basically everyone underestimates how big of a role office selection plays in the outcomes of companies and their cultures.

i recently had the chance to spend 24 hours at LEGO headquarters. it is a great example of how company culture is directly downstream of physical space


LEGO is a relatively strange company for the toy industry. even at ~$10b in annualized revenue, the company has never taken a dollar of equity financing, and is still family owned and controlled since 1932

the company is based in billund denmark, a farm town of just 7000.

regardless of where the ai cycle ends, it is inevitable that the number of investable assets pre-ipo is going to go from 1000s to dozens pretty quickly

most of the market has intuited this, but very few are taking it deadly seriously.

my view of what’s going on here; I’ve written about the causes of this shift elsewhere, but the story is very simple,

even if all model progress plateaus tmrw (or already has months prior) we already have a world where the marginal cost of the inputs that make up a company are orders of magnitude cheaper

if you talk to every investor up >80% this year at institutional scale they all have kind of the same view in private

ai will not lead to super intelligent utopia, it’ll plateau far before then, but it will allow everyone to wirehead themselves on fake companionship, labor, etc the question for the entire street is how do you invest in a “global opt out” in a way where the Qataris can still run billions with you.

the answer seems to be to continuously talk about super intelligence and buy the precursors instead of the sin stocks directly

its hard to pinpoint exactly when it happened, but sometime in the last five years our world shifted from most people being resonable, high social trust actors

to grifting, scamming, and violence being the norm and i don't think we're going back to high trust society. whatever the cause, i'm very unsympathetic to the easy explanations like "m2 supply" "trump" "plandemic" etc. there's something different going on here that started before 2016.

i am even less sympathetic to the idea that the solution is "monasteries" or some kind of "exit"

the cultures of tech and washington are fundamentally incompatible.

in tech the foundation of a good career are reckless sharing of favors, expecting nothing in return, endorsing young ideas and people, and public networks of influence

in washington, any of these will end you in the fullness of time tech will end up having dramatically less influence on american politics than finance or any other industry that was once a similar size.

we are used to infinite, positive sum games. tech came in like a conquering army, and will be run out by midterms

the reason you feel exhausted is because you've convinced yourself being always online is the requirement for great work. great work isnt driven by 24/7 slack messages, isn't driven by coding at the party. great work is driven by intense periods of focus, followed by leisure this is ultimately one of the weird side effects of 1) internet companies spitting off so much cash and 2) that cash being so unattributable from the individual labor/work units of a single individual.

when the faangs professionalized, they brought in professional management

theres dozens of stories every week now about people finding miracle cures for lifelong conditions with LLMs

I think what’s going on here is much weirder than people think:

https://twitter.com/reidhoffman/status/1913265771087626547

i spent ~3 years dealing with debilitating pain and weakness in my leg before progressing to the point where I was nearly unable to walk.

I went to every top doctor I could find, and none could offer a consistent diagnosis, let alone a cure. why?

two years later, its crazy to look back at my $5000 executive physical experience.

the three diagnoses I was given all turned out to be wrong. so why do patients flock here every year?

patients want "more healthcare", but what happens when this comes at a serious medical cost?

https://twitter.com/WillManidis/status/1696515577442103585

to review: executive health is a major profit driver for top hospitals.

you, a fancy executive, are flown out to any number of world class hospitals that are happy to take your money in exchange for a cash pay 3-day visit with a series of world class specialists.

If Elon wants to create the Texas Institute of Technology, he should replicate Olin's model.

Olin College, founded in 1997, became the top ranked engineering school in the country in just 10 years before its recent stumbles.

Here's the brief outline:

https://twitter.com/KTmBoyle/status/1754985420008415478

1. Free tuition for all students

Olin short cut selectivity by offering full tuition scholarships to every student. You don't need billions to achieve this, a $400m endowment did it for Olin for 20 years before mismanagement cut it short.

This works, steal it.

I went to Olin College, a tiny engineering school outside Boston.

Olin was once the top engineering college in America, now its in free fall. The actions of the board and administration are unacceptable; Olin was a powerhouse, and it still can be.

Here's what's really going on Olin was founded in 1997, fueled by a $460 million gift from the Olin Foundation, as an experimental hub for reimagining engineering education.

It championed hands-on, project-based learning. The approach worked, and scaled up at many top universities.

In 2020, an explosion rocked Satartia, Mississippi.

A thick cloud engulfed the town as 911 calls flooded in. One mother begged for help as her daughter gasped for air. Residents passed out standing up

Satartia is the most important infrastructure failure you've never heard of. Satartia, Mississippi is a small community on the banks of the Yazoo River in western Mississippi.

Most residents were unaware that a 24-inch CO2 pipeline ran near their town-- part of a system the White House sees as key to defeating climate change.

Every week, a dozen new companies boasting "tech-enabled healthcare for the rich" announce massive funding rounds.

I think nearly every single one fundamentally misunderstands the business of high end medical care.

Here's how to build a real executive physical killer: over the last two years I've done basically every single executive physical.

I've flown to the Mayo Clinic in the middle of winter, five times, I met a referral only infusion clinic in an empty warehouse filled with buddha statues, I've done every variety of full body MRI

five thoughts on choosing who you work with/for: 1) moral alignment matters more than incentive alignment

people focus too much on aligning incentives. incentives are messy and can hardly be aligned. find people you share convictions and faith with, and keep working with them for long amounts of time. it'll work out.

within months you will be able to buy genomics data from 14 million americans for +/- $200m?

the inevitable fire sale of this mess to an overseas PE firm is going to be a national security matter on the scale of which we haven't seen in healthcare in years in general, hhs has left open a dangerously large hole around healthcare data sales

the reg we have now are so deeply embedded in precision oncology/2010s-RWD that they are completely unprepared to address what post-LLM healthcare data sales will actually mean

what’s the best truly banned book?

not like 1984 banned — I mean PDFs that are literally unprintable, truly arcane knowledge the McKinsey internal firm history is an obvious one though easy to get these days

the sequoia history that mm wrote is an obvious one (unless @shaunmmaguire 🤝)

The AI/healthcare discourse has reached new levels of insane this week

A close friend, a MD at a prestigious medical center, recently shared the following memo with me. He asked me to share this anonymously.

"What we don't talk about when we talk about AI/medicine" 1. Standard of Care isn't Standard Care

Novel modalities of care (AI-assisted, etc.) are measured against a platonic ideal of SOC that doesn't exist in clinic

Medicine is as much of an art as a science, providers are overworked, tired, and often veer dramatically from SOC.

The Executive Order on AI issued by the White House today represents the beginning of a complete overhaul of the regulatory landscape for healthcare AI.

Here are my notes on what matters from the 100+ pages: Let's start with a quick summary of the EO's requirements:

- Within 180 days, HHS shall publish a plan to promote responsible AI use in public benefits like Medicare/Medicaid. The plan should address access to benefits, notice, evaluation for unjust denials, etc

(Section 7.2b)

healthcare is having its top deck of the titanic moment

what happens in the next year will define the next century of american healthcare, and basically everyone is ignoring it.

here's the real story: Healthcare has been defined by four factors:
1. Extremely limited supply (MDs are scarce and costly).
2. Principal-agent problem with payments (your insurance pays, not you).
3. Inelastic demand and high trust (you need it and have confidence in it).
4. Regulatory capture.

You can outperform most venture funds by buying LEGO.

I analyzed the last 20 years of secondhand LEGO pricing data, and found randomly purchasing sets will match most VC's returns

if you're somewhat intentional about what you buy-- you massively outperform even the best firms I pulled data on 16,000 LEGO releases since the year 2000. I dropped any promotional items, duplicate items, or any other oddballs. This got me down to 10k or so.

For each, I then pulled in resell data from bricklink for each item to get current market price (ebay prices higher)

Norton Commons is the most underappreciated development project of the last few decades.

A hyper-walkable, basically car free, traditional community built in the middle of Kentucky in 2003

No venture funding, no twitter threads on vitality. They simply chose to build well.



Norton Commons is in Prospect-- a farming community roughly 15 miles west of Louisville.

The land was originally a family farm owned by the Norton Trust. Mary Shands inherited the farmland in 1988 and wanted to preserve the rural character of the land.

Last year, I paid thousands of dollars for a physical at one of the best hospitals in America

I wanted to see how different healthcare was for the ultra-rich, and what this meant for the rest of the healthcare system

Here's what I learned: I work in healthcare.

I was always aware that executive physicals— ultra-high-end, luxury concierge care— existed, but I had never met someone who went through one.

and now, due to an accident with my flexible spending account, I ended up with enough cash to try it out.