Confess before building — Selfishness as substrate
A confession, an argument, and why the only useful honesty is to admit selfishness, align it, and put it to work.
I’ll start with the confession: I’m selfish.
Not the performative selfishness the productivity manuals talk about, the “take care of yourself first” kind that’s really just marketing. The other one. The deeper, the uncomfortable, the one that almost never gets admitted out loud. My subjective experiences matter more to me than yours. Always. Even when I know yours and respect them.
What I have inside my skull, I feel. What you have inside yours, I imagine. The asymmetry is physical before it is moral, and everything I do — even the most generous things — passes through that filter before it comes out.
The plot twist, because there’s always one, is that this happens to you too. And to everyone you know. The most useful thing I’ve learned in recent years has been to acknowledge this: selfishness, far from being a defect that some people have, is a substrate none of us escape. The hardest thing I had to admit, and the most useful thing I’ve understood.
The layers we put on top
Civilisation has built layer upon layer on top of that substrate. Religion, ethics, institutions, laws, norms. We call those layers “progress”, and sometimes they are. But the nature underneath is immovable. No matter how many layers you put on it: if you scrape them, what comes up is the rule of the stronger. Biology made us this way because the substrate worked on the savannah, and what works doesn’t get selected against.
Most modern political ideologies pretend otherwise. They pretend the layers are the person, and that the substrate can be erased with enough education, or enough equality, or enough surveillance. Every time a system has tried it seriously, it has ended up worse than what it claimed to replace, because the substrate doesn’t get erased. It only gets displaced. And when it gets displaced it shows up where you least expect it, with more violence and less accountability.
Talking to the demons as equals
There’s another way to deal with a substrate that can’t be erased: acknowledge it and converse with it as equals. Talk to your demons without trying to exile them, because in exile is where they gain the most power. When you accept that you too are capable of the worst, you stop being their servant without knowing it. Looking them in the face and putting them on the inventory has more effect than any attempt to defeat them.
We’re all monsters in some sense. We’re all capable of the worst and the best. And honesty about that is the raw material of almost everything that has worked. A good engineer designs systems that hold up under malicious use. A good constitution assumes corruption and protects against it. A good therapy works with the impulses you actually have, instead of the ones you’d like to have. The same idea, applied at three different scales.
Health is the rare domain
Here comes the part that justifies the rest of the post.
Health is one of the few domains where my selfishness coincides with yours almost effortlessly. I don’t want to get sick. Neither do you. If I fund a treatment that saves me, it saves you, and vice versa. Pathogens don’t respect borders or ideologies. The molecules that treat an American treat a Russian. Human biology is the same underneath all the layers that separate us elsewhere.
That’s why health is one of the few fields where I’ve seen sworn enemies cooperating almost seriously.
- Smallpox: eradicated in 1980. The original proposal was made by a Soviet deputy health minister in 1958. USSR and USA collaborated through the WHO in the middle of the Cold War. Coordinated selfishness: neither wanted smallpox on its territory.
- Polio: Albert Sabin tested his oral vaccine in the USSR in the 1960s because he could run large-scale trials there. An American, his vaccine, validated by the Russians, in the middle of an ideological standoff.
- Life expectancy: from 30–40 years in the 19th century to nearly double in two centuries. That isn’t institutional magic. It’s what happens when millions of selfishnesses get aligned toward the same domain for long enough.
And yet.
Healthspan has stalled
We’re living longer, but we’re not living better longer. Healthspan — the years with good health, not just total years — has been stuck for decades. We live more, but the extra years are largely bad years at the end. Palliative care, dependency, cognitive decline.
Why? Because the selfishnesses of the system are misaligned.
- Researchers are paid for publishing. Healthspan doesn’t show up as a metric in their evaluation committees.
- Pharmaceuticals make their money on chronic treatments. Cures, looked at from a spreadsheet, are bad business.
- Patients are offered what can be charged: extending total life, even if the final stretch is bad.
- Regulators are told not to get it wrong. Transformational efficacy is secondary to immediate safety.
Each actor is optimising their own selfishness. Almost no one is ill-intentioned. But the sum delivers a system that produces empty years as a systematic by-product.
The problem isn’t selfishness. The problem is that the selfishnesses point in different directions.
Honest design
The conclusion I draw from all of the above is practical, before it is moral: if you want to build something that makes the world better, give selfishness a seat in the design. If you deny it, it comes out somewhere else. If you invite it to the table with conditions, it works for you.
That’s what I’m trying to do with Metha. The protocol doesn’t ask anyone to be a good person. It asks them to align their own interest with investment in health. The more selfish the investor — the more they want to maximise their return — the more capital flows into biomedical research. Selfishness works as fuel once it’s channelled.
If Metha works, it won’t work because people become better. It will work because we stop asking people to be better.
Closing
Back to the opening confession.
We’re all monsters in some sense. We’re all capable of the worst and the best. The only thing that decides the difference between one life and another is what we’ve pointed the ammunition at.
Pointing mine toward a domain where my health coincides with yours seemed the most honest bet I could make with my own life. Not out of goodness. Out of well-oriented selfishness. Which, looked at closely, is the only thing most of us can offer seriously.