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Feb 9, 2023Edited
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People died of coronavirus. I agree the lockdown didn't pass a cost/benefit analysis. But if you want more lockdowns by all means continue the "it's just the flu bro" idiocy.

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Feb 9, 2023
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What do you mean, "also the clockmakers"? Their motto ["time is the commander/ruler of things"] is focused on their work and completely ignores God. Arguably it rejects the importance of God, though you'd have to be reading into it to get there. They easily pass the test of "we talk about clocks, not the Pope".

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The guilds lived in a one-party state with Church and State proudly merged. They had to recite Church/State slogans. Also lots of them were sincere Christians.

American Associations for the Advancement of Grant Money live off the federal bureaucracy, which is monopolized by the D party and forces them to recite D party slogans. Also lots of academics really believe this kitsch.

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I followed your link and saw that they did indeed spell “all” with one “l”, but in the ACX context I immediately read that as A.I. worship.

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Thanks, I've updated to include that.

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Incidentally, I'm up for $1K on the Rootclaim side if anyone wants to get a collection together

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I am unable to find any evidence that the bet was ever "off"? Am I missing something?

It looks like Rootclaim was working towards coming to terms around the time Kirsch cancelled the open call for bets, but negotiation on terms continued unhindered during this time.

Perhaps there is some other information on this I haven't seen and that isn't linked in your article?

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Looks like Steve changed the title - this was the article where he looked like he was backing out https://stevekirsch.substack.com/p/the-chairman-of-rootclaim-wanted

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Is Steve saying the debate is only on if someone else puts up an additional $500,000?

Or is he saying the will be a debate, either way, but other people can also bet against him?

The key question isn't the facts of the debate, it's who the judges will be. The contract mentions a "picker" of judges. In the earlier conversation it was suggested that might be [John] Ioannidis. Do we know if that's still the case? Do we know how likely he is to choose impartial people?

Also, what do we know about the escrow process and how safe that is?

Looking over Steve's list of bets, I only see one that I think could actually be resolved with a simple experiment, not a panel of judges, so I suppose that's the only one I'd be willing to wager against.

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Re #17, while HUAC was reoriented from Fascists to Communists, McCarthy, a Senator, wasn't responsible. His famous "list" of infiltrators came a couple years after HUAC had investigated Alger Hiss.

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Worth noting the builders remedy manifold market only has 5 trades right now (2 of which are mine). Might want to wait to see what it settles on once this article makes it popular.

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I think they’re going to need to come up with a more compelling name than “vat meat” or even “cultured meat”... yet they’ll have to invoke the lab aspect if they want to get people to eat endangered species’ meat.

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It looks from the article like maybe they're going for "cultivated meat", which is probably fine.

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Would help if I read the article... agree that’s the most compelling! I think Impossible and Beyond have paved the way a little.

It will be really interesting to see what happens with the alternative species. I would bet it ends up being seen as a fancy, liberals-only option due to “traditional” recipes being cooked with the classic meats.

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Feb 9, 2023
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Sustainable hunting seems way less problematic ethically than farming.

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I can absolutely see Manly Conservative Grilling Culture going for lion steaks.

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Yeah this is Tesla Roadster level marketing brilliance. Ignore the actual benefits of your product and invent some new way to satisfy ego drive.

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The trick would be getting the "Not feeling enough like a MAN!?!? You should be eating the HEART OF A LION for breakfast!" influencers on board without provoking the Blue Tribe into deciding that cultured meat was therefore outgroup-coded and Problematic. On the other hand, the Red Tribe probably consume meat disproportionately, so if you have to pick one tribe to convert to cultured meat they'd be the one to go for.

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It's like the flip side of gas stoves. It's becoming a Red Tribe thing which is funny because it's mostly blue staters that actually have access to gas networks. If you're going to turn one group off to gas cooking, it should be democrats.

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The advice to advertisers was "Sell the sizzle, not the steak".

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I can’t believe it’s not meat.

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'Cruelty-free meat' seems like a good starting point, though only for the initial push looking for niche audiences.

I imagine the goal is to eventually get it cheaper than growing livestock, at which point you just call it 'meat' and let it compete on price and quality rather than branding.

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I like “cruelty-free meat”! And great point on pricing, I hadn’t thought of that.

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The risk is that traditional meat producers will sue because “cruelty-free meat” can imply its actual traditional meat and not synthetic. Some of that is already happening: https://www.forbes.com/sites/tommytobin/2019/07/30/meat-alternative-label-restrictions-lead-to-lawsuits/?sh=74d217b37b82

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Legal defence: "Meat" is the Old-English word for food in general.

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I think it'll be a lot harder for them to object to calling it meat when it's actually made of animal cells.

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I assure you that that will not dissuade them in the least. https://reason.com/2018/04/14/special-interest-groups-want-to-slaughte/

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Something like "No Kill Meat" feels more to the point and less judgemental to me.

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> I imagine the goal is to eventually get it cheaper than growing livestock

That's not going to be possible for the foreseeable future, unless you cheat by making livestock 10x expensive. Nature is hard to beat.

https://thecounter.org/lab-grown-cultivated-meat-cost-at-scale/

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I am not convinced. This reads like someone in the 1950's talking about how much complexity and vacuum tubes were needed to build even the simplest computers. It's a combination of "current ways of doing this are slow and hard" with "I can't see a better way". And no of course you can't see the way. Someone from 20 years in the future may well be able to say "it's simple, just repolymerize the lignates ..." The arguments presented seem the typical "I can't see how to do X, therefore X can't be done" type thinking that appears. The problem is that their impossibility proof is never watertight. There are often little edge cases and tricks. And so the entire field gets built around some loophole. Like maybe the thermodynamics of energy seem airtight. But actually, if you genetically engineer the cells to be photosynthetic, expose them to sunlight, and then get the cells to rip up that extra DNA on a chemical signal, then you can get around the energy constraints.

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By that logic, you could just as easily argue that it is not "impossible" to build Dyson spheres and turn the solar system into computronium either. Doesn't mean it is going to happen in our lifetimes, let alone that it is something right around the corner worth making important decisions about.

For practical purposes, "there is no known or foreseeable way to do this and the obstacles look pretty fundamental" is about as good as you're going to get.

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Firstly, I wouldn't be surprised if a dyson sphere got built within a year of ASI. Whether or not that's in our lifetimes depends on the state of AI alignment.

For technologies like this, the expected state is one of "we don't know how to do this", whether or not that tech turns out to happen. And I don't think the obstacles are that "fundamental". On the contrary, the whole system is complicated and loaded with workarounds.

The report linked to by the article you sent seems loaded with fundamental assumptions that could easily be broken. For a start, it's looking at large bioreactor volumes. Bread factories don't make bread in one giant loaf tin. The scaling laws don't work that way. Instead they have a production line covered in lots of small loaf tins.

The paper just assumed aseptic growth conditions, instead of say using the animal's immune system by adding some cultured white blood cells.

Basically I don't regard the paper as strong evidence one way or the other. They showed a particular set of designs won't be economic under a particular set of assumptions. So sure, if a solution is found, then it will probably involve something somewhere that breaks one of his assumptions.

This may be the strongest evidence we are going to get, but is still isn't strong.

It is very hard to prove a technology impossible by listing techniques that won't work.

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"Artisan meat" might attract the right crowd.

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I would guess that "artisan meat" becomes, in the developed world anyway, ranchers' collective counter branding. "Artisan" is a marketing tag typically used to distinguish away from mass-produced (e.g. "grown in a lab") and towards "a skilled human being personally created this" (e.g. "meet the ranch family who carefully tend their herd of grass-fed cattle....").

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Yeah, in the long run, definitely. But in the short run you get limited-availability expensive vat-grown meat that was carefully designed to look, smell and taste a certain way, which matches an intuitive meaning of artisanal, if not a literal one.

Sort of like I expect the meaning of "a self-driving car" to flip from the "car that drives itself" to "you have to drive it yourself", once most cars become autonomous.

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You mean…an automobile?

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return to the roots of the term, hah.

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It might attract the exact wrong crowd. I suspect there's a disproportionately high proportion of vegetarians / vegans , or at least those already cutting down on meat or making some effort towards more ethically sourced meat already in those to who "artisinal" would appeal as marketing, meaning there's much less room for gains. Ideally you'd want to appeal to the portion of population eating the most meat.

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You're misunderstanding the purpose of a marketing framing for an existing product.

For an existing product that is trying to _defend_ its market share (e.g. beef and pork and chicken from farmed animals), the marketing label isn't about attracting a new crowd. Rather it is about defending/empowering the product's existing customers. The goal is to make them feel better about continuing to consume the product that they know and are comfortable with. (With in this case a side benefit of pre-empting "artisinal" from being deployed by the competition in the opposite way.)

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But this *is* a new product: it isn't being sold anywhere yet, so there's no market to defend. Any customers are by definition, new customers, and you're going to want to look for them among those already consuming the product you're substituting for.

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What? You're making no sense there.

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At the upcoming meeting of the American Philosophical Association, one of the papers is titled “Is Eating Cultured Human Meat Cannibalism?” Who says these A_A meetings aren’t addressing the pressing questions of the times?

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I wonder if anybody there would be based enough to point out that it's an instance of The Worst Argument In The World.

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"Yes, but it's the good kind of cannibalism."

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Somebody could go meta and ask about Eating Cultured Cannibal Balls.

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'Carniculture' worked for H Beam Piper's Space Vikings. Now for antigravity, hyperspace and collapsium.

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And veradicators for our legal system! Credit to Piper for pointing out in *Little Fuzzy* that a truth machine wouldn't solve as many legal issues as one might hope, and in *Space Viking* that they would be eagerly adopted by tyrants.

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Cultured meat - because we're not barbarians.

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The milk products that are currently on the market (e.g.: https://braverobot.co/pages/process) seem to be going with phrases like "animal-free milk protein."

I guess "animal-free meat" might be an eye-catching phrase, but I'm not sure it's really enough to distinguish the stuff from the other animal-free "meats" and "milks" on the shelf (the ones made with mashed-up beans and stuff).

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When I was a kid there was an urban legend that McDonalds food didn’t contain any actual animals. Instead the stuff in your nuggets was carved off a huge block of disembodied solid flesh suspended in a tank of water. They called it “Animal 57”, which is what I instinctively call all these cultured meat products in my head.

I should make a list of all the things that were expected to gross me out in 1993 but which now have my complete personal buy-in. It would be an interesting way to chart cultural change.

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I suppose Tub o' Cells wouldn't go over well.

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"Why not crossbows?"

Intimidation, and the idea that melee feels much more in the right spirit than crossbows under anti-gun regs. Also, crossbows aren't great unless massed and at that point you are killing thousands of enemy troops.

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They're on to something with the maces. I'm all for it. If you're going to do violence, then do it firsthand. Live with it and its consequences.

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Nah, the whole thing is barbaric and backwards. If something isn't worth fighting to the death for, by any means, it's not worth fighting for. Sign a damn peace treaty, don't send your citizens into a melee to get permanently injured or killed for purely symbolic reasons. And if you think people who "do violence" with modern weapons don't "live with it and its consequences", I would suggest going to your nearest VA and expressing that opinion. I'm sure it'll go over well.

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Also, I'm not sure how modern chainmail/sharkmail fares against modern crossbows, but I could plausibly imagine that crossbows are just not effective anymore.

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I would imagine mail, modern or not (and by my reckoning modern mail is no better than historical), fares pretty poorly. Consider this Arrows vs Armor video featuring authentic armor and warbows: https://youtu.be/ds-Ev5msyzo?t=2267

Even the mail aventail (neck and throat protection intended as primary defense) featuring dense, heavy, inflexible, mail weave, isn't quite a proof against English longbow arrows - sometimes it stops them and sometimes it does not - and crossbows made with modern techniques could pack quite a bit bigger punch than a 160 pound draw weight longbow. Here's an arrow hitting the less robust mail on the side of the torso (probably still more robust than e.g. shark mail), goes straight through: https://youtu.be/ds-Ev5msyzo?t=1590

I would imagine there are some mutually agreed-upon taboos and unwritten rules limiting the sides from directly escalating to use of 16th century style plate armor and the most lethal weapons you can come up with within the constraints, so choice of weapons is a function of what works, yes (otherwise they'd have stuck to fisticuffs), but also escalation management, and showing off with impressive but less lethal weapons (for one thing, even as far as melee weapons go, the humble spear probably is more effective than the Wolf's Fangs mace).

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Mail is bad, but modern armour should be a lot better. This video has arrows failing to penetrate modern armour (starting around 4:40). Admittedly it's not a crossbow, but it's also pretty darn close range.

If the enemy can be covered in modern body armour, then the lack of edged weapons makes sense. Cutting through fancy armour is damn near impossible, but getting smacked in the head with an enormous mace is going to hurt even with a helmet.

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I believe that's why the War Hammer (sometimes called Raven's Beak, Bec de Corbin) was a thing in the era of armored knights.

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Link?

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Brett Deveraux has some useful information in his post "punching through some armor myths" (google should find that). Otherwise, the youtube channel Shadiversity (no "diversity" intended here, it's "Shad's university") has some reconstructions and experiments.

Given the energy carried by a gun bullet is much, much higher than what you'd get from any crossbow that's not a siege ballista, and modern armor can sometimes stop a bullet, Kevlar and the like are looking pretty good here - they're also designed to offer some protection against an attacker with a knife, so they should help against a cut with a sword too.

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Which video is this? At 4:40 they are talking about plate mail.

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The video appears to show arrows penetrating mail, but not plate armor. I think modern armor, designed to resist firearms (which outclass human-powered projectiles), would fare better than mail.

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Modern crossbows have very little in common with the old versions. They are used in spec-ops in some countries, and are just ridiculously more powered, smaller, precise and lethal than medieval hand cranked stuff you might imagine.

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I'm sure, but shark mail is also very good compared to old chainmail, and while there's no such thing as a truly bulletproof vest there might be truly crossbow proof. Just not sure.

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Chainmail, I recall reading once, was good for stopping slashing weapons. It didn't do well against pointy, stabbing weapons like spears or arrows.

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It is my understanding that a bulletproof vest & stabproof vest work very differently, and one can't substitute for the other.

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Probably so, but I don't think either one works like medieval chainmail did.

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YouTube has some decent channels that do practical experiments on that sort of thing: https://www.youtube.com/@tods_workshop

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Crossbows are probably more-effective now than in the old days, because they're better, and most people don't wear armor now. I've often wondered why no revolutionary groups in countries with strict gun control use bows as weapons. They're SO much easier than guns and bullets to make at home, and aren't as much outclassed by rifles in urban environments as they would be elsewhere.

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Maybe for the same reason NBA players don't shoot free-throws underhand aka granny style, even though it's more or less proven to be more effective: it would just look kinda goofy, and both revolutionaries and professional athletes are very concerned about public perception.

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I dunno, you could definitely spin "our side fights with bows" to your advantage in the PR fight - either "we're modern-day Robin Hoods" (Robins Hood?) or "we kill silently and with no warning".

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Because it's easier to make a simple musket than either a bow or crossbow.

Source: my adolescence

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By now I wouldn't even be surprised if they have a truce where all ranged weapons should be removed from the contested are by their range or 50 km, whichever is smaller…

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Not an expert, but like many here I read ACOUP, and one thing I've taken away is that modern people wrongly assume pre-modern ranged weapons tactically function similar to modern guns.

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What were the main differences?

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By my understanding, mostly just much lower lethality. Well equipped and disciplined heavy infantry can hold position or advance against arrow fire in a way that would be completely suicidal against guns.

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Yup. Heavy infantry can walk through arrow fire and expect to come out the other side in formation and capable of fighting.

Ranged weapons in the pre-gunpowder era were effectively battle-shaping rather than war winning weapons. Even in the most talked-about cases like Agincourt, the fact is that the battle was still decided by clash of arms rather than the fire itself being enough to push an opponent off the field.

It should also be noted that this was true (although to a lesser and lesser extent as time went on) all the way up until the invention of cartridge breech loaders. Which is why the cult of the bayonet (which seems so ridiculous now) held on for as long as it did. The fact that technology now allowed massed fire alone to fend off a determined advance was something that the Western world only fully realised in 1914.

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Not sure if that's true against modern crossbows. I suspect they've gotten a lot better.

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Maybe true, I don't know much about modern crossbows. But modern body armor has also gotten a lot better, so it's hard to know how that would go when nobody has used crossbows at scale in hundreds of years.

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Their effectiveness at long range (at which they lost most of their energy) are often much over-rated. An arrow at 10m is gonna kill (or badly wound) you, at 150m, even tho it can technically reach you, is unlikely not penetrate armor or shield, and if it does (or hit an unarmored part), may well be a tolerable wound.

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Here's the blog they're talking about: https://acoup.blog/2019/07/04/collections-archery-distance-and-kiting/

And more on armor: https://acoup.blog/2019/06/21/collections-punching-through-some-armor-myths/

Another difference between bows and guns (or crossbows) that movies often get wrong is when the camera shows archers aiming it's implied that they keep their bows drawn for several minutes before the enemy gets in range. With warbows especially, drawing back takes effort, so you wouldn't want to just hold the string and wait. Instead you'd nock the arrow but stay relaxed, and only draw when it's time to actually fire.

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I feel like those maces were chosen for intimidation. If they really get into the "we're here to kill people" mindset, they're going to drop the no guns rule.

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There's both a specific agreement and also quite a bit of cultural norming around how the Line of Control conflict is conducted.

“Neither side shall open fire, cause bio-degradation, use hazardous chemicals, conduct blast operations or hunt with guns and explosives within two kilometres from the LAC” - from the 1996 agreement between the two countries. This has been interpreted to include projectile weapons more advanced than rocks.

If you read the statements of people on both sides of the conflict, it's clear that they've developed a set of norms around what is considered acceptable on both sides, with actual killing seemingly somewhat "out of bounds" in the minds of the participants, while "beating the absolute hell out of the other guy" seems to be expected and honorable.

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Depending on how you want to interpret it, "neither side shall open fire" may prohibit crossbows.

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That was my thought.

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Thanks, this explains a lot. Neither side wants to use a gun substitute, and developing massed infantry tactics for, e.g. using spears and shields would be a pointless escalation.

So they're essentially going around in full gear trench raiding each other with blunt weapons.

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Makes sense. Thanks.

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Probably has more to do with setting the stopping point for the arms race at the level of close quarter combat. Introducing projectile weapons, or "fires" in military terminology, would be an escalation from status quo and demand a tit-for-tat response.

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Regarding #47--the polled question concerns satisfaction derived from a social cause. Wokeness isn't in itself a social cause, but more like a new religion.

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I think they're thinking of "social causes" like "fighting for transgender rights", and classifying people who derive satisfaction from them as woke.

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Yea seems like a classification error.

Wokeness has long struck me as grounded in wanting to feel like one of the world's righteous, specifically "secular white people desperately seeking righteousness." This is my anecdotal hypothesis, from living and working deep in the heart of "blue" America throughout the gradual rise of that particular ideology, that those who've enthusiastically embraced the worldview which we are calling "woke" overwhelmingly fit the above description. Secular liberals who grew up in secular households are, at least in my own circles, much less likely to be bought into it. The people I know who are now woke evangelists often turn out to have grown up accompanying their parents or grandparents to church but they either never developed a belief in God or lost that belief as young adults.

That is so far as I yet know an analysis based only on anecdata. I would like to see some rigorous surveying which tests it. Are Americans who strongly agree with a half-dozen woke-consensus statements disproportionately (a) nonreligious and (b) from childhoods/families in which religious faith was a consistent belief and practice prior to their own generation. (Or the flip side: is it a correct observation at scale that secular liberals who grew up in secular households are much less likely to know be woke evangelists than people fitting the above categorization?)

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I also think that there are just a ton of ways to read that data. It is interesting and stops some superficial theories, but not much more than that.

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Yeah, I'm not surprised at all by the finding there. It's been very obvious to me that the "good parts" of wokeness are very similar to the "good parts" of Christianity (love thy neighbor), there's similar radical elements (camel through the eye of the needle, he who is least among you, etc), and the failure modes of wokeness are very congruent to the failure modes of e.g. Evangelicalism.

It only makes sense that religious liberals (already those naturally susceptible to religious-type fervor by the low base rates of religiosity among liberals) would be more involved in similar political movements.

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#13 seems mostly false or at least highly misleading. They identified 160 cancer trials which recieved in total ~$5 billion in federal funding. They then assess these trials as saving 14 million DALYs. Dividing one by the other gives $326 / DALY. But the federal funding is not the only cost for the drugs saving these lives. An honest assessment would have to include the private funding for the trials as well as the drug development costs.

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Hmm, I don't know if it's misleading, so much as that causal reasoning around money is naturally confusing. I think it depends whether the private funding was downstream of the federal funding or not. For example, suppose that for every $326 the government invests, it becomes clear that some new drug will be a blockbuster that makes a lot of money, and private companies take it the rest of the way. In that case, the government investing $326 really will *cause* one more DALY, and the government should keep investing $326 increments until that stops being true.

If the government was 1% of trial funding, and private charitable foundations were 99%, and the government's contribution wasn't necessary, and the private foundations would have just funded 99% as many trials without them, then I agree this is bad logic.

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I think it's even more complicated than that. In particular, that private money wasn't going to be wasted so we presumably have to consider the social value of whatever it was diverted from funding .. indeed, I don't see how this is at all even sorta measuring the delta DALYs versus a world in which these studies weren't done.

But that's kinda besides the point because on top of publication bias the cancer study delibrately limited it's examination to studies showing a statistically significant effect which is basically only counting the costs of the winners.

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If the federal funding being measured was for basic research then that might be the case (although still dubious). In this case it looks like the funding is specifically for phase III trials which feels like it definitely would have been funded anyways.

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That seems unlikely. Sure, no doubt some of them would have been funded but phase 3 trials are very expensive and without the prospective availability of government money to help fund these trials it seems quite plausible that in some cases it wouldn't have made economic sense to test the compound or potentially to fund the earlier stage development at all. I think it's more accurate to say this paper really tells us nothing about would have happened absent this funding.

Besides, since they seem to have only looked at statistically significant results it's cherry picking winners.

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That's fair, the money spent obviously has some impact, but likely no more impact than a subsidy at any other point in the process.

It looks like about 50-70% of drugs fail phase III trials. So that reduces the effectiveness by another factor of 2-3

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To get some perspective, I thought it might be useful to look at some of the trials and see what they did. One might as well look at the best-performing ones.

The study claims 14.2 million life years gained, but from Figure 1, it sure looks like most of those gained are due to only a small number of trials, with the top 4 contributing about 20%.

The trials that met the criteria are listed in the Supplement: https://ascopubs.org/doi/suppl/10.1200/JCO.22.01826/suppl_file/DS_JCO.22.01826.pdf

But which ones are the top performing? From Figure 1 it looks like the top two happened before 1983. Only three trials listed in the Supplement occurred before that date and had life years calculated:

https://pubmed.ncbi.nlm.nih.gov/7015139/

https://pubmed.ncbi.nlm.nih.gov/7046900/

https://pubmed.ncbi.nlm.nih.gov/6366141/

Here’s one of the abstracts:

"Previously untreated patients with multiple myeloma were entered on a randomized clinical trial to determine whether the use of alternating combination chemotherapy, including vincristine, doxorubicin, alkylating agents, and prednisone (160 patients) was more effective than conventional chemotherapy with melphalan and prednisone (77 patients), and whether the addition of the immunomodulating agent levamisole to maintenance chemotherapy enhanced the survival of patients achieving remission. The treatment groups were well matched for all major factors. The more aggressive chemotherapy was more effective at inducing remission, with a significantly higher proportion of patients achieving at least 75% tumor mass regression (53% with alternating combinations versus 32% with melphalan-prednisone, p = 0.002). Furthermore, the median survival was increased to 43 months with alternating combination chemotherapy as compared to 23 months with melphalan-prednisone (p = 0.004). After six to 12 months of induction therapy, 84 patients achieving remission were rerandomized to receive maintenance chemotherapy alone or with the addition of levamisole. The survival from the start of maintenance therapy was longer in patients receiving the added levamisole than with chemotherapy alone (p = 0.01). These findings support the use of aggressive multiagent chemotherapy for remission induction in patients with advanced-stage multiple myeloma."

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Take a good look at the inclusion criteria of the cited paper to understand why this is implausible as a whole:

They only included in the analysis the trials which were POSITIVE in favor of the experimental treatment (first paragraph of the DATA in the Methods section).

So this paper basically says that the federal cancer funding *when funding positive trials* lead to $326 per DALY.

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At the very least, it shouldn't be compared to the $50k/DALY tor EAs $100/DALY which (presumably) include all the downstream costs of the actual intervention.

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The implications of this are also implausible -- that the USG is a superb capital allocator for R and D.

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They don't need to be superb to occasionally score a big win, though. And in this case, private industry is the one running with the ball.

In any case the history is complicated. While I agree with the libertarian position that government capital allocation is likely to end up as a bloated mess as a result of various sorts of capture, it's not as if it has some consistent track record of failure. Vannevar Bush wrote a decent book ('Pieces of the Action') about the birth of US federal science policy during WWII. It certainly seemed to have achieved its near term goals, like the Manhattan Project.

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Also, is it accounting for differences in per-treatement costs? If $1m in research discovers a new drug that saves 10M DALYs, the research provides $100 per DALY only if providing the drug itself costs nothing. If there's a per-person cost to providing the treatment, that needs to be included in the cost per DALY. There are some situations where this wouldn't apply (eg. replacing an existing treatment with a more effective one that costs the same), but a lot of new treatments are going to involve additional costs.

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There's definitely a problem with the calculations. The conventional wisdom is that clinical trials cost around $100M per drug, with a 90% failure rate. The cited paper cites 162 trials, so we'd expect that to cost $16G, assuming that they somehow knew in advance that those drugs would be successful. OTOH, in the typical case, 162 successful trials requires 1,600 total trials, at a cost of around $160G. The paper cites about $5G of federal investment, but of course the price of treating the patients when the drug is in production has to pay back the presumably $155G of private investment. So the total cost, adding tax-funded federal R&D, and however the patient care is paid for, comes to 32 times the stated $326/QALY, or about $10k/QALY. But I would add that it seems the threshold for national health systems paying for a treatment is the GDP/capita/year, which for the US is $70k. So this isn't the pinnacle of E.A. but it's still well worth spending taxpayer money on.

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