domain:vinayprasadmdmph.substack.com?page=0?page=1
Dean
12m ago
Further back, Great Expectations was already deconstructing the trope with Pip heading off to become someone.
I've always considered that in particular to be a good demonstration of the sin of Pride. I've known plenty of people who thought only the Important People could be prideful, as if to be full of pride required something to be justifiably proud of. I've tended to disagree- the phrase 'temporarily embarrassed millionaire' seems suitable characterization of prideful people of modest means.
HalloweenSnarry
19m ago
I would counter your assertion by raising the example of Hardcore Henry, but that was a year short of your second cutoff point.
FiveHourMarathon
Listen to Pierre
20m ago
But my point isn't about the unity or diversity of right wing viewpoints, it's about the way issues are pulled to front or pushed to the back burner or memory holed by forces vastly larger than any one substack writer. I'm not concerned with who is in the tent, I'm concerned with which ringmaster is putting on the circus.
I posit that a lot of people like OP think that they're independent and heterodox thinkers, taking bold stands against the mainstream, when really they're just eating up slop someone else chose for them. They're downstream of a vast and powerful party apparatus, which they imagine not to exist because those running it desire to create an illusion of insurgency that serves to disclaim their power.
sodiummuffin
20m ago
In real life female peach-fuzz/vellus hair is normally very short, very fine, and barely-noticeable. Videogames generally do not depict details that tiny, so if a videogame model tries to depict something like that there's a good chance of it ending up being bigger and more prominent than it almost always is in real life. Compare to something like the left side of this stock photo. The real face has an incredibly subtle fuzz, with 3 tiny strands of longer hair, while Aloy's face seems covered in hair as long as those 3 strands. Or this set of 279 photos of women without makeup.
There is of course a range of exceptions (all the way up to women with full beards), and either those are the target audience for peach-fuzz removal products or they use them as examples while expecting the actual audience to be women with a more normal amount. But it's pretty far from typical. Now, I don't think the developers outright planned to have her be an outlier, I think it was probably "we have graphics so good we can have this incredibly fine detail", and then when that wasn't actually true and it was too prominent they were woke enough that nobody was willing to point that out.
sodiummuffin
46m ago
That screenshot is from Horizon Zero Dawn in 2017, the one people complained about/mocked was her changed model from Horizon Forbidden West in 2022. Here is her 2017 model compared to her face-model Hannah Hoekstra, while here is a comparison with her 2022 model. Also here is her early Zero Dawn concept art and here is the famous comparison with mukbang Youtuber Nikocado Avocado.
HaroldWilson
54m ago
Not in such basics as 'not loading', but qualitatively the twitter experience is now way worse, to the point I don't really use it anymore it's so bad. The prioritisation of blue check replies has made replies on any post that becomes popular totally worthless, since it's mostly bots/meaningless garbage. For You is totally worthless as it just serves up the worst kind of lowest common denominator internet slop, and while one can (and I usually did) just use the other tab for accounts you follow, twitter alongside mostly giving me my own follows' posts used to regularly suggest interesting and worthwhile smaller posts and accounts. Now the garbage rises to the top, the cream to the bottom. Checking back now having been away for a few weeks I've been followed by 50+ scam bots.
So while it still functions what made the app useful and good has basically been totally ruined. I think monetisation was a dreadful idea since it gives strong incentives to post slop in order to rise to the top, and the same goes for allowing people to pay to boost their nonsense. No doubt the slop existed before Elon, but I at least never really had it pushed to me by twitter before, it became relentless so no I don't bother. Elon's own account is really the embodiment of the kind of place twitter has become. It would probably be good again if they summarily IP banned anyone who had ever bought a blue check.
I have no idea whether any of this has anything to do with the staff that were sacked, but I think it's a cautionary tale against tech bro 'disruptors' and the 'move fast and break things' philosophy. For all people rightly say 'twitter isn't real life', it used to be a pretty important gathering place for influential and interesting people in the UK politics, policy and journalism sphere. Now it tends to be like scrolling a big subreddit in 2014.
self_made_human
Kai su, teknon?
59m ago
Assuming they actually prolong life. My understanding is that "statin clinical trials have shown marginally significant benefits on mortality" at best over 5 years, and there's no good evidence they reduce long-term morality. That's why I came here to ask the question, I'm curious if there's newer or better evidence to support their effectiveness. If they don't work, then we're just risking side-effects for no gain.
I haven't seen any studies recently that have made me update significantly. I do agree that the benefits from statins are marginal, which is why I pointed out that they're so cheap that it's not too much of a fuss to take them. For primary prevention, it's minimal, it's somewhat better for secondary prevention where an adverse cardiovascular event has already occurred.
The risks, however, are also rather small. So we have a class of drugs that doesn't do very much good, doesn't do very much harm, but on the margin seem slightly positive and don't cost much. I wouldn't go out of my way to recommend them, but I have no issue with prescribing them either.
I get that nutrition is hard to study, but do you really have no opinions about this topic as a doctor? Shouldn't lifestyle changes be the first line of treatment for this sort of thing? If you had to recommend the optimal diet to a patient with high cholesterol, what would it be?
Please keep in mind that I'm a psychiatry trainee haha. While dietary advice isn't out of my core practice, especially with diseases like bulemia or when some drugs cause weight gain, I genuinely think that overly obsessing over dietary intake beyond basic, Common Sense™ knowledge is of minimal utility.
If someone did ask me for dietary advice (and everything is from a do as I say, not as I do stance, don't look at what I eat), then I'd suggest making sure they're eating leafy greens, and avoiding large quantities of deep fried or smoked meats. I'm not going to tell them how many eggs to eat, or what brand of milk to drink. Even for the advice against highly processed meat, the carcinogenic risk is also tiny in absolute terms, so I wouldn't belabor the point.
I do this not because I enjoy being ignorant, but because nutritional science makes no sense. As long as your diet avoids any obvious nutritional deficits and you're getting vitamins and minerals, while keeping to a healthy weight I'd be fine with it.
More specific advice would be tailored towards people with particular diseases like diabetes, and for those with cholesterol issues, I'd stress weight loss more than any particular category of food.
(Mild exception, I think the evidence for ice cream being good for you is interesting, and unless you eat a bucket a day having more won't hurt)
She is not at all overweight, goes on long hikes/jogs daily, skis, bikes, and is otherwise very physically active for a 70 year old.
She's doing better than me! I'd tell her to keep on keeping on really. While GLP-1As have some surprising benefits, with interesting evidence emerging of all kinds of surprising yet positive impacts, including reduction in Alzheimer's risks, I would at least recommend looking into them, though of course you'd need a doctor willing to prescribe them. But if she's otherwise doing well and her existing diet isn't grossly unhealthy, I'd say to not fix what isn't broken.
SomethingMusic
1hr ago
Just an FYI, inherited retirement accounts have a minimum required distribution (on which you pay taxes). Please look at the details with a financial planner or advisor, because if you don't take the RMD it will be taxed at ridiculous rates.
orthoxerox
If you can read this, you're using a custom theme
1hr ago
That's my go-to burger sauce! I haven't tried it on fries yet.
Ben___Garrison
Voltaire's Viceroy
1hr ago
The relevant line from Noah is here:
In the 2010s, immigration went from a technocratic consensus to a progressive cause célèbre. This happened for two reasons. The primary reason was that Donald Trump and his reactionary movement were against immigration, probably on racial grounds (though they never explicitly admit this). For many progressives, that made fighting for immigration a way of fighting against racism. A more minor reason was that many progressives either implicitly or explicitly bought into the idea that immigration would create a permanent Democratic majority.
This all seems broadly correct to me. The Gallup chart he posts indicates the left really did become much more pro-immigration during Trump's presidency, likely due to thermostatic equilibrium. They're WAY more pro-immigration than, for instance, the 90s as you say. And while not all people who oppose immigration (like me) oppose it on racial grounds, there are many (including on this very site!) who do.
While some schools may still be quite woke, the first derivative on DEI efforts overall is negative. The NYT published a very long hit piece on UMichigan's DEI efforts, for instance. There will still be some schools that are holdouts, but that's to be expected given academia is where wokeness was born and where its staunchest advocates came from.
I think of wokeness today like I think of evangelical Christians in the late '00s or early '10s. They still have some residual power, but they're losing on every front. Your perspective from academia is like someone from a megachurch telling me nothing has changed to evangelicals.
WhateverHappenedToNorman
1hr ago
Innocent black men are routinely killed by corrupt police in large numbers,
Not a conspiracy theory, just a retarded belief.
and the murders are covered up.
Are there (a significant amount of relevant) people who believe this?
Brett Kavanaugh is a rapist, and the Republican machine helped him cover it up.
This also seems like a strained framing, a lot of blue tribers believe that Brett Kavanaugh is a rapist (unlikely but unknowable) and believe that Republicans don't care about it because they hate women/whatever (wrong, Republicans just don't believe he is a rapist).
2 and 3 are one point stretched into two. But it's true that Russiagate stuff is definitely conspiratorial thinking, but it's miles more believable than QAnon (so is the Stop the Steal stuff, for whatever that's worth).
guajalote
1hr ago
The Number Needed To Treat for statins is about 138.
I believe her LDL is around 135.
I would suspect that given standard monetary values of QALY and DALY in the West, it would be a net positive given how damn cheap drugs are.
Assuming they actually prolong life. My understanding is that "statin clinical trials have shown marginally significant benefits on mortality" at best over 5 years, and there's no good evidence they reduce long-term morality. That's why I came here to ask the question, I'm curious if there's newer or better evidence to support their effectiveness. If they don't work, then we're just risking side-effects for no gain.
As for eggs, I have more or less given up on attempting to understand nutritional science, there's hardly a more cursed and confounded field on the planet.
I get that nutrition is hard to study, but do you really have no opinions about this topic as a doctor? Shouldn't lifestyle changes be the first line of treatment for this sort of thing? If you had to recommend the optimal diet to a patient with high cholesterol, what would it be?
I ask this because my mother is something of a health nut and will follow credible diet and lifestyle advice religiously. When her doctor told her to cut out red meat, butter, and eggs, she completely eliminated these things from her diet. If a doctor told her eating nothing but unseasoned boiled potatoes was the key to lower cholesterol, she'd eat nothing but unseasoned boiled potatoes. On the other hand, her doctor has not told her to avoid things like processed sugars or margarine, so she still eats plenty of that stuff.
So I'm interested in trying to set her up with the best evidence-based diet and lifestyle interventions possible. Since she is going to religiously follow some sort of diet program regardless, it may as well be the best possible program.
Finances willing, I'd put very many people on GLP-1 agonists, so if granny could do with losing weight and not just cholesterol, that's my recommendation.
She is not at all overweight, goes on long hikes/jogs daily, skis, bikes, and is otherwise very physically active for a 70 year old.
hydroacetylene
1hr ago
Uh, what do you think a ‘government’ is other than the biggest, strongest gang?
pigeonburger
1hr ago
The universal root of horror is not death or pain, it's powerlessness. For women it tends to be loss of social power. For instance, desperately pleading to someone for help only to be ignored or dismissed, or being unable to exert any influence on others. That second one is what a lot of this "suburban 50s" genre is playing to.
Turniper
1hr ago
Pretty sure it was this one: https://exploringegregores.wordpress.com/
BurdensomeCount
Apparently "BIPOC" is a racial slur now.
1hr ago
There is no good reason to ever watch or read anything made after 2012 and doubly so after 2016. There's enough great material to last you a lifetime from before then.
Ben___Garrison
Voltaire's Viceroy
1hr ago
I haven't seen any evidence that puberty blocker hormone prescriptions are down or anything of the sort.
Is there any data on this anywhere? The way you're wording this is a bit sus, making a claim without evidence, but implicitly demanding evidence of a specific kind for any rebuttal.
FCfromSSC
Nuclear levels of sour
2hr ago
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Innocent black men are routinely killed by corrupt police in large numbers, and the murders are covered up.
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Donald Trump is a Russian Asset, controlled through Kompromat.
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The Russians hacked the 2016 election
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Brett Kavanaugh is a rapist, and the Republican machine helped him cover it up.
It seems to me that these four fit your definition of "conspiracy theory", do they not?
hydroacetylene
2hr ago
Monasteries in the late Middle Ages, mostly.
These were well known for obesity.
hydroacetylene
2hr ago
It’s a civilizational horror of mediocrity. A deracinated and atomized people always, from every perch, know deep down that they don’t matter. In the Anglosphere you aren’t born someone unless you happen to be born into the British royal family; to not make something notable of yourself is to be no one.
In other societies- the ones humans are designed to live in- everyone is someone. Male or female, slave or free, old or young- there is a role, a set of marching orders from the top of society to the bottom, and it is no great sin to be average at whatever your role is. In the Anglosphere, to be average is to be so bad as to not have a role, not have a spot in society.
This may have gotten worse over time, but it is not a new problem- the plot of It’s a Wonderful Life is about Mr Bailey despairing at being no one and being convinced that he is some one. Further back, Great Expectations was already deconstructing the trope with Pip heading off to become someone.
HaroldWilson
2hr ago
They have completely different standards from what constitutes "unfit" from the mainstream Republican voter. It's a two-party system, you vote for your guy and against the other
They should have different standards. They owe the voter their judgement, not their obedience. Also, Murkowski and Collins are not 'defecting' from anything because they were never part of the Trump coalition. 'Republicans' might have lost the presidency without Trump, but for Collins particularly he is a liability who will probably sink her in 2026. Tulsi is not 'their guy' for moderate or hawkish Republicans, they hold her views in total contempt - why would they ever vote for someone who is very nearly the last person they would ever choose to fill that role? Politics exists outside of the eternal horse race. They think she would be a disastrous DNI, so they won't vote for her. Simple as.
Calling cabinet appointments fundamentally random, as OP did, is an anti-explanation.
They are obviously not random in the most literal sense, what he likely meant is that appointments are being made without any cohesive overall strategy, on an ad-hoc basis. Individual picks have their rationales, but out-of-range disruptive picks like Tulsi and Gaetz destroy any chance of it being some sort of compromise, unity cabinet. I don't think this is an unreasonable perspective to take on Trump of all people, someone who managed to drift fairly in a fairly directionless manner through a whole four year Presidency. Perhaps if he did have strategies he might have achieved something other than tax cuts.
She has more experience in politics than Obama or Trump did when they assumed office.
She does, but roles like DNI require more experience than President, and I mean that very seriously. Since a President can by definition not be an expert on all of his briefs, it doesn't really matter if he's expert in none of them. Advisors and officials like the DNI however are there precisely to provide expert and experienced guidance from a like-minded political perspective. Even Trump's longest serving DNI last time round had been in politics since 1976, had a strong interest in foreign affairs throughout his time in Congress and was a former ambassador to Germany.
ThenElection
2hr ago
Not quite a suicide and more "nothing to see here, just bad luck," but the crash of the airplane carrying Lin Biao.
The official story: Lin Biao was planning a coup against Mao, but once he realized it was going to fail, he hopped on a plane with his family to flee to the Soviet Union. Unfortunately, he forgot to put any fuel in it, so it ran out of fuel early on and crashed in Mongolia.
There are some conspiracy theorists who find this suspicious.
urquan
2hr ago
I am fascinated by this genre of "horror" (loosely described) having such a hold on women.
Heck, I'm surprised horror-qua-horror has such a hold on women! All the people I know who are into horror movies are women. Not to mention True Crime!
It seems like women are either really not into horror, or they're really, really really into horror.
What is the patriarchy or whiteness except the ultimate in shadowy central planning? With it white men crushed and destroyed the natural inclination of society to employ black women in every leadership role and it wasn't until about a decade ago that we finally realised that and ushered in the current age of milk and honey.
Uncoordinated behaviours wouldn't involve making up entire branches of science to trick people into thinking your ethnicity and sex is superior, and yet that is apparently one of two possible reasons white men do better than their counterparts on iq tests and tests of strength - either a shadowy cabal of evil white men engineered hyper specific tests that look like general knowledge testing or a strict measure of weight lifting while actually biasing these tests on behalf of other whites and guys, or every white just knows in their racist hearts how to pass an iq test the same way every man knows the secret sexist trick to win at arm wrestling.
The only reason q anon or flat earth is different is because it doesn't have the backing of the so called experts. But the experts have been peddling conspiracy theories for decades and the right have been pointing it out the entire time. Don't confuse holding institutional power for actual expertise. Progressives do not deserve endless charity and conservatives do not deserve endless scrutiny.
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