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Culture War Roundup for the week of November 11, 2024

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the entire concept of rewarding companies for treating disease is getting dunked on

But Tabarrok didn't say "we should reward companies for treating disease". What he actually said (if you scroll up a few posts) was:

Pharma stocks nosediving means your life expectancy is nose diving.

This is not good.

When I read this in the political context of the ongoing vaccine debates, the implied connotation I get is something like: "Listen here, you ignorant yokels. You might like to think that you're 'self-sufficient', but you're not. You depend on me, my tribe, the educated elites. Without us, you'd be dead. Specifically, you are dependent on the stock valuations of big megacorps continuing to rise. You know; stocks, the global finance market, i.e. that same thing that is the engine of mass immigration, the offshoring of industrial labor, the woke-industrial complex, and so many other things that you find politically abhorrent."

Obviously, he didn't write those exact words. But that's how it comes off. And that's a poor way to endear people to your cause, regardless of the actual merit of your claims. So the backlash he got on twitter makes perfect sense to me.

Listen here, you ignorant yokels. You might like to think that you're 'self-sufficient', but you're not. You depend on me, my tribe, the educated elites. Without us, you'd be dead. Specifically, you are dependent on the stock valuations of big megacorps continuing to rise. You know; stocks, the global finance market,

I mean, yeah. That is the implied connotation, because it's true. It's true the same way that you or I would tell the guys who set up the Capitol Hill Autonomous Zone that their project is doomed without the support of public infrastructure. That's just not how the world works. If they can't tell the difference between investment in medical innovation being driven by the expectation of future profitable sales, and the nebulous forces driving the educated consensus on immigration, then they are just stupid.

That is the implied connotation, because it’s true.

Well, not in an entirely unqualified sense, obviously. We know that people can live without vaccines, because they did so for thousands of years. Life expectancy may have been lower, sure, but modern medicine is not a necessary precondition for human civilization to exist.

Vaccines are not even the sine qua non of modern medicine- no doubt they’re much cheaper than things like modern sewage systems and mass availability of antibiotics, but life expectancy started skyrocketing with improvements in sanitation and treatments for infection with vaccines more an acceleration of trend than a cause of it.

Smallpox vaccine was great because it put a stop to outbreaks of mass death. Measles and diphtheria vaccines were great because it ended a whole lot of infant and child mortality. Mumps vaccine is pretty good because it nearly wiped out a less deadly but still nasty childhood illness, similar with pertussis. Rubella also, and rubella is really bad for fetal development. Tetanus immunization is probably less important in the first world, but it is a bulwark against less-than-perfect sanitation.

Chicken pox vaccine is a step down from mumps vaccine; chicken pox is rarely fatal, though it is common and nasty. But when you're immunizing children against hepatitis B in the first world, then unless that vaccine is perfectly safe, you're probably past the point of diminishing returns.

Why is Tetanus less relevant in the first world? Are we less likely to get dirty cuts?

Most people in the first world don't roll infants around in the dirt, certainly. Also, there's something called neonatal tetanus which is probably caused by contamination of the blade used to cut the umbilical cord -- but not only is that something that should be very rare in the first world, the vaccine has to be given to the mother, not the infant.

I refused hep b for my kids. It’s clearly a scam and exhibit 1 in terms of the fda hhs and pharma collusion. It was an expensive to develop vaccine for gay men and it drug users. They couldn’t get enough customers to cover the cost of the drug so they got it on the newborn schedule. They give it to a baby in the first 24 hours.

Even if it were a miracle vaccine, it is absurd to give it to a baby in the first 24 hours of life. It’s obvious that the reason they do this is because it’s a garunteed touch point for doctors to administer it. Prioritizing vaccine sales over all other considerations.

And this is what is frustrating about modern vaccine discussions. Take for example the covid vaxx. It basically was useless unless you were old. But modern vaccines use the goodwill earned from the old vaccines to short circuit discussions on whether the new vaccines are worthwhile.

“The people who disagree with me are stupid” is massively uncharitable, and well below what I expect of this place. That’s a stereotype of boo outgroup, and you’re saying it to the very word.

There’s a lot about what you’re saying that’s right! But you don’t seem to have understanding of the reasons people are critical of big pharma, and instead are just calling them dumb. It’s exactly the fact that people who criticize these things are immediately called every insulting name in the book that makes them become distrustful, resentful, and vengeful.

Are you trying to move past shady thinking here, or are you more interested in dunking on your outgroup? It would be much more productive to try and engage with what @Primaprimaprima said and develop a greater understanding of where your opponents are coming from — that will make you much better at being able to be both compassionate and convincing.

I suppose I could have called them, "unable or unwilling to understand the production function of medical goods, the capital structure of pharmaceutical corporations, the inherent unfairness of mass tort litigation, the difficulty for an individual consumer to determine the expected utility to himself of a given medical product, p-hacking, and the extent of the natural human disease burden," but that would be just padding the word count.

Doesn't all of this get side-stepped if we're talking about a system where that isn't the case at all? Surely the Soviets developed some genuine medical tech all on their own state dime.

No, that’s not just padding out the word count: the two things you’ve said are not equivalent.

In particular, now you’re actually discussing the values, beliefs, and arguments behind your position, which is a dramatic difference from “all my opponents are dummy dumbs”.

And actually stating plainly your values means that people who are actually smart can now productively disagree with you: maybe someone can go “actually the production function of medical goods doesn’t work like that,” or “maybe tort litigation isn’t actually all that unfair,” or “it’s actually not that difficult for the average consumer to make an informed decision about the expected utility of a medical intervention” — and then what you’ve got is an actual discussion that can illuminate both sides!

And even if you’re right about 100% of your claims, the way you stated it before didn’t make you sound right: it made you sound like a bully relying on thought-terminating cliches. Someone whose arguments are well thought out and informed by evidence doesn’t need to act like that. Providing evidence, discussing trade offs, and engaging in constructive debate is what smart and credible people do. Calling people stupid is just, well, stupid.