Tag: Medical

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Medical

Day 982 and Not Small Men

I’ve been working on getting a deeper understanding of my hormone profile and where I can better support my cycle.

I’ve been surprised by just how little we seem to know about women’s health and the baselines that are considered ideal. Between the battles over health education in school (abstinence only) and the eagerness with which we put my millennial generation on birth control as teenagers, we’ve got both an under-informed and potentially over medicated population. Which wasn’t the case for our mother’s generation who went on birth control much later in life if at all.

A tweet from last week

I’ve had my fair share of fucked up fertility experiences and yet I’ve only just in the last few years learned to understand how my follicular phase impacts me so differently from my luteal phase. If you don’t know what that means either well it’s probably time.

The phases a woman’s cycle

I generally feel most energetic, pain free, and happy during my follicular phase. Despite knowing this I couldn’t tell you what an ideal FSH hormone level would be. I don’t know what balance of estrogen I should have at any given phase. I have no clue what my LH should be during my luteal stage either.

It strikes me that these levels should be taught along with implications for what it means and how to work with them just as we know our ideal blood pressure rage and resting heart rates. It’s some of the most crucial and basic self knowledge about our bodies.

When I think of how many other crucial biometrics I’ve got memorized (I track my SED rate and CRP quarterly for inflammation) it seems odd that something so crucial as one’s hormones wouldn’t be known, tracked and improved. I watch my heart rate variability like my recovery depends on it because it does. So do most serious biohackers.

Knowing more about own health is part of being a responsible adult. And I’m sad that we do so little to educate women on basic rhythms. I can’t tell if it’s a lack of interest from women or a dismissal from the medical profession. Women aren’t just small men.

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Biohacking Medical

Day 974 and Flare

As most casual observers of this daily log have probably noticed, one of my main interests is biohacking. It was a hobby in the time of my life I mislabel as “before chronic illness.” It’s not accurate so much as recency bias. I’ve been into biohacking my whole life because I’ve had to manage an unruly body.

I had the best health of my life between 24 and 34. I am rounding the end of my 39th year as I write today. I didn’t think of myself as being chronically ill for that decade.

Probably why I think of my life as having a “before” illness is more that I’ve been in the worst flare of my life for the last five years. It came crashing down with a one two punch of being a startup founder & getting pumped full of hormones for fertility treatments at 33. I was on bedrest and chemotherapy drugs by the time I was 34.

So I have to remind myself there is no time before chronic illness. There was remission. I had long years of robust health interspersed with autoimmune diseases that flared and were contained.

Diagnosis has been a lifelong battle which started with inflammatory skin conditions and horrendous allergies and ended up with the inflammation going inside my spine and joints. Ankylosing spondylitis and psoriatic arthritis is what codes with insurance.

Looking at my health records, I had my first issues at 7 when I entered school, then after puberty as teenager around 15 & 16. I had to drop out of high school and ran a giant let of standardized tests to claw myself to university.

I was hale for college and my first startup but flared so badly after the acquisition of my first company I was put on an experimental immune reboot protocol. Ask me about being put on cyclosporin without an organ transplant.

My most recent, worst and longest flare was in the five year battle after doing IVF and egg freezing in my early thirties. I’ve only really felt like I was able to work my preferred hours this past year. So perhaps that flare is finished. I don’t want to tempt it. Though I yearn to live harder & faster and bigger.

Writing it all out in a timeline makes it seem like the pattern is introducing change and stress into my routines but also there are two big incidents involving hormones. Being put on birth control as a teenager and then whatever the opposite of birth control might be with IVF. Maybe no more synthetic hormone control for me.

Managing your health isn’t easy for anyone. It’s particularly challenging for me. And if the current post pandemic climate is any indication a lot more people are grappling with poorer health. I wish I could offer more help other than saying it’s not easy but flares can be contained. Sometimes with a lot of pharmaceutical intervention. Sometimes with better habits. Sometimes with time. And sometimes it’s just a crap shoot.

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Biohacking Medical Startups

Day 971 and Patients Rights With Artificial Intelligence

If you are working in artificial intelligence or medicine I’d like to pleased my case to you. Id just like to pass along a note.

The current “responsible” safety stance is that we should not have AI agents dispense healthcare advice as if they had the knowledge of a doctor. I think this is safetyism and rob’s sick people of their own agency

I have very complicated healthcare needs and have experienced the range of how human doctors fail. The failure case is almost always in the presumption that you will fall within a median result.

Now for most people this is obviously true. They are more likely to be the average case. And we should all be concerned that people without basic numerate skills may misinterpret a risk. Whether it’s our collective responsibility to set limits to project regular people is not a solved problem.

But for the complex informed patient knows they are not average? The real outliers. Giving them access to more granular data let’s them accelerate their own care.

It’s a persistent issue of paternalism in medicine to assume the doctor knows best and the presumption that the patient is either stupid, lying, or hysterical is the norm. It’s also somewhat gendered in my experience.

I now regularly work with my doctors using an LLM precisely so we can avoid these failure cases where I am treated as an average statistic in a guessing game. I’m a patient not a customer after all. I decided my best interest.

A strict regulatory framework constricts access without solving any of the wider issues of access to care for those outside of norms. Artificial intelligence has the capacity to save lives and improve quality of life for countless difficult patients. It’s a social good and probably a financial one too.

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Politics

Day 968 and Precautionary

Do you recall learning Hippocratic Oath at some point in your schooling?

First do no harm

That turns out to not even be in the original oath but one of the many varied additions over the ages. The more often repeated phrase is translated as follows. “I will abstain from all intentional wrong-doing and harm.”

The document dictated standards like keeping professions secrets and avoiding using poisons knowingly for suicide or abortions. But somehow in popular imagination “do no harm” has really stuck.

Now we are stuck with the precautionary principle as it’s heir. The principle suggests there is a social responsibility to protect “the public” from harm when there may be a plausible risk even in theory. Big ups to Hans Jonas’s imperatives on responsibility for giving us the ethical frameworks for technological skepticism.

We apply the precautionary principle in many fields from medicine to the military. It suggests precautionary protections should be relaxed only if there is evidence that no harm will result. It’s for your own good!” It’s included as a statutory in some areas of law. Progress can’t be too fast lest someone get hurt

But before you give too much credit caution, it’s important realize the cost of inaction can be high.

As Mercatus Center’s Adam Thierer put it, “Where there is uncertainty about future risks, the precautionary principle defaults to play‐it‐safe mode by disallowing trial‐and‐error progress, or at least making it far more difficult.”

The inclination to play things safe can have incredibly high costs for people who need progress. Much the current debate around artificial intelligence is centered on doomsday scenarios. Safety and alignment researchers bring up terrifying scenarios as justification for taking things slow.

But we shouldn’t be too quick to dismiss what AI can do to make life better. You want to tell someone with a painful chronic illness it’s better to wait on medical progress because of some theoretical harm? They already live with an all too real harm that we should be just as eager to to fix with powerful new tools like AI.

Fuck Safetyism

I’d rather we adopt a more ambitious attitude towards problem solving. Fuck your safetyism.

We need to put a complete moratorium on the precautionary principle until we’re sure that it doesn’t have any negative consequences

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Biohacking Emotional Work

Day 965 and Bounce Back

I had a really shitty day yesterday. I was attuned to the haunted corners in myself and others. I was in an astonishing amount of pain. I got into a fight with a family member over a misunderstanding.

I found myself in a state of reactivity. It’s a huge challenge to manage nervous system regulation for me when I tip from the pain scale from my typical 4-5 to the impossible ignore 7-8 range.

I have become quite used to living with pain that would be distracting for others. I monitor biometrics like my heart rate variability to keep track of how stressed my body is from the pain.

I’ve found it important to learn how to bounce back from unexpected pain. It’s important to stop stress and reactivity in its tracks. If you let stress hijack your nervous system you can do yourself a lot of damage.

I took care of myself last night. I did what I needed to get my nervous system under control and the pain manageable. And it worked.

I turned myself around today. I lifted weights, I meditated, I took my supplements, and I tackled my work load with pleasure. I can feel the fatigue sweeping back in as the day winds up. But I can rest easy knowing I set myself up to bounce back again tomorrow. Budget for the body you have and not the fantasy one which you don’t have.

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Community Emotional Work Media

Day 960 and Summer Frailty

Rounding the bend into a thousand posts is teaching me some lessons in humility and frailty. I am reaching to get words word as my mind is slow.

I am not reacting to something in an average way and it’s been a struggle to keep going over the laser week or two. I’ve put one foot in front of the other but I can see that I only slept for a couple hours last night. Ironic to be considering averages when one’s own responses are so slowed.

I am just trying to get through August. If my standards are simply to plod through then any achievement like throwing a successful policy night or recording a podcast for Wealth Actually on early stage venture capital count for something.

Much of my struggle is probably just some better living through chemistry problems. A new addition to the biohacking routine went awry. I’m struggling with the heat wave and the air quality of summer in the mountain west. The long days of bright lights slowly unspooling my sanity as I wait for cooler less cruel months to come. Just breathe in and out and try to eat and sleep.

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Biohacking Chronic Disease

Day 953 and Sugar

If you’ve been following me for a while chances are good that you’ve seen me discuss my biohacking.

I’ve got an autoimmune condition called ankylosing spondylitis. It’s a form of arthritis in the spine. When it flares the inflammation can be so painful that basic tasks like walking or standing can be out of the question. It’s impacted my daily life in strange and sometimes sadly poignant ways.

Now thanks to the wonders of modern biologic injectables like interleukin inhibitors (my lucky number is IL-17h), non steroidal anti-inflammatories, the occasional round of chemotherapy workhorse methotrexate, and the ultimate big boss inflammation killer known as prednisone I lead a pretty normal life.

I am however always looking for new ways to improve my situation. You name a modality of healing and I’ve surely done it.

I’m regularly throwing myself at new pharmaceuticals, new workouts, new devices, and new routines. I track it all obsessively. If you want a 10 day water fast buddy call me.

This kind of thinking means I am prone to optimism and the occasional “one weird cure” line of thinking. The hope that springs eternal is the fantasy what ails can fixed with a gluten free diet (nope) or the du nude Goop wellmania cure which costs $500.

One of my biggest “I’ll be cured” fantasies is that the extra body fat I gained from multiple rounds of steroids and hormone treatments is actually the cause of my health problems and not one of its symptoms.

Notice they I don’t say biggest fears. My biometrics don’t really suggest that adipose tissue is my root issue. Being fat is a core problem for many people but for me it’s a symptom. I don’t want to disclose said biometrics as I fear insurance companies and pharmacies might decide to dig.

In pursuit of a cure for this symptom, I’ve been way ahead of the GLP-1 agonists like semaglutide. My Novo Nordisk and Eli Lily stockholdings are up 100%. I had success on Ozempic but went off it as the side effects got to be too much for me after nine months when I reached a healthy body weight.

But I recently I paid out of pocket to try Mounjaro as I’ve not happy with where I am currently at for excess adipose tissue. It’s supposed to be less brutal on the stomach. It’s got a duel mechanism as a GLP-1 and GIP receptor have lead to excellent clinical trial results.

I’d say about three weeks in those results for me are not forthcoming. I’ve been in a perpetual state of low grade anxiety that seems to be from hypoglycemia. I’ve been sluggish, cranky, moody and my mind unfocused and hazy.

As it turns out the glucose-dependent insulinotropic polypeptide receptor (GIP receptor) primarily affects the body’s physiological response to food intake and blood sugar regulation. So I’ve got low blood sugar.

Luckily throwing fruit at the problem helps the symptoms. I have not lost so much as an ounce though. I think I’d rather go back to Ozempic which at least took weight off. I’d rather have a fucked up stomach than a fucked up mind. Maybe other people need to eat less sugar. I guess I don’t have that problem.

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Medical

Day 950 and Good Teeth

I’ve always quite liked dental hygiene. Twice daily brushing and flossing after every meal has always been one of those daily habits for me. I do not compromise on it. You’ve probably seen me with a toothpick after a meal. Taking care of my teeth is just engrained into my routine.

It would seem a lifetime of good habits pays off. I’ve only had a handful of cavities (I think two) and no issues with grinding, my gums, or other periodontal problems. My teeth have been so chill that when I was broke I went to the NYU dental school for care. I learned a lot and it was cheap.

I finally found myself a dentist in Montana and went in for an intake and a cleaning today. It has been about a year since my last dental visit. I came through with a clean bill of health. They took a bunch of X-rays and fancy imagery and nothing looks problematic. Flossing really does pay off it would seem. You should do it!

I am happy my teeth are in good shape but slightly pissed. You see last year a dentist in Boulder did her best to convince me that I needed a root canal. A lifetime of good dental health and I’m being pushed for oral surgery for a tooth that didn’t even hurt.

I said I didn’t feel any pain or discomfort so I wasn’t inclined to get surgery prophylactically. She seemed a bit pissed. She did her best to insist I go see an oral surgeon. I demurred. I did not want an additional medical issue that was voluntary.

Now a year later, a dentist with much more advanced equipment could not locate the issue and told me I’ve got nothing to worry about. Maybe she got it wrong? He couldn’t quite be sure what she saw as his imagery and X-rays didn’t show any issues. I had no sensitivity or nerve issues so it’s possible she got it wrong.

We have a tendency to believe credentialed professionals like doctors, dentists and lawyers. They must know right? I’d never have considered saying no to a root canal before last year but at the time I just didn’t feel like I could handle an invasive procedure. And thank goodness I pushed it off.

And it does turn out that dentistry as a profession has issues with unnecessary treatments and fraud. This investigation in the Atlantic discusses how prevalent unnecessary treatments are in America.

Had I not turned down a root canal last year I would have subjected myself to something I didn’t need. Given my chronic health issues, you can imagine that I’m not eager to spend money and time on treatments I don’t need. Particularly ones known to be painful with the potential for side effects like infection. So be careful out there. And I hope you have a dentist like mine in Montana.

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Biohacking Medical

Day 949 and Stomach Stuff

I was very excited for today. My first Monday with my new schedule after my “season of no” cleared the calendar.

I am into the day brimming with optimism. Naturally, it was only fair that I lost my entire day to some kind of stomach bug.

I am experimenting with a new GLP1 agonist and have found the side effects to be troublesome. I made an attempt to have a protein shake and it cascaded from there. So I don’t have much to say today except that my biohacking went awry so I’ve got little to say.

Instead I’ll recommend you go read my post from yesterday on assigning value. It’s some thoughts on alignment for artificial intelligence and the impossible task of being sure we all share the same idea of value.

Categories
Culture Medical Politics

Day 948 and Assigning Value

What does assigning value mean to you? How do you begin to investigate what is valuable? If someone asked you to value “object X” do you know what tools you would use first to make a measurement?

If I tell you determining value is a cultural problem, you may investigate the problem of value through religious or philosophical frameworks. If I tell you value is an artistic problem, you may use taste in finding value.

If I tell you that assigning value is primarily a computing problem, you may search for weightings, databases and referents to determine value.

So what happens when determining value has to account for multiple or even contradictory frameworks? Which framework assigns the ultimate value? And how do we align them?

Congratulations, you’ve known become an artificial intelligence alignment researcher. I bet you thought that required a doctorate but it doesn’t.

It’s not an entirely intractable problem. The Industrial Revolution found ways to align competing frameworks. We assigned labor value and made currencies to facilitate the exchange of different goods.

Markets can, and do, spring up for all kinds of previously impossible to value things. Capitalism done its best to make cultural value fungible and legible to an agreed upon value. Sure, artisans and artists complain we conclude incorrect values regularly. But we don’t always agree on value.

Generally we’ve found that what can pay for itself survives and what can profit for others thrives.

Not all people are motivated by profit, but we all are motivated to survive. And so we contribute what we believe has value to each other and hope the frameworks of value that others have will align with ours. The balance between the two has held together humanity for sometime.

But deciding on value isn’t the same thing as a thing driving a profit and we have to remember that truth. Between the gaps in the models of what we value is the epsilon of what cannot be calculated.

If you’d like to read a horror story on how assigning fungible value in a database can end up assigning a value to something we humans generally don’t consider interchangeable at all, then I’d go read this piece on how public hospice care’s incentives have been perverted by private equity profit motive.

I don’t always agree with the author of the piece Cory Doctorow. But I think he’s raising a powerful point on how we are assigning value when we overlay competing frameworks.

This is the true “AI Safety” risk. It’s not that a chatbot will become sentient and take over the world – it’s that the original artificial lifeform, the limited liability company, will use “AI” to accelerate its murderous shell-game until we can’t spot the trick

If you aren’t familiar with Doctorow, he’s a powerful voice in right to repair circles, a classical hacker opposed to corporate oligopoly, and a bit of a anarcho-syndicaticalist in his preferred solutions.

I like markets more than governments for most things. More of us can contribute to markets than we can contribute to specialist bureaucracies

But we have assigned value to end of life care inside the convoluted system of profit motives and medical ethics and it’s not the value most of us share on life.

And that’s going to happen a lot more as we get further and further abstracted away from the existing models of value that govern our lives. So remain skeptical when someone tells you that they know what you value. How they assign value might be different than you.