In the hospital the unknowns twist
And characters enter stage ER
Faster than you can
Dictate the
Script

When you are a certain kind of
Black bones tired
Everything feels like a dream anyway
And so so emotional
People die with disturbing regularity until it is only
Disturbing the
Families and they seem to be hamming up the
Scene and you just want to
Check the fridge to make sure you didn’t leave
Anything smelly in it 48 hours ago
When you left home
But the fridge is near the bed so you
Don’t although you hope you got all the
Blood off
Your shoes

So that is when you start to see
Now-right and future-wrong
It’s about the time you stop….
Needing to change the plot
And stand back, a precise narrator
Sometimes intervening, but always on script
And you see that you are caught
Because the now-right could easily be future-wrong
And the people in front of you
Can’t see it

You can say all the [conveying uncertainty] and [autonomous decision-making]
You want but they will only remember
It right if the ending is
Happy
And you don’t write the endings
The story is convoluted and you can
Barely make breakfast, in fact you
Didn’t eat that day
Maybe longer

Time can be a bitch
When emotions happen out of
The true
Choice sequence
And sometimes all you can do is
Carve a space out of the air
And a silence to emphasize
That a decision is being made
And everyone
Including a trembling tremulous poorly fed and
Sleep-starved you
Will have to face
The consequences

Commentary

This piece was originally written for a publication that required commentary or interpretation. Personally, I think poetry should speak for itself, but since I wrote it, you get it.

I’ve begun to think of medicine as paths and nodes. Doctors and nurses, equal. Simply doctors make decisions, at a node. And a nurse walks your path with you. Different jobs, true. Intertwined.

Decision fatigue the AMA calls it, as if it could be so neatly summarized. What we wish patients knew about our work. It affects everything: mental and emotional exhaustion, surgeons’ choice to operate, cancer screening tests. It leads us to overly rely on the status quo, the heuristic, the absolution of choice. Yet there is more.

Part of becoming a doctor, in the endless hours of residency, is the strange sense that comes while haunting the hospital that you people a character in a poorly-scripted play. All the family’s arrayed in circles, and all the important decisions add up, blend together and a pattern emerges. The parody of time. The unpredictable nature of the outcomes. What you know that they don’t.

That you are not in control.

We like to think we can control everything, but we can’t. And clinicians know the deep trauma that comes from pretending that we can — only to find out we were wrong. One only needs to reassure a patient falsely once, to remember the unending shame of claiming a right to a future we do not own.

The body is a complex system. Not simple, not complicated, but complex. Chaos theory describes complex as “multiple component parts that interact in a nonlinear fashion, and the results of their interaction are often greater than the sum of their parts”.

Perhaps the most difficult part of medical practice, is learning not to be angry when patients do not remember their journey, their decisions properly. When the outcomes affect how they view you, even if you did everything right.

We say terms like “autonomy” and “conveying uncertainty” in training. But the reality is these actions are just compassion. When you know that a decision can only be right in the moment, and only sometimes in the past. When your patients don’t. When you tell them as well as you can.

When you forgive them for not understanding until it is too late.

Yeah, it was a blue parakeet. I still can’t look at photos of parakeets easily.

Friendship and the ethics of inaction

I’m writing this story because I had a real fight, with a real friend, last year. I had a child sex trafficking case and chose to report it despite significant personal risk. It was scary. I was scared, and I called my friend when I was really afraid. I had been shaking for about two hours and couldn’t beat the fear. So I called a friend. And that’s how my friend knew about it.

In fact, I called a lot of friends during that period. A lot of responsible adults who had been a support network for me for years.

And half of them said not to report. They said I was too important to risk my life on a report like that. That they wouldn’t. They wouldn’t report and sometimes it wasn’t worth it.

And half of them said, of course you reported. There is literally nothing else you could have done. And it sucks, and we’re here for you.

One friend was really mad at me. They said they really didn’t believe that anyone is ever responsible for things they chose not to do. Inaction, they said, means no accountability. And they said I had other responsibilities and I couldn’t put my life at risk over something that wasn’t my problem. And that was a real disagreement, and I really lost a relationship over it.

Because I refused. Or rather, I chose not to share that position. And I don’t need people in my intimate space who truly hold it. It’s hard enough as it is to act; having people around you who tell you not to, or don’t help, is just too difficult.

The research on defiance and nonconformity runs roughly 35% → 9% → under 0.5%, as the cost of holding the line moves from awkwardness to death.

So I lost half of my friends over this, people I really like and respect in other ways, over this decision. We can still be friends, but we’re not intimate friends. And there is a difference, and it does suck. But life is long, and relationships evolve, and we’ll see what happens.

It’s just what happened for me at this age.

• The Golden State - John Doe

Why do I believe in the ethics of inaction?

I could call on my formal medical training for this. They hit doctors hard for this in training. Formally, in most programs with ethicists, but also in training when things happen. And if you don’t get tagged for it formally and it doesn’t get through, you handle far too many cases for something not to teach you hard if you have empathy about the things you “should have done”.

There is actually a lot of grief when in a position of power over other people, like a clinician. And most empathetic people privately agonize about decisions made under uncertainty that later become clearer, and you wonder if you made the right call and have to find a way to internally cope with that.

Some of us harden, try to shut the empathy off. Others explore it a lot and learn how and when to take responsibility. How to cope with mistakes.

Uncertainty and rapid decision-making come into play in emergency services. I’ve had discussions about this with international development folks, ER docs, paramedics, wildland firefighters, special forces, and sailboat captains. All of these fields require experienced rapid decision-makers.

You get good at it when there are real stakes. Your empathy forces you to; your profession holds you accountable. Reality bites. Some get depressed; some leave.

It sounds cool and smart. But you need to know where it came from. Doing this professionally is just how I practice the skill now. It’s definitely not where I learned it.

I learned it from the parakeet.

• Trendsetter - Connor Price & Haviah Mighty

What happened to the parakeet?

My family wasn’t functional. First. I need to say that so you know I was young, in a really toxic system. Bowen’s family theory is really helpful for toxic systems, and I highly recommend it, not only for families but for toxic workplaces. I was the Hero in this system. Basically assigned the role of being responsible for achieving and justifying the system.

So briefly, I was 12 and the oldest child. There were 6 children in the house at that time. I was a parentified child and had the care of two extra children under 5 that we did daycare for. So, not a great situation. Probably we moved to another state later that year because of child services reports, but as a child you don’t really understand things like that.

A relative came to the house and left a parakeet. The relative correctly interpreted the system as toxic, but their intervention was to leave a very cute, very well-trained, and very elaborately accessorized parakeet with my sister, who was 10 and two years younger than I was. She had the assigned role of the Angel in the system, responsible for nothing but being beloved by everyone.

I was probably a very controlling little kid, and an outsider might not have understood why, so they were probably just trying to restore balance. But the end result is I was forbidden to have anything to do with the parakeet. The parakeet was only my sister's to feed and care for, and she got special 1:1 training and special treatment and the special role of ‘parakeet owner’.

The relative was asked to leave, and there we were. Me at 12 — the actual caregiver in the household, my sister at 10 — just kind of a normal, if a bit underaccountable, kid, and the unfortunate parakeet. Let’s leave my parents out of this. They were morally accountable too, but that’s another story. In this story, they didn’t take care of anyone and were often out of the house. Who cares why. It just was.

This is about me and the parakeet.

So for a few months my sister did look after the parakeet. Then she lost interest, and the less appealing tasks started falling to me. So for a while I was allowed to clean the cage but not do the feeding. Then I was allowed to refill the water, but not go to the pet store.

Then she stopped doing anything. And the daily ritual of opening up the cage cover and other things just didn’t happen. Or I’d have to yell at her to do it because I wasn’t allowed to. And she got more and more grudging about me telling her what to do.

Like normal siblings, but not in a normal situation.

So this part is important: I was pissed.

I was 12. I wasn’t that mature, and I had been treated unjustly. Not only did I have to clean up the shit, but I didn’t get to go to the pet store, and I wasn’t allowed to take the parakeet out and let it walk around and actually play with it. All the fun stuff went to my sister, and all the actual work fell to me. So I was pissed.

And one day I just refused to do anything. I said fuck it, the parakeet is not my problem. These people are jerks; it’s their parakeet, fine. They can take care of it. And I mentally crossed my arms and just did NOTHING.

So there is the cage, the cover on, and there is chirping and indignant flapping from within the cage, and I just walked by the cage. I don’t remember for how long. But I remember at least two times quite clearly that I did that.

I didn’t open the cover. I didn’t tell my sister. I just did…

Nothing.

And when I finally opened the cage later, it was too late. The parakeet had starved in a house full of people. And I was the one who had to take the starved bird’s body from under the cover, the henpecked cage. I made a matchbox casket, and I buried the bird.

I wish I could say I consoled my sister, but I don’t think I did. I was horribly, horribly, horribly upset. I wish I could say that I didn’t tell her it was her fault, but I probably did. She was as upset and inconsolable as I was. I do remember that, although I think I was the one officially blamed. The setting and the setup were so far out of proportion to the actual consequence. And we were both old enough to accurately perceive the real consequence. The actual consequence was truly gut-wrenchingly horrible.

I wish I could tell you properly about that feeling so you never, never feel it. I felt the horrible starvation death of that parakeet in my soul. And no one else was in that feeling. No one could absolve me from it, or console me with it.

There were all these other complicit, accountable, and responsible people around me who had seemed to fail in small and meaningless ways. It was as if they conspired to trap me in this consequence. The temptation was to rage, pass blame, and explain it away. Certainly, my mind gnawed at this problem for years afterward. But facing the outcome directly, it really wasn’t on the table. Over the years, they all dropped out of the story. Because I was the one who had to go on living with the irrevocable consequence. My Indigenous friends say time is testimony. And with time, it clarified.

It was totally, completely between the parakeet and me.

• Black Cat Bone - Laika

What I learned about the ethics of inaction

So I will tell you what I learned.

I learned it doesn’t matter if it’s fair. It doesn’t matter who else is involved and how they set up the story. These things happen in the cracks of society, groups, institutions, and procedures. We’re often just the bystanders, always just a little bit easier not to lift the cover and look inside the cage.

It doesn’t matter what they do.

When I really learned the ethics of inaction, it was between me and me. When I finally got it, doctor training didn’t teach me anything I didn’t already know. Nor can it replace that reckoning.

And I can truly say I learned my lesson.

• Lucky Now — Ryan Adams

How I applied what I learned

This experience changed a lot of things about my life.

I’ve always been into wild animals in adulthood. My personal conclusion was that the cage itself was wrong. The parakeet would have fed itself if it hadn’t been in a cage. I prefer wild animals and take a lot of joy in watching wild birds. I don’t believe in exotic pets or animal trafficking. The entire supply chain that put the parakeet in the cage in our house, I decided I didn’t want to invest in.

I work a lot on biodiversity; we do ecotourism at Savimbo so people can see birds in the wild with guides. Which is a cooler way to meet foreign and exotic birds.

I worked as a doctor, firefighter, and paramedic. High-tech CEO now and lots of international development. This training and experience refined my feelings on this topic and gave me practice making ethical decisions in scenarios of uncertainty.

I have a panel of people I consult and trust who also have experience and rely a lot on feedback for different scenarios. Lately, that includes a lot of Indigenous elders and shamans, which is an extra dimension of deliberation I really enjoy. Their leadership training is different but very rich.

I pick up the odd human rights case; this month I’m at the UN Human Rights Commission for a rough mining case that came across my desk last year. I learned various reporting and enforcement protocols; there is a system for this kind of shit ‚— when it’s bigger than a parakeet.

I work a lot in climate, where ethics of inaction get a lot of people because nature and the planet are a real area of tough collective inaction. Mark Carney and his speech at Lloyd’s in 2015 was a great summary of this with a real effect. I like the work of PIK Potsdam Climate Institute on that. It’s clear, informative, and action-oriented. Empowering stuff.

But I’m telling you this story and how it affected me for a reason.

I hope you will learn from my story. So you never have to learn the ethics of inaction the hard way. You can learn from experience, or you can learn from love. And sometimes when you see high-functioning people, its easy to misunderstand the cost they paid for that function.

So I’m sharing my real story, not the Trendsetter one, out of love.

• Love at the Five and Dime - Hart Rouge

People get addicted
To an illusion and the
Illusion
Kills them slowly
Because illusions are not real

Looking at her emaciation
Each vertebra clearly curled
She is a tiny fern
In a spiral on the bed
Bleached of nutrients

Heroin was her illusion
Each one has its signs

I see a tiny fragile child
Newborn kitten
Beginning and ending blurred

A good nurse teaching me today and a
Good hospital
She’s dying the nurse says
And gently guides my hands to tap the spine with a long grey needle and draw the fluid that will tell us
Uselessly
Of what else, because we all know
Why

All I remember, aside from the deft
Maneuver trapped in my hands

Is the love radiating from the nurse
Somehow this moment replaces all my judgements
Of this condition
Forever

Because I know how it ends now

Junky they call them
But at the end they are only our brothers
Beautiful forgiven children

And there is only love
For those who know they need it
But mistake
Its source

"Tell the truth, tell the truth... or at least don't lie, that's a start." - Jordan Peterson

I think if you listen to Peterson straight, it’s a bit contaminated, like there are some flavors of the ideas that don’t come through properly. But Peterson, through the filter of Akira and the Don, comes through clean, like a refraction of light.

This is a clear cold sweep of an example.

”You get to choose which poison you’re going to take, that’s it.” — Jordan Peterson

From The Prophet (1923):

You are the bows from which your children as living arrows are sent forth.

The archer sees the mark upon the path of the infinite, and He bends you with His might that His arrows may go swift and far.

Let your bending in the archer’s hand be for gladness.

For even as He loves the arrow that flies, so He also loves the bow that is stable.

The reason I like it is it waives aside so many illlusions. The mythos of parenting with the mythic reality.

He is the first person who made me see the parent-child relationship clearly, perhaps properly.

Jubrān Khalīl Jubrān was a Lebanese-American poet and author of The Prophet. I think his words speak for themselves. He had a deep understanding of human nature.

There were no tricks in his poetry, just the compassionate truth written down and profound, and rich for that quality.

In March 2014, the sitting president of the United States walked onto a Funny Or Die set with two potted ferns, sat across from Zach Galifianakis, and let himself be insulted on camera for six minutes.

The point was the Affordable Care Act. Healthcare.gov enrollment among young people had been lagging. The administration needed a way to reach an audience that wasn’t watching the State of the Union. So Obama did Between Two Ferns.

It worked. Traffic to healthcare.gov spiked. The video drove more young sign-ups than any other single piece of outreach that season.

But what makes it beautiful isn’t the policy outcome. It’s the deadpan. It’s the willingness to look small, to be the straight man, to let the bit land. When I first saw this it was radical to see a president be made fun of and stay in the joke. A head of state who seemed to be able to let the ego slide artlessly without losing the necessary poise.

I think about this clip a lot. About how power can be wielded with lightness. About comedy as civic infrastructure.

The grandchild of slaves, and the tenth child of sharecroppers, he won four gold medals at the 1936 Berlin Olympics. The games were intended to be a showcase of Aryan superiority by the Germans who were hosting.

Jesse’s phenomenal performance, and the other German athletes who supported him in friendship, remain a testament to the beauty of inclusion and friendship in athletic performance that echo through time.

Sometimes the best among us, and our best performances, are withheld through fear or bigotry. Jesse showed the world that this is not always the case. I love the photos of his smiles during this performance.

They are truly genuine and speak to real joy.

Every time I watch it, I’m impressed again by the beauty of the message, the unity of the leaders, and their deep love and understanding of Nature.

In 2024, the leaders with whom we were friends from Savimbo said that the atrocities of WWII had led to the release and adoption of the Human Rights Code. They felt that the energy behind climate change, and the threats to Mother Earth, had opened an opportunity for a new era in human relationships to Nature.

See for yourself if their words resonate with you. I think this video is one of the most beautiful things I’ve ever seen.

Maybe this is how art is if you really participate in making it, it doesn’t feel like yours at all. I don’t know I just know this is the one piece on my list I was involved in and it feels like it just happened near me and is equally as transcendent and involving as the other ones.

Sometimes the contemplation of great injustices and inhuman behavior can spark a response from deep in the soul of intense beauty — a shout into the void.

We see this from other people on our list. Charles Dabrowski, Viktor Frankl, Chief Joseph. Some of the world’s greatest art has originated from oppressed peoples in response to that oppression.

As Joy DeGruy explains in her work on Post-Traumatic Slave Syndrome, multigenerational trauma is the lived history of many Black people the world over.

This song, if you really listen to it, is the opposite of that pain. “I need something, give me something wonderful,” sings Michael, and the many voices that people this performance. Pay particular attention to the unobtrusive soloist who emerges at the end.

Sometimes we see only wounds. Please lend an ear instead to the sound of healing.

The lock between the bloodstream and the cell is broken. What’s missing isn’t more sugar in the blood — it’s a key that fits.

I’m a doctor. A weird one, but still a doctor. I trained in one of the best health systems in the world, with some of the most competent doctors — mentors who I still love and respect. And what they taught me about blood circulation, healing tissues, and restoring flow, I have applied to poverty, war, ecological destruction, and violence at a population scale.

Kapital is a very specific invention. Fernando Lezama and Jhony Lopez's financial coaching on how to pay impoverished Indigenous collectives properly, our “delinquent savants” activist fintech payment system backing it, funded by the World Bank, named by Nwki Flores, and automated.

Like the ancient story of the seven blind men and the elephant this problem has confounded a lot of people, who then argue. It turns out Kapital is just an odd shape, and everyone was right. But it’s the shape it is. It’s a magical realism guara. And if you don’t know what that means, then no problem — I gave you a picture.

But Kapital is just a weird beast.

Globally, it has proven to be an incredible solution. There is no shortage of capital. There is a shortage of perfusion — of capital actually reaching the cells doing the metabolic work. Indigenous communities. Smallholder farmers. The people producing food and keeping ecosystems alive. Diabetes is, at bottom, a disease of distribution, not supply. So is this.

Which is why, when people who were smart enough to see the scale started asking about who was going to be inflating the pricing of Kapital (specifically who was going to take attribution, data/learning rights, delivery ownership, and platform/success economics) we decided not to reinvent the wheel.

This problem has already been solved.

The synthesized key

We didn’t build Kapital to make a gazillion dollars. We built it to pay our partners fairly without controlling them.

Specifically in international development and climate markets, it solves the control paradox. The service layer solves the recipient problem. Partners that were so badly treated for so long by the financial system, they couldn’t even receive the money when it arrived, or had strongly negative emotional responses to positive money flows.

It’s a synthesized key in the lock of poverty. And there is a lock, a protocol, just like getting sugar into a cell. And it’s blocked right now. So the design fit the lock between the bloodstream and the cells that have been shut out of it in a very particular way.

Indigenous communities are like cells. They have a homeostasis, a controlled and regulated environment. And they have a protocol, a safety system for influences from outside. And when capital enters, specifically digital currencies, it needs to respect that homeostasis and regulatory mechanism.

So this design gets capital to the people the current system routes around — without corroding their culture if they have opted out of the system. And many Indigenous communities have never converted to a system designed to impoverish them. Or they have been excluded by cultural protocols that are corrosive to their internal balance or regulate against it in many ways, large and small.

We need to convert capital to Kapital, in other words.

When we got the key to the lock, we realized it was critical to use it properly. Savimbo never allows debt on the Kapital platform, for instance. We get traditional approval, and we put the traditional regulatory mechanism into the system. Then we introduce capital.

We’ve been debating the pricing internally for a long time. And the more we argued, the more the insulin analogy stopped being a metaphor and became a model. Diabetes is a comparatively simple disease. The ethics of treating it are well-worked. And insulin, specifically, comes with almost a century of hard-earned lessons about what happens when you get the pricing of essential infrastructure right — and what happens when you let it drift.

What insulin was supposed to be

In 1923, Frederick Banting, Charles Best, and James Collip were granted the US patent for insulin and sold it to the University of Toronto for one dollar each. (The University of Toronto still holds scans of the original assignment document, dated December 1922; the sale was formally recorded on January 1, 1923.) The line usually attached to that decision — “insulin does not belong to me, it belongs to the world” — is almost certainly apocryphal, first appearing in a 1959 children’s biography written eighteen years after Banting’s death. But the act itself is real, and it’s what matters: three scientists deliberately declined to own a thing that could keep people alive. The University then licensed it broadly to keep supply high and prices low, and insulin reached patients worldwide within a few years.

That was the ideal. A life-saving essential, deliberately un-monopolized, priced for access rather than extraction.

Here’s the part that makes “priced like insulin” a loaded phrase — and I want to name it directly rather than let it sit as an accidental double meaning. The founders’ gift did not, on its own, hold. Over the following century, three manufacturers came to control roughly 90% of the US insulin market, and the list price of a product that costs a few dollars to make climbed into the hundreds. People rationed. People died rationing. It took until 2023 — a hundred years after that one-dollar patent — for a $35 monthly cap to arrive, first for Medicare beneficiaries under the Inflation Reduction Act, then extended by Eli Lilly, Novo Nordisk, and Sanofi under sustained political pressure, who cut list prices by up to 78% almost simultaneously.

So when I say we priced Kapital like insulin, I mean it in the full, uncomfortable sense. We mean it the way insulin was supposed to be priced — the 1923 ideal. And we’re building with our eyes open about the hundred years that followed, because the cautionary tale is baked into the same word as the aspiration. An essential priced for access doesn’t stay that way by default. It stays that way by design and by governance, or it doesn’t stay that way at all.

Priced for access, governed against drift

If Kapital works the way we’ve designed it to, it has to be priced and governed the way the world learned — painfully, and twice over — that insulin has to be. Essential. Never withheld. Priced for access rather than extraction. Not a luxury good. Not a speculative asset. Infrastructure for keeping a body alive.

That’s a real constraint, not a slogan, and the obvious objection is: how do you sustain something you refuse to price for yield?

We already have the existence proof. Watch Signal. A genuinely secure, genuinely essential piece of communications infrastructure, built and scaled sustainably without extracting from its users — funded as a nonprofit, governed to stay that way, and better than most of its extractive competitors precisely because it isn’t optimizing for extraction. Signal is the answer to “that’s naive.” It isn’t naive. It’s a different design target. You can build essential infrastructure that sustains itself without turning its users into the product — but only if you decide that’s what you’re building before the incentives decide for you.

That’s the harder half of the insulin lesson. The 1923 gift wasn’t enough. The governance around it — who holds the patent, who sets the price, who’s accountable when it drifts — is what actually determines whether an essential stays accessible. So we’re not just pricing Kapital like insulin. We’re trying to govern it against the century that happened to insulin afterward.

A bigger patient

Automated finance models extract from the periphery by default. It’s not malice; it’s the metabolism. Capital pools where capital already is, and the algorithms optimize the pooling. Standing up something that runs the other way — that moves capital out to the cells, and is structurally prevented from clawing it back — means standing against that default on purpose, and building the governance to keep standing there.

I never really left medicine. I just got a bigger patient.

We are all at the mercy of childhood conditioning and subconscious wiring in so much of our lives. It also takes tremendous strength to absorb traumas and not perpetuate them. To give better than we get.

Who do we want to be in this chain?

I really adore this art piece. The performance troupe doesn’t have a lot of work online, but honestly, just this one video is enough. I must have watched it hundreds of times.

But I didn’t really appreciate his show until I heard long-time contributor Starlee Kine interview Phil Collins on the Break-Up episode shortly after a tough divorce

.

Over the years, I’ve listened to this episode again and again, and each time I’m in a different place. Each time I hear something different. Creativity, heartbreak, renewal, and always… compassion.

I think this might be the most authentic and healing radio piece I’ve ever listened to, and I’ll probably be a fan of radio until I die and they hold my funeral in VR :)

If your heart is broken, try giving it to Ira and Starlee for a bit. I promise you they will make it better.

Break-Up — This American Life

https://www.thisamericanlife.org/339/break-up

Resources:

• Tiny Habits are TRULY the only way to get started. I used this science to break the chain FIRST.

• Govert Van Lankeren Matthes is truly the real deal as a yoga teacher. I looked all over the world and recommend him as the top teacher who really gets it, AND gets how to teach it.

• You need strong foundational training to do it safely, and I always recommend 90-min hot Bikram training from an intact hatha lineage like Kata Hot Yoga or people they reccomend. Afterwards, you can maintain a daily practice with Ashtanga. I use this book.

• Intermittent fasting was the answer for me, but in the industrialized world, you'll need this book for food. Tosca Reno nailed and democratized the food science and chemical reduction with the Eat Clean Diet.

I think something about the originality of the song, the way it rewrites itself each verse, the compassion, and the awe she expresses toward life sticks with me.

Regina seems to sing this gladness with a round, and stable voice. This one is for all my friends who sense the exquisite pain of the beauty and bitterness of the wheel of time.

As we face global environmental crisis, increasingly global economic and health systems, the need to reevaluate the US justice system, and politicized strife in many countries, we can all benefit from how an island nation solves its problems. What do you do when you don’t have space for a feud? What do you do when there is nowhere to run, and you don’t want to fight?

Hawaiians worked this out 5,000 years ago and we can learn from them.

Hoʻoponopono is defined in the Hawaiian Dictionary as:

(a) “To put to rights; to put in order or shape, correct, revise, adjust, amend, regulate, arrange, rectify, tidy up, make orderly or neat, administer, superintend, supervise, manage, edit, work carefully or neatly; to make ready, as canoemen preparing to catch a wave.”

(b) “Mental cleansing: family conferences in which relationships were set right (hoʻoponopono) through prayer, discussion, confession, repentance, and mutual restitution and forgiveness.”

Perhaps most telling is where the process starts. Instead of “conflict” or “dispute,” Hawaiians see the problem as “stubborn dispute,” “having difference,” or “entanglement.”

Can this mantra help us find resolution?

I find her work deeply soothing. I also want to give a shout-out to all the adult caregivers out there. Susan is someone who really gets it.

Nez Percé traditional lands covered northeastern Oregon, southeastern Washington, and central Idaho, but any perusal of history will show Chief Joseph was a great leader, facing a terrible future for his people with dignity, candor, and courage. Anyone living on these traditional lands needs to read his words, as they speak of a custodianship that must be honored.

I am tired of talk that comes to nothing. It makes my heart sick when I remember all the good words and all the broken promises. There has been too much talking by men who had no right to talk. Too many misinterpretations have been made; too many misunderstandings have come up between the white men and the Indians.

If the white man wants to live in peace with the Indian he can live in peace. There need be no trouble. Treat all men alike. Give them the same laws. Give them all an even chance to live and grow. All men were made by the same Great Spirit Chief. They are all brothers. The earth is the mother of all people, and all people should have equal rights upon it.

— Chief Joseph, 1879, Washington DC

No speech from Chief Joseph as a leader can be free of grief, gravitas, and historical unfairness. But his words stand as a testament that no one’s circumstances define their bearing and ability to express themselves.

There is a reason people sang this song at this time. I think it might make more sense to people who live in Northern latitudes who understand the cyclical nature of deep winter and early spring.

I liked this article about the phenomenon. Here’s an EDM Remix of the Viral “Wellerman” TikTok Sea Shanty — And It’s Actually a Banger. There was something about the call to hope that resonated in its leadership, and the echoing response.

We ought not forget our species’ strengths when we fight to overcome its weaknesses.

@thats.mindblowing#duet with @_luke.the.voice_ #bass #xyzbca #xyzcba #stitch #foru #foryou #fyp #banger #seashanty @nthnevnss

Tiktok failed to load.

Enable 3rd party cookies or use another browser

Two best-practices to prevent difficulty with scientific authorship include: discussing authorship early and often, and using acknowledgment statements to clarify contributions. Newer trends like co-first authorship hold promise for more flexible structures in future.

The problem with authorship

Science is experiencing a reproducibility crisis that stems from systematic bias (1).

Systematic bias in medicine comes in many forms. It may mean selectively reporting positive results, doing selective analysis, or designing research with incorrect specifications (2). It can also come in writing, publishing, and authorship. The incentive structure of biomedical research has a pervasive influence on how and what biomedical research gets published (3).

High-profile scientists such as Marcia McNutt, former Editor-in-Chief of The Journal Science, have called for system-wide authorship reform (4).

In this article, we examine authorship bias and propose two simple practices to prevent both authorship bias and authorship disputes.

Many scientists are familiar with at least one well-documented instance of authorship fraud. However, authorship fraud is just an extreme example in the more subtle issue of authorship bias, which systematically corrupts the accuracy, equity, and quality of published clinical evidence (5,6).

Typical examples of authorship bias

In a 2011 survey, authors of nearly 900 articles at six high-profile medical journals — Annals of Internal Medicine, JAMA, Lancet, Nature Medicine, New England Journal of Medicine, and PLoS Medicine — estimated that 8% of their published studies lacked an author. A further 18% of studies had authors who had not met the criteria for authorship (7).

• Missing authors. Valid contributors intentionally or unintentionally omitted from scientific credit. This practice is a leftover from an era when authors of disadvantaged populations — minorities, the developing world and women— were unrecognized for their various scientific achievements (5, 8,9 ). One example of this form of selective credit was popularized in the 2016 movie Hidden Figures, which dramatizes female African-American mathematicians at NASA.

• Ghost authorship. The practice of omitting professional contributors from scientific credit. Ghost authorship is a growing issue in bioscience. It is related to an increase in professional medical writers and pharmaceutical-sponsored research.

• Honorary authorship. The practice of “guest,” “gift” or “legacy” authorship. This term refers to senior authors taking credit for a junior author’s work. It may also be an author included in a publication out of respect rather than legitimate scientific contribution. Credit confusion is one of the most common reasons for academic disputes, often involving a hierarchical power imbalance in medicine, academia, or other sciences.

Solutions for authorship

Scientific authorship has two simple functions: credit authors for their work, and document responsibility for its authenticity.

An accepted standard for authorship is the International Committee of Medical Journal Editor’s (ICMJE) 4 criteria:

1. “Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

2. Drafting the work or revising it critically for important intellectual content; AND

3. Final approval of the version to be published; AND

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.”

However, ICMJE criteria are often misapplied, used as evaluation criteria at the end of a research project, instead of when they are most valuable — at the beginning.

Proper scientific authorship combines credit with accountability. This means that good authorship is intrinsically bound to research execution. A first-author is accountable for all aspects of a research project, including ethics approval, data collection, data analysis, write-up, and submission of their work.

While authorship can be renegotiated as workflow and research groups change, it should never be unclear at any point in a research project for any member of the team.

Two simple research practices can help scientists clarify authorship and prevent embarrassing complications down the road:

1) Discuss authorship early and often

Be upfront, candid, and practical about authorship in your work group.

Researchers are more comfortable with their contribution to a project when authorship is coupled with research workflow, which in turn, helps prevents academic fraud.

Attributing proper authorship is an ongoing and responsibility. It is important when a research project is first being considered and can be used as an aid for defining research tasks. It should clearly spell out who does what as new work is assigned or evaluated.

Authorship is also relevant when clinical partnerships are formed, as research personnel come and go, or as publication dates change.

A good co-authorship agreement will cover all the essential points on authorship, but an attitude toward discussing authorship openly and without rancor as a prelude to contribution is more valuable than a written agreement to clinical research collaborations.

2) Put authorship on the front page of the drafted research work

Let contributors see their formal credit when writing starts.

The historical practice of allowing the PI to assign authorship when work is submitted is outdated.

With today’s cloud-based collaborative writing projects, coauthors have access to drafted work in real-time. By placing authorship on the first page of research drafts, coauthors have the opportunity to review and clarify their contributions to a research project right off the bat and apportion their time and energy appropriately thereafter.

The first page of every research draft should have a title and an authorship list as it will appear in the final published work. It should also have an ‘acknowledgments’ section to differentiate between authors and contributors. This way, all collaborators can see their work recognized and understand how it intersects with others.

For example:

Acknowledgements: Author A and Author B conceptualized the topic. Author A and Author C contributed to research design. Author D oversaw data collection performed by Author A. Author E performed data analysis. Author A led the writing of the article and was assisted by all authors. All authors reviewed, revised and approved of the final article.

The future of authorship

The practice of scientific authorship is quickly evolving. One way to accurately acknowledge the diversification of scientific contribution in the future is by using more advanced authorship metrics.

For now, we can start by applying the metrics we do have with greater finesse. Good authorship points to a future of good science.

References:

1. J. P. A. Ioannidis, Why most published research findings are false. , e124 (2005).

2. N. S. Young, J. P. A. Ioannidis, O. Al-Ubaydli, Why current publication practices may distort science. , e201 (2008).

3. M. K. McNutt, Transparency in authors’ contributions and responsibilities to promote integrity in scientific publication. Proc Natl Acad Sci USA. , 2557–2560 (2018).

4. Y. A. Shen, J. M. Webster, Y. Shoda, I. Fine, Persistent underrepresentation of women’s science in high-profile journals. (2018), doi:10.1101/275362.

5. S. Cummings, P. Hoebink, Representation of Academics from Developing Countries as Authors and Editorial Board Members in Scientific Journals: Does this Matter to the Field of Development Studies? Eur. J. Dev. Res. , 369–383 (2017)

6. D. M. Bennett, D. M. Taylor, Unethical practices in authorship of scientific papers. Emerg Med (Fremantle). 15, 263–270 (2003).

7. J. S. Wislar, A. Flanagin, P. B. Fontanarosa, C. D. Deangelis, Honorary and ghost authorship in high impact biomedical journals: a cross-sectional survey. BMJ. 343, d6128 (2011).

8. D. Sarna‐Wojcicki, M. Perret, M. V. Eitzel, L. Fortmann, Where Are the Missing Coauthors? Authorship Practices in Participatory Research. Rural Sociology. 82, 713–746 (2017).

9. S. Cummings, P. Hoebink, Representation of Academics from Developing Countries as Authors and Editorial Board Members in Scientific Journals: Does this Matter to the Field of Development Studies? Eur. J. Dev. Res. 29, 369–383 (2017).

10. R. Smith, Authorship: time for a paradigm shift? BMJ. 314, 992 (1997).

11. R. Smith, Authorship is dying: long live contributorship. BMJ. 315, 696 (1997).

This article was written at the request of Research Medics, a professional research writing website, and is reprinted with permission. Originally published at Researchmedics.com on October 22, 2021.

I’m obsessed with this psychology science project run by Brian Nosek at the Open Science Collaboration. Researchers basically dropped Institutional siloing in favor of figuring out what science was good in psychology.

DM me on LinkedIn if you're into open science and want to hack biodiversity science for the planet. Instructions in the links below.

I could probably explain this more simply, but explaining it precisely helps me narrow the interest level. Feeling lazy, lots of work here!