string theory.
Anyways, it's very naive to think that "panels of experts" is a sustainable way to judge scientific quality. Eventually, those panels start awarding grants more on the basis of "pattern matching" vs "good science" and then the grant awardees who have been cargo-culted in, start serving on panels.
We don't know what could've happened, but we do know what did happen. It's like those people that say that the New Deal was bad, actually, and if we did nothing that would be the same or better!
Right... but no. Because the New Deal did pull us out of the depression. It's one of the most potent and effective pieces of policy in American History. We can play armchair economist all day. But we have to face what we know worked and think about why it worked.
I would add that weird ideas can be surprisingly useful; nobody expected research on gila monsters to lead to our most successful weight loss treatment to date.
There are problems with this system. Researchers often have to spend a lot of time writing grant applications, and grants can be rejected for any number of bad reasons. And there are cases where research was funded that probably shouldn't have been funded. But research funding isn't given willy-nilly to whoever asks, and taxpayers wasting money on kooky ideas isn't a particularly big problem.
Patents last for about 25 years, but important innovations have returns far into the future, hundreds of years. At that rate, you would very often be better off accumulating interest on capital anyways.
Notwithstanding the nature of scientific progress as an accumulation of smaller experiences (each individually harder to justify with a profit motive).
Indeed, even privately funded research is often openly published, such as the now-famous paper "attention is all you need". There's just not that much to gain from keeping every single thing under wraps. More to gain with openness.
It's also not practical to keep those facts as trade secrets over the several decades over which their applications need to develop. Even if an industry consortium was willing to discover that clouds are made of water droplets, it would certainly leak before the science of meteorology had progressed far enough for that consortium to offer saleable rain forecasts.
Finally, companies are unwilling to train people about basic facts. Academia is the only system where "and then you tell everybody" is a part of the incentive structure. Privately, you have a strong incentive to reveal nothing and punish leakers.
More realistically, what would happen would be that rather than sacrificing themselves for the greater good in some kind of voluntarily socialist outpouring of wealth, they'd ask us to look to China for our scientific future.
An example is the superconducting supercollider. Chemistry and pharma industry were making NMRs cheaper and the cost of the supercollider components went down. So the LHC was a much more effective "buy" than the SSC.
To imply that private companies reap the rewards of basic research without contribute much is ignoring the many other components of translational work.
Second, biotech/pharma actually already do invest quite a lot in R&D. But they tend to focus on translational work rather than speculative exploration, because it is less risky.
1. By way of self-inflicted damage
> More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%), wages for physicians (~10%) and registered nurses (~5%), and medical machinery and equipment (less than 5%). Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending.
https://www.commonwealthfund.org/publications/issue-briefs/2...
That was a lie to justify insurance price gouging.
Funding the research privately increases costs to end user as private ensurer is directly accruing more cost. Research stopping increases costs to end user as new/novel cures/treatments aren't found.
Cost for consumer goes up because of lost opportunity cost of 1) learning to diagnose earlier 2) finding new or cheaper cures/treatments.
You can make the argument 'But other countries will pick up the slack!' - but that doesn't necessarily help either, why would they give us the results of their research cheaper? US already jacked up pricing via an executive order on drug pricing just this year to knock that.
Publicly funded medical research is an absolute positive for the US general public health and wallets. We're all losing here on both ends of the spectrum ($$ and actual general public health).
Edit: as a follow up (because I feel like I strawmanned you), I am just trying to say that p-hacking is not always malice or incompetence. Sometimes limited methods/theory miss confounding variables, sometimes labs lack resources, etc.
... but it won't be.
Talking about rebuilding after just shifts this problem instead of solving it. When you start to spin things back up, who's at the front of the line looking for new grant money?
Most research is still following a medical model that worked for infectious diseases in the 1950s but does not yield any meaningful information or treatments for chronic, complex disorders that have multiple interrelated factors.
And since doctors are trained primarily in the treatment of acute diseases, even the useful information that’s found by research is largely ignored in practice. The ignorance of the average MD about chronic illnesses is astounding.
I’ve been sick for the last two years and I’ve given up going to doctors. They are a waste of my time. I’ve done much better by doing my own research and treating myself. Much of what’s helped has been stuff that I’ve seen described as pseudoscience, even though it’s empirically based, because there aren’t enough RCTs for it to qualify as “evidence”. This makes me incredibly angry.
The system is utterly broken. I’d like to scrap the whole thing and start over. Hopefully, we’ll find a way to start over when the smoke clears.
Once again we are proving the US is just "I got mine, the rest of you can suffer" Country.
Examples are research on ALS, Childhood Diabetes and Cancer and many more issues too numerous to list. Already funding has been cut for ALS and Cancer research.
Welcome to depending upon China and Japan for ground breaking treatments. From what I have read Japan has been doing a lot and I think China is ramping up quickly.
The fact that the headline from the NYT is "The Disappearing Funding for Chronic Diseases" not "The Disappearing Funding for Health Research that Critics say has Dubious Value" is dishonesty.
The headline, at least, is one big question beg. The issue is whether these particular research avenues, which overlap heavily with left wing politicking, should be funded by taxpayers, not whether chronic disease in general should be researched. As usual though the NYT hopes you're too stupid to notice what they're doing.
https://taggs.hhs.gov/Content/Data/HHS_Grants_Terminated.pdf
Just look at that MAHA report. Exactly the sort of thing you would expect when you ask an AI to support something false. A human generally recognizes when a search throws up a totally false hit. And, in general, the right hits show up in the results before the wonky stuff--but when you're searching for something that doesn't exist, or doesn't exist in a web-readable form all you get is the wonky stuff. But the AIs don't have the ability to recognize they're in the garbage and distill it out so you no longer see it's pedigree. But it's still garbage.
Just to reiterate a few things, while estimates vary, every $1 spent on medical research returns multiple dollars of economic value. One study out of England suggest that for ever pound invested in medical research, the return is .25 pounds every year after, forever. [1] The cost of these cuts, as others have said, is quite large.
In addition, these grants are peer reviewed by expert panels, and only grants that score within certain top N percentiles which are determined each year. For the marquee grants, you have to score in the top ~10th percentile (see [2], for example.) This scoring is done by expert panels, which are composed of leading experts / professors from around the country. While one can adjust funding priorities, part of the price to pay for having cutting edge basic research always available is that there will be certain things one disagrees with.
There is plenty of room for a discussion of how to increase the efficiency of scientific funding, and if the current science-funding institutions are at... 'a near-optimal position in tradeoff space.' However, taking a chainsaw to the agencies to punish them is like blaming doctors for outbreaks of diseases, the latter being sadly predictable.
[1] https://www.kcl.ac.uk/news/health-research-offers-a-big-retu...
[2] https://www.niaid.nih.gov/grants-contracts/niaid-paylines
That or they would rather simply ignore biology in service of this or that politically-motivated special interest, and put off any problems for the next generation to deal with.
The current research system has serious problems, but we need accurate criticism to build a better future. "YC is all wasteful spending; why doesn't YC just choose to only fund the hits?" is absurd, but somehow we allow this argument when discussing NSF/NIH/DOE/DARPA.
It’s not a business. Its job is clearly outlined in the preamble of the constitution.
lentoutcry•1d ago
bediger4000•1d ago
lentoutcry•1d ago
sorokod•1d ago
Very likely those opinions will be shaped by social media and LLMs steering in turn public health policies, plugging into politics and back to start.
A neat vertically integrated system.
mystraline•1d ago
That's very double-edged.
The open question is should humans have the right to take substances individually?
Sure, you get Ivermectin/covid deniers. But you also get homemade Solvaldi (cure for Hepatitis C). I can make it for $300 for the 12 week course, and it retail costs $84000
Of course, even making and taking this drug you manufacture is illegal, even aside patent bullshit.
https://news.ycombinator.com/item?id=42538903
But why shouldn't I be able to treat myself? Why do we accept really shitty gatekeepers (medical establishment, doctors) gatekeep treatments and cures from us?
And more currently, now that der fuhrer quit the emergency use allocation for Covid shots, now you need a doctors scrip for 'allowing to get a vaccine'. I should be able to get this if I pay for it. But nope, now need to pay for needless doctor payment and more barriers.
So at least in that side, I'm on Qanon's view that I should be able to personally treat myself with whatever substance I deem. Of course, I'll definitely heed a doctor's suggestion as an expert. But fuck.. My body, my choice.
sorokod•1d ago
Consider this analogy: you should be allowed to put a gun to your own head and pull the trigger. You should not be allowed to put on a suicide vest and blow yourself up in a group of people.
mystraline•1d ago
We have a 'right' drink a handle of whiskey a day, up to the point we get liver disease. Same with smoking 3 packs a day of cigarettes. Same with horrendous diet. But those ways of killing yourself are "acceptable" and also legal. But they're slower.
The second, you're harming other people. That example is blatantly ridiculous, and appears just to gain an emotional response by invoking terrorism.
sorokod•1d ago
bigbadfeline•1d ago
Have you watched a movie lately? Talk about contagious violence. I can tell you this, your fate is just a blip on the back side of other people's large screen TV where the movies are shown.
Spivak•1d ago
It ends so many stupid discussions we have in the US. Can this medication be prescribed for an off-label use? Who cares because you can just buy it. Do you meet some arbitrary federal weight guideline for Ozempic? Who cares you can just buy it.
* every rule has exceptions, don't get bogged down with them.
bediger4000•1d ago
mystraline•1d ago
In that situation (the only one at this time), is the majority of resistances are made.
Controlling the supply, especially if you know you have a bacterial disease, can be solved readily.
In fact, on a camping trip, I was bit by 15 ticks. Was bad. When I got back to civilization, I started getting spots all over my body. Surprise, it was rocky mountain spotted fever. But if I could determine the 2 drugs for curing spotted fever and Lyme, I absolutely would have did both. But the shitty gatekeeper (doctor) wouldn't do Lyme course. Again, logically made a lot of sense, especially that Lyme tests are 60% accurate. And, 15 ticks.
bediger4000•1d ago
Spivak•1d ago
bediger4000•1d ago
Spivak•16h ago
Hard to create a strain of antibiotic resistant bacteria when you didn't have any in your system to begin with. Turns out you can't #gatekeep #girlboss your way out of this and have to educate your way out regardless if antibiotics are behind-the-counter non-prescription or not.
MandieD•1d ago
Antibiotic Resistance.
Longer explanation: how do you know exactly which bacteria you’re infected with, and which antibiotics will work well against them, and which ones they’ll throw a middle finger at? Even if you have the exact same symptoms as the last time, how do you know that taking the same antibiotic will work just as well, and won’t just further select for bacteria it has no effect on?
LorenPechtel•1d ago
I believe all recreational drugs should either be legal or else available by prescription with the explicit statement in the law that addiction management is a valid reason for a prescription. None of the controlled substances hoops. And I think *renewing* maintenance meds should be within the realm of the pharmacist.
But I think all agents for which resistance is a factor should be doctor only.
Spivak•1d ago
This is great and all but it ignores that getting an antibiotic prescription is not difficult at all. I literally just get in a video call, describe the symptoms of strep, and they write me a prescription. It's less expensive to treat than to test. In 15 years I've never had a doctor actually test me for what bacteria I actually have. They sometimes do the bare minimum of looking at it to be pretty confident it's bacterial but that's about it.
However stupid you think the general populace is, doctors count themselves among their numbers. Your average urgent care or primary care doc is just going to give the same broad spectrum antibiotics without any real thought. Except for the one bona-fide MD who looked at my very obvious case of strep, knowing from my chart that I have chronic bacterial sinusitis, and me telling them as much, looking at my puss filled tonsils and concluding that it's allergies and that I should take Claritin. Never go to urgent care man.
add-sub-mul-div•1d ago
bediger4000•1d ago
mystraline•1d ago
Like, covid shots. Now you need to beg a doctor to get them. Hope you pass their gatekeeping test.
Or now women are being arrested and charged with murder for miscarriages and missing periods.
And there's another round of "get rid of ACA, which includes banning non-coverage of preexisting conditions. Treating yourself is a strong protection of not being covered.
RFK is going through medical records across the country for anybody with autism, ADD, and ADHD. What and how are these lists being used for? (I know how the German nazies used them...)
My body, my choice.
Vilian•1d ago
A problem that only exist in USA, you could follow literally any other country and you wouldn't get the same problem, and no other country avoided that issue but letting dumb people take dumb things that they heard in the internet
os2warpman•1d ago
This is not true.
In the United States GENERALLY SPEAKING you can manufacture any substance that is not on the list of controlled substances on the CSA Schedule.
You cannot sell it or administer it to others.
Also IN GENERAL you can consume any substance that is not illegal to possess or manufacture.
In the non-pharmaceutical realm there are a few additional restrictions, like ethanol (which you can manufacture for industrial use but not human consumption) and various nuclear, biological, and chemical munition components. (Don't know how many people are ingesting those)
If you have the ability, you can manufacture your own sofosbuvir and ingest it.
You cannot sell or give it to anyone else.
msgodel•1d ago
nerdponx•1d ago
The Project 2025 document makes a lot of accusations about this or that department being politicized and left-aligned. But that's not exactly a good standard to go by.
mrguyorama•1d ago
It also became political when we were trying to introduce evolution, a well understood and supported scientific discovery, into science curriculums, and that made religious people extremely angry
It also became political in like 2000 when Bush jr. banned stem cell research because it made religious people mad.
It also became political in like 1980 when Exxon understood unequivocally that they were directly causing the destruction of the Earth's climate and that they could probably just spend money on PR campaigns to make it a culture war issue so they wouldn't have to fix it.
It also became political when geology proved the earth was more than 6000 years old.
It also became political when Eugenics. This also made religious people angry when scientific racism was demonstrably wrong.
It also became political when scientists knew there was a clear connection between cigarettes and lung cancer but it took like thirty years to produce the kind of scientific studies that were required to convince the general public because of immense counter-narrative campaigns by cigarette companies that insisted that cigarettes were healthy.
They also became political when the Christian Scientists parlayed their insane cult beliefs into laws to allow them to send their unvaccinated kids to school at everyone else's expense.
It also became political in the 90s when the sugar industry funded an immense anti-narrative campaign to trick the majority of the US into believing that fat was more harmful than other forms of the same amount of calories.
It is currently political to understand even basic highschool biology like "mRNA won't change your DNA"
It was political when a Utah politician and two chemists tried to turn the result of a single extremely poorly run fusion experiment that no physicist was able to replicate and had clear methodological problems (and math problems) that any physicist would have wanted to fix into federal funding to the tune of $25 million after claiming in the Press Release that the intial experiment was funded with $100k of their own money and they wanted maybe a couple million to scale up and confirm their results.
It was political when Nazis burned an institute setup to research gender and sexuality.
Knowledge has always been political to people who confuse their ignorant beliefs for reality, and rely on public ignorance for their support. You should notice that these events were not politicized by scientists.
biophysboy•1d ago
The problem is that the current admin's actions/proposals go far, far beyond this issue.
LorenPechtel•1d ago
msgodel•21h ago
I don't think you'll be able to manage the combination of self reflection and empathy required to understand this. Most people on your side are behaving in a similar way. It's why this stuff is going away and very unlikely to come back.
LorenPechtel•9h ago