What is OnlyFans?

It’s a song. It’s a meme. It’s an endless font of cultural critique. It’s a subscription porn site that is mechanically best likened to an online strip club. It’s an internet juggernaut at the vanguard of sex, work, and sex work. It’s worth understanding better than you do right now.

Ostensibly, OnlyFans is a platform for creative types to post content online and charge fans directly for access in the form of subscription fees, tips, and pay per view extras. In its marketing, OnlyFans never explicitly mentions NSFW content; its website is plastered with information from/for  musicians and artists. But we know better. 

It’s a porn site with novel mechanics. The focus on direct monetization from subscriptions and upsells is a major departure from the “tube sites” that came to dominate internet porn over the last decade. OnlyFans has collapsed the barrier between amateur and professional. By moving from ad-based revenue sharing models (which more realistically turn into production for exposure with monetization elsewhere) to subcription, OnlyFans has turned porn “stars” into influencers. Users aren’t buying or subscribing to content; they’re subscribing to a person who in turn is responsible for sourcing their own demand and managing their own production.

In some respects, this is kind of the platonic ideal for sex work. Sex workers can earn money safely from their homes away from violence and the police. While OnlyFans takes a 20% cut of gross earnings, it’s a far cry from a pimp.

But whatever you think of online sex work - and we can certainly talk about the negatives - the business is working. Piecing together some information put out in May and April of this year, OnlyFans is almost certainly a billion dollar company. At least. It’s bigger than Playboy. It’s bigger than Patreon. 

But if big numbers aren’t enough to get you to care, don’t fret.

If Porn is ur-internet, influencers are a close second. At the intersection of those two, OnlyFans is the most internet of the most internet. It best embodies the liberating commercial spirit (serving the full spectrum of human desire without prejudice) but also its worst tendencies (the bulk of the earnings go to the small pool at the top).

Beyond the commercial disruption of traditional porn and sex work - a disruption COVID has only since accelerated - OnlyFans represents a shift or convergence between technology and sexuality. It’s sex work native to the contemporary internet.

In the 1950s, sociologists coined the term “parasocial” relationships to describe the feeling of intimacy between certain types of broadcasters and their audiences. The man on the TV is talking to thousands or even millions of people, but I feel like he’s talking to me. I feel close to him because of that. It’s a phenomenon that has become so ubiquitous as to be unnoticeable as our media and media consumption has become both more intimate (the media is richer and we consume it alone) and incessant (the average American consumes 12 hours of media a day). 

We’re all familiar with it even if we don’t have a name for it. Think of the podcaster you listen to for banter or the YouTuber who opens with “hey guys, thanks for listening”.

From the New York Times: 

Parasocial relationships are, by definition, one-sided, but like normal friendships, they can deepen over time, enriched by the frequent and dependable appearance of the charming persona on the television set. Podcasts, with their own unique set of formal quirks, are perhaps even better poised to foment this kind of bond. An ideal complement to multitasking, the podcast is ingrained in daily household chores, the morning commute, the bedtime routine. A two-way conversation can be taxing. Podcasts allow us to get to know someone else without all the stress of making ourselves known. 

OnlyFans is parasocial by design. Unlike the tube sites which got their start hosting pirated versions of studio produced porn for 1:many broadcasting, OnlyFans productizes and prioritizes intimacy and feedback. There are whole online classes for OnlyFans creators to learn about managing that because that ultimately is the business. The convergence of sex work and confessional-style social media influencers shouldn’t surprise us. After all, modern influencer parasocial relationships are a form of emotional labor akin to sex work any way.

OnlyFans is at the forefront of a new online sexual revolution. It stands head and shoulder above the rest of the “creator economy.” It’s a testament to how puritanical ideas about sex and sexuality bias and limit our thinking about what matters. It’s a business to watch and understand because it’s at the bleeding edge of the consumer internet and human sexuality.

I've been thinking a lot about and wanted to share in full something I wrote in September 2017 - before 99D found it’s current home on Substack.

That blog is no longer publicly accessible so some of the links don’t work anymore and I’m too lazy to deal with that. Sue me.

I’m sharing it again in part because it now seems quaint but also (hopefully) prescient, at least insofar as I was thinking about the the blurring of “work” and “life” in our self-conception and actualization. We’ve never had a good or healthy conception of “balance” but anything we had seems like heaven compared to the purgatory of working from our kitchens forever…

I was also moved to revisit this after reading Jomayra Harrera’s fantastic essay on The Empowered Economy, which provides some ideas for how the “market self” (in my words) can bolster the cause of fulfillment, flourishing, and non-market social participation. I highly recommend you check that out.

Back to Work!

Summer is over and the Fall grind begins, making this a good time to continue some thinking about the nature of work and our working lives. I’ve written before about the conflicts and idiosyncrasies between work and life, and the shortcomings of the putative work/life balance. “But First, Let Me Apologize,” the argument that the two are not separate and the zero-sum-game of “balance” is inadequate to describe the complex nature of our selves in and outside of work. I wrote:

If your work and life are separate, and you are separate within them, them then when and where are you yourself? And with whom? Given how much more time we spend at our jobs than we do anywhere else, there’s a reasonable case that who we are at work is who really are. Left to its own devices, the work self will overrun the supposedly separate and true self. (It’s all very Dr. Jekyll and Mr. Hyde). Where once hours and working locations were regular and fixed, the internet has eroded clearly delineated borders between what/when/where is and is not work. I emphasized mutual permeability over simple “balance” because it is holistic compatibility, not the mere allocation of time, that really matters. 

Rather than balance, mix is a better term to describe the optimal relationship. In “Status Update” I wrote about the consequences of letting work become the core of an identity:

Today, we pride ourselves on always being busy, always working longer hours, always running a sleep deficit. The people who work regular hours or don’t work at all? Lazy and worthless! In a near future where a larger and larger portion of labor has been automated away, just having a job will be a sign that you are a “big brain.” Work and work-related stress have become indelible markers of status and success. We love to trade horror stories of not having a personal life. It’s a badge of honor, signifying that we’re important and our skills are in demand. This is completely toxic.

A culture prizing work above everything else isolates us from one another. It strips the richness out of life and distorts our perception of personal (not financial) worth. As US Surgeon General Vivek Murthy said, the most prevalent health issue in the country is not cancer or heart disease or obesity. It is isolation. We find meaning and divine our place in the world through our work, at any cost to ourselves. We’ve so deeply internalized these problems as normal that even admitting them is tantamount to failure, admitting that you’re a loser. Socializing has been socialized out of us.

This is not an isolated phenomenon. The increasing primacy of work over every other aspect of our lives is one part of a much larger, longer, and deeper shift in the basic organizing principles of our society: the subsumption of our non-market lives/selves by our market lives/selves. Not only have the parts of lives/selves participating in commerce and the market taken over a greater share of the whole, commerce and the market itself have increasingly encroached on all aspects of our lives and turned them into commercial rather than social endeavors. 

It’s important to add some historical context here. First, the concept of a work self and a life self is a relatively recent invention. It didn’t really exist in the western world before the wide adoption of wage labor, which only began to become the dominant form of labor (excepting slavery) in the US in the early 19th century. And then the two selves were mostly understood with respect to slavery, industrialism, and the decline in artisanship - a trade that was a personal identity.

In The Half Has Never Been Told, Eric Foner juxtaposes the simultaneous advents of wage labor and slavery. He cites the widespread acceptance of wage labor as an essential outgrowth of and development in the expansion of a capitalist market system. There was a marked disdain for wage labor, which was popularly viewed as a form of “dependence.” Moralizing slave owners went so far as to portray slavery as a kinder institution than “wage slavery,” – working for a paycheck. So the idea of a profession separate from the core identity of a person is a new one. It should be obvious why. It requires a sufficiently productive and industrialized society, one which has accounted for or begun to account for, the lower portions of Maslow’s Hierarchy of Needs to begin to debate the nature of the self in any meaningful way.

Second, it’s a myth that the market and non-market aspects of a person were ever fully divided. Nor were there ever was fully market or fully non-market transactions; the two realms always bleed into one another and always have. In Commerce Before Capitalism, historian Martha Howell chronicles how since the 13th century and before the dawn of anything remotely recognizable to us as a market system in the West, social/non-market institutions and relationships (the church, country fairs, gift exchange) laid the groundwork for commerce and modern capitalism. 

The shape has changed - a public ledger of church donations became a rotary club became a networking happy hour became a personal brand - but the idea stayed the same. Business is and always was personal.

I do not mean to brush aside the significance of the changes being wrought. Though the encroachment of the market sphere is not new, we are nevertheless experiencing a tremendous change as the market system is voraciously incorporating and taking over non-market areas of our lives and selves. (With respect to traditionally non-market transactions previously governed over by/transacted with the state, this is what people call neoliberalism - at least when they use the term correctly, which they mostly don’t). This shift in our social and relational norms is not unrelated to Amazon and cities, dating apps, social networks, etc. I wrote about eCommerce:

Going to the grocery store or the downtown shopping center or the farmers market isn’t just a market experience; it is the quintessential urban experience. According to Laura Seidman, an energy efficiency consultant who also teaches at the University of San Francisco, “The downfall of humanity is the invention of the refrigerator. When I was living in Brooklyn, the infrastructure existed from the earlier days, and on my way home I would pass a green grocer, a fruit seller, a fishmonger, the bagel place, the pizza place. That would get you out in the community.” (Link) When you don’t have to go to the store for bread - and in doing so interact with people, run into acquaintances, see other modes of life and ways of being - you’re functionally not living in a city any more. Just a more densely packed suburb.

So as I said at top, the changing dynamics of work are emblematic of the larger trend: the commodification of non-market areas of life. When the mixed market and non-market transactions (like buying bread from a local grocery) become pushed further and further towards being purely market transactions, we gain new efficiency and productivity but we do risk losing something.

Telemedicine in some form has existed for decades. The basic premise is fairly intuitive - “I conduct lots of business remotely, why not healthcare?” Despite that, the adoption rate has remained persistently low until very recently and it is largely only used for primary care.

Historically, one barrier to widespread adoption was the lack of reimbursement parity. Insurers would often pay less for remote care on the basis that it cost less to deliver (I’m not paying for an office you don’t need for this visit). Unsurprisingly, providers responded to that incentive and largely avoided telemedicine. Laws requiring “reimbursement parity” have been passed in a growing number of states over the past decade, providing a major catalyst for telemedicine. There’s money it in now.

Concurrently, the ACA pushed up deductibles such that lots of routine care would likely be paid for out of pocket, especially for the younger people who more often go for high deductible plans. If people are paying for care themselves, they start acting like consumers and want to be treated as such. Cost, convenience, and user experience matter more if care is paid for out of pocket and telemedicine fits nicely with that.

Suddenly the pandemic is blowing that up even more and providers are scrambling to move their practices to telemedicine-first or telemedicine-only to provide care while maintaining social distancing. Telemedicine can help keep them and their patients safer than in-person care.

Insurance set the stage and COVID created the urgency.

Telemedicine 1.0: optimizing patients

The first, simplest phase of telemedicine largely address problems faced by patients. Getting to a doctor is inconvenient under the best of circumstances and most people aren’t in the best of circumstances. If you live in a dense city and can schedule an appointment, you might reasonably travel 20 minutes each way, hang out in a waiting room for 40 minutes, and sit in an exam room for 20 minutes all for a 15 minute visit with a doctor.

You’ve spent over an hour and a half for a 15 minute visit. That means the total time efficiency of the visit is just a measly 15%. And the real averages are almost all much worse on each of those underlying estimates.

Moving that visit to a phone call means spending less time getting care overall. You could pretty reasonably get to 75% efficiency even if the care you receive is itself unchanged.

The first known telemedicine visit of this type occurred in 1879. The standard operating procedure basically hasn’t changed since then. This is what our health system is rushing to adopt as we try to cope with the pandemic. Other than the phone, the doctor is not using any tools differently than she otherwise would have. The direct cost to her practice is functionally unchanged.

Telemedicine 2.0: optimizing providers

Starting in the 1990s, the internet offered the chance for “store and forward” telemedicine. Store and forward, as the name implies, means information is recorded (stored) and sent (forwarded) to a doctor who then reviews it later. The doctor-patient interaction is “asynchronous” (not at the same time) versus a phone or video call which is synchronous.

Asynchronous is only just now starting taking off, in no small part because of recent changes allowing doctor patient relationships to be established over store and forward (asynchronous) mediums.

This creates opportunities to add more technology to the administration of healthcare, not just the delivery mechanism. Parts of the patient journey like intake forms can be productized without the need for large administrative staffs.  Scheduling can largely be obviated for much of routine care if patients and doctors can message asynchronously. If communication is tied directly to medical records systems, charting can be (semi-) automated and data can be originated in structured, machine-readable formats. 

Mixing synchronous and asynchronous communications can help practices better triage and allow providers to spend more time with more acute patients. That also means enabling them to spend less time doing the things they hate doing (charting, admin, etc.), the biggest factor in provider burnout. 

In all, telemedicine 2.0 takes much fuller advantage of the technology at its disposal. It is healthcare built for telemedicine with the effect of scaling doctors, rather than just trying to port in-person care onto a new medium to make it more convenient for patients. That in turns means making healthcare dramatically more available and affordable.

Telemedicine 3.0: what comes next?

Everything described thus far represents clear advantages to patients and providers but comes with very obvious limitations in both the scope (what can you treat this way) and the benefits (why would you bother). No, we’re never going to eliminate all in-person care nor should we even want to. But even as telemedicine 2.0 makes healthcare more available by optimizing throughput, it still does not fully realize the vision of digital-first healthcare.

That is, the 2.0 scheme is still digitizing and modifying analog practices rather than building digital health tabula rasa and with an eye to the newly possible.

The long term opportunity for telemedicine is not to ignore its limitations (home surgery by an on-demand robot!) or pump vaporware (AI for fully autonomous primary care!) but to provide substantively better outcomes and experiences where it can by doing things that in-person care cannot.

That means taking full (fuller?) advantage of connectivity to do things like passive monitoring to track integrated health and lifestyle data. It means continuous patient monitoring and longitudinal data for both better patient experiences and easier, faster clinical trials. It means unlocking whole new modalities for care delivery and coordination build on top of interoperable medical records (eventually). Imagine all that health data from all those different sources and providers coming together into integrated medical records hubs that can surface conditions or direct patients to care proactively. Missing out on the opportunity to find unexpected issues through more casual patient interactions is a legitimate criticism of telemedicine and will always be part of any sober cost benefit analysis.

It means building adherence and retention directly into patient-facing products and provider-facing tools. It means putting even more process automation behind and products in front of providers to scale knowledge and expertise. It means rather than bolting telemedicine onto a physical world practice, going the other way around to build digital-first full service practices. Imagine starting a patient-provider relationship online and directing a patient to in person care only when necessary and where remote care isn’t enough.

What will all this mean for the health systems’ lock in and pricing power? How will it change the physical and operational needs of providers, and in turn the organization of provider groups? How does the slow shift towards value-based care affect (or even effect) this and vice versa? How will we measure the impacts on individual health? On population health? There is certainly more that we don’t know than what we do.

Whatever digital health 3.0 will look like, it seems clear that that timeline has just gotten pulled forward. It’s happening.

Huge shout out and thank you to Nikhil Krishnan for his excellent post detailing the new HC infrastructure and for giving feedback on this post.  If you’re interested in this kind of thing, go subscribe to his newsletter Out Of Pocket.

As I’m sure you all are, I’ve been thinking a lot about “what comes next.” Or at least I’ve been trying to as I deal with the distraction and existential dread brought on by every sunrise and push alert.

One idea in particular that I’ve been noodling on has been how surging unemployment today might lead to structural labor shortages tomorrow.

The US is facing unprecedented levels of unemployment and even with extended UI, people are going to be hurting for work. That will create tons of interest in sharing/gig economy work just like after the last recession even if many of the mainstays (rideshare especially) are seeing their businesses crash and burn. Across the board, this is a great time to be hiring - even in highly skilled professions, the power dynamics have completely reversed overnight.

But that’s just today. Further out, the picture seems murkier.

The median age of the American worker is 42 years old. 37 million working Americans are at or near retirement age. (BLS) Even a temporary loss of income will likely push some of them out of the workforce altogether and into retirement, if for no other reason than the fact that unemployment last much longer for older workers. Still more will probably have to find work in other fields without being able to go back into their original profession. Over a 40% of tax preparers, commercial drivers, appraisers, HVAC mechanics, engineers, opticians, CFAs, funeral managers, construction managers (just to name a few categories) are approaching or above retirement age. (BLS)

Most of these categories (in total there are 46 such categories employing over 6 million people) are either skilled labor that is difficult to quickly train (bookkeepers and opticians, e.g.) or family-run businesses where a younger generation evidently did not want to take over (funeral homes and farms, e.g.). Skilled trade like engineers, HVAC, and industrial workers are each small but together make a large population on similar terms. As some portion of the older workers are pushed out from or semi-voluntarily exit the workforce/their field, the supply shortages could prove very persistent. There’s not some new crop of precision instrument and equipment repairers just ready to turn on overnight.

Even if the overall labor force participation rate for older people goes up as retirement savings get decimated (it happened in 2008), that won’t be unevenly distributed by profession. So whether it’s opting for an early retirement or needing to find work elsewhere (the bookkeeper becoming a warehouse worker to make ends meet), these fields may get seriously hallowed out.

If certain professions exit the labor force in droves, we might return to some form of full employment but productivity will be constrained by the undersupply of whole categories of workers.

Every category that suffers from this kind labor force participation decline should present opportunities for 1) automation and tooling to help the reduced supply become productive enough to meet demand and 2) supply-side aggregation as the extant supply becomes a more highly sought-after commodity. If it’s departure of older workers causing these shortages, that theoretically means the remaining (younger) workers will be more open to using new technology and services…

So I guess this is a request for startups for a vertical labor marketplace for morticians?

For those of you fortunate enough to not know or not care, Marc Andreessen wrote an essay. People lost their shit. It’s Time to Build is a call to action to innovate coming out of the CV19 crisis and focus on bigger, more ambitious projects.

The problem is desire. We need to *want* these things. The problem is inertia. We need to want these things more than we want to prevent these things. The problem is regulatory capture. We need to want new companies to build these things, even if incumbents don’t like it, even if only to force the incumbents to build these things. And the problem is will. We need to build these things […]

Every step of the way, to everyone around us, we should be asking the question, what are you building? What are you building directly, or helping other people to build, or teaching other people to build, or taking care of people who are building? If the work you’re doing isn’t either leading to something being built or taking care of people directly, we’ve failed you, and we need to get you into a position, an occupation, a career where you can contribute to building. There are always outstanding people in even the most broken systems — we need to get all the talent we can on the biggest problems we have, and on building the answers to those problems.

Cool. Like so much by tech luminaries, the essay reads like something written by someone who's never taken a social studies class or paid attention to politics or history except insofar as it relates to Great Men of Business.

Andreessen is right that accomplishing huge breakthrough projects requires an ambition and risk tolerance that we presently seem to lack. It’s very much in the vein of “we were promised flying cars and all we got was 140 characters,” and even acknowledges that. But the essay lacks any consideration of the structural factors or incentive problems getting in the way beyond the plea to "demand more" of various types of leaders.

Want a specific actionable suggestion? Provide 10x more funding for basic research.

The Apollo Mission and the Human Genome Project are incredible feats of human ingenuity and we are still reaping their benefits. They were also only possible with massive, unthinkable infusions of taxpayer support.

To understand why, look at the difference between “basic” and “applied” scientific research. Applied research has measurable ROI, focuses on direct (commercial) applications, and generally operates on relatively short timelines and budgets. Think of Ford-employed engineers and scientists working to make a car 10% more fuel efficient by studying wind resistance and weight distribution. Worthy and valuable.

Basic research, on the other hand, is generally tedious and fruitless. 1000 researchers in 100 labs might spend a decade each on the thermodynamics of batteries with nothing to show for it. But maybe the 101st lab on the first day of the 11th year will run into a physics or chemistry problem their model cannot solve. They’ll need to rework that model and in so doing, maybe they’ll discover something novel about battery construction. Maybe that novel thing will stand up to scrutiny and peer review. Maybe it will be reproduce-able in other labs. Maybe then it will lead to a new way of thinking about batteries which in turn might spur a surge of new research that could lead to a novel battery altogether potentially paving the way for 10x more efficient electric cars in another decade. But maybe not.

See the difference?

Basic research needs to be publicly funded because it requires massive scale and has unclear/unpredictable benefits on indeterminate timelines. Understandably, corporate shareholders don’t love that. Even if they did, private companies don’t have the capital to fund enough basic research and wouldn’t have the incentives to put its results in the public domain. If basic science is guarded as trade secret rather than shared publicly, its potential impacts are severely hampered; basic research can only be as groundbreaking as the applications it eventually spurs. The one private entity with a real track record of funding and sharing basic research was Bell Labs, which eventually led to the failure of its parent company.

Without basic research, scientific progress runs into natural limits and technological progress faces diminishing returns eeking out percentage points of efficiency rather than making great leaps or paradigm shifts. To unlock the next phase of technological and social progress, we need the desire and ambition but we also need the funding.

We are falling down miserably on this front.

Exhortations to service are great and we should certainly demand more from our political and business leaders. Nothing will actually change until we recognize the structural causes beyond just laziness, lack of ambition, or shortterm-ism. Why do we have ample military funding, Andreessen asks, when we can’t fund public projects?

Is the problem money? That seems hard to believe when we have the money to wage endless wars in the Middle East and repeatedly bail out incumbent banks, airlines, and carmakers. The federal government just passed a $2 trillion coronavirus rescue package in two weeks! Is the problem capitalism? I’m with Nicholas Stern when he says that capitalism is how we take care of people we don’t know — all of these fields are highly lucrative already and should be prime stomping grounds for capitalist investment, good both for the investor and the customers who are served. Is the problem technical competence? Clearly not, or we wouldn’t have the homes and skyscrapers, schools and hospitals, cars and trains, computers and smartphones, that we already have.

But this is ass backwards. We have the money to fund things when there are people to advocate for them. People can advocate for them when they stand to profit and benefit directly. Of course those fields attract private investment but where specifically the money goes and to what end is colored by the demands of private capital - namely timely ROI. And as for those smartphones and cars and buildings, they are all relying on basic research done decades ago. We have refined and enhanced but we have not replaced. Until or unless we fund research at a huge new scale, we will be stuck on our present loops and limited by the boundaries of our basic knowledge. We will feel like we are making progress but we will be living in basically the same world with basically the same rules.

What if the real sophon block was defunding the NSF?

Anyone who is really interested in this should read two books:

1. The Structure of Scientific Revolutions by Thomas Khun. It’s the precursor to the oft-quoted by rarely understood Innovator’s Dilemma by Clayton Christensen. Funny enough, Christensen was effectively applying Khun’s theoretical work on the field of science to the field of business - thereby reproducing the exact dynamic they were each describing.

2. Three Body Problem and Dark Forest by Cixin Liu.