SHINY THINGS

We can love them and know they’re not enough.

I love shiny things. LOVE.

For example, precision medicine is awesome. Or — it will be awesome. Soon. At some point. For some of us?

Wait! Don’t go.

Again I want to be crystal clear: I’m INCREDIBLY excited about the technologies and treatments that will reinvent and redefine medicine, food, power, and more.

Truly. I soak this stuff up. Oh, we can do surgery on fetuses in the womb now? We can probably cure blindness soon? We can make drugs in space? Fuck yeah, sign me up. Plug it into my veins.

There’s a reason so many movies hinge on finding the antidote to some terrible, timely poison. An antidote worth its weight in gold because everybody needs it.

But what if — hear me out — we stopped poisoning everyone in the first place?

Until we stop actively making ourselves sick, futuristic new tools like CRISPR will remain the equivalent of the world’s most expensive bailing out of a boat that still has a widening hole in it (I did not run this essay through Grammarly).

A while back, I wrote a strange essay/breakdown/thing called “How to Survive”.

It’s about the very most basic shit that every single one of us needs, full stop, and how over time we’ve made access to these more complicated and expensive.

Today we’re going to revisit those needs in the context of the many exciting, mind-blowing discoveries and innovations coming down the pipe, some of which are difficult to believe, much less understand (well, for me), and all of which, in isolation, should be celebrated.

But also want to help you understand that we have some very basic shit we definitely do understand that we need to be doing, that could affect 100x more people right now, today, but that we’re just choosing not to do.

💨 Air

Who doesn’t love air? Nobody! Who doesn’t need air? Also nobody! Even fish need air, something I learned when I was 39.

But dirty air really just makes everything worse, and between wildfires, transportation, farms, and factories, we’ve got a pseudo-pandemic of respiratory, cardiovascular, and — fun! — brain diseases like dementia, all due in part to dirty air.

Great news: Eli Lilly’s got a drug that may slow Alzheimer’s progression.

But hold on — while that’s verifiably cool, and could help millions of people — Eli Lilly will sell it while we continue subsidizing the industries and bad guys who make the air more toxic every day for billions of people, but especially for the historically marginalized.

Eli Lilly’s obviously pumped that their total addressable market (TAM) is growing (pharmaceutical companies are generally much more interested in recurring revenue streams like treatments vs finite ones like cures), but maybe…fuck that?

Meanwhile, indoors, we’re still arguing over (incredible) vaccines and masks but — while tens of millions of federal funding are still available — we haven’t made a war-time effort to upgrade HVAC, air filters, and windows across America’s schools, offices, and homes, to level the playing field against the viruses themselves.

💦 Water

Water is goddamn delicious and you should drink more of it. Preferably some without forever chemicals (here’s my favorite under-sink water purifier). And in fact, when it’s this fucking hot, you should add some sodium and other electrolytes — I’m a big fan of Nuun.

Do all of that and you get the juice of life, pound for pound (or I guess gallon for gallon) the single most effective way to keep your bag of meat standing upright.

The problem is — despite living on what is effectively a planet absolutely saturated with water — very VERY little of it is immediately drinkable. And even that naturally-provided allocation is dwindling thanks to cheese, nut, meat, and monocrops to support cheese and meat — and now — data centers.

Could desalination save the day? Maybe! Is it a massive energy hog? For sure! Do we know what to do with the residual salt? Not really!

Is wastewater treatment and recycling the future? No, it’s the present. The amount of potable freshwater we waste is astronomical.

So yeah, get your undercounter or whole-home or in-fridge purifier going, add some electrolytes if you can afford to. But at a broader scale, cleaning up our existing supply by replacing every single lead pipe, banning forever chemicals, and taxing meat can go a long, long way. And preserving even more of our natural supply through massively increased stormwater capture would be a great idea, too.

🥑 Food

It’s so cool that process plants (and…err…other stuff) into realistic-looking and tasting chicken and meat, cheese and yogurt. It’s wild that our friends at Apeel have figured out how to safely coat and extend the life of our produce.

Food scientists are at work making hybrid rice and wheat and other crops that are more nutritious, that can grow with less water, and can survive in hotter climates. It’s super cool!

But in the meantime, there’s a lot we can do to, you know, make it stop heating up? To not subsidize and grow monocrops that ruin the soil, that go mostly to feeding future burgers, and consume most of the Colorado River?

We can choose to attack not only the demand side with plant-based burgers that have real-life grill marks, but also the supply side by taxing the hell out of meat.

(Yeah, look, I usually operate from a place of what is even remotely politically realistic, and I fully understand how politically toxic this topic is, but the less we shy away from talking about it, the less we start to address it).

🏡 Shelter

Sure, we can 3D print houses now, which is really cool, but how do we fix zoning so we can build 4 million new ones? And electrify all the existing ones? And recruit and train a million new electricians to wire them? And pay experienced electricians not to do the work but to teach the next generation instead?

Oh also we’re about to have a pretty old population, but there are massive nursing shortages at nursing homes?

In a world getting hotter every day, providing affordable, electrified shelter is probably the single most important adaptation move we can make, one that is DRIPPING with co-benefits.

⚡️ Power

Speaking of electrification — solar is, in many places, the cheapest energy of all time.

It’s more efficient than it’s ever been, and we’re on the cusp of even better versions. We can build huge solar farms, community-level setups, miles of panels over canals and farms, on top of parking lots and Walmarts, low-income buildings and suburban McMansions — if HOA’s allow it.

We can power our cars with it, we can power batteries with it. But — amazing news — it’s not our only clean energy option. Offshore wind is incredible (if expensive), onshore wind is dope, nuclear still works (very expensive to build anew but VERY safe), and advanced geothermal — MAGMA — is coming along nicely.

But we need to build 75,000 miles of new long-distance transmission lines to connect all of these clean energy sources to all of those millions of new homes and (empty) office buildings. And again — our inability to do so is just a choice we’re making.

Building a new fossil gas line? Just a vote from FERC.

Building a new transmission line? Requires approval from everyone you’ve ever met and the next ten years of your life.

We can do better. But we have to elect the people that’ll make it happen. If we do? Less gas that goes boom-boom, cheaper utility bills, and cleaner air for everyone who’s ever lived near fossil fuel production.

❤️ Health

After years (decades?) of biotech promise, we might be finally seeing the light.

Ready?

Imagine: mRNA vaccines for everyone and everything, malaria vaccines, cancer blood tests, CRISPR, protein folding, AI for antibiotics, Apple’s iOS 17 mental health big swing, molecular manufacturing is a thing, psychedelics for PTSD are getting exciting, Ozempic, we’ve got an RSV shot for kids, self-destructing cancer drivers, we’re back to work on a Lyme disease shot, we’re working on cell maps to grow new organs and maybe new limbs?

1. All of that is very welcome and very fucking rad

2. We have some really basic shit we keep deciding not to do, and we should decide to not not do those things

We could stop overprescribing antibiotics to adults, kids, and livestock. We could reduce our reliance on cars and help people who are able to walk and bike more. We could slow global warming and the rise of ticks. We could reduce alcohol consumption by taxing the shit out of it and improve liver health before livers need to be replaced by 3D printed ones.

You get the point. There’s nuance to everything, but at some point, we have to decide to plug the leaks. Once we do, we can EVEN MORE excited about the future.

I want to be clear though: We are already way better off than ever before. We just keep leaving a collection of folks behind.

The CHARITABLE view is we’re playing with the society game with one hand tied behind our back, and NOT SO CHARITABLY we’re afraid to overturn legacy systems that are racist and sexist and incredibly self-defeating.

As my children are loathe to hear even one more time — many things can be true at once. We are capable and on the cusp of transformative breakthroughs, but reluctant to commit to the unsexy work, like, for example, simply reducing the paperwork required just to prove you qualify for Medicaid.

Americans’ life expectancy is dropping in 2023 not just because we don’t yet have broad availability of the aforementioned incredible innovations, not just because of COVID, not just because of cars, not just because of guns, not just because of overdoses, not just because of our food and air and water, but because of all of it.

Our increasingly specialized doctors receive very little nutritional training, there’s no federal requirements for parental leave and sick leave. Most folks who do have health insurance can’t get an appointment with our primary physician for months, as doctors and nurses leave the workforce in droves and the remaining ones get bought up by private equity firms.

Pharmaceutical companies slow-walk HIV treatments to protect profits and fight tooth and nail against Medicare’s nascent ability to negotiate prices for a very small list of drugs. Corporations are people, dark money is everywhere, insurers use AI to reject thousands of claims.

We’re projected to spend $7.2 trillion on healthcare by 2031, or almost 20% of GDP, up from 17% last year, which is at least 2x other democracies. Meanwhile, most US bankruptcies are because of medical expenses.

And don’t even get me started on women’s health, or maternal health. Sure, yeah, maybe new ways of making babies are on the horizon. Very cool.

Not cool is giving women rat poison to treat vaginal infections, restricting bodily autonomy, and maternal death rates that — at best — top every single wealthy country on the planet.

Here’s what’s awesome: None of this — none of it — has to be this way. We can fix all of these things, a list simply rife with co-benefits — and that’s undeniably awesome.

We have to be honest with ourselves. I’m trying to help you see the full picture.

I just want you to understand — I really want you to understand — that our remaining baseline issues are many of the same issues we’ve always wrestled with, and they are virtually always because of policy choices we’ve made.

I will be the first to trumpet the historic progress we’ve made in poverty and basic living standards. I can’t wait to celebrate the next shiny technological accomplishment of the people working so hard on the frontlines of the future.

But I absolutely refuse to leave behind everyone else — the poor, the historically marginalized, and Long COVID sufferers among them — just because the work is hard, because the money aligned against our better interests is deep and widely dispersed.

These essays are for people who give a shit — radicalized people who understand that hope is something we do, who are more excited about thousands of new community health clinics than flying cars.