Canada

Article

Canada is a recurring place in the Astral Codex Ten archive, appearing 45 times across 45 issues between April 14, 2021 and April 01, 2026. The archive places it in contexts such as “list of Best Practice Peer Countries including: Canada”; “Canada’s border with the United States”; “launching grounds in Canada and the Caribbean”. It most often appears alongside Australia, Scott, Germany.

Metadata

Category: Places
Mention count: 45
Issue count: 45
First seen: April 14, 2021
Last seen: April 01, 2026

Appears In

- Australia (20 shared issues)
- Scott (19 shared issues)
- Germany (18 shared issues)
- United States (18 shared issues)
- Mexico (17 shared issues)
- China (16 shared issues)
- Europe (16 shared issues)
- France (16 shared issues)
- ACX (15 shared issues)
- Brazil (15 shared issues)
- Japan (15 shared issues)
- Netherlands (15 shared issues)

External Links

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Prospectus On Próspera

April 14, 2021 · Original source

This policy is close to my heart, because like many people I’ve had Uber drivers who were doctors back in their home countries. They’re stuck driving Ubers because the US insists that nobody - not British doctors, not Canadian doctors, nobody - can work in the US unless they repeat their last four years of training in an American hospital. American hospitals don’t have many training positions, and reserve the ones they do have for American med students, so most of them can’t do it. Meanwhile, my patients complain of having to wait months to get a desperately-needed appointment, and the hospitals just say “well, there aren’t enough doctors”. There are, they’re just all driving Ubers because of regulatory failure! I’m not sure Próspera goes far enough - a lot of the real gains would come from allowing Indian or Iranian doctors - but go further than anywhere else.

The concerns around Próspera mirror the case of Randy Jorgensen, a Canadian porn mogul, who founded a chain of Honduran tourist resorts. He expropriated land from native communities, especially a group called the Garifuna who are descended from escaped African slaves. Jorgensen and his supporters in the Honduran government did use violence (and other tactics, like cutting off basic services) to force the Garifuna off the land. It was terrible, and everyone in this part of Honduras is understandably on edge. Although there's no connection between Jorgensen and the ZEDE, some people see them as the product of the same pro-business, pro-development tendency in Honduran government.

Inline links: Randy Jorgensen

Do the Prósperans seem a little defensive about this? I think it’s warranted. The government of actual Honduras has been expropriating things right and left throughout this area for decades. This is part of the failure of Honduran governance that they’re trying to provide an alternative to. Instead of having to live in a country that expropriates your land whenever Canadian porn moguls ask them to, you could live in a libertarian paradise obsessed with property rights and rule of law. Trey says: "Land expropriation is the exact kind of governance failure Próspera exists to fix".

Inline links: Trey says:

Your Book Review: The Accidental Superpower

May 21, 2021 · Original source

We didn’t just get tremendous economic growth though – we got “magical” results, but they were based on a one-time confluence of factors that “overwhelmed the normal rule that lots of twenty-and thirty-somethings make for an expensive-capital environment.” What were these one-time accelerants? He identifies the peace dividend – cuts in military spending that allowed capital to be put to more productive uses – as one such change, along with the emergent dominance of the US dollar, particularly boosted by Russian demand thanks to the collapse of their currency, and a later boost in demand thanks to the East Asian financial crisis. With the Europeans’ decision to eliminate national currencies (agreed upon in a 1992 treaty, with the Euro to be introduced in 1999), they became relatively unattractive, and the Euro itself (an “unprecedented experiment in pan-government planning”) was too risky. Many holders of European currencies switched to the US dollar, such that between 1994 and 2002 (“when the euro finally got some traction and the surge dialed back”) there was a $2 trillion increase in the money supply. Zeihan also points to a collapse in commodities prices influenced by the elimination of Russian demand, but continued Russian production of oil and other commodities, followed by a collapse in demand thanks to the East Asian financial crisis. This story of capital coming to the West (“allowing consumption-driven growth not simply to soar, but to explode”) is one of chance world events. However, the story of capital coming from the Boomer cohort is one of demographics. By the 2000s, they’re the mature workers of Zeihan’s four stages described above – and as the bulge in the demographic pyramid, they started flooding the world with capital. Accordingly, “The cost of credit plummeted to levels never before experienced.” Zeihan suggests that developed-world demographics are the cause of booms in places that haven’t been well-developed, from Southern Europe to Brazil, Russia, and India. But he says it’s quickly coming to an end; Boomer savings into stocks and bonds will be moving to low-risk instruments and then turning into withdrawals rather than savings, and the cohort behind them is too small to replace all of that capital. And it’s a worldwide phenomenon: In every single developed country there is currently an American-style population inversion between the about-to-retire and the about-to-be-mature-workers age groups. Japan’s Boomers bulge is a decade older than the American equivalent, while Spain’s is roughly fifteen years younger. Everyone else falls somewhere in between. It dictates a period of chronically low growth and high credit costs, just not on precisely the same time frame. The undeveloped world is that way because it can’t self-fund, so without foreign capital, their growth will come to an end. In sum, the 1990-2005 period of high growth and easy capital was a historical anomaly; “the post-Cold War financial flight was a once-in-a-generation event” and the demographic bulge that coincided with it won’t come around again for decades, if ever. 4 2: America’s incredible advantages As noted above, Zeihan really likes America’s position in the world. He likes its demographics (relative to other developed countries) and loves its geography. Taking the population question first, in America, “the demographic inversion is only a temporary development.” America is younger than the rest of the developed world, as it urbanized later and its enormous size made having kids easier despite that urbanization (i.e., the suburbs exist). This makes the demographic crunch a single-generation issue, as the Millennials are a huge cohort. And even if they weren’t, America assimilates immigrants more easily than other places – Zeihan attributes this to it being a “settler society” – which can help with demographic problems. The rest of the developed world doesn’t have similar cohorts following their massive Boomer and Gen-X analogues. Accordingly: While the American financial world will be past its period of maximum stress by 2030, for the rest of the world 2030 will simply be another year of an ever-deepening imbalance between retirees and taxpayers, with smaller and smaller generations coming up the ranks generating less and less growth. For the developed world beyond the United States—and even large portions of the developing world—chronic capital poverty and permanent recession will be the new normal from which there is no return. Together with America’s Millennial-led growth and abundant energy (there’s a chapter explaining how shale is a done deal that, as of the mid-2014 writing, already made America the world’s largest energy producer 5), by 2030 Zeihan sees it as practically the only country with an economy worth noting. Anyone who is familiar with American geography should see the argument that’s coming about that aspect of Zeihan’s model. Isn’t the Mississippi River a pretty big deal? And those oceans on the east and west coasts seem like nice borders. Indeed, while he gives us many reasons why there was always going to be an American superpower, geography is central to his story. He has lots to say about America’s internal river systems, farmland, and other geographic features. What mountain barriers exist are apparently better than in other countries in terms of allowing internal transport; the Rockies have major passes, several of which have large cities within them, and the easiest pass in the Appalachians featured America’s first National Road, 130 miles of buried logs that linked two rivers, and thus the east coast with the best farmland in the world. As we saw with his exposition on the Nile, Zeihan puts a lot of emphasis on the value of river systems. He argues that America’s waterway network alone should be sufficient for “global dominance.” The numbers he provides in support of this point are impressive. For example, “the Mississippi is only one of twelve major navigable American rivers. Collectively, all of America’s temperate-zone rivers are 14,650 miles long. China and Germany each have about 2,000 miles, France about 1,000. The entirety of the Arab world has but 120.” He praises US barrier islands that mitigate oceanic destruction and effectively create another river system, as well as the fact that the river system is an actual network. All of this gives America more internal waterways than the rest of the world combined. Thus, we get cheap transportation for “Nebraska corn or Tennessee whiskey or Texas oil or New Jersey steel or Georgia peaches or Michigan cars,” enabling savings that “can be used for whatever Americans (or their government) want, from iPhones to aircraft carrier battle groups.” America doesn’t have to spend on artificial infrastructure, like German roads and rails, but when it does, the competition from the rivers keeps transport costs low. Cheap internal transportation has other benefits. “It’s a recipe for small government and high levels of entrepreneurship,” as small government keeps taxes low, leaving people with plenty of capital. Some people may think of the American consumer with disdain, but it isn’t a new phenomenon. Zeihan points out that America has been the world’s largest consumer market “since shortly after the Civil War.” His observation about a robust food supply forming the base of any civilization bodes well for America, which apparently has the largest connected stretch of quality farmland in the world (the Midwest), the value of which is exponentially increased by the fact that it overlaps with so many of these amazing river systems. It isn’t just the Midwest that he gushes over. California’s Central Valley and the Sacramento River, and Washington and Oregon’s farmland with the Columbia and Snake Rivers get praise. The only major farmland more than 150 miles from a navigable waterway is some of the Great Plains near the Rockies. ***** Zeihan provides a reminder that national security is actually a thing, and that at its most basic level, it’s about protection against invasions. It was something of a shock reading about America’s land borders in that context. “As Santa Anna discovered during the Texas Independence War, there is no good staging location in (contemporary) Mexican territory that could strike at American lands.” And, “Canada’s border with the United States is much longer, more varied, and even more successful at keeping the two countries separated,” thanks to mountains and thick forests over much of it. The mid-continent lands are much more connected, but Zeihan frames these Canadian areas as basically American; they’re physically separated from Canada’s core eastern provinces, so trade with them is weaker than with the closer American states. Then there are the oceans. As much as Zeihan loves deserts for protection, he loves oceans more (particularly in a post-World War II world; more on that below). We get a story about the War of 1812 nearly splitting America into three when the British attacked Baltimore. America learned about “strategic vulnerability and sea approaches,” as the attack “on Baltimore—indeed, the entire war effort—would have been impossible without launching grounds in Canada and the Caribbean.” American foreign policy since then can be understood with respect to this lesson. Zeihan cites it as inspiration for America’s steps to make its ocean borders truly impenetrable, such as working to sever Canada from Britain, and the imperial-era acquisitions of Alaska, Hawaii, Midway, Puerto Rico, and de facto control of Cuba (preventing enemies from cutting off Mississippi River-based trade from the rest of the world). There’s more to Zeihan’s being awestruck by America than his analysis of its balance of transport advantages. He argues that America has been the world leader for agriculture, technology, finance, and industry since the Civil War, and runs through a litany of reasons for its preeminence: America is like a continent-sized island (because of its effective land borders), which is always going to be a more natural naval power than a more landlocked country.

Inline links: 4, 5

The second half of The Accidental Superpower is filled with Zeihan’s predictions about what happens if the big thesis is right. Some states will fail, as they don’t have what’s needed to survive (Syria, Greece, Libya). Some will decentralize, as they’re in the same boat, just not as hard up (Russia, China). Some will merely decline, as they have some capacity to address challenges (Brazil, India, Canada). Some will cope (UK, France, Peru, Philippines). A few will join the US as “masters of the chaos,” as they have favorable geographies and other advantages (Australia, Argentina, Angola, Turkey, Indonesia, Uzbekistan).

Instead Of Pledging To Change The World, Pledge To Change Prediction Markets

June 07, 2021 · Original source

This is nice, but I can't help but remember eg Australia's 2009 Copenhagen summit pledge to decrease emissions 5% by 2020 (in fact, they increased 17%). Or Brazil's pledge at the same summit to cut emissions 38% by 2020 (in fact, they increased 45%). Or Canada's pledge for -20% (they got +1%). I'm not cherry-picking bad actors here, I'm just going through the alphabet (pledges source, outcomes source) . For that matter, what about George W. Bush's pledge to return Americans to the moon by 2020?

Inline links: pledges source, outcomes source, pledge to return Americans to the moon

Meetups Everywhere 2021: Times And Places

August 23, 2021 · Original source

MEXICO CITY, MEXICO (RSVP) Contact: Fornicad Cigarros, fagarrido[at]gmail[dot]com Time: 4:00 PM, Saturday, September 11 Location: Bosque de Chapultepec by the Canadian Totem Coordinates: https://w3w.co/spoiled.given.waving

Inline links: RSVP, https://w3w.co/spoiled.given.waving

ONLINE Contact: Joshua Fox, joshua[at]joshuafox[dot]com Time: 5:30 PM GMT, Sunday, September 19 Location: See https://joshuafox.com/acx-online-meetups/ Notes: The time given is GMT. Meetups include a speaker and then mingling. The listed meetup is one that can serve as a Schelling point for newcomers, but all are welcome to come to any sessions. We would be glad to get other organizers onboard. CANADA CALGARY, AB (RSVP) Contact: David Piepgrass, qwertie256[at]gmail[dot]com Time: 1:00 PM, Sunday, September 5 Location: Pearce Estate Park: parking on 17a St SE, one of the 10 picnic tables northeast of the parking area, unless full. Look for a red-shirt guy and "ACX". Coordinates: https://w3w.co/readily.rosette.pools

Inline links: https://joshuafox.com/acx-online-meetups/, RSVP, https://w3w.co/readily.rosette.pools

Highlights From The Comments On Orban

November 11, 2021 · Original source

…A North American equivalent would be if there had been an agreement between Canada, US and Mexico that refugees could be returned to the country of “first entry” – which would usually be Mexico. For obvious reasons, Mexico would not have been happy with such an agreement (and EU countries bordering on non-EU countries, including bordering on the Mediterranean, have also tried – so far unsuccessfully- to change the Dublin agreement).

Ivermectin: Much More Than You Wanted To Know

November 17, 2021 · Original source

95% of ivermectin patients got negative PCRs at some time point, compared to 75% of controls, p = 0.004. I am pretty suspicious of this study, not least because it comes from Egypt which has an awful reputation for fake studies, and it returns extreme results that I wouldn’t expect even if ivermectin was actually a wonder drug. But I cannot find any particular thing wrong with it, nor did anyone else I looked at, so I will grudgingly let it stand. Krolewiecki et al: Another Argentine study. This one is a real RCT. 30 patients received ivermectin, 15 were the control group (no placebo, again). Primary outcome was difference in viral load on day 5. The trend favored ivermectin but it was not statistically significant, although they were able to make it statistically significant if they looked at a subset of higher-IVM-plasma-concentration patients. They did not find any difference in clinical outcomes. A pro-ivermectin person could point out that in the subgroup with the highest ivermectin concentrations, the drug seemed to work. A skeptic could point out that this is exactly the kind of subgroup slicing that you are not supposed to do without pre-registering it, which I don’t think this team did. I agree with the skeptic. Vallejos et al: Another Argentine study. It’s big (250 people in each arm). It’s an RCT. It tries to define a primary outcome (“Primary outcome: the trial ended when the last patient who was included achieved the end of study visit”), but that’s not what “primary outcome” means, and they don’t offer an alternative. Other outcomes: no difference in PCR on days 3 or 12. Hospitalization is nonsignificantly better in the ivermectin group (14 vs. 21, p = 0.2), but death is nonsigificantly better in the placebo group (3 vs. 4, p = 0.7). This isn’t even the kind of nonsignificant that might contribute to an exciting meta-analysis later. This is just a pure null result. I cannot find any problem with this study, and neither can anyone else I checked. This is the biggest RCT we’ve seen so far, so we should take it seriously. TOGETHER Trial: Speaking of big RCTs… This one hasn’t been published yet. There’s a video of a talk about it, but I am not going to watch it, because it is a video, so I am getting information secondhand from eg here. Apparently, it compares 677 people (!) randomized to ivermectin to 678 people randomized to placebo. 86 ivermectin patients ended up in the hospital compared to 95 placebo patients, p-value not significant. This was a really big professional trial done by bigshot researchers from a major Canadian university, and the medical establishment is taking it much more seriously than any of these others. When it comes out, it will probably get published in a top journal. When discussing Lopez-Medina, I wrote: When people say things like “sure, a lot of small studies show good results for ivermectin, but the bigger and more professional trials don’t”, this is one of the two big professional trials they’re talking about. This is the other one. Not coincidentally, it’s also the other trial that ivmmeta.com has a warning letter underneath telling you to disregard. Their main concern is that instead of truly randomizing patients to ivermectin vs. placebo, they did a time-dependent randomization that meant during some weeks more patients were getting one or the other. This is a problem because the trial takes place in Brazil, where different variants were more common at different times. Here’s their image: On the one hand, I have immense contempt for ivmmeta for letting all those other awful studies pass and then pulling out all the stops to try to nitpick this one. I have no idea if their proposed randomization failure really happened. And no doubt the reason they’re even able to investigate this is that this study is really careful and transparent - most of them don’t tell you anything about their randomization method. I would be shocked if other studies don’t have all these problems and worse. On the other hand, the point isn’t to be fair, it’s to be right. And this is a potential confounder. Not a huge one. But a potential one. I guess all we can do is try to bound the damage. Even if the confounding is 100% real and bad, there’s no way to make this study consistent with the crazy super-pro-ivermectin results of studies like Espitia-Hernandez and Aref. And even if we deny any confounding, we see the same slight pro-ivermectin trend - 86 hospitalizations vs. 95 - that we’ve seen in so many other studies. Nothing is going to make me believe that this isn’t in the top 33% of studies we’ve been looking at, so let’s add it as grist for the meta-analysis (though maybe not quite as much grist as its vast size indicates) and move on, angrily. Buonfrate et al: An Italian RCT. Patients were randomized into low-dose ivermectin (32), placebo (29), or high-dose ivermectin (32). Primary outcome was viral load on day 7. There was no significant difference (average of 2 in ivermectin groups, 2.2 in placebo group). They admit that they failed to reach the planned sample size, but did a calculation to show that even if they had, the trial could not have returned a positive result. Clinically, an average of 2 patients were hospitalized in each of the ivermectin arms, compared to 0 in the placebo arm - which bucks our previously-very-constant pro-ivermectin trend. Mayer et al: Not an RCT. Patients in an Argentine province were offered the opportunity to try ivermectin; 3266 said yes and become the experimental group, 17966 said no and became the control group. There were many obvious differences between the groups, but they all seemed to handicap ivermectin. There was a nonsignificant trend toward less hospitalization and significantly less mortality (1.5% vs. 2.1%, p = 0.03). While looking into this study, I learned the term “immortal time bias”. This means a period in between selection for the study and the beginning of study recording where patient outcomes are not counted. I think the problem here is that if you signed up for the system on Day X, and if you got sick before they could give you ivermectin, you were in the control group. See this Twitter thread, I have not confirmed everything he says. This only hardens my resolve to stay away from non-RCTs. Borody et al: Our last paper! …is it a paper? I can’t find it published anywhere. It mostly seems to be on news sites. Doesn’t look peer-reviewed. And it starts with “Note that views expressed in this opinion article are the writer’s personal views”. Whatever. 600 Australians were treated with ivermectin, doxycycline, and zinc. The article compares this to an “equivalent control group” made of “contemporary infected subjects in Australia obtained from published Covid Tracking Data”; this is not how you control group, @#!% you. Then it gets excited about the fact that most patients had better symptoms at the end of the ten-day study period than the beginning (untreated COVID resolves in about ten days). Why are these people wasting my time with this? Let’s move on. The Analysis If we remove all fraudulent and methodologically unsound studies from the table above, we end up with this: Gideon Meyerowitz-Katz, who investigated many of the studies above for fraud, tried a similar exercise. I learned about his halfway through, couldn’t help seeing it briefly, but tried to avoid remembering it or using it when generating mine (also, I did take the result of his fraud investigations into account), so they should be considered not quite independent efforts. His looks like this: He nixed Chowdhury, Babaloba, Ghauri, Faisal, and Aref, but kept Szenta Fonseca, Biber (?), and Mayer. There was correlation of 0.45, which I guess is okay. I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Meyerowitz-Katz disliked. We end up with the following short list: We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Meyerowitz-Katz was suspicious of them. …but honestly this table still looks pretty good for ivermectin, doesn’t it? Still lots of big green boxes. Meyerowitz-Katz accuses ivmmeta of cherry-picking what statistic to use for their forest plot. That is, if a study measures ten outcomes, they sometimes take the most pro-ivermectin outcome. Ivmmeta.com counters that they used a consistent and reasonable (if complicated) process for choosing their outcome of focus, that being: If studies report multiple kinds of effects then the most serious outcome is used in calculations for that study. For example, if effects for mortality and cases are both reported, the effect for mortality is used, this may be different to the effect that a study focused on. If symptomatic results are reported at multiple times, we used the latest time, for example if mortality results are provided at 14 days and 28 days, the results at 28 days are used. Mortality alone is preferred over combined outcomes. Outcomes with zero events in both arms were not used (the next most serious outcome is used — no studies were excluded). For example, in low-risk populations with no mortality, a reduction in mortality with treatment is not possible, however a reduction in hospitalization, for example, is still valuable. Clinical outcome is considered more important than PCR testing status. When basically all patients recover in both treatment and control groups, preference for viral clearance and recovery is given to results mid-recovery where available (after most or all patients have recovered there is no room for an effective treatment to do better). If only individual symptom data is available, the most serious symptom has priority, for example difficulty breathing or low SpO2 is more important than cough. I’m having trouble judging this, partly because Meyerowitz-Katz says ivmmeta has corrected some earlier mistakes, and partly because there really is some reasonable debate over how to judge studies with lots of complicated endpoints. By this point I had completely forgotten what ivmmeta did, so I independently coded all 11 remaining studies following something in between my best understanding of their procedure and what I considered common sense. The only exception was that when the most severe outcome was measured in something other than patients (ie average number of virus copies per patient), I defaulted to one that was measured in patients instead, to keep everything with the same denominator. My results mostly matched ivmmeta’s, with one or two exceptions that I think are within the scope of argument or related to my minor deviations from their protocol. Placebo vs. ivermectin groups sometimes differed in size, which I’ve adjusted for and rounded off. Probably I’m forgetting some reason I can’t just do simple summary statistics to this, but whatever. It is p = 0.15, not significant. This is maybe unfair, because there aren’t a lot of deaths in the sample, so by focusing on death rather than more common outcomes we’re pointlessly throwing away sample size. What happens if I unprincipledly pick whatever I think the most reasonable outcome to use from each study is? I’ve chosen “most reasonable” as a balance between “is the most severe” and “has a lot of data points”: Now it’s p = 0.04, seemingly significant, but I had to make some unprincipled decisions to get there. I don’t think I specifically replaced negative findings with positive ones, but I can’t prove that even to myself, let alone to you. [UPDATE 5/31/22: A reader writes in to tell me that the t-test I used above is overly simplistic. A Dersimonian-Laird test is more appropriate for meta-analysis, and would have given 0.03 and 0.005 on the first and second analysis, where I got 0.15 and 0.04. This significantly strengthens the apparent benefit of ivermectin from ‘debatable’ to ‘clear’. I discuss some reasons below why I am not convinced by this apparent benefit.] (how come I’m finding a bunch of things on the edge of significance, but the original ivmmeta site found a lot of extremely significant things? Because they combined ratios, such that “one death in placebo, zero in ivermectin” looked like a nigh-infinite benefit for ivermectin, whereas I’m combining raw numbers. Possibly my way is statistically illegitimate for some reason, but I’m just trying to get a rough estimate of how convinced to be) So we are stuck somewhere between “nonsignificant trend in favor” and “maybe-significant trend in favor, after throwing out some best practices”. This is normally where I would compare my results to those of other meta-analyses made by real professionals. But when I look at them, they all include studies later found to be fake, like Elgazzar, and unsurprisingly come up with wildly positive conclusions. There are about six in this category. One of them later revised their results to exclude Elgazzar and still found strong efficacy for ivermectin, but they still included Niaee and some other dubious studies. The only meta-analysis that doesn’t make these mistakes is Popp (a Cochrane review), which is from before Elgazzar was found to be fraudulent, but coincidentally excludes it for other reasons. It also excludes a lot of good studies like Mahmud and Ravakirti because they give patients other things like HCQ and azithromycin - I chose to include them, because I don’t think they either work or have especially bad side effects, so they’re basically placebo - but Cochrane is always harsh like this. They end up with a point estimate where ivermectin cuts mortality by 40% - but say the confidence intervals are too wide to draw any conclusion. I think this basically agrees with my analyses above - the trends really are in ivermectin’s favor, but once you eliminate all the questionable studies there are too few studies left to have enough statistical power to reach significance. Except that everyone is still focusing on deaths and hospitalizations just because they’re flashy. Mahmud et al, which everyone agrees is a great study, found that ivermectin decreased days until clinical recovery, p = 0.003? So what do you do? This is one of the toughest questions in medicine. It comes up again and again. You have some drug. You read some studies. Again and again, more people are surviving (or avoiding complications) when they get the drug. It’s a pattern strong enough to common-sensically notice. But there isn’t an undeniable, unbreachable fortress of evidence. The drug is really safe and doesn’t have a lot of side effects. So do you give it to your patients? Do you take it yourself? Here this question is especially tough, because, uh, if you say anything in favor of ivermectin you will be cast out of civilization and thrown into the circle of social hell reserved for Klan members and 1/6 insurrectionists. All the health officials in the world will shout “horse dewormer!” at you and compare you to Josef Mengele. But good doctors aren’t supposed to care about such things. Your only goal is to save your patient. Nothing else matters. I am telling you that Mahmud et al is a good study and it got p = 0.003 in favor of ivermectin. You can take the blue pill, and stay a decent respectable member of society. Or you can take the horse dewormer pill, and see where you end up. In a second, I’ll tell you my answer. But you won’t always have me to answer questions like this, and it might be morally edifying to observe your thought process in situations like this. So take a second, and meet me on the other side of the next section heading. … … … … … The Synthesis Hopefully you learned something interesting about yourself there. But my answer is: worms! As several doctors and researchers have pointed out (h/t especially Avi Bitterman and David Boulware), the most impressive studies come from places that are teeming with worms. Mahmud from Bangladesh, Ravakirti from East India, Lopez-Medina from Colombia, etc. Here’s the prevalence of roundworm infections by country (source). But alongside roundworms, there are threadworms, hookworms, blood flukes, liver flukes, nematodes, trematodes, all sorts of worms. Add them all up and somewhere between half and a quarter of people in the developing world have at least one parasitic worm in their body. Being full of worms may impact your ability to fight coronavirus. Gluchowska et al write: Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases. Treatment of worm infections might reduce the negative effect of COVID-19! And ivermectin is a deworming drug! You can see where this is going… The most relevant species of worm here is the roundworm Strongyloides stercoralis. Among the commonest treatments for COVID-19 is corticosteroids, a type of immunosuppresant drug. The types of immune responses it suppresses do more harm than good in coronavirus, so turning them off limits collateral damage and makes patients better on net. But these are also the types of immune responses that control Strongyloides. If you turn them off even very briefly, the worms multiply out of control, you get what’s called “Strongyloides hyperinfection”, and pretty often you die. According to the WHO: The current COVID-19 pandemic serves to highlight the risk of using systemic corticosteroids and, to a lesser extent, other immunosuppressive therapy, in populations with significant risk of underlying strongyloidiasis. Cases of strongyloidiasis hyperinfection in the setting of corticosteroid use as COVID-19 therapy have been described and draw attention to the necessity of addressing the risk of iatrogenic strongyloidiasis hyperinfection syndrome in infected individuals prior to corticosteroid administration. Although this has gained importance in the midst of a pandemic where corticosteroids are one of few therapies shown to improve mortality, its relevance is much broader given that corticosteroids and other immunosuppressive therapies have become increasingly common in treatment of chronic diseases (e.g. asthma or certain rheumatologic conditions). So you need to “address the risk” of strongyloides infection during COVID treatment in roundworm-endemic areas. And how might you address this, WHO? Treatment of chronic strongyloidiasis with ivermectin 200 µg/kg per day orally x 1-2 days is considered safe with potential contraindications including possible Loa loa infection (endemic in West and Central Africa), pregnancy, and weight <15kg. Given ivermectin’s safety profile, the United States has utilized presumptive treatment with ivermectin for strongyloidiasis in refugees resettling from endemic areas, and both Canada and the European Centre for Disease Prevention and Control have issued guidance on presumptive treatment to avoid hyperinfection in at risk populations. Screening and treatment, or where not available, addition of ivermectin to mass drug administration programs should be studied and considered. This is serious and common enough that, if you’re not going to screen for it, it might be worth “add[ing] ivermectin to mass drug administration programs” in affected areas! Dr. Avi Bitterman carries the hypothesis to the finish line: First two images are with all relevant studies; second two are a sensitivity analysis that removes some of the most dubious. The good ivermectin trials in areas with low Strongyloides prevalence, like Vallejos in Argentina, are mostly negative. The good ivermectin trials in areas with high Strongyloides prevalence, like Mahmud in Bangladesh, are mostly positive. Worms can’t explain the viral positivity outcomes (ie PCR), but Dr. Bitterman suggests that once you remove low quality trials and worm-related results, the rest looks like simple publication bias: This is still just a possibility. Maybe I’m over-focusing too hard on a couple positive results and this will all turn out to be nothing. Or who knows, maybe ivermectin does work against COVID a little - although it would have to be very little, fading to not at all in temperate worm-free countries. But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong! The people who called it a miracle drug against COVID were wrong. The people who dismissed all the studies because they F@#king Love Science were wrong. Ivmmeta.com was wrong. Gideon Meyerowitz-Katz was…well, he was right, actually, I got the worm-related meta-analysis graphic above from his Twitter timeline. Still, an excellent troll. Also, the best part is that I ignorantly asked, in my description of Mahmud et al above: And it was! It was a fluke! A literal, physical, fluke! For my whole life, God has been placing terrible puns in my path to irritate me, and this would be the worst one ever! So it has to be true! The Scientific Takeaway About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies. Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies. These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools. I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for. Part of this new toolset is to check for fraud. About 10 - 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like: The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

Here’s the prevalence of roundworm infections by country (source). But alongside roundworms, there are threadworms, hookworms, blood flukes, liver flukes, nematodes, trematodes, all sorts of worms. Add them all up and somewhere between half and a quarter of people in the developing world have at least one parasitic worm in their body. Being full of worms may impact your ability to fight coronavirus. Gluchowska et al write: Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases. Treatment of worm infections might reduce the negative effect of COVID-19! And ivermectin is a deworming drug! You can see where this is going… The most relevant species of worm here is the roundworm Strongyloides stercoralis. Among the commonest treatments for COVID-19 is corticosteroids, a type of immunosuppresant drug. The types of immune responses it suppresses do more harm than good in coronavirus, so turning them off limits collateral damage and makes patients better on net. But these are also the types of immune responses that control Strongyloides. If you turn them off even very briefly, the worms multiply out of control, you get what’s called “Strongyloides hyperinfection”, and pretty often you die. According to the WHO: The current COVID-19 pandemic serves to highlight the risk of using systemic corticosteroids and, to a lesser extent, other immunosuppressive therapy, in populations with significant risk of underlying strongyloidiasis. Cases of strongyloidiasis hyperinfection in the setting of corticosteroid use as COVID-19 therapy have been described and draw attention to the necessity of addressing the risk of iatrogenic strongyloidiasis hyperinfection syndrome in infected individuals prior to corticosteroid administration. Although this has gained importance in the midst of a pandemic where corticosteroids are one of few therapies shown to improve mortality, its relevance is much broader given that corticosteroids and other immunosuppressive therapies have become increasingly common in treatment of chronic diseases (e.g. asthma or certain rheumatologic conditions). So you need to “address the risk” of strongyloides infection during COVID treatment in roundworm-endemic areas. And how might you address this, WHO? Treatment of chronic strongyloidiasis with ivermectin 200 µg/kg per day orally x 1-2 days is considered safe with potential contraindications including possible Loa loa infection (endemic in West and Central Africa), pregnancy, and weight <15kg. Given ivermectin’s safety profile, the United States has utilized presumptive treatment with ivermectin for strongyloidiasis in refugees resettling from endemic areas, and both Canada and the European Centre for Disease Prevention and Control have issued guidance on presumptive treatment to avoid hyperinfection in at risk populations. Screening and treatment, or where not available, addition of ivermectin to mass drug administration programs should be studied and considered. This is serious and common enough that, if you’re not going to screen for it, it might be worth “add[ing] ivermectin to mass drug administration programs” in affected areas! Dr. Avi Bitterman carries the hypothesis to the finish line: First two images are with all relevant studies; second two are a sensitivity analysis that removes some of the most dubious. The good ivermectin trials in areas with low Strongyloides prevalence, like Vallejos in Argentina, are mostly negative. The good ivermectin trials in areas with high Strongyloides prevalence, like Mahmud in Bangladesh, are mostly positive. Worms can’t explain the viral positivity outcomes (ie PCR), but Dr. Bitterman suggests that once you remove low quality trials and worm-related results, the rest looks like simple publication bias: This is still just a possibility. Maybe I’m over-focusing too hard on a couple positive results and this will all turn out to be nothing. Or who knows, maybe ivermectin does work against COVID a little - although it would have to be very little, fading to not at all in temperate worm-free countries. But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong! The people who called it a miracle drug against COVID were wrong. The people who dismissed all the studies because they F@#king Love Science were wrong. Ivmmeta.com was wrong. Gideon Meyerowitz-Katz was…well, he was right, actually, I got the worm-related meta-analysis graphic above from his Twitter timeline. Still, an excellent troll. Also, the best part is that I ignorantly asked, in my description of Mahmud et al above: And it was! It was a fluke! A literal, physical, fluke! For my whole life, God has been placing terrible puns in my path to irritate me, and this would be the worst one ever! So it has to be true! The Scientific Takeaway About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies. Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies. These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools. I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for. Part of this new toolset is to check for fraud. About 10 - 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like: The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

Inline links: source, Gluchowska et al, the WHO, carries, https://substackcdn.com/image/fetch/$s_!xExE!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F5da21781-249c-4e59-b616-9f23d83cc044_2048x1184.jpeg, https://substackcdn.com/image/fetch/$s_!4SMr!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fdcd6e4b2-37f7-4602-93d5-2581c3b27a60_700x432.png, https://substackcdn.com/image/fetch/$s_!-6n2!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F7fd6e8f4-093e-4e02-bce7-363615146c9c_2228x1346.jpeg, https://substackcdn.com/image/fetch/$s_!CPZs!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fb0425847-198a-4bd3-a63b-149f15d147ba_700x432.png, https://substackcdn.com/image/fetch/$s_!H3rK!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F9972491b-25b0-4c06-8aca-86fce102ae63_666x147.png, even in 2014, The Carlisle-Stouffer-Fisher method

Does Georgism Work, Part 3: Can Unimproved Land Value be Accurately Assessed Separately From Buildings?

December 11, 2021 · Original source

Gwartney says that when he was the assessment commissioner and chief executive officer in British Columbia, he had a staff of 690, and that this number has not changed significantly since then. British Columbia has a population of about 5 million, so that's 1 assessment officer for every 7,250 British Columbians. For context, the IRS has a staff size of 74,454, or about one IRS agent for every 4,425 Americans. I don't have data on how many property tax assessors the USA has in total, but the above slide suggests British Columbia's figure is on the high end. As for how you actually do assessments, sure, you can send out an army of assessors to value each and every property in your jurisdiction by hand. However, not only is that labor-intensive, it's also a recipe for inconsistency. Whatever method you're using to value properties needs to be consistent and standardized across all properties, so you don't have sharp discontinuities on the assessment map that are due solely to differences between Assessor Fred and Assessor Sally's personal methodologies. Thankfully, we're living in the modern age, and we have some fancy new tools at our disposal. 4. Modern Technology Georgists were doing split-rate assessments to allegedly good success long before the rise of the computer, such as J. J. Pastoriza's effort in setting up a Georgist tax regime in Houston, Texas in 1911. Today, we have spreadsheets, property value databases, GIS mapping visualizations, regression analysis, machine learning...the works. According to Gwartney, the Canadian province of British Columbia has revalued all its land and all its property on an annual basis simply by using computers and market analysis, ever since he first helped them set up their system back in 1975. Not every jurisdiction revalues their land this thoroughly and this often, but Gwartney says there is no significant technical or staffing barrier standing in the way. Gwartney has been retired for some time, so his seminar didn't cover all the latest cutting-edge techniques that have come out in the last few years. Let's look at some recent papers and see what new tools assessors have to play with. The first on my list is Land Value Appraisal Using Statistical Methods by Kolbe, Schulz, Wersing, and Werwatz (2019). This is a study on mass appraisal techniques using real estate transaction data from Berlin, Germany. It claims that not only are the results cheaper and faster to generate than those done by conventional property assessment methods, but they are also no less accurate than those done "by hand" by experts. Kolbe et al. assert that, provided you have access to high quality market transaction data, you can perform accurate and efficient mass appraisals of land values. They chose Berlin because it "has a very effective system of property transaction data collection and storage," in contrast to other parts of Germany. They cite some prior work by Almy (2014) studying Canada, the Netherlands, and the United States, suggesting that the assessment cost per property can be brought down to 20 Euros–25 times cheaper than what some other people (Fuest, et al. (2018)) assert. Given an average tax receipt of 2,000 Euros per property, this means that the assessment cost should represent only about 1% of the funds raised. Is that good? Let's take this assertion at face value for the moment and compare it to the cost of the IRS. Federal tax receipts in 2020 were $3.42 trillion, and operation costs for the IRS were $12.3 billion, or 0.36%. However, the IRS outsources most of the labor of tax preparation to the taxpayers themselves, with compliance costs estimated between $200 billion and $400 billion a year, to the delight of Intuit. Add that up and the total cost of federal tax collection to the economy is anywhere between 6-12% of the amount it raises. And what about sales tax? According to a 2006 report by PriceWaterHouseCoopers: The study finds that the national average annual state and local retail sales tax compliance cost in 2003 was 3.09 percent of sales tax collected for all retailers, 13.47 percent for small retailers, 5.20 percent for medium retailers, and 2.17 percent for large retailers So a compliance cost of 1% would be way more efficient in terms of cost collection than the other two most common forms of taxation, and taxpayers don't even have to do anything themselves, other than pay the bill. Alrighty, how about the accuracy? The authors cite two international examples, Australia and Lithuania, as among the few countries in the world that have both a Land Value Tax and statistical methods for mass appraisals. Hefferan and Boyd (2010) assert that objections to assessments from property owners in Australia are less than 1%. I'm willing to buy the improved efficiency claims just by taking a look at some methodologies. It seems reasonable that computerized records and algorithms can cut costs significantly; the real question is if you're trading off accuracy. The other papers I found on the subject are Bencure, et al (2019) in BayBay City, Philippines, Kilić, et al (2019) in Croatia, Yalpir & Unel (2017) in Konya, Turkey, and Raslanas et al. (2014) in Vilnius, Lithuania. Let's dive in and examine some methods. 5. Mass Appraisal Methods Here are some of the latest mass appraisal methods cribbed from the research papers listed above. All of these are based on taking market transaction data, plotting them out on a map, and running computations over them to estimate valuations for the properties you don't have known values for. Furthermore, all of these methods are able to value land and building values separately. Multiple Regression Analysis This paper by Yalpir and Unel out of Turkey gives a straightforward example of using Multiple Regression Analysis for land valuation. For those of you who didn't study math, let me explain regression analysis. This is a family of mathematical models where you basically take a data set, ask the question "what mathematical formula would best fit this data," choose a basic equation model, and then have a computer search for a set of coefficients that "best fit" that curve to the data with the least amount of error. The simplest example is using linear regression on a scatterplot of observed data points to fit a trend line. This is a common exercise in freshman physics and statistics classes. You can use more complicated versions of this numerical method to take a big bag of observations (real estate sales) and use "multiple regression" to tease out dependent variables (land value and improvements value) based on the independent variables (size, location, age, number of bedrooms) of your observations. In this case the team identified about a hundred different factors that can affect the price of a property: Then you create an entry for each property, fill in the values for each of those characteristics, and run it through the regressor. Take note of how many of these factors start with the words "proximity to." Each of these can be calculated automatically just by knowing where the property is on a map, and each of them is an independent contributor to the value of the property's location. The next step is to generate individual "index maps" that combine various related features into combined heat maps. Then you run everything through and see if it works. You can get the land share of the final value by combining the contributions of all the individual factors that you associate with "land," such as proximity to important things. In the verification section the authors say: As a result of the analysis, since the significance level (0.000) p <.05, corresponding to the F values in the ANOVA test, indicates that the regression analysis is appropriate and the models are significant. The criteria that make up the model account for about 85% of the market value and 15% cannot be explained for reasons such as economic, non-existent data and unearned income. Unfortunately, they don't say anything about how accurate their model is for assessing land values specifically. Otherwise, this is a pretty good example of using the Multiple Regression method for estimating the individual contributions of various factors to overall property values. Gwartney says Multiple Regression Analysis was a standard method he typically used, of which this specific paper is just one example. Nonparametric kernel regression This will be a method familiar to the programmers in the audience who have any experience with image processing algorithms. Here's an example from this old Gamasutra article: The basic idea here is to take a matrix of numbers, called a "kernel", and run that over every pixel in a source image. The kernel tells you how strongly to weight all of the source pixel's neighbors to compute a final result for that position. A simple "box blur" is a kernel where every value is 1 (meaning it averages the values of all neighboring pixels within a range). The more subtle gaussian blur illustrated above uses a two-dimensional normal distribution of values so that each pixel is most affected by those nearest to it. So let's apply the same principle to land valuations. If you have a map with lots of transaction data of pure land sales–defined as sales of either vacant land or teardown properties (where the building value is essentially zero)–then you can use a special kernel filter to smoothly interpolate land values across the region. So you basically have a smooth curve that mostly favors close-by points, tapers off a bit, and then disregards anything outside a certain distance entirely. The big assumption here is that land values change smoothly and do not change suddenly across very short distances. There are, in fact, locations with sharp jumps in value (any town with an "other side of the tracks," for instance). But for cases where we know a priori that land values change smoothly, this method is appropriate. No other prior restriction is placed on the form of the land value map, however, and this is why it's called "nonparametric." Here's an illustration. The outer box is the entire search distance that the kernel considers, and the circles represent the falloff of the curve itself. The size of the box is called the "bandwidth" and is set by the user. Everything outside of it will have zero influence on the kernel's output at any given location. This method operates on the same basic logic that I used when I hand-estimated the land value of that San Francisco house in Part I based on the value of the empty lot next door. However, it makes the whole procedure systematic. It can easily and accurately estimate the land value of a property with a big fat building on it simply by smoothly interpolating the known values of the nearby parking lots. Of course, it has limitations. First and foremost, it's a highly local operation, so if you have properties you're trying to value that don't have nearby pure land sales data, you can't really do much with this. Also, most people assume that city centers have less market transactions for undeveloped land than the countryside, as did I until I read that paper by Albouy in Part I. But in any case, this is just one method in your toolbox and might not be sufficient by itself. Its key advantage is that it works directly from true market data for land and doesn't need or want any other subjective data. In the end, basic kernel estimation just fills in the land value of unmeasured locations with a local weighted average of known locations. Nonparametric adaptive regression Kolbe, et al. build on the kernel regression method with a technique called Adaptive Weights Smoothing (AWS), which runs in several iterations and adds additional weight to any observed data points that are sufficiently close to the point being estimated. I'm not 100% sure about what all the math means, but it seems like it's basically a "smarter" version of the basic kernel method. Left: Nonparametric kernel regression, Right: Adaptive Weights Smoothing. I think the authors goofed and printed the same figure twice with different headings because they're identical if you overlay them in Photoshop. Semiparametric regression Now, the above two methods assume you have plenty of "pure" land sale records to work with. But if you're trying to work out prices in the city center, you've probably mostly got land and buildings mixed together. To do this effectively, we need more data, and this is where the "parameter" in "semiparametric" comes in. The model described in Kolbe et al. seems like a flavor of multiple regression analysis that takes the price, the location, and various characteristics of the building and feeds it into a regressor. But we've got "semi" parametric here. What does that mean? Well, if you already know how certain relationships between the data work a priori, it's better to enforce those relationships yourself rather than leave it to the computer. Here, we enforce the assumption that if two properties are right next to each other, then the value due to location is going to be essentially identical. This algorithm starts by ordering things geographically and then working out the differences in observed price by regressing on the difference between remaining property characteristics. In this method, the power of "location, location, location" is not something we're leaving to the regressor to discover by itself. Results of the Semiparametric regression method, we can see some significant differences from the simple kernel-based model. As you can see above, this gives you more detailed and likely more accurate results, and you're better able to assess the values of properties with buildings on them, even in the absence of pure land sales. This technique is more complicated and bakes in assumptions about the power of location, but otherwise doesn't assign subjective human weights to the various property characteristics. The chief human bias comes in the form of deciding which property characteristics are measured and made legible to the model in the first place. Okay great, but how accurate are the above three methods? Their main point of comparison is this thing called the "Bodenrichtwerte," or BRW. I think that means "ground-level-values" in English, and it's an expert-assessed map of land values for Berlin done the traditional way. The nonparametric kernel regression method has a correlation of 0.704 with the traditional method and has the added disadvantage that it's not able to produce estimates for the city center, only the outlying areas. Furthermore, the BRW map does show sharp discontinuities, which is another knock against the kernel method, at least for the city center. What about the iterative method? Kolbe et al. find that "the agreement between [Adaptive Weights Smoothing] land value estimates and, both, land prices and BRW land values is fairly good for all values of λ." Doing some quick checks, their values seem to be within about 85% of the BRW values. A different Kolbe et al. paper called Identifying Berlin's land value map using adaptive weights smoothing goes into more detail and claims to give "similar" values to that of the BRW. For the semiparametric method, they "found a strong positive correlation of 0.845" between their numbers and a previously expert-assessed set done using the traditional method. That sounds pretty good. It seems their margin for error is about plus or minus 15% compared to the traditional expert method. I'd like to see more direct comparisons against market transactions themselves, though, because if the prior expert assessments are wrong, then the main achievement here is improved efficiency, not accuracy. However, this method doesn't seem to be dramatically less accurate than the old way of doing things. The last three models came from the Berlin case study, where you have excellent market transaction data in an extremely wealthy and high-trust society. But what if you're trying to assess land in a developing nation with poor market transaction records, weak institutions, and widespread poverty? Innovative Land Valuation Model (iLVM) This is the particular name of the method described in Development of an Innovative Land Valuation Model (iLVM) for Mass Appraisal Application in Sub-Urban Areas Using AHP: An Integration of Theoretical and Practical Approaches by Bencure, Tripathi, Miyazaki, Ninsawat, and Kim. They used BayBay City, Philippines as their case study. Whereas the previous models are very "hands-off" and let the computer work out the relationships between prices and property characteristics, here you get expert human opinion directly involved in building the model, baking in weights that directly embody judgments like "properties next to major roads are more valuable." These judgments are based on expert opinions that presumably come from observed experience but are a priori judgments nonetheless. Here, look at this big complicated flowchart. The "Analytic Hierarchy Process" in the box on the left is a particular kind of method for getting experts to set weights. The authors give this reason for using it: Despite criticism pinpointed by other scholars, the AHP remains the commonly used in many research fields and practical applications. This is because the AHP: (1) overcomes human difficulty in making simultaneous judgment among factors to be considered in the model; (2) is relatively simple as compared to other MCDA [multi-criteria decision analysis] methods; (3) is flexible to be integrated in various techniques such as programming, fuzzy logic, etc.; and (4) has the ability to check consistency in judgment After identifying a list of "factors" that can affect land value, they group them into taxonomical buckets: Note that certain factors like "Coastline" appear in multiple buckets; this captures the various influences a characteristic can have. For instance, land on the coast tends to be more economically valuable because of tourism, shipping, fishing, etc., so that goes under "economic." But land that's next to the coast is also more likely to flood, so it also goes under "environmental." And then there are various land use restrictions that apply specifically to coastal areas, so it goes under "legal" as well. In this way, a single factor like "the property is on the coastline" can have both positive and negative effects on land value (e.g., it's more economically valuable but it also might flood, and there are certain things you aren't allowed to do there). The next step is to set down some rules for how sensitive each factor is to location and distance. So here we can see that the economic benefit of being on the coast is most strongly felt if you're within half a kilometer of the ocean, but the environmental effect (e.g., risk of flooding) is most strongly felt when you're within 0.03 kilometers. And so on and so forth. Your experts help you work out all these rules. Note that for a few of these factors (such as land use and slope), you use metrics other than distance (e.g. land use classification and grade). Then you take all that stuff and assign everything a value between 0 and 5. Your team of experts then uses this table to come up with a set of weights for everything. What essentially comes out of this is a big linear equation with a bunch of coefficients for every one of your factors, which is then broadly fit to the observed market prices. When you're done, you can take any property on your list, multiply each of its characteristics by its respective weight, run that through your equation, and calculate the predicted price of the land. So how accurate is it? The authors compare it to standard Multiple Regression Analysis and claim it fares better. The Root Mean Square Error is quite a bit less than MRA. In addition, I think it's also saying that the MRA algorithm decided that only four of the factors were significant and basically ignored all the rest. By contrast, iLVM was able to maintain contributions from all the factors, because it doesn't leave that decision to the computer. I'm not 100% sure; it's not clear from the paper. The authors claim that about 67% of the variability is explained by their model, but they note that there are some areas where the model can be off by more than a factor of 1.0 in either the positive or negative direction. One thing that's kind of fun about this model is that you can make neat graphs like this that show the individual contribution of each factor: The main downside to this model is that it relies on a whole lot of subjective expert opinion and can be questioned on that basis. That said, it can be cheaply deployed in a transparent and consistent way across a large area. You can see why that's attractive for a developing nation with weak institutions and poor market transaction records; the argument is that this is a significant improvement over the former status quo. I wonder how well this model performs when you feed it better market transaction data, and how that would compare against all the others methods under identical conditions. More research is needed. Rather than drag you through a bunch more research papers, I'll just leave these others I found cited in the above studies: Killić et al. (2019) - Fuzzy expert system for land valuation in land consolidation processes

Book Review: Which Country Has The World's Best Health Care?

January 19, 2022 · Original source

But partly it’s because all national health systems are surprisingly similar. One of my favorite books is David Friedman’s Legal Systems Very Different From Ours, which catalogues the world’s weirdest legal systems and expands your space of possibilities about what law codes would be like. I was hoping to find something similar here, but Emanuel’s book could easily have been titled Medical Systems Very Similar To Ours. People talk about how the US system is “privatized” and the Canadian system “socialized”, but a lot of this comes down to whether your payments for the same basic package are marked “paycheck deductions” vs. “taxes”. Or whether your choices are limited to one state insurance company vs. to 2-3 plans offered by your employer which are legally mandated to be basically the same. It was hard to find any really fundamentally different visions. And absent truly different designs, the 300 pages were a lot of stuff on how various bureaucracies were organized and which three-letter acronyms they used.

Inline links: Legal Systems Very Different From Ours

But this made it hard for me to understand this section of the book, which praised countries who managed to keep drug prices low. “Keeping drug prices low” mostly seems to involve having a process that reliably generates low numbers for the government’s offers. For example, Canada used to have high drug prices, because its process was to offer the average price paid by seven other countries: France, Germany, Italy, Sweden, Switzerland, UK, and US. But then the Canadians decided that was too high, and removed the US from their basket; since the US had the highest drug prices, this brought the average price down, and made Canadian drugs cheaper. Emanuel praises this as a good decision. But Norway does even better: they take the average of the cheapest three countries in their basket. Obviously this works, but then why not the cheapest two? Why not just say your drug price will be Norway’s price minus one dollar? Half Norway’s price? I didn’t get a good sense of why some countries had cheaper algorithms and baskets than others. Maybe they had tougher negotiators?

2: Single Payer With Very Limited Private Insurance is typical of Canada, China, Norway, and Taiwan. The government runs everyone’s insurance. But doctors, hospitals, etc can be independent businesses or nonprofits. They negotiate some kind of payment rate with the national insurance, who reimburses them. This is similar to how Medicare works in the US.

Highlights From The Comments On Health Care Systems

January 27, 2022 · Original source

I don't really think this is a question that could even be answered usefully in a statistically rigorous way, but I'll add that Peter Attia- a Canadian physician who currently runs a highly specialized clinic for the ultrawealthy in the US- has said something somewhat similar based on his experience (it was in a podcast episode, I don't remember which one, so you're going to have to take my word on it).

The take might be incorrect, and it might also be out of date- even pre-pandemic, the last few years have not been kind to Canada's healthcare system. He specifically gave the example of having a heart attack and showing up to an emergency room as a case where its better to be Canadian, which DEFINITELY feels out of date. But it broadly fits with what I've heard a lot of providers who have practiced in both the US and another developed country say.

I want to push back on the assertion Scott made that "Certainly rich people in America get good health care." After he published this book in June 2020, Ezekiel Emmanuel published an article in JAMA IM (link: https://bit.ly/3nGRHL8) called "Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries." He wanted to test the commonly stated trope that a feature of the US healthcare system is that the rich here get the very best care in the world. To do that, he looked at outcomes across six benchmark diseases (heart attack, colon cancer, breast cancer, infant mortality, maternal mortality, and pediatric acute lymphocytic leukemia). He compared outcomes for white people in the 1% of richest counties in the US, 5% richest counties in the US, and average outcomes in 12 rich countries (i'm not going to type them all out but they're places like Australia, Canada, and Germany). The results were...not so great for rich Americans!

Inline links: https://bit.ly/3nGRHL8

Predictions For 2022

February 01, 2022 · Original source

YGLESIAS PREDICTIONS 1. Democrats lose both houses of Congress (90%) HOLD 2. Democrats lose at least two Senate seats (80%) HOLD 3. Democrats lose fewer than six Senate seats (80%) HOLD 4. Nancy Pelosi announces retirement plans (70%) HOLD 5. Stephen Breyer does not retire (60%) N/A 6. Some version of Build Back Better passes (60%) HOLD 7. Joe Biden is still president (90%) HOLD 8. At least one Biden cabinet-rank official resigns (70%) HOLD 9. No military conflict between the PRC and Taiwan (a worryingly low 90%) HOLD 10. New U.S. sanctions on Russia (70%) HOLD 11. Saudi Arabia and Israel establish diplomatic relations (60%) SELL to 50% 12. Fewer U.S. Covid deaths in 2022 than in 2021 (80%) BUY to 90% 13. Emmanuel Macron re-elected (60%) HOLD 14. Traffic light coalition exploits loopholes to get around the constitutional debt brake (70%) HOLD 15. No recession in 2021 (90%) SELL to 80% 16. Liz Cheney loses primary (80%) HOLD 17. Some version of USICA passes Congress (70%) HOLD 18. Lula elected president of Brazil (60%) SELL to 50% 19. China officially abandons Covid Zero (70%) HOLD 20. Fewer U.S. Covid-19 deaths in 2022 than in 2020 (80%) BUY to 90% 21. Additional booster shots of mRNA vaccines authorized for seniors (80%) HOLD 22. November 2022 year-on-year CPI growth is below 6% (70%) BUY to 80% 23. November 2022 year-on-year CPI growth is above 4% (70%) SELL to 50% 24. The Fed ends up doing more than its currently forecast three interest rate hikes (60%) HOLD 25. Russia does not invade Ukraine (60%) HOLD 26. Viktor Orbán loses power in Hungary (60%) HOLD 27. Sinn Fein becomes the largest party in the Northern Ireland assembly (60%) HOLD 28. The U.S. and Canada reach an agreement on softwood lumber (70%) HOLD 29. Democrats go down at least one governor on net (60%) HOLD 30. The unemployment rate stays between 4 and 5% (70%) SELL to 60% if you mean 12/22, to 40% if you mean it never gets outside that range at all

Your Book Review: The Internationalists

July 01, 2022 · Original source

Well, let me ask you a question. Why didn't the death of Princess Diana in France because of a car chase with a paparazzo cause Italy to go to war with Canada?

Your Book Review: Viral

July 30, 2022 · Original source

[4] This report was widely criticized, with the governments of the US, Canada, Australia, Japan, South Korea, the UK, and others expressing “shared concerns” about the investigation. Even the head of the WHO, Dr. Tedros, suggested that a more thorough follow-up investigation might be required.

Meetups Everywhere 2022: Times & Places

August 26, 2022 · Original source

HUNTSVILLE, AL Contact: Mike, mjhouse[at]protonmail[dot]com Time: Saturday, September 3, 3:00 PM Location: Barnes & Noble – 300 The Bridge St #100, Huntsville, AL 35806. I'll be in the cafe with a sign that says ACX MEETUP on it. Coordinates: 866MP88H+53 Event link(s): LessWrong Notes: Barnes & Noble has an area for little kids. If you want to bring a service animal, that's probably fine, but I doubt they allow pets. PHOENIX, AZ Contact: Ben Morin, benjamin[dot]j[dot]morin[at]gmail[dot]com Time: Saturday, October 15, 1:00 PM Location: Thirsty Lion Pub in Tempe. I will have a table with an ACX sign. Coordinates: 8559FVVQ+6C Event link(s): LessWrong Group info: This will be our 5th meetup (started during the meetups everywhere last year). Notes: Please email if interested to be added to the email list, even if you can't make this event BELMONT, CA Contact: Moshe Z., belmont-acx[at]devskillup[dot]com Time: Sunday, September 4, 2:00 PM Location: Twin Pines Park, Picnic Tables. The table will have some sign saying 'ACX Meetup' on it. Coordinates: 849VGP8C+RRG Event link(s): LessWrong Group info: You can join the mailing list here. BERKELEY, CA Contact: Scott Time: Sunday, September 18, 1:00 PM Location: Rose Garden Inn, a rationalist event space at 2740 Telegraph Ave. Come in through the front gate on Telegraph. Coordinates: 849VVP5R+X7V Event link(s): LessWrong Group info: The Bay rationality community has a mailing list, a Discord server, and a Facebook group. There are dinner meetups every Thursday at 7 PM in the East Bay, and occasional meetups in SF and South Bay. FILLMORE, CA Contact: Ryan, wiserd[at]gmail[dot]com, Discord: Wiserd#0906 Time: Saturday, October 1st, 6:00 PM Location: It's my house. There are a bunch of plants on the porch and garbage bins in the driveway. Coordinates: 856393VX+VQ Event link(s): LessWrong Notes: Please RSVP to my email or Discord. Kids and dogs are welcome in the back yard. Full vaccinations (on the honor system) and masks required. GRASS VALLEY, CA Contact: Max Harms, raelifin[at]gmail[dot]com Time: Saturday, September 10, 2:00 PM Location: Condon Park by the prospector statue. In the case of rain we'll change the location to a residence, so RSVP to get updated! Coordinates: 84FW6W8H+C5 Event link(s): LessWrong IRVINE, CA Contact: Nick C, cohenskijanuary1[at]mail[dot]com Time: Saturday, October 1, 2:00 PM Location: University Town Center Coordinates: 8554M526+7H Event link(s): LessWrong Group info: We meet once a month at the same location. LOS ANGELES, CA Contact: Vishal Prasad (koreindian), vprasadcs[at]gmail[dot]com, Contact me on Discord. I am "Vishal" on the server. Time: Saturday, October 8, 6:30 PM Location: 11841 Wagner St., Culver City, CA 90039 Coordinates: 8553XHWM+GP Event link(s): LessWrong Group info: We meet weekly every Wednesday. We have been around for over 8 years. We discuss articles, watch movies, lift weights. We have a Discord server, a LessWrong group, and a website! Notes: Please RSVP on LessWrong so I know how much food to get. NEWPORT BEACH, CA Contact: Michael M, michaelmichalchik[at]gmail[dot]com Time: Saturday, August 27, 2:00 PM Location: Picnic tables next to 1900 Port Carlow community clubhouse. The park is verdant and pleasant and easy to access. Free street parking nearby. In case of bad weather, we have a couple of near by places to relocate to. Coordinates: 8554J48R+WCX Event link(s): LessWrong, Facebook event Group info: We will meet most Saturdays at 2pm until whenever. There will be short suggested readings and question most weeks to spur conversation, but they are optional. Each week we will ask if people have had something happen recently that surprised them or changed the way they looked at the world. Something that should or did update their priors. Participation is optional. Notes: Its a public park with tables and BBQ's so you can bring food and well behaved pets. We may regularly go on casual walks in the surrounding area. SAN DIEGO, CA Contact: Julius, julius[dot]simonelli[at]gmail[dot]com Time: Sunday, October 9, 3:00 PM Location: We will meet up in Bird Park. I will be wearing a red shirt. Coordinates: 8544PVQ8+Q7 Event link(s): LessWrong, Meetup.com Group info: Join our Discord server SAN FRANCISCO, CA Contact: Derek Pankaew, derekpankaew[at]gmail[dot]com Time: Sunday, September 18, 11:00 AM Location: We'll between in the Panhandle, between Ashbury and Masonic, with a 'ACX' sign. Coordinates: 849VQHC3+V8 Event link(s): LessWrong SAN JOSE, CA Contact: David Friedman, ddfr[at]daviddfriedman[dot]com Time: Saturday, September 17, 2:00 PM Location: 3806 Williams Rd, San Jose, CA 95117 Coordinates: 849W825J+6P Event link(s): LessWrong Group info: Before Covid we hosted every month or two. No structure, just conversation and food. We feed everyone who is still there at dinner time. We have done it once or twice since Covid. I have an email list of interested people. Notes: Kids are welcome. Please RSVP to my email so I will have a rough count of how many we are feeding. SAN MARCOS, CA Contact: Eric F., EricF14159[at]gmail[dot]com Time: Sunday, September 25, 2:00 PM Location: Hollandia Park Soccer Field. At the tables near the top parking lot. Coordinates: 85544VW4+RV Event link(s): LessWrong BOULDER, CO Contact: Josh Sacks, josh[dot]sacks+acx[at]gmail[dot]com Time: Sunday, October 16, 3:00 PM Location: 9191 Tahoe Ln, Boulder, CO 80301 Coordinates: 85GP2V96+JQ Event link(s): LessWrong Notes: Please RSVP on LessWrong so we know ~ how many people to expect! CARBONDALE, CO Contact: Nick, naj[at]njarboe[dot]com Time: Saturday, September 3, 1:00 PM Location: Sopris Park - Center covered picnic tables - blue shirt with ACX sign on table Coordinates: 85FJ9QXP+QMF Event link(s): LessWrong DENVER, CO Contact: Ian Philips, iansphilips[at]gmail[dot]com, Discord: palebone#2796 Time: Sunday, October 2, 11:00 AM Location: We'll be in the backyard patio of St. Mark's Coffee House. I'll wear a white shirt with (my brothers') baby faces on it and have a brown hat on. Coordinates: 85FQP2VP+9R Event link(s): LessWrong Group info: We meet typically 4 times a year. LAKEWOOD, CO Contact: Steven Zuber, stevenjzuber[at]gmail[dot]com Time: Wednesday, October 5, 7:00 PM Location: We meet in the clubhouse located in this townhome community: 8769 W Cornell Ave Lakewood, CO 80227 Coordinates: 85FPMW64+MW Event link(s): LessWrong, Meetup.com Group info: We meet the first Wednesday of every month. Informal, casual atmosphere with occasional presentations by people. Notes: Check the Meetup page or Facebook group for updates. FAIRFIELD, CT Contact: Justin Barclay, barclay[dot]justin[at]gmail[dot]com Time: Saturday, September 10, 10:00 AM Location: South Pine Creek Beach. I'll set up near the lifeguard stand. Coordinates: 87H84PCH+CM Event link(s): LessWrong MANCHESTER, CT Contact: Mike, park-mike[at]outlook[dot]com Time: Saturday, September 17, 5:00 PM Location: Near flagpole on top of hill Coordinates: 87H9QFFH+J7 Event link(s): LessWrong NEW HAVEN, CT Contact: RM, acx[dot]meetup[dot]nhv[at]gmail[dot]com Time: Sunday, September 18, 12:30 PM Location: Cross Campus (Yale University), New Haven, CT 06511. We'll be on the grass on the northern half of Cross Campus, closest to Sterling Memorial Library. I'll be wearing an orange shirt. Coordinates: 87H9836C+8VG Event link(s): LessWrong Notes: Feel free to bring friends! The vibe will be welcoming and relaxed, and you can stay for any amount of time. Please email me if you're thinking about coming so I can get the right number of Insomnia cookies! WASHINGTON, DC Contact: John Bennett, WashingtonDCAstralCodexTen[at]gmail[dot]com Time: Saturday, September 17, 6:00 PM Location: Froggy Bottom Pub: 2021 K Street NW, Washington, D.C. 20006 Coordinates: 87C4WX33+3J Event link(s): LessWrong, Facebook event Group info: The Washington DC ACX/SSC group has been active since the first Meetups Everywhere in 2017. We have Monthly Socials downtown, hikes, board game days, and other cultural events. We're looking to spin up more rationality Dojo-type events with nearby groups in the coming months. Notes: We've rented out the Froggy Bottom Pub for the night, dinner and soft drinks will be provided. Alcohol available for purchase if desired, but no purchases are required. Metered street parking on nearby blocks is free after 6:30. Closest Metros are Farragut West and Farragut North. CAPE CORAL / FORT MYERS, FL Contact: Shawn Spilman, shawn[dot]spilman[at]outlook[dot]com, 508 655 8123 Time: Sunday, October 2, 1:00 PM Location: 929 SW 54th Ln, Cape Coral, FL 33914 Coordinates: 76RWH224+44 Event link(s): LessWrong Notes: RSVP via email. I can be flexible about the date. GULF BREEZE / PENSACOLA, FL Contact: Christian, christian[dot]h[dot]williams[at]gmail[dot]com Time: Wednesday, October 12, 7:30 PM Location: The Bridge Bar - 33 Gulf Breeze Pkwy A, Gulf Breeze, FL 32561 Coordinates: 862J9RCF+G6 Event link(s): LessWrong Notes: Please RSVP by emailing me. Thanks! If I don't hear from anyone, I won't be there. I work for Metaculus, but promise not to talk your ear off about forecasting. (Unless you want it talked off.) MIAMI, FL Contact: Eric Magro, eric135033[at]gmail[dot]com, Discord: eric135#4943 Time: Sunday, September 11, 5:00 PM Location: Buckminster Fuller Fly's Eye Dome 140 NE 39th St #001, Miami, FL 33137 ----- Look for a paper sign on a table that says ACX MEETUP west of the dome. Coordinates: 76QXRR65+V2 Event link(s): LessWrong Group info: Miami ACX started in 2017. Our official meetup happens monthly in either Miami or Broward. There are activities happening on a weekly basis from Miami to Palm Beach. We have a Facebook group, Discord server, and Meetup.com group. ORLANDO, FL Contact: Noah Topper, noah[dot]topper[at]gmail[dot]com Time: Friday, September 16, 7:00 PM Location: 4000 Central Florida Blvd, Orlando, FL. We'll be meeting up at UCF's pavilion near Garages A and I. I'll have a pretty ACX Meetup sign. Coordinates: 76WWJQ2X+82 Event link(s): LessWrong Group info: We try to meet up once a month, so far they've just been casual social meetups with natural discussions of rationality topics. Here's our Discord link :) Notes: RSVPs on LessWrong would be greatly appreciated. :) TALLAHASSEE, FL Contact: JF, jf19o[at]fsu[dot]edu Time: Monday, August 29, 2:00 PM Location: Landis, FSU. I will be wearing a black shirt Coordinates: 862QCPR3+PX Event link(s): LessWrong ATHENS, GA Contact: Dallon, knox[dot]dallon[dot]a[at]gmail[dot]com, Discord: leonard#4208 Time: Saturday, October 15, 3:00 PM Location: Hendershots on Prince Avenue Coordinates: 865RXJ68+2W Event link(s): LessWrong Notes: I might bring some board games ATLANTA, GA Contact: Steve French, steve[at]digitaltoolfactory[dot]net Time: Saturday, September 17, 2:00 PM Location: Bold Monk Brewing - 1737 Ellsworth Industrial Blvd NW suite d-1 · Atlanta, GA (upstairs – look for the ACX Atlanta sign) Coordinates: 865QRH2F+V8 Event link(s): LessWrong, Meetup.com Group info: We've been in existence for four years – we have a dedicated crew and a very active Slack group Notes: Please RSVP on LessWrong or Meetup.com HONOLULU, HI Contact: Matt Popovich, mattpopovich[at]outlook[dot]com Time: Saturday, September 3, 4:00 PM Location: We'll meet at Magic Island at Ala Moana Beach Park, 1201 Ala Moana Blvd, Honolulu, HI 96814. From the parking lot, walk along the left side of the peninsula out toward Magic Island Lagoon. We're usually near the end of the peninsula, somewhere around the bathroom building. Look for the large 'ACX' sign. Coordinates: 73H475M3+JP Event link(s): LessWrong, Meetup.com Group info: Honolulu Rationality hosts discussion meetups about twice a month in Ala Moana Beach Park. Check us out on our website BOISE, ID Contact: Julia and John, jae[dot]miomu[at]gmail[dot]com Time: Friday, October 7, 6:00 PM Location: Old Timer's Shelter in Ann Morrison Park. I will have an ACX sign. Coordinates: 85M5JQ6P+96 Event link(s): LessWrong Notes: Please RSVP and feel free to bring kids. CHAMPAIGN-URBANA, IL Contact: Ben, cu[dot]acx[dot]meetups[at]gmail[dot]com Time: Friday, September 9, 7:00 PM Location: Siebel Center for Computer Science, Room 4403 Coordinates: 86GH4Q7G+H8F Event link(s): LessWrong Group info: Discord server Notes: RSVPs are appreciated but not at all required. You can RSVP by email or by pinging me in the Discord server. Suggested entrance is the East side of the building (see Coordinates) - we'll try to make sure at least that door is unlocked, but if it isn't then ping us on email or Discord. CHICAGO, IL Contact: Todd, info[at]chicagorationality[dot]com, https://chicagorationality.com/ Time: Sunday, September 18, 1:00 PM Location: Grant Park - North side of Balbo between the tracks and Columbus Coordinates: 86HJV9FH+84 Event link(s): LessWrong Group info: Chicago Rationality does a monthly discussion meetup (typically the first Saturday of the month) and a monthly social meetup (typically the third weekend of the month) Notes: Sign up for our email list to be notified of future meetups EVANSTON, IL Contact: Uzair, uzairq93[at]gmail[dot]com Time: Saturday, October 1, 7:00 PM Location: 626 Church Street, Evanston IL 60201 Coordinates: 86JJ28X9+5WQ Event link(s): LessWrong Notes: The venue is a pub but it's really more of a restaurant, big long tables available so space should be fine and non drinkers shouldn't feel too out of place. BLOOMINGTON, IN Contact: Avery, acxbloomington[at]fastmail[dot]com Time: Sunday, October 16, 2:00 PM Location: Switchyard Park. Will be at one of the tables near the Rogers Street parking lot. I will bring a cardboard sign that says “ACX”. Coordinates: 86FM4FX6+4Q Event link(s): LessWrong Group info: We met last year for Meetups Everywhere and it was fun! Here's a link to our Discord. Notes: You can RSVP via Discord or email, but you are encouraged to show up even if you did not RSVP! WEST LAFAYETTE, IN Contact: NR, mapreader4[at]gmail[dot]com Time: Saturday, September 17, 1:00 PM Location: 1275 1st Street, West Lafayette, IN 47906. We'll be in the south of the Earhart Hall lobby (not the dining court) near the piano, and I will be wearing a green shirt and carrying a sign with ACX MEETUP on it. Coordinates: 86GMC3GG+728 Event link(s): LessWrong LEXINGTON, KY Contact: Nathan, nwculley[at]gmail[dot]com Time: Saturday, September 3, 7:00 PM Location: Blue Stallion Brewing. 610 W. 3rd St., Lexington, KY 40508. We will have a sign indicating we are the ACX meetup. Coordinates: 86CQ3F4X+VF Event link(s): LessWrong Group info: We meet 1-2 times a month to talk about ACX, books, memes, etc., often over drinks and board games. NEW ORLEANS, LA Contact: Blake, blake[at]philosophers[dot]group Time: Sunday, September 4, 11:11 AM Location: Petite Clouet Cafe. Look for the group with an iPad that has a People’s Pint sticker. Coordinates: 76XFXX73+8R Event link(s): LessWrong Group info: Website Notes: Hybrid in-person and online, video link sent weekly. Email for the link. BOSTON, MA Contact: Robi Rahman, robirahman94[at]gmail[dot]com, 7039818526 Time: Saturday, September 10, 5:00 PM Location: Boston Common, at the Parkman Bandstand gazebo Coordinates: 87JC9W3M+PR Event link(s): LessWrong, Facebook event Group info: Mailing list, Facebook group, Meetup.com Notes: We'll be providing food at the meetup, and giving out free books related to ACX, rationality, and effective altruism. Email the hosts if you'd like a particular book or you have any dietary restrictions. Our group is also doing a tour of the JFK Presidential Library on September 9, you’re welcome to join! NORTHAMPTON, MA Contact: Alex, alex[at]alexliebowitz[dot]com Time: Friday, September 9, 6:00 PM Location: The Deck, 125A Pleasant St., Northampton MA 01096. The official address is bizarre and inaccurate; it's the outdoor dining part of a group of bars & restaurants in a former rail station... a whole block away from Pleasant St. The simplest way to get to The Deck is to enter The Platform, one of the other restaurants, by its street entrance around 36 Strong Ave., here (make sure to look at street view). Go inside and ask them to show you to The Deck. We'll have a sign. Coordinates: 87J9899F+H7H Event link(s): LessWrong, Facebook event Group info: We started in the 2018 Meetups Everywhere and is still going strong. We aim to meet about once every two weeks. At most meetups we get about 5-7 people out of a rotation of 15-20; Meetups Everywhere and other special events tend to bring in a few more than usual. We're a totally social meetup with no 'format' or suggested readings. Although it's not rare for us to touch on ACX articles and related topics, the conversation varies wildly, and you are welcome even if you're the most occasional ACX reader. Notes: We have a (not very active) Discord where you can DM me or post on a public channel. I'm most responsive by email. There is a small chance we'll have to change the location to somewhere else in Northampton. Please check the Less Wrong or Facebook posts on or after August 26 to get the final word on location. BALTIMORE, MD Contact: Rivka, rivka[at]adrusi[dot]com Time: Sunday, September 11, 7:00 PM Location: UMBC outside of the Performing Arts and Humanities Building, on the north side. I will have a sign that says ACX meetup. Parking is free on the weekends. Edit: Rain is forecasted; if it’s raining, we will be inside of the Performing Arts building, on the ground floor just inside the entrance. Coordinates: 87F5774P+53 Event link(s): LessWrong Group info: We meet Sundays at 7pm — half are in person and half are virtual. Notes: There will be pizza and drinks DETROIT, MI Contact: Matt Arnold, matt[dot]mattarn[at]gmail[dot]com Time: Tuesday, September 20, 7:00 PM Location: Tenacity Craft, 8517 2nd Ave, Detroit, MI 48202 Coordinates: 86JR9WG9+R6 Event link(s): LessWrong MINNEAPOLIS, MN Contact: Timothy, tmbond[at]gmail[dot]com Time: Saturday, September 10, 1:00 PM Location: Meet at the picnic tables near the southeast corner of Powderhorn Park - the ones by the parking lot. I will be wearing a green Google t-shirt and have a sign that says ACX. Coordinates: 86P8WPRW+76 Event link(s): LessWrong Notes: I will bring some snacks (but not a full lunch, so eat before or bring something if you'll be that hungry). Please RSVP on LessWrong. KANSAS CITY, MO Contact: Alex, alex[dot]hedtke[at]gmail[dot]com Time: Friday, September 16, 6:30 PM Location: We will be in the courtyard above Whole Foods (which is also an apartment complex). You can enter through the apartment lobby, located on Oak Street. We will have runners shepherding people from the entrance up to the courtyard. Coordinates: 86F72CM8+RR Event link(s): LessWrong, Meetup.com SAINT LOUIS, MO Contact: JohnBuridan, littlejohnburidan[at]gmail[dot]com Time: Saturday, October 8, 1:00 PM Location: Lily Pond Shelter, Tower Grove Park, St. Louis Coordinates: 86CFJP4R+XV Event link(s): LessWrong Notes: BYOB WEST PLAINS, MO Contact: Liam, liamhession[at]gmail[dot]com Time: Saturday, September 17, 12:00 PM Location: 10/40 Coffee, 24 Court Square, West Plains, MO Coordinates: 868CP4HW+CV Event link(s): LessWrong Notes: Hoping to get anyone from around the Ozark region DURHAM, NC Contact: Will Jarvis, willdjarvis[at]gmail[dot]com Time: Thursday, September 8, 7:30 PM Location: Ponysaurus Brewing Company, 219 Hood St, Durham Coordinates: 8773X4Q3+QW Event link(s): LessWrong Group info: We meet weekly! We also have a Discord LAKEWOOD, NJ Contact: Ben L, mywebdev3[at]gmail[dot]com Time: Saturday, October 29, 8:30 PM Location: TBD Event link(s): LessWrong MORRISTOWN, NJ Contact: Matt, matt[dot]brooks[at]impactmarkets[dot]io, Discord: Matt B#0216 Time: Saturday, October 1, 2:00 PM Location: 10 N Park Pl, Morristown, NJ 07960 (at the center of the Morristown Green) Coordinates: 87G7QGW9+RJ Event link(s): LessWrong Group info: This is the first meetup, come be a founding member of the Northern NJ ACX/EA/LW group! PRINCETON, NJ Contact: Danny K, dskumpf[at]gmail[dot]com Time: Saturday, October 1, 3:00 PM Location: Palmer Square, Princeton, NJ 08540. On the green right outside The Bent Spoon and Rojo's Roastary, near the big tree. I'll have some sort of ACX Meetup sign! Coordinates: 87G7982Q+2CP Event link(s): LessWrong LAS VEGAS, NV Contact: Jonathan Ray, ray[dot]jonathan[dot]w[at]gmail[dot]com Time: Sunday, September 11, 11:45 AM Location: At El Segundo Sol restaurant with giant ACX MEETUP signs Coordinates: 85864RHJ+3H Event link(s): LessWrong, Facebook event Group info: We meet regularly and mostly just socialize. We have a new Discord server. RENO, NV Contact: Steven, stevenl451[at]gmail[dot]com, Discord: Steeven#7407 Time: Friday, September 2, 5:30 PM Location: We'll be in Crissie Caughlin Park, near the tables and the swing set Coordinates: 85F2G46W+FG Event link(s): LessWrong Notes: Feel free to bring kids/dogs and please RSVP on LessWrong if you are going BUFFALO, NY Contact: George Herold, ggherold[at]gmail[dot]com Time: Sunday, September 11, 1:00 PM Location: 932 Welch Rd. Java Center, NY 14082 Coordinates: 87J3W467+8P Notes: Last-minute location change! LONG ISLAND, NY Contact: Gabe, gabeaweil[at]gmail[dot]com Time: Thursday, October 27, 7:00 PM Location: Whales Tale in Northport Coordinates: 87G8VJRW+99 Event link(s): LessWrong NEW YORK CITY, NY Contact: Jasmine, jasminermj[at]gmail[dot]com Time: Sunday, September 11, 4:00 PM Location: Pavillion @ Rockefeller Park, Warren St / River Terrace Coordinates: 87G7PX9M+4J3 Event link(s): LessWrong Group info: OBNYC has a Discord and a Google Group; the Google Group is the main mailing list we use for events NEWBURGH, NY Contact: Pedro David Bonilla, proportionatetoevidence[at]gmail[dot]com, Cell 8452001681 Time: Saturday, September 24, 10:00 AM Location: Perkins Restaurant & Bakery, 1421 NY-300, Newburgh, NY 12550 Coordinates: 87H7GWCH+GF Event link(s): LessWrong ROCHESTER, NY Contact: Skivverus, skivverus[at]gmail[dot]com, Discord: Skivverus#5915 Time: Saturday, October 8, 1:00 PM Location: 4870 Culver Road; will be wearing a polo shirt, jeans, and glasses, and may or may not have figured out a sign due to just getting back from honeymoon. Look for a pair of parrots, one white, one green with a yellow/orange head. Coordinates: 87M46FM6+Q5P Event link(s): LessWrong Notes: Venue very near amusement park; non-bathroom, non-parking amenities are therefore available but not free. Plan accordingly. Not particularly attached to specific location named, just happen to live reasonably close to there; alternative suggestions acceptable. Canadian visitors also welcome should your logistics permit; airport transportation available. RSVP via Discord preferred, but email will also work. CLEVELAND, OH Contact: Jack Zhang, LukeZhao9[at]protonmail[dot]com Time: Saturday, September 24, 1:00 PM Location: Picnic tables at Wade Oval (university circle) Coordinates: 86HWG96Q+GC5 Event link(s): LessWrong COLUMBUS, OH Contact: Daniel, daniel[dot]m[dot]adamiak[at]gmail[dot]com Time: Saturday, September 17, 3:00 PM Location: Jeffrey Park - Clinton Shelter. I will be wearing a red shirt. Coordinates: 86FVX3C3+QF Event link(s): LessWrong Group info: We meet once a month. We discuss EA, AI and other two letter initialisms. Occasionally we go for walks in local grottos and nature trails. Notes: Email me if you want to be added to the mailing list to receive any updates or future invites. RSVPing is appreciated. TOLEDO, OH Contact: Scout, scout[dot]sivar[at]gmail[dot]com Time: Saturday, September 10, 12:00 PM Location: Black Kite Coffee Coordinates: 86HRMCCV+9R Event link(s): LessWrong OKLAHOMA CITY, OK Contact: bean, battleshipbean[at]gmail[dot]com Time: Sunday, October 9, 1:00 PM Location: Edmond Public Library/Shannon Miller Park. I will be wearing a hat that says USS Iowa on it. Coordinates: 8674MG3C+MW Event link(s): LessWrong Group info: Had four people last year and a good time, moved to Edmond because a lot of us are up here. ALBANY, OR Contact: Kenan (he/him), kbitikofer[at]gmail[dot]com Time: Saturday, October 1, 2:00 PM Location: Bowman Park, Albany, Oregon. In or near the shelter. I will wear a bright red shirt and carry a sign with ACX MEETUP on it. Coordinates: 84PRJWR7+XC6 Event link(s): LessWrong CORVALLIS, OR Contact: Ethan Ashkie, ethanashkie[at]gmail[dot]com Time: Wednesday, September 7, 6:00 PM Location: Common Fields, in the reserved outdoor seating near the entrance Coordinates: 84PRHP5P+VQ Event link(s): LessWrong EUGENE, OR Contact: Ben Smith, benjsmith[at]gmail[dot]com Time: Wednesday, August 31, 7:00 PM Location: The Barn Light, 924 Willamette St, Eugene 97401 Coordinates: 84PR2WX4+VV Event link(s): LessWrong Notes: Please RSVP on LessWrong so I know how much pizza to get, but if you forget, don't worry about it, we want you to come along anyway PORTLAND, OR Contact: Sam F Celarek, support[at]pearcommunity[dot]com, 513-432-3310, Discord: Sam Celarek#2845 Time: Friday, September 9, 5:00 PM Location: 205 NW 4th Ave Coordinates: 84QVG8FG+V4 Event link(s): LessWrong, Meetup.com Group info: Portland Effective Altruism and Rationality is very active. We have book clubs, bi-weekly AI safety meet-ups, bi-weekly topical meet-ups, bi-weekly socials, and have an active Discord. Notes: We would prefer you RSVP on Meetup.com a week beforehand so that we can get the right amount of food! HARRISBURG, PA Contact: Phil, acxharrisburg[at]gmail[dot]com Time: Saturday, September 24, 2:00 PM Location: Ever Grain Brewing Co, 4444 Carlisle Pike, Camp Hill, PA 17011 - We will be sitting at one of the picnic tables outside with an ACX MEETUP sign Coordinates: 87G562QQ+8P Event link(s): LessWrong Group info: Small monthly meetup group based out of Harrisburg - celebrating 1 year of actuality! You can see more of our events on LessWrong. INDIANA, PA Contact: Eric, ericindianapa[at]gmail[dot]com, 717-256-2717 Time: Saturday, September 24, 11:00 AM Location: Caffè Amadeus in downtown Indiana, PA. I will have a sign with 'ACX Meetup' on one of the tables. Coordinates: 87G2JRFX+48 Event link(s): LessWrong Notes: Please RSVP via email or text message so I know how many to expect. PHILADELPHIA, PA Contact: Wes and Diana, rationalphilly[at]gmail[dot]com Time: Thursday, September 22, 6:30 PM Location: The Philadelphia Ethical Society, 1906 Rittenhouse Square. The meeting room is in the basement, look for the signs. Coordinates: 87F6WRXG+FQ Event link(s): LessWrong Group info: We tend to meet in downtown Philly on the last Thursday of the month. We're aiming to make the Ethical Society our new steady location. We have many links: Discord, Google Calendar, Facebook, Meetup, Google Group Notes: We'll be ordering food from a local restaurant, so no need to eat first. BYOB PITTSBURGH, PA Contact: Justin, pghacx[at]gmail[dot]com Time: Saturday, September 24, 2:00 PM Location: Westinghouse Shelter @ Schenley Park (W Circuit Rd near Schenley Dr). We have the outdoor shelter reserved, so light rain shouldn't be a problem, but in the event of extreme weather, we may relocate indoors (our default 'contingency indoor location' is Crazy Mocha Coffee on 2100 Murray Ave in Squirrel Hill). Coordinates: 87G2C3Q4+773 Event link(s): LessWrong Group info: We meet monthly-ish for general discussion and chit-chat, email me if you'd like to be notified of future meetups. STATE COLLEGE, PA Contact: John Slow, auk480[at]psu[dot]edu Time: Thursday, September 8, 5:00 PM Location: Old Main. I will be carrying an ACX meetup sign. Coordinates: 87G4Q4WP+HV Event link(s): LessWrong SAN JUAN, PUERTO RICO Contact: Dan Gelfarb, danielgelfarb[at]gmail[dot]com Time: Saturday, September 10, 1:00 PM Location: Lote 23, back corner under the tents. I will be wearing a blue shirt with a sign that says ACX meetup on it. Coordinates: 77CMCWVM+W32 Event link(s): LessWrong PROVIDENCE, RI Contact: James Bailey, feanor1600[at]gmail[dot]com Time: Saturday, September 17, 4:00 PM Location: Prospect Terrace park, to the right of the Roger Williams statue Coordinates: 87HCRHJV+24 Event link(s): LessWrong SIOUX FALLS, SD Contact: S. C., villainsplus[at]protonmail[dot]com Time: Sunday, October 2, 5:00 PM Location: 410 E 26th St, Sioux Falls, SD 57105 - the pavillion on the west side of McKennan Park, or the tables just south of it if I can't book it. I'll be the guy with the grill. Coordinates: 86M5G7JH+W57 Event link(s): LessWrong MEMPHIS, TN Contact: Michael, michael[at]postlibertarian[dot]com Time: Monday, September 5, 1:00 PM Location: French Truck Coffee at Crosstown Concourse, Central Atrium 1350 Concourse Ave, Memphis, TN 38104. We will be at one of the many tables near French Truck Coffee and I will have a sign that says ACX MEETUP. Coordinates: 867F5X2P+QHC Event link(s): LessWrong Group info: We meet about every month or so. We've been around since 2019 but only regularly since mid 2021 due to the pandemic. We have a Discord server. NASHVILLE, TN Contact: Ellen, enwiegand[at]gmail[dot]com Time: Saturday, October 1, 11:00 AM Location: OneCity Nashville (8 City Blvd, Nashville, TN 37209), next to the volleyball courts. I'll have a pink ballcap that says SPINSTER on it. Coordinates: 868M552H+XW Event link(s): LessWrong AUSTIN, TX Contact: Silas Barta, sbarta[at]gmail[dot]com Time: Saturday, October 8, 12:00 PM Location: 4001 N Lamar, Austin Texas, park by Central Market near stone tables and tents Coordinates: 86248746+8C Event link(s): LessWrong Group info: Austin LessWrong has a weekly focused discussion, a weekly social mixer, a weekly online book club, and a monthly movie night. Been around since 2011. Notes: Location may change as we are talking to other venues BRYAN/COLLEGE STATION, TX Contact: Kenny, easwaran[at]gmail[dot]com Time: Friday, September 9, 5:00 PM Location: Back patio of Torchy's Tacos at Texas and New Main. I'll have a yellow umbrella and pinkish/purple hair Coordinates: JMFC+4J Event link(s): LessWrong DALLAS, TX Contact: Ethan Morse, ethan[dot]morse97[at]gmail[dot]com, Discord: ethanmorse#5255 Time: Sunday, September 11, 12:00 PM Location: Union, 3705 Cedar Springs Rd, Dallas, TX 75219. We'll be in the upstairs conference room. Coordinates: 8645R55R+9M9 Event link(s): LessWrong Notes: Please RSVP on LessWrong so I know how much food to get HOUSTON, TX Contact: Eric Magro, eric135033[at]gmail[dot]com Time: Sunday, September 18, 4:00 PM Location: Empire Cafe, 1732 Westheimer Rd, Houston, TX 77098 ---- Look for a table with an ACX MEETUP sign. Coordinates: 76X6PHVW+5H Event link(s): LessWrong Group info: There are meetups every week. We have a Discord and a Facebook group. WACO, TX Contact: Mike, BaylorACX[at]gmail[dot]com Time: Saturday, October 1, 1:00 PM Location: Cameron Park, picnic tables next to Jacob's Ladder Coordinates: 8634HVG2+V9 Event link(s): LessWrong Notes: Please email me if you're thinking about attending! Would love to start an ACX community here :) SALT LAKE CITY, UT Contact: Ross Richey (aka Jeremiah), wearenotsaved[at]gmail[dot]com Time: Saturday, October 8, 3:00 PM Location: Liberty Park near the ChargePoint stations Coordinates: 85GCP4WF+VJ Event link(s): LessWrong Group info: We meet every other month, we do book clubs and movie nights as well. Notes: Will be outdoors. If the weather looks bad, email event organizer to check on location. CHARLOTTESVILLE, VA Contact: RL, effectivealtruismatuva[at]gmail[dot]com Time: Sunday, September 4, 5:00 PM Location: 12 Rotunda Drive Charlottesville, VA 22903 - We’ll meet at the picnic tables across the street from The Virginian. There will be an ACX sign. Coordinates: 87C32FPX+3H4 Event link(s): LessWrong LYNCHBURG, VA Contact: Craig, craigbdaniel[at]gmail[dot]com Time: Saturday, September 17, 4:00 PM Location: Three Roads Brewing - I will be wearing a purple t-shirt and will place an ""ACX"" card on the table Coordinates: 8792CV65+5G NORFOLK, VA Contact: Willa, walambert[at]pm[dot]me Time: Sunday, September 18, 4:00 PM Location: Pagoda & Oriental Garden, 265 W Tazewell St, Norfolk, VA 23510. I will be wearing a bright green shirt, will have a large green & yellow hat on, and will have a sign with ACX Meetup on it. Coordinates: 8785RPX4+W3 Event link(s): LessWrong, Facebook event Group info: Hi! Virginia Rationalists was co-founded in Norfolk VA earlier this year by Willa & Yitzi with the goal of growing a thriving ACX / LW / EA community in our city & the state of Virginia. We meet every week at Fair Grounds cafe on Wednesday evenings from 5-7:30pm Eastern Time. We have a Discord server and a Twitter. RESTON, VA Contact: James, jrbalch333[at]gmail[dot]com Time: Saturday, September 24, 1:30 PM Location: The matchbox at 1900 Reston Station Blvd, Reston, VA 20190 on the 1st floor of the giant Google building. I'll be holding a copy of Sapiens. Coordinates: 87C4WMX6+9X Event link(s): LessWrong Notes: Email me to be added to the WhatsApp group RICHMOND, VA Contact: Cedar, cedar[dot]ren+acxmeetup[at]gmail[dot]com, @Cedar at this Discord server Time: Saturday, October 1, 2:30 PM Location: Richmond Public Libraries, West End Branch 5420 Patterson Ave, Richmond, VA 23226 Coordinates: 8794HFHQ+3G Event link(s): LessWrong Notes: Please RSVP on LessWrong & optionally reach out to me on Discord to introduce yourself! BURLINGTON, VT Contact: Forrest, lucidobservor[at]gmail[dot]com Time: Saturday, September 10, 2:00 PM Location: Battery Park, at the benches in the south-western corner of the park, near the cannons facing the lake. I will have an 'ACX Meetup' sign. Coordinates: 87P8FQJH+8P Event link(s): LessWrong BELLINGHAM, WA Contact: Alex, bellinghamrationalish[at]gmail[dot]com Time: Thursday, September 29, 5:30 PM Location: Lake Padden Park, at one of the tables near the lake by the dog park. If it's rainy, we'll meet in one of the two covered gazebo areas just north (right, if you're facing the lake) of the planned spot. If the forecast looks really bad (e.g. very cold), I'll post an indoor location to the Meetup.com page at least three days in advance. Coordinates: 84WVMHX3+GM Event link(s): LessWrong, Meetup.com Group info: Bellingham Rationalish discusses (in good faith!) topics in and around rationality. We usually meet the evening of the last Wednesday of each month. Our first meeting was a 2021 ACX Everywhere meetup. Notes: Please RSVP on Meetup so I have an idea how many people to expect. Kids, animals, food, beverages, etc. are all welcome. SEATTLE, WA Contact: Nikita Sokolsky, sokolx[at]gmail[dot]com Time: Sunday, October 9, 5:00 PM Location: Optimism Brewing (1158 Broadway, Seattle) Coordinates: 84VVJM7H+4Q Event link(s): LessWrong, Facebook event, Meetup.com Notes: Please RSVP on LessWrong (or FB/Meetup) for planning purposes MADISON, WI Contact: Mary Wang, mmwang[at]wisc[dot]edu Time: Saturday, September 10, 1:00 PM Location: 1022 High St. Blue house with red porches. If weather permits, we'll be in my large backyard, which has more seating now than last year. If rain, come in the side door. There will be air purifiers and open windows. Masks optional. Look for a sign at the end of the driveway that says ACX/SSC Meetup. Coordinates: 86MG3H3X+XW Event link(s): LessWrong, Facebook event Group info: We have met fortnightly in the past, but quit last year when it got too cold to meet outside. We typically have shared a meal, sat around my kitchen table and talked. Have held a Solstice celebration.

Canada

BRISBANE, AUSTRALIA Contact: Jarred Filmer, jarred[dot]filmer[at]gmail[dot]com Time: Saturday, September 10, 7:00 PM Location: 52 McCaul Street Taringa (house) Coordinates: 5R4JFXXQ+P8 Event link(s): LessWrong, Facebook event Group info: We used to meet once a month years ago, but now just meet whenever there's a Meetups Everywhere :) Notes: Snacks will be provided but dinner will not be, would recommend eating before you come CANBERRA, AUSTRALIA Contact: Andy Bachler, Andy[dot]Bachler[at]gmail[dot]com Time: Wednesday, August 31, 5:30 PM Location: Badger & Co pub at ANU. Central location, parking free after 5pm, might be loud, sorry! Coordinates: 4RPFP4FC+34 Event link(s): LessWrong, Eventbrite Notes: Parking area just to the north of the pub, over the river, is free after 5pm! GOLD COAST (SOUTH), AUSTRALIA Contact: Lerancan, lerancan[at]gmail[dot]com Time: Sunday, September 11, 2:00 PM Location: A picnic table, Wyberba Street Reserve, Tugun Coordinates: 5R3MVF5W+555 Event link(s): LessWrong Notes: Email me in case of bad weather/you can't find me/you can't make that time etc. MELBOURNE, AUSTRALIA Contact: Ryan, xgravityx[at]hotmail[dot]com Time: Friday, September 2, 6:00 PM Location: Beer Deluxe Federation Square Coordinates: 4RJ65XM9+3Q Event link(s): LessWrong, Facebook event Group info: We're officially the Less Wrong Melbourne social meetup group, though our members include the broader rationalist community. We meet once a month for casual discussion (and beers for those so inclined). Please join our Facebook group to see the meeting invite; there you will see a WhatsApp group link - please join that group too to ensure timely updates in case of changes (Facebook notifications don't work reliably for this). Notes: Please RSVP to the meeting invite on the Facebook group so that I can make an appropriate booking. PERTH, AUSTRALIA Contact: Madge, madgech[at]gmail[dot]com Time: Sunday, September 25, 2:00 PM Location: Russell Square, Northbridge, corner of Shenton and Aberdeen St. There will be some sort of ACX meetup sign. Coordinates: 4PWQ3V34+W6 Event link(s): LessWrong, Facebook event Group info: I run one meetup per year, if someone else wants to take over please do Notes: Please RSVP on LessWrong or Facebook SYDNEY, AUSTRALIA Contact: Eliot, Redeliot[at]gmail[dot]com Time: Thursday, September 15, 6:00 PM Location: City of Sydney rsl, lvl 2 in the fishbowl Coordinates: 4RRH46F4+983 Event link(s): LessWrong, Meetup.com Group info: We meet monthly WOLLONGONG, AUSTRALIA Contact: Jason, jason[dot]bowkettblogs[at]gmail[dot]com Time: Saturday, September 3, 12:00 PM Location: UOW Library Coordinates: 4RQGHVVH+69 Event link(s): LessWrong CHENGDU, CHINA Contact: Alex, acx[dot]chengdu[at]gmail[dot]com Time: Thursday, September 15, 7:00 PM Location: Chef Wenwu Hot & Spicy Jianghu Food (Yulin store)/文武大厨·热辣江湖菜(玉林店). I (a foreigner) will be wearing a green shirt. Coordinates: 8P26J3C5+462 Event link(s): LessWrong Notes: Please RSVP at the above email address, I will give you my Wechat contact if you're interested in attending. Open to time/date/location changes, so let me know if the proposed event doesn't work for you! Can be a bilingual event; all welcome. 有双语交流的可能性。如果想来的话，请提前发给我个电子邮件。 HONG KONG Contact: Nathan, nathan[at]xevarion[dot]org Time: Saturday, September 10, 1:00 PM Location: The Catalyst, 2 Po Yan Street, Sheung Wan. Big wooden door. Coordinates: 862M74PW+6XP Event link(s): LessWrong BANGALORE, INDIA Contact: Nihal, propwash[at]duck[dot]com, Discord: propwash#4648 Time: Sunday, September 18, 4:00 PM Location: Matteo Coffea, Church Street Coordinates: 7J4VXJF4+PR Event link(s): LessWrong Group info: We're the longest active group in Asia — we've been meeting monthly for the last 4 years, discussing ACX posts, LW content with a diverse and friendly group of people. Check our website for more info. Notes: Please RSVP on LessWrong to help me be better prepared. HYDERABAD, INDIA Contact: Vatsal, vmehra[at]pm[dot]me, Whatsapp: +919944430856 (username: Vim) Time: Sunday, September 11, 5:00 PM Location: The Weekend Cafe, Plot No D, 3, Vikrampuri Colony, beside vac's bakery, Vikrampuri Colony, Lane, Secunderabad, Telangana, 500015, India Coordinates: 7J9WFF4X+5P Event link(s): LessWrong Group info: Our rationality meetup group has been around for about 3 months and we discuss articles and exercises (eg. CFAR handbook) that can help us improve epistemic and instrumental rationality. MUMBAI, INDIA Contact: PB, e2y94n1nv[at]relay[dot]firefox[dot]com Time: Sunday, October 9, 4:00 PM Location: Jamjar Diner, Versova Coordinates: 7JFJ4RM6+5W Event link(s): LessWrong Notes: Please RSVP on LessWrong or via email so I can plan activities accordingly. NEW DELHI, INDIA Contact: Suryansh Tyagi, suryanshtyagiphone[at]gmail[dot]com, WhatsApp/phone +919997299972 Time: Sunday, September 11, 5:00 PM Location: Select CityWalk Mall, Saket. Where inside the mall depends on the number of people interested. Coordinates: 7JWVG6H9+8H Event link(s): LessWrong Notes: Please either send me an email or message me on WhatsApp if you want to attend. Any suggestions/changes are welcome. UDAIPUR, RAJASTHAN, INDIA Contact: Shailendra Paliwal, acx-meetup-2022[at]shailendra[dot]me Time: Saturday, September 10, 7:00 PM Location: We'll be at Doodh Talai near Pichola Lake and I'll be wearing a gray t-shirt carrying a sign ACX Meetup Coordinates: 7JPMHM9M+HG Event link(s): LessWrong Notes: Please RSVP on LessWrong so that I can plan ahead UBUD, BALI, INDONESIA Contact: William Ubud, Napaproject[at]gmail[dot]com Time: Tuesday, August 30, 6:00 PM Location: PARQ Ubud Coordinates: 6P3QG789+F7 Event link(s): LessWrong TOKYO, JAPAN Contact: Harold Godsoe, hgodsoe[at]gmail[dot]com Time: Saturday, October 8, 10:00 AM Location: Near Nakameguro station - RSVP for details Coordinates: 8Q7XJPV2+QFP Event link(s): LessWrong, Meetup.com Notes: ACX Tokyo meets monthly since Sept 2021. Our meetups are in English, so far. To join in, feel free to get in touch in any of the many ways to do so (email, Meetup.com). It's useful to be in contact before coming to an event, to help with that first leap of faith. KUALA LUMPUR, MALAYSIA Contact: Yi-Yang, yi[dot]yang[dot]chua[at]gmail[dot]com, LessWrong profile Time: Saturday, September 17, 2:00 PM Location: I'll be in Lisette's Bangsar, which is a 5-minute walk from Bangsar LRT. I'll be wearing a pale green t-shirt and carrying an ACX sign. Coordinates: 6PM34MHH+VW Event link(s): LessWrong AUCKLAND, NEW ZEALAND Contact: Jonathan De Wet, jonpdw[at]gmail[dot]com Time: Saturday, September 3, 6:30 PM Location: 32 Stanley Ave Milford, Auckland Coordinates: 4VMP6QH4+86 Event link(s): LessWrong, Facebook event Notes: It’s a dinner party! Please RSVP on FB so I know how much food to make DUNEDIN, NEW ZEALAND Contact: Gavin, bisga673[at]student[dot]otago[dot]ac[dot]nz Time: Saturday, September 3, 3:00 PM Location: Picnic tables outside of St. David's lecture theatre on Otago University campus. I'll make a sign with ACX meetup. Coordinates: 4V6G4GP7+GM5 Event link(s): LessWrong Notes: There is no Dunedin group as far as I'm aware of, but I'd be keen to meet other likeminded people and organise group hangouts occasionally. WELLINGTON, NEW ZEALAND Contact: Ben W, benwve[at]gmail[dot]com Time: Tuesday, September 27, 5:30 PM Location: Rutherford House, Bunny Street, Wellington. Room MZ05, which is on the mezzanine floor Coordinates: 4VCPPQCH+FGC Event link(s): LessWrong Notes: We're running the event this time in partnership with Effective Altruism Wellington LAPU LAPU, CEBU, PHILIPPINES Contact: Dave, tokkolizard[at]tutanota[dot]com Time: Sunday, September 4, 2:00 PM Location: Starbucks in Mactan Newtown, there will be a sign with ACX MEETUP on it. Coordinates: 7Q268257+4F Event link(s): LessWrong Notes: Please RSVP by mail so I know if I need to set up a bigger meeting place SINGAPORE Contact: Jonathan Ng, jonathan[dot]ng1[at]gmail[dot]com, Telegram @derpy Time: Tuesday, September 6, 6:30 PM Location: Tanjong Pagar MRT gantry, I'll be wearing the dark blue EA Global 2022 jumper Coordinates: 6PH57RGW+J8 Event link(s): LessWrong CANADA CALGARY, AB Contact: David Piepgrass, qwertie256[at]gmail[dot]com Time: Saturday, September 10, 2:00 PM Location: Marlborough Mall food court Coordinates: 9538324C+CH9 Event link(s): LessWrong Group info: It's small! EDMONTON, AB Contact: JS, ⁨ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, October 13, 6:30 PM Location: Polar Park Brewing Company - we will have a sign. Coordinates: 9558GG82+GG Event link(s): LessWrong Group info: LessWrong VANCOUVER, BC Contact: Tom Ash and Dirk Haupt, events[at]philosofiles[dot]com Time: Saturday, September 10, 1:00 PM Location: Dude Chilling (aka Guelph) Park, near the intersection of Main, Broadway & Kingsway. We'll be just west of the garden - look for Tom in a neon yellow shirt. Coordinates: 84XR7W73+PG Event link(s): LessWrong, Facebook event Group info: For future events, join the following: For rationalism, this Facebook group, for effective altruism, this Facebook group for both, Meetup.com Notes: ?? We'll have a sushi lunch for everyone who comes (fish or vegan). This is not at all necessary, but posting on the Facebook event to say you will or won't want this will help estimate numbers. RSVPing there will help boost attendance too. VICTORIA, BC Contact: Sarah McManus, sarahmcmanusbc[at]gmail[dot]com, Twitter @SarahAMcManus Time: Friday, September 23, 7:00 PM Location: Snowy Village, 4071 Shelbourne St #2a, Victoria, BC V8N 5Y1 - It's a small cafe, I'll be at a table with an ACX MEETUP sign on it Coordinates: 84WRFMG9+H3 Event link(s): LessWrong, Facebook event HALIFAX, NS Contact: Conor Barnes (ideopunk), conorbarnes93[at]gmail[dot]com Time: Sunday, September 25, 1:00 PM Location: Seven Bays Cafe (2017 Gottingen Street) Coordinates: 87PRMC29+9C Event link(s): LessWrong Notes: Join us at Seven Bayes KITCHENER-WATERLOO, ON Contact: Jenn, hi[at]jenn[dot]site Time: Sunday, September 25, 1:00 PM Location: Goudie's Lane, besides 8 Queen St N, Kitchener. I'll be wearing white boots and at one of the picnic tables if it's not raining, or further back in the parking area if it is. There will be some sort of ACX MEETUP sign. Coordinates: 86MXFG26+5CV Event link(s): LessWrong Group info: We have a new regular meetup group! We meet up every other Thursday. Events are posted on LessWrong, and we also have a website. Notes: Please RSVP on LessWrong if possible, but show up anyways if you weren't able to! Generally, past meetups everywhere events have attracted 8-15 people. OTTAWA, ON Contact: Tess Walsh, rationalottawa[at]gmail[dot]com Time: Friday, September 16, 6:00 PM Location: We are meeting at the Atelier d'innovation sociale, located at 95 Clegg St, K1S1C5. Specifically in the Lounge area, there will be numerous signs for ACX MEETUP where needed. Coordinates: 87Q6C84F+PM4 Event link(s): LessWrong, Facebook event Group info: We meet weekly on Friday evenings, and that allows us enough opportunity to try out a huge variety of different types of events — probably some that you, yes you, would enjoy! Here are our Facebook, LessWrong, and Discord (where the action really is) Notes: I always appreciate RSVP's in any form! It helps me set expectations/plan the best meetup I can! You can also contact me, Tess Walsh, with any questions whatsoever at rationalottawa@gmail.com TORONTO, ON Contact: Sean Aubin, seanaubin[at]gmail[dot]com Time: Sunday, September 18, 3:00 PM Location: Located at the picnic tables located in The Bentway, which is the sheltered area underneath the Gardiner Expressway. Coordinates: 87M2JHPR+X5W Event link(s): LessWrong Group info: Currently meeting monthly with ambitions to meet bi-monthly. Notes: Please RSVP on LessWrong so I know how many people to anticipate.

Inline links: 5R4JFXXQ+P8, LessWrong, Facebook event, 4RPFP4FC+34, LessWrong, Eventbrite, 5R3MVF5W+555, LessWrong, 4RJ65XM9+3Q, LessWrong, Facebook event, 4PWQ3V34+W6, LessWrong, Facebook event, 4RRH46F4+983, LessWrong, Meetup.com, 4RQGHVVH+69, LessWrong, 8P26J3C5+462, LessWrong, 862M74PW+6XP, LessWrong, 7J4VXJF4+PR, LessWrong, our website, 7J9WFF4X+5P, LessWrong, 7JFJ4RM6+5W, LessWrong, 7JWVG6H9+8H, LessWrong, 7JPMHM9M+HG, LessWrong, 6P3QG789+F7, LessWrong, 8Q7XJPV2+QFP, LessWrong, Meetup.com, Meetup.com, LessWrong profile, Lisette's Bangsar, 6PM34MHH+VW, LessWrong, 4VMP6QH4+86, LessWrong, Facebook event, 4V6G4GP7+GM5, LessWrong, 4VCPPQCH+FGC, LessWrong, 7Q268257+4F, LessWrong, 6PH57RGW+J8, LessWrong, 9538324C+CH9, LessWrong, 9558GG82+GG, LessWrong, LessWrong, 84XR7W73+PG, LessWrong, Facebook event, this Facebook group, this Facebook group, Meetup.com, 84WRFMG9+H3, LessWrong, Facebook event, 87PRMC29+9C, LessWrong, 86MXFG26+5CV, LessWrong, on LessWrong, a website, 87Q6C84F+PM4, LessWrong, Facebook event, Facebook, LessWrong, Discord, rationalottawa@gmail.com, 87M2JHPR+X5W, LessWrong

Book Review Contest 2022 Winners

September 02, 2022 · Original source

The Fall Of Robespierre, reviewed by Duane McMullen. Duane is from Ottawa, Canada, and is trying to figure out how to make a difference.

Inline links: The Fall Of Robespierre

Semaglutidonomics

November 24, 2022 · Original source

“Mounjaro” sounds like the playful animal sidekick in a Disney movie. From a purely economic perspective, semaglutide costs the health system money (because it’s expensive) but also saves the health system money (because we don’t have to pay for obesity consequences like diabetes and heart attacks). Which effect wins out? According to the Institute for Clinical and Economic Review, benefits would outweigh costs if semaglutide cost less than about $8,000/year. Since it costs $15,000 year now, it’s not cost effective. But if Morgan Stanley’s model comes true and it costs $4,000/year in 2030, then it will be cost effective. So at some point, Medicare (and so insurance companies) may start covering it more out of self-interest. I can’t tell whether the model takes this into account or not. (there’s also a third-level effect where it costs the health system money again, because it prevents people from dying of obesity-related complications, and dead people stop needing expensive health care. I think health economists are supposed to ignore this level.) 11.3 million prescriptions at $4,000/year comes to $45 billion, but Morgan Stanley expects that not everyone will fill their prescriptions consistently or stay on the medication the same amount of time, leading to their $31 billion figure. Towards The Glorious Post-Obesity Transhuman Future The Morgan Stanley report shows that even the greediest pharma investors, openly plotting to medicalize obesity, can’t bring themselves to believe in more than 11 million US semaglutide patients by 2030. That’s less than 10% of the US obese population. Isn’t that kind of disappointing? We’ve got > 100 million people dealing with a condition that not only makes them unhealthy, but also causes them psychological distress, and makes lots of people low-grade disappointed in and repulsed by our society. And we’ve got an effective drug that treats the condition. And we’re going to use it on less than 10% of the people involved? In 2032, semaglutide goes off-patent. It will probably take a few years to sort out legal issues and ramp up generic production, but by the mid-2030s, its price will go way down. I don’t think there are technical barriers to getting it down as low as $10 - $100 per month. By then, maybe there will be even more exciting branded weight loss drugs for wealthy people to choose from. But at the very least, semaglutide itself should become much more widely available even to poor or uninsured patients. I’m not sure what will happen. Will there be an inflection point, where so many people use semaglutide that obesity becomes unusual again, and then the remaining obese people start using it just to fit in? Will obesity become an optional fashion statement, like shaving your head or getting a tattoo? Or will semaglutide end up disappointing us in some way, like so many promising drugs have before? I come at semaglutide from a transhumanist perspective. I want to hack genetics and biology until everyone is as tall as they want, as strong as they want, as smart as they want, and whatever gender they want. If you want wings, you should be able to have wings. And yes, part of this vision is everyone having the weight they want. I’m not sure this will happen, but for the first time I can see a clear path to how it might. Postscript 1: Should You Take Semaglutide? I can’t answer this, please ask your doctor. But I do want to add that there are potential side effects I haven’t mentioned in this post, including nausea, gastrointestinal problems, pancreatitis, and kidney problems. Semaglutide has been accused of slightly increasing risk of pancreatic and thyroid cancers. Studies have found trends in this direction, but these conditions are so rare that even over thousands of patients over many years, the increase hasn’t yet reached clear statistical significance. The current consensus position is that it may increase thyroid cancer by a tiny amount not relevant to most patients, and that it probably doesn’t increase pancreatic cancer. I think my father has looked over these data more and is less sure than other people about the lack of pancreatic cancer risk, but he can’t get the resources he needs to prove anything, and I can’t remember his exact argument. More broadly: like all medications, semaglutide has benefits and risks, and you shouldn’t blindly take it after reading one blog article. Postscript 2: Is There A Way To Cheat The System To Get Semaglutide For Lower Cost? Health care is much like airline tickets: everyone pays a different price for everything and there’s usually a secret way to get what you want for much less money. Is this true of semaglutide? Pharma company Novo Nordisk offers a Savings Card that they say brings the price down to as low as $25 per month. I’m a little suspicious of this - pharma company offers are rarely as good as they sound - but I don’t notice any obvious tricks in this one and it should probably be your first bet. This startup claims that they can get insured people semaglutide for a $25/month copay “after their deductible is met” by negotiating with the insurance company very effectively. I can’t imagine how that works or what they have to negotiate with, but they seem pretty convinced, so I would welcome more information. Otherwise, you don’t have many great options. Although there are two older forms of semaglutide not FDA-approved for weight loss - Ozempic and Rybelsus - these are both more expensive, milligram per milligram, than Wegovy itself. Canada is also of no help. The usual Canadian pharmacies don’t seem to carry Wegovy, and charge about the same amount for Ozempic as American pharmacies do. This article in Drug Discovery Trends says that compounding pharmacies have been selling semaglutide for $300/month, less than a quarter of the sticker price. This is a bit confusing: compounding pharmacies are small local operations permitted to dispense unusual medications by mixing existing ones together in nonstandard ways. They’re arguing that they can legally dispense the semaglutide because they’re mixing it with vitamins, which, fine, but how are they getting it in the first place? Everyone else seems as confused as I am: "Nobody knows how [compounding pharmacies are] getting it," said Karl Nadolsky, an endocrinologist at Spectrum Health. "Who's making it? [The pharma company that makes it] Novo [Nordisk]'s not giving it to them. They're the ones with the rights to the molecule, so how is anybody getting semaglutide?" Has nobody asked compounding pharmacists about this? Do they have a conspiracy of silence? Does the FDA sometimes send their goons in to extract the information, but the compounding pharmacists compound sleeping gas / smoke grenades and vanish into the night? Anyway, the usual authorities warn you not to take compounded semaglutide under any circumstances, but they’re the same people who tell you never to buy drugs from a Canadian pharmacy because they might be adulterated. You can decide how much you want to trust them. Postscript 3: What About Europe And The Rest Of The World? Countries that are not the US usually negotiate with pharmaceutical companies over price. Because of some combination of “negotiation works” and “they are free-riding off Americans’ hard work”, they usually get much lower prices. What does semaglutide cost elsewhere? This is hard to find out because government health agencies sometimes keep their prices secret, plus Wegovy mostly isn’t available in other countries yet. The only information I could find was from Britain, which is in the process of making Wegovy available to patients. It looks like NHS will “restrict the expensive drug’s availability to very obese people attending specialist weight-loss clinics”, but that it might be possible to get it from private clinics for £199/month = £2400/year. Wegovy has been approved in the EU but doesn’t seem to have made it there yet. I can’t find any information about any other country. Non-weight-loss-indicated versions of semaglutide are available in many countries, but I wouldn’t expect their health care systems to be flexible about redirecting it for weight. Canadian regulators have approved Wegovy, but it doesn’t seem to be available there yet. I haven’t seen any evidence that Ozempic costs less in Canada than it does in the US, and I’m not sure why. Maybe the pharma companies have figured out that anything that happens in Canada gets imported into the US, and they’re playing hardball this time. I don’t know whether Canadians will be able to get it for cheaper than Americans or not. Postscript 4: Predictions (all predictions are conditional on no singularity or global catastrophe) 10 million Americans on semaglutide (or yet-to-be-approved equally good or superior alternatives) by 2030: 75%

Inline links: Institute for Clinical and Economic Review, don’t think there are technical barriers, offers a Savings Card, This startup, about the same amount for Ozempic, This article in Drug Discovery Trends, Everyone else seems as confused as I am, NHS will, private clinics

Highlights From The Comments On Semaglutide

November 30, 2022 · Original source

Re canada, if you are american and have a prescription you should be able to get semaglutides for a couple hundred dollars a month through CanShipMeds. (At least, you could as of a couple months ago).

I am a huge fan of semaglutide and here in Canada, it is really not that expensive (about $3,000 /year).

Why I'm Less Than Infinitely Hostile To Cryptocurrency

December 08, 2022 · Original source

This tactic reached a new level during the 2021 Ottawa protests, where the Canadian government told banks to freeze the accounts of suspected protesters. All of a sudden their families couldn’t afford food and they had to back down. This is a very effective anti-protester tactic, and there’s no reason that governments who don’t like people protesting them (eg all governments) shouldn’t try it in the future.

Inline links: told banks to freeze the accounts of suspected protesters

“Oh, so you’re one of those annoying libertarians?” Maybe! But I’ve donated to enough Democrats to get spam texts from Nancy Pelosi. And a lot of them say things like “our democracy is in danger” or “this could be our last free election ever” . If you really think January 6 was a close call, where do you think we’d be if Trump had succeeded? Would he have just passed a few more tax cuts and built a few more miles of border wall? Or would he have actually done the fascism thing? And if he actually did the fascism thing, do you think he would have shown more restraint than the Canadians, and backed down from freezing bank deposits as a weapon against protesters?

ACX Survey Results 2022

January 20, 2023 · Original source

I don’t think I can Google Forms only present data from people who agreed to make their responses public, so I’ve deleted everything identifiable on the individual level, eg your written long response answers. Everything left is just things like “X% of users are Canadian” or “Y% of users have ADHD”. There’s no way to put these together and identify an ADHD Canadian, so I don’t think they’re privacy relevant. If you notice anything identifiable on the public results page, please let me know.

Who Predicted 2022?

January 24, 2023 · Original source

4th: Andreas H. Andreas describes himself as a student of geography who splits his time between Canada and Germany. He is also interested in transportation, politics, and economics. His Twitter is https://twitter.com/AH23923011

Inline links: https://twitter.com/AH23923011

Highlights From The Comments On Telemedicine Regulations

April 03, 2023 · Original source

In my province (Canada) we have lots of telemedicine but no prescribing restrictions. However, all scripts for controlled drugs are copied to a central prescription monitoring programme, via one part of a triplicate prescription pad, and if you prescribe a lot to a patient, escalating amounts to a patient, or the drugs to more patients than other doctors in your specialty, you will get, first, a warning with a request for an explanation. Then follows a practice assessment where your records are examined to check appropriateness of prescription and whether you follow guidelines for alternative treatments, used patient contracts etc. If you are felt to be abusing your prescribing privileges, this then escalates to a complaint to the licensing body and usually you lose the right to prescribe narcotics after that, and have to place a notice of humiliation in your waiting room saying yo cannot prescribe these drugs.

Spring Meetups Everywhere 2023

April 10, 2023 · Original source

North America (including Canada)

CALGARY, ALBERTA, CANADA Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, April 15th, 02:00 PM Location: inner City Brewing Coordinates: https://plus.codes/95372WVC+62

Inline links: https://plus.codes/95372WVC+62

EDMONTON, ALBERTA, CANADA Contact: Joseph Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, April 27th, 07:00 PM Location: Underground Tap & Grill. 10004 Jasper Ave, Edmonton, AB T5J 1R3. We will have an ACX sign Coordinates: https://plus.codes/9558GGR5+JP Event Link: https://www.lesswrong.com/events/MiZ6vuG8nwwDqPSLo/acx-meetups-everywhere-2

Inline links: https://plus.codes/9558GGR5+JP, https://www.lesswrong.com/events/MiZ6vuG8nwwDqPSLo/acx-meetups-everywhere-2

The Question Of Separatism

May 19, 2023 · Original source

Maybe you’re a pacifist and are thinking, “well yeah, pouring money into the military is dumb, we should use the money to help people instead.” Well, Jane Jacobs has bad news for you. Welfare programs are also transactions of decline. They, too, drain the wealth away from cities. When the Canadian government takes production from the Toronto city region and redirects it to your choice of: 1) the poor province of New Brunswick; 2) unproductive retired people; 3) farmers who depend on agricultural subsidies, that’s production that Toronto could have exported to an economically dynamic city instead, fostering development in both. Poor regions on the receiving end might seem better off, but remember that they don’t develop from welfare: depending on the exact shape the aid takes, they become clearance regions, transplant economies, or artificial city regions.

It was the golden age of technocracy; it was the triumph of high modernism. From now on wealth was assured, because we weren’t blind anymore: we had the curves. And yet — by the 1970s and 1980s, when Jane Jacobs was writing, the theories all stopped working. There was high inflation and high unemployment. People called it stagflation. Keynesian advisers in various governments were devastated: either their ideas were wrong, or they were applying them wrong. Economists such as Milton Friedman, from a rival school of economists called the monetarists or the Chicago school, came to the rescue — but their remedy, Jacobs believes, only made things worse. Whatever governments did to increase employment made inflation worse; whatever they did to attenuate inflation killed employment. The seesaw from the theories was working in application, even though it didn’t explain reality anymore. Stagflation was not supposed to exist, so stagflation could not be fought. At this point we’re near the end of Chapter 1, the densest part of the book. Jacobs has artfully guided us along economic history and laid out the mystery for us. What’s going on? we wonder. How are we supposed to deal with the two-headed monster of stagflation, if all economists are stumped? Then Jacobs, in a masterstroke, flips the whole thing over. I was impressed enough that I would have inserted a spoiler alert here, if it didn’t feel so silly putting a spoiler alert in an essay on economics. Stagflation is not a strange monster from legend. It is, Jacobs says, just the normal state of everything. Backward economies are in fact constantly in a state of stagflation. The prices in a poor country like Portugal or India (her two examples) feel low for an American or Canadian, but they’re high for most Portuguese or Indian people. At the same time, Portugal and India provide too few jobs to their residents. Inflation and unemployment are both perennially high, and none of that feels surprising whatsoever. Stagflation, in short, is just good ol’ poverty. All these fancy economists, from Cantillon in 1700s France to Keynes and Friedman in the 20th century Anglosphere, were thinking and writing about unusual places: rich countries that were undergoing fast economic development. They were making the classic mistake of treating poverty as a mystery and wealth as a given, when in fact poverty is the normal order of things and wealth, when it does occur, is what warrants an explanation. The result is that we don’t really know how to fix the economy of poor countries, nor do we know how to deal with decline in rich countries, whether we call it stagflation or something else. Jacobs derives from this a pretty damning view of macroeconomics. It is to her a science that has failed again and again, each time engulfing the equivalent of billions of dollars in wasted wealth. “We must,” she writes at the close of Chapter 1, “find more realistic and fruitful lines of observation and thought than we have tried to use so far. It is bootless to choose among existing schools of thought. We are on our own.” Fortunately, she has some ideas. II. Nations and the Wealth of Cities The original sin of macroeconomics, Jacobs believe, is to treat sovereign countries, or nations, as the main unit of economic analysis. This error, she claims, goes back to mercantilism, one of the first formal economic policies. Oversimplified, mercantilism states that wealth is synonymous with the amount of gold and silver in a nation’s treasury. This makes nations the main unit of economic analysis by definition. It’s a tautology — and one that was somehow embedded so deep in economic thinking that even the non-mercantilist Adam Smith would eventually choose, for his masterpiece of economic theory, the title An Inquiry into the Nature and Causes of the Wealth of Nations. Today, even though mercantilism has long been obsolete, we perpetuate the same tautology whenever we talk of the Gross Domestic Product or look at the very nice charts from Our World in Data, which for the most part allow only one level of resolution: sovereign countries. Of course, nations are an economically important concept because of that one property: they are sovereign, and therefore they write laws and implement policies that affect the economy. These policies can be productively compared. But that’s about it — for everything else, nations aren’t the right way to think about wealth. One reason is simply that they’re very different from one another: “it affronts common sense,” Jacobs writes, “to think of units as disparate as, say, Singapore and the United States, or Ecuador and the Soviet Union, or the Netherlands and Canada, as economic common denominators.” I would add that countries are arbitrary and changing: when the Soviet Union was replaced by 15 sovereign countries, the economic reality didn’t suddenly reshape itself to match the new borders. Lastly, nations contain, under the hood, many sub-economies that are also highly different from one another. None of that is secret or forbidden knowledge. Everyone has always been aware that New York City, or Milan, are economically very different from rural Mississippi or Sicily. But I find that it’s far easier to think in terms of “the United States” or “Italy,” especially when you’re not from there. Nations are an abstraction of real-life complexity, and are accordingly very tempting to use. Also, they’re often the entities that collect statistics, which is another difficult-to-resist temptation for anyone who likes quantitative data. Cities as Radiators of Economic Forces If nations aren’t the best unit to analyze the economy, what is? This is a Jane Jacobs book, so the answer is obviously going to be cities. Jacobs doesn’t actually give a clear argument why. Maybe that was in her previous book, The Economy of Cities. So far as I can see, her reasoning is, ironically, a bit tautological: “all developing economic life depends on city economies; it depends on them by definition because, wherever economic life is developing, the very process itself creates cities and has probably always done so.” But so far as I can see, this reasoning is correct. Cities concentrate people, and therefore economic life, and therefore economic power. The driving force for all this is a phenomenon that, from what I gather, was discovered by Jacobs when she wrote The Economy of Cities: import replacement. Consider, say, Boston back when it was a tiny settlement, not yet a city, in colonial times. At first, Boston didn’t produce much, especially not much that would be of interest to its main trading partner, London. It exported some natural resources: timber, fish. Whatever else the Bostonians needed, they needed to import it from other cities, again mostly London. (Remember to think of imports and exports in terms of cities, not nations.) For instance, at first, all metal tools in Boston came from European cities, and were paid for by the revenue from selling the timber and fish. Then, one day, some Bostonians decided to build an ironworks and make metal tools themselves. (Pictured: a reconstruction of the Saugus Iron Works, established 1646.) This wasn’t of any interest to London or other European cities. The Bostonians weren’t nearly as good or efficient at making metal tools as Londonians were. So Boston couldn’t export the metal tools back to Europe — but it could use them internally, and also export them to other American cities that were about as poor as Boston was, or poorer. Internally, this meant the spark of a manufacturing economy in Boston, as easily obtained metal parts made it easier for other Bostonians to replace other imports from European cities, and eventually develop a symbiotic network of industries. It also meant that the revenue from fish and timber could be used to import new things, including new innovations from European cities (which would later become opportunities for more import replacement). And because there were customers for Boston-made metal goods in New York and Philadelphia, and eventually Cincinnati and Chicago and Pittsburgh as these cities came into existence, it meant additional revenue for Boston that it could reinvest into developing its production further. For Jacobs, virtually all city development can be seen through the lens of import replacement (which, to be clear, has approximately nothing to do with policies of import substitution industrialization; import replacement is not a policy, but a naturally arising free market phenomenon). Her book contains many other examples than Boston, such as Venice, which started off in the early Middle Ages as a small town that sold salt to Constantinople, but then diversified its production to become one of the wealthiest cities of its time; or Taipei and Kaohsiung, two cities in Taiwan that kickstarted their development not long before the 1980s, by forcing expropriated landlords to invest into local import-replacing businesses. One is reminded of Scott’s review of How Asia Works. Import replacement, then, is what makes cities economically powerful. And this power is so great that it causes ripples in distant places. In fact it is the main reason that anything happens at all in non-city areas. Jacobs gives the example of Bardou, a small village in southern France. Bardou looks like this: To the extent that Bardou ever had an economic life, that life was almost entirely driven by distant cities. In ancient times, the area was populated because of iron mines nearby. The mines were exploited to serve the needs of people in the distant cities of Lugdunum (Lyon), Nemausus (Nîmes), or even Rome. As Jacobs notes, we could say that the mines served “the Roman Empire,” but that would be another example of using the abstraction of sovereign countries when we should instead be specific. It was Lugdunum, Nemausus and Rome that wanted the iron — not some random rural area of the empire, and certainly not the part of the empire in which Bardou was located. Eventually the mines and the region were abandoned. More than 1,000 years later, peasants moved into the area and built the modern village. For centuries they lived a wretchedly poor life of subsistence farming. No cities exerted any influence on it, and indeed nothing happened. Then, in the 19th century, the people of Bardou learned that they could improve their situation by moving to distant cities such as Paris, and most of them did. Again, the force wasn’t being exerted by “France”; Bardou was already part of France. The force was specifically being exerted by Paris and other cities with jobs for poor peasants. By the 1960s, only one old man was left. That’s when two foreign visitors, a German and an American, happened upon the village, decided to buy most of it, revitalized it, and turned it into a tourist spot (and even, for a brief time, into a set for a movie company). Today Bardou is a popular place for travelers — who are mostly city people, and spend money that was mostly earned in cities. The Bardou story contains examples of several of the forces that import-replacing cities radiate, according to Jacobs. These forces are central to her thinking. There are five of them: Markets. Cities house a lot of people who need a lot of goods and services, and are therefore strong markets to sell goods and services to. This was the force that acted on the Bardou area when it was a Roman mining region, and again today when it functions as a tourist spot for city vacationers.

Inline links: Our World in Data, https://substackcdn.com/image/fetch/$s_!zS15!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F7d533e64-f407-4b05-aea5-5b5a9dbdc7bc_1600x1130.png, import replacement, https://substackcdn.com/image/fetch/$s_!5j2T!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F7f2675d9-ce56-4ac5-9b78-a16720269dea_1600x1159.png, import substitution industrialization, Scott’s review of, Bardou, https://substackcdn.com/image/fetch/$s_!RfMs!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fc119b085-f7b3-4e09-a586-9f4fc4c2ea21_1200x1600.png

There is a nice modern road in that screenshot, but between its 18th-century founding and the 1920s, there wasn’t even a path that a horse-drawn wagon could use, and so Higgins was extremely isolated. It barely sold anything to anyone outside, and accordingly imported very little. The people lived from subsistence farming. Their lives were so difficult, so focused on sheer survival, that they gradually forgot many of the skills and techniques that their British ancestors had, like candle making, weaving from a loom, and even masonry. When Jacobs’ aunt arrived as a Presbyterian missionary in 1922, and suggested that they build a church out of stone, the people of Higgins confidently stated that this was impossible: mortar just wasn’t strong enough. “These people came of a parent culture that had not only reared stone parish churches from time immemorial, but great cathedrals,” Jacobs writes, and yet eventually they forgot that stone buildings were a possibility at all. Such is the fate of regions that get cut off from cities. Jacobs calls them bypassed places. Sometimes these places are entire countries, such as Ethiopia, once the seat of an empire, but which as of the 1980s had barely any links to cities except its own backward ones. Unsurprisingly, Ethiopia has high prices (for Ethiopians) and too few jobs. That will always be so, unless one of its cities can start the process of import replacement. III. Should Everything Be a City-State? That was roughly the first half of the book. After that, Jane Jacobs discusses various consequences of her theory, including why decline happens and how we can, in theory, prevent it. We’ll get there — but first, it’s time for a detour through the other book, The Question of Separatism, which provides a great case study of Jacobs’s ideas. After an introductory chapter in which Jacobs acknowledges that separatism always makes everyone emotional, and warns that she’s going to study it in a dispassionate manner anyway, she starts by describing the issues in Quebec and Canada through a specific lens. You can probably guess which lens. That’s right — cities. To her, the question of Quebec separatism is primarily the question of how the two main cities in Canada, Toronto and Montreal, have coexisted and will coexist in the future. At this point you need at least a basic understanding of Canadian history. Here’s a quick primer, focusing on those two cities. Canadian History Speedrun (Jane’s Version) Canada, a word that used to refer to the large valley around the St. Lawrence river and the Great Lakes, was originally a colony of the Kingdom of France. Then the Kingdom of Great Britain conquered it in 1760. For various reasons, most of the French settlers stayed in Canada rather than emigrating to France or being deported, so at first, a small British elite ruled over a mostly French-speaking and Catholic colony. However, immigration from the British Isles, as well as from the newly seceded United States (loyalists who wanted to live in a monarchy rather than a republic for some reason) eventually tipped the linguistic and cultural balance. The population sorted itself such that the lower part of the valley (what is now Quebec) remained French, while the upper part (what is now Ontario) became English. The exception to this trend was the city of Montreal. Although located in Quebec, it became an English-speaking city and the hub for the British merchant elite. For at least a hundred years, it was the main city in Canada across almost all metrics: population, wealth, manufacturing, political influence. In the middle of the 20th century, Montreal grew enormously and became French-speaking again, owing to immigration from rural Quebec. It became the center of Quebecois culture and, with its increasingly educated population, the breeding ground for new ideas, including separatism. At the same time, the main city in Ontario, Toronto, was growing even faster. Immigrants from all over Canada and other countries poured into it (including Jane Jacobs herself). Sometime around 1970, it became bigger and wealthier than Montreal, and replaced it as the main economic hub. Many people attribute this to the rise of Quebec separatists, which supposedly scared the Anglo elite of Montreal into moving all the banks and companies to Toronto, and, to be sure, some of that happened — but of course, Jacobs prefers explanations that rely on city economics. One of the reasons for Toronto's economic and demographic growth is that it became the nexus of what Jacobs calls a conurbation, and would have called a city region if we were in the other book. In case you craved another concrete example of a city region, here’s a map of Ontario with two ways to define Toronto’s so-called “Golden Horseshoe” (Toronto itself is just the tiny strip in the middle of the red area, next to the lake): Meanwhile, Montreal never generated a conurbation or significant city region. This is Jacobs’s main hypothesis for why it was overtaken by Toronto, though she doesn’t give a lot of detail on why it happened. In any case, the result was that Montreal lost its status as the economic capital of the country. It became a regional city. The problem is that regional cities tend to do poorly. The nature of nations is to centralize everything in one place (we’ll come back to this). That’s why Paris has a large and rich city region, but Lyon and Marseille don’t. That’s why London looms so large in the UK’s economy while Glasgow or Manchester now contribute very little. There’s nothing wrong per se with being an economically stagnant regional city. Such cities can be fine places. When they’re the center of a supply region, like Calgary and Edmonton in oil-rich Alberta, they can even be wealthy. The complication for Montreal, though, is that its previous status as the main Canadian metropolis made it grow too large for this purpose. Yet, at the same time, Montreal plays an outsized cultural role for French-speaking Canadians — one that Toronto doesn’t even come close to fulfilling. So, Jacobs sees only decline for Montreal. And she thinks this means decline for Quebecois culture generally. Without a strong import-replacing city, Quebec will become a patchwork of supply regions, regions that workers abandon, or transplant economies, like the poverty-stricken Atlantic provinces in eastern Canada already are. Either the Quebecois resign themselves to this fate, she says, or they fight it — and the only true way to fight it is to declare independence. As of the 1980 referendum, she thinks they should go for independence. Generalized Separatism Quebecers did not go for independence, neither then in 1980 nor in 1995 when they voted on the question again. If they had, it would probably have been an example of a peaceful secession. Jacobs points out that there haven’t been many of those, if you exclude the decolonization of overseas imperial possessions (like Canada from Britain). Non-peaceful secessions have been common, but in those cases the destructiveness of war tends to overshadow everything else, economically speaking. In fact that might be the main reason most of us intuitively dislike separatism: we associate it with conflict. But peaceful non-colonial secessions do happen. Since 1980 there have been several more cases, like Czechia and Slovakia. When Jacobs wrote her book, though, the only good example she could think of was the independence of Norway from Sweden in 1905. She tells a great account of the process, noting that the outcome wasn’t predetermined: Sweden didn’t want to lose its western province, and did what it could to contain Norwegian nationalist sentiment. But Norwegian nationalist sentiment won — and importantly, both Norway and Sweden seemingly benefitted. Neither of them was particularly rich in the 19th century, and Norway was in fact dirt poor, which is why so many Norwegians escaped by emigrating to North America. Yet after the dissolution of their union, the two countries developed quickly, and both are now among the wealthiest countries in the world. They certainly didn’t disintegrate. (Of course, in Norway the wealth is due in large part to the oil that they discovered in the late 1960s. But they were pretty advanced by that point already — advanced enough that they could use the oil to develop their own industry, rather than get rich quick by exporting it raw, which is what keeps many countries trapped as supply regions.) When people argue against separatism, they often tout the benefits of being large. A Canada that would be split in two would mean smaller markets, and a weaker political counterweight to the United States. (Not to be mean to Canadian readers, but this argument seems delusional to me — I don’t think Americans currently see Canada as a political counterweight of any significance.) It would certainly be less prestigious. Large size, Jacobs says, is associated with power, and we admire power. We love slogans like “unity makes strength.” But after the medium-sized country of Sweden-Norway became the two smaller countries of Sweden and Norway, they both did well. Small size is less powerful, but it has its own advantages, such as nimbleness and ability to fail non-catastrophically. Small size also allows more diversity in cultural and economic matters, and here Jacobs waxes philosophical, pointing out that favoring diversity over uniformity is a recent, post-Enlightenment idea that has not yet been fully embraced in politics. We can see analogs everywhere. Europe, split into numerous small countries from the Middle Ages onward, became far more advanced than China, which has been unified more often than not. The city-states of ancient Greece and Renaissance Italy are seen as golden ages of Western civilization, even if they weren’t part of larger political units and therefore constantly went to war with one another. In business, large companies are impressive and powerful, but people always complain that Google or Microsoft have become stagnant and that the best place to work is tiny startups of about 2 cofounders and 4 employees. In biology, humans are more successful than numerous larger animals, and in terms of raw numbers, small animals like rats or insects are the most successful of all. Jacobs’s point isn’t that smaller is always better. Her point is that the converse statement, “bigger is always better,” is false — despite how intuitive it feels for political entities. Just like we don’t view a small nation like Switzerland or Singapore as a failure of unity, we (and in particular, Canadians) shouldn’t see the secession of a place like Quebec, if it’s done peacefully and democratically, as a failure either. Still, some people in online reviews of the book complain that this argument is a bit thin, especially considering that it serves as the foundation for the later chapters (which are more directly about late 1970s Quebec politics). Sure, small is beautiful, but large states are great for stability, peace, markets, whatever. If the potential benefits of small national size are Jacobs’s strongest argument, then we can breathe a sigh of relief and go back to agreeing that separatism is bad. Pointing out the widespread bias in favor of unified political entities does seem valuable to me, but okay, fair enough. Does Jacobs have deeper reasons why separatism might be a good idea in general? Yes, and for this we go back to the second half of Cities and the Wealth of Nations. Why Nations and Empires Fail Our breathing rate is regulated through a feedback mechanism. Too much carbon dioxide in the blood, or too little oxygen, and the brain stem commands the diaphragm to accelerate breathing. Once the levels are back to normal, the brain stem receives this feedback and slows breathing down again. Now, Jacobs asks, imagine an impossible creature: ten people, all doing their own thing, but whose breathing is somehow regulated by a single brain stem. The feedback the brain stem receives is a consolidated average of everyone’s carbon dioxide and oxygen levels, and the breathing rate the stem decides on is applied to all ten people, regardless of whether they’re sleeping or playing tennis. This, to put it mildly, wouldn’t work. This creature is an analogy, representing a nation. The ten people are its individual cities, and the breathing rate is the cities’ economies. If it sounds like a stupid analogy, that’s because it is: “I have had to propose a preposterous situation,” writes Jacobs, “because systems as structurally flawed as this don’t exist in nature; they wouldn’t last.” Nor do they exist in machines we design; they wouldn’t work. But “nations, from this point of view, don’t work either, yet do exist.” The feedback mechanism that fails to work properly in a nation is currency. A currency always fluctuates according to the exports and imports of the area where it circulates. Let me use the Republic of Venice and its ducat as a toy example, because the coins look nice: Whenever Venice produces something (like salt) and sells it abroad, foreigners need ducats to buy the exports, so the demand for ducats increases. When Venice buys something from abroad, it needs to use foreign currencies, so the demand for ducats decreases. Add up everything that Venice exports and imports, and you get either a trade surplus (more exports than imports) or a trade deficit (more imports than exports), which determines the value of the ducat relative to other currencies. In both cases, a negative feedback loop restores balance over time, just like our brain stem does with carbon dioxide levels. A trade surplus, and therefore a strong ducat, means that when foreigners want Venetian salt, it’s expensive. So Venice’s exports decrease, while imports increase, since Venetians can use their valuable ducats to buy stuff cheaply from abroad. Conversely, a trade deficit makes exports a bargain for foreigners and imports expensive for Venetians. This feedback loop is great. It’s exactly what a city needs to trigger the crucial import replacement process. When exports decrease and a trade deficit begins (maybe because Constantinople found a cheaper source of salt somewhere else), the weak ducat means that Venice is less able to afford the resources and manufactured goods it used to import. The people of Venice don’t want to have less of those goods, though, so they figure out ways to produce some themselves — that is, they do import replacement. Later they will be able to export the output of the newly expanding industries too, strengthening the ducat and continuing the cycle. Currencies, Jacobs explains, function as automatic tariffs (to protect local industry from foreign imports) and automatic export subsidies (to encourage local industry to export). They are “automatic” because of the feedback mechanism. Just like an accelerated breathing rate, they take effect exactly when they are needed — and no longer. … Or so they should, except that import replacement, as we discussed, is a city process. Whereas most currencies are national or supranational. National currencies work well for city-states, like the Republic of Venice or today’s Singapore. But in large nations, which, remember, are not the fundamental unit of economic life, they mess everything up. Take a city like Detroit. When Detroit’s exports (primarily cars) decrease, Detroit gets no feedback about this, because its currency is the United States dollar, and the United States dollar’s value depends on much more than Detroit. It depends on other cities whose foreign exports might be increasing at the moment. And on rural regions that are selling resources like oil abroad. Also, trade between Detroit and other cities that use the United States dollar — i.e., American cities — is structurally unable to provide any feedback whatsoever. So Detroit doesn’t get the signal that it should buy less stuff from other cities and replace the missing imports with local production. Instead, it just declines. Jacobs hypothesizes that this issue of national currencies is at the root of every large country’s economic troubles. It is why nations and empires always centralize everything into one large city, whether that’s Paris, London, Tokyo, or Toronto, or ancient Rome: that city, being the largest, is simply the only one for which national-level currency feedback works fine. The rest of the nation or empire, then, declines. But of course, nations and empires don’t accept this. They care about the economic well-being of their peripheral regions, sometimes out of genuine concern for the people there, sometimes out of fear that they rebel or hold independence referendums. So nations and empires will embark on every possible solution to reverse the decline. All of their solutions will look like good ideas at first, and yet fail at helping the peripheral regions. Worse, these solutions will weaken the cities, thereby destroying the only real wealth of the country and bringing untold hardship for everyone. Eventually the nation or empire will disintegrate, as nations and empires always do, and always will. Jacobs calls these false solutions transactions of decline. She identifies three types, and, content warning, you might not like some of them depending on your political sensibilities. Sustained military production is a transaction of decline. Permanent military bases and garrison towns are a special kind of settlement: they import a lot and export nothing. Superficially, producing weapons and supplies for the military seems like a good deal for some cities — Jacobs gives the example of Seattle, which, before Microsoft and Amazon were a thing, depended mostly on making military aircraft. But because nobody in a military base ever tries to replace those weapons and supplies with their own production, the trade is sterile in terms of economic development. In a sense, the wealth is slowly “drained” from cities. Large empires are especially prone to this: eventually all of their wealth is destined to the military just to keep the empire together.

Inline links: https://substackcdn.com/image/fetch/$s_!Qj1l!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ff727cfae-ec34-42c4-b509-9a25f4126f2d_1600x834.png, https://substackcdn.com/image/fetch/$s_!T392!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ff9795745-8a40-40c1-8173-5296c13eef3b_1600x1553.png, https://substackcdn.com/image/fetch/$s_!zETj!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F3e99b106-d34e-4a49-93a8-553a8f57952a_1600x1130.png, https://substackcdn.com/image/fetch/$s_!YeXj!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F6fe681e6-b571-4f4c-aa90-313f77fc1dbb_750x359.png

Hypergamy: Much More Than You Wanted To Know

May 24, 2023 · Original source

I am a week into Christian Mingle and I must say I have a 'feeling' about this site. Although I am in Canada the only matches I am sent are from the US. The first day I noticed an advertisement for Drink N Date with 'racy' (for lack of a better word) pictures of girls. I found this offensive as apparently it is supposed to be a Christian site and the reason I signed up. I emailed them to tell them so.

Your Book Review: Lying for Money

May 26, 2023 · Original source

In discussing different equilibrium points for trust, Davies brings up what he calls the "Canadian Paradox," which is an observation that a low-trust society will have less commercial fraud than a high-trust society (an example of one such high-trust society being Canada, which in 1985 was home of the Vancouver Stock Exchange, dubbed by Forbes Magazine's Joe Queenan as the "Scam Capital of the World.")

It still remains the case that if you can find a crooked geologist, and if your fake mine is remote enough to make inspections unfeasible, you can get away with a lot. As recently as 1997, a more or less valueless hole in the ground in Indonesia was valued by Canadian investors at $12 billion, on the basis of reports which seemed to suggest that it was the largest gold discovery in the history of the world.

Links For May 2023

June 01, 2023 · Original source

31: Claims about Canadian population (source):

Inline links: source

1: The Chateau Frontenac in Quebec, one of Canada’s grand railway hotels:

Inline links: Chateau Frontenac, grand railway hotels

Open Thread 279

June 05, 2023 · Original source

2: Some link corrections: Canada’s population center may not be in Michigan. Nisean horses might be fake? (although clearly by Roman/Byzantine times there were specific horses people thought were Nisean) Australia’s National Sorry Day is minor and not helpful. Maybe I was metamistaken in saying I was mistaken about the bonobo study, I don’t even know anymore and will have to look into this in more depth.

Inline links: may not be in Michigan, might be fake, is minor and not helpful, about the bonobo study

Meetups Everywhere 2023: Times & Places

August 25, 2023 · Original source

SHEFFIELD, UK Contact: Colin Contact Info: czr[at]rtnl[dot]org[dot]uk Time: Saturday, September 16th, 3:00 PM Location: 200 Degrees, 25 Division St, S1 4GE. I'll have a piece of paper on the table with ACX written on it. Coordinates: https://plus.codes/9C5W9GJG+2M Notes: I'll be there from 3pm to at least 5pm, and maybe later if other people want to hang out for longer. So feel free to come join at any point. North America Canada CALGARY, ALBERTA, CANADA Contact: David Piepgrass Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, September 16th, 2:00 PM Location: Inner City Brewing, 820 11 Ave SW Coordinates: https://plus.codes/95372WVC+52C Group Link: https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

Inline links: https://plus.codes/9C5W9GJG+2M, https://plus.codes/95372WVC+52C, https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

CALGARY, ALBERTA, CANADA Contact: David Piepgrass Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, September 16th, 2:00 PM Location: Inner City Brewing, 820 11 Ave SW Coordinates: https://plus.codes/95372WVC+52C Group Link: https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

Inline links: https://plus.codes/95372WVC+52C, https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

EDMONTON, ALBERTA, CANADA Contact: Joseph Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, September 21st, 7:00 PM Location: Underground Tap & Grill, 10004 Jasper Ave, Edmonton, AB T5J 1R3. We will have an ACX sign - it usually isn't too busy, so we should be easy to find. Coordinates: https://plus.codes/9558GGR5+JP Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG

Inline links: https://plus.codes/9558GGR5+JP, https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG

Your Book Review: Why Nations Fail

August 25, 2023 · Original source

Even if correct, it is much less interesting and useful than it appears. Epistemic status: I have a decade-old PhD in economics (not in the field of economic growth) and a handful of peer-reviewed papers in moderately-ranked journals. I'm not claiming to make any original technical points, or to give a comprehensive evaluation of the economic growth literature. My criticisms are largely straight from the authors' own mouths. 1. What is this book about? Why is it not very good? Acemoglu and Robinson (AR) argue that countries are rich or poor because of their political institutions, not culture, geography or policy ignorance. I'll do this as much as possible in AR’s own words. Why Nations Fail was written during the Arab Spring, so the preface begins with Egypt. Some stress that Egypt’s poverty is determined primarily by its geography, by the fact that the country is mostly a desert and lacks adequate rainfall, and that its soils and climate do not allow productive agriculture1. Others instead point to cultural attributes ... Egyptians, they argue, lack the same sort of work ethic and cultural traits that have allowed others to prosper, and instead have accepted Islamic beliefs that are inconsistent with economic success. A third approach, the one dominant among economists and policy pundits, is based on the notion that the rulers of Egypt simply don’t know what is needed to make their country prosperous, and have followed incorrect policies and strategies in the past. Unsurprisingly, those other economists and policy pundits turn out to be wrong and the authors turn out to be right. In this book we’ll argue that the Egyptians in Tahrir Square, not most academics and commentators, have the right idea. In fact, Egypt is poor precisely because it has been ruled by a narrow elite that have organized society for their own benefit at the expense of the vast mass of people. And the Egyptian lesson turns out to be general. Whether it is North Korea, Sierra Leone, or Zimbabwe, we’ll show that poor countries are poor for the same reason that Egypt is poor. Countries such as Great Britain and the United States became rich because their citizens overthrew the elites who controlled power and created a society where political rights were much more broadly distributed, where the government was accountable and responsive to citizens, and where the great mass of people could take advantage of economic opportunities. What are “institutions” anyway? (The economic and political kind, not the prison and mental hospital kind.) Basically, AR mean politics. The word "institutions" occurs over 1000 times in Why Nations Fail2. I'll just focus on how AR use it without worrying about the dictionary, different schools of economics, or other social sciences. They begin with what institutions do rather than what they are. Nogales, Arizona, is in the United States. Its inhabitants have access to the economic institutions of the United States, which enable them to choose their occupations freely, acquire schooling and skills, and encourage their employers to invest in the best technology, which leads to higher wages for them. They also have access to political institutions that allow them to take part in the democratic process, to elect their representatives, and replace them if they misbehave. The word is used dozens more times before ARattempt a more general definition. Each society functions with a set of economic and political rules created and enforced by the state and the citizens collectively. Economic institutions shape economic incentives: the incentives to become educated, to save and invest, to innovate and adopt new technologies, and so on. It is the political process that determines what economic institutions people live under, and it is the political institutions that determine how this process works. So while economic and political institutions can be separated, it is the political institutions that matter in the long run. The good kind of institutions that lead to economic growth are "inclusive", as opposed to "extractive". To be inclusive, economic institutions must feature secure private property, an unbiased system of law, and a provision of public services that provides a level playing field in which people can exchange and contract; it also must permit the entry of new businesses and allow people to choose their careers. ... such rights must exist for the majority of people in society. Political pluralism is necessary, but not sufficient without a strong centralised state. ... political institutions that distribute power broadly in society and subject it to constraints are pluralistic. ... the key to understanding why South Korea and the United States have inclusive economic institutions is not just their pluralistic political institutions but also their sufficiently centralized and powerful states. A telling contrast is with the East African nation of Somalia. I am still a bit hazy as to the relative importance of de jure written rules versus the de facto struggle for power. AR are somewhat circular: Politics is the process by which a society chooses the rules that will govern it. Politics surrounds institutions ... When there is conflict over institutions, what happens depends on which people or group wins out in the game of politics ... The political institutions of a society are a key determinant of the outcome of this game. They are the rules that govern incentives in politics. But overall, you could just say ‘politics’ and not be too far off. AR do this themselves occasionally. South Korea ended up with very different economic institutions than the North because different people with different interests and objectives made the decisions about how to structure society. In other words, South Korea had different politics. AR's academic reputation is based on statistical analysis, but Why Nations Fail tries to do narrative history, IMHO not very well. When Jeffrey Sachs reviewed the book, he complained: They never define their key variables with precision, present any quantitative data or classifications based on those definitions, or offer even a single table, figure, or regression line to demonstrate the relationships that they contend underpin all economic history. Instead, they present a stream of assertions and anecdotes about the inclusive or extractive nature of this or that institution. AR replied baldly: Sachs ... argues that we provide no evidence. Right, we do not in the book. But that’s because a book for a general audience is not the right forum for presenting academic research, and we spent many years of our lives precisely on writing academic papers providing exactly the sort of evidence. ... So yes, we don’t provide the econometric evidence in the book, which isn’t of course the right place to do it, but econometric evidence is abundantly loud in the way it speaks on these topics. So, don't expect Why Nations Fail to be an accessible explanation of AR's academic work, which is what I was hoping for when I first read it. What do they spend over 500 pages on then? Well, after the preface, there's fifteen chapters of, as Sachs says, "assertions and anecdotes". Not just about "the inclusive or extractive nature of this or that institution", to be fair, but how institutions can change at "critical junctures" such as the Black Death or colonisation, and why it can be in elites’ interests to block economic innovation if it threatens their power, so that growth under extractive institutions is unlikely to be sustained. These chapters are not particularly good – I found them poorly organised and repetitive – but not particularly bad, if you are willing to accept the underlying premise that institutions are the main determinant of economic growth. Cumulatively they have an effect similar to the Old Testament, if you are willing to accept the underlying premise that the fortunes of the nation of Israel are determined by the LORD. Only the second chapter, ‘Theories that Don't Work’, makes a sustained argument against alternative theories. Geography is disposed of by noting the stark differences at the US-Mexican, North-South Korean and East-West German borders, and the reversal of fortune by which the present day US and Canada only became richer than Mexico, Central and South America following European colonisation. Culture is hand-waved away with the assertion that institutions determine the any relevant cultural behaviours, not the other way around, referring to the same border examples, the rapid catch up of Catholic Europe despite Weber's Protestant Ethic, the malign influence of the European and Ottoman empires on Africa, the range of outcomes within the former British Empire, and the more European population of Argentina and Uruguay versus the US and Canada, or of Columbia versus Ecuador and Peru. Not a bad list of anecdotes, but one could equally well point to the cross-border success of Ashkenazi Jews, overseas Chinese, or Baltic and Volga Germans. Ignorance is simply dismissed with the assertion that "if ignorance were the problem, well-meaning leaders would quickly learn what types of policies increased their citizens’ incomes and welfare, and would gravitate toward those policies." Various good and bad policy changes are explained as the result of political pressures rather than improved knowledge. The implication seems to be that good policies are so obvious they don’t require expert knowledge or advice, or that the experts never get it wrong. This appears most implausible in the debate over socialism and economic planning. Writing off the entire Communist experience as simply another elite trying to preserve its power feels inadequate, especially considering that some distinguished bourgeois economists thought central planning was a plausible road to riches until quite late in the day. Genetics or race is not mentioned, but would presumably attract the same counterexamples as geography and culture. Another theory AR do not discuss is crude exploitation: while colonial empires are excoriated, it is for setting up persistent extractive political institutions rather than for a direct theft of resources. The prosperity of white-owned South African farms next to poverty-stricken Bantustans is explained by the better quality of the institutions available to whites under apartheid, not relative population densities and land quality. For the rest of the book, I'll just list a few nitpicks to signal I read the whole thing and know a bit of history, but feel free to skip this – the real evidence for AR's thesis is in their academic papers, and I'll discuss those in the next section. I think AR overrate the importance of the Glorious Revolution, to the point of claiming it "created the rule of law" – after all, Parliament had already deposed and executed a king, then brought back the king’s son on their own terms after a decade of republican government. No less a luminary than Edmund Burke asserted "The Revolution was made to preserve our ancient indisputable laws and liberties, and that ancient constitution of government which is our only security for law and liberty." Also, strong signs of British economic uniqueness – the abnormal growth of London and reliance on coal as a fuel – predated 1688.

Inline links: 1, 2, dictionary, schools, economics, social sciences, reviewed, replied, Protestant Ethic, planning, distinguished, bourgeois, Glorious Revolution, Edmund Burke, predated

Book Review: Elon Musk

September 13, 2023 · Original source

Musk claims to be self-made; he moved to Canada at age 17 with $2500 and worked his way up from there. For a while he supported himself by cutting logs, Abe Lincoln style. Nobody paid for his college and he took out $100,000 in debt. Musk’s father invested $28,000 in his first company, but Musk dismissed this as a “later round” and claimed he was already successful at that point and would have gotten the money anyway. The total for that round was $200,000, so Musk’s father’s contribution was only about 15%.

Highlights From The Comments On Kidney Donation

November 07, 2023 · Original source

(The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here. Still, the US was one of the first, and I’m still proud of it.)

Spring Meetups Everywhere 2024

March 30, 2024 · Original source

KYIV Contact: Artem Batogovsky (or Forux) Contact Info: https://t[dot]me/forux Time: Friday, April 5th, 7:00 PM Location: Ziferblat Cafe (Циферблат кафе) Group Link: https://t.me/lwkyiv Notes: The meetup has been moved to online due to the situation in Ukraine. Use the group link. North America Canada CALGARY, ALBERTA, CANADA Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, April 27th, 2:00 PM Location: Side Street Pub: 1167 Kensington Crescent NW. I'll bring an "ACX" sign with red letters. Coordinates: https://plus.codes/95373W26+R8G Notes: Please RSVP on LessWrong

Inline links: https://t.me/lwkyiv, https://plus.codes/95373W26+R8G

CALGARY, ALBERTA, CANADA Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, April 27th, 2:00 PM Location: Side Street Pub: 1167 Kensington Crescent NW. I'll bring an "ACX" sign with red letters. Coordinates: https://plus.codes/95373W26+R8G Notes: Please RSVP on LessWrong

Inline links: https://plus.codes/95373W26+R8G

EDMONTON, ALBERTA, CANADA Contact: Joseph Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, April 18th, 7:00 PM Location: Irrational Brewing Company, 10643 124 St #109, Edmonton, AB T5N 1S5. We will have an ACX sign! More information at https://www.lesswrong.com/events/Fez72WdfeyDZAM796/acx-spring-meetups-everywhere-1 Coordinates: https://plus.codes/9558HF27+7Q Event Link: https://www.lesswrong.com/events/Fez72WdfeyDZAM796/acx-spring-meetups-everywhere-1 Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: Please do your best to RSVP on LessWrong so we know how much food to get

Highlights From The Comments On The Lab Leak Debate

April 09, 2024 · Original source

This collapses the ‘extreme coincidence’ claim, which as explained above, turns lab-leak into the leading hypothesis. My strongest disagreement is with his Point 3 - the inference from other seafood-market-based COVID spread events. Saar writes: A common objection to this method is that these outbreaks are caused by cold-chain products brought into these markets. However, this still fails to explain why markets form these early clusters and not the many other places where cold chain products are delivered to. Additionally, this only demonstrates the importance of cold wet surfaces in preserving SARS2 infectivity, further strengthening the hypothesis in method 1 that a crowded location with many wet surfaces like HSM is highly conducive for rapid SARS2 spread. Last, it also opens the possibility that the HSM outbreak was also caused by cold-chain products. This would reduce the significance of Wuhan being the outbreak location (as the product could have come from anywhere), but since the other evidence for lab-leak is so strong, Wuhan can be given no weight and still lab-leak would be highly likely – Rootclaim’s conclusion will only drop from 94% to 92%. Most of these outbreaks have been traced back to either a migrant worker (eg a fisherman from a country with COVID sells fish at the market of a country with Zero COVID) or a cold chain product. For example, here’s Dai et al on the Xinfadi outbreak, the most important event of this type: According to a joint publication by the Beijing CDC and 13 research institutions, the outbreak at Xinfadi Market was likely to be initiated by fomite transmission from contaminated foods imported via cold-chain logistics (Pang et al., 2020; Beijing Daily, 2020b). Based on the epidemiological investigations at the Xinfadi Market, the researchers preliminarily concluded that booth #S14 in the aquaculture product selling area on the basement floor of the primary trading hall was the source of the initial transmission. Specifically, five customers were tested positive for IgG/IgM antibodies against SARS-CoV-2 in serological screenings, all of whom visited booth #S14 on May 30 and 31, 2020. On May 30, 2020, the owner of booth #S14 procured imported and fully packaged salmon from a company's cold storage warehouse, then cut and processed the salmon for sale at the Xinfadi Market. Laboratory tests showed that sample swabs from five salmon fish from this supplier were tested positive by examining all salmon in the original sealed packages (n = 3582) in the cold storage facility. Viral genome sequencing showed that the viral strain isolated from one of the positive salmon swabs was homologous to that isolated from the infected persons and environmental samples at the Xinfadi Market (Beijing Daily, 2020b). The joint study reported that an ancestral strain isolated from the Xinfadi Market in Beijing was markedly different from the strains identified in two preceding outbreaks in China and the sequences obtained in March 2020 in Beijing. Phylogenetic analysis assigned the ancestral Xinfadi strain to clade B.1.1. Given the fact that the ancestral sequences were mainly identified in Europe, the strain was more likely to be imported to Beijing rather than derived from strains previously circulating in China (Pang et al., 2020). I know China has a bias towards believing frozen food COVID explanations, but this all sounds pretty convincing to me. Why is it more often markets than other places with cold chain products? Partly it’s the migrant workers - a lot of seafood markets are right next to seaports, and the contact tracing eventually traces back to a fisherman who came in through the seaport - I don’t think this is any more mysterious than epidemics often starting via airport or any other transportation hub. But even just keeping the focus on cold chain products, - there have also been outbreaks in seafood distribution warehouses, on docks, and in a seafood processing work area. Markets have many more people than any of those locations, and maybe (total speculation) cutting on cutting boards could aerosolize bits of fish. The strongest evidence that the Wuhan / Huanan Seafood Market epidemic wasn’t caused by migrant workers or imported seafood products is that there was no previous COVID-infected source of workers or seafood. If there had been, we would have noticed when the outbreak there spread (see Section 1.4 on Brazil). Responses to a few of Saar’s other points below: How many locations other than markets provide an interface with wildlife? Were markets actually identified in advance to be high-risk spillover locations or only in retrospect? I think scientists had called wet markets as an especially dangerous potential transmission location in advance. See for example Infectious Diseases Emerging From Chinese Wet Markets, published in 2006, which says: » “In Chinese wet-markets, unique epicenters for transmission of potential viral pathogens, new genes may be acquired or existing genes modified through various mechanisms such as genetic reassortment, recombination and mutation. The wet-markets, at closer proximity to humans, with high viral burden or strains of higher transmission efficiency, facilitate transmission of the viruses to humans.” In 2004, a paper on an emerging bird flu expressed hope that it would not spread too widely, but concluded that: » “Even in the event of yet another lucky escape, more measures must be taken to limit the amplification of viruses with pandemic potential in the wet markets around the world.” In 2007, Reuters published an investigation: Chinese Markets May Be Breeding Ground For Deadly Viruses, which said things like: » “We face similar threats from other viruses and such epidemics can happen because we continue to have very crowded markets in China," said Lo Wing-lok, an infectious disease expert in Hong Kong. "Even though official measures are in place, they are not faithfully followed. We are not talking about just civet cats, but all animals," he added.” Wet Markets, A Continuing Source Of SARS And Influenza, published 2004, is admittedly focusing on the next SARS1 outbreak instead of on SARS2, but gets bonus points for mentioning both wet markets and labs as likely causes of the next pandemic: » “Will SARS reappear? This question confronts public-health officials worldwide, particularly infectious disease personnel in those regions of the world most affected by the disease and the economic burden of SARS, including China, Taiwan, and Canada. Will the virus re-emerge from wet markets or from laboratories working with SARS CoV, or are asymptomatic infections ongoing in human beings? Similar questions can be asked about a pandemic of influenza that is probably imminent. Knowledge of the ecology of influenza in wet markets can be used as an early-warning system to detect the reappearance of SARS or pandemic influenza.” Saar mentions that there are several other possible sources like restaurants or farms. I think Peter demonstrated during the debate that pandemics are unlikely to start in rural areas, so farms aren’t that important. Restaurants mostly source their products from wet markets. During SARS1, some pandemics started in restaurants because they kept the civets in cages next to the diners (like how some Western restaurants keep lobsters). After SARS1, restaurants stopped doing that and became a less likely spillover location. Saar again: Scott quotes Peter, who implies that under the lab-leak hypothesis, we would expect the confirmed early cases to be centered around the WIV. However, cases are not expected to center on the lab. The lab is not spraying viruses into the air or hosting thousands of locals daily. If a worker gets infected, they spread the virus to their friends and family at completely different locations. In most places with an outbreak of known origin, epidemics show some geographic clustering. This has been true ever since the very beginning of epidemiology, when John Snow successfully traced a cholera outbreak back to its origin at a contaminated water pump by taking the center of the map of cholera cases. This isn’t a 100% law of nature; an infected lab worker might get lucky and not pass it to any of his lab co-workers. Still, we might expect him to infect his family, the stores he went to, or the restaurants he went to. If he lived near his workplace, these might also be near the lab. If he didn’t - let’s say he lived on the other side of town and had a long commute - he would start a cluster near his house, or his favorite store, or his favorite restaurant. Then the people there would infect their families/co-workers/stores/restaurants. The cluster would start somewhere! Sure, some people would infect nobody close to their work or home, and instead just infect one person a hundred miles away who they breathed on during a trip - but this is the exception, not the rule. So you wouldn’t expect a totally random distribution of cases all around Wuhan. There would be one center, or maybe several centers. But none of the claims that COVID was quietly spreading for months before the wet market have pointed to some alternate center of cases. If COVID was spreading for months before the lab, it somehow spread in a completely diffuse geographical pattern, with people exactly as likely to infect people far away from them as close to them - until it reached the wet market in December, and then spread in the normal center-radiating-outward way that every other infection spreads. All the evidence trying to support a spillover at the market is based on complex models with many single points of failure, built from unreliable and biased data. Therefore, it is difficult to give this evidence significant weight as there is always a possibility of errors in the data or its interpretation. More on this in the UFO comment below. Disagree. “First known case was at a wet market” is as simple as it comes. Certainly it’s less complex than “the virus has a 12 nucleotide insertion at the furin cleavage site, and even though those sometimes happen by natural recombination probably this one didn’t, and even though it looks out of frame maybe there was some weird thing going on with serine that made it in frame this one time only”, which is Saar’s star piece of evidence. I understand Saar thinks he can come up with lots of objections to “seen near wet market is suspicious for wet market origin”, then claim that getting over those objections requires “complexity”. But if Peter had no dignity, he could also come up with lots of objections to “seen in same city as Wuhan Institute of Virology is suspicious". He could say that maybe the civet farms of Hubei province were uniquely blah blah blah, and then Saar would have to prove that the civet farms weren’t uniquely blah blah blah, and then he could say “Oh, sure seems like you have a complex model with lots of unique points of failure, it all depends on fifty facts about the regulation of civet farms.” To illustrate what a market looks like in a real zoonotic pandemic, consider this study from SARS1. The researchers went to a random market and sampled the wildlife sold there. 4 of 6 civets sampled were positive, and 3 of them were phylogenetically distinct (i.e. infected in completely different places). A scientist I talked to says the 3 phylogenetically distinct lineages were most likely sampling errors. Still, this seems irrelevant to me since, again, no raccoon-dogs were tested. Scott explains that Covid’s closest known relative, BANAL-52, is rare and so it’s highly unlikely the WIV would’ve had it available as the starting point to engineer Covid . . . This is a basic mistake. SARS2 is not based on BANAL-52 but a relative of it. There is nothing unlikely here. No BANAL-52 relative close enough to create COVID from has ever been discovered. By mentioning BANAL-52, I was trying to be maximally charitable to the lab leak side. In order to create COVID, they would need a virus very close to COVID. But in years and years of searching, nobody has ever discovered a virus like this. Therefore it must be rare. As a way of bounding how rare, let’s see how rare the closest virus ever discovered is. That’s BANAL-52. It is very rare. Therefore, the COVID ancestor must be rarer than that. I don’t know how strong this argument is, because maybe there are millions of rare viruses capable of becoming pandemics, such that getting any one of them is very easy, even though each one individually is rare. The version of this I find convincing is that it should be a probabilistic cost to say that WIV did gain-of-function on a seemingly undiscovered and so-far-very-hard-to-discover rare virus instead of on any of the usual SARS-like viruses that people do their gain-of-function research on. Overall, all attempts to portray [Connor Reed] as an unstable, delusional person were unsuccessful. He is an ordinary person who very accurately described Covid-19 symptoms in real-time and claims to have received a positive test result. The timing and location matches the lab leak hypothesis and is impossible for the HSM claim. Therefore, they must discredit him. It is worth noting here the biased evidentiary standards used by zoonotic proponents. Reed’s testimony about his sickness, given on camera to multiple outlets, is deceitful and should be ignored. Yet, an anonymous voice testimony in one Chinese publication is definitely identified as Mr. Chen (another possible pre-HSM case) and should be considered reliable. See above for why I don’t trust Connor Reed. I’m not sure why Saar attributes Mr. Chen to “an anonymous voice testimony in one Chinese publication”. When I looked for Chen information, I got this thread, where it’s attributed to two Chinese hospital doctors, cross-checked with the Chinese COVID data repository, and double-cross-checked with the supplementary table in a peer-reviewed paper published by a team of Wuhan doctors. To understand how ridiculous the claim is that the HKU1 insertion looks just as engineered as SARS2’s, here are their alignments. Hopefully that should be enough. COVID: HKU1: I’m not a virologist, but I question how this comparison works. Surely HKU1 got its insert on some specific day. If you take the virus the day before, and then the other virus the day after, there will be no differences except the insert, and it will look just like COVID (ie an insert without many other mutations). The fact that the COVID comparison has few mutations, and the HKU1 insert has many mutations, just shows that whatever older virus we chose to compare HKU1 to is more distant from HKU1 than BANAL-52 (or whatever) is from COVID. Or am I missing something here? [The evidence that China tried to cover up zoonosis from the start] is untrue. They clearly said from the start this is a zoonotic spillover at HSM, and at least part of the government went to immense efforts to identify the animal, close farms, etc. (and of course couldn’t find any infected animal). Only in late 2020 did they start suspecting an import from cold-chain products after having multiple outbreaks that seem related to cold-chain products. From a Vox article from March 2023: From the start, the Chinese government interfered with efforts by both Chinese and international experts to study the pandemic, including its origins. Reporting by the AP found that even as WHO officials were publicly praising China’s cooperation, behind the scenes they were complaining about lack of access and a refusal to share data. Within months of the beginning of the pandemic, the Chinese government imposed restrictions on academic research into the origins of the novel coronavirus … China’s intransigence wasn’t unusual — countries are rarely eager to confirm that they’re the source of a deadly disease — but it went beyond the norm. International investigators weren’t permitted to see the market until more than a year after the pandemic began and a WHO-affiliated team was allowed a highly choreographed and controlled visit. The resulting report that came out of the Wuhan visit, which dismissed the possibility of a lab origin, pointed the finger at some kind of zoonotic spillover while concluding that it was unlikely that the spread started at the market, which surprised many experts. It also found that it was “possible” that the virus had been introduced via contaminated frozen food products from abroad. While few experts took that possibility seriously, it fit a narrative the Chinese government had been pushing, against nearly all evidence, that the pandemic had in fact not originated in China. “China just doesn’t want to look bad,” Filippa Lentzos, a biosecurity expert at King’s College London, told Science last August. “They need to maintain an image of control and competence. And that is what goes through everything they do.” […] it seems clear that with more cooperation, scientists could have been looking at raccoon dogs a year or more ago. “The big issue right now is that this data exists and that it is not readily available to the international community,” Maria Van Kerkhove, the WHO’s Covid-19 technical lead, told reporters on Friday. “This is first and foremost absolutely critical, not to mention that it should have been made available years earlier, but that data needs to be made accessible to individuals who can access it, who can analyze it and who can discuss it with each other.” The irony is that by making it so difficult to properly investigate a zoonotic origin of Covid, the Chinese government has created a vacuum that has been filled by claims on all sides, including the much more damning accusation that the pandemic was the result of a lab error at the Wuhan Institute of Virology. For what it’s worth, my timeline of Chinese denials and coverups looks like this: December: COVID doesn't exist, it's all lies Early January: Fine, it exists, but it’s just some wet market thing that can't spread from person to person Late January: Fine, it can spread from person to person, but we’ve got it under control now. February: Fine, it’s out of control, but you would not believe how great our response was. We're basically heroes. March: COVID was a US bioweapon, or possibly came from Italy. April: Chinese people are banned from researching the origins of COVID without government permission. 2: Comments Arguing Against Lab Leak 2.1: Is the pandemic starting near WIV reverse correlation? randomstringofcharacters wrote: Isn't [the pandemic starting near the lab] a reverse correlation issue? The lab is situated there because it's an area where coronaviruses were found in the past. Many people had this question, but Wuhan Institute of Virology was founded in 1956, didn’t originally focus on coronaviruses, and isn’t in a coronavirus hot spot. Most of WIV’s coronavirus samples come from Yunnan, about a thousand miles away. COVID’s closest relatives were found in Laos, almost two thousand miles away. During the debate, both Saar and Peter calculated the odds of a natural pandemic arising in Wuhan by dividing the population of Wuhan by the total urban population of East Asia (Saar) or South China (Peter). Saar got 1.5%, Peter got 3% (he later said this could be as high as 10% because it was a central hub in the wildlife trade). This isn’t an Official Position and I don’t think anyone else shares it, but during the debate Peter pointed out a few times that there are plenty of disease-ridden bats in Hubei (the province Wuhan is in), and that it’s not impossible that a bat virus currently known only in Laos could be active in Hubei. Still, this is the minority viewpoint and most scientists just think it involved something about the wildlife trade. 3: Other Points That Came Up 3.1: Apology to Peter re: extreme odds quiet_NaN wrote: Hot take: Peter clearly failed to convince anyone. The lab leak odds, in log10 (i.e. orders of magnitude are): Peter -20.7 Saar 2.7 Eric -3.1 Will -2.5 Scott -1.2 Daniel -1.4 One of these numbers is clearly an outlier. Scott mentions it and calls it "trolling", I would argue that it is debating in bad faith. 2e-21 is a ratio which is just silly. For one thing, the gain of function at WiV pathway is not the only pathway towards a lab leak. The WIV could also have released a naturally occurring coronavirus at the wet market. At 2e-21 odds, we would probably have to consider the possibility that the WIV built a time machine and went back in time to infect the wet market. I might have screwed up here - or at least I should have emphasized the “trolling” part. Peter complained about my presentation of his extreme-odds slide, saying: This is basically accurate. During the debate, Saar gave lots of different numbers. I don’t want to say exactly what the different numbers meant, because in earlier drafts of my post, Saar said I misunderstood them. My impression were that some of his numbers were conservative, others were central, others were extreme, others were adjusted-for-out-of-model-error, others were not-adjusted, etc. In an early draft of the post, I gave higher numbers for Saar. Saar asked me to replace them with the numbers I ended up using. I decided to agree, because I wanted to represent Saar fairly with the numbers he most centrally believed, but also because these were closest to the numbers on his Rootclaim site so it wasn’t like he was making them up just to fool me. Peter didn’t argue quite as hard, and also he didn’t have anything like the Rootclaim site, so I just took his first set of numbers. Trying to piece things together, I think a reasonable summary would be: During the debate, Saar mentioned 700-million-to-one odds in favor of lab leak, not because he thought this was plausible, but just as a discussion of where the situation would end up if you didn’t adjust for human fallibility.

Inline links: Dai et al, Pang et al., 2020, Beijing Daily, 2020b, seafood distribution warehouses, on docks, a seafood processing work area, Infectious Diseases Emerging From Chinese Wet Markets, a paper on an emerging bird flu, Chinese Markets May Be Breeding Ground For Deadly Viruses, Wet Markets, A Continuing Source Of SARS And Influenza, this study from SARS1, this thread, https://substackcdn.com/image/fetch/$s_!dcI7!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fc5aabd26-d70b-4f35-97cb-96d351bb52fd_552x920.png, https://substackcdn.com/image/fetch/$s_!UQ14!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F2411167c-1405-4fde-914b-6388ee498523_935x851.jpeg, a Vox article, wrote, wrote, https://twitter.com/tgof137/status/1773797640607850745

ACX Survey Results 2024

April 19, 2024 · Original source

I can’t make Google Forms only present data from people who agreed to make their responses public, so I’ve deleted everything identifiable on the individual level, eg your written long response answers. Everything left is just things like “X% of users are Canadian” or “Y% of users have ADHD”. There’s no way to put these together and identify an ADHD Canadian, so I don’t think they’re privacy relevant. If you think you’ve found something identifiable on the public results page, please let me know.

Highlights From The Comments On Hanson And Health Care

May 10, 2024 · Original source

» As a result, U.S. maternal mortality is overestimated by two to three times. Properly measured, the real U.S. maternal mortality rate in 2019 was 9.9 maternal deaths per 100,000 births, which would put it at 36th place—still not impressive by comparison, but somewhat better than Canada and a bit worse than Finland or the United Kingdom […]

Your Book Review: Two Arms and a Head

August 02, 2024 · Original source

(Source) A diagram of the human spine next to a diagram of the human body, indicating which parts of the body are innervated by which vertebrae in the spinal column. The cervical, thoracic, lumbar, and sacral regions of the spine are highlighted in different colors, with the corresponding body regions highlighted in the same colors. Starting at the top, the cervical (neck) vertebrae control the head, neck, arms, and fingers. The thoracic (torso) vertebrae control the entire torso and abdomen. The lumbar (lower back) vertebrae control the hips and front muscles of the legs. The sacral (tailbone) vertebrae control the back muscles of the legs and the groin area. The very last vertebra, S5, innervates the anus and genitals. Clayton is injured quite high up on the torso at the T5 vertebra. Let's consider the ramifications of having everything below the nipples be completely numb and limp. To start off, that means that he has no use of the muscles that hold him upright. Nothing keeps me sitting up—no hip flexors, erector spinae, hamstrings, or abdominal muscles. I am arms-and-a-head on a column of Jell-O. He can't put both arms out in front of him, lest he fall over. He has to continuously prop himself up with one arm while doing anything at arm's length. After only 1.5 years of being paralyzed, this has already caused significant repetitive strain injuries in his elbows, shoulders, and ulnar nerves. Clayton still has to deal with all the logistics of life, despite two-thirds of his body being a hunk of corpse-flesh. He dedicates huge swaths of the text to all the little time-wasting tasks he now has to do. How much of his life is ticking away with every delay, every piece of effort, every task that is trivial for an able-bodied person but monstrously difficult for him. Something as simple as getting out of a car is an entire production—let alone running errands, cleaning, doing laundry, cooking. Since the lower two-thirds of his body no longer sends pain signals to his brain, he must proactively tend to all of its physical needs. Complications include pressure sores, infections, and a high chance of blood clots. Aside from suicide, the leading causes of death among paraplegics are all related to poor circulation. In addition to the loss of conscious sensation and muscle control, problems with the autonomic nervous system—heart rate, orthostatic blood pressure, temperature regulation—are common. This is even more pronounced in cervical spine (neck) injuries. Some quadriplegics black out or the blood rushes to their head when being moved from lying down into reclining in a wheelchair. A spinal cord injury wreaks havoc on the body's functioning. Go back to that diagram. The groin area is innervated by the very end of the spinal cord, at the S5 vertebra. We tend to think of our legs as being “below” the crotch, but the nerves that control bowel movements and urination are downstream of the ones for the legs. To keep the party rolling I will tell you about piss and shit. [...] To urinate I have to slide a catheter down my urethra. [...] To defecate I finger myself up the ass and root around and around until the shit comes out. Nuggets, smooshy, whatever it is I’m digging in it. He describes the disgusting, nauseating process at length. For the sake of your lunch, I will refrain from quoting it all. In addition to being unable to open and close his sphincters on command, he also receives no signals of needing to go. If he eats the wrong thing and gets a bout of diarrhea, he will have no warning—no abdominal discomfort and no final urge to rush to the bathroom. One afternoon he "has an accident" while lounging on his couch. In trying to move from the couch to the toilet, he subsequently smears feces all over the couch, the carpet, his wheelchair, the toilet seat, and the shower. After he digs the poop out of his anus and washes himself off, he then has to clean all of that up by himself. From a wheelchair. Bending down, stretching, trying not to fall over, trying to reach the floor to scrub feces off the carpet. From a wheelchair. This episode was hardly the first time. He would routinely wake up in the morning to find that he had soiled himself overnight. Imagine struggling to rip dirty sheets off the bed, stuff them in the laundry, and put a clean sheet on the mattress—from a wheelchair. I don't know about you, but I can barely get a fitted sheet on my own mattress, and I get to do it while standing up. And unless I want to piss or shit myself, there can be no rest from this drudgery, ever, for the rest of my life. No relieving stretch of time without piss-dowsing and fingering myself up the asshole. Nobody told Kid Me that Professor X has to dig turds out of his anus every day. The groin dysfunction doesn't stop there. To be redundant once more, I can’t feel my penis. [...] Men, think how losing your penis would make you feel. Ladies, think of having your clit amputated and never having sex again. [...] True, the unfeeling penis attached to the living corpse I drag around can become erect but what has that to do with me? The one time he tries to have intercourse after his injury, it goes about as well as you'd expect: Watching a woman bob up and down on the penis attached to the corpse that used to be my body struck me as macabre and disturbing. It was like necrophilia. It’s like watching a woman get off by rubbing my amputated foot on herself. The disturbing facts just keep on rolling. One final note about the physical symptoms: spinal cord injuries hurt. Everything below the damage is numb, but the injury itself is a massive tear in the central nerve that controls the body. The pain is insistent, nagging, and so sharp it seems to crackle. [...] It’s just as sharp and intense every time, over and over, like it’s mocking you. Sometimes it happens when I’m lying in bed and it’s like trying to fall asleep with someone sticking a needle between my ribs or the bones of my big toe. But, surely, the only real problem is the physical limitations? Clayton is still the same person he'd always been, right? He has the same brain, same personality he did before the accident. Even if he can't walk anymore, he still has his memories. Not so fast. Yes, Even Worse Than That What kind of mental and emotional toll does all of this take on Clayton? The feeling I experience is a frantic, frenzied, desperate distress. [...] I need to move. I need to move. [...] Not only is two-thirds of my body paralyzed, but so is a huge part of my innermost self. It wants more than anything to feel and experience life. To exist. But it exists now only in a place between reality and nothingness with no hope of ever coming back. [...] All it can do is degenerate in the solitary place it has been forever exiled to. A popular heuristic in neuroscience is "use it or lose it." This is usually in the context of memorization, but it also applies to sensory organs and limbs. When Clayton is injured, his brain's connection to everything below his nipples is severed. Lacking any more sensory input from down there, the brain simply overwrites and repurposes the unused neurons. His injury is not limited to his present and future, but also reaches back into his past: Certain of my memories seem to be disappearing. For example, when I try to remember doing things that involved running, jumping, and sex, the memories seem less real or vivid than they used to. [...] If I imagine taking another person’s hand in mine, or kissing someone’s face, or someone touching my face, I feel something similar to sensation in those parts of my body when I imagine it. [...] But my lower body is now just a void, and its death started the creation of a void in my brain. Not only can I not feel it, but my ability to imagine feeling it is disappearing, as is my capacity to remember feeling it, and doing things with it. He likens himself to a Cartesian brain, a part of the world but outside of it, forever locked away, unable to exert his will on the outside world. Not only has he lost his legs; he is beginning to lose the memory of those legs, too. Everything he ever was, any skills that he ever learned related to being able-bodied, are destined to die over the coming years. His mind is doomed to slowly decay as its neurons do what neurons do: rewrite themselves until none of the person he used to be is left. Toxic Positivity Can Clayton actually talk about any of these things with his peers? Not really. He has a small circle of other recently paralyzed friends who understand, but outside of that, no. American culture has an entire social ecosystem that reinforces the idea that disabled people should be upbeat and optimistic about their life prospects. Almost any interview with a paraplegic ends on some upbeat note about how their disability "doesn't stop them from doing all the things they want to do" and that "they can do anything” an able-bodied person can. In fact, Two Arms and a Head opens with one such quote from Stephen Hawking: “I try to lead as normal a life as possible, and not think about my condition, or regret the things it prevents me from doing, which are not that many.” —Stephen Hawking This is patently absurd. Why do they say these things? Do they actually mean it, or are they just being hyperbolic for rhetorical effect? Surely they all know, secretly, that they’re lying to themselves? Clayton argues that no, they mean it, and they’re not lying to themselves. Remember how disability affects the brain? How all those unused neurons get repurposed, and any concepts of using those paralyzed limbs gets overwritten (if they ever existed in the first place)? They [lifelong paraplegics] tend to only see life in terms of the possibilities that exist for them [...] Their view becomes somewhat tautological. “What I can do is all that is possible, therefore I can do all that is possible.” Just as able-bodied people cannot comprehend what it’s like to be a paraplegic, lifelong paraplegics and quadriplegics simply cannot grasp what it is to be able-bodied. I’m not saying that lightly. The difference is biological. They have different brains. [...] They do not understand the experience of being able-bodied—neither the subtleties or much of what, to observers, is overt and glaring. They can try to imagine it, but they don’t even come close to comprehending the potential that exists there. Hence the common refrain that there are “not many” things that they can’t do. Adding to this dynamic is that it is considered impolite in our culture to call them out on it: If I were still able-bodied and a paraplegic told me he could do everything I could, I would just think “Looks like being crippled fucked up his mind too, because that’s insane.” I’m not sure what I’d actually say to him, but I know it wouldn’t be that. [...] So the disabled are basically allowed to go around saying whatever on Earth they want. They acquire a kind of de facto moral infallibility because nobody is going to argue with them. On top of this, humans have a basic need to belong, stay positive, and avoid people who are negative and miserable. If paraplegics were honest about all the body horror and misery, they would quickly find themselves devoid of friends. So what is a newly paraplegic person to do in order to maintain connections during a time in their life when they desperately need comfort and support? Brainwash themselves, of course! Clayton was staring down the prospect of what he would have to do to his mind in order to survive in our current society as a paraplegic. It was bad enough to be mutilated physically; he didn't also want to be mutilated mentally. What happened to my body is frightful, but no less than what happens to the minds of many disabled people. We have to have some kind of integrity to our views of the world and reality, and the more the better. [...] So my unwillingness to adopt certain “attitudes” or whatever people call them is something like a desperate struggle to evade the clutches of madness. It gets worse. This does not just affect their social lives and beliefs. These dynamics ripple out into the medical community’s attitudes about paraplegia. If every interviewee swears that paralysis doesn’t hold them back in life, then why pour resources into finding a cure? I’ve heard people say that spinal cord injury is not a priority for medical research like cancer because “people can live like that”. No, we can’t live like this. This is not “life”. Which raises the question—have there been any breakthroughs since 2008? The State of the Cure Let’s take a short break from the existential horror to look at the science of spinal cord injuries. Clayton killed himself in 2008 because there was no cure at the time. Have there been any new developments in the ~15 years since? The short and upsetting answer is "not yet"—though there are some glimmers of hope. Why are Spinal Cord Injuries So Hard to Fix? The spinal cord consists of multiple concentric layers of nerve fibers, not unlike an electrical cable. Wherever the spinal cord has trauma, the nerve cells die off and form lesions of scar tissue that block all nerve signals from traveling downstream of whichever thread was damaged. Some patients are lucky in that only parts of the spinal cord are damaged, resulting in paralysis on only one side of the body. Nerve cells in the spinal cord do not regenerate themselves. Once damaged and scarred, there’s nothing anyone can do. The good news is that emergency medicine has come a long way in arresting the formation of scar tissue at the moment of injury. Patients coming into the ER today have a much better prognosis than they did a few decades ago. The interventions are straightforward treatments like stabilizing the spine, surgery to release pressure on the pinched nerves, and shots of corticosteroids to reduce swelling and inflammation. But beyond that, there is no clinically-proven, FDA-approved treatment for an existing injury. Clayton describes the challenge of rebuilding his injury as something similar to “reconstructing a crushed strawberry.” No amount of stabilization would have put his smeared spinal cord back together. The Latest Research Treatments fall into two camps: bridging the injury, and encouraging the injured scar tissue nerves to regenerate. Implanted Nerve Cells In 2012, Prof. Geoffrey Raisman's team at University College London successfully treated a paralyzed man in Poland. The treatment involved removing one of the olfactory bulbs in his brain in order to culture olfactory ensheathing cells (OECs), which are the only nerve cells in the human body that continuously regenerate. The surgeons removed a section of nerve from the patient's ankle, then implanted both the ankle nerve and the OECs into his spine at the injury site. The grafted tissue bridged the gap between his brain and the healthy spinal cord just below the injury. After years of rehab and physical therapy, in 2014 the researchers announced their success to impressive fanfare. As of 2016, the patient could walk, ride a tricycle, and had regained bladder, bowel, and sexual function. He was far from his pre-injury self, but his quality of life had improved immensely compared to before the treatment. The call went out to recruit two more volunteers for another study. And then... crickets. This follow-up study has yet to be performed. It could have been delayed for a number of reasons. Perhaps they never found suitable volunteers whose profiles satisfied the demands of European regulators. Perhaps Brexit threw a bureaucratic wrench in the collaboration between UCL and the research center in Poland. Perhaps they ran out of funding. To make matters worse, Prof. Raisman passed away in 2017. In the years since, the team has been making progress in fits and starts. As of 2022, the current focus at UCL has been on figuring out how to culture OECs from the nasal mucosa instead of needing to crack open the skull to get at the olfactory bulbs directly. They’ve also made improvements in the technique for applying these cells to the injury site. Things are certainly happening, albeit at a glacial pace. This treatment strategy may become widespread in the future, but at the moment, it remains experimental. NervGen's "Wiggling Molecules" In 2021, NervGen Pharma announced a drug that encourages damaged spinal tissue to heal without scarring. A bioengineered molecule, NVG-291, is injected into the spinal cord and acts as a scaffold for the nerve cells to attach to as they regrow. The molecules of this scaffold naturally "wiggle” and stimulate nearby nerve cell receptors, promoting healing. Animal models were extremely promising. NVG-291 is currently in Phase 1b/2a clinical trials, which are scheduled to start in August of 2024. I’m cautiously optimistic. The main impediments to finding a cure are the same ones that plague any other field of medical research: lack of funding and unreasonable requirements from regulators. The main problems at this point in time appear to be bureaucratic rather than strictly biological. Will any of this research pan out within the next 5, 10, or even 20 years? Maybe. Only time will tell. (Someone should start a prediction market about this!) Alas, this is all coming too late to have saved Clayton. The Decision to Die I am absolutely and heartbreakingly in love with life. But this is not life. [...] For those who like to say this one: “Suicide is a permanent solution to a temporary problem.” I reply that suicide in my case is a permanent solution to a permanent problem. [...] I have only one serious problem in life and it’s being paralyzed. Clayton does not come to this decision lightly. He considers it exhaustively and systematically. When deciding whether to keep living, he starts from the premise that there is some amount of suffering past which life stops being worth it. He evaluates where that dividing line is by examining the sources of meaning in his life. He starts by asserting that there is nothing wrong with his mental health or his reasoning abilities: I am not depressed, I am tortured, and there is a difference. [...] If they came up with the cure today and I got better instantly, I could win myself a Nobel Prize in medicine for proving that depression was caused not by anything in the brain as previously thought, but by damage to a few cubic centimeters of nervous tissue in the spinal cord. Because I guarantee I’d pop up and be feeling as merry as a lark in about one second. [...] My problem is not depression. [...] There is no problem with my reasoning powers. [...] So if I say, “Paraplegia prevents me running. A life without running is not worth living. Therefore, my life is not worth living.” you might not agree with one of my premises, but there is no question of whether I’m being reasonable. This is similar to Frankl’s argument in Man’s Search for Meaning, and in fact Clayton spends an entire section talking about Frankl. He has a few disagreements with the book, but he has no gripe with the core message. Clayton decides to die because he had meaning in his life—and then the accident took it all away: Probably the life of a deaf man would be good enough for me, or that of a mute or a man missing a leg or an arm. But not the life of a paraplegic. There is not enough left for me. [...] The life I dreamed of and loved with all my heart is gone forever and there is nothing I can do about it. And it’s not just slightly changed, but utterly devastated. [...] My skills as a carpenter, roofer, plumber, gardener, all devastated. My ability to conduct my everyday life with wonderful efficiency, devastated. The wonderful way I was able to relate to other people, devastated. My sex life, devastated. My social life, devastated. [...] I am who I am, I love what I love, and given what I need from life, existence is no longer tenable for me. Some readers may look at that list and call him shallow. Even if that were so, that doesn't change his argument. Maybe most people don't place having sex, controlling one's bowels, and running through the woods as the quintessence of life-affirming values, but I'd be willing to bet that they're still important. Reading this book should prompt a moment of introspection. If you disagree with Clayton’s list above, then reflect on what does give your life meaning. No, seriously, make a list: family, friends, partners, children, hobbies, skills, etc. Write them down. Cross out one entry at random. How would you feel if you lost that entry? Would you still have enough left over to carry on? Probably. Now cross out a few more. Lose your partner. Lose your children. Lose your parents. Your siblings. Your best friend. Your favorite hobby. How do you feel? Still worth it? Add in some physical negatives: chronic pain. Constant nausea every time you eat. Losing feeling and control of your bowels, your legs, your genitals, your diaphragm, your non-dominant hand, your dominant hand, both arms. What about loss of sight? Hearing? Speaking? Communicating at all? What about ending up like the title character in Johnny Got His Gun, where he is left with no legs, no arms, and is rendered blind, deaf, and mute? What would life be like as a disconnected brain in almost complete sensory deprivation? How much would you have to lose before your life stops being worth living? That list—and the dividing line between "worth it" and "not"—is different for everyone. The decision to end one's life is deeply personal. Clayton happened to draw the line at a particular point. Others may agree or disagree, but Clayton’s judgment was his own. Decision in hand, next comes the hard part. The Roadblocks I did not want much from the world in dying. To be able to put my affairs in order without fear of being taken prisoner and treated like I was insane. To say goodbye to those I loved without the same fear. To die a painless death without worrying about leaving behind something gruesome. And to be comforted as I died. When a person has absolutely nothing left and is facing annihilation, all he wants is not to be alone. For Clayton, killing himself is not a simple matter. At the time only one US state, Oregon, had any kind of “Death With Dignity” law on the books. However, this law only allowed assisted suicide for terminally ill patients with less than six months to live, while Clayton’s condition was stable. The slightest whisper of suicidal ideation would have gotten him locked up in the psych ward. He has to write his book in secret, he has to lay his thoughts out for the world in secret, and he has to die in secret. Becoming paralyzed destroys him on two fronts—the disability itself, and the fact that he is completely, utterly, devastatingly alone with his feelings. He writes Two Arms and a Head because he needs to show the world how agonizing it is to face death alone and how important it is for physical-assisted suicide to become—and stay—legal. How empty to exist in this universe and share your feelings and experience with nobody! But that is how you, the world, have left me to die, alone. But what you don’t realize is this: in turning your backs on me, you have turned your backs on yourselves. [...] Someday you will be on your deathbed and maybe you will remember me. What I say to the world is that if you don’t do something about the way death and assisted suicide are dealt with, you may someday find yourselves in an unimaginably horrible situation with no way out. [...] Beware! There could be a horrible fate waiting for you and if you don’t all get together, look each other in the eye, recognize the insanity, and change the laws, you could wake up tomorrow as a head on a corpse with no way out for the next thirty years. A lingering question you might be asking is: if he cared so much about it, then why didn’t he become an activist to get it legalized? The Overton Window was shifting. Washington state would pass a bill a few months after his death, and it would be legalized in Montana by a court case in 2009. Several more states would follow suit in the mid-2010s. He could have shared his experiences far and wide and joined the burgeoning movement that existed back then. He was a law student at Vanderbilt for crying out loud; surely he could have enlisted the help of at least a couple of his colleagues? No one but him could have answered that, though I suspect that the answer is because he didn’t want to. He found his existence to be so ghastly that he didn’t want to stay in it for a second longer than necessary. The only reason he lasted as long as he did was because he wanted to finish the book. He chose to leave Two Arms and a Head as his legacy for the world, and nothing more. We’ve gone over the state of the cure over the last ~15 years. Has there been any progress on amending the laws for physician-assisted suicide? The State of MAiD Medical Assistance in Dying (MAiD) is currently legal in a patchwork of countries and US states. The exact rules, restrictions, and methods vary. In most places that have legalized it, the patient’s condition must be considered terminal (i.e. death is expected within six months) to be eligible for MAiD. The procedure itself is typically either an IV injection administered by a nurse, or a prescription cocktail of benzodiazepines, digoxin, and opioids which patients drink themselves. In Canada and the Netherlands, MAiD is also available to patients with a disability that does not present as immediately terminal. The Netherlands currently includes severe treatment-resistant mental illness as a qualifying condition, and Canada will follow suit in 2027. So it sounds like Clayton got his wish, at least in Canada and parts of Europe. Now, when a Canadian ends up in a terrible accident, they have a choice in the matter of whether they want to spend the next few decades as a quadriplegic head-on-a-corpse. Phew. However, it’s not all smooth sailing. It seems like every few months there’s another horror story in the press coming out of Canada or Europe. Two news stories came out in quick succession in late March/early April 2024—one from Canada, the other from the Netherlands. In Canada, a 27-year-old autistic woman with no disclosed physical symptoms was granted the right to proceed with MAiD by an Alberta court. The story broke after her father sued to try and stop her. In the Netherlands, a 28-year-old woman has decided to pursue MAiD due to her treatment-resistant clinical depression and borderline personality disorder. Her MAiD is scheduled for sometime in May 2024. At the time of this writing, she has yet to undergo it. These stories are nothing new. They certainly sound dreadful. Diving into every big story from the last ten years would be beyond the scope of this review, but let’s return to the one about the 27-year-old autistic Canadian woman who was granted MAiD. Both the Calgary Herald and CBC framed the story as a grieving father desperately trying to prevent his autistic daughter from being led astray by unethical doctors cherry-picked by the Alberta Health Service. The father insists that his adult daughter is physically healthy, albeit “vulnerable and not competent” to make medical decisions due to her autism and ADHD. Despite this, the judge has allowed MAiD to proceed anyway. Meanwhile, reading the actual court decision shows that the legal issue at hand is whether the woman is required to disclose the physical ailment(s) that led to two doctors approving MAiD. The judge ruled that the woman is competent to make her own medical decisions, and that she is not required to disclose her diagnosis to either her family or the court. The father has since filed an appeal. (July 2024 Update: the appeal hearing was subsequently scheduled for October 7, 2024 - six months in the future. Not willing to wait that long, the woman began a voluntary stoppage of eating and drinking (VSED) on May 28. The hearing was rescheduled for June 24. However, the woman continued to refuse food and water going into June. The father withdrew his appeal on June 11. It is unknown whether the woman has undergone MAiD at this time of this update.) She is not choosing MAiD because of autism or ADHD. We don’t know what her physical diagnosis is. We only have the father’s insistence that “her physical symptoms, to the extent that she has any, result from undiagnosed psychological conditions.” That’s the father’s words, not a physician’s, and not the patient’s. Neurodivergence does not bestow immunity against all the nasty ailments that can cut someone down in their twenties. I’m not accusing every news piece about MAiD of being similarly sensationalized, but I’m not not accusing every MAiD story of being similarly sensationalized. Despite so many of these stories not holding up to their headlines, many remain opposed to the expanded rules. There is a massive contingent of activists who want to keep MAiD illegal. Not Dead Yet Clayton had a particular amount of ire directed at one prominent anti-MAiD disability rights org: Not Dead Yet. Not Dead Yet (NDY) was founded in 1996 by the same people who lobbied to get the Americans with Disabilities Act passed a few years prior. As the name implies, they reject the notion that death could ever be an acceptable response to living with a disability. Like any activist org worth their salt, they have a convenient Talking Points page where they lay out all the reasons why they’re opposed to MAiD. They argue that MAiD is deadly discrimination against disabled patients, with current programs having insufficient safeguards to prevent foul play. NDY argues against a medical field that has decided that death is preferable to disability. They insist that they are not against individual autonomy; patients will always be free to commit “un-assisted” suicide if they truly wish to die. The page opens by explaining that MAiD is necessarily a disability issue, even in places where MAiD is only available to the terminally ill. Although people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. When terminally ill patients get polled on why they are choosing MAiD, it turns out that avoiding pain isn’t the primary motivation. In Oregon, where MAiD is only available for the terminally ill, every patient fills out a questionnaire when they apply for the program. Tallying up all the surveys from 1998–2023, to top reasons are: “Losing autonomy” (90%)

Inline links: Source, Prof. Geoffrey Raisman's, As of 2016, As of 2022, NervGen Pharma, Phase 1b/2a clinical trials, Medical Assistance in Dying (MAiD), late March, early April, These stories, are nothing new, CBC, court decision, filed an appeal, May 28, withdrew his appeal on June 11, Not Dead Yet, Talking Points, In Oregon,

“Financial implications of treatment” (7%) The top five all relate to the disabling symptoms that come with dying. “Less able to engage in activities” sounds remarkably similar to Clayton’s reasoning of, “the things that gave my life meaning are no longer possible, therefore it’s time to die.” This isn’t surprising when considering that palliative care is legal in all 50 states. If someone’s condition is judged to be terminal, as Oregon requires, they already get a bottomless supply of morphine. Pain is not really the problem anymore. The problem is that a failing body is, well, failing. Patients become weak and frail. They struggle to walk and use the bathroom. They may become dependent on a feeding tube or a respirator. Somewhere along the way they might lose their minds to dementia. All of these are serious, debilitating symptoms that can suck the meaning out of life, so many patients choose to die before they get to that point. Not Dead Yet condemns this status quo. We Don’t Need To Die to Have Dignity In a society that prizes physical ability and stigmatizes impairments, it’s no surprise that previously able-bodied people may tend to equate disability with loss of dignity. This reflects the prevalent but insulting societal judgment that people who deal with incontinence and other losses in bodily function are lacking dignity. People with disabilities are concerned that these psycho-social disability-related factors have become widely accepted as sufficient justification for assisted suicide. They argue that patients and physicians are merely reflecting a “prevalent but insulting” prejudice when they decide that death is preferable to debility. NDY paints a picture of the type of physicians who provide MAiD to patients: In judging that an assisted suicide request is rational, essentially, doctors are concluding that a person’s physical disabilities and dependence on others for everyday needs are sufficient grounds to treat them completely differently than they would treat a physically able-bodied suicidal person. [...] Legalized assisted suicide sets up a double standard: some people get suicide prevention while others get suicide assistance, and the difference between the two groups is the health status of the individual, leading to a two-tiered system that results in death to the socially devalued group. This is blatant discrimination. There’s a lot to unpack here. NDY is starting from the premise that the desire to end one’s life is always and necessarily the product of an irrational mind, Claytons of the world be damned. Medical professionals, given that they’ve sworn an oath to protect life, have an obligation to treat all suicidal ideation with “suicide prevention” care (i.e. involuntary commitment until the patient comes to their senses). A society that has legalized MAiD still extends this preventive care to the able-bodied who want to die, but then turns around and gladly assists disabled patients in ending their lives. This is discrimination! Doctors are murdering the undesirables! To drive the point home, the Canadian chapter of NDY has this image on their homepage: A line drawing wherein a wheelchair user notices that the office of the Suicide Prevention Program is inaccessible, whereas the office of the Assisted Suicide organization has a wheelchair ramp. Clayton counters this by pointing out that doctors give different treatments for different circumstances all the time. For example, begging for opioids out of the blue is considered “drug seeking” and will get you referred to addiction treatment; begging for opioids while in the ER for a severed leg... will get you opioids. Refusing to provide opioids and instead providing “addiction prevention care” to the able-bodied is not discrimination against the legless. The Canadian chapter of Not Dead Yet has a similar Talking Points page, with this one written in the style of an FAQ. They raise some concerns about a lack of safeguards to prevent foul play. In Canada and parts of the United States, a MAiD patient simply picks up the lethal cocktail at a pharmacy, then takes it home to drink. No witness is required when the drugs are taken. There’s no way to ensure that it’s voluntary. If something goes wrong, there’s no way to help the person. A lethal dose of drugs may sit around the house for weeks or months. ...That’s concerning. I didn’t know any of that before I read the website. An obvious solution to this problem would be to do what the Netherlands does and require a medical professional to be present. That way, said clinician can ensure that the patient gives affirmative consent with no abuser standing over the patient’s shoulder. Once the patient has passed, the clinician can pack up the leftover meds for safe disposal. In the Netherlands, these professionals are part of dedicated teams who travel to patient homes for exactly this purpose. Except NDY does not suggest this. In fact, they do the opposite. NDY condemns the Dutch approach by referring to these clinicians as members of a “mobile euthanasia unit” that dispatches patients in their own homes. Everything seems to circle back to blaming doctors. But why? Ableism Underpinning Not Dead Yet’s objections to MAiD is the belief that society has a prejudice against disabilities. This prejudice is so strong that the average person believes that being disabled is sufficiently miserable to justify death. The disability rights community has a name for this bigotry: ableism. Ableism is: “A system of assigning value to people’s bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness.” When Clayton concludes that his paraplegic life is less “valuable” than his pre-accident life, he is invoking the societally constructed premise that “being able to walk, have sex, and control one’s bowel movements are good and desirable traits.” That is indeed one of his core values, and he is indeed being ableist. The anti-ableist framework holds that a value judgment like “being able to walk, have sex, and control one’s bowel movements are good and desirable traits” is arbitrary bigotry on par with “having white skin is a good and desirable trait.” When disability activists argue that our society should reject ableism, what they are saying is that we should reject the notion that “being able to walk, have sex, and control one’s bowel movements are good and desirable traits.” Given what Clayton has told us of his life, that argument is cosmically, outlandishly insane. So... why do they make it? What’s going on? They can’t really believe this, can they? The knee jerk response is to dismiss them as just being in denial, but Clayton offers a much more horrifying explanation: they do mean it. I have no desire to begrudge other paraplegics their happiness, though many of them evidently have every desire to begrudge me my feelings. I find them monstrous and inhuman the moment they want to insist that my feelings indicate from some kind of defect within me. [...] A clam is comfortable in its shell and thinks all of the other animals should envy it. A clam does not see why an eagle would rather die than be a clam. Let’s explore this with a thought experiment. The Four-Armed Alien You probably don't fantasize on a daily basis about what life would be like with four arms. If you really try, you could imagine a few ways that life would be easier: You could chop ingredients with two hands and stir the skillet with a third.

Inline links: Canadian chapter, https://substackcdn.com/image/fetch/$s_!xOGz!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fcd23bfaf-4b86-485f-ad54-8cb48b2420fa_900x695.jpeg, FAQ, ableism

A line drawing wherein a wheelchair user notices that the office of the Suicide Prevention Program is inaccessible, whereas the office of the Assisted Suicide organization has a wheelchair ramp. Clayton counters this by pointing out that doctors give different treatments for different circumstances all the time. For example, begging for opioids out of the blue is considered “drug seeking” and will get you referred to addiction treatment; begging for opioids while in the ER for a severed leg... will get you opioids. Refusing to provide opioids and instead providing “addiction prevention care” to the able-bodied is not discrimination against the legless. The Canadian chapter of Not Dead Yet has a similar Talking Points page, with this one written in the style of an FAQ. They raise some concerns about a lack of safeguards to prevent foul play. In Canada and parts of the United States, a MAiD patient simply picks up the lethal cocktail at a pharmacy, then takes it home to drink. No witness is required when the drugs are taken. There’s no way to ensure that it’s voluntary. If something goes wrong, there’s no way to help the person. A lethal dose of drugs may sit around the house for weeks or months. ...That’s concerning. I didn’t know any of that before I read the website. An obvious solution to this problem would be to do what the Netherlands does and require a medical professional to be present. That way, said clinician can ensure that the patient gives affirmative consent with no abuser standing over the patient’s shoulder. Once the patient has passed, the clinician can pack up the leftover meds for safe disposal. In the Netherlands, these professionals are part of dedicated teams who travel to patient homes for exactly this purpose. Except NDY does not suggest this. In fact, they do the opposite. NDY condemns the Dutch approach by referring to these clinicians as members of a “mobile euthanasia unit” that dispatches patients in their own homes. Everything seems to circle back to blaming doctors. But why? Ableism Underpinning Not Dead Yet’s objections to MAiD is the belief that society has a prejudice against disabilities. This prejudice is so strong that the average person believes that being disabled is sufficiently miserable to justify death. The disability rights community has a name for this bigotry: ableism. Ableism is: “A system of assigning value to people’s bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness.” When Clayton concludes that his paraplegic life is less “valuable” than his pre-accident life, he is invoking the societally constructed premise that “being able to walk, have sex, and control one’s bowel movements are good and desirable traits.” That is indeed one of his core values, and he is indeed being ableist. The anti-ableist framework holds that a value judgment like “being able to walk, have sex, and control one’s bowel movements are good and desirable traits” is arbitrary bigotry on par with “having white skin is a good and desirable trait.” When disability activists argue that our society should reject ableism, what they are saying is that we should reject the notion that “being able to walk, have sex, and control one’s bowel movements are good and desirable traits.” Given what Clayton has told us of his life, that argument is cosmically, outlandishly insane. So... why do they make it? What’s going on? They can’t really believe this, can they? The knee jerk response is to dismiss them as just being in denial, but Clayton offers a much more horrifying explanation: they do mean it. I have no desire to begrudge other paraplegics their happiness, though many of them evidently have every desire to begrudge me my feelings. I find them monstrous and inhuman the moment they want to insist that my feelings indicate from some kind of defect within me. [...] A clam is comfortable in its shell and thinks all of the other animals should envy it. A clam does not see why an eagle would rather die than be a clam. Let’s explore this with a thought experiment. The Four-Armed Alien You probably don't fantasize on a daily basis about what life would be like with four arms. If you really try, you could imagine a few ways that life would be easier: You could chop ingredients with two hands and stir the skillet with a third.

Inline links: FAQ, ableism

Meetups Everywhere 2024: Times & Places

August 29, 2024 · Original source

Contact: Colin Z. Robertson Contact Info: czr[at]rtnl[d ot]org[do t]uk Time: Saturday, September 07th, 03:00 PM Location: 200 Degrees, 25 Division St, Sheffield S1 4GE. I'll have a piece of paper on the table with ACX written on it. Coordinates: https://plus.codes/9C5W9GJG+2M Group Link: https://discord.gg/8RMx8BvZbz North America Canada CALGARY, CANADA Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, September 07th, 02:00 PM Location: First Street Market, 1327 1st Street SW, Calgary. Look for a red ACX sign. Coordinates: https://plus.codes/95372WRM+2F Group Link: https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

Inline links: https://plus.codes/9C5W9GJG+2M, https://discord.gg/8RMx8BvZbz, https://plus.codes/95372WRM+2F, https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27

Contact: David P Contact Info: qwertie256[at]gmail[dot]com Time: Saturday, September 07th, 02:00 PM Location: First Street Market, 1327 1st Street SW, Calgary. Look for a red ACX sign. Coordinates: https://plus.codes/95372WRM+2F Group Link: https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27 EDMONTON, CANADA Contact: Joseph Shapkin Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, September 19th, 07:00 PM Location: Underground Tap and Grill, 10004 Jasper Ave, Edmonton, AB T5J 1R3, Canada. We will have an ACX sign so you can easily find our table. Coordinates: https://plus.codes/9558GGR5+GP Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: https://www.lesswrong.com/events/kBCpoouwrn4GoAZyr/acx-meetups-everywhere-5

Inline links: https://plus.codes/95372WRM+2F, https://www.lesswrong.com/groups/LZQ6HBAd8afoqPP27, https://plus.codes/9558GGR5+GP, https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG, https://www.lesswrong.com/events/kBCpoouwrn4GoAZyr/acx-meetups-everywhere-5

Contact: Joseph Shapkin Contact Info: ta1hynp09[at]relay[dot]firefox[dot]com Time: Thursday, September 19th, 07:00 PM Location: Underground Tap and Grill, 10004 Jasper Ave, Edmonton, AB T5J 1R3, Canada. We will have an ACX sign so you can easily find our table. Coordinates: https://plus.codes/9558GGR5+GP Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: https://www.lesswrong.com/events/kBCpoouwrn4GoAZyr/acx-meetups-everywhere-5

Inline links: https://plus.codes/9558GGR5+GP, https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG, https://www.lesswrong.com/events/kBCpoouwrn4GoAZyr/acx-meetups-everywhere-5

Your Book Review: The Pale King

September 06, 2024 · Original source

What to say about Infinite Jest? It remains Wallace’s masterpiece, widely considered the greatest novel of Generation X. It takes place in a near future where the US, Canada and Mexico have been merged into a single state. Each year is corporately branded, with most of the action taking place in “The Year of the Depend Adult Undergarment.” It’s set in three locales: a drug rehabilitation center, an elite tennis academy, and a Quebecois terrorist cell.3 The novel clocks in at over a thousand pages, two hundred of which are footnotes. It includes sentences of absurd length, with some descending into multi-page molecular descriptions of various drugs. The book pulls the kind of stunts that shouldn’t work, but in Infinite Jest they do, because the book is that good, the characters that deep, the subject matter that prescient. Infinite Jest is often considered the “first internet novel,” predicting in particular its addictive allure.

Inline links: 3

H5N1: Much More Than You Wanted To Know

January 01, 2025 · Original source

From “Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus”, linked above. You may recognize the lead author - Michael Worobey has also been a leading voice on the zoonotic side of the COVID origins debate. The recent history of the flu, as far as I can tell, is: 1918: An H1N1 flu (“Spanish flu”) jumped from birds to humans in America and killed 50 million people worldwide. This replaced all older strains, so most seasonal flus during this era were H1N1. 1957: An H2N2 flu (“Asian flu”) crossed from birds to humans in China, and killed about 2 million people worldwide. It replaced the H1N1 strain, so most seasonal flus during this era were H2N2. 1968: An H3N2 flu (“Hong Kong flu”) crossed from pigs (?) to humans in Hong Kong, and killed another 2 million people worldwide. It replaced the H2N2 strain, so most seasonal flus during this era were H3N2. 1977: An H1N1 flu (“Russian flu”) leaked from a biology lab (?) in Russia (it might have been a strain from the 1940s, which the Russians were trying to make a vaccine for). It didn’t kill that many people, but it stuck around, and from then on, seasonal flus could be either H3N2 or H1N1. 2009: An H1N1 flu (“Mexican flu” until the PC police stepped in; afterwards “swine flu”) took some horrible circuitous route between birds and pigs and back again, crossed over into humans in Mexico, and killed 200,000 people. It outcompeted older strains of H1N1, but couldn’t crowd out H3N2, so seasonal flus are still either H3N2 or H1N1. …which brings us to the present, hopefully illuminating why “new flu strain crosses over from animals into humans” is such an “uh oh” moment. The Bird Flu Technically, all pandemic flus start as bird flus. Influenza A evolved in birds. Sometimes it spreads to other animals, including pigs, cattle, and humans. The most common way for a bird flu to spread to humans is to “reassort” (not exactly virus sex, but close enough, and the real version is less memorable) with a human flu virus (ie one that has already crossed over to humans). The resulting virus has all of the human flu virus’ human adaptations, but borrows enough new antigens from the bird virus to evade the immune system. Pigs can be infected by both human and bird viruses, so they are a common place for this reassortment to take place. If reassortment is sort of like viral sex, pigs are sort of like Tinder. When a bird flu and human flu reassort in pigs, the resulting disease is called a swine flu. At least the 2009 flu pandemic was a swine flu, and a minority opinion thinks the 1918 pandemic was too. There aren’t major epidemiological differences between direct-from-bird flus and swine flus. H5N1 was first noticed in birds - specifically, a flock of chickens in Scotland in 1959 - after which it disappeared for forty years. In 1996, it showed up in geese in China, then gradually increased its market share among birds worldwide. In 2022, it was found in minks; apparently it had learned to infect mammals. By early 2024, it was seen in cows. Now it’s in cow herds in 16 states, and one of them (California) has declared a state of emergency. And in October, H5N1 was found in pigs for the first time. It’s not uncommon for humans to catch an animal disease. This doesn’t mean the disease has “crossed over” to humans. If the virus isn’t suited to human-to-human transmission, it simply dies off (either before or after killing its human host). Thus, chicken farmers have been reporting scattered H5N1 cases since 1997; now that the virus has spread to cattle, cow farmers have started reporting the same. A Metaculus comment on this topic introduced me to the phrase “biocomputational surface”. Every viral replication that takes place in a human gives the virus one more chance to develop the set of mutations that makes it human-transmissible and start the next pandemic. Or, more likely, every viral replication that takes place in a human who has both the H5N1 bird flu and a normal human flu - or in a pig which has both viruses - gives the virus one extra chance to reassort in a way that produces a bird-antigen-fortified human-adapted flu virus. This doesn’t mean H5N1 will definitely become human-transmissible soon. Many viruses hang out on the borders of transmissibility for decades. Some, for unclear reasons, never cross over at all. But all of this is compatible with the virus becoming transmissible soon. So: What Is The Chance Of A Pandemic? The prediction markets on this topic ask a question about “10,000 cases in the United States”. Does this necessarily mean “pandemic”? Might it be possible to get to 10,000 cases just from the scattered chicken and cow farmers, with no human-to-human transmission? Despite many chicken and cow infections this year, there have only been 60 - 70 recorded human cases. Unless there is a phase change in screening methods, it seems hard for this number to increase to 10,000 off farmers alone. I think it’s fair to treat this question as operationalizing “what is the chance of a pandemic”? By this definition, Manifold estimates a 40% chance of an H5N1 pandemic in 2025. Metaculus estimates a 5% chance. You can see below whether that’s changed since I wrote this essay: 5% versus 40% is a big difference! Who do we trust? I trust Metaculus. Metaculus has beaten Manifold in both of the two head-to-head comparisons that I know of (Jeremiah Johnson’s and mine). Manifold’s number swings by a factor of two from week to week; Metaculus has been steady. But also, Metaculus hosts a CDC-sponsored respiratory disease forecasting tournament which has enriched them in epidemiological expertise. And if you look at the quality of comments on both sites, it’s pretty obvious where the people with more intellectual chops are hanging out. The Manifold comments are mostly single sentences, or occasionally just links to an article about new cases. The Metaculus comments look more like this one by dimaklenchin: Despite the panic propaganda, H5N1 is unlikely to be "just a single mutation away from switching host preference": 1) It normally takes a lot more than a single mutation to switch hosts. E.g., there are at least five different reasons why SIV (monkey equivalent of HIV) is not infectious to humans. Heck, a variant of SIV that bears HIV's receptor-recognizing surface protein (SHIV) is still not infectious to humans. HIV most certainly evolved from SIV but, almost as certainly, it took a very long time to get there. Not that all viruses are the same and things can't turn out differently with flu, but I don't subscribe to the idea that a mere change of receptor specificity (something that can take 1-2 mutations) will be sufficient. 2) We have data. Lots of human infections with other varieties of bird flu in the past - all those viruses ultimately went nowhere. Why would H5N1 be radically different? E.g., the "Canadian teen", despite what sounds like a prolonged exposure, failed to infect anyone around him. Since I am at 18% for the h-2-h H5N1 detection in 2025, I am arbitrarily going ~ an order of magnitude lower than that for something as unprecedented as 10K human infections. Maybe should be much lower but hedging for the time being and will allow another couple months of observations. And Sergio: I'm currently at 20% on the question of reported human-to-human transmission of highly pathogenic avian influenza H5N1 globally before 2026. However, this question is only about the US, and is more general about all subtypes of H5. But H5N1 very strongly appears to be the most important subtype to consider in this time period. And, given the current situation in the US with H5N1 human cases derived from exposure to poultry or cattle (with cattle(mammals) being more worrisome), h2h transmission seems quite more likely to arise in North America than elsewhere before 2026. Conditioning on h2h transmission in the US (and also trying to consider, with lower probability, a start in Canada), I want to estimate the chances that it becomes sustained and out of control (in which case, if it starts in Canada, I largely expect it to spread to the US). The (6) past events of probable h2h transmission of avian H5(N1), none of which were sustained, could serve as a base rate, although I'm a bit wary of giving much weight to this precedent, since the last event was quite a while ago (2007), and also because reporting and testing standards may have improved considerably since then (so perhaps they might not have been classified as h2h transmission events if they had occurred more recently). The current situation in the US, and events such as the Canadian teen who got sick with H5N1, do suggest a higher background level of risk than normal (which would be reduced if a vaccine for cattle is licensed soon), but I'm wary of overupdating. Conditioned on sustained h2h transmission, reaching over 10k cases in a few months seems likely, although perhaps very strong monitoring and surveillance could contain the situation in time (at the very least to moderate the growth rate). Trying to combine all these factors somewhat haphazardly, I'm currently at 3.5% for this question. That’s before 2026. What about longer-term? Manifold gives a ~50% chance before 2030; Metaculus uses a more complicated method but it says about 25% chance before 2030. H5N1 may cross to humans, but it could take a while. Superforecaster Juan Cambeiro at The Institute For Progress estimated a 4% chance of a “worse than COVID” H5N1 pandemic in “the next year”, but their estimate was made in 2023, without the benefit of the Metaculus estimates or most of our current knowledge. This feels high now - Metaculus says 5% total for H5N1 pandemic, and most pandemic flus are not worse than COVID. IFP also seem to be expecting a case fatality rate greater than 10%, which I find unlikely for the reasons mentioned above. I trust their estimate less than Metaculus’ current ones. I conclude that the most plausible estimate for the chance of an H5N1 pandemic in the next year is 5%. Interestingly, 5% is about the base rate for pandemic flus per year: five in the past century = one per twenty years = 5% chance per year. Isn’t it surprising that we’re still at the base rate when we can see a dangerous-looking flu virus spreading through the types of animals that have caused pandemic flus in the past? Part of the answer is that we’re not - in addition to the 5% chance of H5N1, we have to add the chance of some other pandemic flu. This probably isn’t 5% on its own; scientists monitor flu strains closely, and they haven’t found any others which are giving off as many red flags as H5N1. Still, something could always come out of left field. Maybe we should add a 2.5% chance of some other strain, for a total of 7.5% chance of a flu pandemic (ie beyond normal seasonal flu) next year. But still, isn’t it surprising that we’re so close to the base rate? One way to think about this: the base rate represents how concerned we should be if there was no epidemiological monitoring at all. In that case, we would estimate a probability distribution across different epidemiological landscapes, most of which contain some concerning-looking flu strains. Since we are doing the epidemiological monitoring, we can collapse that distribution into a single picture: one flu strain, H5N1, is in fact pretty concerning, and other strains mostly aren’t. This is enough to move our prior from 5% to 7.5%, but no more. The forecasters I talked to raised one other point of uncertainty: does the flu work more like a dice roll, or like a bus? Dice rolls are uncorrelated with their predecessors; even if it’s been a hundred rolls since you last rolled a 6, your chance this time is still 1/6. But buses come at fixed intervals; if the buses are hourly, and you haven’t seen a bus in the past 59 minutes, then your chance of seeing a bus in the next minute is very high. It’s been 16 years since the last flu pandemic; these pandemics come (on average) every 20 years. I don’t think anyone has a good sense of how to think about this. But it was 40 years between the Spanish and Hong Kong flus, so the twenty year number is at best a rule of thumb. The 5% number feels very low to me (and, apparently, to the average Manifold forecaster). Isn’t H5N1 spreading to cows and pigs and all sorts of other mammals? Isn’t it in the news all the time? I trust Metaculus a lot, but I agree that this is a surprising update, and I’m taking it on faith rather than feeling it in my bones. What Would The Fatality Rate Be For An H5N1 Pandemic? There are four basic stories you could tell about likely H5N1 mortality. First, maybe mortality would be 50%. The argument here is that official statistics report this mortality rate in the chicken farmers who have been infected with H5N1 so far. Several news sources and even some scientists have raised the specter of a pandemic version of H5N1 pandemic with this same death rate, which could kill a quarter to a third of the world population. THIS IS EXTREMELY FAKE. The official statistics only report fatality rate in the infections we know about. Bird flu is rare, there’s no mass testing, and we only learn that somebody had it if they’re in a hospital and the doctors are worried enough to test for rare conditions. Of Americans who got bird flu in the past year, 0 out of 61 have died. Probably this is mostly because America upped its detection game and is now finding milder cases; we also can’t rule out the virus mutating to become less virulent. Metaculus estimates the current true mortality rate as 1.25%. …but leaves a wide 90% confidence interval, from 0.5% to 7%. Second, maybe mortality would be somewhere around 1.25%. The argument here is that Metaculus uses this as its central estimate of US mortality. But Sentinel discusses some reasons to be skeptical of broad inferences from the US numbers: Scientists have been puzzled by the apparently low H5N1 case fatality rate in humans in the US. They offer a number of hypotheses: “The way in which the virus is being transmitted — along with the amount of virus exposure — is limiting the severity of disease.”

Inline links: was found in pigs, Jeremiah Johnson’s, mine, a CDC-sponsored respiratory disease forecasting tournament, dimaklenchin, Sergio, reported human-to-human transmission of highly pathogenic avian influenza H5N1 globally before 2026, human cases, past events, vaccine for cattle is licensed soon, https://substackcdn.com/image/fetch/$s_!fL7J!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fd6a70fa6-b356-422d-ba9a-5db431e5a056_751x471.png, The Institute For Progress estimated, news, sources, scientists, Sentinel discusses

ACX Survey Results 2025

January 29, 2025 · Original source

I can’t make Google Forms only present data from people who agreed to make their responses public, so I’ve deleted everything identifiable on the individual level, eg your written long response answers. Everything left is just things like “X% of users are Canadian” or “Y% of users have ADHD”. There’s no way to put these together and identify an ADHD Canadian, so I don’t think they’re privacy relevant. If you think you’ve found something identifiable on the public results page, please let me know.

Links For July 2025

July 01, 2025 · Original source

54: Cremieux: Novo Nordisk, manufacturer of Ozempic, forgot to pay the patent fee in Canada, and now it’s off-patent there. And an obscure FDA regulation lets Americans import certain drugs from Canada. With a sufficiently permissive legal theory, you could combine these facts into a way for the government to get unlimited cheap Ozempic without technically violating IP laws.

Inline links: Cremieux

Your Review: My Father’s Instant Mashed Potatoes

August 08, 2025 · Original source

These shreds resemble the ancestral stock of modern Instant Mashed Potatoes (source) The result was an affront. The potatoes were swimming in their own gluten, released during the granule-making process, which when mixed with imprecise water ratios made for a slop that was somehow both gluey and soupy. Immediately after the war, French’s (now best known for mustard) tried to introduce “instant mashed potatoes” as a consumer product category. America’s veterans were not having it. They didn’t want to be reminded of the awful slurry they’d had on the front. The commercial fortunes of instant mashed potatoes began to turn around a decade later, however, when food scientists in the US and Canada converged on methods for producing dehydrated potato flakes rather than granules. The flakes had substantial advantages. They didn’t get as glutinous when reconstituted. Their geometry made them easier to dry quickly, on the order of minutes or even seconds. Using a multi-step process called the “Philadelphia Cook”, they could lock in a more natural flavor. When prepared on the stove with butter and milk, they were supposed to turn out almost as good as the real thing without any onerous prep work on the part of the consumer. This raises the question, though, of why food scientists kept working on improving instant mashed potatoes a decade after they were no longer required for the war effort. If you’re no longer constrained by having to stick it to the Axis, why not return to Glasse-style maſhed potatoes in all circumstances? This is a pattern that recurs frequently in reading about American foodways of the 20th century: choices and innovations made under extreme duress in the World War II economy didn’t fade away when the duress subsided. Instead they echoed back into American life a few years later, despite the lean conditions that birthed them being replaced by extreme abundance. Why did America start eating like it was on a total war footing again when my parents’ generation was young? There are a lot of overlapping explanations. Here are a few: Industrial inertia: Companies that had spun up to supply a vast army didn’t want to shut down overnight, so they necessarily pivoted to the consumer market. Some of these efforts succeeded at entrenching new consumer categories (fish sticks, canned peaches) while others (hamburgers-in-a-can) did not.

Inline links: source

Meetups Everywhere 2025: Times and Places

August 29, 2025 · Original source

This year we have meetups planned in over a hundred and eighty cities, from Alberta, Canada to Wellington, New Zealand. Thanks to all the organizers who responded to my request for details, and to Meetups Czar Skyler and the Less Wrong team for making this happen.

Contact: Skittle Contact Info: witneymeetup[a t]proton[period]me Time: Saturday, September 27th, 2:00 PM Location: The top end of Church Green, near the war memorial. I’ll wear a red jacket, and have an ‘ACX Meetup’ sign. If it’s raining, retreat to the Buttercross for a passing moment, or the Wetherspoon’s (‘The Company of Weavers’) if it looks like we need a longer period of shelter. Close to ‘Market Square’ bus stop, or Witney has free parking. Coordinates: https://plus.codes/9C3WQGM9+9F North America Canada CALGARY Contact: Megh Contact Info: meghss[a t]proton[period]me Time: Saturday, October 4th, 11:00 AM Location: At Bono Coffee Roasters, I will have ACX meetup sign Coordinates: https://plus.codes/95373X33+6HW

Inline links: https://plus.codes/9C3WQGM9+9F, https://plus.codes/95373X33+6HW

Contact: Joseph Shapkin Contact Info: ta1hynp09[a t]relay[period]firefox[period]com Time: Thursday, September 18th, 7:00 PM Location: Irrational Brewing Company, 124 Street, Edmonton, AB, Canada. We will have an ACX sign at our table. Coordinates: https://plus.codes/9558HF27+7Q Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: https://www.lesswrong.com/events/NQ7HDPkEMjmm4mdTq/acx-fall-meetups-everywhere

Inline links: https://plus.codes/9558HF27+7Q, https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG, https://www.lesswrong.com/events/NQ7HDPkEMjmm4mdTq/acx-fall-meetups-everywhere

Slightly Against The "Other People's Money" Argument Against Aid

January 23, 2026 · Original source

The average person nods along to insane statements like “if Elon Musk distributed his fortune evenly, every American would get ten million dollars” and probably doesn’t have the reasoning skills to think about coordination problems clearly. Along with these reasons, it seems like people don’t donate money even when they care a lot about something. How many people care a lot about wokeness, either pro or con? How many have donated significant amounts of money to organizations promoting or opposing it? Why? Is the answer just free rider problems? Are they just virtue signaling when they talk about wokeness, and they don’t really care? Forget about reaching 90% - would even half of Americans sign this contract and follow through? Or would we announce the end of coercive military taxation to great fanfare, and then immediately be invaded by Canada and turned into the 11th province? Contra the economists, I’m not sure that we fund the military through coercive taxation only to avoid free rider problems. I think we fund it through taxation to avoid the same kinds of transaction cost issues that would sink the assurance contract. Since charity suffers these same transaction costs, the same arguments may apply. The Multiple Preferences Argument Everyone has multiple conflicting sets of preferences that change based on how they’re being elicited. These go by many names: Near Mode vs. Far Mode, superego vs. id, “my best self” vs. “my regular self”. Many people say phones are terrible and destroying society and that their life would be much better without a phone and that they wish they could quit their phone. Then they spend all their time on their phone.

"All Lawful Use": Much More Than You Wanted To Know

March 01, 2026 · Original source

Mass domestic surveillance of Americans, American companies, and US permanent residents (or for that matter generally their counterparts in other Five Eyes partners – UK, Canada, Australia, and New Zealand) is more complicated. The current law is (roughly) that it’s illegal to seek this kind of data, but legal to “incidentally obtain” it. So for example, if the US was looking for al-Qaeda communications, it might tap a major undersea cable, and if tapping that cable happened to incidentally give it data on millions of Americans, it could keep that data. But after “incidentally obtaining” the data, it may only query the resulting database in a targeted way. So the government might take its trove of citizen data that it “incidentally” collected looking for al-Qaeda, and search for a specific citizen’s history if it thinks (for example) that this citizen might be a spy.

Inline links: generally their counterparts in other Five Eyes partners, may only query the resulting database in a targeted way

Meetups Everywhere Spring 2026: Times & Places

April 01, 2026 · Original source

Contact: Colin Z. Robertson Contact Info: czr[@]rtnl[.]org[.]uk Time: Saturday, April 25th, 3:00 PM Location: 200 Degrees, 25 Division St, Sheffield S1 4GE. I’ll have a piece of paper on the table with ACX written on it. Coordinates: https://plus.codes/9C5W9GJG+2M Group Link: https://discord.gg/8RM [remove this bit] x8BvZbz North America Canada CALGARY Contact: LN Contact Info: laibanas20[@]gmail[.]com Time: Saturday, May 16th, 10:30 AM Location: Calgary West Farmers Market- Near the west entrance Coordinates: https://plus.codes/95373QQG+6W Notes: Please RSVP to laibanas20@gmail.com

Inline links: https://plus.codes/9C5W9GJG+2M, https://plus.codes/95373QQG+6W

Contact: Joseph Contact Info: ta1hynp09[@]relay[.]firefox[.]com Time: Thursday, April 16th, 7:00 PM Location: Irrational Brewing 10643 124 St #109, Edmonton, AB T5N 1S5, Canada We will have an ACX sign at our table. Coordinates: https://plus.codes/9558HF27+7Q Group Link: https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG Notes: Event Page: https://www.lesswrong.com/events/czvNZKJPeF3tx3cbt/acx-spring-meetups-everywhere-3

Inline links: https://plus.codes/9558HF27+7Q, https://www.lesswrong.com/groups/hNzrLboTGkRFraHWG, https://www.lesswrong.com/events/czvNZKJPeF3tx3cbt/acx-spring-meetups-everywhere-3

Astral Codex Ten

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Astral Codex Ten

Table of Contents

Atlas

Canada

Canada

Article

Metadata

Appears In

Related Pages

External Links

Source Context

Backlinks