Trying my very hardest to find good in “Rich Dad, Poor Dad”

I was recommended the book by someone whose business success I highly respect. To his credit, he willingly identified several flaws but recommended it on the balance. I’m a fan of reading things I don’t necessarily believe, so I was willing to push through the huge amount of criticism online to give the book a shot.

To get this out of the way first: Basically all that criticism is warranted. (But keep reading, there’s more!)

I found it valuable to interpret the book as more of an inspiring parable than a specific source of actual literal facts. The whole spirit is best summed up by a short section towards the end where he advocates putting your income into investments before you put it towards your bills. Of course, he says, you must also pay your bills, but you should use the anxiety of falling short for motivation to work harder, earning more, investing more, and ultimately making all of your income from dividends.

This arbitrary rearrangement of two things, both of which you are going to do anyway, is both logically inane and emotionally powerful. It’s a visceral way to put investment on the top of your mind, along with some of the other things he advocates like following a few businesspeople alongside your sports heroes, and talking frankly with friends about your financial goals and strategies.

Probably the strongest concept in the book is a move away from her thinking of “financial literacy“ as just “make sure you are not spending more than you save each month”. It has to extends to how you are handling the accumulated excess. The book argues that once you get smart enough, you’ll see investment options even better than just putting it in a broad index fund (though that would have more than doubled since the book was published). It doesn’t go in depth on any of those options besides real estate, which is a huge weakness (but I’m staying positive here!)

Abstractly speaking, investing means buying productive assets that create value on a regular basis. In the best case, it does so without any effort on your part and without any risk of losing value. As you get further from conventional asset classes like stocks and bonds, I think opportunities meeting those criteria become rare. But that feeds into one of the most underrated lessons of the book: The importance of learning sales skills for opening up entirely new opportunities to invest. After all, after your asset spits out some value, someone (probably you!) needs to find someone who will actually pay you cash for it.

If you’re willing to do the work to evaluate assets, and then find buyers for their output, you stand a chance to evade the economist’s dollar bill paradox. The book provides the inspiration to build the skills and pound the pavement to make that happen. Orchestrating the flow of resources and labor is basically the economic definition of a business, which aligns naturally with the book’s encouragement that everybody should incorporate a legal entity around their investment activities.

He mentions the value of teaching financial skills with games and simulations as opposed to lectures. I am sympathetic to that idea, given that conventional financial literacy classes are almost completely useless (EDIT: and 1/3rd of fees paid by low-literacy Americans could have been easily avoided)

I promised not to disparage the book (and I hope that we’re all appreciating how many times I’ve had to delete a sentence because of that promise), but I do have to take a respectful but direct stand against one pair of intertwined themes: The devaluation of specialized education and of income earned as wages.

In fact, the legendary 1 Percenters, who we’ll use as shorthand for “rich”, are often highly educated working professionals. They are not living off of the rent of some valuable estate like a English aristocrat. They are living off of the rent of their valuable education and credentials, their Human Capital. It is a less tangible asset, and doesn’t do as well on Instagram, but by far the more common way to be affluent in modern America. (EDIT: For people who don’t mind numbers, including high salaries, I’ve fleshed this argument out here)

Also, there is something to be said for actually personally producing value each day, but as that is not the thrust of the book I will continue focusing this review raking in the dollah dollah bills.

Shockingly, even many wealthy small business founders are a mixture of owners and highly skilled employees. They have successfully invested in the business, but its value is still tied to their active involvement, as shown in this fascinating paper. No seriously, this is based on an analysis of 11 million Rich Dads (and Moms and those without children), analyzed by the US Treasury department, UC Bekeley Chicago Business School and Princeton. Here, I’ll link it again.

I’ll leave it there and get to bed. Then I can resume making money while I sleep!

I gave a talk!

With words!

Nimble Machine Learning with Data Pipelines

It went extremely well. Because my wife is so visible as a vocal soloist in our community, people often ask what my artistic talent is. I’ve long been at a loss, but I (totally seriously!) think that it might be semi-technical communication. The moment I realized that was when I was tossing and turning at night, overcome by ideas for little tweaks that I could make to the presentation. In the same way that my wife obsesses over the details of her music (most of which I cannot even conceptually understand) I cannot help but obsess over the conceptual flow, metaphors and energy throughout my presentations.

A quick meditation on the value of bureaucracy

When people think of bureaucracy they often imagine the DMV. And it often deserves its reputation. I think there’s a 1% chance that all of the offices have been infiltrated by foreign operatives with the long term goal of undermining American faith in government. Our own Central Intelligence Agency distributed a guide for accomplishing exactly that (see page 28).

But, in my role as slight-apologist-for-everything, I think our cultural version to it throws some baby out with the bathwater. This was my (weirdly abstract) take away from a pair of books that I have read recently which seem extremely disconnected: Killers of the Flower Moon and Bad Blood. The first is about the cold blooded murders of Osage Native Americans for the purpose of stealing their reservation’s oil riches. Some of victims were essentially killed by their own white spouses – a betrayal shocking even in the context of a horrific history of mistreatment. The second is about a blood testing company Theranos, which lied to investors, regulators and ultimately patients about their ability to detect disease.

Both stories are written chronologically, giving the reader a growing dread as suspicions slowly solidify into horrifying reality. In both cases, the eventual scale of the harm overwhelms even those who initially started looking into it. But there are more subtle connections between the two books, even though the Osage murders took place nearly 100 years earlier than the Theranos you-can’t-quite-prove-that-there-was-manslaughter.

Then, as now, most people are not actively evil. However, choices are rarely made with full information. And people’s curiosity can vary quite a bit. As Upton Sinclair said “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

For the Osage, it was the local law enforcement, and townspeople who shrugged their shoulders when no progress was made on the case. For Theranos, it was the many executives who hindered and overruled their own due diligence processes.

Processes – that’s where the bureaucrats start to look awfully attractive. They really, truly, don’t care about you. They don’t care if you’re an oppressed minority, or a charismatic Silicon Valley founder. There’s no upside to treating anyone differently, no glory in being the one who approved or denied some specific application. Just a stack of papers and a vague fear of being fired for breaking the rules.

Of course, they’re not all perfect. Some are susceptible to bribes, or become petty tyrants. But every system is made up of components. And a system that rewards by-the-book conservatism 99% of the time is going to be made up of people who are, as individuals and as a culture, pretty resilient in the face of fishy behavior. So let’s definitely have some elements of the Wild West in our research labs and movie studios. Even in our companies! But when there’s pressure to ignore age-old processes of justice, regulation, policy, or even democracy “just this once”, it’s worth understanding why our society found it worthwhile to build them up in the first place.

What is Quantified Self? (And why should you care?)

As a child, the word “science“ evoked image of making volcanoes out of vinegar and baking soda. Of course, I enjoyed making the ensuing mess as much as any kid. But I think it is a tragedy that I (and maybe you too!) finished school without realizing what science really means.

Making volcanoes is not experiment

We followed the volcano worksheet,  and got exactly the result we were promised. It was like a cooking recipe, with a paragraph about chemistry at the end. We never got to say “I wonder what would happen if I tried it that way?“ Nor did we ask about the principles at play. At the root of it, that’s all scientists are doing: Looking for universal patterns and principles.

Does everything move towards the center of the earth?

The specific techniques vary based on what is being measured, but all scientific disciplines share the basic cycle of brainstorming a theory, designing an experiment and analyzing their data.

If you want personally relevant insights, you might need to discover them yourself

As much as astrophysics is fascinating, I don’t have the money for a radio telescope. As much as cancer research is important, MIT wisely prohibits amateurs from messing around in their labs. But smaller things matter, too. Maybe they’re not life threatening, or only impact a tiny percentage of the population. But I think that we’re all “a tiny percentage of the population” in one way or another. If you’re frustrated that nobody’s figured out the universal solution to your problem yet: Good news! You and your sample size of 1 are uniquely well positioned to do some SCIENCE.


And, as anyone with a mosquito bite can tell you, nothing is so motivating as your own itch.

So, Quantified Self

The British Royal Society’s 358-year-old motto is Nullius in verba, “Take nobody’s word for it”. Quantified Self says that you do not need to rely exclusively on an expert or even a book to make your decisions. You can brainstorm a hypothesis, design an experiment, and analyze the data – all by yourself. If you don’t get the outcome you want, just run another! It doesn’t have to be complex, and most experiments that I’ve seen people do are virtually risk free.

Nor does it invalidate expert advice. In fact, one of the benefits of experimentation is that you come into conversations with experts with much more knowledge (and confidence!). Many of my most successful experiments have been in collaboration with doctors and other medical professionals.

Whether it’s managing an ache, improving my personal productivity or even deciding on my retirement plan, the scientific mindset has enabled you to systematically develop understanding and make progress in life every day, and I hope it can help you too!

Misc Quantified Self Resources

  • Patientslikeme: Organized around medical diagnoses, which makes a lot of sense, but can be a little difficult if the problem is lack of firm diagnosis
  • EverlyWell: I got so excited when I read what they do, but some background research (always do the background research!) turned up some very credible concerns. Stat News is especially reliable, so I’ll link to that, but there are others:
  • Considered the gold standard in aggregating and summarizing medical research. They’re pretty conservative, which is appropriate in a field that’s inclined towards hype, so it should be your first but not necessarily last stop if you’re trying to find relevant scientific articles
  • Another aggregation site. Make sure to actually look at the studies, because you might realize that there’s a twist which gets a little lost in the broad categories. For example, you might see “4 studies suggest that X reduces Y”, but upon inspection, 3 of the studies were on pregnant women and 1 was related to surgical complications. If that doesn’t describe you, downgrade your confidence appropriately
  • Doctor/Nurse On Call through your insurance: I’m not sure how prevalent this is, or how useful, but it’s often free (or 1/10th even a basic office visit), so worth looking into. They often don’t give you a definitive diagnosis, but can allay fears and/or suggest some low impact lifestyle changes that might help

Should I go to a Nutritionist? (Post #1)

One way to narrow down the list of medical professionals that I could go to is by looking at what my insurance will cover. This is pretty compelling, since it offers a chance that my out of pocket expenses will be lower. It’s a perverse indication about the healthcare system that this is just a chance, between random denials of coverage, and things like 10% co-insurance on services that cost 15x as much as they should.

But, when I look at “Find Care” under my Aetna website (which is quite a bit better designed than I would have expected, so check it out if you happen to have Aetna), there are 5 categories under “Alternative”:

  1. Acupuncture: Not relevant
  2. Chiropractor: Not relevant
  3. Massage Therapist: Wish I’d checked here before paying for one last year!
  4. Naturopathy: I’m surprised that Aetna is covering this. For all the (often justified) flak that insurance companies get, there’s something to be said for having a voice in the system that says “I really need to see some statistical proof of effectiveness before subsidizing this treatment”. My feelings about naturopathy are here.
  5. Dietician: That’s what we’ll be digging into today

The problem is that the list gives me dozens of choices, but no relevant information to select on. They’re all listed simply as ‘registered dietician’, with no indication of whether they specialize in weight loss (which is not my goal) or something else. And there’s even less information about what I’m really looking for, whether they would work with me over time as an active partner. That’s the sort of thing that would come out in patient reviews, but less than 10% of providers have any, and they’re incredibly focused on the patient experience, not the clinical approach or outcomes. Some examples:

  • Not only do they never postpone my appointment, they always try go get me in as fast as possible.
  • They had plenty of staff members to help me whenever I needed assistance
  • They’ve never used foul language, which bothered me at some other places I’ve been to

This isn’t going to help me find the relatively rare approach that I’m looking for. The next step is going to see if any of them have blogs or other outlets where they discuss their philosophy and see if they think about things besides weight loss, regularly consider the medical literature, and generally appear to think critically and flexibly.

UPDATE: I’ve done that for everyone within a 3mi radius. People are pretty non-specific, saying things like “helping others develop a healthy relationship with food and reach their health and wellness goals” (LinkedIn) While I’d love to find someone who’s tweeting an in-depth literature review around a relevant set of symptoms, the realistic signal that I’m looking for is that they self identify as focusing on scientific and quantitative approaches. Barring that, just some specificity would be great. Here’s a good example: “My expertise & passion is in the prevention and treatment of diabetes.” (LinkedIn) Not a fit for me, but I much prefer to come to a crisp ‘yes/no’ than the endless ‘meh’ that the previous example provokes!

One of them had a website full website, though it was last updated in 2015. She referenced going to a conference at Harvard, which is the best that I’ve found so far. I wish that I had something better to go on, but that puts her well ahead of the pack, so I’ve reached out.

UPDATE 02: I went to her and it was pretty good. No breakthroughs, but I will try out a few of the things she suggested and go back in a month or two.

Should you go to a Naturopath?

This ended up being shorter than originally envisioned. My answer is: No, unless a specific course of treatment has proven effective for someone whose judgement you really trust, is extremely low cost/risk, and is not replacing more widely accepted treatment.

What is a naturopath?

Broadly, anyone who defines themselves as one. 17 US states also have a licensing system, and there are a handful of schools that are accredited to teach it.

What’s worrisome?

These schools teach some things which I am willing to have an open mind about, like massage therapy and dietary advice, but it also teaches things which are widely discredited like homeopathy. Worse, they are linked to the anti-vaccine movement (more here). The schools and professional bodies have also reportedly behaved in ways that suggest less of a “Let’s rationally investigate and debate these alternative approaches which could have value” and more of a “Let’s squash the non-believers” mentality. I came in willing to give them benefit of the doubt about being honest, if sometimes credulous, truth-seekers. More details here.

Sermon Review: Truth and Empathy [2018.04.22]

My wife has been encouraging me to find ways to engage with the FUUSN community, as we’re relatively new to checking it out. Most of the things which appear to compel longtime worshipers (regardless of specific denomination/religion) have never resonated with me, but Samuel Foster’s rookie sermon had just provoked a bunch of thoughts. And since writing a sermon review can’t be considered weirder than putting Barney in your TensorFlow installation guide, I figured this was as good a first step towards experimenting with building a relationship with the church.

Theme 1: Coming To Agreement

Sam started with a recurring dream about finding his sister in a big city. She was also looking for him, but they had no way of communicating, so they each needed to guess where the other was likely to guess they would be likely to go. I almost yelled “Aha, a classic Schelling Point!” but I’m still not clear whether this is one of those congregations where people yell about spirits or game theoretic concepts.

The sermon deftly wove in the morning’s childrens’ story, about the blind men coming to different conclusions based on feeling different parts of an elephant (summary here). This had a twist which I hadn’t heard before: They argued angrily until the Prince asserted his comprehensive understanding of its nature, and gave them a pleasant elephant ride home. This segued into the next theme:

Theme 2: Objective Reality as Power

The moment I decided I loved the sermon is when Sam pulled apart the layers of the children’s story and questioned the implied superiority of the Prince’s viewpoint, even pointing out the political power dynamics both within the story and around its creative goal: “After all, storytellers must also be paid. ” Fortunately, he was respectful enough to do so after the children left so that they did not become upset or postmodernists.

This is a good illustration of his third theme, which I’m going to summarize with a word that I don’t think he actually used:

Theme 3: Empathy

The final major touchpoint was a poem which had been read, about a gas station and its visitor’s transition from judgement to humanization of the dirty grease-covered owners. That transition, based on no new objective information, started with the recognition of details that suggested home. In particular, a home that somebody loved and cared for, just as much as the visitor presumably cared about her own.

Throughout, there were references to the church community. Like the elephant, it’s bigger than any one of us can touch. Like the urban search, the ‘right answer’ depends entirely on what everyone agrees on. And like the gas station, we’re going to have different initial reactions to the same space (physical, social, political, etc), but we need to at least consider each others’ viewpoints when passing judgement.

In fact, particularly in the elephant segment, Sam celebrates the diversity of truths that the blind men initially came to, and suggests that their abandonment in favor of the Prince’s was a loss. I’d argue that the acceptance and rejection of divergent truths needs a more nuanced treatment

My Thoughts

In the elephant story, it’s not clear what the blind men plan to do with their understanding of the elephant. Are they trying to decide whether to be scared of it? Because then the one who felt the trunk, and declared it like a snake, would sound awfully alarmist to the one who felt its rope-like tail. If they planned on cooling off with it, the one who felt its ears could never coordinate with the one who push on its side. In fact, the very existence of differences caused them to get into a loud argument that attracted the prince. It was only when he aligned them on a completely different model of elephants (as things you could comfortably ride), that they got any benefit from the whole exercise.

Many situations are like this. There’s no moral reason to drive on the left or right side of the road, but it’s very important that we all agree. The book Sapiens argues that the primary advantage that humans had over the apes was our ability to create ‘myths’, which started with specific variants of “God will kill you if you are not pro-social” and have evolved into “You can trust that this dollar bill will have value tomorrow” and “voting is a thing you should probably do”. They allow us to coordinate at a level that would be unthinkable in an I-only-trust-my-family-and-friends culture. And if you think that organization based strictly on mutually held ideas is unstable, try changing one.

There are certainly situations where a diversity of opinions is valuable. The average tourist’s obsession with the Mona Lisa is probably more of a headache than benefit to the Louvre. Science is driven forward when one person thinks “Maybe things work a little differently” and proves it. But what’s critical is how they act in the meantime.

Specifically, respecting other people’s dignity. It’s easy to see how telling someone that one of their beliefs is wrong could disrespect their dignity. Worse still is not telling them, and simply disregarding both their opinions (which might be invalid, if based on flawed assumptions) and their needs (which are quite likely still valid!).

There are actually plenty of examples of the opposite, where everyone has a similar mental model, but some are being massively victimized anyway. The Stanford Prison Experiment is case in point. The participants knew that their assignment into prisoner and guard were totally random, and the prisoners knew that they were getting the short end of the stick. They certainly disagreed on things, but largely did it within the shared model of how prisons worked. There didn’t need to be a breakdown in either shared facts or beliefs for one group to be systematically deprived of dignity.

So I guess what I’m saying is that, in general, we should be striving to converge our understanding of reality. We should also acknowledge that we’re far from it at the moment, and need to have meta agreements for managing our disagreements in the meantime (voting is a common one, though not without drawbacks). But, critically, it should all be in the context of trying to lift the common denominator, and for the love of god prevent our children from becoming postmodernists.

Lessons from installing TensorFlow 1.7 for NVIDIA GPU on a Samsung Odyssey running Ubuntu 17.10

I’ve never been so jubilant to see custard apple (score = 0.00147) in my terminal window. It meant that I had finally classified an image using TensorFlow on my brand new GPU. Despite my confidence as I sat down with the visually appealing official guide, I found the process to be time consuming and frustrating. Based on the number and diversity of issues I saw others having as I Googled (actually DDGed) around, it looks like I’m not alone. As the beneficiary of their hard won experience, I wanted to contribute some of the things that I learned in the process.

I’m going to experiment a bit with the structure, alternating between abstract and specific thoughts. The value of specific thoughts is intuitive, but worth illuminating: None of this article has any value if it doesn’t help you, the reader, do something differently. Not “change your viewpoint” or “deepen your understanding”, but literally tap a different sequence of keys on your keyboard than you would have otherwise. Directly saying “Type this, not that” is the shortest path to this goal, and shorter paths are less likely to be waylaid.

Unfortunately, as Barney the Purple dinosaur tried to warn us, we’re all unique in our own way You're special!. This is mostly a good thing, but it can make it difficult to share advice. If nothing else, simply copying my .bash_history would start to fail as soon as you got to paths starting with `/home/mritter/`. You’re smart enough to trivially take that, abstract it up to “He means his home directory” and granularize it back to `/home/jsmith/` or whatever. You’re smart, you could do this, but there’s no reason I should make all of my readers perform that same first step, particularly for less obvious situations.

Specific: Ensure the right graphics driver is being used by blacklisting the default

Even after going through the installation steps, my Samsung Odyssey laptop wasn’t recognizing the existance of my GPU. The final step to fixing this was editing my /etc/modprobe.d/blacklist-nouveau.conf file to contain:

blacklist nouveau
options nouveau modeset=0

then running sudo update-initramfs -u

and restarting. I could then confirm the recognition of the GPU with `lshw -C video`. I tried other things beforehand (the probably-relevant parts of which will be detailed below), but I can’t know whether they were critical to this final bug or totally separate.

Abstract: The state space with positive outcomes was much smaller than I expected

Because the guides that I was reading were a few months old (which is years in internet time, and centuries in Deep Learning time), I assumed that I should just use the latest version of each suggested library or driver. This assumption has served me well for dozens of previous installation processes, but it failed this time. Perhaps I should have been more suspicious because of the unusual cross-corporate nature of the situation, or maybe you just win some and lose some. I won’t get into all of the other instances where a minor deviation from the advice cause cascading issues, but it was an important reminder that “extremely similar” configurations are not always good enough.

Specific: Be careful with CUDA 9.1!

The first major issue that I identified after trying to follow this comprehensive guide is that I’d installed CUDA 9.1 instead of 9.0 I assumed that since it wasn’t a major version number, it would be fully backwards compatible. To its credit the official documentation mentions the correct version number, but some of the commands it suggests default to the more recent version of various libraries, which have presumably changed since it was published. This short video  does a good job of outlining the small changes you need to make for it to work.

Note that you can get away with 9.1 if you build TensorFlow from source. But that sounded like opening up a shipping container of boxes of cans of worms, so I didn’t go down that route.

General: This stuff is still bleeding edge

I’ve always had a romantic notion of what it would have been like to work with steam engines during the Victorian age, or airplanes when they were new. New records being set every day! Limitless opportunity! …And frustrating setbacks caused by obscure parts!

The Wright Brothers, for example, had attempted a flight before the one which went down in history. It took two whole days to repair the ‘minor’ damage that the machine suffered, so that they could make their successful attempt. Their inspiration, a world famous glider pilot named Lilienthal, had (over the course of his 5 years in the spotlight) spent just 5 hours in the air. About half a workday actually doing the thing he was world famous for, the rest of the time handling logistics.

Good user experience fades into the background, and it’s easy to forget how hard and complex things are. When you’re at the bleeding edge, there’s nobody in change of making your experience pleasant, or even guaranteeing that what you want to do is even possible. When you’re lucky enough to find a guide, it usually assumes that you have considerable experience, which will let you fill in the gaps. For example, when was the last time someone digressed from their Stack Overflow answer to clarify “sudo means that you have to type your admin password”? That’s just a common denominator on that website, as are hundreds of other little bits of knowledge. Somehow our computing culture has come together on some de facto curriculum that lets most people understand each other, most of the time. But on the bleeding edge, when you’re talking about graphics drivers and rapidly updating libraries, those gaps can become impossible to bridge.

Specific: These commands are your friend

sudo dpkg/apt-get --purge <package> # Completely remove an installed system package, including drivers
apt list --installed | grep <package> # Search through installed packages (make sure they're all the right version!)
sudo dpkg -l | grep "cuda" # Search through installed packages (make sure they're all the right version!)
lshw -C video # See whether the GPU is visible to the machine
lsmod | grep nvidia # See list of relevant drivers (Make sure none are of the wrong version)
cat /proc/driver/nvidia/version # See Driver information
/usr/lib/nvidia-384/bin/nvidia-smi # See GPU details

The hardest part of the project was not doing things, but UNdoing them. Followed closely by knowing whether I had to undo them in the first place.

General: Learn to quickly Create, Read, Update and Delete in the system you’re debugging

Because I was largely operating in a space that I’m unfamiliar with, I didn’t know how to verify that I was on track until the end of the installation process. That would not have been as bad if the errors I got there had been more specific, but I was left with a diagnosis that boiled down to “One (or more!) of the 10 steps that you took is interacting with one (or more!) of your unknowable number of system configurations incorrectly” That, combined with my lack of fluency with the basic CRUD operations around drivers, made debugging by elimination extremely slow.

Working through it with a friend who both had this background, plus a running system to validate against, was critical for getting mine set up. THANK YOU STAN!!!

Specific: CUDNN doesn’t usually seem to be the root of issues, and CUDA versions often are

The download page is mercifully specific about which CUDA version each CUDNN option requires. I didn’t have to re-install it after moving a bunch of other things around – it really is just a few files, which you can see with the ls /usr/local/cuda-9.0/lib64/libcudnn* command.

Make sure that you’ve got the right CUDA version (denoted by the 3 digit number) on your PATH (and its parent directory on your LD_LIBRARY_PATH) /usr/lib/nvidia-384/bin

That’s what I’ve got for you. If you’re trying to get TensorFlow set up, I wish you the best of luck – it’s definitely possible (as long as you actually have a GPU!), and actually doesn’t take too long if you’re lucky enough to find a guide that aligns with your needs perfectly 🙂 If you run into issues, I definitely recommend finding someone who’s been through it before recently. In this and so many things, there’s a lot to be said for good friends! (I’ll take this opportunity to thank Stan again – I couldn’t have done it without the 150+ chat messages that we shared while debugging everything.)

Choosing a Medical Provider – Overview (Post #1)

I’ve decided that I need to find a new doctor.

The problem isn’t with my current doctor, who I like quite a bit, but with the entire system around her. All of the ancillary stuff, like getting a referral, moving my records, getting significant time from specialists, has been disastrous. Because moving medical records is so difficult, I figure that I need to switch sooner rather than later, because every visit with her is further investment into a system that I don’t want to be at long term.

My first option is finding another MD in another medical system. That’s absolutely on the table, but there are significant drawbacks: 1) It will probably take me months to get the first appointment, and then weeks to a follow up. It’s like getting my medical advice by snail mail from England. 2) It costs at least $400 per basic appointment. Sometimes I pay, sometimes my insurance pays, but it’s certainly insane. 3) It takes at least 2 hours of my time for 15 minutes of actual doctor time.

To be clear, I believe in medical science, in the sense that I don’t think there’s any other process that reliably produces better understanding and advice on human ailments. On the other hand, doctors are not doing a complete literature review before each diagnosis. They’re listening to me for about 7 minutes, glancing through my medical record, and coming up with their best guess on the spot. They don’t submit a case study document with citations for peer review, and they don’t necessarily follow up after a week for detailed feedback on their treatment’s impact. While medical school was absolutely based on science, but the actual clinical process simply doesn’t allow time for an hypothesis-experimentation-analysis cycle.

So I have the highest respect for doctors and medical researchers. The problem is in the business. With the exception of some specific chronic diseases like diabetes, the model is designed for point diagnosis, not to work with patients over time (especially not with their active participation). That is why I started considering (emphasis on considering) other options. For what it’s worth, I’m hardly alone: about 1/3 of American adults were actively using a Complementary/Alternative Medicine technique according to the NIH (though it’s worth noting that they’re grouping together things like “Deep Breathing” and “Meditation” with “Chiropractics”).

One of the attractions of CAM is that many of the interventions are extremely low risk, and low cost. I already meditate, which almost certainly isn’t hurting anything, and has cost less than $50 for books and an app. In the last year, I’ve twice gotten therapeutic massages in response to acute muscle pain. The first time, it led to an immediate and lasting improvement. The second time, it didn’t work, but felt nice. ¯\_(ツ)_/¯ The benefit of the first absolutely justified the second. (1hr/$90 each)

So I’m doing some research into nutritionists, naturopaths (UPDATE: no), and anything else that people might find valuable. Email me if you’ve got ideas or personal experiences in this space!

UPDATE: I’m getting particularly interested in finding people who are more like guides than experts. A loose example would be a fitness guide, who might give their client some suggestions, some things to read, and check back in on a weekly basis. At the outset, they can’t know what will work, but by pairing objective research with the client’s ongoing results, they help iterate towards the right solution. Most of these people are focused on weight loss, though, not sure how to find anyone who helps with anything else!

UPDATE 2: I’ve looked into dieticians, with mixed results. But I’ve scheduled an appointment with the one who seemed most scientifically grounded.