We Need Major, But Not Radical, FDA Reform
post by Maxwell Tabarrok (maxwell-tabarrok) · 2024-02-24T16:54:33.061Z · LW · GW · 12 commentsThis is a link post for https://www.maximum-progress.com/p/we-need-major-but-not-radical-fda
Contents
Patent medicines and snake oil Chesterton’s fence Does the FDA actually help innovation? Addendum None 12 comments
Fellow progress blogger Alex Telford and I have had a friendly back-and-forth going over FDA reform. Alex suggests incremental reforms to the FDA, which I strongly support, but these don’t go far enough. The FDA’s failures merit a complete overhaul: Remove efficacy requirements and keep only basic safety testing and ingredient verification. Any drug that doesn’t go through efficacy trials gets a big red warning label, but is otherwise legal.
Before getting into Alex’s points let me quickly make the positive case for my position.
The FDA is punished for errors of commission: drugs they approve which turn out not to work or to be harmful. They don’t take responsibility for errors of omission: drugs they could have approved earlier but delayed, or drugs that would have been developed but were abandoned due to the cost of approval. This asymmetry predictably leads to overcaution.
Every week the Covid-19 vaccines were delayed, for example, cost at least four thousand lives. Pfizer sent their final Phase 3 data to the FDA on November 20th but was not approved until 3 weeks later on December 11th. There were successful Phase I/II human trials and successful primate-challenge trials 5 months earlier in July. Billions of doses of the vaccine were ordered by September. Every week, thousands of people died while the FDA waited for more information even after we were confident that the vaccine would not hurt anybody and was likely to prevent death. The extra information that the FDA waited months to get was not worth the tens of thousands of lives it cost. Scaling back the FDA’s mandatory authority to safety and ingredient testing would correct for this deadly bias.
This isn’t as radical as it may sound. The FDA didn’t have efficacy requirements until 1962. Today, off-label prescriptions already operate without efficacy requirements. Doctors can prescribe a drug even if it has not gone through FDA-approved efficacy trials for the malady they are trying to cure. These off-label prescriptions are effective, and already make up ~20% of all prescriptions written in the US. Removing mandatory efficacy trials for all drugs is equivalent to expanding this already common practice.
Now, let’s get to Alex’s objections. Most of his post was focused on my analogy between pharmaceuticals and surgery. There are compelling data and arguments on both sides and his post shifted my confidence in the validity and conclusions of the analogy downwards, but in the interest of not overinvesting in one particular analogy I’ll leave that debate where it stands and focus more on Alex’s general arguments in favor of the FDA.
Patent medicines and snake oil
Alex notes that we can look to the past, before the FDA was created, to get an idea of what the pharmaceutical market might look like with less FDA oversight.
Maxwell argues that in the absence of government oversight, market forces would prevent companies from pushing ineffective or harmful drugs simply to make a profit. Except that there are precedents for exactly this scenario occurring. Until they were stamped out by regulators in the early 20th century, patent medicine hucksters sold ineffective, and sometimes literally poisonous, nostrums to desperate patients. We still use “snake oil” today as shorthand from a scam product.
There is no denying that medicine has improved massively over the past 150 years alongside expanding regulatory oversight, but this relationship is not causal. The vast majority of gains in the quality of medical care are due to innovations like antibiotics, genome sequencing, and robotic surgery. A tough and discerning FDA in the 1870s which allows only the best available treatments to be marketed would not have improved medical quality much because the best available treatments at the time were still bad. And even the most lackadaisical and laissez-faire FDA today would not make us forget vaccines or antibiotics or to wash our hands before surgery. The strength of regulatory oversight explains little of the differences in medical quality over the past century.
The main problem with 19th century medicine is not that hucksters sold fake treatments, its that real treatments did not exist and no one knew how to make them. Learning how to make new treatments is still the largest source of gains today. If we can cure cancer, double lifespan, or develop these 8 vaccines, this innovation will far outstrip any gains from sorting through the medicines we already have.
If we further consider that the FDA’s filtration is paid for by a tax on innovation, the tradeoff looks worse. The ever-growing cost of regulatory approval drains hundreds of billions from the research that we rely on for progress.
Chesterton’s fence
In a related point, Alex points out that the FDA has been built incrementally over time, with each new piece a reaction to fill a gap revealed by a scandal. This means that the institutional design of the FDA encodes a lot of information which we ignore at our own risk.
The FDA did not spring into existence fully formed, its powers were granted and expanded over time in response to specific safety scandals and societal pressure (I cover these events in some detail in act 3 of my long post on the history of the pharmaceutical industry, thalidomide being the most notable). Anyone proposing we eliminate the FDA should keep in mind that we’ve already tried an unregulated pharmaceutical industry, and we decided that we didn’t much like it, thank you very much.
I agree with Alex’s description of how the FDA came to be, but this description is exactly why I am confident that the FDA is far too cautious. The FDA is built out of reactions to safety scandals and societal pressure, but the scandal per-life-lost is much higher for errors of commission than errors of omission. The FDA ought to be optimizing to save lives, but instead it’s shaped in reaction to scandal and pressure so it is willing to send millions to the invisible graveyard in exchange for avoiding a few dozen deaths of malpractice.
The FDA shut down Strep A vaccine research for thirty years, for example, based on an uncontrolled study with 21 participants that showed a scandalous risk, ignoring previous successful trials with tens of thousands of participants and a human challenge trial with no serious adverse safety events. Strep A kills five hundred thousand people a year globally.
We know why Chesterton’s fence is there and we know why it’s too high.
Does the FDA actually help innovation?
At the end of the essay, Alex steelmans the case for how drug regulators may help progress and innovation in pharmaceuticals.
The existence of the FDA is a forcing function which incentivises drug companies to generate data that shows that their drugs have a positive risk-benefit profile. Information on what works and doesn’t work is fed back into the development process for future drugs, improving the quality of future drug development decisions
(as a corollary to #1) Because drug companies make money if their products are demonstrated to work, they are incentivised to pursue scientific research in a truth-seeking manner. Over time, market forces conspire to eliminate companies that do bad science and reward those who make discoveries that benefit humanity. By creating a mechanism for the market to reward good science, academic science (as a source of talent and ideas for biotech) is also indirectly incentivised to produce higher quality work
By creating a regulatory pathway which encodes some value judgements on what type of technologies are worth developing and in what manner, regulators can help funnel talent, money, research, and economic activity (incl. entrepreneurship) down channels that are ultimately beneficial for society
A defined regulatory pathway with established value generating milestones (IND, phase I, phase II, phase III…) makes investing in biotech more predictable and attractive
The first three points are closely related. Drug regulation creates incentives for drug companies to produce useful data and research. This data and research has big positive externalities, so its good to provide incentives for them. However, the FDA provides this incentive by making all drug development more expensive, but making failed drug development even more expensive. Because the FDA provides these incentives with a stick instead of a carrot, the net effect on the output of the industry is negative.
The FDA’s growing power does correlate with higher levels of medical quality over time, but the rate of growth is negatively correlated with FDA oversight. There are many possible reasons for this but it is suggestive that the period before FDA efficacy requirements 1900-1962 saw much faster medical progress than the subsequent 60 years.
Imagine we applied the FDA’s incentive strategy to some other public good like carbon removal. Before you can start your carbon removal machine, you have to go through a multi-year, multi-million dollar testing gauntlet to verify exactly how much carbon the machine removes and whether it is more or less effective than planting trees. This process would produce some useful data, and it would make inefficient machines less rewarding relative to machines which pass the tests, but it won’t incentivize entry into the field on net. It would be much better to subsidize the public good industry for producing something we want, or have a government agency directly run the tests rather than taxing all public goods producers, but the good ones a little less.
New medical treatments have massive positive externalities so we want to sort through and differentially reward them without decreasing the overall output of the industry. Instead of raising the cost of entry for all drugs with extra punishments for ineffective ones, we should lower barriers and provide extra rewards to the most effective and safe drugs. One easy way to accomplish this is to remove efficacy requirements, lowering development costs for all drugs, and retrospectively reward the drugs whose early results hold up best in voluntary efficacy trials, post-market surveillance, or government funded trials.
Many parts of clinical research are public goods. Instead of taxing the private rewards that pharmaceutical companies get from this research and returning only a portion of the tax to the public-good-producing industry, we could spend much more on producing research directly. Doubling the NIH budget and running a bunch of clinical trials is a far cheaper and more effective way to incentivize the research, data, and talent that Alex and I both want than the FDA’s current strategy.
Alex’s fourth point about a defined regulatory pathway seems outside of the clash of our debate. The regulatory structure I am proposing is certainly not less defined or predictable than the current one, so it doesn’t seem like a relevant metric by which to compare them.
Alex and I agree on more about the FDA than either of us and the median person you’d find on the street would. Still, we have our disagreements. Fundamentally, I think our disagreements stem from differing weights on the importance of innovation vs selection in medical progress and on the importance of errors of omission vs commission in the FDA’s decision making. I would much rather live in a world with lots of medical innovation and poor selection than the other way around, and I view commission bias as fundamental and pervasive in all of the FDA’s decisions.
To correct for this bias I propose a major, but not a radical, reform to the FDA. Return to the FDA of 1960. Expand the standards we already apply to a large proportion of prescriptions: Remove efficacy requirements for approval. If there are still market distortions which favor ineffective drugs, fix them with subsidies rather than regulatory hurdles so that we don’t siphon resources from the innovative engines which are responsible for the vast majority of medical progress.
Addendum
Supplements
Alex also highlights the modern day supplement industry as a cautionary tale for pharmaceutical deregulation. An investigation from Scott Alexander, which Alex cites, finds that even niche nootropic supplements by-and-large contain what they claim to. Still, most supplements aren’t really good treatments for anything.
I put this section in the addendum because I think supplements are a separate issue from what most discussion of the FDA centers on. Usually, the FDA is framed as a correction to misalignments between the interests of consumers and pharmaceutical companies. People want effective medicine but pharmaceutical companies can give them sugar and sawdust for cheap and it is difficult for patients to find out.
The main problem with supplements, though, is that people don’t want effective treatments. It’s not that consumers ask for one thing and get another, it’s that they get what they want but we think what they want is bad for them. More like gambling or alcohol than snake oil. Whether and when this kind of paternalism is justified is a complicated philosophical debate which is worth further investigations but I thought was orthogonal to our other points about the FDA.
12 comments
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comment by JenniferRM · 2024-02-25T00:06:28.274Z · LW(p) · GW(p)
This bit might be somewhat true but I think that it actually radically understates the catastrophic harms that the FDA caused.
Every week the Covid-19 vaccines were delayed, for example, cost at least four thousand lives. Pfizer sent their final Phase 3 data to the FDA on November 20th but was not approved until 3 weeks later on December 11th. There were successful Phase I/II human trials and successful primate-challenge trials 5 months earlier in July. Billions of doses of the vaccine were ordered by September. Every week, thousands of people died while the FDA waited for more information even after we were confident that the vaccine would not hurt anybody and was likely to prevent death. The extra information that the FDA waited months to get was not worth the tens of thousands of lives it cost. Scaling back the FDA’s mandatory authority to safety and ingredient testing would correct for this deadly bias.
Something else that the FDA regulated was covid testing. In December of 2019 there were many tests for covid in many countries. I could have made one myself, and by February of 2020 I was pricing PCR machines and considering setting up "drive through covid testing" without any regulatory oversight.
Part of my "go / nogo" calculus was that I expected to get personally financially destroyed by the FDA for totally ignoring their oversight processes, but I was imagining that either (1) being destroyed by evil would be worth the good it does or (2) people would begin to realize how evil the FDA is in general and I'd be saved by some equivalent of jury nullification.
If the FAA and CDC and other authorities relevant to ports of entry had had millions of covid tests in US airports in January of 2020 then there is a possibility that nearly all covid deaths in general would have been prevented by preventing community spread by preventing covid from even getting into the US.
One of several reasons nothing like this was even conceivably possibly is that the FDA made all covid tests (except maybe 50 per day done by hand by a couple scientists in Atlanta Georgia) illegal all the way up to March or April of 2020 or so (they started authorizing things irregularly after the panic started, when community spread was undeniable, but not before).
The US was proven to basically entire lack the CONCEPT of "actual public health" where actual public health unpacks into a centralized and strategically coherent system for preventing the entry and spread of communicable diseases in the US.
The FDA is a critical part of the prevention of actual public health for every novel disease that has come along since 1962, and everything that will come along unless they "do correct policy by hand by turning off their stupid policies every time their stupid policies become OBVIOUSLY stupid in a new emergency".
If Ebola had gotten into the US in the past, the FDA would have prevented large volumes of new tests for that too. This is a fully general problem. Until we fix it structurally, we will be at the mercy of either (1) the natural evolution of new diseases or (2) the creation of new diseases by madmen in virology labs.
The US government is catastrophically stupid-to-the-point-of-evil here. It has not banned gain of function research outside of BSL5s. It has not set up a real public health system. It systematically misregulates medicine with the goal of suppressing new medicine.
Right how the US has a godawful mix of public/private "collaboration" so that we have all the charity and kindness of capitalism, mixed with all the flexibility and efficiency of the soviet empire.
We literally don't even have a private medical industry OR a public medical system and BOTH are critical for life and health.
This "worst half of each" combo we have right now should be lit on fire and two better systems should be built on their ashes.
The existing FDA is THE KEYSTONE of this vast edifice of corrupt government-based evil. Any presidential candidate will get my vote if they promise to completely reboot the entire US medical system in the direction of (1) freedom in privatized medicine and (2) huge increases in state capacity to detect and prevent terrible new diseases so that we also have good public medicine.
The CDC should go back to being part of the military. OSHA should stop regulating medical workplaces. The NIH and the residual parts of the FDA that aren't stupid-unto-evil (and I grant that the FDA isn't literally 100% evil because nothing is 100% except in math) should be put under the CDC. The efficacy mandate of the FDA should be removed. The safety mandate of the FDA should ALSO be removed. The right way to manage safety concerns for brand new drugs is tort reform for medical malpractice. Grownups OWN THEIR OWN RISK.
There should be a real right to try for people with terrible illnesses with no known reliably safe cures, who want to roll the dice and try something new that has never been tried before. Doctors in clinical practice should be able to get a signature on a risk acceptance contract, and then do crazy new medicine, and be protected in that from lawsuits.
The time to do "FDA-like oversight of the first 20 people to try a new therapy" is not PROSPECTIVELY for literally EVERY medicine. It should be done in retrospect, when it failed, and the result was sad, and the patient thinks that the sadness was not the sort of sadness they were warned about in the contract they signed when they accepted the risks of trying something new.
The existing medical system has SO MANY bad ideas and so little coherent planning about how to do actual good that a reboot with new people in a new organizational shape is strongly indicated.
The existing FDA is THE KEYSTONE of this vast edifice of corrupt government-based evil.
FDA delenda est.
Replies from: M. Y. Zuo, shankar-sivarajan↑ comment by M. Y. Zuo · 2024-02-25T14:43:38.615Z · LW(p) · GW(p)
What's a realistic reform plan that will get through both Congress, and the White House, and not get struck down by the Supreme court on the first few dozen challenges?
Obamacare had to be watered down many times from its original vision, and encumbered with millions of words of legalese, so much so that it might even have resulted in a net negative to society depending on perspective, and even then it squeaked through by a very slim margin.
I just don't see much of a chance for anything more ambitious.
Replies from: JenniferRM↑ comment by JenniferRM · 2024-02-27T21:25:17.232Z · LW(p) · GW(p)
I wrote 1843 words in response, but it was a bad essay.
This is a from-scratch second draft focused on linking the specifics of the FDA to the thing I actually care about, which is the platonic form of the Good, and its manifestation in the actual world.
The problem is that I'm basically an albigenisian, or cathar, or manichian, in that I believe that there is a logically coherent thing called Goodness and that it is mostly not physically realized in our world and our world's history.
Most governments are very far from a "Good shape", and one of the ways that they are far from this shape is that they actively resist being put into a Good shape.
The US in 1820 was very unusually good compared to most historically available comparison objects but that's not saying very much since most governments, in general, are conspiracies of powerful evil men collaborating to fight with each other marginally less than they otherwise would fight in the absence of their traditional conflict minimization procedures, thus forming a localized cartel that runs a regional protection racket.
The FDA is thus a locally insoluble instance of a much much larger problem.
From December 2019 to February 2022 the nearly universal failure of most governments to adequately handle the covid crisis made the "generalized evil-or-incompetent state" of nearly all worldy governments salient to the common person.
In that period, by explaining in detail how the FDA (and NIH and OSHA and CDC and so on) contributed to the catastrophe, there was a teachable moment regarding the general tragedy facing the general world.
The general problem can be explained in several ways, but one way to explain it is that neither Putin nor Hamas are that different from most governments.
They are different in magnitude and direction... they are different from other governments in who specifically they officially treat as an outgroup, and how strong they are. (All inner parties are inner parties, however.)
Since Putin and Hamas clearly would hurt you and me if they could do so profitably, but since they also obviously can't hurt you and me, it is reasonably safe for you and me to talk about "how Putin and Hamas would be overthrown and replaced with non-Bad governance for their respective communities, and how this would be Good".
From a distance, we can see that Putin is preying on the mothers and families and children of Russia, and we can see that Hamas is preying on the mothers and families and children of Palestine.
Basically, my argument is that every government is currently preying upon every group of people they rule, rather than serving those people, on net.
I'm opposed to death, I'm opposed to taxes, and I'm opposed to the FDA because the FDA is a sort of "tax" (regulations are a behavioral tax) that produces "death" (the lack of medical innovation unto a cure for death).
These are all similar and linked to me. They are vast nearly insoluble tragedies that almost no one is even willing to look at clearly and say "I cannot personally solve this right now, but if I could solve it then it would be worth solving."
Not that there aren't solutions! Logically, we haven't ruled out solutions in full generality in public discussions yet!
I'm pretty sure (though not 100%) that "science doesn't know [LW · GW] for sure" that "benevolent government" is literally mathematically impossible. So I want to work on that! <3
However... in Palestine they don't talk much in public about how to fix the problem that "Hamas exists in the way that it does" and in Russia they don't talk much in public about how to fix that "Putin exists in the way that he does" and in China they don't talk much in public about how to fix that "the CCP exists in the way that it does", and so on...
The US, luckily, still has a modicum of "free speech" and so I'm allowed to say "All of our presidents are and have been basically evil" and I'm allowed to say "FDA delenda est" and I'm allowed to say "The Constitution legally enshrines legalized slavery for some, and that is bad, and until it changes we in the US should admit that the US is pretty darn evil. Our median voter functionally endorses slavery, and so our median voter is functionally a moral monster, and if we have any moral leaders then they are the kind of moral leader who will serve evil voters IN SPITE of the obvious evils."
I don't usually bring up "that the FDA is evil" very much anymore.
Covid is old news. The common man is forgetting and the zeitgeist has moved on.
Lately I've been falling back to the much broader and simpler idea that the US Constitution should be amended to simply remove the part of the 13th amendment that literally legalizes literal slavery.
This seems like a cleaner thing, that could easily fit within the five word limit [LW · GW].
And perhaps, after decades of legalisitic struggle, the US could change this one bad law to finally make slavery fully illegal?
But there are millions of bad laws.
Personally, I think the entire concept of government should be rederived from first principles from scratch and rebooted, as a sort of "backup fallback government" for the entire planet, with AI and blockshit, until all the old governments still exist, like the way there are still torture machines in museums of torture, but we just don't use any of the old governments anymore.
There's a logically possible objection from the other direction, saying that government is necessarily evil and there just shouldn't be one. I disagree with this because good institutions are incredibly important to good outcomes, empirically, and also the consent of the governed seems like valid formula. I'm an archist and not an anarchist.
But I'd aim for a state of affairs where instead of using the old governments, we would use things like a Justice API, and Local Barter Points, and a Council of DACs, and a Polyhive Senate Of Self Defense, and Open Source Parliamentarians (AIs built to represent humans within an Open Source Governance framework like in the backstory of Lady Of Mazes), and other weird new things?
Then at some point I'd expect that if most people on Earth looked at their local violence monopoly and had the thought "hey, I'm just not using this anymore" it would lead to waves, in various places, and due to various crises, of whole regions of Earth upgrading their subscriptions to the new system (maybe taking some oaths of mutual defense and signing up for a few new DACs) and then... we'd have something much much better without the drawbacks of the old stuff.
If such "fallback governance systems" had been designed and built in 2019, then I think covid would have caused such a natural phase transition for many countries, when previous systems had visibly and clearly lost the global mandate of heaven.
And if or when such phase transitions occur, there would still be a question of whether the old system will continue to try to prey on the people voluntarily switching over to a new and better system...
And I think it is clear to me and most of my readers that no such reform plan is within any Overton Window in sight...
...and maybe you therefore don't think THIS could be a realistic way to make the FDA not exist in 2026 or 2028 or 2033 (or any other near term date)...
...but a cautious first principles reboot of the global order to address the numerous and obvious failures of the old order is currently the best I can currently come up with on BOTH the (1) realism and (2) goodness axes.
And while possible replacement system(s) for the government are still being designed, the only people I think it would be worth working with on this project are people who can independently notice that the FDA is evil, and independently notice that slavery is bad and also legal in the US (and also hopefully they can do math and have security mindset).
So, I still endorse "FDA delenda est" but I don't think there's a lot of point to beating that dead horse, or talking about the precise logistics of how to move deck chairs on the titanic around such that the FDA could be doing slightly less evil things while the ship sinks.
The ship is sinking. The water is rising. Be Noah. Build new ships. And don't bother adding "an FDA" to your new ship. That part is surplus to requirements.
Replies from: Wei_Dai, M. Y. Zuo↑ comment by Wei Dai (Wei_Dai) · 2024-02-28T06:11:59.634Z · LW(p) · GW(p)
I'm pretty sure (though not 100%) that "science doesn't know for sure" that "benevolent government" is literally mathematically impossible. So I want to work on that! <3
Public choice theory probably comes closest to showing this. Please look into that if you haven't already. And I'm interested to know what approach you want to work on.
Personally, I think the entire concept of government should be rederived from first principles from scratch and rebooted, as a sort of "backup fallback government" for the entire planet, with AI and blockshit
I think unfortunately this is very unlikely in the foreseeable future (absent superintelligent AI). Humans and their relationships are just too messy to fully model with our current theoretical tools, whereas existing institutions have often evolved to take more of human nature into account (e.g., academia leveraging people's status striving to produce knowledge for the world, militaries leveraging solidarity with fellow soldiers to overcome selfishness/cowardice).
As an investor I'm keenly aware that we're not even close to deriving the governance of a publicly held corporation from first principles. Once somebody solves that problem, I'd become much more excited about doing the same thing for government.
Replies from: JenniferRM↑ comment by JenniferRM · 2024-02-28T21:06:19.035Z · LW(p) · GW(p)
Public Choice Theory is a big field with lots and lots of nooks and crannies and in my surveys so far I have not found a good clean proof that benevolent government is impossible.
If you know of a good clean argument that benevolent government is mathematically impossible, it would alleviate a giant hole in my current knowledge, and help me resolve quite a few planning loops that are currently open. I would appreciate knowing the truth here for really real.
Broadly speaking, I'm pretty sure most governments over the last 10,000 years have been basically net-Evil slave empires, but the question here is sorta like: maybe this because that's mathematically necessarily how any "government shaped economic arrangement" necessarily is, or maybe this is because of some contingent fact that just happened to be true in general in the past...
...like most people over the last 10,000 years were illiterate savages and they didn't know any better, and that might explain the relatively "homogenously evil" character of historical governments and the way that government variation seems to be restricted to a small range of being "slightly more evil to slightly less evil".
Or perhaps the problem is that all of human history has been human history, and there has never been a AI dictator nor AI general nor AI pope nor AI mega celebrity nor AI CEO. Not once. Not ever. And so maybe if that changed then we could "buck the trend line of generalized evil" in the future? A single inhumanly saintlike immortal leader might be all that it takes!
My hope is: despite the empirical truth that governments are evil in general, perhaps this evil has been for contingent reasons (maybe many contingent reasons (like there might be 20 independent causes of a government being non-benevolent, and you have to fix every single one of them to get the benevolent result)).
So long as it is logically possible to get a win condition, I think grit is the right virtue to emphasize in the pursuit of a win condition.
It would just be nice to even have an upper bound on how much optimization pressure would be required to generate a fully benevolent government, and I currently don't even have this :-(
I grant, from my current subjective position, that it could be that it requires infinite optimization pressure... that is to say: it could be that "a benevolent government" is like "a perpetual motion machine"?
Applying grit, as a meta-programming choice applied to my own character structures, I remain forcefully hopeful that "a win condition is possible at all" despite the apparent empirical truth of some broadly catharist summary of the evils of nearly all governments, and darwinian evolution, and so on.
The only exceptions I'm quite certain about are the "net goodness" of sub-Dunbar social groupings among animals.
For example, a lion pride keeps a male lion around as a policy, despite the occasional mass killing of babies when a new male takes over. The cost in murdered babies is probably "worth it on net" compared to alternative policies where males are systematically driven out of a pride when they commit crimes, or females don't even congregate into social groups.
Each pride is like a little country, and evolution would probably eliminate prides from the lion behavioral repertoire if it wasn't net useful, so this is a sort of an existence proof of a limited and tiny government that is "clearly imperfect, but probably net good".
((
In that case, of course, the utility function evolution has built these "emergent lion governments" to optimize for is simply "procreation". Maybe that must be the utility function? Maybe you can't add art or happiness or the-self-actualization-of-novel-persons-in-a-vibrant-community to that utility function and still have it work?? If someone proved it for real and got an "only one possible utility function"-result, it would fulfill some quite bleak lower level sorts of Wattsian predictions. And I can't currently rigorously rule out this concern. So... yeah. Hopefully there can be benevolent governments AND these governments will have some budgetary discretion around preserving "politically useless but humanistically nice things"?
))
But in general, from beginnings like this small argument in favor of "lion government being net positive", I think that it might be possible to generate a sort of "inductive proof".
1. "Simple governments can be worth even non-trivial costs (like ~5% of babies murdered on average, in waves of murderous purges (or whatever the net-tolerable taxation process of the government looks like))" and also..
If N, then N+1: "When adding some social complexity to a 'net worth it government' (longer time rollout before deciding?) (more members in larger groups?) (deeper plies of tactical reasoning at each juncture by each agent?) the WORTH-KEEPING-IT-property itself can be reliably preserved, arbitrarily, forever, using only scale-free organizing principles".
So I would say that's close to my current best argument for hope.
If we can start with something minimally net positive, and scale it up forever, getting better and better at including more and more concerns in fair ways, then... huzzah!
And that's why grit seems like "not an insane thing to apply" to the pursuit of a win condition where a benevolent government could exist for all of Earth.
I just don't have the details of that proof, nor the anthropological nor ethological nor historical data at hand :-(
The strong contrasting claim would be: maybe there is an upper bound. Maybe small packs of animals (or small groups of humans, or whatever) are the limit for some reason? Maybe there are strong constraints implying definite finitudes that limit the degree to which "things can be systematically Good"?
Maybe singleton's can't exist indefinitely. Maybe there will always be civil wars, always be predation, always be fraud, always be abortion, always be infanticide, always be murder, always be misleading advertising, always be cannibalism, always be agents coherently and successfully pursuing unfair allocations outside of safely limited finite games... Maybe there will always be evil, woven into the very structure of governments and social processes, as has been the case since the beginning of human history.
Maybe it is like that because it MUST be like that. Maybe its like that because of math. Maybe it is like that across the entire Tegmark IV multiverse: maybe "if persons in groups, then net evil prevails"?
I have two sketches for a proof that this might be true, because it is responsible and productive to slosh back and forth between "cognitive extremes (best and worst planning cases, true and false hypotheses, etc) that are justified by the data and the ongoing attempt to reconcile the data" still.
Procedure: Try to prove X, then try to prove not-X, and then maybe spend some time considering Goedel and Turing with respect to X. Eventually some X-related-conclusion will be produced! :-)
I think I'd prefer not to talk too much about the proof sketches for the universal inevitability of evil among men.
I might be wrong about them, but also it might convince some in the audience, and that seems like it could be an infohazard? Maybe? And this response is already too large <3
But if anyone already has a proof of the inevitability of evil government, then I'd really appreciate them letting me know that they have one (possibly in private) because I'm non-trivially likely to find the proof eventually anyway, if such proofs exist to be found, and I promise to pay you at least $1000 for the proof, if proof you have. (Offer only good to the first such person. My budget is also finite.)
↑ comment by M. Y. Zuo · 2024-02-28T05:01:39.021Z · LW(p) · GW(p)
Can you reformulate your thoughts to be more readable? It's quite hard to make heads or tails out of the points listed.
Replies from: JenniferRM↑ comment by JenniferRM · 2024-02-28T21:30:33.524Z · LW(p) · GW(p)
I apologize. I think the topic is very large, and inferential distances [? · GW] would best be bridged either by the fortuitous coincidence of us having studied similar things (like two multidisciplinary researchers with similar interests accidentally meeting at a conference), or else I'd have to create a non-trivially structured class full of pre-tests and post-tests and micro-lessons, to get someone from "the hodge-podge of high school math and history and biology and econ and civics and cognitive science and theology and computer science that might be in any random literate person's head... through various claims widely considered true in various fields, up to the active interdisciplinary research area where I know that I am confused as I try to figure out if X or not-X (or variations on X that are better formulated) is actually true". Sprawl of words like this is close to the best I can do with my limited public writing budget :-(
Replies from: M. Y. Zuo↑ comment by Shankar Sivarajan (shankar-sivarajan) · 2024-02-25T05:15:45.631Z · LW(p) · GW(p)
I grant that the FDA isn't literally 100% evil
I suppose they do contain organs that might one day be harvested to save a life.
comment by Viliam · 2024-02-24T20:33:43.246Z · LW(p) · GW(p)
It’s not that consumers ask for one thing and get another, it’s that they get what they want but we think what they want is bad for them.
I think it makes sense to distinguish three situations:
- the consumer wants X, the company sells Y in a bottle labeled "X"
- the company sells X, telling everyone using advertising and bribed experts: "science proves that X makes you healthy, and lack of X makes you sick", but that is a lie
- the company sells X, everyone knows that X is bad for you, but the customers buy it anyway
The first is clearly a problem, most people would agree with that. The last probably cannot be avoided -- if you don't allow the customers to buy the product legally, they will buy it illegally -- plus there is a chance that the government is wrong.
It is the second case that bothers me. I don't think it is completely fair to say "customers want it", even if they kinda do, because they only want it because they are lied to. I wouldn't want the government to stop me from getting what I want, but I would want to be told clearly when someone is lying to me. (And yes, there is also a risk that the government would be wrong. But I don't think that it is a good solution to let the lies unaddressed, or to let various people -- scientists and scammers alike -- say different things and expect the average person to sort it out without any more hints.)
So, I would like to see some sort of "scientific authority" that would have a monopoly on providing official medical recommendations, which would be clearly displayed on health-related products, or their absence would be obvious for everyone. Something like, each actual medicine contains a red rectangle with a logo saying "this is actual medicine", and no one is allowed to put anything similar on their product, unless FDA allows them. You are allowed to buy and sell stuff without the red rectangles, but everyone is told, repeatedly and unambiguously by media: "if it claims to have medical benefits, but it doesn't have the red rectangle, it's fraud -- always check the red rectangle". (The test criterion for "repeatedly and unambiguously" is that an average person with 80 IQ can tell you what the red rectangle means.)
comment by ChristianKl · 2024-02-25T13:36:27.757Z · LW(p) · GW(p)
Usually, the FDA is framed as a correction to misalignments between the interests of consumers and pharmaceutical companies. People want effective medicine but pharmaceutical companies can give them sugar and sawdust for cheap and it is difficult for patients to find out.
The Ranbaxxy case suggests that the FDA isn't that good at preventing that from happening. They mostly work on a basis where they trust pharmaceutical companies to do what they are saying they do.
comment by [deleted] · 2024-03-16T01:10:54.028Z · LW(p) · GW(p)
I found this post useful because of the example of the current practice of doctors prescribing off-label treatments. I'm very uncertain about the degree to which the removal of efficacy requirements will lead to a proliferation of snake oil treatments, and this is useful evidence on that.
I think that this debate suffers from a lack of systematic statistical work, and it seems hard for me to assess it without seeing any of this.