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PaperclipPerfector  13d ago (text post)   33068 thread views

Culture War Roundup for the week of March 31, 2025

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So, I can often be found posting on here complaining about bias in medicine (although I disagree about some of the kinds of bias with quite a few posters here).

We do have something of an update to a long running story that’s worth sharing.

Meddit link for more discussion and detail: https://old.reddit.com/r/medicine/comments/1jotpzz/follow_up_on_the_study_showing_discrepancies_in/

Basically, awhile back there was a headline about how black babies received worse outcomes when care for by white doctors. Apparently, this went so far as to get cited in the supreme court.

Sometime later someone on Meddit (which is still quite pro-woke) noticed that they forgot to control for birth weight, which would likely completely kill the effect size (explanation: white physicians have more training and take care of sicker babies who have worse outcomes). At the time there was a significant amount of speculation essentially going “how do you miss this? That would be the first you would control for.”

Well, it turns out that someone filed a FOIA request and well, to quote Reddit:

“A reporter filed a FOIA request for correspondence between authors and reviewers of the article and found that the study did see a survival benefit with racial concordance between physician and patient, however it was only with white infants and physicians. They removed lines in the paper *stating that it does not fit the narrative that they sought to publish with the study.” *

While I often criticize medicine for being political, I’m often found here telling people to trust the experts when it comes to (certain aspects) of COVID or whatever, and well this kinda stuff makes it very very hard.

The initial findings were passed around very uncritically and sent up all the way to the supreme court.

How can people trust with this level of malfeasance? How do we get the trust back? How do we stop people from doing this kind of thing? I just don’t know.

“A reporter filed a FOIA request for correspondence between authors and reviewers of the article and found that the study did see a survival benefit with racial concordance between physician and patient, however it was only with white infants and physicians. They removed lines in the paper *stating that it does not fit the narrative that they sought to publish with the study.”

How does this fit together with this:

(explanation: white physicians have more training and take care of sicker babies who have worse outcomes)

If white physicians get sicker white babies as well, they should do better on average with black physicians as well, no? Or did they account for birth weight?

Black physicians deal with healthier babies including healthier black babies. The sick black babies go to white physicians. Therefore black physicians have better outcomes for black babies than white physicians do.

They focused specifically on what happened to black babies for the paper.

I understand that point, I don't understand why white babies are doing better with white doctors: "the study did see a survival benefit with racial concordance between physician and patient, however it was only with white infants and physicians".

How can people trust with this level of malfeasance? How do we get the trust back?

From personal experience: you just wait a little. The medical establishment has the gigantic advantage of actually performing miracles every day. Doing that reliably certainly helps in (re-)building trust.

I used to be very skeptical, almost averse to what doctors and the medical establishment were doing.

But then they just healed a very annoying genetic condition I have, restored 100% of physical ability after life wrecked my body, I watched them save my child by emergency C-section, and a family member was diagnosed with advanced cancer. The last two were scary, of course. Seeing the medical machine throw its full weight towards you with urgency puts some real fear into you.

But it worked. Healthy son, cancer in remission with remarkably little side effects. So I had to admit: "OK, many of you actually know exactly what you're doing." And of course, they're pretty nonchalant about it. "Chances were decent to begin with, actually so much better than 10 years ago..."

Sure, the field is a mess and some skepticism is more than justified. But I mostly trust doctors again.

I love this comment, well said! Medicine does do a lot of amazing work.

My mother was saved of a stroke a few years back that would've killed her for sure just a decade earlier. It truly is amazing.

I think the flip side of this is important to hold onto when it comes to why so many people hate medicine.

For most people, the most important things that happen in their lives (aka life and death and the prevention of the latter) involve interaction with medicine.

When it goes poorly, that sticks and it hurts. If your mother passed away as a complication from a clot treatment (assuming ischemic stroke) you'd hate that intervention, and maybe even your doctor and healthcare. Maybe you have the wherewithal to know that's an emotional response - but it would still hurt and feel that way.

One invalidating interaction, one missed diagnosis or bad outcome...and suddenly the emotional connection to the idea that the system is useless and needs to be burned down is established. It's really hard to avoid and generates a lot of the ill feeling.

The opposite happens too! But you only have to get it wrong once and that's not avoidable.

why so many people hate medicine.

For me, my defining moment when dealing with medical professionals was when I began having irregular heart rhythms, along with a boatload of other symptoms. Unfortunately, one of those symptoms was weight gain. Once that happens, doctors will not, in any way, listen to a single thing that you tell them.

Every time I would go to the doctor, they would tell me to exercise and lay off the junk food. The fact that I had completely cut out junk food and upped my gym routine to 90 minutes a day/5x a week sailed in one ear and straight out the other.

Eventually I collapsed at the gym and showed up at the ER with a 240 bpm heart rate. It turns out I'd had an autoimmune disorder for several years that had wrought absolute havoc on my body's symptoms. A doctor ran a simple, inexpensive blood test and had me diagnosed and medicated in a few days. All my problems went away and I lost 65 pounds in six months.

Every single one of those events could have been prevented if any doctor in a three year period had actually listened to me instead of telling me to go fuck myself.

I don't know how to fix it either and I have been losing sleep about it for a while, but I am glad to know you can see it now too. In the broadest scope @faceh nails it with consequences, but enacting consequences is going to be a real challenge. It does seem like we're going to need a significant numbers of lives lost in an actual disaster to occur before we can snap enough people out of the fog of complacency, because until lives are lost the buck is too easy to pass, it's too easy to downplay and dismiss it as 'misinformation'.

Wouldn't surprise me if lives were already lost from black parents losing trust in white doctors or similar effects, just not in a legible way.

I think the best 'consequences' are those that follow naturally/intrinsically from failure to be honest. Lying must have a cost, one that cannot be avoided if you lie/defect consistently.

If you're flying a passenger plane, you probably shouldn't have an ejection seat or parachute if your passengers don't have such an escape option. That way you will be extra sensitive to possible danger. The norm that The Captain is the last to leave a sinking ship operates similarly. And you can also surmise that the more responsibility inherent to your position, the more severe the consequences should be for misuse or screwup.

Sometimes you can't make the consequences that immediate but you can still align incentives. Did you (or a company you run) design an airplane? You should be forced to take flights on that particular model of plane regularly for a couple years to showcase your confidence. Boeing should probably take this idea.

For politicians, I'd suggest that they must be forced to endure the direct consequences of rules they impose. If you are supporting criminal justice reform, you should probably be required to live at least part-time in the most crime-ridden districts in your jurisdiction. If you want to drastically increase police authority or make penalties for crimes harsher, you should be subject to 'random' investigations where you will be arrested and tried for ANY crimes discovered. "If you've done nothing wrong you have nothing to hide," right?

The penalty for publishing bad science or bad statistics, especially if you intentionally hide the stuff that would destroy your conclusions... well that's tricky. We discussed this a while back and I admitted to not having a solution. Prediction markets are a decent mechanism, require scientists to put their money at risk on a market betting on whether their results will replicate or not.

Many institutions seem to have failed or been corrupted by introducing 'false' consequences, where a member who is caught screwing up is 'publicly' reprimanded but privately, they're not punished, or maybe they're even rewarded, and rather than removed from power, they get shuffled off somewhere else in the system and hope that nobody notices.

Partially this is due to a 'circling the wagon' effect, if someone is part of your ingroup you don't want to let the outgroup hurt them so that you, too, can be protected if they come for you. Even a 'good' person would want to insulate their fellows from consequences since they are insulated in return.

But I suspect a lot of it comes from malicious actors FIRST convincing members of a group to remove the factor that actually punishes malfeasance, and then grabbing up as much power as they can for their own purposes... and other bad actors see that there's power to be grabbed and minimal consequences, so it becomes attractive to bad actors.

So the REALLY important factor is that the consequences actually have to filter out bad actors or incompetents from the system entirely, which allows the system to improve via iteration. You can't have consequences that ONLY inflict pecuniary loss, for example, if the person can afford to pay the 'fines' and yet continue to maintain their position of influence and authority.

Did you (or a company you run) design an airplane? You should be forced to take flights on that particular model of plane regularly for a couple years to showcase your confidence. Boeing should probably take this idea.

Modestly related: Boeing Everett, their biggest factory, is attached to a WPA era airfield. Over the last decade or so there was a big push to add a passenger terminal and start up scheduled flights. But it's still a small regional airport with very little passenger volume, so all the planes are little regional jets, a type of plane Boeing hasn't made in decades. So all the traffic in and out of Boeing's airport are Brazilian single aisle jets: https://www.flightstats.com/v2/flight-tracker/departures/PAE

Did you (or a company you run) design an airplane? You should be forced to take flights on that particular model of plane regularly for a couple years to showcase your confidence.

This assumes that you have control over the dangerous parts of producing the airplane. If you run the company, perhaps you do in some sense. If you're an engineer or software developer, you do what the company tells you to do, and you can't resign from the company after every poor decision outside your control that goes into the airplane, so this is just a way to doubly screw employees over by management.

Management, up to and including C-Suite, should really be the ones on the hook as they're the ones with authority and responsibility.

I vaguely remember hearing something about architects in ancient Rome (?) being obliged to live in houses directly under the bridges they'd designed.

Probably made up and didn't actually happen, but its the exact kind of idea that would align incentives.

A friend works on high-danger vehicles (let's say helicopters) as a software engineer. The first thing that happens when they push a software update is that as many engineers as possible get rounded up to take a flight on the helicopter.

Similarly Kawasaki Heavy Industries used to show off their confidence in the precision and reliability of their industrial robots by having the CEO and various others sit on a sofa while their biggest robot moved it around, although that's obviously more staged.

My favorite example of this is the weird enthusiasm with which Richard Davis loves to shoot himself to promote body armor.

I wondered for a second why he has to pull the trigger himself and not a trusted, very steady-handed compatriot.

But it actually occurs to me he probably didn't want anyone to risk ending up with a death on their conscience, or worse a manslaughter charge, if something goes wrong.

It has to be quite exhilarating. All your instincts telling you you're done for, only to escape death without a scratch. I could see myself getting addicted to it.

but I am glad to know you can see it now too

Nah this problem is why I first started posting way back in the days where some of our most reasonable contributors didn't see that the news and "science" was biased. I think pretty much everyone still here gets that at this point, so I've spent more time arguing about overreaction lately, but my views haven't changed.

This is a particularly good example for everyone to toss into their brain for later though.

How can people trust with this level of malfeasance? How do we get the trust back? How do we stop people from doing this kind of thing? I just don’t know.

I see you’re starting to understand how me and mine felt during/after the scamdemic overreaction.

Fucked if I know how you get the trust back. It’s gone. We’re just going to have to, as a society, deal with a permanently lower vaccination rate. I don’t have a solution, except to say that defenestrating the people pushing the medical… narratives, not just the Covid one but lots of other blatantly political stuff, would start a slow process of rebuilding trust. Not regaining, rebuilding. The uncritical trust in doctors is dead, and the medical establishment killed it.

I’ve been harping a lot recently on the need to build new, functional, things to replace the old ones going haywire in entirely predictable ways. I don’t really have a ‘solution’ solution in the case of the medical establishment but I’m pretty sure the medical price transparency crowd will be the ones best positioned to come up with one.

I don’t really have a ‘solution’ solution in the case of the medical establishment but I’m pretty sure the medical price transparency crowd will be the ones best positioned to come up with one.

Nope. This is a culture sort of thing that pretty much cannot be fixed by any sort of discrete and minimal use of political power which can plausibly be granted to humans. A major reason for this is the speech/opinion vs. conduct divide.

Fundamentally, medical price transparency can be viewed as a discrete regulation on conduct. Thou shalt simply give thy patient a couple numbers that thou unquestionably has (even if thou wants to play dumb/lie and pretend that thou art incapable of even identifying the names of the numbers in question). We can easily check if you're giving your patients the numbers or not. It can be mostly checked by people who know almost nothing about medicine, using a simple bureaucratic process, which has proven itself capable in many other domains.

We don't have to care whatsoever about your opinion-based speech. In fact, if you want to be really bold, you can even persist in telling your patient that you don't have the numbers in question, so long as you still actually hand those numbers over. (I have to imagine that, in practice, even doctors would manage to conjure up some feeling of shame in going that far in telling such obvious, in your face, observable lies.) No penalty whatsoever for even the most boldly false speech, so long as you just do the simple thing of handing them a piece of paper with a couple numbers on it.

Whereas the production/dissemination of knowledge is inherently riddled with opinion/speech, through and through. In my nonpolitical field, it is my personal opinion that there are tons of papers that are just garbage... some of which I believe are simply wrong or not true. But that's just, like, my opinion, maaaaaan. I'm sure that popularizers of science outputs ("science journalists") have varying opinions on what makes for good popular science... and of course, I have my own opinions on which such institutional outlets I think have reasonable such opinions vs. those which I think have gone off the rails. But again, those are just my opinions. I may be wrong! I may be wrong within my own field! It is entirely possible (though I think unlikely, at least in the extremely narrow domains in which I hold the strongest opinions) that future developments will demonstrate that some of my opinions are, indeed, flatly wrong! I know that I have been wrong in the past (thankfully, most of the examples I can think of were very long ago while I was still a learning student, including one where a mistake was found in the review process that I was thankfully able to fix before publication). I've pointed out to colleagues where they've been wrong in some of their prior publications (and thankfully managed to convince them and maintain incredibly good working relations with them).

How could we possibly impose some external, bureaucratically-enforceable rules on that world? Yes yes, we might be able to slice off one tiny little fraction where we have indisputable proof that someone engaged in willful, knowing fraud. But I think the standard of proof needs to be pretty darn high in order to avoid catching a bunch of people who are just "innocently" wrong.

All of that is, unless, of course, you somehow want a Ministry of Truth to determine when anyone is merely wrong. But I have a feeling that such a Ministry would make haste to torch its own credibility even more rapidly than many folks are currently doing so.

[Culled a bunch of rambling about the side-hobby of trying to come up with various ideas that could help and all the problems with them. Maybe I'll post on that another time, but it's probably just distracting here.]

If you probably don't want a Ministry of Truth and basically none of the ideas for little tweaks can really cut through the inherent subjectivity in the process, it's probably simply subject to culture and commons-problems. We probably don't have much of a solution besides just watching which cultures are more prone to commons-burning. Given that the medical industry is willing to torch its credibility on simple, objective shit like numbers on pieces of paper, I'm pretty doubtful that its culture has the soul/spirit to carefully tend to its knowledge-production garden. There really is something to the virtue ethics point of view that lies and being accustomed to lying really does damage the heart/vigor to pursue the truth elsewhere in the face of likely personal consequences.

How can people trust with this level of malfeasance? How do we get the trust back?

In Star Trek: The Next Generation, a powerful immortal trickster being ("Q") who has tangled with the Enterprise many times appears on the bridge of the Enterprise. He tells a story of having his powers stripped for his sins and begs the crew's help. The crew are, understandably, skeptical. He plaintively claims to be mortal and asks what he can do to convince the crew that he is indeed mortal. The Enterprise's Klingon security officer has the answer:

Die.

Wouldn't a powerful immortal trickster be able to successfully trick some muggles into believing he was dead (e.g. and then engage them again as a different person)?

Yeah, that's why everyone was reluctant to trust him.

Die

Very funny Worf, eat any good books lately?

If you check the raw emails you can also see someone warned them about controlling for birth weight but they ignored the warning.

https://cdn01.dailycaller.com/wp-content/uploads/2025/03/U-MN-FOIA-concordance.pdf

I was talking with a health economist about it & he asked 2 questions.

...

[2] When discussing possible mechanisms, he asked whether there is an effect on birth weight (and I would add gestational age). I said that this is conditional on the hospital stay when giving birth, so there's not much scope for affecting these at that point. He suspected that the patient-physician relationships might pre-date birth and we might see a legitimate good effect on it. Alternatively, seeing nothing could be interpreted as evidence against selection, a placebo. These competing interpretations make it a bit dicey.

[2] We do have controls for low weight and early term in the estimations. Do you want me to split based on these?

[2] No. The idea would be to use them as outcomes, rather than controls. But I'm not sure we want to go down that road. It could be a mechanism but it requires that the baby's doctor (not the mom's) exert some influence during the pregnancy. Given that we think the mother's doctor is more important prenatally than the baby's, it would be more informative if we could see the effect of mother's doctor race on child birth weight and gestation. But this is not possible, I think.

Yeah the Meddit thread goes into some of this and that's a very sympathetic audience going.....oh my.

How do we get the trust back?

You don't? I'm pretty sure the correct answer is "make like the police and get defunded." Or get subject to a constant background level of social opprobrium for the rest of your life. Same difference.

Everybody knew what they were getting into when they kicked this off. They just thought it was worth the risk.

They just thought it was worth the risk.

No, most people were fooled just as much as anyone else was. Everyone in medicine is in the academia basically, and most of the academy are true believers.

No, most people were fooled just as much as anyone else was.

They were warned. Repeatedly. Not quietly. Not by conservatives.

I really don't think that is true. People in medicine are there because they are willing to suffer to help people. They are getting it wrong because of propaganda efforts by the university administrations and journalist classes.

They are just as fooled as everyone else, even the bad actors in this case think they are helping and doing the right thing because "these things are true, if the data doesn't match we must have done something wrong!" after years of being brainwashed.

They are just as fooled as everyone else, even the bad actors in this case think they are helping and doing the right thing because "these things are true, if the data doesn't match we must have done something wrong!" after years of being brainwashed.

So I don't know if this is the point that Listening is getting at, my take on this is that anyone in academia - which medicine counts as close enough and people who do medical research certainly fit - who is brainwashed is entirely responsible for their being brainwashed. One of the core themes of academia is to be skeptical, especially of oneself. This requires checking things against objective reality and listening to people who disagree with oneself, especially when it comes to narratives that sound convincing. If they bought into the propaganda efforts by the university administrations and journalist classes, then they ignored these basic, fundamental "warnings" that are core to any form of higher education.

On a practical level I think that sort of thinking is gone from almost all modern education - we don't really focus on critical thinking any more and much of the university experience in America is essentially just a fancy trade school.

In medicine in particular you have to get phenomenally good at box checking and thinking too much is going to get you in serious trouble and unable to advance. This is magnified by downstream pressures - people who are republican or unable to hide being republican don't get admitted to medical school, people who aren't willing to engage in games about social signaling don't end up at good programs for residency, teachers who don't engage with wokeness either get fired or pushed into non-teaching roles and so on.

Outside of medicine most disciplines in school don't really select for or allow much in terms flexibility on this front.

Some people do still have those chops but you have to be very good at turning them off and not saying shit to succeed.

Basically blame the framework for brain washing people, not the people who got brainwashed.

If your job requires you to not notice - at every level, for years, with tremendous pressure to do so....it's hard to keep noticing.

And while the impacts of not noticing from medicine are higher, I'm not sure we should be held to a higher standard than anyone else - all the other disciplines are having this problem and medical professionals are already held to a higher standard in so many different ways that put much of the community on the knife's edge of burnout, suicide, substance abuse, and exit. Don't add more.

On a practical level I think that sort of thinking is gone from almost all modern education

This seems more like an argument for the dissolution of the monasteries than a defense.

And while the impacts of not noticing from medicine are higher, I'm not sure we should be held to a higher standard than anyone else

Of course not—the sea pouring in certainly won't be confined to just medicine.

Basically blame the framework for brain washing people, not the people who got brainwashed.

I blame both. The framework didn't fall from the Heavens on a tablet that we must follow lest we be barred from Paradise forever, it was formed by individuals making individual decisions. The framework of brainwashing is maintained in a large part by people who were - and continue to be - brainwashed in the past, and it is only maintained because people are willing to be brainwashed. Refusing to blame the brainwashed because of the framework just reinforces the framework.

Perhaps critical thinking in higher education is truly almost all gone - I'm skeptical that "almost all gone" is an accurate description, but it's not an absurd proposition - but it's not all all gone, and it's also something individuals can develop on their own. Anyone who's intelligent enough to become a doctor - or any other sort of high level professional in such an academic field - has the full capability to develop in their own. They can notice the framework and play the game while not being subsumed by it, so as to improve the framework in the long run. Yes, it is difficult to get a man to understand something, when his salary depends on his not understanding it, as Upton Sinclair said - this is a fairly well known quote, and educated people ought to be expected to at least understand the concept and to counter it in themselves. After all, it's difficult, not impossible, and one of the entire points of being a professional in an academic-related field is that they're capable of doing things that are intellectually difficult.

I think this is easy to say in principle but if you look at how successful identity politics were at taking over such a large part of the public discourse and intellectual framework...well we don't need to speculate what happens in practice, which is that some people figure it out (cough cough looks around) but most don't and it isn't enough.

Moral panics and crowd hysteria and Hersey have always been part of human culture. Expecting that to not be the case is foolhardy, even if we can feel comfortable tossing out labels about lack of ethics or whatever.

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I really don't think that is true.

You really don't think it's true that people were warned? That's really not a question of mental state.

I'm not sure what you mean.

"The mental state of people in medicine isn't related to whether they were warned about what they were normalizing."

I'm sorry you still aren't being clear.

How can people trust with this level of malfeasance? How do we get the trust back?

The same way you get trust back in a normal human relationship: you apologize unreservedly, make concrete steps to prevent the issue happening again, and accept that it will be a long time (if ever!) before the trust is rebuilt to what it used to be.

In this case, that means that first, everyone who repeated this false evidence needs to retract it, and apologize for their error in repeating it. No holding back because they think that fighting racism is a noble goal, no minimizing to try to avoid reputation damage, nothing. Full on admit the fault and apologize. Second, this man himself needs to be banned from ever doing research again without supervision from someone more trustworthy. Third, publications which repeated this falsified research need to brainstorm a plan for how they will catch future problems like this, and that should include a good honest look at how their own biases helped it to happen (because I have very little doubt they didn't check too closely because this research confirmed some editors' biases).

The medical profession needs to do that not only for this case, but for any other cases that come to light. And then wait. They will no doubt be beaten up in the short term by people who are angry at having been betrayed. They will get this thrown back in their faces from time to time. But eventually, if they are patient and keep acting with integrity, the wound will (probably) heal and the trust will be back. It's not an easy or fast process though.

The same way you get trust back in a normal human relationship: you apologize unreservedly, make concrete steps to prevent the issue happening again, and accept that it will be a long time (if ever!) before the trust is rebuilt to what it used to be.

That's not how it works with institutions. They lack that kind of singular agency and direction. There is no Emperor Of Medicine that can credibly make that kind of commitment.

There is no Emperor Of Medicine that can credibly make that kind of commitment.

For a few years Fauci was as close as anyone has ever been to being such a singular figure of The Medical Establishment, but he clearly had no interest in acknowledging the failures and making any sort of credible apology.

There was no Emperor of Medicine that made medical professionals overall trustworthy to the general public in the first place, either. I'm thinking that it was probably done piecemeal, by having doctors be credible by actually correctly diagnosing and fixing problems based on research that other doctors did, and having organizations that certified these people as competent being correlated with these doctors actually being competent, and the like. So this could be repeated, where whatever organization these researchers are part of taking the steps SubstantialFrivolity suggested, and this being repeated by other organizations whose employees and associates did similarly untrustworthy things. If the organizations are too big with diffuse responsibility, then we can get smaller, to the departments these researchers were part of. If the departments are similarly too big, then we can get down to the individual researchers themselves. It just needs to be done rigorously, each and every time, and eventually, over time, the overall credibility of the field will go back up, though perhaps never reaching what it once was.

This is the professional website of the study's lead author

This is me reading tea-leaves a little bit, but some things stand out to me.

The majority of his academic background is in business (MBA) and a fanci-fied version of IT. His professional experience was with CACI which is laughably described as a "mid-size" consulting firm. CACI is a notorious "body shop" Beltway Bandit that makes billions of dollars off of staff augmentation for Federal Contracts. Their own website states they employ about 25,000 people.

This provides a mental model, at least, of how this study - and its accompanying malfeasance - came into being. This is a consultant in a classroom. "What does the client want as an outcome? Racism. Okay, great! We can work the numbers to make it say that."

In the Daily Caller piece that the reddit post links to, they have a screenshot of this guy's Microsoft Word comments - one of them literally says, "this is not the story we're trying to tell." This is straight out of a consulting 101 MBA class.

At some point in the 2000s, Academia became a kind of side option career for people who aren't actually serious academics or researchers. You could pickup up a PhD from somewhere in something and then get associate or adjunct status. Sure, this salary wasn't great, but it gave you that credential to pass around as a digital hustler - you could go on podcasts, do paid speaking engagements, consult on the side for $300 an hour. It was a weird kind of self-reputation-maxxing. And that's part of the real long term rot of the academy. If you got a PhD in the 1950s or before, it's because you were almost monkish in your devotion to serious study in a field.

How can people trust with this level of malfeasance? How do we get the trust back? How do we stop people from doing this kind of thing? I just don’t know.

TAPS

THE

SIGN

Although admittedly this is not about 'elites' doing things on behalf of a whole society. A lot of blame can probably be ascribed to people who spread this information without checking it or by uncritically accepting it and parroting it as if it is true.

Which, it turns out, includes a SCOTUS Justice. Its in an actual, published SCOTUS opinion now (albeit a dissent, so it probably won't be used as precedent).

Should she formally retract that, somehow?

To be fair, she did tell us that she was not a biologist.

The study that was a big part of the Brown v. Board of Education ruling was later revealed to be complete bullshit and nobody cared about that, so I think she is probably safe.

There's probably a pretty solid essay or law review article to be written (probably already has) pointing out that empirically, it is better for the courts to stick to textualism/legislative intent when interpreting the law, as they have an extremely dubious track record when it comes to interpreting science and statistics while reasoning about what laws mean or 'ought' to mean.

Recent decisions the go into the form and function of various firearms/ parts of firearms when ruling on gun control laws suffer from similar issues.

You should never trust a single study. Scott said it well “beware the man of a single study”

However there is a fair bit of research on racial concordance and how this improves healthcare outcomes. Apparently black people feel better about having black doctors and are more likely to adhere to their meds if a black doc prescribes them. Makes sense given how extreme the ingroup bias is among black people, so I don’t doubt the results. On the other hand, does this mean I as a white pefson can legitimately demand I have a white physician because that would make me feel more comfortable? No?

On the other hand, does this mean I as a white pefson can legitimately demand I have a white physician because that would make me feel more comfortable? No?

Tons of people pick a doctor on the basis of ‘bedside manner’ or otherwise feeling comfortable with the doctor. It’s everywhere.

Pick a doctor? Sir I don’t speak American, can you rephrase?

Where I’m from, you’re sometimes lucky to even have one at all. Mine is Filipino and I’m white. Which is fine, he seems pretty competent although truth be told I’d still rather a white doctor.

In American major cities people with good insurance usually have the ability to choose between several primary care physicians; crappy insurance means you’re stuck with the one who accepts it, rural areas means there’s probably only one nearby.

Most people with the ability to choose doctors are not going off of any sort of proxy for being good at doctoring. They tend to go off of bedside manner.

I believe that's usually attributed to Aquinas:

"Cave ab homine unius libri."

And, as I understand it, he meant it admiringly, in the Bruce Lee "I fear the man who has practiced one kick a thousand times, not the man who has practiced a thousand kicks one time" sort of way.

Interesting. I've heard others imagine it as a compliment as well. I always took it as a slight --the obsessive who can see no other perspective than his own. One of those quotes you can read however you want, I guess.

How can people trust with this level of malfeasance? How do we get the trust back? How do we stop people from doing this kind of thing? I just don’t know.

I say this of any institution public or private. The answer to restoring trust is a simple but apparently too difficult to actually do — be trustworthy. It’s kind of a crazy question. When doctors lie and misrepresent the truth, when they openly try to manipulate the public into believing things that are not supported by research in order to get them to obey, or when they push unneeded drugs and treatments on people, it’s easy to lose trust. And I find the loss of trust in medical professionals and institutions to be actually dangerous because honestly most people are horrible at understanding health information without a doctor to help them.

More directly:

Being untrustworthy should come with fairly immediate consequences upon revelation.

And you should DEFINITELY be kicked from any position of trust and banned from future ones.

That sort of mentality would probably do a lot for police reform, too.

Yep. I think it was Yudkowsky who had a list of possible police reforms in the wake of the Death of George Floyd that included immediate and permanent removal of any police officer who is involved in the death of an unarmed person during an interaction. They just cannot work in law enforcement thereafter.

Drastic, but if there's an extremely low rate of deaths in police interactions (that's a claim the pro-police side usually makes) then it restores trust to know that no cop will ever be put back on the streets after killing someone without justification. And of course, prison time can still result if there wasn't justification. Minimal cost overall.

It would be really handy to remove the massive 'benefit of the doubt' that goes in favor of on-duty cops that allows the actual nasty/predatory ones to act with impunity for far longer than they would if they were held to the standard of a normal citizen. And it aligns incentives so that cops are really motivated to avoid doing anything life-threatening to unarmed persons.

At its core, that is what feels like is the major problem. Incentives aren't aligned in a way that points towards outcome everyone wants. We'd all like to be able to take scientific research seriously and NOT have to be immediately skeptical. Scientists would like to believe they're pushing boundaries of knowledge forward and have some social prestige from that pursuit. We want policies to be informed by good, accurate, reliable information, while accounting for uncertainties.

But that requires screwups to be uncovered and corrected quickly and bad actors to be removed before they cause too much damage. It ain't what we have currently.

Yudkowsky who had a list of possible police reforms in the wake of the Death of George Floyd that included immediate and permanent removal of any police officer who is involved in the death of an unarmed person during an interaction

I remember seeing this from Yudkowsky and thinking it was ridiculous and yet another example of how unserious a person he is. Many ""unarmed"" people killed by the police attack a cop and try to take their gun. You cannot "unarmed" fight a cop. That's a fight with a gun involved.

Perhaps, but look at the exact context of the incident that led to this.

George Floyd died while he was in handcuffs, face to the floor, with a grown man kneeling on top of him. He was 'unarmed' by any fair definition of the word.

A lot of people believe the cop's actions killed him, a lot of people believe it didn't, and say it was probably the drugs. Indeed, the mainstream conservative position is turning into Derek Chauvin deserves a pardon.

The rule proposed by Yudkowsky cuts the knot and just removes any 'bad' cops from the job even if we don't know for sure they're bad cops, so as to restore trust to the police as a whole, where the people who believe ACAB at least see that there's a consequence for the death of 'innocent' (yeah, I know I know) people in police encounters, and the "law and order" people can see that its the simple application of a facially neutral rule that holds the police to a 'high' but not unfair standard.

George Floyd was murdered and his murderer is currently in prison. The system worked, to the degree it does for handling murderers after the fact.

I would rather point to Michael Brown of "hands up, don't shoot" fame. He severely beat a cop with his bare hands. Fractured skull while in a car wearing a seat belt level beating. But Mr. Brown failed to take the cop's gun despite trying. Many cops have retention holsters and merely grabbing the grip of their gun and pulling won't get it out. Michael Brown then briefly ran away, but stopped, turned and charged the cop. It was then this cop defensively and justifiably shot an unarmed man to death.

Despite attempted railroading by the Obama administration, this cop escaped criminal punishment for his entirely justified defensive shooting of an unarmed man. Good thing Yudkowsky doesn't have some special veto power to punish this cop regardless. There's a reason we don't just cut knots. We need unruined un-carved-apart basic government institutions.

How do we get the trust back?

I think one thing that American liberals / institutionalists desperately need to recover is an understanding that most people don't see themselves in some universal, internally sympathetic class with our well-credentialed elites, and thus that the claim of such elites earning and maintaining trust is itself nothing like a default. And "But I did well on the test administered by elites like me" isn't enough. I think that's a really hard pill to swallow for people who have put all their chips on the current meritocracy, though, and it's understandable, because we were all born into a world that once had more default institutional trust.

It's interesting, because I don't think these ideas are hard to get across in the abstract.

I've asked before, as an example, some well-credentialed liberals I knew if they would accept universal health care funded and run by the government, with the constraint that it would be entirely run and maintained by experts from the Communist party of China, with their own internal methods for determining who was an expert. And (it should go without saying), I have not got any takers - and honestly, it's a bit interesting to try to tease out why exactly. And yet, realistically, for many Americans, administration by the current system internally gatekept and administered by American liberals is obviously not that dissimilar to that thought experiment for large swathes of Americans who are entirely alienated from those liberal gatekeepers too. They could well be forgiven for suspecting that the American liberal gatekeepers, as a class, despise them much more, and are much keener to socially engineer away their communities, than a similar program administered by the Chinese might be. At the very least, they can go read what the American version are actually saying in English about them on social media.

I get why it's a tough spot, emotionally, to be in for the winners of the meritocracy I'm gesturing at. It's really nice to get free institutional legitimacy, and it totally sucks to lose that if you were accustomed to having it, especially if you are the tail end of a long process of drawing down that legitimacy that had been built up by your forbearers who understand power and public trust in deep ways that they apparently didn't pass on (which I personally think is an accurate description of the institution builders of the progressive era compared to their "progressive" great-grandchildren). But from shirt sleeves to shirt sleeves in 3 generations is a thing. And I think American liberals simply no longer have the luxury of being oblivious to the realities of where power and legitimacy come from, and thus how they absolutely HAVE to rigorously publicly police themselves and their institutions to regain that trust. This stuff isn't magic. But I see a whole lot of behavior that looks like magical thinking, with a complete obliviousness to cause-and-effect when it comes to public trust.

Even if "Racism is a public health emergency" made any sense at all, people who want public power have to be smart enough to understand that you can't announce that stuff and then be surprised and huffy when large amounts of white people ignore your authority when you announce you intend to squirt novel fluid in their kids arms via flu vaccine. There's a total misunderstanding about the role of "consent of the governed", and how it means something much bigger in the way Americans organize themselves culturally than just questions about law and the Federal government...

They could well be forgiven for suspecting that the American liberal gatekeepers, as a class, despise them much more, and are much keener to socially engineer away their communities, than a similar program administered by the Chinese might be

The core red tribe does not believe this. The Chinese are dirty uncivilized commie barbarians, they’re even worse than democrats.

But many of these institutions are suffering self inflicted wounds. It’s been obvious since I’ve been paying attention to news (starting in junior high) that the news “of record” was liberal to a fault, was generally secular, and that it was pro-LGBT (this was in mid 1990s so well before Woke). And once you understand such a thing, and understand that “the news of record” has no interest in telling unbiased news, and will happily distort, misreport, play up or down different stories in order to create the impression that they want you to have. Learning that basically killed my trust in mainstream news.

University was much the same way. Outside of extremely skill or maths heavy courses, you could just simply expect that ideas like social libertarianism if not outright celebration of degenerate if not destructive lifestyles, government control, generous welfare states, free college, free healthcare, and basically socialism. And so you eventually understand that these scholars are not disinterested Confucian scholars simply looking for knowledge. If that were the case, it seems that at least some of them would come out t9 be socially conservative, or economically libertarian.

And once you understand such a thing, and understand that “the news of record” has no interest in telling unbiased news, and will happily distort, misreport, play up or down different stories in order to create the impression that they want you to have. Learning that basically killed my trust in mainstream news.

Agreed. The mainstream media is a joke - even "reputable" institutions like the NYT have very little interest in providing balanced coverage of things. What interest exists is generally from an older generation of journalists, who are aging out and being replaced by young zealous partisans. And by and large, people not only have no interest in fixing it, they don't even have interest in seeing the problem! See smug slogans like "reality has a liberal bias" - that sort of attitude is just not indicative of genuine intellectual honesty and willingness to see things from other points of view.

If that were the case, it seems that at least some of them would come out t9 be socially conservative, or economically libertarian.

In fairness there were libertarians in the economics department where I went to college, so that does happen some of the time. I don't know how often, but it does at least seem that some academics do come out the way you describe.

And this is why those old institutions are no longer trusted by anyone under 50. Nobody under 50 cites a story on the NYT website as a truth claim, because they have known since they began to understand the concept of bias in reporting that NYT and similar news sites are Cathedral sources and will push The Narrative. Getting that trust back would obviously require admitting it, fixing it, cleaning house to prevent it, and begin writing the news as it’s actually happening and not twisting it.

That’s what rebuilding trust is — until tge problems that caused the lack of trust are dealt with, trust is gone.

I think one thing that American liberals / institutionalists desperately need to recover is an understanding that most people don't see themselves in some universal, internally sympathetic class with our well-credentialed elites, and thus that the claim of such elites earning and maintaining trust is itself nothing like a default. And "But I did well on the test administered by elites like me" isn't enough. I think that's a really hard pill to swallow for people who have put all their chips on the current meritocracy, though, and it's understandable, because we were all born into a world that once had more default institutional trust.

The problem is that studies like this make this harder. It's a cycle.

They do think they're smarter, but that's not all of their claim. Or they wouldn't find it so hard to grant that someone like Elon is smart.

It's that they are necessary, precisely because the bigotry and ignorance of the unsympathetic part of the populace can't be left unchecked. It's not only harmful to them, it disproportionately harms those America owes a blood debt. It hurts the marginalized the worst and, to steal a line, that's too serious a matter to be left up to the voters to decide themselves.

They know they are disliked by some, they expect it. But a) people always resist progress and b)those people are people who don't know about things like this.

It's much harder to climb down this sort of moral position than it is to admit you're not as certain about a purely technical matter. It's much harder to see the necessity.

I've asked before, as an example, some well-credentialed liberals I knew if they would accept universal health care funded and run by the government, with the constraint that it would be entirely run and maintained by experts from the Communist party of China, with their own internal methods for determining who was an expert. And (it should go without saying), I have not got any takers

That's a wonderful hypothetical.

They seem to be coming around though!

https://x.com/tracewoodgrains/status/1906727995307381025

Summary: TracingWoodgrains ran a poll for both left and right respondents, asking if they'd rather have their opposite running the world vs. China.

For left respondents, China won handily, opposite for right-responders. Obvious selection bias and all, but troubling. The days of substantial fifth-columnism may be returning.

Is there one offering Russia and Iran as possible alternatives instead? I suspect Putin is slightly more popular than democrats among right wingers, the ayatollah in between democrats and xi, and and the CCP last of all.

This might just be a measure of partisanship, though. Two years ago, would the results be different?

  1. This is an online poll.

  2. The alternative was Trump, so it became a fargroup vs. outgroup question.

I really don’t see the left having much admiration for China, they’re too involved in religious repression of Muslim minorities and too ethnically-chauvinist for the social-and-not-economic left to find them appealing. There’s also the one-child policy legacy, widely understood as a policy that led to mass-murder of female infants and thus is seen as horrifically misogynist (it’s literally an example of the government controlling women’s reproductive rights!). I’m sure there’s some tankies somewhere who admire Mr. Xi, but they’re not mainstream.

If anything, “China is not trustworthy and can’t be allowed to grow in power” is the one foreign policy matter where there’s broad agreement across the political spectrum in the US. See strong support for the Hong Kong protesters, spy balloon fiasco, scandals about Chinese students being spies, fear of a war over Taiwan, the CHIPs Act (that failed). There’s bipartisan support for a firm position against China and the progressive left has no interest in allying with them. I suspect if tensions over Taiwan ever went hot, left-wingers would be more likely than right-wingers to support war; it would be another Ukraine.

I know some grassroots right-wingers who’ve bought into the propaganda that Russia is some great haven for social conservatism, but I don’t know any left-wingers who believe China is anything but a repressive authoritarian regime. Unlike the Soviet Union, they don’t have the cover of limited information — when an elderly official was dragged out of a party meeting it was all over Twitter — and people on the ground who speak English like the people of Hong Kong and Taiwan can speak to how China’s actions threaten their freedom.

Plus, their regional dominance threatens Japan, and everyone in America seems to agree the Japanese are cool.

Conspicuous China hatred is a racially tinged deep red thing to me; it might have religious overtones(persecution of Chinese Christians) and almost certainly has fifties level anti communist paranoia.

Maybe conspicuous Chinese hatred is like that, but my point is that low-level suspicion and dislike is so ubiquitous that it's not conspicuous. Particularly when it's focused on the CCP and not Chinese people, as it almost always is.

I'm not really talking about "The Chinese eat dogs!!!" stuff, which I agree has a racial component. Though I do believe there's growing suspicion more broadly about Chinese attitudes towards animals after the China-sympathetic view of COVID's origins was that people in Wuhan were eating bats, and especially after reports that the Chinese government was mass-killing family pets of infected people.

(If you want to find the few tankies who like the Chinese government, find the people who would get mad at me using the acronym "CCP" and loudly insist it's actually the "CPC". It's the lowest tier of language policing, which is why you'll only find it among internet communists.)

The question is not whether the left has suspicion and dislike of the Chinese, it's whether that level of suspicion and dislike is lower than the levels of suspicion and dislike of the right in their own country.

And to answer that question, we’re going to need something much better than a Twitter poll.

I found the old /r/Medicine thread when this study first came out, and I saw that even the, the majority of opinions were skeptical. I'd upvoted all of them.

It's a shame that there isn't much legal penalty for such knowing academic fraud, but if any of the authors are doctors, the AMA should throw their license in a bin and light it on fire. Knowing what I do about the AMA, that is unfortunately rather unlikely.

but if any of the authors are doctors, the AMA should throw their license in a bin and light it on fire.

-They weren't doctors IIRC.

-Lol don't listen to the anti-AMA nonsense, they aren't that influential.

Yup. I forgot the AMA is analogous to the BMA, and that you guys don't have a central regulator like we do in the form of the GMC.

Yeah we have a bunch of national and state level regulators and things. It. Is. A. Nightmare.

Also great! (but often for bad actors)

I felt like this fell within the realm of social science (especially since authors weren't doctors) rather than medicine even when it came out and as such should have been treated with extreme skepticism just the same as other social "science". No need to really update beyond the already existing heuristic of social scientists are lying charlatans who shouldn't be trusted.

That is not to say that there isn't problems within medicine but this felt a bit orthogonal to that.

The problem is that I saw plenty of doctors uncritically citing this, using it to mentally update, and using it define future research and goals.

Much of medicine is social science or even just art (they call it the art and science of healthcare for a reason!) often this is because patient interaction and buy in and convincing is most of the job and ethics impairs how much hard science we actually have.

I've mentioned several times here, I've been reading Gibbon's Fall and Decline of the Roman Empire. By Volume 3 and 4 (where I currently am), the citizens of the Western Roman Empire, crushed by taxes and "illiberal edicts" whatever that means to Gibbon or the Romans, were in some proportion somewhere between indifferent and cautiously optimistic for Gothic, Vandal or Frankish rule. Of the Gothic rule in Italy in particular, in some ways and for some time Theodoric was perceived as protecting the glory and the ways of the Italians.

From an intellectual perspective, you read the sequence of events, and it makes a certain neocon "We'll be welcomed as liberators" sort of sense. But as often as that hasn't played out in our age, we know it's not that simple. It's profoundly rare for a peoples to willingly accept a foreign tyranny over a native tyranny. There are usually at least some vague feelings of tribal unity lying around in mothballs to man the lines against the invaders. They won't make slaves out of us! We're already slaves of one of our own god damnit! How completely detached from your ruling class, how utterly neglected is their noblesse oblige before the peoples are willing to trade one slave master for another?

Now I can only speak for myself, but this is the kind of shit that makes me go "Oh, I get it now." The relentless naked blood libel from my "betters" directed towards me is insufferable. If any other country attacked the US with intentions to conquer it, I'd at least be willing to hear them out.

The relentless naked blood libel from my "betters" directed towards me is insufferable. If any other country attacked the US with intentions to conquer it, I'd at least be willing to hear them out.

Yeah, I get what you mean. We've had some posters talk about how they wish China would take over the country, and on the one hand that's an obviously bad idea. The Chinese government really is a repressive, authoritarian government with a culture very foreign to ours. It would be rather miserable to have them rule us. But on the other hand, I get why people say it. There's only so much naked hatred and contempt you can see your countrymen show for your values and your way of life before you go "fuck it, maybe at least those other guys would consider letting me live the way I want. I know this group never will".

Does China even want to rule us directly? Like Russia straightforwardly would, yeah, but does China want more than trade and foreign policy concessions?

No idea. It's just something I've seen kicked around on the motte in the past; I'm way too ignorant of Chinese goals to say if that's something they'd want even if offered it.

Kudos to you for updating after seeing a particularly bad case of massaging the science for political outcomes. I also genuinely don't know how you reform academia and medicine when they are willing to be this blatantly political in their "science."

It's a shame because I love the Academy as an institution and an ideal, but it has become so corrupted it's shocking to me even on the 100th example. I hope for all our sakes we can find a way to save science without burning down too much.

I wouldn't call this an update/change haha. Because of how far people go in the other direction here I'm often defending the academy but not always, and out in the real world I'm almost always complaining about it. I do however this example is particularly egregious and because it's a multi-year follow-up too many people will miss it.

Priors here slanted opinions against the academy regardless of the legal outcome, because the only presentation the academy cares to display is sanctimonious moralizing. The only change would be whether the judiciary is viewed as equally captured.

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