{
  "author": {
    "name": "Dylan Fitzgerald",
    "url": "https://dylanfitzgerald.net/"
  },
  "blyg": "0.4",
  "changelog": [
    {
      "at": "2025-01-15T04:54:00Z",
      "note": "Imported from the Ctrl+Shift archive",
      "version": 1
    }
  ],
  "content_hash": "sha256:4ed94475bce4739c086da926c4ef3f4c722d4ad81df1851a44b3bfb3643ea85c",
  "content_html": "\u003ch1\u003ePrescribing the Big Pill\u003c/h1\u003e\n\u003cfigure\u003e\u003cimg src=\"https://dylanfitzgerald.net/ox-hugo/big_pill.jpeg\"\u003e\n\u003c/figure\u003e\n\n\u003ch2 id=\"willful-self-injury\"\u003eWillful self-injury\u003c/h2\u003e\n\u003cp\u003e\u003ca href=\"https://www.peacecorps.gov/\"\u003ePeace Corps\u003c/a\u003e volunteers returning from parts of West Africa are given the Liver Bomb, and strict instruction: continue malaria prevention, abstain from alcohol completely for weeks, and follow the protocol exactly. This potentially harmful medication is administered presumptively, without any presenting symptoms.\u003c/p\u003e\n\u003cp\u003eWhy?\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eThe risk is high: these volunteers spend years in rural areas with limited sanitation, facing near-certain exposure to parasites.\u003c/li\u003e\n\u003cli\u003eThe threats are severe: from potentially fatal (and certainly \u003cem\u003emiserable\u003c/em\u003e) \u003ca href=\"https://en.wikipedia.org/wiki/Plasmodium_falciparum\"\u003emalaria\u003c/a\u003e to permanently damaging conditions like \u003ca href=\"https://en.wikipedia.org/wiki/Onchocerciasis\"\u003eriver blindness\u003c/a\u003e and \u003ca href=\"https://en.wikipedia.org/wiki/Schistosomiasis\"\u003eschistosomiasis\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eThe alternatives aren\u0026rsquo;t viable: Waiting for symptoms is a non-starter, since these tropical diseases are often misdiagnosed or missed entirely in Western healthcare settings until serious damage occurs. And less aggressive treatments aren\u0026rsquo;t effective enough.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe Liver Bomb\u0026ndash;the Big Pill\u0026ndash;gets prescribed presumptively, despite lack of symptoms, and despite it potentially causing some minor harm, because it mitigates a much greater harm that has a fair chance of actually happening.\u003c/p\u003e\n\u003ch2 id=\"what-s-your-big-pill\"\u003eWhat\u0026rsquo;s your Big Pill?\u003c/h2\u003e\n\u003cp\u003eThis is a newsletter about tech leadership, not tropical medicine (though permit me some nostalgia). So why am I telling you about this?\u003c/p\u003e\n\u003cp\u003eSometimes, we need to consider and accept team and organizational \u0026ldquo;injuries\u0026rdquo; to prevent greater harms.\u003c/p\u003e\n\u003cp\u003eSome technical examples:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003ecode freezes before major releases or known high-traffic dates, or\u003c/li\u003e\n\u003cli\u003ethe continued high friction of zero-trust infrastructure, or\u003c/li\u003e\n\u003cli\u003estrictly curtailing access to your production data.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOr, at an organizational level:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eyou might deliberately have redundant staffing, or\u003c/li\u003e\n\u003cli\u003edevolve power and decisionmaking across multiple centers that compete for resources, or\u003c/li\u003e\n\u003cli\u003eyou might need to remove a poor-fit employee or even branch without a clear succession path, or even\u003c/li\u003e\n\u003cli\u003epush for industry-wide regulation that you\u0026rsquo;d be subject to.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe key is to thoughtfully consider the context\u0026ndash;the levels of risk and severity, and cost of the mitigating actions. A five-person startup probably doesn\u0026rsquo;t need to worry about devolving authority, and a sticker seller on Shopify is unlikely to need Kubernetes. But identifying your team\u0026rsquo;s and organization\u0026rsquo;s \u0026ldquo;Big Pills\u0026rdquo; \u0026ndash; and when to take them \u0026ndash; is crucial for their long-term health.\u003c/p\u003e\n",
  "content_md": "# Prescribing the Big Pill\n\n{{\u003c figure src=\"/ox-hugo/big_pill.jpeg\" \u003e}}\n\n\n## Willful self-injury {#willful-self-injury}\n\n[Peace Corps](https://www.peacecorps.gov/) volunteers returning from parts of West Africa are given the Liver Bomb, and strict instruction: continue malaria prevention, abstain from alcohol completely for weeks, and follow the protocol exactly. This potentially harmful medication is administered presumptively, without any presenting symptoms.\n\nWhy?\n\n-   The risk is high: these volunteers spend years in rural areas with limited sanitation, facing near-certain exposure to parasites.\n-   The threats are severe: from potentially fatal (and certainly _miserable_) [malaria](https://en.wikipedia.org/wiki/Plasmodium_falciparum) to permanently damaging conditions like [river blindness](https://en.wikipedia.org/wiki/Onchocerciasis) and [schistosomiasis](https://en.wikipedia.org/wiki/Schistosomiasis).\n-   The alternatives aren't viable: Waiting for symptoms is a non-starter, since these tropical diseases are often misdiagnosed or missed entirely in Western healthcare settings until serious damage occurs. And less aggressive treatments aren't effective enough.\n\nThe Liver Bomb--the Big Pill--gets prescribed presumptively, despite lack of symptoms, and despite it potentially causing some minor harm, because it mitigates a much greater harm that has a fair chance of actually happening.\n\n\n## What's your Big Pill? {#what-s-your-big-pill}\n\nThis is a newsletter about tech leadership, not tropical medicine (though permit me some nostalgia). So why am I telling you about this?\n\nSometimes, we need to consider and accept team and organizational \"injuries\" to prevent greater harms.\n\nSome technical examples:\n\n-   code freezes before major releases or known high-traffic dates, or\n-   the continued high friction of zero-trust infrastructure, or\n-   strictly curtailing access to your production data.\n\nOr, at an organizational level:\n\n-   you might deliberately have redundant staffing, or\n-   devolve power and decisionmaking across multiple centers that compete for resources, or\n-   you might need to remove a poor-fit employee or even branch without a clear succession path, or even\n-   push for industry-wide regulation that you'd be subject to.\n\nThe key is to thoughtfully consider the context--the levels of risk and severity, and cost of the mitigating actions. A five-person startup probably doesn't need to worry about devolving authority, and a sticker seller on Shopify is unlikely to need Kubernetes. But identifying your team's and organization's \"Big Pills\" -- and when to take them -- is crucial for their long-term health.",
  "created": "2025-01-15T04:54:00Z",
  "id": "3f6cx2qt7m718nq6wpj4pyfpx0",
  "kind": "thread",
  "media": [],
  "origin": "https://dylanfitzgerald.net/blyg/",
  "page": "https://dylanfitzgerald.net/blog/prescribing-the-big-pill/",
  "transclusions": [],
  "updated": "2025-01-15T04:54:00Z",
  "version": 1
}