Pathology Resident (PGY-1) Panama 🇵🇦
Panama City, Panama
Joined April 2019
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Luis Felipe Rivera retweeted
强烈建议能力不差、还想多赚钱的人，都去做一次 Human 3.0。
这是油管大神 Dan Koe 提出的一套人生进化框架：心智、身体、精神、事业四个象限，每个都按 1.0 到 3.0 定位你现在的等级，再据此给你做未来规划，把整个人生往更完整的状态推。
有条件的话尽量用Claude去对话，效果会更好，让你的 AI按这套模型从四个象限给你打分，再用采访的方式一层层追问你的真实想法，最后给出一份只属于你的人生模型和进化指南。
你答得够具体、够真诚，一个问题一个问题耐心回，结果基本都会超预期。
Luis Felipe Rivera retweeted
“The curse of discipline is that every day looks the same as the one before. The curse of no discipline is that every year looks the same as the one before.”
Luis Felipe Rivera retweeted
We created gyms because modern day work no longer required physical activity. Without exercise, our muscles atrophy.
I predict we’ll need gyms for our brains too, once AI starts doing our knowledge work.
Luis Felipe Rivera retweeted
Long range career advice. (Won't help you get a job tomorrow, this is a ~10-20 year thing)
You want to run two processes. Your main loop:
1. Knock on doors, many outside your league, and get yourself in a room with the most competent people who will have you.
2. Work your ass off to be reliably useful to them. Like, really, _really_ hard. However hard you think you're working to be reliably useful, work ten times harder. Also, be cheerful.
3. Every once in a while pop your head out and go to step 1.
Your background loop: look around for weird asymmetric opportunities. A startup to found/join, a project to hack on, an angel investment into a friend's company, whatever. When your heart sings, jump on it. (You will fail a lot but that's fine so long as you handle failure well, I'll cover that in another post)
In exchange for working really hard you get two things. First, knowledge/experience-- you learn a ton. Second, relationships-- ppl will remember how great it was to work with you. Knowledge and relationships with competent ppl create crazy asymmetric opportunities. You then jump on those. (There is a lot of twitter slop about compounding, well this is what career compounding looks like.)
---
Now some failure modes. Do _not_ do this:
"I deserve much better than this company/role, I'm just going to begrudgingly collect a paycheck" --> first, you deserve what the market clears and that's that. Second, if you act this way you'll only hurt yourself. Your colleagues will remember you as a grouch and it will wreck the compounding loop. Third, it's a very unpleasant state to be in, and you should choose not to be in it.
"But I work at Home Depot, what's there to compound?" --> that's extremely shortsighted. Maybe you do a super good job helping a customer who then has an open spot and remembers you. Maybe your store manager becomes a regional manager and calls you. Maybe years down the line your quiet peer is looking for a partner to start their own store. Maybe none of this happens, but it doesn't matter because empirically ppl who try hard to be useful wherever they are tend to do great, and people who don't, don't. (Home Depot is a metaphor, obviously)
"I hate this place, I quit! And anyway they're a faceless corporation that will lay me off any time." --> don't do that. The company may be a faceless corporation, but your colleagues are not faceless. They bet on you, hopefully you did a great job, and now they depend on you. Leaving is never easy, but do it in a way that respects the trust ppl put in you.
"Everyone around me is an idiot, I hate this!" --> maybe they are, or maybe you're not ready and some day will discover you were wrong about this. In any case you can learn from everyone and everything. So do that and be useful, don't break the compounding loop because opportunities will surprise you and things are often not what they seem.
“_I_ should have been promoted not that other guy/why is my manager layering me, screw this!” --> every time that happened i eventually understood I deserved it, you probably do too. Don’t hold grudges, do your best to figure out how to learn from this and move on, it will make sense eventually.
P.S. it helps if you’re a little talented.
Luis Felipe Rivera retweeted
You’re supposed to use every unfair advantage you have. Connections, looks; money, all of it.
You're not noble by picking the hardest path just to look like an underdog.
Luis Felipe Rivera retweeted
Program directors who rank applicants based on research pubs need to recognize that they are perpetuating a system that makes students miserable, and also cheapening the value of scientific research.
Now with AI generating an AI-slop meta analysis or review in an hour, this problem is only going to get compounded.
RIP program directors and admissions committees.
The answer of course is simple, but unpopular. DOWNGRADE "research" in the resident selection process. Select for people who will become good CLINICIANS. I have been pounding the table for years on this.
Of course, it is tough to remove an objective data point (# of publications), but this # is garbage, and will become even more garbage. and i feel for IMGs who DO produce research with integrity because they don't have many other options to increase chances of matching. But if you engage in this, it is very ethically dubious
Research is important of course, but we need to be training doctors to be good clinicians first.
Is anyone in academic medicine talking about this problem?
Luis Felipe Rivera retweeted
"The trouble with the rat race is that even if you win, you're still a rat." - Lily Tomlin
Luis Felipe Rivera retweeted
Moderna/Merck just ran a 1,137-patient Phase 3 trial where every single dose was unique to that patient's tumor. It worked.
The pipeline: surgical resection → whole exome + RNA sequencing → ML neoantigen ranking → mRNA encoding up to 34 patient-specific targets → manufactured and shipped in 8 weeks. One drug, different sequence for every patient.
The ML step is worth to note: the algorithm ingests WES + RNA-seq to identify somatic mutations, then predicts which of those will actually be immunogenic, ie, displayed on tumor cell surface and trigger a T-cell response. It's designed to keep learning from accumulated clinical and immunogenicity data across patients, not just per-patient.
INTerpath-001 (Stage IIB-IV resected melanoma, 2:1 randomized): combination with pembrolizumab beat Keytruda alone on both primary (RFS) and key secondary (DMFS) at interim. Phase 2b at ASCO 2026 showed 49% reduction in recurrence/death, 59% in distant metastasis/death at 5 years. Phase 3 confirmed both.
What this validates:
— tumor-specific neoantigen prediction by ML works in a blinded trial at scale
— 8-week personalized mRNA manufacturing is operationally real
— effect is additive on PD-1 blockade, not redundant
This is first positive Ph3 for individualized neoantigen therapy. First positive Ph3 for any mRNA cancer therapeutic.
What a great time to live in!! This is the best time for AI & biotech!
Moderna and @Merck today announced positive topline results from the Phase 3 INTerpath-001 trial evaluating adjuvant treatment with intismeran autogene, a novel investigational mRNA-based individualized neoantigen therapy jointly developed by Merck and Moderna, in combination with KEYTRUDA® (pembrolizumab), Merck's anti-PD-1 therapy, in patients with completely resected Stage IIB-IV melanoma.
Read more:
Luis Felipe Rivera retweeted
Last week I posted a new paper with Patrick Norrick: “Terra Incognita: The Economics of a Shrinking World.”
We chose the title deliberately. No society in history has experienced the fertility levels now seen in South Korea, China, Thailand, Colombia, Chile, and many other countries. Our knowledge of the causes (and of the economic consequences) remains far more limited than most public discussion acknowledges. Much of what we write is, at best, educated conjecture.
The paper also struggles against a space limit. We wrote 20,000 words, far from the 250,000 or so we would need to address some issues in more detail (if I had the time and resources to hide away for a year, I could do that, but not now). That means some ideas are only sketched.
Nonetheless, we emphasize several important points.
First, fertility has fallen very fast everywhere: rich and poor countries, east and west, north and south, conservative and liberal societies, religious and non-religious societies (with the exception of the Jewish population of Israel; fertility has also collapsed among the Muslim population within the pre-1967 borders), you name it. Even in sub-Saharan Africa we see fast and unprecedented drops in fertility (alas, from a high initial level).
Second, and this is really interesting, the fertility collapse has been concentrated in poor and lower-middle-income countries much more than in rich countries. By now, income per capita and fertility are positively correlated within OECD countries. We conjecture this will hold globally in a few decades.
Third, and related to the second point, the fertility collapse has been concentrated among poor and lower-middle-income women within countries. In countries such as the U.S., the rich and highly educated now have more children than the poor and less educated.
Fourth, we document why we do not understand the data from the U.N. World Population Prospects. See, for example, Tables A.1 and A.2.
Fifth, we explain why some proposed mechanisms struggle when confronted with the data.
A more subtle point is at work here. Many commentators do not seem to understand the difference between proximate causes and ultimate causes. Yes, births might have gone down because fewer women are in long-run relationships. That is the proximate cause. But you need to explain why fewer women are in long-run relationships (the ultimate cause), and saying that they spend more years in school, to take one example, does not get us very far. Why do they spend more years in school? Once you start down the whole chain of reasoning, things become much harder than they seem.
The paper can be found here:
sas.upenn.edu/~jesusfv/Demog…
Comments always welcome!
Luis Felipe Rivera retweeted
I think that becoming an excellent doctor out of residency is roughly represented by this equation:
Excellence = Baseline Factors x Education
baseline factors = (baseline intellect X humility X emotional intelligence)
Education = (# cases seen x learning per case) x mentorship coefficient.
You need BOTH lots of learning per case, and, lots of cases.
Then there is a mentorship X factor where a great mentor is a multiplier on educational learning…
Curious thoughts (obviously not an exact science )
Luis Felipe Rivera retweeted
The curse of discipline is that every day looks the same. The curse of indiscipline is that every year does.
Luis Felipe Rivera retweeted
You'll regret it if you get married, you'll regret it if you don't get married. You'll regret it if you have kids and you'll regret it if you don't. Kierkegaard said this 200 years ago as follows - whatever you choose, you'll regret it, because the problem isn't in your choices, it's in romanticizing your life. A person always finds an untravelled path alluring and mysterious. That's why the issue isn't making the right choice. It's choosing and deciding which regret you'll live with. In life, we must choose our regret.
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