Covid 10/21: Rogan vs. Gupta

by ZviDon't Worry About the Vase28 min read21st Oct 202163 comments

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Covid-19
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I finally got my booster shot yesterday. I intended to get it three weeks ago, but there was so much going on continuously that I ended up waiting until I could afford to be knocked out for a day in case that happened, and because it’s always easy to give excuses for not interacting with such systems. When I finally decided to do it I got an appointment literally on my block an hour later for that and my flu shot, and I’d like to be able to report there were no ill effects beyond slightly sore arms, but I’m still kind of out of it, so I’ll be fine but if I made some mistakes this week that’s likely the reason. I also had to wait the fifteen minutes. I would have simply walked out the moment they weren’t looking, but they held my vaccine card hostage until time was up. 

We now have full approval for every iteration of booster shots, including mix and match, for those sufficiently vulnerable. If you’re insufficiently vulnerable but would still rather be less vulnerable, there’s a box you’ll need to check. 

I got a chance to listen to the Rogan podcast with Gupta, and have an extensive write-up on that. It was still a case of ‘I listen so you hopefully do not have to’ but it was overall a pleasant surprise, and better than most of what passes for discourse these days.

Executive Summary

  1. Conditions continue to improve.
  2. Booster sequences including mix-and-match have been approved.
  3. Rogan did a podcast and I listed to it so you don’t have to.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 481k cases (-12%) and 9,835 deaths (-11%).

Results (from data source unadjusted): 472k cases (-15%) and 11,605 deaths (+1%).

Results (adjusted for Oklahoma which will be baseline for next week): 472k cases (-15%) and 10,705 deaths (-3%). 

Prediction for next week: 410k cases (-13%) and 9,600 deaths (-10%).

Wikipedia reported over 1,100 deaths in Oklahoma this week. That’s not plausible, so I presume it was a dump of older deaths or an error of some kind, and removed 900 of them from the total. 

There’s no hard and fast rule for when I look for such errors or how I do the fixes, so you can decide if what I’m doing is appropriate. Basically if an entire region gives a surprising answer I’ll look at the individual states for a large discrepancy, which is at least slightly unfair since sometimes it makes the number look ‘normal’ when it shouldn’t, but time is limited. 

This is still more deaths than I expected, but given cases continue to drop I expect deaths to keep dropping. It’s possible there was another past death backlog I didn’t spot because it wasn’t big enough to be obvious.

Deaths

Chart and graph are adjusted (permanently) by -900 deaths this week in Oklahoma.

Death counts seemed higher than plausible in general even after the fix, but it’s a small mistake. Next week will tell us whether or not it is a blip.

Cases

The South’s situation continues to improve rapidly, and it now has fewer cases than multiple other regions, but we see improvement everywhere. Solid improvement in the more northern states is especially promising in terms of worries about a possible winter wave. Can’t rule it out, but it seems somewhat less likely. 

We are now down more than 50% in cases from the recent peak, and over the last five weeks, although regionally that is only true in the South. But we’ve clearly peaked everywhere. 

Vaccinations 

Nothing ever changes. Which at this point is good. Steady progress is more meaningful each week as more of the population is already vaccinated.

Vaccine Effectiveness and Approvals

In the words of Weekend Editor: Today the FDA formally authorized Moderna boosters, J&J boosters, and all the mix-and-match combination boosters. This is very aggressive for them! 

Indeed, and congratulations to the FDA for doing the right thing, at least on this particular question. When someone does the right thing is the time to thank them, no matter how long overdue it might be. 

As per procedure now the CDC gets to have all the same discussions, because if there’s one thing we need enough of it’s veto points. We’ll know the outcome on that next week.

Vaccine Mandates

Support for older vaccine mandates is declining. This could end up being quite bad.

There continue to be claims that there will be massive waves of people quitting over vaccine mandates, this time in New York City. No, we are not going to lose half our cops, no matter how excited that prospect makes some people these days. We’ll find out soon enough:

On the one hand $500 is in the ‘let’s actually get it done’ range and worth it if it works, and should smooth over any general grumbling, on the other hand it’s enough that I’m pissed off that they’re getting that many extra tax dollars for what they should have done anyway. 

Here’s a Zeynep thread on the psychology involved. Lot of good food for thought.

A vaccine mandate carries with it the requirement to verify that it is begin followed. This in turn means verifying people’s vaccine status and ID at various points. When does this end? Some people who based on their previous writings really should know better are seemingly fine with ‘never’ and I notice I am most definitely not okay with that for everyday activities. There will be a point these mandates \(\) everyday actions turn negative, and it’s not that far off, and then we’ll have to figure out how to unwind them. Would be increasingly happy to start now. 

This post looks at vaccine persuasion in Kentucky, notes that $25 Walmart gift cards were a big draw, doesn’t seem to offer much hope that persuasion via argument would work. But have we tried bigger gift cards?

California state works are somehow vaccinated at a rate much lower than the state average. Ignoring for the moment that they don’t seem to be doing much to fix this problem, one can draw various conclusions about how the state government operates and hires based on this. And one can wonder why, if the state is willing to impose so many other restrictions, they can’t or won’t take care of business in this way. However, the article also notes that this is comparing the number who provided proof of their vaccination status as employees, versus the number who actually got vaccinated as adults. It seems that some employees may have simply decided not to provide proof, either as a f*** you to the demand for proof of vaccination, or because it seems that if you don’t vaccinate they ‘make’ you get tested a lot but that’s free and some people like the idea of getting tested frequently, so whoops. 

Washington State’s football coach is out: 

So is an NHL player, and even if you oppose mandates I hope most of us think that faking a vaccine card is not a permissible response.

This is a remarkably high tolerance of importantly fraudulent behavior. Very much does not seem like a sufficient response.

Not endorsed, but noting the perspective that the unvaccinated are holding us hostage, because the threat of potentially running out of health care capacity is the reason we still take major preventative measures, and if everyone got vaccinated we would go back to normal. I find the hostage situation metaphor apt because hostage situations are mostly because we choose to care about them. Every so often, someone on a show will grab a hostage, and the response will quite correctly be ‘I’m not going to reward threats to destroy value by giving you what you want’ and I wrote a contest essay back in grade school arguing this should be standard procedure. Instead, we’re more like a DC hero who thinks that if you point a weapon at any random citizen they are forced to hand over the world-destroying superweapon codes. I will leave it to you to draw the appropriate metaphor to our current situation on other fronts.

NPIs Including Mask and Testing Mandates 

From New Zealand and Offsetting Behavior comes the story of Rako. Rako offered to scale up their Covid-19 tests, the government said they weren’t interested, then when it turned out the tests were good they reversed course and decided to take what tests and capacity that did exist without much paying for them, among other disasters going on there, and hope that somehow anyone will be interested in helping with such matters next time around. It doesn’t look good. Neither does the Australian decision not to securely keep the police away from the contract tracing records

How much should you update on a Covid-19 test? We’ve got a new concrete reasonable attempt answer that, although it still uses the PCR test results as their ‘gold standard’ and thus is underestimating the practical usefulness of other testing methods. 

The Bayes factors for positive tests are pretty high. The ones for negative results are less exciting, but if you’re focusing on infectiousness, I believe you end up doing a lot better than this. Those who do math on this stuff a lot are encouraged to look into the details.

It turns out Rapid Antigen Testing works rather well at telling who is infectious. Here’s a thread explaining why they’re much more accurate than people thought, which is that when the PCR tests came back with what were effectively (but arguably not technically) false positives, not matching those was a failure. The fallback general official response has for a long time been something like this.

Where ‘have Covid’ is defined as ‘have or recently have had any trace of Covid’ although that’s rarely the thing that has high value of information. It is very reasonable for someone to want to know if they have (or others have) Covid, and it is also very reasonable for someone to know if they are (or others are) infectious. Different purposes, different tools, and it turns out both tools are highly useful. The mistake we made for over a year was saying that because people might also want to know if they have Covid, the test that is very good at detecting infectiousness and less good at detecting Covid was illegal, so we should instead not test at all or use a test that was more expensive, slower and less useful in context. It is good that things seem to be coming around a bit.

Restaurant that isn’t as good as Shake Shack lets people in, is now told they are out. 

This was only a temporary shutdown of one store, since they only have one store in San Francisco. Depending on exactly where their stores are, this could be a very smart move, as it wins them massive points with the outgroup.  

Permanent Midnight

Some of us think the ultimate goal is to become complacent about Covid-19 once it’s no longer a major threat, and return to our lives. Our official authorities say, madness.

This is an explicit call for vaccinated children to be forced to mask permanently. This is utterly insane. If not them, then who? If not now, then when?

I sincerely hope the kids neither forgive nor forget that this happened to them.

This also brings up another of my humble proposals of ‘maybe we should teach children that skipping a meal every so often is fine, so they have that valuable skill in life that’s done me worlds of good’ but mostly it’s that they are literally forcing children to go outside in the rain to eat.

Remember. 

Here’s Sam Bankman-Fried going over why calls for large permanent interventions are nowhere near ever passing cost-benefit tests, and giving an attempt at a calculation and thus an opportunity to nitpick and refine.

Semi-constant mask wearing costs a lot more than 0.4% of GDP. I don’t know exactly what you’d have to pay people to get them to wear masks indefinitely (with no other benefits) but I’d be stunned if it’s under 1% of consumption. Even if we knew it would work on its own with no help I have no idea why you’d even consider this.

Staying home if you have a sick housemate, to me, seems mostly like a good idea even before Covid-19. You can call this a cost of one day per year, but you have to make a bunch of assumptions to get there. Days of work can’t be fungible, so taking a random day off means your productivity is lost and can’t be made up later, and there aren’t substantial benefits from taking that extra day off on the margin. But that’s kind of weird, since if there was such a big net loss from losing a random day of work it strongly implies you’re not working enough at the baseline. And it seems likely to me that you save the office collectively a full day of productive work (since being low-level sick makes work less effective on top of less fun) by avoiding additional infections. 

The exception here would be if work on that day can’t be done from home, and isn’t fungible with either other times or other people, so you lose something close to a full day’s productive value. I think that is rarely the case, and that Sam’s history of being stupidly productive at all times makes this a blind spot. For most people, my model says that either (A) you can mostly get others to cover for you without too much loss and (B) most of the work where this isn’t true can be done remotely for a day or two. 

Zoom meetings are a mixed bag, but this week I had my first work in-person meeting in over a year and it was incredibly more productive than a similar Zoom meeting would have been. There are big advantages the other way, so this won’t always be the case, but I strongly agree that giving up on seeing people in person is a productivity (and living life) nightmare that costs way more than we could plausibly give up. But on the margin more Zoom meetings than 2019 is good actually.

That leaves the vaccines, which he estimates at a day of cost, and I don’t understand this number at all. Sometimes the vaccine will knock one out for a day, but this does not need to be the case and I wrote most of this the day after getting my booster shot. Over time, we’ll figure out the right dosing and regimens and the side effect impact will decline, and you can plan ahead so you choose a day when it’s not that expensive to be somewhat out of it. 

If we end up passing a ‘everyone must miss a work day after the shot so everyone feels permission to get the shot’ law then it could end up costing a day, I guess, but also giving people some paid time off at the time of their choice that they plan for seems like it isn’t even obviously a bad idea?

Rogan Versus Gupta

I got the chance to listen to Joe Rogan’s podcast with Dr. Gupta. It’s a fascinating combination of things, some of which are great and some of which are frustrating and infuriating, from both of them.

The opening is a discussion of why the two of them were willing to sit down together. Gupta sat down with Rogan to try and understand Rogan’s thinking process and because Rogan can reach a huge audience that is otherwise exceedingly difficult to reach, and to convince Rogan on vaccines. Rogan sat down with Gupta because Gupta’s public changing of his mind on marijuana (which they talk then about a bit) revealed to Rogan that Gupta is willing to look at the data, change his mind and admit when he’s wrong. 

In this past, both of them acquitted themselves well. The central point here was well taken. On its surface it was about the potential of marijuana and why we should not only legalize but embrace it and research what it can do for us, and I’m while I don’t have any desire to use it myself I am totally here for that. 

The real point was that one needs to think for oneself, look the data with your own eyes and an open mind, be curious and come to conclusions based on where that takes you, and that doing this is how you earn many people’s respect. That Gupta was here with the ability to engage in (admittedly imperfect, but by today’s standards pretty darn good) discourse because he’d shown himself in the past to be an honest broker and truth seeker acting in good faith. 

They then started getting down to it and discussing the situation in earnest. Compared to my expectations, I was impressed. Joe Rogan came in curious and seeking truth. He had many good points, including some where he’s more right than and where he was wrong, he was at least wrong, making substantive claims for reasons and open to error correction and additional data and argument. He was continuously checking to see if Gupta’s story added up and whether it lined up with Rogan’s model of the world in general, but was quite open to learning more.

Like any discourse or debate, there were many ways all participants could have done better.

Several people have noted that Joe Rogan is drawing a distinction between vaccines, where the burden of proof of safety is being put on the vaccines, and on various other things like Ivermectin, where he largely puts the burden on others to show they are not safe, and holds them to a very different standard. In general, it seems like Rogan is hunting for an angle whereby the vaccines will look risky. Not full solider mindset, but definitely some of that going on. 

It’s worth noting that Rogan explicitly states in minute 59 that the risks from the vaccines are very, very small. This is despite Rogan listing off people he claims to know who had what he thinks are deadly serious adverse reactions, so it’s not clear to me that he in his position should even believe these risks are all that small. 

Rogan’s point that Gupta is at far greater risk as a vaccinated healthy older adult, than a child would be unvaccinated, is completely correct and a kill shot when not tackled head on. None of our actions around children and this pandemic make any sense because we refuse to reckon with this. Gupta has no answer. The response ‘I think you have to draw a distinction between those that have immunity and those that don’t’ is not a meaningful answer here – saying the word ‘immunity’ and treating that as overwriting age-based effects is Obvious Nonsense and Gupta is smart enough to know that. As are his attempts to move back and forth between risk to self and risk to others when dealing with kids. If he wants to make the case that vaccinating kids is mostly about protecting others, that’s a very reasonable case, but you then have to say that part out loud.

Which is why Rogan keeps coming back to this until Gupta admits it. Gupta was trying to have it both ways, saying he’s unconcerned with a breakthrough infection at 51 years old, and that young children need to be concerned about getting infected, and you really can’t have this one both ways. Eventually Gupta does bite the bullet that child vaccinations are about protecting others, not protecting the child (although he doesn’t then point out the absurdity of the precautions we force them to take), and frames the question in terms of the overall pandemic. 

The question of protecting others was a frustrating place, and the one where I’m most disappointed in Rogan. Rogan pointed out that vaccinated people could still spread Covid-19 (which they can) and then said he didn’t see the point of doing it to protect others, whereas he’s usually smarter than that. Gupta pointed out that the chances of that happening were far lower, although he could have made a stronger and better case.

Gupta was very strong in terms of acknowledging there was a lot we didn’t know, and that he had a lot of uncertainty, and that data was constantly coming in, and in engaging the data presented with curiosity and not flinching, if anything taking Rogan’s anecdata a little too seriously but in context that was likely wise. 

The key moment where Rogan turns into the Man of One Study seems to start in minute 62. In response to Gupta referring to the study, Rogan has it brought up. The study’s surface claim is that for some group of young men, the risk of the vaccine causing myocarditis is 4.5x the chance of being hospitalized for Covid-19. Gupta had previously pointed out that the risk of myocarditis from Covid-19 is higher than that risk from the vaccine, and tries to point out that the study here is not an apples-to-apples comparison, as it’s comparing hospitalization risk to diagnosis risk. Rogan grabs onto this and won’t let go. It takes a few minutes and Gupta stumbles in places, but around the end of minute 65 Gupta gets through to Rogan that he’s claiming myocarditis risk from the disease is higher than from the vaccine. Rogan responds that this is inconsistent with the data from the study, which seems right. Then Gupta gives the details of his finding, but his finding is based on all Covid-19 patients in general, which is consistent with this particular risk being higher for young boys from the vaccine than from Covid-19, and potentially with the results of the study. 

At another point, Gupta threw the Biden administration under the bus on the issue of boosters, blaming them for daring to attempt to have an opinion or make something happen without waiting for word to first come from the Proper Regulatory Authorities, and claiming this was terrible and caused two people to resign and treating their decision to resign as reasonable (Rogan was asking about the resignations repeatedly). He equated ‘data driven’ with following formal procedure and only accepting Officially Recognized Formats of Data. I wasn’t happy about this, but the alternative would be to start speaking truth about the FDA.

My model is that Rogan’s take on vaccines differing from the standard line comes mainly from Rogan placing an emphasis on overall health and the strength of a person’s immune system, and from taking these questions seriously and spotting others not taking the questions seriously. 

Rogan’s entire model of health and medicine, not only his model of Covid-19, consistently gives a central role to maintaining overall good health. People should devote a lot of time and effort to staying in good health. They should eat right, exercise and stay active, maintain a healthy weight, take various supplements and so on. This is especially important for Covid-19, whose severity seems highly responsive to how healthy someone is, with large risk factors for many comorbidities, although not as large as age. 

From Rogan’s perspective, one option against Covid-19 is vaccination, but another option is to get or stay healthy. As Gupta points out multiple times, this is a clear ‘why not both’ situation, except that there’s complete silence around helping people get healthy, even though it’s a free action. It’s worth getting and staying healthy anyway, why not use Covid-19 as an additional reason to get people started on good habits? And if you’re unwilling to help people get healthy, why should we listen to you about this vaccine? Which is a fair point, you mostly shouldn’t listen to these people in the sense that their claims are not in general especially strong evidence. It’s that in this case, it’s very clear for multiple distinct reasons that they are right.

Minute 88 is when they get into Ivermectin. Joe Rogan is not happy that he was described as taking ‘horse dewormer.’ As he points out, this is very much a human medicine, regardless of how some people are choosing to acquire it, and those people are not him: “Why would they lie and call it horse dewormer? I can afford people medicine, motherf***er, this is rediculous. It’s just a lie. Isn’t a lie like that dangerous? When you know that they know they’re lying?” 

So then he played the clip, and the CNN statement wasn’t lying, exactly. It was technically correct, which as we all know is the best kind of correct – it said that he said he had taken several drugs including Ivermectin. Then it said that it was used to treat livestock, and that the FDA had warned against using it to treat Covid. Now all of those statements are technically correct – the FDA definitely warned about it and doesn’t want you doing that, and among other things Ivermectin is used to treat livestock, although it is also often used for humans and Rogan had a doctor’s prescription. 

Now, in context, does that give a distinctly false impression to viewers? Yes. Are they doing that totally on purpose in order to cause that false impression? Absolutely. Is it lying? Well, it’s a corner case, and technically I guess I’m going with no? Gupta’s response is that they shouldn’t have done it, but he’s not willing to call it a ‘lie’ and is denying that there was glee involved. (Morgan Freeman narrator’s voice: Oh, there was glee involved.)

Rogan asks, if they’re lying about this, what do we think about what they’re saying about Russia, or any other news story? And my answer would be that this is the right question, and that it’s the same thing. They’re (at least mostly) going to strive to be technically correct or at least not technically wrong, and they’re going to frame a narrative based on what they want the viewer to think, and as a viewer you should know that and act accordingly.

Later on comes the part that should be getting more attention. In minute 125, Rogan explains that he almost got vaccinated, but didn’t, and what happened.

  1. The UFC got some doses and offered one to Rogan. He accepted.
  2. Logistical issues. Rogan had to go to a secondary location to get it, his schedule didn’t allow it, had to be somewhere else, planned to take care of it in two weeks.
  3. During the two week period, Johnson & Johnson got pulled.
  4. Also, his friend had a stroke and Rogan connected this to the vaccination, whether or not this actually happened.
  5. Rogan goes “holy ****” and gets concerned.
  6. Another of Rogan’s friends has what looks like a reaction to the vaccine, gets bedridden for 11 days. And another guy from ju-jitsu that he knows had what looked like another issue, having a heart attack and two strokes.
  7. A bunch of these reactions don’t get submitted to the official side effects register.
  8. Rogan concludes that side effects are likely to be underreported.
  9. Rogan goes down a rabbit hole of research, finds opinions on shape of Earth differ.
  10. Rogan doesn’t get vaccinated, thinking he’s healthy and he’ll be fine.
  11. Rogan gets Covid-19, his family presumably gets it from him (Minute 135), it isn’t fun, but he gets over it and he’s fine, and they get over it and they’re fine.
  12. Rogan tells these stories to millions of people, teaching the controversy, but still advocating vaccination for the vulnerable and for most adults, but is highly skeptical about vaccinating kids and thinks people should be free to choose.
  13. Gupta tries to get Rogan to get vaccinated despite having been infected, while admitting Rogan has strong immunity already, which goes nowhere.
  14. Rogan says repeatedly that he’s not a professional, that you shouldn’t take his advice, to listen to professionals, that he is just some guy with no filter. But this includes naming The Man We Don’t Talk About as an expert.
  15. But of course, he knows that saying ‘my advice is not to take my advice’ mostly never works.

The first thing he mentions in his story, the start of this reversal, is when they pulled Johnson & Johnson to ‘maintain credibility.’ This is a concrete example of the harm done by that action. It contributed directly to Rogan not being vaccinated. That speaks to how many other people had similar reactions, and also Rogan then shared his thoughts with millions of people, some of whom doubtless therefore did not get vaccinated. 

The bulk of his points were about side effects in particular people that Rogan knew. From his perspective, the side effects looked very much like they were being severely underreported, especially since these particular side effect cases weren’t reported. How could he not think this? From his epistemic position, he’d be crazy not to think this. He has quite a lot of friends and people who would count as part of the reference class that he’d observe here, and the timing of some of what looked like side effects could easily have been a coincidence rather than causal, but still, he saw what looked like three of these serious cases in rapid succession, in people who seemed otherwise healthy. Meanwhile, similar risks are being used as a reason to pull one of the vaccines. 

He responded to all this quite strong (from his position) Bayesian evidence, combined with his good health and his model that Covid-19 was unlikely to be that bad for him, did a bunch of research that under these circumstances put him in contact with a bunch of Covid-19 vaccine skeptics, and declined the vaccine. 

I strongly feel he made the wrong decision, took an unnecessary risk and would have been much better off getting vaccinated. But mostly the heuristics and logic used here seem better than blindly trusting a bunch of experts. Sometimes that gets you the wrong answer, but so does trusting the experts. 

Given he continues to mostly advocate for vaccination of adults, and seems to have come around to believing the generally accepted vaccine safety profile, that both speaks highly to his epistemic process used since he was exposed to a bunch of his good friends who were peddling other conclusions rather forcefully, and also makes me think I know here he did make his mistake.

My guess (and I could be wrong, he didn’t make this explicit) is that the decision ultimately came down in large part to blameworthiness in Rogan’s mind. In the frame most of us have, vaccines are safe and effective, so if you get Covid-19 without being vaccinated that’s on you, and if you have one of the exceedingly rare serious side effects (many or more likely most of which are a coincidence anyway) then that’s not on you. The incidents with his friends reversed this for him, combined with thinking that outcomes from Covid-19 are tied to health. In his mind, if Covid-19 got him, that was his fault for being unhealthy. If the vaccine got him, that would be on him for seeing these things happening to his friends, and taking it anyway. So he did what most people do most of the time, especially when he saw the decision as otherwise only a small mistake, and avoided what he thought of as blame, and did what he could feel good about doing. And of course, the decision was in many ways on brand. But the undercurrent I sense is that yeah, he knew it was objectively a mistake in pure health terms, but not a huge one, so he just did it anyway. 

One thing that reinforces this is that Rogan comes back repeatedly to individual examples of people, especially young healthy people, who had problems that happened after getting vaccinated, and says that it was overwhelmingly likely that that particular person would have been fine had they gotten Covid-19. Which is true, but it was also far more overwhelmingly likely that they would not have had the problem they had if they got vaccinated. If you trade one risk for another smaller risk, sometimes the smaller risk happens to you. That’s what a risk is. But if you instinctively use forms of Asymmetric Justice, what matters is that this particular person is now worse off, even if on net people who took such actions are better off, therefore blame.

That of course is an aspect of vaccines being held to a different burden of proof. In his mind and many others, they’re unsafe until proven safe, and that includes long term data, and the prior on ‘artificial thing we made to do this’ in some sense is stronger than any of our ‘this is how this mechanically works or when we’d see the effects show up’ style arguments could hope to be. Whereas he puts his assortment of other stuff into a different bucket, with a different burden and a radically different prior. Which isn’t a crazy thing to do, from his perspective, although I don’t see it as mapping to the territory.

They finish up with a discussion about the lab leak hypothesis, and they certainly don’t make me less suspicious about what happened on that front. 

That’s a giant amount written about a three hour podcast I listened to (mostly at 1.5x speed) so you didn’t have to. It was less infuriating than I expected, and contained better thinking, and is to be hailed for its overall good faith. We need to be in a place where such actions and exploration are a positive thing, even when they make mistakes and even when they end up causing people to be pushed towards worse decisions in many cases. 

In Other News

Bioethicists have profoundly inverted ethics.

No, seriously, imagine speaking this sentence out loud. Say, to whoever is listening, “We don’t ask people to sacrifice themselves for the good of society.” 

Then realize that bioethicists are far more insane than that, because what they’re actually saying is, “We don’t allow people to sacrifice of themselves, or take risks, for the good of society.” 

Over half of respondents to this survey report being lonely, with only a small effect from identifying as autistic. We had a crisis of loneliness before and Covid-19 had to have made it much worse, and at this point I worry about such effects far more than Covid-19.

Not Covid, but a good politician never wastes a crisis, so here’s a look into the child care portion of the Build Back Better bill. I solved for the equilibrium, and I doubt anyone’s going to like it.

As the weeks continue to blend into one another, it seems like it’s getting to be time to formally write up my lessons from the pandemic. I don’t know when I’ll have the bandwidth, but I’m authorizing people to periodically ask why I haven’t finished that yet.

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Several people have noted that Joe Rogan is drawing a distinction between vaccines, where the burden of proof of safety is being put on the vaccines, and on various other things like Ivermectin, where he largely puts the burden on others to show they are not safe, and holds them to a very different standard.

This seems defensible if you're trying to mandate the former and forbid the latter.

Discussion in question was about whether to get vaccinated rather than whether to mandate vaccination. 

Also, we effectively totally mandate treatments all the time, the force of 'doctor insists you do this' in many spots is 'I'll physically do it without asking permission' and in many others it's 'we will refuse you any other care until you do this.' In ways I find pretty terrible, mind you, but worth noting this.

https://www.ft.com/content/d4e58d38-37d6-40cd-9d72-6b9bfd0a3683

Very Good news on Boosters: first RCT of a Pfizer booster in Israel confirms 95.6% efficacy Vs infection!

https://mobile.twitter.com/DevanSinha/status/1451147345664618496

That basically takes us right back to where we started in efficacy terms

"The trial took place during a period when the Delta coronavirus variant was prevalent, and the median time between second and third doses was about 11 months, with a median follow-up time of two-and-a-half months."

Plus there's reason to think the immunity will also wane slower,

https://twitter.com/JamesWard73/status/1451147065925554183?t=bjBh1wqz3moJP8cD4tmsXg&s=08

Combined with the long covid news from last week the picture looks a lot better... Assuming they let us get boosters

I think I'm opposed to the vaccine mandate.

This is NOT about being opposed to vaccines. 

I'm vaccinated and so are my family. Yay for vaccines for keeping healthy people relatively healthy!

Based on what I currently know, I'm highly in favor of everyone I care about, including "generic random humans, in the US, and outside it" getting the vaccine if they have not already had covid because it will probably, on net, selfishly protect their own health... while society slowly collapses around them due to failed public health policies more generally.

The right policy, in my opinion, is regular mass testing

Spit in a cup and mail it in, every single day, and get a stream of "negative negative negative". Coupled with thoughtful quarantine policies, that might get us to eradication, and a return to normal everyday life :-)

...but in the US at least we aren't aiming for eradication. We aren't doing regular mass testing. We're not setting up border medical testing and quarantines. We're NOT getting ready to be healthy as a nation.

...

So then a thing that seems kind of insane(?) (like I keep hearing this, and keep not quite believing that it could be this way, and so I wonder if I'm hearing wrong, or if it really is just this stupid) is that apparently the vaccine mandate has no opt-out for "people who already got covid"?

So like... if I haven't misunderstood this, this is asking people to RISK THEMSELVES FOR NO BENEFIT TO OTHERS OR TO SELF

Because... they had covid and lived... so that's better immunological protection than merely vaccinated people, right? 

Like their previous infection protects them and also it makes them less likely to be infectious already so it protects others too...

So why the fuck is self-harm, for this group, then being mandated by the government? 

What is the public policy logic here? 

Seatbelts are a useful dividing line: from a libertarian political model it is fucked up to mandate them because everything the government does is coercive violence, and you shouldn't use coercive violence unless it is an absolute fallback mechanism for maintaining the core of civilizational adequacy. 

When people are burning down courthouses: that's the time to use state power.  Smash heads. Hold trials. Throw 'em in jail. When people are carjacking, or scaring kids in the street... that harms others: put em in jail.

BUT if "it is good for you and you aren't doing it" is a reason to destroy people's lives or livelihood using state power, then why not fire people or jail them if they don't regularly brush their teeth or eat enough meat to get their B vitamins?

"Its good for them" is a BAD basis for using state power.

I admit that lots of random idiots like seatbelt laws because... seatbelts are nearly always the right move? 

And they are idiots... so to them it looks like curmudgeonly resistance to do something OTHER than wear seatbelts just as a matter of personal principle. 

The principle is good, but seatbelts aren't the best place to fight that battle.

However, with a BLANKET vaccine mandate, there are people for whom this is a NET HARM, where it increases risks from "medical complications in general" for people who were already infected in a way that provides essentially no real benefits to them.  And then this self-harm it doesn't even help others that I'm aware of either, because they were already "essentially vaccinated" simply from having the disease already?

Also, they would be precisely the ones who would be mostly likely to have bad reactions? Because their immune system would freak out about the injections more than for other people? Right???

And also NONE OF THIS is advancing towards covid eradication?

So this mandate, for some people is just... pointless patient-harming authoritarianism?

I don't understand how the blue tribe became "in favor, because its common sense" of doing pointless harm to random citizens for the sake of some OCD-like compulsion to get a number (the number vaccinated)... to 100%... even though actual complete success doesn't even LOOK like 100% vaccination?

Maybe I'm modeling something wrong here, but the way my models work currently, this feels like more of a "kill shot" on vaccine mandates than any problem with kids.

Rogan’s point that Gupta is at far greater risk as a vaccinated healthy older adult, than a child would be unvaccinated, is completely correct and a kill shot when not tackled head on. None of our actions around children and this pandemic make any sense because we refuse to reckon with this. Gupta has no answer. The response ‘I think you have to draw a distinction between those that have immunity and those that don’t’ is not a meaningful answer here – saying the word ‘immunity’ and treating that as overwriting age-based effects is Obvious Nonsense and Gupta is smart enough to know that. As are his attempts to move back and forth between risk to self and risk to others when dealing with kids. If he wants to make the case that vaccinating kids is mostly about protecting others, that’s a very reasonable case, but you then have to say that part out loud.

Which is why Rogan keeps coming back to this until Gupta admits it. Gupta was trying to have it both ways, saying he’s unconcerned with a breakthrough infection at 51 years old, and that young children need to be concerned about getting infected, and you really can’t have this one both ways. Eventually Gupta does bite the bullet that child vaccinations are about protecting others, not protecting the child (although he doesn’t then point out the absurdity of the precautions we force them to take), and frames the question in terms of the overall pandemic. 

At least with kids you can explain that the little germ factories could otherwise be harboring germs that will take down their elders, so their is a pro-social reason to do something here to clear covid from that subpopulation that is inherently mixed into a larger population with people at risk from covid...

But this doesn't really scan, because it doesn't ERADICATE covid, it just mildly tweaks the R_t... 

So far as I'm aware, vaccines are great, because they selfishly protect you from serious harms from covid while covid remains endemic, which it seems on track to be until... until maaaaaybe (if we are lucky) the next presidential election when someone runs on the slogan "Fuck Covid, Vote For Me" and gets elected and fixes the broken systems (plural) and eradicates covid?

But Biden ain't gonna, just like Trump didn't.  (They are the same, in my book. They won an election and deserve a modicum of respect, but their leadership has been highly flawed and inadequate to the demands of this historical period.)

...

So, maybe I'm missing something important. But in the absence of any positive justification for forcing people who already had covid to get a pointless vaccine in order to stay employed, one starts looking for alternative reasons.

The best I have so far is: the firings ARE THE POINT. 

Maybe the goal is to punish stupid weak people by driving them out of polite society and immiserating them and turning them against the law and the government and all of it?

The police have a bunch of people who are pro-Trump, and didn't get vaccinated (and plausibly already got covid in the line of duty anyway), and imposing a health harming hazing ritual on them will either drive out the "disloyal to blue tribe" police or give them cognitive dissonance in favor of following stupid orders going forward? Working out these details, it seems very plausible that these people were fired because the goal might have been to fire them?

Why not just do a test to see if they've already got antibodies?

(Also, for that matter, if someone gets vaxxed and doesn't form antibodies... they might be an infection risk and should perhaps be fired for being immuno-compromised in a role that apparently requires immune competence for the good of those they interact with? Like if there is a world of atoms "out there" that makes sense, and our public policies just internalize and react to "the sense of the world itself", then... this is the kind of logic that you'd see going right along with a SANE "vaccine mandate" (that had an opt out for people who got their antibodies in a movie theatre rather than a clinic).)

...

Maybe the problem is that we can't let the (private, for-profit) hospitals fill up? 

But if that's the issue, then just tell people: "If you stupid fuckers don't have antibodies from a previous infection and don't get vaxxed when you have the chance, and THEN you end up in the hospital, AND it starts to get full, you go to the bottom of the triage list". That would just be justice of a sort: they make a choice, they experience the consequences. Simple. Clean. Honorable even?

...

I hate how dumb everyone seems about this and I hate how the actual things playing out lead me into this Kremlinological reading of the nuances of everything to decode "what the real deal is" after noticing that the stated actions make no sense.

I feel like I have to do sense-making almost purely from scratch, and I hate it.

That said, Zvi, this seemed like an unaddressed elephant to me:

(4) Also, his friend had a stroke and Rogan connected this to the vaccination, whether or not this actually happened.

(5) Rogan goes “holy ****” and gets concerned.

(6) Another of Rogan’s friends has what looks like a reaction to the vaccine, gets bedridden for 11 days. And another guy from ju-jitsu that he knows had what looked like another issue, having a heart attack and two strokes.

(7) A bunch of these reactions don’t get submitted to the official side effects register.

(8) Rogan concludes that side effects are likely to be underreported.

So point (8) there seems like a sound (though only partial and probabilistic) inference to me. 

Not well sampled, of course.

But data censorship is terrible because once you know it is happening, all of a sudden everything downstream of that point becomes untrustworthy.

Data censorship is probably worse than bad sampling.  Bad sampling is like "normal noise" (another convenience sample: yawn) whereas data censorship is "enemy action"... it deletes things BECAUSE of what they are likely to show, which the entity that deletes is trying to prevent people from knowing about.

Once you grant that people are trying to vaxmax the US population via any means necessary, even when it doesn't make any sense (like for people with non-vax-based antibodies)... I personally trust Rogan's anecdata more than I trust statistical summaries from researchers with an axe-to-grind.

I'm very curious if this point was dealt with somehow.

There's a ton of stuff here so I can't take time to properly respond to it all, but I did want to note (I've talked about this before) my intuition pump around the data suppression question, and why I think it's hugely unlikely there are much more common serious side effects.

Which is that there are tons of people both pro and anti vaccine who are actively on the prowl for such effects. If we catch even a whiff of anything, no matter how statistically irrelevant, it endangers the ability to use the vaccines at all - see J&J, and see the Moderna suspensions, over basically nothing in both cases. Thus, the Responsible Authorities are keeping eyes peeled looking for non-existent problems, and the anti-vax crowd is of course looking for any problems, and reporters know it's a good story, and a lot of people would report hearing about such things especially if they knew multiple cases, etc etc. 

It's not that I trust it because the people in charge are saying so, it's because my model says if the problems existed we would know. Rogan is the first I've heard who reported a personal pattern or other pattern of serious (not short term you feel bad) symptoms from the vaccines. E.g. I don't know of anyone I know who knows anyone who had a non-short-term side effect of vaccination (or even thinks they did), whereas my personal trainer from pre-Covid is in terrible long term condition from Long Covid, etc. And the only other sources claiming to know such folks in multiples are, at best, 'less credible than Rogan.' 

Basically, when you have a huge anti-vax (not merely anti-mandate) faction, highly motivated to find things, you need to compare what evidence is found to what evidence you expect. And from Rogan's particular perspective, even if this is mostly a timing coincidence, that evidence looks suspicious, but from yours and mine, it doesn't (unless you have personal data I don't know, if I missed it I apologize). 

(Also, for that matter, if someone gets vaxxed and doesn't form antibodies... they might be an infection risk and should perhaps be fired for being immuno-compromised in a role that apparently requires immune competence for the good of those they interact with?

Is this a reference to something in particular, or is it entirely hypothetical? Has anyone been discovered not to have an antibody response who was not already known to be generally immune compromised?

I'm curious about your opposition to seatbelt laws, seeing as not wearing one can potentially turn you into a dangerous projectile that could cause harm to others.

That's not how anyone justifies that law, ever. "Human projectile harms to other people than the projectile" are very rare. No one optimizes this. It is a bad faith argument I'm pretty sure?

However, engaging with it as if it were in good faith... (maybe it is a good faith thought experiment?)

...you could have people buy extra insurance for paying out extra damages on that specific additional liability "having your body go flying and smash into other people" harm, and get a little logo on your insurance card, and that logo would mean cops couldn't ticket you for seat belt stuff.

That would be the same move of "opting-out of coercive paternalism while complying with coherent and valid demands to protect others from harms via negligence or accident".

Are you sure nobody justifies the law based on that? There are laws about tying down payloads on pickup trucks for exactly this reason.

If you can find someone who wrote a coherent article whose central pro-seatbelt argument is based on how seatbelts protect third parties from being struck by the catapulting bodies of idiots who didn't wear their seatbelt, I'm happy to change my mind.

How do you feel about mandating an annual physical?

I admire the question! It shows that you saw the larger point and found another example by which to test the general principles. If I'm wrong, I'd be happy to learn something.

In this case, I observed a direct instance of this with High School sports annual checkup requirement, and back then I started to dig in my heels, but my reaction produced a sensical (if abstractly saddening) explanation, roughly:

If you get hurt playing a sport and sue, this requirement by the school selfishly protects the ongoing functioning of the school from your possible stupid lawsuit, and requiring this lowers the school's insurance costs, and you don't have to... you just don't get to play sports if you don't. Look, everyone already understands that sports are a luxury for the rich since even in public schools they require fees anyway. You capitulate and play... or refuse and don't get to personally enjoy something fun and active and mostly healthy (though slightly personally dangerous).

Accepting a dysfunctional tort system as irreparable... and being selfish... you pay the "government dysfunction tax" and move along? It costs little. It protects the school's budget. Its designers are able to acknowledge reality on the down low... sure... why not play along.

That was back then. Covid radicalized me to some degree. 

It now seems abti-social-enough-to-deserve-moral-chiding to silently tolerate obvious-to-me dysfunction in my democratically elected government, because sometimes it really matters

It would be better to stop fucking over the poor in ways that rich smart people can tolerate.

It would be better to stop lying by default about public matters. 

Maybe other people don't want to hold themselves to this standard, but I personally want to be able to look in the mirror without flinching.

"I'm hurting you (by restricting your legal moves under threat of punishment) for your own good" is not a valid policy justification in government as far as I can tell. It is an incorrigible pattern.

Anyone who falls back to that justification for the coercive use of government power has essentially admitted (whether they realize it or not) that their subjectively assessed strongest argument is inadequate, and so they are probably wrong.

On corrigibility: individuals know more about their situation and are affected more by their own choices, and when the law is locally counter-productive, they can't propagate the local information in their head, which serves them and their interests (and thus is likely to serve any thoughtful person in very similar local circumstances in a generally valid way), back into the overarching legal framework.

Thus every unusual circumstance becomes potentially quite painful in the presence of "paternalist" laws with no opt-out, that takes no feedback, and requires public discussion to change... 

...and there are few mechanisms to shrink the scope and complexity of laws, which mostly grow over time, and so the default is for things to worsen over time.

Government (with a smarmy smile): I'm sorry, you have to X now.
Self: Why?
Government (rolling eyes at "another one of those people"): X is for your own good.
Self: Nice! Yay for defaults that are selfishly beneficial to the average default accepting person... I will opt-out then.
Government (exasperation fading into contempt): There is no opt-out.
Self: Of course there is. We live in a good country. I'm not your slave. I'm also not the slave of your boss's boss's boss. Neither are you (unless you're on an H1-B or something I guess (in which case you have my extreme sympathy)). So (barring other bad laws) you could also opt-out without super high costs if it mattered enough to you. Paternalist laws in (1) good countries are helpful-by-default when the country is benevolently run, but (2) they also need to have opt-outs for normally good and free people, and (3) sometimes they aren't even beneficial when the government is actually out to get you. I judge X to not be selfishly beneficial to me for reasons that would take a while to explain... but one of the joy's of being free is not needing to explain such things in cases like this... so where is my opt-out?
Government (adopting a threatening tone): There. Is. No. Opt. Out.

This is where the "Self" character has various choices. 

The lies have been revealed as lies in the text of the game... Now what?

When I project myself into that role, under a "radicalized by covid" frame that rejects stupid evil government not just as invalid, but as "morally praiseworthy to point out the problems of" then if I was the Self then I'd be tempted to "become the unit test case" and fight for my rights, until "the unit test that is me" turns green by me getting the thing that I think "helps me most", rather than what the authoritarian thinks "helps me most"?  

But I try to refrain from public self defense mostly (which is perhaps a higher standard than universalizes well).

The reason to refrain is a collection of obvious-to-me problems. What if I win but the victory doesn't propagate up to the root cause and then back down to others, who are less powerful, in a helpful way? That isn't morally praiseworthy... that would just advance my privileged legal status.

Also, I'd be very entangled, and it looks kind of selfish. So the signal isn't very clear. Also, if I fail maybe it was because I was a bad test case and my flaws, in my case, might contaminate reasoning about the larger point (that I'm pretty sure is correct)?

So a cleaner thing, in terms of raising the civic sanity waterline, is to notice other people in the role of a self standing up to an evil and stupid government, and praise and defend them, while articulating the coherent principle, with the goal of propagating the general principle back into <any part of the system able to learn at all that remains hidden deep inside an otherwise sclerotic and dysfunctional and oligarchic disaster of the formerly good government of a nation I care about>.

An interesting rebuttal to my position might be this point from Zeynep.

A debate on what the previously-infected should be recommended etc. is valid imo, but has little to do with the questions around the *sociology* of the unvaccinated. I think it’s one of those talking points for the very-online/polarized, rather than a big deal for many out there.

So, I agree with the sociological point here. I am sort of "very online" I guess?

Also most unvaccinated people are dealing with real problems and deserve sympathy and sociological humanization and help. Maybe 3% of them would volunteer something like my critique, on their own? 

However, I'm pretty sure they would "get it" almost instantly, and see me as a reasonably honest ally, and see that what I'm trying to fight for is each of them having a voice in their own goddamn medical treatment or else the right to opt out of an incoherent authoritarian socio-medical regime.

I have not acquired my position from anyone else that I'm aware of... 

Except in the broad cultural sense that I am thoughtful, and reasonably well informed, and can do math, and have some leisure time, and am culturally downstream of Locke and Hobbes and Jefferson and Condorcet and the rest.

From my perspective, Zeynep is the one who is "really online". I've tweeted 1481 times in 10 years. Zeynep has tweeted ~109,500 times over 12 years.

The thing I'm articulating is not a "talking point". No one handed me media briefer just before I showed up on CNN or Fox or whatever other propaganda outlet people-who-watch-TV pay attention to lately.

I'm not in favor of polarization. I'm in favor of its opposite, subject to constraints of fairness, justice, and actual rationality (not the US government's current official standard of rationality, which is abysmal because it is mostly used to justify obvious corruption).

I'm just trying to say something I think true and important for America (focusing on clean and clear political test cases that are currently failing for people other than me) and that I think America needs to remember if America is to have any hope of remaining a virtuous and free people engaged in virtuous self rule.

If Zeynep has heard other people say the same thing as me, and wants to propose that we are in a conspiracy with each other...

...my counter-proposal is that great minds think alike, and our conspiracy communicates with each other in public, across centuries, about abstract ideals with coherently rigorous applications to the details of good governance, in general.

I could be wrong. I'm imperfect in many ways, and thinking perfectly is literally computationally intractable... so... if you see clearly articulable flaws in my current set of heuristics and hunches and cherished attachments, it would be nice to update to something that feels less "austerely demanding" :-/

Sorry, I should have emphasized that I'm actually in favor of mandating annual physical exams at some point in the future, as an alternative to vaccine mandates, because it would add a certain amount of flexibility. The government could just ask "Did this person get their physical exam?" and medical professionals could assess whether a person is "OK", where the definition of "OK" might vary depending on current knowledge and individual circumstances.

I'm confident that we'll start acquiring a lot more knowledge that will allow us to make assessments of how immune people are, without having to measure antibody levels every time - age, weight, sex, prior infection, whether they're taking immunosuppressive medications, etc. At the same time, that starts to get into some deeply personal health information. So having that information "siloed" in a physical exam (a "black box" from the government's perspective) ought to be more agreeable to those of us who want something that "feels" more normal but doesn't disregard the lessons of the past 20 months.

[+][comment deleted]1mo 1

Did you actually see the statistical summaries of vaccine side-effects? 

I've seen so many statistical summaries. Can you be more specific?

Something like this with all the side effects and their frequencies enumerated.

Or this from the manufacturer.

I assume you mean this table?

From page 7 here.

Speaking to the table above: I don't see numbers in the table or a methods section in the document.

This appears to be a legal compliance document, or maybe technical marketing, but it doesn't seem like science or like an example rigorously adequate quality engineering.

From a legal perspective, all those "Not known" cells look like wiggle room for a legal defense to me in case things go sideways and lots of people get one of those side effects?

This does not bother me exactly. 

My general model of the vaccines is that they are experimental medicine that is more likely to help than to hurt. All medical treatments are a gamble. FDA safety pronouncements in general don't actually mean something is fully and generically safe for specific patients with specific issues. This is not a binary question, so the binary pronouncement is pretty silly, causing individual inefficiencies EITHER way the decision goes...

The eventual default for humans is death.  As this gets predictably nearer, crazy bets to stave off death are more and more justified at an individual level. The early covid vaccines for "at risk groups" were a very large N experiment that I've updated on... mostly in the direction that "the vaccines are safe enough to be helpful enough for many people".

In general, my advice for most people is to take the current vaccines. This advice is calibrated from a lot of data sources, including and especially macroscale efficacy hints from live clinical operations, which are experiments that produce observational data, even if people don't want to admit that normal clinical practice is always at least partly "an experiment that is probably worth it". Israel tends to go fast, and its government is likely to be benevolent to its own citizens, so I look to that market pretty often...

...but also my models assumed no major sources of data censorship in the reporting processes for vaccine side effects. 

If that assumption in systematically wrong for some sources of data, then maybe my advice is miscalibrated? I haven't reviewed things very much lately and have wide error bars here, and "anecdotes about censored data" would be relevant to the meta-question about how much my current object level impression was formed properly or not.

Could you be more specific about what you've observed, or what you think the observations justify in terms of newer (and presumably still tentative) conclusions? Do you know specifically that there's no data censorship in various areas that you've used to form a similar "pro-vaccine" position to my own? Or are you similar to me in being "pro-covid-vaccine" in a way that could hypothetically shift if you found out some of the evidence you've seen was adversarially manipulated with a conscious intent to cause people like us to have the posterior that we both probably still have?

Rogan offered evidence of data censorship. I'm just curious how much to update on it.

If there is significant systematic data censorship than we are all reduced to Rogan's level of data, namely, observation of people in our immediate circle and their immediate contacts, so one degree of separation. This is 17th century science. It is not likely to give us a strong enough signal to update in any direction. 

VAERS data used to be sufficient to ascertain vaccine safety in the past. Can you trust VAERS data for covid vaccines? When it comes to death reports closely following vaccination it gives a signal which is 200 times stronger than for flu vaccines. Can this signal be explained by FDA urging medical professionals to report literally every death occurring after vaccines? If VAERS is broken, what other sources can we use to estimate just how and in what direction VAERS is broken?

For example, can we compare the number of anaphylactic allergic reactions compiled by sources other than VAERS and the number of these reactions reported in VAERS?

I think this will be my last response. I can see VAERS and hypothetically I could download it and do some datascience on it, perhaps? 

However, until just now I didn't know that that system existed... and then I had to search for it (not follow a helpful link from you) and probably someone else has done datascience on that already...

So since you know about such things, why aren't you teaching me? Why aren't you linking to helpful stuff to tell me exactly how and why vaccines are safe making a positive case from these data sources you know about and trust? Or tracking down such research conducted by someone with government funding, but also where you actually respect the researchers personally and personally vouch for their work?

This is 17th century science.

Hey, they invented calculus, the slide rule, and the first human powered submarine, and they discovered carbon, phosphorus, and bacteria.... on essentially zero budget. Don't knock it till you try it, maybe?

Part of my overarching thesis is that the entire "system system" is trash until proven to be non-trash. Covid has shown me, over and over and over and over again that every time I make an assumption about the diligent benevolent systematic competence of the US government I am surprised in a negative way shortly thereafter. 

I don't think this applies to all of society, just the parts that have protectionist guarantees from the government, including the protectionist guarantees offered by parts of the government to other parts of the government.

As articulated by Richard Smith (for many years the chair of the Cochrane Library Oversight Committee, member of the board of the UK Research Integrity Office, and cofounder of the Committee on Medical Ethics (COPE)):

Stephen Lock, my predecessor as editor of The BMJ, became worried about research fraud in the 1980s, but people thought his concerns eccentric. Research authorities insisted that fraud was rare, didn’t matter because science was self-correcting, and that no patients had suffered because of scientific fraud. All those reasons for not taking research fraud seriously have proved to be false, and, 40 years on from Lock’s concerns, we are realising that the problem is huge, the system encourages fraud, and we have no adequate way to respond. It may be time to move from assuming that research has been honestly conducted and reported to assuming it to be untrustworthy until there is some evidence to the contrary.

I don't think this actually means we've lost 4 centuries of scientific capacity, myself... you're the one who said that if data censorship was common then it would be that bad. I

I think we've only fallen back to maybe the 1870s or or perhaps to just before WW1 or so... the problems we're having are translating things that wikipedia already knows, and can explain in small words into the actual practices of powerful people, like hospital administrators, pension planners, presidents, bond raters, tenured sociologists, and so on.

All I'm claiming is that there might be a LOT of people who should be fired (but who won't be fired (and that's most of why they're doing a shitty job))... who are currently getting paid by the US tax payers in exchange for essentially injecting noise into processes that care for the US tax payers, and thus harming the US tax payers.

I am certain of nothing, and I want to test everything in proportion to my doubt and the thing's importance. That is all.

When people start doing their own data science on VAERS database, the result sometimes looks like this document. Do you want to explain why covid vaccines appear to be 100 times less safe than flu vaccines?

It seems like you’re talking as if your goal is to score point in a debate with an opponent; your comments are only minimally useful from the standpoint of helping an honest interlocutor gain understanding. Yet it seems to me that JenniferRM shows all possible signs of being such an honest interlocutor (and indeed you are far more likely to find the latter on Less Wrong than the former).

What's the chance that the whole medical research apparatus in the US is corrupt and the vaccine numbers are off? That's the bit that might be underlying Rogan's model which he's not spelling out, that leads to "I don't trust statistics"

Is it 1% ? 10%? 20%? 90%? If so the unkown-unkowns of a vaccine become very high.

Given that it's widely accepted both Russia and China have faked their data, given that he knows people which had issues that were not reported, given previous failures of the health system during the pandemic.

It seems to me that Joe (and most Americans) are irrational for even considering getting vaccinated.

I for one am to deep down into "assume science in the west is generally not corrupt" rabbit hole, if a large % of data in hard science studies were faked my whole world would collapse so I might as well bet on that, most people here are in that camp, but Joe isn't.

Also Joe isn't able to decouple "public policy" from "scientific consensus", neither are most people, even I or most people here can't. Like, I have a few good heuristics like "If it's a simple statistical analysis and the author shared the data with a bunch of people that replicated and n is very high then it's ok" (ala vaccine studies), or "if it's a metaanalysis from cochren then I trust it", but those are less than rational heuristics and I have no idea how an MMA fighter could reach them or why he'd care.

On the whole Joe's response to the pandemic was on-point, I'd be surprised if he'll change his mind past "a lot of people think otherwise so let's meet in the middle". Because that's the rational view based on his (rather dumb and scientifically illiterate) PoV.

Right. It's hard to have a rational argument without an agreed upon set of facts.

PSA on boosters - the CDC just added mental illness is a qualifying criterion for boosters.

Wow. I found this hard to believe so I looked it up, and indeed:

Mental health conditions

Having mood disorders, including depression, and schizophrenia spectrum disorders can make you more likely to get severely ill from COVID-19.

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Yeah, I had to look it up too when I read about it in the Washington Post. Mental health professionals have been advocating for this for a while.

Thank you for continuing to do the executing summary. I could skip most of the post because of it.

While skimming I noticed this:

There will be a point these mandates  everyday actions

I find the PoliMath tweets kind of fascinating (in terms of psychology) because by the last tweet, he's expressing a reasonable, concrete complaint that I think most people would agree with:

my 8 year old daughter still cries b/c the last time she saw her best friend was when she was 6.

That girl's parents wouldn't even let them play together outside and masked, even this summer

The burden placed on the children here is large, and two children playing outside (even unmasked, but especially masked) is extremely safe. I completely sympathize with him here.

But for some reason that led to the hyperbole in the first tweet:

no one is going to admit they were pro-masking for kids in 10 years

Regardless of his feelings about kids and masks, this is not even complaining about the same position as what prompted the thread! His underlying motivating scenario is completely lost.

If I had only read the first tweet, I would have wrote him off as completely insane and blocked him (and in fact I think I do have him blocked on twitter). But thanks to your summary here, I can see this is more a case of being bad at communication.

A takeaway lesson as a listener: absurd hyperbole can conceal legitimate grounds for frustration.

A takeaway lesson as a communicator: to be more persuasive, identify the specific, concrete scenario that you believe is being handled incorrectly, and present that instead of vague generalities.

I don't like listening to Rogan, but I do like hearing him translated into rationalist-speak.

Huh, sort of strong +1 this. I do like listening to Rogan talk shit with friends, and I do like the way he brings ideas and knowledge out of interesting people, but I do not like him debating.

Yet Zvi made the debating eminently readable and both actually sounded sensible, which is a skill I do not have myself. If I'd written it then it would have been filled with the irritation I felt while listening to it. Zvi wrote it really well.

This feels like the kind of thing I could do more of if it were high value, in other contexts, but it requires a lot of time. Certainly would be happy to do it paid. 

Estimation of covid reinfection rates in the future was in the news recently:
https://www.theguardian.com/world/2021/oct/19/without-covid-19-jab-reinfection-may-occur-every-16-months-say-scientists

The actual paper:
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00219-6/fulltext

I always wanted to ask that question. There are 30 million more people with one shot than fully vaccinated.

Vaccination rate is 800 thousand per day. That means that 18 million out of 30 will not be back for shot two after two weeks and 13 million will not be back for shot two after three weeks.

Why is that?

I've been wondering for a little while now, is it momentum that keeps NE-ex-NY separate from NY? Is it because, since you're from there, it matters to you to keep them separated? Because outside of the original outbreak, I don't think NE-ex-NY + NY (aka just NE) has ever risen above the next-lowest region since May of last year.

"This is an explicit call for vaccinated children to be forced to mask permanently. This is utterly insane." Yes this is insane if your only concern is COVID.  But what's the positive impact on other diseases if we permanently mask kids while at school?  What is the lifelong fitness and intelligence loss caused by pathogens that infect us when we are children?  How much protection would masking kids give us against potential future bioterrorist attacks?

how much protection would allowing children that have at-home parents to stay at home and only come to school optionally for recess to play with other kids give you? A lot more

Throw in being able to go home if they start sneezing, or feel like it.

Precisely, the mask thing keeps the tourturous forced herding and makes it even worst, it's inhumane.

Probably really bad, actually.  The first thing that comes to mind here is the hygiene hypothesis—preventing kids from getting low-strength diseases as children when their immune systems are "being trained" to fight it off is likely going to cause issues in the future, and to solve a relatively small problem anyways (not many kids are hospitalized or die from other pathogens, and there isn't any good evidence that the long-term effects of diseases on children cause fitness or intelligence loss in the general population). Not to mention, masks are a major cost. Would you ask adults to wear masks in the workplace permanently? Obviously you wouldn't because that would cause riots. Requiring masks in schools for essentially tiny risks is significantly more overbearing and inconveniencing than, for example, requiring seatbelts, and yet it would likely save far fewer lives in the long run.

So forcing kids to mask permanently has:

Relatively tiny short-term effects, because not that many kids are dying of infectious diseases anyways;

Unknown long-term effects, because we really have no idea which way the fitness advantage is going and it may well be that minor infectious diseases as children are a positive thing;

An inconvenience ranging from minor to major for literally 56.4 million public and private school students, for 6-8 hours a day, or something like 143 billion person-hours per year.

Given that we are exposed to a lot more pathogens than were 99%+ of humans who have ever existed, the hygiene hypothesis doesn't make theoretical sense.  I can accept that if you are going to be exposed to a lot of pathogens as an adult you might be better off being exposed to them as a kid, but it seems that you would be better off if you are never exposed to them.

What do you mean and how do you know it? I'm guessing that you mean that density causes exposure to microorganisms adapted to humans. But we're probably a lot less exposed to random microorganisms from eating dirt (though it's not clear they should be called "pathogens").

The hygiene hypothesis of allergy is speculative, but here's a concrete, widely accepted claim: before 1900, infants contracted polio and had very mild cases. After 1900, they contracted it at a later age and had bad cases. This suggests increased hygiene at the same time of increasing density, apart from the question of whether hygiene is good or bad at the current margin.

Yes population density, international travel combined with the huge human population, and also the way do and have raised farm animals.

I would expect the effect on health (in either direction) to be dwarved by stuff like: detrimental effects on understanding people (even as an adult I struggle quite a bit to communicate when both sides wear masks), especially if your teacher is masked, or if you're learning English as a foreign language; detrimental effects on socializing (humans have various instincts for reading facial expressions which have not evolved to take masks into account); etc.

Do you have evidence that masks are effective against any other common diseases?

Common sense implies that they must be at least partially effective at reducing transmission of various diseases, in the same way that wearing gloves does (i.e. a barrier is created which partially blocks movement of potentially harmful particles).

Common sense also implies that masks will inevitably get dirty and will harbor pathogenic bacteria in a warm moist place contaminated with food and in close proximity to child's face. Covid aside, this seems like a net negative from common sense perspective.

Presumably this is why surgeons wear them and why even before COVID it was common for sick people in Asia to wear them.  Also premature births went down during lockdown perhaps because of a reduce spread of whatever pathogens contribute to premature births 

Surgeons are breathing in close proximity to open wounds

Sick kids should not be in school, masks or not. 

Do you have any evidence that healthy kids who show no symptoms are a significant risk of spreading common diseases other than covid asymptomatically.

"Sick kids should not be in school, masks or not. "  People should not be committing crime therefore we should not take costly preventive measures against crime.

 We  suffer from a lot of diseases that seemed not to effect hunter-gatherers living in their traditional environment, and we are exposed to lots more pathogens, and it's possible indeed even likely that these pathogens are inflicting significant damage on us.  What if, and this is just a wild guess, 20% of cancers, heart diseases, obesity and mental illnesses  were caused by pathogens and the average adult living in a rich country has lost 5 IQ points because of pathogens?  Common physical illnesses and mental illnesses not caused by pathogens or physical injury and striking people before old age are weird from an evolutionary viewpoint.

Living in cities is weird from evolutionary viewpoint.

What pathogens will be slowed by masks? How do we balance that with the inevitable reality that masks will get moist and dirty and harbor pathogenic microorganisms in close proximity with children's faces? Do you have any studies that masks help more than hurt with any pathogen besides covid.

I don't have any studies, but given that masks were in widespread usage by medical personal and in Asia before COVID my strong prior is that they significantly reduce the spread of some pathogens.  I'm not claiming that kids should wear masks, I'm claiming that there is a lot we don't know about masks and the harm pathogens inflict on kids and it is possible that if we knew more many reasonable people would want kids to wear masks while in school.  

Medical personnel work in close proximity to obviously sick patients and particularly surgeons work close to open wounds. None of the medical professionals are children, they are trained to use their PPE and take care of it. Mask use in Asia may have more to do with protection from particular air pollution. There is no evidence that people in Asia are less susceptible to pathogens.

Pre-COVID, Asian students in my classes sometimes wore masks, presumably when they were sick and didn't want to spread infection.  We could train kids  to use masks, it's not that complicated.  "No evidence" means we should generate evidence because of the massive amount of harm that pathogens cause, probably more than its generally realized because of their possible role in causing some cancers and lower some IQ scores. 

During the pandemic, RSV and influenza (but little else) have been driven nearly to zero. They must be transmitted in the same ways as covid. It's not clear how much of this is masks and how much is other interventions, but it's not clear for covid, either. 

We used to believe that for influenza handwashing and avoiding hand contact with mucous membranes is much more important than for covid. Are we updating on this?

I think that "we" believing is a category error. I think that even authorities "believing" is a category error. People did experiments to prove that hand sanitizer helped against the flu. They didn't update on these experiments because they weren't experiments to learn, but to prove what they wanted.

Regarding "open ended" vaccination mandates, in the Twitter thread you link to, some people draw the analogy with car inspections (safety and emissions). That gives me an idea: what if, moving forward, we mandated annual physicals instead of getting into the weeds on who is and isn't considered fully vaccinated? Or rather, let individual doctors get in the weeds, so that the rest of us don't have to? Physicians could take everything into account - medical history, age, sex, weight, antibody levels if necessary, prior infections, conditions that might compromise immunity - and based on all of that, give you clearance for a certain period of time. I think an "abstraction layer" could be extremely beneficial.

People who aren't able to pass the physical exam due to underlying conditions would be presumptively eligible for public assistance, for their own safety and the safety of others (even Typhoid Mary was eventually given a nice little cottage and a job - it worked a lot better than the punitive approach).

If a doctor is found to be "passing" too many people or not vaccinating enough people, that would be evident to regulators.

I think you have too much faith in doctors and their ability and willingness to put a lot of thought and judgement into low-paid parts of health care.  And I KNOW you have too much faith in regulators' ability or willingness to ... do almost anything useful, especially things that require judgement or speed of action.

[edit to add] you may be using a heuristic of projecting from doctors and regulation that you regularly encounter.  But for this kind of question, you need to consider the bottom part of the curve, not the average or common parts.  

Sorry, my intent was to propose a middle ground reflecting Zvi's discomfort with specific vaccine mandates targeted at the individual, indefinitely. There's a lot to be said for separating "code" from "regulations". We see this with a lot of regulations related to fire codes, safety standards, etc. E.g. NIST, NFPA, DSM, etc. Is that a little clearer?

So this is the kind of slippery slope that makes me think we might be better off mandating annual physicals - France is requiring boosters, but only for people over 65.

https://nyti.ms/309jD1b

I really don't want this level of granularity/micromanagement by the government. Once you start mandating boosters for some people but not for others, depending on the "state of the art" it seems like it's better to punt that responsibility (keeping up with the latest science) to individuals and their primary care doctors. I certainly don't want to live in a world where the government has specific requirements depending on sex, or BMI, or whether you're immunocompromised. However I would be totally OK with the government knowing that I consulted with my physician in the past year, who gave me the all-clear. Nice and binary.

Car inspections cost less than a 100 dollars. How much will this mandated physical cost? Do we even have more doctors than automechanics?

I mean, some of this could be delegated to physician assistants, nurses, etc.