Category: Everything else

Dr. Peter Attia’s team shared a thoughtful retrospective on a proposed explanation they shared previously.

Two years ago, they shared results from a trial that showed GLP-1 drugs (Ozempic, Wegovy) weren’t just remarkable in combating efficacy and type II diabetes – but that they were also effective in reducing major adverse cardiovascular events (heart attacks, stokes).

Taking a simplistic Occam’s razor inspired approach, they’d suggested that the reduction in cardiovascular risk was likely due to the weight loss involved.

However, additional data released recently showed that the drugs had a separate positive impact on cardiovascular risk because there was no correlation between a patient’s weight loss and their cardiovascular risk.

Their post ended with a reflection –

Occam’s razor is a useful heuristic for problem-solving across many disciplines, but biology and medicine are rife with instances where this principle has failed. (Indeed, there’s a principle that specifically opposes Occam’s razor in the context of medicine—Hickam’s dictum, which is typically presented as the observation that “a patient can have as many diseases as they damn well please.”).

So although defaulting to the simplest explanation may make sense when all else is equal, biology is often far more complex than we predict, and therefore, we need to be ready to abandon or revise the simpler theory when presented with new information. Such is the case, it would seem, with GLP-1 drugs and cardiovascular benefits.

There were 3 things I loved about this –

1. The reflection resonated. Topics involving biology are complex and often require a lot of nuance. Occam’s Razor isn’t always the best tool as a result.
   
2. I appreciated the retrospective post. We need more of these.
   
3. Hickam’s dictum – a patient can have as many diseases as they damn well please. – is hilarious.

We were halfway into our Sunday morning soccer game on a local middle school turf field when a dad walked up and told us we had to leave. He was the coach of a kids’ team, he’d booked the field for 8 a.m., and we needed to move immediately.

It was inconvenient – the grass nearby was wet, uneven, and far from ideal – but we moved and finished our game.

But here’s the kicker:

We were only using a third of the turf.

And for the entire next hour, the kids he was coaching also used only a third of the turf… on the opposite end.

They didn’t come near the space we had been occupying even once.

On our way out, we all chuckled. The whole thing had been unnecessary. It wasn’t about need – it was about “because I can.”

Two lessons.

Next time they ask us, I’ll make sure to ask if they actually plan to use the field. This might avoid the whole dance. Sometimes people enforce rules by default because no one asks.

The second lesson is that I’m sure I’ve done the same thing at some point – enforced something simply because I could.

It’s a good reminder to catch myself the next time I’m in that position.

Just because you can doesn’t mean you should.

Ascribing good intent or bad intent is one of the most quietly powerful choices we make about the people around us. The intent we assume becomes the lens through which we interpret every action. If we don’t trust someone’s intent, it almost doesn’t matter what they do – we’ll find a way to see it negatively. And the reverse is also true.

The most powerful experience I’ve had on intent comes from George R.R. Martin’s A Song of Ice and Fire. The books are a work of art because the entire plot is advanced from the point of view of various characters.

In the first two books, the story is told largely from the Stark family’s point of view. They despise the Lannisters, and through their eyes, Jaime Lannister becomes the embodiment of arrogance, selfishness, and everything that is wrong with human nature. I remember reading those books and feeling the same way – hating Jaime without ever hearing from him directly.

Then book three arrives, and suddenly there’s a chapter from Jaime’s point of view.

One chapter.

And by the end of it, I found myself thinking he was one of the most misunderstood, complex, even heroic characters in the story. Nothing about his circumstances changed – only the intent I had been unconsciously ascribing to him.

It was a revelation.

Everyone else had been projecting bad intent onto him, and I absorbed their view without questioning it.

Ever since, I’ve held onto that lesson.

If someone in your life ascribes bad intent to everything you do, there’s almost no path out. Your actions won’t matter if the lens is fixed.

And whenever I find myself frustrated with someone, or forming a story about why they did something, I think back to Jaime Lannister. It forces me to pause, reflect, and ask: Am I making the same mistake?

Because sometimes, all it takes is a single different point of view to completely change the story.

I had two wildly different customer service experiences recently.

The first was at a nearby AT&T store as we tried to upgrade our phones – and it had everything you hope never to experience.

Attempts to sell you products based on incomplete information.

Multiple hours of waiting and back and forths.

Staff walking away mid-conversation to serve someone else and not taking accountability for the job being done.

Managers hovering but doing nothing.

The crazy part was being sent to the Apple Store because “it’ll be easier there.”

It was apathy all the way down.

We then interacted with four different people at the Apple Store – each one exceptional.

They cared.

They took accountability.

They stayed with us until things were resolved.

They kept humor and energy throughout.

It was genuinely impressive.

The previous day, we had stopped by Gordon Ramsay’s Burger for a quick meal, mostly because of our fondness for MasterChef. Again, the service was incredible – fast, attentive, and thoughtful.

I tried to unpack the difference.

Was the AT&T issue about monopolies? Probably not – Apple has an even stronger market position, and it hasn’t eroded their service.

Was it about training? Maybe partially, but that didn’t feel like the root cause.

The conclusion I came to was simple a somebody at the top gives a damn.

At Gordon Ramsay’s place, I’m sure everyone knows that Gordon cares deeply about the experience – and he hires people who care too.

At the Apple Store, the culture of caring goes all the way back to Steve Jobs and has been kept alive by the leadership team. You can feel it in every interaction.

And at that AT&T store? My guess is no one up top truly cares. Or at least, not enough to hire the right people, set the right expectations, or hold anyone accountable for the experience customers actually have.

It’s a reminder to anyone in a leadership role – what you consistently care about, measure, hire for, and reinforce eventually becomes the lived experience of your customers.

If you want customers to feel cared for, you need leaders who give a damn first – and then who hire people who do too.

There’s a wonderful moment on The Graham Norton Show when one of the guests jokingly asked Lin-Manuel Miranda for Hamilton tickets.

Graham Norton turned to him and asked, half-seriously, “Is this what your life is now? Just people asking you for tickets?”

Lin-Manuel smiled and gave a thoughtful answer (paraphrased) – “Yes – but I’d much rather this than busking outside the theatre and asking people to come watch the show. I’ve done that too. And this is better.”

Lin-Manuel was (/is) at the top of his craft but was still grounded enough to remember what it was like to be on the other side.

He hadn’t forgotten where he started and that led to this beautiful combination of perspective and gratitude…

It was both lovely and inspiring.

The folks at Ember shared three exponential curves – new solar additions, Electric vehicles as a share of car sales, and US coal demand.

The fascinating part of the chart isn’t just the s-curve trend and the direction of the arrow, it is the grey lines that show the forecasts.

I’ve been writing about these technologies for years, and I’ve shared many of the prevailing forecasts along the way. In every one of these cases, reality has outpaced even the most optimistic predictions.

Solar and electric vehicles continue to scale faster than projected while coal demand continues to fall quickly.

It’s a reminder of a simple fact – our instincts map to linear curves.

This just means we are terrible at intuitively understanding and forecasting exponential curves.

One of the most useful life skills is knowing what the right decision for you feels like in the moment you’re faced with a set of reasonable choices.

If you ask “Why me?” or “Why now?” when something bad happens, make sure you ask the same questions when something good happens unexpectedly.

It is human nature to notice the negative surprises and overlook the positive ones.

Randomness and luck, however, cut both ways.

I recently shared a post about the importance of taking the time to get to clarity about what you’re looking for. Once we have clarity, the decisions and actions that follow become so much easier.

Rebecca, who has been part of this community for many years, wrote in with a beautiful addition. She shared from her own experience that while the most effective action does flow from clarity, there are times when clarity simply isn’t available. In those moments, even misdirected action can be what ultimately creates the clarity you need.

I’ve found that to be true as well.

If you can get to clarity first, that’s wonderful.

But if you can’t – move. Try something. Action reveals insight.

It was also a lovely reminder of a principle I come back to often: the opposite of a good idea is often a good idea.

Sometimes clarity leads to action. Sometimes action leads to clarity.

Both paths can work. The right one at any given time just depends on context.

Berkshire Hathaway released Warren Buffett’s thanksgiving letter. I loved the last section with his reflections and advice. There’s a lot of wisdom in these notes that resonated (“Don’t count on a newsroom mix-up” is gold) – sharing in full below.

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One perhaps self-serving observation. I’m happy to say I feel better about the second half of my life than the first.

My advice: Don’t beat yourself up over past mistakes – learn at least a little
from them and move on. It is never too late to improve.

Get the right heroes and copy them. You can start with Tom Murphy; he was the best.

Remember Alfred Nobel, later of Nobel Prize fame, who – reportedly – read his own obituary that was mistakenly printed when his brother died and a newspaper got mixed up. He was horrified at what he read and realized he should change his behavior.

Don’t count on a newsroom mix-up: Decide what you would like your obituary to say and live the life to deserve it.

Greatness does not come about through accumulating great amounts of money, great amounts of publicity or great power in government. When you help someone in any of thousands of ways, you help the world. Kindness is costless but also priceless.

Whether you are religious or not, it’s hard to beat The Golden Rule as a guide to behavior.

I write this as one who has been thoughtless countless times and made many mistakes but also became very lucky in learning from some wonderful friends how to behave better (still a long way from perfect, however). Keep in mind that the cleaning lady is as much a human being as the Chairman.

I wish all who read this a very happy Thanksgiving. Yes, even the jerks; it’s never too late to change. Remember to thank America for maximizing your opportunities. But it is – inevitably – capricious and sometimes venal in distributing its rewards.

Choose your heroes very carefully and then emulate them. You will never be perfect, but you can always be better.