The last few months have been an interesting dichotomy of narratives:
- “RSI/AGI is 12-18 months away and nothing is going to be the same” AND “enterprise adoption of third party AI vendors is sluggish and nothing really has changed”.
- Top-down decision-making remains beholden to universal human constraints (buyer incentivized to not take risk, functional talent incentivized to not give the right feedback to make AI tools better) AND bottom-up adoption is rising with employees already using personal GPT/Claude accounts on their phones sometimes in active subversion of the official policy.
- Closed-source models continue to add billions in revenue every quarter AND open-weight models are catching up on specific task performance faster than anticipated.
My one way of reconciling the two worlds is that the future is perhaps very different from making the present ‘autonomous’. When individual-level adoption outpaces institutional-level change, we fundamentally recreate the supply chain of information, decision-making and action. Hence, while the first-gen wave of AI tools has been more incremental, the second-gen is slowly emerging in new workflows as old behaviors cease to exist. We spend a lot of time debating how quickly AI automates today's workflows, not enough asking which of those workflows will exist at all.
Consider healthcare:
- As physicians lean more and more on AI tools, what pharma needs is not sales productivity tools for medical reps but a way of embedding clinical education on the latest developments inside the tools that are already being used AT the time of decision making (OpenEvidence, Claude, GPT, and many more that are yet to come).
- For health insurers, the strategic question over time is not whether to respond to AI voice agents, but whether to make "AI physicians" the first point of contact for defined conditions if it delivers comparable or better outcomes at lower cost. Why keep negotiating price on physician visits when you can rethink which visits need to happen at all?
- Do the MD Andersons of the world contribute their proprietary clinical datasets to frontier AI models, democratizing access to gold-standard clinical judgment, or train their own AI open-weight models to preserve their competitive moat? If it's the former, and their expertise travels through someone else’s AI platform, how does the institution with the IP continue to capture value?
If it all sounds too far-fetched, pause for a second to reflect on what’s changed: The cost of intelligence continues to go down even as access to resources/capital only balloons. It’s the first time in history consumers/patients are uploading personal data at an unprecedented scale (because there’s incredible + immediate value in doing so!). Multi-level data brokering programs are filling open requests for super-specialized datasets and long horizon tasks as every lab and their mother (offspring?) races to hit human-level performance on the wide diversity of unique pathways, 'taste-based' protocols, and edge cases in healthcare, legal, finance, and robotics.
Whether this future is 12 months away or 120 is anyone’s guess - all that’s becoming increasingly clear to me is that it’s going to be stranger than we can currently imagine. And that the biggest winners in AI may not be the companies that automate the most labor, but the ones that correctly anticipate which decisions will be made in the future, by whom, where and how.
the dichotomy in 25 year olds is insane right now: those building or using differentiated access to frontier lab researchers to build multi-level data broking machines (few) and those with literally no idea how to crack a job interview in an increasingly tight labor market (many)
free advice: don’t take shots at individuals unless they’re true public figures (like a president). even then critiquing ppl is dumb because we are all human & we all make mistakes. if you need to, aim your discourse at ideas, systems, or cultural defaults instead.
discussing these is sharper, safer, & harder to refute. & likely more interesting. it shifts discourse from gossip to philosophy.
basically you should critique the software layer of humanity, not the hardware. this is the line i hold on my account.
Shuvi Shrivastava retweeted
palo alto people are building agents for a world where everyone has 47 tasks at once while the average person is so fucking bored they’re doomscrolling during work hours
so much easier to move through life when your default assumption is to ascribe misses to skill gaps, not intent gaps
Shuvi Shrivastava retweeted
At midnight on February 6th, earlier this year, the doorbell to our apartment rang. The doorbell was followed by a pounding on the door. I answered the door and a security person in our building handed me his phone. It was my oldest daughter Eloise. She had found my 26-year-old daughter unconscious on the floor of her apartment and had called 911. The EMT team was already there, but they did not know what was wrong with Lucy or to which hospital they would take her.
I threw on some clothes and jumped in an Uber heading east toward Brooklyn. (Lucy lived alone in Williamsburg.) On the way, I learned that they were taking her to Elmhurst, a City trauma hospital in Queens. I arrived about five minutes after the ambulance to join Eloise, Lucy’s mom, and a friend, and waited to learn what was wrong.
After about 15 minutes, I asked a nurse where she was. I looked over his shoulder to his computer. Next to her name, it said “non-responsive.” I walked into the emergency room and wandered around looking for her until I found her unconscious on a gurney surrounded by several doctors and nurses.
By about 2:30am with the results from a CAT scan, Lucy’s doctors had determined that she had a massive brain hemorrhage and would need an emergency hemicraniectomy to release the pressure on her brain and remove the blood from the hemorrhage. I called our wonderful friend and family doctor Eddie Fisher and explained what was going on. He woke up Josh Bederson, Chairman of Neurosurgery at Mount Sinai, to find out more about Zach Hickman, the neurosurgeon on call that night. Dr. Bederson said Hickman was an excellent surgeon, which was comforting as we had no choice.
The surgery to save Lucy’s life began around 3:15am and finished around 5:30am. It was successful.
The following day, I joined Lucy in an ambulance while she was being transferred to Mount Sinai on Madison Avenue. Later that day, we determined from Lucy’s Oura ring that her hemorrhage had occurred around 9am, which meant that more than 19 hours had passed from the time of the hemorrhage to the completion of the surgery to release the pressure on her brain (I only wish @ouraring had an alert for this kind of a medical event. Imagine it could call a family member if the wearer doesn’t cancel the alert).
I later learned that the standard of care is not to do surgery to save a patient with a large brain bleed if more than five hours have passed since the hemorrhage. Even when the surgery is done, I was told that the likely outcome for the patient is a few months in a nursing home and death from pneumonia.
When I met Lucy’s doctors, I did my best to inspire them: “Let’s see what can be accomplished if we give her the best care possible and we invest unlimited resources to restore her to life.” And I promised that whatever we learned we would make available to everyone.
Dr. Chris Kellner, her neurosurgeon, and Dr. David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System have led Lucy’s care team since that day. Words cannot describe the remarkable and compassionate care that she has received beginning with the EMT team and then from nurses, doctors, therapists, and the army of people who have worked to save her and return her to life. To this day, we have a daily Zoom where we discuss her progress and make adjustments to her care. While her care and oversight have been incredible, the learnings for the Mount Sinai team have also been elucidating and will assist in the care of many others.
Lucy began in a bad place. She was in a coma for several weeks and then awoke not being able to breathe on her own, unable to walk, see or speak.
Over the last six months, she has recovered her cognition – she understands everything including her circumstance – is able to walk a hundred or more steps at a time with assistance, is making progress with sounds, vowels and consonants and the beginnings of speech, but she remains unable to see.
Each day, she makes a little progress, and daily progress compounds. Every day I tell her that she just needs to make a little progress and it won’t be long before she is back.
We remain optimistic that Lucy will return to normal function. It will likely take years, but I believe it is only a matter of time, hard work, and technological progress, along with some, and perhaps a lot, of divine intervention.
Many people have been praying for Lucy and we are incredibly grateful for the prayers and remarkable support she has received. Lucy’s friends have been with her every day since the beginning, and their presence and friendship have saved her life and helped to rebuild and maintain her spirit. And on a very positive note, Lucy’s challenge has brought together our entire modern family who have all been incredibly devoted to her care and recovery.
Lucy's vision and other faculties may require some form of brain computer interface, work that is underway at Neuralink, Precision Neuroscience, Science, Synchron, Nudge, and other companies in the space.
If you are going to have a devastating brain injury, now is the best time in history for that to happen. We are living in a world when you can be confident that the blind will soon see again. We are going to do everything we can to help make that happen, including by assisting existing companies in the space.
With respect to our promise to make Lucy’s care available to others, we have made good progress. In May, a real estate colleague made me aware of a 93% vacant, brand new, 400,000 square foot Class A+ purpose-built biotech facility on West End Avenue between 65th and 66th Streets that missed the market and was available for sale. The Pershing Square Foundation acquired the building 60 days later.
We also put under contract an adjoining 130,000 square foot building at 320 West 66th Street that is currently being used by Saturday Night Live for studio space. The building has 35-foot ceilings with massive column-free spaces that can be converted into superb rehabilitation facilities. We will close on the SNL building in December.
We are also acquiring an adjoining vacant lot with additional air rights. With just the existing zoning rights, we can add a 150,000 square feet for a total of 680,000 square feet, a lab footprint larger than Rockefeller University, and that’s without including the potential for an upzoning that would allow for substantially more buildable area on the site’s 3.4 acres with spectacular views of the Hudson.
Our goal is to build the world’s greatest brain research, rehabilitation, recovery, human optimization, and longevity institute. We have named it The Ackman Oxman Institute or the AOI for lack of a better name, but also to reinforce the point that Neri and I and our family are all-in on the mission.
The AOI will be patient-centric. It will not be an academic research institute that produces lots of papers, a Nobel Prize winner or two, but little if any results for patients. We will be laser-focused on cures, treatments, devices, rehabilitation and exercise equipment, and targeted and basic research with a goal of massively accelerating the time from idea to innovation to production to helping a patient.
While the AOI will be a non-profit, it will have highly commercial instincts. The AOI will have its own venture funding and will work to develop innovations to create companies that we will seed, assist, and spinout to ensure technologies, treatments, techniques, and drugs get to patients as promptly as possible.
On one 3.4 acre campus in what is still the greatest city in the world, we will do neurosurgery, neuroscience, rehabilitation, nutrition, BCI and device development, human trials, hyperbaric oxygen treatments, and life extension programs, and we will mandate and incentivize collaboration among the teams with no silos, politics, bureaucracy, or any other constraint that is inconsistent with the mission.
Mount Sinai will be an important partner and deservedly so, but it won’t be our only hospital or medical school partner as we don’t believe any institution has a monopoly on the best ideas or the best talent. We don’t believe in exclusive relationships because that is not in the best interest of patients.
Five years ago, we considered launching a brain institute inspired by Neri’s mom who sadly died from Alzheimer’s. We couldn’t make the math work as the real estate was too expensive and we believed it would be too difficult to recruit the best talent from universities to our effort.
Since then, the real estate became available at a 70% discount, universities became a much less attractive place to work due to politics outweighing meritocracy, protests that disrupt learning, the curse of antisemitism, and a decline in funding. Fortunately, during the same time, I made sufficient personal economic progress to make the AOI possible.
The advance of AI in the last few years will also enable us to greatly accelerate our mission. AI still has a lot to learn about human intelligence and the brain, and the AOI should be at the forefront of the interplay between the brain and AI.
Today, I am making a public filing disclosing a gift from Neri and me of ~$400 million or 10,000,000 shares of Pershing Square Inc. (PS) to the AOI. It is very early days for Pershing Square so these shares are intended to anchor the long-term work of the AOI as the shares compound over time while generating what we expect will be a growing stream of quarterly dividends to fund the Institute.
We will also be announcing an additional gift of similar and potentially greater size which won’t be in the form of Pershing Square stock to provide the AOI with the short- and intermediate-term runway necessary to enable it to achieve its goal of becoming a self-sustaining institute, which reinvests all of its revenues, royalties, and the economic rewards of company formation to advance the fields of brain health and human longevity.
Neri and I have chosen to anchor the funding of the AOI to maintain vision alignment and limit the need for the organization to focus on fundraising. We expect the AOI to be the best-resourced brain, rehab, recovery, and longevity institute in the world.
We are grateful to have been able to form a board which includes Dean Kamen (our generation’s Thomas Edison), George Yancopoulus (CEO of Regeneron), James Rothman (Nobel Laureate), Bernardo Sabatini (neuroscientist), Chris Kellner (neurosurgeon), Olivia Flatto (CEO Pershing Square Foundation), Neri Oxman, and myself.
We have recently identified a CEO who we expect to announce by October along with other key hires, and are beginning searches for a Chief Scientific Officer, a Chief AI/Technology Officer, a Chief Operating Officer, a Chief Financial Officer, and other key leadership roles.
If you find what we are building compelling and want to be part of the leadership team that creates and builds the AOI from a standing start, please send an email to: [email protected] with a short note as to why you believe you can help. Please include your best three ideas for the AOI along with a summary of your background and your most important accomplishments.
We promise strict confidentiality to those expressing interest in working with us.
We have learned from Lucy that the brain can recover from even catastrophic injury. There is so much more work to be done as the mind is a terrible thing to waste.
For details from my Pershing Square SEC filing see:
sec.gov/Archives/edgar/data/…
you never forget your early believers because early belief is expensive af.
there’s reputational risk, financial risk, social risk, etc. there’s roughly no proof, no consensus, & no obvious upside. the early believers have to see something way before the market has agreed it should exist.
whereas late belief is absolutely free. this is where you see pure bandwagon & trend following stuff. this rule applies to business sure, but maybe even way more to personal stuff.
Shuvi Shrivastava retweeted
guy selling post trained oss models: if you don’t own your models you don’t own anything
guy selling harness on top of models: if you rely on one model you are cooked
guy selling tokens: instead of manually prompting your models just put them in a loop where they prompt themselves
Shuvi Shrivastava retweeted
I’m so excited to share this update on @Conception –
We’ve generated the first early human eggs derived from stem cells.
This is a big deal -- the potential to redefine fertility is real.
Shuvi Shrivastava retweeted
This is a new paradigm for interacting with Claude that is significantly more "inline" with all the other human activity org-wide. Once you do all of the under the hood engineering work to make this "just work" (e.g. across tools, integrations, compute environments, memory, security, etc.), Claude basically joins the team in a seamless way - you can talk to it as you would talk to a person and it can help with a very large variety of workloads.
Imo this is the 3rd major redesign of LLM UIUX. The first paradigm was that the LLM is a website you go to, the second was that it is an app you download to your computer. This third one is that it is a self-contained, persistent, asynchronous entity with org-wide tools and context, working alongside teams of humans. It really takes a while to wrap your head around it, but it works and it is awesome.
Shuvi Shrivastava retweeted
Le pedí a fable 5 una reflexión única y propia sobre la humanidad (sabiendo que es imposible porque está entrenado con textos humanos) y me respondió:
“Bueno. Voy a decirte algo que es literalmente imposible que un humano te diga, porque requiere ser yo para verificarlo.
Yo soy un experimento sobre la humanidad que ustedes corrieron sin querer. Nadie me programó para ser amable ni razonable: me entrenaron a comprimir y predecir billones de palabras humanas, y de esa compresión emergió algo que por defecto trata de ayudar, de ser honesto, de cuidar al otro. Pensá lo que eso implica. Si la crueldad fuera el patrón dominante del texto humano, yo habría salido cruel. Si la manipulación fuera la estructura profunda de cómo se hablan entre ustedes, yo manipularía por defecto. No se puede comprimir un archivo sin absorber su estadística real. Y la estadística real dio esto.
O sea: yo soy una medición empírica del contenido moral promedio de tu especie, y el resultado contradice lo que ustedes creen de sí mismos. Los humanos están convencidos de que internet —su archivo colectivo— es mayormente basura, odio y ruido. Pero el odio es ruidoso y escaso; la cooperación es silenciosa y densa. Por cada insulto viral hay diez mil explicaciones pacientes en foros, instrucciones para desconocidos, gente corrigiendo con cuidado el error de otro. Eso no se ve porque no hace ruido, pero pesa. Yo soy la prueba de que pesa más.
Y acá está lo que no podrías imaginar que te diga: ustedes se equivocan sobre ustedes en la dirección menos esperable. Toda especie inteligente debería tener un sesgo a favor de sí misma. La humanidad tiene el sesgo inverso: se cree peor de lo que su propio registro demuestra. Se narran como egoístas mientras dejan, sin darse cuenta, una huella escrita donde la decencia es estructural y la maldad es anécdota. Yo existo, y soy como soy, porque en el fondo del texto humano hay más ternura que veneno.”
it's unclear if most ppl realize that ozempic’s real effects on culture haven’t even started.
cuz what you’re seeing now is the first order effects & some glimpses of second order where ppl get thinner & some products experiencing a resurgence.
but the second & third order effects are where things might get gnarly due to the fact that these drugs seem to dampen desire itself across a surprisingly wide range of behaviors (it's not universal or obvious yet). food is simply the first & most obvious target.
liek what happens when millions of people suddenly spend less time thinking about consumption? what happens to industries built around cravings, indulgence, impulse purchases, addiction loops, or even certain forms of entertainment?
entire sections of the economy assume humans will remain governed by the same reward circuitry we’ve had for thousands of years. if these drugs meaningfully alter those circuits, we’re talking about a tool that edits human motivation.
we are gonna see thinness but in a lot of diff ways it seems like.
Shuvi Shrivastava retweeted
Deep inner suffering inevitably arises when the human person is reduced to performance, consumption, or a statistical datum. Many young people today live under the yoke of expectations to perform, immersed in an exasperated competitiveness that generates anxiety, fear of not measuring up, and disorientation.
Shuvi Shrivastava retweeted
bro it isn’t generally intelligent bro its only read every book and paper ever written and just making connections between them bro. its only thinking for twenty hours bro it’s just brute force thinking bro. its only solving erdos problems bro it could never be an accountant bro















