the resulting AIs will be powerful enough to enable hegemony and determine the future, when in other contexts he does not think they will even enable sustained 10% GDP growth. Thus at this point, I choose to treat most of Tyler's thoughts on AI as if they are part of the second conversation, with an implicit 'assuming an AI at least semi-fizzle' attached ...

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The case for more ambitious language model evals, published by Arun Jose on January 30, 2024 on The AI Alignment Forum. Here are some capabilities that I expect to be pretty hard to discover using an RLHF'd chat LLM: Eric Drexler tried to use the GPT-4 base model as a writing assistant, and it [...] knew who he was from what he was writing. He tried to simulate a conversation to have the AI help him with some writing he was working on, and the AI simulacrum repeatedly insisted it was by Drexler. A somewhat well-known Haskell programmer - let's call her Alice - wrote two draft paragraphs of a blog post she wanted to write, began prompting the base model with it, and after about two iterations it generated a link to her draft blog post repo with her name. More generally, this is a cluster of capabilities that could be described as language models inferring a surprising amount about the data-generation process that produced its prompt, such as the identity, personality, intentions, or history of a user[1]. The reason I expect most capability evals people currently run on language models to miss out on most abilities like these is primarily that they're most naturally observed when dealing with much more open-ended contexts. For instance, continuing text as the user, predicting an assistant free to do things that could superficially look like hallucinations[2], and so on. Most evaluation mechanisms people use today involve testing the ability of fine-tuned[3] models to perform a broad array number of specified tasks in some specified contexts, with or without some scaffolding - a setting that doesn't lend itself very well toward the kind of contexts I describe above. A pretty reasonable question to ask at this point is why it matters at all whether we can detect these capabilities. A position one could have here is that there are capabilities much more salient to various takeover scenarios that are more useful to try and detect, such as the ability to phish people, hack into secure accounts, or fine-tune other models. From that perspective, evals trying to identify capabilities like these are just far less important. Another pretty reasonable position is that these particular instances of capabilities just don't seem very impressive, and are basically what you would expect out of language models. My response to the first would be that I think it's important to ask what we're actually trying to achieve with our model eval mechanisms. Broadly, I think there are two different (and very often overlapping) things we would want our capability evals[4] to be doing: Understanding whether or not a specific model is possessed of some dangerous capabilities, or prone to acting in a malicious way in some context. Giving us information to better forecast the capabilities of future models. In other words, constructing good scaling laws for our capability evals. I'm much more excited about the latter kind of capability evals, and most of my case here is directed at that. Specifically, I think that if you want to forecast what future models will be good at, then by default you're operating in a regime where you have to account for a bunch of different emergent capabilities that don't necessarily look identical to what you've already seen. Even if you really only care about a specific narrow band of capabilities that you expect to be very likely convergent to takeover scenarios - an expectation I don't really buy as something you can very safely assume because of the uncertainty and plurality of takeover scenarios - there is still more than one way in which you can accomplish some subtasks, some of which may only show up in more powerful models. As a concrete example, consider the task of phishing someone on the internet. One straightforward way to achieve this would be to figure out how...

Today we discuss hitting 26 weeks with baby number two, problematic Disney movies from the past, reading fiction and nonfiction, peering into the old nursery, perspective on "having a smart kid," raising children in different decades, the simplicity aspects of having the second child, first gymnastics class, and more Podcast: https://link.chtbl.com/ParentallyUnprepared Twitter: https://twitter.com/PUnpreparedPod Email: ParentallyUnprepared@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/pupod/support

Real News Now Podcast: 25 Republican Governors Unite To Support Texas In Its Fight To Secure The Border Twenty-five Republican leaders across our great nation came together, unified, to voice their support for the Lone Star state, Texas, in its mission for enhanced border security. Tensions have stirred in recent times as the new administration actively impends Texas' determined pursuit for border fortification around its Mexican boundary. This has consequently been perceived as an open invitation to unchecked illegal immigration. The current President's Administration has left us wide open, susceptible to an intense influx of illegal immigration unprecedented in our nation's vibrant history. Broadly speaking, instead of prioritizing laws established by our forefathers and taking measures to secure our borders, the political leadership now lodged in the White House has instead chosen to question and challenge Texas for its commitment to protect its own citizens. This contention is against escalating waves of illegal immigration, the fervor of deadly narcotics such as fentanyl, and an underlying concern of invisible threats infiltrating our homeland. The Administration's actions betray the eyes of strengthened vigilance that never rest, always ready to defend our freedom. Twenty-five leaders, a representation of genuine American spirit and resilience, boldly stand in solidarity with the Governor of Texas, Greg Abbott. Together, they support his state's resilience and adaptability in employing every practical tool and method at their disposal, even bolstering security with a razor wire fence, to secure the sovereign borderland Texas cherishes. This critical step is, in part, a countermeasure to the refusal of the current Administration to reinforce immigration laws fundamentally enshrined in our nation. This refusal has led to a sweeping and near-unilateral allowance for migrants who entered our nation unlawfully to roam free, leaving the burden to the states and their leaders unceremoniously. These prominent leaders argue coherently that our U.S. Constitution adequately dictates that each state reserves the right to defend itself. A role none more important now when the present administration seemingly forgoes its constitutional responsibilities to the states. Hence, substituting and amplifying the role of Texas with every possible legal means towards sovereignty becomes the noble and justifiable course of action. Strikingly, they opine that our nation's sovereignty should similarly be fortified using every legally permissible mechanism. The distinguished collection of voices bear in their signatures the weight of resolve and unity. An impressive roster includes Governor Ron DeSantis of Florida, Governor Brian Kemp of Georgia, Oklahoma's Governor Kevin Stitt, Montana's Governor Greg Gianforte, Nevada's Governor Joe Lombardo, and Iowa's Governor Kim Reynolds, among others. Continuing this notable list of patriots and leaders, the Granite State's Governor Chris Sununu, Governor Kay Ivey from Alabama, Governor Mike Dunleavy of Alaska, Governor Sarah Sanders of Arkansas, and Governor Brad Little representing Idaho all added their support for this cause. Further backing came from Governor Eric Holcomb of Indiana, Louisiana's Governor Jeff Landry, Governor Tate Reeves of Mississippi, Missouri's Governor Mike Parson, and Governor Jim Pillen from Nebraska. They all join this concerted effort towards border security. Governor Doug Burgum of North Dakota, the Buckeye State's Governor Mike DeWine, Governor Henry McMaster of South Carolina, and South Dakota's Governor Kristi Noem have also thrown their support behind Texas, further consolidating the call for sovereign protection. Adding to this meaningful accord, Governor Bill Lee from Tennessee, Utah's Governor Spencer Cox, Virginia's fresh leadership in the form of Governor Glenn Youngkin, West Virginia's Governor Jim Justice, and Wyoming's Governor Mark Gordon round off this resolute group of leaders standing alongside Texas. Indicatively, there wasn't unanimous consensus among all Republican governors. Significantly committing to the sidelines, Vermont Governor Phil Scott represents the singular Republican governor across the nation who abstained from adding his name to this substantial statement—a notable lack of unity. Source: https://www.realnewsnow.com/25-us-leaders-rally-behind-texas-for-border-security/ Follow Real News Now on Social Media Facebook: https://www.facebook.com/RealNewsNowApp/ X Twitter: https://twitter.com/realnewsapp Instagram: https://www.instagram.com/realnews/ TikTok: https://www.tiktok.com/@realnewsnowapp Threads: https://www.threads.net/@realnews/ Truth Social: https://truthsocial.com/@RealNews YouTube:https://www.youtube.com/@realnewsnowapp Video: https://youtu.be/pL2jaOml2AQ    See omnystudio.com/listener for privacy information.

If you feel like you're in a constant cycle of building things in life just to watch them get knocked down again, there could be a very good reason for that.Broadly speaking, our lives are divided into two phases: times when we can thrive, and times when the best we can do is survive. The length of these phases can depend on lots of circumstancesA lot of struggle comes from misunderstanding the phase of life you're in - which isn't always as obvious as you might think.Today, I'm going to help you understand and identify those phases, and give you some strategies for each. Get my book: For When Everything is Burning https://bit.ly/forwheneverythingisburning Get better sleep, naturally (affiliate link) https://bit.ly/DrScottEilersSleep Connect with me on TikTok: https://www.tiktok.com/@dr.scott.eilers See the Podcast: https://www.youtube.com/@DrScottEilers Disclaimer: This content is not intended to be a replacement for receiving treatment. It is purely educational in nature. My relationship with you is that of presenter and audience, not therapist and client. But I do care. --- Support this podcast: https://podcasters.spotify.com/pod/show/scott-eilers/support

In today's episode, we're going to talk about Blue Oceans and Red Oceans, a concept talked about in Blue Ocean Strategy by Renée Mauborgne, W. Chan Kim. Broadly speaking, a “blue ocean” is uncontested market space—something that no one else is really doing, like Cirque Du Soleil when they first started. Compare that with a “red ocean”, or a supersaturated market in which you're unlikely to succeed, like me selling you my NFTs of my head spliced onto Ryan Reynold's body for the low low price of just 2 ETH! Joining us today is Ramiro Velasco, President and Co-Founder of GoAvance, a company that specializes in Amazon e-commerce but specifically in Latin America. The reason I wanted to do this show is because we tend to think only of opportunity in the country we live in. But perhaps, if certain techniques no longer work in your country, the blue ocean is applying those ideas to a different market, in this case, Mexico. I try to expand your ideas of what's possible with this show, and maybe moving to Mexico and setting up shop there is exactly what you should do to find your own, uncharted waters. We'll talk about practical tips for selling on Amazon in any country and also some general trends in marketing and ecommerce—this is especially relevant if you've ever wanted to sell something online. ➡️ https://goavance.com/ ➡️ https://rosspalmer.com/ramiro-velasco ➡️ Follow me on Instagram: @therosspalmer ➡️ Subscribe on YouTube: @therosspalmer

The future seems primed for electric vehicles (EVs), yet some owners in the Windy City are grappling with obstacles posed by the city's severe winter weather. Numerous public charging stations throughout the city have resembled automotive wastelands over recent days. As Tesla vehicle owners flock to the brand's exclusive supercharging stations, places like the one in Oak Brook are witnessing frantic attempts by numerous drivers to rejuvenate their energy-depleted vehicles. The period of inclement weather has highlighted an issue that's been turning city landscapes into troubling scenes of long queues and deserted automobiles. Mizelle, a local resident, found herself adrift in this burgeoning situation. Her car stubbornly refused to absorb the urgently needed power, leaving her with little option but to leave her car behind and rely on a friend's assistance for transportation. Her experience is far from unique, with countless other motorists facing similar predicaments. An unidentified gentleman aptly captured the essence of the unfolding crisis with his blunt assessment: 'It's a virtual horde of defunct automatons out here'. Indeed, the day had been a fraught one for a significant number of EV owners, who found themselves staring at an unexpected challenge posed by nature's elements. The predicament throttled Kevin Sumrak's normalcy out of gear. The EV owner touched down at O'Hare after a flight on Sunday evening, only to encounter the chilling realization that his Tesla had succumbed to the city's harsh sub-zero temperatures. The cold related issues are not unique to Tesla, but apply to all EVs, Bilek enlightened. The frigid temperatures can render the machines into a rather uncooperative state, which is why he suggests drivers to ensure they activate their preconditioning feature prior to attempting to charge their battery. Bilek highlighted the fact that charging an EV in cold weather does not equal a simple plug-and-play operation. Rather, it's a slightly more intricate process. A preparatory step of preconditioning, or warming the battery up to its optimal temperature, is necessary before it can smoothly embrace a quick charge. The preconditioning process is designed to get the battery warmed up and ready to accept a fast charge - a critical step under conditions of extreme cold. Skipping this step can lead to the scenario reminiscent of an automotive graveyard as witnessed recently. This situation serves as a powerful reminder that the leap towards an electrified future, though promising, is not without its own set of hurdles. Particularly in cities like Chicago, where the winters can be relentless, the journey towards a complete transition to electric mobility appears to be more challenging than anticipated. The freezing temperatures in Chicago have underlined the additional steps and care required for maintaining the autonomy of electric vehicles under extreme weather conditions. It reinforces the crucial need for diligence and forward planning on the part of EV owners especially during winters. It becomes evident from this episode that owning and operating electric vehicles in environments regularly exposed to punishing weather patterns necessitates a newfound awareness of the machines' nuanced needs. Users need application of suitable anticipatory strategies, like pre-conditioning, to ensure the vehicles continue to operate smoothly. In conclusion, the stories of distraught EV owners bear testimony to a paradox inherent to the world of electric mobility. While the leap towards electric vehicles signifies a stride into the future, it also brings with it a new set of challenges and operational nuances that need to be understood and addressed. The hardships experienced by these EV owners add to the growing list of considerations that future prospective buyers should bear in mind. While the lure of guiding one's vehicle on an electrified pathway towards the future is undoubtedly powerful, it also pays to be aware of the contingencies in place. In hindsight, the Chicago incident may serve to enlighten prospective EV customers across the globe, highlighting the importance of temperature consideration and battery preconditioning when living in colder climates. Broadly speaking, the shift toward the EV future surely demands a meticulous and learned approach. Finally, as cities prepare for an electric future, adapting to and overcoming the challenges of temperature and climate will stand as a pivotal step. Meanwhile, EV owners may have to embrace a few operational intricacies, like battery preconditioning, as part and parcel of the broader transition to environmentally-friendly automotive technology. Article: https://www.realnewsnow.com/electric-vehicle-owners-in-chicago-face-battery-woes-in-freezing-temperatures/ Real News Now Follow RNN on Social Media Facebook: https://www.facebook.com/RealNewsNowApp/ X Twitter: https://twitter.com/realnewsapp Instagram: https://www.instagram.com/realnews/ YouTube: https://www.youtube.com/@realnewsnowapp TikTok: https://www.tiktok.com/@realnewsnowapp Threads: https://www.threads.net/@realnews/ Truth Social: https://truthsocial.com/@RealNews Video: https://youtu.be/Ahv1Bg3QcBs Real News Now PodcastSee omnystudio.com/listener for privacy information.

The Dow Jones Industrial Average fell near a one-month low after Fed official's comments indicated the central bank will take cautious tack toward any interest rate cuts.Important DisclosuresInformation on this site is for general informational purposes only and should not be considered individualized recommendations or personalized investment advice. The type of securities and investment strategies mentioned may not be suitable for everyone. Each investor needs to review a security transaction for his or her own particular situation. All expressions of opinion are subject to change without notice in reaction to shifting market, economic and geo-political conditions.Data contained herein from third-party providers is obtained from what are considered reliable sources. However, its accuracy, completeness or reliability cannot be guaranteed.All corporate names are for illustrative purposes only and are not a recommendation, offer to sell, or a solicitation of an offer to buy any security.Investing involves risk, including loss of principal.Past performance is no guarantee of future results.The Schwab Center for Financial Research is a division of Charles Schwab & Co., Inc.Apple Podcasts and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries.Google Podcasts and the Google Podcasts logo are trademarks of Google LLC.Spotify and the Spotify logo are registered trademarks of Spotify AB.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Will 2024 be very hot? Should we be worried?, published by A.H. on December 29, 2023 on LessWrong. tl;dr: There are several trends which suggest that global temperatures over the next year will experience a short-term increase, relative to the long-term increase in temperatures caused by man-made global warming. Credits: Most of the information comes from Berkley Earth monthly temperature updates. Several people on Twitter (Robert Rohde, Zeke Hausfather, James Hansen and Roko) have also been talking about the issues discussed here for a while. Man-made global warming has been causing a steady, long-term increase in average global temperatures since the industrial revolution. However, recently several trends are lining up which suggest that the next year/few years might experience temporary greater-than-average warming, on top of baseline man-made warming. Some of these factors are already in play and 2023 is 'virtually certain' to be the hottest year on record. The story can be summed up in this lovely graphic from Berkley earth: I've had a look into some of the things that are happening and have written up what I've learned. I am not a climate scientist, so take this all with a pinch of salt. El Niño What is El Niño? Periodically, the strength and direction of the winds over the Pacific ocean changes, causing the surface waters to flow differently, which leads to changes in the amount of cold water coming up from the depths of the ocean. This pattern is known as the El Niño-Southern Oscillation. The phase when the surface waters are warmer is known as El Niño, and the phase when the surface waters are cooler is known as La Niña. These periods occur irregularly every few years and last approximately a year. How does it affect global temperatures? Unsurprisingly, during the El Niño period, when surface waters are warmer, more heat is released into the atmosphere, leading to warmer global surface temperatures. In general, years with El Niño are hotter and years with La Niña are cooler on average. This is a pretty reliable generalisation but is not a totally hard-and-fast rule as shown in the figure below[1]. However, like a lot phenomena in climate science, El Niño has different effects depending on what part of the world you are in. Broadly, areas in the southern hemisphere and areas by the coast experience more warming than others. But El Niño can actually cause cooling in some areas, so its important to check where you live. When averaged out over the globe, global surface temperature during El Niño years is about 0.1-0.2C higher than normal. What about second-order effects? This change in temperature can cause all kinds of other effects such as flooding, drought, disease and crop failures, on top of the direct effects of heat. Are we currently in an El Niño phase? Yes, it started in early summer this year. How long will it last? It is expected to last until (Northern Hemisphere) summer 2024 and expected to peak around (Northern Hemisphere) winter (ie. soon). However, (quoting Berkley Earth) again: 'Due to the lag between the development of El Niño and its full impact being felt on global temperatures, it is plausible that the current El Niño will have a greater impact on global temperatures in 2024 than it does in 2023.' So it is not over yet. Even though it will peak during Northern Hemisphere winter, its effects will still be felt into the summer, on top of normal seasonal temperature increases. Is this one going to be bad? The current El Niño phase is shaping up to be the one of the strongest ever. However, one thing I don't understand: is this just because of 'standard' increases from man-made warming or is it something about the winds/ocean currents which makes this one strong? Solar Cycles What is the solar cycle? Approximately every 11 years, for reasons I d...

Top Publication of 2023: ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids 

What were some of the biggest milestones achieved by Vendasta in 2023?On this special year-in-review episode of the Conquer Local Podcast, we are joined by Brendan King, the co-founder and CEO of Vendasta Technologies.Brendan shares the milestones achieved by Vendasta in 2023, including the acquisition of Broadly and the release of new products in the customer engagement space. He also discusses the changing economic landscape and the importance of profitable growth in today's market.Tune in as Brendan highlights the exciting trends to watch in 2024, particularly the advancements in AI and its potential to revolutionize customer relationship management. Join us on the latest episode to gain valuable insights and get a sneak peek into Vendasta's roadmap for the upcoming year!Conquer Local is presented by Vendasta. We have proudly served 5.5+ million local businesses through 60,000+ channel partners, agencies, and enterprise-level organizations. Learn more about Vendasta, and we can help your organization or learn more about Vendasta's Affiliate Program and how our listeners (like yourself) make up to $10,000 off referrals.Are you an entrepreneur, salesperson, or marketer? Then, keep the learning going in the Conquer Local Academy.

The major indexes resumed a year-end rally as investors remained confident in an outlook for Fed rate cuts and a soft landing for the economy.Important DisclosuresInformation on this site is for general informational purposes only and should not be considered individualized recommendations or personalized investment advice. The type of securities and investment strategies mentioned may not be suitable for everyone. Each investor needs to review a security transaction for his or her own particular situation. All expressions of opinion are subject to change without notice in reaction to shifting market, economic and geo-political conditions.Data contained herein from third-party providers is obtained from what are considered reliable sources. However, its accuracy, completeness or reliability cannot be guaranteed.All corporate names are for illustrative purposes only and are not a recommendation, offer to sell, or a solicitation of an offer to buy any security.Investing involves risk, including loss of principal.Past performance is no guarantee of future results.The Schwab Center for Financial Research is a division of Charles Schwab & Co., Inc.Apple Podcasts and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries.Google Podcasts and the Google Podcasts logo are trademarks of Google LLC.Spotify and the Spotify logo are registered trademarks of Spotify AB.

The train is leaving the station - get on or get run over. Inflation is turning and now there is what? Fed rally - just in time for Christmas. PLUS we are now on Spotify and Amazon Music/Podcasts! Click HERE for Show Notes and Links DHUnplugged is now streaming live - with listener chat. Click on link on the right sidebar. Love the Show? Then how about a Donation? Follow John C. Dvorak on Twitter Follow Andrew Horowitz on Twitter Warm Up - AND it is LIVE - CTP Cup for 2024 - More layoffs - End pf year - bullish sentiment and candy cane dreams - AMAZING - NOW Deflation is starting to bubble up - Fed-Ex Earnings... Market Update - Data matters - but only bull case - Yields - next stop? What is it saying about the future economy? - Adobe M&A stopage - Homebuilders - hitting new highs - Hacking - another hit - Supply Chain Redux? Fed Rally - Then Chill - This is getting out of hand... - Just days after a Federal Reserve meeting that penciled in an ample course of interest rate cuts next year, which in turn unleashed a broad rally in financial markets, one of the U.S. central bank's top policymakers pushed back on the ebullience on Friday. - "We aren't really talking about rate cuts right now," New York Fed President John Williams said in an interview with CNBC.  (WHAT????) - When it comes to the question of lowering rates, "I just think it's just premature to be even thinking about that" as the central bank continues to mull whether monetary policy is in the right place to help guide inflation back to its 2% target, he said. DEFLATION concept entering the market - Deflation is happening on the "goods" side of the U.S. economy, or the tangible objects that Americans buy, economists said. - For one, a strong U.S. dollar makes imported goods cheaper. Some of those savings get passed on to consumers, said Mark Zandi, chief economist of Moody's Analytics. ----- A strong dollar is a likely contributor to deflation in certain categories like household furniture and appliances, Zandi said. Additionally, weaker demand may be a factor: Households that spent liberally on home goods in the early days of Covid-19 lockdowns are likely no longer doing so, he added. --- Broadly, the pandemic snarled global supply chains, causing shortages that fueled big spikes in prices. Energy costs surged when Russia invaded Ukraine, pushing up transportation and other distribution costs. ------ Now, supply-chain disruptions are largely in the rearview mirror, economists said. The Global Supply Chain Pressure Index, for example, has fallen back to pre-pandemic levels from historic highs at the end of 2021. - Some prices, like those for airline tickets and eggs, are also falling back to earth after hitting record-high levels. The latter, for example, soared largely due to a historically deadly bout of avian flu among egg-laying hens. Egg and airline ticket prices are down about 22% and 12% in the past year, according to CPI data. Year Over Year November - Not Seasonally Adjusted - Does not include rents/housing. ( A big part of the the CPI index) Deflation - Food/Energy Deflation - All Items (X) Red Sea - War is hell - now ships diverted - Have to go around Cape Horn adding massive time for deliveries - Will this cause any price hikes? - Oil Prices? FedEx Earnings - FedEx shares tumbled 8% in after-hours trading Tuesday after the package-delivery giant lowered its revenue forecast as weaker demand hit sales. - The company said it expects a low-single-digit decline in revenue for the fiscal year, down from a previous forecast for flat sales year-over-year - less that analysts predicted. - It's the second consecutive quarter FedEx has lowered its sales outlook. - Meanwhile - Apple lowered its numbers for several quarters and the stock still rallies (Buybacks) Layoffs Auto - General Motors plans to lay off about 1,300 workers in Michigan starting early next year due to ve...

This episode is sponsored by BetterHelp. Give online therapy a try at https://www.betterhelp.com/SURVIVOR, and get on your way to being your best self. ***Join our Patreon for Exclusive Content*** https://www.patreon.com/thesurvivorsquad New episodes of The Survivor Squad will return on January 4, 2024! *Audience Note: As we take some time to be with family for the holiday season, please enjoy this replay of PART 2 of a two-part interview with Amanda Knox. Amanda Knox is an exoneree, journalist, public speaker, and author of the New York Times best-selling memoir, Waiting to Be Heard (HarperCollins, April 2013). Between 2007 and 2015, she spent nearly four years in an Italian prison and eight years on trial for a murder she didn't commit. The controversy over Amanda's case made international headlines for nearly a decade and thrust her into the spotlight, where she was vilified and shamed. Amanda now works to shed light on the issues of wrongful conviction, truth-seeking, and public shaming. Her essays and journalism have been published in USA Today, the L.A. Times, the Seattle Times, Seattle Magazine, BROADLY, and the West Seattle Herald. She is the host, writer, and producer of The Scarlet Letter Reports (2018), a VICE and Facebook Watch series in which she interviews other women who, like her, have been objectified and villainized by the media. She currently hosts the podcast Labyrinths: Getting Lost with Amanda Knox with her husband. https://linktr.ee/AmandaMarieKnox Instagram @amamaknox Twitter @amamaknox Podcast: Labyrinths: Getting Lost with Amanda Knox ***Join our Survivor Squad True Crime Podcasting Course!*** https://coaching.terranewellsurvival.com/ethical-true-crime-podcasting/ Survivor Squad Podcast links: https://linktr.ee/thesurvivorsqaud Join our Patreon: https://www.patreon.com/thesurvivorsquad • Terra's links: https://linktr.ee/terranewell  • Collier's links: https://collierlandry.com/links • Collier's Podcast https://podcasts.apple.com/us/podcast/the-collier-landry-show/id1551076031 • Book a 1-on-1 with Terra for trauma/ toxic relationship coaching: https://calendly.com/terranewell91/15-minute-coaching-consult?month=2023-06  • Join Terra's Complementary Trauma Support Group: Every 1st and 3rd Monday 5:00 PM PT mailto: Terranewellcoaching@gmail.com   It's important to consider seeking support from a licensed mental health professional or support group. Talking to a trusted friend/family member can also be beneficial in overcoming trauma and its aftermath.  •Psychology Today: https://www.psychologytoday.com/ •Trauma-Recovery.org: https://trauma-recovery.org/ •American Psychological Association: https://www.apa.org/ •National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml •National SA Hotline 1-800-656-4673 https://www.rainn.org/ •National Domestic Violence Hotline 800-799-7233 https://www.thehotline.org/

On December 3, Alaska Airlines announced an agreement with Hawaiian Airlines to merge. Pending regulatory approval, this announcement begins a long process that will conclude with a merged pilot group working under a single Collective Bargaining Agreement. In this episode, Host Strategic Communications Chair Capt. David Campbell discusses the steps required before a merger will be complete as it relates to pilots. Broadly, these steps include negotiating a Transition Process Agreement and a Joint Collective Bargaining Agreement, merging the pilot Seniority Lists, and finally merging the respective Master Executive Councils into what will become the new governing body of the merged pilot group. Campbell is joined by MEC Chair Capt. Will McQuillen, MEC Executive Administrator Drew Coyle, and Alaska Merger Committee Chair Capt. Greg Wertz.    Pilots of either carrier may submit questions via the DART system.     DART.alpa.org  

------------------Support the channel------------ Patreon: https://www.patreon.com/thedissenter PayPal: paypal.me/thedissenter PayPal Subscription 1 Dollar: https://tinyurl.com/yb3acuuy PayPal Subscription 3 Dollars: https://tinyurl.com/ybn6bg9l PayPal Subscription 5 Dollars: https://tinyurl.com/ycmr9gpz PayPal Subscription 10 Dollars: https://tinyurl.com/y9r3fc9m PayPal Subscription 20 Dollars: https://tinyurl.com/y95uvkao   ------------------Follow me on--------------------- Facebook: https://www.facebook.com/thedissenteryt/ Twitter: https://twitter.com/TheDissenterYT   This show is sponsored by Enlites, Learning & Development done differently. Check the website here: http://enlites.com/   Cecilie Traberg is a Psychology PhD Candidate in the Social Decision-Making Lab at the University of Cambridge supervised by Professor Sander van der Linden where her work seeks to bridge the fields of social influence and cognitive science. Broadly speaking her research focuses on how groups act as sources of influence on our judgments and beliefs: including how intergroup biases impact our ability to assess the veracity of information, and how social cues and interactions with other people affect individual-level cognition.   In this episode, we talk about misinformation. We start by discussing what misinformation is. We talk about perceived source similarity and perceived source credibility. We discuss if liberals and conservatives are equally susceptible to misinformation. We talk about motivated cognition. We discuss inattention accounts of the sharing of fake news. We get into interventions to reduce susceptibility to fake news, and discuss how they are measured; debunking and prebunking approaches; inoculation theory; fact-based and technique-based approaches; and how effective inoculation against misinformation is. We also talk about Cecilie's current work. -- A HUGE THANK YOU TO MY PATRONS/SUPPORTERS: PER HELGE LARSEN, JERRY MULLER, HANS FREDRIK SUNDE, BERNARDO SEIXAS, OLAF ALEX, ADAM KESSEL, MATTHEW WHITINGBIRD, ARNAUD WOLFF, TIM HOLLOSY, HENRIK AHLENIUS, JOHN CONNORS, FILIP FORS CONNOLLY, DAN DEMETRIOU, ROBERT WINDHAGER, RUI INACIO, ZOOP, MARCO NEVES, COLIN HOLBROOK, PHIL KAVANAGH, SAMUEL ANDREEFF, FRANCIS FORDE, TIAGO NUNES, FERGAL CUSSEN, HAL HERZOG, NUNO MACHADO, JONATHAN LEIBRANT, JOÃO LINHARES, STANTON T, SAMUEL CORREA, ERIK HAINES, MARK SMITH, JOÃO EIRA, TOM HUMMEL, SARDUS FRANCE, DAVID SLOAN WILSON, YACILA DEZA- ARAUJO, ROMAIN ROCH, DIEGO LONDOÑO CORREA, YANICK PUNTER, ADANER USMANI, CHARLOTTE BLEASE, NICOLE BARBARO, ADAM HUNT, PAWEL OSTASZEWSKI, NELLEKE BAK, GUY MADISON, GARY G HELLMANN, SAIMA AFZAL, ADRIAN JAEGGI, PAULO TOLENTINO, JOÃO BARBOSA, JULIAN PRICE, EDWARD HALL, HEDIN BRØNNER, DOUGLAS FRY, FRANCA BORTOLOTTI, GABRIEL PONS CORTÈS, URSULA LITZCKE, SCOTT, ZACHARY FISH, TIM DUFFY, SUNNY SMITH, JON WISMAN, DANIEL FRIEDMAN, WILLIAM BUCKNER, PAUL-GEORGE ARNAUD, LUKE GLOWACKI, GEORGIOS THEOPHANOUS, CHRIS WILLIAMSON, PETER WOLOSZYN, DAVID WILLIAMS, DIOGO COSTA, ANTON ERIKSSON, CHARLES MOREY, ALEX CHAU, AMAURI MARTÍNEZ, CORALIE CHEVALLIER, BANGALORE ATHEISTS, LARRY D. LEE JR., OLD HERRINGBONE, MICHAEL BAILEY, DAN SPERBER, ROBERT GRESSIS, IGOR N, JEFF MCMAHAN, JAKE ZUEHL, BARNABAS RADICS, MARK CAMPBELL, TOMAS DAUBNER, LUKE NISSEN, KIMBERLY JOHNSON, BENJAMIN GELBART, JESSICA NOWICKI, LINDA BRANDIN, NIKLAS CARLSSON, ISMAËL BENSLIMANE, GEORGE CHORIATIS, VALENTIN STEINMANN, PER KRAULIS, KATE VON GOELER, ALEXANDER HUBBARD, LIAM DUNAWAY, BR, MASOUD ALIMOHAMMADI, JONAS HERTNER, URSULA GOODENOUGH, GREGORY HASTINGS, DAVID PINSOF, SEAN NELSON, MIKE LAVIGNE, JOS KNECHT, ERIK ENGMAN, AND LUCY! A SPECIAL THANKS TO MY PRODUCERS, YZAR WEHBE, JIM FRANK, ŁUKASZ STAFINIAK, TOM VANEGDOM, BERNARD HUGUENEY, CURTIS DIXON, BENEDIKT MUELLER, THOMAS TRUMBLE, KATHRINE AND PATRICK TOBIN, JONCARLO MONTENEGRO, AL NICK ORTIZ, AND NICK GOLDEN! AND TO MY EXECUTIVE PRODUCERS, MATTHEW LAVENDER, SERGIU CODREANU, BOGDAN KANIVETS, AND ROSEY!

***Join our Patreon for Exclusive Content*** https://www.patreon.com/thesurvivorsquad New episodes of The Survivor Squad will return on January 4, 2024! *Audience Note: As we take some time to be with family for the holiday season, please enjoy this replay of PART 1 of a two-part interview with Amanda Knox. Amanda Knox is an exoneree, journalist, public speaker, and author of the New York Times best-selling memoir, Waiting to Be Heard (HarperCollins, April 2013). Between 2007 and 2015, she spent nearly four years in an Italian prison and eight years on trial for a murder she didn't commit. The controversy over Amanda's case made international headlines for nearly a decade and thrust her into the spotlight, where she was vilified and shamed. Amanda now works to shed light on the issues of wrongful conviction, truth-seeking, and public shaming. Her essays and journalism have been published in USA Today, the L.A. Times, the Seattle Times, Seattle Magazine, BROADLY, and the West Seattle Herald. She is the host, writer, and producer of The Scarlet Letter Reports (2018), a VICE and Facebook Watch series in which she interviews other women who, like her, have been objectified and villainized by the media. She currently hosts the podcast Labyrinths: Getting Lost with Amanda Knox with her husband. https://linktr.ee/AmandaMarieKnox Instagram @amamaknox Twitter @amamaknox Podcast: Labyrinths: Getting Lost with Amanda Knox***Join our Survivor Squad True Crime Podcasting Course!*** https://coaching.terranewellsurvival.com/ethical-true-crime-podcasting/ Survivor Squad Podcast links: https://linktr.ee/thesurvivorsqaud Join our Patreon: https://www.patreon.com/thesurvivorsquad • Terra's links: https://linktr.ee/terranewell  • Collier's links: https://collierlandry.com/links • Collier's Podcast https://podcasts.apple.com/us/podcast/the-collier-landry-show/id1551076031 • Book a 1-on-1 with Terra for trauma/ toxic relationship coaching: https://calendly.com/terranewell91/15-minute-coaching-consult?month=2023-06  • Join Terra's Complementary Trauma Support Group: Every 1st and 3rd Monday 5:00 PM PT mailto: Terranewellcoaching@gmail.com   It's important to consider seeking support from a licensed mental health professional or support group. Talking to a trusted friend/family member can also be beneficial in overcoming trauma and its aftermath.  •Psychology Today: https://www.psychologytoday.com/ •Trauma-Recovery.org: https://trauma-recovery.org/ •American Psychological Association: https://www.apa.org/ •National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml •National SA Hotline 1-800-656-4673 https://www.rainn.org/ •National Domestic Violence Hotline 800-799-7233 https://www.thehotline.org/

2023 is coming to a close, and a lot has happened in the world of CDR this year. We're going to take a look at the year in carbon removal to find out what's changed in the last year- and what hasn't.  Investment in CDR remains strong, with many big deals making headlines- but what hasn't changed? Deployments remain small and few in number. The traditional offset market has faced scrutiny like never before, and seen a dip in investment. What's still the same? Corporate buyers are still seeking out the lowest quality products. Broadly climate progress is being made, but a new emissions gap report highlights how much more work there is and how much CDR has to grow to contribute.  So join us as our business panel takes a look at what's new in CDR, and what's the same as it ever was.    On This Episode Susan Su Na'im Merchant Radhika Moolgavkar Resources Oxy-Climeworks Deal New Frontier DAC Purchase Heirloom Announces First US DAC Plant Carbon Market Chaos Bloomberg Report on Offsets UN Emissions Gap Report Connect with Nori Nori Nori's Twitter Nori's other podcast Reversing Climate Change Nori's CDR meme twitter account   --- Send in a voice message: https://podcasters.spotify.com/pod/show/carbonremovalnewsroom/message Support this podcast: https://podcasters.spotify.com/pod/show/carbonremovalnewsroom/support

How do Americans feel about Israel? Broadly, there is deep sympathy for Israel and its response to Hamas in Gaza. But polling shows that among America's more diverse, younger generation, attitudes toward both Israel and Palestinians are more complicated.   Harry Enten, Senior Data Reporter at CNN, is here to parse the numbers and tease out some conclusions.   Sept. 15 CNN Poll: Americans are deeply sympathetic toward Israelis and see their military response to Hamas attacks as justified   Call and leave us an Assignment: ‪(202) 854-8802‬ To learn more about how CNN protects listener privacy, visit cnn.com/privacy