The Ridiculous FDA

From the FI Discord chat (link at bottom)

I didn’t participate in this particular chat but I thought it was good.

curi
the FDA is fucking ridiculous btw

curi
u can do 100 studies just to get 2 successes with 95% confidence to submit

curi
failures don’t matter

curi
this is one of the reasons getting drugs approved can be expensive – they don’t reliably work, but run enough trials and u can get them approved.

Freeze
yikes

Freeze
the p value being 0.05, meaning 5% statistical significance, is what contributes to 95% confidence right? And no negative or null results being published means yeah… you can keep running trials. so if you can afford it, you can get any drug approved eventually?

curi
something like that

Freeze
ah, not exactly, ok

curi
they don’t just write their policies clearly on their website

curi
but i read several things to check on this

Freeze
friend commenting on this:

well that’s why the replication crisis is such a huge problem
another part of the problem is that no one wants to be the replicator
they want to be the one finding results
so no one wants to fact check other people’s work, especially if they’ll probably get a negative (non-present) result

Freeze
i sent him an invite to this group

curi
the underlying cause is govt-funded/run science instead of profit motive. if a for-profit company runs research, they want real results they can use in products. if the govt runs research, it’s a social climbing contest to get in favor with those in power.

curi
also with free market drug effectiveness testers, they would care about their reputation a lot. develop better policies or go out of biz.

Freeze
ah… so capitalism would fix this error too, because results would be prioritized over political bias/promises?

curi
the FDA does not compete in the market and prevents – by force – companies from using better, alternative standards

curi
capitalism was the primary source of major scientific progress in the industrial revolution

curi
roughly: no1 blames companies who say “well the FDA approved it, we used the highest standards anyone could expect of us”. actually companies have somewhat higher standards than the FDA in some ways, some integrity, but it’s a bad system.

curi
many companies. some are just abusive.

curi
and they are pressured to be abusive by the false belief that abusing stuff like that brings profit and that they are required to maximize profit.

curi
which is not a fucking capitalist idea, contrary to all the propaganda. capitalism wants to maximize profits in the sense of being efficient, not wasting money, etc., and taking into account long term factors not just self-destructive money grabs.

curi
making a good product and keeping customers happy is good, profitable biz

Freeze
the best businesses seem to really seek win/wins

Freeze
i remember what you mentioned about… the invention of the iPhone helping far more people than most charity efforts

Freeze
I never thought about innovation that way, but it makes sense

Freeze
and raising the quality of living and wealth of others is a form of reducing suffering/improving happiness, adding choices to their lives, enabling more creativity and freedom etc.

Freeze
The idea of ‘institutions that suppress the creation of moral knowledge are morally bad’ is something i’ve been thinking about. If the FDA is suppressing medical progress/medical knowledge creation, then we have to find some way to improve it. Capitalism seems to work because it lets all of these errors be corrected by incentivizing innovation that gets people what they want.

Freeze
capitalism seems completely compatible with honesty. In fact it seems like being dishonest causes more problems than benefits, but maybe these problems are harder to spot e.g. poor error correction internally, lots of missed opportunities to improve processes and relationships, lower innovation etc. but in the real world it seems difficult to find companies or leaders that believe in and practice honesty.

Healthcare freedom thoughts

Adapted from a discord discussion:

TheRat: I am kind of weird because I like the idea of Healthcare for all. But I think Universities should be subject to market pressures to kill most of the deadwood. I think it would make them much more affordable too. But at this point I am wildly guessing at things I have no knowledge about.

universities used to be way cheaper before government tried to ensure everyone got access by giving everyone federally-backed loans, which drove up the price

likewise there are a variety of government actions that drive up the cost of healthcare

the government restricts the supply of physicians and other health professionals, restricts the supply of hospitals (see “Certificate of need”), restricts the supply and increases the cost of pharmaceuticals (through the FDA), distorts the health insurance market (with direct regulations and tax policy stuff like favoring employer-provided insurance), and on and on

if you like the idea of healthcare for all, you should be in favor of laissez faire free market healthcare, which will get us much closer to healthcare for all than some system of govt controls and govt rationing

just as if you’re in favor of Food for All you should want to maintain the current system of private production of food as opposed to shifting to a govt-controlled system

people often think that healthcare is somehow fundamentally different than other things on the market and want to treat it differently in various ways

i do not think there is a case for such different treatment

people will also argue that folks shouldn’t have to economize, that everyone should have healthcare access as a moral ideal

but there is an actual scarcity of doctors, medical devices, etc

how do they propose to deal with that, in a way better than the market will deal with it?

why would a system of govt controls and rationing produce better outcomes than the marketplace would for healthcare, when such govt-controlled systems fail miserably elsewhere?

people have long wait times for various procedures in Canada, UK and the other countries the advocates of healthcare socialism cite as their ideals

I think some people like the long wait times, cuz they would prefer that people all suffer together in the same line rather than having a system where some people could pay to get healthcare faster

i remember hearing about some minor proposed reform in Canada where people would be able to pay privately for some kinda medical tests, and there was a public outcry cuz people didn’t like the idea of folks skipping the queue.

the people willing to pay would actually be helping the govt system, since they’d move out of the queue for the govt system.

like, they already paid tax dollars for their “free” healthcare, and were willing to pay extra, out of pocket, for care outside the system.

but ppl got mad and IIRC this reform wasn’t permitted

also consider someone entering the medical profession, their perspective

if you want to be a doctor and offer patients your professional advice and judgment, how will you feel about the idea of offering care according to a govt schedule, subject to the whims of cost-cutting bureaucrats who know less than you about what a patient needs?

people become doctors so they can offer patients their professional judgment in order to save lives and improve health, not to be some bureaucrat’s bitch

TheRat: Healthcare became so politicized that I find it overwhelmingly complicated to even look at. Got half the experts saying one thing the others the exact opposite

regarding some of these experts

townhall.com/tipsheet/katiepavlich/2014/11/10/obamacare-architect-yeah-we-lied-to-thestupid-american-people-n1916605

www.breitbart.com/politics/2014/09/18/obamacare-creator-die-75/

Emanuel’s push for people to die at 75 is deeply connected to Obamacare, which insists that care be rationed for the elderly – who, presumably, must be encouraged to make the same “mature” decision about death Emanuel has made. Emanuel pushes back against those attempting to lengthen their own lives, castigating them as morally deficient:

Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal. I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop. Emanuel says he will stop having “colonoscopies and other cancer-screening tests.” He wants flu shots stopped for the elderly, as well.

But it’s not enough for Emanuel to feel that way. We all must feel that way, and we must construct policy around that belief. He believes that life-expectancy statistics should be ignored once they move beyond 75 years old. And while he insists that he is not “saying that those who want to live as long as possible are unethical or wrong,” his entire article is premised on that belief. Otherwise, why write it? And given the fact that Emanuel directs the Clinical Bioethics Department at the National Institutes of Health, his opinion carries weight.

it’s no accident that the advocates of socialism are, literally and explicitly, the advocates of death, and that they stand against unlimited progress

a patient in the free market has aligned incentives with his doctor. you pay a doctor and he’s happy to give you the benefit of his time and judgment. the doctor takes good care of the patient and the patient will recommend the doctor and maybe come back for more visits down the line when necessary.

in a bureaucratic system of controls and rationing, the patient is one of a group of people in a line waiting to get their ration of care. the doctor has to provide a certain number of care-units per week in order to meet their quota, and provide such care according to certain cost controls imposed by the provider of the “free” care. healthcare being “free”, the doctor knows he will always have an unlimited number of beggars — i mean patients — waiting in line for his attention, so he does not have much incentive to do an outstanding job, nor does he have the time or resources to do so even if he were so inclined.

the govt cost controls clash with doing an outstanding job, and the unlimited demand for “free healthcare” means he spends a bunch of time dealing with the cuts and sniffles and imaginary diseases of people queuing up for their “free” care. between such marginal visits and the paperwork overhead of the bureaucratic healthcare system, he doesn’t have much attention or time left over for dealing with people’s more serious medical issues. the incentive structure he faces is not based on what’s best for the patient and what will best serve the needs of people in the marketplace for medical care, but only on what the govt demands. he who pays the piper calls the tune.

but don’t worry, everyone gets free flu shots and band-aids so it’s all good!

Another thing people say is profiting off illness is wrong so healthcare should be run as not for profit

First thing there is that profiting off sickness is literally not what happens

Doctors offer their services to try to make you well. They offer reasonable attempts helping improve your wellness. They don’t get a check when you get sick

Also demanding that someone provide services not as a profit is demanding that someone labor for you and get no benefit. That’s demanding slavery

Also you should want a system where your incentives are aligned with the doctor’s. Instead of the doctors incentives being aligned with the bureaucracy’s dictates

You wanna be the consumer

It’s like, Facebook’s real customers – the people who pay the bills – are the advertisers, so FB kinda sucks from a consumer perspective in terms of privacy and stuff

Whereas with Apple, incentives are aligned way better cuz Apple is catering to the ppl paying $1K for their phones etc

Gotta Cut Back

Environmentalism offers the same answer regarding the satisfaction of human desires/ends/purposes it doesn’t like, regardless of the situation or subject matter or purported crisis-of-the-moment.

new ice age? gotta cut back. global warming? gotta cut back. peak oil? gotta cut back. plenty of oil? gotta cut back.

use petroleum? gotta cut back. use nuclear? gotta cut back. use coal? gotta cut back. use hydro? gotta cut back.

ride planes? gotta cut back. drive a car? gotta cut back. use plastic bags? gotta cut back. use plastic straws? gotta cut back. like meat? gotta cut back.