Ben White

Amazon founder Jeff Bezos on his decision to start an online bookstore in the 1990s:

The framework I found which made the decision incredibly easy was what I called the regret minimization framework. I wanted to project myself forward to age 80 and look back on my life and I want to have minimized the number of regrets I have. And I knew that when I was 80 I was not going to regret having tried this. I was not going to regret trying to participate in this thing called the internet that I thought was going to be a really big deal. But I knew the one thing I might regret is not ever having tried. And I knew that that would haunt me every day. So when I thought about it that way it was an incredibly easy decision.

With unavoidable uncertainty and wild problems, sometimes regret minimization is the best paradigm we have.

// 01.28.26

Basecamp’s Jason Fried’s brief discussion of product development should be required reading for anyone who designs software, including EHRs, PACS, dictation, or whatever new dumb AI implementation someone is pitching to revolutionize healthcare (but that no one talked to an actual doctor about).

The critical tension is the balance between making features obvious, easy, and possible. You have to have opinions, and you have to choose, because being everything to everyone isn’t an option.

// 01.27.26

Number Games

01.22.26 // Medicine, Miscellany

More from Alchemy: The Dark Art and Curious Science of Creating Magic in Brands, Business, and Life by Rory Sutherland (Part 1 is here):

When every function of a business is looked at from the same narrow economic standpoint, the same game is applied endlessly. Define something narrowly, automate or streamline it – or remove it entirely – then regard the savings as profit. Is this, too, explained by argumentative thinking, where we would rather win an argument than be right?

Especially egregious in large institutions engaging in budgetary arbitrage. A hospital where I work “saved” money a few years ago by outsourcing a lot of its IT abroad. I guarantee they didn’t actually save money for the organization despite spending less on the IT line item.

Today, the principal activity of any publicly held company is rarely the creation of products to satisfy a market need. Management attention is instead largely directed towards the invention of plausible-sounding efficiency narratives to satisfy financial analysts, many of whom know nothing about the businesses they claim to analyse, beyond what they can read on a spreadsheet. There is no need to prove that your cost-saving works empirically, as long as it is consistent with standard economic theory. It is a simple principle of business that, however badly your decision turns out, you will never be fired for following economics, even though its predictive value lies somewhere between water divining and palmistry.

[…]

The problems occur when people try to solve ‘wide’ problems using ‘narrow’ thinking. Keynes once said, ‘It is better to be vaguely right than precisely wrong’, and evolution seems to be on his side. The risk with the growing use of cheap computational power is that it encourages us to take a simple, mathematically expressible part of a complicated question, solve it to a high degree of mathematical precision, and assume we have solved the whole problem.

There’s a line from Tony Fadell’s Build that I love: “Data can’t solve an opinion-based problem.” So many meetings and dashboards, and so much of that data is used as a proxy to somehow “answer” the real question: Is this all really working? Can we do this better? Not just the one part that’s easy to measure—but the whole thing?

In the event, the platform has improved since we adopted it, but the fact that a cost-saving decision could be made without any consideration of the hidden risks to efficiency was nonetheless alarming. Why are large commercial organisations adopting this ideological approach to business? That was supposed to be the weakness of communism.

At least in many healthcare and other large organizations, it’s departmental siloing and abstracting both strategy and tactical decision making to layers of managers with little or out-of-date domain expertise. I have seen even good initial decisions with involved stakeholders ruined by implementation decisions by suits.

People’s motivations are not always well-aligned with the interests of a business: the best decision to make is to pursue rational self-justification, not profit. No one was ever fired for pretending economics was true.

Moral hazard is potent, especially when combined with the Peter Principle.

We fetishise precise numerical answers because they make us look scientific – and we crave the illusion of certainty. But the real genius of humanity lies in being vaguely right – the reason that we do not follow the assumptions of economists about what is rational behaviour is not necessarily because we are stupid. It may be because part of our brain has evolved to ignore the map, or to replace the initial question with another one – not so much to find a right answer as to avoid a disastrously wrong one.

It’s comfortable but wrong to wave away unavoidable uncertainty with a blanket of data.

[Herbert] Simon used satisficing to explain the behaviour of decision makers under circumstances in which an optimal solution cannot be determined. He maintained that many natural problems are characterised by computational intractability or a lack of information, both of which preclude the use of mathematical optimisation procedures.

[…]

Consequently, as he observed in his speech on winning the 1978 Nobel Prize, “decision makers can satisfice either by finding optimum solutions for a simplified world, or by finding satisfactory solutions for a more realistic world.

I’ve included Simon’s work on “bounded rationality” in a bunch of my talks, but surprisingly not much on this site. Simon’s work set the stage for much of behavioral economics and modern decision science. It is of both incredible personal and professional value.

From Developmental Editing by Scott Norton:

Few pleasures are as great as the taste of a fresh idea. A new insight melts in the brain like chocolate on the tongue. Whether the insight is unprecedented in human history or news only to yourself doesn’t matter; the first time a thought occurs is always magic.

That magic is so fickle, perishable. I always find the strong desire to capture as much of it as possible, and the more I can horde upfront the better chance I have of making it to the finish line of anything.

// 01.14.26

Kevin Kelly, adding 101 new bits to his growing collection of pithy advice. A few of my favorites:

  • Forget trying to decide what your life’s destiny is. That’s too grand. Instead, just figure out what you should do in the next 2 years.
  • Try to define yourself by what you love and embrace, rather than what you hate and refuse.
  • Read a lot of history so you can understand how weird the past was; that way you will be comfortable with how weird the future will be.
  • There should be at least one thing in your life you enjoy despite being no good at it. This is your play time, which will keep you young. Never apologize for it.
  • The patience you need for big things, is developed by your patience with the little things.
  • There is a profound difference between thinking less of yourself (not useful), and thinking of yourself less (better).
    Avoid making any kind of important decision when you are either hungry, angry, lonely, or tired (HALT)
// 01.07.26

From a highly enjoyable “So you wanna de-bog yourself” (about getting “unstuck”) by Adam Mastroianni:

“Declining the dragon” – a medieval knight metaphor for getting unstuck: Sometimes I’ll know exactly what I need to do in order to leave the bog, but I’m too afraid to do it. I’m afraid to tell the truth, or make someone mad, or take a risk. And so I dither, hoping that the future will not require me to be brave.

Everybody thinks this is a bad strategy because it merely prolongs my suffering, but that’s not why it’s a dumb thing to do. Yes, every moment I dither is a moment I suffer. But when I finally do the brave thing, that’s not the climax of my suffering—that moment is the opposite of suffering. Being brave feels good. I mean, have you ever stood up to a bully, or conquered stage fright, or finally stopped being embarrassed about what you love? It’s the most wonderful feeling in the world. Whenever you chicken out, you don’t just feel the pain of cowardice; you miss out on the pleasure of courage.

Medieval knights used to wander around hoping for honorable adventures to pop up so that they could demonstrate their bravery. They were desperate for big, scary dragons to appear. When I put off doing the brave thing, I am declining the dragon: missing an opportunity to do something that might be scary in the moment but would ultimately make me feel great.

The whole post makes for great early January reading.

// 01.06.26

From The World I See, a memoir by the godmother of AI, Dr. Fei-Fei Li:

This, collectively, is the next North Star: reimagining AI from the ground up as a human-centered practice. I don’t see it as a change in the journey’s direction so much as a broadening of its scope. AI must become as committed to humanity as it’s always been to science. It should remain collaborative and deferential in the best academic tradition, but unafraid to confront the real world. Starlight, after all, is manifold. Its white glow, once unraveled, reveals every color that can be seen.

// 12.30.25

Treadmill Desks Are So Worth It

12.26.25 // Miscellany, Radiology

I finally got a standing desk, which means I was finally able to try a foldable treadmill under it. I love it.

In early 2024, I started using an under-desk elliptical, and it worked surprisingly well. One downside is that since it is only self-paced, it’s easy to stop.

This fall, I got the WALKINGPAD P1, which is a foldable treadmill I stow behind my door when not in use. It’s reasonably quiet and has served me well for a couple of months so far. If I were to buy one right now, I actually really meant to get the R2, which has a handle that allows for higher speeds and, more importantly to me, also means it’s easier to move and can be stably stored upright. If folding and stowage weren’t important to me, I’ve also heard good things about the Pacerocker, which has a 9-level incline feature to make things harder without increasing your walking speed (though I have no idea if having an incline would make it too hard to concentrate?). I may still upgrade to the R2 at some point.

Prior to purchasing, I had wondered if I’d be able to work while walking. I figured if I couldn’t, I could at least use it for meetings and maybe lighter/passive tasks like email.

The answer is I can definitely work while walking, at least at modest speeds, and I can easily clock 15-20k steps walking intermittently during a workday.

Admittedly, super fine motor control with the mouse is a bit harder, especially at higher walking speeds. It can, for example, be hard to measure lesions if you’re bouncing, so I find myself walking at a slower pace than my natural cadence. But while mouse control is a little harder, typing on the keyboard is surprisingly natural. It also definitely remains much easier to scroll effortlessly with my Contour Shuttle, which uses a finger, than power scrolling with the mouse.

Additionally, while the treadmills are definitely movable, it doesn’t mean they’re the kind of thing that you really want to have to wheel all the way to and from their corner multiple times per day. I find that when I would like to sit, I tend to just fold the treadmill back under the desk into the leg nook and use it as a bit of a footrest or put my feet along its sides. Having a standing desk means that you can adjust the height a bit as needed to keep things comfortable to accommodate those few extra inches. The main downside of sitting in front of the folded treadmill is that the wheels on your chair can easily bump up against it. It’s best to sit slightly back, so having a pull-out keyboard tray (which I do) really helps with positioning. This is the main reason I wish I’d bought the model with the handle, which would make it easier to move around and probably obviate the need to ever do this. If you try it and don’t like sitting at it folded, the answer is probably just to use it in one session per day and move it away when you’re done.

I think standing desks on their own are somewhat overrated. I like standing at work sometimes for variety, but it’s also sorta meh? Unless you like to do a little dancing in place, the data suggest that standing isn’t really magically better than sitting, and there is some data that they’re not great for your lower extremity veins if you clock too many hours. Being sedentary has more to do with not moving than the actual position you’re staying still in.

The opportunity to try work-walking was my main motivation for wanting a standing desk at home in the first place. I’m not a teleradiologist, so I’m not cranking in my pajamas during the workweek as a full-time job, but as a component of my hybrid workweek, the treadmill desk has been awesome.

A helpful note from a reader:

  • I recently purchased the WalkingPad R2, which has been working well so far. What I’ve found especially useful is the KS Fit app that syncs with the treadmill. It unlocks a few features that significantly improve the experience:
  • 1. Disable auto-stop – This is a big one. By default, the treadmill stops if you step off even briefly. When I’m reading out studies, there are moments where I need to stand on the rails for 5–10 seconds to make precise measurements, then hop back on. Disabling auto-stop lets me keep the speed constant without restarting the treadmill each time. Much smoother workflow—and no more awkward Fred Flintstone tricks to keep it running.
  • 2. Accurate step tracking with Apple Health integration – You can enter your height and weight, and the app tracks steps and syncs with Apple Health. This turned out to be huge for me. A lot of my walking simply wasn’t being counted by my phone or Apple Watch (not surprising, given how still your upper body is while working). With the app, those steps finally count—and importantly, it doesn’t count steps when I step off the treadmill to measure something. It seems to track based on pressure rather than just belt rotation. [Ed: if you don’t have a watch but keep your phone in a pocket, it will track your steps. Obviously, this doesn’t work for everyone based on their phone-use and clothing.
  • 3. Finer speed control – The default 0.5 mph increments always felt too coarse. Through the app, you can adjust speed in 0.1 mph increments and even preset three favorite speeds that you can switch between with a single tap.

It seems the R2’s more robust build quality would be better allow you to stand on the rails intermittently as suggested. I’ve tried this as a way to take a brief measurement/stretch break here and there to stretch my back or do some fine mouse control, but I will admit that it’s a little bit hard on my P1 with its plastic rounded edges. It’s another reason why I’m thinking about upgrading, being able to hop on and off without needing to restart the treadmill would be awesome.

Choosing Status Games

12.11.25 // Miscellany, Reading

Via The Wealth Ladder by Nick Maggiulli:

As Robert Sapolsky wrote in Why Zebras Don’t Get Ulcers: When we sit around and worry about stressful things, we turn on the same physiological responses—but they are potentially a disaster when provoked chronically. A large body of evidence suggests that stress-related disease emerges, predominantly, out of the fact that we so often activate a physiological system that has evolved for responding to acute physical emergencies, but we turn it on for months on end, worrying about mortgages, relationships, and promotions. If you find yourself chronically worried in life, finding ways to destress will be paramount for keeping your mental wealth intact. Studies show that exercise, sleep, meditation, yoga, as well as various mindfulness techniques can help to reduce stress. Whatever you decide to do, finding what works for you is what’s important. Lastly, focusing on yourself and your self-esteem is another key component of mental wealth. And for many, self-esteem is built on how they perceive their social status. If you believe that you haven’t accomplished anything, then you will probably feel low status. But if you believe that what you do has purpose, then you will feel high status. More importantly, your perceived status does not need to be based on money or career accomplishments. You can find status and self-esteem in many areas of life. Once again from Robert Sapolsky: So, the lowly subordinate in the mailroom of the big corporation may, after hours, be deriving tremendous prestige and self-esteem from being the deacon of his church, or the captain of her weekend softball team, or may be the top of the class at adult-extension school. One person’s highly empowering dominance hierarchy may be a mere 9-to-5 irrelevancy to the person in the next cubicle.

You get to, as suggested by Calvin & Hobbes creator Bill Watterson, “recreate constructively” and construct life’s meaning. Unlike most games, the status game allows you to choose how to keep score.

Status is relative to the context in which it is being evaluated.

In some contexts, the aspirations of status can even backfire. The trappings of wealth, in the wrong setting, can function more as a cloak of shame. Being deliberate in your context (career, schools, neighborhood, etc) has an incredible impact on perceived status. As in, which Joneses are you trying to keep up with?

Thankfully, you get to choose which status game you want to play and how you want to evaluate yourself. This is both a blessing and a curse, because you can be objectively great at something and feel like a failure or you can be just okay at something and feel like a massive success. It’s all based on how you feel. It’s based on the story you tell yourself about yourself.

I am reminded of David Brooks’ distinction between resume virtues and eulogy virtues.