4 ms·

...but it was not even let to to either work OR fail on its own, so we'll never know if some of the ideas could have worked. ...like it happens with all attemp

by nnq 13y ago

...but it was not even let to to either work OR fail on its own, so we'll never know if some of the ideas could have worked. ...like it happens with all attempts of any kind of technocratic government: sooner or later some groups of power totally freak out contemplating god knows what imaginary consequences of its future development and pull the plug on it and paint it as another "failed experiment". When will we actually become mature enough to be able to truly run social-engineering experiments in a scientific way and asses their results? (repeatedly and periodically, because with time people's mentalities change, so what didn't work in the past might work in the future and viceversa). When will we accept that "political 'science'" can only be an experimental 'science', so we have to at least try and run unbiased experiments from time to time and see what works better, instead of just letting the blind watchmaker of evolution run its inefficient search of the problem space? As an analogy [EDIT+ to clarify] of how wrong I think we do politics and social engineering now [/EDIT]: Imagine that in medicine you'd run 10% of a drug trial, then stop/pause it and make an "educated guess" based on this 10%, and based on this published guess have people vote whether to put the drug on the market or not. Sounds reasonable to anyone? :)

dnautics 13y ago
To run with your analogy. Let's take the case of vioxx, which was voluntarily withdrawn by merck after post-approval experiments showed statistically significant increases in heart attacks - never mind that this is exactly biasing the 'experiment' against vioxx (http://www.evanmiller.org/how-not-to-run-an-ab-test.html http://www.evanmiller.org/how-not-to-run-an-ab-test.html). The people vote to withdraw vioxx from the market. Because, heart attacks! Well, what of the plenty of people who decide that they'd rather have a slightly increased risk of heart attack instead of debilitating, quality-of-life-shattering daily pain? To take it further, what about conditions that specifically only address a minority of people, let's say that we made a drug that cures sickle-cell anemia, but gives a 100% chance of getting cancer by age 70. Who should make these decisions? Also: Who gets to be the person deciding on the 'educated guess'? And how can I be this person so that I can pick my pharmaceutical stocks ahead of time?
- kingkawn 13y ago
  The era of evidence-based medicine will be remembered for trying to apply population-level analyses to individual cases, which as I've understood it is not really the point of population level analyses.
  - nnq 13y ago
    well, in medicine we'll soon have personalized/individualized-medicine. but you can't really have personalized/individualized societies, unless we all isolate ourselves from each other and leave as ascets in caves :)
    - kingkawn 13y ago
      You can do population analysis, but thats valuable in terms of making population level decisions. Not decisions about individual care. An example being; where do we build a hospital. Not; which medication should we give this person. Right now we have universalized standards of care for things like hypertension that clearly do not work for the entire population yet we have accepted that x% improvement overall is the best. I think the future will involve identifying the subtleties of genetic and microbiome impact on all medications, and tailoring regimens based on those indicators rather than the EBM-based standards of care.
- nnq 13y ago
  Generally speaking: Whether something should be "on the market" and "how it should be used" are two different things. As political examples, natzism should definitely be "off the market"! But different forms of socialism can work well for some groups of people. Same as unregulated anarcho-capitalism might work well for other that share the values and accept the tradeoffs. But about the whole family of technocratic governments or of forms of governance base on cybernetic models, or of social orders with a "minimum guaranteed income" or maybe others even more exotic we have no usable experimental data! Addressing the specifics: Withdrawing vioxx from the market was, rationally speaking, a bad idea for the patients at the time, the rational thing to do would have been to modify the prescription guidelines and availability. But considering the reality of lots of MDs being not always up to date or just stupid (especially when it comes to 'kind of subtle to some' pharmacology issues, speaking from a 'past life' experience in the healthcare area), lives might have been saved by removing it from the market, especially in the USA where it was overprescribed. Nowadays there are other selective COX-2 inhibitors available, so the fact that vioxx is no longer on the market doesn't matter - there are mostly equivalent or better alternatives. About a hypothetical "drug that cures sickle-cell anemia, but gives a 100% chance of getting cancer by age 70": it should obviously be on the market. There are countless people dying from sickle-cell anemia, and, if regulated as a "last resort" treatment it would be a true life saver. I would be used just like aggressive chemotherapy or heavy dose radiation therapy is used (is can cure your current cancer or put it into remission, but it will almost surely give you cancer if you live long enough after it). Also: maybe the drug approval example was a bad analogy and it just pushed things off topic... Also: kudos for the link, it really is insightful! EDIT+: I think you misunderstood me, the example with the drug trial was about what should not happen, but happens now in politics! I phrased it like this to make it obvious how wrong it would be if, for example, we did medical research the way we do politics.

by nnq 13y ago

dnautics 13y ago

To run with your analogy. Let's take the case of vioxx, which was voluntarily withdrawn by merck after post-approval experiments showed statistically significant increases in heart attacks - never mind that this is exactly biasing the 'experiment' against vioxx (http://www.evanmiller.org/how-not-to-run-an-ab-test.html http://www.evanmiller.org/how-not-to-run-an-ab-test.html). The people vote to withdraw vioxx from the market. Because, heart attacks! Well, what of the plenty of people who decide that they'd rather have a slightly increased risk of heart attack instead of debilitating, quality-of-life-shattering daily pain? To take it further, what about conditions that specifically only address a minority of people, let's say that we made a drug that cures sickle-cell anemia, but gives a 100% chance of getting cancer by age 70. Who should make these decisions? Also: Who gets to be the person deciding on the 'educated guess'? And how can I be this person so that I can pick my pharmaceutical stocks ahead of time?

kingkawn 13y ago
The era of evidence-based medicine will be remembered for trying to apply population-level analyses to individual cases, which as I've understood it is not really the point of population level analyses.
- nnq 13y ago
  well, in medicine we'll soon have personalized/individualized-medicine. but you can't really have personalized/individualized societies, unless we all isolate ourselves from each other and leave as ascets in caves :)
  - kingkawn 13y ago
    You can do population analysis, but thats valuable in terms of making population level decisions. Not decisions about individual care. An example being; where do we build a hospital. Not; which medication should we give this person. Right now we have universalized standards of care for things like hypertension that clearly do not work for the entire population yet we have accepted that x% improvement overall is the best. I think the future will involve identifying the subtleties of genetic and microbiome impact on all medications, and tailoring regimens based on those indicators rather than the EBM-based standards of care.
nnq 13y ago
Generally speaking: Whether something should be "on the market" and "how it should be used" are two different things. As political examples, natzism should definitely be "off the market"! But different forms of socialism can work well for some groups of people. Same as unregulated anarcho-capitalism might work well for other that share the values and accept the tradeoffs. But about the whole family of technocratic governments or of forms of governance base on cybernetic models, or of social orders with a "minimum guaranteed income" or maybe others even more exotic we have no usable experimental data! Addressing the specifics: Withdrawing vioxx from the market was, rationally speaking, a bad idea for the patients at the time, the rational thing to do would have been to modify the prescription guidelines and availability. But considering the reality of lots of MDs being not always up to date or just stupid (especially when it comes to 'kind of subtle to some' pharmacology issues, speaking from a 'past life' experience in the healthcare area), lives might have been saved by removing it from the market, especially in the USA where it was overprescribed. Nowadays there are other selective COX-2 inhibitors available, so the fact that vioxx is no longer on the market doesn't matter - there are mostly equivalent or better alternatives. About a hypothetical "drug that cures sickle-cell anemia, but gives a 100% chance of getting cancer by age 70": it should obviously be on the market. There are countless people dying from sickle-cell anemia, and, if regulated as a "last resort" treatment it would be a true life saver. I would be used just like aggressive chemotherapy or heavy dose radiation therapy is used (is can cure your current cancer or put it into remission, but it will almost surely give you cancer if you live long enough after it). Also: maybe the drug approval example was a bad analogy and it just pushed things off topic... Also: kudos for the link, it really is insightful! EDIT+: I think you misunderstood me, the example with the drug trial was about what should not happen, but happens now in politics! I phrased it like this to make it obvious how wrong it would be if, for example, we did medical research the way we do politics.