A profile of an AI healthcare startup overlooked the creaky business model behind it, as well as the tech sector's worship of "high agency."
OpenAI CEO Sam Altman, the sociopathic poster boy for Silicon Valley’s “high agency” revolution(Anna Moneymaker/Getty Images)
Was The New York Times just bamboozled by a grifter? Earlier this month, the paper of record ran what it clearly intended as an inspirational story for our AI age, profiling a 41-year-old entrepreneur named Matthew Gallagher who used an assortment of AI tools to conjure up a telehealth marketing startup called Medvi. According to Gallagher, the company is on track to do $1.8 billion in sales this year, with a staff of only two (Gallagher and his younger brother).
Too good to be true? Well, yes. Almost immediately critics online filled in what the Times had left out: a warning letter the FDA sent to Medvi over alleged deceptive marketing practices; a RICO lawsuit against Medvi’s fulfillment partner over a weight-loss compound that hasn’t been proven to work; a slew of AI-generated fake doctors shilling for Medvi in thousands of spammy ads.
After the online outcry over the article, the Times added a few paragraphs describing some of the ways that “Medvi’s aggressive advertising has led to legal and regulatory issues”—which is putting it a little gingerly. But the story remains largely unchanged on the Times website. I say let it stand. Because every age gets the heroes it deserves, and Gallagher is in many ways a perfect representative of our current Gilded Age 2.0.
The problem runs deeper than the Times‘ questionable editorial judgment; the paper seems to have been seduced by an ideology that made it incapable of seeing the con. That ideology is “high agency,” Silicon Valley’s currently trendy success mythology, which suggests that the defining trait of the exceptional individual is the refusal to accept constraints. Its catchphrase is “just do the thing.”
The high-agency concept was introduced in 2016 by Eric Weinstein—mathematician, podcaster, and at the time managing director of Peter Thiel’s investment firm. Weinstein described high-agency people as those who, when told something is impossible, immediately begin formulating ways around the limitation. The concept lay largely dormant until early 2024, when a viral essay by writer and entrepreneur George Mack titled “High Agency in 30 Minutes” sent it exploding across Silicon Valley and into mainstream business culture. Mack’s touchstone example: a quote from Silicon Valley “hacker philosopher” Paul Graham about Sam Altman, now the CEO of OpenAI: “You could parachute him into an island of cannibals and come back in five years and he’d be the king.” High-agency heroes, in this telling, don’t just work hard; they exist in a different relationship with reality than the rest of us plebes. The world’s “no” just means “try harder.” Rules, regulations, institutional procedures—they’re all just temporary obstacles to work around.
Talk of agency is everywhere in Silicon Valley these days, with Altman himself arguing that in the age of AI “the returns on agency clearly have never been higher.” With the help of AI tools, he says, “a single person with drive and an idea and willpower can make incredible things happen.” Indeed, several years ago Altman predicted that AI would enable a single person to build a billion-dollar startup. He just didn’t predict that the “incredible things” the startup would be doing would include using AI to generate before-and-after weight-loss pictures of wholly imaginary customers.
But he probably should have. Because if you look at the names that come up again and again in the writings of the high-agency ideologues, you’ll quickly discover that many of them are at least as ethically challenged as Gallagher is.
There’s Elon Musk, described by one AI expert as “the most holistically intelligent, high-agency person I know,” who has not only turned what used to be called Twitter into a haven for Nazi shitposters; he also, far more egregiously, used his position running DOGE to dismantle USAID, an action that that researchers at The Lancet estimate could cause as many as 14 million excess deaths by 2030. Then there’s Mark Zuckerberg, who allowed Facebook to be used as a platform for incitement during the Rohingya genocide in Myanmar – with just two Burmese-language content moderators for 60 million users. Internal company documents also reveal that Meta knew that Instagram was engineering addiction among teenage girls. As for Altman himself, the New Yorker recently published an exhaustive investigation in which former colleagues described him in terms that don’t appear in most CEO profiles: one said he possessed “almost a sociopathic lack of concern for the consequences that may come from deceiving someone.”
It’s almost enough to make one nostalgic for the original Gilded Age of the late 19th century. Back then, the defenders of the horrors of capitalism at least pretended to care about nurturing a semblance of virtue among the elite. William Graham Sumner, America’s most famous social Darwinist, argued that the millionaires of his age were “a product of natural selection.” But they were more than just the winners of an amoral natural process; they were also, in his mind, morally blessed, and he contended that their victories in the market reflected not just commercial canniness but habits of frugality, courage, perseverance, prudence, and other Boy-Scout-grade virtues. As Sumner fondly imagined, the robber barons of the industrial age had a spark in them that the lower classes lacked. “The great captains of industry are as rare as great generals,” he wrote. “Men of routine or men who can do what they are told are not hard to find; but men who can think and plan and tell the routine men what to do are very rare. They are paid in proportion to the supply and demand of them.”
It was bullshit, of course—a way to blame the victims of capitalist exploitation as undeserving. But to paraphrase Walter Sobchak in The Big Lebowski: say what you will about the tenets of social Darwinism, at least it’s an ethos. Today’s high-agency ideologues have a lot more in common with the nihilists that Sobchak so roundly despised.
Sumner’s social Darwinism was a crude but unstable mixture of evolutionary pseudoscience and quasi-Christian morality; the Valley’s high-agency ideology is essentially Nietzsche with a Substack. Its adherents are a temperamental aristocracy; they hew to the belief that they’re constitutively different from the rest of us, and essentially see themselves as “beyond good and evil,” in Nietzsche’s famous phrase. They don’t bother to explain why anyone else might benefit from them having such immense wealth. They simply assert their superiority and treat the assertion as self-evident. In Nietzsche’s framework, demanding justification from the powerful is itself a symptom of Christianity’s outmoded “slave morality”—a retrograde effort on the part of the resentful masses to constrain those naturally superior to them. The high-agency ideologues may not have taken Philosophy 101 in college but they seem to have absorbed this idea almost completely.
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Sumner caricatured the poor as “negligent, shiftless, inefficient, silly, and imprudent.” That’s cruel, but at least it grants (however perversely) a kind of moral agency to the poor: they could, in principle, reform themselves. The high-agency ideologues dispense with even this concession. Those who lack the requisite agentic temperament are written off as NPCs, a term borrowed from video games for “non-player characters”—the background figures who populate game worlds, running on scripts, repeating the same lines over and over. In this taxonomy, the poor aren’t failing to be virtuous enough; they don’t even quite qualify as human. High agency is, in the end, the most aristocratic justification for inequality that American capitalism has yet produced, and it’s arrived just in time for the most grotesquely unequal moment in American life since the first Gilded Age.
Which brings us back to Matthew Gallagher and his AI-powered telehealth empire. The Times framed his story as inspiration–an early indication of what AI technology can achieve in the hands of a user singularly focused on market conquest. Critics called it fraud. But perhaps it’s most usefully read as a demonstration: this is what “just do the thing” looks like when the thing in question is selling an inert compound to people desperate to lose weight, with fake doctors and fake patients in your ads, and an FDA warning letter in the drawer. The ideology doesn’t distinguish between the thing being worth doing and the thing merely being doable. Unlike the New York Times, Gallagher at least seems to have understood the assignment.
David FutrelleDavid Futrelle is a writer whose work has appeared in The New York Times, The Washington Post, Slate, and Vice. He writes the newsletter Brotopians.