A key point underpinning my thoughts, which I don’t think this really responds to, is that scientific consensus actually is really good, so good I have trouble finding anecdotes of things in the reference class of ivermectin turning out to be true (reference class: things that almost all the relevant experts think are false and denounce full-throatedly as a conspiracy theory after spending a lot of time looking at the evidence).
There are some, maybe many, examples of weaker problems. For example, there are frequent examples of things that journalists/the government/professional associations want to *pretend* is scientific consensus, getting proven wrong—I claim if you really look carefully, the scientists weren’t really saying those things, at least not as intensely as they were saying ivermectin didn’t work. There are frequent examples of scientists being sloppy and firing off an opinion on something they weren’t really thinking hard about and being wrong. There are frequent examples of scientists having dumb political opinions and trying to dress them up as science. I can’t give a perfect necessary-and-sufficient definition of the relevant reference class. But I think it’s there and recognizable.
I stick to my advice that people who know they’re not sophisticated should avoid trying to second-guess the mainstream, and people who think they might be sophisticated should sometimes second-guess the mainstream when there isn’t the exact type of scientific consensus which has a really good track record (and hopefully they’re sophisticated enough to know when that is).
I’m not sure how you’re using “free riding” here. I agree that someone needs to do the work of forming/testing/challenging opinions, but I think if there’s basically no chance you’re right (eg you’re a 15 year old with no scientific background who thinks they’ve discovered a flaw in E=mc^2), that person is not you, and your input is not necessary to move science forward. I agree that person shouldn’t cravenly quash their own doubt and pretend to believe, they should continue believing whatever rationality compels them to believe, which should probably be something like “This thing about relativity doesn’t seem quite right, but given that I’m 15 and know nothing, on the Outside View I’m probably wrong.” Then they can either try to learn more (including asking people what they think of their objection) and eventually reach a point where maybe they do think they’re right, or they can ignore it and go on with their lives.
reference class: things that almost all the relevant experts think are false and denounce full-throatedly as a conspiracy theory after spending a lot of time looking at the evidence
This seems to be the wrong reference class for Ivermectin.
There are some, maybe many, examples of weaker problems. For example, there are frequent examples of things that journalists/the government/professional associations want to *pretend* is scientific consensus, getting proven wrong—I claim if you really look carefully, the scientists weren’t really saying those things, at least not as intensely as they were saying ivermectin didn’t work.
In the beginning, Ivermectin seemed to be the case for Ivermectin that the journalists/the government/professional associations wanted to pretend that and “the scientists” published Hariyanto et al (and others at the time) that was in favor of Ivermectin. The LW census from looking at the meta-analysis at the time seemed to point toward the pro-Ivermectin meta-analysis being higher quality.
It might be that the scientists who published the pro-Ivermectin meta-analysis changed their mind later as more evidence came to light but it’s hard to know from the outside whether or not that’s the case. Given the political charge that the topic had it’s hard to know whether later opinions by scientists who spoke on the topic actually spent a lot of time looking at the evidence.
It’s worth noting that the logical conclusion from your post on Ivermectin is that in areas with high worm prevalence, it’s valuable to give COVID-19 patients Ivermectin which conflicts with the WHO position.
General relativity is in a very different reference class where you actually have a lot of experts in every physics department in the world who looked at the evidence.
I think the Ivermectin debacle actually is a good demonstration for why people should just trust the ‘experts’ more often than not. Disclaimer of sorts: I am part of what people would call the scientific establishment too, though junior to Scott I think (hard to evaluate different fields and structures). However, I tend to apply this rule to myself as well. I do not think I have particular expertise outside of my fields, and I tend to trust scientific consensus as much as I can if it is not a matter I can have a professional opinion on.
It seems quite reasonable that ivermectin doesn’t do much for covid-19, but kills the intestinal worms (strongyloidiasis) it is typically prescribed for. Oh, and the prevalence in some countries exceeds 15%, and those worms can cause deadly hyperinfection when used with corticosteroid that are also used to manage covid-19. This would explain why in developed countries ivermectin trials appear to do essentially nothing, and why it shouldn’t be used as a first-line covid-19 treatment, but instead can be used as preventative medication against worms before use of immunosuppressive medication if there is a significant risk of strongyloidiasis.
There was also a large trial in the US, with about as many patients as the original meta-studied has, but in a single double-blinded randomised placebo-controlled trial. It didn’t find a significant effect: https://jamanetwork.com/journals/jama/fullarticle/2797483
The key here is this: there is an resolution to this debacle, but it ultimately still came from experts in the field! I think everyone has significant cognitive biases, me included. One typical bias I’ve seen on LW and many other haunts of rationality and EA-types is that humans are lean mean bayesian machines. I know I am not, and I’m a scientist so I’d like to think I put a lot of effort into integrating evidence objectively. Even then, I find it extremely difficult to do comprehensive reviews of all available information outside of my field of study. Ultimately, there is just so much information out there, and the tools to evaluate which papers are good and which are bad are very domain-specific. I have a pretty decent stats background, I think; I actually do statistics in my field day to day. Yet I just don’t know how to evaluate medical papers at all beyond the basics of sample size, because of all the field-specific jargon especially surrounding metastudies. Even for the large trial I linked, I figure it is good because experts in the field said so.
In short, we would all like to believe the simple picture of our brains taking evidence in and doing bayesian inference. However, to be exposed to all the information that you need to be to get a good picture of a field includes understanding all the jargon, being up to date on past studies and trends, understanding differences in statistical procedure between fields, understanding the major issues that could plague studies typical to the field, etc., in addition to just the evidence. This is because both synthesising “evidence” into actual bayesian evidence and being so steeped in the literature that one can have a birds’ eye view essentially require one to be an expert in the field.
Yet I just don’t know how to evaluate medical papers at all beyond the basics of sample size, because of all the field-specific jargon especially surrounding metastudies. Even for the large trial I linked, I figure it is good because experts in the field said so.
So it basically boils down to “there’s a resolution to this debacle because experts said so”.
I haven’t looked into Ivermectin evidence recently and thought like Zvi that engaging more with Alexandros isn’t worth my time.
One problem with trusting the experts is that there doesn’t seem to really be experts at the question of how the knowledge gained in clinical trials translates into predicting treatment outcomes for patients.
If you ask the kind of people who do those trials simple questions like “Does blinding as it’s commonly done mean that the patients don’t know whether they are taking the placebo or not?” You likely get a lot of them falsely answering that it means that because they are ignorant of the literature that found that if you ask patients they frequently have some knowledge.
There are billion-dollar Big Pharma companies that regularly pay billions of dollars in fines for all sorts of ways they manipulate the epistemic environment to their ends. Those companies profit from medical studies being read a certain way. The fact that they historically engaged in conspiracies where they bribed doctors to recommend their treatments is on the open record.
You could imagine a field where doctors make predictions of treatment outcomes and study how knowledge gained from academic papers about the treatments helps make better predictions but we don’t have that field. That field doesn’t exist.
It might very well be that the experts actually know what they are doing but it’s hard to tell from the outside.
“Does blinding as it’s commonly done mean that the patients don’t know whether they are taking the placebo or not?” You likely get a lot of them falsely answering that it means that because they are ignorant of the literature that found that if you ask patients they frequently have some knowledge.”
Accurate—and obvious on reflection, particularly with the COVID vaccines. I knew multiple people in the COVID vaccine trials. Just over half confidently said they got the real vaccine, and they knew it because of side effects. The rest were in most cases less certain but suspected they got the placebo, because so many participants had the side effects and they didn’t.
Yes, it’s worth noting here that if researchers would care about whether patients know whether or not they get verum or the placebo, they could easily add another question to the forms that the patients fill out and report the answers in their papers.
The status quo of how trials are run is that researchers are willfully ignorant about the extent to which patients know they take verum or placebo.
One problem with trusting the experts is that there doesn’t seem to really be experts at the question of how the knowledge gained in clinical trials translates into predicting treatment outcomes for patients.
If you ask the kind of people who do those trials simple questions like “Does blinding as it’s commonly done mean that the patients don’t know whether they are taking the placebo or not?” You likely get a lot of them falsely answering that it means that because they are ignorant of the literature that found that if you ask patients they frequently have some knowledge.
You could probably find some specific examples of common misconceptions in most fields. However, I’d really wager that most people outside the fields have more. That is in addition to the breadth of exposure to studies, which is a point you completely ignored. Ultimately, even if you can integrate evidence perfectly, bayesian thinking relies on 2 things: interpreting evidence correctly, and having a lot of evidence. We disagree regarding interpreting evidence correctly. Sure, maybe you think you can do as well as the average medical researcher; I still think that is pretty bad advice in general. I don’t think most people will. In addition, I doubt people outside of a field would consider the same breadth of evidence as someone in the field, simply because in my experience just reading up enough to keep up to date, attending talks, conferences, etc. ends up being half of a full-time job.
This is not an argument against bayesian thinking, obviously. This is me saying if someone has integrated evidence for you, you should evaluate that evidence with a reasonable prior regarding how trustworthy that person is, and one should also try to be objective regarding their own abilities outside of their field. A reasonable prior is to not think of oneself as exceptional, and look at how often people venture outside of their fields of expertise fall flat on their face.
Someone inside a field is generally able to see a larger breadth of evidence but at the same time, they have incentives not to bite the hand that feeds them. Big Pharma spends a lot of money to shape the system in a way where they can earn a lot of money by having patent-protected drugs that went through every expensive clinical trials being seen as the gold standard.
Misconceptions about the nature of blinding don’t exist because the involved researchers are stupid. Researchers that do well in STEM academia tend to be very intelligent. They exist because there are incentive pressures to keep those misconceptions alive.
When thinking about whether to look more at Ivermectin the question isn’t “Do I as an outsider know more?” but “Are the billions that big pharma spends to bias research toward finding that patent pending drugs are better than generics strong enough to affect the expert judgments on Ivermectin”.
Your model of medical research could be true, if only countries with extensive investments in pharmaceuticals do clinical trials, all funding is controlled by “Big Pharma”, and scientists are highly corruptible. Even then, it only takes one maverick research hospital to show the existence of a strong effect, if there is one. Thus, at best, you can argue that there’s a weak effect which may or may not be beneficial compared to side-effects.
I don’t think your view seems correct anyway. Many clinical trials, including those that found no significant effect, came from countries that seem relatively unlikely to be controlled by American and European pharmaceutical companies. A lot of them are also funded by government sources, and etc. Perhaps your view is correct in the US; however, much of the rest of the world doesn’t suffer from extreme medication prices. If “Big Pharma” can’t even effect that change, which they are much more likely to be able to due to market power and also affects their bottom line more directly, why would we still think there are tentacles throughout research all over the world?
At the end of the day, your worldview involves so much worldbuilding and imagination that it’s likely highly penalised by Occam’s razor considerations (or whatever quantitative version of your choice) that you’d need a lot of evidence to justify it. Just “saying things” isn’t evidence of a worldwide conspiracy. And if there’s no worldwide conspiracy, there’s really nothing to your argument, since there are clinical trials from all over the world saying similar things.
Even then, it only takes one maverick research hospital to show the existence of a strong effect, if there is one.
In the Ivermectin case, you have a bunch of hospitals doing that. Enough that you could publish scientific meta-reviews in respected journals that came out in favor of Ivermectin. At the same time, you had the establishment organizations talk about how Ivermectin certainly can’t work. That was the reason to look closer.
At the time I thought, well here are those published meta-reviews and then there are the institutions that say that Ivermectin doesn’t work, that’s odd and I started a LessWrong thread to look together at the different papers.
much of the rest of the world doesn’t suffer from extreme medication prices. If “Big Pharma” can’t even effect that change, which they are much more likely to be able to due to market power and also affects their bottom line more directly, why would we still think there are tentacles throughout research all over the world?
Prices are relatively legible to political stakeholders. It’s easy for politicians to push in the direction of lower drug prices because they want to balance healthcare budgets.
Poorer countries can say something along the lines of “Either you give us the drugs at a price that our citizens can afford, or we allow our own companies to produce the drugs in violation of your patent”. Big Pharma companies are okay with making their profits mostly in rich countries and selling drugs in lower prices to poorer companies in exchange for their patents not being violated.
Directly, after COVID-19 emerged it would have been possible for governments to fund studies to investigate all generics that are candidates for possible treatments. To me that was surprising. While there are multiple different things that went wrong in the COVID response, it caused me to update that the existing institutions are more flawed than I previously assumed.
Just “saying things” isn’t evidence of a worldwide conspiracy.
I think you need plenty of imagination to have a world where companies regularly have to pay billions in fines because they illegally bribed people and those bribes also had no effect.
Plagiarism is generally considered an academic crime and yet plenty of researchers are willing to put their names on papers written by Big Pharma that they themselves did not write. Researchers regularly conspire in that process with Big Pharma to mislead the public about who wrote papers.
It’s interesting that you assume I’m talking about poorer countries. What about developed Asia? They have a strong medical research corp, and yet they are not home to companies that made covid-19 medication. Even in Europe, many countries are not host to relevant companies. You do realise that drug prices are much lower in the rest of the developed world compared to the US, right? I am not talking about ‘poorer countries’, I am talking about most of the developed world outside of the US, where there are more tightly regulated healthcare sectors, and where the government isn’t merely the tail trying to wag the proverbial dog.
Also, your evidence is not evidence of a worldwide conspiracy. Everything you’ve mentioned is essentially America-centric.
Plagiarism is generally considered an academic crime and yet plenty of researchers are willing to put their names on papers written by Big Pharma that they themselves did not write.
I’m starting to feel like you really don’t know much about how these things work. People put their names on papers they don’t write all the time. Authorship of a paper is an attribution of scientific work, but not necessarily words on paper. In many cases, even minor scientific contribution can mean authorship. This is why in physics author lists can stretch to the thousands. At any rate, improper authorship isn’t the same ‘academic crime’ as plagiarism at all. The problem isn’t plagiarism, it is non-disclosure (of industry links) and improper authorship. It’s also important to note that this is not some kind of unique insight. Even a quick Google search brings up myriad studies on the topic in medical journals, such as: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800869
Studies on ghostwriters in ‘establishment’ journals, by ‘establishment’ authors, recommending more scrutiny!
India and China can actually make credible threads that they just let their own companies break patents if Big Pharma doesn’t sell them drugs at prices they consider reasonable.
When it comes to reducing prices paid, if you look at the UK for example, they have politicians who care about the NHI budget being manageable. If drugs don’t provide enough benefits for the price they cost they don’t approve them, so there’s pressure to name reasonable prices.
It’s also important to note that this is not some kind of unique insight.
Yes, the fact that there’s a lot of conspiracy going on in Big Pharma is not an unique insight. That’s just business as usual for Big Pharma in a way that should be obvious to any observer that pays attention.
Ghost authorship isn’t just putting a name on a paper to which you little contributed but also about the real authors not appearing on the paper. Ghostwriters are people who wrote something and don’t appear on the author list.
If a student goes to upwork, lets someone write him an essay, does a few minor changes, and then turns it in under their own name while leaving out the real author of the paper that’s seen as plagiarism by every academic department out there.
India and China can actually make credible threads that they just let their own companies break patents if Big Pharma doesn’t sell them drugs at prices they consider reasonable.
When it comes to reducing prices paid, if you look at the UK for example, they have politicians who care about the NHI budget being manageable. If drugs don’t provide enough benefits for the price they cost they don’t approve them, so there’s pressure to name reasonable prices.
Sure, but that doesn’t address why you think researchers in these countries would be so affected by American pharma that there aren’t enough people to do convincing studies that would affect American bottom lines. In other words, still the same thing: why you think there is evidence of a worldwide conspiracy.
Ghost authorship isn’t just putting a name on a paper to which you little contributed but also about the real authors not appearing on the paper. Ghostwriters are people who wrote something and don’t appear on the author list.
If a student goes to upwork, lets someone write him an essay, does a few minor changes, and then turns it in under their own name while leaving out the real author of the paper that’s seen as plagiarism by every academic department out there.
I don’t think that’s right. I think it would be considered academic dishonesty but not plagiarism per se, because for students the expectation for graded work is that they are submitting their own work (or work with fellow students in the same class, for some classes and types of work). However, for papers, works are supposed to be collaborative, so just having additional contributors isn’t itself a problem. The problem instead is that all authors are listed and all authors contributed. In terms of industry research, disclosure of industry links is another problem.
I looked up a few articles on the subject, and it really doesn’t seem like ghostwriting is plagiarism (though it depends on the definition and who you ask!), but it certainly can violate ethical codes or journal guidelines:
I think this is my last post on this thread. I’ve made several arguments that were ignored, because you seem to be in favour of raising new points as opposed to addressing arguments. I don’t think it’s quite a Gish Gallop, but unfortunately I also don’t have unlimited time, and I think I’ve already made a strong case here. Readers can make their own decisions on whether to update their beliefs, and feel free to get a last word in.
I looked up a few articles on the subject, and it really doesn’t seem like ghostwriting is plagiarism (though it depends on the definition and who you ask!), but it certainly can violate ethical codes or journal guidelines:
Whether or not you use the word plagiarism, it’s an ethical violation where people are paid money to do something in secret to further the interest of pharma companies.
What’s what conspiring in private to mislead the public is about. The ghostwriting case is one that’s well-documented. It’s evidence that a lot of conspiracy exists in the field.
I’ve made several arguments that were ignored, because you seem to be in favour of raising new points as opposed to addressing arguments.
Your argument is basically “if they have power to do X, why don’t they also have power to do Y”. The only way to address that is to get into the details of how the power works. That means making new points.
A key point underpinning my thoughts, which I don’t think this really responds to, is that scientific consensus actually is really good, so good I have trouble finding anecdotes of things in the reference class of ivermectin turning out to be true (reference class: things that almost all the relevant experts think are false and denounce full-throatedly as a conspiracy theory after spending a lot of time looking at the evidence).
There are some, maybe many, examples of weaker problems. For example, there are frequent examples of things that journalists/the government/professional associations want to *pretend* is scientific consensus, getting proven wrong—I claim if you really look carefully, the scientists weren’t really saying those things, at least not as intensely as they were saying ivermectin didn’t work. There are frequent examples of scientists being sloppy and firing off an opinion on something they weren’t really thinking hard about and being wrong. There are frequent examples of scientists having dumb political opinions and trying to dress them up as science. I can’t give a perfect necessary-and-sufficient definition of the relevant reference class. But I think it’s there and recognizable.
I stick to my advice that people who know they’re not sophisticated should avoid trying to second-guess the mainstream, and people who think they might be sophisticated should sometimes second-guess the mainstream when there isn’t the exact type of scientific consensus which has a really good track record (and hopefully they’re sophisticated enough to know when that is).
I’m not sure how you’re using “free riding” here. I agree that someone needs to do the work of forming/testing/challenging opinions, but I think if there’s basically no chance you’re right (eg you’re a 15 year old with no scientific background who thinks they’ve discovered a flaw in E=mc^2), that person is not you, and your input is not necessary to move science forward. I agree that person shouldn’t cravenly quash their own doubt and pretend to believe, they should continue believing whatever rationality compels them to believe, which should probably be something like “This thing about relativity doesn’t seem quite right, but given that I’m 15 and know nothing, on the Outside View I’m probably wrong.” Then they can either try to learn more (including asking people what they think of their objection) and eventually reach a point where maybe they do think they’re right, or they can ignore it and go on with their lives.
This seems to be the wrong reference class for Ivermectin.
In the beginning, Ivermectin seemed to be the case for Ivermectin that the journalists/the government/professional associations wanted to pretend that and “the scientists” published Hariyanto et al (and others at the time) that was in favor of Ivermectin. The LW census from looking at the meta-analysis at the time seemed to point toward the pro-Ivermectin meta-analysis being higher quality.
It might be that the scientists who published the pro-Ivermectin meta-analysis changed their mind later as more evidence came to light but it’s hard to know from the outside whether or not that’s the case. Given the political charge that the topic had it’s hard to know whether later opinions by scientists who spoke on the topic actually spent a lot of time looking at the evidence.
It’s worth noting that the logical conclusion from your post on Ivermectin is that in areas with high worm prevalence, it’s valuable to give COVID-19 patients Ivermectin which conflicts with the WHO position.
General relativity is in a very different reference class where you actually have a lot of experts in every physics department in the world who looked at the evidence.
I think the Ivermectin debacle actually is a good demonstration for why people should just trust the ‘experts’ more often than not. Disclaimer of sorts: I am part of what people would call the scientific establishment too, though junior to Scott I think (hard to evaluate different fields and structures). However, I tend to apply this rule to myself as well. I do not think I have particular expertise outside of my fields, and I tend to trust scientific consensus as much as I can if it is not a matter I can have a professional opinion on.
As far as I can tell, the ivermectin debate is largely settled by this study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790173
It seems quite reasonable that ivermectin doesn’t do much for covid-19, but kills the intestinal worms (strongyloidiasis) it is typically prescribed for. Oh, and the prevalence in some countries exceeds 15%, and those worms can cause deadly hyperinfection when used with corticosteroid that are also used to manage covid-19. This would explain why in developed countries ivermectin trials appear to do essentially nothing, and why it shouldn’t be used as a first-line covid-19 treatment, but instead can be used as preventative medication against worms before use of immunosuppressive medication if there is a significant risk of strongyloidiasis.
There was also a large trial in the US, with about as many patients as the original meta-studied has, but in a single double-blinded randomised placebo-controlled trial. It didn’t find a significant effect: https://jamanetwork.com/journals/jama/fullarticle/2797483
The key here is this: there is an resolution to this debacle, but it ultimately still came from experts in the field! I think everyone has significant cognitive biases, me included. One typical bias I’ve seen on LW and many other haunts of rationality and EA-types is that humans are lean mean bayesian machines. I know I am not, and I’m a scientist so I’d like to think I put a lot of effort into integrating evidence objectively. Even then, I find it extremely difficult to do comprehensive reviews of all available information outside of my field of study. Ultimately, there is just so much information out there, and the tools to evaluate which papers are good and which are bad are very domain-specific. I have a pretty decent stats background, I think; I actually do statistics in my field day to day. Yet I just don’t know how to evaluate medical papers at all beyond the basics of sample size, because of all the field-specific jargon especially surrounding metastudies. Even for the large trial I linked, I figure it is good because experts in the field said so.
In short, we would all like to believe the simple picture of our brains taking evidence in and doing bayesian inference. However, to be exposed to all the information that you need to be to get a good picture of a field includes understanding all the jargon, being up to date on past studies and trends, understanding differences in statistical procedure between fields, understanding the major issues that could plague studies typical to the field, etc., in addition to just the evidence. This is because both synthesising “evidence” into actual bayesian evidence and being so steeped in the literature that one can have a birds’ eye view essentially require one to be an expert in the field.
So it basically boils down to “there’s a resolution to this debacle because experts said so”.
I haven’t looked into Ivermectin evidence recently and thought like Zvi that engaging more with Alexandros isn’t worth my time.
One problem with trusting the experts is that there doesn’t seem to really be experts at the question of how the knowledge gained in clinical trials translates into predicting treatment outcomes for patients.
If you ask the kind of people who do those trials simple questions like “Does blinding as it’s commonly done mean that the patients don’t know whether they are taking the placebo or not?” You likely get a lot of them falsely answering that it means that because they are ignorant of the literature that found that if you ask patients they frequently have some knowledge.
There are billion-dollar Big Pharma companies that regularly pay billions of dollars in fines for all sorts of ways they manipulate the epistemic environment to their ends. Those companies profit from medical studies being read a certain way. The fact that they historically engaged in conspiracies where they bribed doctors to recommend their treatments is on the open record.
You could imagine a field where doctors make predictions of treatment outcomes and study how knowledge gained from academic papers about the treatments helps make better predictions but we don’t have that field. That field doesn’t exist.
It might very well be that the experts actually know what they are doing but it’s hard to tell from the outside.
This is an important point that is often ignored.
“Does blinding as it’s commonly done mean that the patients don’t know whether they are taking the placebo or not?” You likely get a lot of them falsely answering that it means that because they are ignorant of the literature that found that if you ask patients they frequently have some knowledge.”
Accurate—and obvious on reflection, particularly with the COVID vaccines. I knew multiple people in the COVID vaccine trials. Just over half confidently said they got the real vaccine, and they knew it because of side effects. The rest were in most cases less certain but suspected they got the placebo, because so many participants had the side effects and they didn’t.
Example: Moderna And Pfizer Vaccine Studies Hampered As Placebo Recipients Get R eal Shot : Shots—Health News : NPR “Mott, who lives in the Overland Park, Kan., got a strong reaction to the second shot, so she correctly surmised she had received the Moderna vaccine, not the placebo.”
Our blind and double-blind methodology is nowhere near the perfect black box we pretend.
Yes, it’s worth noting here that if researchers would care about whether patients know whether or not they get verum or the placebo, they could easily add another question to the forms that the patients fill out and report the answers in their papers.
The status quo of how trials are run is that researchers are willfully ignorant about the extent to which patients know they take verum or placebo.
I mean, kinda? But at the same time, translation of clinical trials into patient outcomes is something that the medical community actively studies and thinks about from time to time, so it’s really not like people are standing still on this. (Examples: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704144/ and https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1870-2)
You could probably find some specific examples of common misconceptions in most fields. However, I’d really wager that most people outside the fields have more. That is in addition to the breadth of exposure to studies, which is a point you completely ignored. Ultimately, even if you can integrate evidence perfectly, bayesian thinking relies on 2 things: interpreting evidence correctly, and having a lot of evidence. We disagree regarding interpreting evidence correctly. Sure, maybe you think you can do as well as the average medical researcher; I still think that is pretty bad advice in general. I don’t think most people will. In addition, I doubt people outside of a field would consider the same breadth of evidence as someone in the field, simply because in my experience just reading up enough to keep up to date, attending talks, conferences, etc. ends up being half of a full-time job.
This is not an argument against bayesian thinking, obviously. This is me saying if someone has integrated evidence for you, you should evaluate that evidence with a reasonable prior regarding how trustworthy that person is, and one should also try to be objective regarding their own abilities outside of their field. A reasonable prior is to not think of oneself as exceptional, and look at how often people venture outside of their fields of expertise fall flat on their face.
Someone inside a field is generally able to see a larger breadth of evidence but at the same time, they have incentives not to bite the hand that feeds them. Big Pharma spends a lot of money to shape the system in a way where they can earn a lot of money by having patent-protected drugs that went through every expensive clinical trials being seen as the gold standard.
Misconceptions about the nature of blinding don’t exist because the involved researchers are stupid. Researchers that do well in STEM academia tend to be very intelligent. They exist because there are incentive pressures to keep those misconceptions alive.
When thinking about whether to look more at Ivermectin the question isn’t “Do I as an outsider know more?” but “Are the billions that big pharma spends to bias research toward finding that patent pending drugs are better than generics strong enough to affect the expert judgments on Ivermectin”.
Your model of medical research could be true, if only countries with extensive investments in pharmaceuticals do clinical trials, all funding is controlled by “Big Pharma”, and scientists are highly corruptible. Even then, it only takes one maverick research hospital to show the existence of a strong effect, if there is one. Thus, at best, you can argue that there’s a weak effect which may or may not be beneficial compared to side-effects.
I don’t think your view seems correct anyway. Many clinical trials, including those that found no significant effect, came from countries that seem relatively unlikely to be controlled by American and European pharmaceutical companies. A lot of them are also funded by government sources, and etc. Perhaps your view is correct in the US; however, much of the rest of the world doesn’t suffer from extreme medication prices. If “Big Pharma” can’t even effect that change, which they are much more likely to be able to due to market power and also affects their bottom line more directly, why would we still think there are tentacles throughout research all over the world?
At the end of the day, your worldview involves so much worldbuilding and imagination that it’s likely highly penalised by Occam’s razor considerations (or whatever quantitative version of your choice) that you’d need a lot of evidence to justify it. Just “saying things” isn’t evidence of a worldwide conspiracy. And if there’s no worldwide conspiracy, there’s really nothing to your argument, since there are clinical trials from all over the world saying similar things.
In the Ivermectin case, you have a bunch of hospitals doing that. Enough that you could publish scientific meta-reviews in respected journals that came out in favor of Ivermectin. At the same time, you had the establishment organizations talk about how Ivermectin certainly can’t work. That was the reason to look closer.
At the time I thought, well here are those published meta-reviews and then there are the institutions that say that Ivermectin doesn’t work, that’s odd and I started a LessWrong thread to look together at the different papers.
Prices are relatively legible to political stakeholders. It’s easy for politicians to push in the direction of lower drug prices because they want to balance healthcare budgets.
Poorer countries can say something along the lines of “Either you give us the drugs at a price that our citizens can afford, or we allow our own companies to produce the drugs in violation of your patent”. Big Pharma companies are okay with making their profits mostly in rich countries and selling drugs in lower prices to poorer companies in exchange for their patents not being violated.
Directly, after COVID-19 emerged it would have been possible for governments to fund studies to investigate all generics that are candidates for possible treatments. To me that was surprising. While there are multiple different things that went wrong in the COVID response, it caused me to update that the existing institutions are more flawed than I previously assumed.
There’s tons of evidence. Take https://www.theguardian.com/business/2012/jul/03/glaxosmithkline-fined-bribing-doctors-pharmaceuticals it’s about a Big Pharma company having to pay $3bn in fines because they conspired with doctors by bribing them to encourage the prescription of unsuitable antidepressants to children.
I think you need plenty of imagination to have a world where companies regularly have to pay billions in fines because they illegally bribed people and those bribes also had no effect.
Plagiarism is generally considered an academic crime and yet plenty of researchers are willing to put their names on papers written by Big Pharma that they themselves did not write. Researchers regularly conspire in that process with Big Pharma to mislead the public about who wrote papers.
It’s interesting that you assume I’m talking about poorer countries. What about developed Asia? They have a strong medical research corp, and yet they are not home to companies that made covid-19 medication. Even in Europe, many countries are not host to relevant companies. You do realise that drug prices are much lower in the rest of the developed world compared to the US, right? I am not talking about ‘poorer countries’, I am talking about most of the developed world outside of the US, where there are more tightly regulated healthcare sectors, and where the government isn’t merely the tail trying to wag the proverbial dog.
Also, your evidence is not evidence of a worldwide conspiracy. Everything you’ve mentioned is essentially America-centric.
I’m starting to feel like you really don’t know much about how these things work. People put their names on papers they don’t write all the time. Authorship of a paper is an attribution of scientific work, but not necessarily words on paper. In many cases, even minor scientific contribution can mean authorship. This is why in physics author lists can stretch to the thousands. At any rate, improper authorship isn’t the same ‘academic crime’ as plagiarism at all. The problem isn’t plagiarism, it is non-disclosure (of industry links) and improper authorship. It’s also important to note that this is not some kind of unique insight. Even a quick Google search brings up myriad studies on the topic in medical journals, such as: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800869
Studies on ghostwriters in ‘establishment’ journals, by ‘establishment’ authors, recommending more scrutiny!
India and China can actually make credible threads that they just let their own companies break patents if Big Pharma doesn’t sell them drugs at prices they consider reasonable.
When it comes to reducing prices paid, if you look at the UK for example, they have politicians who care about the NHI budget being manageable. If drugs don’t provide enough benefits for the price they cost they don’t approve them, so there’s pressure to name reasonable prices.
Yes, the fact that there’s a lot of conspiracy going on in Big Pharma is not an unique insight. That’s just business as usual for Big Pharma in a way that should be obvious to any observer that pays attention.
Ghost authorship isn’t just putting a name on a paper to which you little contributed but also about the real authors not appearing on the paper. Ghostwriters are people who wrote something and don’t appear on the author list.
If a student goes to upwork, lets someone write him an essay, does a few minor changes, and then turns it in under their own name while leaving out the real author of the paper that’s seen as plagiarism by every academic department out there.
Sure, but that doesn’t address why you think researchers in these countries would be so affected by American pharma that there aren’t enough people to do convincing studies that would affect American bottom lines. In other words, still the same thing: why you think there is evidence of a worldwide conspiracy.
I don’t think that’s right. I think it would be considered academic dishonesty but not plagiarism per se, because for students the expectation for graded work is that they are submitting their own work (or work with fellow students in the same class, for some classes and types of work). However, for papers, works are supposed to be collaborative, so just having additional contributors isn’t itself a problem. The problem instead is that all authors are listed and all authors contributed. In terms of industry research, disclosure of industry links is another problem.
I looked up a few articles on the subject, and it really doesn’t seem like ghostwriting is plagiarism (though it depends on the definition and who you ask!), but it certainly can violate ethical codes or journal guidelines:
https://www.insidehighered.com/blogs/sounding-board/ethics-authorship-ghostwriting-plagiarism
https://www.turnitin.com/blog/ghostwriting-in-academic-journals-how-can-we-mitigate-its-impact-on-research-integrity
https://www.plagiarismtoday.com/2015/03/02/why-is-ghostwriting-not-always-considered-plagiarism/
I think this is my last post on this thread. I’ve made several arguments that were ignored, because you seem to be in favour of raising new points as opposed to addressing arguments. I don’t think it’s quite a Gish Gallop, but unfortunately I also don’t have unlimited time, and I think I’ve already made a strong case here. Readers can make their own decisions on whether to update their beliefs, and feel free to get a last word in.
Whether or not you use the word plagiarism, it’s an ethical violation where people are paid money to do something in secret to further the interest of pharma companies.
What’s what conspiring in private to mislead the public is about. The ghostwriting case is one that’s well-documented. It’s evidence that a lot of conspiracy exists in the field.
Your argument is basically “if they have power to do X, why don’t they also have power to do Y”. The only way to address that is to get into the details of how the power works. That means making new points.