New newsletter: HOW THE 2020s BROKE OUR BRAINS
It's the Tragic Twenties, and Americans can't stop feeling like hot garbage.
- The UMich consumer sentiment survey is now at its lowest rate on record
- The Fed's job satisfaction survey is at its lowest rate on record
- Both the General Social Survey and the World Happiness Survey have found that happiness in the US plunged in 2020 and has since been mired at levels significantly below previous decades
You shouldn't assume that your favorite pet issue is the main culprit here. Conservatives might point to cultural changes, like the decline of marriage and religiosity, but those have been going on for decades. The left might reach for wage inequality, but that has actually narrowed in the last six years. This can't even primarily be about phones, since what's most clear in the data set is something that changed this decade, not last decade.
I spent a long time reading, talking to people, and doing my own research, and I think the most parsimonious explanation I can provide is this:
The Pandemic Never Ended.
This thesis has three parts.
TPNE 1: The biological antagonist of COVID gave way to the economic antagonist of inflation, and after decades of coming to rely on lowflation and meager wage growth for low-income workers, price levels have increased 3x faster this decade than in the previous 40 years, and economists simply have to accept that inflation makes people angrier than it used to. This isn't even a strictly American phenomenon. Around the world, incumbents have lost power faster than any post-WWII period, as affordability concerns bludgeon their electorate. The few countries where happiness levels have increased in the western world in the last 6 years have had some of the lowest levels of inflation.
TPNE 2: Institutions down, individualism up: The 2020s have seen trust plummet for practically every institution, along with growing distrust in strangers, and rising alone time and at-home time. At best, community offers a buffer in times of crisis. But today, the absence of community—and the triumph of a tech-enabled, hyper-introverted atomism—makes every crisis feel more existential and unsolvable. And that's a problem bc...
TPNE 3: The 2020s have been the permacrisis crisis decade. It's really been one fucking thing after another, hasn't it? Pandemic, inflation, interest rates, Ukraine, Gaza, Iran, AI. Meanwhile, phones give us constant contact with both the scary news cycle and the panic-inducing fears and anxieties of the commentariat.
Inflation makes today's life feel harder to live. The news cycle makes tomorrow's world scarier to live through. And the post-pandemic decline of institutions and acceleration of toxic individualism weakens our socio-emotional immune system to deal with all of it.
TLDR: The pandemic never ended, and it's left us with the Tragic Twenties.
A single nasal spray vaccine could protect against all coughs, colds and flus, as well as bacterial lung infections, and may even ease allergies, says U.S. researchers.
https://t.co/L73hEeNoPH
@bryan_johnson Thank you for your bravery in speaking up. The advice I give is to be empathetic and listen. Don’t try to convince or cajole. Don’t use the phrase “I know how you feel.” Oftentimes the presence of presence is the most helpful vs any specific words. Love is showing up
Today, I had the honor to present the state of our city.
For the first time in five years, San Franciscans believe we're moving in the right direction. Our recovery is well underway.
The work now is to make it durable for everyone. For that to happen, we have to keep our focus on public safety, clean streets, and a lasting economic recovery.
2025 will go down as one of the safest years in our city's history. Crime is down nearly 30%, car break-ins are at a 22-year low, and homicides haven't been this low since 1954.
The fentanyl crisis changed our city, so we have changed our approach. We stopped freely handing out drug supplies and made San Francisco a recovery-first city. Encampments are down 44% from 2024 and we've opened 600 new treatment-focused beds.
Over the past year, cleaner, safer streets helped our economy come roaring back.
But one year of momentum is not enough. When tech booms, opportunity grows—but so does anxiety about rising rents and displacement. This boom-and-bust cycle has historically left too many people behind. Opportunity and stability must rise together for every resident and every neighborhood.
Today marks the beginning of our Family Opportunity Agenda—a powerful effort to reduce the cost of living for San Francisco families by tens of thousands of dollars each year.
In December, we approved The Family Zoning Plan—a generational roadmap that will help ensure San Franciscans can afford to raise their kids here and expand housing supply while preserving the character of our neighborhoods and protecting rent-controlled buildings.
And starting this month, a family of four making less than $230K a year will qualify for free childcare at hundreds of high-quality providers across San Francisco. By this fall, those earning up to $310K a year will receive a 50% subsidy.
Twelve months into this administration, the state of our city is resilient. But I don’t just want to bring San Francisco back. I want to build something better that will last, a city you and your children and their children are proud to call home.
We're just getting started, and we aren't going to leave anyone behind.
Let's go, San Francisco.
some words and a lot of new polling data on the loneliness crisis — and how it's way deeper and more multidimensional than most people seem to think. https://t.co/8KS682rbwv
One of our most requested resources within our venture assistance is help with pitching and storytelling -- here's the workshop on "Nailing your Fundraise" i gave our CEOs at our summit and full deck linked on our site
https://t.co/Xd0B5Y246F
Smartphones are becoming the cigarettes of our time.
Gen Alpha will likely view them exactly how Millennials view smoking: once ubiquitous, now heavily regulated due to knowledge of harm.
https://t.co/Au9bJoCNPP
I have a guest essay in @nytimes today about autonomous vehicle safety. I wrote it because I’m tired of seeing children die. Done right, we can eliminate car crashes as a leading cause of death in the United States
@Waymo recently released data covering nearly 100 million driverless miles. I spent weeks analyzing it because the results seemed too good to be true. 91% fewer serious-injury crashes. 92% less pedestrians hit. 96% fewer injury crashes at intersections. The list goes on.
39,000 Americans died in crashes last year. More than homicide, plane crashes, and natural disasters combined. The #2 killer of children and young adults. The #1 cause of spinal cord injury. We’ve accepted this as the price of mobility.
We don’t have to.
In medicine, when a treatment shows this level of benefit, we stop the trial early. Continuing to give patients the placebo becomes unethical. When an intervention works this clearly, you change what you do.
In driving, we’re all the control group.
Cities like DC and Boston are blocking deployment. And cities are not the only forces mobilizing to slow this progress.
It’s time we stop treating this like a tech moonshot and start treating it like a public health intervention that will save lives.
Link to article below.
👀 this video of Waymo cars evading crashes with people and vehicles. I especially note the ones that require it having a 360° view.
My sincere thanks to Alex Ellerbeck and @acsifferlin for their wisdom and sure hand in editing this piece.
Automating IVF to help families conceive with great results. So cool to see Conceivable, one of Scrub Capital's portcos in the news for their great work https://t.co/hklaf2I50c
I had the pleasure of organizing the first Scrub Capital Innovation Summit last week, bringing together 60 incredible clinicians, founders, operators, and investors passionate about improving patient lives and the US healthcare system.
@nikillinit On it's own, Cialis helps to make an erection possible. It has to be paired with an arousing stimulus to get to half (or full mast). Which seems like playing Russian roulette if you take it before going to a gym full of attractive sweaty people...
@KeithSakata One of my strategies for approaching a convo with someone with different views is to ask “Could anything I say change your mind?” Opens up the possibility on the front end without getting stuck in an endless debate
I’m a psychiatrist.
In 2025, I’ve seen 12 people hospitalized after losing touch with reality because of AI. Online, I’m seeing the same pattern.
Here’s what “AI psychosis” looks like, and why it’s spreading fast: 🧵
So proud to be part of this effort with the wonderful team at Scrub Capital! @RebeccaCoelius is an incredible leader working to effect positive change in our healthcare system on a large scale
What a top VC thinks is overhyped and underhyped in healthcare:
This week on How I Doctor, Offcall co-founder Dr. @grahamwalker, MD, sits down with Rebecca Mitchell, a San Francisco-based physician and the co-founder of Scrub Capital.
Scrub Capital is an innovative new venture firm built around a bold premise: Give clinicians a seat at the table and on the cap table! Alongside partners Christina Farr and Jonathan Slotkin, Rebecca has brought together over 800 physicians, nurses and frontline clinicians to fund companies that solve real (often unsexy) problems in healthcare that clinicians actually care about.
In the episode, Rebecca and Graham dive into:
👉 The founding story of Scrub Capital
👉 Who Scrub's LPs are and how other clinicians can get involved
👉 Scrub's unique value add to founders and the benefits of having more clinicians on their cap table!
👉 A rapid-fire breakdown of the biggest trends shaping medicine — from AI to GLP-1s, fertility, psychedelics, and more.
Physicians, if you’re ready to break into venture capital, if you're founding a company, or if you just want to make sense of medicine's biggest buzzwords, this episode is for you.
🎧 Listen to the full episode of How I Doctor now on your favorite podcast app or click here: https://t.co/nNGOQ6x0RI
And drop your thoughts below. Do you agree with Rebecca on what is overhyped or underhyped in healthcare?
#HowIDoctor #PhysicianInnovation #PrimaryCare #HealthcareTech #Offcall #PhysiciansFirst #DoctorsDeserveBetter #MedicalAI #GLP1s #HealthEquity