The Eureka Theory of History Is Wrong
theatlantic.com
theatlantic.com
TFA reminds me of this story (which reminded me of the situation sketched by TFA when I had read it, except perhaps for the ratio of leavers to left behinds) but I cannot recall its name?
One of my favorite book. I read it every 5 years or so.
"The fine article" also sounds weird to me.
For usages see https://hn.algolia.com/?query=TFA&sort=byDate&type=comment
I've given up on trying to learn them and just take a stab based on context
1) Recruit 22 orphaned boys
2) Inject two of them with the cowpox virus (which is the actual smallpox vaccine)
3) Put all the boys on a ship leaving Spain for Venezuela
4) Scrape material from the two boy's pustules (appearing after a couple of days) and inject two more boys with that - the first two boys recover
5) Continue this daisy-chain approach until reaching Venezuela
6) Go on with people in Venezuela, arm-to-arm
7) Continue to Mexico and other places
8) Go global
At some point it got swapped, maybe a milk maid actually got it off a horse and assumptions were made.
No current smallpox vaccine stock is molecularly likely to come from cowpox as I understand it.
[0] https://genomebiology.biomedcentral.com/articles/10.1186/s13...
My trust in institutions is limited, but I got vaxxed without hesitation, because it's a specific decision, the kind of decision that has been made many times, where the relevant institutions have a track record and every incentive to get it right.
I sometimes get the impression that people want to sell trust in institutions as an all-or-nothing package. Institution will not discuss when to trust institutions and when not to.
1) Turns out those heartless capitalists could be producing vaccines in ~2 years. The tech is there, the regulators aren't ready for the level of risk in the COVID response as a routine thing.
2) Turns out that people aren't going to inject themselves with uncertain technologies, to the point of irrationality. Contrast this to one of the usual response to "we need less medical regulation" which is that people are stupid and will hurt themselves with unproven products. My suspicion is that over the long term this irrational looking swarming behaviour actually turns out to be pretty good at managing risk no matter how crazy the individuals in it are behaving.
The problem in building, construction, technology and mining is pretty consistent. We see the strategies that work in Asia and maybe eventually in Africa - if you let capitalism happen it has powerful enough results at a such speed vs. central planning that it can be rightly called a miracle.
https://media.nature.com/lw767/magazine-assets/d41586-020-03...
That doesn't have anything to do with mRNA per se, the Uk vaccine AstraZeneca was ready even faster.
Insofar as there is any progress made on vaccines in the absence of strong market incentives, it’s due to government funding, not benevolent capitalists choosing to take on decades-long loss-leading blue sky research projects.
The approval happened quickly not because there was some crazy regulatory overhaul but because drug regulation is always a cost-benefit analysis. In this case, the vaccines themselves worked phenomenally well, their risk profile was extremely good, and the costs of doing nothing was extremely high.
It’s not strange for drugs to conclude trials early based on strong early data and strong patient need, just most drugs in most scenarios don’t meet that bar.
COVID appeared in March, they had the vaccine in clinical trials by April. The technical aspects aren't a factor here - the time taken to develop a vaccine is basically instant.
Covid poured accelerant on MERS vaccine research. Suddenly, there was a disease with lots of cases with lots of people willing to sign up for trials. In addition, there was a lot of money sloshing around so companies were willing to take the financial risk to combine Phase II and Phase III trials (to be fair--a Covid vaccine passing a Phase II trial was always going to pass a Phase III trial until we had many different vaccines). And, please do remember, nobody knew if mRNA for Covid was actually going to work.
Other mRNA vaccines are in the pipe. However, they have to go through trials with a lot less funding and a lot less money at the end. Rabies(!) got a Phase I trial--but it's hard to get to Phase II since rabies is so rare. mRNA flu vaccines are in Phase III. mRNA HIV vaccines are in Phase I and may be in Phase II by now.
What you see is that if we drop the equivalent of the Manhattan Project at producing a vaccine, we can pretty much produce a vaccine for a virus in a hurry. However, if we're not willing to drop that kind of cash, progress is slow.
If you want more vaccines, tell some of these multi-jillionaires to quit fucking around with virtual crap like Bitcoin and Twitter and start dropping some non-virtual gigabucks on vaccine companies that are trying to produce real products.
That was a good standard and an appropriate thing to do. But that standard is lower than what the medical regulators usually accept. As you point out, Phase 3 trials are good to do but it is going to make it a lot harder to get a vaccine to market if people have to take them seriously. Vaccine makers should be allowed to sell vaccines that are merely safe and effective; they shouldn't have to pass a higher standard than that to sell the things with a disclaimer label.
As an aside I'd also question the efficacy results as the vaccines are probably a lot less effective now. It appears the virus has mutated quite substantially. But that hasn't changed the vaccine approval status, raising interesting questions around why efficacy is even a requirement to sell the thing. Why not just a safety study with the requirement that efficacy data will be collected and made available? We need to figure out if something is efficacious, but there will be more money to do that - and better data - if it is allowed to go to market. As we can see from COVID, jabs in arms and money are the two things missing to make vaccine development fast. The normal regulatory framework makes both those things hard to get.
> If you want more vaccines, tell some of these multi-jillionaires to quit fucking around with virtual crap like Bitcoin and Twitter
Didn't most of the wealthy people in Bitcoin make their money in Bitcoin? There weren't a lot of ultra-wealthy people putting serious money behind it as I recall.
[0] https://www.reuters.com/world/europe/finland-pauses-use-mode...
The reality of drug approvals is that they always take into account proven benefits and risks (including some room for yet-unknown risks) compared to the available alternatives (including other vaccines, other medication, or even not treating the disease at all).
This calculation was not necessarily changed for Covid in some special way. The bug difference with Covid was that governments pumped billions into getting the research done, as did the companies themselves knowning that they will likely be able to literally sell tens of billions of doses of this vaccine if they make it work even a little bit.
A lot of people - dare I say most - have a higher tolerance for risk than the health authorities do. Why is it necessary to hold back progress because of nervous bureaucrats? We could make faster progress by letting people willing to take risks take risks.
The argument for not making this decision fully decentralized is that assessing the risk-to-benefit ratio requires a significant level of expertise, both in the subject matter itself (were the studies conducted well? what possible blind spots may they have methodologically? what plausible effects could these blind spots have on public health?), and in the more political/social side (are the doctors running these studies trustworthy? are the results being accurately reported between observation and collation? will this medicine be over-sold to patients in disregard of the studied benefits/risks? what is the cost/benefit estimate for using this in public hospitals?).
Now, it would be possible in principle for the state to provide the current centralized verification services, but then only give consultation-level opinions to the populace, doctors (and/or the public health system). But given the strength of PR and direct-to-consumer marketing, this seems to be extremely risky in terms of people ending up swindled to spend huge amounts for terrible medication sold by unscrupulous corporations (a free-for-all version of the opioid crisis).
You don't get to claim this and also simultaneously make claims about low prevalence myocarditis from Covid vaccines. Sorry, I'm not letting you get away with that rhetoric.
People like to think they have higher risk tolerance--until their bet comes up snake eyes. At that moment, you find out what their risk tolerance really was.
Lots of anti-vaxxers thought that they had high risk tolerance about Covid and vaccines--until they came down with Covid and landed in the hospital. Suddenly, their risk tolerance went out the window and they all wanted lots of heathcare treatment and suddenly were asking for the vaccine (without the understanding that the vaccine was now useless).
I took a dose of the AZ vaccine after the blood clotting issue was on the radar. Turns out my risk tolerance for vaccines was relatively high.
> People like to think they have higher risk tolerance--until their bet comes up snake eyes. At that moment, you find out what their risk tolerance really was.
You find out what their response is to being unlucky. If I lost all my money in an investment I'd be fuming and ranting for a few days but that doesn't tell us anything about my risk tolerance.
> Suddenly, their risk tolerance went out the window and they all wanted lots of heathcare treatment
Did you expect them to be hospitalised and refuse medical treatment? Again, you're finding out someone's response to being unlucky, not getting a read on their risk tolerance. I agree that most people are bad at judging personal risk; but people should have a right to make their own mistakes.
Are patients ready for that level of risk? Are children ready for that level of risk? Outside of emergencies, does anything justify that level of risk?
"We see the strategies that work in Asia and maybe eventually in Africa - if you let capitalism happen it has powerful enough results"
So Asia is capitalist? But other countries are not capitalist? This sentence seems to imply that America is not capitalist but Asia is capitalist. I've seen this kind of writing before. Without a rigorous definition of "capitalism" then this kind of thing quickly becomes "capitalism is all the stuff that I agree with and socialism is all the stuff that I disagree with."
"if you let capitalism happen it has powerful enough results at a such speed vs. central planning that it can be rightly called a miracle"
This suggests that capitalism is the opposite of central planning, but we could clearly design a highly decentralized version of Communism:
https://demodexio.substack.com/p/how-to-build-a-pragmatic-co...
Actual title? Are they testing out titles.
Things of the genre “everything is going to shit and here’s what to blame” are not worth reading. Exposing “The decline” of whatever the target audience cares about sure is good for attention but it’s just a toxic emotional manipulation and not useful to actually enlighten anyone.
It comes down to things always changing and having a bad attitude about the present and an unreasonable positive attitude about the past is very prevalent.