6 ms·

I understand where your ideas come from, I wish they were true. But sadly they are misinformed on many levels, and the root of the problem is you are playing a

by ErrantX 15y ago

I understand where your ideas come from, I wish they were true. But sadly they are misinformed on many levels, and the root of the problem is you are playing a statistical game where reality will win. - There are not enough Billionaires to meet your needs, statistically you'll need quite a few to find any decent cures. Especially with 30 teams in play on each case; figuring out "what worked" is a bad numbers game in that case. - Science shows there is unlikely to be one "magic bullet" for cancer, which makes it hard to cure individuals and then take that science into a wider populace; "something here worked, but does it work generally?" - Cancer treatments are harsh and invasive - by design! 30-40 competing drugs is unsustainable, you would be, to put it mildly, royally fucked. So death could come simply by exhausting the body with treatment, as easily as anything else. - You invoked Godwin's law, which is never a good sign. I agree with your general premise; which is that it takes too long to iterate ideas into actual production. But the reason that scenario exists is not just "quack medicine" and other hopeful (but useless) remedies, it is for the case of "oh shit, I just killed a million people because we didn't investigate long term effects". And that is where your theory really fails; because you are trading an unknown collateral now, for an unknown collateral in the future. I'm not arguing against either as a good or bad thing; but it does highlight the fatal flaw in the argument "you are killing X people right now by not releasing/iterating fast enough"

Jach 15y ago
I have some questions about your points... How many people do you think one would need to find any decent cures/treatments? How many patients are current researchers making use of to accomplish the feat? If moldbug had said something along the lines of "you can increase the numbers by having billionaires fund people other than themselves, such as their parents or other people they care about, or just as donations, in ways that don't bankrupt them but still provide lots of experimental data", do you think the increased number could still not possibly be enough, would you still object? If moldbug had started with 5 concurrent treatments instead of 30, would you object to that? (Though considering death is coming I personally would rather die of treatment exhaustion from X treatments than the actual cancer, knowing I tried many potential solutions. (This conditional on a cancer that actually threatens my life.)) Lastly, are the "unknown collaterals" equivalent unknowns? Shouldn't we try to estimate them and decide whether ramping up the release/iterate process is worth it? That people are dying because the research system sucks doesn't seem that controversial to me or very unknown in truth-value. How likely do you think it is that someone kills 1 million people with some remedy, and how likely do you think it is that the same 1 million people would have lived much longer without such a remedy being attempted on them?
Game_Ender 15y ago
I am going to echo Jach comments a bit. Millions of people are dying from cancer, and will die at the pace of current research. The argument is that if you turn up the pace, you will kill more people but in the longer term you may save a lot more. Instead of decades from idea to human trial you push into a few years.
- ErrantX 15y ago
  Millions of people are dying from cancer, and will die at the pace of current research. The argument is that if you turn up the pace, you will kill more people but in the longer term you may save a lot more. You can't predict these numbers though; which is my point. Neither is a very useful argument. There are a lot of improvements that could take place; the moving of more drug research from the US to other countries, for example (that's probably a controversial opinion in itself).
moldbug 15y ago
Statistically you'll need quite a few This is exactly the problem: statistics. In a problem where every case is unique, any use of statistics is an abuse of statistics. The roots of Western medicine are arguably pre-scientific, and certainly pre-statistical. We knew and could do a lot of things before we knew what a p-value was. If what "advancing knowledge" means to you is "accumulating p-values so I can publish papers," this kind of experiment can produce no information whatsoever. If what "advancing knowledge" means to you is "we think we know what's going on and we think we can do it better next time," the answer is very different. Of course this is what most people, indeed most industries, mean by "learning." We don't have to know absolutely that we know - we don't have that luxury. Instead we need to get things done. Modern scientific medicine is supposed - no, required (with the increasingly narrow exception of surgery) - to learn only in the first way. Guess what? It doesn't seem to be learning much. Or at least, much of any use. Maybe medicine isn't as much like physics as we'd thought. it is it is for the case of "oh shit, I just killed a million people because we didn't investigate long term effects". And you're lecturing me about Godwin's law? For what it's worth, long-term effects of OTC non-cancer drugs aren't investigated for shit. I'm permanently achlorhydric from permanently solving my GERD with daily omeprazole. As recommended by actual doctors. What the hell is the effect of taking omeprazole for a decade? Who the hell knows? And that is where your theory really fails; because you are trading an unknown collateral now, for an unknown collateral in the future. Did you ever read Asimov's Foundation? Remember the bits set on Trantor? Your whole mindset is straight out of Trantor, I fear - and it's certainly not exclusive to you.
- ErrantX 15y ago
  For what it's worth, long-term effects of OTC non-cancer drugs aren't investigated for shit. I'm permanently achlorhydric from permanently solving my GERD with daily omeprazole. As recommended by actual doctors. What the hell is the effect of taking omeprazole for a decade? Who the hell knows? Omeprazole has been about for nearly quarter of a century; and is fairly well understood - hell I can walk down to my local drug store and pick up a load from the shelves. What you are describing, IMO, is either one of two things: - a systemic failure in healthcare provision (not drug development) - or a valid trade off between cure and side-effect If what "advancing knowledge" means to you is "we think we know what's going on and we think we can do it better next time," The problem here is that you're going to kill a larger number of people in-trial due to mistakes or missteps. We know this because that is what early medicine did. Whether this is more than those who would die without aggressive research is something of a moot argument. Arguing the numbers is largely pointless because it's impossible to predict what will happen (that, after all, is the point). Now; I see your argument that this is a valid tradeoff. Indeed, I think we should take more risks than we do. But not quite to the extent you are arguing.

by ErrantX 15y ago

Jach 15y ago

I have some questions about your points... How many people do you think one would need to find any decent cures/treatments? How many patients are current researchers making use of to accomplish the feat? If moldbug had said something along the lines of "you can increase the numbers by having billionaires fund people other than themselves, such as their parents or other people they care about, or just as donations, in ways that don't bankrupt them but still provide lots of experimental data", do you think the increased number could still not possibly be enough, would you still object? If moldbug had started with 5 concurrent treatments instead of 30, would you object to that? (Though considering death is coming I personally would rather die of treatment exhaustion from X treatments than the actual cancer, knowing I tried many potential solutions. (This conditional on a cancer that actually threatens my life.)) Lastly, are the "unknown collaterals" equivalent unknowns? Shouldn't we try to estimate them and decide whether ramping up the release/iterate process is worth it? That people are dying because the research system sucks doesn't seem that controversial to me or very unknown in truth-value. How likely do you think it is that someone kills 1 million people with some remedy, and how likely do you think it is that the same 1 million people would have lived much longer without such a remedy being attempted on them?

Game_Ender 15y ago

I am going to echo Jach comments a bit. Millions of people are dying from cancer, and will die at the pace of current research. The argument is that if you turn up the pace, you will kill more people but in the longer term you may save a lot more. Instead of decades from idea to human trial you push into a few years.

ErrantX 15y ago
Millions of people are dying from cancer, and will die at the pace of current research. The argument is that if you turn up the pace, you will kill more people but in the longer term you may save a lot more. You can't predict these numbers though; which is my point. Neither is a very useful argument. There are a lot of improvements that could take place; the moving of more drug research from the US to other countries, for example (that's probably a controversial opinion in itself).

moldbug 15y ago

Statistically you'll need quite a few This is exactly the problem: statistics. In a problem where every case is unique, any use of statistics is an abuse of statistics. The roots of Western medicine are arguably pre-scientific, and certainly pre-statistical. We knew and could do a lot of things before we knew what a p-value was. If what "advancing knowledge" means to you is "accumulating p-values so I can publish papers," this kind of experiment can produce no information whatsoever. If what "advancing knowledge" means to you is "we think we know what's going on and we think we can do it better next time," the answer is very different. Of course this is what most people, indeed most industries, mean by "learning." We don't have to know absolutely that we know - we don't have that luxury. Instead we need to get things done. Modern scientific medicine is supposed - no, required (with the increasingly narrow exception of surgery) - to learn only in the first way. Guess what? It doesn't seem to be learning much. Or at least, much of any use. Maybe medicine isn't as much like physics as we'd thought. it is it is for the case of "oh shit, I just killed a million people because we didn't investigate long term effects". And you're lecturing me about Godwin's law? For what it's worth, long-term effects of OTC non-cancer drugs aren't investigated for shit. I'm permanently achlorhydric from permanently solving my GERD with daily omeprazole. As recommended by actual doctors. What the hell is the effect of taking omeprazole for a decade? Who the hell knows? And that is where your theory really fails; because you are trading an unknown collateral now, for an unknown collateral in the future. Did you ever read Asimov's Foundation? Remember the bits set on Trantor? Your whole mindset is straight out of Trantor, I fear - and it's certainly not exclusive to you.

ErrantX 15y ago
For what it's worth, long-term effects of OTC non-cancer drugs aren't investigated for shit. I'm permanently achlorhydric from permanently solving my GERD with daily omeprazole. As recommended by actual doctors. What the hell is the effect of taking omeprazole for a decade? Who the hell knows? Omeprazole has been about for nearly quarter of a century; and is fairly well understood - hell I can walk down to my local drug store and pick up a load from the shelves. What you are describing, IMO, is either one of two things: - a systemic failure in healthcare provision (not drug development) - or a valid trade off between cure and side-effect If what "advancing knowledge" means to you is "we think we know what's going on and we think we can do it better next time," The problem here is that you're going to kill a larger number of people in-trial due to mistakes or missteps. We know this because that is what early medicine did. Whether this is more than those who would die without aggressive research is something of a moot argument. Arguing the numbers is largely pointless because it's impossible to predict what will happen (that, after all, is the point). Now; I see your argument that this is a valid tradeoff. Indeed, I think we should take more risks than we do. But not quite to the extent you are arguing.