Building in healthcare, tech, & retail. Sculpture nerd. Helping scientists at CU Health. Fmr: Founder @ Toggle Health, Humana, Walgreens, Target, LaunchBlueKY

Louisville, KY
Joined November 2009
I get that "why am I watching this weird AI commercial" feeling every time I see Elizabeth Holmes speak
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"primarily a social and cultural problem" 😤
We almost didn't get GLP-1RAs. The management at Novo Nordisk was resistant to getting their drugs approved for obesity because of a stigma against doing so. It took researchers continually pushing on this to realize the promise of the drugs.
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Wow… The Babies are No Longer Protected Against Measles Moms antibodies used to give 6-9 months of Ab protection to infants Now, protection is gone by ~4 months Neutralizing Ab titers = 0 by 6m And… if we give MMR early to fill the gap it can drive a long-term problem 1/
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Jake Miller retweeted
Two routes to $10 billion "The vertical axis is my best estimate of net revenue per patient-year. The horizontal axis: the patient-years that estimate implies (sales ÷ price). Each point shows one assumption twice. Shaded bars are my price ranges. Each dashed diagonal is one level of annual sales; everything on a line earns the same." positioningpharmaceuticals.s…
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I love this quote, but I also have an irrational fear that the bowling ball will just show up somehow if I do this
"They’re claiming that believing something enough causes it to happen without you having to take any action. So for anyone who believes this, I really want you to, every morning, believe as hard as you can that there’s a bowling ball in your freezer, and just do it every morning until you no longer believe this works." ~@SpencrGreenberg
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Jake Miller retweeted
Where did 2025’s 30 best-selling medicines actually come from? Industry made more of the molecules than the “pharma just buys innovation” story suggests, but 28 of the 30 rest on biology first found in academic labs. Where a molecule starts tells you surprisingly little. Maybe an interesting set-up for AI and the next 15 years... asymmetriclearning.substack.…
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Jake Miller retweeted
So good
Security called me at 6:12 AM today. "Patch every PHP server immediately." I asked what happened. "Two critical vulnerabilities. Remote code execution. No authentication required." Cool. How many PHP servers do we have? According to inventory: 12 According to reality: Nobody knows. We found one running WordPress. Three running old internal tools. One under someone's desk. Two inside vendor appliances. A forgotten employee directory from 2016. And a server named: PHP-OLD-DO-NOT-TOUCH Naturally, that one runs payroll exports. Then we found a PHP 5.6 box. I asked who owned it. The documentation said: BRIAN. Brian left in 2019. We called Brian. He said: "Oh wow, that's still running?" Excellent. By 8 AM, leadership joined the incident call. CEO: "Can hackers actually get in?" Security: "Potentially yes." CEO: "Without a password?" Security: "Yes." CEO: "Then why do WE need passwords?" Not the lesson. Finance asked if we could wait until the weekend to patch because downtime affects revenue. Security explained that the alternative was letting strangers execute code on our servers. Finance asked for a cost comparison. At 9:17, someone suggested temporarily taking the vulnerable websites offline. Marketing refused. "Our campaign is live." So for the next hour, the company officially decided maintaining a landing page for 20% off webinar registration was more important than preventing remote server takeover. We finally patched everything we could find. Then our scanner discovered another PHP server. Hostname: TEMP-PHP-2014 Uptime: 4,512 days. Nobody knows what it does. Nobody owns it. Nobody can shut it down. But every time we block network access, the warehouse stops printing shipping labels. Security has classified it as critical infrastructure. It is running PHP 5.4. The vulnerability has existed longer than half our employees. The emergency patch took four hours. Finding out what PHP actually runs took eleven. The internet isn't held together with code. It's held together with servers everyone is afraid to turn off.
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Beautiful essay on what it means for humans to be the children of dancers and how AI allows everyone, not just those in college, to have the equivalent of stoned dorm-room conversations
AI IS AMAZING I know it's hip to worry about the decline in book reading and how chatbots will impoverish our brains. But TBH, this is not at all what I see. I wrote about how we're in this wild moment for intellectual flourishing and how all of us are the children of dancers.
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Toddlers, it turns out, are tiny altruists: They’re happier giving treats away than receiving them... suggestive evidence that human altruism is driven by the inbuilt emotional rewards of lending a helping hand. stevestewartwilliams.com/p/e…
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Jake Miller retweeted
How To: Genetically Modify a Flower 🧬🌹
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Same in start-ups vs large orgs: "But it does make me wonder why, in some situations, a team comes together almost seamlessly, everyone gets the information they need, and the plan moves forward quickly. And in others, it feels like pulling teeth to get everyone moving in the same direction."
I think many of us who work in clinical environments where emergencies are common have had this experience: you’ve assessed a situation, developed a plan, and some part of that plan needs to be carried out by others. Those people arrive at the bedside, and suddenly you find yourself having to revisit the events and decisions that led to that plan. I try to take my ego out of these situations. The people coming to help have their own informational needs. They may have important questions or perspectives that haven’t been considered. But it does make me wonder why, in some situations, a team comes together almost seamlessly, everyone gets the information they need, and the plan moves forward quickly. And in others, it feels like pulling teeth to get everyone moving in the same direction. I think a lot of it comes down to trust. Particularly in large medical centers, so many of us are pulled in different directions that it’s difficult to build a core group of people who know and trust one another’s clinical judgment. We’re often working with people we barely know, sometimes meeting for the first time in the middle of a crisis. Without that established trust, even getting everyone on the same page can be difficult, creating tension and sometimes unnecessary delays. I think back to residency, when I worked with a relatively consistent group of colleagues. There were people I trusted implicitly, and who trusted me. That didn’t mean we didn’t question one another. But there was something reassuring about walking into a room knowing we could work together and move quickly because that trust was already there. I don’t know that there’s an easy fix, but it makes me think about how we build that kind of rapport and trust when we’re so often working with unfamiliar colleagues, under enormous pressure. It doesn’t feel as easy as it used to be.
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Lots more life & death situations in start-ups. Trust builds quickly. Too many high-inertia people in large orgs and too many situations where what you are doing doesn't really matter
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Jake Miller retweeted
"you will have some difficulty imagining what mental life and everyday existence can be like for someone whose IQ is more than 10-15 points away from your own. This is especially true if you have only ever spent time around similar individuals to yourself" robkhenderson.com/p/smart-pe…
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The longevity guys like using these, but this it the actual use case for CGMs
Should we offer continuous glucose monitors (CGM) to patients with type 2 diabetes who aren't on insulin? A recent NEJM published. tldr; YES. CONNECT (Oser et al., NEJM 2026) randomized 283 adults with HbA1c of 7.5% (58 mmol/mol) or higher at 22 US primary care practices. Both groups had six visits in 26 weeks, and a trial clinician reviewed glucose data and adjusted treatment at each one. 📊 HbA1c difference -0.9 points (95% CI -1.1 to -0.6), or -10 mmol/mol 📈 HbA1c below 7% (53 mmol/mol) in 46% with CGM vs 24% with usual care 📊 Glucose-lowering drugs were added in 31% vs 17%, mostly GLP-1 agonists ❌ Weight change did not differ (-2.5 vs -1.8 kg) 📊 Exploratory subgroups showed -2.1 points at HbA1c 10% (86 mmol/mol) or higher and -0.3 at 7.0 to 7.9%, with an interval crossing zero 🟢 No severe hypoglycemia, and 3 minor sensor-related bleeds The case is strongest for patients well above target who also get planned follow-up. 🏁 doi.org/10.1056/NEJMoa260857…
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Jake Miller retweeted
I recently spent some time with former colleagues from academia. All of them brilliant, peak human capital. Almost all of them fundamentally unable to plug into the economy, inoculated against productivity by a youth spent experimenting in laboratories instead of building wealth for society. Dealing with real people in the real world. 90% of them have left academia in the last 10-15 years, and 90% of those are functionally unemployed. Grad school does a lousy job of training scientists to be professors (since most of them don't get the good postdoc or tenure track position) and an even worse job of preparing people for real life. We complain that our societal infrastructure is collapsing, our state capacity is low, our incumbent industries are faltering. Where are the next generation of leaders that can push us forward? A huge fraction of them were conveyor-belted into academia by schooling systems that have no mechanism to channel ambition and 99+%ile competence, and our universities are mostly hedge funds with glorified psych wards/academic departments on the side, running an insane pyramid scheme that exists only to prove, over and over again, the Shirky Principle: Institutions will try to preserve the problem to which they are the solution. We literally poured trillions of dollars into state-funded research and effectively neutered our elite civilian technical leadership development programs. I recently asked a few academic friends if they were finding AI useful in accelerating their programs of research. You know, to solve the Big Problem their entire field exists to solve? Some were. But most were complaining about how it created pedagogical issues, explaining how their department decided to ban the use of AI, or how it took 18 months to approve an enterprise account, or how they tried Gemini 2 on a puzzle a year ago and it wasn't very helpful, or repeating nonsense about datacenters and water consumption, or supposed IP theft by model companies, as though that has any bearing on their ability to, eg, accelerate a cure for cancer. Elon sometimes calls AI a supersonic tsunami - a huge wave you don't see coming. I see it coming. But even the people who you'd think have been waiting for this their entire careers are steadfastly looking in the other direction.
During a business trip I heard about multiple companies who are struggling to hire people. Jobs available but they can't fill them. There is a huge disconnect in the job market somewhere- the systems responsible for efficient and effective recruitment have completely failed.
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Probably a lot of truth to this one. The Walgreens execs involved were really into TED and attended regularly
One of the things that hasn’t been talked about with Elizabeth Holmes: She was created in the era of the Ted Talk Entrepreneur. Between 2011-2015 (after the release of the Social Network), there was an entire apparatus built around “Child Prodigies”: college accelerators, young entrepreneur organizations, etc. I watched countless founders of hard tech companies present fraudulent products at conferences. They had fake studies with fudged numbers. Most of the adults in the room excused it as “faking it ‘til you make it.” But Holmes was the one who rode the wave better than anyone else. When the Ted Talk Era came to an end and people finally came to their senses, she was still running the same playbook—and in the most scrutinized field there is: medical technology. When people ask how she got so far, it’s largely explained by the period she did it in. And she got caught when the world suddenly woke up.
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Jake Miller retweeted
The kids are all right.
North Carolina A&T students marched an hour each way to vote on the first day of early voting after their campus polling site was removed by the Guilford County Elections Board. Proud 👏🏽
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wife: what are you looking at on your phone at dinner me: just some shit wife: what kind of shit me: well we got that rolling tv so i wanted to see if those rolling nurse workstations are purchasable, which they are and also most hospital equipment like vitals monitors so then i was curious like if you set up a home medical wing, what’s the top 10 substances given to patients, but not by volume but like by occurence, and then its injectable saline by like a large margin, and im like can you buy that and it turns out you can’t, totally prescription but not for like great reasons other than people might fuck themselves up administering it, but like how is it made and who makes it and it turns out one company has like 60% market share (of like 3 domestically) and 20% global market share and that’s crazy their proprietary processes and ip are like national security, fabric of society and civilization type shit how crazy is that?
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Jake Miller retweeted
A real world digital GLP-1 structured treatment program achieved marked weight loss, high retention, metabolic improvement, and no serious adverse events in over 8,000 women. Suggests scalability with minimal need for clinician support. nature.com/articles/s41591-0…
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