**Part the First: No, This Is Not Another Bell Labs. **Bell Labs was justifiably renowned as the place to do high level physics and engineering. It also supported Arno Penzias and Robert Wilson in their research that identified the background cosmic microwave radiation that is the remnant of the Big Bang. But Bell Labs worked because the parent company was a regulated monopoly that could afford to spend part of its revenue on “blue sky” research.

Episteme has a nice name, but that is about as far as it goes, unless Cambridge University Press wants to object to their use of the name:

Last month, yet another billionaire-backed Silicon Valley company emerged. With a post on Substack, tech journalist Ashlee Vance announced the existence of Episteme, a company spun up with an undisclosed amount of money from Sam Altman, CEO of OpenAI, and Masayoshi Son, CEO of SoftBank. It doesn’t have any products yet, or even a focused line of business—just a kitted-out lab space in San Francisco to support 15 scientists following their curiosity in fields from artificial intelligence to biotech, with no need to worry about grant proposals or journal articles.

CEO Louis Andre is confident the gamble will pay off. He thinks world-changing, profitable ideas can emerge from basic research, as long as scientists are freed up from hassles. “Profit should be a byproduct,” says Andre, a startup veteran with a background in neuroscience and computer science. He says he founded Episteme after a series of conversations with Altman. “The main focus should be impact. When you do great science, commercialization opportunities will emerge.”

Winning grants from public funders has long been a slog through slow, risk-averse bureaucracies. It’s easy to see the appeal of Episteme, which is modeled on the big-money corporate labs of yore, like Bell Laboratories and Xerox PARC. Andre says he is picking people for their “theory of change” rather than their science. “If an idea fails, that’s OK, and you should give space for a researcher to pivot,” he says. Episteme will determine intellectual property rights and ownership of spun-out startups case by case.

Giving independent biomedical scientists, and all others, the resources to pursue their calling without having to spend two-thirds of their time writing grant proposals and the other third trying to figure out how to get rich using the Bayh-Dole Act of 1980 for cover would lead to untold advances. But we already knew that:

In fact, studies show publicly supported basic research eventually results in bigger economic gains than private efforts do—measured not just in gross domestic product, but economic productivity, too. Back in 2013, a team of economists from Stanford University and the London School of Economics found that public and private R&D funding combined yielded productivity returns of about 55%, whereas private money alone led to just a 21% increase. And a 2024 study by Andrew Fieldhouse, an economist at Texas A&M University, found an even bigger effect, putting overall productivity returns from public, nondefense R&D funding at a whopping 140% to 210%.

Andrew Fieldhouse’s results are probably closer to the truth than those of the Stanford/LSE research. And it is absurd to put “biotech” in the mix of fifteen labs at Episteme. Labs funded by the Howard Hughes Medical Institute are a case in point. At one time I had a friendly acquaintance and erstwhile collaborator, but for my failed grantsmanship, who is a Howard Hughes Investigator. She probably gets a million dollars a year from HHMI to complement her research supported by NIH and NSF. Her work is pathbreaking. But this is possible only because she is at the single best university for molecular cell biology in the world. It is a public institution. The notion that her lab could be so productive in isolation at Episteme no matter her budget, is absurd. The Roche Institute of Molecular Biology was a Bell Labs for biomedical science for a bright, shining 28 years. I spent three weeks their learning recombinant DNA technology. Alas, it was euthanized by its own parent because reasons. Its scientists were scooped up by academic institutions with alacrity.

Part of me asks, “At the moment, what does it all matter?” We have transitioned into the Era of Policy-Based Science rather than the other way around (not that science is the determinant of all policy). This will not last forever, but the damage will be enduring. Which is not to say that all was sweetness and light before 20 January 2025. But it is easier to tear down that to build up. My successors in disinterested biomedical science will have a lot of work to do.

**Part the Second: Orcas on the Brink. **This one is a bit personal. I spent part of each summer during the 1980s working in the place where the current members of this group of Orcas spend much of their time. A friend had a house on the high bluff on Haro Strait between San Juan Island and Victoria, British Columbia, where the whales would surface and perform for his very excitable Corgi. This was an amazing sight. These southern resident whales are endangered entirely due to the actions of humans:

Pierre-Louis: What happened to cause that population decline?

Harper: Essentially, we happened, particularly Western colonizers in the Pacific Northwest. When they moved in they saw these killer whales as competition with fishermen or a vermin species that needed to be exterminated or perhaps a threat to people themselves, and so many of them were killed. And then the issue shifted but continued when orcas were shown to be these gentle giants that could live in an aquarium and perform in a show. And there was a capture era in, like, the late ’60s and early ’70s where dozens of orcas were fished out from the Salish Sea and sent around the country, around the world to aquariums. A lot of these were southern residents, basically because of their proximity to people.

So that was their initial decline, but they were initially recovering, and by the ’90s their population went from around 80 to nearly 100. But then their population declined by about 20 percent over, like, five or six years—this sudden drop. And that’s when researchers were like, “Oh, something’s going on with the southern residents. What’s happening here?”

And so in the last couple of decades of research scientists have identified three main threats to this population: vessel noise and interactions with vessels, chemical pollution and lack of prey. So the Salish Sea has become one of the busiest waterways in North America, and it—metropolitan areas of Seattle and Vancouver have flourished on their coastlines, so there’s tons of people, tons of boats, a lot more pollution and a lot more hungry mouths trying to eat the same salmon that the killer whales need to eat.

The main type of salmon that they eat, Chinook salmon, their populations have plummeted since the ’80s due to a combination of habitat loss, particularly damming of rivers where they spawn, overfishing as well and also other changes, including the same pollution that is affecting the whales, etcetera, etcetera. So it’s a wide-ranging issue that ends up impacting the whales because they rely on this kind of salmon, in addition to other fish, for the bulk of their diet.

The question is, can we stop our behavior and save these, and other whales such as the critically endangered North Atlantic Right Whale, which calves along the South Atlantic coast of North America? Adrienne Buller has discussed this question in The Value of a Whale: On the Illusions of Green Capitalism. The “Market” will not provide the answer. Citizens could, however. It’s up to us.

Part the Third: We Are Born Knowing How to Count. This comes from an older but fascinating article. It turns out that humans come into this world with an “innate number sense.” We see shapes and also sense numbers. As do other species. For example, wolves know that a larger group is required to take down an elk. The nature of the experiments in this research are illustrated very well at the link, for when you have time to look.

Part the Fourth: Zoom Is Not Always Your Friend. Not that there could be any serious doubt about this, however useful Zoom/Teams/WebEx are in our ill-designed disconnected world. The Research Briefing in Nature is entitled The hidden cost of video-call glitches. The underlying paper states it plainly: Video-call glitches trigger uncanniness and harm consequential life outcomes. From the Abstract:

People are increasingly using video calls for high-stakes interactions that once required face-to-face contact: from medical consultations, to job interviews, to court proceedings. But video calling introduces a new communication issue: minor glitches, or intermittent errors in the transmission of audiovisual information during a virtual interaction. Here, through five experiments and three supplementary studies using both live and recorded interactions, we show that minor audiovisual glitches during video calls harm interpersonal judgements in consequential life domains (for example, hiring decisions after a virtual interview, or trust in a medical provider after a telehealth visit). In addition, two archival datasets from real-world video calls reveal that glitches are associated with both reduced social connection and a lower likelihood of being granted criminal parole. We find that audiovisual glitches damage interpersonal judgements because they break the illusion of face-to-face contact (for example, by distorting faces, misaligning audio and visual cues or making movements appear ‘choppy’), evoking ‘uncanniness’ – a strange, creepy or eerie feeling. As the uncanniness of a glitch increases, so does its negative effect on interpersonal judgements. Furthermore, audiovisual glitches undermine interpersonal judgements only in video calls that simulate face-to-face interaction, showing that the negative effect produced by glitches goes beyond mere disruptiveness, comprehension difficulties and negative attributions. These findings have important implications for digital equity. Despite being considered a boon to access, virtual communication might unintentionally perpetuate inequality. Because disadvantaged groups often have poorer internet connections, they are likely to encounter more glitches, and, in turn, to experience worse outcomes in consequential contexts such as health, careers, justice and social connection.

One of the strangest manifestations of the current zeitgeist is that “virtual” teaching and learning, both synchronous and asynchronous, are sufficient to their tasks. This is completely ridiculous and will not end well at any level. My experience in medical education for the past five years has been telling. And my institution did better than most. Our teaching is done in small tutorial groups for the most part and we “went remote” only from March – May 2021. We were back “in person” by the time the next academic year began in August. But Zoom-creep is a real thing, based primarily on the false notion that efficiency and effectiveness are one and the same. They are not even in the same zip code.

And another concern is that all applicants to medical school are interviewed before they are accepted. This is now done using Zoom or equivalent at most medical schools. Our system has worked much better than we expected five years ago, for example, by standardizing our one-on-one interviews. But the nagging question remains, “What have we lost?” Whatever that might be, there will be no going back. There is no escape mechanism in this or any other social, political, or economic ratchet.

Part the Fifth: Health Insurance. The category mistake that is health insurance continues to wreak havoc. Insurance is purchased to insure against losses that probably won’t happen, accident or early death. Needing a doctor is not one of those things, except for those who die young unexpectedly or those who are lucky, very lucky. Professor Zack Cooper of Yale has addressed this conundrum in $27,000 a Year for Health Insurance. How Can We Afford That?, which was published in The New York Times two weeks ago. The simple answer is that we cannot “afford” it as individuals. But the Congress of the United States is still making like the proverbial ostrich and keeping its head embedded firmly in the sand:

The debate over whether to extend the expanded Affordable Care Act subsidies has consumed lawmakers over the past two months, precipitated a government shutdown and sparked Republican infighting. Unfortunately, it’s the wrong debate.

While I believe we should extend the subsidies, which expire at the end of the month, to help families pay their insurance premiums, doing so wouldn’t fix the underlying problem: surging health care spending. That’s the reason we need the subsidies in the first place, and it’s bankrupting families and shredding jobs for low- and middle-income workers across the economy.

I have been fortunate for most of my working life that my health insurance has come with my job. I was also lucky until my old age in that I never really needed expensive attention or treatment for a medical attention. That luck ran out four years ago. My out-of-pocket expenses were “minimal,” but only because I was lucky enough to afford them. Professor Cooper is not wrong here:

I wish there were a simple way to lower U.S. health spending. It’s easy to come up with ideas for what a better health system would look like if we could start from scratch. Unfortunately, the sheer scale of our system (if the U.S. health system were a country, in dollar terms, it would be the third-largest economy in the world) means there are no silver bullet solutions. Reform involves trade-offs. One person’s health care spending is another person’s health care income — profits, jobs and paychecks for the tens of millions of people who work in the health care sector. And some higher spending does lead to better care. As long as they’re in competitive markets, higher-priced hospitals deliver higher quality care. Slowing health spending would create winners and losers, which makes the politics of reform tricky.

His economic solutions are predictable, and unlikely to be worth the pixels they are printed with until we stop confusing consumer with citizen and patient. These are two fundamental lies of the Neoliberal Dispensation. Thoroughly workable approaches to our problem are available, provided we develop the wisdom to pursue them. I do know that the primary care physicians-in-training (Family Medicine, Internal Medicine, OB/GYN, Pediatrics, General Surgery, Psychiatry) that constitute about 80% of the students in my institution are aware of these problems, especially in a very large and rich state that nevertheless ranks at the bottom in maternal and child health. So, there is some hope.

Part the Sixth: An Appreciation of Christopher Lasch. It is essential to choose one’s teachers well if one wants to navigate this world with intention. This applies to every serious person of every persuasion. Christopher Lasch has been one of those teachers for me since I read The True and Only Heaven: Progress and Its Critics when it was published in 1991. As usual, I was late to the party. But I caught up with Haven in a Heartless World, The Culture of Narcissism, and his other books. In his posthumous The Revolt of the Elites and the Betrayal of Democracy, Lasch excoriated the modern liberal and explained our predicament that is the natural liberal habitat.

This, of course, gladdened the hearts of (some) conservatives, and all serious men and women on a genuine Left, small as they may be as a group. Paul Baumann explains in Commonweal, The Real Christopher Lasch: What his conservative champions are missing:

In trying to explain Donald Trump’s political appeal, conservatives have recently been celebrating the work of historian and cultural critic Christopher Lasch (1932–94). Lasch wrote approvingly of populism’s historical defense of traditional morality, marriage, family-centered economics, patriotism, and democratic self-determination. At the same time, he was scathing in his denunciation of liberal and corporate managerialism, income inequality, and what he called the “therapeutic society.” His skepticism toward feminism and opposition to abortion alienated many liberals. Lasch insisted that Americans, seduced by the false promise of sexual liberation championed by elites, marketers, and popular culture, had abandoned the wisdom of inherited culture and religion when it came to ordering their private lives and families. “American capitalism has rejected priestly and monarchical hegemony, only to replace it with the hegemony of the business corporation, the managerial and professional classes who operate the corporate system, and the corporate state,” he claimed. The result, he wrote in his bestselling *The Culture of Narcissism *(1979), is a citizenry whose thin sense of self and lack of firm connection to any community are easily exploited by business and politicians of both the right and left.

Writing in The Atlantic (“The Rising,” November), New York Times columnist David Brooks even attributes Trump’s popularity to how he “has deepened the Laschian critique by repeatedly telling the people that their democracy has been usurped by a permanent ruling class of educated elites.” Brooks downplays the scorn Lasch unleashed on corporate capitalism and hedonistic consumerism, and instead emphasizes Lasch’s disdain for the arrogance of the liberal “elites.” This is the side of Lasch that conservatives find so appealing. “The traditional American story is built on hope and possibility,” Brooks writes. Lasch found this sort of clichéd Reaganite optimism naïve. Modern capitalism’s absurd concentration of wealth and power and its heedless pursuit of endless material progress were a snare and a delusion.

Lasch was an early Cassandra when it came to the environmental crisis. The “creative destruction” demanded by the modern economy was the real enemy of traditional values and democratic egalitarianism. Brooks notes that “Trump’s ethos doesn’t address the real problems plaguing his working-class supporters: poor health outcomes, poor educational outcomes, low levels of social capital, low levels of investment in their communities and weak economic growth.” But Brooks’s agenda for turning back the Trump onslaught and reviving American democracy lacks Lasch’s realism about the necessity of limits and his skepticism about technological progress. “Historical tides shift when there is a shift in values,” Brooks writes. “A group of thinkers conceives a new social vision, and eventually, a social and political movement coalesces around it.” Lasch, by contrast, thought that you needed to change the way you live if you were to think differently about what is economically and politically possible.

Lo, David Brooks is with us still, but as far as I know the local Applebee’s still does not have a salad bar. Digging deeper, Paul Baumann referred to an article Christopher Lasch wrote in the New York Review of Books in 1988, Reagan’s Victims (archived version, worth the read for those to whom this is ancient history). This resonates still:

Notwithstanding his lip service to “traditional values,” (Reagan’s) policies have continued to undermine them…. There is a fundamental contradiction between Reagan’s rhetorical defense of “family and neighborhood” and his championship of the unregulated business enterprise that replaced neighborhoods with shopping malls and superhighways. A society dominated by the free market, in which the “American dream” means making a bundle, has small place for “family values.’’

Christopher Lasch is not the only essential teacher who the Right has attempted to co-opt. Wendell Berry is also at the top of this list, along with a host of others, some as old as the Nashville Agrarians of one hundred years ago. But that is a topic for another time.

Happy Boxing Day! Best wishes to all, whatever and however you celebrate. Thank you for reading and for providing a real, dispersed but not virtual, community in which we can make sense of our world. What we have here is what the late, great Robert W. McChesney described as the complete antithesis of what he saw coming at the dawn of the internet age.

Happy New Year! It promises to be interesting…