This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
The problem is that MAGA offers no credible alternative. If they had a trans-skeptic secretary of health who would cut down woke excesses back to the level of empiricism, that would be one thing.
Instead they have someone whose whole point was to bring in the votes of the anti-vaxxers and a president who joins him in announcing their big medical discoveries.
I mean, sure, if one believes that the medical priesthood is made up out of charlatans who talk about make-believe concepts like proteins, p-values, PCR or the like, then there is no problem in replacing them with different charlatans who can make just as convincing a show of knowing the secret language of the priesthood.
I will grant you this. For a lot of vaccines, the social benefit is that the immunized can no longer transmit the infection. Not so for COVID. So the main public health effect is not present.
A fair solution, in my opinion, would have been to announce that vaccination would be entirely voluntary, but that in triage situations, the willfully unvaccinated would simply get a penalty in their QALY-based score. Say divide their expected QALY gain from interventions by a factor of two, so that you might be indifferent between putting a 40yo unvaccinated patient or a 60yo vaccinated patient on oxygen.
This has good precedent: we already allow people to engage in a lot of dangerous activities such as smoking, drinking, or base jumping, which frequently kills them. The idea is that everyone has their own risk appetite, and as long as they just kill themselves we should generally let adults do what they want. Only when they endanger others is when we should restrict their behavior.
So if someone decides to gain immunity to COVID the natural way instead of getting microchipped by Bill Gates, let them. Just don't let them take a spot in the ICU from someone who followed the recommended vaccination schedule if spots are limited, send them home with a bucket of Ivermectin or something.
Sadly, our society is utterly incapable of discussing care prioritization in triage situations at all. The closest we get to it is probably taking current alcohol abuse into account when deciding who gets a new liver first.
The problem with suddenly slapping a QALY triage system on covid vaccination is that covid just doesn't have that big an effect on QALY. About 1-2 weeks loss per infection on average. This pales in comparison to other risks, like smoking (loss measured in years) and even to politically polarised risks like being a sexually active gay man. If you were assembling a checklist or survey you use for the calculation you wouldn't bother putting covid vaccination on it over hundreds of other risk factors.
This policy would rightly be seen by its victims as a blatant and obvious political attack on them specifically rather than part of a calculated dispassionate healthcare strategy. So no different than the mandates themselves.
My argument was that in most of situations, if people want to get the covid vaccine or not is a private choice between them and their risk appetite, same as smoking or driving a motorcycle.
The difference between covid patients and lung cancer patients is that covid patients are not poisson distributed and a wave of infections can easily overwhelm the medical system.
In situations where the medical system is overwhelmed, we need some triage procedure to prioritize patients. Using the QALY gains from the intervention seems like the obvious choice here. Obviously this makes a big difference. If a 50yo with severe covid has a 50% higher survival chance with O2 than without, that is decades of QALYs.
However, in health care emergencies, I find it fair to prioritize people who were not complicit in causing the health care emergency. If ten patients come into the ER after a highway accident, and you know for a fact that five of them were involved in an illegal street race which caused the accident, then I would think it fair to operate on the other traffic victims first, all other things being equal. (Typically, you do not know such information reliably, which is why we do not have policies for that.)
Outside of healthcare emergencies, everyone should receive care, of course, no matter how stupid and complicit they were in causing their health care problem. Smokers get lung cancer treatments, anti-vaxxers get ICU beds and so on.
My policy proposal is a lot less paternalistic and impactful than vaccination mandates. Most of the triage situations I heard about were from before vaccines became widespread. It would be also compatible with free market solutions like some anti-vaxxers voluntarily paying a private ICU facility a premium to keep a fraction of a bed to compensate for their higher risk of overwhelming the medical system.
This is very different to my approach to other vaccines where the immunized do not spread the disease, and being unvaccinated means, in the more extreme cases, that you are actively playing for team Nurgle.
Sure, but there is no existing policy for this, no past policy, and to bring it in for 2021 would obviously be perceived as an ad-hoc move to punish political enemies.
Further, if done in a dispassionate way, the main people who are complicit in causing a COVID emergency will be the elderly for the crime of being old.
What is the risk of "overwhelming" a free market private medical system? This is like saying gluttonous people should have to pay restaurants a premium in case they show up when the restaurant is already full - a misunderstanding of what a free market would actually mean in terms of having the choice to turn away customers.
Again this would end up being ad-hoc because we don't actually treat behaviours that spread disease like this in proportion to their risk of spreading disease. Outside of obvious culture war examples like anal sex, consider that alive while immunosuppressed will do a lot of damage all by itself.
More options
Context Copy link
More options
Context Copy link
Proposal: triage based on available annual renewable term life insurance premium for each patient conditional only on those attributes predictably downstream of a patient's choices. This plan would ensure that foregoing the covid vaccine resulted in a difference in triage ordering that was correct. This plan has no downsides. Thank you for coming to my TED talk.
Covid vaccination has such a minor effect compared to other patient choices that you would never bother surveying for it unless you are doing so for political partisan reasons. Covid just isn't dangerous enough for that to matter.
To provide an example, heavy smoking (which is a lower threshold than you'd expect) costs the average heavy smoker about 10 QALY, so any amount you charge for being unvaccinated, you'd have to charge heavy smokers ~500 times more. Already this stretches the bounds of feasibility. Any cost high enough to cover the cost of repeatedly vaccinating yourself for covid (Yep, that's a thing still, are you up to date according to local recommendations?) will be greater than the additional insurance cost, unless the premium increases by so much that you bankrupt all smokers. Not to mention the "gay tax" you'll have to charge for HIV risk, which for sexually active gay men is also a much higher risk than covid.
Edit: For the sake of providing real-world numbers, with the caveat that the UK doesn't operate on an insurance model, official recommendations are 1 booster shot every 6 months for £100 each when offered privately. Therefore if you increase insurance premiums on the unvaccinated, they will need to be at least £200/y more to be more expensive than simply being unvaccinated. Therefore you'd want to look at charging heavy smokers an extra £100,000 a year, which is multiple times the average annual income in the UK.
I'm afraid no matter what you try to do to construct a rational basis for punishing covid vaccine dissidents, it will succumb to the simple fact that covid isn't dangerous enough to justify it, unless you are also willing to simultaneously hit other groups with orders of magnitude more severe punishments.
Unrelated note - it might be fun at some point for us to do an adversarial collaboration on covid vaccines, because I hold the position that the mRNA vaccines (the speed of development and production scaling) were actually a bright spot in the covid pandemic and gave us some tools which we should be investing a bunch more into. Pretty much everything the public health policy makers did during covid in the US was stupid but the vaccines themselves are a medical miracle.
This wouldn't be particularly adversarial. The vaccines are kind of mediocre but fine. A bright spot in the covid pandemic is like the least stinky shit in a sewer. My disagreements are all with how states used vaccines to engage in yet more flagrant violations of human rights and violate medical ethics. I think we shouldn't invest into these tools, not as an isolated principle against mrna or viral vector treatments, but because of the risk the current institutions would use that investment just as they did in 2020-2022 for ill.
If the vaccines were released outside the context of lockdowns and other restrictions I would have nothing to say on them and there would have been no substantial opposition to them.
More options
Context Copy link
More options
Context Copy link
The joke was "covid vaccination status fades into noise by the annual renewable term life insurance premium metric". It's similar in spirit to proposing that we keep plastic straws, but charge consumers a carbon tax for the carbon that goes into its production (i.e. proposing to keep plastic straws but tax them at $0.0002 each), except my proposal is also "let's spend lots of time getting price quotes on term life insurance for people in medical triage, trying to address equity concerns in a triage situation is definitely a good use of resources so we should make sure to do it right".
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
How many academic journals would even consider a well-researched trans-skeptical study? Not even publish, but get to the point of doing a serious peer review? And going down the list of other things MAGA/MAHA takes seriously, tge same question— if a journal received a paper that was well-researched but says ivermectin is an effective treatment for Covid, do they send it out for peer review, or is it simply circular filed and ignored? In order to start doing the serious alternative research you want MAGA/MAHA to do, they need access to the journals and conferences that give legitimacy to the science. Furthermore, could a secretary go back to empirical evidence if the studies are strongly biased and the journals are captured? If the medical and science establishment were radically traditional Catholic, you aren’t going to be able to roll back to “evidence backed monotheism” because anything that isn’t in line with traditional Catholic teachings hasn’t gotten through.
In theory, a fair amount.There was the Cass Review, which included many published and peer reviewed papers, and the recent Gordon Guyatt drama resulted from trans-skeptical studies being published, though as the authors would have it, the issue was not the studies themselves, but the fact that they were used in a trans-skeptical way, which is why the customary activist pressure was applied.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link