Hi there, it’s Mehdi Yacoubi and this is The Long Game Newsletter. To receive it in your inbox, subscribe here:
In this episode, we explore:
Let’s dive in!
I’ve listened to Calley and Casey Means over the summer and was fascinated by how clearly and eloquently they were able to articulate the problems with health as a whole in the US. Here’s a short summary of the episode:
They discuss how the healthcare system often treats symptoms instead of root causes, largely because doctors aren't trained enough in nutrition and prevention.
Calley explains how food and pharmaceutical industries influence policies, leading to an abundance of unhealthy, processed foods that contribute to rising chronic diseases like obesity and diabetes.
They show that the system profits more from illness than health, which results in over-prescription of medications, even in children. Their solution is to return to whole, unprocessed foods, cook at home, and make mindful dietary choices.
They advocate for systemic changes to support healthy food options and greater transparency in medical research funding. Their push for people to take control of their health through informed choices and for a healthcare system that truly promotes well-being.
As a follow-up, I found these suggestions made by Justin Mares very good:
Remove corporate interests from FDA and USDA guidelines. Today, Big Pharma funds 75% of the FDA’s drug division budget, and 95% of the USDA panel charged with updating nutrition guidelines had conflicts with food or pharma. This is how you get “research” finding Lucky Charms are healthier than ground beef (really).
Eliminate the ability of Big Pharma to buy off the mainstream news. As of today, the US and New Zealand are the only countries that allow pharma to directly advertise to the public (and the US has only allowed this since 1997). When pharma accounts for 55% of the mainstream media’s budget, they effectively own the media. It’s how you get crazy things like a pharma-funded doctor saying obesity is genetic and kids should be on lifetime Ozempic injections, and no mainstream mentions of the many downsides (inflammation, gut issues, etc) that come with Ozempic.
Remove conflicts of Interest at the NIH. Currently, there are no conflict-of-interest bans at the NIH, and 8,000 researchers have "major" conflicts. Until 2005, NIH researchers were allowed to accept direct stock options and consulting fees (which 40% of them) did. This is why 40x more money is spent on ways to "manage" cancer than to prevent it: prevention is far less profitable than treatment.
Prevent pharma from price-gouging the American people. Today, buying Ozempic in Germany costs 17x less than it costs for Medicare to buy the same drug. Medicare is the largest buyer of healthcare services in the world, yet under a 2003 law, it’s prohibited from negotiating prices with pharma companies. This leads to absurd schemes like pharma “charging” consumers $1000/mo for Ozempic, then giving them rebates to get the total cost closer to $200/mo. At the same time, Medicare (and thus the US taxpayer) pays the full $1000/mo.
Remove toxins from our food supply. The American food system is uniquely poisonous. We allow 150 pesticides that Europe bans, and high levels of these toxic pesticides are found in 93% of American’s blood/urine samples.
A simple approach would be to adopt the same chemical regulatory approach as the EU. Today, the EU bans 80,000+ chemicals the US allows in our food, water, skincare, and other products. We should follow the EU’s model and do safety testing on new chemicals before they’re introduced to the food system, rather than ban chemicals decades after we have proof of harm (more here).
Increase patient choice with HSAs. Today’s healthcare robs Americans of choice. Patients are shuttled into a 1-size-fits-all program where insurers cover only certain treatments, with certain doctors, and under certain conditions. We should introduce consumer choice (both by exposing prices to consumers via companies like Superscript) and by making HSAs and FSAs key pillars of all healthcare policy. A good step would be to unlock universal HSAs for consumers.
No soda on SNAP. Coca-Cola and other soda manufacturers make billions each year from SNAP recipients. 75% of all $115B in SNAP funds go towards processed foods, and 10% of all SNAP funding goes to soda. This is insane: we are incentivizing the poorest among us to eat processed foods and drink soda. This policy is a key reason why the poorest men die 15 years earlier than their wealthier counterparts: almost entirely due to food-based chronic illness.
School lunch reform - Today, eating school lunches is a risk factor for childhood obesity. School lunches are toxic, largely due to captured interests that push for Lunchables to be sold in school lunches and who say pizza is a vegetable (due to the tomato sauce. Yes, a tomato is a fruit). We need to reform these corrupt guidelines to focus on nutrient density from whole foods, and ban ultra-processed foods from school cafeterias.
Additionally, school lunch programs should likely have a health feedback loop. If the kids in a given district fall below certain health metrics (obesity, BMI, whatever), then the school lunch program should be changed! With such a feedback loop, almost every school lunch program in the country would be forced to change today.
Support a transition to regenerative agriculture - Some studies estimate that if 25% of our agricultural lands transitioned to carbon-sequestering regenerative agriculture, the US would solve its carbon emissions issue.
Beyond the climate impact, regenerative agriculture improves soil health, leading to more nutrient-dense plants and healthier animals (and hence, to healthier humans). Incentivizing farmers to transition from chemically-intensive forms of monocropping to regenerative agriculture would do wonders for the climate and the health of our food system.
Reform crop subsidies - Under today’s system of crop subsidies, planting corn/soy/wheat is heavily subsidized, with most subsidies going to large agricultural corporations and landowners. These subsidies make corn/soy/wheat artificially cheap, which is why they end up in everything in their most processed forms (soybean oil - which today accounts for nearly 20% of the average American’s caloric intake - and high fructose corn syrup to name a few). Our subsidies program is so corrupt that the government subsidizes tobacco 4x more than vegetables.
I wrote more about this topic here, but if there’s one thing I could change in today’s US system, it’s probably this.
Fix our water supply - Our water supply is in dire straits. Not only are there issues with water in places like Flint, MI, but at the national level our drinking water is riddled with PFAS, glyphosate, and many other toxins. A recent study found 95% of all tap water exceeded the limit for at least 1 carcinogen, and half of all water is contaminated with PFAS.
Current EPA and drinking standards should be improved, as current federal limits are often 10-100x higher than scientifically established safe limits. For example, the acceptable level of glyphosate in tap water is 7000x higher than the current EU standard.
Break up the foreign-owned meatpacking monopolies - 85% of the meatpacking industry is owned by 4 companies, 3 of which (National Beef, JBS, WH Group) are located in Brazil or China and have a long history of abuses and outright fraud. JBS in particular has paid over $3B in fines in the last 20 years for (at various times) bribing inspectors to let them sell tainted meats to school cafeterias, creating unsafe working environments, price fixing, and lying about the amount of rainforest they clear-cut for their cattle herds. JBS in particular is the company that is most responsible for clear-cutting the Amazon for cattle. American companies should control the American meat supply!
Additionally, a national law similar to TX SB 691 should be passed that allows for the processing and slaughter of animals at small farms. For a healthier and more resilient food system, we need to decentralize the system and make sure that 85% of beef processing does not go through just 4 centralized companies.
Require nutrition classes and functional medicine in MD programs - Today, 80% of medical schools require zero nutrition classes. Practically zero MD programs take a holistic, functional approach to medicine that aims to treat root cause issues (ie lifestyle).
New presidential fitness standards - JFK wrote a letter in 1960, The Soft American, which called for a reworking of the Presidential Fitness Test to create new physical standards and expectations for our children to develop healthy bodies. It is time to issue a new standard and framework and encourage a new baseline for physical fitness for our children.
Pair with: A great highlight from the hearing.
I find it good to remind myself of this idea frequently.
You create your own misery by caring too much about your feelings. As long as you're alive, you're meant to cycle across the entire spectrum of the human experience
Don't let the occasional funk trigger internal alarm. By reacting, you condition your brain to perceive negative emotions as a threat you need to run away from
Let your moods naturally fluctuate. Don't rashly interpret that something is wrong. Happiness isn't a conscious goal to seek, rather an unconscious byproduct of lessening its importance.
Pair with: Assured Misery, and this:
I think if you’re so smart why aren’t you happy is actually kind of a good criticism. I know so many brilliant generally successful people who want to be happy and if you ask them okay how do you think happiness works, what have you tried, who have you hired to help etc nothing
I’ve come back a lot to this idea over the last few years:
“Do not remove a fence until you know why it was put up in the first place.”
The lesson of Chesterton’s Fence is what already exists likely serves purposes that are not immediately obvious.
Fences don’t appear by accident. They are built by people who planned them and had a reason to believe they would benefit someone. Before we take an ax to a fence, we must first understand the reason behind its existence.
The original reason might not have been a good one, and even if it was, things might have changed, but we need to be aware of it. Otherwise, we risk unleashing unintended consequences that spread like ripples on a pond, causing damage for years.
You can see that everywhere in society today, where so many things start to be perceived as useless, only to find ourselves worse off after having them removed.
Intellect is therefore a vital force in history, but it can also be a dissolvent and destructive power. Out of every hundred new ideas ninety-nine or more will probably be inferior to the traditional responses which they propose to replace. No one man, however brilliant or well-informed, can come in one lifetime to such fullness of understanding as to safely judge and dismiss the customs or institutions of his society, for these are the wisdom of generations after centuries of experiment in the laboratory of history.
— Will and Ariel Durant, The Lessons of History
AI agents are a fascinating topic that’s worth getting into.
An AI agent is a type of model architecture that enables a new kind of workflow.
The AI we started with formulates an answer and returns it to the user. Ask it something simple, like “Does an umbrella block the rain?” and OpenAI’s GPT-4 returns the answer, “Of course it does, you dumbass.” The large language model is able to answer the question without relying on external data because it uses internal data and executes on the prompt without making a plan. It's a straightforward line connecting input and output. And every time you want a new output, you have to provide a fresh prompt.
Agentic workflows are loops—they can run many times in a row without needing a human involved for each step in the task. Under this regime, a language model will make a plan based on your prompt, utilize tools like a web browser to execute on that plan, ask itself if that answer is right, and close the loop by getting back to you with that answer. If you ask, “What is the weather in Boston for the next seven days, and will I need to pack an umbrella?” the agentic workflow would form a plan, use a web browsing tool to check the weather, and use its existing corpus of knowledge to know that, if it is raining, you need an umbrella. Then, it would check if its answers are right and, finally, say, “It’ll be raining (like it always does in Boston, you dumbass) so, yes, pack an umbrella.”
What makes an agentic workflow so powerful is that because there are multiple steps to accomplish the task, you can optimize each step to be more performative. Perhaps it is faster and/or cheaper to have one model do the planning, while smaller, more specialized models do each sub-task contained within the plan—or maybe you can build specialized tools to incorporate into the workflow. You get the idea.
Right now some companies are going horizontal, while others go for specific verticals:
We can put these companies on a spectrum: On the left-hand side is “vertical task automation,” and on the right is “horizontal selling of AI agents.” A vertical work application automates a variety of tasks within one industry—think AI agents for legal, like Harvey ($80 million-plus raised). In the middle are AI agents geared toward one specific task, such as software engineering. Cognition Labs ($20 million-plus raised) focuses on performing one large task—writing code—that cuts across many industries. On the far right are companies that sell AI agents as a service. You pay to access AI agents that can do a variety of horizontal tasks, like calendering, note-taking, or PDF summary. Lindy ($50 million raised), which offers a tool that has dozens of AI agents, is an example of this kind of company. There are many of these players, and arguably, every software company could be an AI agent company.
Pair with: this video.
Fascinating topic—the logic of female and male intra-sexual competition:
To me, the most interesting finding in this line of work is that how tough a guy looks to men appears to be a much stronger predictor of mating success than how attractive he is to women.
Researchers recorded short videos of 157 different men. Next, another group of men watched these videos. Researchers asked them a question about each of the men in the videos: “How likely is it that this man would win a physical fight with another man?” They used a scale ranging from “extremely likely” to “extremely unlikely.”
A group of women also viewed the videos. They responded to a question about each of the men: “How sexually attractive is this man?” They used a scale ranging from “extremely unattractive” to “extremely attractive.”
Eighteen months later, the men in the videos completed a questionnaire asking about their sexual history over the 18 months. How tough a guy looked to men predicted his reported mating success better than how attractive he looked to women. The researchers concluded, “Men with higher physical dominance, but not sexual attractiveness, reported higher quantitative mating success.”
Pair with: How men compete for status
... and the reason is one of the most interesting findings from modern behavioral genetics
I mentioned that the difference between IQ and height is one of the most interesting findings in modern behavioral genetics and I do think that is true. Though we’ve known theoretically that the causal arrow between genes and culture could go both ways, these new molecular findings are a clear demonstration of cultural forces shaping and mimicking genetic processes — and the lack of similar forces on height serves as an important negative control. In the context of population differences — a focus of the piece in The Atlantic — direct/within-family heritability provides an upper bound on how much a trait can drift between populations under neutrality (see [Edge and Rosenberg (2015)] and summary). For educational attainment, for example, we can already calculate that the expected variance between continental populations under neutrality is minuscule: heritability*Fst = 0.04*0.15 = 0.006. But if we do ever disentangle the direct and indirect components, they could be leveraged to estimate cross-generational influences that are otherwise very difficult to observe. Scientists enjoy a challenge and the study of a complex, stratified, environmentally sensitive process without construct validity is a veritable feast of challenges.
I found this post to be very thought-provoking. I definitely think the author is onto something true.
Why we should worry less and have more kids Even as birthrates are crashing, parenting has gotten a lot more demanding over time. Parents spend around twice as much time with their kids as they did 40 years ago, according to one study. Travel teams, a rare thing a generation ago, are the norm today. Growing up most of us would walk to the bus stop by ourselves. These days at school bus stops, the number of waiting parents is almost equal to the number of kids. How do they find the time for that? It seems like it would be hard to have a lot of kids when parenting is like this. And the data bears this out. Time intensive parenting is linked to lower fertility Data analyst and journalist John Burn-Murdoch looked at a number of policy and cultural factors impacting fertility rates. The two most negative correlations? For OECD countries, the amount of time mothers spent on ‘hands-on parenting’ and the amount time kids spent on homework both were linked to much lower birthrates. Both of these are proxies for high-intensity parenting.
This makes sense. If raising kids is seen as an onerous task, fewer people will want to be parents at all. Those that do become parents will want a lot less children. The best family model? Whatever works The Boom Campaign, a pronatalist group in the UK, presented this chart finding that the belief that “a child is likely to suffer if their mother works” was linked to lower fertility rates in Europe. (TFR values are from 2015-2019; fertility is lower everywhere now.)
For traditionalists, this is tough to swallow. Surely it is beneficial for kids to have their mother stay at home with them when they are little, right? Stay-at-home moms are a cornerstone of many successful families. But so are working moms. In parenting more than almost anything else, we make the perfect the enemy of the good. It turns out that if women think they must choose either work or having children, then a lot of them will choose only work and birthrates end up being lower. This seems robust. Policy writer Aria Babu looked at the same question for a number of additional countries and found the relationship still holds. It is more pro-natal to welcome either option, having a full-time parent or having two working parents, with equal enthusiasm. A majority of women want to work, and many have incredible talent. If society denigrates either careerist mothers or stay-at-home moms, a lot of women will reject motherhood completely. Mainly we need more parents. For that it helps to be very flexible about how people get there.
Tiger mothers: How is it going?
There is one group so known for intensive parenting that there is a word for it. Yale Professor Amy Chua wrote a bestselling book, Battle Hymn of the Tiger Mother that valorized the intensive parenting-style of Asian parents worldwide. Her book drew a lot of strong reactions. Some were inspired to try harder, while many parents were upset that their children would be left behind. No doubt, the book and the mindset that inspired it meant ratcheting parenting up more than ever. How is all that tiger parenting going? Not very well, if the goal is to keep the lights on in the long run.
Is this just a quirk within East Asian countries? No. The East Asian pattern of high investment in very few children holds around the world. In the United States, East Asian women have the lowest fertility rate of any group, even though they have the highest marriage rates of all. A lot of pronatalist thinkers are saying the same thing: We should go easier on parenting while having more kids Bryan Caplan Economist Bryan Caplan notes in his book Selfish Reasons to Have More Kids that parenting should be easier than ever because of modern conveniences and our better quality of life compared to our ancestors. In theory, people should have more kids as society grows richer. Instead, we have fewer, and parenting feels harder. Why? We have placed many new requirements and expectations on ourselves that earlier parents never had. A lot of that effort isn't necessary, he says. Caplan gives another reason not to try too hard with parenting: biology. Nature has a huge influence on how kids turn out regardless of what parents do. Adoption studies show that for all the effort that adoptive parents put into raising kids, they tend to be quite similar to their biological parents. This is liberating in a way. If our parenting matters less, we might as well have fun and not stress so much about whether someone got a little more TV than they were supposed to.
Pair with: Understanding the impact of the drop
A fertility rate below 1.6 means 50% less new people after three generations, say 100 years. Below 1.2 means an 80% drop. The U.S. is at 1.64. China, Japan, Poland, Spain all below 1.2. South Korea is at 0.7—96% drop. Mass extinction numbers.
I’ve been learning a lot from Ogilvy over the last few months. Truly an exceptional thinker.
The creative process requires more than reason. Most original thinking isn't even verbal. It requires 'a groping experimentation with ideas, governed by intuitive hunches and inspired by the unconscious.' The majority of business men are incapable of original thinking because they are unable to escape from the tyranny of reason. Their imaginations are blocked.
Pair with: On Advertising
This is a good article linking dating apps to the collapse of birthrates in recent years. Whether it’s through the paradox of choice, the ease of finding casual connections delaying the moment people commit to serious relationships, the impact of dating apps on social skills or the culture shifts normalising casual dating combined with the natural window for having kids that remains the same the article covers it all.
Many people aren’t finding love - and seem to be giving up. The number of monthly active dating app users worldwide has dropped from 287 million people in 2020 to 237 million people in 2023, according to the Economist.
Part of the reason that people are ‘giving up’ is that people aren’t that interested in dating anymore, as shown in this graph from Pew Research. 50% of singles are tapped out of the dating market. According to Morning Consult, 79% of women are uninterested in using the apps in the future. This is unsurprising. The US is already an individualistic society, and being single is more affordable than ever (however, married people do better economically).
To be clear, the apps work for some people. According to Pew Research, 1 in 5 partnered adults under 30 met on a dating app. It’s a brilliant way to get outside of a social bubble, to meet people you might have never crossed paths with, and to get practice dating (and find love!) There is a reason that 10% of adults met their significant other on the apps (rising to 20% for under-30s) - and it’s because they can work.
Pair with this tweet:
I was on dating apps for a few months and studied the market carefully. The reason most dating apps don't work is kind of toxic.
It boils down to adverse selection + female hypergamy leading to most women chasing a small fraction of high status dudes, most of whom are uninterested in relationships.
The average male and the average female have vastly different experiences on apps. Average men get basically nothing and struggle to get responses. Average women are overwhelmed with choice and struggle connecting with flaky, emotionally unavailable guys while being bombarded by a bajillion messages.
This occurs because women overwhelmingly match with a minority of the most attractive guys. Men are willing to sleep with a very wide range of women, so women match with men who are out of their league relationship-wise. The result is a small fraction of men end up sleeping with lots of women and the creation of Facebook groups like "Are we dating the same guy?"
A reasonably attractive woman on a dating app gets an inflated sense of her appropriate match and she becomes very picky. e.g., about half of women on Bumble screen out guys who are shorter than 6'.
For the top guys, there is little incentive to settle down. They stay on the apps and run through many women. This leads to an adversely selected pool of men who are a) very attractive, b) very good at dating, and c) not interested in relationships.
If you’re a long-time subscriber you know how much Dr. Sarno means to me. His work saved me from chronic back pain.
Since I fixed my pain 3 years ago, I sometimes have small bouts of pain that resurface during stressful periods. Over the last few weeks, I happened to have back/ leg pain resurfacing so I re-watched/ re-read many things related to mind-body syndromes which helped me get pain-free.
Pair with: The Book that Healed 70% of My Back Pain
This is the best website creator I’ve used. Instead of a clunky product, you can just prompt your website in plain words, and iterate on it with a chat. Very well done product. You can also build tools with it.
That is how I like to work: I go in with a blind belief that something will happen, and until it’s proven impossible, I will continue banging my head against the wall.
— Rick Rubin
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Until next time,
Mehdi Yacoubi
