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PaperclipPerfector  7mo ago (text post)   29327 thread views

Culture War Roundup for the week of October 2, 2023

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One common pattern of argument you often see from people who have not been doing too well in life is that they often blame rich/powerful interests for why they have not been successful, or alternatively why a certain social institution does not seem to work in the best interests of all of society. Their thinking is that to fix the problem, all we need to do is bring these rich/powerful people to heel. The problem according to such people is that fundamentally these small interest groups are disproportionately sucking up value from society and to fix this, they need to be punished.

This is seen in regard to blaming the FDA and peer review for impeding progress of new ideas and treatments. The FDA does not impede progress and peer review does not stop news ideas. Treatments that fail the FDA are not denied because of bureaucracy, but because they simply do not work, not because there is some conspiracy by rich people, drug companies, or governments to deny treatments. That is what a clinical trial does. But very few experimental drugs yield a successful treatment, especially for cancer. it does not even make business sense for a drug company to 'horde' treatments given that the government is paying for it anyway under Medicare or Medicaid. Regarding peer review, the process is not to block new ideas but block things which are unscientific to begin with, poor fit for the journal, or not written in a logically coherent way.

The denial of a drug isn’t the problem. The problem is the decades long process of very expensive, repetitive testing that can often add billions of dollars in research costs and delay the deployment of the drug. There’s also the issue of the drugs that don’t get released because the expected costs of bringing them to market isn’t that much less than the profit they can get for the drug, either because the disease is too rare to profitability treat, or because the disease is mild enough that patients won’t buy the drug if it costs too much.

If the disease is rare then the drug becomes absurdly expensive and covered by Medicaid .

The FDA does not impede progress

I feel like you could have chosen literally any other example and had a more compelling argument, particularly given our history here. Reverse Voxsplaining: Drugs vs. Chairs, Did A Melatonin Patent Inspire Current Dose Confusion?, etc, etc, etc. Sometimes high costs are because it takes billions of dollars to sift through millions of candidate chemicals and determine their effects on a noisy sample of thousands of people. Sometimes the high costs are because "Epipen" is easier to write than "Epinephrine Autoinjector".

Gleevec was approved to treat acute leukemia and was a major breakthrough. I would say that was progress. The vast majority of trials yield no improvement or even make the patient worse. yeah, regulation imposes a cost, but so does actually developing the drugs. There needs to be some firewall against useless or harmless treatments. A generic EpiPen was approved in 2018 https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-version-epipen

Gleevec was approved to treat acute leukemia and was a major breakthrough

Okay? The FDA does not perfectly impede progress isn't a contentious claim. How about bromantane from my last link (An Iron Curtain Has Descended Upon Psychopharmacology):

My guess is the reason we can’t prescribe bromantane is the same reason we can’t prescribe melatonin and we can’t prescribe fish oil without the charade of calling it LOVAZA™®©. The FDA won’t approve a treatment unless some drug company has invested a billion dollars in doing a lot of studies about it. It doesn’t count if some foreign scientists already did a bunch of studies. It doesn’t count if millions of Russians have been using the drug for decades and are by and large still alive.

Does that count as impeding progress?

A generic EpiPen was approved in 2018 https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-version-epipen

It only took them nine years! Congratulations to Teva Pharmaceuticals on their achievement.

I suppose it also comes down to the baseline we're discussing. Does the FDA impede progress relative to what, and by how much?

I think that the FDA impedes progress relative to a theoretical-within-punishing-the-elites pharmaceutical regulator, and the difference is enough to make a material impact on a decent fraction of people.

This would be a better argument if we didn't have plenty of evidence of peer review being used to sabotage new ideas for all manner of reasons from moneyed interests to petty university politics.

Besides, the idea that the current publishing process' point is to root out unscientific publications is both ahistorical (this is not how it came about) and practically risible (it has not in fact succeeded in doing so, and has produced more unreplicated garbage than ever).

There is no general rule. Institutions aren't inherently trustworthy or untrustworthy. The men that make them are probably much more important than the stories they tell about themselves.

you'd have to consider the counterfactual of no peer review though... lots more papers disproving Einstein, proving/disproving the Riemann hypothesis, etc. based on demonstrably wrong arguments . Peer review, as imperfect as it is, is better than the alternative. One can argue "let the community decide" in which case the communtiy is flooded with a deluge of unscientific junk and only a finite amount of time to process it.

The thing is, we do have the counterfactual, which is what happened before the reification of scientific publishing and what still happens in novel disciplines: it was a free for all with all manner of cranks and yet the quality of scholarship people actually cared about wasn't worse, on the contrary. Nor indeed was it any harder to parse than what journals have now become where most of what is published is garbage and even the most prestigious ones are not what they used to be.

I hint at it in my previous post but the point of journals and peer review was never originally to credential knowledge production (which is actually anathema to the scientific method) but to solve a logistical problem for institutions that had to rely on paper and its very narrow and expensive bandwidth. A problem that no longer actually exists in any meaningful sense.

If you snapped your fingers and took all of Elsevier out of existence tomorrow, I'd wager the lives of scientists would actually become easier by a large margin. And I submit as evidence the fact that most scientists in most disciplines actively circumvent copyright laws on the daily.

I also submit to you that it is in fact the credentialist approach that produces the greater incentive for fraud as the rewards of State funding are much easier to game when they are behind a list of bureaucratic checkboxes than behind a genuine need or the true esteem of one's peers.

I hint at it in my previous post but the point of journals and peer review was never originally to credential knowledge production (which is actually anathema to the scientific method) but to solve a logistical problem for institutions that had to rely on paper and its very narrow and expensive bandwidth. A problem that no longer actually exists in any meaningful sense.

time is a finite resource. so is manpower. people who read journals do not want to have to sift through piles of crud. peer review is not just about saving space but about curation.

The thing is, we do have the counterfactual, which is what happened before the reification of scientific publishing and what still happens in novel disciplines: it was a free for all with all manner of cranks and yet the quality of scholarship people actually cared about wasn't worse, on the contrary. Nor indeed was it any harder to parse than what journals have now become where most of what is published is garbage and even the most prestigious ones are not what they used to be.

The crank ideas fell out of favor because of peer review. Otherwise we'd still be seeing papers about luminiferous aether, spontaneous generation, and perpetual motion machines. It's not so much as a 'free for all' , but that competing ideas can coexist and then one wins out as being correct and the other is discarded.

This entire line of argument is a post-hoc rationalization. Again this isn't actually how peer review came about, this is the excuse to keep it going, but regardless of the merits of peer review, that excuse is nonsense, because the process has proven quite unable to filter out garbage science.

What it does do is prevent heterodox publication, which is completely different

It's not so much as a 'free for all' , but that competing ideas can coexist and then one wins out as being correct and the other is discarded

What's you're describing here is paradigmatization as conceptualized by Kuhn, the process in which a discipline becomes more structured and predictable by producing more incremental work based on an assumed theory or framework until it becomes so untenable that some crank show it all to be wrong and the process begins anew.

Now if you want to say that this process is necessary for science to move along, that's fine, and I'll agree. But if you want to say that increasing the level of control on publication to exclude the bad stuff is how you get new discoveries then that's just plainly wrong. It's quite the opposite actually. Scientific revolutions come from the margins.

And in that light, it makes attempts at sorting out the cranks from the serious people by establishing some bureaucratic authority and process quite futile.

Otherwise we'd still be seeing papers about luminiferous aether, spontaneous generation, and perpetual motion machines.

Yeah, maybe if we'd tightened it a little more we would even not have to see papers about semiconductors, aerodynes, and other such discredited impossible things. What a great win for humanity that would have been.

Again, to bring this back to my main point, peer review , contrary to popular belief here, does not suppress new or fringe ideas. The only criteria is the ideas must follow some guidelines, like be mathematically or logically consistent. For example, Alcubierre Miguel's 1994 paper about warp drives, which is speculative even by the standards of theoretical physics, was published in a peer reviewed journal, and the idea has now gained mainstream attention from that original publication. Same for ADs-CFT, in 1997. or theories in which Newtonian physics is modified.

Speculative and heterodox are different concepts.

But I mean, you're not going to convince me something I have witnessed first hand doesn't exist.

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