The Pattern Problem & The 2 Questions Driving Who You Are

I had just come from a cardiologist appointment. John and Victor (names anonymized to protect my friends’ privacy) were waiting for me at PJ Clarke's, fresh from a workout. I was late—they already had the table, menus open—but I made it just in time to order.

The conversation drifted through the usual territory until John posed a question that stuck with me: "I think everyone who helps someone else only does it because there's something in it for them."

He's a religious guy, and he used religion to prove his point—when he helps a stranger, part of him knows he's accumulating blessings, credit in God's ledger. The altruism isn't pure. There's always a transaction.

He turned to Victor. "When's the last time you helped someone out of your way?" Victor paused, thought about it, couldn't come up with anything recent. This bothered him—not because the question was unfair, but because it revealed something he hadn't wanted to see.

Then John turned to me.

My answer came out before I'd fully thought it through: "I help people because if I don't, the thought lingers. Like I neglected something I was supposed to do."

John wanted this to be about religion. But as I explained it more, I realized it wasn't. What I actually felt was that by not helping, I'd be casting a vote—a vote for becoming someone who doesn't help. And that every choice like this, no matter how small, was a vote for the kind of person I'm becoming.

That reframing seemed trivial at the time. Dinner moved on. But I've thought about it constantly since, because I think it reveals something about human psychology that, once you see it, explains a lot of self-sabotage.

The Wrong Question

Most people, when facing a decision, ask: "What should I do?"

This framing is almost always wrong, because it treats the decision as isolated. Should I go to the gym today? Should I send that email? Should I help this person? Each choice appears as its own little dilemma, to be evaluated on its own merits.

But decisions aren't isolated. They're patterned. And patterns compound.

The person who skips the gym "just today" is running an experiment: what happens when I skip? The answer, usually, is nothing. No immediate punishment. The world continues. So the next time the decision arises, the skip-option has been validated. It's slightly easier to choose. Not because anything external changed, but because a precedent now exists.

This is how patterns form. Not through dramatic choices, but through tiny precedents that accumulate until they become defaults.

The Right Question

The better framing is: "What pattern am I reinforcing?"

This question does something the first one doesn't—it connects the present choice to a trajectory. It forces you to see the decision not as a single point, but as a vote in an ongoing election. An election where the winner becomes your identity.

When you ask "should I go to the gym today?" you can easily rationalize a no. You're tired. You went yesterday. One day won't matter. All true, in isolation.

But when you ask "what pattern am I reinforcing?"—you have to confront something harder. You're either reinforcing the pattern of someone who trains consistently, or the pattern of someone who finds reasons not to. There's no third option. Inaction is itself a vote.

Why Your Brain Sabotages You

Here's where it gets interesting. Humans are famously bad at intuiting exponential functions. We can feel linear growth—ten dollars a day for a year feels like it's worth about $3,650, and it is. But compound growth breaks our intuitions completely. A penny doubled daily for 30 days feels like it should be worth a few dollars. It's actually $5.3 million.

This isn't just a math curiosity. It's a deep flaw in human cognition that sabotages our decision-making constantly.

The tragedy is this: exponential curves start slower than linear ones. Put them on the same graph and, for the first several periods, the linear line is actually ahead. Exponential growth only overtakes linear growth later—sometimes much later. Which means that at the moment of decision, when you're comparing options, the exponentially better choice will often feel worse.

Going to the gym once feels like nothing. Eating a salad feels like something—immediate, tangible, virtuous. Both are good decisions. But the gym compounds in ways the salad doesn't. The salad gives you roughly what you'd expect: some nutrients, some fiber, slightly better digestion that day. The gym gives you something that's nearly invisible at first but accumulates into a completely different body, energy level, mental clarity, and self-image over years. The first few gym sessions might actually feel less rewarding than the first few salads. That's the trap.

This is true for almost every high-value behavior. The things that compound dramatically tend to feel the most pointless in the early stages, precisely because exponential curves start slow. Writing one page feels meaningless compared to reading an interesting article. Sending one networking email feels awkward compared to browsing LinkedIn passively. Having one difficult conversation feels painful compared to just letting things slide.

In every case, the higher-leverage choice feels worse initially.

The Discomfort Heuristic

This suggests a counterintuitive heuristic: if you're choosing between two reasonably good options and one feels noticeably more uncomfortable or pointless in the short term, that's often a signal that it's the exponential bet.

Not always. Some things feel bad because they're actually bad. But among choices that are plausibly beneficial, short-term discomfort or apparent meaninglessness often correlates with long-term compounding.

The workout that feels like a waste of time. The cold email that feels awkward. The skill practice that feels tedious. The boundary-setting conversation that feels harsh. The early-morning routine that feels brutal. These tend to be the exponential plays. And they tend to feel worse than their linear alternatives precisely when you need to start them—at the beginning, when the exponential curve is at its flattest.

Your brain will try to talk you out of these choices using perfectly reasonable logic. One session won't matter. You can start tomorrow. The linear alternative is good too. This is all true in the immediate frame. It's catastrophically false in the cumulative frame.

The Tactic

Here's something concrete you can use immediately.

The next time you face a decision—especially a small one where you're tempted to take the easier path—complete this sentence:

"If I choose X, I'm voting to become the kind of person who ___."

Fill in the blank honestly.

If I skip the gym, I'm voting to become the kind of person who skips when it's inconvenient. If I send the email, I'm voting to become the kind of person who handles uncomfortable tasks promptly. If I help this stranger, I'm voting to become the kind of person who helps. If I walk past, I'm voting to become the kind of person who walks past.

Then ask a second question: "Is this a linear or exponential bet?"

Linear bets give you roughly what they appear to give you. Exponential bets appear to give you almost nothing at first, then everything later. The discomfort of the early stages is a feature, not a bug—it's the price of admission to the steep part of the curve that most people never reach because they quit while the curve is still flat.

The Hidden Leverage

This reframing reveals where the real leverage exists in your life.

Most people think high-leverage decisions are the big ones: what career to pursue, who to marry, where to live. Those matter, but they're rare—a handful per decade.

The decisions you make dozens of times daily—how you spend your morning, whether you keep small promises, how you respond to minor friction, whether you do the slightly harder thing or slightly easier thing—these feel low-leverage because their individual stakes are low. But they're the highest-leverage decisions you make, because they're the raw material of exponential curves.

One gym session is nothing. A thousand gym sessions is a different person.

One awkward networking email is nothing. A thousand such emails is a different career.

One moment of helping a stranger is nothing. A thousand such moments is a different character.

The question is whether you can tolerate the flat part of the curve long enough to reach the steep part. Most people can't. Not because they lack discipline, but because their intuitions are calibrated for linear growth, and exponential growth feels like a lie until it suddenly doesn't.

The Identity Flip

Back at that dinner, John wanted to know why people help each other. It's a fine philosophical question. But I think the more useful question is mechanical: what does the pattern of helping or not helping actually do to you over time?

And the answer is that it compounds. Not linearly—you don't just become "a little more helpful" with each act. You become a different kind of person, with different defaults, different instincts, different possibilities available to you. The same is true for every pattern you run.

This sounds abstract, but the implication is concrete: if you want to change who you are, you need to change your relationship with discomfort. Not dramatically—you don't need to become an ascetic. But you need to learn to recognize the feeling of "this seems pointless right now" as a possible signal that you're on an exponential curve, in the flat part, where most people quit.

The things that will change your life the most are probably the things that feel the least rewarding in the beginning. That's not a motivational platitude. It's a mathematical property of exponential functions, applied to human behavior.

The question is never "what should I do?"

The question is "what pattern am I reinforcing, and does it compound?"

You're answering it every day, whether you realize it or not.

The Book Cover Problem

I was in third or fourth grade when I first realized adults lie to children—not in the obvious ways, like about Santa Claus or the Tooth Fairy, but in more insidious ways that reveal something broken in how we think.

The librarian and teachers kept repeating this phrase: "Don't judge a book by its cover." They said it with the kind of moral certainty adults reserve for things they want to be true. But even as a kid, I could see they were full of shit.

The thing that struck me wasn't just that it was false—it was that it was obviously false. If you don't judge books by their covers, why do publishers spend millions on cover design? Why did the teacher herself pick up Charlotte's Web instead of the book next to it? Some judgment must have occurred. The cover communicated something, and she responded to it. That's literally what covers are for.

What bothered me wasn't the advice itself—maybe they meant something like "don't only judge books by their covers," which would at least be coherent. What bothered me was the gap between what they preached and what they practiced. They were lying, and worse, they seemed to believe their own lie.

I was too young to articulate it this way at the time. My rebellion was simpler: a defiant insistence that yes, I do judge books by their covers, and so does everyone else. It was the intellectual equivalent of a kid yelling "the emperor has no clothes." I was confident I was right, but I couldn't yet explain why the adults were wrong in such a specific, systematic way.

The First Crack

Looking back now at 25, I think that was the moment I first glimpsed something important about how the world works. Not that people lie—every kid knows that—but that people lie to themselves. They construct elaborate narratives about who they are and what they believe, and then they defend these narratives even when reality contradicts them.

The book cover thing was trivial, but the pattern wasn't. People say one thing and do another. They preach principles they don't practice. Sometimes this is conscious hypocrisy, but more often it's something stranger: they genuinely can't see the contradiction. They've told themselves the story so many times that they've forgotten it's a story.

And here's the really unsettling part: they want you to adopt their delusions too. It's not enough for them to believe that judging books by their covers is wrong while doing it anyway. They need you to believe it too, to participate in the same collective fiction. There's something almost desperate about it.

The Harder Problem

At this point, observing that people deceive themselves isn't interesting anymore. It's just a baseline assumption about how humans work. What's interesting now is the second-order problem: if this was obvious to me in third grade, what's obvious to a 35-year-old or 45-year-old that I'm missing now?

The liars have gotten better. They're older, more articulate, better at constructing persuasive narratives. They have professional credentials and sophisticated arguments. They speak with passion and conviction—often because they genuinely believe what they're saying, having internalized their own lies so thoroughly that they're no longer distinguishable from beliefs.

This is much harder to detect than a teacher contradicting herself about book covers. When you're young, adult hypocrisy is like a neon sign. But sophisticated self-deception in adults, by other adults, is camouflaged. It hides behind complexity, expertise, good intentions, and social consensus.

The scary question is: what have these better liars already convinced me of? What beliefs am I carrying around right now that are just more sophisticated versions of "don't judge a book by its cover"—things that sound right, that everyone around me agrees with, but that don't survive contact with reality?

The Mirror

But there's an even more uncomfortable question lurking beneath that one: what lies am I telling myself?

I'm 25 now. I'm one of the adults. It's entirely possible—likely, even—that I'm doing exactly what that librarian did. Saying things that sound wise and principled while acting in ways that contradict them. The only difference is that I can't see it yet. Just like she probably couldn't.

This bothers me for two reasons. The obvious one is that I'd like to be closer to the truth. I'd like congruence between what I believe and what I do, between what I say and what I practice. There's something inherently valuable in that alignment, independent of outcomes.

But there's a second reason that I find more interesting: I wonder if the very act of watching for incongruence—of constantly checking whether your actions match your words—creates its own kind of value.

Maybe the person who's perpetually on the lookout for gaps between their stated beliefs and revealed preferences becomes, almost as a side effect, more honest. More self-aware. More confident, even, because their self-image is grounded in reality rather than aspiration.

It's not that hunting for incongruence necessarily makes you truthful. You could spot all your contradictions and decide not to fix them. But there might be a correlation. The kind of person who habitually checks their beliefs against their behavior might be more likely to develop genuine integrity—not because they're more moral, but because they've made it harder to fool themselves.

Pattern Recognition

I've started to notice that the book cover problem has a signature. It shows up whenever there's a large gap between stated and revealed preferences. When what people say they value and what they actually do with their time, money, and attention point in different directions.

It shows up in moral advice that, if followed literally, would make you worse off—and that the advice-giver clearly doesn't follow themselves. "Be yourself" from people who carefully curate every aspect of their presentation. "Follow your passion" from people who chose lucrative careers. "Don't judge books by their covers" from people who judge books by their covers.

It shows up in explanations that are optimized for sounding good rather than being true. The kind of thing that gets nods of approval in conversation but doesn't generate any useful predictions about the world.

The tricky part is that these patterns are easy to see in domains you understand well and nearly impossible to see in domains you don't. That third-grade version of me could spot the book cover lie because I had direct, repeated experience of how book selection actually works. But in areas where I lack that ground truth—politics, relationships, career advice, what makes people happy—I'm as vulnerable as anyone else to confident-sounding bullshit.

And this includes my own bullshit. The stories I tell about myself.

The Vigilance Question

So I keep coming back to this question: is there value in vigilance itself? Not just in achieving congruence, but in the active practice of looking for incongruence?

I suspect the answer is yes, but not in a straightforward way. It's not that checking for contradictions automatically makes you more honest—you could just become better at rationalizing them. But the habit of checking creates a certain kind of friction. It makes self-deception more expensive, more effortful. And over time, that friction might push you toward truth almost accidentally, the way water finds the easiest path downhill.

There's also something about confidence here that I'm still working out. I think real confidence—the kind that isn't brittle or defensive—comes from having an accurate map of your own abilities and beliefs. When you know what you actually think (as opposed to what you wish you thought) and what you can actually do (as opposed to what you imagine you could do), you can move through the world with less anxiety. You're not constantly worried about being exposed as a fraud, because you've already done the exposing yourself.

The person who habitually checks for misalignment between belief and action might develop this kind of confidence naturally. Not because they're perfect—they'll find plenty of contradictions—but because they've at least looked. They know where the gaps are. They're not operating under a comforting delusion that could shatter at any moment.

The Real Lesson

The librarian probably meant well. Maybe she was trying to teach us not to be superficial, to give things a chance before dismissing them. That's a reasonable lesson. But by packaging it in an obvious falsehood, she accidentally taught me something more valuable: that the way people explain the world is often decorative rather than functional. It's social signaling dressed up as wisdom.

The real skill isn't detecting lies versus truth. It's detecting which explanations are load-bearing—which ones actually help you navigate reality—versus which ones are just there to make you or someone else feel good.

At 25, I'm still working on this. I can spot the obvious stuff, the third-grade-level contradictions. But I'm sure I'm surrounded by more sophisticated versions of the same thing, lies that have been refined over generations until they sound like common sense.

And I'm sure I'm telling some of those lies myself. Right now. To you, to others, to myself.

The question I keep coming back to is: what would a 45-year-old version of me see that I can't see yet? What am I confidently wrong about right now? What obvious lie am I telling myself?

I don't know. But I'm pretty sure that whatever it is, it seems just as self-evidently true to me now as "don't judge a book by its cover" seemed to that librarian.

The best I can do is keep looking. Not because vigilance guarantees truth, but because the kind of person who keeps looking is more likely to find it. And maybe, over time, that vigilance itself builds something valuable: a version of myself that's harder to bullshit, including by me.

That might be the real lesson from third grade. Not "watch out for liars"—that's too easy. But "watch out for the liar in the mirror, and check often, because he's gotten very good at his job."

You are probably very selfish; I hope you become a capitalist

Why Healthcare's Future Lives Where Doctors Aren't Looking

I got into a philosophical discussion recently about whether everyone has equal worth no matter what they do. As someone who likes to measure things, I ended up defending money as our best metric to measure productive output in society. Not perfect, not the only one—just the best we have to measure how much someone has done to give other people things they want. (Non-profits exist to cover the externalities that are needed in society for social value but do not have economic value.)

That conversation stuck with me. I landed on using Physics to guide me. I claimed that almost everyone has equal potential value, but people differ in their actualized value. The actions you take, or do not take, determine the delta between actualized and potential. Think kinetic versus potential energy.

This got me thinking about the difference between potential value and actualized value in terms of labor.

Think about it this way: Elon Musk has pretty much maximized his actualized value. You and I? We've actualized more than a lot of people, sure. But we probably still have a ton of potential left on the table.

Then I realized something about the job of a physician: physicians are in the business of restoring potential value. Someone gets sick or injured, we patch them up and restore what they're capable of. But we do absolutely nothing to help them actually actualize that potential. That all happens outside the clinic.

And nobody's helping with that part. That's a gap.

The Gap Nobody's Talking About

Here's what's happening right now in healthcare, and most doctors are pretending it isn't:

On one side: Consumers are obsessed with health data. Wearables everywhere. WHOOP, Oura Ring, Apple Watch. People tracking sleep, HRV, glucose, steps, strain. Supplements are mainstream now. Longevity isn't fringe anymore—it's what everyone's talking about. Patients are generating mountains of data about their bodies and desperately want someone qualified to help them understand it.

On the other side: Physicians are leaving traditional practice in droves for Direct Primary Care. Why? Because they want actual ownership over how they treat patients. They're tired of insurance companies dictating care through billing codes. At the same time, they're closing their eyes and ears to clear consumer demand in wearables, longevity, supplements, whole body MRIs etc.

So here's the absurd part: patients have all this data they want analyzed. DPC doctors have the time and autonomy to analyze it. But it's still not happening.

Why? Because there's no ICD-10 code for "assessed WHOOP data from patient." Insurance doesn't pay for it in traditional settings, so traditional doctors ignore it. (Fun fact, did you know a full Review of Systems isn't actually required anymore in a patient note? We just keep doing it because insurance used to want it!) And DPC doctors haven't figured out how to systematically integrate all this new patient data.

But imagine if they did. Imagine WHOOP partnering with a DPC clinic: pay a premium tier membership and you get physician analysis of your wearable data included. Your doctor actually reviews your sleep architecture, your recovery scores, your strain patterns. Not as a gimmick—as real preventative medicine.

That could exist today. It doesn't.

The Industry Doctors Love to Ignore

Let me hit you with a number: the global supplements industry is worth $200 billion and growing at 8% annually.

For context, the entire global music industry is $20 billion.

Supplements are 10x bigger than music. And growing faster.

As physicians, our response to this has been to dismiss the entire thing as pseudoscience. Overdiagnosis. The worried well wasting money. We close our eyes and plug our ears and insist it's all nonsense.

But when an industry is that massive and growing that fast, maybe "it's all nonsense" isn't the full picture. Maybe there's actual value being delivered—or at least, value that could be delivered if someone with medical training approached it professionally, methodically, with aligned incentives instead of just selling snake oil.

The demand is real. Patients don't care that we're skeptical. They're spending the money anyway. Commerce happens online now. Health optimization happens online. Life happens online. And physicians have retreated to exam rooms, insisting everything outside is bad medicine.

We're missing the entire conversation. And worse, we're letting unqualified people lead it.

Building Healthcare's Apple

My long-term vision is this: build the Apple of healthcare.

Not in the sense of making gadgets. In the sense of integration. Products, software, and services that work seamlessly together to deliver exceptional patient care. The Ritz-Carlton of healthcare—a chain of clinics where hospitality isn't an afterthought, it's the foundation.

You don't build that overnight. You need to build the atom before the molecule, the molecule before the compound.

The compound is that chain of integrated clinics with exceptional end-to-end care. But the atom? That needs to start with something consumers already want. And whether doctors like it or not, right now that's supplements, sleep products, and wearables.

So here's the plan: start by learning to sell luxury health products. Not commodity stuff—luxury. Premium supplements at $80. Sleep masks at $100. High margins because that's what makes the unit economics work. You can't build a real business selling $20 products online when Meta Ads cost $30+ per click. At least, I can't.

The interesting challenge isn't manufacturing. It's figuring out how to make someone want to pay $80 for something that costs $15 to produce. That's all storytelling. Education. Brand building. Creating something people want to be part of, not just buy from. I'm thinking something along the lines of how James Dyson would attach little index cards sharing the story behind Dyson, when it first launched in stores. This helped buyers feel they were a part of a story, not just a consumer.

The Evolution: Products → Software → Clinics

Once you have the consumer products working, here's how it builds:

Phase 1: Premium products. Meet customers where they already are. Build brand credibility. Generate cash flow. Learn how to acquire customers profitably online.

Phase 2: Software layer. At this point you already have a list of thousands of patients across the country. But you can tap into an easy adjacent market by offering a new upsell; I've noticed a lot of the patients I get to meet in school keep health journals—little notebooks tracking symptoms, medications, habits, sleep, mood. What if we made a beautiful physical journal as a product? Then a year or two later, we introduce an AI tool: photograph your journal pages and upload your entire health history into a private digital vault. Regardless in the end, you now have converted DTC consumer health customers into a patient panel. And you even managed to load it up with real consenting patient data!

Suddenly you've built the early version of an EMR without calling it that. You have patients in a digital ecosystem you control. You have longitudinal data. You have real relationships. Best of all, you keep big-bad wolf Epic away.

Phase 3: Clinical services. Now you build the actual clinics and can start offering nationwide Telehealth as well. You already have brand recognition. You have patient relationships. You have data infrastructure. You create a licensed clinic model that integrates everything—the products, the software, the hospitality-driven care.

Products → software → services. Atom → molecule → compound.

Why This Actually Matters

Healthcare is broken, but not because doctors don't care. It's broken because the incentive structures are completely misaligned. Insurance reimbursement dictates what's medically possible. Patients are optimizing their health everywhere except with their doctors because we've made it clear we're not interested in that conversation.

But we should be interested. We're the ones with actual medical training. We have clinical judgment. We can distinguish signal from noise. We should be the trusted guides in a landscape that's become overwhelming and often predatory.

Instead, we've ceded that entire space to people selling $200 multivitamins with no medical oversight.

The future of healthcare isn't just telehealth and AI diagnostics. It's meeting patients where they're already trying to optimize their health and bringing real medical expertise into those spaces. It's building systems with aligned incentives where doctors can actually practice good medicine without fighting insurance companies for every decision.

Someone's going to build the Apple of healthcare. I thought it would be Kaiser, then I thought it'd be One Medical, then I thought it'd be Function Health. They all kept failing for one main reason. It should probably be people who understand medicine. But the people who understand medicine get lured into ivory towers, and we end up going in circles.

So in reality, it'll probably be young physician-builders who understand DTC e-commerce, storytelling, and brand building; which is probably like less than 100 people across the whole U.S. right now.

More soon.

The Blue Link and the Backseat

When Marc Andreessen was asked why hyperlinks were blue, his answer was disarmingly simple: he liked the color blue. That was it. No committee, no grand design study, no academic consensus. Just one man’s preference, stamped onto the architecture of the internet forever. And now billions of people live inside a world colored by his impulse.

This story is trivial on the surface and profound underneath. It reveals the hidden scaffolding of culture: it is not built by invisible laws or forces of nature. It is built by people—individuals—who dared to assert that their preference, their taste, their decision should become reality. The world is littered with the fingerprints of those who refused to wait for permission.

But most people, confronted with this reality, recoil. To admit that society is shaped by the strongest personalities is to admit that you, too, could shape it if only you stepped forward. That truth is too heavy for most to bear. It’s easier to believe in inevitability—systems, institutions, “the way things are.” It’s easier to resign yourself to the backseat and call it humility or realism.

Modern culture thrives on this sense of helplessness. It whispers that you are a mere consumer, not a creator. That the rails are already laid, that the best you can do is ride along and maybe choose your seat. But this is a lie. Every building, every law, every tradition, every pixel on your screen was once arbitrary. Once, someone said: I like blue better than green. And the world bent around that choice.

You are allowed to do the same.

The battleground of ideas is not fair, and it has never been. The loudest, most consistent, most relentless voices set the tone of their era. That has always been the case, and it always will be. The question is not whether this is fair. The question is whether you will accept the weight of your own preferences as worthy of shaping reality—or whether you will surrender them, pretending they don’t matter, while others build the world in their image.

Most people resign themselves to the backseat of life. But the front seat is empty, waiting for anyone willing to grab the wheel and say, I like blue.

How your weakness can become your greatest strength

We are all born into life carrying burdens we did not choose. Some are written on our bodies, others woven into our temperaments, still others etched by circumstance and family. They are the traits, the failures, the scars we’d rather not confess. When we think about our weaknesses, we usually see them as proof of inadequacy, reasons to hide, excuses for why we cannot lead or achieve. But what if this very way of looking at weakness is incomplete?

Imagine, for a moment, writing down every single flaw, every failing, every fear. Make the list as brutally honest as possible—your impatience, your insecurity, your mistakes, your illnesses, your struggles. Then ask a simple question: What if God let this happen to me for a reason? What if these weaknesses are not arbitrary curses but invitations to growth?

One of the ways I implement this is by regularly asking myself: If God wanted to make someone tough, would he give them an easy life?

When we reframe weakness in this way, something extraordinary happens. Each burden becomes a potential gift, each wound a source of wisdom. A person who has wrestled with anxiety may be uniquely equipped to guide others through storms of fear. Someone who has known the sting of poverty might carry an unmatched compassion for the marginalized. A leader who once failed profoundly may have the humility and patience to help others avoid similar ruin. In this light, weakness becomes a teacher—and more than that, a calling.

The paradox is that our struggles create a familiarity that cannot be faked. You cannot lead people out of darkness unless you have known what it feels like to walk there yourself. You cannot speak with authority about resilience unless you have endured. The authority of lived weakness is not in theory, but in testimony. And so the very things we once sought to bury become the foundation upon which our most authentic influence is built.

This is the alchemy of weakness: to recognize that the list of flaws we once despised is, in fact, a catalog of unique strengths. Where others see shame, we can see training. Where others see limitation, we can see preparation. Our wounds are not simply healed; they are transfigured into wisdom and power that can only come from having lived them.

So perhaps the challenge is not to rid ourselves of weakness, but to reinterpret it. To accept that the things that make us feel small may be the very things that make us indispensable. To see our lives not as accidents, but as carefully tailored paths where even the jagged stones were placed with purpose.

In the end, we lead not despite our weaknesses, but because of them.

P.S. Over the past 5 years I have been quietly planning a 3rd book. Many people comment on my world view and personal philosophy and many people have commented on how much it has helped them move forward during tough times. I frequently get messages from strangers I have never met and it is in those moments I remember the power of the internet. So, despite always feeling uncomfortable about this, I feel it is my responsibility to take the positive feedback and share it with others whom I do not converse with regularly.

I will be writing this book, in public, in realtime. For now, I have collected my most important maxims. These were discovered through personal trials & across multiple countries with an inordinately abnormal variety of experiences for someone my age.

For now, you can find them here: https://blog.thisisalimirza.com/meditations/

I will be turning each of those maxims into a chapter of the book. Each chapter will contain a personal story putting the maxim in context, some stories from historical figures who lived them, as well as a section on how to implement the maxim in your own life.

This will probably take me around 2 more years. I will continue adding maxims to that page, and eventually I will share a live public google document where I will be writing out the rest of the book as it takes form. I think this will be fun.

My view on the problems in healthcare today

In my first few months of medical school, I kept hearing the same sentence over and over—from doctors, nurses, even administrators:

"The healthcare system is broken."

At first, I thought this was just casual pessimism or burnout talking. But the longer I've spent in medicine—and simultaneously in entrepreneurship and technology—the more I've realized that healthcare isn't randomly dysfunctional. It’s predictably dysfunctional, structured in ways that consistently produce poor outcomes.

But why exactly does healthcare feel broken? And, more importantly, how can we fix it?

The fundamental reason healthcare feels broken is actually simpler than most people realize: incentives in healthcare are systematically misaligned.

The Concept at the Core

When people say "healthcare is broken," they usually mean that patients, physicians, and hospitals are all frustrated, burned out, and operating in ways that seem irrational. But these frustrations aren't accidental. They’re symptoms of deeper structural problems:

• Patients want affordable, high-quality care that improves their long-term health.
• Physicians want autonomy, meaning, efficiency, and the ability to genuinely help their patients.
• Hospitals and healthcare institutions want stable revenues, manageable risk, and compliance with regulatory metrics.

At first glance, none of these goals seem unreasonable. But the underlying incentives that guide behavior within healthcare almost never align with these goals simultaneously. Incentives shape how people behave, often even without realizing it. When incentives are misaligned, even well-intentioned people produce suboptimal or outright irrational outcomes.

This isn't unique to healthcare. Misaligned incentives cause dysfunction everywhere—from business to politics. But healthcare is particularly vulnerable because misalignment directly affects human wellbeing.

A Concrete Example

Consider a practical example from my own medical school experience:

Physicians are routinely required to spend enormous amounts of time documenting patient encounters. On the surface, documentation seems obviously good—detailed records help patient safety, continuity of care, and medical accountability.

But here's the hidden incentive misalignment:

• Hospitals and clinics often require highly detailed documentation primarily because that's how they bill insurance effectively and maximize reimbursement. The more detailed the documentation, the more defensible the billing codes.
• Physicians, however, aren’t paid for time spent documenting—they’re paid primarily for patient encounters. Excessive documentation reduces their time available for actual patient care, eroding the very purpose that drew them into medicine.
• Patients, meanwhile, experience rushed visits, distracted doctors, and less personalized care because their physician is stuck behind a computer optimizing billing codes instead of clinical outcomes.

This simple example highlights a profoundly misaligned incentive: physicians must optimize for billing, not care. Predictably, frustration, burnout, and worse patient outcomes result.

How Can We Fix Misaligned Incentives?

Once you clearly see incentive misalignment, the question becomes: How do you realign incentives in a structurally sustainable way?

There are no easy answers, but there are a few practical solutions we can prioritize immediately:

1. Shift Payment Models From Volume to Value

Today’s "fee-for-service" model pays physicians and hospitals based on how many procedures and visits they perform. Naturally, this incentivizes quantity over quality.

Moving toward value-based care models—paying for outcomes rather than volume—realigns incentives clearly and directly. Physicians can finally optimize patient health outcomes, rather than the number of procedures billed. While value-based care isn’t perfect and comes with its own complexity, its fundamental direction aligns incentives far more clearly than the status quo.

2. Prioritize Physician Autonomy and Clinical Judgment

Many frustrations arise because highly-trained clinicians feel stripped of autonomy by bureaucratic processes aimed primarily at compliance or reimbursement.

When physicians lose autonomy, burnout spikes. Patient care suffers. To realign incentives, hospitals and policymakers must explicitly prioritize clinical judgment. Protocols and checklists have their place, but trusting physician judgment—backed by appropriate accountability—improves both patient outcomes and physician satisfaction.

3. Use Technology to Enable Care—Not Just Billing

Electronic Health Records (EHRs) today optimize primarily for billing and compliance. Physicians spend hours clicking through billing codes rather than truly focusing on patients.

As someone deeply involved in technology and entrepreneurship, I see clearly how dramatically software can improve productivity, patient communication, and clinical decision-making. We need EHRs and tech systems designed explicitly around physicians’ workflow and patient care—not simply around billing codes.

4. Make Pricing and Outcomes Transparent

Healthcare is one of the only major industries where consumers (patients) have virtually no visibility into pricing or quality until after receiving care.

Transparent pricing and clear outcome metrics would immediately pressure healthcare providers to align their incentives around quality, cost-effectiveness, and efficiency. This transparency would empower patients and reward providers who deliver genuine value.

Why I Chose Medicine (despite these misaligned incentives)

Given these systemic problems, why do I still believe medical school was the right choice?

Because medicine provides uniquely powerful leverage for realigning these broken incentives at scale. Yes, healthcare feels broken, but precisely because it’s so deeply important and complex, any genuine improvements generate massive human impact.

This is the opportunity behind the frustration.

My dual lens—entrepreneurship and medical training—clarifies something powerful: Medicine itself isn't broken; it's the incentives and structures around medicine that are broken. Those incentives and structures are human-designed—which means they're human-changeable.

Physicians, especially physician-leaders and physician-entrepreneurs, have enormous leverage to realign incentives clearly, ethically, and strategically. By deeply understanding both the system’s dysfunction and potential solutions, we can become uniquely positioned to improve healthcare from within.

Final Thoughts

To health-tech founders, patients, future colleagues, or others within healthcare reading this: Misaligned incentives aren’t inevitable. They’re problems of design, not destiny. Recognizing misalignment clearly is the first step toward fixing it systematically.

Clearly understanding why healthcare feels broken also makes clear how we can meaningfully fix it—and why doing so matters immensely.

Healthcare doesn’t have to stay broken. We just need the clarity, strategy, and the courage to realign the incentives at its heart.

That’s precisely the work I intend to do.

— Ali

Everything is an info-product.

The viral app CAL AI

There’s a viral app that’s been making a lot of waves lately.

It’s called Cal AI. It is basically like MyFitnessPal except powered by an AI Camera. You use it by taking a picture of whatever you’re eating and it’ll use an AI model to infer what’s in the picture, estimate quantity, ingredients, and arrive at a total calorie estimate.

The idea is that it makes it really easy to calorie count and help you on your weight loss/ gain process.

They’ve been claiming around $3.6 Million / month in revenue, and I do believe them. I like to think people have no reason to lie usually. It’s not always true, but I’d simply rather have that belief than the opposite one. So let’s keep the working assumption that they indeed make $3.6M/month in revenue.

That’s impressive! They’re also a bunch of young 20 somethings, a few of them are just freshman, and one of the four founders is actually at the University of Miami, my alma matter!

What’s all the talk about?

But here’s the thing— yesterday, they announced that they will be launching a course teaching other people how to build similar apps as they have. Ostensibly I have no issue with this personally. I believe everything in the world comes at a cost, and so you either pay with money or you pay with time. You simply must decide for every “purchase” which currency you’d like to use. I prefer to spend money on things that I don’t want to spend time on— I think everyone does. I also see courses as a similar situation: I prefer to spend $1,000 on a course that will teach me exactly how 4 young guys in their 20s built a set of apps that gets them $3.6M/month. To me, I could probably figure that out on my own too but it’ll probably take me a decent few months of trial and error. And sure, I’ve learned a lot of things through trial and error but one of those things was also that the only thing that matters most is getting the job done, and not all time expenditures are worth the same as others. So personally, I’d gladly cough up $1k for their course, rapidly implement and I’d probably see a return on my investment pretty quickly. If I really wanted I’d calculate the Internal Rate of Return (IRR) of the venture and determine if it beats the returns I get from JANUS or other ventures, or even the medical path.

But I’m not going to do any of that because I am entering a season of “no”. I want to say “no” to a lot more things than I say “yes” to. I think I’ve said yes to so many things over the past years that I have developed a very, very unique skillset. I feel it is about time I focus intensely on momentum, and every “no” is an active decision to preserve momentum. Every “yes” is an expenditure of said momentum. So, that being said, I will not be purchasing this course, because app development is not a priority for me right now.

If it is for you, feel free to check it out: https://appmafia.com/

First, let’s look at the numbers

Now, that all being said, what I also wanted to do in this newsletter piece is address a very common misconception I see in many people, and I see us business folks take advantage of this far too often. The honest ones will usually point out the difference but the one’s that benefit from optics will usually not, and you’ll be left with a wrapped sense of reality and you’ll make poor decisions. I want to prevent you from making poor decisions as best as I can determine them to be poor.

• So, App Mafia, the team behind Cal AI claims to make $3.6M/month revenue. As mentioned, let’s assume this is true. Regardless, since it is all App Store driven sales, Apple takes a cut of 30% on every transaction.
• That leaves them with $2.52M/month.
• Now, they probably spend around 80% of that to get the sales and attention in the first place. This is almost always a combination of Meta Ads, UGC, paid acquisition.
• That leaves them with: $0.5M/month.
• Of this, there’s around a 40% federal tax rate on them.
• So that leaves them with $0.3M/month.
• Now since it’s a team of 4 young guys, that net’s them each $75,000/month.

That is a great amount! It’s certainly more money than most people will know what to do with, and at that young of an age, they’re doing well for themselves. If that’s what you’re thinking right now, I’m not here to argue with you— I don’t even disagree!

Where the circles I’m in are taking interest in this story however is that it is interesting to see how quickly $3.4 MILLION gets diluted down to $75k.

That’s a 2% net margin on their viral business.

It’s worse than the average 6-10% net margins of a restaurant. It’s way worse than the 50-75% net margins I have running JANUS. It’s even more worse than the 90% net margins of selling courses.

What does this tell us about their incentives?

And this is my final point. This is why, allegedly someone who is making $3.6/month will take time out of their business hours to instead start recording content for a course business. The only reason that makes business sense for them is because they finally looked at their numbers and realized that their business, is in fact, quite sh**.

They work far more than most, for far less margins. It’s also a business they can never sell because there is absolutely no inherent MOAT, so there isn’t really an exit path either. So, of course these guys figured it’s time to cash out by selling a course.

That’s not to say it’s a bad thing at all— they clearly know what they are doing and its not like their results aren’t real. It is however important that folks understand THEIR incentive and reason for this. The business model they want to sell you on does make money, it made them $75k/month for around a year, but they themselves eventually found something else to be worth more, and they are exiting it by teaching you the model.

Lot’s of cases like these around. This is also probably why course gurus get attacked for being scammy.

I like to never lay judgement on people. There is no point in judging other’s actions since given enough crossover between their life and yours, you’d probably make the same decisions.

I, instead, prefer to assess motivations, strategies, and intent.

I hope this read was somewhat educational for you, and helps you get a better snap judgement of the numbers you see people plaster online.

Have a good upcoming week.

Cheers,

Ali

What kills a boomer business? Community.

At first glance, it may seem like legacy companies and their upstart competitors are chasing completely different things. But in reality, they’re not. The needs of established businesses and the needs of startups are surprisingly aligned: both want growth, efficiency, and customer loyalty.

The real difference lies in how they go about achieving these outcomes—and more importantly, in what incumbents are willing to neglect.

One of the most common blind spots is personalized attention to existing clients. Established businesses often assume their size, track record, and brand are enough to keep clients around. That assumption is exactly what allows newer startups to wedge their way into the market and begin siphoning away customers, often without the incumbent realizing what’s happening until it’s too late.

This isn’t speculation. It’s a playbook. At startup incubators like Y Combinator, founders are explicitly trained to find these wedges and exploit them. They’re taught to identify where big companies grow complacent, to attack those weak points with laser precision, and to build disruptive momentum from there.

If incumbents want to survive, they need to pay attention.

Why Community is the Ultimate Lock-In

One of the simplest and most cost-effective defenses against disruption is cultivating community. Building a community around your product or service creates some of the strongest lock-in imaginable—and compared to other strategic investments, it costs very little.

Consider Apple.

Every year, Apple hosts WWDC, its Worldwide Developers Conference. On the surface, it’s a technical event for developers. But look closer, and you’ll see it’s one of the most powerful community-building tools in business.

Developers walk away not only with knowledge, but with a renewed sense of loyalty. They feel valued, seen, and inspired. Apple, in turn, gets mindshare—every single year, for over two decades. The result? It becomes almost unthinkable for a developer to suddenly prioritize Android, even when Android is innovating faster in certain areas.

This is the key point: innovation alone doesn’t guarantee loyalty. Community does.

Lessons from Healthcare’s Quiet Giant

I saw this firsthand when I worked at Epic, the largest B2B healthtech company in the world.

Epic’s software runs 100% of the top 20 hospitals in America and over 80% of all hospitals nationwide.

Inside their campus bathrooms, plastered across the walls, is a simple mantra: “Perception = Reality.”

Epic lives by this principle.

Sure they provide software; but really their secret is in how they cultivate relationships. Their annual User Group Meeting (UGM) isn’t just a conference—it feels more and more like a festival each year (with costumes and amusements all part and parcel of the show!) Epic invests heavily in making it a can’t-miss event, even once flying out client executives from a financially distressed hospital to ensure their attendance.

Why? Because they also understand what Apple also understands: longitudinal relationships are everything.

Bringing clients together year after year creates a sense of belonging, loyalty, and shared identity. And when your business is interwoven with a client’s community, you’re no longer just a vendor—you’re indispensable.

The Wake-Up Call for Incumbents

The message for incumbents is clear: disruption doesn’t come out of nowhere. It starts in the gaps you leave behind. Personalized attention and community-building aren’t just nice-to-haves—they’re existential defenses against competitors eager to pry open cracks in your armor.

Startups are trained to look for wedges. I can tell you this because I am a 25 year old medical student who works with startups on a weekly basis for the past 2 years and will inevitably build one myself soon too. I am telling you point-blank, unless you figure this out, your business is probably one of the boomer businesses most likely to be disrupted by the folks I meet on a regular basis. We’ve all seen how quickly some startups can topple incumbents— I implore you to look for the pattern, but if you want to save yourself the time, just take my word for it.

If you’re an incumbent, your job is to close these wedges before anyone else gets the chance to Trojan Horse your market. Build communities. Show up consistently. Make your clients feel like insiders, not just account numbers.

In the end, perception really is reality. And if your clients perceive that you’ve stopped caring, the reality will be that they’re already halfway out the door.

Hot to get whatever you want (the only tried & tested method)

The first time you earn $1,000 independently—outside of a salary, a part-time job, or any structured role—your relationship to money fundamentally changes.

It seems arbitrary. A thousand dollars isn’t a life-changing sum, especially if you’re used to earning a stable income. But psychologically, the shift is profound. Once you cross that threshold, your entire perception of value, time, and opportunity transforms forever.

I’ve experienced this shift firsthand—and I've since watched others experience it repeatedly. Here’s why it happens, why it matters far more than you might expect, and exactly how you can create that shift yourself.

Mental Accounting: Why Independent Money Feels Different

To understand why your first independent earnings feel disproportionately meaningful, you first need to understand something behavioral economists call mental accounting.

Mental accounting means that people mentally categorize money differently, depending on how it's earned and spent. Even though every dollar is technically the same, money doesn’t actually feel the same psychologically.

• A paycheck feels stable, predictable, and constrained.
• Independent income—especially your first significant earnings—feels powerful, surprising, and liberating.

Your first independently earned $1,000 doesn’t just feel like ordinary money. It feels like a fundamentally new category. Because it didn't come from someone else's approval, someone else's decision, or a system outside your control, it feels uniquely yours—directly connected to your personal choices, skills, and decisions.

This new reference point permanently resets how you think about value.

Reference Points: How Your Baseline Shifts Permanently

Earning $1,000 independently does something subtle but powerful to your thinking: it creates a new reference point.

A reference point is simply your baseline measure of value. If you've only ever earned money at $15 per hour, your mental reference point for value is hourly wages. Every purchase is subconsciously measured in how many hours of work it costs.

When I first started earning independent income by selling marketing videos at around $2,000 each, my reference point shifted from "hours worked" to "videos sold."

This seems minor, but it changed everything:

Suddenly, everything I considered buying wasn’t measured in hours or dollars—but in terms of the new reference point I'd created. For example, consider food. Before, I carefully budgeted and worried about grocery prices. But after selling a few videos, I realized something slightly absurd but fundamentally important:

"I could literally eat Chipotle twice a day, every single day, and it would only cost about $1,000 a month. One half-hour sales call could land me a $2,000 project—covering two months of meals. So why was I spending hours going to the grocery store, picking ingredients, cooking meals, and cleaning dishes?"

This wasn't actually about Chipotle. It was about the radical shift in my perception of value. Cooking and cleaning stopped looking like sensible frugality and started looking like wildly inefficient uses of time.

This kind of shift—funny and trivial though it may sound—symbolizes a far deeper change. Once your reference point resets, your entire relationship to time, effort, and opportunity cost shifts dramatically.

The New Reality Problem: Why You Can’t Go Back

Here’s the critical insight most people miss:

Once your reference point changes, you can’t comfortably go back. Your desires, realities, and possibilities all shift irreversibly. What once felt rational or responsible now seems painfully inefficient, even irrational.

This sounds scary, but it’s powerful—because this new discomfort motivates fundamentally different decisions and actions. Things you never considered possible suddenly feel accessible. Things that previously seemed prudent now feel unnecessarily restrictive.

You start seeing your surroundings in terms of opportunity cost rather than absolute cost. Your choices become driven by leverage—by how efficiently you can achieve meaningful outcomes, rather than how cheaply you can survive day-to-day.

That’s why the first independent $1,000 changes everything: It resets your mental baseline in a way that permanently alters your behavior.

How to Actually Earn Your First Independent $1,000

Given how powerful this shift is, the obvious next question is: how do you actually achieve it?

Here’s the method I used personally—and recommend to anyone else looking for that critical first $1,000:

1. Identify One Clear Skill

You don’t need ten skills—you just need one skill that people clearly value.
For me, this was initially making simple but effective marketing videos.

2. Package It Cleanly

Make your offer simple, clear, and well-defined.
“I'll create a professional marketing video explaining your software product for $2,000.” Clear, simple, and precise.

3. Sell Manually First (Don’t Overcomplicate)

Forget websites, funnels, or branding initially. Just sell manually: reach out to your network, send direct messages, find one interested person, and make your offer clearly.
Keep the first sale as simple as possible.

4. Anchor High, Deliver Value

Most people undercharge initially. Resist this.
Anchor your price high enough that you can hit your $1,000 goal in one or two sales—not twenty.
Deliver clearly on your promise. Your first sale doesn’t need to scale. It just needs to exist.

5. Experience the Shift Fully

Once you earn that first independent $1,000, explicitly acknowledge the shift in your thinking. Notice how your reference points immediately reset. Feel how your perception of value, time, and effort has changed.

From that moment onward, everything looks different.

Why This Matters More Than You Think

The first independent $1,000 matters disproportionately—not because it’s a large amount of money—but because it permanently resets how you see money itself.

The shift from dependent money (salary) to independent money (directly earned through your own agency) changes your fundamental relationship with value. Your baseline recalibrates, your reference points shift, and new desires—previously invisible or unrealistic—become obviously achievable.

I experienced this firsthand, and I’ve never looked at value, money, or even simple choices (like cooking vs. buying Chipotle) the same way again.

The practical takeaway is simple:

If you haven't earned your first independent $1,000 yet, prioritize it now—not because of the money itself, but because of how it will change your thinking forever.

And once your thinking changes, your entire reality changes with it.

— Ali

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