Ram Sesha

2/2 Momentum building 🤝

A patient with “recurrent mouth ulcers” walks into your OPD Most get symptomatic treatment Few get evaluated properly And almost everyone assumes “Mouth ulcers = vitamin deficiency” Reality? Recurrent aphthous stomatitis is primarily a T-cell mediated disease Let’s decode what we’re actually missing 👇

1/ We are publishing the first proof that AI can reason as well as clinicians in live clinical environments. Our AI diagnosed ~2400 patients as accurately as board certified clinicians in a real environment and was 30 percentage points better than Google’s equivalent system.

A bespoke software revolution? I don't buy it. It'll exist. It already exists. Small consultants and big consulting firms have made custom software for years. It almost always sucks. It’s bloated, confusing, and because the client pays, it’s built wrong in all the ways. Who’s excited about bespoke software? Software makers! Of course they're excited about building bespoke software — that's what they do. X is full of them. Your feed is full of people who love making software talking about making software. Of course they’re excited about the revolution. Echo, echo, echo... Most people don’t like computers. Nobody in tech wants to say that out loud. People tolerate computers. They use them because they have to. Given the choice, most would rather not think about them at all. So when someone suggests that AI means everyone will build their own custom tools, ask who "everyone" is. The three-person accounting firm drowning in client paperwork? They want the paperwork gone, not a new system to maintain. The regional logistics company with 40 trucks? They want the routes optimized, not Joe spouting off about this new system he’s been messing around with. The law firm billing 70-hour weeks? They want leverage on their time, not a software project to design. They don’t hate technology. But building and maintaining their own critical systems isn’t their wheelhouse, regardless of how much faster and easier it’s become. It's another job on top of the job. Will these people use AI? Absolutely, for all sorts of things. Will some outliers go deep and build real custom systems? Sure, but they're almost always people who already had some pull toward software. The curiosity was already there. They were dabblers before. Giving everyone access to software building tools doesn't mean everyone becomes a builder. A powerful excavator doesn't turn a homeowner into a contractor. Most people just want the hole dug by someone else. They don’t want the responsibility either.

It is harder for Asians to get into top colleges than other races, but it is much harder for South Asians than East Asians.

Blue state playbook: create a supply problem, throw subsidies at the symptoms, then raise taxes to pay for it all. Because you increased demand instead of supply everything gets more expensive. See: housing, energy, healthcare, childcare in CA vs TX. Eventually, people leave (or don't come), including many wealthy folks in the tax base (the top 1% pay 45% of taxes in CA)… but you keep spending, so taxes have to keep going up. Washington, New York, California are all moving to increase taxes, meanwhile, red states are moving in the opposite direction, competing for the same wealthy residents that blue states are pushing away, and they are attracting them, and many of them are bringing jobs with them… and people can live there because it’s cheap. I spent some time in Texas this year and it’s easy to see why their model works- it’s the real abundance state… They just let people build and don’t get in their way. Often ugly, but it is cheap to live there, and that makes a huge difference. They have TONS of immigrants for this reason. They have jobs and it's cheap to live there- pretty simple. Despite all the subsidies for immigrants in California, and lack of them in Texas, immigrants choose Texas over California... Cheap housing does more for quality of life than any government program. Same pattern with solar. California subsidizes demand while making it painfully slow to permit and install, while Texas just makes it easy to build. Texas generates more solar power than California and is adding new capacity at 7x the rate. Why don't I move? SF has network effects in tech and is the most beautiful state in the US. I just wish it were better governed!

Medicine is the only profession where people willingly give up their youth to study for twelve years beyond high school while accumulating interest on $300K worth of student debt, only to be told they’re: 1) Pharma Shills 2) Doing it all wrong 3) Unsafe without supervision from folks with a fraction of the training As thanks, Doctors work nights, weekends & holidays, pay thousands out of pocket for ever increasing “merit badges” like “maintenance of certification”… And still have to ask for permission to prescribe drugs or perform a procedure….from people who aren’t at the bedside. Those bureaucrats also give them 10-15 minutes to spend with each patient, while documenting minutiae that is completely irrelevant to care. They top off the week with uncompensated documentation time so hospitals can make more money off of their work. God forbid they prescribe an opioid… That’s career ending.

Nobody comes into my office and says they've been losing ground for years. They come in for a knee or a shoulder. But when you ask the right questions, a different story emerges. They stopped hiking because it got too hard. They gave up tennis. They hesitate before the stairs they used to take without thinking. They've quietly rearranged their lives around what they can no longer do... and most of them didn't notice it happening. This is what I think of as the narrowing of people's lives. It's not a dramatic event. Instead, it's a gradual shrinking of what's physically possible, so slow that people mistake the adaptation for a choice. It wasn't a choice. It was the slow, quiet disappearance of capacity that nobody warned them to protect. They normalized all the changes and attributed them solely to aging. The narrowing is not inevitable!! Dammit... it's not ;-)! But it requires intention to resist because the body will not hold the capacity to do things you do not train, and the losses accumulate in silence until they don't.