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Culture War Roundup for the week of July 3, 2023

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I've got good news and bad news for you, my Indian friend.

The good news: You're already an American, at least in spirit. You understand this country, and thus you've assimilated. This is a boundless country, a place with no limits. An average sperglord from nowhere can become a millionaire, and having done so, lose it all on one night at the poker table. Having done that, you can hop in your car, head out over the horizon, and start again. Here bankruptcy is no shame, everyone wants to give you a second chance, and you call your boss by his first name.

This is a place where you can be born to a high school girl and a unicycle performer, be raised by that woman and her refugee second husband, get a first job at McDonalds, and become the richest man on the planet and start your own space program.

America is an egalitarian place, with little patience for the social distinctions of your native India and your adopted England. The status hierarchies that dominated life in what Jared Diamond memorably calls "the world before yesterday" are disdained here. America doesn't care about yesterday, and America doesn't care about who you are.

Silvio Berlusconi used to say that Italians would say "He used to be nothing but a singer on a cruise ship, and now he thinks he can be Prime Minister" as a way to mock him - but Americans would say the same exact thing, only as praise. You, a gregarious, funny, open-hearted brown man who loves AR-15s and America? We will love you here, and rednecks will fawn over you like a lost puppy.

The bad news: Your girlfriend is already an American as well, at least in spirit. She understands this country, and thus she's assimilated.

The angriest Americans are not, as you might suspect, the Africans. Whenever the African American asks for redress of his grievances, he does so not as an African, but as an American. He does not care that he was taken from Africa, and his demands revolve around the fulfilment of his rights as an American.

The angriest Americans are white women of a certain middling sort, elevated enough to feel superior to the egalitarian masses, but not quite high enough to escape them. To them, America is hell.

They are angry at America for that same reason you love it. They are angry that it is a place of chaos without social distinction, a place where you could lose a life of savings on the poker table, and where the markers of social position provide less insulation against the market.

This segment of America dominates our community and communication industries, for obvious reasons, and it is this segment of America that has assimilated your girlfriend. For better or for worse, they are as American as we are.

So where should you go from here? You are an American already in spirit, and we want to see you here. I have a dream that sons of former slaves, sons of former slaveowners, and gregarious Indian bros shall all bro out together at the gun range.

Your MD will get you into this country, just not as a doctor. You seem charismatic, and your ability to write clearly is exceptional even for our little community. There are plenty of finance and biotech companies that would gladly hire you. Exceptional communication skills and an MD are a rare combination, and a little brown guy tech job nepotism can't hurt.

As to your girlfriend, you can't reason someone out of something they didn't reason themselves into. So long as she sees this as a difference between the two of you, the harder you try to convince her of your point, the more she will be convinced that this is something you disagree on.

First, I'd back off. Validate her by validating her complaints. Agree with her that there are things and places about America that are terrible. Tell her that you'd love to visit America, perhaps for an extend period, and that you want to see the parts of America that everyone loves (generally speaking, the national parks).

By validating her concerns, and having provided the social proof of "the parts of America that everyone loves", you have built a relationship around the issue. Now, take the playfully oppositional view. Every time she expresses a Basic White Chick opinion about America, tease her, and tell her she's the one that sounds like an American now. Playfully object to it from a traditional Indian point of view, with a comical bobs-and-vagene intonation. Now you've set up a dichotomy in her mind of the high status first world American vs the low status third worlder.

Now that you've validated her feelings, provided a social context, and then subtly set up your point of view as high status, bring her to western National Park America. Get out of the cities as fast as possible, as they have all the problems she complains about - violence, inequality, greed, etc. Take a road trip. While the parks themselves are surrounded by high-priced tourist traps, rural America five miles away from the park gate is full of the stereotypical gregarious and generous Americans. Interact with them as much as possible. After a month-long road trip seeing everything between the Olympics to the Grand Canyon, she'll love it.

Thank you, this is a very thoughtful comment to make.

Part of the reason I even bothered posting in places where there are plenty of Americans (well, is there much where they aren't the majority? Vk or Bilibili maybe) is that my girl has internalized the kind of self-critique that many Americans themselves succumb to. They take the good for granted, and find only some satisfaction in signal boosting the BAD. Arguments that work against them would work on her.

If you have anything to add regarding the opportunities in Finance and Biotech you mentioned, I'd be very open to hear them. I have considered applying for Pharma roles in the UK, but they're already getting heated as the locals realize that they're strictly superior to normal medicine, at least in terms of pay and WLB.

(Shame she sees everything I write these days, my opsec is utterly compromised haha)

I am intent on dragging her there on a vacation, a close friend of mine getting married in the next year or two is sufficient pretext. Hopefully I have enough money to really see the sights, but I'm shameless enough to lean on the Bank of Mom and Dad if needed to make the most of it!

And indeed, you're right that I'm born an American at heart. Now onto the far harder task of signaling that with the rest of me.

First, the easy part: There are plenty of resources for American doctors who no longer want to practice medicine. Drop Out Club is the big one. An American doctor who no longer wants to practice medicine and an Indian doctor who may not practice medicine are likely to be searching for the same jobs.

Your MD or MBBS comes with two signals: knowledge of medicine, and general aptitude and work ethic. How close do you want to stay to clinical medicine, and how willing are you to take on additional degrees? The most direct paths out here would be management in a health care organization. The next step out would be working for a health insurance company, medical informatics, or a biotech company. Further out would be an investment, consulting, or accounting firm covering a one of those companies. The last step out would be a bottom rung analyst at such a firm. You can find a (likely unpleasant) first job in America, and then move up, or you can lateral out of medicine in the UK, and then jump over the the US. Lateraling into a US firm, and then getting a transfer, is probably the best move.

There are Americans born all over the world, they just need to come home.

Now the hard part: Your girl hasn't internalized any self-critique, because it's not self-critique.

America is based on the idea that we are all equal, even the proles. America loves proles, and proles love America - so much so that most of our electoral campaigns are full of PMC and upper class strivers pretending to be proles. Generational millionaires drive pickup trucks because they are pretending to be contractors and cowboys. They drive them to Home Depot, and often change their own oil. I love it.

Unfortunately, if you want to reject proles, you must reject America, as the two have fused into one. There's no place in our cultural mythology for a cultural upper class.

If you're a certain sort of social climbing young woman, there's a ladder to climb in England, there's a ladder to climb in India, but you cannot climb within American culture, so you must reject it. AWFL Anti-Americanism is a way of signalling that you're not one of the proles with their yards and their trucks, because there's no way to be an American without also being a prole.

That's why this is the hard part. You asked for "arguments that worked against them", but there are none, because you can't reason people out of something they didn't reason themselves into. For the educated millennial female, this is fundamentally a social and emotional response, and only social and emotional stimuli will move her.

If you're lucky, your girlfriend is a reasonably logical person who just isn't aware of the subtext behind basic white girl liberalism. Once you point this out to her, everything will start making sense. AWFLs are magnifying the (real and serious) problems with America not because they want to solve them, but because they're social climbers. If your girlfriend isn't a reasonably logical person, and like an AWFL is driven by the need for status and belonging, I wish you luck in the wars to come.

I find concrete advice tailored to my circumstances very helpful, and I'm grateful that you offered it.

How close do you want to stay to clinical medicine, and how willing are you to take on additional degrees?

The main reason I am in all this rush is because of my timelines till transformative AI. I think my median is about 5 years till.

This makes spending more than 2 or 3 years doing a degree something I am uncomfortable with, unless they payoff is astronomical. A PhD seems to be entirely off the cards.

I would personally like to do a degree, I feel like I missed out on a fun college or uni experience, and god knows I'm going to be studying my ass off anyway with no end of exams in sight. But my rational brain tells me this is an indulgence I can ill afford.

I have no strong issue with staying in clinical medicine, but only if the salaries are good, and by the time they're merely mediocre in the UK, it'll largely be too late.

As it seems, I'll probably be spending one year at the minimum working in the UK, I've done the hard part, and I just need to save up money.

The most direct paths out here would be management in a health care organization

My dad owns a hospital. It's a very small one, don't get your hopes up that I have fuck you money. It's more like fuck me money haha.

I don't want to stay in India if I can help it, which is why I never considered doing a hospital management course or staying here and running it.

If you say its an option in the States, I can look into it, but I feel like it's not something I have any real aptitude for. I certainly see how hard my dad works to keep it going, and it scares me.

The next step out would be working for a health insurance company, medical informatics, or a biotech company. Further out would be an investment, consulting, or accounting firm covering a one of those companies. The last step out would be a bottom rung analyst at such a firm. You can find a (likely unpleasant) first job in America, and then move up, or you can lateral out of medicine in the UK, and then jump over the the US. Lateraling into a US firm, and then getting a transfer, is probably the best move.

I have considered moving laterally into Pharma in the UK. It's all the rage with the pissed off locals, but I think my Indian degree is a mild handicap since they're looking for people with regulatory knowledge and field experience in the UK itself. Not impossible, but I'd need to spend a few years working there to build up my credentials I think.

The idea of going into consulting scares me, because if you thought doctors are mildly at risk from AI, the overpaid consultants of a different sort at McKinsey have seen nothing yet.

you're a certain sort of social climbing young woman, there's a ladder to climb in England, there's a ladder to climb in India, but you cannot climb within American culture, so you must reject it. AWFL Anti-Americanism is a way of signalling that you're not one of the proles with their yards and their trucks, because there's no way to be an American without also being a prole.

I don't think my girl has ladder climbing tendencies that I've seen, beyond a desire to escape the genteel poverty she was born into.

Other than that, I broadly agree with your points and think they're good advice. I hope that if I can drag her there on vacation, simply looking around will knock her out of a funk that mere verbal argumentation can't.

Meeting nice Americans , enjoying the lovely weather, seeing the sheer wealth and happiness they have, those are far more like to.

Thank you for taking time out of your day to help me! I'll mull over what you said, especially that Drop Out Club you mentioned.

This makes spending more than 2 or 3 years doing a degree something I am uncomfortable with, unless they payoff is astronomical. A PhD seems to be entirely off the cards. ... The idea of going into consulting scares me, because if you thought doctors are mildly at risk from AI, the overpaid consultants of a different sort at McKinsey have seen nothing yet.

At least in America PhD is merely a scam for foreigners who want a visa or Americans who don't understand time value of money. I was thinking more of a professional degree - executive MBA in the health field, a partially-remote data science or bioinformatics MA/MS. That leads to banking/consulting in the medical sector.

McKinsey consultants have nothing to fear from AI, because their job isn't to provide solutions. If you wanted to fix your problems, you could simply ask your employees how to improve. Managers hire a McKinsey consultant to give you social cover to refine and then do what they wanted to do in the first place. They are a priestly caste, not a service provider.

Non-MBB consultants might take a hit from AI, but even that's a good job as a springboard. You use your MBBS to get into the UK, you use your time in the UK to find some 1 year, possibly half-remote MBA/Masters, use that to get into banking/consulting, use that to get a transfer to the US office, use that to find out where you want to go in the future, which could be something different. It's the crazy American in me talking here - always be evolving, always be seeking, and swing from your vine to whatever better vine is swinging by.

If AI is your thing, there's probably someone hiring in medical AI.

I don't think my girl has ladder climbing tendencies that I've seen, beyond a desire to escape the genteel poverty she was born into.

Then tell her the real truth about AWFLs and social climbing. Watch her normie feed, and point out every time someone says something disparaging about America. See if there's a hidden class climbing motive to it. There almost always is. 99% of the time it's some AWFL trying to show how they're more caring/educated than their prole background, or complaining that their life is so hard because they're underappreciated by the proles. I've managed to pop plenty of rational but agreeable women out of the basic white chick liberalism memeplex simply by pointing out the status posturing underlying so much of it.

This isn't to say that America doesn't have problems. Be honest with her, America has problems, some of America's problems can be solved, and some of America's problems can be solved by (honest) liberals. But AWFL liberalism isn't about solving America's problems, America's problems, or even America. It's about the social status of AWFLs.

Out of curiosity - why are you ineligible to take the USMLE exams? I'm assuming you graduated from a decent medical school in India, and after having done that you could take Step 1 and 2. After that you could apply for a US residency. Unfortunately, I can't help you there, being a lowly medical student.

https://www.themotte.org/post/565/culture-war-roundup-for-the-week/117227?context=8#context

My med school was below average, I was horrendously depressed and couldn't convince my parents to get me treated for ADHD when I gave the NEET exam necessary to get in. As the name suggests, if you don't have any AA to help you, you need to make yourself a NEET studying 24/7 to get in.

If I'd known that it would lead to all of this, I'd have never joined, gone to the other place I qualified for, or just dropped a year and tried again.

So I can't sit for the USMLE, but all hope is not lost since the ECFMG told me they can retroactively certify us if the college can prove that their quality of education at the time met ECFMG standards.