"In light of the ignorance of typical political leaders and members of the general public, we might be tempted by the idea of rule by experts, as in Plato’s Republic. 18 Unfortunately, when it comes to descriptive social theory, even the experts’ knowledge is unimpressive, as demonstrated recently by the social psychologist Phillip Tetlock. Tetlock conducted a fifteen-year study in which he collected tens of thousands of predictions from hundreds of political experts concerning matters within their areas of expertise (for example, would the economy slide into recession, would the Soviet Union survive, who would win the next Presidential election, and so on). Tetlock’s finding, in brief, was that the best experts did only slightly better than chance at predicting outcomes. When asked to assign probabilities to their predictions, experts proved systematically overconfident; for example, events predicted with 100% confidence happened less than 80% of the time."
I don't think this is a fair characterization. There are definitely subjects where expertise is real (infectious disease is probably actually one of the clearer-cut ones). Much of Tetlock's work is about identifying which subjects have real expertise and which ones don't.
What I quoted did note, "when it comes to descriptive social theory". I think it was Scott's claim that "Expertise isn't a sham" which isn't a fair characterization and is too broad. There's a separate and more complicated philosophical question of whether mental health fits into social theory or neurophysiology.
Medicine, even physical medicine, still seems much less scientific than something like aerospace engineering. As Greg Cochran & Nassim Taleb like to point out, doctors were on net harmful for most of the very long existence of their profession. And "public health experts" if anything seem to be more captured by political activism than your typical never-heard-of-Bayesian-probability doc.
My impression is that public health experts were pretty impressive when public health was a major concern -- say, during the Panama Canal era of the first half of the 20th Century.
But as infectious disease became less of a problem, public health experts tended to become more politicized and less useful. Few public health experts in the 1980s dared enunciate the chief cause of the AIDS epidemic in the US, Gay Liberation, which led to a lot of unnecessary paranoia among heterosexuals who had never been close to Castro Street, Santa Monica Boulevard, or Christopher Street. And in recent decades, public health experts who, deep down, know better, have shamefully countenanced the popular myth that AIDS was, somehow, due to the supposed homophobia of Ron and Nancy Reagan.
Wasn't the AIDS crisis actually a big problem caused by infectious disease? My understanding is that it was the biggest cause of death for adults under a certain age. Granted, it was highly concentrated in certain populations and not actually as prone to "breaking out" as the experts warned.
Polio got worse during the 20th Century in the US, with the 1952 outbreak being the worst in US history. My vague impression is that the post WWII fight against polio was more or less the climactic chapter of the heroic age of the struggle against infectious disease, which had included the triumph over yellow fever at the Panama Canal.
Over the next few decades, public health, especially in the US, became more routine. That's a good thing, but it also meant that less top talent flowed into the field and practitioners got less practice at dealing with novel crises. Perhaps this caused problems when AIDS and COVID came along?
Interestingly/bizarrely, there are or were a bunch of qualified experts who believe(d) that AIDS is not caused by HIV. They believe both exist but that HIV is a relatively harmless virus that was in effect 'framed' by bad science. The people in question had long careers in virology, microbiology or in one case as a journalist who covered the AIDS epidemic over a period of about a decade for a major national newspaper.
One of their many arguments is that it shouldn't be possible for a virus to express a preference for homosexuals, or at least not for very long, because they're too small and simple to be able to 'know' the orientation of their host. The long-predicted break-out into the heterosexual community never happened. Even today most AIDS cases are gay and male, except in Africa where AIDS affects both genders the same. This is also posited as being inexplicable if African AIDS is the same phenomenon as western AIDS, because again, a virus is too small and simple to prefer men in the west but have no gender preference in Africa.
Past tense used because I'm not sure if those people are still around. I found out about this because one of them was the inventor of PCR testing, but he's dead now.
The name familiar to me for that is Duesberg, and I believe his argument is that AIDS is actually caused by drug use, which was common for many of the victims at the time. The difference between sub-Saharan Africa and the rest of the world does seem odd. Here's the one theory I'm aware of to attempt to explain it: https://www.overcomingbias.com/2010/02/africa-hiv-perverts-or-bad-med.html
> Few public health experts in the 1980s dared enunciate the chief cause of the AIDS epidemic in the US
Early named for AIDS were literally "GRID" for "gay-related immune deficiency" and "4H" for the four groups (including "homosexuals") among which it initially clustered.
But of course this comment section being what it is, this claim got five upvotes despite this being common knowledge among anyone with even the slightest familiarity with the history of AIDS. Hey, fellow lurkers, I suggest you look up this person's name and tell me if you think that's the sort of person you want making undebunked claims in your intellectual space.
Obviously, the doctors and scientists dealing with Castro Street AIDS patients in the early 1980s knew how it was being spread.
Over the years, however, the Establishment has managed to obfuscate, such as by angrily denouncing anyone who points out the history, the role that Gay Liberation played in AIDS. So that today few seem aware anymore of the historical connection. I wouldn't be surprised if more people today thought AIDS was caused by homophobia.
Your claim wasn't about today. You literally said:
> Few public health experts *in the 1980s*
If public health experts are talking about it in the New York Times, it's not a victim of a hypothetical early-80s cancel-culture. Plain and simple.
---------
As to the rest of your claim:
I believe, and would discuss and have discussed with other members of the queer community, that being the receptive partner in anal sex is the riskiest common sexual activity with respect to HIV transmission.
No one (well, almost no one, there's always a crazy person or three) objects to this claim. You'll find this claim in a pamphlet on the table in every student queer group in America, in the waiting room of every LGBT-inclusive therapist's office, in the sidebar of every LGBT subreddit. I know this because I spent a good chunk of my 20s in those rooms and got really, really sick of it. And in fact, we can go to the CDC website right now (https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html) and find exactly that claim in black and white:
"Anal sex is the riskiest type of sex for getting or transmitting HIV.
Being the receptive partner (bottom) is riskier for getting HIV than being the insertive partner (top)."
So your claim, basically, is that the feared "Establishment"'s best shot at suppressing news of the risks of anal sex is to promote them in every channel it has. If that's their best shot, well, I don't think you have much to worry about.
It seems rather likely that if we had legalized gay marriage back in the 1970s, HIV would have been less severe in the gay community.
The gay community was (and is) both promiscuous and engaged in the most dangerous type of sex (anal sex) regularly. It is still the highest risk factor in the US. The second highest is being black - 42% of HIV diagnoses are in black people, and it is likely actually worse than that because black people are probably less likely to get diagnosed because of anti-doctor sentiments in the black community.
Gay liberation wasn't really the issue; gay promiscuity was.
This is a mischaracterization of Tetlock's work which he himself has rebutted in the first chapter of Superforecasting
> But I realized that as word of my work spread, its apparent meaning was mutating. What my research had shown was that the average expert had done little better than guessing on many of the political and economic questions I had posed. “Many” does not equal all. It was easiest to beat chance on the shortest-range questions that only required looking one year out, and accuracy fell off the further out experts tried to forecast—approaching the dart-throwing-chimpanzee level three to five years out. That was an important finding. It tells us something about the limits of expertise in a complex world—and the limits on what it might be possible for even superforecasters to achieve. But as in the children’s game of “telephone,” in which a phrase is whispered to one child who passes it on to another, and so on, and everyone is shocked at the end to discover how much it has changed, the actual message was garbled in the constant retelling and the subtleties were lost entirely. The message became “all expert forecasts are useless,” which is nonsense. Some variations were even cruder—like “experts know no more than chimpanzees.” My research had become a backstop reference for nihilists who see the future as inherently unpredictable and know-nothing populists who insist on preceding “expert” with “so-called.”
And, it should be noted that not all experts were equally overconfident. Tetlock found that experts who used a particular framing 100% of the time were systematically overconfident and bad at forecasting, while experts who used multiple different framings of the issue and a variety of different philosophies of analysis were much more accurate. He dubbed the former "hedgehogs", and the ladder "foxes".
> One group tended to organize their thinking around Big Ideas, although they didn’t agree on which Big Ideas were true or false. Some were environmental doomsters (“We’re running out of everything”); others were cornucopian boomsters (“We can find cost-effective substitutes for everything”). Some were socialists (who favored state control of the commanding heights of the economy); others were free-market fundamentalists (who wanted to minimize regulation). As ideologically diverse as they were, they were united by the fact that their thinking was so ideological. They sought to squeeze complex problems into the preferred cause-effect templates and treated what did not fit as irrelevant distractions. Allergic to wishy-washy answers, they kept pushing their analyses to the limit (and then some), using terms like “furthermore” and “moreover” while piling up reasons why they were right and others wrong. As a result, they were unusually confident and likelier to declare things “impossible” or “certain.” Committed to their conclusions, they were reluctant to change their minds even when their predictions clearly failed. They would tell us, “Just wait.”
> The other group consisted of more pragmatic experts who drew on many analytical tools, with the choice of tool hinging on the particular problem they faced. These experts gathered as much information from as many sources as they could. When thinking, they often shifted mental gears, sprinkling their speech with transition markers such as “however,” “but,” “although,” and “on the other hand.” They talked about possibilities and probabilities, not certainties. And while no one likes to say “I was wrong,” these experts more readily admitted it and changed their minds
> ...
> Foxes beat hedgehogs. And the foxes didn’t just win by acting like chickens, playing it safe with 60% and 70% forecasts where hedgehogs boldly went with 90% and 100%. Foxes beat hedgehogs on both calibration and resolution. Foxes had real foresight. Hedgehogs didn’t.
How did hedgehogs manage to do slightly worse than random guessing? To answer that question, let’s meet a prototypic hedgehog.18
> Larry Kudlow hosted a business talk show on CNBC and is a widely published pundit, but he got his start as an economist in the Reagan administration and later worked with Art Laffer, the economist whose theories were the cornerstone of Ronald Reagan’s economic policies. Kudlow’s one Big Idea is supply-side economics. When President George W. Bush followed the supply-side prescription by enacting substantial tax cuts, Kudlow was certain an economic boom of equal magnitude would follow. He dubbed it “the Bush boom.” Reality fell short: growth and job creation were positive but somewhat disappointing relative to the long-term average and particularly in comparison to that of the Clinton era, which began with a substantial tax hike. But Kudlow stuck to his guns and insisted, year after year, that the “Bush boom” was happening as forecast, even if commentators hadn’t noticed. He called it “the biggest story never told.” In December 2007, months after the first rumblings of the financial crisis had been felt, the economy looked shaky, and many observers worried a recession was coming, or had even arrived, Kudlow was optimistic. “There is no recession,” he wrote. “In fact, we are about to enter the seventh consecutive year of the Bush boom.”19
As I was crafting my message to Dr. Huemer, I fail to understand what he mischaracterized. He wrote that experts' knowledge is "unimpressive" and characterized Tetlock's research as "the best experts did only slightly better than chance at predicting outcomes".
Is that incorrect? Your paragraphs on foxes and hedgehogs were interesting subset analyses but didn't cite any numbers. Did foxes do much better than chance?
Tetlock writes, "The message became “all expert forecasts are useless,” which is nonsense"
But I think this does not apply to the linked Huemer paper. Huemer ends with accepting that experts are often the best that we have:
"Political leaders, voters, and activists are well-advised to follow the dictum, often applied to medicine, to “first, do no harm.” A plausible rule of thumb, to guard us against doing harm as a result of overconfident ideological beliefs, is that one should not forcibly impose requirements or restrictions on others unless the value of those requirements or restrictions is essentially uncontroversial among the community of experts in conditions of free and open debate. Of course, even an expert consensus may be wrong, but this rule of thumb may be the best that such fallible beings as ourselves can devise."
I'll preface this by saying I only know that Tetlock thinks that
> As I was crafting my message to Dr. Huemer, I fail to understand what he mischaracterized. He wrote that experts' knowledge is "unimpressive" and characterized Tetlock's research as "the best experts did only slightly better than chance at predicting outcomes".
It's very hard to read, and would certainly benefit from some color-coding, but the best experts do slightly better than chance in calibration, and much better than chance in discrimination, even though the majority of experts, and the group's average do worse. Assuming the dotted lines indicate some kind of equivalence gradient, then the best experts do significantly better than random chance.
(Note too that "mindless competition" ranges from chimps throwing darts to "moderate and extreme case-specific extrapolation" (I have no idea what this means, since I haven't read Expert Political Judgement). Not everything in that category is pure chance. I made this mistake when first looking at the graph, and became very confused.)
> Tetlock writes, "The message became “all expert forecasts are useless,” which is nonsense"
> But I think this does not apply to the linked Huemer paper.
It's plausible that the paper's conclusion survives this relatively minor mistake, especially when it ends up concluding that despite the lack of high predictive-power experts, we still have nothing better (which I'd disagree with because a) superforecasters exist, and many others are anecdotally able to beat the experts very often, and b) points #35-37 do significantly better on discrimination and calibration than experts, dilettantes, foxes, and hedgehogs. Though as I've said I don't know what "moderate and extreme case-specific extrapolation" nor "generalized autoregressive distributed lag" are. Though I haven't read Huemer's essay in full, so maybe he addresses this, or it's irrelevant to his case.).
I was mainly arguing that Tetlock's work does not support the conclusion that expertise is a sham. Even if there are important considerations and grains of salt which you should take when making use of expert forecasts.
> A lot of what we get is adjacent expertise. So somebody who studies viruses, and maybe knows a lot about the protein structure of viruses, will opine about masks, right? And you’ve got to ask yourself, "Do they have subject matter expertise in this mask thing? Whose expertise do we need here?"
> Because one thing that I think clearly came out of the whole masks controversy is that public health experts underrated how easy it would be to get cloth masks in everybody's hands. It didn't occur to them as a solution to the PPE shortages that we could just get everybody a cloth mask.
> And that's because they're not experts in textile manufacturing. And it's no shame on them for not being experts in textile manufacturing. But they were thinking about, “Will masks give people a false sense of security?” Which is a psychology question. They were thinking about “Can we substitute away from surgical masks?” Which is a textile supply chain question. They were thinking about “Well, what are the antiviral properties of cloth masks?” Which again is a textile question. That's not a public health -- it's obviously relevant to public health, but it's a material science question.
> They didn't have expertise in those areas, and were in fact just on a par with me, or anybody else, right? But they had the, sometimes, arrogance that comes with believing you're being asked about your area of expertise.
As a general point, there are many kinds of experts. It looks like Tetlock is using "expert" as shorthand for "experts in fields related to political prediction". His work probably doesn't tell you anything about medical predictions.
Perhaps this could be an objective definition of an expert: An expert is somebody who is usually right about a topic too boring for the average person to have a strong opinion about. For example, most practicing tax lawyers are, under this definition, experts on what the IRS will and won't let you deduct on your 1040. They get the various questions right the great majority of the time. But they seldom get nationally famous for their expertise.
On the other hand, topics that huge numbers of people find interesting, such as who will win the Super Bowl, tend to be ones that are hard to predict. The NFL is set up so that if you can predict the eventual Super Bowl winner at the start of the NFL 10% of the time, you are doing well. And even predicting the winner right 70% of the time at the opening kickoff is pretty hard. You can be a famous expert Super Bowl forecaster on TV without being right very much at all if you are at least interesting in the way you defend your wrong predictions.
As for Dr. Fauci, I don't watch much TV, so I have less of an opinion about him that almost everybody. I presume that most of the time during Dr. Fauci's long career, practically nobody among the general public was interested in him. I imagine he was pretty accurate during those boring times, thus meeting my definition of an expert.
During the two times when people were interested in Dr. Fauci, AIDS and Covid, he was probably less accurate. Not because he changed, but because the topics at hand became less predictable by expertise and thus less boring.
So, if experts are people who are usually right about boring topics, interesting topics are those which even the experts are frequently wrong about.
I would imagine that there are hundreds of little known NFL obsessives who have a better track record predicting who will win NFL games than the famous people who give their opinion of who will win on TV.
It's also possible that there are also amateur tax experts with better track records at predicting IRS behavior than the paid experts. But, I suspect, there are more amateur hobbyists following the NFL for fun than following the tax code for grins.
Tetlock can be interpreted as not saying "experts are wrong", but rather "experts aren't great at probabilities". The people who do well in Tetlock's research are non-experts but they do consult experts. Most of their advantage comes from being well calibrated to produce probabilities based on interpretations of the experts.
Yes, I'm one of Tetlock's Superforecasters and I like this framing. I like to point out that Superforecasters *are* experts - at making and assigning probabilities to predictions.
Many 'experts' actually are bad (think stereotypical pundits). But plenty of experts do have real expertise but are just bad at thinking quantitatively or rigorously about uncertainty, and they could be competent forecasters with training.
A: We're monkeys who more or less only *just* upgraded from feudalism. Things are going well considering we just need to keep iterating
B: Decisions get made that so clearly go against everyone's best interest on the regular. We can glimpse a better world and what we've build (while keeping us safe) is blocking us from moving forward.
I think the more fully we can recognise both the better, but A is a lot less represented in the current discourse, thanks for the reminder.
Ada Palmer puts it this way in her Terra Ignota series:
Is there anything important enough that you would destroy this world for it? Would you destroy this world to build a better one? Or would you destroy the chance of a better world, to save this flawed but in many ways utopian society?
(The society in her books is more clearly utopian than ours, but also clearly flawed in recognizable ways.)
Gosh I love those books. Though I'm still holding out hope for iteration rather than choosing between stagnation or revolution. Ideally Atlantis never has to fall.
onically, with the WebMD example, if you want the most precise I formation without political/legal intfluence you would choose an even more specialist (or professional) resource, such as the BNF (for drugs in the UK, which definitely doesn't list all side effects; I find it odd when a patient asks me about a side effect of a drug that I've prescribed for them that they've read in the leaflet yet the side effect is not significant enough to warrant listing in the British National Formulary so when I look it up I can't find it), fpnotebook, CKS etc
So? Is it true that disproportionately many borderline personality cases are young women with lots of piercings and tattoos? What does that tell us about diagnosis and etiology?
Scott has written before about how the same symptoms get labelled differently on different people. So I'd guess self reinforcing stereotypes are to blame
If x is mildly correlated with y, that still doesn't mean it makes sense to treat x like a "warning sign", especially when y isn't that common. Bayesian rules still apply here.
Especially when x is in this case is something like "having a non-conformist appearance", which I'm sure does have some minimal correlation with certain psychological disorders, but also tens to correlate much more strongly with traits I actively seek out, like "being a highly creative person" or "having a tolerant worldview towards LGBT people."
Yes! Keeping power vs. being right is a great constraint to point out. I would maybe suggest expanding "being right" to "competence" though -- I'm willing to buy that Zvi is really good at being right, but he might not be nearly as good at hiring, leadership, working with other people, keeping schedules or any of the other things that are sometimes completely unimportant and sometimes absolutely critical to a job.
The head of the CDC job and benevolent dictator in particular probably require a LOT more in terms of managerial than predictive skills. Zvi would, I suspect, be most useful as an advisor to the benevolent dictator than the dictator himself. It's a shame that governments don't employ advisors anymore.
That’s true to some degree certainly. But this article could easily be a very different article, based around “the CDC director is chosen based on skill at managing all disease needs, and Dr Fauci is the best person out there who can handle the management of a large agency, making public health decisions on new pandemics, and spearheading efforts to deal with existing diseases. It’s doubtful that he’s the best at all three, but I’m also doubtful that Zvi is superior at that combination, even ignoring need to do politics. Zvi’s skills, based on his blogposts about COVID, are focused around things like statistical analysis and observing new research. But those are not at all the same skills as managing a large agency. One response then might be that we should split up those tasks to different people - the head person manager, the head disease predictor, etcetera. But of course then you get back to politics - what do you do when those people disagree about how to handle a situation?
Governments absolutely have advisors (for example, POTUS has 'senior advisors,' who are not confirmed by the Senate). Frequently, these advisors are part of the problem that Scott has identified, in that they frequently push their nominal superiors towards complying with the will of special interest rather than acting in the general interest, and/or to whatever is most likely to maintain the superior's power, which in turn is good for their power.
They're also frequently and more straightforwardly part of the corruption that makes being right difficult; often, such jobs are handed out as patronage or given to figures who would not (for instance) survive confirmation, or to tick special interest boxes themselves on an org chart.
Of course, the other kind, which you envision, exist as well. Smart and driven professionals who, by the nature of their appointments, are unbounded by the need to pander to the political breeze of the day or to special interests and who might be able deploy their skills towards the singular goal of being right as often as possible.
The key, I suppose, is to optimize for the latter over the former. I'm not sure there's a good way to do that, since it's always going to depend to a large degree on the character and priorities of the appointer. If the appointer is themselves appointed or elected, we know well that their characters vary widely and in ways that aren't straightforward to control (as in, who gets elected, and who those elected people then appoint to [for instance] Senate-confirmed posts, who then appoint advisors).
I'm sure our current system doesn't do a good job of optimizing for this. Even if we assume that there is one of the 'good' kind for every one of the 'bad' kind (which I doubt; I suspect the real distribution favors the 'bad'), the best you're likely to get is for them to cancel each other out. An advisor that makes the right call doesn't count for anything if her superior acts instead on the recommendation of another advisor who prioritizes power. And, under our current system, it's likely that there's more than one realpolitker for every truth-seeker.
In this regard, despite many efforts to curb patronage (that, historically speaking, have been unquestionably and extremely successful), it still definitely exists. Especially these days, when people desiring patronage frequently have impeccable CVs themselves, studded with degrees and honors from tier 1 institutions, work experience in tier 1 private entities, or government experience in tier 1 or 2, and reams of glowing recommendations. With an elite culture as credentialed and extensive as ours, it can be very difficult, even for an appointer who wants to stock their kitchen cabinet with the 'good' kind to pick them out of such a crowd. Frequently, the solution chosen is to pick people you've known your whole career, which of course has its own pitfalls.
And then these pitfalls lead to their own, and so and so on ad infinitum until you really do have to fall back on Scott's thesis, and hoping that we've built a sufficiently resilient and effective system that actually does optimize, in any marginal way, for obtaining the right outcome.
Cool hominid party trick: The world is abominably complex, so we call up organizational superstructures from the depths of meme hell and put them to work managing said abominable complexity. This is adaptive, apparently.
The dread blueprint of the FDA lurks latent in the collective unconscious, waiting to manifest and consume the souls of unsuspecting hunter-gatherers.
Killing someone to take all their stuff is adaptive for the killer, but probably not adaptive for society at large. Summoning the FDA is adaptive for Anthony Fauci, but...
Are you referring to the articles on lorienpsych.com as your small database? I thought you meant more like a weighted average of patient ratings like when you recently compared different amphetamines.
Yes - the amazing thing is that our society works far better than we have any right to expect. (And far better than it would if 99% of reform proposals were adopted.)
And...just put a link to this post on your database (BTW, where is it?).
That *ought* to be sufficient, but of course it won't be for some people. You just have to live with that - valuable info online will help many people and hurt a few who misuse it. But it does net positive good.
The alternative is to become WebMD. They're *cowards*. They know they're destroying the utility of the information they offer, but they have shareholders to appease and lawyers to fear.
You can, and must, be braver. Probably you won't get sued over this, and if you do you'll probably win. But you're in the lucky position - unlike WebMD - of having a large fanbase who appreciate what you do and will bail you out if all goes pear shaped. I can (and do) guarantee that you'll never have to worry about financial hardship because of losing a lawsuit over this stuff - somebody in your fanbase will ensure you have a well-paying job (in the unlikely event you need help).
> you're in the lucky position - unlike WebMD - of having a large fanbase who appreciate what you do and will bail you out if all goes pear shaped. I can (and do) guarantee that you'll never have to worry about financial hardship because of losing a lawsuit over this stuff - somebody in your fanbase will ensure you have a well-paying job (in the unlikely event you need help).
in other words, scott has his own political capital he can draw on to do things in the world, much as faucci has his political capital. i wonder if there's something here... for instance, what if faucci had his own circle of fans who would protect him if things went "pear shaped"? i guess he actually probably does, but he still wouldn't be able to continue occupying his current position in his current power structure.
is it just the problem that faucci's power structure is too big, and his enemies too diffuse in too many other competing power structures? going too far, does our utopian future lie in smaller, more distributed power structures?
Fauci clearly has a lot of political capital. He has survived in his current role since at least the 1980s, through two pandemics that he partially mismanaged, but then greatly improved his management of (and improved more than any of the obvious replacements seem like they would have). He seems to be one of the very few Trump administration executive officers that survived long past crossing Trump many times.
"What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong. People who most brutally and nakedly optimized for power would gain power; that's what "optimize" means. The interesting thing about the current system is that, after millions of very smart and altruistic people have contributed to it over generations, sometimes gaining and keeping power within it is modestly correlated with being good and right."
This is so brutally insightful and hilarious at the same time.
Where did Marx say anything like that? If it's an "insight" it has to correlate to something Marx wrote. Scott Alexander provided absolutely no evidence that this fallacy can be traced to Marx.
I don't know a whole lot about Marxism (despite the profile picture), but I'm actually under the impression that he believed the opposite - that to get to communism, after destroying capitalism an intermediate strong government would be needed to gradually transition the country to communism.
Perhaps he underestimated the difficulty in ensuring such an intermediate government would remain true to the goals of the revolution that got them there, but he certainly didn't think communist utopia would naturally emerge.
As a former citizen of the USSR I would say that the socialistic government always remained true to the goal of building communism and that's why they were a failure. In this I totally agree with Scott Alexander and I am even surprised how he can have such great insights. Most Americans simply don't get it and they think of the USSR only in terms of a culture war – that they were bad because they wanted to take over the world or something like that.
Being a former citizen of the USSR doesn't make you an expert in Marxist thought. If you want to defend Scott's point here you should quote Marx using primary sources - not give us anecdotes.
It makes me a test subject and my verdict is – it doesn't work and experts were wrong.
I actually had to study Marxism-Leninism at school. It does not matter if Marx said precisely those words or not. It is something what a reasonable person looking at the history would conclude.
Test subjects aren't the one writing scientific reports and conclusions, so your metaphor doesn't make sense.
>It does not matter if Marx said precisely those words or not.
If Scott Alexander wants to call something "Marx's fallacy" then I suggest he prove that Marx thought something along those lines. This really should not be too difficult (if Marx indeed made such a mistake) using primary sources. Otherwise it seems more like Scott Alexander is failing an Ideological Turing Test.
"Marx believed that all world history was a “history of class struggles.” According to Marx, oppressor and oppressed have always “stood in constant opposition to one another.” One group—the oppressors—owned the means of production, such as land, raw materials, and money. They controlled government and society. The other group—the oppressed—owned nothing and depended on the owners of the means of production. Marx believed he saw a society that was "more and more splitting up into two great hostile camps, into two great classes directly facing each other: Bourgeoisie and Proletariat." The bourgeoisie—the middle class—were the oppressors. The proletariat (PROH•luh•TEHR•ee•uht)—the working class—were the oppressed. Marx predicted that the struggle between the two groups would finally lead to a revolution. The proletariat would violently overthrow the bourgeoisie. After their victory, the proletariat would form a dictatorship to organize the means of production. However, because the proletariat victory would essentially abolish the economic differences that create separate social classes, Marx believed the final revolution would ultimately produce a classless society. The state itself, which had been a tool of the bourgeoisie, would wither away." -Mcgraw Hill Education company. (if you think this one is inaccurate, it's literally being used in schools)
I don't think he needs to correlate it because it's the foundation of Marxism.
Marx revised to define exactly what communism is because it must arise from the conditions of the world when the revolution comes.
That is: Marx believed so strongly in the fact that the revolution would make things perfect that he refused to guide that revolution at all.
Here is a relevant quote:
"Communism is for us not a state of affairs which is to be established, an ideal to which reality [will] have to adjust itself. We call communism the real movement which abolishes the present state of things. The conditions of this movement result from the premises now in existence."
That is, Marx defined communism as the complete overthrow of the current state of affairs. This is the basis of communism.
"That is: Marx believed so strongly in the fact that the revolution would make things perfect"
He doesn't say anything about the revolution making things "perfect" in the quote you offered. Neither does it say anything about " if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top".
He's saying that Marxism says that communism will naturally arise from revolution/when the current state of affairs are overthrown. It's saying that communism (the "perfect" system) will naturally rise to the top.
Where does Marx call communism a "perfect" system? If we're attributing words and ideas to Marx we should probably be very careful about finding primary sources. I also think people are putting an undue emphasis on "naturally" here, as if it occurs without foresight. Marx is talking about very deliberate political movements, which yes, arise from the seeds sown by capitalism.
For anyone wondering, MarxBro is a dedicated troll of the rationalish community, coming out of the woodwork anytime Marx is mentioned to make ever escalating demands for rigor. No criticism or even mention of Marx or Marxism is well-founded unless it engages with primary sources to MarxBro's standards, a standards which tellingly has never been met by any interlocutor ever. Don't waste your time.
When someone has claimed Marx has made a "fallacy" I'm well within my rights (and indeed, common sense in general) to ask where that fallacy exists in their original works. Using citations. If that seems like an "escalating demand" then I'm very happy to escalate the rationalist community by uplifting their standards.
As a reader with no dog in this hunt, I'm not sure what to make of this ad hominem comment about marxbro1917. Maybe my troll-o-meter is not very sensitive.
I thought Marx argued that capitalism bore the seeds of its own destruction, that this was a core tenet of dialectical materialism, not that Marx was a kind of crass "burn it down" accelerationist nor a theorist ignorant of how power corrupts. So it seemed reasonable to me that someone might ask why is Scott attributing this very common human fallacy to Marx specifically.
There are legions of people fantasizing in our present-day moment about how if we burned everything down, something better would just naturally kind of spring up. Of all the ideological lineages that feed this kind of naivete, I wouldn't associate it mainly with Marxism. So in that sense, I'm sympathetic to the request for greater precision.
I guess I would wish for more tolerance in our conversational norms around calling people out for politely requesting greater precision or clarity or whatever to any given point. If we have a dedicated Marxist in our midst who can do that around Marx-adjacent thoughts, isn't that a good thing?
We have libertarian economists on here who can press fine points around their arenas of concern and anti-feminists around their arenas of concern, and I've done my share around the finer points of Buddhist philosophy or non-pharmaceutical mental healthcare, or the particular brokenness of the U.S. health insurance system. If someone's not just ranting angrily but is bringing some (dare I say?) expertise to the conversation, is that not welcome, even if they only have one arena of expertise they tend to bring?
I guess maybe this raises a larger question about where is the line between troll, hobby horse, and desire for clarity around things one knows something about?
"As a reader with no dog in this hunt, I'm not sure what to make of this ad hominem comment about marxbro1917. Maybe my troll-o-meter is not very sensitive."
You perhaps were not around for previous interactions with Marxbro before he came back as Marxbro1917. But even in this exchange, can you not see his modus operandi? "I don't care that you grew up in a country that implemented Communism, you had to study Marxist-Leninism, and you can comment on how the theory works out in practice, I still maintain that flying elephants are totally possible!" He's not honest in his interactions.
I'm very honest in my interactions. And if I'm being honest, I'm not impressed by people who say "I've studied Marxism-Leninism" but then fail to produce the primary sources and citations I've been asking for. My point here is very simple, Marx regards socialism as developing and superseding capitalism from within the capitalist system itself. He does not advocate to "burn it all down" (not sure what this would even mean when we're talking about international economies), nor does he have the naive analysis of power that Scott Alexander attributes to him (without citation, of course).
Therefore, I am asking for evidence, please. If "Marx's fallacy" exists in Marx's writings then someone should be able to find it, using quotes from the source.
I'm very suspicious of the troll label based on the comments of others who have a social history with the accused -- especially when the accused appears transparent and thus vulnerable in advocating for their project. As a relative newcomer here, this forum appears above average when it comes to the expression of independent thought (rather than piling on socially with the intent to suppressing others).
But, perhaps, Marxbro, you are guilty of pedanticism, which is nowhere in the neighborhood of trolling. Trolling employs a very wide and shallow focus, while pedanticism is laser focused -- and your defensively-trained laser may be missing a wider, more social point about Marxism writ large. I.e., "Marxism" today is an enormous trope that we all play around with for various reasons -- which your project naturally bristles at.
When it comes to primary source material, the thing that's more relevant to me than whether Marx actually penned certain words, is how ideas and history actually merged, and I was blown away (and thoroughly entertained) recently by the English-dubbed "Comrade Detective" series (the dubbing making it primarily a primary source) -- which helped give me a glimpse of both how huge and complex the commitment to socialism still was by that time, but also, simultaneously, how correct the notion seemed that, in human cultures, those who optimize for power always seem to perform the act of power most efficiently.
Well, yes, for a certain value of "honest". We can always depend on you to tell us that no matter who, no matter what, no matter that you did live in a country basing itself on an understanding of Marx's thought that "she doesn't have the range" https://www.youtube.com/watch?v=zq97J-7Mwzc
You do remind me of the literalists going "Where is that in the Bible?"
I definitely don't have the insight into what Marx actually meant that say, his 103-year-old brother might possess. But when he writes: "The Communists disdain to conceal their views and aims. They openly declare that their ends can be attained only by the forcible overthrow of all existing social conditions. Let the ruling classes tremble at a Communistic revolution. The proletarians have nothing to lose but their chains. They have a world to win." in The Communist Manifesto (part IV) it seems to me that he is advocating "burn it all down" when he says "forcible overthrow of all existing social conditions". Of course, I'm sure I probably didn't even cite it in the proper formatting (MLA? APA? USSR?) Full disclosure, I don't know a lot about Marx [insert your own Duck Soup joke here] nor have I studied Marxism-Leninism. I also don't know why I'm posting here, I feel like I'm giving a whining 3-year-old the sucker they've been throwing a tantrum about only to have them tell me it's not the right flavour (just wait, it'll happen).
I think that Scott described his view leading him to call it Marx's Fallacy in his Marxism related book reviews. I think it was this one in particular: https://slatestarcodex.com/2014/09/13/book-review-singer-on-marx/ . But there might be other related ones that I've forgotten.
I do not think that Scott Alexander has undertaken an accurate reading of Marx. His presentation of "Marx's fallacy" - which I, as a Marxist, do not recognise at all. I think Scott is failing the Ideological Turing Test here. This is why I'm challenging him to find a primary source where Marx says anything like
"if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top."
If that's "Marx's fallacy", if that's what Marx said, then it should be easy for Scott Alexander (or anybody else) to find Marx saying this in his writings. I believe in evidence, and I'm asking for evidence on this matter.
I've read both Scott's piece and your response. I didn't find your response convincing. I'll take one argument to explain why, rather than go through every single one.
Marx says: "But the essence of man is no abstraction inherent in each single individual. In reality, it is the ensemble of the social relations." Scott/Singer summarise this as he "believed there was no such thing as human nature and everything was completely malleable".
That seems like an accurate summary to me. Marx is saying quite clearly that merely being human tells you nothing whatsoever about how that person might behave, think or live their life. Nothing. Zero. Whether you call it "essence of man" or "human nature", in normal English these terms mean "that which is common to every [developed] human regardless of their experience of background".
Yet here Marx claims that this thing, which is literally defined as "that which is inherent to any individual" is actually not inherent at all, it's rather socially constructed and is thus, by definition, malleable, because the "ensemble of the social relations" is neither fixed or inherent. Indeed Marx's entire philosophy was that by changing that ensemble, humanity could become greater.
You keep demanding primary sources, but in your review Scott/Singer literally quote Marx word for word and you just claim their rephrasing into more modern English is wrong. If Marx is so hard to interpret that people can read completely opposite things into the same sentence then he is just an objectively terrible writer, but I don't think this passage is actually hard to interpret. He rejects the notion of a fixed, immutable human nature and claims that what makes people act the way they do is purely social in nature (implication: and thus can be changed via social means, like revolution).
Marx could certainly have been philosophically and theoretically correct about human nature, while still being clueless about pragmatics (such as scope and timeframe and other material complexities). Maybe it's not so fair to judge philosophers by how politicians and societies attempted to adopt and manifest (and fight against) their philosophies?
>Marx is saying quite clearly that merely being human tells you nothing whatsoever about how that person might behave, think or live their life. Nothing. Zero.
He doesn't say that, though. He says that " the essence of man is no abstraction inherent in each single individual. In reality, it is the ensemble of the social relations." i.e that generalisation about human nature are only describing wide ensembles of human behavior, not any particular individual. "Malleable" is also different to "completely malleable" - notice the shifting goalposts here.
> If Marx is so hard to interpret
Marx isn't really hard to interpret, which is why I suspect that Scott Alexander simply didn't read it very carefully.
For another point of data, I would call myself a Marxist. I have read Kapital but not the Communist Manifesto or any of his other works. I think Marx was notably good in diagnosis of the political economy of his time, but notably poor in prescription of how to fix it, and particularly what a better functioning political economy would look like. I don't begrudge him this, the latter are much harder problems.
I think he was conflicted about the question of who would rise to the top after a revolution. On the one hand, a lot of what I read from him was at pains to try and conceive of an organisation that could ensure that future leaders better represented working class people. I don't think he did a particularly good job of describing or building that organisation but he certainly tried and recognised it to be a hard problem. On the other, he seemed to maintain a confidence that revolution was inevitable and that the world would be better afterwards. A contradiction between faith and rationality, perhaps? I sorta recognise that you have to maintain some kind of faith in the possibility that things will ever get better to remain sane in this world.
I agree with this analysis of "politics vs being right/doing the right thing" but it creates another obvious problem: the good of being right in the moment is bounded, but the good of being right in the future is unbounded
One of my favorite scenes from the Wire is when the newly-elected mayor of Baltimore has a problem. He needs money to bail out the public school system, which he can get from the governor, but if he does, he becomes "the mayor whose failing public schools forced the governor to get involved and the state as a whole to contribute tax dollars to bail him out," thus ending his future ambitions of becoming governor himself. And of course, once he is governor, his ability to do good things will be much greater than his ability as mayor. So he decides to let the school system continue to collapse to preserve his opportunity at future success, and future good.
I think almost every politician or person who has a political component to their job has made this calculation at some point in their lives. And in some sense its hard to say they are making the wrong call. Because if that fictional politician goes on to become President and signs a bill which ends child poverty, whose to say it wasn't worth a few thousand kids in Baltimore?
I don't have a solution to this problem, except to say that at some point everybody in every position that might even have a glimmer of power has to ask themselves "what's the absolute amount of good worth sacrificing today for the prospect of being able to do good tomorrow?" And to think really hard about the answer.
Flip side- nobody who habitually compromises the public good for advancement will ever, ever, sign a bill that ends child poverty. The selection process weeds out the ones who would.
The Wire also depicts the same problem with lawyers; anyone who presses real cases that could a difference would upset the apple cart and prevent career advancement. The prosecutors who don’t play politics never become judges. The solution presented- STOP TRYING TO BE JUDGES.
I recently read an interesting blog post somewhere (I misremember where) carving out a workable, useful definition of decadence. Rather than resort to stereotypes about Manly Men Becoming Comfortable and Weak or sex orgies or drug use, it defined decadence as when the elites of a society stop competing with each to see who can provide the greatest benefit to the community, and start jockeying for the greatest *status* within the community. The moment you take what power you have and start scheming on how to get ahead of the pack to higher honors and more power instead of focusing on doing the best damn job you can do today, you have left virtue behind and are now part of the problem.
"History isn’t going to rap you on the knuckles because people are having a bit too much gay sex or men have long hair now, history is going to rap you on the knuckles if people aren’t committed to larger projects than themselves."
Not exactly-- it's important for people to be committed to projects (of whatever size and requiring however much commitment) which actually work.
That sounds like Peter Turchin's theories about an overproduction of elites who squabble against each other for the few available spots at the top. Of course, he borrowed his logic from Ibn Khaldun.
> at some point everybody in every position that might even have a glimmer of power has to ask themselves "what's the absolute amount of good worth sacrificing today for the prospect of being able to do good tomorrow?" And to think really hard about the answer.
this is almost the opposite of the discount rate -- what is the amount of good in the future that i can discount to get a smaller amount of good right now. in ksr's recent "ministry for the future" there's a section arguing that we place too *high* a value on present good, at the cost to our future selves/descendants. i find the same problem occurs with thinkers like, e.g., tyler cowen -- "ignore climate change now and focus on getting rich, and we'll be so rich in the future that climate change will be super-cheap to solve relative to our newfound wealth"
You are missing the HCQ elephant in the room (and the Ivermectin rhino too....). This makes your otherwise excellent post dismayingly close to worthless, until you can come to terms with the extraordinary number of lives lost due to the corruption of the process that Fauci, putting it enormously too mildly, allowed to occur.
While there are some side effects, I really don't think the emergency prescription of HCQ caused an extraordinary number of lives to be lost, main harm would be the money wasted and some nausea in patients who wouldn't otherwise need to feel it
That is so unbelievably backwards that I’m not going to even argue with you, you’re a hopeless case. The consensus is FINALLY coming around to “HCQ and Ivermectin are effective treatments if given EARLY”, which most of the rest of the world has known for many months, but which people who only consume US media have been shockingly gaslighted about.
Could you point me to some high quality research, so I can be de-gaslighted? Preferentially research in which the control group wasn't significantly older or more comorbid than the HCQ group, or meta-analysis that know you can't just multiply p-values?
I gave a link which is somewhat polemical but full of references to both studies and meta-analyses. In this very special case indeed, polemics are appropriate, because there has been intentional bad faith and lying. The bad faith and lying is so shocking that you may need to see the references in the context of the narrative given in this article to overcome the initial reaction that 95% of English-speaking medical professionals have (“this can’t possibly be right because my sources have so universally told me it is wrong therefore I do not need to pay attention to it”).
Sadly, when looking at the individual studies, you can always spot very important methodological flaws (usually, the placebo group will be significant older or have more diseases previous to COVID infection, when compared to the HCQ group). Whenever this selection effect is corrected by proper randomization of patients into treatment/placebo group, HCQ fails to show an effect. You can check this by yourself, usually on table 1 of any paper about the treatment. This raises the question: if the treatment is so effective, why don't the researchers publish a well-researched study, to actually convince people that it works? Why are all positive studies filled with so much shoddy statistics? Dexamethasone, a cheap over-the-counter drug IS accepted as a treatment, so why wouldn't HCQ be too?
(for context: I am a Brazilian physician working in emergency care, so I am familiar with the narrative purported by Filipe Rafaeli in the original publication)
In the Supplementary Materials: look at page 17, titled "Figure S1. Forest Plot of A Priori Identified Subgroups" (based on page 13, titled "Table S6. Subgroup Analysis of Risk of New Covid-19 Compatible Illness"). Look especially at the "days exposure" section of page 17.
When I look at Figure S1 overall what jumps out is that using the protocol of this study nearly *every* subgroup did better with HCQ than without it but *how* well they did is *time-dependent*, meaning *the sooner post-exposure treatment started, the larger the positive effect*. That looks to me like a dose-response relationship! 1 day worked *very* well, 2 days worked well, 3 days worked kind-of-okay, and waiting as long as 4 days was worse than placebo.
If you take that set of results and toss ALL the data together in one bucket the "4-days" negative result and "3-days" marginal result drag down the average effectiveness but if you just look at day 1 or days 1 and 2, treatment was effective at the .05 level. Based on that study one should assume HCQ DOES help (especially for younger people) if started right away or better yet if started *prior* to exposure. The results suggest that young medical workers should keep it on hand and start taking it right away upon any accidental exposure unless and until there's a better option.
(one worrisome fly in the soup is that subgroup "age>50" also failed to be helped by HCQ. Maybe the older patients were less likely to start treatment right away? Dunno, that's something to look at in a larger followup study, but it shouldn't have stopped us from at LEAST advocating that younger medics use HCQ early on).
How are those results significant? They are a very small relative risk reduction, with a wide confidence interval that covers both "no effect" and "may increase risk"
The confidence interval is very wide because the N is too small. A drug that on its own (without help from any other assisting intervention) reduces your risk of covid symptoms by merely ~33% (rather than the intended 50%) is still worth taking and would save thousands of lives, but needs a larger N than was used to show a .05 certainty level in a study such as this. If you re-ran this study with twice the participants the confidence interval would narrow; assuming a similar pattern for the mean expected result the interval wouldn't have to narrow *much* to exclude "may increase risk" for days=1, right?
(I take back the claim that days={1,2} are *already* shown to be "effective at the .05 level" - I was reading the wrong data column. Drat this interface that doesn't let you revise after posting!)
The paper I linked has a long analysis of the NEJM Boulware study and shows how the data of that study was misinterpreted. I had come to similar conclusions at the time it was published. The study really shows that HCQ has a benefit but the statistical significance of the effect was underestimated.
As I said, there is a big difference between USA and areas very influenced by it, and other parts of the world (much of which has a great deal of experience with HCQ over the last 75 years and knows things about its toxicity profile that writers and researchers here have sometimes been quite ignorant of). The most recent work seems to show that Ivermectin is at least as good; but I already knew last April that HCQ was good and last May that Ivermectin was good because I was paying attention to the entire world. Much more on this at my link.
The most recent This Week in Virology had a really interesting paper they discussed going into the details as to why HCQ did so badly in *in vivo* studies despite doing so well *in vitro*. https://www.microbe.tv/twiv/twiv-715/
It failed when given late, succeeded when given early, and there was an unbelievably intense effort in the USA to obliterate all knowledge of this distinction in order to portray it as “HCQ doesn’t work” full stop.
Congratulations on being part of the 95%. I TOLD you there were references to both studies and meta-analyses, I EXPLAINED that this was a special case where it was necessary to read something even though it had a polemical tone, but STILL you sought and found an excuse to avoid it. F*** off, I’m done here.
Apologies, I now realize you may have been responding to one of my previous two replies without having seen the other one, due to delays in comments showing up on the site.
Nobody is going to read 50,000 words filled with irrelevant minutiae presumably designed to answer every argument this dude has ever heard from anyone. Just link what you consider to be the best studies, otherwise you come off like guys who can only "prove their point" with rambling 90 minute youtubes.
There’s a big difference between a 90 minute youtube and a paper written in several dozen numbered sections with hyperlinks to actual studies. The whole point is that it is a complicated story so I am not going to over simplify it, I am instead giving you the best summary I know of of the entire STORY which is about not only medical truth but a great deal more!
Enjoy it, or enjoy the feeling of satisfaction finding an excuse to snarkily avoid it gives you, I won’t presume to tell you which of those to prefer.
This is not "a polemical tone." This is 90% polemics. I could flip to literally any paragraph and find either an irrelevant side-story or a ramble about why the establishment got it wrong. He spends 7 paragraphs saying that the scientific establishment wouldn't have believed Yuri Gagarin when he said the Earth is blue.
You're correct, I didn't see your other post saying that this was a special case, but "this is a special case" is hardly convincing either way. Every crackpot claims that they're not like all those other conspiracy theorists, they're a special case, and just this once, you should read 15,000 words about how the establishment is lying and suppressing the truth.
Just the facts, please. I've seen many websites like this and approximately 0% of them have been worth my time. I'm not going to dig through all this crap about Yuri Gagarin and pandas, just link to the scientific evidence that supports your case.
Oh wait, not 15,000 words, there are like 5 different essays on that site and I have no way of knowing which one you're actually referring to, and they're all equally long and equally crackpot-looking. You are literally telling me to read a novel's worth of text on the hopes that there are actual studies somewhere in there.
I'd like to think I read about all the major studies on HCQ that came out over the summer and I don't think that's a fair summary of the evidence. Dosing time has been a routine cofounder as people do RCTs on people who show up in the hospital 7 to 10 days after symptom onset for drugs like broad spectrum antivirals, monoclonal antibodies, and vitamin D. But the only study I'd say looked good for HCQ was one out of India looking a prophylactic dosing and that wasn't a RCT so I don't think I trust it.
Your tone and choice to be hyperbolic are disappointingly out of keeping with the spirit of the SSC community. It's still an open question whether inflammatory phrasing and hot takes like yours becomes the norm due to this new blog transition or whether behavior like yours is discouraged well enough that people either self-regulate or go elsewhere. I hope it's the latter.
Sorry, but that’s totally wrong. My ORIGINAL reply was quite “normal” in tone, and I shall re-paste it here:
“It failed when given late, succeeded when given early, and there was an unbelievably intense effort in the USA to obliterate all knowledge of this distinction in order to portray it as “HCQ doesn’t work” full stop.”
AFTER I posted that reply, I encountered resistance and snark, and responded in kind, so don’t go lecturing me about the “spirit” of the “community”.
My understanding is that HCQ is effective when combined with another medication to block another pathway for the virus for transmit, but not especially otherwise, and this explains the divergent results in studies. __ice9 has written about this, although unfortunately on twitter rather than blogging like a civilized person.
The combination with another drug such as azithromycin is important, but much more important is the fact that it is proven effective when given in the first few days (outpatient basis) after symptoms appear, and a large number of studies which showed no effectiveness or low effectiveness for patients who had already become sick enough to be hospitalized were systematically misrepresented (I know because I was paying very close attention all along) so that early use was discouraged or discontinued (including some actually fraudulent studies!).
I see one snarky comment from beleester, but other than that it's mostly people being extremely charitable to a position that you've so far only defended by linking to one website that pings an awful lot of red flags for being conspiracy theory nonsense.
I'm certainly not seeing anything that would warrant replies like:
>>That is so unbelievably backwards that I’m not going to even argue with you, you’re a hopeless case.
On the contrary. It was *precisely* backwards to think that when I spoke of the “HCQ elephant in the room”, I was referring to deaths FROM using HCQ, rather than deaths from NOT using HCQ.
Here is an extremely transparently done very thorough and complete ongoing meta-analysis:
I get that, but you could have phrased that very differently, for example:
"Actually, I think you got that backwards, the elephant in the room is the deaths from using HCQ, rather than the deaths from NOT using HCQ. You see, HCQ and Ivermectin are actually effective treatments as long as they are given early."
Rather than calling the person you respond to "a hopeless case" and saying they are "being gaslit by US media".
I think this is a wildly uncharitable take on the situation. One can argue about whether Trump or Fauci is culpable; one cannot _not_ argue about it and just say it's Fauci.
You seem to be willing to argue in good faith as long as you don't feel attacked, so let me try to start this discussion over. If you feel like any of my claims needs better substantiation, please tell me and I'll provide sources.
You linked https://truthabouthcq.com/hcq-works/ , a mostly narrative review by a layperson who doesn't claim to know biostatistics. While a thorough debunking of his over 50 points is more than what I'm willing to do, I will debunk some of them, and if you feel like I glossed over anything important, let me know and I will check, but here's why you shouldn't put too much stock into that narrative:
Point 1 cites Raoult's original paper, one of the first to be released regarding HCQ therapy. While finding positive results, this paper has several limitations, which bring it's validity in question. You can see, on page 10 of the manuscript cited by your source, that "Six hydroxychloroquine-treated patients were lost in follow-up ... three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1 ... one patient died on day3 post inclusion ... One patient decided to leave the hospital ... finally, one patient stopped the treatment on day3 post-inclusion because of nausea".
This is extremely relevant, as not adoption an "intentional-to-treat" protocol basically changes the result from "HCQ works" to "When you don't count the cases that didn't work, HCQ works"
It is also of note that on this foundational paper, reference to "early treatment" is found absolutely NOWHERE. You will see that arguing for early treatment only became a thing AFTER results from other trials came back negative.
Your source also spends lots of time purporting a "big pharma conspiracy", in which the cheap, widely available HCQ was being passed over to benefit redemsevir, an expensive, patented drug. The problems with this narrative are: we know redemsevir ALSO doesn't work, and approved interventions for covid include Dexamethasone, also a cheap, widely available drug, and pronated position, which is LITERALLY free.
Are there any other important points that you feel like I glossed over? The graphs at the end haven't aged especially well since July, when it seems last updated, but I don't know if you feel they are integral to the narrative
I disagree with your analysis — that corruption/self-preservation explains why Dr Fauci does not always say the truth. Externalities and/or the possibility of being misunderstood are more important factors IMO. For instance, while an unknown blogger can say in March 2020 "we should all wear mask now", Dr Fauci or the NYTimes cannot say the same because they're afraid it will push people to hoard masks.
But there is a cost to this--many people bought masks anyway, because enough people had figured out masks were probably a good idea based on other pandemics/countries. It delayed people making makeshifts masks. And it also created confusion, as guidance switched overnight from "you don't need a mask, you silly germaphobe" to "MASK OR ELSE", and it caused trust issues--if the government is willing to lie about masks, what else might they lie about?
I'm pretty convinced that the real reason was actually that they didn't believe it worked due to cognitive dissonance. That is, Western health authorities don't recommend that the populace wear masks, western health authorities give good advice, therefore there must be a good reason for that and we have to figure out what it is.
But if it was, I still think it's relevant that Zvi can just say whatever is true, and Fauci has to optimize for a bunch of other things based on the consequences of people listening to him (even if he is doing this in a prosocial way and his decision was ethical)
What do you make of Adler-Bell's point that there is some point (presumably in the thousands of dead people) past which you are obligated to noisily give up power instead of make those compromises?
Such a tough call. If you wield power imperfectly in order to keep it and 10K people die because of your compromises, would you be better off noisily giving up power and being replaced by someone who is worse and results in more deaths? Some people who we think are power-hungry collaborators may in fact be selling their souls in public at great personal cost because they think the next in line would do way worse. I may be being too charitable, but I sometimes felt like that was Fauci not resigning when working with Trump.
This comes up with statistics a lot. E.g. when Nate Silver says that candidate A has an 80% chance of winning, people in general interpret that as "certain" and if they don't people get mad and say he was wrong. So he can give correct information knowing it will be constantly misunderstood, and people may make bad decisions based on it (e.g. not turn out and vote for candidate A). Or he could change his prediction to be incorrect, but people be more likely to get the correct impression from it
This is a really excellent post. It certainly makes me feel grateful we have a magic machine for consistently extracting pretty-good people with pretty-good ideas out of the population.
That said, there's a related issue: Why has the magic machine's performance seemingly decline over the course of the last ~80 years? Maybe it's an inevitable result of Moloch (for example, because as you optimize more aggressively, the gap between the most competitive and most good-producing ideas grows, or something). If so, too bad, guess we're screwed. If not, then we could sure benefit from figuring out what's causing the machine to function worse.
(As this post argues, any tinkering we do trying to fix the magic machine should be very cautious, because it sure would be a shame if something were to happen to it.)
Hasn't the magic machine been generally doing better? I mean, life expectancies and median incomes and press freedom and all those good indicators generally seem to have been on an upward trajectory, with occasional decade-long blips on some of them (like crime in the US in the '70s and '80s, opioid deaths and pedestrian fatalities in the US in the past decade, various things in Syria in the past decade, etc.)
I think what you're referring to is not the same machine I'm referring to. The "magical machine" I'm referring to is the process by which we select leaders/bureaucrats/experts. Even if those people are somewhat less competent than in the past (which many think they are), you would still expect things to get better because of improving technology, increasing wealth, general progress, etc.
I think you're both right in your own way. I think our institutions have gotten better (dare I compliment our bloated bureaucracies?) on the whole, and generally the people who run their day-to-day operations have gotten more competent. But at the same time some of our processes for selecting the figureheads haven't produced the best results. Kind of like when The Imperial Bureaucracy was opened up to freedmen but at the same time the Praetorian guard was selling the right to be Roman Emperor. Parallel question - how long can a competent bureaucracy sustain an incompetent set of rulers? Okay I'm taking the example too far, soon CommodusBro180 will be posting asking me to cite documents lost in the Library at Alexandria.
Has it declined? 80 years ago was the Tuskegee Experiments - I think I like our current medical experts a lot more than those from 80 years ago.
What examples of 'decline' are you thinking about here? The present always looks worse than the past because you're there to notice the flaws, but beyond that are there specific issues you're thinking about?
I want to give basically the same reply here that I gave to Kenny above. But I guess I'll try to say it more clearly this same.
I agree that the present is way better than the past in a whole lot of ways. But I also think this is expected, due to technology improvements, wealth accumulation, and general progress. Nevertheless, there is one way in which the present looks somewhat worse than the past: leader/expert/bureaucrat selection. A common complaint is that it would be impossible to build the interstate highway system nowadays -- our modern government is too ineffective to get anything on that scale done. (Of course, great things on that scale still get done. They just get done by Elon Musk or whoever while the government is spending lots of money failing to lay train tracks.)
In the case of the Tuskegee Experiments, my guess is that the general population back then was way more okay with stuff like that than we are now -- that's a form of moral progress. So even if you're doing a pretty good job of selecting the top, say, 40% most ethical doctors out of society, you'll probably still gonna end up doing unethical stuff. My worry is that we're now selecting from society less effectively (e.g. only getting the top 50% most ethical doctors). But because society as a whole is more ethical, things still look more ethical overall.
I think in some sense Tuskegee may be a clue to why sclerosis has grown in so many institutions, back then researchers could perform unethical research with relatively little scrutiny, and lots of freedom to experiment etc. The backlash to such programs lead to lots of process restrictions that lead to an increase in the percent of decisions made to 'cover your ass', or 'follow the process', as well as an overstrong embrace of the precautionary principle
Sometimes I wonder if it's always been this way, but we're only able to notice it more now. A few decades ago, being as informed as we can be today would have required vastly more effort.
So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives. It's a fine hypothesis, but what evidence is there in favor of it? In academia at least I can point to an ocean of crappy research whose existence benefits no-one, so you can't blame the incentives. A Stanford epidemiologist attending a conference in March tweeted:
>At AHA #EpiLifestyle20 in a room full of epidemiologists and scientists and not ONE person is wearing a mask. Lots of hand washing & sanitizer stations. If 800 epidemiologists aren't wearing masks, you don't need to either!
We're talking about (tenured) people personally putting themselves in the way of harm here, can we really blame corruption and incentives?
I think you need to more seriously entertain the hypothesis of genuine incompetence.
Do you have a link or archived link to the Tweet somewhere? I'm trying to compile a list of sources for and against the "noble lie" hypothesis. (FTR I mostly think the noble lie hypothesis is wrong).
This is the only source I could find. I assume it was deleted, though it's also possible it was fake (to be clear, I don't know; it doesn't look fake, but I don't want to rule out the possibility).
> So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives.
I think this is a mild misreading of Scott's point. It's more like "the process that selects experts is not optimizing for competence, but rather some mixture of competence + political savvy + careerism." So the claim isn't that Fauci is secretly is secretly a public health super-genius who is hiding his true ability, but rather that the version of Fauci who is a public health super-genius doesn't get into as high a position as real-Fauci did.
>The Director of the CDC could generate opinions as accurate as (or more accurate than) Zvi's, if she wanted to. Maybe she's even doing that internally, when she decides what precautions she and her family should take.
On the lighter claim that selection happens on competence + political savvy + careerism I agree entirely.
I agree my post focused more on the competent-but-corrupted narrative, but I hope I also at least nodded to the possibility that there are some Fauci equivalents who suck at epidemiology but are good at networking and got their positions that way.
Makes me think of those studies that show that markets can allocate well, even if the people in the market are trading randomly.
If the system is setup correctly it doesn’t matter about the competence of the people involved.
Could be that people are generally only competent at the networking element, and that it’s the general system design that leads to better outcomes generally.
The problem is that the government doesn't involve a lot of trading. It does what it does by force or fiat. I can't elect to do business with the CDC head which I prefer. I only get the one which is there.
I think this is the more important part, particularly if expanded beyond "networking" which I think is a trivialization of the kind of skills that are necessary to become a top-level political appointee. I personally think if someone just appointed Zvi he would do much better at the public communication portion of the job, at least. Maybe there are other aspects of agency management that are not within his competency that also are important.
The issue presumably is that even if they are super competent the outcome is the same as if they are mediocre, because the incentives constrain the actions they can take
> So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives.
No, I think the central claim is that experts at the top must be competent at playing political games in order to arrive at the top, but in our system they also tend to have some baseline of technical competence. The related point is that if they were super competent, they still wouldn't be able to act like it because of the need to toe the political line.
> "A machine which takes Moloch as input and manages - after spending billions of dollars and the careers of thousands of hard-working public servants - to produce Anthony Fauci as output. This should be astonishing"
I think this is indeed a v good approximate account of our situation, & it shows both how well we usually do, considering how bad things could go, & also how tenuous is our toehold above the abyss. So far we've avoided the really terrible outcomes (the last four years of D.T. notwithstanding), but there have indeed been some terrible outcomes for some, & some very close calls -- some of which we know about (Bay of Pigs, Three Mile Island) & some we don't. There have also been some heartbreaking misses (eg the history Nathaniel Rich details in his (doubtless imperfect) _Losing Earth_). How well will our luck hold as we move on into 21st Century Climate Change -- to name just a single one of the many fun, um, opportunities staring us in the eye? I too am a reformer not a revolutionary, if I have my choice, but that choice is "all other things being equal," & more & more, they aren't.
Don't know how it works in the US but in Germany (and I think in the EU in general) drugs always list their side effects by frequency (e.g. "very often: more than 1 in 10 people treated", "frequently: less than 1 in 10 but more than 1 in 100 people treated", etc.)
I just searched for "uk drug database". It seems like at https://products.mhra.gov.uk/ you can actually access the UK medicine leaflets. (Search by active ingredient, as the brand names may be different in your country.) The leaflets list the definitions of the frequencies somewhere (e.g. common means 1 in 10 to 1 in 100, uncommon means 1 in 100 to 1 in 1000, rare means 1 in 1000 to 1 in10000). You can probably find similar databases from any other European country; I searched for UK to get an English language one.
Speaking of which, isn't crazymeds that Scott has blogged about before a counterexample to the WebMD dilemma? What's their secret? (I'm guessing the answer is probably just "not big enough to fall under as much scrutiny", but I'm prepared to be wrong about that if there's something more interesting going on.)
I would be surprised if that data is collected to a high degree of accuracy once drugs are beyond clinical trial.
You'd basically have to have a centralized database that somehow knew every time a drug was prescribed and then cross-reference that with patients reporting (to whom?) specific symptoms. But the doc who proscribes isn't always part of the same system where a patient is subsequently admitted, and how can you say it's because of Drug X and not Drug Y that the patient was also taking, etc. And then if you wanted to share that info with a drug company, you'd have to anonymize it, and at some point, who's paying for all of this tracking?
So yeah, you could report out the clinical trial data, but my impression is that the rest is still word-of-mouth, case studies, and rumor.
I'd be happy to have someone familiar with medical record-keeping disabuse me of this pessimism.
I'd guess that there are hundreds if not thousands of records of how common or severe the side effects are. But they're not organized or shared. They exist in the notes of individual doctors and the databases of individual hospitals, which aren't connected. AFAIK, doctors are pretty good at keeping records of *individual patients* but pretty shit at organizing that information in a way that can be analyzed on a massive scale. That type of thing can be done with deliberate forethought, focus, and funding, but not in a way that's just like "do it for every drug, ever."
The best bet might be the large-scale HMOs like Kaiser, which at least keep everything for individuals in-house. Maybe you could do something like query everyone's records for whether or not they were ever proscribed a certain drug, and then also query them for specific notations of side effects to that specific drug? But again, I'm not sure how you get at the causal question.
Again, happy for an individual with hands-on experience with these types of systems to correct me if I'm wrong. I'd mostly categorize this as educated guesswork.
Oh, and I have no idea where WebMD gets their lists. Probably from the drug manufacturers plus randos who email them and get their complaints through whatever Process they've created, per Scott's description above.
Most likely from the FDA-approved patient information or prescribing information. If WebMD is just regurgitating the FDA-approved text they are almost certainly in the clear (even if they are wrong and know they are wrong). When you start providing non-FDA-approved medication information you start having to worry about legal risk.
A very good piece and essentially correct, unfortunately. The one part I'm not sure of is the implicit assumption that even mediocre expertise feeding into a political decision mechanism is better than no political mechanism.
Consider Covid. The advice that was given by Fauci and others was probably better than what most people would have done with no advice, better on average than what most would have done (although possibly worse than what you and I would have done) relying on whatever sources of information they trusted. On the other hand, the vaccines we are now getting took about a week to design and eleven months to get FDA approval. In a world without the FDA and other political constraints, a month of challenge trials would have shown that they were effective and not very dangerous, after which they could sell them to all comers as fast as they could ramp up production. It's hard to believe that that wouldn't have saved a couple of hundred thousand lives in America, a million or so in the world. So if you look at the overall effect, it may be negative. We might be better off with the same level of mediocre expertise and no levers of power for it to be applied to.
At a tangent ... . Your description of Fauci reminded me of my conclusion about Nixon. There's a bit of the tapes where he is talking with one of his people about the idea of ending the interest equalization tax, which was a restriction on capital mobility. Nixon points out that one or two people have said doing it would be a good idea (true). The aide points out that there are no votes in it. Nixon says (by memory, not a quote) "What the hell. Let's do something just because it's good for a change." My feeling was that he had spent his life getting power in order, as he saw it, to do good things, and then found that he had to use the power almost entirely in order to keep power.
The current dramatic case of people choosing the wrong expert to believe in is the election. Something like a quarter of the population, if polls can be believed, thinks Trump really won. Their experts say so — and they have concluded (correctly, although not in this case) that the official experts can't be trusted.
"So if you look at the overall effect, it may be negative. We might be better off with the same level of mediocre expertise and no levers of power for it to be applied to."
It gets complicated. Without authority to begin with, no challenge trials would matter, as we need validated sources to back them up.
In any ideal world, a hierarchy of knowledge will emerge, that will adjudicate these conflicts. This hierarchy will never be perfect.(it's comprised of the interaction of many people with the potential of making many mistakes) But it's a similar sort of problem whether it's bureaucracy accountable to democrats, the Soviet Union, or Consumer Reports.
And to be honest, it's really hard to actually reliably say anybody is the expert who beats "the experts". Or let me put it this way: If Zvi announces changed results at 90% confidence and the CDC waits for 95%, then Zvi will generally lead the CDC, and we may not be able to identify a significant error rate. But that doesn't mean the CDC is bad to wait. And separating out results like that can also be hard, as they bleed into the same "politics is bad" message here.
I think the failure to develop a test in good time for a known problem is different than lagging in terms of adopting advice.
Or to put it another way: a counter argument on whether it is bad to wait requires identifying the risk of both types of errors: adopting an idea too quickly(and finding it wrong) vs adopting an idea too slowly(and finding it correct).
I think advice (where people can take it or not) has a different calculus than things like requiring FDA approval (which actively prevents people who are smarter than you from doing the right thing).
I remain broadly libertarian, but I think even in a world without governments we would have this same problems with expertise. WebMD's problems are mostly non-governmental (though arguably the government is responsible for the lawsuit situation).
"In a world without the FDA and other political constraints, a month of challenge trials would have shown that they were effective and not very dangerous, after which they could sell them to all comers as fast as they could ramp up production."
A wonderful dream. But in reality, you would recruit 1000 people for the trial, then have them sign an airtight waiver absolving you of any harm. 4 people would get terribly sick and/or die and then their families would sue you to oblivion. If that doesn't work, they would take the story to the news and the resulting public outrage would force your business to close. Public trust in vaccines falls and we end up with no vaccine ever.
Why are you positing your scenario as the reality to David's dream? I could see presenting it as a different possible outcome but in this particular case people didn't get sick and die and the chances of healthy people dying would be super low anyway, so I don't see any reason to believe your scenario is more likely.
I'm a bit unclear on the relevance of this question. You think without an FDA a bunch of popup vaccine companies would have been competing against Pfizer with fake vaccines that killed people and would have made lots of quick profits and then fled?
Anyway, the FDA could be purely advisory, or there could and likely would be a private advisory group like UL. There's an extensive literature on alternatives to the FDA. Of course there was no requirement by the FDA to prove effectiveness prior to 1962. There would obviously be very serious civil and criminal liabilities for making a fake vaccine that would likely deter most psychopaths from trying.
Also, most people would probably be reluctant to take novel medicines in such a world without a strong basis for doing so, like a bunch of experts being convinced and supporting it publicly. While many people believe outlandish things with little evidence, I think that is somewhat less likely to be an issue when we're talking about injecting an unknown substance into your own body. People might be happy to take a vaccine from Pfizer with $100B pockets who put out extensive testing data and with support of public health figures, but a fake pop-up vaccine company? I doubt it.
Huh. It's a surprise to me that somebody doesn't know UL. I thought it was "in the water" for the past 80 years or so.
It's Underwriter's Laboratories, which is a private consortium founded by insurance underwriters to certify electronics so they don't start fires. Pick up pretty much anything that plugs into the wall and you can see their logo on it.
Do you think most people would have adapted earlier than they did in reality in the absence of advice? This particular advice was bad, but if we count all official advice throughout the pandemic, they probably did good on the net.
First of all, I'm not sure the world without the FDA looks like 'an effective vaccine is found and distributed within a month and hundreds of thousands of lives are saved'.
I've done some historical research on the bad old days of patent medicines and the like, and I suspect it would look more like '100,000 vaccines are released within a week, most of them being sugar water, possibly mixed with mild doses of cocaine, everyone takes something random and then believes they're protected and takes no precautions, and rejects the 'proven' vaccines experts recommend because they've already taken a vaccine, lots more people die over a longer period.'
Of course, the response may be 'I'm not saying have *no* regulations or expert oversight, just not the nightmare of the FDA,' but the people who made the FDA weren't *trying* to create a nightmare, and I'm not sure that the imagined 'good' regulation/oversight is possible/practical without a concrete proposal and a reviewable test case.
Second, even if everything you say about the Covid vaccines is 100% correct, I think this is still cherry-picking the absolute worst-case scenario for the FDA. Like, yes, a once-in-a-century global pandemic is a bad time to have a slow, measured process, but what about all the other times and all the other conditions? Again, snakeoil salesmen are a very real and omnipresent threat to patient health and medical advancement, and I'm not confident to say that the FDA hasn't saved more than 400K lives over the last hundred years by tamping down on them.
Of course, I'd agree that the FDA should have different, highly expedited procedures for emergencies like this one. But that's not 'the FDA is the problem' so much as 'the FDA needs one minor tweak.'
> Even if this flattering story is true, it doesn't scale... Compared to the median person who disagrees with the experts, the experts look pretty good.
This is an interesting way of phrasing it. I would say that the problem you're pointing at - the incentives for getting and holding power mean you get mediocre experts is, _itself_, a scaling problem.
Here are two thought experiments to illustrate my point:
a) Imagine there's a single unified government for the entire solar system, with population in the hundreds of billions of people, and levels of wealth substantially beyond what's available today. Billionaires are a dime a dozen - any pop star or athlete easily makes it there. There are people who own entire planets. Are the incentives for being honest and accurate _more_ aligned with getting and holding power, or less? How corrupt would you imagine the official councilor on health, for the entire solar system, which includes multiple alien races and sentient robots and the bio-corporations of titan?
b) Imagine that the federal government basically doesn't exist and almost all power - taxation, trade regulation, everything else - falls on the individual states. Each state has its own experts, who compete for power in _much_ smaller games. How corrupt is the state health controller for each state?
It seems to me that the more people involved in a competition, the greater the disparity between 'strategies to get and hold power and status' and 'strategies to be accurate.
The lesson of moloch, to me, is that we should try to avoid, as much as possible, massive, winner-take-all games of power. _That_ seems to be the thing that doesn't scale - i.e., it works OK when you do it with smaller numbers of people, but it falls apart as you start to add more and more people to the system.
There's likely a lower limit here too - with too few people, there's not enough of a pool of capable people to select from. With too many people involved, the selective pressures get so insane that the winners must be corrupted.
Many small, independent states are ideal, except that if we care about people (esp. children) having the ability to leave a given state and enough knowledge to choose, we need an umbrella government with sufficient power to punish or threaten the largest state, which means quite a bit of power actually, which means it will inevitably, eventually, be given to someone who will abuse it and usurp the power of the many independent states.
> if we care about people (esp. children) having the ability to leave a given state and enough knowledge to choose, we need an umbrella government with sufficient power to punish or threaten the largest state
Why? I understand that this is what lots of people believe. It just seems like a laser focus on one proposed solution, which we know doesn't work.
Are we saying we've searched the entire space of solutions to this problem, and this is the best answer?
I don't know about searching the entire possible solution space, but I think a lot of cultures are quite good at keeping at least some of their people trapped.
This is essentially the logic behind the old American and Canadian practice of "Indian schools." Allowing children to be brought up in pagan religions and uncivilized cultures was thought to deny them the choice to embrace Christianity and modern civilization and removing them from their parents and tribes to educate them 'properly' was judged as a small imposition relative to that. It is not a fondly remembered policy today.
Parents generally look after the interests of their children: there are horrific exceptions, but as with most cases of 'market failures' those exceptions become the rule when church or state bureaucrats are given control. The same rule applies to a lesser extent in natural communities like tribes or small towns, and we would be wiser to adopt a policy of subsidiarity and leave people minding their own business well-enough alone.
I love that you conclude that we are "insufficiently grateful" for Anthony Fauci, while belittling his free-agency in the same breath. It's surprisingly effective, and somewhat hilarious in light of the Fauci-is-Jesus-reincarnate memes that people are worryingly sincere about.
Funny that you say Trump is some sort of specifically bad outcome when the alternative was Hillary. I'd say the system failed by the time it presented either of them to us as a choice.
While disagreeing with you about the relative merits of Trump vs. Hillary, I agree that the system presenting either of them to us as plausible choices is further proof that merit and the-legible-appearance-of-merit are very different things.
This is one of the most troubling aspects of today's iteration of "libertarianism" -- its desire is to separate "the people" from "the system," scoffing cynically at the democratic notion that we ARE the system. By assuming the stance that "the system" was responsible for "presenting" us with our choices, we give ourselves permission to collaborate around our workplace water coolers and political blogs depressing everyone and ourselves with Susan Sarandon-style anger that nothing is more important than "speaking truth" against the system.
To my eyes, it was entirely We the People who failed in 2016 by collaborating to devalue Hillary's expertise, and devaluing the significant incremental progress we had made the prior eight years, in order to feast on collective cynicism, making it hip to stay home, or vote Green, or worse. The emotional piling on (by liberals and conservatives alike) manifested one of the greatest collective errors in modern history. But the error was ours, not some displaced "system." We screwed up.
"Benevolent dictatorship, obviously, just get the best person in the country and let her fix everything. But everyone realizes this is easier said than done; the procedure to pick the best person is corruptible. "
One of Mary Renault's historical novels, _The Praise Singer_, is in part about tyranny, meaning, in the Greek context, popular dictatorship. One of the tyrants she describes, Pisistratus, is benevolent. In her version, he was the younger lover of Solon, who created the Athenian legal system. He tells the protagonist that when Solon finished everyone liked it, except one thing — everyone wanted a change to favor him. Solon's response was to leave Athens, because if he wasn't there they couldn't make him change it. "They keep his laws — I see to that, who could have given them laws they liked less well." The tyrant has been kept honest by the memory of his dead lover.
It's a powerful scene, but not a very reliable procedure.
> What's the best form of government? Benevolent dictatorship, obviously, just get the best person in the country and let her fix everything. But everyone realizes this is easier said than done; the procedure to pick the best person is corruptible. At one point we tried a very simple best-person-picking procedure that really should have worked and ended up choosing Donald Trump as the best person. I'm still not really sure what went wrong there, but apparently this is really hard.
I know you’re having trouble being serious here, but no, at one point y’all tried a very simple best-person-out-of-two-far-from-obviously-close-to-the-best-in-the-country-picking procedure. The prior picking-which-two-people-to-choose-from-procedure was very complicated and obscure and probably very corruptible.
The procedure was "democracy". Anyone who paid a small fee and filed some papers was allowed to be on the ballot. I agree we managed to screw that up somehow, but that's my point!
"I agree we managed to screw that up somehow" -nothing was screwed up; it's silly to think the will of a plurality of a plurality is consistently either the most broadly popular option or a competent option.
Sure, but there are plenty of generalizations of Arrow's theorem to many settings. If people have opinions about whether or not policy A ought to be the case; people have opinions about whether or not policy B ought to be the case; and people have opinions about whether or not A<->B ought to be the case, then there is no consistent function from those opinions to a social choice that works the same way for each of these three propositions.
If you can put in cardinal strengths of desire, and find a unique interpersonal scale for those cardinal strengths, then you can do it. If you can assume a stronger set of comparisons on the individual level than you want your function to return on the social level, then you can often also do it. Otherwise you usually can't.
Sure, but just because it has a one-word name doesn’t mean that it’s not very complicated and obscure and very corruptible. It might be better than all other procedures (I don’t have any better candidate), but that doesn’t mean it’s simple or legible or hard to corrupt. Lots of countries use Democracy (TM), but their procedures can vary quite a bit. Democratic People's Republic of Korea has it right there in the name, doesn’t really mean they’re basically the same as the US.
> Anyone who paid a small fee and filed some papers was allowed to be on the ballot.
No, they didn’t. I, for example, am both too young and not an American, therefore I wasn’t allowed.
Even if I were, there are very complicated rules on who is allowed to say what to encourage people to vote, and how much money is allowed to change hands and how in order to do that, and which people exactly are allowed to vote, and how that set of people is allowed to change, and I bet a hundred other things I didn’t even hear about.
Then there is a very complicated set of unwritten rules about what candidates the media will talk about and in what tone, and who you can talk to your acquaintances about without sounding like a weirdo, and probably a thousand other things that wouldn’t occur to me but are quite important.
“Democracy” is not meaningless, it’s a word that is pointing to a concept, but the concept is vague and fuzzy and applies to very different things with very different behaviors. It’s just barely clear enough that you could argue DPRK is using it wrong. You can’t actually use it for much without really going into the details.
You tell a hypothetical story about what would happen if Biden appointed Zvi. But what actually happened when Trump actually appointed Scott Gottlieb head of FDA? Why did he only last two years? Was he pushed out as a political cost, as in your story? Did he burn out fighting with the organization, a different but parallel story? Did he have power to control the organization, or would it not have made a difference if he had stayed for another two years?
For the reasons this post talks about, I often wonder when I see people say "Scott Gottlieb seems to be endorsing good policies the current FDA isn't following, it would have been great if he was still FDA commissioner", whether if Gottlieb was still head of the FDA whether he would have endorsed those policies. Once you're out of the position you stop being affected by those forces as much and so can start endorsing good policies again.
I've also seen people talk about Balaji Srinivasan having been considered for FDA head before the pandemic, and how things would have gone better if he'd been chosen. But in that case we might have just got the world where Balaji is fired in February for being too extreme about COVID and replaced with someone else.
My favorite aphorism for understanding bureaucracy is: Where you stand depends on where you sit.
I say this as somebody who flipped his opinion on the importance of correctly filling in a particular database used by the the US Army over a weekend. The previous week, I was a staff officer responsible for ensuring the correctness of that database. The following week, I was a company commander with many, many more responsibilities than that stupid database. It's very, very easy to change your mind on something depending on the incentives acting on you.
If Balaji had replaced Gottlieb shortly before covid, he probably would have been quickly fired. But if he had been the first director and survived two years at FDA, I think he would have had the slack to cotinue. I don't think he would have made it through those two years, though.
Perhaps we should disentangle speech from action. If Gottlieb had continued as head of FDA, we probably would not have heard from him, because FDA is mainly not about public speech. Thus we would not be talking about him. Mainly we should judge FDA on the timeline of approving tests and vaccines. Approval is complicated and opaque and those the influence of the director is very hard to judge. Gottlieb first came to my attention when he explained that the first action FDA had taken was to ban tests, and that this was a terrible idea. This seems like something that the director could have vetoed without the cooperation of the rest of the organization. But I can't know what he would have done.
WebMD is useless but your specific example is an unusual choice. Aspirin is relatively safe for healthy people but less so if you have liver damage. The Wikipedia article for salicylate poisoning says there were 20,000 cases in America in 2004.
This is true, but the number of people taking Aspirin must be at least an order of magnitude greater than Warfarin, so the conclusion that Warfarin is much more dangerous holds.
in theory, I think this is what that tenure system of universities was supposed to(and maybe used to) get us. Once you've gained admittance to the ivory tower, you're unimpeachable and can sit in your tower and spout whatever you want with immunity
Incentives for corruption still exist, they just tend in different directions. Writers with a patron have to flatter that patron and appeal to their preexisting beliefs to keep food on the table. People who live off patreon or substack need to appeal to their fans. Communities give status to people who say the things that the community wants to hear.
The "fuck you money" and prediction markets examples are slightly different. As the problem there is transferable expertise. Even with the best incentive system being an excellent software deisgner won't make you a good epidemiologist.
There are examples in real-world governance of officials with some level of independence. Judicial independence seems to work relatively well in most democracies, often with tenures of life (or up to some fixed retirement age). There is a norm of central banks having a decent degree of independence in the last few decades. As far as I understand, Fauci himself could afford to sometimes disagree with Trump because, in the American administrative system, Trump didn't have the power to replace him on a whim.
These officials may not be perfectly independent, but the concept exist in real-world governments. It would be interesting to investigate whether jurisdictions with more strongly independent officials perform better (though it would be very difficult to disentangle the effects of other differences). My impression is that systems with too strong checks and balances, such as the US can have too much inertia; overly complicated regulatory systems develop over time, and no one has the power to streamline them.
Great post. The last line -- "prediction markets would still be better" -- is idiotic [1], but we can't have everything. Scott isn't perfect, but he is better than we deserve; legibly mediocre.
[1] If prediction markets were so great, we'd see them happening *somewhere*. Gambling is legal in Canada; you can't blame everything on anti-gambling laws. Where are the Canadian companies that use prediction markets to make decisions? They don't exist. You think they should? Go to Canada, start a company that uses prediction markets instead of a CEO, become a billionaire, and THEN I will believe that prediction markets work. Until then, they are just a way to signal "rationalist community good".
Agreed. It's kind of a strong form of EMH, which we thankfully have "Inadequate Equilibria" to thank for sparking gajillions of discussions on why things are sometimes not perfect.
Just to clarify, do you predict that if someone started a company in Canada and used prediction markets instead of a CEO, that person would become a billionaire? Why or why not?
The modal response might be that the optimal decision is to avoid burning the corporate commons* and instead dissolve and distribute the company's assets to the shareholders, which the CEO would prefer to avoid.
That's a cop-out response, in particular because in this thought experiment, the founder is both the CEO and the primary shareholder (so there is no "the CEO would prefer to avoid giving money to shareholders" scenario).
In any case, I assume that if you're of the belief that shareholders are so irrational that they voluntarily give money to CEOs that burn it, then you're also not a fan of prediction markets.
I am a fan of prediction markets. I think shareholders give money to companies even though some of it is burnt because that's the cost of doing business and the returns are generally still positive. They would simply be even higher without the agency problem of executives burning the commons. Robin Hanson's idea for the first place decision markets should be used is a "fire the CEO market", and there's a pretty obvious reason why CEOs would be averse to that.
What are you arguing here? That there should be no companies at all? Or that most companies should be dissolved?
I don't get the "burning the commons" terminology either. I usually see the terminology as referring to game-theoretic analogues of the tragedy of the commons. I don't see the analogy here.
(What is a modal response? Is this lesswrong jargon?)
It's a fully-general argument against supposedly fully-general decision-making techniques, yes.
You really think this niche community came up with One Weird Trick that makes superior decisions to everything else humans ever tried? Is it not legitimate to ask "if it's so great, why aren't you sitting on a mountain of utility"?
Well it seems to work super-well where it is tried, right? Has it ever been tried and failed? I think people have this innate disgust for gambling on important outcomes.
Um, yes? Oodles and gobs and dozens and hundreds of times? Many companies use internal prediction markets to improve forecasting. Google and Microsoft do it. Drug companies and hedge funds do it. Use *internal* to a firm is legal, hence actually happens and can be a competitive advantage. That these markets are still used *less often* than Hanson would like doesn't mean they've never been tried at all and the ones that have been tried definitely work; the hard part is navigating internal politics. Management often resists using markets to make decisions for much the same reason that doctors resist using expert systems to make diagnoses - it's weird, it might prove that their *prior* strategies were bad, and it might undermine their own perceived market value. So adoption is *slow* but it still happens.
"Despite theoretically adverse conditions, we find these markets are relatively efficient, and improve upon the forecasts of experts at all three firms by as much as a 25% reduction in mean-squared error. "
Your links do not contain the terms "hedge fund" or "drug", and I couldn't find (by skimming) any information about hedge funds or drug companies using prediction markets. Can you give me a link claiming hedge funds use prediction markets, or else retract the claim?
Google and Microsoft seems to have *experimented* with prediction markets; I don't see any claim that they use them for important decisions. Let me know if I missed it.
As for your earlier question of whether prediction markets have been tried and failed: Nate Sliver has consistently outperformed betting markets when predicting US election results. He does so every year, and all the markets often have some absurd predictions (e.g. Hillary Clinton becoming president in 2021, even though she stated early on that she wasn't running). I know that advocates of prediction markets like to no-true-Scotsman this and claim that the election prediction markets are not true prediction markets for some reason or another, so I didn't mention it as an example earlier.
I believe Robin Hanson has written some about attempts to introduce prediction markets into companies. It's not that they don't work. It's that they tend to step on the toes of too many important people. Exactly the sort of political considerations Scott writes about here, in other words.
Do you have a link? From your description it sounds to me like "prediction markets were tried, they sucked, but Hanson needs an excuse for saying it's not the markets' fault", but I'm willing to keep an open mind.
"...while such markets have consistently performed well in terms of cost, accuracy, ease of use, and user satisfaction, they have also tended to be politically disruptive – they often say things that embarrass powerful people, who get them killed. It is like putting a smart autist in the C-suite, someone who has lots of valuable info but is oblivious to the firm’s political landscape. Such an executive just wouldn’t last long, no matter how much they knew."
I think you are overinterpreting that last line. It's not a serious claim that prediction markets should replace the Faucis and every decision Faucis make.
I'm surprised that no one has yet mentioned Zeynep Tufekci (https://zeynep.substack.com/people/299814-zeynep) as another writer who seems to have consistently been righter than the experts. She's been my go to for COVID information for quite some time, and probably the person who's most influenced my actions and what I recommend to others.
I'm not sure I understand what the problem with this article is supposed to be. In any case, if it is problematic, it appears to be one problematic article she has had in several years of really useful public discussion about major events.
The problem, Kenny, is that in February, when coronavirus was already spreading throughout the United States, Zeynep's message to the American people wasn't "coronavirus is already spreading throughout the United States, and you can't expect America's public health response to be even remotely as good as China's -wear masks, avoid crowded settings, etc.", but "China bad, authoritarian systems bad". This claim can easily be tested: did China perform badly against coronavirus? No. Was there any obvious relationship between the quality of coronavirus response and central government authoritarianism? No. Is the whole premise of the article -that surveillance and censorship result in inferior coronavirus responses relative to reliance on free media- correct? No.
Maybe she should have posted that one five days earlier and the one you posted five days later, but she was posting both of these in the same week (which is basically the week that I realized this was a major event we were living through, and I needed to talk to my students about it the day I got back to class from a conference I had been traveling for).
But as for your other questions:
In the sense of how the Chinese government responded *after* it had started spreading, their reaction was as effective as anyone's at stopping the spread (except maybe Taiwan). They might have been more effective at eventually stopping the spread than even South Korea, Australia, and New Zealand, but that doesn't mean that their overall response was better, given that these countries did it in ways that were arguably not as harmful to the other aspects of the well-being of their residents.
But this isn't the question she is addressing here. She's addressing the question of how well they performed in the *initial* phase, *before* it started becoming widespread. Here we don't have any comparison cases, except maybe the response to SARS by a few governments in 2003. Would some other government form have better succeeded in detecting and stopping the initial outbreak? That's the question Tufekci is asking in the article you linked.
You may disagree with her conclusion, but you haven't provided any evidence that she's wrong.
The problem with that piece is that "flatten the curve" was still no different from "herd immunity" and was obviously still very bad policy. At least it was realistic.
This was also wrong: "All of this means that the only path to flattening the curve for COVID-19 is community-wide isolation: the more people stay home, the fewer people will catch the disease."
South Korea kept the virus more or less contained without any mass stay-at-home orders. It probably could have eliminated the virus within its territory, as well, had it used local travel restrictions and mass testing.
Her mask advice was also not the greatest.
"Would some other government form have better succeeded in detecting and stopping the initial outbreak?"
Considering most countries didn't make serious attempts at containing the virus, I think very few countries would have done better than China at containing it initially. Maybe Australia, Vietnam, Thailand, or North Korea.
"China’s use of technology to ratchet up surveillance and censorship may have made things worse, by making it less likely that Xi would even know what was going on in his own country."
Censorship made it much easier to distinguish the signal from noise (compare America's freedom of speech on coronavirus back in February, when numerous newspapers were outright floomer), and China's surveillance system was obviously a major plus in contact tracing, and something many countries would have killed for.
"Given exponential growth dynamics of infectious diseases, containing an epidemic is straightforward early on, but nearly impossible once a disease spreads among a population."
Also wrong; containment of the virus was always straightforward. Li Wenliang was not a "whistleblower".
China waited to act against the coronavirus until it knew it was a serious threat. This was quite excusable, given the costs of overreaction. The Wuhan pneumonia outbreak could, given the information available at the time, easily have been either a minor and self-containing outbreak or as non-fatal and widespread as H1N1 flu. The characteristics of the coronavirus in early January were not just unknown, they were unknowable, regardless of what system China had. Only time could tell how contagious and dangerous the coronavirus was, not rumor-mongering. Tanner Greer had the far better initial take on coronavirus: https://scholars-stage.blogspot.com/2020/01/political-and-practical-implications-of.html
"China’s use of technology to ratchet up surveillance and censorship may have made things worse, by making it less likely that Xi would even know what was going on in his own country.
"Authoritarian blindness is a perennial problem, especially in large countries like China with centralized, top-down administration. Indeed, Xi would not even be the first Chinese ruler to fall victim to the totality of his own power. On August 4, 1958, buoyed by reports pouring in from around the country of record grain, rice, and peanut production, an exuberant Chairman Mao Zedong wondered how to get rid of the excess, and advised people to eat “five meals a day.” Many did, gorging themselves in the new regime canteens and even dumping massive amounts of “leftovers” down gutters and toilets. Export agreements were made to send tons of food abroad in return for machinery or currency. Just months later, perhaps the greatest famine in recorded history began, in which tens of millions would die because, in fact, there was no such surplus. Quite the opposite: The misguided agricultural policies of the Great Leap Forward had caused a collapse in food production. Yet instead of reporting the massive failures, the apparatchiks in various provinces had engaged in competitive exaggeration, reporting ever-increasing surpluses both because they were afraid of reporting bad news and because they wanted to please their superiors.
"Mao didn’t know famine was at hand, because he had set up a system that ensured he would hear lies."
"Censorship made it much easier to distinguish the signal from noise"
Assuming, of course, the information reaches them in the first place. The Hubei authorities arrested Li for spreading misinformation.
"China waited to act against the coronavirus until it knew it was a serious threat. This was quite excusable, given the costs of overreaction."
I find it hard to justify inaction over action when it comes to a new, relatively unknown virus, that we knew was SARS-like very early on. To err on the side of caution in this case would be to monitor the virus, and at the very least, stop lying about its human-to-human transmissibility.
I read the article and I can report a clear lack of sinophobic nonsense. It just sounds like you have some kind of grievance you're not telling us about.
It was Sinophobic nonsense. The obvious implication, written plainly between the lines, was that coronavirus was an exclusively Chinese problem that could never seriously affect countries of such as the United States, Britain, or Sweden. Also, the idea that either censorship or surveillance was a minus in China's response was transparently absurd. The West resorted to a great deal of censorship against floomers in spring and summer of last year -much of it crudely applied, but all in all probably insufficient in quantity. The surveillance network, of course, allowed China's coronavirus response to get off the ground in a much more energetic fashion than otherwise.
"The obvious implication, written plainly between the lines, was that coronavirus was an exclusively Chinese problem that could never seriously affect countries of such as the United States, Britain, or Sweden."
I'm quite sure that the plainness between the lines is the whiteness of the background.
I've read the article. I couldn't see how it implies this would never affect Western countries.
One assumption that I'm not entirely sure I agree with is this one:
"If you expose the plan to politics, the politics will drag it in the direction of being worse. Every feedback channel you open up is a way for somebody to attack you. "
Some massive assumptions involved are that:
1) You will consistently have specific illegible experts
2) These experts have satisfactory self-contained knowledge
I agree with the mechanism that politics CAN drag things in the direction of being worse because it inevitably creates channels for people to jam questionable inputs.
But politics also has the ability to create channels for people to jam in relevant inputs. Most people can't, don't, and won't develop the approach needed to balance a proposal against multiple different objectives. Part of this is maintaining power. However, Fauci isn't strictly acting as providing medical advice, but rather his pronouncements have economic & sociological impacts.
I think the essay creates a good argument for Plato's Republic, but when you keep in mind that Plato's ruling class must exercise judgment in lying, and that the web of information in a modern society is an order of magnitude more complex, etc, etc. Then... I'm not so sure. I am not sure if I want to sign off in an idealized theory even.
Let's put it another way: does Fauci & the CDC by itself have sufficient expertise to decide to lockdown the US economy? The answer is probably no, because why shouldn't the CEA (Council of Economic Advisors) get a say in that? That's a really big decision that hit's their domain. And maybe we need the APA (American Psychological Association) because this really could cause psychological stresses that the CDC may not be as expert in. And... at this point, we may also be talking about a value judgment, which requires some sources to provide those inputs (ethicists? representatives of the US population?) And when you realize all of the people who should legitimately be consulted to make a complex decision, you now have politics.
That leads to the idea that politics is a natural result of human interactions involving complex decisions. Some politics is good & some politics is bad. But it needs to exist, and it isn't so easily separated into "impure power-grabbing". Coordinating with all stakeholders is "maintaining political power", but the stakeholders legitimately exist! And pretending they can be replaced (even in theory) with the ideal dictator means that we somehow don't believe there are other stakeholders, or that we think they can be ignored. Sometimes bypassing stakeholders works!! However, it really can blow up quite horribly!! "Move Fast and Break Things" is a very productive & very destructive slogan.
All of which is to say: Scott this is a great post. Can you please tell me if Democratic Republics are good or bad? This post has implications and I just gotta know.
I like this post in general, and I agree with the central thesis. However (as someone who put nontrivial thought into both masks and coronavirus case/death estimates, see eg: https://pandemic.metaculus.com/rankings/), I disagree with the causal mechanism is that corruption caused accurate people to become less accurate in public-facing ways.
I think it's more likely that the corruption caused counterfactually competent people to be less accurate, even in their own thoughts.
Speaking of Lorien Database changes, you might want to make the UI a bit more useable on mobile. There was some charcoal-on-prussian-blue text and stuff last I checked.
IIRC the state of fomites as a vector is somewhere around “has probably happened in a nonzero number of cases, but really isn’t a significant concern”.
I think you’ve conflated two forms of “expert,” the advisor and the policy maker.
While a policy maker is evidently subject to the sort of public pressure you describe, one would hope a president could get better advice in private, and that experts whose public facing role limits them might still be able to speak more frankly “on background” to reporters, politicians, etc.
I... do not get the sense our expert class recognizes their failures in private. It is not clear to me, for instance, that the FDA’s top leadership suspects that their refusal to consider and approve the Astra-Zeneca vaccine is effectively mass murder. And it isn’t clear to me that in private public health officials understood the threat of COVID-19 until remarkably late. That’s more worrisome than that our system puts pressure on the most public-facing roles.
Or, put another way, we are selecting almost entirely for “can handle dealing with the public” rather than “gives the best possible advice” in the filter that selects for our public experts.
I would add a third category – the expert who is the predictor of the future.
In my understanding being an expert, let's say about TB treatments, doesn't let you predict what will happen to a specific patient. An expert knows exactly what tests he needs to order, what medicines he needs to prescribe, what are side-effects and what to do with them, what are challenges with drug resistant TB and treating immunocompromised people. He may even know about socioeconomic aspects of TB and suggest measures to improve adherence to the therapy of homeless people etc.
While he can give a past statistical success (like 95% patients treated within 6 months), he cannot say confidently how any individual patient will do for many different reasons. New resistant strains appear, some patients lie about taking the medicines regularly and so on.
The predictions about coronavirus pandemic are like that. On average CDC or WHO may have been quite good with containment of epidemics. But things can happen differently and because there are so many people who always cry wolf, some of them were correct this time. It doesn't mean they had great insights or would have done better. Many potentially promising ideas didn't work out: hydroxychloroquine, antibody treatments, even need to produce more ventilators turned out unnecessary. Vaccines seem to be working so far but it is still to early to see the end-game as the emergency of vaccine resistant strains is still a possibility.
My current nomination for "most trusted pandemic amateur" would be Zeynep Tufekci. I'm skeptical that Zvi always optimizes for being right, versus coming up with hot takes to make us angry about how people are handling the pandemic? (Maybe we should be angry, but I need better evidence.) Still a good source of link and questions, though.
In particular, I am wondering if anyone has good sources or explanations for how the FDA is making decisions about vaccines during the pandemic? This seems mysterious and many have questions, but I don't think I understand it yet.
Thoroughly disagree. Robin Hanson, Zeynep Tufekci, and Tyler Cowen are all massively overrated pundits. Greg Cochran, Lyman Stone, and Scott Sumner, are underrated.
"The experts successfully swooped in and saved us from all of that, figuring out which way the wind was blowing only two weeks later than competent amateurs. This was a useful service. Without the experts, things would have stayed open forever."
I expect that people would, in Bill Gate's memorable phrase, "notice the bodies piling up in the corner" eventually.
It's hard to say? Honestly, it's really weird, but people (without centralized leaders) often really do just fall into collective action failure modes. Statistically COVID is obvious, but in reality many people call it "wu-flu" and deny that it's a dangerous disease.
Piling of the bodies may just mean that in the pursuit of profits we have over-optimized the funeral services that we cannot deal with a sudden 20% increase anymore. My understanding is that the mortality is somewhere at the level of 1980s. This is bad but how bad is clearly a subjective evaluation.
Does it seem very bad? Not to me. I don't remember 2003 as particularly bad year when a lot of people died.
The article is biased and tries to argue that excess mortality as compared to previous 5 years are much higher and mortality improvements similarly compared to previous 5 years have nosedived. This again seems to be choosing too much from degrees of freedom. Why exactly 5 year period and not, let's say 10 years? Because it looks that for long time we have had a period of great stability and continuous mortality improvement and also that the mortality usually were not that much different from one year to another. The return back by 17 years causes a bigger jump but it also means that the mortality was worse and more stable at the same time and not that now it is worse than in 2003.
Maybe due to great efforts of WHO and CDC we were able to escape many health crises but that was not sustainable indefinitely and we had to suffer some setback. Maybe before 2003 such an event would merge with the background mortality and wouldn't be even noticeable whereas now we made such a big issue exactly because we have been doing so well for many years.
It's my opinion that Fauci has done a terrible job, but I genuinely don't know anyone else who would've done better in this nightmare. We have a crisis of expertise AND implementation.
Zvi probably also has a very permissive peer group. For normal people it's still a multi-criteria decision-making problem: maximize rightness together with minimizing slights/offense/loss of status within the peer group. Whatever experts are proclaiming also gets used as input and it gets difficult to deviate from it depending on how peers process it. At least us normals don't have to deal with lobbyists or activists that want to remove us, I guess.
I sold my stock in Big Fomite early on when it became apparent that Korea (where contact tracing is effective and food delivery plentiful) wasn't getting a ton of spread through that route.
These guys tested infectiousness in vitro rather than just looking for rna fragments, which helped me resolve the question about whether people were just detecting dead virus. I don't have a guess how many infections are caused by it, but it does appear to be a viable vector.
> These guys tested infectiousness in vitro rather than just looking for rna fragments, which helped me resolve the question about whether people were just detecting dead virus.
Resolve which way? Based on the Results section, it seems like viable virus can be detected on some surfaces up to a week at 30 °C; at 20 °C, the half-life is more than a day on all surfaces.
I concluded that yeah, fomite transmission seems like a probable risk. I keep my other risk factors really low, so I decided to keep quarantining packages for a week and washing refrigerated perishables.
I love it when multiple things I read converge around the same time even when they weren't created at the same time. I just rewatched the classic CGP Grey video, Rules for Rulers, yesterday - https://www.youtube.com/watch?v=rStL7niR7gs&ab_channel=CGPGrey, which discusses what people in power need to do to stay in power, and has a nice similar energy to this post.
It was just yesterday that I was commenting on Robin Hanson's post (though I was also thinking about a recent podcast he was on) about Experts Versus Elites*, pointing out that experts got COVID-19 wrong initially and elites had to correct them. This would have been a good post to link to.
One takeaway that I get from this is how important anonymity can be, sometimes empowering people to speak the truth which would otherwise have too great negative consequences for themselves and the systems they represent. While we probably don't want anonymous people running our country, it's definitely among the simplest ways to bypass some of the unintended forces of corruption mentioned here, and is, for example, why voting is at least intended to be anonymous (and ideally would be so in our government as well, just with cryptography to provide all of the various assurances and verification that we'd want).
A government of anonymous people (at least at the top) would be a great premise for a science fiction novel.
I'm not sure it ever happened in the real world, but there are stories about kings anonymously going out to get direct knowledge of what's happening in their kingdom.
The Unknown Fathers in _Inhabited Island_ (apparently translated as _Prisoners of Power_ instead/as well) by Strugatsky brothers are such a government.
Yeah, I've thought before about systems that would verify basic credentials and identity, but then discard that information and never display it, such that you could take a platform like e.g. Twitter, and know someone has certain experience or knowledge, but not know who they are necessarily
You establish an online identity secured by your digital signature and build the reputation of that identity. What you have to prove is not what university you got your degree from but how consistently you give what turns out to be the right answer to a problem.
Excellent post. Although it sounds like one solution would be to bring the requirements of "being in power" more in line with "being right"; e.g., by calling out, defunding, demoting, firing, cancelling subscriptions to, etc., institutions and individuals who have done markedly worse than competent amateurs and have caused harm in the process. So "taking to the streets, pitchfork in hand," but to a lesser degree.
I'm really nervous about all of that, because what you're actually doing is calling out, defunding, demoting, etc people who are legibly wrong, wrong according to the populace and the media that convinces them of things, etc. Sort of making sure nobody has any slack, which could go either way.
Are the problems Scott is addressing here [just] special cases of the general issue of how to juggle social signaling with efforts at accuracy / rationality / reliability? I'm not trying to trivialize it -- I think this problem is one that repeatedly arises both here (and back in the day at SSC) and in lots of places both in the Less Wrong crowd and more generally: how to raise questions *at all* when certain questions or certain responses or certain thresholds of reliability, etc, are also *signals* that mean things like "I am on your side," "I am powerful and you should be on MY side," or "I am NOT on your side and you should fear me." I am thinking of certain social justice questions, for instance, but one could multiply examples ad nauseam. Part of Scott's point, I take it, is that questions of scale play into this issue complicating the matter.
I want to offer a small correction. You claim: "What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong. People who most brutally and nakedly optimized for power would gain power; that's what "optimize" means."
At first glance, this claim seems by definition correct. But it does not *necessarily* hold. If there is ex ante heterogeneity in attributes. For instance, if we burnt down the current system and declared that the person born on the birthdate determined by some unpredictable quantum fluctuation has all the power, it would be *difficult* to overcome your ex ante handicap (birthdate in this case).
While that's a pedantic example, the same could imaginably be true if we only allowed the most excellent and well-respected academic economists to rise to power. Even for an optimizing power-hungry sociopath, it is unlikely that they will be able to rise to the top--not enough natural talent.
You could instead say that part of what needs to be optimized (natural talent) is out of the individual's control space.
For a statistician, if the variance in the latent variable that determines power is primarily driven by non-optimizing behaviors (primarily natural talent) then optimization has less of a potential role to play.
All that said, I agree with your overarching point, for most practical situations such as Marx's, what I said is nonsense--but in the interests of steelmanning, I think the theoretical idea that one can build a society that isn't driven entirely by power-hungry optimizers is not as self-contradictory as it might seem.
It would probably be possible to devise a better way of assigning power; the problem is how to implement it stably. Usually, once the previous system is burned down, the system that replaces it is less stable -- people are less used to it, less attached to it, and less able to tell which changes to it are harmless and which ones are potentially destabilizing -- so that a newly devised replacement system is likely to be easier for power-hungry sociopaths to game. Power being determined by natural talent would only be likely to work if the idea of meritocracy (along with a not-very-manipulable measure of merit) was already too strongly accepted to be easily overturned.
I agree completely. I only wanted to point out that power-hungry optimizers winning seems to be the rule *by definition* when it isn't. If enough variation in the latent variable that determines winning is generated by optimizing behavior, it is true. And to your point, perhaps when we burn down society, *more* variation is determined by power-hungry optimization.
Which perhaps was Scott's point to begin with. Thanks!
Scott Alexander provided zero evidence that Marx wrote or thought anything similar to that "fallacy". Indeed, Scott Alexander is presenting a strawman about Marx's writings on historical change. Scott Alexander has repeatedly shown that he has not understood Marx's work. e.g:
In my reading, he is referring to revolutions inspired by Marx, not Marx himself. If he had instead rephrased it to "The Fallacy of Historical Marxian Revolutions" would you still object? It's certainly the case that that self-proclaimed Marxist-Leninists Stalin, Mao, and Pol Pot all rose to the top of unstable revolutions meant to build a better world.
It seems as though current Marxists should or do embrace his point--I believe they claim that the reason historical Marxist revolutions have ended in bloodbaths was that they were corrupted, and Scott describes why (because when you burn down society, the people who end up with power are the Stalins, Maos, and Pol Pots. People who claim to be Marxist-Leninists, but really were sociopaths/power-hungry, etc.)
Then he should quote Marxist revolutionaries and seriously study them, not accuse them of a fallacy they did not commit. Have you noticed how Scott has cited precisely zero evidence here? Why is he calling it "Marx's Fallacy" if Marx committed no such fallacy?
Again- I challenge Scott - show me where Marx said anything like this, using quotes from primary sources. Since I'm an especially charitable man, I will accept similar "fallacies" from other Marxist thinkers like Lenin and Stalin - but I still need some sort of proof that they actually said anything like this.
Well, Marx did oppose utopianism, didn't he? It may be a polemic simplification to summarize this as "Let's do a revolution and hope our current problems won't reappear afterwards" (which is even more simplistic than how Scott puts it), but I don’t think the fundamental opposition wouldn’t resist to a closer reading of Marx.
As for the Sneer Club post: How is it different in practice to say “Marx didn’t believe in human essence” and “Marx didn’t believe in the essentiality of the traits we call human essence”?
Would this same line of argument posit Fidel Castro or Kim Sung Il as successful socialist scientists? After all - their experiments are still running to this day.
>It may be a polemic simplification to summarize this as "Let's do a revolution and hope our current problems won't reappear afterwards"
I'm not interested in "polemic simplifications" that destroy Marx's meaning. Scott Alexander also has a habit of sneaking in political terms that are more contested than he thinks they are - like "power". Power to do what? Marx writes a lot about this kind of stuff, but Scott doesn't acknowledge any of it.
>As for the Sneer Club post: How is it different in practice to say “Marx didn’t believe in human essence” and “Marx didn’t believe in the essentiality of the traits we call human essence”?
That's self-evidently two different things. To disagree about the essentiality of this-or-that trait is NOT to say that there is "no such thing as human nature" or that "everything was completely malleable"
> . Citizens Against Lockdowns argues that the CDC already screwed up by stressing the later-proven-not-to-exist fomite-based transmission, ignoring the needs of ordinary people in favor of a bias towards imagining hypothetical transmission mechanisms that never materialize;
I know you're making an example and trying to be funny, but this is a really important point that needs to be made:
Most of the CAL-types (at least, the normal ones who aren't walking conspiracy-theorist stereotypes) aren't mad because "they said fomites are real but fomites don't real". They're mad because the experts figured out fomites don't real six months ago _but we're still going through all the surface-decontamination safety theatre_. They aren't mad that experts got it wrong. For that matter, it's not even clear to me that they're mad at the experts at all. They're mad that the people who constantly say that they're "following the science" didn't update their beliefs when the science came in, and it's been six fucking months of doing all this ritual bullshit that has provably zero effect on anything.
"but we're still going through all the surface-decontamination safety theatre"
China claims COVID can be spread through cold chain transmission, and they seem competent, so I wouldn't discount the surface decontamination stuff as theatre just yet.
Another CDC vs. Zvi difference is that the CDC is doing public communication to a mass audience, often filtered by the media / the public discourse. Whereas Zvi is writing directly for a niche audience of people who are willing & able to put in an unusually large amount of time/attention/thought to build detailed models. Doing mass communication pushes towards:
Just sharing your conclusions rather than the details of your reasoning
Giving simple guidelines/approximations (e.g. "wear a mask", "6 ft apart") rather than more details or the underlying model
Not sharing things that you're more uncertain about
Trying to keep a consistent story rather than changing your views fluidly
Zvi doing mass communication would face some challenges that the real Zvi hasn't had to face (and which a Zvi-in-a-cave setting policy might be able to dodge). Just replacing pages on the CDC website with Zvi blog posts would create some problems.
I really appreciate this analysis. I only wish you emphasized more the relevance of regulatory capture. Whereas the FDA, CDC, and NIH are supposed to regulate the pharmaceutical industry, they very often are a mouthpiece for that industry, having been captured by it.
The generic drugs hydroxychloroquine and ivermectin, for example, have been successfully marginalized, despite abundant evidence of their efficacy against Covid-19. See hcqmeta.com and ivmmeta.com for summaries of the research to date and links to the original studies—which are abundant, at this point. (Really, please do look!)
For hydroxychloroquine: "The probability that an ineffective treatment generated results as positive as the 198 studies to date is estimated to be 1 in 1 quadrillion (p = 0.00000000000000083). Early treatment is most successful, with 100% of studies reporting a positive effect and an estimated reduction of 66% in the effect measured (death, hospitalization, etc.) using a random effects meta-analysis. ... 91% of Randomized Controlled Trials (RCTs) for early, PrEP, or PEP treatment report positive effects, the probability of this happening for an ineffective treatment is 0.0059."
For ivermectin: "100% of the 37 studies to date report positive effects. Early treatment is more successful, with an estimated reduction of 82% in the effect measured using a random effects meta-analysis. ... Prophylactic use also shows high effectiveness. 100% of the 19 Randomized Controlled Trials (RCTs) report positive effects, with an estimated reduction of 72%. ... The probability that an ineffective treatment generated results as positive as the 37 studies to date is estimated to be 1 in 137 billion (p = 0.0000000000073)."
It requires a certain amount of research-savviness to evaluate studies like these firsthand, rather than relying on media reports and authority opinion. But for those who do, and who proceed to evaluate the relevant research firsthand ... whoa!
Given America's dire need for cheap, safe, and effective early treatment, I find it hard to explain the marginalization of these repurposed generic drugs any other way, than through capture of the relevant institutions and regulatory bodies.
The NIH canceled their large RCT for hydroxychloroquine as soon as it became clear that a vaccine for HCQ would be possible. In the months since, no other treatment has been allowed to steal the limelight. We're just been told to wait (and wait) for the vaccine.
I am really distressed by this. But I see no other explanation which accounts for (a) the abundant research available and (b) the official narrative about these drugs, which appallingly contradicts that same research.
"For hydroxychloroquine: "The probability that an ineffective treatment generated results as positive as the 198 studies to date is estimated to be 1 in 1 quadrillion (p = 0.00000000000000083)."
This number comes from multiplying the individual p values of every study, which is completely pointless; if that helped anything, every single meta-analysis would come back positive, as p-values are always lower than 1!
If you check the individual study, you will see most of the positive results come from comparing a younger, healthier population on HCQ with an older and more comorbid population on placebo. Whenever a study controls for that with proper randomization, the results come back as non-significant
Comparing the number of positive studies with the number of negative studies is a huge statistical fallacy, one single well-designed and we'll conducted study will be more accurate than the sum of hundreds of biased studies.
The argument those sites make is similar to me arguing that I am history's best chess player, because the most world championships anyone has is 6, while I have DOZENS of wins aganist my 8-year old cousins
There's also the fact that Dexamethasone, which IS cheap, safe and effective, HAS been approved as a treatment
I asked a professional statistician, Mathew Crawford, to evaluate and respond to you claims. He wrote this, for me to share:
###
"This number comes from multiplying the individual p values of every study, which is completely pointless"
This is absolutely not true. You just made that up. That is not how p-values are computed or worked with. Nobody finds the probability of flipping 2 heads out of 20 by multiplying the probabilities of finding 1 head out of 20 (though we can compute convolutions for such discrete cases).
I can add additionally that I (as a statistician) personally checked the methodology and results prior to the hcqmeta site going live using the standard inferential methods Ronald Fisher developed so many decades ago.
Your statement here is jaw-droppingly irresponsible, and if you want to stand by the veracity of your statement, we can get together in a zoom video and walk through those computations publicly.
"If you check the individual study, you will see most of the positive results come from comparing a younger, healthier population on HCQ with an older and more comorbid population on placebo."
This is not true, either. I personally read every study at c19study.com through early November. In general, most studies do a good job of correcting for age differential, but the most biased in this regard were not the positive studies, but the negative (VA study, the Geleris study, etc.). If you're going to make a claim dismissing this kind of avalanche of data, you should put it in a spreadsheet and show us. Defend the veracity of this statement.
"Comparing the number of positive studies with the number of negative studies is a huge statistical fallacy"
1. That's not what anyone is doing, primarily.
2. The number of studies does give something like a first order demonstration of success, but the hcqmeta.com authors went to great pains to correctly summary the data together. The differential between the number of patients who died or deteriorated with and without HCQ is enormous, particularly in the early treatment studies!
"one single well-designed and we'll conducted study will be more accurate than the sum of hundreds of biased studies."
How are the positive studies "biased" (aside from your incorrect claim that the age groups are wildly disparate)?
And thanks to statisticians like Concato and Kraus, we know that after small number, retrospective studies give almost identical statistical power to results.
Thanks for the reply, I would like to address some of the points
"This is absolutely not true. You just made that up. That is not how p-values are computed or worked with. Nobody finds the probability of flipping 2 heads out of 20 by multiplying the probabilities of finding 1 head out of 20 (though we can compute convolutions for such discrete cases)"
Very well, I confess I did not personally check the graph and just reproduced the argument I heard from a cardiology professor. I retract my first paragraph (I would edit it out if possible), and will refrain to comment until I get a better grasp of what figure 1D is telling me
"In general, most studies do a good job of correcting for age differential, but the most biased in this regard were not the positive studies, but the negative (VA study, the Geleris study, etc.)"
I don't see how that fits with the data presented. Taking the largest studies:
Early Treatment:
Sulaiman, 5.541 patients (~30% of the population): Standard care group had 4.17% of patients >65, HCQ group had 0.55%, SC group had significantly higher pulmonary disease, hypertension, no data on obesity
Lagier, 3,737 patients (~20%) of population: HCQ group had 52.8% of patients from 18-44, 3.6% over 74, vs 36.4% 18-44 and 16% over 74 in the control group. Significantly more cancer, diabetes, heart disease, hypertension and respiratory diseases in the control group
Late treatment:
The largets study, counting over 29 thousand patients is Shoaibi, which was comparing famotidine with HCQ, and no mention of HCQ vs placebo o standart of care? Why is this even included?
Second largest, Fried, with 11.721 patients, shows harm in the use of HCQ. There are some disclaimers about it being retrospective and having methodological flaws (completely agree, but why the previous study, also retrospective has no such disclaimers, when Fried has been peer reviewed and Shoaibi,a pre-print has no such disclaimers?)
Third largest, Gonzalez, with 9644 patients, is not evaluating HCQ vs any other treatment, and taking the mortality data there you would conclude that corticosteroids are harmful?
Fourth largest, Catteau, with 8.075 patients, has a median age of 66 in the HCQ group, with 23% being >80, while the control group has a median age of 77, with 44% being over 80. Control group also has significantly higher Cardiovascular disease, Arterial hypertension, Chronic renal disease, Neurological disorders, Cognitive disorders and Immunosuppressive conditions
Looking at the descriptions of the positive vs negative studies, it seems very clear that a great amount of work is put in to find errors and sources of bias in the negative studies (And that's good! Peer review is excellent!), but whenever a study is positive, no such analysis is shown, with just a passing comment about what the results were. For instance, in the Gelais study, there is the following remark "Since patients with hypertension are at much greater risk of mortality (HR 2.12, see [1]), this appears to invalidate the results.", but why are no such remerks present in the larger studies I cited?
"Very well, I confess I did not personally check the graph and just reproduced the argument I heard from a cardiology professor."
This is not okay. You expressed a claim confidently, as if it were your own observation, and now slough it off on an expert. You have at worst admitted dishonesty in the course of evaluating an important medical claim, and at best pointed out the dishonest ineptitude of experts. The rest of your case doesn't read so well either, so it's probably good for you that you're writing anonymously. You should be ashamed, though I suspect you probably are not.
Before I dive into your critiques of the individual studies, I would like to make some observations.
As I mentioned already, we should be focusing on the early treatment studies. While these are 100%, and we could call it a day by saying, "All statistical analysis points toward early treatment being more effective than late treatment," you make two cherry-picked observations, seemingly dismissive of all of the rest of the data.
Your point about the larger number of extreme elderly in the Sulaiman study is addressed by the study in the statistical analysis, in the usual ways (multivariate analysis). We could reasonably [cut out the extremely old] and say that this research indicates clearly that giving HCQ+AZM (and zinc) to patients in KSA under the age of 65 results in a clear reduction of mortality since few patients older than 65, but that too few patients 65 or older were treated that way to make inferential analysis confident. But to act as if the study is otherwise biased is incorrect. And in fact, due to earlier treatment protocols, this analysis avoids the Simpson's paradox I bring up later…
While you bring up the 3,737 Lagier/Raoult patients, you failed to mention that the Marselleis UHI has now treated a five-digit number of patients over a long enough time frame that age demographics have balanced (they update their website weekly, which turns out to be a better source of overall analysis than the publications because there is simply more data and breakdowns of it), and that the disparity between the Marseille UHI's case fatality rate and that of larger France has grown in proportion since the Lagier study, not shrunk!
But the Lagier paper breaks down analysis into age subgroups for separate analysis. And in every single age group, those receiving HCQ/AZM therapy were FAR less likely to be admitted to ICU or die. Did you read this part of the paper and write what you wrote, anyway? Was the goal to be one-sided?
Dr. Raoult, most published researcher in history on infectious diseases, discoverer of more human borne microbes than any in history (around 500 out of 2500), who has written treatments for a dozen diseases, has lost only 4 of his last 10,000+ COVID-19 patients in Marseille where the month mortality rate is roughly double that in ordinary times! France had the highest CFR of any nation in the world through most of the pandemic. Numerous other doctors in the U.S. (Zelenko, Tyson, Procter, etc.) have reported treating thousands of patients early with HCQ and had scarcely few fatalities among them---a tiny fraction of the CFR of the U.S. epidemic. I could add to this doctors such as Prado in Brazil or Carvanna in Italy, or many others, who all seem to achieve similar results. Dr. Risch summarized some of these results, but there are additional sets of results he hasn't included yet in his publications.
Raoult has also taken charge during an disease epidemic and treated it, halting its progress. That makes him unlike most health officials around the world. What is the price tag for all the livestock slaughtered in the name of panic in the UK alone?
It might be worth thinking through why Marseilles loves Raoult, and showers him with affection.
"Looking at the descriptions of the positive vs negative studies, it seems very clear that a great amount of work is put in to find errors and sources of bias in the negative studies (And that's good! Peer review is excellent!)"
This is wrong on so many levels.
Just how good is peer review, anyhow? Nobody in the world with experience with both statistics and medical data could have bought into the Surgisphere paper at a first glance.
But let's add to that the Cavalcanti study. The researchers were at least open about the fact that they recruited a substantial number of patients from the ICU, where it was already believed HCQ had less of a chance to be effective. But critics forced them to publish a multi-part apology for numerous gross withholdings of critical data, including the fact that around 40% of the patients in the "control" group had received HCQ or AZM immediately prior to the "experiment".
Then there are the three Minnesota RCTs, none of which used an inert placebo. That's just not done in honest science. Ever! At least some premed undergrads in any classroom should call this into question, and that so many professional eyeballs let that fly represents a total failure of the scientific community! Those placebos (folate and vitamin C) are not yet well enough studied during this pandemic, but both are subject to positive reports and studies with substantial effect sizes. Even if the true effects turn out to be zero, the practice alone should be enough for us to cast doubt on the researcher responsible (who happened to have a Gilead relationship, which he happened to not mention as a conflict of interest until somebody twisted his nipple over it).
The rest of the study designs and executions aren't much better, including internet enrollments that led to (a) a young set of cohorts that likely dampened observed effects (meaning substantially more patients would be required to reach good statistical power), and (b) long enough delays in reception of the medication that it pushed the envelope of early treatment. Critics have pointed out both that the results would have been statistically significant (and positive) had the original number of patients planned been achieved, but that those treated within the first few days showed a time dependence curve one would expect from an anti-viral medication, and that the numbers taken in that context already achieved statistical significance.
Then there are the WHO studies which tested HCQ on very late stage patients, mostly on oxygen, without a macrolide (usually azithromycin) or zinc, and in doses far higher than those used by doctors in scores of nations around the world. How does that pass through anyone's bullshit filter as a good faith attempt at designing an experiment for the best possible use of a medication?! There is a lot more to be said here, but I'll save it for the book I've been working on.
So no, the negative studies do not look less biased. It certainly appears that many or even possibly most were designed to fail (though a few of them accidentally showed HCQ efficacy).
Now, let us talk about the studies you did cite.
First, regarding the Shoaibi paper (and many others). The results are already subject to a massive skew against HCQ that I explain in this conversation (at around the 15 minute mark) with science reporter Charles Platt, due to a Simpson's paradox that should be well understood by well trained statisticians, but probably isn't by many due to what we might call "requisite professional ignorance":
Note that not a single word has been printed about this obvious Simpson's paradox (so far as I've seen) by any of the journal editors. But I would not hire a statistician who didn't recognize it, and I employed one who did not, I'd fire them without hesitation. I might even phone their professors and chew them out. Lack of stratification by policy absolutely muddies the data, substantially, and necessarily in one direction. This is one reason to be skeptical of all U.S. studies that group hospitals together for retrospective analysis, and prefer those studies from nations with more uniform treatment policies. In general, such retrospectives have been almost uniformly more positive, as predicted.
Next, the majority of the Shoaibi text and tables are committed to propensity score analysis, which is to say that the statistical analysis is designed to compare cohorts with similar demographic profiles. So, your claim that "whenever a study is positive, no such analysis is shown" and "Shoaibi,a pre-print has no such disclaimers?" suggest to me that you are either incapable of reading research or that you didn't bother. What is your experience with medical research, anyhow?
Maybe you can slough that off on a cardiologist, too, eh? At least name them this time.
The Fried paper fails to stratify by policy, too, and in particular we can see the negative results come specifically from those in the latest disease stages. Ventilation mortality was 70.5% versus 11.6%, while twice the proportion of patients given HCQ were on ventilators. If we assume HCQ has no effect or a negative effect of patients on ventilators (perhaps due to heart stress...and the fact that nobody expects an antiviral to have much of an effect after the first few days of illness), then we have clear confounding by indication. That's exactly the Simpson's paradox. The entire study should be recast in that lens after separating out hospitals that used HCQ as "compassionate use" on only late stage patients.
The Gonzalez study does in fact include a multivariate analysis in order to more directly compare patients of demographics. Without that correction, there is a 50% reduction in mortality. After the correction, that is 26.6%. Still far better. Also...still a study on patients with progressed illness as opposed to those treated early.
"and taking the mortality data there you would conclude that corticosteroids are harmful?"
Not exactly. Spain thumbed its nose at the WHO and Big Pharma and made HCQ a standard of care. We should not assume then that the research on corticosteroids in patients not generally receiving HCQ as early should look the same. It may be that corticosteroids do less good for patients treated early enough with HCQ and AZM. It might also be that Spanish hospitals used different corticosteroids than those studied elsewhere. There are dozens of them, after all. At the very least, all we should say is that it would be nice to see a breakdown of efficacy of those used around the world.
We should also note that early treatment studies show far fewer patients reaching severe stages of illness where corticosteroids would primarily be administered.
In the case of the Catteau study, you repeat the critique of Schryver et al that was well answered by the original authors. The cohort size was large enough that propensity matching did reasonably still show a substantial effect. It is only reasonable to point out that the effect size is similar to those from studies in other European nations such as Italy and Spain that used HCQ therapy on a large scale. You failed to mention that there were no demographic subgroups of substantial size at all for which HCQ did not outperform! If it works better for the elderly, the middle-aged, and the young, that's something, even if the statistical power of such propensity matching lowers the statistical power of the study. Lower power for an individual study tends to fade in the meta-analysis as those studies are grouped together, with age mis-matches washing together in huge numbers. And that has been the case!
(Quotations taken out of order to make response more clear)
"What is your experience with medical research, anyhow?"
I am a physician with basic knowledge of epidemiology and biostatistics, as it pertains to my occupation. My main contact with biomedical research is doing a "sniff test" to see if the evidence provided for a given treatment is strong enough to warrant prescription, since often there's at least some incentive to make drugs appear better than they actually are. Mostly, this takes form as a strong bias aganist prescribing anything without support of an adequate "pre-test" probability of working and properly conducted studies
"This is not okay. You expressed a claim confidently, as if it were your own observation, and now slough it off on an expert. You have at worst admitted dishonesty in the course of evaluating an important medical claim, and at best pointed out the dishonest ineptitude of experts. "
What can I say? A professor who so far had been reliable told me that, and as I didn't have have reason not to trust him, I assumed it was true and didn't check. A mistake, to be sure, but one that is bound to happen again. I am glad to be corrected
"As I mentioned already, we should be focusing on the early treatment studies. While these are 100%, and we could call it a day by saying, "All statistical analysis points toward early treatment being more effective than late treatment," you make two cherry-picked observations, seemingly dismissive of all of the rest of the data."
Well, perhaps the method in which this discussion is being conducted is not being helpful for mutual understanding. I initially replied to a comment citing hcqmeta.com, and my commentary so far has been about that site in particular. Perhaps I should have made that more clear
I "cherry-picked" the two largest studies in the "early treatment" section, given that they were about 50% of the population. I considered commenting the bigger RCTs, but they were mostly negative, so I didn't have much to add. I commented on more of the late-treatment ones because there were more of them, and the population in was more evenly distributed among them
"Your point about the larger number of extreme elderly in the Sulaiman study is addressed by the study in the statistical analysis, in the usual ways (multivariate analysis)."
Correct me if I am wrong, but isn't multivariate analysis a tool to correct for known confounders, and not very useful for selection bias?
"This research indicates clearly that giving HCQ+AZM (and zinc) to patients in KSA under the age of 65 results in a clear reduction of mortality"
It could, but there were significant differences in comorbidities and location between the groups (I really don't know enough about KSA to know if there's a big wealth gap between regions). How do I know the difference in effect was due to HCQ prescription, and not because of one of those factors?
"While you bring up the 3,737 Lagier/Raoult patients, you failed to mention that the Marselleis UHI has now treated a five-digit number of patients over a long enough time frame that age demographics have balanced"
Well, there's no reference to that on the site being discussed and I had no idea that such data existed. I will look it over later.
"But the Lagier paper breaks down analysis into age subgroups for separate analysis. And in every single age group, those receiving HCQ/AZM therapy were FAR less likely to be admitted to ICU or die."
They did, but in a weirdly suspicious way. They split death/ICU into a >60y bracket, when the main imbalance is in >74y patients? HCQ group had 113/503 patients at the highest risk factor, while the control group had 99/199 patients. At the lower age brackets, was the difference in deaths/ICU transfers due to the treatment or due to an imbalace in comorbidities or lung damage at baseline?
There would still be more to comment, like the unbalance in nromal/severe CT at baseline between the groups. Did the control group fare worse because it didn't receive HCQ or because it was made up by sicker patients?
"Did you read this part of the paper and write what you wrote, anyway? Was the goal to be one-sided?"
The goal was to provide a short commentary on what could have been written in the comment at hcqmeta.com.
For instance, the Gelais study has the following comment: "Even if all propensity matched control patients had hypertension, the control prevalence would only be 14% compared to 49% for treatment. Since patients with hypertension are at much greater risk of mortality (HR 2.12, see [1]), this appears to invalidate the results.". Wouldn't the same kind of comment be warranted on the Lagier study? Why is there only one line saying "Early treatment leads to significantly better clinical outcome and faster viral load reduction. Matched sample mortality HR 0.41 p-value 0.048. Retrospective 3,737 patients."?
"So, your claim that "whenever a study is positive, no such analysis is shown" and "Shoaibi,a pre-print has no such disclaimers? suggest to me that you are either incapable of reading research or that you didn't bother."
It wasn't a claim on the discussions on the paper themselves, it was a claim about the commentary on hcqmeta.com, as explained above
"First, regarding the Shoaibi paper (and many others). The results are already subject to a massive skew against HCQ that I explain in this conversation (at around the 15 minute mark) with science reporter Charles Platt, due to a Simpson's paradox that should be well understood by well trained statisticians, but probably isn't by many due to what we might call "requisite professional ignorance""
It's comparing famotidine and HCQ and finding no difference between them, but why should I care about that? There's nothing on the paper comparing HCQ to standart of care or placebo
"The Fried paper fails to stratify by policy, too, and in particular we can see the negative results come specifically from those in the latest disease stages. Ventilation mortality was 70.5% versus 11.6%, while twice the proportion of patients given HCQ were on ventilators."
So, you're saying that the validity of a study becomes questionable when there are significant baseline differences between groups? I couldn't agree more. This is an observational study and shouldn't change anyone's practice. I commented on it because it was the largest one in the column
"The Gonzalez study does in fact include a multivariate analysis in order to more directly compare patients of demographics. Without that correction, there is a 50% reduction in mortality. After the correction, that is 26.6%. Still far better. Also...still a study on patients with progressed illness as opposed to those treated early."
Is that even relevant for anything? It's a retrospective cohort study to evaluate the prognostic value of eosinophil count that happens to have a table with HCQ on it. It wasn't designed, powered or preregistered to evaluate the impact of HCQ therapy on survival. If any drug company tried to convince me with this kind of analysis, they'd be swatted with a newspaper
"In the case of the Catteau study, you repeat the critique of Schryver et al that was well answered by the original authors."
Where can I find that response? Not doubting, but hcqmeta.com makes no mention out of it
"You failed to mention that there were no demographic subgroups of substantial size at all for which HCQ did not outperform! If it works better for the elderly, the middle-aged, and the young, that's something, even if the statistical power of such propensity matching lowers the statistical power of the study."
It's an observational study, how can you infer a causal factor by HCQ? How can you know "HCQ works better for the elderly, middle aged and the yound" and not "HCQ was given to less severe patients that would have had a positive outcome anyway"?
"Lower power for an individual study tends to fade in the meta-analysis as those studies are grouped together, with age mismatches washing together in huge numbers. And that has been the case!"
Don't you need well-designed, well-conducted studies with minimal risk of bias and small amounts of heterogeneity in order to produce a reliable meta-analysis?
HCQ starts off with a very low probability of working. Low-quality observational studies, whether positive or negative, are not enough to push that probability to reasonable levels, nor is success in small clinical trials. The same logic that leads me to conclude that redemsevir is not a very effective treatment for COVID, and is only discussed as a treatment due to outside pressures applies to HCQ. The larger RCTs with HCQ failed to show significant benefit, and even if they are full of biases, that's not an argument that HCQ should be prescribed.
> The experts successfully swooped in and saved us from all of that, figuring out which way the wind was blowing only two weeks later than competent amateurs. This was a useful service. Without the experts, things would have stayed open forever.
I don't understand how you can be as smart as you are and still think that "things staying open forever" would be a bad thing. Cities with no meaningful lockdowns and widespread noncompliance are having VIRTUALLY IDENTICAL outcomes to cities that locked down super hard. In some cases, they're having better outcomes (though my gut check is that this is just statistical noise). It is not AT ALL obvious that the 'experts' that California has delegated their critical thinking to have done anything other than perpetrate an absolutely massive crime against humanity.
Sweden vs. Lithuania is a great example. Sweden has some restrictions but nothing serious compared to other countries. Lithuania locked down hard and escaped the first wave. And yet, now their mortality is very close to Sweden despite having shorter life expectancy and reintroducing strict lockdowns again.
A big unknown. The same way why is Latvia almost twice as good as Lithuania, and Estonia again twice as as good as Latvia. They are very similar countries by culture, life expectancy etc. They introduced the same restrictions etc. There are some differences but it is not clear which factors played the role.
What was really interesting how much the governments of the Baltic countries gloated in summer how they did everything right and how stupid Sweden was.
Great article but it offers no proof for causal relationship.
I heard this argument in spring that if only the worst hit countries had started lockdowns a week or two sooner they would have avoided many deaths. Maybe it is true but then what happened to those many countries who seemingly succeeded in the spring and then failed in winter at the second or third wave?
Apparently it is very hard to time the start of the lockdown correctly. This hammer and dance was a good idea but in practice it largely failed like many other good ideas, like contact tracing; testing of all people – Slovakia did it twice; an app which will notify users that you have been in contact with an infected person; wearing masks – yes, mask are moderately effective but still didn't prevent a second or third wave in many countries. Lockdowns probably belong to the same category – moderately effective but have high collateral damage.
Sweden did differently and implemented policies that could work long-term despite the international pressure to abandon these policies.
This is, to put it mildly, incredibly terribly wrong. First, remember that even a little compliance can have a massive effect on the graph of connections between individuals, and Covid travels on edges, not on vertices. Start here: if you lock in place 10% of citizens, how many connections in % (defined as "two people being 2 meters across one another for 5 minutes or more") have you severed?
No country in the world did not encourage working from home, or social distancing, or did not cancel mass gatherings of any kind. There is no "placebo group" for Covid measures effectiveness other than countries in February with widespread circulation and close to no safety measures: Italy is an example, and look at the spike and the excessive deaths. Compare it with Germany in March/April, that reacted to the virus with a lockdown: unless you think that open vowels and good food make Covid19 outcomes worse, then this should be enough to recognize that lockdowns work, and work well.
Now, you could argue that lockdowns were somewhat excessive, and I agree it is a delicate balance, but lockdowns took place when Covid19 was a largely unknown virus and we only had partial numbers from China, of which, further, we had reason to be suspicious. Planning for a reasonable worst case scenario is not wrong, even when that scenario turns out to not be the real one.
(oh, and now we have B117 for which, it looks like, lockdowns are barely enough.)
What explains in your opinion that, in places like Italy, cases doubled every 3 days until the lockdown, then 10-15 days after the lockdown was introduced, they plateaued, and then started to decrease? Why didn't they keep increasing exponentially, if not because of the lockdown? It's not that they reached herd immunity: there was a big second wave in the fall.
The only argument I've seen to the effect that the lockdown orders were unnecessary is that people voluntarily sheltered in place on their own initiative anyway, even in places without a lockdown order. That would negate most of the benefit of a lockdown order, but it would also negate most of the harm.
Scott, the best systems for combating COVID aren't ours, but the ones in the countries that got COVID right. These are, variously, China, Vietnam, New Zealand, Mauritius, Singapore (outside migrant worker dorms), North Korea (apparently), Australia, Thailand, Taiwan, etc. Japan, the Philippines, South Korea, Cuba, Norway, Finland, Denmark, Cyprus, Mongolia, etc. did better than average. The question is not to burn the system down or not, but whether to move to a better system. I propose a government by superforecasters, because superforecasters seem like people who know what they're doing.
"There are few biologists who deny evolution, few epidemiologists who think vaccines don't work, and few economists who are outright communists."
Low bar. Let's raise it higher.
"This should be astonishing, and we are insufficiently grateful."
We got half a million deaths and counting. That's twice as good as Russia per capita, but it's worse than Brazil and far worse than the Philippines. It's impressive by precisely zero metrics.
Are you saying that only people who are highly successful in prediction markets should vote? While in theory this sounds interesting, in practice there's no way to get there.
The US had such a disastrous response because of the existing leadership, selected by the existing population, with their existing Overton Window.
"While in theory this sounds interesting, in practice there's no way to get there. "
The most plausible way to get there is to simply create an advisory council of superforecasters and to steadily give it more and more power, much as what happened to the bureaucracy and judiciary.
So, we set up a group: "The Council of Superforecasters" and hope it goes the way of the bureaucracy and judiciary over the next 100 years, instead of the way of the Office of Technology Assessment?
As it is, getting Congress to consult "The Experts" is hard enough. "The Experts" even have financial and social capital behind them. People who just happened to do really well on betting websites seems like a much harder sell
Government by superforecasters is hard (look where Dominic Cummings got by trying). I'd rather have government by prediction market, and let investors with deep pockets hire the superforecasters and make sure they're driving the prices.
One of the big things I like about the idea of futarchy is that it's a mechanism focused primarily on *what* rather than *who*. I think if you focus on "who", your mechanism will become corrupted by politicking -- so if you try to put experts in power, the route for politickers to get into power will be by becoming "experts", which they'll do by confounding your society's ability to actually distinguish true from false. OK, I'm a bit wary of running with that conclusion, which would seem to suggest you should never have governance based on expertise, as we do seem to have some, as you say, mediocre ways of doing it. Still, I think moving away from government-by-people and towards government-by-mechanism is a good thing.
Dominic Cummings didn't meaningfully try to put experts in charge or use mechanisms like prediction markets. He talked a good game, but whenever it came done to actual decisions he went for the answer that supported his ideological team
Which is possibly also a lesson, that people who aren't swayed by normal political incentives can still have political biases of their own. So shouldn't be taken at face value
One consequence of this kind of thinking is that its interesting to look at different incentive structures, and see where they have better results. The first comparison I thought of for this was countries with public healthcare systems. For example the nhs.uk has a similar to webmd encyclopedia of common conditions, drugs, etc. Which seems much clearer to me as a non expert. eg the page on aspirin says its mostly safe, and lists common side effects with the context that they are rare. https://www.nhs.uk/medicines/aspirin-for-pain-relief/
I don't think this is because public healthcare systems are magically better, (and please don't make this thread into an argument about m4a). My best guess for the difference is:
If you are a National Healthcare Service you have access to huge numbers of government lawyers on retainer, and massive institutional power, so the risks and potential of being sued are much lower than for someone like webmd.
Also, for webmd, someone with a headache deciding they have an obscure cancer does you no direct harm, but if you are a public healthcare provider they will be taking up your time and resources. So presumably someone did the calculation that it was better to stop those false positives and deal with the occasional complaint.
And on the individual level, a large organisation can shield people from bad incentives. Presumably these pages were written by employees of the health service (probably in committees) who reported to higher up adminstrators, not dealing directly with the end consumer. So they could be given an instruction "write clear and concise advice" without the political issues trickling down to them.
So maybe the takeaway is that as well as there being a function of being too small to care you can also be too big to care? If Fauci was the american health tsar he would give better advice, though that runs into the benevolent dictator issues. The brits don't seem to have done so great with covid advice, so maybe the protection only works when things don't get too political
There's also the fact that the NHS is somewhat insulated from the political sphere. Formally, the governance as a non-departmental public body seems to be set up in such a way that her majesty's government can't micromanage things. Informally, a politician who tries to restructure the NHS tends to make a lot of enemies.
My big problem with the expert response was the lying -- statements early on like "don't wear masks because they don't work", which was an obvious lie to keep people from panic-buying masks, only to then mandate masks later. Followed by "we just need to lock down for 6 weeks to flatten the curve", followed by "we'll probably still be locked down at the end of 2021". Or the refusal to talk about honest tradeoffs - "this is how many people will likely die if we don't lock down. This is how many people will probably permanently become poor if we do."
The American people did, in fact, elect an idiot game show host. However, we were given the choice between an idiot game show host, and possibly the most unlikable person to ever run for office. Hell, this time around, the Democrats chucked any candidates that were even remotely interesting, and seems so hell-bent on telling the millions of people that voted for Trump that they are ontologically bad people that need to be scorned and punished. That's how you get someone far worse but more competent in 4 years.
I agree wholeheartedly that tearing down the system and assuming that somehow people that care about things other than power will magically rule us benevolently is a pipe dream. But it seems that both the far left and far right have lost all hope that things can look less than shitty for them and their kind in the forseeable future, so they're willing to chance it. This is something that the current administration, if they were competent at all, would attempt to diffuse.
This is a great post, thanks! That experts, institutions, and other avatars of Consensus are a weighted-like-a-ball-and-chain average of the views of the rest of society is a really cool and powerful idea. So is the point that they aren't inherently dishonest or unprincipled-- it's just that the Institutional Power Genie shows up and replaces them if they get too principled or honest.
But I have three reservations.
1. Who exactly is the Institutional Power Genie that hypothetically gets Zvi fired as CDC Director? Since we live in a democracy it must represent some actual people, right? But it clearly doesn't represent you and Zvi. And it doesn't represent your Straw Rednecks either, because they're, shall we say, not Biden's core constituency. The charitable interpretation is that it represents some third group, Straw Bluenecks who think the virus is real and bad but either are risk-averse in a very particular way that makes Zvi unacceptable to them, or just get a lot of utils out of knowing that Very Serious People are in charge. The uncharitable interpretation is that the Straw Bluenecks are just Fauci in a trenchcoat-- that the institutional, power-seeking mindset has become self-perpetuating by getting itself unfairly weighted into the average. I favor the uncharitable interpretation.
2. If Zvi's proposals are in practice not implementable by real-world institutions, then how are we supposed to interpret them? After all, a lot of what he (and everyone) posts really does amount to "here's what I would do as a benevolent dictator" not "here's my advice to you, a private person, as a friend". Is he trying to change people's minds to shift the weighted average? Or is he saying the average should be weighted differently-- toward him? To the extent that he succeeds in shifting the average, how concerned should we be that some illegible blogger can shift the average just by being popular and insistent? To the extent that he doesn't succeed, how concerned should we be that his posts are just a form of outrage-mongering entertainment?
3. What does it even mean to say that someone is "illegibly good" or "illegibly bad", if it's misleading (due to illegibility) to imagine their beliefs actually being implemented? Good or bad for whom? Zvi's advice is good for us, maybe, but that seems to just boil down to saying that we agree with it. How would we convince Straw Redneck's audience that it's good for them? Wouldn't we have to appeal to consensus-- i.e. Fauci? And if so, why are we still trying to shift Fauci's position toward our own? This model, when you work it out, actually seems to support Weyl's point of view: the benefit of Fauci, insofar as there is a benefit, is that he's legible to the broadest possible range of people.
1. I don't know enough about politics to be sure, but my guess is somebody who is basically a slighty worse version of Anthony Fauci, is gunning for Zvi's position, and has lots of allies in high places.
2. Partly we can intepret them as private individuals, eg whether or not we should get the vaccine, how much we should social distance, et cetera. Otherwise, perhaps as conditional statements, like the conditional prediction markets on the Metaculus post earlier this week - "if you vaccinated people this way, it would save a lot of lives".
3. I'm not sure where you're getting this from. I think it's objectively true that if you followed COVID policy A rather than COVID policy B, it would save more lives. We can't objectively know that it's true with total certainty since we can never see both branches, but sometimes we can be pretty sure (ie it seems like shutting the borders while it was still limited to China would have been good). Overall not sure what you're asking here.
1) In a word, normies. People who think in more bureaucracy-friendly ways, many of whom will be bureaucrats (public or private) themselves, and who think that "untested", "not properly reviewed", "risky", and "irresponsible" are synonyms. The sort of people who turn into helicopter parents with their kids, NIMBYs with their neighbourhoods, and Helen Lovejoy's infamous "Won't somebody please think of the children!?" in their politics. Zvi would drive them apoplectic, by bulldozing all of their concerns in favour of his grand vision.
And in their defense, "bulldozing all opposition to implement their grand vision" is a process with a truly *awful* history in practice. Lincoln's "Seven nays, one aye; the ayes have it" is a rare (and possibly apocryphal) case. The best common case is Robert Moses, and Lysenkoism is the common failure mode. (And the extreme failure mode is Pol Pot). I think Zvi is more right than Fauci here, but that isn't something we can generalize. The precedent is genuinely a dangerous one.
2) If you think of his policy proposals as a vector, the magnitude can be impractical while the direction can still be wise. And by convincing people of his full proposed vector, he can help create political pressure in that direction, and thereby move even the power-minded.
3) If you were to ignore the process and posit an absolute dictator over the issue, we think that Zvi's stated preferences would solve the problem substantially better than Fauci's stated preferences. However, it would be very difficult to convince a layman of that, so his superiority in that hypothetical is illegible to a real normal person here and now.
The way we would hopefully convince the Straw Normies of this is to create a discussion that pushes the expert consensus in this direction, with the goal of that trickling down to normies. (Other options exist in principle, but we are not good at public relations as a community, so it's difficult for us to influence the masses without taking some kind of high ground directly through relationships with elites.)
There's another aspect to what Dr. Fauci does -- He isn't there to dispense the truth to the masses, he's there to make statements to the masses that will cause them to do what is optimal relative to Dr. Fauci's plan. Within that goal, he tries to avoid saying anything that is actually false.
For instance, early in the epidemic there was a real risk that the public panic-buying masks would vacuum the supply chain empty of them right at the moment that medical people needed far more of them. So the statement was made that there was no solid evidence that masks worked against Covid, which was true but any person who attempted to analyze it would realize that masks were likely to be quite effective. Readers of this blog will probably notice that is an attempt to avoid the tragedy of the commons -- for each individual, buying a mask as quickly as possible is the optimal choice, but also preventing others from buying masks is also optimal.
aMore subtly, the optimal plan depends on where one is in the economy. As a computer programmer, the cost of an intense lockdown is personal nuisance. For a restaurant worker, it might be homelessness. Someone has to strike the balance between those competing interests, and that's a lot easier to do if you disguise that it is being done.
Everything here reminds me of this Fantastic Anachronism post last month -- despite the horrible track record of replication in social science we should still default to trusting credentialed experts because it's better than any alternative https://fantasticanachronism.com/2021/01/12/unjustified-true-disbelief/
I'm really glad you're writing on moral mazes. I've been troubled by Zvi's simulacra work for a while now: he seems to be saying important things about what happens to adversarial systems, but the end result is so bleak. I had to go back and re-read the goddess of everything else to remind myself about the power and beauty of cooperation.
I would be very grateful for a theory that harmonizes Zvi's work with Elua's power. This article is a good first draft, but I long for hope that the Elons and Zvis of the world aren't anomalies, that the quokkas can learn to protect themselves and the slytherins can become great philanthropists.
I generally agree with this, but: I don't think it's always been this bad. Back during WW2, for example, we seemed to have competent leadership. We put Vannevar Bush in charge of military research, and that worked out great. I think something has gotten worse over time. And it's worth trying to figure out what that is and why it happened.
> When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
I think it's really more complicated than that. I haven't been on the 'other side' of public decision very often in my life, but I have a few times through my job at a tech company, and I know these kinds of things almost look unrecognizable to an insider, compared to an outsider.
My tech company example is, say, a widely-publicized product launch to which the general public assumed a lot of fair things, the gist of which is that we were insane and had no idea what we were doing. In fact, the true explanation was completely unrelated to that -- that the target of the launch was a type of enterprise customer that was alien to the public.
I can imagine many forms of this that might happen for a Fauci public statement that take different directions than "maintaining power". For one thing, in the early days of the pandemic, it was truly not clear in the data how serious it was. A random person can say: "oh, I have a feeling this is much worse" but the CDC / whichever officials can't. They have to balance their gut against the data they have, their internal policies, and the fact that if they say something extreme it carries a lot of weight, which means shouldn't be wrong both for logistical reasons and to maintain credibility.
There's just nothing on the line for an individual making predictions. When you end up in a position of great influence, there's a lot on the line, and you have to be much more careful. Rationally, of course, it would make the most sense to overcorrect for harmful outcomes, and spend more resources than needed. But then what happens if you're wrong, and a lunatic congress comes at you for budget cuts decrying your uselessness? (And this doesn't even broad the question of what the right behavior is when you're trying to avoid completely losing Trump's ear. The "Case Against Fauci" article thinks it's not worth it, but I'm pretty skeptical.)
I'm just saying -- it's just not just being right and being in power. "Being right" looks very different for a public official in a political situation than it does for a blogger.
I'm discovering Substack doesn't let you edit comments yet, so I guess I'll append: I meant "it's not just a choice between being right and being in power".
Those are the only economists who are correct, though. Remember Scott that in your own reading of Marx you could not seem to comprehend his basic sentences and instead deferred to Peter Singer's own (incorrect) analysis. This is politics as the mind-killer, as the Rationalists say.
>What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong.
Where did Marx say anything like that? Using quotes from primary sources please. Otherwise you are creating a strawman (as usual).
Now that I think about it, Marxists don't have a history of tearing it all down and hoping something better will be built. They have a history of tearing a lot down and thinking that if they're in charge they can do better.
What I've been seeing lately on both the left and the right is what I call tearitdownism*-- a belief that things are so bad that destruction can only lead to improvement. I think this is a fairly modern development and more of an emotional change (quite a frightening one if it gets common) than an ideological change.
*Is this what people mean when they talk about nihilism?
For Marxists it has nothing to do with an "emotional change", it has to do with a logical analysis of capitalism's flaws. Where the abolitions who thought they could do better than slavery tearitdownists?
Hi Scott, long time reader. Really like your writing.
But I've noticed a somewhat distressing tendency in your recent posts (by which I don't really mean just the ones on substack) and I think it's getting worse and so I will speak up. I notice an increasing frequency of things like this:
"But someone else will decide to always trust *their* friend, a guy in a MAGA cap who says coronavirus is fake and Dr. Fauci is a Satanist. "
"At one point we tried a very simple best-person-picking procedure that really should have worked and ended up choosing Donald Trump as the best person. "
"Our system of expert-having is actually much better than we deserve, given that we elected Donald Trump president."
And I have to wonder if this is necessary or even good, or if it is just dabbing on trump supporters because it feels good. Is the point you are trying to make actually best served by including a MAGA cap, or is this just exclusionary to some of your potential audience? Politics is the mind-killer.
This seems to be about the kind of fun dunking on silly ideas that Scott's been doing in an equal-opportunity fashion forever. (And he did write *You Are Still Crying Wolf*.) I'm not American and have no dog in the fight, but from what I can tell the thoughtful people who supported Trump did so with a level of caution such that they could have earnestly agreed with all those sentences *and* pulled the lever for the guy for complicated reasons. There's some overlap in the readership with reluctantly Republican anti-war *American Conservative* types -- for instance, Rod Dreher, who's sympathetic to the reluctant Trumpists but isn't one himself, has cited Scott a few times -- but I don't think this blog is a likely hangout for "true believer" MAGAists who Scott risks alienating here.
The MAGA phenomenon is now a necessary trope for contemplation -- I would argue just as historically necessary as the mindset behind Hitler's enablers and apologists.
The "thoughtful but reluctant" supporters of the past president tended to believe in grand, dramatic, anti-democratic sentiments such as the Flight 93 justification for storming the cabin: the whole plane may crash into a field, but that's way better than Hillary!
The plane did crash, but still the fascistic phenomenon stubbornly persists (see the state of today's remaining GOP). Many of Hitler's supporters across the German countryside stayed loyal decades after the war, and likewise the MAGA stain here will take much time and effort to mitigate -- and it's the duty of smart, creative, communicative citizens to call it out directly, as a matter of fact, without apology or fear of offending those who erred by supporting a monster.
Google still filters results based on your IP and browser even when you're in incognito mode. Without the quotes, my first Google result is Nuvance Health with the snippet, "The Centers for Disease Control and Prevention (CDC) is the main place to go to for reliable and useful information about COVID-19 in the United States." Meanwhile, Bing gives me a Marquette University essay with the conclusion "We have to accept what the experts say."
(With the quotes, Bing gives me no results, and Google gives me this post.)
"The whole scientific-technocratic complex is a machine which takes Moloch as input and manages - after spending billions of dollars and the careers of thousands of hard-working public servants - to produce Anthony Fauci as output. This should be astonishing, and we are insufficiently grateful."
That kinda sounds like a proof-of-work blockchain. It consumes vast amounts of resources, but that's not (just) because it's inefficient, it simply takes a *lot* of effort to defend such a system from attacks with our current technology.
Do you think that locking your household down two weeks early as a good decision? It doesn't seem like one to me, though as the pandemic lengthens it kind of seems like well, two weeks here and there, who cares? But just in the spirit of self-reflection, didn't you lengthen your personal pain at a time when the chance of infection was essentially negligible?
If you know anyone who has been tempted to despair about supposed 'failures' of the western, liberal world order and its institutions over the last year then I'd encourage you to send them this. Whether something is considered acceptably good depends on what you compare it to - what we have now is clearly far better than what we would get by burning the system down. What's more interesting is whether what we have now is better than what we had in the past - and there's evidence (from things like the way the polio vaccine rollout was much faster in the 40s than our rollout today) that there are a few aspects of the current expert-selecting institutions that seem to have regressed, or not kept up with the increasing difficulty of the problems handed to them.
I think it's worth noting that the historical comparisons aren't ever to us actually succeeding at dealing with pandemics in the past, but to things like "WWII-style" efforts - i.e. thinking that if we could just do x as well as we once did y then things would have been a lot better. This implies that if you made an institution analogous to e.g. the weapons researchers of WW2 and the governments that funded them, or NASA in the 1960s, without copy-pasting 1940s/1960s society wholesale, the outcome would have been better.
To me that suggests its institution design that's the culprit, and that there are ways to filter our legible experts to be better that we've missed out on.
But even in making that kind of comparison, we're already back in the sane, concrete realm of institution design and trying to patch up the system we have with tweaks we know might give us better experts more reliably, rather than the ethereal realm of comparing the whole of our society to some imaginary alternative.
> Whether something is considered acceptably good depends on what you compare it to - what we have now is clearly far better than what we would get by burning the system down.
That's still somewhat past-oriented analysis. The future shows a lot of rot, with all the oddball behavior of the blue victors, general increasing insanity, and woke takeover of K-12, and the establishment's increasing blind hostility to the red tribe. The system of a couple years back may not have needed burning, the future one may very well need it.
I'm lucky enough that I have had no reason ever to use medical services in the US, so I can't comment on that. But I have had quite a bit to do with the US political system professionally , and have had a chance to see how it works (it doesn't). It's an almost uniquely dysfunctional system, massive, labyrinthine, highly politicised and personalised, where it's hard to know who is in charge of what, and decisions take forever. Irrespective of who your political leaders are, I think your country is going to have a terrible time coping. Most of the states that have coped well have strong, professional and well-managed public services which draw a strict line between career and political appointments. (Singapore is a good example). Countries that used to do that but don't any more (like Britain and to an extent France), have suffered worse as a result.
But it isn't just the political system(and of course sheer luck plays a big part as well). You have to take into account the social capital of the country and the willingness to work together (again, most Asian countries have done well for this reason, but so has New Zealand). You also have to take into account political culture, and what seems important not only to politicians but to the whole PMC and media classes. The rest of the world watched in stunned disbelief as these classes in the US descended into severe Trump Derangement Syndrome, and stayed there, even while the epidemic was ramping up. But we had problems in Europe as well. Closing frontiers was essential but not done nearly quickly enough for reasons of political culture. Partly this was the EU's neoliberal ideology of open markets and borders. Partly it was the identification of frontier controls with nationalism (hiss) and even Trump (double hiss), which meant that if you supported them you were a Xenophobic Nazi Fascist. "Viruses don't have passports" smirked one European politician, who I think is out of a job now.
On Scott's wider point, I found his remarks uncomfortably apposite because I've suffered from a couple of these dilemmas about getting information on medicines. For the last fifteen years I've been taking blood thinners (first Fluindione, which is like Warfarin, and then Rivaroxaban). I was warned about not taking aspirin as well, and then I was told not to eat certain foods (bananas for example) rich in Vitamin K, and then as I began to read around, I discovered that most foods have an effect of some kind. Since I'm intolerant of gluten, I realised quite quickly that I was as likely to die of hunger than of blood clotting, and in the end I took a personal decision to eat a normal (but gluten-free) diet, on the basis that one thing would cancel out another. I'm fine and don't show any symptoms of uncontrolled bleeding for example. But nobody tells you anything useful. Nobody says how precisely this or that food affects the fluidity of the blood, for how long or in what combination. I've been told not to take Ibuprofen. Fine, but does that mean not even once, at 200mg? Or does it mean not continuously at a higher dose? If I take one for an inflammatory problem, will I die? Nobody seems to have any idea, or if they do they are not telling.
And I've been a chronic insomniac, probably for longer than most of the readers of this blog have been alive. There are two kinds of doctors in my experience. Good sleepers, who tell you to make sure you have a dark room and get plenty of exercise and you'll be fine, and won't prescribe anything, and insomniacs, who know that insomnia is terrible for general health, and that sometimes, lying awake at 4am and wondering how you are ever going to make it through the day, you start to think that suicide may be the easier option. The latter will prescribe something. So I've been taking Bromazepam from time to time, and, as Scott's wonderful new site points out, it's been argued that even small doses will kill you. I'm still alive, and I think I'll choose my own method of dying than you. Indeed, I think the only thing you can do is to try and see what happens. In Europe the problem with medical advice isn't quite so serious, perhaps, as in the US, but it's pretty serious. I've pretty much given up hope of getting any useful advice from medical sites, and I'm much more inclined to try something that has demonstrably worked for someone else. So I eagerly took up Scott's suggestion of Theanine, and took 500mg before bed (that was the only dose I could find). I was awake half the night and finally gave up. Any other suggestions gratefully received, but I'm going to try them for myself, not just be guided by websites that produce lots of words but no actual help.
It's not at all obvious that travel bans had much of a benefit. The virus arrived in Europe well before anyone realized it was a big deal. At the same time, later during the pandemic there have been many pointless border restrictions, such as countries banning or restricting entry from countries with similar or lower case loads.
It depends which countries you are talking about, and in many cases major outbreaks were linked to individuals or small groups, often returning home from abroad. But the point I was making is that travel bans were opposed from all parts of the political spectrum not because of doubts about their usefulness but because they offended against the ideologies of those opposing them. To a much greater extent than anyone realised, perhaps, idealists had gained the upper hand over consequentialists in political debate.
> But the point I was making is that travel bans were opposed from all parts of the political spectrum not because of doubts about their usefulness but because they offended against the ideologies of those opposing them.
That makes no sense: not all or even most parts of the political spectrum are ideologically opposed to border restrictions. As far as I recall, there was some ideological opposition to travel bans, but it didn't dominate the discourse.Rather, what I recall is right-wing ideologues asserting there wouldn't be any travel bans because of the globalist ideology, to be proven wrong: Curtis Yarvin asserted on Jan 30 that no one could say that travel from China should be banned because of internationalist ideology; the US and Italy banned it the next day.
January 31 was around the time most of the World even started to realize there was a serious problem. Travel bans were by far the earliest intrusive measure against the pandemic in the West.
>When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
As an excellent example of this, look no further than Professor David Nutt. Nutt was a Fauci-esque figure in the UK: he was, at one point, an advisor to the Ministry of Defence, Department of Health, and the Home Office, as well as President of the European College of Neuropsychopharmacology.
He also had no interest in optimising for keeping allies and power, and used his government positions to go around telling theh public exactly what the science said about addiction, illegal drugs, and so on.
He was rapidly fired for this, with several senior government figures accusing him of "talking about politics rather than science" -- which, ironically, was precicely the opposite of what he was doing.
Perhaps you should use a kind of Captcha in order to access your site? Instead of identifying 'all instances of porpoises waiting at stop signs', it could be a randomised test of the ability to reason statistically?
'If you can't pass this test, here's a helpful site where you can find out how not to misunderstand what I'm giving you..'
A very strong post, without a doubt the best you've written since your comeback.
There's a profound truth to the idea that only people outside a corruption-based system such as politics can regularly find and speak truth. Constant excellence is possible only on the individual level; mix in groups of people (with inevitable bias and selfishness) with varying incentive, and what you get is a compromised mess.
To remain a priest of Poverty (whether in an economic, social or political sense) who can always wager most, or to give up the vows for real gain? That is the question, and God knows it's not an easy one.
The biggest issue to me is that our system (particularly in medicine) has very few mechanisms for punishing over caution and lots of mechanisms for punishing good faith bold action. As a result, everyone with anything to lose is in maximum CYA mode at all times.
In a pandemic (or a war, or any other complex fast moving crisis) inaction is often just as deadly as incorrect action. But our medical establishment totally dropped the ball on switching to a “war footing”, instead acting as if minor relaxations of the normally truly Byzantine approval processes were bold acts of heroism. How many lives would have been saved if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V? No one will be punished for these tens of thousands of bodies, but if the vaccine had merely saved a hundred thousand while causing a couple hundred birth defects or whatever, heads would have rolled. This is absolutely backwards.
Of course it would be one thing if Fauci were merely over cautious - but he didn’t only make “WebMD errors” of excessive ass covering. He, by his own admission, told 2 big lies (or at least things he was pretty sure were untrue): “you should not be walking around wearing a mask” and “modulating my estimate of herd immunity based on what I think people will believe”. And beyond Fauci, “Racism is a bigger threat than COVID, so protests in a pandemic are justifiable”. That was not a WebMD error.
We have medical experts to deliver medical expertise. Perhaps we accept a bit of politicking and over caution as a cost of doing business. But when experts start openly lying because, hey, they’re experts, you wouldn’t go against science, would you? That shatters public trust in expertise. Fauci maintaining power might be good for him, but it’s bad for everyone else because half the country isn’t going to listen to him, and that’s in good part his own fault.
> How many lives would have been saved if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V?
Probably fewer than you'd at first expect. As I understand it, Moderna and Pfizer were both establishing production lines in parallel with the approval process. The approval step delayed the start-point for vaccines going into arms, but deliveries have already caught up to current production. Earlier approval would have just resulted in a period of genuine shortage (in the US -- there's still shortage in more or less every other nation that can't access US production facilities.)
You don’t think Moderna and Pfizer were pacing their production ramp up knowing that approval was still months away? There was no incentive for them to engage in an expensive crash program just to have production lines ready to sit idle. And how much time was spent “building a functional production line” vs “getting the FDA happy with the production line”? (I genuinely don’t know that answer).
In any case - we could have done better. We probably could have done better enough to outweigh the risk of going faster by at least a couple orders of magnitude. But there was apparently insufficient incentive to do so, and lots of reasons not to.
As I understand, AstraZeneca started building manufacturing capacity from the moment it signed the contract with the government and received pre-payment. The EU signed such a contract 3 months later than to the UK and it has manifested in delayed vaccine deliveries to the EU.
Early regulatory approval probably was not that important, whereas generally being more proactive with investing into development, pre-orders even if knowing that in some cases the investment will be lost, actually has made a difference.
Now even the EU is trying to order a Russian vaccine but they have capacity issues just like all other pharma companies. But who knows, if instead of sneering, the EU without any delay had ordered Russian vaccine the moment it was approved, they would have much more vaccine available right now.
> if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V?
What do you mean by the time Sputnik V was approved? As far as I understand, it wasn't widely distributed until December; the August 11 "registration" was more of a publicity trick.
Do you think having more prestige for working in government bureaucracy would increase the correlation between gaining power and capability? East Asian countries seem to do a decent job of having competent officials and these things are much more prestigious there.
Really amazing writeup and there are a lot of valuable points in here. I'd like to give a bit more attention to this point since no one else has:
"Or maybe I'm dumb and biased, and actually the experts are doing much better than Zvi"
I don't think that's true in general, but after reading through Zvi's blog there is an error that could have cost thousands of lives if Zvi were in charge. He thinks that at least one of the vaccines should have been open source.
If Zvi is a tech worker, then it's easy to see where he's coming from. In tech you want a thousand flowers to bloom, and the best survive. Doesn't matter if one product sucks, only the good ones will still be on the market in 3 years. Well medicine isn't like that - move fast and break things does not work.
Medicine is built upon trust - and trust is hard won and easily lost. If 5 startup vaccine manufacturers compete to produce the vaccine doses as fast as possible and just 1 of them screws up that's a huge problem. Perhaps 5% of doses are ineffective due to insufficient QA or perhaps some of the doses result in higher rates of side effects. Well then the entire well is poisoned - news stories come out, politicians on the left and right seeking easy political points lambast vaccine producers, anti-vaxxers see a golden opportunity to move public discourse. Perhaps it doesn't kill vaccine production entirely, but public trust falls, investors and regulators become wary and vaccination decreases.
And all that for what purpose exactly? The companies best able to reliably ramp up production of millions of doses are the companies that have already done that in the past. And they have done that with rigorous QA that they've been forced to develop after hundreds of failures and lawsuits. Open sourcing would not significantly increase production and it would introduce unnecessary risk.
Now perhaps I'm misunderstanding him, perhaps he doesn't really mean open source - just that any established pharmaceutical company should also be able to secure a contract to make the vaccine - no exclusivity deals. I doubt that would actually change much. All of the big players interested in vaccine production seem to already have jumped in, and they've all chosen their champion. And the reason is simple - economies of scale. It's cheaper to produce 10 million of one kind of vaccine than 5 million of one and 5 million of the another.
The problem with balancing optimization for truth and optimization for power is that such compromises might not be stable. Individual people's ability to find the truth is judged by the very institutions in which they're trying to advance. So the more institutions optimize for maintaining power, the lesser their ability to find the truth, including recognizing people with the theoretically optimal balance of truth-seeking and power-seeking. As the capacity to recognize truth degenerates into noise, power-seeking becomes ever more important until it's all that's left.
If power can feed on the corpse of truth-seeking, but the reverse is not true, sooner or later truth will be devoured.
> The second reason I'm writing this is because people keep asking me "should we listen to experts"?
I think you're missing a step here. Experts, especially in a policy realm, are applying a different standard of proof than you are.
Locking down your house, for example, made sense as soon as you thought it was more likely than not that it would be helpful. Maybe an even lower standard (a precautionary principle) could have applied, since the consequences of a covid infection could be so severe.
On the other hand, issuing this kind of directive for an entire region imposes costs on other people. If you're wrong about your own house, then you and your housemates voluntarily pay the price; if you're wrong about policy then everyone pays.
Therefore, mandatory orders do (and should!) use a higher standard of proof, somewhere between "clear and compelling evidence" and "blindingly obvious."
Where we fail, however, is that we don't allow experts to offer sub-certain judgments. Fauci can't go up and say "we think school closures are a pretty good policy, but we're not yet certain about it." In my opinion, this happens for two major reasons:
* First and foremost, society-writ-large is not comfortable with ambiguity. Some of this is cultural (see the general confusion over election predictions, where 55% is treated as a certainty); some of it is also personal because people have limited bandwidth to perform their own risk/reward analysis.
* Second, "wrong" predictions, even when advertised as uncertain, tarnish expert credibility. Some of this is an outgrowth of the first point on ambiguity; some is a response to an adversarial environment where other motivated actors (political opponents, charlatans, conspiracy theorists) amplify failures. This is where I think your analysis on the politics comes into play, as well, and the end result is to retreat into a defensive certainty.
In turn, this has two negative policy implications:
* The first is a retreat into process. "Experts" can't always speak in hindsight, so defensive certainty prompts agencies to develop rigorous policy for drawing conclusions. Even if the conclusion is wrong, as long as the right steps were followed then the experts can claim success. See for example medical approvals. We know now that the major yet-to-be-approved covid vaccines are more likely than not to be helpful, but experts won't bless that decision until the right steps have been followed to certify the proof.
* The second implication is a strong status quo bias. The status quo is no lockdown, so there must be compelling evidence to prompt one. The status quo is no masks, so there must be compelling evidence to recommend masks. The status quo is no covid vaccines, etc. And after said compelling evidence, the policy prescription becomes the new status quo, equally unshakeable. This leads to the oft-maligned "eggs are good, bad, good, bad" flip-flop, and it also gives undue power to whoever can define the status quo -- often a political choice that we as a society don't really consider.
Little here has to do with the political realities of placating stakeholders. Instead, so much of it derives from an inappropriate (or even impossible) demand for certainty, including our instinct to conflate certainty with correctness.
Maybe a comprehensive civics education should include a long module on Bayesian-style reasoning (maintaining uncertain priors and updating with new information) and the Kelley criterion for wagering (relating the size of one's stake to both expected benefit and expected variance).
Before finally giving up on trying to convince my non-SSC friends of the wisdom of Zvi, I gave this analogy (mostly about FDA approval):
There's a water delivery man who normally delivers at 1 mph. There's a drought and he manages to get his speed up to 2 mph, saving twice as many people. But I think while very unpleasant for him, he could have gone 10 mph. Should I be happy he managed to double his speed or sad at the shortfall of what I thought possible?
I think some amount of it is about what should our emotional reactions be to inadequate equilibria in the world. Is frustration and anger a good source for driving change? Or is equanimity and understanding of bad incentives?
By what standard to we judge Fauci: Zvi or Lysenko?
Alex Tabarrok has mentioned this a little bit, being thankful for Warp Speed, but still pressing for more.
Should we focus on feasible alternatives of conceivable ones?
Maybe the answer is both, but it's easier to digest in separate posts, or separate speakers. Zvi can depress us about all the things that could have been done, and remind us that there is so much more possible. Scott can cheer us up by reminding us that we did okay giving the existing constraints in place.
We actually can infere what Zvi would do if he became director of the CDC. He wrote it several times. 9/3 "Burn it to the ground. CDC Delenda Est." (https://www.lesswrong.com/posts/RF5HjYYLY5FWgtA9v/covid-9-3-meet-the-new-cdc), 9/24: "CDC Delenda Est" (https://www.lesswrong.com/posts/E8fp7BxpuzcwaMGtz/covid-9-24-until-morale-improves), 12/17: "CDC Delenda Est" (https://www.lesswrong.com/posts/Rvzdi8RS9Bda5aLt2/covid-12-17-the-first-dose). So I suppose Zvi is your friend "pitchfork in hand, trying to burn down the system". And maybe the Fallacy does not seem to be Marx's Fallacy, it's possibly some Marxists' fallacy and possibly some other ...ists' Fallacy, and maybe "..." can be "Trump" but it can also be "Rational"; after all, your own folks never optimize for power. Making some very smart people a world dictator may make the world a Well-Kept Garden from his/her perspective. But given that this whole rationality community talks a lot about the problem that it's really hard to define a utility function that does not turn out to optimize for something you did not want in the first place, I think it could be slightly more modest with regards to politics.
"Just get the best person in the country and let _her_ fix everything"
Which is a correct statement because women actually are better leaders, on average. See, this is why I like to read you, nuances like this one and the hundreds I probably don't catch.
In that trolley problem, it’s worth noting that the out of control trolley is going to round the bend and kill all six people either way. That’s a common problem in illustrations of the trolley problem.
Additional problem with installing your friend as world dictator is that a lot of the reason they succeed is there working with good information and if there world dictate a lot of people will be very interested in warped there information diet
Prediction markets are not better for policy issues like covid, climate change, poverty, etc. Markets are great for aggregating information on parochial issues like the price of gold, the present value of a corporation, and all the various baskets of these things. To have a successful prediction market you need a metric that measures what good-faith people really care about. Political issues like climate change or poverty necessarily use intermediate goals that are deficient.
Many are subject to Goodhart's law, which states that any statistical regularity will collapse once pressure is placed upon it for control purposes. For example, Mao maximized steel output in the 1950s to modernize his economy because the best economies had high steel production. It was a disaster because the prioritization of steel production over everything else ignored marginal costs which would be reflected in the profit-and-loss system used by decentralized economies.
Covid deaths are bad, but so too is shutting down the economy, preventing people from seeing friends and family. These costs are difficult to measure, so one can always dismiss them, but they include not merely psychic costs, but real deaths. We can give everyone an education, but the value of this declines the more it is put into a national policy, and many now have useless degrees and much debt. CO2 production is bad, but invariably it is measured piecemeal, ignoring fixed costs, and counting negative externalities for one process while ignoring the negative externalities for another.
If Biden proposed a new Middle East peace policy, a market in Middle East peace would be of no value. The same is true for any of our great issues of debate: racism, sexism, inequality, the environment.
> Covid deaths are bad, but so too is shutting down the economy, preventing people from seeing friends and family. These costs are difficult to measure, so one can always dismiss them, but they include not merely psychic costs, but real deaths.
The deaths at least can be subject to prediction markets: have bets on how many people will die in total in a given year if we choose one policy or another. (The bets on the policy we don't end up choosing are refunded.)
How to weigh deaths vs preventing people from seeing friends and family is a difficult question, and can't be decided with prediction markets, but we can still make a better decision if at least we have better estimates (from prediction markets) on the inputs we can measure in numbers, such as how many lives lockdowns save.
The current Western protocol of attributing all deaths to covid based on a presumptive diagnosis, or having been diagnosed using 35 cycles in a PCR test prior to death, has no precedent: how many dead old people have trace amounts of a flu or cold virus? Now with the vaccine, subsequent deaths are automatically presumed non-covid. There are financial incentives for hospitals and long-term care facilities for attributing death to covid (instant guaranteed payment at 2x the usual rate), and there were clear political incentives for creating a crisis, as it hurt Trump and opened the door for various initiatives supported by those who dominate media and academia (Build Back Better, Great Reset).
11 months ago, I naively thought that 'covid death' would be relatively immune to this sort of chicanery, and so recently lost a $1k bet with Robin Hanson on this.
Again, the issue of how deaths are attributed to causes is avoided if we have prediction markets on the total number of deaths (from any cause) in the event of different measures.
That would be better, in that it would get around the cause of death politics, and also count the iatrogenic therapies like aggressive intubation, which had a 99% mortality rate for people over 65 last spring. But note that wasn't an obvious concern at first, highlighting it's hard to know ex-ante what metrics are best.
This doesnt quite correlate w my experience following epidemiologists and virologists.
Late January I had a flu and Wuhan was a story already, so that was a way to enjoy a respiratory disease, by considering the chances of a pandemic. I was following 'This week in Virology' podcasts reading up on early cases of community transmission on flutrackers.com (did they catch all the contacts of this or that tourist from Wuhan? Oh no, this early case in Thailand infected a taxi driver, and this case in Japan was a guide a tour bus etc), There were R0 studies giving various numbers mostly between 2.5 and 3, and existing (flu) plans indicated NPIs are unlikely to control the spread of something >2. If anything, this turned out to be pesimistic. By Feb.4. I had bought a few months of food supplies (recently checked the date on that receipt), to be able to stay home during peak transmission. I was hoping it wouldn't become a big deal here in Europe before Spetember, if they managed to catch early transmission and warm weather being just aroung the corner, until Italy happened. Though w Iran (Feb 19th) it was clearly a pandemic, as epitwitter at the time explained. Also expected mortality was in the range of 0,5% to 2%, already.
Overall, I think listening to the chatter of experts, and immersing oneself in the discoruse was a good way to stay well informed about this pandemic. Quite possibly the official statements of government bodies were far more conservative, exobiting high normalcy bias.
This is a fair point - experts as individuals seemed to have a better read on things than institutional boards. I think Scott has a post on that phenomenon somewhere, where most scientists' beliefs are more accurate than 'scientific consensus'.
This matches my experience, but note that Professor in Epidemiology at 2nd tier university is much closer to optimizing for truth than director of the CDC, but it is the latter that we employ to get things right.
Also, I think most experts in February were locally right, i.e. had a good guess about R0, but were not able to connect the dots, e.g. even semi-privately endorsing border closures.
The problem is worse than you describe, because in many cases what we are looking for is polymathic expertise. For the efficacy and side effects of psychiatric drugs, we need psychiatry and pharmacology and general medicine - and since psychiatrists are MDs, a good psychiatrist gets us most of what we need. But for pandemic response, we need epidemiology plus sociology, economics, education, politics and not just in the how-do-I-stay-in-power sense, and more other fields than I'm going to try and enumerate here. Some of that we need to know if a proposed intervention is even feasible - sociology tells us how long we can keep people locked down before they start going to private house parties or mass political rallies instead of bars. Some of it we need to know whether the proposed cure is worse than the disease - how much harm does a year of zoom-schooling do to the long-term life prospects of elementary, middle, and high school students?
But it's hard enough finding legible but mediocre expertise in one field, that we generally call the job done when we find a Dr. Fauci. Fauci, working within the limits of the political system we have, is a mediocre expert in one thing. The one most important thing of the past year, perhaps, but not more important than all the other things put together. Not good enough.
Polymathic expertise does exist, and it's not *that* hard to find if you're looking for it. Zvi, for example. Or Scott. But broadly legible polymathic expertise, is very hard to come by.
Scott give prediction markets lots of credit lately. Is there a good source that argue why we should give it this credit and not just treat it like another random idea that sounds nice but probably doesn't really work as advertised, like blockchain?
(If you think that blockchain is not just another trend, same question)
That would be a fairly good format, though it should also include where a symptom falls on the annoying to fatal scale, and also whether the symptom goes away if you stop the drug.
However, people have brought up the question of how the information about symptoms is gathered. And I don't think anyone has mentioned the need to update it now and then.
Re: not worrying more about addiction to Adderall than alcohol: Most people don't drink every day [citation needed]. They drink occasionally at social events. Adderall is recommended to patients to be taken regularly for some period, isn't it? If I drunk every day, I'd definitely be worried about the possibility of getting addicted.
I'm a layman who knows basically nothing about either Adderall or alcohol addiction. My point is that your comparison is not easy to interpret for someone who has never drunk regularly, and has never had a reason to investigate how much one can drink regularly without getting addicted.
What about Medscape. Appears much more professional and informative and less "political". I generally use it for medical questions. Haven't tried it for mental health issues.
“a kind of bumbling careerist with a decent understanding of epidemiology” is harsh for someone who was lead editor of Harrison’s. I mean, sheesh. Dude’s not a saint or Einstein but he seems pretty smart. I mean, not as smart as the economists who all seem to know marginally more than anybody about anything...
I agree about the general problem of power inviting corruption, but I think you're being far too kind to the current system.
Burn-it-downism actually works a lot better than I'd naively expect. The Bolshevik Revolution led to Stalinism, yes, but Stalinism involved possibly the most successful economic development program ever - mortared, of course, with a great deal of blood, but not the implosion one might have predicted. Even attempts at outright anarchy haven't ended with everyone starving to death. The bigger issue is violence, which revolution always causes and which our current systems are reasonably good at preventing. Of course, an anarchist would argue that the entire thing is built on the *threat* of force, but being held at gunpoint is still better than being shot.
But - with simulacra levels and all that - we currently have leaders that are detached from reality entirely, which is the reason for the uptick in populist sentiment, with the aura of revolution and violence that's always implied. When Congress has an approval rating below 25% for ten years straight, it really shouldn't be surprised to get a lynch mob at its gates. You talk about Fauci not being Lysenko, but Lysenko was very much the exception in the USSR; Fauci isn't Korolev, either, and I'd say Lysenko has closer analogues in the modern American public service than Korolev (something something bioethics). The Attila the Hun comparison is misleading because Attila was leader, not expert, and honestly I'm not sure Trump is all that far from an Attila in temperament. Not that we actually know much about Attila, historically. I could say something about Tamerlane and US foreign policy, but I don't really have any well-formed thoughts on that. The point is that the positive elements you're talking about are institutional successes fifty years old; I mean, even Fauci himself isn't exactly a new appointment. Possibly this is because the Cold War USA faced an actual threat in communism, and before that the Axis, and therefore had to acknowledge physical reality to fight them.
And you could say that, sure, our society's current paralysis is bad, but it's still better than risking things on any big changes because those can backfire, and basically that what we have is good enough. This is called conservatism. The problem with that, even if you're of the opinion that <gestures at planet> this is fine, it's not *stable*. Technological change leads to social change, sustainability is more than just a buzzword, relying on imports from increasingly poor countries has a natural endpoint, and if it takes ten years to repair one highway intersection our infrastructure will eventually fail entirely. We need utopianism in our discourse - we need multiple competing utopias - because otherwise we're reduced to using the literal worst expert ever as the bar our experts need to jump. And we probably need the threat of a mob with pitchforks (preferable distant, but with present dysfunction a more immediate one seems to be required) to make our elected and unelected leaders actually optimize for something besides power - in layman's terms, do their jobs.
"but Stalinism involved possibly the most successful economic development program ever - mortared, of course, with a great deal of blood,"
That's wildly false. Compare Japan and Russia c. 1910 and Japan and Russia today. For a still more extreme example, compare Russian growth from the beginning of the communist regime to the end with Hong Kong growth from 1945 to 2000, which gets you well past the point when per capita income passed that of the U.K.
I'm not going to quibble over GDP figures (apparently Japan and the USSR had comparable growth rates 1910-1950, and comparing Hong Kong to Russia is absurd), but broadly, the USSR being the world's second superpower, the second nation to build nukes, and the first spaceflight is not something that one would expect from its state in 1910, even accounting for its size. (How quickly living standards improved is a somewhat separate question, of course, but I doubt that's the part Stalin cared about.) There's a custom on both the Left and the Right to say Stalinism was economically disastrous, but I've become increasingly convinced this is the just-world fallacy in action.
None of which, of course, ameliorates the mass murder, totalitarianism, arguable genocide, et cetera. But morality and competence are not the same thing.
Morality and *success*, I wanted to say. Not individual competence, but results.
Anyway, I concede that I may have overstated my point in that sentence. Stalinism was very successful, to the point that no historical comparisons besides the PRC come to my mind, at *something*, and it's probably not correct to call that something economic development, but it's related.
There is surely also the principle of the low hanging fruit at work. The more primitive a nation is at the start the steeper its curve of improvements can be, especially if other countries already have implementations to copy.
> Burn-it-downism actually works a lot better than I'd naively expect.
Wait, you're holding up bolshevism as an economic development *success*? It was falling behind the growth rate of similar countries, rather than going faster, so that seems a bit strange.
This is a fantastic line of inquiry. But, doesn't it bump up against anti-culture war imperatives? It has all the trappings of previous ones: expertise vs. non-expertise, authoritarianism vs. individualism, and seems to also land on standard left vs. right spectrums
This isn't kind, but it's true and I think adds something specific: the two times I've met Zvi in person (at rationalist-adjacent meet-ups in NYC, three years apart) I found him arrogant and unpleasant, to such a degree that it really stuck with me. Like, loudly declaiming his opinions and derisive toward anyone who disagreed with him. I'm generally pretty unbothered by non-neurotypical people, but that didn't feel like what was going on. I think it was just a difficult, non-collaborative personality.
I haven't read his blog much so maybe he's much easier to hear in writing. But I also wonder if these traits are somewhat correlated with being right about something early and loudly and also anticorrelated with the skills it would take to affect the world outside of, say, the rationalist-adjacent blogosphere. I also worry it leads to worse, un-dampened outcomes when he's wrong. Somewhat related to the broader "competence" point that others mention.
(This is really an unkind thing to say, so Scott please feel free to delete if you think it doesn't add enough to be worth it.)
I remember reading a really good article you wrote about a book you read on Marx. It was really insightful to me, but I got the feeling that communism could be fixed by more carefully thinking about the problems on a system like that, maybe using simulations, etc. But it seems you heavily dislike communism and I would like to understand if you see a problem with the core idea of the workers owning the means of production and also the redistribution of wealth.
I don't know much about Marx, although I agree with most of his capitalism criticism, which I got second hand. But I follow a lot of marxists, and most of them don't really seem to have a solid idea of what a communist society would look like, except for some key points. If I press some of them, what they say seems a little like what Scott interpreted too: they think everything would be solved the conflict and resolution happened and things ended well in a new order (I don't understand enough of the revolution to agree or not). I like the idea of communism, though, but I heavily disagree if people think things will just work. I would like to understand whether there are good arguments that even planned communist systems wouldn't work, or if there is some marxist intellectual who really thought about that and have a decent plan (someone recommended me Rosa Luxemburg, it's on my to read list).
>When Zvi asserts an opinion, he has only one thing he's optimizing for - being right - and he does it well.
>When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
The senior officials in the CDC are (both reasonably, and according to their own claims,) optimizing for *saving lives* and keeping power. Sometimes, the thing they do to try to save lives is shut up about true things, or even say false things. That seems to be what happened with masks; they were trying to manage an economic supply/demand system to make sure hospitals and healthcare workers, who were at higher risk, had masks, and that the general public didn't go out and buy them. Was this a bad idea? In retrospect, obviously it was - but more critically, truth is a harsh mistress, and it seems that you can't serve two different goals, even when the first goal is honesty, and the other goal is public health.
This post really exemplifies the saying "damning with feint praise." Sure, the experts are consistently wrong but that's only because they are optimizing for something other than being right! Come on, man. I don't know why you defend these people.
>The Director of the CDC reads those same papers. But some important Senator says that if airborne transmission is announced, important industries in his state will go bankrupt. [...] So the Director puts out a press release saying the evidence is not quite strong enough to say airborne transmission definitely happens, and they'll review it further.
Not saying this isn't true, but I wonder why these pressures aren't balanced out by countervailing pressures. The correct press release could harm the important Senator's state, but should greatly benefit the average citizen, so the important Senator's objection should be counter-balanced by the support of many other Senators (who should profess their objection to fire the CDC Director). This is why we believe representative democracy has a chance to benefit citizens at all. If other Senators will not resist the Senator's pressure, it means they need his support for something else, more important. In the end, this should theoretically (ideally) work out for the best compromises to benefit everyone. And when something is very important, like covid, we should expect to see fewer decisions related to it being compromised for something else.
What is the reason it doesn't work out that way? Irrationality? Politicians representing not the interests of their constituencies but their donors/lobbies? Rigid structures, e.g. the Senator in charge of CDC appointments was decided before it was so important, and now can't be changed?Something else?
OK - so the system as a whole produces mediocre expert advice - the question is can we (whatever group smaller than the general popupation that 'we' represents) develop a system that would give us better expertise?
Feel like the driving factor for a lot of this is chance. There are a vanishing number of competent people and a vast sea of incompetents. If you have a mechanism for competence selection that is in any way imperfect, you're getting an idiot.
"Maybe expertise is a sham, and a smart guy thinking for five minutes can outdo a decade of working on a PhD."
I think about this a lot with respect to my field: urban mobility. I have a PhD in operations research / transportation, I work at an urban mobility startup, and I spend a nonzero fraction of my free time learning about urban mobility. I know a lot about this area. And yet, I know approximately nothing that you couldn't realize by looking out the window and thinking sufficiently deeply about what you see.
But most people - even in the industry - haven't realized many of the things which are realizable just by thinking hard. So can a smart person thinking for 5 minutes outdo a decade of learning? I suppose for a sufficiently smart person, yes? But sufficiently smart is a high bar. In mobility, time investment seems to serve as a substitute for something like "raw smarts" or "wisdom," a way to crowd source deep thoughts. In practice, everyone needs at least some time investment.
(Example of something that most people don't seem to have internalized, but should be obvious to us all if only we were all wise enough: for most intra-urban origin-destination pairs served by multiple transit modes, most of the modes should be approximately equally costly (including non-monetary costs) most of the time! E.g. if it were easier and faster and cheaper to go A -> B by bus than by car, people would shift car -> bus, the bus would slow down and become more unpleasant, traffic would decrease and thus car travel times would decrease, etc.)
I think not all fields are like this. E.g. no amount of staring out the window and thinking hard could reveal to me that human cells use DNA to store genetic information.
Just on a really narrow point it seems like both your recs and the recs from WebMD could be dramatically improved by adding a dime numerical score of how bad the side effects are. This allows one to both give a detailed summary of all the side effects and not require denying their importance while still giving a general sense of danger level relative to other drugs (forcing those who say this drug ruined a family members life to essentially debate the ppl claiming other drugs ruined lives they know).
> rather than being minimaxed for COVID-prediction
So this essay is great, but you've hit one of my pet peeves; you're using the word "minmaxed" wrong.
Minmaxing means something pretty specific; it doesn't just mean "optimized". For example, when I evaluate positions in a chess game, I assume my opponent makes the worst-for-me ("min") moves they can make and that future me makes the best-for-me ("max") moves future me can make. In short, it's only natural to use "minmax" to describe a situations where I'm trying to do something despite the actions of something else which I'm assuming is trying to thwart me. (Granted, technically we could call it minmaxing where there's a mathematically trivial opponent who doesn't do anything, but it's still a misleading word choice, like calling something a pentagon when you totally know it's a square and then defending your word choice by saying that one of the five sides has length zero.)
If you're trying to do something but there is no opponent (like covid prediction), the word "optimized" is a better fit than "minmaxed".
Here’s how I use medical article databases. I’ve had x problem which the small-town PCP was ignoring. So hours on WebMD and similar gave me enough background that the next time it acted up I went to the ER and said “I think this might be a hernia” (they did an ultrasound, I was right.) Did that for a few other things. We can’t all access actual experts, so I need just enough info to get through to the doctors in front of me who can treat - prescribe, order tests, etc. Those databases are great for that.
I felt like crap for a month and couldn’t get any answers from docs and hit the databases. Compared bloodwork and got “why do they say nothing is wrong when the Internet says these numbers are metabolic acidosis?” Then more googling and it was possibly a side effect of a medication, so I did a taper myself and felt a little less crappy. I will never know if I was “right” but I burned less days feeling like crap. The databases are like a 2nd amendment for medical knowledge. We can arm ourselves. That being said, more info is better.
Excellent article highlighting the sloppy content on WebMD. It's a trash shite selling snake funded snake oil. Nobody with an iota of critical thinking takes this site seriously. WebMD is literally a lousy joke of the online world.
I don't think it's really a corruption thing that led Fauci to F up. Birx clearly wanted to stay in her job and thought that her being in place was better than Trump installing a 100% yes man. For Fauci, and the rest of the CDC, FDA, and NIH I think there's this massive status quo bias that is hard to overcome. Working in pharma it is clear that regulators and doctors want to be really really confident about something before they do it, even if the risk of them being wrong is no way near as severe as not doing anything. I think that's what happened with lockdowns, masks, at home antibody tests, etc. Until you could get a sufficient amount of data to be bulletproof (for non-delusional people/denialists) they won't do anything.
I don't think anyone thinking COVID was the killer virus that the WHO made it out to be at the beginning can reasonably judge experts.
Well, maybe not. I suppose it's the same conundrum for Scott Alexander as for Fauci. If he ever openly says that COVID was a false alarm (which it was) and the response a massive civilizational fuck up the likes of which you won't find in the history of the planet until now (which it was and is), he would lose a lot of his supposedly "rational" audience.
> Expertise isn't a sham.
Tetlock begs to differ: https://spot.colorado.edu/~huemer/papers/passivity.htm
"In light of the ignorance of typical political leaders and members of the general public, we might be tempted by the idea of rule by experts, as in Plato’s Republic. 18 Unfortunately, when it comes to descriptive social theory, even the experts’ knowledge is unimpressive, as demonstrated recently by the social psychologist Phillip Tetlock. Tetlock conducted a fifteen-year study in which he collected tens of thousands of predictions from hundreds of political experts concerning matters within their areas of expertise (for example, would the economy slide into recession, would the Soviet Union survive, who would win the next Presidential election, and so on). Tetlock’s finding, in brief, was that the best experts did only slightly better than chance at predicting outcomes. When asked to assign probabilities to their predictions, experts proved systematically overconfident; for example, events predicted with 100% confidence happened less than 80% of the time."
I don't think this is a fair characterization. There are definitely subjects where expertise is real (infectious disease is probably actually one of the clearer-cut ones). Much of Tetlock's work is about identifying which subjects have real expertise and which ones don't.
What I quoted did note, "when it comes to descriptive social theory". I think it was Scott's claim that "Expertise isn't a sham" which isn't a fair characterization and is too broad. There's a separate and more complicated philosophical question of whether mental health fits into social theory or neurophysiology.
Medicine, even physical medicine, still seems much less scientific than something like aerospace engineering. As Greg Cochran & Nassim Taleb like to point out, doctors were on net harmful for most of the very long existence of their profession. And "public health experts" if anything seem to be more captured by political activism than your typical never-heard-of-Bayesian-probability doc.
My impression is that public health experts were pretty impressive when public health was a major concern -- say, during the Panama Canal era of the first half of the 20th Century.
But as infectious disease became less of a problem, public health experts tended to become more politicized and less useful. Few public health experts in the 1980s dared enunciate the chief cause of the AIDS epidemic in the US, Gay Liberation, which led to a lot of unnecessary paranoia among heterosexuals who had never been close to Castro Street, Santa Monica Boulevard, or Christopher Street. And in recent decades, public health experts who, deep down, know better, have shamefully countenanced the popular myth that AIDS was, somehow, due to the supposed homophobia of Ron and Nancy Reagan.
Wasn't the AIDS crisis actually a big problem caused by infectious disease? My understanding is that it was the biggest cause of death for adults under a certain age. Granted, it was highly concentrated in certain populations and not actually as prone to "breaking out" as the experts warned.
Polio got worse during the 20th Century in the US, with the 1952 outbreak being the worst in US history. My vague impression is that the post WWII fight against polio was more or less the climactic chapter of the heroic age of the struggle against infectious disease, which had included the triumph over yellow fever at the Panama Canal.
Over the next few decades, public health, especially in the US, became more routine. That's a good thing, but it also meant that less top talent flowed into the field and practitioners got less practice at dealing with novel crises. Perhaps this caused problems when AIDS and COVID came along?
Interestingly/bizarrely, there are or were a bunch of qualified experts who believe(d) that AIDS is not caused by HIV. They believe both exist but that HIV is a relatively harmless virus that was in effect 'framed' by bad science. The people in question had long careers in virology, microbiology or in one case as a journalist who covered the AIDS epidemic over a period of about a decade for a major national newspaper.
One of their many arguments is that it shouldn't be possible for a virus to express a preference for homosexuals, or at least not for very long, because they're too small and simple to be able to 'know' the orientation of their host. The long-predicted break-out into the heterosexual community never happened. Even today most AIDS cases are gay and male, except in Africa where AIDS affects both genders the same. This is also posited as being inexplicable if African AIDS is the same phenomenon as western AIDS, because again, a virus is too small and simple to prefer men in the west but have no gender preference in Africa.
Past tense used because I'm not sure if those people are still around. I found out about this because one of them was the inventor of PCR testing, but he's dead now.
The name familiar to me for that is Duesberg, and I believe his argument is that AIDS is actually caused by drug use, which was common for many of the victims at the time. The difference between sub-Saharan Africa and the rest of the world does seem odd. Here's the one theory I'm aware of to attempt to explain it: https://www.overcomingbias.com/2010/02/africa-hiv-perverts-or-bad-med.html
> Few public health experts in the 1980s dared enunciate the chief cause of the AIDS epidemic in the US
Early named for AIDS were literally "GRID" for "gay-related immune deficiency" and "4H" for the four groups (including "homosexuals") among which it initially clustered.
You can't seriously claim no one was considering orientation when they literally named the damn thing after it and then got a whole New York Times article to themselves entitled "NEW HOMOSEXUAL DISORDER WORRIES HEALTH OFFICIALS" (https://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html)
But of course this comment section being what it is, this claim got five upvotes despite this being common knowledge among anyone with even the slightest familiarity with the history of AIDS. Hey, fellow lurkers, I suggest you look up this person's name and tell me if you think that's the sort of person you want making undebunked claims in your intellectual space.
Obviously, the doctors and scientists dealing with Castro Street AIDS patients in the early 1980s knew how it was being spread.
Over the years, however, the Establishment has managed to obfuscate, such as by angrily denouncing anyone who points out the history, the role that Gay Liberation played in AIDS. So that today few seem aware anymore of the historical connection. I wouldn't be surprised if more people today thought AIDS was caused by homophobia.
Your claim wasn't about today. You literally said:
> Few public health experts *in the 1980s*
If public health experts are talking about it in the New York Times, it's not a victim of a hypothetical early-80s cancel-culture. Plain and simple.
---------
As to the rest of your claim:
I believe, and would discuss and have discussed with other members of the queer community, that being the receptive partner in anal sex is the riskiest common sexual activity with respect to HIV transmission.
No one (well, almost no one, there's always a crazy person or three) objects to this claim. You'll find this claim in a pamphlet on the table in every student queer group in America, in the waiting room of every LGBT-inclusive therapist's office, in the sidebar of every LGBT subreddit. I know this because I spent a good chunk of my 20s in those rooms and got really, really sick of it. And in fact, we can go to the CDC website right now (https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html) and find exactly that claim in black and white:
"Anal sex is the riskiest type of sex for getting or transmitting HIV.
Being the receptive partner (bottom) is riskier for getting HIV than being the insertive partner (top)."
So your claim, basically, is that the feared "Establishment"'s best shot at suppressing news of the risks of anal sex is to promote them in every channel it has. If that's their best shot, well, I don't think you have much to worry about.
It seems rather likely that if we had legalized gay marriage back in the 1970s, HIV would have been less severe in the gay community.
The gay community was (and is) both promiscuous and engaged in the most dangerous type of sex (anal sex) regularly. It is still the highest risk factor in the US. The second highest is being black - 42% of HIV diagnoses are in black people, and it is likely actually worse than that because black people are probably less likely to get diagnosed because of anti-doctor sentiments in the black community.
Gay liberation wasn't really the issue; gay promiscuity was.
Aerospace engineering was also net-harmful before the 20th century.
There wasn't nearly as much of it as there was medicine.
"infectious disease is probably actually one of the clearer-cut ones"
Doesn't seem like it.
This is a mischaracterization of Tetlock's work which he himself has rebutted in the first chapter of Superforecasting
> But I realized that as word of my work spread, its apparent meaning was mutating. What my research had shown was that the average expert had done little better than guessing on many of the political and economic questions I had posed. “Many” does not equal all. It was easiest to beat chance on the shortest-range questions that only required looking one year out, and accuracy fell off the further out experts tried to forecast—approaching the dart-throwing-chimpanzee level three to five years out. That was an important finding. It tells us something about the limits of expertise in a complex world—and the limits on what it might be possible for even superforecasters to achieve. But as in the children’s game of “telephone,” in which a phrase is whispered to one child who passes it on to another, and so on, and everyone is shocked at the end to discover how much it has changed, the actual message was garbled in the constant retelling and the subtleties were lost entirely. The message became “all expert forecasts are useless,” which is nonsense. Some variations were even cruder—like “experts know no more than chimpanzees.” My research had become a backstop reference for nihilists who see the future as inherently unpredictable and know-nothing populists who insist on preceding “expert” with “so-called.”
And, it should be noted that not all experts were equally overconfident. Tetlock found that experts who used a particular framing 100% of the time were systematically overconfident and bad at forecasting, while experts who used multiple different framings of the issue and a variety of different philosophies of analysis were much more accurate. He dubbed the former "hedgehogs", and the ladder "foxes".
> One group tended to organize their thinking around Big Ideas, although they didn’t agree on which Big Ideas were true or false. Some were environmental doomsters (“We’re running out of everything”); others were cornucopian boomsters (“We can find cost-effective substitutes for everything”). Some were socialists (who favored state control of the commanding heights of the economy); others were free-market fundamentalists (who wanted to minimize regulation). As ideologically diverse as they were, they were united by the fact that their thinking was so ideological. They sought to squeeze complex problems into the preferred cause-effect templates and treated what did not fit as irrelevant distractions. Allergic to wishy-washy answers, they kept pushing their analyses to the limit (and then some), using terms like “furthermore” and “moreover” while piling up reasons why they were right and others wrong. As a result, they were unusually confident and likelier to declare things “impossible” or “certain.” Committed to their conclusions, they were reluctant to change their minds even when their predictions clearly failed. They would tell us, “Just wait.”
> The other group consisted of more pragmatic experts who drew on many analytical tools, with the choice of tool hinging on the particular problem they faced. These experts gathered as much information from as many sources as they could. When thinking, they often shifted mental gears, sprinkling their speech with transition markers such as “however,” “but,” “although,” and “on the other hand.” They talked about possibilities and probabilities, not certainties. And while no one likes to say “I was wrong,” these experts more readily admitted it and changed their minds
> ...
> Foxes beat hedgehogs. And the foxes didn’t just win by acting like chickens, playing it safe with 60% and 70% forecasts where hedgehogs boldly went with 90% and 100%. Foxes beat hedgehogs on both calibration and resolution. Foxes had real foresight. Hedgehogs didn’t.
How did hedgehogs manage to do slightly worse than random guessing? To answer that question, let’s meet a prototypic hedgehog.18
> Larry Kudlow hosted a business talk show on CNBC and is a widely published pundit, but he got his start as an economist in the Reagan administration and later worked with Art Laffer, the economist whose theories were the cornerstone of Ronald Reagan’s economic policies. Kudlow’s one Big Idea is supply-side economics. When President George W. Bush followed the supply-side prescription by enacting substantial tax cuts, Kudlow was certain an economic boom of equal magnitude would follow. He dubbed it “the Bush boom.” Reality fell short: growth and job creation were positive but somewhat disappointing relative to the long-term average and particularly in comparison to that of the Clinton era, which began with a substantial tax hike. But Kudlow stuck to his guns and insisted, year after year, that the “Bush boom” was happening as forecast, even if commentators hadn’t noticed. He called it “the biggest story never told.” In December 2007, months after the first rumblings of the financial crisis had been felt, the economy looked shaky, and many observers worried a recession was coming, or had even arrived, Kudlow was optimistic. “There is no recession,” he wrote. “In fact, we are about to enter the seventh consecutive year of the Bush boom.”19
What an excellent reply. Thanks for spending the time to add it.
Thanks. I will ask Dr. Huemer to see what he responds.
That would be very cool. If he has any criticisms I'd like to know them.
As I was crafting my message to Dr. Huemer, I fail to understand what he mischaracterized. He wrote that experts' knowledge is "unimpressive" and characterized Tetlock's research as "the best experts did only slightly better than chance at predicting outcomes".
Is that incorrect? Your paragraphs on foxes and hedgehogs were interesting subset analyses but didn't cite any numbers. Did foxes do much better than chance?
Tetlock writes, "The message became “all expert forecasts are useless,” which is nonsense"
But I think this does not apply to the linked Huemer paper. Huemer ends with accepting that experts are often the best that we have:
"Political leaders, voters, and activists are well-advised to follow the dictum, often applied to medicine, to “first, do no harm.” A plausible rule of thumb, to guard us against doing harm as a result of overconfident ideological beliefs, is that one should not forcibly impose requirements or restrictions on others unless the value of those requirements or restrictions is essentially uncontroversial among the community of experts in conditions of free and open debate. Of course, even an expert consensus may be wrong, but this rule of thumb may be the best that such fallible beings as ourselves can devise."
I'll preface this by saying I only know that Tetlock thinks that
> As I was crafting my message to Dr. Huemer, I fail to understand what he mischaracterized. He wrote that experts' knowledge is "unimpressive" and characterized Tetlock's research as "the best experts did only slightly better than chance at predicting outcomes".
Here's a graph summarizing some results from Expert Political Judgement https://imgur.com/a/3rxoNAx
It's very hard to read, and would certainly benefit from some color-coding, but the best experts do slightly better than chance in calibration, and much better than chance in discrimination, even though the majority of experts, and the group's average do worse. Assuming the dotted lines indicate some kind of equivalence gradient, then the best experts do significantly better than random chance.
(Note too that "mindless competition" ranges from chimps throwing darts to "moderate and extreme case-specific extrapolation" (I have no idea what this means, since I haven't read Expert Political Judgement). Not everything in that category is pure chance. I made this mistake when first looking at the graph, and became very confused.)
> Tetlock writes, "The message became “all expert forecasts are useless,” which is nonsense"
> But I think this does not apply to the linked Huemer paper.
It's plausible that the paper's conclusion survives this relatively minor mistake, especially when it ends up concluding that despite the lack of high predictive-power experts, we still have nothing better (which I'd disagree with because a) superforecasters exist, and many others are anecdotally able to beat the experts very often, and b) points #35-37 do significantly better on discrimination and calibration than experts, dilettantes, foxes, and hedgehogs. Though as I've said I don't know what "moderate and extreme case-specific extrapolation" nor "generalized autoregressive distributed lag" are. Though I haven't read Huemer's essay in full, so maybe he addresses this, or it's irrelevant to his case.).
I was mainly arguing that Tetlock's work does not support the conclusion that expertise is a sham. Even if there are important considerations and grains of salt which you should take when making use of expert forecasts.
On reflection, I don't think Tetlock's work is even very highly relevant to the question of whether expertise is a sham. He was testing experts' ability to forecast general questions, while the whole point of expertise is to be *really good* at only one particular thing. I like Matt Yglesias's framing here http://static1.1.sqspcdn.com/static/f/468275/28400876/1612383295720/rs251transcript.pdf?token=heYBwKmPnUMuTcXxQ4rRIEXSyEQ%3D
> A lot of what we get is adjacent expertise. So somebody who studies viruses, and maybe knows a lot about the protein structure of viruses, will opine about masks, right? And you’ve got to ask yourself, "Do they have subject matter expertise in this mask thing? Whose expertise do we need here?"
> Because one thing that I think clearly came out of the whole masks controversy is that public health experts underrated how easy it would be to get cloth masks in everybody's hands. It didn't occur to them as a solution to the PPE shortages that we could just get everybody a cloth mask.
> And that's because they're not experts in textile manufacturing. And it's no shame on them for not being experts in textile manufacturing. But they were thinking about, “Will masks give people a false sense of security?” Which is a psychology question. They were thinking about “Can we substitute away from surgical masks?” Which is a textile supply chain question. They were thinking about “Well, what are the antiviral properties of cloth masks?” Which again is a textile question. That's not a public health -- it's obviously relevant to public health, but it's a material science question.
> They didn't have expertise in those areas, and were in fact just on a par with me, or anybody else, right? But they had the, sometimes, arrogance that comes with believing you're being asked about your area of expertise.
Oops. That first sentence should be deleted. Curse you Substack for your lack of editable comments!
> I don't think Tetlock's work is even very highly relevant to the question of whether expertise is a sham
IIRC, he taught or organized generalists to dominate DARPA forecasting competitions, no?
Isn't his later work highly suggestive that you can actually train (some) people to excel at forecasting itself, across domains?
As a general point, there are many kinds of experts. It looks like Tetlock is using "expert" as shorthand for "experts in fields related to political prediction". His work probably doesn't tell you anything about medical predictions.
Perhaps this could be an objective definition of an expert: An expert is somebody who is usually right about a topic too boring for the average person to have a strong opinion about. For example, most practicing tax lawyers are, under this definition, experts on what the IRS will and won't let you deduct on your 1040. They get the various questions right the great majority of the time. But they seldom get nationally famous for their expertise.
On the other hand, topics that huge numbers of people find interesting, such as who will win the Super Bowl, tend to be ones that are hard to predict. The NFL is set up so that if you can predict the eventual Super Bowl winner at the start of the NFL 10% of the time, you are doing well. And even predicting the winner right 70% of the time at the opening kickoff is pretty hard. You can be a famous expert Super Bowl forecaster on TV without being right very much at all if you are at least interesting in the way you defend your wrong predictions.
As for Dr. Fauci, I don't watch much TV, so I have less of an opinion about him that almost everybody. I presume that most of the time during Dr. Fauci's long career, practically nobody among the general public was interested in him. I imagine he was pretty accurate during those boring times, thus meeting my definition of an expert.
During the two times when people were interested in Dr. Fauci, AIDS and Covid, he was probably less accurate. Not because he changed, but because the topics at hand became less predictable by expertise and thus less boring.
So, if experts are people who are usually right about boring topics, interesting topics are those which even the experts are frequently wrong about.
I would imagine that there are hundreds of little known NFL obsessives who have a better track record predicting who will win NFL games than the famous people who give their opinion of who will win on TV.
It's also possible that there are also amateur tax experts with better track records at predicting IRS behavior than the paid experts. But, I suspect, there are more amateur hobbyists following the NFL for fun than following the tax code for grins.
Tetlock can be interpreted as not saying "experts are wrong", but rather "experts aren't great at probabilities". The people who do well in Tetlock's research are non-experts but they do consult experts. Most of their advantage comes from being well calibrated to produce probabilities based on interpretations of the experts.
Yes, I'm one of Tetlock's Superforecasters and I like this framing. I like to point out that Superforecasters *are* experts - at making and assigning probabilities to predictions.
Many 'experts' actually are bad (think stereotypical pundits). But plenty of experts do have real expertise but are just bad at thinking quantitatively or rigorously about uncertainty, and they could be competent forecasters with training.
It's useful to hold the tension between
A: We're monkeys who more or less only *just* upgraded from feudalism. Things are going well considering we just need to keep iterating
B: Decisions get made that so clearly go against everyone's best interest on the regular. We can glimpse a better world and what we've build (while keeping us safe) is blocking us from moving forward.
I think the more fully we can recognise both the better, but A is a lot less represented in the current discourse, thanks for the reminder.
Ada Palmer puts it this way in her Terra Ignota series:
Is there anything important enough that you would destroy this world for it? Would you destroy this world to build a better one? Or would you destroy the chance of a better world, to save this flawed but in many ways utopian society?
(The society in her books is more clearly utopian than ours, but also clearly flawed in recognizable ways.)
Gosh I love those books. Though I'm still holding out hope for iteration rather than choosing between stagnation or revolution. Ideally Atlantis never has to fall.
onically, with the WebMD example, if you want the most precise I formation without political/legal intfluence you would choose an even more specialist (or professional) resource, such as the BNF (for drugs in the UK, which definitely doesn't list all side effects; I find it odd when a patient asks me about a side effect of a drug that I've prescribed for them that they've read in the leaflet yet the side effect is not significant enough to warrant listing in the British National Formulary so when I look it up I can't find it), fpnotebook, CKS etc
So? Is it true that disproportionately many borderline personality cases are young women with lots of piercings and tattoos? What does that tell us about diagnosis and etiology?
Scott has written before about how the same symptoms get labelled differently on different people. So I'd guess self reinforcing stereotypes are to blame
Or perhaps lots of piercings, tattoos, and, especially, nose rings are a warning sign?
who hurt you
If x is mildly correlated with y, that still doesn't mean it makes sense to treat x like a "warning sign", especially when y isn't that common. Bayesian rules still apply here.
Especially when x is in this case is something like "having a non-conformist appearance", which I'm sure does have some minimal correlation with certain psychological disorders, but also tens to correlate much more strongly with traits I actively seek out, like "being a highly creative person" or "having a tolerant worldview towards LGBT people."
Yes! Keeping power vs. being right is a great constraint to point out. I would maybe suggest expanding "being right" to "competence" though -- I'm willing to buy that Zvi is really good at being right, but he might not be nearly as good at hiring, leadership, working with other people, keeping schedules or any of the other things that are sometimes completely unimportant and sometimes absolutely critical to a job.
The head of the CDC job and benevolent dictator in particular probably require a LOT more in terms of managerial than predictive skills. Zvi would, I suspect, be most useful as an advisor to the benevolent dictator than the dictator himself. It's a shame that governments don't employ advisors anymore.
Yes, expand it to general competence. The head of the CDC is chosen for keeping power at the expense of being a good manager.
That’s true to some degree certainly. But this article could easily be a very different article, based around “the CDC director is chosen based on skill at managing all disease needs, and Dr Fauci is the best person out there who can handle the management of a large agency, making public health decisions on new pandemics, and spearheading efforts to deal with existing diseases. It’s doubtful that he’s the best at all three, but I’m also doubtful that Zvi is superior at that combination, even ignoring need to do politics. Zvi’s skills, based on his blogposts about COVID, are focused around things like statistical analysis and observing new research. But those are not at all the same skills as managing a large agency. One response then might be that we should split up those tasks to different people - the head person manager, the head disease predictor, etcetera. But of course then you get back to politics - what do you do when those people disagree about how to handle a situation?
Governments absolutely have advisors (for example, POTUS has 'senior advisors,' who are not confirmed by the Senate). Frequently, these advisors are part of the problem that Scott has identified, in that they frequently push their nominal superiors towards complying with the will of special interest rather than acting in the general interest, and/or to whatever is most likely to maintain the superior's power, which in turn is good for their power.
They're also frequently and more straightforwardly part of the corruption that makes being right difficult; often, such jobs are handed out as patronage or given to figures who would not (for instance) survive confirmation, or to tick special interest boxes themselves on an org chart.
Of course, the other kind, which you envision, exist as well. Smart and driven professionals who, by the nature of their appointments, are unbounded by the need to pander to the political breeze of the day or to special interests and who might be able deploy their skills towards the singular goal of being right as often as possible.
The key, I suppose, is to optimize for the latter over the former. I'm not sure there's a good way to do that, since it's always going to depend to a large degree on the character and priorities of the appointer. If the appointer is themselves appointed or elected, we know well that their characters vary widely and in ways that aren't straightforward to control (as in, who gets elected, and who those elected people then appoint to [for instance] Senate-confirmed posts, who then appoint advisors).
I'm sure our current system doesn't do a good job of optimizing for this. Even if we assume that there is one of the 'good' kind for every one of the 'bad' kind (which I doubt; I suspect the real distribution favors the 'bad'), the best you're likely to get is for them to cancel each other out. An advisor that makes the right call doesn't count for anything if her superior acts instead on the recommendation of another advisor who prioritizes power. And, under our current system, it's likely that there's more than one realpolitker for every truth-seeker.
In this regard, despite many efforts to curb patronage (that, historically speaking, have been unquestionably and extremely successful), it still definitely exists. Especially these days, when people desiring patronage frequently have impeccable CVs themselves, studded with degrees and honors from tier 1 institutions, work experience in tier 1 private entities, or government experience in tier 1 or 2, and reams of glowing recommendations. With an elite culture as credentialed and extensive as ours, it can be very difficult, even for an appointer who wants to stock their kitchen cabinet with the 'good' kind to pick them out of such a crowd. Frequently, the solution chosen is to pick people you've known your whole career, which of course has its own pitfalls.
And then these pitfalls lead to their own, and so and so on ad infinitum until you really do have to fall back on Scott's thesis, and hoping that we've built a sufficiently resilient and effective system that actually does optimize, in any marginal way, for obtaining the right outcome.
These are good points.
I went to college, Rice U., with the head of the CDC, Steve Hahn, and was the friend of Steve Hahn at Rice.
But, it turns out, they are two different Steve Hahns.
Cool hominid party trick: The world is abominably complex, so we call up organizational superstructures from the depths of meme hell and put them to work managing said abominable complexity. This is adaptive, apparently.
The dread blueprint of the FDA lurks latent in the collective unconscious, waiting to manifest and consume the souls of unsuspecting hunter-gatherers.
Only when our self created kafkaesque systems are as impentrable and complex as external reality can they succeed in taming it
Killing someone to take all their stuff is adaptive for the killer, but probably not adaptive for society at large. Summoning the FDA is adaptive for Anthony Fauci, but...
Are you referring to the articles on lorienpsych.com as your small database? I thought you meant more like a weighted average of patient ratings like when you recently compared different amphetamines.
Yes, I'm referring to Lorien Psych.
Best post since you came back online, Scott!
Yes - the amazing thing is that our society works far better than we have any right to expect. (And far better than it would if 99% of reform proposals were adopted.)
And...just put a link to this post on your database (BTW, where is it?).
That *ought* to be sufficient, but of course it won't be for some people. You just have to live with that - valuable info online will help many people and hurt a few who misuse it. But it does net positive good.
The alternative is to become WebMD. They're *cowards*. They know they're destroying the utility of the information they offer, but they have shareholders to appease and lawyers to fear.
You can, and must, be braver. Probably you won't get sued over this, and if you do you'll probably win. But you're in the lucky position - unlike WebMD - of having a large fanbase who appreciate what you do and will bail you out if all goes pear shaped. I can (and do) guarantee that you'll never have to worry about financial hardship because of losing a lawsuit over this stuff - somebody in your fanbase will ensure you have a well-paying job (in the unlikely event you need help).
> you're in the lucky position - unlike WebMD - of having a large fanbase who appreciate what you do and will bail you out if all goes pear shaped. I can (and do) guarantee that you'll never have to worry about financial hardship because of losing a lawsuit over this stuff - somebody in your fanbase will ensure you have a well-paying job (in the unlikely event you need help).
in other words, scott has his own political capital he can draw on to do things in the world, much as faucci has his political capital. i wonder if there's something here... for instance, what if faucci had his own circle of fans who would protect him if things went "pear shaped"? i guess he actually probably does, but he still wouldn't be able to continue occupying his current position in his current power structure.
is it just the problem that faucci's power structure is too big, and his enemies too diffuse in too many other competing power structures? going too far, does our utopian future lie in smaller, more distributed power structures?
Fauci clearly has a lot of political capital. He has survived in his current role since at least the 1980s, through two pandemics that he partially mismanaged, but then greatly improved his management of (and improved more than any of the obvious replacements seem like they would have). He seems to be one of the very few Trump administration executive officers that survived long past crossing Trump many times.
"What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong. People who most brutally and nakedly optimized for power would gain power; that's what "optimize" means. The interesting thing about the current system is that, after millions of very smart and altruistic people have contributed to it over generations, sometimes gaining and keeping power within it is modestly correlated with being good and right."
This is so brutally insightful and hilarious at the same time.
Where did Marx say anything like that? If it's an "insight" it has to correlate to something Marx wrote. Scott Alexander provided absolutely no evidence that this fallacy can be traced to Marx.
I don't know a whole lot about Marxism (despite the profile picture), but I'm actually under the impression that he believed the opposite - that to get to communism, after destroying capitalism an intermediate strong government would be needed to gradually transition the country to communism.
Perhaps he underestimated the difficulty in ensuring such an intermediate government would remain true to the goals of the revolution that got them there, but he certainly didn't think communist utopia would naturally emerge.
As a former citizen of the USSR I would say that the socialistic government always remained true to the goal of building communism and that's why they were a failure. In this I totally agree with Scott Alexander and I am even surprised how he can have such great insights. Most Americans simply don't get it and they think of the USSR only in terms of a culture war – that they were bad because they wanted to take over the world or something like that.
Being a former citizen of the USSR doesn't make you an expert in Marxist thought. If you want to defend Scott's point here you should quote Marx using primary sources - not give us anecdotes.
It makes me a test subject and my verdict is – it doesn't work and experts were wrong.
I actually had to study Marxism-Leninism at school. It does not matter if Marx said precisely those words or not. It is something what a reasonable person looking at the history would conclude.
Test subjects aren't the one writing scientific reports and conclusions, so your metaphor doesn't make sense.
>It does not matter if Marx said precisely those words or not.
If Scott Alexander wants to call something "Marx's fallacy" then I suggest he prove that Marx thought something along those lines. This really should not be too difficult (if Marx indeed made such a mistake) using primary sources. Otherwise it seems more like Scott Alexander is failing an Ideological Turing Test.
"What Is Marxism? Marxism is a social, political, and economic philosophy named after Karl Marx. It examines the effect of capitalism on labor, productivity, and economic development and argues for a worker revolution to overturn capitalism in favor of communism." - https://www.investopedia.com/terms/m/marxism.asp#:~:text=Was%20Marx%20Right%3F-,What%20Is%20Marxism%3F,capitalism%20in%20favor%20of%20communism.
"Marx believed that all world history was a “history of class struggles.” According to Marx, oppressor and oppressed have always “stood in constant opposition to one another.” One group—the oppressors—owned the means of production, such as land, raw materials, and money. They controlled government and society. The other group—the oppressed—owned nothing and depended on the owners of the means of production. Marx believed he saw a society that was "more and more splitting up into two great hostile camps, into two great classes directly facing each other: Bourgeoisie and Proletariat." The bourgeoisie—the middle class—were the oppressors. The proletariat (PROH•luh•TEHR•ee•uht)—the working class—were the oppressed. Marx predicted that the struggle between the two groups would finally lead to a revolution. The proletariat would violently overthrow the bourgeoisie. After their victory, the proletariat would form a dictatorship to organize the means of production. However, because the proletariat victory would essentially abolish the economic differences that create separate social classes, Marx believed the final revolution would ultimately produce a classless society. The state itself, which had been a tool of the bourgeoisie, would wither away." -Mcgraw Hill Education company. (if you think this one is inaccurate, it's literally being used in schools)
I don't think he needs to correlate it because it's the foundation of Marxism.
Marx revised to define exactly what communism is because it must arise from the conditions of the world when the revolution comes.
That is: Marx believed so strongly in the fact that the revolution would make things perfect that he refused to guide that revolution at all.
Here is a relevant quote:
"Communism is for us not a state of affairs which is to be established, an ideal to which reality [will] have to adjust itself. We call communism the real movement which abolishes the present state of things. The conditions of this movement result from the premises now in existence."
That is, Marx defined communism as the complete overthrow of the current state of affairs. This is the basis of communism.
"That is: Marx believed so strongly in the fact that the revolution would make things perfect"
He doesn't say anything about the revolution making things "perfect" in the quote you offered. Neither does it say anything about " if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top".
He's saying that Marxism says that communism will naturally arise from revolution/when the current state of affairs are overthrown. It's saying that communism (the "perfect" system) will naturally rise to the top.
Where does Marx call communism a "perfect" system? If we're attributing words and ideas to Marx we should probably be very careful about finding primary sources. I also think people are putting an undue emphasis on "naturally" here, as if it occurs without foresight. Marx is talking about very deliberate political movements, which yes, arise from the seeds sown by capitalism.
For anyone wondering, MarxBro is a dedicated troll of the rationalish community, coming out of the woodwork anytime Marx is mentioned to make ever escalating demands for rigor. No criticism or even mention of Marx or Marxism is well-founded unless it engages with primary sources to MarxBro's standards, a standards which tellingly has never been met by any interlocutor ever. Don't waste your time.
When someone has claimed Marx has made a "fallacy" I'm well within my rights (and indeed, common sense in general) to ask where that fallacy exists in their original works. Using citations. If that seems like an "escalating demand" then I'm very happy to escalate the rationalist community by uplifting their standards.
As a reader with no dog in this hunt, I'm not sure what to make of this ad hominem comment about marxbro1917. Maybe my troll-o-meter is not very sensitive.
I thought Marx argued that capitalism bore the seeds of its own destruction, that this was a core tenet of dialectical materialism, not that Marx was a kind of crass "burn it down" accelerationist nor a theorist ignorant of how power corrupts. So it seemed reasonable to me that someone might ask why is Scott attributing this very common human fallacy to Marx specifically.
There are legions of people fantasizing in our present-day moment about how if we burned everything down, something better would just naturally kind of spring up. Of all the ideological lineages that feed this kind of naivete, I wouldn't associate it mainly with Marxism. So in that sense, I'm sympathetic to the request for greater precision.
I guess I would wish for more tolerance in our conversational norms around calling people out for politely requesting greater precision or clarity or whatever to any given point. If we have a dedicated Marxist in our midst who can do that around Marx-adjacent thoughts, isn't that a good thing?
We have libertarian economists on here who can press fine points around their arenas of concern and anti-feminists around their arenas of concern, and I've done my share around the finer points of Buddhist philosophy or non-pharmaceutical mental healthcare, or the particular brokenness of the U.S. health insurance system. If someone's not just ranting angrily but is bringing some (dare I say?) expertise to the conversation, is that not welcome, even if they only have one arena of expertise they tend to bring?
I guess maybe this raises a larger question about where is the line between troll, hobby horse, and desire for clarity around things one knows something about?
"As a reader with no dog in this hunt, I'm not sure what to make of this ad hominem comment about marxbro1917. Maybe my troll-o-meter is not very sensitive."
You perhaps were not around for previous interactions with Marxbro before he came back as Marxbro1917. But even in this exchange, can you not see his modus operandi? "I don't care that you grew up in a country that implemented Communism, you had to study Marxist-Leninism, and you can comment on how the theory works out in practice, I still maintain that flying elephants are totally possible!" He's not honest in his interactions.
I'm very honest in my interactions. And if I'm being honest, I'm not impressed by people who say "I've studied Marxism-Leninism" but then fail to produce the primary sources and citations I've been asking for. My point here is very simple, Marx regards socialism as developing and superseding capitalism from within the capitalist system itself. He does not advocate to "burn it all down" (not sure what this would even mean when we're talking about international economies), nor does he have the naive analysis of power that Scott Alexander attributes to him (without citation, of course).
Therefore, I am asking for evidence, please. If "Marx's fallacy" exists in Marx's writings then someone should be able to find it, using quotes from the source.
I'm very suspicious of the troll label based on the comments of others who have a social history with the accused -- especially when the accused appears transparent and thus vulnerable in advocating for their project. As a relative newcomer here, this forum appears above average when it comes to the expression of independent thought (rather than piling on socially with the intent to suppressing others).
But, perhaps, Marxbro, you are guilty of pedanticism, which is nowhere in the neighborhood of trolling. Trolling employs a very wide and shallow focus, while pedanticism is laser focused -- and your defensively-trained laser may be missing a wider, more social point about Marxism writ large. I.e., "Marxism" today is an enormous trope that we all play around with for various reasons -- which your project naturally bristles at.
When it comes to primary source material, the thing that's more relevant to me than whether Marx actually penned certain words, is how ideas and history actually merged, and I was blown away (and thoroughly entertained) recently by the English-dubbed "Comrade Detective" series (the dubbing making it primarily a primary source) -- which helped give me a glimpse of both how huge and complex the commitment to socialism still was by that time, but also, simultaneously, how correct the notion seemed that, in human cultures, those who optimize for power always seem to perform the act of power most efficiently.
"I'm very honest in my interactions".
Well, yes, for a certain value of "honest". We can always depend on you to tell us that no matter who, no matter what, no matter that you did live in a country basing itself on an understanding of Marx's thought that "she doesn't have the range" https://www.youtube.com/watch?v=zq97J-7Mwzc
You do remind me of the literalists going "Where is that in the Bible?"
I definitely don't have the insight into what Marx actually meant that say, his 103-year-old brother might possess. But when he writes: "The Communists disdain to conceal their views and aims. They openly declare that their ends can be attained only by the forcible overthrow of all existing social conditions. Let the ruling classes tremble at a Communistic revolution. The proletarians have nothing to lose but their chains. They have a world to win." in The Communist Manifesto (part IV) it seems to me that he is advocating "burn it all down" when he says "forcible overthrow of all existing social conditions". Of course, I'm sure I probably didn't even cite it in the proper formatting (MLA? APA? USSR?) Full disclosure, I don't know a lot about Marx [insert your own Duck Soup joke here] nor have I studied Marxism-Leninism. I also don't know why I'm posting here, I feel like I'm giving a whining 3-year-old the sucker they've been throwing a tantrum about only to have them tell me it's not the right flavour (just wait, it'll happen).
I think that Scott described his view leading him to call it Marx's Fallacy in his Marxism related book reviews. I think it was this one in particular: https://slatestarcodex.com/2014/09/13/book-review-singer-on-marx/ . But there might be other related ones that I've forgotten.
I have covered Scott Alexander's misunderstandings of Marx here:
https://www.reddit.com/r/SneerClub/comments/gc27k5/author_reacts_to_ssc_book_review/fpbulfv/
I do not think that Scott Alexander has undertaken an accurate reading of Marx. His presentation of "Marx's fallacy" - which I, as a Marxist, do not recognise at all. I think Scott is failing the Ideological Turing Test here. This is why I'm challenging him to find a primary source where Marx says anything like
"if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top."
If that's "Marx's fallacy", if that's what Marx said, then it should be easy for Scott Alexander (or anybody else) to find Marx saying this in his writings. I believe in evidence, and I'm asking for evidence on this matter.
I've read both Scott's piece and your response. I didn't find your response convincing. I'll take one argument to explain why, rather than go through every single one.
Marx says: "But the essence of man is no abstraction inherent in each single individual. In reality, it is the ensemble of the social relations." Scott/Singer summarise this as he "believed there was no such thing as human nature and everything was completely malleable".
That seems like an accurate summary to me. Marx is saying quite clearly that merely being human tells you nothing whatsoever about how that person might behave, think or live their life. Nothing. Zero. Whether you call it "essence of man" or "human nature", in normal English these terms mean "that which is common to every [developed] human regardless of their experience of background".
Yet here Marx claims that this thing, which is literally defined as "that which is inherent to any individual" is actually not inherent at all, it's rather socially constructed and is thus, by definition, malleable, because the "ensemble of the social relations" is neither fixed or inherent. Indeed Marx's entire philosophy was that by changing that ensemble, humanity could become greater.
You keep demanding primary sources, but in your review Scott/Singer literally quote Marx word for word and you just claim their rephrasing into more modern English is wrong. If Marx is so hard to interpret that people can read completely opposite things into the same sentence then he is just an objectively terrible writer, but I don't think this passage is actually hard to interpret. He rejects the notion of a fixed, immutable human nature and claims that what makes people act the way they do is purely social in nature (implication: and thus can be changed via social means, like revolution).
Marx could certainly have been philosophically and theoretically correct about human nature, while still being clueless about pragmatics (such as scope and timeframe and other material complexities). Maybe it's not so fair to judge philosophers by how politicians and societies attempted to adopt and manifest (and fight against) their philosophies?
>Marx is saying quite clearly that merely being human tells you nothing whatsoever about how that person might behave, think or live their life. Nothing. Zero.
He doesn't say that, though. He says that " the essence of man is no abstraction inherent in each single individual. In reality, it is the ensemble of the social relations." i.e that generalisation about human nature are only describing wide ensembles of human behavior, not any particular individual. "Malleable" is also different to "completely malleable" - notice the shifting goalposts here.
> If Marx is so hard to interpret
Marx isn't really hard to interpret, which is why I suspect that Scott Alexander simply didn't read it very carefully.
For another point of data, I would call myself a Marxist. I have read Kapital but not the Communist Manifesto or any of his other works. I think Marx was notably good in diagnosis of the political economy of his time, but notably poor in prescription of how to fix it, and particularly what a better functioning political economy would look like. I don't begrudge him this, the latter are much harder problems.
I think he was conflicted about the question of who would rise to the top after a revolution. On the one hand, a lot of what I read from him was at pains to try and conceive of an organisation that could ensure that future leaders better represented working class people. I don't think he did a particularly good job of describing or building that organisation but he certainly tried and recognised it to be a hard problem. On the other, he seemed to maintain a confidence that revolution was inevitable and that the world would be better afterwards. A contradiction between faith and rationality, perhaps? I sorta recognise that you have to maintain some kind of faith in the possibility that things will ever get better to remain sane in this world.
I agree with this analysis of "politics vs being right/doing the right thing" but it creates another obvious problem: the good of being right in the moment is bounded, but the good of being right in the future is unbounded
One of my favorite scenes from the Wire is when the newly-elected mayor of Baltimore has a problem. He needs money to bail out the public school system, which he can get from the governor, but if he does, he becomes "the mayor whose failing public schools forced the governor to get involved and the state as a whole to contribute tax dollars to bail him out," thus ending his future ambitions of becoming governor himself. And of course, once he is governor, his ability to do good things will be much greater than his ability as mayor. So he decides to let the school system continue to collapse to preserve his opportunity at future success, and future good.
I think almost every politician or person who has a political component to their job has made this calculation at some point in their lives. And in some sense its hard to say they are making the wrong call. Because if that fictional politician goes on to become President and signs a bill which ends child poverty, whose to say it wasn't worth a few thousand kids in Baltimore?
I don't have a solution to this problem, except to say that at some point everybody in every position that might even have a glimmer of power has to ask themselves "what's the absolute amount of good worth sacrificing today for the prospect of being able to do good tomorrow?" And to think really hard about the answer.
Flip side- nobody who habitually compromises the public good for advancement will ever, ever, sign a bill that ends child poverty. The selection process weeds out the ones who would.
The Wire also depicts the same problem with lawyers; anyone who presses real cases that could a difference would upset the apple cart and prevent career advancement. The prosecutors who don’t play politics never become judges. The solution presented- STOP TRYING TO BE JUDGES.
I recently read an interesting blog post somewhere (I misremember where) carving out a workable, useful definition of decadence. Rather than resort to stereotypes about Manly Men Becoming Comfortable and Weak or sex orgies or drug use, it defined decadence as when the elites of a society stop competing with each to see who can provide the greatest benefit to the community, and start jockeying for the greatest *status* within the community. The moment you take what power you have and start scheming on how to get ahead of the pack to higher honors and more power instead of focusing on doing the best damn job you can do today, you have left virtue behind and are now part of the problem.
Regarding decadence, I think you're referring to DePonySum's recent post https://deponysum.com/2021/01/26/reflections-occasioned-by-reading-michael-sandels-the-tyranny-of-merit-part-1/
Heyyyy there it is. I should bookmark that site.
"History isn’t going to rap you on the knuckles because people are having a bit too much gay sex or men have long hair now, history is going to rap you on the knuckles if people aren’t committed to larger projects than themselves."
Not exactly-- it's important for people to be committed to projects (of whatever size and requiring however much commitment) which actually work.
That sounds like Peter Turchin's theories about an overproduction of elites who squabble against each other for the few available spots at the top. Of course, he borrowed his logic from Ibn Khaldun.
Sounds like what Ibn Khaldun said about North African politics 700 years ago.
> at some point everybody in every position that might even have a glimmer of power has to ask themselves "what's the absolute amount of good worth sacrificing today for the prospect of being able to do good tomorrow?" And to think really hard about the answer.
this is almost the opposite of the discount rate -- what is the amount of good in the future that i can discount to get a smaller amount of good right now. in ksr's recent "ministry for the future" there's a section arguing that we place too *high* a value on present good, at the cost to our future selves/descendants. i find the same problem occurs with thinkers like, e.g., tyler cowen -- "ignore climate change now and focus on getting rich, and we'll be so rich in the future that climate change will be super-cheap to solve relative to our newfound wealth"
You are missing the HCQ elephant in the room (and the Ivermectin rhino too....). This makes your otherwise excellent post dismayingly close to worthless, until you can come to terms with the extraordinary number of lives lost due to the corruption of the process that Fauci, putting it enormously too mildly, allowed to occur.
HCQ?
hydroxychloroquine
Can you be more explicit?
While there are some side effects, I really don't think the emergency prescription of HCQ caused an extraordinary number of lives to be lost, main harm would be the money wasted and some nausea in patients who wouldn't otherwise need to feel it
That is so unbelievably backwards that I’m not going to even argue with you, you’re a hopeless case. The consensus is FINALLY coming around to “HCQ and Ivermectin are effective treatments if given EARLY”, which most of the rest of the world has known for many months, but which people who only consume US media have been shockingly gaslighted about.
Could you point me to some high quality research, so I can be de-gaslighted? Preferentially research in which the control group wasn't significantly older or more comorbid than the HCQ group, or meta-analysis that know you can't just multiply p-values?
I gave a link which is somewhat polemical but full of references to both studies and meta-analyses. In this very special case indeed, polemics are appropriate, because there has been intentional bad faith and lying. The bad faith and lying is so shocking that you may need to see the references in the context of the narrative given in this article to overcome the initial reaction that 95% of English-speaking medical professionals have (“this can’t possibly be right because my sources have so universally told me it is wrong therefore I do not need to pay attention to it”).
https://truthabouthcq.com/hcq-works/
Sadly, when looking at the individual studies, you can always spot very important methodological flaws (usually, the placebo group will be significant older or have more diseases previous to COVID infection, when compared to the HCQ group). Whenever this selection effect is corrected by proper randomization of patients into treatment/placebo group, HCQ fails to show an effect. You can check this by yourself, usually on table 1 of any paper about the treatment. This raises the question: if the treatment is so effective, why don't the researchers publish a well-researched study, to actually convince people that it works? Why are all positive studies filled with so much shoddy statistics? Dexamethasone, a cheap over-the-counter drug IS accepted as a treatment, so why wouldn't HCQ be too?
(for context: I am a Brazilian physician working in emergency care, so I am familiar with the narrative purported by Filipe Rafaeli in the original publication)
Did you look at the subgroup analysis of the NEJM prophylaxis study?
The study (which claims to show HCQ doesn't help) is here: https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
and the subgroup analysis is in the "Supplementary Materials" here: https://www.nejm.org/doi/suppl/10.1056/NEJMoa2016638/suppl_file/nejmoa2016638_appendix.pdf
In the Supplementary Materials: look at page 17, titled "Figure S1. Forest Plot of A Priori Identified Subgroups" (based on page 13, titled "Table S6. Subgroup Analysis of Risk of New Covid-19 Compatible Illness"). Look especially at the "days exposure" section of page 17.
When I look at Figure S1 overall what jumps out is that using the protocol of this study nearly *every* subgroup did better with HCQ than without it but *how* well they did is *time-dependent*, meaning *the sooner post-exposure treatment started, the larger the positive effect*. That looks to me like a dose-response relationship! 1 day worked *very* well, 2 days worked well, 3 days worked kind-of-okay, and waiting as long as 4 days was worse than placebo.
If you take that set of results and toss ALL the data together in one bucket the "4-days" negative result and "3-days" marginal result drag down the average effectiveness but if you just look at day 1 or days 1 and 2, treatment was effective at the .05 level. Based on that study one should assume HCQ DOES help (especially for younger people) if started right away or better yet if started *prior* to exposure. The results suggest that young medical workers should keep it on hand and start taking it right away upon any accidental exposure unless and until there's a better option.
(one worrisome fly in the soup is that subgroup "age>50" also failed to be helped by HCQ. Maybe the older patients were less likely to start treatment right away? Dunno, that's something to look at in a larger followup study, but it shouldn't have stopped us from at LEAST advocating that younger medics use HCQ early on).
How are those results significant? They are a very small relative risk reduction, with a wide confidence interval that covers both "no effect" and "may increase risk"
The confidence interval is very wide because the N is too small. A drug that on its own (without help from any other assisting intervention) reduces your risk of covid symptoms by merely ~33% (rather than the intended 50%) is still worth taking and would save thousands of lives, but needs a larger N than was used to show a .05 certainty level in a study such as this. If you re-ran this study with twice the participants the confidence interval would narrow; assuming a similar pattern for the mean expected result the interval wouldn't have to narrow *much* to exclude "may increase risk" for days=1, right?
(I take back the claim that days={1,2} are *already* shown to be "effective at the .05 level" - I was reading the wrong data column. Drat this interface that doesn't let you revise after posting!)
The paper I linked has a long analysis of the NEJM Boulware study and shows how the data of that study was misinterpreted. I had come to similar conclusions at the time it was published. The study really shows that HCQ has a benefit but the statistical significance of the effect was underestimated.
https://arxiv.org/abs/2007.09477
Ivermectin I'll grant you, but my impression is that boosters of antivirals still aren't enthusiastic about HCQ.
As I said, there is a big difference between USA and areas very influenced by it, and other parts of the world (much of which has a great deal of experience with HCQ over the last 75 years and knows things about its toxicity profile that writers and researchers here have sometimes been quite ignorant of). The most recent work seems to show that Ivermectin is at least as good; but I already knew last April that HCQ was good and last May that Ivermectin was good because I was paying attention to the entire world. Much more on this at my link.
This kind of gratuitous personal attack is the antithesis of what I come here for.
not sure if you're right or wrong but I am sure your being a dick sapped my energy to find out
The most recent This Week in Virology had a really interesting paper they discussed going into the details as to why HCQ did so badly in *in vivo* studies despite doing so well *in vitro*. https://www.microbe.tv/twiv/twiv-715/
It failed when given late, succeeded when given early, and there was an unbelievably intense effort in the USA to obliterate all knowledge of this distinction in order to portray it as “HCQ doesn’t work” full stop.
Details here:
https://truthabouthcq.com/
Boy, that site looks something that is definitely trustworthy and free from bias! /s
Congratulations on being part of the 95%. I TOLD you there were references to both studies and meta-analyses, I EXPLAINED that this was a special case where it was necessary to read something even though it had a polemical tone, but STILL you sought and found an excuse to avoid it. F*** off, I’m done here.
Apologies, I now realize you may have been responding to one of my previous two replies without having seen the other one, due to delays in comments showing up on the site.
Nobody is going to read 50,000 words filled with irrelevant minutiae presumably designed to answer every argument this dude has ever heard from anyone. Just link what you consider to be the best studies, otherwise you come off like guys who can only "prove their point" with rambling 90 minute youtubes.
There’s a big difference between a 90 minute youtube and a paper written in several dozen numbered sections with hyperlinks to actual studies. The whole point is that it is a complicated story so I am not going to over simplify it, I am instead giving you the best summary I know of of the entire STORY which is about not only medical truth but a great deal more!
Enjoy it, or enjoy the feeling of satisfaction finding an excuse to snarkily avoid it gives you, I won’t presume to tell you which of those to prefer.
This is not "a polemical tone." This is 90% polemics. I could flip to literally any paragraph and find either an irrelevant side-story or a ramble about why the establishment got it wrong. He spends 7 paragraphs saying that the scientific establishment wouldn't have believed Yuri Gagarin when he said the Earth is blue.
You're correct, I didn't see your other post saying that this was a special case, but "this is a special case" is hardly convincing either way. Every crackpot claims that they're not like all those other conspiracy theorists, they're a special case, and just this once, you should read 15,000 words about how the establishment is lying and suppressing the truth.
Just the facts, please. I've seen many websites like this and approximately 0% of them have been worth my time. I'm not going to dig through all this crap about Yuri Gagarin and pandas, just link to the scientific evidence that supports your case.
Oh wait, not 15,000 words, there are like 5 different essays on that site and I have no way of knowing which one you're actually referring to, and they're all equally long and equally crackpot-looking. You are literally telling me to read a novel's worth of text on the hopes that there are actual studies somewhere in there.
I'd like to think I read about all the major studies on HCQ that came out over the summer and I don't think that's a fair summary of the evidence. Dosing time has been a routine cofounder as people do RCTs on people who show up in the hospital 7 to 10 days after symptom onset for drugs like broad spectrum antivirals, monoclonal antibodies, and vitamin D. But the only study I'd say looked good for HCQ was one out of India looking a prophylactic dosing and that wasn't a RCT so I don't think I trust it.
Your tone and choice to be hyperbolic are disappointingly out of keeping with the spirit of the SSC community. It's still an open question whether inflammatory phrasing and hot takes like yours becomes the norm due to this new blog transition or whether behavior like yours is discouraged well enough that people either self-regulate or go elsewhere. I hope it's the latter.
Sorry, but that’s totally wrong. My ORIGINAL reply was quite “normal” in tone, and I shall re-paste it here:
“It failed when given late, succeeded when given early, and there was an unbelievably intense effort in the USA to obliterate all knowledge of this distinction in order to portray it as “HCQ doesn’t work” full stop.”
AFTER I posted that reply, I encountered resistance and snark, and responded in kind, so don’t go lecturing me about the “spirit” of the “community”.
My understanding is that HCQ is effective when combined with another medication to block another pathway for the virus for transmit, but not especially otherwise, and this explains the divergent results in studies. __ice9 has written about this, although unfortunately on twitter rather than blogging like a civilized person.
The combination with another drug such as azithromycin is important, but much more important is the fact that it is proven effective when given in the first few days (outpatient basis) after symptoms appear, and a large number of studies which showed no effectiveness or low effectiveness for patients who had already become sick enough to be hospitalized were systematically misrepresented (I know because I was paying very close attention all along) so that early use was discouraged or discontinued (including some actually fraudulent studies!).
I see one snarky comment from beleester, but other than that it's mostly people being extremely charitable to a position that you've so far only defended by linking to one website that pings an awful lot of red flags for being conspiracy theory nonsense.
I'm certainly not seeing anything that would warrant replies like:
>>That is so unbelievably backwards that I’m not going to even argue with you, you’re a hopeless case.
On the contrary. It was *precisely* backwards to think that when I spoke of the “HCQ elephant in the room”, I was referring to deaths FROM using HCQ, rather than deaths from NOT using HCQ.
Here is an extremely transparently done very thorough and complete ongoing meta-analysis:
https://c19study.com/
I get that, but you could have phrased that very differently, for example:
"Actually, I think you got that backwards, the elephant in the room is the deaths from using HCQ, rather than the deaths from NOT using HCQ. You see, HCQ and Ivermectin are actually effective treatments as long as they are given early."
Rather than calling the person you respond to "a hopeless case" and saying they are "being gaslit by US media".
I think this is a wildly uncharitable take on the situation. One can argue about whether Trump or Fauci is culpable; one cannot _not_ argue about it and just say it's Fauci.
You seem to be willing to argue in good faith as long as you don't feel attacked, so let me try to start this discussion over. If you feel like any of my claims needs better substantiation, please tell me and I'll provide sources.
You linked https://truthabouthcq.com/hcq-works/ , a mostly narrative review by a layperson who doesn't claim to know biostatistics. While a thorough debunking of his over 50 points is more than what I'm willing to do, I will debunk some of them, and if you feel like I glossed over anything important, let me know and I will check, but here's why you shouldn't put too much stock into that narrative:
Point 1 cites Raoult's original paper, one of the first to be released regarding HCQ therapy. While finding positive results, this paper has several limitations, which bring it's validity in question. You can see, on page 10 of the manuscript cited by your source, that "Six hydroxychloroquine-treated patients were lost in follow-up ... three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1 ... one patient died on day3 post inclusion ... One patient decided to leave the hospital ... finally, one patient stopped the treatment on day3 post-inclusion because of nausea".
This is extremely relevant, as not adoption an "intentional-to-treat" protocol basically changes the result from "HCQ works" to "When you don't count the cases that didn't work, HCQ works"
It is also of note that on this foundational paper, reference to "early treatment" is found absolutely NOWHERE. You will see that arguing for early treatment only became a thing AFTER results from other trials came back negative.
Your source also spends lots of time purporting a "big pharma conspiracy", in which the cheap, widely available HCQ was being passed over to benefit redemsevir, an expensive, patented drug. The problems with this narrative are: we know redemsevir ALSO doesn't work, and approved interventions for covid include Dexamethasone, also a cheap, widely available drug, and pronated position, which is LITERALLY free.
Are there any other important points that you feel like I glossed over? The graphs at the end haven't aged especially well since July, when it seems last updated, but I don't know if you feel they are integral to the narrative
I disagree with your analysis — that corruption/self-preservation explains why Dr Fauci does not always say the truth. Externalities and/or the possibility of being misunderstood are more important factors IMO. For instance, while an unknown blogger can say in March 2020 "we should all wear mask now", Dr Fauci or the NYTimes cannot say the same because they're afraid it will push people to hoard masks.
But he didn't have to say "we shouldn't wear masks because they don't do much good and might make things worse," which is roughly what he did say.
But there is a cost to this--many people bought masks anyway, because enough people had figured out masks were probably a good idea based on other pandemics/countries. It delayed people making makeshifts masks. And it also created confusion, as guidance switched overnight from "you don't need a mask, you silly germaphobe" to "MASK OR ELSE", and it caused trust issues--if the government is willing to lie about masks, what else might they lie about?
I'm pretty convinced that the real reason was actually that they didn't believe it worked due to cognitive dissonance. That is, Western health authorities don't recommend that the populace wear masks, western health authorities give good advice, therefore there must be a good reason for that and we have to figure out what it is.
I don't think that was behind the anti-mask decision - see the beginning of Part 3 of https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/ .
But if it was, I still think it's relevant that Zvi can just say whatever is true, and Fauci has to optimize for a bunch of other things based on the consequences of people listening to him (even if he is doing this in a prosocial way and his decision was ethical)
What do you make of Adler-Bell's point that there is some point (presumably in the thousands of dead people) past which you are obligated to noisily give up power instead of make those compromises?
Who enforces it?
Such a tough call. If you wield power imperfectly in order to keep it and 10K people die because of your compromises, would you be better off noisily giving up power and being replaced by someone who is worse and results in more deaths? Some people who we think are power-hungry collaborators may in fact be selling their souls in public at great personal cost because they think the next in line would do way worse. I may be being too charitable, but I sometimes felt like that was Fauci not resigning when working with Trump.
This comes up with statistics a lot. E.g. when Nate Silver says that candidate A has an 80% chance of winning, people in general interpret that as "certain" and if they don't people get mad and say he was wrong. So he can give correct information knowing it will be constantly misunderstood, and people may make bad decisions based on it (e.g. not turn out and vote for candidate A). Or he could change his prediction to be incorrect, but people be more likely to get the correct impression from it
This is a really excellent post. It certainly makes me feel grateful we have a magic machine for consistently extracting pretty-good people with pretty-good ideas out of the population.
That said, there's a related issue: Why has the magic machine's performance seemingly decline over the course of the last ~80 years? Maybe it's an inevitable result of Moloch (for example, because as you optimize more aggressively, the gap between the most competitive and most good-producing ideas grows, or something). If so, too bad, guess we're screwed. If not, then we could sure benefit from figuring out what's causing the machine to function worse.
(As this post argues, any tinkering we do trying to fix the magic machine should be very cautious, because it sure would be a shame if something were to happen to it.)
Hasn't the magic machine been generally doing better? I mean, life expectancies and median incomes and press freedom and all those good indicators generally seem to have been on an upward trajectory, with occasional decade-long blips on some of them (like crime in the US in the '70s and '80s, opioid deaths and pedestrian fatalities in the US in the past decade, various things in Syria in the past decade, etc.)
I think what you're referring to is not the same machine I'm referring to. The "magical machine" I'm referring to is the process by which we select leaders/bureaucrats/experts. Even if those people are somewhat less competent than in the past (which many think they are), you would still expect things to get better because of improving technology, increasing wealth, general progress, etc.
I think you're both right in your own way. I think our institutions have gotten better (dare I compliment our bloated bureaucracies?) on the whole, and generally the people who run their day-to-day operations have gotten more competent. But at the same time some of our processes for selecting the figureheads haven't produced the best results. Kind of like when The Imperial Bureaucracy was opened up to freedmen but at the same time the Praetorian guard was selling the right to be Roman Emperor. Parallel question - how long can a competent bureaucracy sustain an incompetent set of rulers? Okay I'm taking the example too far, soon CommodusBro180 will be posting asking me to cite documents lost in the Library at Alexandria.
Perhaps they've continued upward but with a lower slope. Great Stagnation and all that.
Has it declined? 80 years ago was the Tuskegee Experiments - I think I like our current medical experts a lot more than those from 80 years ago.
What examples of 'decline' are you thinking about here? The present always looks worse than the past because you're there to notice the flaws, but beyond that are there specific issues you're thinking about?
I want to give basically the same reply here that I gave to Kenny above. But I guess I'll try to say it more clearly this same.
I agree that the present is way better than the past in a whole lot of ways. But I also think this is expected, due to technology improvements, wealth accumulation, and general progress. Nevertheless, there is one way in which the present looks somewhat worse than the past: leader/expert/bureaucrat selection. A common complaint is that it would be impossible to build the interstate highway system nowadays -- our modern government is too ineffective to get anything on that scale done. (Of course, great things on that scale still get done. They just get done by Elon Musk or whoever while the government is spending lots of money failing to lay train tracks.)
In the case of the Tuskegee Experiments, my guess is that the general population back then was way more okay with stuff like that than we are now -- that's a form of moral progress. So even if you're doing a pretty good job of selecting the top, say, 40% most ethical doctors out of society, you'll probably still gonna end up doing unethical stuff. My worry is that we're now selecting from society less effectively (e.g. only getting the top 50% most ethical doctors). But because society as a whole is more ethical, things still look more ethical overall.
I think in some sense Tuskegee may be a clue to why sclerosis has grown in so many institutions, back then researchers could perform unethical research with relatively little scrutiny, and lots of freedom to experiment etc. The backlash to such programs lead to lots of process restrictions that lead to an increase in the percent of decisions made to 'cover your ass', or 'follow the process', as well as an overstrong embrace of the precautionary principle
Sometimes I wonder if it's always been this way, but we're only able to notice it more now. A few decades ago, being as informed as we can be today would have required vastly more effort.
So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives. It's a fine hypothesis, but what evidence is there in favor of it? In academia at least I can point to an ocean of crappy research whose existence benefits no-one, so you can't blame the incentives. A Stanford epidemiologist attending a conference in March tweeted:
>At AHA #EpiLifestyle20 in a room full of epidemiologists and scientists and not ONE person is wearing a mask. Lots of hand washing & sanitizer stations. If 800 epidemiologists aren't wearing masks, you don't need to either!
We're talking about (tenured) people personally putting themselves in the way of harm here, can we really blame corruption and incentives?
I think you need to more seriously entertain the hypothesis of genuine incompetence.
Do you have a link or archived link to the Tweet somewhere? I'm trying to compile a list of sources for and against the "noble lie" hypothesis. (FTR I mostly think the noble lie hypothesis is wrong).
This is the only source I could find. I assume it was deleted, though it's also possible it was fake (to be clear, I don't know; it doesn't look fake, but I don't want to rule out the possibility).
https://ifunny.co/picture/michelle-vote-odden-michelleodden-being-an-epidemiologist-right-now-is-WyOz8OJz7
Not fake: https://web.archive.org/web/20200304192637/https://twitter.com/michelleodden/status/1235278717938622466
Excellent, thanks for the confirmation.
https://web.archive.org/web/20200304192637/https://twitter.com/michelleodden/status/1235278717938622466
> So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives.
I think this is a mild misreading of Scott's point. It's more like "the process that selects experts is not optimizing for competence, but rather some mixture of competence + political savvy + careerism." So the claim isn't that Fauci is secretly is secretly a public health super-genius who is hiding his true ability, but rather that the version of Fauci who is a public health super-genius doesn't get into as high a position as real-Fauci did.
That's how I interpreted this part:
>The Director of the CDC could generate opinions as accurate as (or more accurate than) Zvi's, if she wanted to. Maybe she's even doing that internally, when she decides what precautions she and her family should take.
On the lighter claim that selection happens on competence + political savvy + careerism I agree entirely.
I agree my post focused more on the competent-but-corrupted narrative, but I hope I also at least nodded to the possibility that there are some Fauci equivalents who suck at epidemiology but are good at networking and got their positions that way.
Makes me think of those studies that show that markets can allocate well, even if the people in the market are trading randomly.
If the system is setup correctly it doesn’t matter about the competence of the people involved.
Could be that people are generally only competent at the networking element, and that it’s the general system design that leads to better outcomes generally.
The problem is that the government doesn't involve a lot of trading. It does what it does by force or fiat. I can't elect to do business with the CDC head which I prefer. I only get the one which is there.
Do you have a link to any of those studies? Sound interesting
I think this is the more important part, particularly if expanded beyond "networking" which I think is a trivialization of the kind of skills that are necessary to become a top-level political appointee. I personally think if someone just appointed Zvi he would do much better at the public communication portion of the job, at least. Maybe there are other aspects of agency management that are not within his competency that also are important.
The issue presumably is that even if they are super competent the outcome is the same as if they are mediocre, because the incentives constrain the actions they can take
> So the central claim is that the experts at the top are genuinely super-capable, but corrupted by incentives.
No, I think the central claim is that experts at the top must be competent at playing political games in order to arrive at the top, but in our system they also tend to have some baseline of technical competence. The related point is that if they were super competent, they still wouldn't be able to act like it because of the need to toe the political line.
> "A machine which takes Moloch as input and manages - after spending billions of dollars and the careers of thousands of hard-working public servants - to produce Anthony Fauci as output. This should be astonishing"
I think this is indeed a v good approximate account of our situation, & it shows both how well we usually do, considering how bad things could go, & also how tenuous is our toehold above the abyss. So far we've avoided the really terrible outcomes (the last four years of D.T. notwithstanding), but there have indeed been some terrible outcomes for some, & some very close calls -- some of which we know about (Bay of Pigs, Three Mile Island) & some we don't. There have also been some heartbreaking misses (eg the history Nathaniel Rich details in his (doubtless imperfect) _Losing Earth_). How well will our luck hold as we move on into 21st Century Climate Change -- to name just a single one of the many fun, um, opportunities staring us in the eye? I too am a reformer not a revolutionary, if I have my choice, but that choice is "all other things being equal," & more & more, they aren't.
Is there some reason why WebMD couldn't include information about how common various side effects? The severity of reported side effects?
Don't know how it works in the US but in Germany (and I think in the EU in general) drugs always list their side effects by frequency (e.g. "very often: more than 1 in 10 people treated", "frequently: less than 1 in 10 but more than 1 in 100 people treated", etc.)
I just searched for "uk drug database". It seems like at https://products.mhra.gov.uk/ you can actually access the UK medicine leaflets. (Search by active ingredient, as the brand names may be different in your country.) The leaflets list the definitions of the frequencies somewhere (e.g. common means 1 in 10 to 1 in 100, uncommon means 1 in 100 to 1 in 1000, rare means 1 in 1000 to 1 in10000). You can probably find similar databases from any other European country; I searched for UK to get an English language one.
Speaking of which, isn't crazymeds that Scott has blogged about before a counterexample to the WebMD dilemma? What's their secret? (I'm guessing the answer is probably just "not big enough to fall under as much scrutiny", but I'm prepared to be wrong about that if there's something more interesting going on.)
My uninformed guess would be that the infrastructure to collect that data in a reasonably-high-confidence way doesn't exist and so they don't know.
I would be surprised if that data is collected to a high degree of accuracy once drugs are beyond clinical trial.
You'd basically have to have a centralized database that somehow knew every time a drug was prescribed and then cross-reference that with patients reporting (to whom?) specific symptoms. But the doc who proscribes isn't always part of the same system where a patient is subsequently admitted, and how can you say it's because of Drug X and not Drug Y that the patient was also taking, etc. And then if you wanted to share that info with a drug company, you'd have to anonymize it, and at some point, who's paying for all of this tracking?
So yeah, you could report out the clinical trial data, but my impression is that the rest is still word-of-mouth, case studies, and rumor.
I'd be happy to have someone familiar with medical record-keeping disabuse me of this pessimism.
Where does WebMD get its list of side effects from? Is there really no record at all of how common or severe the side effects are?
Mostly speculating here but ...
I'd guess that there are hundreds if not thousands of records of how common or severe the side effects are. But they're not organized or shared. They exist in the notes of individual doctors and the databases of individual hospitals, which aren't connected. AFAIK, doctors are pretty good at keeping records of *individual patients* but pretty shit at organizing that information in a way that can be analyzed on a massive scale. That type of thing can be done with deliberate forethought, focus, and funding, but not in a way that's just like "do it for every drug, ever."
The best bet might be the large-scale HMOs like Kaiser, which at least keep everything for individuals in-house. Maybe you could do something like query everyone's records for whether or not they were ever proscribed a certain drug, and then also query them for specific notations of side effects to that specific drug? But again, I'm not sure how you get at the causal question.
Again, happy for an individual with hands-on experience with these types of systems to correct me if I'm wrong. I'd mostly categorize this as educated guesswork.
Oh, and I have no idea where WebMD gets their lists. Probably from the drug manufacturers plus randos who email them and get their complaints through whatever Process they've created, per Scott's description above.
Most likely from the FDA-approved patient information or prescribing information. If WebMD is just regurgitating the FDA-approved text they are almost certainly in the clear (even if they are wrong and know they are wrong). When you start providing non-FDA-approved medication information you start having to worry about legal risk.
A very good piece and essentially correct, unfortunately. The one part I'm not sure of is the implicit assumption that even mediocre expertise feeding into a political decision mechanism is better than no political mechanism.
Consider Covid. The advice that was given by Fauci and others was probably better than what most people would have done with no advice, better on average than what most would have done (although possibly worse than what you and I would have done) relying on whatever sources of information they trusted. On the other hand, the vaccines we are now getting took about a week to design and eleven months to get FDA approval. In a world without the FDA and other political constraints, a month of challenge trials would have shown that they were effective and not very dangerous, after which they could sell them to all comers as fast as they could ramp up production. It's hard to believe that that wouldn't have saved a couple of hundred thousand lives in America, a million or so in the world. So if you look at the overall effect, it may be negative. We might be better off with the same level of mediocre expertise and no levers of power for it to be applied to.
At a tangent ... . Your description of Fauci reminded me of my conclusion about Nixon. There's a bit of the tapes where he is talking with one of his people about the idea of ending the interest equalization tax, which was a restriction on capital mobility. Nixon points out that one or two people have said doing it would be a good idea (true). The aide points out that there are no votes in it. Nixon says (by memory, not a quote) "What the hell. Let's do something just because it's good for a change." My feeling was that he had spent his life getting power in order, as he saw it, to do good things, and then found that he had to use the power almost entirely in order to keep power.
The current dramatic case of people choosing the wrong expert to believe in is the election. Something like a quarter of the population, if polls can be believed, thinks Trump really won. Their experts say so — and they have concluded (correctly, although not in this case) that the official experts can't be trusted.
"So if you look at the overall effect, it may be negative. We might be better off with the same level of mediocre expertise and no levers of power for it to be applied to."
It gets complicated. Without authority to begin with, no challenge trials would matter, as we need validated sources to back them up.
In any ideal world, a hierarchy of knowledge will emerge, that will adjudicate these conflicts. This hierarchy will never be perfect.(it's comprised of the interaction of many people with the potential of making many mistakes) But it's a similar sort of problem whether it's bureaucracy accountable to democrats, the Soviet Union, or Consumer Reports.
And to be honest, it's really hard to actually reliably say anybody is the expert who beats "the experts". Or let me put it this way: If Zvi announces changed results at 90% confidence and the CDC waits for 95%, then Zvi will generally lead the CDC, and we may not be able to identify a significant error rate. But that doesn't mean the CDC is bad to wait. And separating out results like that can also be hard, as they bleed into the same "politics is bad" message here.
"But that doesn't mean the CDC is bad to wait."
Right: https://twitter.com/CDCgov/status/1223350241539215360
https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html
I think the failure to develop a test in good time for a known problem is different than lagging in terms of adopting advice.
Or to put it another way: a counter argument on whether it is bad to wait requires identifying the risk of both types of errors: adopting an idea too quickly(and finding it wrong) vs adopting an idea too slowly(and finding it correct).
I think advice (where people can take it or not) has a different calculus than things like requiring FDA approval (which actively prevents people who are smarter than you from doing the right thing).
I remain broadly libertarian, but I think even in a world without governments we would have this same problems with expertise. WebMD's problems are mostly non-governmental (though arguably the government is responsible for the lawsuit situation).
"In a world without the FDA and other political constraints, a month of challenge trials would have shown that they were effective and not very dangerous, after which they could sell them to all comers as fast as they could ramp up production."
A wonderful dream. But in reality, you would recruit 1000 people for the trial, then have them sign an airtight waiver absolving you of any harm. 4 people would get terribly sick and/or die and then their families would sue you to oblivion. If that doesn't work, they would take the story to the news and the resulting public outrage would force your business to close. Public trust in vaccines falls and we end up with no vaccine ever.
Oops.
Why are you positing your scenario as the reality to David's dream? I could see presenting it as a different possible outcome but in this particular case people didn't get sick and die and the chances of healthy people dying would be super low anyway, so I don't see any reason to believe your scenario is more likely.
If you're imagining a world with no FDA, then how do you prevent fake drug companies from making fake vaccines with this profile?
I'm a bit unclear on the relevance of this question. You think without an FDA a bunch of popup vaccine companies would have been competing against Pfizer with fake vaccines that killed people and would have made lots of quick profits and then fled?
Anyway, the FDA could be purely advisory, or there could and likely would be a private advisory group like UL. There's an extensive literature on alternatives to the FDA. Of course there was no requirement by the FDA to prove effectiveness prior to 1962. There would obviously be very serious civil and criminal liabilities for making a fake vaccine that would likely deter most psychopaths from trying.
Also, most people would probably be reluctant to take novel medicines in such a world without a strong basis for doing so, like a bunch of experts being convinced and supporting it publicly. While many people believe outlandish things with little evidence, I think that is somewhat less likely to be an issue when we're talking about injecting an unknown substance into your own body. People might be happy to take a vaccine from Pfizer with $100B pockets who put out extensive testing data and with support of public health figures, but a fake pop-up vaccine company? I doubt it.
What is UL? (Sorry, I'm fed up with the proliferation of unexpanded, not-universally-known acronyms, so I'm going to ask when I see one.)
Huh. It's a surprise to me that somebody doesn't know UL. I thought it was "in the water" for the past 80 years or so.
It's Underwriter's Laboratories, which is a private consortium founded by insurance underwriters to certify electronics so they don't start fires. Pick up pretty much anything that plugs into the wall and you can see their logo on it.
"The advice that was given by Fauci and others was probably better than what most people would have done with no advice"
Wrong, wrong, wrong: https://www.today.com/video/dr-fauci-on-coronavirus-fears-no-need-to-change-lifestyle-yet-79684677616
Do you think most people would have adapted earlier than they did in reality in the absence of advice? This particular advice was bad, but if we count all official advice throughout the pandemic, they probably did good on the net.
First of all, I'm not sure the world without the FDA looks like 'an effective vaccine is found and distributed within a month and hundreds of thousands of lives are saved'.
I've done some historical research on the bad old days of patent medicines and the like, and I suspect it would look more like '100,000 vaccines are released within a week, most of them being sugar water, possibly mixed with mild doses of cocaine, everyone takes something random and then believes they're protected and takes no precautions, and rejects the 'proven' vaccines experts recommend because they've already taken a vaccine, lots more people die over a longer period.'
Of course, the response may be 'I'm not saying have *no* regulations or expert oversight, just not the nightmare of the FDA,' but the people who made the FDA weren't *trying* to create a nightmare, and I'm not sure that the imagined 'good' regulation/oversight is possible/practical without a concrete proposal and a reviewable test case.
Second, even if everything you say about the Covid vaccines is 100% correct, I think this is still cherry-picking the absolute worst-case scenario for the FDA. Like, yes, a once-in-a-century global pandemic is a bad time to have a slow, measured process, but what about all the other times and all the other conditions? Again, snakeoil salesmen are a very real and omnipresent threat to patient health and medical advancement, and I'm not confident to say that the FDA hasn't saved more than 400K lives over the last hundred years by tamping down on them.
Of course, I'd agree that the FDA should have different, highly expedited procedures for emergencies like this one. But that's not 'the FDA is the problem' so much as 'the FDA needs one minor tweak.'
David, Scott - any advice for a public servant functionary who wants to both do good and one day be in a position to do good?
> Even if this flattering story is true, it doesn't scale... Compared to the median person who disagrees with the experts, the experts look pretty good.
This is an interesting way of phrasing it. I would say that the problem you're pointing at - the incentives for getting and holding power mean you get mediocre experts is, _itself_, a scaling problem.
Here are two thought experiments to illustrate my point:
a) Imagine there's a single unified government for the entire solar system, with population in the hundreds of billions of people, and levels of wealth substantially beyond what's available today. Billionaires are a dime a dozen - any pop star or athlete easily makes it there. There are people who own entire planets. Are the incentives for being honest and accurate _more_ aligned with getting and holding power, or less? How corrupt would you imagine the official councilor on health, for the entire solar system, which includes multiple alien races and sentient robots and the bio-corporations of titan?
b) Imagine that the federal government basically doesn't exist and almost all power - taxation, trade regulation, everything else - falls on the individual states. Each state has its own experts, who compete for power in _much_ smaller games. How corrupt is the state health controller for each state?
It seems to me that the more people involved in a competition, the greater the disparity between 'strategies to get and hold power and status' and 'strategies to be accurate.
The lesson of moloch, to me, is that we should try to avoid, as much as possible, massive, winner-take-all games of power. _That_ seems to be the thing that doesn't scale - i.e., it works OK when you do it with smaller numbers of people, but it falls apart as you start to add more and more people to the system.
There's likely a lower limit here too - with too few people, there's not enough of a pool of capable people to select from. With too many people involved, the selective pressures get so insane that the winners must be corrupted.
Ah, the old *Archipelago Paradox*:
Many small, independent states are ideal, except that if we care about people (esp. children) having the ability to leave a given state and enough knowledge to choose, we need an umbrella government with sufficient power to punish or threaten the largest state, which means quite a bit of power actually, which means it will inevitably, eventually, be given to someone who will abuse it and usurp the power of the many independent states.
> if we care about people (esp. children) having the ability to leave a given state and enough knowledge to choose, we need an umbrella government with sufficient power to punish or threaten the largest state
Why? I understand that this is what lots of people believe. It just seems like a laser focus on one proposed solution, which we know doesn't work.
Are we saying we've searched the entire space of solutions to this problem, and this is the best answer?
I can't say that I have personally done the kind of universe-searching you're talking about, but Scott lays out a pretty convincing case in *Archipelago and Atomic Communitarianism* - https://slatestarcodex.com/2014/06/07/archipelago-and-atomic-communitarianism/
I don't know about searching the entire possible solution space, but I think a lot of cultures are quite good at keeping at least some of their people trapped.
I don't actually want an umbrella government. I want enough decentralization to ensure there's no suicide-by-singularity. https://www.overcomingbias.com/2018/11/world-government-risks-collective-suicide.html
Doh, that should be "suicide-by-singleton".
This is essentially the logic behind the old American and Canadian practice of "Indian schools." Allowing children to be brought up in pagan religions and uncivilized cultures was thought to deny them the choice to embrace Christianity and modern civilization and removing them from their parents and tribes to educate them 'properly' was judged as a small imposition relative to that. It is not a fondly remembered policy today.
Parents generally look after the interests of their children: there are horrific exceptions, but as with most cases of 'market failures' those exceptions become the rule when church or state bureaucrats are given control. The same rule applies to a lesser extent in natural communities like tribes or small towns, and we would be wiser to adopt a policy of subsidiarity and leave people minding their own business well-enough alone.
I love that you conclude that we are "insufficiently grateful" for Anthony Fauci, while belittling his free-agency in the same breath. It's surprisingly effective, and somewhat hilarious in light of the Fauci-is-Jesus-reincarnate memes that people are worryingly sincere about.
Funny that you say Trump is some sort of specifically bad outcome when the alternative was Hillary. I'd say the system failed by the time it presented either of them to us as a choice.
While disagreeing with you about the relative merits of Trump vs. Hillary, I agree that the system presenting either of them to us as plausible choices is further proof that merit and the-legible-appearance-of-merit are very different things.
This is one of the most troubling aspects of today's iteration of "libertarianism" -- its desire is to separate "the people" from "the system," scoffing cynically at the democratic notion that we ARE the system. By assuming the stance that "the system" was responsible for "presenting" us with our choices, we give ourselves permission to collaborate around our workplace water coolers and political blogs depressing everyone and ourselves with Susan Sarandon-style anger that nothing is more important than "speaking truth" against the system.
To my eyes, it was entirely We the People who failed in 2016 by collaborating to devalue Hillary's expertise, and devaluing the significant incremental progress we had made the prior eight years, in order to feast on collective cynicism, making it hip to stay home, or vote Green, or worse. The emotional piling on (by liberals and conservatives alike) manifested one of the greatest collective errors in modern history. But the error was ours, not some displaced "system." We screwed up.
By way of nominative determinism, it's worth noting that many people die to warfarin'.
"Benevolent dictatorship, obviously, just get the best person in the country and let her fix everything. But everyone realizes this is easier said than done; the procedure to pick the best person is corruptible. "
One of Mary Renault's historical novels, _The Praise Singer_, is in part about tyranny, meaning, in the Greek context, popular dictatorship. One of the tyrants she describes, Pisistratus, is benevolent. In her version, he was the younger lover of Solon, who created the Athenian legal system. He tells the protagonist that when Solon finished everyone liked it, except one thing — everyone wanted a change to favor him. Solon's response was to leave Athens, because if he wasn't there they couldn't make him change it. "They keep his laws — I see to that, who could have given them laws they liked less well." The tyrant has been kept honest by the memory of his dead lover.
It's a powerful scene, but not a very reliable procedure.
> What's the best form of government? Benevolent dictatorship, obviously, just get the best person in the country and let her fix everything. But everyone realizes this is easier said than done; the procedure to pick the best person is corruptible. At one point we tried a very simple best-person-picking procedure that really should have worked and ended up choosing Donald Trump as the best person. I'm still not really sure what went wrong there, but apparently this is really hard.
I know you’re having trouble being serious here, but no, at one point y’all tried a very simple best-person-out-of-two-far-from-obviously-close-to-the-best-in-the-country-picking procedure. The prior picking-which-two-people-to-choose-from-procedure was very complicated and obscure and probably very corruptible.
The procedure was "democracy". Anyone who paid a small fee and filed some papers was allowed to be on the ballot. I agree we managed to screw that up somehow, but that's my point!
"I agree we managed to screw that up somehow" -nothing was screwed up; it's silly to think the will of a plurality of a plurality is consistently either the most broadly popular option or a competent option.
The electoral college is at best democracy correlated
Arrow's theorem shows that there is no such thing as democracy though.
I personally wouldn't *define* democracy as single-member ranked-choice voting systems.
Sure, but there are plenty of generalizations of Arrow's theorem to many settings. If people have opinions about whether or not policy A ought to be the case; people have opinions about whether or not policy B ought to be the case; and people have opinions about whether or not A<->B ought to be the case, then there is no consistent function from those opinions to a social choice that works the same way for each of these three propositions.
If you can put in cardinal strengths of desire, and find a unique interpersonal scale for those cardinal strengths, then you can do it. If you can assume a stronger set of comparisons on the individual level than you want your function to return on the social level, then you can often also do it. Otherwise you usually can't.
> The procedure was "democracy".
Sure, but just because it has a one-word name doesn’t mean that it’s not very complicated and obscure and very corruptible. It might be better than all other procedures (I don’t have any better candidate), but that doesn’t mean it’s simple or legible or hard to corrupt. Lots of countries use Democracy (TM), but their procedures can vary quite a bit. Democratic People's Republic of Korea has it right there in the name, doesn’t really mean they’re basically the same as the US.
> Anyone who paid a small fee and filed some papers was allowed to be on the ballot.
No, they didn’t. I, for example, am both too young and not an American, therefore I wasn’t allowed.
Even if I were, there are very complicated rules on who is allowed to say what to encourage people to vote, and how much money is allowed to change hands and how in order to do that, and which people exactly are allowed to vote, and how that set of people is allowed to change, and I bet a hundred other things I didn’t even hear about.
Then there is a very complicated set of unwritten rules about what candidates the media will talk about and in what tone, and who you can talk to your acquaintances about without sounding like a weirdo, and probably a thousand other things that wouldn’t occur to me but are quite important.
“Democracy” is not meaningless, it’s a word that is pointing to a concept, but the concept is vague and fuzzy and applies to very different things with very different behaviors. It’s just barely clear enough that you could argue DPRK is using it wrong. You can’t actually use it for much without really going into the details.
It's common to hear the following:
1. If group I dislike is disproportionately responsible for problem X, it's group I dislike's fault.
2. If group I like is disproportionately responsible for problem X, it's a society's fault, or the general incentive structure, etc.
I see this in the response to corona of many people here. Who is to blame for corona spreading because people refuse to wear masks? Dumb people. I personally agree fully, see https://alexanderturok.wordpress.com/2020/07/08/march-of-the-clevons/
But then, who to blame for the lack of prediction markets and challenge trials? Well, that's a problem with "society" and "incentives."
You tell a hypothetical story about what would happen if Biden appointed Zvi. But what actually happened when Trump actually appointed Scott Gottlieb head of FDA? Why did he only last two years? Was he pushed out as a political cost, as in your story? Did he burn out fighting with the organization, a different but parallel story? Did he have power to control the organization, or would it not have made a difference if he had stayed for another two years?
For the reasons this post talks about, I often wonder when I see people say "Scott Gottlieb seems to be endorsing good policies the current FDA isn't following, it would have been great if he was still FDA commissioner", whether if Gottlieb was still head of the FDA whether he would have endorsed those policies. Once you're out of the position you stop being affected by those forces as much and so can start endorsing good policies again.
I've also seen people talk about Balaji Srinivasan having been considered for FDA head before the pandemic, and how things would have gone better if he'd been chosen. But in that case we might have just got the world where Balaji is fired in February for being too extreme about COVID and replaced with someone else.
My favorite aphorism for understanding bureaucracy is: Where you stand depends on where you sit.
I say this as somebody who flipped his opinion on the importance of correctly filling in a particular database used by the the US Army over a weekend. The previous week, I was a staff officer responsible for ensuring the correctness of that database. The following week, I was a company commander with many, many more responsibilities than that stupid database. It's very, very easy to change your mind on something depending on the incentives acting on you.
If Balaji had replaced Gottlieb shortly before covid, he probably would have been quickly fired. But if he had been the first director and survived two years at FDA, I think he would have had the slack to cotinue. I don't think he would have made it through those two years, though.
Perhaps we should disentangle speech from action. If Gottlieb had continued as head of FDA, we probably would not have heard from him, because FDA is mainly not about public speech. Thus we would not be talking about him. Mainly we should judge FDA on the timeline of approving tests and vaccines. Approval is complicated and opaque and those the influence of the director is very hard to judge. Gottlieb first came to my attention when he explained that the first action FDA had taken was to ban tests, and that this was a terrible idea. This seems like something that the director could have vetoed without the cooperation of the rest of the organization. But I can't know what he would have done.
Maybe list all the side effects but in a font size proportional to their frequency?
Not enough font sizes.
WebMD is useless but your specific example is an unusual choice. Aspirin is relatively safe for healthy people but less so if you have liver damage. The Wikipedia article for salicylate poisoning says there were 20,000 cases in America in 2004.
This is true, but the number of people taking Aspirin must be at least an order of magnitude greater than Warfarin, so the conclusion that Warfarin is much more dangerous holds.
I like the idea of cocooned experts, incorruptibly sealed while they print out opinions.
Promising instances:
• Scott and his substack
• a wealthy patron paying the living expenses of a writer
• forecasters on prediction markets that capture some vig
• the crop of very smart people who made, are making a killing [in crypto, other investors] and can pursue their own ends, e.g. fuck you money
• communities like LessWrong where status is accorded to thoughtful, considerate correctness
in theory, I think this is what that tenure system of universities was supposed to(and maybe used to) get us. Once you've gained admittance to the ivory tower, you're unimpeachable and can sit in your tower and spout whatever you want with immunity
but it seems we've messed that up too
Incentives for corruption still exist, they just tend in different directions. Writers with a patron have to flatter that patron and appeal to their preexisting beliefs to keep food on the table. People who live off patreon or substack need to appeal to their fans. Communities give status to people who say the things that the community wants to hear.
The "fuck you money" and prediction markets examples are slightly different. As the problem there is transferable expertise. Even with the best incentive system being an excellent software deisgner won't make you a good epidemiologist.
Superforecaster Georg, who lives in a cave and makes 10,000 correct predictions a day is an outlier...
There are examples in real-world governance of officials with some level of independence. Judicial independence seems to work relatively well in most democracies, often with tenures of life (or up to some fixed retirement age). There is a norm of central banks having a decent degree of independence in the last few decades. As far as I understand, Fauci himself could afford to sometimes disagree with Trump because, in the American administrative system, Trump didn't have the power to replace him on a whim.
These officials may not be perfectly independent, but the concept exist in real-world governments. It would be interesting to investigate whether jurisdictions with more strongly independent officials perform better (though it would be very difficult to disentangle the effects of other differences). My impression is that systems with too strong checks and balances, such as the US can have too much inertia; overly complicated regulatory systems develop over time, and no one has the power to streamline them.
Great post. The last line -- "prediction markets would still be better" -- is idiotic [1], but we can't have everything. Scott isn't perfect, but he is better than we deserve; legibly mediocre.
[1] If prediction markets were so great, we'd see them happening *somewhere*. Gambling is legal in Canada; you can't blame everything on anti-gambling laws. Where are the Canadian companies that use prediction markets to make decisions? They don't exist. You think they should? Go to Canada, start a company that uses prediction markets instead of a CEO, become a billionaire, and THEN I will believe that prediction markets work. Until then, they are just a way to signal "rationalist community good".
That sounds like a fully-general argument against innovation.
Agreed. It's kind of a strong form of EMH, which we thankfully have "Inadequate Equilibria" to thank for sparking gajillions of discussions on why things are sometimes not perfect.
Just to clarify, do you predict that if someone started a company in Canada and used prediction markets instead of a CEO, that person would become a billionaire? Why or why not?
The modal response might be that the optimal decision is to avoid burning the corporate commons* and instead dissolve and distribute the company's assets to the shareholders, which the CEO would prefer to avoid.
* https://modeledbehavior.wordpress.com/2011/01/13/burning-the-corporate-commons/
That's a cop-out response, in particular because in this thought experiment, the founder is both the CEO and the primary shareholder (so there is no "the CEO would prefer to avoid giving money to shareholders" scenario).
In any case, I assume that if you're of the belief that shareholders are so irrational that they voluntarily give money to CEOs that burn it, then you're also not a fan of prediction markets.
I am a fan of prediction markets. I think shareholders give money to companies even though some of it is burnt because that's the cost of doing business and the returns are generally still positive. They would simply be even higher without the agency problem of executives burning the commons. Robin Hanson's idea for the first place decision markets should be used is a "fire the CEO market", and there's a pretty obvious reason why CEOs would be averse to that.
What are you arguing here? That there should be no companies at all? Or that most companies should be dissolved?
I don't get the "burning the commons" terminology either. I usually see the terminology as referring to game-theoretic analogues of the tragedy of the commons. I don't see the analogy here.
(What is a modal response? Is this lesswrong jargon?)
It's a fully-general argument against supposedly fully-general decision-making techniques, yes.
You really think this niche community came up with One Weird Trick that makes superior decisions to everything else humans ever tried? Is it not legitimate to ask "if it's so great, why aren't you sitting on a mountain of utility"?
Well it seems to work super-well where it is tried, right? Has it ever been tried and failed? I think people have this innate disgust for gambling on important outcomes.
Has it ever been tried and worked?
Um, yes? Oodles and gobs and dozens and hundreds of times? Many companies use internal prediction markets to improve forecasting. Google and Microsoft do it. Drug companies and hedge funds do it. Use *internal* to a firm is legal, hence actually happens and can be a competitive advantage. That these markets are still used *less often* than Hanson would like doesn't mean they've never been tried at all and the ones that have been tried definitely work; the hard part is navigating internal politics. Management often resists using markets to make decisions for much the same reason that doctors resist using expert systems to make diagnoses - it's weird, it might prove that their *prior* strategies were bad, and it might undermine their own perceived market value. So adoption is *slow* but it still happens.
Here's a relevant Hanson interview: https://www.sintetia.com/robin-hanson-full-interview-about-prediction-markets/
A Columbia paper that looked at Google, Ford and a third "firm X" ( https://www8.gsb.columbia.edu/researcharchive/articles/25925 ) says:
"Despite theoretically adverse conditions, we find these markets are relatively efficient, and improve upon the forecasts of experts at all three firms by as much as a 25% reduction in mean-squared error. "
Your links do not contain the terms "hedge fund" or "drug", and I couldn't find (by skimming) any information about hedge funds or drug companies using prediction markets. Can you give me a link claiming hedge funds use prediction markets, or else retract the claim?
Google and Microsoft seems to have *experimented* with prediction markets; I don't see any claim that they use them for important decisions. Let me know if I missed it.
As for your earlier question of whether prediction markets have been tried and failed: Nate Sliver has consistently outperformed betting markets when predicting US election results. He does so every year, and all the markets often have some absurd predictions (e.g. Hillary Clinton becoming president in 2021, even though she stated early on that she wasn't running). I know that advocates of prediction markets like to no-true-Scotsman this and claim that the election prediction markets are not true prediction markets for some reason or another, so I didn't mention it as an example earlier.
I believe Robin Hanson has written some about attempts to introduce prediction markets into companies. It's not that they don't work. It's that they tend to step on the toes of too many important people. Exactly the sort of political considerations Scott writes about here, in other words.
Do you have a link? From your description it sounds to me like "prediction markets were tried, they sucked, but Hanson needs an excuse for saying it's not the markets' fault", but I'm willing to keep an open mind.
"...while such markets have consistently performed well in terms of cost, accuracy, ease of use, and user satisfaction, they have also tended to be politically disruptive – they often say things that embarrass powerful people, who get them killed. It is like putting a smart autist in the C-suite, someone who has lots of valuable info but is oblivious to the firm’s political landscape. Such an executive just wouldn’t last long, no matter how much they knew."
https://www.overcomingbias.com/2017/09/prediction-markets-update.html
Right, but this is just an *assertion* by Hanson, with not much evidence to back it up. He's not exactly an unbiased source for this topic!
I think you are overinterpreting that last line. It's not a serious claim that prediction markets should replace the Faucis and every decision Faucis make.
I'm surprised that no one has yet mentioned Zeynep Tufekci (https://zeynep.substack.com/people/299814-zeynep) as another writer who seems to have consistently been righter than the experts. She's been my go to for COVID information for quite some time, and probably the person who's most influenced my actions and what I recommend to others.
Scott did write about her here: https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/
Nah; she seems pretty useless. Take a look at this Sinophobic nonsense: https://www.theatlantic.com/technology/archive/2020/02/coronavirus-and-blindness-authoritarianism/606922/
I'm not sure I understand what the problem with this article is supposed to be. In any case, if it is problematic, it appears to be one problematic article she has had in several years of really useful public discussion about major events.
The problem, Kenny, is that in February, when coronavirus was already spreading throughout the United States, Zeynep's message to the American people wasn't "coronavirus is already spreading throughout the United States, and you can't expect America's public health response to be even remotely as good as China's -wear masks, avoid crowded settings, etc.", but "China bad, authoritarian systems bad". This claim can easily be tested: did China perform badly against coronavirus? No. Was there any obvious relationship between the quality of coronavirus response and central government authoritarianism? No. Is the whole premise of the article -that surveillance and censorship result in inferior coronavirus responses relative to reliance on free media- correct? No.
Here was Tufekci's message to the American people in the last week of February:
https://blogs.scientificamerican.com/observations/preparing-for-coronavirus-to-strike-the-u-s/
Maybe she should have posted that one five days earlier and the one you posted five days later, but she was posting both of these in the same week (which is basically the week that I realized this was a major event we were living through, and I needed to talk to my students about it the day I got back to class from a conference I had been traveling for).
But as for your other questions:
In the sense of how the Chinese government responded *after* it had started spreading, their reaction was as effective as anyone's at stopping the spread (except maybe Taiwan). They might have been more effective at eventually stopping the spread than even South Korea, Australia, and New Zealand, but that doesn't mean that their overall response was better, given that these countries did it in ways that were arguably not as harmful to the other aspects of the well-being of their residents.
But this isn't the question she is addressing here. She's addressing the question of how well they performed in the *initial* phase, *before* it started becoming widespread. Here we don't have any comparison cases, except maybe the response to SARS by a few governments in 2003. Would some other government form have better succeeded in detecting and stopping the initial outbreak? That's the question Tufekci is asking in the article you linked.
You may disagree with her conclusion, but you haven't provided any evidence that she's wrong.
The problem with that piece is that "flatten the curve" was still no different from "herd immunity" and was obviously still very bad policy. At least it was realistic.
This was also wrong: "All of this means that the only path to flattening the curve for COVID-19 is community-wide isolation: the more people stay home, the fewer people will catch the disease."
South Korea kept the virus more or less contained without any mass stay-at-home orders. It probably could have eliminated the virus within its territory, as well, had it used local travel restrictions and mass testing.
Her mask advice was also not the greatest.
"Would some other government form have better succeeded in detecting and stopping the initial outbreak?"
Considering most countries didn't make serious attempts at containing the virus, I think very few countries would have done better than China at containing it initially. Maybe Australia, Vietnam, Thailand, or North Korea.
Taiwan
Elaborate? How is it Sinophobic or nonsense?
This is nonsense, for instance:
"China’s use of technology to ratchet up surveillance and censorship may have made things worse, by making it less likely that Xi would even know what was going on in his own country."
Censorship made it much easier to distinguish the signal from noise (compare America's freedom of speech on coronavirus back in February, when numerous newspapers were outright floomer), and China's surveillance system was obviously a major plus in contact tracing, and something many countries would have killed for.
"Given exponential growth dynamics of infectious diseases, containing an epidemic is straightforward early on, but nearly impossible once a disease spreads among a population."
Also wrong; containment of the virus was always straightforward. Li Wenliang was not a "whistleblower".
China waited to act against the coronavirus until it knew it was a serious threat. This was quite excusable, given the costs of overreaction. The Wuhan pneumonia outbreak could, given the information available at the time, easily have been either a minor and self-containing outbreak or as non-fatal and widespread as H1N1 flu. The characteristics of the coronavirus in early January were not just unknown, they were unknowable, regardless of what system China had. Only time could tell how contagious and dangerous the coronavirus was, not rumor-mongering. Tanner Greer had the far better initial take on coronavirus: https://scholars-stage.blogspot.com/2020/01/political-and-practical-implications-of.html
You may want to quote the rest of the section:
"China’s use of technology to ratchet up surveillance and censorship may have made things worse, by making it less likely that Xi would even know what was going on in his own country.
"Authoritarian blindness is a perennial problem, especially in large countries like China with centralized, top-down administration. Indeed, Xi would not even be the first Chinese ruler to fall victim to the totality of his own power. On August 4, 1958, buoyed by reports pouring in from around the country of record grain, rice, and peanut production, an exuberant Chairman Mao Zedong wondered how to get rid of the excess, and advised people to eat “five meals a day.” Many did, gorging themselves in the new regime canteens and even dumping massive amounts of “leftovers” down gutters and toilets. Export agreements were made to send tons of food abroad in return for machinery or currency. Just months later, perhaps the greatest famine in recorded history began, in which tens of millions would die because, in fact, there was no such surplus. Quite the opposite: The misguided agricultural policies of the Great Leap Forward had caused a collapse in food production. Yet instead of reporting the massive failures, the apparatchiks in various provinces had engaged in competitive exaggeration, reporting ever-increasing surpluses both because they were afraid of reporting bad news and because they wanted to please their superiors.
"Mao didn’t know famine was at hand, because he had set up a system that ensured he would hear lies."
"Censorship made it much easier to distinguish the signal from noise"
Assuming, of course, the information reaches them in the first place. The Hubei authorities arrested Li for spreading misinformation.
"China waited to act against the coronavirus until it knew it was a serious threat. This was quite excusable, given the costs of overreaction."
I find it hard to justify inaction over action when it comes to a new, relatively unknown virus, that we knew was SARS-like very early on. To err on the side of caution in this case would be to monitor the virus, and at the very least, stop lying about its human-to-human transmissibility.
I read the article and I can report a clear lack of sinophobic nonsense. It just sounds like you have some kind of grievance you're not telling us about.
It was Sinophobic nonsense. The obvious implication, written plainly between the lines, was that coronavirus was an exclusively Chinese problem that could never seriously affect countries of such as the United States, Britain, or Sweden. Also, the idea that either censorship or surveillance was a minus in China's response was transparently absurd. The West resorted to a great deal of censorship against floomers in spring and summer of last year -much of it crudely applied, but all in all probably insufficient in quantity. The surveillance network, of course, allowed China's coronavirus response to get off the ground in a much more energetic fashion than otherwise.
"The obvious implication, written plainly between the lines, was that coronavirus was an exclusively Chinese problem that could never seriously affect countries of such as the United States, Britain, or Sweden."
I'm quite sure that the plainness between the lines is the whiteness of the background.
I've read the article. I couldn't see how it implies this would never affect Western countries.
One assumption that I'm not entirely sure I agree with is this one:
"If you expose the plan to politics, the politics will drag it in the direction of being worse. Every feedback channel you open up is a way for somebody to attack you. "
Some massive assumptions involved are that:
1) You will consistently have specific illegible experts
2) These experts have satisfactory self-contained knowledge
I agree with the mechanism that politics CAN drag things in the direction of being worse because it inevitably creates channels for people to jam questionable inputs.
But politics also has the ability to create channels for people to jam in relevant inputs. Most people can't, don't, and won't develop the approach needed to balance a proposal against multiple different objectives. Part of this is maintaining power. However, Fauci isn't strictly acting as providing medical advice, but rather his pronouncements have economic & sociological impacts.
I think the essay creates a good argument for Plato's Republic, but when you keep in mind that Plato's ruling class must exercise judgment in lying, and that the web of information in a modern society is an order of magnitude more complex, etc, etc. Then... I'm not so sure. I am not sure if I want to sign off in an idealized theory even.
Let's put it another way: does Fauci & the CDC by itself have sufficient expertise to decide to lockdown the US economy? The answer is probably no, because why shouldn't the CEA (Council of Economic Advisors) get a say in that? That's a really big decision that hit's their domain. And maybe we need the APA (American Psychological Association) because this really could cause psychological stresses that the CDC may not be as expert in. And... at this point, we may also be talking about a value judgment, which requires some sources to provide those inputs (ethicists? representatives of the US population?) And when you realize all of the people who should legitimately be consulted to make a complex decision, you now have politics.
That leads to the idea that politics is a natural result of human interactions involving complex decisions. Some politics is good & some politics is bad. But it needs to exist, and it isn't so easily separated into "impure power-grabbing". Coordinating with all stakeholders is "maintaining political power", but the stakeholders legitimately exist! And pretending they can be replaced (even in theory) with the ideal dictator means that we somehow don't believe there are other stakeholders, or that we think they can be ignored. Sometimes bypassing stakeholders works!! However, it really can blow up quite horribly!! "Move Fast and Break Things" is a very productive & very destructive slogan.
All of which is to say: Scott this is a great post. Can you please tell me if Democratic Republics are good or bad? This post has implications and I just gotta know.
This seems really right.
I like this post in general, and I agree with the central thesis. However (as someone who put nontrivial thought into both masks and coronavirus case/death estimates, see eg: https://pandemic.metaculus.com/rankings/), I disagree with the causal mechanism is that corruption caused accurate people to become less accurate in public-facing ways.
I think it's more likely that the corruption caused counterfactually competent people to be less accurate, even in their own thoughts.
Fuller explanation on Twitter:
https://twitter.com/LinchZhang/status/1357839902163931136
Greg Cochran would agree with you. They really believe false things.
Speaking of Lorien Database changes, you might want to make the UI a bit more useable on mobile. There was some charcoal-on-prussian-blue text and stuff last I checked.
Also is it true that formites are not a vector?
IIRC the state of fomites as a vector is somewhere around “has probably happened in a nonzero number of cases, but really isn’t a significant concern”.
I think you’ve conflated two forms of “expert,” the advisor and the policy maker.
While a policy maker is evidently subject to the sort of public pressure you describe, one would hope a president could get better advice in private, and that experts whose public facing role limits them might still be able to speak more frankly “on background” to reporters, politicians, etc.
I... do not get the sense our expert class recognizes their failures in private. It is not clear to me, for instance, that the FDA’s top leadership suspects that their refusal to consider and approve the Astra-Zeneca vaccine is effectively mass murder. And it isn’t clear to me that in private public health officials understood the threat of COVID-19 until remarkably late. That’s more worrisome than that our system puts pressure on the most public-facing roles.
Or, put another way, we are selecting almost entirely for “can handle dealing with the public” rather than “gives the best possible advice” in the filter that selects for our public experts.
I would add a third category – the expert who is the predictor of the future.
In my understanding being an expert, let's say about TB treatments, doesn't let you predict what will happen to a specific patient. An expert knows exactly what tests he needs to order, what medicines he needs to prescribe, what are side-effects and what to do with them, what are challenges with drug resistant TB and treating immunocompromised people. He may even know about socioeconomic aspects of TB and suggest measures to improve adherence to the therapy of homeless people etc.
While he can give a past statistical success (like 95% patients treated within 6 months), he cannot say confidently how any individual patient will do for many different reasons. New resistant strains appear, some patients lie about taking the medicines regularly and so on.
The predictions about coronavirus pandemic are like that. On average CDC or WHO may have been quite good with containment of epidemics. But things can happen differently and because there are so many people who always cry wolf, some of them were correct this time. It doesn't mean they had great insights or would have done better. Many potentially promising ideas didn't work out: hydroxychloroquine, antibody treatments, even need to produce more ventilators turned out unnecessary. Vaccines seem to be working so far but it is still to early to see the end-game as the emergency of vaccine resistant strains is still a possibility.
My current nomination for "most trusted pandemic amateur" would be Zeynep Tufekci. I'm skeptical that Zvi always optimizes for being right, versus coming up with hot takes to make us angry about how people are handling the pandemic? (Maybe we should be angry, but I need better evidence.) Still a good source of link and questions, though.
In particular, I am wondering if anyone has good sources or explanations for how the FDA is making decisions about vaccines during the pandemic? This seems mysterious and many have questions, but I don't think I understand it yet.
I agree Zeynep is great.
Thoroughly disagree. Robin Hanson, Zeynep Tufekci, and Tyler Cowen are all massively overrated pundits. Greg Cochran, Lyman Stone, and Scott Sumner, are underrated.
Could you elaborate on why? I'll even grant that I agree (to some extent) on some of those.
> (but prediction markets would still be better)
I'm absolutely not sold on this. Perhaps you already have an article explaining why you believe this, or plan to create one?
"The experts successfully swooped in and saved us from all of that, figuring out which way the wind was blowing only two weeks later than competent amateurs. This was a useful service. Without the experts, things would have stayed open forever."
I expect that people would, in Bill Gate's memorable phrase, "notice the bodies piling up in the corner" eventually.
It's hard to say? Honestly, it's really weird, but people (without centralized leaders) often really do just fall into collective action failure modes. Statistically COVID is obvious, but in reality many people call it "wu-flu" and deny that it's a dangerous disease.
Piling of the bodies may just mean that in the pursuit of profits we have over-optimized the funeral services that we cannot deal with a sudden 20% increase anymore. My understanding is that the mortality is somewhere at the level of 1980s. This is bad but how bad is clearly a subjective evaluation.
I was wrong, actually in the UK the mortality in 2020 was at the level on 2003.
https://news.sky.com/story/covid-19-how-mortality-rates-in-2020-compare-with-past-decades-and-centuries-12185275
Does it seem very bad? Not to me. I don't remember 2003 as particularly bad year when a lot of people died.
The article is biased and tries to argue that excess mortality as compared to previous 5 years are much higher and mortality improvements similarly compared to previous 5 years have nosedived. This again seems to be choosing too much from degrees of freedom. Why exactly 5 year period and not, let's say 10 years? Because it looks that for long time we have had a period of great stability and continuous mortality improvement and also that the mortality usually were not that much different from one year to another. The return back by 17 years causes a bigger jump but it also means that the mortality was worse and more stable at the same time and not that now it is worse than in 2003.
Maybe due to great efforts of WHO and CDC we were able to escape many health crises but that was not sustainable indefinitely and we had to suffer some setback. Maybe before 2003 such an event would merge with the background mortality and wouldn't be even noticeable whereas now we made such a big issue exactly because we have been doing so well for many years.
For something in a loosely related vein by Zvi himself, see https://thezvi.wordpress.com/2017/10/29/leaders-of-men/
It's my opinion that Fauci has done a terrible job, but I genuinely don't know anyone else who would've done better in this nightmare. We have a crisis of expertise AND implementation.
"but I genuinely don't know anyone else who would've done better in this nightmare"
The Thais, Chinese, and Vietnamese. Or, if you want something closer to home, the Taiwanese, Norwegians, and Finns.
The Taiwanese would disagree.
Zvi probably also has a very permissive peer group. For normal people it's still a multi-criteria decision-making problem: maximize rightness together with minimizing slights/offense/loss of status within the peer group. Whatever experts are proclaiming also gets used as input and it gets difficult to deviate from it depending on how peers process it. At least us normals don't have to deal with lobbyists or activists that want to remove us, I guess.
> later-proven-not-to-exist fomite-based transmission
I know this is a little off-topic, but did that ever get proven? Last I knew it was in the "weak evidence that it isn't very common" category.
I sold my stock in Big Fomite early on when it became apparent that Korea (where contact tracing is effective and food delivery plentiful) wasn't getting a ton of spread through that route.
https://virologyj.biomedcentral.com/articles/10.1186/s12985-020-01418-7#Sec7
These guys tested infectiousness in vitro rather than just looking for rna fragments, which helped me resolve the question about whether people were just detecting dead virus. I don't have a guess how many infections are caused by it, but it does appear to be a viable vector.
> These guys tested infectiousness in vitro rather than just looking for rna fragments, which helped me resolve the question about whether people were just detecting dead virus.
Resolve which way? Based on the Results section, it seems like viable virus can be detected on some surfaces up to a week at 30 °C; at 20 °C, the half-life is more than a day on all surfaces.
I concluded that yeah, fomite transmission seems like a probable risk. I keep my other risk factors really low, so I decided to keep quarantining packages for a week and washing refrigerated perishables.
I love it when multiple things I read converge around the same time even when they weren't created at the same time. I just rewatched the classic CGP Grey video, Rules for Rulers, yesterday - https://www.youtube.com/watch?v=rStL7niR7gs&ab_channel=CGPGrey, which discusses what people in power need to do to stay in power, and has a nice similar energy to this post.
It was just yesterday that I was commenting on Robin Hanson's post (though I was also thinking about a recent podcast he was on) about Experts Versus Elites*, pointing out that experts got COVID-19 wrong initially and elites had to correct them. This would have been a good post to link to.
* https://www.overcomingbias.com/2021/02/experts-versus-elites.html
One takeaway that I get from this is how important anonymity can be, sometimes empowering people to speak the truth which would otherwise have too great negative consequences for themselves and the systems they represent. While we probably don't want anonymous people running our country, it's definitely among the simplest ways to bypass some of the unintended forces of corruption mentioned here, and is, for example, why voting is at least intended to be anonymous (and ideally would be so in our government as well, just with cryptography to provide all of the various assurances and verification that we'd want).
A government of anonymous people (at least at the top) would be a great premise for a science fiction novel.
I'm not sure it ever happened in the real world, but there are stories about kings anonymously going out to get direct knowledge of what's happening in their kingdom.
The Unknown Fathers in _Inhabited Island_ (apparently translated as _Prisoners of Power_ instead/as well) by Strugatsky brothers are such a government.
The problem is that when people are anonymous they only have the credibility of everyone else commenting anonymously online
On the internet noone knows you're the director of the CDC. But also on the internet noone knows you're a dog.
Yeah, I've thought before about systems that would verify basic credentials and identity, but then discard that information and never display it, such that you could take a platform like e.g. Twitter, and know someone has certain experience or knowledge, but not know who they are necessarily
You establish an online identity secured by your digital signature and build the reputation of that identity. What you have to prove is not what university you got your degree from but how consistently you give what turns out to be the right answer to a problem.
Excellent post. Although it sounds like one solution would be to bring the requirements of "being in power" more in line with "being right"; e.g., by calling out, defunding, demoting, firing, cancelling subscriptions to, etc., institutions and individuals who have done markedly worse than competent amateurs and have caused harm in the process. So "taking to the streets, pitchfork in hand," but to a lesser degree.
I'm really nervous about all of that, because what you're actually doing is calling out, defunding, demoting, etc people who are legibly wrong, wrong according to the populace and the media that convinces them of things, etc. Sort of making sure nobody has any slack, which could go either way.
Are the problems Scott is addressing here [just] special cases of the general issue of how to juggle social signaling with efforts at accuracy / rationality / reliability? I'm not trying to trivialize it -- I think this problem is one that repeatedly arises both here (and back in the day at SSC) and in lots of places both in the Less Wrong crowd and more generally: how to raise questions *at all* when certain questions or certain responses or certain thresholds of reliability, etc, are also *signals* that mean things like "I am on your side," "I am powerful and you should be on MY side," or "I am NOT on your side and you should fear me." I am thinking of certain social justice questions, for instance, but one could multiply examples ad nauseam. Part of Scott's point, I take it, is that questions of scale play into this issue complicating the matter.
I want to offer a small correction. You claim: "What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong. People who most brutally and nakedly optimized for power would gain power; that's what "optimize" means."
At first glance, this claim seems by definition correct. But it does not *necessarily* hold. If there is ex ante heterogeneity in attributes. For instance, if we burnt down the current system and declared that the person born on the birthdate determined by some unpredictable quantum fluctuation has all the power, it would be *difficult* to overcome your ex ante handicap (birthdate in this case).
While that's a pedantic example, the same could imaginably be true if we only allowed the most excellent and well-respected academic economists to rise to power. Even for an optimizing power-hungry sociopath, it is unlikely that they will be able to rise to the top--not enough natural talent.
You could instead say that part of what needs to be optimized (natural talent) is out of the individual's control space.
For a statistician, if the variance in the latent variable that determines power is primarily driven by non-optimizing behaviors (primarily natural talent) then optimization has less of a potential role to play.
All that said, I agree with your overarching point, for most practical situations such as Marx's, what I said is nonsense--but in the interests of steelmanning, I think the theoretical idea that one can build a society that isn't driven entirely by power-hungry optimizers is not as self-contradictory as it might seem.
It would probably be possible to devise a better way of assigning power; the problem is how to implement it stably. Usually, once the previous system is burned down, the system that replaces it is less stable -- people are less used to it, less attached to it, and less able to tell which changes to it are harmless and which ones are potentially destabilizing -- so that a newly devised replacement system is likely to be easier for power-hungry sociopaths to game. Power being determined by natural talent would only be likely to work if the idea of meritocracy (along with a not-very-manipulable measure of merit) was already too strongly accepted to be easily overturned.
I agree completely. I only wanted to point out that power-hungry optimizers winning seems to be the rule *by definition* when it isn't. If enough variation in the latent variable that determines winning is generated by optimizing behavior, it is true. And to your point, perhaps when we burn down society, *more* variation is determined by power-hungry optimization.
Which perhaps was Scott's point to begin with. Thanks!
Scott Alexander provided zero evidence that Marx wrote or thought anything similar to that "fallacy". Indeed, Scott Alexander is presenting a strawman about Marx's writings on historical change. Scott Alexander has repeatedly shown that he has not understood Marx's work. e.g:
https://www.reddit.com/r/SneerClub/comments/gc27k5/author_reacts_to_ssc_book_review/fpbulfv/
I read the Sneer Club post, thank you!
In my reading, he is referring to revolutions inspired by Marx, not Marx himself. If he had instead rephrased it to "The Fallacy of Historical Marxian Revolutions" would you still object? It's certainly the case that that self-proclaimed Marxist-Leninists Stalin, Mao, and Pol Pot all rose to the top of unstable revolutions meant to build a better world.
It seems as though current Marxists should or do embrace his point--I believe they claim that the reason historical Marxist revolutions have ended in bloodbaths was that they were corrupted, and Scott describes why (because when you burn down society, the people who end up with power are the Stalins, Maos, and Pol Pots. People who claim to be Marxist-Leninists, but really were sociopaths/power-hungry, etc.)
Then he should quote Marxist revolutionaries and seriously study them, not accuse them of a fallacy they did not commit. Have you noticed how Scott has cited precisely zero evidence here? Why is he calling it "Marx's Fallacy" if Marx committed no such fallacy?
Again- I challenge Scott - show me where Marx said anything like this, using quotes from primary sources. Since I'm an especially charitable man, I will accept similar "fallacies" from other Marxist thinkers like Lenin and Stalin - but I still need some sort of proof that they actually said anything like this.
Well, Marx did oppose utopianism, didn't he? It may be a polemic simplification to summarize this as "Let's do a revolution and hope our current problems won't reappear afterwards" (which is even more simplistic than how Scott puts it), but I don’t think the fundamental opposition wouldn’t resist to a closer reading of Marx.
As for the Sneer Club post: How is it different in practice to say “Marx didn’t believe in human essence” and “Marx didn’t believe in the essentiality of the traits we call human essence”?
Marx was more utopian than the "utopian" socialists he criticized: https://www.econlib.org/archives/2012/10/utopian_experim.html
Would this same line of argument posit Fidel Castro or Kim Sung Il as successful socialist scientists? After all - their experiments are still running to this day.
>It may be a polemic simplification to summarize this as "Let's do a revolution and hope our current problems won't reappear afterwards"
I'm not interested in "polemic simplifications" that destroy Marx's meaning. Scott Alexander also has a habit of sneaking in political terms that are more contested than he thinks they are - like "power". Power to do what? Marx writes a lot about this kind of stuff, but Scott doesn't acknowledge any of it.
>As for the Sneer Club post: How is it different in practice to say “Marx didn’t believe in human essence” and “Marx didn’t believe in the essentiality of the traits we call human essence”?
That's self-evidently two different things. To disagree about the essentiality of this-or-that trait is NOT to say that there is "no such thing as human nature" or that "everything was completely malleable"
"Anthony Fauci is neither Attila the Hun nor Trofim Lysenko. "
Sure Jan: https://www.today.com/video/dr-fauci-on-coronavirus-fears-no-need-to-change-lifestyle-yet-79684677616
https://www.spglobal.com/marketintelligence/en/news-insights/trending/lfG-uPOaVGA2qlV4OSZnQg2
> . Citizens Against Lockdowns argues that the CDC already screwed up by stressing the later-proven-not-to-exist fomite-based transmission, ignoring the needs of ordinary people in favor of a bias towards imagining hypothetical transmission mechanisms that never materialize;
I know you're making an example and trying to be funny, but this is a really important point that needs to be made:
Most of the CAL-types (at least, the normal ones who aren't walking conspiracy-theorist stereotypes) aren't mad because "they said fomites are real but fomites don't real". They're mad because the experts figured out fomites don't real six months ago _but we're still going through all the surface-decontamination safety theatre_. They aren't mad that experts got it wrong. For that matter, it's not even clear to me that they're mad at the experts at all. They're mad that the people who constantly say that they're "following the science" didn't update their beliefs when the science came in, and it's been six fucking months of doing all this ritual bullshit that has provably zero effect on anything.
"but we're still going through all the surface-decontamination safety theatre"
China claims COVID can be spread through cold chain transmission, and they seem competent, so I wouldn't discount the surface decontamination stuff as theatre just yet.
Can you elaborate or link? I am involved in some supply chain stuff like this at work and am curious.
Another CDC vs. Zvi difference is that the CDC is doing public communication to a mass audience, often filtered by the media / the public discourse. Whereas Zvi is writing directly for a niche audience of people who are willing & able to put in an unusually large amount of time/attention/thought to build detailed models. Doing mass communication pushes towards:
Just sharing your conclusions rather than the details of your reasoning
Giving simple guidelines/approximations (e.g. "wear a mask", "6 ft apart") rather than more details or the underlying model
Not sharing things that you're more uncertain about
Trying to keep a consistent story rather than changing your views fluidly
Zvi doing mass communication would face some challenges that the real Zvi hasn't had to face (and which a Zvi-in-a-cave setting policy might be able to dodge). Just replacing pages on the CDC website with Zvi blog posts would create some problems.
I really appreciate this analysis. I only wish you emphasized more the relevance of regulatory capture. Whereas the FDA, CDC, and NIH are supposed to regulate the pharmaceutical industry, they very often are a mouthpiece for that industry, having been captured by it.
The generic drugs hydroxychloroquine and ivermectin, for example, have been successfully marginalized, despite abundant evidence of their efficacy against Covid-19. See hcqmeta.com and ivmmeta.com for summaries of the research to date and links to the original studies—which are abundant, at this point. (Really, please do look!)
For hydroxychloroquine: "The probability that an ineffective treatment generated results as positive as the 198 studies to date is estimated to be 1 in 1 quadrillion (p = 0.00000000000000083). Early treatment is most successful, with 100% of studies reporting a positive effect and an estimated reduction of 66% in the effect measured (death, hospitalization, etc.) using a random effects meta-analysis. ... 91% of Randomized Controlled Trials (RCTs) for early, PrEP, or PEP treatment report positive effects, the probability of this happening for an ineffective treatment is 0.0059."
For ivermectin: "100% of the 37 studies to date report positive effects. Early treatment is more successful, with an estimated reduction of 82% in the effect measured using a random effects meta-analysis. ... Prophylactic use also shows high effectiveness. 100% of the 19 Randomized Controlled Trials (RCTs) report positive effects, with an estimated reduction of 72%. ... The probability that an ineffective treatment generated results as positive as the 37 studies to date is estimated to be 1 in 137 billion (p = 0.0000000000073)."
It requires a certain amount of research-savviness to evaluate studies like these firsthand, rather than relying on media reports and authority opinion. But for those who do, and who proceed to evaluate the relevant research firsthand ... whoa!
Given America's dire need for cheap, safe, and effective early treatment, I find it hard to explain the marginalization of these repurposed generic drugs any other way, than through capture of the relevant institutions and regulatory bodies.
The NIH canceled their large RCT for hydroxychloroquine as soon as it became clear that a vaccine for HCQ would be possible. In the months since, no other treatment has been allowed to steal the limelight. We're just been told to wait (and wait) for the vaccine.
I am really distressed by this. But I see no other explanation which accounts for (a) the abundant research available and (b) the official narrative about these drugs, which appallingly contradicts that same research.
"For hydroxychloroquine: "The probability that an ineffective treatment generated results as positive as the 198 studies to date is estimated to be 1 in 1 quadrillion (p = 0.00000000000000083)."
This number comes from multiplying the individual p values of every study, which is completely pointless; if that helped anything, every single meta-analysis would come back positive, as p-values are always lower than 1!
If you check the individual study, you will see most of the positive results come from comparing a younger, healthier population on HCQ with an older and more comorbid population on placebo. Whenever a study controls for that with proper randomization, the results come back as non-significant
Comparing the number of positive studies with the number of negative studies is a huge statistical fallacy, one single well-designed and we'll conducted study will be more accurate than the sum of hundreds of biased studies.
The argument those sites make is similar to me arguing that I am history's best chess player, because the most world championships anyone has is 6, while I have DOZENS of wins aganist my 8-year old cousins
There's also the fact that Dexamethasone, which IS cheap, safe and effective, HAS been approved as a treatment
I asked a professional statistician, Mathew Crawford, to evaluate and respond to you claims. He wrote this, for me to share:
###
"This number comes from multiplying the individual p values of every study, which is completely pointless"
This is absolutely not true. You just made that up. That is not how p-values are computed or worked with. Nobody finds the probability of flipping 2 heads out of 20 by multiplying the probabilities of finding 1 head out of 20 (though we can compute convolutions for such discrete cases).
I can add additionally that I (as a statistician) personally checked the methodology and results prior to the hcqmeta site going live using the standard inferential methods Ronald Fisher developed so many decades ago.
Your statement here is jaw-droppingly irresponsible, and if you want to stand by the veracity of your statement, we can get together in a zoom video and walk through those computations publicly.
"If you check the individual study, you will see most of the positive results come from comparing a younger, healthier population on HCQ with an older and more comorbid population on placebo."
This is not true, either. I personally read every study at c19study.com through early November. In general, most studies do a good job of correcting for age differential, but the most biased in this regard were not the positive studies, but the negative (VA study, the Geleris study, etc.). If you're going to make a claim dismissing this kind of avalanche of data, you should put it in a spreadsheet and show us. Defend the veracity of this statement.
"Comparing the number of positive studies with the number of negative studies is a huge statistical fallacy"
1. That's not what anyone is doing, primarily.
2. The number of studies does give something like a first order demonstration of success, but the hcqmeta.com authors went to great pains to correctly summary the data together. The differential between the number of patients who died or deteriorated with and without HCQ is enormous, particularly in the early treatment studies!
"one single well-designed and we'll conducted study will be more accurate than the sum of hundreds of biased studies."
How are the positive studies "biased" (aside from your incorrect claim that the age groups are wildly disparate)?
And thanks to statisticians like Concato and Kraus, we know that after small number, retrospective studies give almost identical statistical power to results.
Thanks for the reply, I would like to address some of the points
"This is absolutely not true. You just made that up. That is not how p-values are computed or worked with. Nobody finds the probability of flipping 2 heads out of 20 by multiplying the probabilities of finding 1 head out of 20 (though we can compute convolutions for such discrete cases)"
Very well, I confess I did not personally check the graph and just reproduced the argument I heard from a cardiology professor. I retract my first paragraph (I would edit it out if possible), and will refrain to comment until I get a better grasp of what figure 1D is telling me
"In general, most studies do a good job of correcting for age differential, but the most biased in this regard were not the positive studies, but the negative (VA study, the Geleris study, etc.)"
I don't see how that fits with the data presented. Taking the largest studies:
Early Treatment:
Sulaiman, 5.541 patients (~30% of the population): Standard care group had 4.17% of patients >65, HCQ group had 0.55%, SC group had significantly higher pulmonary disease, hypertension, no data on obesity
Lagier, 3,737 patients (~20%) of population: HCQ group had 52.8% of patients from 18-44, 3.6% over 74, vs 36.4% 18-44 and 16% over 74 in the control group. Significantly more cancer, diabetes, heart disease, hypertension and respiratory diseases in the control group
Late treatment:
The largets study, counting over 29 thousand patients is Shoaibi, which was comparing famotidine with HCQ, and no mention of HCQ vs placebo o standart of care? Why is this even included?
Second largest, Fried, with 11.721 patients, shows harm in the use of HCQ. There are some disclaimers about it being retrospective and having methodological flaws (completely agree, but why the previous study, also retrospective has no such disclaimers, when Fried has been peer reviewed and Shoaibi,a pre-print has no such disclaimers?)
Third largest, Gonzalez, with 9644 patients, is not evaluating HCQ vs any other treatment, and taking the mortality data there you would conclude that corticosteroids are harmful?
Fourth largest, Catteau, with 8.075 patients, has a median age of 66 in the HCQ group, with 23% being >80, while the control group has a median age of 77, with 44% being over 80. Control group also has significantly higher Cardiovascular disease, Arterial hypertension, Chronic renal disease, Neurological disorders, Cognitive disorders and Immunosuppressive conditions
Looking at the descriptions of the positive vs negative studies, it seems very clear that a great amount of work is put in to find errors and sources of bias in the negative studies (And that's good! Peer review is excellent!), but whenever a study is positive, no such analysis is shown, with just a passing comment about what the results were. For instance, in the Gelais study, there is the following remark "Since patients with hypertension are at much greater risk of mortality (HR 2.12, see [1]), this appears to invalidate the results.", but why are no such remerks present in the larger studies I cited?
Further reply from Mathew Crawford (part 1):
"Very well, I confess I did not personally check the graph and just reproduced the argument I heard from a cardiology professor."
This is not okay. You expressed a claim confidently, as if it were your own observation, and now slough it off on an expert. You have at worst admitted dishonesty in the course of evaluating an important medical claim, and at best pointed out the dishonest ineptitude of experts. The rest of your case doesn't read so well either, so it's probably good for you that you're writing anonymously. You should be ashamed, though I suspect you probably are not.
Before I dive into your critiques of the individual studies, I would like to make some observations.
As I mentioned already, we should be focusing on the early treatment studies. While these are 100%, and we could call it a day by saying, "All statistical analysis points toward early treatment being more effective than late treatment," you make two cherry-picked observations, seemingly dismissive of all of the rest of the data.
Your point about the larger number of extreme elderly in the Sulaiman study is addressed by the study in the statistical analysis, in the usual ways (multivariate analysis). We could reasonably [cut out the extremely old] and say that this research indicates clearly that giving HCQ+AZM (and zinc) to patients in KSA under the age of 65 results in a clear reduction of mortality since few patients older than 65, but that too few patients 65 or older were treated that way to make inferential analysis confident. But to act as if the study is otherwise biased is incorrect. And in fact, due to earlier treatment protocols, this analysis avoids the Simpson's paradox I bring up later…
While you bring up the 3,737 Lagier/Raoult patients, you failed to mention that the Marselleis UHI has now treated a five-digit number of patients over a long enough time frame that age demographics have balanced (they update their website weekly, which turns out to be a better source of overall analysis than the publications because there is simply more data and breakdowns of it), and that the disparity between the Marseille UHI's case fatality rate and that of larger France has grown in proportion since the Lagier study, not shrunk!
But the Lagier paper breaks down analysis into age subgroups for separate analysis. And in every single age group, those receiving HCQ/AZM therapy were FAR less likely to be admitted to ICU or die. Did you read this part of the paper and write what you wrote, anyway? Was the goal to be one-sided?
Dr. Raoult, most published researcher in history on infectious diseases, discoverer of more human borne microbes than any in history (around 500 out of 2500), who has written treatments for a dozen diseases, has lost only 4 of his last 10,000+ COVID-19 patients in Marseille where the month mortality rate is roughly double that in ordinary times! France had the highest CFR of any nation in the world through most of the pandemic. Numerous other doctors in the U.S. (Zelenko, Tyson, Procter, etc.) have reported treating thousands of patients early with HCQ and had scarcely few fatalities among them---a tiny fraction of the CFR of the U.S. epidemic. I could add to this doctors such as Prado in Brazil or Carvanna in Italy, or many others, who all seem to achieve similar results. Dr. Risch summarized some of these results, but there are additional sets of results he hasn't included yet in his publications.
Raoult has also taken charge during an disease epidemic and treated it, halting its progress. That makes him unlike most health officials around the world. What is the price tag for all the livestock slaughtered in the name of panic in the UK alone?
It might be worth thinking through why Marseilles loves Raoult, and showers him with affection.
"Looking at the descriptions of the positive vs negative studies, it seems very clear that a great amount of work is put in to find errors and sources of bias in the negative studies (And that's good! Peer review is excellent!)"
This is wrong on so many levels.
Just how good is peer review, anyhow? Nobody in the world with experience with both statistics and medical data could have bought into the Surgisphere paper at a first glance.
Continued from Mathew Crawford (part 2):
But let's add to that the Cavalcanti study. The researchers were at least open about the fact that they recruited a substantial number of patients from the ICU, where it was already believed HCQ had less of a chance to be effective. But critics forced them to publish a multi-part apology for numerous gross withholdings of critical data, including the fact that around 40% of the patients in the "control" group had received HCQ or AZM immediately prior to the "experiment".
Then there are the three Minnesota RCTs, none of which used an inert placebo. That's just not done in honest science. Ever! At least some premed undergrads in any classroom should call this into question, and that so many professional eyeballs let that fly represents a total failure of the scientific community! Those placebos (folate and vitamin C) are not yet well enough studied during this pandemic, but both are subject to positive reports and studies with substantial effect sizes. Even if the true effects turn out to be zero, the practice alone should be enough for us to cast doubt on the researcher responsible (who happened to have a Gilead relationship, which he happened to not mention as a conflict of interest until somebody twisted his nipple over it).
The rest of the study designs and executions aren't much better, including internet enrollments that led to (a) a young set of cohorts that likely dampened observed effects (meaning substantially more patients would be required to reach good statistical power), and (b) long enough delays in reception of the medication that it pushed the envelope of early treatment. Critics have pointed out both that the results would have been statistically significant (and positive) had the original number of patients planned been achieved, but that those treated within the first few days showed a time dependence curve one would expect from an anti-viral medication, and that the numbers taken in that context already achieved statistical significance.
Then there are the WHO studies which tested HCQ on very late stage patients, mostly on oxygen, without a macrolide (usually azithromycin) or zinc, and in doses far higher than those used by doctors in scores of nations around the world. How does that pass through anyone's bullshit filter as a good faith attempt at designing an experiment for the best possible use of a medication?! There is a lot more to be said here, but I'll save it for the book I've been working on.
So no, the negative studies do not look less biased. It certainly appears that many or even possibly most were designed to fail (though a few of them accidentally showed HCQ efficacy).
Now, let us talk about the studies you did cite.
First, regarding the Shoaibi paper (and many others). The results are already subject to a massive skew against HCQ that I explain in this conversation (at around the 15 minute mark) with science reporter Charles Platt, due to a Simpson's paradox that should be well understood by well trained statisticians, but probably isn't by many due to what we might call "requisite professional ignorance":
https://youtu.be/90h_re5CrMQ
Note that not a single word has been printed about this obvious Simpson's paradox (so far as I've seen) by any of the journal editors. But I would not hire a statistician who didn't recognize it, and I employed one who did not, I'd fire them without hesitation. I might even phone their professors and chew them out. Lack of stratification by policy absolutely muddies the data, substantially, and necessarily in one direction. This is one reason to be skeptical of all U.S. studies that group hospitals together for retrospective analysis, and prefer those studies from nations with more uniform treatment policies. In general, such retrospectives have been almost uniformly more positive, as predicted.
Next, the majority of the Shoaibi text and tables are committed to propensity score analysis, which is to say that the statistical analysis is designed to compare cohorts with similar demographic profiles. So, your claim that "whenever a study is positive, no such analysis is shown" and "Shoaibi,a pre-print has no such disclaimers?" suggest to me that you are either incapable of reading research or that you didn't bother. What is your experience with medical research, anyhow?
Maybe you can slough that off on a cardiologist, too, eh? At least name them this time.
The Fried paper fails to stratify by policy, too, and in particular we can see the negative results come specifically from those in the latest disease stages. Ventilation mortality was 70.5% versus 11.6%, while twice the proportion of patients given HCQ were on ventilators. If we assume HCQ has no effect or a negative effect of patients on ventilators (perhaps due to heart stress...and the fact that nobody expects an antiviral to have much of an effect after the first few days of illness), then we have clear confounding by indication. That's exactly the Simpson's paradox. The entire study should be recast in that lens after separating out hospitals that used HCQ as "compassionate use" on only late stage patients.
The Gonzalez study does in fact include a multivariate analysis in order to more directly compare patients of demographics. Without that correction, there is a 50% reduction in mortality. After the correction, that is 26.6%. Still far better. Also...still a study on patients with progressed illness as opposed to those treated early.
"and taking the mortality data there you would conclude that corticosteroids are harmful?"
Not exactly. Spain thumbed its nose at the WHO and Big Pharma and made HCQ a standard of care. We should not assume then that the research on corticosteroids in patients not generally receiving HCQ as early should look the same. It may be that corticosteroids do less good for patients treated early enough with HCQ and AZM. It might also be that Spanish hospitals used different corticosteroids than those studied elsewhere. There are dozens of them, after all. At the very least, all we should say is that it would be nice to see a breakdown of efficacy of those used around the world.
We should also note that early treatment studies show far fewer patients reaching severe stages of illness where corticosteroids would primarily be administered.
In the case of the Catteau study, you repeat the critique of Schryver et al that was well answered by the original authors. The cohort size was large enough that propensity matching did reasonably still show a substantial effect. It is only reasonable to point out that the effect size is similar to those from studies in other European nations such as Italy and Spain that used HCQ therapy on a large scale. You failed to mention that there were no demographic subgroups of substantial size at all for which HCQ did not outperform! If it works better for the elderly, the middle-aged, and the young, that's something, even if the statistical power of such propensity matching lowers the statistical power of the study. Lower power for an individual study tends to fade in the meta-analysis as those studies are grouped together, with age mis-matches washing together in huge numbers. And that has been the case!
(Quotations taken out of order to make response more clear)
"What is your experience with medical research, anyhow?"
I am a physician with basic knowledge of epidemiology and biostatistics, as it pertains to my occupation. My main contact with biomedical research is doing a "sniff test" to see if the evidence provided for a given treatment is strong enough to warrant prescription, since often there's at least some incentive to make drugs appear better than they actually are. Mostly, this takes form as a strong bias aganist prescribing anything without support of an adequate "pre-test" probability of working and properly conducted studies
"This is not okay. You expressed a claim confidently, as if it were your own observation, and now slough it off on an expert. You have at worst admitted dishonesty in the course of evaluating an important medical claim, and at best pointed out the dishonest ineptitude of experts. "
What can I say? A professor who so far had been reliable told me that, and as I didn't have have reason not to trust him, I assumed it was true and didn't check. A mistake, to be sure, but one that is bound to happen again. I am glad to be corrected
"As I mentioned already, we should be focusing on the early treatment studies. While these are 100%, and we could call it a day by saying, "All statistical analysis points toward early treatment being more effective than late treatment," you make two cherry-picked observations, seemingly dismissive of all of the rest of the data."
Well, perhaps the method in which this discussion is being conducted is not being helpful for mutual understanding. I initially replied to a comment citing hcqmeta.com, and my commentary so far has been about that site in particular. Perhaps I should have made that more clear
I "cherry-picked" the two largest studies in the "early treatment" section, given that they were about 50% of the population. I considered commenting the bigger RCTs, but they were mostly negative, so I didn't have much to add. I commented on more of the late-treatment ones because there were more of them, and the population in was more evenly distributed among them
"Your point about the larger number of extreme elderly in the Sulaiman study is addressed by the study in the statistical analysis, in the usual ways (multivariate analysis)."
Correct me if I am wrong, but isn't multivariate analysis a tool to correct for known confounders, and not very useful for selection bias?
"This research indicates clearly that giving HCQ+AZM (and zinc) to patients in KSA under the age of 65 results in a clear reduction of mortality"
It could, but there were significant differences in comorbidities and location between the groups (I really don't know enough about KSA to know if there's a big wealth gap between regions). How do I know the difference in effect was due to HCQ prescription, and not because of one of those factors?
"While you bring up the 3,737 Lagier/Raoult patients, you failed to mention that the Marselleis UHI has now treated a five-digit number of patients over a long enough time frame that age demographics have balanced"
Well, there's no reference to that on the site being discussed and I had no idea that such data existed. I will look it over later.
"But the Lagier paper breaks down analysis into age subgroups for separate analysis. And in every single age group, those receiving HCQ/AZM therapy were FAR less likely to be admitted to ICU or die."
They did, but in a weirdly suspicious way. They split death/ICU into a >60y bracket, when the main imbalance is in >74y patients? HCQ group had 113/503 patients at the highest risk factor, while the control group had 99/199 patients. At the lower age brackets, was the difference in deaths/ICU transfers due to the treatment or due to an imbalace in comorbidities or lung damage at baseline?
There would still be more to comment, like the unbalance in nromal/severe CT at baseline between the groups. Did the control group fare worse because it didn't receive HCQ or because it was made up by sicker patients?
"Did you read this part of the paper and write what you wrote, anyway? Was the goal to be one-sided?"
The goal was to provide a short commentary on what could have been written in the comment at hcqmeta.com.
For instance, the Gelais study has the following comment: "Even if all propensity matched control patients had hypertension, the control prevalence would only be 14% compared to 49% for treatment. Since patients with hypertension are at much greater risk of mortality (HR 2.12, see [1]), this appears to invalidate the results.". Wouldn't the same kind of comment be warranted on the Lagier study? Why is there only one line saying "Early treatment leads to significantly better clinical outcome and faster viral load reduction. Matched sample mortality HR 0.41 p-value 0.048. Retrospective 3,737 patients."?
"So, your claim that "whenever a study is positive, no such analysis is shown" and "Shoaibi,a pre-print has no such disclaimers? suggest to me that you are either incapable of reading research or that you didn't bother."
It wasn't a claim on the discussions on the paper themselves, it was a claim about the commentary on hcqmeta.com, as explained above
"First, regarding the Shoaibi paper (and many others). The results are already subject to a massive skew against HCQ that I explain in this conversation (at around the 15 minute mark) with science reporter Charles Platt, due to a Simpson's paradox that should be well understood by well trained statisticians, but probably isn't by many due to what we might call "requisite professional ignorance""
Are we even talking about the same paper here? The Shoaibi paper linked on the site is this: https://www.medrxiv.org/content/10.1101/2020.09.23.20199463v1.full.pdf
It's comparing famotidine and HCQ and finding no difference between them, but why should I care about that? There's nothing on the paper comparing HCQ to standart of care or placebo
"The Fried paper fails to stratify by policy, too, and in particular we can see the negative results come specifically from those in the latest disease stages. Ventilation mortality was 70.5% versus 11.6%, while twice the proportion of patients given HCQ were on ventilators."
So, you're saying that the validity of a study becomes questionable when there are significant baseline differences between groups? I couldn't agree more. This is an observational study and shouldn't change anyone's practice. I commented on it because it was the largest one in the column
"The Gonzalez study does in fact include a multivariate analysis in order to more directly compare patients of demographics. Without that correction, there is a 50% reduction in mortality. After the correction, that is 26.6%. Still far better. Also...still a study on patients with progressed illness as opposed to those treated early."
Is that even relevant for anything? It's a retrospective cohort study to evaluate the prognostic value of eosinophil count that happens to have a table with HCQ on it. It wasn't designed, powered or preregistered to evaluate the impact of HCQ therapy on survival. If any drug company tried to convince me with this kind of analysis, they'd be swatted with a newspaper
"In the case of the Catteau study, you repeat the critique of Schryver et al that was well answered by the original authors."
Where can I find that response? Not doubting, but hcqmeta.com makes no mention out of it
"You failed to mention that there were no demographic subgroups of substantial size at all for which HCQ did not outperform! If it works better for the elderly, the middle-aged, and the young, that's something, even if the statistical power of such propensity matching lowers the statistical power of the study."
It's an observational study, how can you infer a causal factor by HCQ? How can you know "HCQ works better for the elderly, middle aged and the yound" and not "HCQ was given to less severe patients that would have had a positive outcome anyway"?
"Lower power for an individual study tends to fade in the meta-analysis as those studies are grouped together, with age mismatches washing together in huge numbers. And that has been the case!"
Don't you need well-designed, well-conducted studies with minimal risk of bias and small amounts of heterogeneity in order to produce a reliable meta-analysis?
HCQ starts off with a very low probability of working. Low-quality observational studies, whether positive or negative, are not enough to push that probability to reasonable levels, nor is success in small clinical trials. The same logic that leads me to conclude that redemsevir is not a very effective treatment for COVID, and is only discussed as a treatment due to outside pressures applies to HCQ. The larger RCTs with HCQ failed to show significant benefit, and even if they are full of biases, that's not an argument that HCQ should be prescribed.
> The experts successfully swooped in and saved us from all of that, figuring out which way the wind was blowing only two weeks later than competent amateurs. This was a useful service. Without the experts, things would have stayed open forever.
I don't understand how you can be as smart as you are and still think that "things staying open forever" would be a bad thing. Cities with no meaningful lockdowns and widespread noncompliance are having VIRTUALLY IDENTICAL outcomes to cities that locked down super hard. In some cases, they're having better outcomes (though my gut check is that this is just statistical noise). It is not AT ALL obvious that the 'experts' that California has delegated their critical thinking to have done anything other than perpetrate an absolutely massive crime against humanity.
Come on Scott. You're smarter than this
> Cities with no meaningful lockdowns and widespread noncompliance are having VIRTUALLY IDENTICAL outcomes to cities that locked down super hard.
E.g.?
Sweden vs. Lithuania is a great example. Sweden has some restrictions but nothing serious compared to other countries. Lithuania locked down hard and escaped the first wave. And yet, now their mortality is very close to Sweden despite having shorter life expectancy and reintroducing strict lockdowns again.
What about sweden vs it's neighboring nordic countries, like norway and finland?
A big unknown. The same way why is Latvia almost twice as good as Lithuania, and Estonia again twice as as good as Latvia. They are very similar countries by culture, life expectancy etc. They introduced the same restrictions etc. There are some differences but it is not clear which factors played the role.
What was really interesting how much the governments of the Baltic countries gloated in summer how they did everything right and how stupid Sweden was.
https://journals.sagepub.com/doi/full/10.1177/1403494820980264
Do you have any thoughts about the graphs and methodology presented in this paper? Sweden seems like an outlier, both in restrictions and in outcomes
Great article but it offers no proof for causal relationship.
I heard this argument in spring that if only the worst hit countries had started lockdowns a week or two sooner they would have avoided many deaths. Maybe it is true but then what happened to those many countries who seemingly succeeded in the spring and then failed in winter at the second or third wave?
Apparently it is very hard to time the start of the lockdown correctly. This hammer and dance was a good idea but in practice it largely failed like many other good ideas, like contact tracing; testing of all people – Slovakia did it twice; an app which will notify users that you have been in contact with an infected person; wearing masks – yes, mask are moderately effective but still didn't prevent a second or third wave in many countries. Lockdowns probably belong to the same category – moderately effective but have high collateral damage.
Sweden did differently and implemented policies that could work long-term despite the international pressure to abandon these policies.
This is, to put it mildly, incredibly terribly wrong. First, remember that even a little compliance can have a massive effect on the graph of connections between individuals, and Covid travels on edges, not on vertices. Start here: if you lock in place 10% of citizens, how many connections in % (defined as "two people being 2 meters across one another for 5 minutes or more") have you severed?
No country in the world did not encourage working from home, or social distancing, or did not cancel mass gatherings of any kind. There is no "placebo group" for Covid measures effectiveness other than countries in February with widespread circulation and close to no safety measures: Italy is an example, and look at the spike and the excessive deaths. Compare it with Germany in March/April, that reacted to the virus with a lockdown: unless you think that open vowels and good food make Covid19 outcomes worse, then this should be enough to recognize that lockdowns work, and work well.
Now, you could argue that lockdowns were somewhat excessive, and I agree it is a delicate balance, but lockdowns took place when Covid19 was a largely unknown virus and we only had partial numbers from China, of which, further, we had reason to be suspicious. Planning for a reasonable worst case scenario is not wrong, even when that scenario turns out to not be the real one.
(oh, and now we have B117 for which, it looks like, lockdowns are barely enough.)
What explains in your opinion that, in places like Italy, cases doubled every 3 days until the lockdown, then 10-15 days after the lockdown was introduced, they plateaued, and then started to decrease? Why didn't they keep increasing exponentially, if not because of the lockdown? It's not that they reached herd immunity: there was a big second wave in the fall.
The only argument I've seen to the effect that the lockdown orders were unnecessary is that people voluntarily sheltered in place on their own initiative anyway, even in places without a lockdown order. That would negate most of the benefit of a lockdown order, but it would also negate most of the harm.
Scott, the best systems for combating COVID aren't ours, but the ones in the countries that got COVID right. These are, variously, China, Vietnam, New Zealand, Mauritius, Singapore (outside migrant worker dorms), North Korea (apparently), Australia, Thailand, Taiwan, etc. Japan, the Philippines, South Korea, Cuba, Norway, Finland, Denmark, Cyprus, Mongolia, etc. did better than average. The question is not to burn the system down or not, but whether to move to a better system. I propose a government by superforecasters, because superforecasters seem like people who know what they're doing.
"There are few biologists who deny evolution, few epidemiologists who think vaccines don't work, and few economists who are outright communists."
Low bar. Let's raise it higher.
"This should be astonishing, and we are insufficiently grateful."
We got half a million deaths and counting. That's twice as good as Russia per capita, but it's worse than Brazil and far worse than the Philippines. It's impressive by precisely zero metrics.
Are you saying that only people who are highly successful in prediction markets should vote? While in theory this sounds interesting, in practice there's no way to get there.
The US had such a disastrous response because of the existing leadership, selected by the existing population, with their existing Overton Window.
"While in theory this sounds interesting, in practice there's no way to get there. "
The most plausible way to get there is to simply create an advisory council of superforecasters and to steadily give it more and more power, much as what happened to the bureaucracy and judiciary.
So, we set up a group: "The Council of Superforecasters" and hope it goes the way of the bureaucracy and judiciary over the next 100 years, instead of the way of the Office of Technology Assessment?
As it is, getting Congress to consult "The Experts" is hard enough. "The Experts" even have financial and social capital behind them. People who just happened to do really well on betting websites seems like a much harder sell
Government by superforecasters is hard (look where Dominic Cummings got by trying). I'd rather have government by prediction market, and let investors with deep pockets hire the superforecasters and make sure they're driving the prices.
One of the big things I like about the idea of futarchy is that it's a mechanism focused primarily on *what* rather than *who*. I think if you focus on "who", your mechanism will become corrupted by politicking -- so if you try to put experts in power, the route for politickers to get into power will be by becoming "experts", which they'll do by confounding your society's ability to actually distinguish true from false. OK, I'm a bit wary of running with that conclusion, which would seem to suggest you should never have governance based on expertise, as we do seem to have some, as you say, mediocre ways of doing it. Still, I think moving away from government-by-people and towards government-by-mechanism is a good thing.
Dominic Cummings didn't meaningfully try to put experts in charge or use mechanisms like prediction markets. He talked a good game, but whenever it came done to actual decisions he went for the answer that supported his ideological team
Which is possibly also a lesson, that people who aren't swayed by normal political incentives can still have political biases of their own. So shouldn't be taken at face value
>That's twice as good as Russia per capita
It's much worse than Russia per capita.
One consequence of this kind of thinking is that its interesting to look at different incentive structures, and see where they have better results. The first comparison I thought of for this was countries with public healthcare systems. For example the nhs.uk has a similar to webmd encyclopedia of common conditions, drugs, etc. Which seems much clearer to me as a non expert. eg the page on aspirin says its mostly safe, and lists common side effects with the context that they are rare. https://www.nhs.uk/medicines/aspirin-for-pain-relief/
I don't think this is because public healthcare systems are magically better, (and please don't make this thread into an argument about m4a). My best guess for the difference is:
If you are a National Healthcare Service you have access to huge numbers of government lawyers on retainer, and massive institutional power, so the risks and potential of being sued are much lower than for someone like webmd.
Also, for webmd, someone with a headache deciding they have an obscure cancer does you no direct harm, but if you are a public healthcare provider they will be taking up your time and resources. So presumably someone did the calculation that it was better to stop those false positives and deal with the occasional complaint.
And on the individual level, a large organisation can shield people from bad incentives. Presumably these pages were written by employees of the health service (probably in committees) who reported to higher up adminstrators, not dealing directly with the end consumer. So they could be given an instruction "write clear and concise advice" without the political issues trickling down to them.
So maybe the takeaway is that as well as there being a function of being too small to care you can also be too big to care? If Fauci was the american health tsar he would give better advice, though that runs into the benevolent dictator issues. The brits don't seem to have done so great with covid advice, so maybe the protection only works when things don't get too political
There's also the fact that the NHS is somewhat insulated from the political sphere. Formally, the governance as a non-departmental public body seems to be set up in such a way that her majesty's government can't micromanage things. Informally, a politician who tries to restructure the NHS tends to make a lot of enemies.
Also, if you have a public health care system, the government has an incentive not to make it too easy to sue healthcare providers.
My big problem with the expert response was the lying -- statements early on like "don't wear masks because they don't work", which was an obvious lie to keep people from panic-buying masks, only to then mandate masks later. Followed by "we just need to lock down for 6 weeks to flatten the curve", followed by "we'll probably still be locked down at the end of 2021". Or the refusal to talk about honest tradeoffs - "this is how many people will likely die if we don't lock down. This is how many people will probably permanently become poor if we do."
The American people did, in fact, elect an idiot game show host. However, we were given the choice between an idiot game show host, and possibly the most unlikable person to ever run for office. Hell, this time around, the Democrats chucked any candidates that were even remotely interesting, and seems so hell-bent on telling the millions of people that voted for Trump that they are ontologically bad people that need to be scorned and punished. That's how you get someone far worse but more competent in 4 years.
I agree wholeheartedly that tearing down the system and assuming that somehow people that care about things other than power will magically rule us benevolently is a pipe dream. But it seems that both the far left and far right have lost all hope that things can look less than shitty for them and their kind in the forseeable future, so they're willing to chance it. This is something that the current administration, if they were competent at all, would attempt to diffuse.
This is a great post, thanks! That experts, institutions, and other avatars of Consensus are a weighted-like-a-ball-and-chain average of the views of the rest of society is a really cool and powerful idea. So is the point that they aren't inherently dishonest or unprincipled-- it's just that the Institutional Power Genie shows up and replaces them if they get too principled or honest.
But I have three reservations.
1. Who exactly is the Institutional Power Genie that hypothetically gets Zvi fired as CDC Director? Since we live in a democracy it must represent some actual people, right? But it clearly doesn't represent you and Zvi. And it doesn't represent your Straw Rednecks either, because they're, shall we say, not Biden's core constituency. The charitable interpretation is that it represents some third group, Straw Bluenecks who think the virus is real and bad but either are risk-averse in a very particular way that makes Zvi unacceptable to them, or just get a lot of utils out of knowing that Very Serious People are in charge. The uncharitable interpretation is that the Straw Bluenecks are just Fauci in a trenchcoat-- that the institutional, power-seeking mindset has become self-perpetuating by getting itself unfairly weighted into the average. I favor the uncharitable interpretation.
2. If Zvi's proposals are in practice not implementable by real-world institutions, then how are we supposed to interpret them? After all, a lot of what he (and everyone) posts really does amount to "here's what I would do as a benevolent dictator" not "here's my advice to you, a private person, as a friend". Is he trying to change people's minds to shift the weighted average? Or is he saying the average should be weighted differently-- toward him? To the extent that he succeeds in shifting the average, how concerned should we be that some illegible blogger can shift the average just by being popular and insistent? To the extent that he doesn't succeed, how concerned should we be that his posts are just a form of outrage-mongering entertainment?
3. What does it even mean to say that someone is "illegibly good" or "illegibly bad", if it's misleading (due to illegibility) to imagine their beliefs actually being implemented? Good or bad for whom? Zvi's advice is good for us, maybe, but that seems to just boil down to saying that we agree with it. How would we convince Straw Redneck's audience that it's good for them? Wouldn't we have to appeal to consensus-- i.e. Fauci? And if so, why are we still trying to shift Fauci's position toward our own? This model, when you work it out, actually seems to support Weyl's point of view: the benefit of Fauci, insofar as there is a benefit, is that he's legible to the broadest possible range of people.
1. I don't know enough about politics to be sure, but my guess is somebody who is basically a slighty worse version of Anthony Fauci, is gunning for Zvi's position, and has lots of allies in high places.
2. Partly we can intepret them as private individuals, eg whether or not we should get the vaccine, how much we should social distance, et cetera. Otherwise, perhaps as conditional statements, like the conditional prediction markets on the Metaculus post earlier this week - "if you vaccinated people this way, it would save a lot of lives".
3. I'm not sure where you're getting this from. I think it's objectively true that if you followed COVID policy A rather than COVID policy B, it would save more lives. We can't objectively know that it's true with total certainty since we can never see both branches, but sometimes we can be pretty sure (ie it seems like shutting the borders while it was still limited to China would have been good). Overall not sure what you're asking here.
1) In a word, normies. People who think in more bureaucracy-friendly ways, many of whom will be bureaucrats (public or private) themselves, and who think that "untested", "not properly reviewed", "risky", and "irresponsible" are synonyms. The sort of people who turn into helicopter parents with their kids, NIMBYs with their neighbourhoods, and Helen Lovejoy's infamous "Won't somebody please think of the children!?" in their politics. Zvi would drive them apoplectic, by bulldozing all of their concerns in favour of his grand vision.
And in their defense, "bulldozing all opposition to implement their grand vision" is a process with a truly *awful* history in practice. Lincoln's "Seven nays, one aye; the ayes have it" is a rare (and possibly apocryphal) case. The best common case is Robert Moses, and Lysenkoism is the common failure mode. (And the extreme failure mode is Pol Pot). I think Zvi is more right than Fauci here, but that isn't something we can generalize. The precedent is genuinely a dangerous one.
2) If you think of his policy proposals as a vector, the magnitude can be impractical while the direction can still be wise. And by convincing people of his full proposed vector, he can help create political pressure in that direction, and thereby move even the power-minded.
3) If you were to ignore the process and posit an absolute dictator over the issue, we think that Zvi's stated preferences would solve the problem substantially better than Fauci's stated preferences. However, it would be very difficult to convince a layman of that, so his superiority in that hypothetical is illegible to a real normal person here and now.
The way we would hopefully convince the Straw Normies of this is to create a discussion that pushes the expert consensus in this direction, with the goal of that trickling down to normies. (Other options exist in principle, but we are not good at public relations as a community, so it's difficult for us to influence the masses without taking some kind of high ground directly through relationships with elites.)
There's another aspect to what Dr. Fauci does -- He isn't there to dispense the truth to the masses, he's there to make statements to the masses that will cause them to do what is optimal relative to Dr. Fauci's plan. Within that goal, he tries to avoid saying anything that is actually false.
For instance, early in the epidemic there was a real risk that the public panic-buying masks would vacuum the supply chain empty of them right at the moment that medical people needed far more of them. So the statement was made that there was no solid evidence that masks worked against Covid, which was true but any person who attempted to analyze it would realize that masks were likely to be quite effective. Readers of this blog will probably notice that is an attempt to avoid the tragedy of the commons -- for each individual, buying a mask as quickly as possible is the optimal choice, but also preventing others from buying masks is also optimal.
aMore subtly, the optimal plan depends on where one is in the economy. As a computer programmer, the cost of an intense lockdown is personal nuisance. For a restaurant worker, it might be homelessness. Someone has to strike the balance between those competing interests, and that's a lot easier to do if you disguise that it is being done.
Fauci famously advised people NOT TO DO ANYTHING AT ALL as late as February 29th: https://www.today.com/video/dr-fauci-on-coronavirus-fears-no-need-to-change-lifestyle-yet-79684677616
Everything here reminds me of this Fantastic Anachronism post last month -- despite the horrible track record of replication in social science we should still default to trusting credentialed experts because it's better than any alternative https://fantasticanachronism.com/2021/01/12/unjustified-true-disbelief/
I'm really glad you're writing on moral mazes. I've been troubled by Zvi's simulacra work for a while now: he seems to be saying important things about what happens to adversarial systems, but the end result is so bleak. I had to go back and re-read the goddess of everything else to remind myself about the power and beauty of cooperation.
I would be very grateful for a theory that harmonizes Zvi's work with Elua's power. This article is a good first draft, but I long for hope that the Elons and Zvis of the world aren't anomalies, that the quokkas can learn to protect themselves and the slytherins can become great philanthropists.
I generally agree with this, but: I don't think it's always been this bad. Back during WW2, for example, we seemed to have competent leadership. We put Vannevar Bush in charge of military research, and that worked out great. I think something has gotten worse over time. And it's worth trying to figure out what that is and why it happened.
WW2: Elites went to war
COVID: Elites tell you to stay inside or we all die and go to restaurant with friends
> When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
I think it's really more complicated than that. I haven't been on the 'other side' of public decision very often in my life, but I have a few times through my job at a tech company, and I know these kinds of things almost look unrecognizable to an insider, compared to an outsider.
My tech company example is, say, a widely-publicized product launch to which the general public assumed a lot of fair things, the gist of which is that we were insane and had no idea what we were doing. In fact, the true explanation was completely unrelated to that -- that the target of the launch was a type of enterprise customer that was alien to the public.
I can imagine many forms of this that might happen for a Fauci public statement that take different directions than "maintaining power". For one thing, in the early days of the pandemic, it was truly not clear in the data how serious it was. A random person can say: "oh, I have a feeling this is much worse" but the CDC / whichever officials can't. They have to balance their gut against the data they have, their internal policies, and the fact that if they say something extreme it carries a lot of weight, which means shouldn't be wrong both for logistical reasons and to maintain credibility.
There's just nothing on the line for an individual making predictions. When you end up in a position of great influence, there's a lot on the line, and you have to be much more careful. Rationally, of course, it would make the most sense to overcorrect for harmful outcomes, and spend more resources than needed. But then what happens if you're wrong, and a lunatic congress comes at you for budget cuts decrying your uselessness? (And this doesn't even broad the question of what the right behavior is when you're trying to avoid completely losing Trump's ear. The "Case Against Fauci" article thinks it's not worth it, but I'm pretty skeptical.)
I'm just saying -- it's just not just being right and being in power. "Being right" looks very different for a public official in a political situation than it does for a blogger.
I'm discovering Substack doesn't let you edit comments yet, so I guess I'll append: I meant "it's not just a choice between being right and being in power".
>and few economists who are outright communists.
Those are the only economists who are correct, though. Remember Scott that in your own reading of Marx you could not seem to comprehend his basic sentences and instead deferred to Peter Singer's own (incorrect) analysis. This is politics as the mind-killer, as the Rationalists say.
>What I sometimes call Marx's Fallacy is that if we burnt down the current system, some group of people who optimized for things other than power would naturally rise to the top. Wrong.
Where did Marx say anything like that? Using quotes from primary sources please. Otherwise you are creating a strawman (as usual).
Now that I think about it, Marxists don't have a history of tearing it all down and hoping something better will be built. They have a history of tearing a lot down and thinking that if they're in charge they can do better.
What I've been seeing lately on both the left and the right is what I call tearitdownism*-- a belief that things are so bad that destruction can only lead to improvement. I think this is a fairly modern development and more of an emotional change (quite a frightening one if it gets common) than an ideological change.
*Is this what people mean when they talk about nihilism?
For Marxists it has nothing to do with an "emotional change", it has to do with a logical analysis of capitalism's flaws. Where the abolitions who thought they could do better than slavery tearitdownists?
I was trying to say that tearitdownism doesn't have a direct connection to Marx.
However, there are a lot of people calling themselves Marxists and I'd like to have some way of talking about them.
I think Marxists can be more rightly categorised as builditupists.
I think you are heavily biased by living in USA and some of your observations might not generalize elsewhere.
Consider this:
https://www.wired.com/story/how-taiwans-unlikely-digital-minister-hacked-the-pandemic/
&
https://blog.pol.is/uber-responds-to-vtaiwans-coherent-blended-volition-3e9b75102b9b
&
https://en.m.wikipedia.org/wiki/Central_Epidemic_Command_Center
Hi Scott, long time reader. Really like your writing.
But I've noticed a somewhat distressing tendency in your recent posts (by which I don't really mean just the ones on substack) and I think it's getting worse and so I will speak up. I notice an increasing frequency of things like this:
"But someone else will decide to always trust *their* friend, a guy in a MAGA cap who says coronavirus is fake and Dr. Fauci is a Satanist. "
"At one point we tried a very simple best-person-picking procedure that really should have worked and ended up choosing Donald Trump as the best person. "
"Our system of expert-having is actually much better than we deserve, given that we elected Donald Trump president."
And I have to wonder if this is necessary or even good, or if it is just dabbing on trump supporters because it feels good. Is the point you are trying to make actually best served by including a MAGA cap, or is this just exclusionary to some of your potential audience? Politics is the mind-killer.
This seems to be about the kind of fun dunking on silly ideas that Scott's been doing in an equal-opportunity fashion forever. (And he did write *You Are Still Crying Wolf*.) I'm not American and have no dog in the fight, but from what I can tell the thoughtful people who supported Trump did so with a level of caution such that they could have earnestly agreed with all those sentences *and* pulled the lever for the guy for complicated reasons. There's some overlap in the readership with reluctantly Republican anti-war *American Conservative* types -- for instance, Rod Dreher, who's sympathetic to the reluctant Trumpists but isn't one himself, has cited Scott a few times -- but I don't think this blog is a likely hangout for "true believer" MAGAists who Scott risks alienating here.
Nah, it seems fine. I'm red-gray and don't mind. Scott's blue-gray and you should expect that to show in honest writing.
The MAGA phenomenon is now a necessary trope for contemplation -- I would argue just as historically necessary as the mindset behind Hitler's enablers and apologists.
The "thoughtful but reluctant" supporters of the past president tended to believe in grand, dramatic, anti-democratic sentiments such as the Flight 93 justification for storming the cabin: the whole plane may crash into a field, but that's way better than Hillary!
The plane did crash, but still the fascistic phenomenon stubbornly persists (see the state of today's remaining GOP). Many of Hitler's supporters across the German countryside stayed loyal decades after the war, and likewise the MAGA stain here will take much time and effort to mitigate -- and it's the duty of smart, creative, communicative citizens to call it out directly, as a matter of fact, without apology or fear of offending those who erred by supporting a monster.
Would you describe this executive order as monstrous? https://www.federalregister.gov/documents/2019/10/15/2019-22624/promoting-the-rule-of-law-through-transparency-and-fairness-in-civil-administrative-enforcement-and
'If a random shmuck who doesn't know anything about anything Googles "who should I trust about COVID?", Google will return Dr. Fauci's name.'
I decided to try this experiment using incognito mode. With the quotes the first result is this post, without them it is the WHO.
Google still filters results based on your IP and browser even when you're in incognito mode. Without the quotes, my first Google result is Nuvance Health with the snippet, "The Centers for Disease Control and Prevention (CDC) is the main place to go to for reliable and useful information about COVID-19 in the United States." Meanwhile, Bing gives me a Marquette University essay with the conclusion "We have to accept what the experts say."
(With the quotes, Bing gives me no results, and Google gives me this post.)
"The whole scientific-technocratic complex is a machine which takes Moloch as input and manages - after spending billions of dollars and the careers of thousands of hard-working public servants - to produce Anthony Fauci as output. This should be astonishing, and we are insufficiently grateful."
That kinda sounds like a proof-of-work blockchain. It consumes vast amounts of resources, but that's not (just) because it's inefficient, it simply takes a *lot* of effort to defend such a system from attacks with our current technology.
Do you think that locking your household down two weeks early as a good decision? It doesn't seem like one to me, though as the pandemic lengthens it kind of seems like well, two weeks here and there, who cares? But just in the spirit of self-reflection, didn't you lengthen your personal pain at a time when the chance of infection was essentially negligible?
Getting ahead of the bulk of the panic buyers is certainly a good move.
I live in the same area as Scott, and didn't get ahead of any panic buyers, and it was fine?
If you know anyone who has been tempted to despair about supposed 'failures' of the western, liberal world order and its institutions over the last year then I'd encourage you to send them this. Whether something is considered acceptably good depends on what you compare it to - what we have now is clearly far better than what we would get by burning the system down. What's more interesting is whether what we have now is better than what we had in the past - and there's evidence (from things like the way the polio vaccine rollout was much faster in the 40s than our rollout today) that there are a few aspects of the current expert-selecting institutions that seem to have regressed, or not kept up with the increasing difficulty of the problems handed to them.
I think it's worth noting that the historical comparisons aren't ever to us actually succeeding at dealing with pandemics in the past, but to things like "WWII-style" efforts - i.e. thinking that if we could just do x as well as we once did y then things would have been a lot better. This implies that if you made an institution analogous to e.g. the weapons researchers of WW2 and the governments that funded them, or NASA in the 1960s, without copy-pasting 1940s/1960s society wholesale, the outcome would have been better.
To me that suggests its institution design that's the culprit, and that there are ways to filter our legible experts to be better that we've missed out on.
But even in making that kind of comparison, we're already back in the sane, concrete realm of institution design and trying to patch up the system we have with tweaks we know might give us better experts more reliably, rather than the ethereal realm of comparing the whole of our society to some imaginary alternative.
> Whether something is considered acceptably good depends on what you compare it to - what we have now is clearly far better than what we would get by burning the system down.
That's still somewhat past-oriented analysis. The future shows a lot of rot, with all the oddball behavior of the blue victors, general increasing insanity, and woke takeover of K-12, and the establishment's increasing blind hostility to the red tribe. The system of a couple years back may not have needed burning, the future one may very well need it.
I'm lucky enough that I have had no reason ever to use medical services in the US, so I can't comment on that. But I have had quite a bit to do with the US political system professionally , and have had a chance to see how it works (it doesn't). It's an almost uniquely dysfunctional system, massive, labyrinthine, highly politicised and personalised, where it's hard to know who is in charge of what, and decisions take forever. Irrespective of who your political leaders are, I think your country is going to have a terrible time coping. Most of the states that have coped well have strong, professional and well-managed public services which draw a strict line between career and political appointments. (Singapore is a good example). Countries that used to do that but don't any more (like Britain and to an extent France), have suffered worse as a result.
But it isn't just the political system(and of course sheer luck plays a big part as well). You have to take into account the social capital of the country and the willingness to work together (again, most Asian countries have done well for this reason, but so has New Zealand). You also have to take into account political culture, and what seems important not only to politicians but to the whole PMC and media classes. The rest of the world watched in stunned disbelief as these classes in the US descended into severe Trump Derangement Syndrome, and stayed there, even while the epidemic was ramping up. But we had problems in Europe as well. Closing frontiers was essential but not done nearly quickly enough for reasons of political culture. Partly this was the EU's neoliberal ideology of open markets and borders. Partly it was the identification of frontier controls with nationalism (hiss) and even Trump (double hiss), which meant that if you supported them you were a Xenophobic Nazi Fascist. "Viruses don't have passports" smirked one European politician, who I think is out of a job now.
On Scott's wider point, I found his remarks uncomfortably apposite because I've suffered from a couple of these dilemmas about getting information on medicines. For the last fifteen years I've been taking blood thinners (first Fluindione, which is like Warfarin, and then Rivaroxaban). I was warned about not taking aspirin as well, and then I was told not to eat certain foods (bananas for example) rich in Vitamin K, and then as I began to read around, I discovered that most foods have an effect of some kind. Since I'm intolerant of gluten, I realised quite quickly that I was as likely to die of hunger than of blood clotting, and in the end I took a personal decision to eat a normal (but gluten-free) diet, on the basis that one thing would cancel out another. I'm fine and don't show any symptoms of uncontrolled bleeding for example. But nobody tells you anything useful. Nobody says how precisely this or that food affects the fluidity of the blood, for how long or in what combination. I've been told not to take Ibuprofen. Fine, but does that mean not even once, at 200mg? Or does it mean not continuously at a higher dose? If I take one for an inflammatory problem, will I die? Nobody seems to have any idea, or if they do they are not telling.
And I've been a chronic insomniac, probably for longer than most of the readers of this blog have been alive. There are two kinds of doctors in my experience. Good sleepers, who tell you to make sure you have a dark room and get plenty of exercise and you'll be fine, and won't prescribe anything, and insomniacs, who know that insomnia is terrible for general health, and that sometimes, lying awake at 4am and wondering how you are ever going to make it through the day, you start to think that suicide may be the easier option. The latter will prescribe something. So I've been taking Bromazepam from time to time, and, as Scott's wonderful new site points out, it's been argued that even small doses will kill you. I'm still alive, and I think I'll choose my own method of dying than you. Indeed, I think the only thing you can do is to try and see what happens. In Europe the problem with medical advice isn't quite so serious, perhaps, as in the US, but it's pretty serious. I've pretty much given up hope of getting any useful advice from medical sites, and I'm much more inclined to try something that has demonstrably worked for someone else. So I eagerly took up Scott's suggestion of Theanine, and took 500mg before bed (that was the only dose I could find). I was awake half the night and finally gave up. Any other suggestions gratefully received, but I'm going to try them for myself, not just be guided by websites that produce lots of words but no actual help.
It's not at all obvious that travel bans had much of a benefit. The virus arrived in Europe well before anyone realized it was a big deal. At the same time, later during the pandemic there have been many pointless border restrictions, such as countries banning or restricting entry from countries with similar or lower case loads.
It depends which countries you are talking about, and in many cases major outbreaks were linked to individuals or small groups, often returning home from abroad. But the point I was making is that travel bans were opposed from all parts of the political spectrum not because of doubts about their usefulness but because they offended against the ideologies of those opposing them. To a much greater extent than anyone realised, perhaps, idealists had gained the upper hand over consequentialists in political debate.
> But the point I was making is that travel bans were opposed from all parts of the political spectrum not because of doubts about their usefulness but because they offended against the ideologies of those opposing them.
That makes no sense: not all or even most parts of the political spectrum are ideologically opposed to border restrictions. As far as I recall, there was some ideological opposition to travel bans, but it didn't dominate the discourse.Rather, what I recall is right-wing ideologues asserting there wouldn't be any travel bans because of the globalist ideology, to be proven wrong: Curtis Yarvin asserted on Jan 30 that no one could say that travel from China should be banned because of internationalist ideology; the US and Italy banned it the next day.
January 31 was around the time most of the World even started to realize there was a serious problem. Travel bans were by far the earliest intrusive measure against the pandemic in the West.
>When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
As an excellent example of this, look no further than Professor David Nutt. Nutt was a Fauci-esque figure in the UK: he was, at one point, an advisor to the Ministry of Defence, Department of Health, and the Home Office, as well as President of the European College of Neuropsychopharmacology.
He also had no interest in optimising for keeping allies and power, and used his government positions to go around telling theh public exactly what the science said about addiction, illegal drugs, and so on.
He was rapidly fired for this, with several senior government figures accusing him of "talking about politics rather than science" -- which, ironically, was precicely the opposite of what he was doing.
Perhaps you should use a kind of Captcha in order to access your site? Instead of identifying 'all instances of porpoises waiting at stop signs', it could be a randomised test of the ability to reason statistically?
'If you can't pass this test, here's a helpful site where you can find out how not to misunderstand what I'm giving you..'
A very strong post, without a doubt the best you've written since your comeback.
There's a profound truth to the idea that only people outside a corruption-based system such as politics can regularly find and speak truth. Constant excellence is possible only on the individual level; mix in groups of people (with inevitable bias and selfishness) with varying incentive, and what you get is a compromised mess.
The Swedish poet Karin Boye incidentally wrote a poem on this subject, whose first stanza is both fitting and poignant. Av tvång (https://www.karinboye.se/verk/dikter/dikter/av-tvang.shtml) from Härdarna (1927):
"Jag är en fattigdomens präst
och ska väl så förbli.
Den inget har kan våga mest,
till dåd och tanke fri."
Roughly
"I am a priest of Poverty
and I shall so remain.
Who nothing owns can wager most
free in deed and thought."
To remain a priest of Poverty (whether in an economic, social or political sense) who can always wager most, or to give up the vows for real gain? That is the question, and God knows it's not an easy one.
The biggest issue to me is that our system (particularly in medicine) has very few mechanisms for punishing over caution and lots of mechanisms for punishing good faith bold action. As a result, everyone with anything to lose is in maximum CYA mode at all times.
In a pandemic (or a war, or any other complex fast moving crisis) inaction is often just as deadly as incorrect action. But our medical establishment totally dropped the ball on switching to a “war footing”, instead acting as if minor relaxations of the normally truly Byzantine approval processes were bold acts of heroism. How many lives would have been saved if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V? No one will be punished for these tens of thousands of bodies, but if the vaccine had merely saved a hundred thousand while causing a couple hundred birth defects or whatever, heads would have rolled. This is absolutely backwards.
Of course it would be one thing if Fauci were merely over cautious - but he didn’t only make “WebMD errors” of excessive ass covering. He, by his own admission, told 2 big lies (or at least things he was pretty sure were untrue): “you should not be walking around wearing a mask” and “modulating my estimate of herd immunity based on what I think people will believe”. And beyond Fauci, “Racism is a bigger threat than COVID, so protests in a pandemic are justifiable”. That was not a WebMD error.
We have medical experts to deliver medical expertise. Perhaps we accept a bit of politicking and over caution as a cost of doing business. But when experts start openly lying because, hey, they’re experts, you wouldn’t go against science, would you? That shatters public trust in expertise. Fauci maintaining power might be good for him, but it’s bad for everyone else because half the country isn’t going to listen to him, and that’s in good part his own fault.
> How many lives would have been saved if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V?
Probably fewer than you'd at first expect. As I understand it, Moderna and Pfizer were both establishing production lines in parallel with the approval process. The approval step delayed the start-point for vaccines going into arms, but deliveries have already caught up to current production. Earlier approval would have just resulted in a period of genuine shortage (in the US -- there's still shortage in more or less every other nation that can't access US production facilities.)
You don’t think Moderna and Pfizer were pacing their production ramp up knowing that approval was still months away? There was no incentive for them to engage in an expensive crash program just to have production lines ready to sit idle. And how much time was spent “building a functional production line” vs “getting the FDA happy with the production line”? (I genuinely don’t know that answer).
In any case - we could have done better. We probably could have done better enough to outweigh the risk of going faster by at least a couple orders of magnitude. But there was apparently insufficient incentive to do so, and lots of reasons not to.
As I understand, AstraZeneca started building manufacturing capacity from the moment it signed the contract with the government and received pre-payment. The EU signed such a contract 3 months later than to the UK and it has manifested in delayed vaccine deliveries to the EU.
Early regulatory approval probably was not that important, whereas generally being more proactive with investing into development, pre-orders even if knowing that in some cases the investment will be lost, actually has made a difference.
Now even the EU is trying to order a Russian vaccine but they have capacity issues just like all other pharma companies. But who knows, if instead of sneering, the EU without any delay had ordered Russian vaccine the moment it was approved, they would have much more vaccine available right now.
> if the Moderna and Pfizer vaccines had been approved at the same time as Sputnik V?
What do you mean by the time Sputnik V was approved? As far as I understand, it wasn't widely distributed until December; the August 11 "registration" was more of a publicity trick.
Do you think having more prestige for working in government bureaucracy would increase the correlation between gaining power and capability? East Asian countries seem to do a decent job of having competent officials and these things are much more prestigious there.
Really amazing writeup and there are a lot of valuable points in here. I'd like to give a bit more attention to this point since no one else has:
"Or maybe I'm dumb and biased, and actually the experts are doing much better than Zvi"
I don't think that's true in general, but after reading through Zvi's blog there is an error that could have cost thousands of lives if Zvi were in charge. He thinks that at least one of the vaccines should have been open source.
If Zvi is a tech worker, then it's easy to see where he's coming from. In tech you want a thousand flowers to bloom, and the best survive. Doesn't matter if one product sucks, only the good ones will still be on the market in 3 years. Well medicine isn't like that - move fast and break things does not work.
Medicine is built upon trust - and trust is hard won and easily lost. If 5 startup vaccine manufacturers compete to produce the vaccine doses as fast as possible and just 1 of them screws up that's a huge problem. Perhaps 5% of doses are ineffective due to insufficient QA or perhaps some of the doses result in higher rates of side effects. Well then the entire well is poisoned - news stories come out, politicians on the left and right seeking easy political points lambast vaccine producers, anti-vaxxers see a golden opportunity to move public discourse. Perhaps it doesn't kill vaccine production entirely, but public trust falls, investors and regulators become wary and vaccination decreases.
And all that for what purpose exactly? The companies best able to reliably ramp up production of millions of doses are the companies that have already done that in the past. And they have done that with rigorous QA that they've been forced to develop after hundreds of failures and lawsuits. Open sourcing would not significantly increase production and it would introduce unnecessary risk.
Now perhaps I'm misunderstanding him, perhaps he doesn't really mean open source - just that any established pharmaceutical company should also be able to secure a contract to make the vaccine - no exclusivity deals. I doubt that would actually change much. All of the big players interested in vaccine production seem to already have jumped in, and they've all chosen their champion. And the reason is simple - economies of scale. It's cheaper to produce 10 million of one kind of vaccine than 5 million of one and 5 million of the another.
Thanks so much for the read. Reminds me a lot of The Use and Abuse of Witchdoctors For Life (https://samzdat.com/2017/06/19/the-use-and-abuse-of-witchdoctors-for-life/). We never really outgrow witchdoctors, we just improve their performance somewhat.
The problem with balancing optimization for truth and optimization for power is that such compromises might not be stable. Individual people's ability to find the truth is judged by the very institutions in which they're trying to advance. So the more institutions optimize for maintaining power, the lesser their ability to find the truth, including recognizing people with the theoretically optimal balance of truth-seeking and power-seeking. As the capacity to recognize truth degenerates into noise, power-seeking becomes ever more important until it's all that's left.
If power can feed on the corpse of truth-seeking, but the reverse is not true, sooner or later truth will be devoured.
> The second reason I'm writing this is because people keep asking me "should we listen to experts"?
I think you're missing a step here. Experts, especially in a policy realm, are applying a different standard of proof than you are.
Locking down your house, for example, made sense as soon as you thought it was more likely than not that it would be helpful. Maybe an even lower standard (a precautionary principle) could have applied, since the consequences of a covid infection could be so severe.
On the other hand, issuing this kind of directive for an entire region imposes costs on other people. If you're wrong about your own house, then you and your housemates voluntarily pay the price; if you're wrong about policy then everyone pays.
Therefore, mandatory orders do (and should!) use a higher standard of proof, somewhere between "clear and compelling evidence" and "blindingly obvious."
Where we fail, however, is that we don't allow experts to offer sub-certain judgments. Fauci can't go up and say "we think school closures are a pretty good policy, but we're not yet certain about it." In my opinion, this happens for two major reasons:
* First and foremost, society-writ-large is not comfortable with ambiguity. Some of this is cultural (see the general confusion over election predictions, where 55% is treated as a certainty); some of it is also personal because people have limited bandwidth to perform their own risk/reward analysis.
* Second, "wrong" predictions, even when advertised as uncertain, tarnish expert credibility. Some of this is an outgrowth of the first point on ambiguity; some is a response to an adversarial environment where other motivated actors (political opponents, charlatans, conspiracy theorists) amplify failures. This is where I think your analysis on the politics comes into play, as well, and the end result is to retreat into a defensive certainty.
In turn, this has two negative policy implications:
* The first is a retreat into process. "Experts" can't always speak in hindsight, so defensive certainty prompts agencies to develop rigorous policy for drawing conclusions. Even if the conclusion is wrong, as long as the right steps were followed then the experts can claim success. See for example medical approvals. We know now that the major yet-to-be-approved covid vaccines are more likely than not to be helpful, but experts won't bless that decision until the right steps have been followed to certify the proof.
* The second implication is a strong status quo bias. The status quo is no lockdown, so there must be compelling evidence to prompt one. The status quo is no masks, so there must be compelling evidence to recommend masks. The status quo is no covid vaccines, etc. And after said compelling evidence, the policy prescription becomes the new status quo, equally unshakeable. This leads to the oft-maligned "eggs are good, bad, good, bad" flip-flop, and it also gives undue power to whoever can define the status quo -- often a political choice that we as a society don't really consider.
Little here has to do with the political realities of placating stakeholders. Instead, so much of it derives from an inappropriate (or even impossible) demand for certainty, including our instinct to conflate certainty with correctness.
Maybe a comprehensive civics education should include a long module on Bayesian-style reasoning (maintaining uncertain priors and updating with new information) and the Kelley criterion for wagering (relating the size of one's stake to both expected benefit and expected variance).
You meeeeean a collective action problem?
Before finally giving up on trying to convince my non-SSC friends of the wisdom of Zvi, I gave this analogy (mostly about FDA approval):
There's a water delivery man who normally delivers at 1 mph. There's a drought and he manages to get his speed up to 2 mph, saving twice as many people. But I think while very unpleasant for him, he could have gone 10 mph. Should I be happy he managed to double his speed or sad at the shortfall of what I thought possible?
I think some amount of it is about what should our emotional reactions be to inadequate equilibria in the world. Is frustration and anger a good source for driving change? Or is equanimity and understanding of bad incentives?
By what standard to we judge Fauci: Zvi or Lysenko?
Alex Tabarrok has mentioned this a little bit, being thankful for Warp Speed, but still pressing for more.
Should we focus on feasible alternatives of conceivable ones?
Maybe the answer is both, but it's easier to digest in separate posts, or separate speakers. Zvi can depress us about all the things that could have been done, and remind us that there is so much more possible. Scott can cheer us up by reminding us that we did okay giving the existing constraints in place.
We actually can infere what Zvi would do if he became director of the CDC. He wrote it several times. 9/3 "Burn it to the ground. CDC Delenda Est." (https://www.lesswrong.com/posts/RF5HjYYLY5FWgtA9v/covid-9-3-meet-the-new-cdc), 9/24: "CDC Delenda Est" (https://www.lesswrong.com/posts/E8fp7BxpuzcwaMGtz/covid-9-24-until-morale-improves), 12/17: "CDC Delenda Est" (https://www.lesswrong.com/posts/Rvzdi8RS9Bda5aLt2/covid-12-17-the-first-dose). So I suppose Zvi is your friend "pitchfork in hand, trying to burn down the system". And maybe the Fallacy does not seem to be Marx's Fallacy, it's possibly some Marxists' fallacy and possibly some other ...ists' Fallacy, and maybe "..." can be "Trump" but it can also be "Rational"; after all, your own folks never optimize for power. Making some very smart people a world dictator may make the world a Well-Kept Garden from his/her perspective. But given that this whole rationality community talks a lot about the problem that it's really hard to define a utility function that does not turn out to optimize for something you did not want in the first place, I think it could be slightly more modest with regards to politics.
"Just get the best person in the country and let _her_ fix everything"
Which is a correct statement because women actually are better leaders, on average. See, this is why I like to read you, nuances like this one and the hundreds I probably don't catch.
In that trolley problem, it’s worth noting that the out of control trolley is going to round the bend and kill all six people either way. That’s a common problem in illustrations of the trolley problem.
Additional problem with installing your friend as world dictator is that a lot of the reason they succeed is there working with good information and if there world dictate a lot of people will be very interested in warped there information diet
Prediction markets are not better for policy issues like covid, climate change, poverty, etc. Markets are great for aggregating information on parochial issues like the price of gold, the present value of a corporation, and all the various baskets of these things. To have a successful prediction market you need a metric that measures what good-faith people really care about. Political issues like climate change or poverty necessarily use intermediate goals that are deficient.
Many are subject to Goodhart's law, which states that any statistical regularity will collapse once pressure is placed upon it for control purposes. For example, Mao maximized steel output in the 1950s to modernize his economy because the best economies had high steel production. It was a disaster because the prioritization of steel production over everything else ignored marginal costs which would be reflected in the profit-and-loss system used by decentralized economies.
Covid deaths are bad, but so too is shutting down the economy, preventing people from seeing friends and family. These costs are difficult to measure, so one can always dismiss them, but they include not merely psychic costs, but real deaths. We can give everyone an education, but the value of this declines the more it is put into a national policy, and many now have useless degrees and much debt. CO2 production is bad, but invariably it is measured piecemeal, ignoring fixed costs, and counting negative externalities for one process while ignoring the negative externalities for another.
If Biden proposed a new Middle East peace policy, a market in Middle East peace would be of no value. The same is true for any of our great issues of debate: racism, sexism, inequality, the environment.
> Covid deaths are bad, but so too is shutting down the economy, preventing people from seeing friends and family. These costs are difficult to measure, so one can always dismiss them, but they include not merely psychic costs, but real deaths.
The deaths at least can be subject to prediction markets: have bets on how many people will die in total in a given year if we choose one policy or another. (The bets on the policy we don't end up choosing are refunded.)
How to weigh deaths vs preventing people from seeing friends and family is a difficult question, and can't be decided with prediction markets, but we can still make a better decision if at least we have better estimates (from prediction markets) on the inputs we can measure in numbers, such as how many lives lockdowns save.
The current Western protocol of attributing all deaths to covid based on a presumptive diagnosis, or having been diagnosed using 35 cycles in a PCR test prior to death, has no precedent: how many dead old people have trace amounts of a flu or cold virus? Now with the vaccine, subsequent deaths are automatically presumed non-covid. There are financial incentives for hospitals and long-term care facilities for attributing death to covid (instant guaranteed payment at 2x the usual rate), and there were clear political incentives for creating a crisis, as it hurt Trump and opened the door for various initiatives supported by those who dominate media and academia (Build Back Better, Great Reset).
11 months ago, I naively thought that 'covid death' would be relatively immune to this sort of chicanery, and so recently lost a $1k bet with Robin Hanson on this.
Again, the issue of how deaths are attributed to causes is avoided if we have prediction markets on the total number of deaths (from any cause) in the event of different measures.
If you're worried about how deaths are classified, maybe you should look at excess death statistics instead?
That would be better, in that it would get around the cause of death politics, and also count the iatrogenic therapies like aggressive intubation, which had a 99% mortality rate for people over 65 last spring. But note that wasn't an obvious concern at first, highlighting it's hard to know ex-ante what metrics are best.
This doesnt quite correlate w my experience following epidemiologists and virologists.
Late January I had a flu and Wuhan was a story already, so that was a way to enjoy a respiratory disease, by considering the chances of a pandemic. I was following 'This week in Virology' podcasts reading up on early cases of community transmission on flutrackers.com (did they catch all the contacts of this or that tourist from Wuhan? Oh no, this early case in Thailand infected a taxi driver, and this case in Japan was a guide a tour bus etc), There were R0 studies giving various numbers mostly between 2.5 and 3, and existing (flu) plans indicated NPIs are unlikely to control the spread of something >2. If anything, this turned out to be pesimistic. By Feb.4. I had bought a few months of food supplies (recently checked the date on that receipt), to be able to stay home during peak transmission. I was hoping it wouldn't become a big deal here in Europe before Spetember, if they managed to catch early transmission and warm weather being just aroung the corner, until Italy happened. Though w Iran (Feb 19th) it was clearly a pandemic, as epitwitter at the time explained. Also expected mortality was in the range of 0,5% to 2%, already.
Overall, I think listening to the chatter of experts, and immersing oneself in the discoruse was a good way to stay well informed about this pandemic. Quite possibly the official statements of government bodies were far more conservative, exobiting high normalcy bias.
This is a fair point - experts as individuals seemed to have a better read on things than institutional boards. I think Scott has a post on that phenomenon somewhere, where most scientists' beliefs are more accurate than 'scientific consensus'.
This matches my experience, but note that Professor in Epidemiology at 2nd tier university is much closer to optimizing for truth than director of the CDC, but it is the latter that we employ to get things right.
Also, I think most experts in February were locally right, i.e. had a good guess about R0, but were not able to connect the dots, e.g. even semi-privately endorsing border closures.
The problem is worse than you describe, because in many cases what we are looking for is polymathic expertise. For the efficacy and side effects of psychiatric drugs, we need psychiatry and pharmacology and general medicine - and since psychiatrists are MDs, a good psychiatrist gets us most of what we need. But for pandemic response, we need epidemiology plus sociology, economics, education, politics and not just in the how-do-I-stay-in-power sense, and more other fields than I'm going to try and enumerate here. Some of that we need to know if a proposed intervention is even feasible - sociology tells us how long we can keep people locked down before they start going to private house parties or mass political rallies instead of bars. Some of it we need to know whether the proposed cure is worse than the disease - how much harm does a year of zoom-schooling do to the long-term life prospects of elementary, middle, and high school students?
But it's hard enough finding legible but mediocre expertise in one field, that we generally call the job done when we find a Dr. Fauci. Fauci, working within the limits of the political system we have, is a mediocre expert in one thing. The one most important thing of the past year, perhaps, but not more important than all the other things put together. Not good enough.
Polymathic expertise does exist, and it's not *that* hard to find if you're looking for it. Zvi, for example. Or Scott. But broadly legible polymathic expertise, is very hard to come by.
Scott give prediction markets lots of credit lately. Is there a good source that argue why we should give it this credit and not just treat it like another random idea that sounds nice but probably doesn't really work as advertised, like blockchain?
(If you think that blockchain is not just another trend, same question)
For side effects, maybe something like this would work:
10% report stomach ache
3% report itching
0.2% report their hair falling out
This gives the facts and avoids having to make value judgements like "dangerous".
That would be a fairly good format, though it should also include where a symptom falls on the annoying to fatal scale, and also whether the symptom goes away if you stop the drug.
However, people have brought up the question of how the information about symptoms is gathered. And I don't think anyone has mentioned the need to update it now and then.
Isn't the entire idea of academia that they don't have to fight for power in this way and can optimize for truth?
As such, the real failure is not in governance, but in science!
Only people with no experience with academic science whatsoever could possibly say that with a straight face.
I was arguing that academia are failing at their task.
Re: not worrying more about addiction to Adderall than alcohol: Most people don't drink every day [citation needed]. They drink occasionally at social events. Adderall is recommended to patients to be taken regularly for some period, isn't it? If I drunk every day, I'd definitely be worried about the possibility of getting addicted.
I'm a layman who knows basically nothing about either Adderall or alcohol addiction. My point is that your comparison is not easy to interpret for someone who has never drunk regularly, and has never had a reason to investigate how much one can drink regularly without getting addicted.
What about Medscape. Appears much more professional and informative and less "political". I generally use it for medical questions. Haven't tried it for mental health issues.
“a kind of bumbling careerist with a decent understanding of epidemiology” is harsh for someone who was lead editor of Harrison’s. I mean, sheesh. Dude’s not a saint or Einstein but he seems pretty smart. I mean, not as smart as the economists who all seem to know marginally more than anybody about anything...
I agree about the general problem of power inviting corruption, but I think you're being far too kind to the current system.
Burn-it-downism actually works a lot better than I'd naively expect. The Bolshevik Revolution led to Stalinism, yes, but Stalinism involved possibly the most successful economic development program ever - mortared, of course, with a great deal of blood, but not the implosion one might have predicted. Even attempts at outright anarchy haven't ended with everyone starving to death. The bigger issue is violence, which revolution always causes and which our current systems are reasonably good at preventing. Of course, an anarchist would argue that the entire thing is built on the *threat* of force, but being held at gunpoint is still better than being shot.
But - with simulacra levels and all that - we currently have leaders that are detached from reality entirely, which is the reason for the uptick in populist sentiment, with the aura of revolution and violence that's always implied. When Congress has an approval rating below 25% for ten years straight, it really shouldn't be surprised to get a lynch mob at its gates. You talk about Fauci not being Lysenko, but Lysenko was very much the exception in the USSR; Fauci isn't Korolev, either, and I'd say Lysenko has closer analogues in the modern American public service than Korolev (something something bioethics). The Attila the Hun comparison is misleading because Attila was leader, not expert, and honestly I'm not sure Trump is all that far from an Attila in temperament. Not that we actually know much about Attila, historically. I could say something about Tamerlane and US foreign policy, but I don't really have any well-formed thoughts on that. The point is that the positive elements you're talking about are institutional successes fifty years old; I mean, even Fauci himself isn't exactly a new appointment. Possibly this is because the Cold War USA faced an actual threat in communism, and before that the Axis, and therefore had to acknowledge physical reality to fight them.
And you could say that, sure, our society's current paralysis is bad, but it's still better than risking things on any big changes because those can backfire, and basically that what we have is good enough. This is called conservatism. The problem with that, even if you're of the opinion that <gestures at planet> this is fine, it's not *stable*. Technological change leads to social change, sustainability is more than just a buzzword, relying on imports from increasingly poor countries has a natural endpoint, and if it takes ten years to repair one highway intersection our infrastructure will eventually fail entirely. We need utopianism in our discourse - we need multiple competing utopias - because otherwise we're reduced to using the literal worst expert ever as the bar our experts need to jump. And we probably need the threat of a mob with pitchforks (preferable distant, but with present dysfunction a more immediate one seems to be required) to make our elected and unelected leaders actually optimize for something besides power - in layman's terms, do their jobs.
"but Stalinism involved possibly the most successful economic development program ever - mortared, of course, with a great deal of blood,"
That's wildly false. Compare Japan and Russia c. 1910 and Japan and Russia today. For a still more extreme example, compare Russian growth from the beginning of the communist regime to the end with Hong Kong growth from 1945 to 2000, which gets you well past the point when per capita income passed that of the U.K.
I'm not going to quibble over GDP figures (apparently Japan and the USSR had comparable growth rates 1910-1950, and comparing Hong Kong to Russia is absurd), but broadly, the USSR being the world's second superpower, the second nation to build nukes, and the first spaceflight is not something that one would expect from its state in 1910, even accounting for its size. (How quickly living standards improved is a somewhat separate question, of course, but I doubt that's the part Stalin cared about.) There's a custom on both the Left and the Right to say Stalinism was economically disastrous, but I've become increasingly convinced this is the just-world fallacy in action.
None of which, of course, ameliorates the mass murder, totalitarianism, arguable genocide, et cetera. But morality and competence are not the same thing.
Morality and *success*, I wanted to say. Not individual competence, but results.
Anyway, I concede that I may have overstated my point in that sentence. Stalinism was very successful, to the point that no historical comparisons besides the PRC come to my mind, at *something*, and it's probably not correct to call that something economic development, but it's related.
There is surely also the principle of the low hanging fruit at work. The more primitive a nation is at the start the steeper its curve of improvements can be, especially if other countries already have implementations to copy.
> Burn-it-downism actually works a lot better than I'd naively expect.
Wait, you're holding up bolshevism as an economic development *success*? It was falling behind the growth rate of similar countries, rather than going faster, so that seems a bit strange.
My grandmother was struck by lightning... :(
This is a fantastic line of inquiry. But, doesn't it bump up against anti-culture war imperatives? It has all the trappings of previous ones: expertise vs. non-expertise, authoritarianism vs. individualism, and seems to also land on standard left vs. right spectrums
Stunning apologetic for elitist behavior that leads to actual harm.
This isn't kind, but it's true and I think adds something specific: the two times I've met Zvi in person (at rationalist-adjacent meet-ups in NYC, three years apart) I found him arrogant and unpleasant, to such a degree that it really stuck with me. Like, loudly declaiming his opinions and derisive toward anyone who disagreed with him. I'm generally pretty unbothered by non-neurotypical people, but that didn't feel like what was going on. I think it was just a difficult, non-collaborative personality.
I haven't read his blog much so maybe he's much easier to hear in writing. But I also wonder if these traits are somewhat correlated with being right about something early and loudly and also anticorrelated with the skills it would take to affect the world outside of, say, the rationalist-adjacent blogosphere. I also worry it leads to worse, un-dampened outcomes when he's wrong. Somewhat related to the broader "competence" point that others mention.
(This is really an unkind thing to say, so Scott please feel free to delete if you think it doesn't add enough to be worth it.)
I remember reading a really good article you wrote about a book you read on Marx. It was really insightful to me, but I got the feeling that communism could be fixed by more carefully thinking about the problems on a system like that, maybe using simulations, etc. But it seems you heavily dislike communism and I would like to understand if you see a problem with the core idea of the workers owning the means of production and also the redistribution of wealth.
The review article you are referring to is this one:
https://slatestarcodex.com/2014/09/13/book-review-singer-on-marx/
However Scott misread many of the passages from Marx, you can read some of my criticisms here:
https://www.reddit.com/r/SneerClub/comments/gc27k5/author_reacts_to_ssc_book_review/fpbulfv/
I don't know much about Marx, although I agree with most of his capitalism criticism, which I got second hand. But I follow a lot of marxists, and most of them don't really seem to have a solid idea of what a communist society would look like, except for some key points. If I press some of them, what they say seems a little like what Scott interpreted too: they think everything would be solved the conflict and resolution happened and things ended well in a new order (I don't understand enough of the revolution to agree or not). I like the idea of communism, though, but I heavily disagree if people think things will just work. I would like to understand whether there are good arguments that even planned communist systems wouldn't work, or if there is some marxist intellectual who really thought about that and have a decent plan (someone recommended me Rosa Luxemburg, it's on my to read list).
>When Zvi asserts an opinion, he has only one thing he's optimizing for - being right - and he does it well.
>When the Director of the CDC asserts an opinion, she has to optimize for two things - being right, and keeping power.
The senior officials in the CDC are (both reasonably, and according to their own claims,) optimizing for *saving lives* and keeping power. Sometimes, the thing they do to try to save lives is shut up about true things, or even say false things. That seems to be what happened with masks; they were trying to manage an economic supply/demand system to make sure hospitals and healthcare workers, who were at higher risk, had masks, and that the general public didn't go out and buy them. Was this a bad idea? In retrospect, obviously it was - but more critically, truth is a harsh mistress, and it seems that you can't serve two different goals, even when the first goal is honesty, and the other goal is public health.
"There are no first world countries"
Can someone explain the joke? Because I don't get it.
This post really exemplifies the saying "damning with feint praise." Sure, the experts are consistently wrong but that's only because they are optimizing for something other than being right! Come on, man. I don't know why you defend these people.
>The Director of the CDC reads those same papers. But some important Senator says that if airborne transmission is announced, important industries in his state will go bankrupt. [...] So the Director puts out a press release saying the evidence is not quite strong enough to say airborne transmission definitely happens, and they'll review it further.
Not saying this isn't true, but I wonder why these pressures aren't balanced out by countervailing pressures. The correct press release could harm the important Senator's state, but should greatly benefit the average citizen, so the important Senator's objection should be counter-balanced by the support of many other Senators (who should profess their objection to fire the CDC Director). This is why we believe representative democracy has a chance to benefit citizens at all. If other Senators will not resist the Senator's pressure, it means they need his support for something else, more important. In the end, this should theoretically (ideally) work out for the best compromises to benefit everyone. And when something is very important, like covid, we should expect to see fewer decisions related to it being compromised for something else.
What is the reason it doesn't work out that way? Irrationality? Politicians representing not the interests of their constituencies but their donors/lobbies? Rigid structures, e.g. the Senator in charge of CDC appointments was decided before it was so important, and now can't be changed?Something else?
OK - so the system as a whole produces mediocre expert advice - the question is can we (whatever group smaller than the general popupation that 'we' represents) develop a system that would give us better expertise?
For 'we' as patients: https://zby.medium.com/rational-patient-community-6d3617dffcfe
Once upon a time, it produced George Marshall as an output. How did that happen? Why hasn't it (apparently) happened since?
How can I access Scott's psychiatry database?
I *believe* it's the Lorien site, which you can reach through a hyperlink in the "about" page on here (https://lorienpsych.com/).
Thank you very much.
Feel like the driving factor for a lot of this is chance. There are a vanishing number of competent people and a vast sea of incompetents. If you have a mechanism for competence selection that is in any way imperfect, you're getting an idiot.
"Maybe expertise is a sham, and a smart guy thinking for five minutes can outdo a decade of working on a PhD."
I think about this a lot with respect to my field: urban mobility. I have a PhD in operations research / transportation, I work at an urban mobility startup, and I spend a nonzero fraction of my free time learning about urban mobility. I know a lot about this area. And yet, I know approximately nothing that you couldn't realize by looking out the window and thinking sufficiently deeply about what you see.
But most people - even in the industry - haven't realized many of the things which are realizable just by thinking hard. So can a smart person thinking for 5 minutes outdo a decade of learning? I suppose for a sufficiently smart person, yes? But sufficiently smart is a high bar. In mobility, time investment seems to serve as a substitute for something like "raw smarts" or "wisdom," a way to crowd source deep thoughts. In practice, everyone needs at least some time investment.
(Example of something that most people don't seem to have internalized, but should be obvious to us all if only we were all wise enough: for most intra-urban origin-destination pairs served by multiple transit modes, most of the modes should be approximately equally costly (including non-monetary costs) most of the time! E.g. if it were easier and faster and cheaper to go A -> B by bus than by car, people would shift car -> bus, the bus would slow down and become more unpleasant, traffic would decrease and thus car travel times would decrease, etc.)
I think not all fields are like this. E.g. no amount of staring out the window and thinking hard could reveal to me that human cells use DNA to store genetic information.
Just on a really narrow point it seems like both your recs and the recs from WebMD could be dramatically improved by adding a dime numerical score of how bad the side effects are. This allows one to both give a detailed summary of all the side effects and not require denying their importance while still giving a general sense of danger level relative to other drugs (forcing those who say this drug ruined a family members life to essentially debate the ppl claiming other drugs ruined lives they know).
This article would have been ever so slightly better, more likely to convince certain people, without two unnecessary jabs at Trump.
>Without the experts, things would have stayed open forever.
My gut reaction: "Oh. Shoot the experts, then."
I would like reading this better if the punctuation were inside the closing quotation marks, where it generally belongs.
> rather than being minimaxed for COVID-prediction
So this essay is great, but you've hit one of my pet peeves; you're using the word "minmaxed" wrong.
Minmaxing means something pretty specific; it doesn't just mean "optimized". For example, when I evaluate positions in a chess game, I assume my opponent makes the worst-for-me ("min") moves they can make and that future me makes the best-for-me ("max") moves future me can make. In short, it's only natural to use "minmax" to describe a situations where I'm trying to do something despite the actions of something else which I'm assuming is trying to thwart me. (Granted, technically we could call it minmaxing where there's a mathematically trivial opponent who doesn't do anything, but it's still a misleading word choice, like calling something a pentagon when you totally know it's a square and then defending your word choice by saying that one of the five sides has length zero.)
If you're trying to do something but there is no opponent (like covid prediction), the word "optimized" is a better fit than "minmaxed".
Citation: https://en.wikipedia.org/wiki/Minimax
Here’s how I use medical article databases. I’ve had x problem which the small-town PCP was ignoring. So hours on WebMD and similar gave me enough background that the next time it acted up I went to the ER and said “I think this might be a hernia” (they did an ultrasound, I was right.) Did that for a few other things. We can’t all access actual experts, so I need just enough info to get through to the doctors in front of me who can treat - prescribe, order tests, etc. Those databases are great for that.
I felt like crap for a month and couldn’t get any answers from docs and hit the databases. Compared bloodwork and got “why do they say nothing is wrong when the Internet says these numbers are metabolic acidosis?” Then more googling and it was possibly a side effect of a medication, so I did a taper myself and felt a little less crappy. I will never know if I was “right” but I burned less days feeling like crap. The databases are like a 2nd amendment for medical knowledge. We can arm ourselves. That being said, more info is better.
Scaling problem: II. Dr. Anthony Fauci is the WebMD of people.
https://twitter.com/nntaleb/status/1246122737602646017?s=20
<blockquote class="twitter-tweet"><p lang="en" dir="ltr">LOCALISM<br>The higher you go the more incompetence/reckelessness (with small exceptions). If this virus ever teaches anything, it is localism.<br><br>You<br>Your family<br>Your town<br>Your region/county/state<br>Federal Gov: CDC<br>The UN/<a href="https://twitter.com/WHO?ref_src=twsrc%5Etfw">@WHO</a></p>— Nassim Nicholas Taleb (@nntaleb) <a href="https://twitter.com/nntaleb/status/1246122737602646017?ref_src=twsrc%5Etfw">April 3, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
The degree to which post-modern opinions and their resultant policy advice are trapped between:
- Who watches the watchmen?
and
- We need a philosopher king in charge of every facet of life
simultaneously fascinates and terrifies me.
Excellent article highlighting the sloppy content on WebMD. It's a trash shite selling snake funded snake oil. Nobody with an iota of critical thinking takes this site seriously. WebMD is literally a lousy joke of the online world.
I don't think it's really a corruption thing that led Fauci to F up. Birx clearly wanted to stay in her job and thought that her being in place was better than Trump installing a 100% yes man. For Fauci, and the rest of the CDC, FDA, and NIH I think there's this massive status quo bias that is hard to overcome. Working in pharma it is clear that regulators and doctors want to be really really confident about something before they do it, even if the risk of them being wrong is no way near as severe as not doing anything. I think that's what happened with lockdowns, masks, at home antibody tests, etc. Until you could get a sufficient amount of data to be bulletproof (for non-delusional people/denialists) they won't do anything.
C'mon, you praise Anthony Fauci, but complains of DFW for loose ends in Infinite Jests? No wonder people send you annoying emails...
just kidding. I know how you feel, I gave up The pale King
This reminds me of Samo Burja's case study of the scientist who back in the day pulled for a Justice League of scientists to control nuclear technology: https://www.bismarckanalysis.com/Nuclear_Weapons_Development_Case_Study.pdf
I don't think anyone thinking COVID was the killer virus that the WHO made it out to be at the beginning can reasonably judge experts.
Well, maybe not. I suppose it's the same conundrum for Scott Alexander as for Fauci. If he ever openly says that COVID was a false alarm (which it was) and the response a massive civilizational fuck up the likes of which you won't find in the history of the planet until now (which it was and is), he would lose a lot of his supposedly "rational" audience.
Nonetheless another brilliant article, as always. Thanks.
Good post despite the obligatory Trump bashing virtue signal