By addressing the organ transplant problem now, you are actively diminishing the pool of money and the pool of candidates for teams working to improve organ transplants.

I literally rolled my eyes at this section. Solving problems on a local level is good, it's not bad because you "discourage" others from creating a generalized problem solver they can use to solve the local problems more efficiently. Second order effects rarely overrule first order effects, etc. etc. This is the type of argument that I expect from tall poppy syndrome afflicted Twitter users, not LessWrong.

This amount and type of evidence would not be sufficient to approve a drug. The quality of these claims is about as good as the quality of claims one could make about a relatively niche diet.

So what I'm hearing is 'we need to stop advocating kidney donation to normal people, and instead buy mailing addresses of identical twins from twin registries and pummel them with pro-kidney-donation propaganda to generate discordant pairs for long-term followup'.

A simple evolutionary argument is enough to justify a very strong prior that kidney donation is significantly harmful for health: we have two of them, they aren't on an evolutionary path to disappearing, and modern conditions have changed almost nothing about the usage or availability of kidneys.

I think the whole situation with kidney donations reflects quite poorly on the epistemic rigor of the community. Scott Alexander probably paid more than $5k merely in the opportunity cost of the time he spent researching the topic, given the positive externalities of his work.

Have most of the researchers looking at kidney donation donated a kidney? Have most nephrology researchers donated a kidney? Most surgeons doing kidney transplants? Obviously not, otherwise we’d have more than 200 donations to strangers each year in the US. There are 10,000 board-certified nephrologists, and a few more hundred are added each year, if they took this data seriously they’d all donate.

Heck, on top of those you can add nephrology researchers, the medical statisticians who happen to focus on kidney disease, transplant surgeons, and all well-informed nurses in the nephrology units… thousands of these specialists are created each year. If most of them believed donation to be essentially safe the shortage of kidneys would be half-sovled.

Maybe they are all evil people? They will not take even a marginal risk to save a life.

We usually don't call people "evil" for not inconveniencing themselves by going through surgery, so you seem to be using this word in a fairly non-standard way here.

Just to elaborate: if I had a condition that could be cured either by having an operation equivalent to a kidney donation or paying $3k, I would almost certainly pay $3k. However, I could likely save a statistical life by donating this $3k to an effective charity. So my not donating my kidney to a stranger provides no more evidence of my evil nature than my not donating $3k to save the life of a random stranger, because I price the inconvenience of the surgery at more than $3k even if the surgery has no long-run consequences for my health.

Have most of the researchers looking at kidney donation donated a kidney?

People mostly do not do prosocial things for zero direct benefit. Donating a kidney is hard and time consuming, setting aside any negative health effects from the surgery itself. Add on top of that the intense moral and social scrutiny that people receive for making this decision, and that's quite sufficient to me to explain why the people who claim kidney donation is safe largely don't elect to do this.

I know quite a few researchers working on bioengineered organs, and the fact that some people donate their kidneys does not make those researchers work less hard.

There is more data, and better data, e.g. data gathered in double-blinded RCTs, that shows things like:

1. Homeopathy works very well for a variety of conditions, sometimes better than real drugs used to treat them.
2. Increasing the healthcare budget and the amount of healthcare people receive. Both in rich countries (e.g. USA) and poor ones (India). Having no effect on mortality.

I can make both of these claims based on many individual RCTs, as well as based on the aggregation of all existing RCTs.

I’m not saying that these claims make sense, they don’t, there are critical lenses through which we analyze research. But if you claim to “just follow the data”, and ignore the issue of data quality, selection bias, and fraud… without applying a critical lens, you are lost.

It seems to me like claim (2) could easily make sense if you interpret it more charitably as "the mortality effects are too small for the studies to detect". I don't have a particularly strong prior that marginal healthcare spending is all that useful for increasing life expectancy - diminishing returns can mean that the average dollar spent on healthcare does much more than the marginal dollar.

Can you justify your claim that (2) does not make sense?

However, having more kidney donors, while a boost in overall QALY equivalent to donating a few thousand dollars, is more than likely to harm people who need kidney transplants in the long run...your donation of a single kidney is buying a few mediocre years of life, in exchange for taking away a few million dollars of the table from any company developing “the proper way” of doing this.

Use the reversal test [? · GW]: if preventing the treatment of kidney disease saves lives, could we save even more lives by inflicting new cases of kidney disease?

I'm not a fan of the accellerationist-ish argument of "you shouldn't mitigate the problem now because by keeping it pressing you create more incentives to solve it for good" because, well, while technically that can happen, it's an incredibly powerful, catch-all "do nothing and feel really smug about it" argument that can apply to almost anything. In practice, I doubt you could see such an influx of voluntary donors to threaten the usefulness of having vat-grown organs.

But yeah, if people think that donating a kidney will just be some kind of cool one-off altruistic gesture, that seems misguided to me. It's obviously something that will be taxing on your body (and the surgery isn't risk-free to begin with!). This means possibly taking the slightly selfish "I'd rather my quality of life be better than someone else's life be saved" but there are tons of other, less irreversible quality-of-life sacrifices we can make that will produce better marginal returns so I think it's pretty fair if people want to hang onto their bodily integrity and health as long as they can. Our body is the most personal of possessions, I don't think anyone should be expected to or guilt-tripped into letting go of any part of it. That said, if you want to make the sacrifice, go for it - just be sure you really know what you're getting yourself into, and what is it that you're sacrificing.

You forgot to explain why these arguments only apply to strangers. Is there a reason to think medical research and economical incentives are better when it’s a family member who need a kidney?

Thank you for saying this outright.  I was appalled by Scott's lack of epistemic rigor and how irresponsible he was at using his widely-read platform and trust as a physician to fool people into thinking cutting out a major organ has very little risk.  Maybe he really did just fool himself, but I don't think that is an excuse when your whole deal is being the guy with good epistemics who looks at medical research.  A comment he made later about guilting 40,000 randomly selected Americans into donating indicates clearly that he has an Agenda.  He does not have your best interests at heart at all and thinks this is obligatory and not superogatory.  If people understand that there are large, not necessarily quantified risks here, and still want to donate, then go right ahead.  I think you are right that this is more about purifying themselves through self-sacrifice than it is about actually improving the world, but hey- a lot of people seem to report that donation has long-term improved their mental well-being.  What I object to is minimizing the risks and guilting people who second-guess the BS data.  People really need to go into this with their eyes open and make this choice for themselves.  I don't think Scott's article is written in good faith. 

And what effect would receiving this letter have on any of your patients Mr. Scott?  Do you think they will be better off?  Or should we convince suicidal people to stick around because they have so many useful organs? Hey, don't feel like you're a burden on your parents - they might need your kidney one day!

I am being unfair, but - if a problem is big enough, the society is in some way "built around it" and not just "unable to solve it". It's not a good thing or a bad thing. In some way, the shortage of available kidneys is built into the current system of "dealing with health issues". And it's not just the official health system; it's the official health system and everything else. Taking away the donors will have more consequences than just having more people die, because not only the artificial kidneys will remain unavailable, they will be unavailable in a society that doesn't accommodate the problem.

The first part of the post boils down to "medical research is complicated and occasionally failable that's why we shouldn't take it into account and instead follow with our gut intuition that organ removal is dangerous". This is not a valid reasoning, even if you bring up the real problems with scientific process and a couple of apparently ridiculous outputs it produced. 

We could use the exact trick to "proove" the opposite conclusion: that one shouldn't trust their intuitions about the danger of kidney donations. After all our intuitions are known to be failiable! There are visual illusions and congnitive biases and all kind of ways how intuitions are maladpted to modern world.

Or we could use the exact same trick to prove that this trick doesn't work. After all, using it bring people to all kind of conspiracy theories! 

Imperfection of our current best tools to find truth about the world isn't a reason to switch back to even worse ones. It can be a narrative one builds around actual evidence, to show that there is a better way to do truthseeking and thus we need to switch to it. But you seem to have thought that you didn't even need any substantial evidence at all. That you can just show that there is research supporting Homeopathy and that's, somehow proves that kidney donations are bad.

Must I make a parade of citing scientific studies that look at large samples of people who donated a kidney to show the obvious?

Yes you must. Moreover, you must not just cherry pick a couple of studies but do an actual analysis of the problem. You are trying to disprove the existent consensus after all - so engage with the arguments of it, instead of constructing a general fabula why the consensus might be wrong. In his post Scott cited research and tried to correct for possible issues. If you want to bring some new insight you should explain why what he was doing isn't enough, how the specific studies he appealed to are flawe even after all his best attempts, and why your way of estimating danger is superrior.

Otherwise, your are being substantionless.