In the spirit of experimentation I want to have a thread where we list examples of gross civilizational inadequacy.

There's subcomment for meta comments on the thread, otherwise I encourage you to have one top-level comment per example of civilizational inadequacy.

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I'm just going to list a few fields in medicine that I think stand out as particularly weak.

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

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

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

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

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

I would be very interested in reading, say a blog post (or series thereof) exploring why this happens (and, if remotely possible, directing motivated individuals towards ways to support faster adoption of successful treatments).

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

Is there a way to find that clinic, given that you know you have condition X?

Doing your own research, though it might take a while. There's not a centralized database or anything. Skimming Google Scholar for exceptional results on the outcome measure you care about, and then looking up the institution where the study was done, is one way to find it.

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

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

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

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

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

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

Female reproductive health is poorly understood and poorly treated.

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

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

I'm a big fan of normalizing talk about reproductive health in general.

It shouldn't be considered "TMI" for a man to hear about menstrual or pregnancy or menopause symptoms.

It should be normal to bring up female-specific (or male-specific) side effects of medication, like whether it makes birth control stop working or causes infertility.

It should be normal to talk about miscarriage or infertility, and to have feelings about that.

>nobody has done studies measuring hormone levels over time and fitting a differential-equation model of how hormones affect each other's levels

What in the everloving fuck? That really seems like the first thing you should do. Has that at least been done for the shared hormones?

So, in general, as a techy person looking at biology, you need to be aware that most biomedical researchers are not educated in quantitative stuff. Like, when I worked at a biotech company, I got frequent questions from the bench biologists that amounted to "how do I test statistical significance in this experiment?" where the answer was "do a t-test."

This means that in any arbitrary field, you're not necessarily going to find that someone has done the "obvious" applied-math/modeling thing.

Some fields, like genetics or epidemiology or systems biology, have a tradition of collaborating with statisticians or machine-learning people, so the "obvious" stuff will have been tried.

In a lot of fields, you can't do the "obvious" thing because the data is really expensive to collect. (Measuring how much of each protein is in a sample? Really expensive if you have more than a handful of proteins to test.)

But sometimes, like with hormone dynamics, I'm genuinely puzzled as to why someone couldn't just do it.

Another example is graph theory for various biochemical networks -- metabolic, gene regulatory, etc. Have we looked at connected components, measures of centrality, Rayleigh quotients, etc in attempts to find "master switches"? Surprisingly rarely even when we have the data.

"Systems thinking" is, as far as I can tell, simply "the ability to ask oneself whether one is dealing with a system of differential equations" and it is way rarer than I would guess. I'm not sure why -- maybe just the fact that most people have very little math education.

We had a physiology class in my Bioinformatics studies that approached physiology from a systems perspective instead of the usual approach. Unfortunately there was no textbook that our professor could use.

Nope! I went looking! Not there!

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

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

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

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

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

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

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

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

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

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

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


In addition to being a skilled software engineer, Matt Might is now a professor, endowed chair, and director of an institute of personalized medicine at University of Alabama's school of medicine. Before that, he was a professor of computer science at the University of Utah.

Advice for pregnant people is really bad. The advice is so risk-averse that it generally doesn't clearly distinguish between "this is moderately risky," "this is a very small risk," and "we have not conclusively proven that a risk does not exist," which means that there are far more pieces of advice than anyone can remember and people quite often end up doing moderately risky things. The FDA continues to recommend limiting fish consumption in spite of the epidemiological evidence that eating fish increases IQ. Cleaning litter boxes is actually a very uncommon way of transmitting toxoplasmosis; it is most likely to come from undercooked meat. Even though gaining too much in pregnancy is only twice as common as gaining too little, and gaining too little has far more serious health consequences, the vast majority of the messaging is about the dangers of gaining too much.

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

Do you know of any good sources for pregnancy advice?

I personally very much enjoyed Expecting Better, Debunking the Bump, the Informed Parent, and the Science of Mom.

Advice regarding the health issues of new mothers is even more lacking. Whoa Baby by Kelly Rowland and Tristan Bickman is a book I liked on the topic.

Another book for new parents, about relationships, that I liked: And Baby Makes Three by John Gottman and Julie Schwartz Gottman.

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

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

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

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

Advertising is a terrible waste of resources. To the extent that advertising is serving a net positive goal (spreading information about the existence and quality of products) anyone could think up ways that are an order of magnitude cheaper and do an order of magnitude better job serving the goal.

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

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

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

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

I don't think there doubt that companies can make profits by advertising. The issue is about whether advertising is a zero-sum game where some providers win over other providers by doing better advertisement.

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It seems like nobody run studies to answer the question of whether you can increase programmer productivity by teaching a programmer to type faster. This hypothesis is made by bloggers like Jeff Atwood.

Increasing programmer productivity is a problem that's very important for our society but typing itself is considered a low status topic to study. As a result no professor at a computer science or the computer engineering department seems to have set himself the task to find out whether this hypothesis is true.

Why do I think there's no such evidence? I put up the question on skeptics.stackexchange and despite the question having 58 upvotes and being unanswered, nobody could till now provide an answer that cites empiric evidence.

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

I'm starting to believe that people with both quite bad and quite good lives are disincentivized to discuss it. I have ground level experience of both ends of the spectrum. If true, this is a large norms tragedy as it results in much less sharing of best practices and everyone reinvents the wheel over and over.

[This is a broad category but has some distinct features that I think make it worth describing as a whole.]

Our civilization is grossly inadequate at providing personal happiness, and providing accurate information on how to achieve personal happiness.

This is "strange" because almost every human being "wants" to optimize for it in some sense or another. But of course reasoning soberly, you would expect it to be the case because there is almost no room for non-personal profit from being happy. Apparently people who make a profit sell only the symbolic representation of happiness, and the market seems saturated with this.

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

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

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

Meta - If you want to comment on the fact that this post exist, please put your comment here.

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

Is there a link you would recommend?

No, because the main reason I recommended this is that I only have a vague understanding of what is meant by civilisational inadequacy.

Eliezer lately wrote a book about it and expanded the concept in multiple post. I would assume that a good portion of the LesserWrong readership read it. If there's a shorter definition somewhere I'm happy to link it.

Subsidies to US corn farmers and import quotas on cane sugar. (Which is why high fructose corn syrup is so cheap.)

  • Cookie warnings in the EU, caused by the GDPR
    • Civilizational cost Fermi estimate
      • 1 warning per day, which takes 2 seconds to close, with ~400 mio. people use the internet regularly, for the 4 years since GDPR was instituted
      • Which at is ~1.6 bio. €
      • Can the benefit compare to this?

Can the benefit compare to this?

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

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

My experience in talking to people is that ~nobody reads the cookie warnings. My perception is that this is an example of red tape intended to assuage people's anxieties.

35% of US adults report an average of fewer than seven hours of sleep, and 28% report frequent insufficient sleep. Rates of insufficient sleep increased between 1985 and 2004, and have probably continued to increase since. Estimates of the prevalence of obstructive sleep apnea range from 3% to 38%. Television schedules may have influenced sleeping patterns; nowadays we have Netflix, which seems likely to make this problem worse. And everyone knows that school starts too early.

There's also atomization, but I think most people here are aware of that by now.

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

This article on treatment for alcoholism comes to mind:

  • Gear sticks for manual gear shifting (which are much more common in the EU, I think)
    • Civilizational cost Fermi estimate
      • Disregarding any costs from increased numbers of crashes, let's assume that ~half of the population of Europe learned to drive with manual (manual might not have been available beforehand), which took them ~5 hours more on average
      • That gives
      • At this is ~7.5 bio. €
      • And this is still disregarding increased crash probabilities from higher cognitive load! (Although maybe automatic cars cost more?)
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Where are you getting the figure of 5 hours longer to learn manual?

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

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

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

Fair enough. I'd assumed the prize was ~the same (experience curves, anyone)?