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"Talks a good game about freedom when out of power, but once he’s in – bam! Everyone's enslaved in the human-flourishing mines."

Book Review: Surfing Uncertainty

[Related to: It’s Bayes All The Way Up, Why Are Transgender People Immune To Optical Illusions?, Can We Link Perception And Cognition?]

I.

Sometimes I have the fantasy of being able to glut myself on Knowledge. I imagine meeting a time traveler from 2500, who takes pity on me and gives me a book from the future where all my questions have been answered, one after another. What’s consciousness? That’s in Chapter 5. How did something arise out of nothing? Chapter 7. It all makes perfect intuitive sense and is fully vouched by unimpeachable authorities. I assume something like this is how everyone spends their first couple of days in Heaven, whatever it is they do for the rest of Eternity.

And every so often, my fantasy comes true. Not by time travel or divine intervention, but by failing so badly at paying attention to the literature that by the time I realize people are working on a problem it’s already been investigated, experimented upon, organized into a paradigm, tested, and then placed in a nice package and wrapped up with a pretty pink bow so I can enjoy it all at once.

The predictive processing model is one of these well-wrapped packages. Unbeknownst to me, over the past decade or so neuroscientists have come up with a real theory of how the brain works – a real unifying framework theory like Darwin’s or Einstein’s – and it’s beautiful and it makes complete sense.

Surfing Uncertainty isn’t pop science and isn’t easy reading. Sometimes it’s on the border of possible-at-all reading. Author Andy Clark (a professor of logic and metaphysics, of all things!) is clearly brilliant, but prone to going on long digressions about various esoteric philosophy-of-cognitive-science debates. In particular, he’s obsessed with showing how “embodied” everything is all the time. This gets kind of awkward, since the predictive processing model isn’t really a natural match for embodiment theory, and describes a brain which is pretty embodied in some ways but not-so-embodied in others. If you want a hundred pages of apologia along the lines of “this may not look embodied, but if you squint you’ll see how super-duper embodied it really is!”, this is your book.

It’s also your book if you want to learn about predictive processing at all, since as far as I know this is the only existing book-length treatment of the subject. And it’s comprehensive, scholarly, and very good at giving a good introduction to the theory and why it’s so important. So let’s be grateful for what we’ve got and take a look.

II.

Stanislas Dehaene writes of our senses:

We never see the world as our retina sees it. In fact, it would be a pretty horrible sight: a highly distorted set of light and dark pixels, blown up toward the center of the retina, masked by blood vessels, with a massive hole at the location of the “blind spot” where cables leave for the brain; the image would constantly blur and change as our gaze moved around. What we see, instead, is a three-dimensional scene, corrected for retinal defects, mended at the blind spot, stabilized for our eye and head movements, and massively reinterpreted based on our previous experience of similar visual scenes. All these operations unfold unconsciously—although many of them are so complicated that they resist computer modeling. For instance, our visual system detects the presence of shadows in the image and removes them. At a glance, our brain unconsciously infers the sources of lights and deduces the shape, opacity, reflectance, and luminance of the objects.

Predictive processing begins by asking: how does this happen? By what process do our incomprehensible sense-data get turned into a meaningful picture of the world?

The key insight: the brain is a multi-layer prediction machine. All neural processing consists of two streams: a bottom-up stream of sense data, and a top-down stream of predictions. These streams interface at each level of processing, comparing themselves to each other and adjusting themselves as necessary.

The bottom-up stream starts out as all that incomprehensible light and darkness and noise that we need to process. It gradually moves up all the cognitive layers that we already knew existed – the edge-detectors that resolve it into edges, the object-detectors that shape the edges into solid objects, et cetera.

The top-down stream starts with everything you know about the world, all your best heuristics, all your priors, everything that’s ever happened to you before – everything from “solid objects can’t pass through one another” to “e=mc^2” to “that guy in the blue uniform is probably a policeman”. It uses its knowledge of concepts to make predictions – not in the form of verbal statements, but in the form of expected sense data. It makes some guesses about what you’re going to see, hear, and feel next, and asks “Like this?” These predictions gradually move down all the cognitive layers to generate lower-level predictions. If that uniformed guy was a policeman, how would that affect the various objects in the scene? Given the answer to that question, how would it affect the distribution of edges in the scene? Given the answer to that question, how would it affect the raw-sense data received?

Both streams are probabilistic in nature. The bottom-up sensory stream has to deal with fog, static, darkness, and neural noise; it knows that whatever forms it tries to extract from this signal might or might not be real. For its part, the top-down predictive stream knows that predicting the future is inherently difficult and its models are often flawed. So both streams contain not only data but estimates of the precision of that data. A bottom-up percept of an elephant right in front of you on a clear day might be labelled “very high precision”; one of a a vague form in a swirling mist far away might be labelled “very low precision”. A top-down prediction that water will be wet might be labelled “very high precision”; one that the stock market will go up might be labelled “very low precision”.

As these two streams move through the brain side-by-side, they continually interface with each other. Each level receives the predictions from the level above it and the sense data from the level below it. Then each level uses Bayes’ Theorem to integrate these two sources of probabilistic evidence as best it can. This can end up a couple of different ways.

First, the sense data and predictions may more-or-less match. In this case, the layer stays quiet, indicating “all is well”, and the higher layers never even hear about it. The higher levels just keep predicting whatever they were predicting before.

Second, low-precision sense data might contradict high-precision predictions. The Bayesian math will conclude that the predictions are still probably right, but the sense data are wrong. The lower levels will “cook the books” – rewrite the sense data to make it look as predicted – and then continue to be quiet and signal that all is well. The higher levels continue to stick to their predictions.

Third, there might be some unresolvable conflict between high-precision sense-data and predictions. The Bayesian math will indicate that the predictions are probably wrong. The neurons involved will fire, indicating “surprisal” – a gratuitiously-technical neuroscience term for surprise. The higher the degree of mismatch, and the higher the supposed precision of the data that led to the mismatch, the more surprisal – and the louder the alarm sent to the higher levels.

When the higher levels receive the alarms from the lower levels, this is their equivalent of bottom-up sense-data. They ask themselves: “Did the even-higher-levels predict this would happen?” If so, they themselves stay quiet. If not, they might try to change their own models that map higher-level predictions to lower-level sense data. Or they might try to cook the books themselves to smooth over the discrepancy. If none of this works, they send alarms to the even-higher-levels.

All the levels really hate hearing alarms. Their goal is to minimize surprisal – to become so good at predicting the world (conditional on the predictions sent by higher levels) that nothing ever surprises them. Surprise prompts a frenzy of activity adjusting the parameters of models – or deploying new models – until the surprise stops.

All of this happens several times a second. The lower levels constantly shoot sense data at the upper levels, which constantly adjust their hypotheses and shoot them down at the lower levels. When surprise is registered, the relevant levels change their hypotheses or pass the buck upwards. After umpteen zillion cycles, everyone has the right hypotheses, nobody is surprised by anything, and the brain rests and moves on to the next task. As per the book:

To deal rapidly and fluently with an uncertain and noisy world, brains like ours have become masters of prediction – surfing the waves and noisy and ambiguous sensory stimulation by, in effect, trying to stay just ahead of them. A skilled surfer stays ‘in the pocket’: close to, yet just ahead of the place where the wave is breaking. This provides power and, when the wave breaks, it does not catch her. The brain’s task is not dissimilar. By constantly attempting to predict the incoming sensory signal we become able – in ways we shall soon explore in detail – to learn about the world around us and to engage that world in thought and action.

The result is perception, which the PP theory describes as “controlled hallucination”. You’re not seeing the world as it is, exactly. You’re seeing your predictions about the world, cashed out as expected sensations, then shaped/constrained by the actual sense data.

III.

Enough talk. Let’s give some examples. Most of you have probably seen these before, but it never hurts to remind:

This demonstrates the degree to which the brain depends on top-down hypotheses to make sense of the bottom-up data. To most people, these two pictures start off looking like incoherent blotches of light and darkness. Once they figure out what they are (spoiler) the scene becomes obvious and coherent. According to the predictive processing model, this is how we perceive everything all the time – except usually the concepts necessary to make the scene fit together come from our higher-level predictions instead of from clicking on a spoiler link.

This demonstrates how the top-down stream’s efforts to shape the bottom-up stream and make it more coherent can sometimes “cook the books” and alter sensation entirely. The real picture says “PARIS IN THE THE SPRINGTIME” (note the duplicated word “the”!). The top-down stream predicts this should be a meaningful sentence that obeys English grammar, and so replaces the the bottom-up stream with what it thinks that it should have said. This is a very powerful process – how many times have I repeated the the word “the” in this paragraph alone without you noticing?

A more ambiguous example of “perception as controlled hallucination”. Here your experience doesn’t quite deny the jumbled-up nature of the letters, but it superimposes a “better” and more coherent experience which appears naturally alongside.

Next up – this low-quality video of an airplane flying at night. Notice how after an instant, you start to predict the movement and characteristics of the airplane, so that you’re no longer surprised by the blinking light, the movement, the other blinking light, the camera shakiness, or anything like that – in fact, if the light stopped blinking, you would be surprised, even though naively nothing could be less surprising than a dark portion of the night sky staying dark. After a few seconds of this, the airplane continuing on its (pretty complicated) way just reads as “same old, same old”. Then when something else happens – like the camera panning out, or the airplane making a slight change in trajectory – you focus entirely on that, the blinking lights and movement entirely forgotten or at least packed up into “airplane continues on its blinky way”. Meanwhile, other things – like the feeling of your shirt against your skin – have been completely predicted away and blocked from consciousness, freeing you to concentrate entirely on any subtle changes in the airplane’s motion.

In the same vein: this is Rick Astley’s “Never Going To Give You Up” repeated again and again for ten hours (you can find some weird stuff on YouTube). The first hour, maybe you find yourself humming along occasionally. By the second hour, maybe it’s gotten kind of annoying. By the third hour, you’ve completely forgotten it’s even on at all.

But suppose that one time, somewhere around the sixth hour, it skipped two notes – just the two syllables “never”, so that Rick said “Gonna give you up.” Wouldn’t the silence where those two syllables should be sound as jarring as if somebody set off a bomb right beside you? Your brain, having predicted sounds consistent with “Never Gonna Give You Up” going on forever, suddenly finds its expectations violated and sends all sorts of alarms to the higher levels, where they eventually reach your consciousness and make you go “What the heck?”

IV.

Okay. You’ve read a lot of words. You’ve looked at a lot of pictures. You’ve listened to “Never Gonna Give You Up” for ten hours. Time for the payoff. Let’s use this theory to explain everything.

1. Attention. In PP, attention measures “the confidence interval of your predictions”. Sense-data within the confidence intervals counts as a match and doesn’t register surprisal. Sense-data outside the confidence intervals fails and alerts higher levels and eventually consciousness.

This modulates the balance between the top-down and bottom-up streams. High attention means that perception is mostly based on the bottom-up stream, since every little deviation is registering an error and so the overall perceptual picture is highly constrained by sensation. Low attention means that perception is mostly based on the top-down stream, and you’re perceiving only a vague outline of the sensory image with your predictions filling in the rest.

There’s a famous experiment which you can try below – if you’re trying it, make sure to play the whole video before moving on:

About half of subjects, told to watch the players passing the ball, don’t notice the gorilla. Their view of the ball-passing is closely constrained by the bottom-up stream; they see mostly what is there. But their view of the gorilla is mostly dependent on the top-down stream. Their confidence intervals are wide. Somewhere in your brain is a neuron saying “is that a guy in a gorilla suit?” Then it consults the top-down stream, which says “This is a basketball game, you moron”, and it smooths out the anomalous perception into something that makes sense like another basketball player.

But if you watch the video with the prompt “Look for something strange happening in the midst of all this basketball-playing”, you see the gorilla immediately. Your confidence intervals for unusual things are razor-thin; as soon as that neuron sees the gorilla it sends alarms to higher levels, and the higher levels quickly come up with a suitable hypothesis (“there’s a guy in a gorilla suit here”) which makes sense of the new data.

There’s an interesting analogy to vision here, where the center of your vision is very clear, and the outsides are filled in in a top-down way – I have a vague sense that my water bottle is in the periphery right now, but only because I kind of already know that, and it’s more of a mental note of “water bottle here as long as you ask no further questions” than a clear image of it. The extreme version of this is the blind spot, which gets filled in entirely with predicted imagery despite receiving no sensation at all.

2. Imagination, Simulation, Dreaming, Etc. Imagine a house. Now imagine a meteor crashing into the house. Your internal mental simulation was probably pretty good. Without even thinking about it, you got it to obey accurate physical laws like “the meteor continues on a constant trajectory”, “the impact happens in a realistic way”, “the impact shatters the meteorite”, and “the meteorite doesn’t bounce back up to space like a basketball”. Think how surprising this is.

In fact, think how surprising it is that you can imagine the house at all. This really high level concept – “house” – has been transformed in your visual imaginarium into a pretty good picture of a house, complete with various features, edges, colors, et cetera (if it hasn’t, read here). This is near-miraculous. Why do our brains have this apparently useless talent?

PP says that the highest levels of our brain make predictions in the form of sense data. They’re not just saying “I predict that guy over there is a policeman”, they’re generating the image of a policeman, cashing it out in terms of sense data, and colliding it against the sensory stream to see how it fits. The sensory stream gradually modulates it to fit the bottom-up evidence – a white or black policeman, a mustached or clean-shaven policeman. But the top-down stream is doing a lot of the work here. We are able to imagine the meteor, using the same machinery that would guide our perception of the meteor if we saw it up in the sky.

All of this goes double for dreaming. If “perception is controlled hallucination” caused by the top-down drivers of perception constrained by bottom-up evidence, then dreams are those top-down drivers playing around with themselves unconstrained by anything at all (or else very weakly constrained by bottom-up evidence, like when it’s really cold in your bedroom and you dream you’re exploring the North Pole).

A lot of people claim higher levels of this – lucid dreaming, astral projection, you name it, worlds exactly as convincing as our own but entirely imaginary. Predictive processing is very sympathetic to these accounts. The generative models that create predictions are really good; they can simulate the world well enough that it rarely surprises us. They also connect through various layers to our bottom-level perceptual apparatus, cashing out their predictions in terms of the lowest-level sensory signals. Given that we’ve got a top-notch world-simulator plus perception-generator in our heads, it shouldn’t be surprising when we occasionally perceive ourselves in simulated worlds.

3. Priming. I don’t mean the weird made-up kinds of priming that don’t replicate. I mean the very firmly established ones, like the one where, if you flash the word “DOCTOR” at a subject, they’ll be much faster and more skillful in decoding a series of jumbled and blurred letters into the word “NURSE”.

This is classic predictive processing. The top-down stream’s whole job is to assist the bottom-up stream in making sense of complicated fuzzy sensory data. After it hears the word “DOCTOR”, the top-down stream is already thinking “Okay, so we’re talking about health care professionals”. This creeps through all the lower levels as a prior for health-care related things; when the sense organs receive data that can be associated in a health-care related manner, the high prior helps increase the precision of this possibility until it immediately becomes the overwhelming leading hypothesis.

4. Learning. There’s a philosophical debate – which I’m not too familiar with, so sorry if I get it wrong – about how “unsupervised learning” is possible. Supervised reinforcement learning is when an agent tries various stuff, and then someone tells the agent if it’s right or wrong. Unsupervised learning is when nobody’s around to tell you, and it’s what humans do all the time.

PP offers a compelling explanation: we create models that generate sense data, and keep those models if the generated sense data match observation. Models that predict sense data well stick around; models that fail to predict the sense data accurately get thrown out. Because of all those lower layers adjusting out contingent features of the sensory stream, any given model is left with exactly the sense data necessary to tell it whether it’s right or wrong.

PP isn’t exactly blank slatist, but it’s compatible with a slate that’s pretty fricking blank. Clark discusses “hyperpriors” – extremely basic assumptions about the world that we probably need to make sense of anything at all. For example, one hyperprior is sensory synchronicity – the idea that our five different senses are describing the same world, and that the stereo we see might be the source of the music we hear. Another hyperprior is object permanence – the idea that the world is divided into specific objects that stick around whether or not they’re in the sensory field. Clark says that some hyperpriors might be innate – but says they don’t have to be, since PP is strong enough to learn them on its own if it has to. For example, after enough examples of, say, seeing a stereo being smashed with a hammer at the same time that music suddenly stops, the brain can infer that connecting the visual and auditory evidence together is a useful hack that helps it to predict the sensory stream.

I can’t help thinking here of Molyneux’s Problem, a thought experiment about a blind-from-birth person who navigates the world through touch alone. If suddenly given sight, could the blind person naturally connect the visual appearance of a cube to her own concept “cube”, which she derived from the way cubes feel? In 2003, some researchers took advantage of a new cutting-edge blindness treatment to test this out; they found that no, the link isn’t intuitively obvious to them. Score one for learned hyperpriors.

But learning goes all the way from these kinds of really basic hyperpriors all the way up to normal learning like what the capital of France is – which, if nothing else, helps predict what’s going to be on the other side of your geography flashcard, and which high-level systems might keep as a useful concept to help it make sense of the world and predict events.

5. Motor Behavior. About a third of Surfing Uncertainty is on the motor system, it mostly didn’t seem that interesting to me, and I don’t have time to do it justice here (I might make another post on one especially interesting point). But this has been kind of ignored so far. If the brain is mostly just in the business of making predictions, what exactly is the motor system doing?

Based on a bunch of really excellent experiments that I don’t have time to describe here, Clark concludes: it’s predicting action, which causes the action to happen.

This part is almost funny. Remember, the brain really hates prediction error and does its best to minimize it. With failed predictions about eg vision, there’s not much you can do except change your models and try to predict better next time. But with predictions about proprioceptive sense data (ie your sense of where your joints are), there’s an easy way to resolve prediction error: just move your joints so they match the prediction. So (and I’m asserting this, but see Chapters 4 and 5 of the book to hear the scientific case for this position) if you want to lift your arm, your brain just predicts really really strongly that your arm has been lifted, and then lets the lower levels’ drive to minimize prediction error do the rest.

Under this model, the “prediction” of a movement isn’t just the idle thought that a movement might occur, it’s the actual motor program. This gets unpacked at all the various layers – joint sense, proprioception, the exact tension level of various muscles – and finally ends up in a particular fluid movement:

Friston and colleagues…suggest that precise proprioceptive predictions directly elicit motor actions. This means that motor commands have been replaced by (or as I would rather say, implemented by) proprioceptive predictions. According to active inference, the agent moves body and sensors in ways that amount to actively seeking out the sensory consequences that their brains expect. Perception, cognition, and action – if this unifying perspective proves correct – work together to minimize sensory prediction errors by selectively sampling and actively sculpting the stimulus array. This erases any fundamental computational line between perception and the control of action. There remains [only] an obvious difference in direction of fit. Perception here matches hural hypotheses to sensory inputs…while action brings unfolding proprioceptive inputs into line with neural predictions. The difference, as Anscombe famously remarked, is akin to that between consulting a shopping list (thus letting the list determine the contents of the shopping basket) and listing some actually purchased items (thus letting the contents of the shopping basket determine the list). But despite the difference in direction of fit, the underlying form of the neural computations is now revealed as the same.

6. Tickling Yourself. One consequence of the PP model is that organisms are continually adjusting out their own actions. For example, if you’re trying to predict the movement of an antelope you’re chasing across the visual field, you need to adjust out the up-down motion of your own running. So one “hyperprior” that the body probably learns pretty early is that if it itself makes a motion, it should expect to feel the consequences of that motion.

There’s a really interesting illusion called the force-matching task. A researcher exerts some force against a subject, then asks the subject to exert exactly that much force against something else. Subjects’ forces are usually biased upwards – they exert more force than they were supposed to – probably because their brain’s prediction engines are “cancelling out” their own force. Clark describes one interesting implication:

The same pair of mechanisms (forward-model-based prediction and the dampening of resulting well-predicted sensation) have been invoked to explain the unsettling phenomenon of ‘force escalation’. In force escalation, physical exchanges (playground fights being the most common exemplar) mutually ramp up via a kind of step-ladder effect in which each person believes the other one hit them harder. Shergill et al describe experiments that suggest that in such cases each person is truthfully reporting their own sensations, but that those sensations are skewed by the attenuating effects of self-prediction. Thus, ‘self-generated forces are perceived as weaker than externally generated forces of equal magnitude.’

This also explains why you can’t tickle yourself – your body predicts and adjusts away your own actions, leaving only an attenuated version.

7. The Placebo Effect. We hear a lot about “pain gating” in the spine, but the PP model does a good job of explaining what this is: adjusting pain based on top-down priors. If you believe you should be in pain, the brain will use that as a filter to interpret ambiguous low-precision pain signals. If you believe you shouldn’t, the brain will be more likely to assume ambiguous low-precision pain signals are a mistake. So if you take a pill that doctors assure you will cure your pain, then your lower layers are more likely to interpret pain signals as noise, “cook the books” and prevent them from reaching your consciousness.

Psychosomatic pain is the opposite of this; see Section 7.10 of the book for a fuller explanation.

8. Asch Conformity Experiment. More speculative, and not from the book. But remember this one? A psychologist asked subjects which lines were the same length as other lines. The lines were all kind of similar lengths, but most subjects were still able to get the right answer. Then he put the subjects in a group with confederates; all of the confederates gave the same wrong answer. When the subject’s turn came, usually they would disbelieve their eyes and give the same wrong answer as the confederates.

The bottom-up stream provided some ambiguous low-precision bottom-up evidence pointing toward one line. But in the final Bayesian computation, those were swamped by the strong top-down prediction that it would be another. So the middle layers “cooked the books” and replaced the perceived sensation with the predicted one. From Wikipedia:

Participants who conformed to the majority on at least 50% of trials reported reacting with what Asch called a “distortion of perception”. These participants, who made up a distinct minority (only 12 subjects), expressed the belief that the confederates’ answers were correct, and were apparently unaware that the majority were giving incorrect answers.

9. Neurochemistry. PP offers a way to a psychopharmacological holy grail – an explanation of what different neurotransmitters really mean, on a human-comprehensible level. Previous attempts to do this, like “dopamine represents reward, serotonin represents calmness”, have been so wildly inadequate that the whole question seems kind of disreputable these days.

But as per PP, the NMDA glutamatergic system mostly carries the top-down stream, the AMPA glutamatergic system mostly carries the bottom-up stream, and dopamine mostly carries something related to precision, confidence intervals, and surprisal levels. This matches a lot of observational data in a weirdly consistent way – for example, it doesn’t take a lot of imagination to think of the slow, hesitant movements of Parkinson’s disease as having “low motor confidence”.

10. Autism. Various research in the PP tradition has coalesced around the idea of autism as an unusually high reliance on bottom-up rather than top-down information, leading to “weak central coherence” and constant surprisal as the sensory data fails to fall within pathologically narrow confidence intervals.

Autistic people classically can’t stand tags on clothing – they find them too scratchy and annoying. Remember the example from Part III about how you successfully predicted away the feeling of the shirt on your back, and so manage never to think about it when you’re trying to concentrate on more important things? Autistic people can’t do that as well. Even though they have a layer in their brain predicting “will continue to feel shirt”, the prediction is too precise; it predicts that next second, the shirt will produce exactly the same pattern of sensations it does now. But realistically as you move around or catch passing breezes the shirt will change ever so slightly – at which point autistic people’s brains will send alarms all the way up to consciousness, and they’ll perceive it as “my shirt is annoying”.

Or consider the classic autistic demand for routine, and misery as soon as the routine is disrupted. Because their brains can only make very precise predictions, the slightest disruption to routine registers as strong surprisal, strong prediction failure, and “oh no, all of my models have failed, nothing is true, anything is possible!” Compare to a neurotypical person in the same situation, who would just relax their confidence intervals a little bit and say “Okay, this is basically 99% like a normal day, whatever”. It would take something genuinely unpredictable – like being thrown on an unexplored continent or something – to give these people the same feeling of surprise and unpredictability.

This model also predicts autistic people’s strengths. We know that polygenic risk for autism is positively associated with IQ. This would make sense if the central feature of autism was a sort of increased mental precision. It would also help explain why autistic people seem to excel in high-need-for-precision areas like mathematics and computer programming.

11. Schizophrenia. Converging lines of research suggest this also involves weak priors, apparently at a different level to autism and with different results after various compensatory mechanisms have had their chance to kick in. One especially interesting study asked neurotypicals and schizophrenics to follow a moving light, much like the airplane video in Part III above. When the light moved in a predictable pattern, the neurotypicals were much better at tracking it; when it was a deliberately perverse video specifically designed to frustrate expectations, the schizophrenics actually did better. This suggests that neurotypicals were guided by correct top-down priors about where the light would be going; schizophrenics had very weak priors and so weren’t really guided very well, but also didn’t screw up when the light did something unpredictable. Schizophrenics are also famous for not being fooled by the “hollow mask” (below) and other illusions where top-down predictions falsely constrain bottom-up evidence. My guess is they’d be more likely to see both ‘the’s in the “PARIS IN THE THE SPRINGTIME” image above.

The exact route from this sort of thing to schizophrenia is really complicated, and anyone interested should check out Section 2.12 and the whole of Chapter 7 from the book. But the basic story is that it creates waves of anomalous prediction error and surprisal, leading to the so-called “delusions of significance” where schizophrenics believe that eg the fact that someone is wearing a hat is some sort of incredibly important cosmic message. Schizophrenics’ brains try to produce hypotheses that explain all of these prediction errors and reduce surprise – which is impossible, because the prediction errors are random. This results in incredibly weird hypotheses, and eventually in schizophrenic brains being willing to ignore the bottom-up stream entirely – hence hallucinations.

All this is treated with antipsychotics, which antagonize dopamine, which – remember – represents confidence level. So basically the medication is telling the brain “YOU CAN IGNORE ALL THIS PREDICTION ERROR, EVERYTHING YOU’RE PERCEIVING IS TOTALLY GARBAGE SPURIOUS DATA” – which turns out to be exactly the message it needs to hear.

An interesting corollary of all this – because all of schizophrenics’ predictive models are so screwy, they lose the ability to use the “adjust away the consequences of your own actions” hack discussed in Part 5 of this section. That means their own actions don’t get predicted out, and seem like the actions of a foreign agent. This is why they get so-called “delusions of agency”, like “the government beamed that thought into my brain” or “aliens caused my arm to move just now”. And in case you were wondering – yes, schizophrenics can tickle themselves.

12. Everything else. I can’t possibly do justice to the whole of Surfing Uncertainty, which includes sections in which it provides lucid and compelling PP-based explanations of hallucinations, binocular rivalry, conflict escalation, and various optical illusions. More speculatively, I can think of really interesting connections to things like phantom limbs, creativity (and its association with certain mental disorders), depression, meditation, etc, etc, etc.

The general rule in psychiatry is: if you think you’ve found a theory that explains everything, diagnose yourself with mania and check yourself into the hospital. Maybe I’m not at that point yet – for example, I don’t think PP does anything to explain what mania itself is. But I’m pretty close.

IV.

This is a really poor book review of Surfing Uncertainty, because I only partly understood it. I’m leaving out a lot of stuff about the motor system, debate over philosophical concepts with names like “enactivism”, descriptions of how neurons form and unform coalitions, and of course a hundred pages of apologia along the lines of “this may not look embodied, but if you squint you’ll see how super-duper embodied it really is!”. As I reread and hopefully come to understand some of this better, it might show up in future posts.

But speaking of philosophical debates, there’s one thing that really struck me about the PP model.

Voodoo psychology suggests that culture and expectation tyrannically shape our perceptions. Taken to an extreme, objective knowledge is impossible, since all our sense-data is filtered through our own bias. Taken to a very far extreme, we get things like What The !@#$ Do We Know?‘s claim that the Native Americans literally couldn’t see Columbus’ ships, because they had no concept of “caravel” and so the percept just failed to register. This sort of thing tends to end by arguing that science was invented by straight white men, and so probably just reflects straight white maleness, and so we should ignore it completely and go frolic in the forest or something.

Predictive processing is sympathetic to all this. It takes all of this stuff like priming and the placebo effect, and it predicts it handily. But it doesn’t give up. It (theoretically) puts it all on a sound mathematical footing, explaining exactly how much our expectations should shape our reality, and in which ways our expectation should shape our reality. I feel like someone armed with predictive processing and a bit of luck should have been able to predict that placebo effect and basic priming would work, but stereotype threat and social priming wouldn’t. Maybe this is total retrodictive cheating. But I feel like it should be possible.

If this is true, it gives us more confidence that our perceptions should correspond – at least a little – to the external world. We can accept that we may be misreading “PARIS IN THE THE SPRINGTIME” while remaining confident that we wouldn’t misread “PARIS IN THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE THE SPRINGTIME” as containing only one “the”. Top-down processing very occasionally meddles in bottom-up sensation, but (as long as you’re not schizophrenic), it sticks to an advisory role rather than being able to steamroll over arbitrary amounts of reality.

The rationalist project is overcoming bias, and that requires both an admission that bias is possible, and a hope that there’s something other than bias which we can latch onto as a guide. Predictive processing gives us more confidence in both, and helps provide a convincing framework we can use to figure out what’s going on at all levels of cognition.

Highlights From The Comments On My IRB Nightmare

Many people took My IRB Nightmare as an opportunity to share their own IRB stories. From an emergency medicine doctor, via my inbox:

Thanks for the great post about IRBs. I lived the same absurd nightmare in 2015-2016, as an attending, and it’s amazing how your experience matches my own, despite my being in Canada.

One of our residents had an idea for an extremely simple physiological study of COPD exacerbations, where she’d basically look at the patient and monitor his RR, saturation, exhaled CO2 temporal changes during initial treatment. Just as you were, I was really naive back in 2015, and expected we wouldn’t even a consent form, since she didn’t even have to *talk* to the patients, much less perform any intervention. Boy I was wrong ! The IRB, of course, insisted on a two-page consent form discussing risks and benefits of the intervention, and many other forms. I had to help her file over 300 pages (!) of various forms. Just as in your case, we had to abandon the study when, two years after the first contact with the IRB, they suggested hilarious “adjustments” to the study protocol “in order to mitigate possible risks”.

From baj2235 on the subreddit:

Currently working in a brand new lab, so one would think I’d have a lot to do. Instead, thus far my job has consisted of sitting in an empty room coming up with increasingly unlikely hypotheses that will probably never be tested because our IRB hasn’t approve our NOU (Notice of use) forms. For those who don’t know, NOUs are essentially 15 page forms that say “We study these this, and we promise to be super responsible while studying it.” We have 4 currently awaiting approval, submitted in May. The reason they aren’t approved yet? The IRB hasn’t met since June, and likely won’t meet again this month because of frickin’ Harvey. Which in essence means the fine American taxpayer has essentially been paying me to sit in a room and twiddle my thumbs for the past 3-months because I can’t even grow E. coli without a frickin’ NOU.

From Garrett in the comments:

Oh, dear! I’ve actually been through this. I work in tech, but volunteer in EMS. As a part of wanting to advance the profession of EMS I figured I’d take on a small study. It would be a retrospective study about how well paramedics could recognize diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) in comparison to ER doctors. […]

I had to do the “I am not a Nazi” training as well. In order to pass that, I had to be able to recite the FDA form number used as a part of new implantable medical device investigations. I wasn’t looking at a new device. I wasn’t looking at an old device. I was going to look at pairs of medical records and go “who correctly identified the problem?” […]

It’s now ~5 years after IRB and because of all of the headaches of getting the data to someone who isn’t faculty or a doctor, and who doesn’t have a $100k+ grant, I still don’t have my data. I need to send another email. I’m sure we can get an IRB extension with a few more trees sacrificed.

From Katie on Facebook:

I used to work at an fMRI research center and also had to take the Don’t Be a Nazi course!

My favorite story about the annoying IRB regulations is how they insisted on an HCG (pregnancy) test for our volunteers, despite the fact that MRI has no known adverse effect on pregnancy. So, fine, extra caution against an unknown but possible risk, sure.

But they insisted on a *blood test* done days in advance instead of five minute urine dip stick test that *actual doctors offices* would use. You know what doesn’t have risks? Peeing in a cup. And what does have risks of fainting, infection, collapsing a vein, etc? A blood draw.

Of course, we had an extra consent form for them to sign, about the risks of the blood draw the IRB was helpfully insisting on.

From Hirsin on Hacker News:

My freshman year of college I proposed a study to our hospitals IRB to strap small lasers to three week old infants in an effort to measure concentrations of a chemical in their blood. The most frustrating part was not the arcane insistence on ink and bolded study names, but the hardline insistence that it was impossible (illegal) to test the device before getting IRB approval – even on ourselves. Meaning that without any calibration or testing, our initial study would likely come back with poor results or be a dud, but we couldn’t find out until we filled out all the paperwork.

What is our country coming to when you can’t even attach lasers to babies anymore?

Some of the other stories were kind of cute. Dahud in the comments:

I’ve had exactly one interaction with an IRB – in 6th grade. My science fair project involved studying the health risks of Communion as performed in the Episcopal church. (For those unfamiliar, a priest lifts a silver chalice of port wine to your lips, you take a small sip, and the priest wipes the site with a linen cloth and rotates the chalice.)

Thing was, the science fair was being held by a Baptist University. The IRB was really not fond of the whole wine thing. They wanted me to use grape juice instead, in the Baptist fashion. I, as a minor, shouldn’t be allowed anywhere near the corrupting influence of the communion wine that I had partaken of last Sunday.

Of course, the use of communion wine was essential to the study, so we reached a compromise. I would thoroughly document all the sample collection and preparation procedures, and let someone of age carry out the experiment while I waited in the hall.

And of course James Miller is still James Miller:

Several forms I have to sign to do things at my college ask if what I will be doing will expose anyone to radiation. Although I’m an economist, this has caused me to think of experiments I could do with radiation such as secretly exposing a large number of students to radiation and seeing, years later, if it influences their income.

Along with these, a lot of other people were broadly sympathetic but thought that if I knew how to play the system a little better, or was somewhere a little more research-focused, things might have gone better for me. Virgil in the comments:

FWIW, I’m a graduate student in the Social Sciences. Our IRBs have the same rules on paper, but we get around it by using generic versions of applications with the critical info swapped out, or just ignoring them altogether. Though we don’t have to face audits, so…I’ve found that usually if you make one or two glaring errors in the application on purpose, the IRB will be happy to inform you of those and approve it when you correct them. They just want to feel powerful / like they’re making a difference, so if you oblige them they will usually let you through with no further hassle.

From Eternaltraveler in the comments:

Most of the bureaucracy you experienced is institutional and not regulatory. I have done research both in an institutional setting (turn around time at UC Berkeley=5 months to obtain ethics approval and countless hours sucking up to self important bureaucrats who think it’s their sacred duty to grind potentially life saving research to a halt over trivia they themselves know is meaningless), and as an entrepreneur and PI at a biotech startup (turn around time for outsourced IRB=5 days with reasonable and informed questions related to participants well being), where we also do quite a bit more than ask questions. FYI the kind of research I did at UC Berkeley that took 5 months for approval has absolutely no regulatory requirements outside of it.

And from PM_ME_YOUR_FRAME on the subreddit (who I might hunt down and beg to be my research advisor if I ever do anything like this again):

Amateur. What you do is you sweet talk the clinicians into using their medical judgement to adopt the form as part of their routine clinical practice and get them to include it as part of the patient’s medical records. Later… you approach the IRB for a retrospective chart review study and get blessed with waived consent. Bonus: very likely to also get expedited review.

And this really thorough comment from friendlygrantadmit:

I’m not an expert in IRB (although that’s kind of my point–getting to that), but I think your headaches were largely institutional rather than dictated by government fiat. Let me explain…

I used to be the grant administrator for a regional university while my husband was a postdoc at the large research university 20 miles away. Aside from fiscal stuff, I was the grants office, and the grants office was me. However, there was an IRB of longstanding duration, so I never had to do much other than connect faculty whose work might involve human subjects with the IRB Chair. I think I was technically a non-voting member or something, but no one expected me to attend meetings.

This was in the process of changing when I left the university because my husband’s postdoc ended and we moved. It was a subject that generated much bitterness among the small cadre of faculty involved. Because I was on my way out, I never made it my business to worry about nascent IRB woes. My understanding was that they had difficulty getting people to serve on the IRB because it was an unpaid position, but as the university expanded, they were going to need more and different types of expertise represented on the IRB. I can’t be more specific than that without basically naming the university, at which I was very happy and with which I have no quarrel. I never heard any horror stories about our IRB, and I would have been the first point person to hear the them, so I presume it was fairly easy to work with.

Anyway, the IRB auditing stuff you outline is just insane. The institutional regulations pertaining to the audits were probably what generated the mind-numbing and arcane complexity of your institution’s IRB. Add in finicky personalities and you have a recipe for endless hassle as described.

So here’s the other thing to bear in mind: almost everyone in research administration is self-trained. I think there are a few programs (probably mostly online), but it’s the sort of field that people stumble into from related fields. You learn on the job and via newsletters, conferences, and listservs. You also listen to your share of mind-numbing government webinars. But almost everyone–usually including the federal program officers, who are usually experts in their field but who aren’t necessarily experts in their own particular bureaucracy–is just winging it.

Most research admins are willing to admit the “winging it” factor among themselves. For obvious reasons, however, you want the faculty and/or researchers with whom you interact to respect your professional judgment. This was never a problem at my institution, which is probably one reason I still have a high opinion of it and its administration, but I heard plenty (PLENTY) of stories of bigshot faculty pulling rank to have the rules and regulations bent or broken in their favor because GRANT MONEY, usually with success. So of course you’re not going to confess that you don’t really have a clue what you’re doing; you’re just puzzling over these regulations like so many tea leaves and trying to make a reasonable judgment based on your status as a reasonably well-educated and fair-minded human being.

What this means in practice is almost zero uniformity in the field. Your IRB from hell story wasn’t even remotely shocking to me. Other commenters’ IRB from just-fine-ville stories are also far from shocking. Since so few people really understand what the regulations mean or how to interpret them, let alone how to protect against government bogeymen yelling at you failing to follow them, there is a wild profusion of institutional approaches to research administration, and this includes huge variations in concern for the more fine-grained regulatory details. It is really hard to find someone to lead a grants or research administration office who has expertise in all the varied fields of compliance now required. It’s hard to find someone with the expertise in any of the particular fields, to be honest.

There is one area in which this is not so much true, and that is financial regulations. Why? Well, for one thing, they’re not all that tricky–I could read and interpret them with far greater confidence than many other regs, despite having a humanities background. The other reason is that despite their comparative transparency, they were very, very widely flouted until the government started auditing large research institutions around 15-ish years ago.

I have a short story related to that, too–basically, when my husband started grad school, we would frequently go out to dinner with his lab group and advisor. The whole tab, including my dinner and that of any other SOs and all alcoholic beverages (which can’t be paid for with grant funds aside from narrow research-related exceptions), would be charged to whichever research grant because it was a working meal. I found it mildly surprising, but I certainly wasn’t going to argue.

Then the university got audited and fined millions of dollars for violations such as these and Found Religion vis-à-vis grant expenditures.

With regards to your story, I’m guessing that part of the reason the IRB is such a big deal is that human subjects research is the main type of research, so they are really, really worried about their exposure to any IRB lapses. However, it sounds like they are fairly provincial in that they aren’t connected to what more major research institutions are doing or how they handle these issues, which is always a mistake. Even if you don’t think some other institution’s approach is going to work for you, it’s good to know about as many different approaches as you can to know that you’re not some insane outlier as your IRB seems to be. As others have noted, it also sounds like that IRB has become the fiefdom of some fairly difficult personalities.

I already know how extensive, thorough, and helpful training pertaining to IRB regs is, which is not very. I remain deeply curious about the qualifications and training of your obviously well-intentioned “auditor.” My guess is she inherited her procedures from someone else and is carefully following whatever checklist was laid down so as not to expose herself to accusations of sloppiness or lack of thoroughness … but that is only a guess.

Even though I hate hearing stories like yours–there is obviously no excuse for essentially trying to thwart any and all human subjects research the way your IRB did–I am sympathetic to the need for some regulations, and not just because of Nazis and the Tuskeegee Syphilis experiments. I’m sympathetic because lack of oversight basically gives big name researchers carte blanche to ignore regulations they find inconvenient because the institutional preference, barring opposing headwinds, will always be to keep researchers happy.

Some people thought I was being too flippant, or leaving out parts of the story. Many of them mentioned that the focus on Nazis overshadowed some genuinely horrific all-American research misconduct like the Tuskegee Syphilis Experiment. They emphasized that my personal experience doesn’t overrule all of the really important reasons IRBs exist. For example, tedwick from the subreddit:

So, I wrote out all of the ways in which Scott’s terrible IRB experience was at least in part self-imposed, and how a lot of the post was about stuff that’s pretty straightforward, but it was kind of a snarky comment. Not unlike his post, but you know, whatever. Long story short, I’ve done similar work (arranged a really simple survey looking at dietary behaviors in kids, another IRB-protected group) and had to interface with the IRB frequently. Yep, it can be annoying at times. But the reason they ask people like Scott whether they’re going to try anything funny with prisoners is because sometimes people like Scott are trying something funny with prisoners. Just because Scott swears that he’s not Mengele doesn’t mean that he’s not going to do something dumb a priori. As his experience with expedited review might indicate, sitting down with an IRB officer for maybe 30 minutes would have cleared up a lot of things on both sides.

Is there room for IRB reform? Sure! Let’s make the easy stuff easy, and let’s make sure IRB intervention is on actual substance. I’m with him on this. However, a lot of the stuff Scott is complaining about doesn’t fall into that category (e.g. “why do all the researchers have to be on the IRB!?”). I get that the post was probably cathartic for Scott to write, but there are plenty of great researchers who are able to navigate this stuff without all the drama. “Bureaucracy Bad” is a fine rallying cry and all that, but most of the stuff Scott is complaining about is not all that hard and there for a reason.

And kyleboddy from the comments:

Nazism isn’t the reason IRBs exist. Far worse. American unethical experimentation is, and omitting it is a huge error. Massive and bureaucratic oversight exists because American scientists would stop at nothing to advance the field of science.

The Tuskegee Syphilis Experiment is the landmark case on why ethical training and IRB approval is required. You should know this. This was 100% covered in your ethical training.

I get why IRB approval sucks. My Informed Consent forms get banged all the time. But we’re talking about consent here, often with disadvantaged populations. It pays to be careful.

Last, most researchers who need speed and expedited review go through private IRB organizations now because the bureaucracy of medical/university systems is too much to handle. Our private IRB that we engage with sends back our forms within a week and their fees are reasonable. Their board meets twice per week, not once per month. The market has solved at least this particular issue.

EDIT: Private IRBs do not care about nonsensical stuff like the Principal Investigator having an advanced degree or being someone high of stature. (For example, I am a college dropout and have had multiple IRB studies approved.) Only bureaucratic, publicly-attached ones do. That’s a very reasonable complaint.

A lot of these are good points. And some of what I wrote was definitely unfair snark – I understand they’ve got to ask you whether you plan on removing anyone’s organs; if they don’t ask, how will they know? And maybe linking to Schneider’s book about eliminating the IRB system was a mistake – I just meant to show there was an existing conversation about this. I definitely didn’t mean to trivialize Tuskegee, to say that I am a radical Scheiderian, to act like my single experience damns all IRBs forever, or to claim that IRBs can’t possibly have a useful role to play. I haven’t even begun to wade into the debate between the critics and proponents of the system. The point I wanted to make was that whether or not IRBs are useful for high-risk studies, they’ve crept annoyingly far into low-risk studies – to the detriment of everyone.

Nobody expects any harm from asking your co-worker “How are you this morning?” in conversation. But if I were to turn this into a study – “Diurnal Variability In Well-Being Among Office Workers” – I would need to hire a whole team of managers just to get through the risk paperwork and the consent paperwork and the weekly reports and the team meetings. I can give a patient twice the standard dose of a dangerous medication without justifying myself to anyone. I can confine a patient involuntarily for weeks and face only the most perfunctory legal oversight. But if I want to ask them “How are you this morning?” and make a study out of it, I need to block off my calendar for the next ten years to do the relevant paperwork.

I feel like I’m protesting a police state, and people are responding “Well, you don’t want total anarchy with murder being legal, do you?” No, I don’t. I think there’s a wide range of possibilities between “police state” and “anarchy”. In the same way, I think there’s a wide range of possibilities between “science is totally unregulated” and “scientists have to complete a mountain of paperwork before they can ask someone how their day is going”.

I dare you to tell me we’re at a happy medium right now. Go on, I dare you.

I regret to say this is only getting worse. New NIH policies are increasingly trying to reclassify basic science as “clinical trials”, requiring more paperwork and oversight. For example, under the new regulations, brain scan research – the type where they ask you to think about something while you’re in an fMRI to see which parts of your brain light up – would be a “clinical trial” since it measures “a health-related biomedical or behavioral outcome”. This could require these studies to meet the same high standards as studies giving experimental drugs or new gene therapies. The Science Magazine article quotes a cognitive neuroscientist:

The agency’s widening definition of clinical trials could sweep up a broad array of basic science studies, resulting in wasted resources and public confusion. “The massive amount of dysfunction and paperwork that will result from this decision boggles the mind” and will hobble basic research.

A bunch of researchers from top universities have written a petition trying to delay the changes (if you’ve got an academic affiliation, you might want to check and consider signing yourself). But it’s anyone’s guess whether they’ll succeed. If not, good luck to any brain researcher who doesn’t want to go through everything I did. They’ll need it.

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Links 8/17: Exsitement

Hackers encode malware that infects DNA sequencing software in a strand of DNA. Make sure to run your family members through an antivirus program before ordering genetic testing.

Every time I feel like I’ve accepted how surprising optical illusions can be, somebody comes out with an even more surprising one that I have to double-check in Photoshop to confirm it’s really illusory.

Effective altruist organizations estimate it may cost about $7,500 in efficient charitable donations to save one life. But the median American believes it only takes about $40. This and more from a survey on charity discussed on 80,000 Hours.

OpenAI creates AI that can beat some of the best human players in a limited version of the complex online multiplayer game DOTA 2. A few days later, Reddit’s DOTA2 community develops strategies for defeating the AIs. Human creativity wins again!

New method of killing bacteria, a “star-shaped polymer [that rips] apart their cell walls” may be a breakthrough in the fight against antibiotic resistance.

Did you know: Pablo Picasso was once questioned by police who suspected he had stolen the Mona Lisa.

Study: Asian-Americans are treated differently due to their weight – ie fat Asians are viewed as more likely to be “real” Americans.

The list of Michigan Department Of Corrections’ list of books prisoners may not read (h/t gabrielthefool). Includes the atlas (providing maps raises escape risk), textbooks on making webpages with HTML (what if they learn to hack?), and all the Dungeons and Dragons manuals (marked as “threat to order and security of institution”, for some reason). “I shouldn’t be astounded at the level of control and dehumanization in such a list, but somehow I am.”

From the jury selection hearings for the Martin Shkreli trial. I refused to believe this was real at first, but I’ve seen it in multiple credible sources and I guess I’m satisfied. And Ross Rheingans-Yoo spoils our fun and reminds us that actually all of this is deeply disappointing.

LiveScience reaches Peak Rat Study: Why Men Love Lingerie: Rat Study Offers Hints. “Just as lingerie turns on human males, tiny jackets do the same for male rats, a new study finds.”

Did you know: Dwayne “The Rock” Johnson’s Twitter was the first source to report on Osama bin Laden’s death.

I assume this is just lawyers amusing themselves, but technically a New Zealand law could disqualify all Australians from serving in their own Parliament.

Annie Dillard’s classic essay on a solar eclipse. I wanted to write something serious and profound about my eclipse experience, but I gave up after realizing there was no way I could match this.

The mountains of Victoria, Australia, include Mount Useful, Mount Disappointment, Mount Terrible, Mount Buggery, and Mount Typo.

Voting system theorists use voting system to systematically vote on voting systems, determine that among 18 options approval voting is best, plurality voting (what the US uses) is worst.

Julia Galef’s List Of Unpopular Ideas About Social Norms. Number 3: “It should not be considered noble to remain anonymous when donating to charity, because publicizing one’s donation encourages other people to donate.”

New Yorker: Is There Any Point To Protesting? This seems like a really important question, especially given how hard it is to trace whether any recent protests have resulted in real change. The article discusses it briefly (and presents some evidence against), but then shifts topics to a less interesting (though still worth reading) tangent about whether modern decentralized protests work worse than 60s-style highly-regimented ones.

I’ve mentioned a bunch of times on here that studies show going to a therapist isn’t necessarily any better than getting a good therapy self-help workbook. Now unsurprisingly a meta-analysis of these studies shows the same thing (paper, popular article).

Just learned 80,000 Hours has a podcast. This week’s topic: pandemic preparedness. I got to talk to some biosecurity researchers at EA Global. The consensus was that we should all be really scared of bioterrorism, but that they can’t explain why – sharing their list of Top Ten Easy Ways To Create A Global Pandemic might not be the best way to promote public safety. If you want to work on this cause and have (or can get) relevant skills, contact 80,000 Hours at the link on their website.

A cartoon from a 1906 newspaper’s Forecasts For 1907 (h/t Steve Omohundro)

I’d previously heard the good news that, even though inequality was rising within developed countries, at least global inequality was on its way down. This good news may no longer be true.

Did you know: Happy, hapless, perhaps, mishap, happen, and haphazard all come from from the same Norse root “hap” – meaning “chance”.

Darktka does a really good nootropics survey – way better than mine – but with mostly expected results. Their tl;dr: “Most substances seem to have no or only slight effects when rated subjectively. Most substances with substantial effects were already well-known for their effects, some of them are prescription drugs or pharmaceuticals.” Do note how selegiline and l-deprenyl often get very different results, sometimes barely within each other’s confidence intervals, despite being different names for the same chemical.

GoogleMemoGate update: Fired memo-sender James Damore has set up a Twitter account at @Fired4Truth with 78,000 followers and is well on his way to receiving $60,000 from crowdfunding. Part of me is optimistic; maybe people will feel less afraid if there’s an expectation that other people will look after them if they’re fired. But another part of me is worried that this creates a strong financial pressure for martyrs to transform themselves into sketchy alt-right-linked celebrities obsessed with being politically incorrect – which will retroactively justify firing them, and leave anyone who defended them with egg on their face. In some ways this is a difficult debate without a clear answer. In other ways – Fired4Truth?! Really?! You really couldn’t think of a less sketchy-sounding brand?!

Related: Quillete has an article by four domain-expert scientists who support some of the Google memo’s claims; their site then gets DDoS-ed and taken down. It seems to be back online now. Remember they’re dependent on reader donations.

Vs. Traffic Court. “Traffic laws are supposed to be about safety. But many of us feel strongly that they’re mostly about money. And in that short trial, I was able to make that point…”

Viral joke going around Chinese Twitter about what they would tell Chairman Mao if he came back today, translated by Matt Schrader.

Finally, AI learns to do something useful: remove watermarks from stock images.

I like Venkatesh Rao’s work, because it gives me a feeling of reading something from way outside my filter bubble. Like it’s by a bass lure expert who writes about bass lures, secure in the knowledge that everyone he’s ever met considers bass lures a central part of their life, and who expects his readers to share a wide stock of bass-lure-related concepts and metaphors. But Rao writes about modern culture from a Bay Area techie perspective, which really ought to be my demographic. I guess filter bubbles extend along more dimensions than I thought. Anyway, everybody’s talking about The Premium Mediocre Life Of Maya Millennial, and people who know more about bass lures than I do assure me it’s really good (it also says nice things about me!)

Spotted Toad: Good And Bad Arguments Against The Obamacare Opiate Effect – ie the claim that some of the increased opiate-related mortality is due to easier access via Obamacare.

Would an ancient Roman dressed in 50s AD clothing look hopelessly out of style to an ancient Roman in the 60s AD? r/AskHistorians on fashion trends in the ancient world.

Big econ study shows that the rates of profit have skyrocketed over the past few decades, adding a twist to standard labor vs. capital narratives. Likely related to monopolies/oligopolies and restriction of competition. Takes from Tyler Cowen, Robin Hanson, Karl Smith, and Noah Smith.

In the aftermath of Hurricane Harvey, cell phone carriers fight the government over proposed changes to emergency alert systems. My position might be biased by my eclipse trip, when the state of Oregon decided it was necessary to send out Statewide Emergency Alerts telling people not to stare at the sun.

Trump’s cybersecurity advisors resign, cite both bad cybersecurity policy and general moral turpitude. Does Trump even have any advisors left at this point?

In some parts of the world, snake oil remains a popular folk treatment, and you can even buy it on Amazon.

I guess I can’t get away without linking McSweeney’s article on Taylor Swifties.

Substances don’t have to be a liquid or a gas to behave as a fluid. For example, have you considered a fluid made of fire ants? (h/t fuckyeahfluiddynamics.tumblr.com)

Samzdat finishes its excellent series on metis, narcissism, and nihilism with a two-post summary/review: The Uruk Machine, The Thresher.

New study in the Lancet (study, popular article) finds that saturated fat in moderation might be good for you, carbs potentially worse. I can’t bring myself to really look into this, but the fundamental questions are always where you started and what you’re trading off against. If someone eats 100% sugar and switches some of their sugar for a little saturated fat from meat, that’s good. If someone eats 100% donuts and switches some of their donuts for a little bit of carbs from fruit, that’s also good. I’m not sure how seriously this study considered these things, but I would warn against taking it as some sort of final “SCIENCE SHOWS FAT GOOD, CARBS BAD, EVERYONE GO HOME NOW.”

QZ: All The Wellness Products Americans Love To Buy Are Sold On Both Infowars and Goop. Infowars is super-Red-Tribe and Goop is super-Blue-Tribe, so it’s fun to compare the way they pitch the same items. See eg the herb advertised on Goop as “Why Am I So Effin’ Tired” vs. on Infowars as “Brain Force Plus”. The former advertises that it “replenishes nutrients you may be lacking..sourced from ancient Ayurveda”, vs. the latter “fights back [against] toxic weapons…with the next generation of advanced neural activation”.

The first written use of the f-word in English is exactly what you expected.

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My IRB Nightmare

[Epistemic status: Pieced together from memory years after the event. I may have mis-remembered some things or gotten them in the wrong order. Aside from that – and the obvious jokes – this is all true. I’m being deliberately vague in places because I don’t want to condemn anything specific without being able to prove anything.]

September 2014

There’s a screening test for bipolar disorder. You ask patients a bunch of things like “Do you ever feel really happy, then really sad?”. If they say ‘yes’ to enough of these questions, you start to worry.

Some psychiatrists love this test. I hate it. Patients will say “Yes, that absolutely describes me!” and someone will diagnose them with bipolar disorder. Then if you ask what they meant, they’d say something like “Once my local football team made it to the Super Bowl and I was really happy, but then they lost and I was really sad.” I don’t even want to tell you how many people get diagnosed bipolar because of stuff like this.

There was a study that supposedly proved this test worked. But parts of it confused me, and it was done on a totally different population that didn’t generalize to hospital inpatients. Also, it said in big letters THIS IS JUST A SCREENING TEST IT IS NOT INTENDED FOR DIAGNOSIS, and everyone was using it for diagnosis.

So I complained to some sympathetic doctors and professors, and they asked “Why not do a study?”

Why not do a study? Why not join the great tradition of scientists, going back to Galileo and Newton, and make my mark on the world? Why not replace my griping about bipolar screening with an experiment about bipolar screening, an experiment done to the highest standards of the empirical tradition, one that would throw the entire weight of the scientific establishment behind my complaint? I’d been writing about science for so long, even doing my own informal experiments, why not move on to join the big leagues?

For (it would turn out) a whole host of excellent reasons that I was about to learn.

A spring in my step, I journeyed to my hospital’s Research Department, hidden in a corner office just outside the orthopaedic ward. It was locked, as always. After enough knocking, a lady finally opened the door and motioned for me to sit down at a paperwork-filled desk.

“I want to do a study,” I said.

She looked skeptical. “Have you done the Pre-Study Training?”

I had to admit I hadn’t, so off I went. The training was several hours of videos about how the Nazis had done unethical human experiments. Then after World War II, everybody met up and decided to only do ethical human experiments from then on. And the most important part of being ethical was to have all experiments monitored by an Institutional Review Board (IRB) made of important people who could check whether experiments were ethical or not. I dutifully parroted all this back on the post-test (“Blindly trusting authority to make our ethical decisions for us is the best way to separate ourselves from the Nazis!”) and received my Study Investigator Certification.

I went back to the corner office, Study Investigator Certification in hand.

“I want to do a study,” I said.

The lady still looked skeptical. “Do you have a Principal Investigator?”

Mere resident doctors weren’t allowed to do studies on their own. They would probably screw up and start building concentration camps or something. They needed an attending (high-ranking doctor) to sign on as Principal Investigator before the IRB would deign to hear their case.

I knew exactly how to handle this: one by one, I sought out the laziest attendings in the hospital and asked “Hey, would you like to have your name on a study as Principal Investigator for free while I do all the actual work?” Yet one by one, all of the doctors refused, as if I was offering them some kind of plague basket full of vermin. It was the weirdest thing.

Finally, there was only one doctor left – Dr. W, the hardest-working attending I knew, the one who out of some weird masochistic impulse took on every single project anyone asked of him and micromanaged it to perfection, the one who every psychiatrist in the whole hospital (including himself) had diagnosed with obsessive-compulsive personality disorder.

“Sure Scott,” he told me. “I’d be happy to serve as your Principal Investigator”.

A feeling of dread in my stomach, I walked back to the tiny corner office.

“I want to do a study,” I said.

The lady still looked skeptical. “Have you completed the New Study Application?” She gestured to one of the stacks of paperwork filling the room.

It started with a section on my research question. Next was a section on my proposed methodology. A section on possible safety risks. A section on recruitment. A section on consent. A section on…wow. Surely this can’t all be the New Study Application? Maybe I accidentally picked up the Found A New Hospital Application?

I asked the lady who worked in the tiny corner office whether, since I was just going to be asking bipolar people whether they ever felt happy and then sad, maybe I could get the short version of the New Study Application?

She told me that was the short version.

“But it’s twenty-two pages!”

“You haven’t done any studies before, have you?”

Rather than confess my naivete, I started filling out the twenty-two pages of paperwork. It started by asking about our study design, which was simple: by happy coincidence, I was assigned to Dr. W’s inpatient team for the next three months. When we got patients, I would give them the bipolar screening exam and record the results. Then Dr. W. would conduct a full clinical interview and formally assess them. We’d compare notes and see how often the screening test results matched Dr. W’s expert diagnosis. We usually got about twenty new patients a week; if half of them were willing and able to join our study, we should be able to gather about a hundred data points over the next three months. It was going to be easy-peasy.

That was the first ten pages or so of the Application. The rest was increasingly bizarre questions such as “Will any organs be removed from participants during this study?” (Look, I promise, I’m not a Nazi).

And: “Will prisoners be used in the study?” (COME ON, I ALREADY SAID I WASN’T A NAZI).

And: “What will you do if a participant dies during this research?” (If somebody dies while I’m asking them whether they sometimes feel happy and then sad, I really can’t even promise so much as “not freaking out”, let alone any sort of dignified research procedure).

And more questions, all along the same lines. I double-dog swore to give everybody really, really good consent forms. I tried my best to write a list of the risks participants were taking upon themselves (mostly getting paper cuts on the consent forms). I argued that these compared favorably to the benefits (maybe doctors will stop giving people strong psychiatric medications just because their football team made the Super Bowl).

When I was done, I went back to the corner office and submitted everything to the Institutional Review Board. Then I sat back and hoped for the best. Like an idiot.

October 2014

The big day arrived. The IRB debated the merits of my study, examined the risks, and…sent me a letter pointing out several irregularities in my consent forms.

IRREGULARITY #1: Consent forms traditionally included the name of the study in big letters where the patient could see it before signing. Mine didn’t. Why not?

Well, because in questionnaire-based psychological research, you never tell the patient what you’re looking for before they fill out the questionnaire. That’s like Methods 101. The name of my study was “Validity Of A Screening Instrument For Bipolar Disorder”. Tell the patient it’s a study about bipolar disorder, and the gig is up.

The IRB listened patiently to my explanation, then told me that this was not a legitimate reason not to put the name of the study in big letters on the consent form. Putting the name of the study on the consent form was important. You know who else didn’t put the name of the study on his consent forms? Hitler.

IRREGULARITY #2: Consent forms traditionally included a paragraph about the possible risks of the study and a justification for why we believed that the benefits were worth the risks. Everyone else included a paragraph about this on our consent forms, and read it to their patients before getting their consent. We didn’t have one. Why not?

Well, for one thing, because all we were doing was asking them whether they felt happy and then sad sometimes. This is the sort of thing that goes on every day in a psychiatric hospital. Heck, the other psychiatrists were using this same screening test, except for real, and they never had to worry about whether it had risks. In the grand scheme of things, this just wasn’t a very risky procedure.

Also, psychiatric patients are sometimes…how can I put this nicely?…a little paranoid. Sometimes you can offer them breakfast and they’ll accuse you of trying to poison them. I had no illusions that I would get every single patient to consent to this study, but I felt like I could at least avoid handing them a paper saying “BY THE WAY, THIS STUDY IS FULL OF RISKS”.

The IRB listened patiently to my explanation, then told me that this was not a legitimate reason not to have a paragraph about risks. We should figure out some risks, then write a paragraph explaining how those were definitely the risks and we took them very seriously. The other psychiatrists who used this test every day didn’t have to do that because they weren’t running a study.

IRREGULARITY #3: Signatures are traditionally in pen. But we said our patients would sign in pencil. Why?

Well, because psychiatric patients aren’t allowed to have pens in case they stab themselves with them. I don’t get why stabbing yourself with a pencil is any less of a problem, but the rules are the rules. We asked the hospital administration for a one-time exemption, to let our patients have pens just long enough to sign the consent form. Hospital administration said absolutely not, and they didn’t care if this sabotaged our entire study, it was pencil or nothing.

The IRB listened patiently to all this, then said that it had to be in pen. You know who else had people sign consent forms in pencil…?

I’m definitely not saying that these were the only three issues the IRB sprung on Dr. W and me. I’m saying these are a representative sample. I’m saying I spent several weeks relaying increasingly annoyed emails and memos from myself to Dr. W to the IRB to the lady in the corner office to the IRB again. I began to come home later in the evening. My relationships suffered. I started having dreams about being attacked by giant consent forms filled out in pencil.

I was about ready to give up at this point, but Dr. W insisted on combing through various regulations and talking to various people, until he discovered some arcane rule that certain very safe studies with practically no risk were allowed to use an “expedited consent form”, which was a lot like a normal consent form but didn’t need to have things like the name of the study on it. Faced with someone even more obsessive and bureaucratic than they were, the IRB backed down and gave us preliminary permission to start our study.

The next morning, screening questionnaire in hand, I showed up at the hospital and hoped for the best. Like an idiot.

November 2014

Things progressed slowly. It turns out a lot of psychiatric inpatients are either depressed, agitated, violent, or out of touch with reality, and none of these are really conducive to wanting to participate in studies. A few of them already delusionally thought we were doing experiments on them, and got confused when we suddenly asked them to consent. Several of them made it clear that they hated us and wanted to thwart us in any way possible. After a week, I only had three data points, instead of the ten I’d been banking on.

“Data points” makes it sound abstract. It wasn’t. I had hoped to put the results in the patients’ easily accessible online chart, the same place everyone else put the results of the exact same bipolar screening test when they did it for real. They would put it in a section marked TEST RESULTS, which was there to have a secure place where you could put test results, and where everybody’s secure test results were kept.

The IRB would have none of this. Study data are Confidential and need to be kept Secure. Never mind that all the patients’ other secure test results were on the online chart. Never mind that the online chart contains all sorts of stuff about the patients’ diagnoses, medications, hopes and fears, and even (remember, this is a psych hospital) secret fetishes and sexual perversions. Study data needed to be encrypted, then kept in a Study Binder in a locked drawer in a locked room that nobody except the study investigators had access to.

The first problem was that nobody wanted to give us a locked room that nobody except us had access to. There was a sort of All Purpose Psychiatry Paperwork room, but the janitors went in to clean it out every so often, and apparently this made it unacceptable. Hospitals aren’t exactly drowning in spare rooms that not even janitors can get into. Finally Dr. W grudgingly agreed to keep it in his office. This frequently meant I couldn’t access any of the study material because Dr. W was having important meetings that couldn’t be interrupted by a resident barging into his office to rummage in his locked cabinets.

But whatever. The bigger problem was the encryption. There was a very specific way we had to do it. We would have a Results Log, that said things like “Patient 1 got a score of 11.5 on the test”. And then we’d have a Secret Patient Log, which would say things like “Patient 1 = Bob Johnson from Oakburg.” That way nobody could steal our results and figure out that Bob was sometimes happy, then sad.

(meanwhile, all of Bob’s actual diagnoses, sexual fetishes, etc were in the easily-accessible secure online chart that we were banned from using)

And then – I swear this is true – we had to keep the Results Log and the Secret Patient Log right next to each other in the study binder in the locked drawer in the locked room.

I wasn’t sure I was understanding this part right, so I asked Dr. W whether it made sense, to him, that we put a lot of effort writing our results in code, and then put the key to the code in the same place as the enciphered text. He cheerfully agreed this made no sense, but said we had to do it or else our study would fail an audit and get shut down.

January 2015

I’d planned to get a hundred data points in three months. Thanks to constant bureaucratic hurdles, plus patients being less cooperative than I expected, I had about twenty-five. Now I was finishing my rotation on Dr. W’s team and going to a clinic far away. What now?

A bunch of newbies were going to be working with Dr. W for the next three months. I hunted them down and threatened and begged them until one of them agreed to keep giving patients the bipolar screening test in exchange for being named as a co-author. Disaster averted, I thought. Like an idiot.

Somehow news of this arrangement reached the lady in the corner office, who asked whether the new investigator had completed her Pre-Study Training. I protested that she wasn’t designing the study, she wasn’t conducting any analyses, all she was doing was asking her patients the same questions that she would be asking them anyway as part of her job for the next three months. The only difference was that she was recording them and giving them to me.

The lady in the corner office wasn’t impressed. You know who else hadn’t thought his lackeys needed to take courses in research ethics?

So the poor newbie took a course on how Nazis were bad. Now she could help with the study, right?

Wrong. We needed to submit a New Investigator Form to the IRB and wait for their approval.

Two and a half months later, the IRB returned their response: Newbie was good to go. She collected data for the remaining two weeks of her rotation with Dr. W before being sent off to another clinic just like I was.

July 2015

Dr. W and I planned ahead. We had figured out which newbies would be coming in to work for Dr. W three months ahead of time, and gotten them through the don’t-be-a-Nazi course and the IRB approval process just in time for them to start their rotation. Success!

Unfortunately, we received another communication from the IRB. Apparently we were allowed to use the expedited consent form to get consent for our study, but not to get consent to access protected health information. That one required a whole different consent form, list-of-risks and all. We were right back where we’d started from.

I made my case to the Board. My case was: we’re not looking at any protected health information, f@#k you.

The Board answered that we were accessing the patient’s final diagnosis. It said right in the protocol, we were giving them the screening test, then comparing it to the patient’s final diagnosis. “Psychiatric diagnosis” sure sounds like protected health information.

I said no, you don’t understand, we’re the psychiatrists. Dr. W is the one making the final diagnosis. When I’m on Dr. W’s team, I’m in the room when he does the diagnostic interview, half the time I’m the one who types the final diagnosis into the chart. These are our patients.

The Board said this didn’t matter. We, as the patient’s doctors, would make the diagnosis and write it down on the chart. But we (as study investigators) needed a full signed consent form before we were allowed to access the diagnosis we had just made.

I said wait, you’re telling us we have to do this whole bureaucratic rigamarole with all of these uncooperative patients before we’re allowed to see something we wrote ourselves?

The Board said yes, exactly.

I don’t remember this part very well, except that I think I half-heartedly trained whichever poor newbie we were using that month in how to take a Protected Health Information Consent on special Protected Health Information Consent Forms, and she nodded her head and said she understood. I think I had kind of clocked out at this point. I was going off to work all the way over in a different town for a year, and I was just sort of desperately hoping that Dr. W and various newbies would take care of things on their own and then in a year when I came back to the hospital I would have a beautiful pile of well-sorted data to analyze. Surely trained doctors would be able to ask simple questions from a screening exam on their own without supervision, I thought. Like an idiot.

July 2016

I returned to my base hospital after a year doing outpatient work in another town. I felt energized, well-rested, and optimistic that the bipolar screening study I had founded so long ago had been prospering in my absence.

Obviously nothing remotely resembling this had happened. Dr. W had vaguely hoped that I was taking care of it. I had vaguely hoped that Dr. W was taking care of it. The various newbies whom we had strategically enlisted had either forgotten about it, half-heartedly screened one or two patients before getting bored, or else mixed up the growing pile of consent forms and releases and logs so thoroughly that we would have to throw out all their work. It had been a year and a half since the study had started, and we had 40 good data points.

The good news was that I was back in town and I could go back to screening patients myself again. Also, we had some particularly enthusiastic newbies who seemed really interested in helping out and getting things right. Over the next three months, our sample size shot up, first to 50, then to 60, finally to 70. Our goal of 100 was almost in sight. The worst was finally behind me, I hoped. Like an idiot.

November 2016

I got an email saying our study was going to be audited.

It was nothing personal. Some higher-ups in the nationwide hospital system had decided to audit every study in our hospital. We were to gather all our records, submit them to the auditor, and hope for the best.

Dr. W, who was obsessive-compulsive at the best of times, became unbearable. We got into late-night fights over the number of dividers in the study binder. We hunted down every piece of paper that had ever been associated with anyone involved in the study in any way, and almost came to blows over how to organize it. I started working really late. My girlfriend began to doubt I actually existed.

The worst part was all the stuff the newbies had done. Some of them would have the consent sheets numbered in the upper left-hand-corner instead of the upper-right-hand corner. Others would have written the patient name down on the Results Log instead of the Secret Code Log right next to it. One even wrote something in green pen on a formal study document. It was hopeless. Finally we just decided to throw away all their data and pretend it had never existed.

With that decision made, our work actually started to look pretty good. As bad as it was working for an obsessive-compulsive boss in an insane bureaucracy, at least it had the advantage that – when nitpicking push came to ridiculous shove – you were going to be super-ready to be audited. I hoped. Like an idiot.

December 2016

The auditor found twenty-seven infractions.

She was very apologetic about it. She said that was actually a pretty good number of infractions for a study this size, that we were actually doing pretty well compared to a lot of the studies she’d seen. She said she absolutely wasn’t going to shut us down, she wasn’t even going to censure us. She just wanted us to make twenty-seven changes to our study and get IRB approval for each of them.

I kept the audit report as a souvenier. I have it in front of me now. Here’s an example infraction:

The data and safety monitoring plan consists of ‘the Principal Investigator will randomly check data integrity’. This is a prospective study with a vulnerable group (mental illness, likely to have diminished capacity, likely to be low income) and, as such, would warrant a more rigorous monitoring plan than what is stated above. In addition to the above, a more adequate plan for this study would also include review of the protocol at regular intervals, on-going checking of any participant complaints or difficulties with the study, monitoring that the approved data variables are the only ones being collected, regular study team meetings to discuss progress and any deviations or unexpected problems. Team meetings help to assure participant protections, adherence to the protocol. Having an adequate monitoring plan is a federal requirement for the approval of a study. See Regulation 45 CFR 46.111 Criteria For IRB Approval Of Research. IRB Policy: PI Qualifications And Responsibility In Conducting Research. Please revise the protocol via a protocol revision request form. Recommend that periodic meetings with the research team occur and be documented.

Among my favorite other infractions:

1. The protocol said we would stop giving the screening exam to patients if they became violent, but failed to rigorously define “violent”.

2. We still weren’t educating our patients enough about “Alternatives To Participating In This Study”. The auditor agreed that the only alternative was “not participating in this study”, but said that we had to tell every patient that, then document that we’d done so.

3. The consent forms were still getting signed in pencil. We are never going to live this one down. If I live to be a hundred, representatives from the IRB are going to break into my deathbed room and shout “YOU LET PEOPLE SIGN CONSENT FORMS IN PENCIL, HOW CAN YOU JUSTIFY THAT?!”

4. The woman in the corner office who kept insisting everybody take the Pre-Study Training…hadn’t taken the Pre-Study Training, and was therefore unqualified to be our liaison with the IRB. I swear I am not making this up.

Faced with submitting twenty-seven new pieces of paperwork to correct our twenty-seven infractions, Dr. W and I gave up. We shredded the patient data and the Secret Code Log. We told all the newbies they could give up and go home. We submitted the Project Closure Form to the woman in the corner office (who as far as I know still hasn’t completed her Pre-Study Training). We told the IRB that they had won, fair and square; we surrendered unconditionally.

They didn’t seem the least bit surprised.

August 2017

I’ve been sitting on this story for a year. I thought it was unwise to publish it while I worked for the hospital in question. I still think it’s a great hospital, that it delivers top-notch care, that it has amazing doctors, that it has a really good residency program, and even that the Research Department did everything it could to help me given the legal and regulatory constraints. I don’t want this to reflect badly on them in any way. I just thought it was wise to wait a year.

During that year, Dr. W and I worked together on two less ambitious studies, carefully designed not to require any contact with the IRB. One was a case report, the other used publicly available data.

They won 1st and 2nd prize at a regional research competition. I got some nice certificates for my wall and a little prize money. I went on to present one of them at the national meeting of the American Psychiatric Association, a friend helped me write it up formally, and it was recently accepted for publication by a medium-tier journal.

I say this not to boast, but to protest that I’m not as much of a loser as my story probably makes me sound. I’m capable of doing research, I think I have something to contribute to Science. I still think the bipolar screening test is inappropriate for inpatient diagnosis, and I still think that patients are being harmed by people’s reliance on it. I still think somebody should look into it and publish the results.

I’m just saying it’s not going to be me. I am done with research. People keep asking me “You seem really into science, why don’t you become a researcher?” Well…

I feel like a study that realistically could have been done by one person in a couple of hours got dragged out into hundreds of hours of paperwork hell for an entire team of miserable doctors. I think its scientific integrity was screwed up by stupid requirements like the one about breaking blinding, and the patients involved were put through unnecessary trouble by being forced to sign endless consent forms screaming to them about nonexistent risks.

I feel like I was dragged almost to the point of needing to be in a psychiatric hospital myself, while my colleagues who just used the bipolar screening test – without making the mistake of trying to check if it works – continue to do so without anybody questioning them or giving them the slightest bit of aggravation.

I feel like some scientists do amazingly crappy studies that couldn’t possibly prove anything, but get away with it because they have a well-funded team of clerks and secretaries who handle the paperwork for them. And that I, who was trying to do everything right, got ground down with so many pointless security-theater-style regulations that I’m never going to be able to do the research I would need to show they’re wrong.

In the past year or so, I’ve been gratified to learn some other people are thinking along the same lines. Somebody linked me to The Censor’s Hand, a book by a law/medicine professor at the University of Michigan. A summary from a review:

Schneider opens by trying to tally the benefits of IRB review. “Surprisingly,” he writes, a careful review of the literature suggests that “research is not especially dangerous. Some biomedical research can be risky, but much of it requires no physical contact with patients and most contact cannot cause serious injury. Ill patients are, if anything, safer in than out of research.” As for social-science research, “its risks are trivial compared with daily risks like going online or on a date.”

Since the upsides of IRB review are likely to be modest, Schneider argues, it’s critical to ask hard questions about the system’s costs. And those costs are serious. To a lawyer’s eyes, IRBs are strangely unaccountable. They don’t have to offer reasons for their decisions, their decisions can’t be appealed, and they’re barely supervised at the federal level. That lack of accountability, combined with the gauzy ethical principles that govern IRB deliberations, is a recipe for capriciousness. Indeed, in Schneider’s estimation, IRBs wield coercive government power—the power to censor university research—without providing due process of law.

And they’re not shy about wielding that power. Over time, IRB review has grown more and more intrusive. Not only do IRBs waste thousands of researcher hours on paperwork and elaborate consent forms that most study participants will never understand. Of greater concern, they also superintend research methods to minimize perceived risks. Yet IRB members often aren’t experts in the fields they oversee. Indeed, some know little or nothing about research methods at all.

IRBs thus delay, distort, and stifle research, especially research on vulnerable subgroups that may benefit most from it. It’s hard to precise about those costs, but they’re high: after canvassing the research, Schneider concludes that “IRB regulation annually costs thousands of lives that could have been saved, unmeasurable suffering that could have been softened, and uncountable social ills that could have been ameliorated.”

This view seems to be growing more popular lately, and has gotten support from high-profile academics like Richard Nisbett and Steven Pinker:

And there’s been some recent reform, maybe. The federal Office for Human Research Protections made a vague statement that perhaps studies that obviously aren’t going to hurt anybody might not need the full IRB treatment. There’s still a lot of debate about how this will be enforced and whether it’s going to lead to any real-life changes. But I’m glad people are starting to think more about these things.

(I’m also glad people are starting to agree that getting rid of a little oversight for the lowest-risk studies is a good compromise, and that we don’t have to start with anything more radical.)

I sometimes worry that people misunderstand the case against bureaucracy. People imagine it’s Big Business complaining about the regulations preventing them from steamrolling over everyone else. That hasn’t been my experience. Big Business – heck, Big Anything – loves bureaucracy. They can hire a team of clerks and secretaries and middle managers to fill out all the necessary forms, and the rest of the company can be on their merry way. It’s everyone else who suffers. The amateurs, the entrepreneurs, the hobbyists, the people doing something as a labor of love. Wal-Mart is going to keep selling groceries no matter how much paperwork and inspections it takes; the poor immigrant family with the backyard vegetable garden might not.

Bureaucracy in science does the same thing: limit the field to big institutional actors with vested interests. No amount of hassle is going to prevent the Pfizer-Merck-Novartis Corporation from doing whatever study will raise their bottom line. But enough hassle will prevent a random psychiatrist at a small community hospital from pursuing his pet theory about bipolar diagnosis. The more hurdles we put up, the more the scientific conversation skews in favor of Pfizer-Merck-Novartis. And the less likely we are to hear little stuff, dissenting voices, and things that don’t make anybody any money.

I’m not just talking about IRBs here. I could write a book about this. There are so many privacy and confidentiality restrictions around the most harmless of datasets that research teams won’t share data with one another (let alone with unaffiliated citizen scientists) lest they break some arcane regulation or other. Closed access journals require people to pay thousands of dollars in subscription fees before they’re allowed to read the scientific literature; open-access journals just shift the burden by requiring scientists to pay thousands of dollars to publish their research. Big research institutions have whole departments to deal with these kinds of problems; unaffiliated people who just want to look into things on their own are out of luck.

And this is happening at the same time we’re becoming increasingly aware of the shortcomings of big-name research. Half of psychology studies fail replication; my own field of psychiatry is even worse. And citizen-scientists and science bloggers are playing a big part in debunking bad research: here I’m thinking especially of statistics bloggers like Andrew Gelman and Daniel Lakens, but there are all sorts of people in this category. And both Gelman and Lakens are PhDs with institutional affiliations – “citizen science” doesn’t mean random cavemen who don’t understand the field – but they’re both operating outside their day job, trying to contribute a few hours per project instead of a few years. I know many more people like them – smart, highly-qualified, but maybe not going to hire a team of paper-pushers and spend thousands of dollars in fees in order to say what they have to say. Even now these people are doing great work – but I can’t help but feel like more is possible.

IRB overreach is a small part of the problem. But it’s the part which sunk my bipolar study, a study I really cared about. I’m excited that there’s finally more of a national conversation about this kind of thing, and hopeful that further changes will make scientific efforts easier and more rewarding for the next generation of doctors.

Contra Askell On Moral Offsets

I.

Philosopher Amanda Askell questions the practice of moral offsetting.

Offsetting is where you compensate for a bad thing by doing a good thing, then consider yourself even. For example, an environmentalist takes a carbon-belching plane flight, then pays to clean up the same amount of carbon she released.

This can be pretty attractive. If you’re really environmentalist, but also really want to take a vacation to Europe, you could be pretty miserable not knowing whether your vacation is worth the cost to the planet. But if you can calculate that it would take about $70 to clean up more carbon than you release, that’s such a small addition to the overall cost of the trip that you can sigh with relief and take the flight guilt-free.

Or use offsets instead of becoming vegetarian. An typical person’s meat consumption averages 0.3 cows and 40 chickens per year. Animal Charity Evaluators believes that donating to a top animal charity this many animals’ lives for less than $5; others note this number is totally wrong and made up. But it’s hard to believe charities could be less cost-effective than just literally buying the animals; this would fix a year’s meat consumption offset price at around $500. Would I pay between $5 and $500 a year not to have to be a vegetarian? You bet.

Askell is uncomfortable with this concept for the same reasons I was when I first heard about it. Can we kill an enemy, then offset it with enough money to save somebody else’s life? Smash other people’s property, then give someone else enough money to buy different property? Can Bill Gates nuke entire cities for fun, then build better cities somewhere else?

She concludes:

There are a few different things that the harm-based ethicist could say in response to this, however. First, they could point out that as the immorality of the action increases, it becomes far less likely that performing this action and morally offsetting is the best option available, even out of those options that actualists would deem morally relevant. Second, it is very harmful to undermine social norms where people don’t behave immorally and compensate for it (imagine how terrible it would be to live in a world where this was acceptable). Third, it is – in expectation – bad to become the kind of person who offsets their moral harms. Such a person will usually have a much worse expected impact on the world than someone who strives to be as moral as they can be.

I think that these are compelling reasons to think that, in the actual world, we are – at best – morally permitted to offset trivial immoral actions, but that more serious immoral actions are almost always not the sorts of things we can morally offset. But I also think that the fact that these arguments all depend on contingent features of the world should be concerning to those who defend harm-based views in ethics.

I think Askell gets the right answer here – you can offset carbon emissions but not city-nuking. And I think her reasoning sort of touches on some of the important considerations. But I also think there’s a much more elegant theory that gives clear answers to these kinds of questions, and which relieves some of my previous doubts about the offsetting idea.

II.

Everything below is taken from vague concepts philosophers talk about all the time, but which I can’t find a single good online explanation of. I neither deserve credit for anything good about the ideas, nor can avoid blame for any mistakes or confusions in the phrasing. That having been said: consider the distinction between axiology, morality, and law.

Axiology is the study of what’s good. If you want to get all reductive, think of it as comparing the values of world-states. A world-state where everybody is happy seems better than a world-state where everybody is sad. A world-state with lots of beautiful art is better than a world-state containing only featureless concrete cubes. Maybe some people think a world-state full of people living in harmony with nature is better than a world-state full of gleaming domed cities, and other people believe the opposite; when they debate the point, they’re debating axiology.

Morality is the study of what the right thing to do is. If someone says “don’t murder”, they’re making a moral commandment. If someone says “Pirating music is wrong”, they’re making a moral claim. Maybe some people believe you should pull the lever on the trolley problem, and other people believe you shouldn’t; when they debate the point, they’re debating morality.

(this definition elides a complicated distinction between individual conscience and social pressure; fixing that would be really hard and I’m going to keep eliding it)

Law is – oh, come on, you know this one. If someone says “Don’t go above the speed limit, there’s a cop car behind that corner”, that’s law. If someone says “my state doesn’t allow recreational marijuana, but it will next year”, that’s law too. Maybe some people believe that zoning restrictions should ban skyscrapers in historic areas, and other people believe they shouldn’t; when they debate the point, they’re debating law.

These three concepts are pretty similar; they’re all about some vague sense of what is or isn’t desirable. But most societies stop short of making them exactly the same. Only the purest act-utilitarianesque consequentialists say that axiology exactly equals morality, and I’m not sure there is anybody quite that pure. And only the harshest of Puritans try to legislate the state law to be exactly identical to the moral one. To bridge the whole distance – to directly connect axiology to law and make it illegal to do anything other than the most utility-maximizing action at any given time – is such a mind-bogglingly bad idea that I don’t think anyone’s even considered it in all of human history.

These concepts stay separate because they each make different compromises between goodness, implementation, and coordination.

One example: axiology can’t distinguish between murdering your annoying neighbor vs. not donating money to save a child dying of parasitic worms in Uganda. To axiology, they’re both just one life snuffed out of the world before its time. If you forced it to draw some distinction, it would probably decide that saving the child dying of parasitic worms was more important, since they have a longer potential future lifespan.

But morality absolutely draws this distinction: it says not-murdering is obligatory, but donating money to Uganda is supererogatory. Even utilitarians who deny this distinction in principle will use it in everyday life: if their friend was considering not donating money, they would be a little upset; if their friend was considering murder, they would be horrified. If they themselves forgot to donate money, they’d feel a little bad; if they committed murder in the heat of passion, they’d feel awful.

Another example: Donating 10% of your income to charity is a moral rule. Axiology says “Why not donate all of it?”, Law says “You won’t get in trouble even if you don’t donate any of it”, but at the moral level we set a clear and practical rule that meshes with our motivational system and makes the donation happen.

Another example: “Don’t have sex with someone who isn’t mature enough to consent” is a good moral rule. But it doesn’t make a good legal rule; we don’t trust police officers and judges to fairly determine whether someone’s mature enough in each individual case. A society which enshrined this rule in law would be one where you were afraid to have sex with anyone at all – because no matter what your partner’s maturity level, some police officer might say your partner seemed immature to them and drag you away. On the other hand, elites could have sex with arbitrarily young people, expecting police and judges to take their side.

So the state replaces this moral rule with the legal rule “don’t have sex with anyone below age 18”. Everyone knows this rule doesn’t perfectly capture reality – there’s no significant difference between 17.99-year-olds and 18.01-year-olds. It’s a useful hack that waters down the moral rule in order to make it more implementable. Realistically it gets things wrong sometimes; sometimes it will incorrectly tell people not to have sex with perfectly mature 17.99-year-olds, and other times it will incorrectly excuse sex with immature 18.01-year-olds. But this beats the alternative, where police have the power to break up any relationship they don’t like, and where everyone has to argue with everybody else about whether their relationships are okay or not.

A final example: axiology tells us a world without alcohol would be better than our current world: ending alcoholism could avert millions of deaths, illnesses, crimes, and abusive relationships. Morality only tells us that we should be careful drinking and stop if we find ourselves becoming alcoholic or ruining our relationships. And the law protests that it tried banning alcohol once, but it turned out to be unenforceable and gave too many new opportunities to organized crime, so it’s going to stay out of this one except to say you shouldn’t drink and drive.

So fundamentally, what is the difference between axiology, morality, and law?

Axiology is just our beliefs about what is good. If you defy axiology, you make the world worse.

At least from a rule-utilitarianesque perspective, morality is an attempt to triage the infinite demands of axiology, in order to make them implementable by specific people living in specific communities. It makes assumptions like “people have limited ability to predict the outcome of their actions”, “people are only going to do a certain amount and then get tired”, and “people do better with bright-line rules than with vague gradients of goodness”. It also admits that it’s important that everyone living in a community is on at least kind of the same page morally, both in order to create social pressure to follow the rules, and in order to build the social trust that allows the community to keep functioning. If you defy morality, you still make the world worse. And you feel guilty. And you betray the social trust that lets your community function smoothly. And you get ostracized as a bad person.

Law is an attempt to formalize the complicated demands of morality, in order to make them implementable by a state with police officers and law courts. It makes assumptions like “people’s vague intuitive moral judgments can sometimes give different results on the same case”, “sometimes police officers and legislators are corrupt or wrong”, and “we need to balance the benefits of laws against the cost of enforcing them”. It also tries to avert civil disorder or civil war by assuring everybody that it’s in their best interests to appeal to a fair universal law code rather than try to solve their disagreements directly. If you defy law, you still get all the problems with defying axiology and morality. And you make your country less peaceful and stable. And you go to jail.

In a healthy situation, each of these systems reinforces and promotes the other. Morality helps you implement axiology from your limited human perspective, but also helps prevent you from feeling guilty for not being God and not being able to save everybody. The law helps enforce the most important moral and axiological rules but also leaves people free enough to use their own best judgment on how to pursue the others. And axiology and morality help resolve disputes about what the law should be, and then lend the support of the community, the church, and the individual conscience in keeping people law-abiding.

In these healthy situations, the universally-agreed priority is that law trumps morality, and morality trumps axiology. First, because you can’t keep your obligations to your community from jail, and you can’t work to make the world a better place when you’re a universally-loathed social outcast. But also, because you can’t work to build strong communities and relationships in the middle of a civil war, and you can’t work to make the world a better place from within a low-trust defect-defect equilibrium. But also, because in a just society, axiology wants you to be moral (because morality is just a more-effective implementation of axiology), and morality wants you to be law-abiding (because law is just a more-effective way of coordinating morality). So first you do your legal duty, then your moral duty, and then if you have energy left over, you try to make the world a better place.

(Katja Grace has some really good writing on this kind of stuff here)

In unhealthy situations, you can get all sorts of weird conflicts. Most “moral dilemmas” are philosophers trying to create perverse situations where axiology and morality give opposite answers. For example, the fat man version of the trolley problem sets axiology (“it’s obviously better to have a world where one person dies than a world where five people die”) against morality (“it’s a useful rule that people generally shouldn’t push other people to their deaths”). And when morality and state law disagree, you get various acts of civil disobedience, from people hiding Jews from the Nazis all the way down to Kentucky clerks refusing to perform gay marriages.

I don’t have any special insight into these. My intuition (most authoritative source! is never wrong!) says that we should be very careful reversing the usual law-trumps-morality-trumps-axiology order, since the whole point of having more than one system is that we expect the systems to disagree and we want to suppress those disagreements in order to solve important implementation and coordination problems. But I also can’t deny that for enough gain, I’d reverse the order in a heartbeat. If someone told me that by breaking a promise to my friend (morality) I could cure all cancer forever (axiology), then f@$k my friend, and f@$k whatever social trust or community cohesion would be lost by the transaction.

III.

With this framework, we can propose a clearer answer to the moral offsetting problem: you can offset axiology, but not morality.

Emitting carbon doesn’t violate any moral law at all (in the stricter sense of morality used above). It does make the world a worse place. But there’s no unspoken social agreement not to do it, it doesn’t violate any codes, nobody’s going to lose trust in you because of it, you’re not making the community any less cohesive. If you make the world a worse place, it’s perfectly fine to compensate by making the world a better place. So pay to clean up some carbon, or donate to help children in Uganda with parasitic worms, or whatever.

Eating meat doesn’t violate any moral laws either. Again, it makes the world a worse place. But there aren’t any bonds of trust between humans and animals, nobody’s expecting you not to eat meat, there aren’t any written or unwritten codes saying you shouldn’t. So eat the meat and offset it by making the world better in some other way.

(the strongest counterargument I can think of here is that you’re not betraying animals, but you might be betraying your fellow animals-rights-activists! That is, if they’re working to establish a social norm against meat-eating, the sort of thing where being spotted with a cheeseburger on your plate produces the same level of horror as being spotted holding a bloody knife above a dead body, then your meat-eating is interfering with their ability to establish that norm, and this is a problem that requires more than just offsetting the cost of the meat involved)

Murdering someone does violate a moral law. The problem with murder isn’t just that it creates a world in which one extra person is dead. If that’s all we cared about, murdering would be no worse than failing to donate money to cure tropical diseases, which also kills people.

(and the problem isn’t just that it has some knock-on effects in terms of making people afraid of crime, or decreasing the level of social trust by 23.5 social-trustons, or whatever. If that were all, you could do what 90% of you are probably already thinking – “Just as we’re offsetting the murder by donating enough money to hospitals to save one extra life, couldn’t we offset the social costs by donating enough money to community centers to create 23.5 extra social-trustons?” There’s probably something like that which would work, but along with everything else we’re crossing a Schelling fence, breaking rules, and weakening the whole moral edifice. The cost isn’t infinite, but it’s pretty hard to calculate. If we’re positing some ridiculous offset that obviously outweighs any possible cost – maybe go back to the example of curing all cancer forever – then whatever, go ahead. If it’s anything less than that, be careful. I like the metaphor of these three systems being on three separate tiers – rather than two Morality Points being worth one Axiology Point, or whatever – exactly because we don’t really know how to interconvert them)

This is more precise than Askell’s claim that we can offset “trivial immoral actions” but not “more serious” ones. For example, suppose I built an entire power plan that emitted one million tons of carbon per year. Sounds pretty serious! But if I offset that with environmental donations or projects that prevented 1.1 million tons of carbon somewhere else, I can’t imagine anyone having a problem with it.

On the other hand, consider spitting in a stranger’s face. In the grand scheme of things, this isn’t so serious – certainly not as serious as emitting a million tons of carbon. But I would feel uncomfortable offsetting this with a donation to my local Prevent Others From Spitting In Strangers’ Face fund, even if the fund worked.

Askell gave a talk where she used the example of giving your sister a paper cut, and then offsetting that by devoting your entire life to helping the world and working for justice and saving literally thousands of people. Pretty much everyone agrees that’s okay. I guess I agree it’s okay. Heck, I guess I would agree that murdering someone in order to cure cancer forever would be okay. But now we’re just getting into the thing where you bulldoze through moral uncertainty by making the numbers so big that it’s impossible to be uncertain about them. Sure. You can do that. I’d be less happy about giving my sister a paper cut, and then offsetting by preventing one paper cut somewhere else. But that seems to be the best analogy to the “emit one ton of carbon, prevent one ton of carbon” offsetting we’ve been talking about elsewhere.

I realize all this is sort of hand-wavy – more of a “here’s one possible way we could look at these things” rather than “here’s something I have a lot of evidence is true”. But everyone – you, me, Amanda Askell, society – seems to want a system that tells us to offset carbon but not murder, and when we find such a system I think it’s worth taking it seriously.

OT83: Slippery Slopen Thread

This is the bi-weekly visible open thread. Post about anything you want, ask random questions, whatever. You can also talk at the SSC subreddit or the SSC Discord server. Also:

1. Comments of the week are Douglas Knight on how “eclipse season occurs like clockwork, about every half of a solar year”, and . on how ant colonies sometimes settle wars through ritual combat.

2. I’ve been getting a lot of questions about whether I still endorse my old post “You Are Still Crying Wolf” in light of recent events. I’m not up for causing more controversy right now, so I’ll hide this here instead of writing a full post, but the short answer is: yes. If this ever changes, I’ll put it on my Mistakes page – if you don’t see it there, I still endorse it. I don’t think anything has changed significantly since I wrote it. Trump continues to condemn white nationalism; his opponents continue to condemn his condemnations as insincere or not good enough. White nationalism continues to be a tiny movement with a low-four-digit number of organized adherents, smaller than eg the Satanists; people continue to act as if it’s a gigantic and important social force. I don’t want to get drawn into another ten thousand words on this, but you can probably piece together where I’m coming from from some of the following: this estimate of about 500 people at the Charlottesville rally; this estimate of about 1100 people at a recent Satanic rally, this poll showing more blacks and Latinos agree with the white supremacist movement than whites do (probably a polling error based on random noise; my point is that the real level of support is literally unmeasurably low), the constant Obama-era claims that Obama’s half-hearted condemnations of Islamic terrorism proved he was a secret Muslim or just dog-whistled some sort of vague spirit of not really opposing terrorism (1, 2, 3, 4, 5, 6, 7, 8, 9, 10), and this analysis of Trump’s completely unprincipled and stupid way of deciding what opinions to have on things. I continue to think crying wolf is a major danger, with the worst-case scenario being a sort of repeat of the War On Terror, where rampant fear of terrorism (even in the general absence of any real threat) transformed our society and our politics for the worse in various ways. And as always, I continue to believe that Trump is a terrible person and a terrible President, and that any attention we focus away from his gaffes should be redirected to all the terrible laws and policies he’s promoting.

3. I’m trying to stay off Twitter and seriously limit my exposure to Facebook for a while, so if you send me any messages over those platforms, I might not see them.

4. New advertisement on the sidebar for Breakdown Notes, an online tool to make notes, diagrams, or mindmaps in your browser with paid and free+ads versions.

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Partial Credit

The explorer lifted his hands toward the sky. “With the heavens as my witness,” he said, “if you do not release me, then I will respond by blotting out the sun…” He took a piece of paper out of his pocket, double-checked some numbers written on it “…starting exactly one minute from now.”

The savages snorted. The chieftain fiddled with the bone in his hair. “You no have power blot out sun,” he accused.

“My people possess great magic,” said the explorer. “And by threatening to eat me, you have incurred my wrath. So let me depart your country, or darkness shall fall over the land, starting…now!”

Nothing happened.

“Sun no get blot out,” said the savage chieftain. A few other savages nodded. “We think we stick with original plan of eat you.”

“The sun in so getting blotted out,” said the explorer. “Just a tiny corner at first. It’s hard to see. But gradually it’ll get bigger.”

One or two of the savages tried to stare at the sun, then averted their eyes after a moment.

“Definitely no blot out,” said the chieftain.

“You can’t see it because the remaining unblotted-out portion of the sun is too bright!” said the explorer.

“Not seem very good magic,” said the tribe’s shaman, joining in the discussion.

“Um. How about this. Do you have a cereal box?”

“What is cereal box?” asked the chieftain skeptically.

“Ah, frick. Um, bark. Do you have long and thin pieces of bark?” Some of the savages went into a hut, came out with some bark. “If you arrange them into a kind of box shape, and you cut a hole in that one there, and then you use it to block the other one, you…”

“Why we do this, again?” asked the shaman. “We hungry. We want eat you now.”

“Because,” said the explorer, “I’m trying to demonstrate that I’m blotting out the sun.”

“Me would think,” said shaman, “that if sun blotted out, maybe not need contraption made of pieces of bark in order to know.”

“I’m blotting it out really slowly! It’s too bright to look at directly!”

“Maybe you should blot out sun faster,” said the chieftain.

“I’M BLOTTING AS FAST AS I CAN!”

“Still not seem very good magic.”

“Oh, screw you, I’ll do it myself,” said the explorer, breaking out from among the warriors standing guard around his party. None of them moved to stop him as he sat down, took the pieces of bark, and propped them up against each other with sticks. He took a knife from his pocket and whittled a little hole into one of them. “See! The sun clearly has a little corner taken out of it.”

The savages all peered down warily. Finally, the shaman asked what all of them were thinking: “What supposed to be demonstrated by this?”

“Oh, for the love of God. It’s a pinhole projector. Normally the sunlight would come through this hole and illuminate a perfectly circular area on this other piece of bark here. But now, because I’m blotting out the sun with my magic, it’s producing this kind of crescent shape, with a bit taken out of the sun.”

“You able to blot out the sun with magic seem like overly complicated explanation for weird shape shadow,” said the shaman. “Maybe shadow made on bark always weird.”

“NO IT’S NOT,” said the explorer. “After I stop blotting out the sun, you’ll see it’s a normal circular shadow.”

“Okay,” said the chieftain. “Is good idea. You unblot sun now, we check for circular shadow, then re-blot sun again.”

“I’m not going to stop blotting out the sun just because you guys don’t understand optics!”

“Just unblot little bit, then reblot little bit. Not so hard.”

“Have you ever blotted out the sun before? No? Then stop telling me what’s hard or easy!”

“So when you stop blotting out sun?”

“After you release me!”

“So we only able to learn if releasing you necessary after you unblot sun, and you only unblot sun after we release you? Sound kind of like trick.”

“Look,” said the explorer. “I’m sorry about this. I really am. There are places north of here that are getting total sun-blotting-outs. If we were a few dozen miles away, this would be really impressive, I promise. But here, I’m only able to blot out the sun partially. Like, ninety percent. I just feel like, as demonstrations of power go, that’s still pretty impressive.”

“But definitely when ninety percent of sun blotted out, it big enough to notice, right?”

“Well…it will probably get darker. I think maybe the difference will be noticeable. And if you look at the pinhole projector…” He touched the contraption of bark and sticks, which promptly fell apart. He cursed and propped it back up again. “If you look at the pinhole projector, you’ll see that the part of the sun that’s missing is gradually increasing.”

The savages stared at the projector, dubiously.

“Look about same,” said the shaman.

“It’s not! Over the past few minutes, the ‘bite’ taken out of the sun has gradually gotten bigger!”

“Maybe should blot out whole sun,” said the chieftain. “Maybe then seem more obvious.”

“I’M NOT GOING TO BLOT OUT THE WHOLE SUN! Come on, can’t you tell it’s getting darker?”

The shaman squinted. “Maybe sort of look dark. Hard to tell.”

The savages started talking to each other. “Maybe look little darker than usual,” the chieftain concluded. “But maybe only because you give me suggestion.”

“Oh, come on,” said the explorer. “It’s clearly darker. Just let me go.”

The chieftain whispered something to the shaman. The shaman whispered something back to the chieftain. Finally, the chieftain turned to the explorer and nodded.

“Not sure if really darker or just power of suggestion. But you make sun come back, we let you go.”

The explorer gave a sigh of relief. He lifted his hands to the heavens. “In the name of the gods of my people,” he declared, “I command the sun to return to the sky!”

Nothing obvious happened. They waited a minute. Two minutes. Finally the chieftain shrugged. “Maybe little bit lighter,” he said. “Hard to tell.”

“Can I go?” asked the explorer.

The chieftain shrugged. Before he could change his mind, the explorer grabbed his pack and rushed out of the village.

Ten minutes later, he was back. The chieftain looked at him quizzically.

“Actually,” said the explorer, “I just saw the traffic on the road out of here. If the offer’s still open, I think I’d rather get eaten.”

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Fear And Loathing At Effective Altruism Global 2017

San Francisco in the middle sixties was a very special time and place to be a part of. Maybe it meant something. Maybe not, in the long run – but no explanation, no mix of words or music or memories can touch that sense of knowing that you were there and alive in that corner of time and the world….There was a fantastic universal sense that whatever we were doing was right, that we were winning. And that, I think, was the handle—that sense of inevitable victory over the forces of Old and Evil.

— Hunter S. Thompson

Effective altruism is the movement devoted to finding the highest-impact ways to help other people and the world. Philosopher William MacAskill described it as “doing for the pursuit of good what the Scientific Revolution did for the pursuit of truth”. They have an annual global conference to touch base and discuss strategy. This year it was in the Palace of Fine Arts in San Francisco, and I got a chance to check it out.
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The lake-fringed monumental neoclassical architecture represents ‘utilitiarian distribution of limited resources’

The official conference theme was “Doing Good Together”. The official conference interaction style was “earnest”. The official conference effectiveness level was “very”. And it was impossible to walk away from some of the talks without being impressed.

Saturday afternoon there was a talk by some senior research analysts at GiveWell, which researches global development charities. They’ve evaluated dozens of organizations and moved $260 million to the most effective, mostly ones fighting malaria and parasitic infections. Next were other senior research analysts from the Open Philanthropy Project, who have done their own detailed effectiveness investigations and moved about $200 million.

The parade went on. More senior research analysts. More nine-digit sums of money. More organizations, all with names that kind of blended together. The Center for Effective Altruism. The Center For Effective Global Action. Raising For Effective Giving. Effecting Effective Effectiveness. Or maybe not, I think I was hallucinating pretty hard by the end.
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I figured the speaker named “Cashdollar” was a hallucination, but she’s right there on the website

One of the breakout rooms had all-day career coaching sessions with 80,000 Hours (motto: “You have 80,000 hours in your career. Make the right career choices, and you can help solve the world’s most pressing problems”). A steady stream of confused altruistic college students went in, chatted with a group of coaches, and came out knowing that the latest analyses show that management consulting is a useful path to build charity-leading-relevant skills, but practicing law and donating the money to charity is probably less useful than previously believed. In their inevitable effectiveness self-report, they record having convinced 188 people to change their career plans as of April 2015.

(I had been avoiding the 80,000 Hours people out of embarassment after their career analyses discovered that being a doctor was low-impact, but by bad luck I ended up sharing a ride home with one of them. I sheepishly introduced myself as a doctor, and he said “Oh, so am I!” I felt relieved until he added that he had stopped practicing medicine after he learned how low-impact it was, and gone to work for 80,000 Hours instead.)

The theater hosted a “fireside chat” with Bruce Friedrich, director of the pro-vegetarian Good Food Institute. I’d heard he was a former vice-president of PETA, so I went in with some stereotypes. They were wrong. Friedrich started by admitting that realistically most people are going to keep eating meat, and that yelling at them isn’t a very effective way to help animals. His tactic was to advance research into plant-based and vat-grown meat alternatives, which he predicted would taste identical to regular meat at a fraction of the cost, and which would put all existing factory farms out of business. Afterwards a bunch of us walked to a restaurant a few blocks down the street to taste an Impossible Burger, the vanguard of this brave new meatless future.
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The people behind this ad are all PETA card-carrying vegetarians. And the future belongs to them, and they know it.

The whole conference was flawlessly managed, from laser-fast registration to polished-sounding speakers to friendly unobtrusive reminders to use the seventeen different apps that would keep track of your conference-related affairs for you. And the of course the venue, which really was amazing.
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The full-size model of the Apollo 11 lander represents ‘utilitiarian distribution of limited resources’

But walk a little bit outside of the perfectly-scheduled talks, or linger in the common areas a little bit after the colorfully-arranged vegetarian lunches, and you run into the shadow side of all of this, the hidden underbelly of the movement.

William MacAskill wanted a “scientific revolution in doing good”. But the Scientific Revolution progressed from “I wonder why apples fall down” to “huh, every particle is in an infinite number of places simultaneously, and also cats can be dead and alive at the same time”. The effective altruists’ revolution started with “I wonder if some charities work better than others”. But even at this early stage, it’s gotten to some pretty weird places.

I got to talk to some people from Wild Animal Suffering Research. They start with the standard EA animal rights argument – if you think animals have moral relevance, you can save zillions of them for almost no cost. A campaign for cage-free eggs, minimal in the grand scheme of things, got most major corporations to change their policies and gave two hundred million chickens an improved quality of life. But WASR points out that even this isn’t the most neglected cause. There are up to a trillion reptiles, ten quintillion insects, and maybe a sextillion zooplankton. And as nasty as factory farms are, life in the state of nature is nasty, brutish, short, and prone to having parasitic wasps paralyze you so that their larvae can eat your organs from the inside out while you are still alive. WASR researches ways we can alleviate wild animal suffering, from euthanizing elderly elephants (probably not high-impact) to using more humane insecticides (recommended as an ‘interim solution’) to neutralizing predator species in order to relieve the suffering of prey (still has some thorny issues that need to be resolved).

Wild Animal Suffering Research was nowhere near the weirdest people at Effective Altruism Global.

I got to talk to people from the Qualia Research Institute, who point out that everyone else is missing something big: the hedonic treadmill. People have a certain baseline amount of happiness. Fix their problems, and they’ll be happy for a while, then go back to baseline. The only solution is to hack consciousness directly, to figure out what exactly happiness is – unpack what we’re looking for when we describe some mental states as having higher positive valence than others – and then add that on to every other mental state directly. This isn’t quite the dreaded wireheading, the widely-feared technology that will make everyone so doped up on techno-super-heroin (or direct electrical stimulation of the brain’s pleasure centers) that they never do anything else. It’s a rewiring of the brain that creates a “perpetual but varied bliss” that “reengineers the network of transition probabilities between emotions” while retaining the capability to do economically useful work. Partly this last criteria is to prevent society from collapsing, but the ultimate goal is:

…the possibility of a full-fledged qualia economy: when people have spare resources and are interested in new states of consciousness, anyone good at mining the state-space for precious gems will have an economic advantage. In principle the whole economy may eventually be entirely based on exploring the state-space of consciousness and trading information about the most valuable contents discovered doing so.

If you’re wondering whether these people’s research involves taking huge amounts of drugs – well, read their blog. My particular favorites are this essay on psychedelic cryptography ie creating messages that only people on certain drugs can read, and this essay on hyperbolic geometry in DMT experiences.
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The guy on the right also works for MealSquares, a likely beneficiary of technology that hacks directly into people’s brains and adds artificial positive valence to unpleasant experiences.

The Qualia Research Institute was nowhere near the weirdest people at Effective Altruism Global.

I got to talk to some people from the Foundational Research Institute. They do a lot of research, and a lot of it is very good, but they’re most infamous within the community for their particle work. It goes like this: the universe is really really big. So if suffering made up an important part of the structure of the universe, this would be so tremendously outrageously unconscionably bad that we can’t even conceive of how bad it could be. So the most important cause might be to worry about whether fundamental physical particles are capable of suffering – and, if so, how to destroy physics. From their writeup:

Speculative scenarios to change the long-run future of physics may dominate any concrete work to affect the welfare of intelligent computations — at least within the fraction of our brain’s moral parliament that cares about fundamental physics. The main value (or disvalue) of intelligence would be to explore physics further and seek out tricks by which its long-term character could be transformed. For instance, if false-vacuum decay did look beneficial with respect to reducing suffering in physics, civilization could wait until its lifetime was almost over anyway (letting those who want to create lots of happy and meaningful intelligent beings run their eudaimonic computations) and then try to ignite a false-vacuum decay for the benefit of the remainder of the universe (assuming this wouldn’t impinge on distant aliens whose time wasn’t yet up). Triggering such a decay might require extremely high-energy collisions — presumably more than a million times those found in current particle accelerators — but it might be possible. On the other hand, such decay may happen on its own within billions of years, suggesting little benefit to starting early relative to the cosmic scales at stake. In any case, I’m not suggesting vacuum decay as the solution — just that there may be many opportunities like it waiting to be found, and that these possibilities may dwarf anything else that happens with intelligent life.

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This talk was called ‘Christians In Effective Altruism’. It recommended reaching out to churches, because deep down the EA movement and people of faith share the same core charitable values and beliefs.

The thing is, Lovecraft was right. He wrote:

We live on a placid island of ignorance in the midst of black seas of infinity, and it was not meant that we should voyage far. The sciences, each straining in its own direction, have hitherto harmed us little; but some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the deadly light into the peace and safety of a new dark age.

Morality wasn’t supposed to be like this. Most of the effective altruists I met were nonrealist utilitarians. They don’t believe in some objective moral law imposed by an outside Power. They just think that we should pursue our own human-parochial moral values effectively. If there was ever a recipe for a safe and milquetoast ethical system, that should be it. And yet once you start thinking about what morality is – really thinking, the kind where you try to use mathematical models and formal logic – it opens up into these dark eldritch vistas of infinities and contradictions. The effective altruists started out wanting to do good. And they did: whole nine-digit-sums worth of good, spreadsheets full of lives saved and diseases cured and disasters averted. But if you really want to understand what you’re doing – get past the point where you can catch falling apples, to the point where you have a complete theory of gravitation – you end up with something as remote from normal human tenderheartedness as the conference lunches were from normal human food.
.

Born too late to eat meat guilt-free, born too early to get the technology that hacks directly into my brain and adds artificial positive valence to unpleasant experiences.

But I worry I’m painting a misleading picture here. It isn’t that effective altruism is divided into two types of people: the boring effective suits, and the wacky explorers of bizarre ethical theories. I mean, there’s always going to be some division. But by and large these were the same people, or at least you couldn’t predict who was who. They would go up and give a talk about curing river blindness in Nigeria, and then you’d catch them later and learn that they were worried that maybe the most effective thing was preventing synthetic biology from taking over the ecosystem. Or you would hear someone give their screed, think “what a weirdo”, and then learn they were a Harvard professor who served on a bunch of Fortune 500 company boards. Maybe the right analogy would be physics. A lot of physicists work on practical things like solar panels and rechargeable batteries. A tiny minority work on stranger things like wormholes and alternate universes. But it’s not like these are two different factions in physics that hate each other. And every so often a solar panel engineer might look into the math behind alternate universes, or a wormhole theorist might have opinions on battery design. They’re doing really different stuff, but it’s within the same tradition.

The movement’s unofficial leader is William MacAskill. He’s a pretty typical overachiever – became an Oxford philosophy professor at age 28 (!), founded three successful non-profits, and goes around hobnobbing with rich people trying to get them to donate money (he himself has pledged to give away everything he earns above $36,000). I had always assumed he was just a random dignified suit-wearing person who was slightly exasperated at having to put up with the rest of the movement. But I got a chance to talk to him – just for a few minutes, before he had to run off and achieve something – and I was shocked at how much he knew about all the weirdest aspects of the community, and how protective he felt of them. And in his closing speech, he urged the attendees to “keep EA weird”, giving examples of times when seemingly bizarre ideas won out and became accepted by the mainstream.
.

His PowerPoint slide for this topic was this picture of Eliezer Yudkowsky. Really. I’m not joking about this part.

If it were just the senior research analysts at their spreadsheets, we could dismiss them as the usual Ivy League lizard people and move on. If it were just the fringes ranting about cyber-neuro-metaphilosophy, we could dismiss them as loonies and forget about it. And if it were just the two groups, separate and doing their own thing, we could end National Geographic-style, intoning in our best David Attenborough voice that “Effective Altruism truly is a land of contrasts”. But it’s more than that. Some animating spirit gives rise to the whole thing, some unifying aesthetic that can switch to either pole and back again on a whim. After a lot of thought, I have only one guess about what it might be.

I think the effective altruists are genuinely good people.

Over lunch, a friend told me about his meeting with an EA philosopher who hadn’t been able to make it to the conference. This friend had met the philosopher, and as they were walking, the philosopher had stopped to pick up worms writhing on the sidewalk and put them back in the moist dirt.

And this story struck me, because I had taken a walk with one of the speakers earlier, and seen her do the same thing. She had been apologetic, said she knew it was a waste of her time and mine. She’d wondered if it was pathological, whether maybe she needed to be checked for obsessive compulsive disorder. But when I asked her whether she wanted to stop doing it, she’d thought about it a little, and then – finally – saved the worm.

And there was a story about the late great moral philosopher Derek Parfit, himself a member of the effective altruist movement. This is from Larissa MacFarquhar:

As for his various eccentricities, I don’t think they add anything to an understanding of his philosophy, but I find him very moving as a person. When I was interviewing him for the first time, for instance, we were in the middle of a conversation and suddenly he burst into tears. It was completely unexpected, because we were not talking about anything emotional or personal, as I would define those things. I was quite startled, and as he cried I sat there rewinding our conversation in my head, trying to figure out what had upset him. Later, I asked him about it. It turned out that what had made him cry was the idea of suffering. We had been talking about suffering in the abstract. I found that very striking.

Now, I don’t think any professional philosopher is going to make this mistake, but nonprofessionals might think that utilitarianism, for instance (Parfit is a utilitarian), or certain other philosophical ways of think about morality, are quite unemotional, quite calculating, quite cold; and so because as I am writing mostly for nonphilosophers, it seemed like a good corrective to know that for someone like Parfit these issues are extremely emotional, even in the abstract.

The weird thing was that the same thing happened again with a philosophy graduate student whom I was interviewing some months later. Now you’re going to start thinking it’s me, but I was interviewing a philosophy graduate student who, like Parfit, had a very unemotional demeanor; we started talking about suffering in the abstract, and he burst into tears. I don’t quite know what to make of all this but I do think that insofar as one is interested in the relationship of ideas to people who think about them, and not just in the ideas themselves, those small events are moving and important.

I imagine some of those effective altruists, picking up worms, and I can see them here too. I can see them sitting down and crying at the idea of suffering, at allowing it to exist.

Larissa MacFarquhar says she doesn’t know what to make of this. I think I sort of do. I’m not much of an effective altruist – at least, I’ve managed to evade the 80,000 Hours coaches long enough to stay in medicine. But every so often, I can see the world as they have to. Where the very existence of suffering, any suffering at all, is an immense cosmic wrongness, an intolerable gash in the world, distressing and enraging. Where a single human lifetime seems frighteningly inadequate compared to the magnitude of the problem. Where all the normal interpersonal squabbles look trivial in the face of a colossal war against suffering itself, one that requires a soldier’s discipline and a general’s eye for strategy.

All of these Effecting Effective Effectiveness people don’t obsess over efficiency out of bloodlessness. They obsess because the struggle is so desperate, and the resources so few. Their efficiency is military efficiency. Their cooperation is military discipline. Their unity is the unity of people facing a common enemy. And they are winning. Very slowly, WWI trench-warfare-style. But they really are.
.

Sources and commentary here

And I write this partly because…well, it hasn’t been a great couple of weeks. The culture wars are reaching a fever pitch, protesters are getting run over by neo-Nazis, North Korea is threatening nuclear catastrophe. The world is a shitshow, nobody’s going to argue with that – and the people who are supposed to be leading us and telling us what to do are just about the shittiest of all.

And this is usually a pretty cynical blog. I’m cynical about academia and I’m cynical about medicine and goodness knows I’m cynical about politics. But Byron wrote:

I have not loved the world, nor the world me
But let us part fair foes; I do believe,
Though I have found them not, that there may be
Words which are things,—hopes which will not deceive,
And virtues which are merciful, nor weave
Snares for the failing: I would also deem
O’er others’ griefs that some sincerely grieve;
That two, or one, are almost what they seem,
That goodness is no name, and happiness no dream.

This seems like a good time to remember that there are some really good people. And who knows? Maybe they’ll win.

And one more story.

I got in a chat with one of the volunteers running the conference, and told him pretty much what I’ve said here: the effective altruists seemed like great people, and I felt kind of guilty for not doing more.

He responded with the official party line, the one I’ve so egregiously failed to push in this blog post. That effective altruism is a movement of ordinary people. That its yoke is mild and it accepts everyone. That not everyone has to be a vegan or a career researcher. That a commitment could be something more like just giving a couple of dollars to an effective-seeming charity, or taking the Giving What We Can pledge, or signing up for the online newsletter, or just going to an local effective altruism meetup group and contributing to discussions.

And I said yeah, but still, everyone here seems so committed to being a good person – and then here’s me, constantly looking over my shoulder to stay one step ahead of the 80,000 Hours coaching team, so I can stay in my low-impact career that I happen to like.

And he said – no, absolutely, stay in your career right now. In fact, his philosophy was that you should do exactly what you feel like all the time, and not worry about altruism at all, because eventually you’ll work through your own problems, and figure yourself out, and then you’ll just naturally become an effective altruist.

And I tried to convince him that no, people weren’t actually like that, practically nobody was like that, maybe he was like that but if so he might be the only person like that in the entire world. That there were billions of humans who just started selfish, and stayed selfish, and never declared total war against suffering itself at all.

And he didn’t believe me, and we argued about it for ten minutes, and then we had to stop because we were missing the “Developing Intuition For The Importance Of Causes” workshop.

Rationality means believing what is true, not what makes you feel good. But the world has been really shitty this week, so I am going to give myself a one-time exemption. I am going to believe that convention volunteer’s theory of humanity. Credo quia absurdum; certum est, quia impossibile. Everyone everywhere is just working through their problems. Once we figure ourselves out, we’ll all become bodhisattvas and/or senior research analysts.

OT82: Threado Quia Absurdum

This is the bi-weekly visible open thread. Post about anything you want, ask random questions, whatever. You can also talk at the SSC subreddit, the SSC Discord server. Also:

1. Comments of the week: CatCube on how organizations change over time, Douglas Knight’s update on self-driving car progress, Tibor on gun laws in the Czech Republic. And Brad explains why comments are closed on some posts here better than I could.

2. I’m off social media for the time being to avoid Discourse. If you need to contact me, try email – on a related note, sorry for being terrible about responding to emails.

3. I’ll be at the Effective Altruism Global conference today. Come say hi. If nothing else, I’ll be at the Rationalist Tumblr Meetup (at least briefly) and Katja Grace’s 5:50 talk on AI.

4. Does anyone have strong feelings about who would make a good SSC moderator? Does anyone actually read all the comments here well enough to moderate them?

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Brief Cautionary Notes On Branded Combination Nootropics

I.

Taking nootropics is an inherently questionable decision. The risk isn’t zero, and the benefits are usually subtle at best.

On the other hand, mountain-climbing also has risks, and is so devoid of benefit that the only excuse mountaineers can come up with is “because it’s there”. So whatever. If someone wants to do either – well, it’s a free country, and we all have to amuse ourselves somehow.

But even within this context, special caution is warranted for branded combination nootropics.

I wanted to make up a caricatured fake name for these sorts of things, so I could make fun of them without pointing at any company in particular. But all of the caricatured fake names I can think of turn out to be real products. MegaMind? Real. SuperBrain? Real. UltraBrain? Real. Mr. Power Brain? Real, for some reason.

Even the ones that don’t make sense are real. NeuroBrain? Real, even though one hopes that brains are always at least a little neuro. NeuroMind? Real, with its own Indiegogo campaign. The only thing I haven’t been able to find is a nootropic called BrainMind, but it’s only a matter of time.

These usually combine ten or twenty different chemicals with potential nootropic properties, then make outrageous claims about the results. For example, Neuroxium says on its ridiculous webpage that:

Neuroxium is a revolutionary brain supplement formulated to give you ultimate brain power. Known in Scientific Terms as a “NOOTROPIC” or “GENIUS PILL” Neuroxium improves mental functions such as cognition, memory, intelligence, motivation, attention, concentration and therefore happiness and success.

Your first warning sign should have been when they said “genius pill” was a scientific term (or as they call it, Scientific Term). If you needed more warning signs, this is word-for-word the same claim made by several other nootropics like Synagen IQ, Nootrox, and Cerebral X. So either they can’t even be bothered not to plagiarize their ads, or they change their name about once a week to stay ahead of the law.

I was eventually able to find a list of the ingredients in this stuff:

DMAE (dimethylethanolamine bitartrate), GABA (?-Amino-butyric acid), Caffeine anhydrous, Bacopa monnieri leaf extract, NALT (N-acetyl-L-tyrosine), Centrophenoxine HCl, Alpha-GPC (a-glycerophosphocholine, Agmatine sulfate, Gingko biloba leaf extract, Pine (Pinus pinaster) bark extract, Phosphatidylserine, Aniracetam, CDC Choline (Citicoline), Sarcosine (N-methylglycine), Vincamine [Lesser Periwinkle (Vinca minor) aerial extract], L-Theanine (?-glutamylethylamide), NADH (nicotinamide adenine dinucleotide), TAU (triacetyluridine), Noopept, Adrafinil, Tianeptine, Piperine [Black Pepper (Piper nigrum) fruit extract 445mg.

And the weird thing is, a lot of these are decent choices. Everyone knows caffeine is a good stimulant. Adrafinil is the over-the-counter version of modafinil, an FDA-approved medication for sleep disorders; many of my patients have been very happy with it. Bacopa monnieri has been found to improve memory in so many studies I can’t even keep track of all of them. Noopept is an approved medication in Russia. Tianeptine is an approved medication in France. All of these are chemicals with at least some evidence base behind them, which are potentially good for certain people. If some nootropics user were to say they wanted to try adrafinil, or bacopa, or noopept, or any of the other stuff on that list, I would classify them with the mountain climber – doing something risky but not necessarily stupid.

But taking Neuroxium/Synagen/CerebralX is exactly as bad an idea as you would expect from the advertising copy.

For one thing, they don’t list the doses of any of these things – but they have to be getting them terribly wrong. A standard dose of adrafinil is 600 mg. A standard dose of bacopa is 300 mg. A standard dose of Alpha-GPC choline is about 600 mg. So combining standard doses of just these three ingredients means you need a 1.5 g pill. This is probably too big to swallow. The only pills I know of that get that big are those gigantic fish oil pills made of pure fish oil that everybody hates because they’re uncomfortably big. But this is just what you’d need to have three of the 22 ingredients listed in CerebralX at full doses. The pill is already unswallowably large, and you’ve only gotten a seventh of the way through the ingredient list.

I conclude that they’re just putting miniscule, irrelevant doses into this so they can say they’ve got exciting-sounding chemicals.

For another thing, all of these substances have unique profiles which have to be respected on their own terms. For example, lots of studies say bacopa improves memory – but only after you’ve taken it consistently for several months. If you just go “WOOO, CEREBRALX!” and swallow a bunch of pills and hope that you’ll do better on your test tomorrow, all you’re going to get are the short-term effects of bacopa – which include lethargy and amotivation.

Most sources discussing Noopept recommend starting very low – maybe as low as 5 mg – and then gradually increasing to a standard dose of 10 – 40 mg depending on how it works for you. Some people will apparently need higher doses, and some find it works best for them as high as 100 mg. Needless to say, none of this is possible if you’re taking CerebralX. You’ll take whatever dose is in the product – which they don’t tell you, and which is probably so low as to be meaningless – and stay at the same level for however long you’re taking the entire monstrosity.

Tianeptine has a short half-life and is typically dosed three times a day, unlike most of the other things on the list which are dosed once per day. CerebralX says you should take their whole abomination once a day, which means you’re getting the wrong dosing schedule of tianeptine.

GABA, taken orally, doesn’t cross the blood-brain barrier and has no effect. The only way it could possibly make a difference – and even this is debatable – is if you join it to niacin to create the N-nicotinoyl-GABA molecule, which these people did not do. As a result, their GABA will be totally inert. This is probably for the best, because most of the things on their list are stimulants, and GABA is a depressant, so it would probably all just cancel out.

Piperine is a chemical usually used to inhibit normal drug-metabolizing enzymes and enhance the effect of other substances. This is very occasionally a good idea, when you know exactly what drug you’re trying to enhance and you’re not taking anything else concurrently. But I can’t figure out which drug they’re trying to enhance the activity of here, or even whether they’re trying to enhance the activity of anything at all, or if they just heard that piperine could enhance things and thought “Okay, it’s in”. And if I were giving someone a concoction of twenty-one different random psychoactive drugs, which I was dosing wrong and giving at the wrong schedule, the last thing I would want to do is inhibit the body’s normal drug metabolism. The entire reason God gave people drug-metabolizing enzymes is because He knew, in His wisdom, that some of them were going to be idiots who would take a concoction of twenty-one different random psychoactive drugs because a website said it was, in Scientific Terms, a “GENIUS PILL”. Turning them off is a terrible idea and the only saving grace is that the dose of everything in this monstrosity is probably too small for it to do anything anyway.

Taking any of the ingredients in CerebralX on its own is a potentially risky affair. But if you study up on it and make sure to take it correctly, then maybe it’s a calculated risk, like mountain climbing. Taking everything in CerebralX together is more like trying to mountain-climb in a t-shirt and sandals. You’re not taking a calculated risk as part of a potentially interesting hobby. You’re just being an idiot.

II.

But that’s too easy. I have a larger point here, which is that these sorts of branded combos are bad ideas even if they’re by smart, well-intentioned people who are doing everything right.

Tru-Brain is undeniably in a class above CerebralX. It has a team including neuroscience PhDs. It seems to be a real company that can keep the same name for more than a week. Instead of promising a GENIUS PILL, it makes comparatively modest claims to be able to “perform at your peak” and “stay sharp all day long”.

Correspondingly, its special nootropics combo makes a lot more pharmacological sense. For one thing, it’s a packet rather than a single pill – a concession to the impossibility of combining correct doses of many substances into a single capsule. For another, it limits itself to mostly things that some sane person could conceivably in some universe want to dose on the schedule they recommend. And it’s only got seven ingredients, none of which counteract any of the others or turn off important metabolic systems that God created to protect you from your own stupidity. This is probably about as well-designed a branded nootropics combo as it’s possible to make.

But I would still caution people away from it. Why?

Last year, I surveyed people’s reactions to various nootropics. I got 870 responses total, slightly fewer for each individual substance. Here are the response curves for two of the substances in TruBrain – piracetam and theanine:

These are on a 1-10 scale, where I directed responders to:

Please rate your subjective experience on a scale of 0 to 10. 0 means a substance was totally useless, or had so many side effects you couldn’t continue taking it. 1 – 4 means for subtle effects, maybe placebo but still useful. 5 – 9 means strong effects, definitely not placebo. 10 means life-changing.

Some substances known to be pretty inert averaged scores of around 4. Piracetam and theanine averaged around 5, so maybe a little better than that. But the most dramatic finding was the range. Almost 20% of people rated theanine a two or lower; almost 20% rated it a nine or higher. More than a third placed it in the “probably placebo” range, but 5% found its effects “life-changing”.

The effect of nootropics seems to vary widely among different people. This shouldn’t be surprising: so do the effects of real drugs. Gueorguieva and Mallinckrodt do an unusually thorough job modeling differences in response to the antidepressant duloxetine, and find a clear dichotomy between responders and nonresponders. This matches psychiatric lore – some medications work on some people, other medications work on others. I particularly remember one depressed patient who had no response at all to any SSRI, but whose depression shut off almost like a lightswitch once we tried bupropion. Other people fail bupropion treatment but do well on SSRIs. Probably this has something to do with underlying differences in their condition or metabolism that we just don’t know how to identify at this point (sample simplified toy model: what we call “depression” is actually two diseases with identical symptoms, one of which responds to SSRIs and one of which responds to bupropion).

I think this is why there are no multidrug combo packs. Your psychiatrist never treats your depression with a pill called “MegaMood”, boasting combination doses of Prozac, Wellbutrin, Remeron, and Desyrel. For one thing, either you’re giving an insufficient dose of each drug, or you’re giving full doses of four different drugs – neither is well-tested or advisable. For another, you’re getting four times the side effect risk. For a third thing, if one of the four drugs gives you a side effect, you’ve got to throw out the whole combo. For a fourth, if the combo happens to work, you don’t know whether it’s only one of the four drugs working and the others are just giving you side effects and making you worse. And if it sort of works, you don’t know which of the four drugs to increase, or else you just have to increase all four at once and hope for the best.

All these considerations are even stronger with nootropics. There shouldn’t be universally effective nootropics, for the same reason there’s no chemical you can pour on your computer to double its processing speed: evolution put a lot of work into making your brain as good as possible, and it would be silly if some random molecule could make it much better. Sure, there are exceptions – I think stimulants get a pass because evolution never expected people to have to pay attention to stimuli as boring as the modern world provides us with all the time – but in general the law holds. If you find a drug does significantly help you, it’s probably because your brain is broken in some particular idiosyncratic way (cf. mutational load), the same way you can double a computer’s processing speed with duct tape if one of the processors was broken.

If everyone’s brain is broken in a different way, then not only will no drug be universally effective, but drugs with positive effects for some people are likely to have negative effects for others. If (to oversimplify) your particular brain problem is not having enough serotonin, a serotonin agonist might help you. But by the same token, if you have too much serotonin, a serotonin agonist will make your life worse. Even if you have normal serotonin, maybe the serotonin agonist will push you out of the normal range and screw things up.

Most effective psychiatric drugs hurt some people. I mean, a lot of them hurt the people they’re supposed to be used for – even the psychotic people hate antipsychotics – but once you’ve brushed those aside, there are a lot of others that help a lot of people, but make other people feel worse. There are hordes of people who feel tired on stimulants, or sleepy on caffeine, or suicidal on antidepressants, or any other crazy thing. You rarely hear about these, because usually if someone’s taking a drug and it makes them feel worse, they stop. But psychiatrists hear about it all the time. “That antidepressant you gave me just made me feel awful!” Oh, well, try a different one. “That’s it? Try a different one? Aren’t you embarassed that your so-called antidepressant made me more depressed?” You’re pretty new to this ‘psychopharmacology’ thing, aren’t you?

Thus the tactic used by every good psychiatrist: try a patient on a drug that you think might work, make them report back to you on whether it does. If so, keep it; if not, switch.

If you take a seven-drug combo pack, you lose this opportunity for experiment. Suppose that two of the drugs make you feel +1 unit better, two others have no effect, and three of the drugs make you feel -0.5 units worse, so in the end you feel +0.5 units better. Maybe that seems good to you so you keep taking it. Now you’re taking five more drugs than you need to, including three making you actively worse, and you’re missing the chance to be a full +2 units better by just taking the drugs that are helping and not hurting.

You’re also missing the opportunity to play with the doses or the schedules of things. Maybe if you doubled the dose of one of the drugs making you +1 better, you could be +2 better, but if you double the dose of the other, you start getting side effects and the drug only breaks even. If you experiment, you can figure this out and take twice the dose of the first and the starting dose of the second, for +3 better. Taking them all as part of a combo ruins this: if you try taking twice the dose of the combo, nothing happens.

(And a special word of warning: if some stimulant product combines caffeine with something else, and you feel an effect, your first theory should be that the effect is 100% caffeine – unless the “something else” is amphetamine. There are like a million products which bill themselves as “organic energy cocktails” by combining caffeine with some rare herb from Burma. People drink these and say “Oh, this high feels so much more intense than just drinking caffeine”. Yeah, that’s because it’s much more caffeine. Seriously. Check the doses on those things. I will grudgingly make an exception for some chemicals that are supposed to decrease caffeine jitters, like theanine, which might have a real effect. But the stimulation is from caffeine. Go get an espresso instead.)

III.

But don’t drugs interact? Instead of viewing these seven drugs as seven different variables, shouldn’t we view them as coming together in a seven-color beautiful rainbow of happiness, or whatever?

Once again, I can only appeal to psychiatry, which is still unsure whether there are any useful interactions between its various super-well-studied drugs which it’s been using for decades and prescribing to millions of people. Take the CO-MED study, which combined the popular SSRI escitalopram with the popular NDRI bupropion. Since depression seems to involve abnormalities in the three major catecholamine systems, and escitalopram hits one of these and bupropion hits the other two, this seems like exactly the sort of synergistic interaction we should expect to work. It doesn’t. CO-MED found that the two antidepressants together didn’t treat depression any better than either one alone, let alone produce some synergy that made them more than the sum of their parts. They did, however, have about twice as many side effects.

Other smaller studies say the opposite, so I’m not saying never try escitalopram and bupropion together. I’m saying we don’t know. These are intensely-studied drugs, the whole power of the existing system has been focused on the question of whether they synergize or antisynergize or what, and we’re still not sure.

Also from psychiatry: we know a lot less about the mechanisms of action of drugs than we like to think. Ketamine has been intensively studied for depression for a decade or so, and we only just learned last year that it probably worked on a different receptor than we thought. SSRIs might be the most carefully studied drug class of all time, and we still don’t really know exactly what’s up with them – it can’t just be serotonin; they increase serotonin within a day of ingestion, but take a month to work.

So when people take these incredibly weird substances that have barely been studied at all, where we have only the faintest clue how they work, and then say from their armchair “And therefore, drug A will enhance the effects of drug B and C” – this is more than a little arrogant. Is it all made up? I can’t say “all” with surety. But it might be.

The best-known and most-discussed interaction in nootropics is piracetam-choline. Piracetam increases levels of acetylcholine, which is formed from choline, so it makes sense that these two substances would go well together. Most sites on piracetam urge you to take them together. TruBrain, which predictably is on top of this kind of stuff, combines them together in its combo pack.

But there’s never been a human study showing that this helps. Examine.com, another group which is usually on top of stuff, summarizes (emphasis carried over from original):

[Choline] may augment the relatively poor memory enhancing effects of Piracetam in otherwise healthy animals, but administration of choline alongside Piracetam is not a prerequisite to its efficacy and has not been tested in humans

I surveyed a bunch of choline users, using a little gimmick. Some of the forms of choline sold these days don’t cross the blood-brain barrier and shouldn’t have an effect, so they provide a sort of placebo control for more active forms of choline. In my survey, people who took piracetam with inactive forms of choline didn’t report any worse an experience than those who took the real thing.

This is the most famous and best-discussed interaction in the entire field of nootropics, and it’s on super-shaky ground. So trust me, the CerebralX people don’t have good evidence about the interactions of all twenty-one of their ridiculous substances.

I have to admit, I’m not confident in this part. Maybe psychiatry is wrong. Sometimes I wonder what would happen if we just throw five different antidepressants with five different mechanisms of action at somebody at once. Realistically, maybe this would involve some supplements: l-methylfolate, SAMe, tryptophan, turmeric, and a traditional SSRI. One day I want to try this on someone I know well enough to let me test things on them, but not so well I don’t mind losing a friend when it all blows up in my face. Until then, keep in mind that anyone who says they bet a certain combination of things will produce a synergistic interaction is engaging in the wildest sort of speculation.

IV.

One more piece of evidence. The 2016 nootropics survey asked people to rate their experiences with 35 different individual substances, plus a branded combo pack (“AlphaBrain”) of pretty good reputation. The AlphaBrain performed worse than any of the individual substances, including substances that were part of AlphaBrain!

This is of course a very weak result – it wasn’t blinded, and maybe the survey responders have the same anti-branded-combo prejudice I do. But it at least suggests knowledgeable people in the nootropics community are really uncomfortable with this stuff.

90% of the people making branded combo nootropics are lying scum. A few, like TruBrain, seem like probably decent people trying to get it right – but are you confident you can tell them apart? And if you do manage to beat the odds and get something that’s not a complete pharmacological mess, aren’t you still just going to end up with an overpriced bundle of black boxes that won’t provide you with useful information, and which, empirically, everyone hates?

If you’re interested in nootropics, consider trying one substance at a time, very carefully, using something like examine.com to learn how to take it and what the possible side effects are. If you can, do what people like Gwern do and try it blind, mixing real pills with placebo pills over the space of a few weeks, so you can make sure it’s a real effect. If you find something that does have a real effect on you, treat that knowledge as a hard-won victory. Then, if you want to go from there, tentatively add a second chemical and test that one in the same way. Do this, and you have some small sliver of a chance of doing more good than harm, at least in the short term.

But if you’re going to order a combination of twenty different things at homeopathic doses from somebody who thinks “GENIUS PILL” is a Scientific Term – well, I hope it works, because you need it.

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