List of civilisational inadequacy

It's often the case that a single clinic has a great medical treatment that doesn't spread to the rest of the world.

My favorite example is the Stone Clinic, which for decades has been treating osteoarthritis successfully by regrowing cartilage with stem cells from bone marrow. Extrapolated from their results, if the entire US used the Stone Clinic's methods, 98% of knee replacement surgeries would be unnecessary. But, for one reason or another, getting widespread adoption is really hard.

Stephen Badylak's clinic regularly regrows organs, but again, this hasn't scaled nationwide.

Francis Levi has found that chemotherapy has half the side effects and double the potency if you give it at night, when cancer cells are dividing but healthy cells have a slowed cell cycle. "Chronotherapy" for cancer is pretty much only available at his hospital.

As a patient, you could probably do much better than average by finding the clinic that does that one really good thing and going there.

Pain treatment is stupid and bad in a number of ways.

A major reason behind the opioid epidemic is that OxyContin is supposed to give 12 hours of pain relief but it doesn't actually last that long. Being chronically slightly short of pain medication and suffering withdrawal symptoms is a great way to get addicted.

Opioids don't actually work on neuropathic pain; they target a totally different pain receptor. Nerve pain is qualitatively different and is sensed by the cannabinoid receptors. And, yet, we don't have a whole suite of drugs to target the cannabinoid receptors. We just have cannabis, which is illegal in a lot of states. (As a stopgap, cannabidiol is a cannabis compound that helps with chronic pain, is non-psychoactive, and legal.)

"Functional" chronic pain conditions where there's no visible injury, like fibromyalgia or chronic fatigue syndrome or back pain with a central sensitization component, are very hard to treat and are stigmatized as "all in the patient's head", whereas there are a fair number of studies showing that people with these conditions look different hormonally, immunologically, and/or neurologically from healthy people. The standard treatment for CFS for a long time was a graded exercise program which has now been shown to have no evidence of efficacy.

If I were in charge of pain research, I'd study a much wider range of drugs in animals, including new drug classes.

If I had a chronic pain condition, I'd definitely expect self-experimentation and doing my own research to be more useful here than with other diseases, because there's biases in the medical system (against drug use and disabled people) and a lot of variation between individuals.

Female reproductive health is poorly understood and poorly treated.

Chronic illnesses which are very common (5-21% of American women have fibroids; 15-20% have PCOS; 3% have endometriosis) and cause real problems (infertility and chronic pain) are frequently incurable or nearly so. We don't know the causes of any of them.. We don't know how a lot of pregnancy complications (like pre-eclampsia) happen. Anecdotally, women get their reproductive health issues ignored by doctors very often even when symptoms are severe; "period pain" gets written off as trivial even though sometimes it's severe.

Female sex hormones fluctuate cyclically, of course, but nobody has done studies measuring hormone levels over time and fitting a differential-equation model of how hormones affect each other's levels. We don't really know, on the gears level, what happens when you alter hormone levels. Which may be why women get such extremely varied responses to hormonal contraception; "the pill" is one-size-fits-all, but we don't understand the normal human variation in hormones well enough to target dose to person.

A lot of people would do better, on the margin, to get less end-of-life care than Americans typically do. There are a lot of laws and incentives that prevent doctors from being frank about the fact that the last treatment in a long series of treatments for a terminally ill person doesn't help that much. The more familiar people are with the medical system, the more likely they are to want to spend their last days at home.

Research quality goes way down for stigmatized populations. There's very little epidemiological evidence about trans people, period. Autism research is frequently "not even wrong" (there are fruit fly and zebrafish behavioral models of autism!)

"Shared common knowledge" within stigmatized communities (e.g. stuff that trans people learn from other trans people) can often outpace the state of the research; it's higher-variance though, because rumor mills often misinform.

Lifestyle choices in general aren't usually going to be studied at all, just because there are so many ways to alter your life. It is true that "paleo diets aren't supported by scientific evidence" -- because they haven't been tested! There's basically no nutritional research that assigns study participants to <20g carbohydrate diets.

Subtle differences between lifestyle setups are also not going to be studied. Just as the studies didn't compare "lightboxes for SAD" to "brighter lightboxes for SAD", you're usually not going to see a study that compares one type of physical therapy to a slightly different type, one type of standing desk to a slightly different type, one type of exercise routine to a slightly different type, etc. If fine details of execution matter, the research literature often isn't going to pick up on that.

(This would also explain why I could believe that, say, a study of accupuncture could find it ineffective for pain relief while one particular person going to a particular accupuncturist could genuinely experience a dramatic effect. If some accupuncturists are "real" while others are "fake", modern medical research isn't going to be able to distinguish them.)

There are only a few thousand drug candidates being studied in the US. Total. Including in-vitro.

The pipeline is tiny, ultimately because the pharma industry is an oligopoly.

"They haven't found a drug that does X" really, really does not mean "a motivated and intelligent wealthy donor couldn't cause someone to find a drug that does X." It does mean that, short of making some really big political changes, it's hard to profit on finding such a drug or distribute it at mass scale.

Rare genetic diseases are a classic example of where motivated patients (and parents of patients) can do their own research and make a difference. Sequencing is getting cheap enough for individuals to afford, but hasn't yet been commoditized that well, so hustling and asking for special favors is useful here. And, of course, if your disease is rare, there isn't a huge market for treating it.

Matt Might is a famous example of a software engineer who identified and found a treatment for his son's rare genetic disorder.

Do you know of any good sources for pregnancy advice?

An odd example of civilizational adequacy and inadequacy at the same time: food fortification has made folic acid deficiency one of the least common nutritional deficiencies, but pregnant people are still advised to take a folic acid supplement, even though they are almost certainly not deficient. (I suppose the idea is that extra folic acid is harmless.)

This is not quite right. Food fortification tends to be somewhat limited in intensity by the fact that many people getting the extra folate aren't pregnant and an excess amount might be bad for them. But normal levels of folate may not be enough to minimize neural tube defects.

The actual wrong thing about this advice is that the supplements are only really useful in preventing birth defects around the time of conception - so by the time you know you're pregnant, it's not likely to make much of a difference.

"Even though gaining too much in pregnancy" is missing the word "weight" I think.

As someone who worked with online marketing services like google AdWords, facebook ads and search engine optimization, I can absolutely assue you that your statement is not generally true. Advertising is definitely not a terrible waste of resources, but you are right insofar that it CAN be. However, if the basic conditions are right (product and price makes sense, website looks attractive and is easily navigable etc.) ads can be amazing and increase your sales by several 1000%. I've had customers that made a return of roughly 100€ for every 3€ invested (yes, including both the cost-per-click for the ad platform as well as our online marketing service priced at 75€/h. And no, people directly navigating to the URL rather than being led to a specific product or landingpage are not counted either).

In fact, next to the stock market advertising may be one of the few examples of actual civilizational adequacy; I'm especially speaking of the ad platform providers themselves (like google or facebook) who have the resources to optimize the absolute crap out of their ad system. If a company who is doing the online advertising (or providing the platform) is the same that is directly profiting from it, then you have an alignment of incentives and the ability to experiment and continuously improve ads in ways that you can almost perfectly quantify and track - this can be incredibly powerful.

Yes, there are companies who can afford to not advertise their product and specific constellations where it in fact may even save a lot money to not advertise, but consider that those are usually products that are completely unique, have high signaling value and are already known and/or are plainly ten times better than anything else the competition has on the market (e.g. Tesla). But if you basically sell the same thing other people are selling, then I'm afraid there is no other similarly reliable way for you to gain visibility and sales than to simply invest in ads. (And if you think otherwise, then please elaborate).

I can't comment on "old world" things like the efficiency of billboards or TV ads, but barring the odd dolt you can be damn sure that the people making decisions about purchasing that adspace or airtime usually know their way around evaluating numbers and I'd honestly be extremely surprised to learn that they are actually all fools burning their money.

I wonder if there is a book or review article that reviews the research into programmer productivity.

Agreed. I would further claim most sellers are not actually aware that they are just selling the representation.

The plain but known and studied "secret" to happiness is to adjust your expectations, refrain from unfavorable social comparisons and keep a gratitude journal or write gratitude letters to people (whether you choose to send them or not), which no ever one does. In my case watching a lot of nature and history documentaries on BBC and being aware on how everyone and everything tends to have a life a lot shittier than me helps keeping track of my relative fortune and put my minor miseries into a stark perspective.

Not being depressed or having some other mental illness helps a lot with happiness too I heard, but we can't reliably help anyone with that.

It would be nice to include a definition of what is meant by civilisational inadequacy, or at least a link to a reference.

Can the benefit compare to this?

Common knowledge is expensive. Cookie warnings are a way to create public knowledge about the fact that there's tracking.

More importantly, it seems to be an intended effect of the design and does not feel in the same reference class where a bunch of different stakeholders exist without any stakeholder being empowered to fix the problem.

Where's exactly the civilisational inadequacy here? I think there's an argument for school starting too early but otherwise this mostly seems to be about individuals making choices.

Where are you getting the figure of 5 hours longer to learn manual?

Googling suggests there is no evidence for either type being safer. It’s noise compared with the driver’s skill.

It looks like you didn't seriously engage with the issue you are complaining about. Quick Googling gives you:

Less expensive to purchase – If you're car shopping on a budget, then there's really no contest between the manual and the automatic. On average, a manual transmission will cost you about a thousand dollars less than an automatic of the same model.