So I issue the challenge. Who wants to try this? I am happy to be part of this experiment. If necessary I would be happy to arrange funding.
Edit: I spent more time reading the paper and now think this study has limited relevance for practical learning, see my reply to romeostevensit below. I'm no longer planning to invest time in this project.
I have already been considering this and would be happy to try it out. I am a biomedical engineering grad student and believe I am well positioned to get the equipment operating. I tried just setting up a strobe at 10 Hz and staring at it for a couple seconds. It's a pretty intense thing to look at. It feels "activating."
Brainstorm
I think it's probably tractable to figure out a way for people to self-test. It's self-blind compatible, since users won't know their brain frequency or phase. Potentially, a computer program could measure these outputs from the EEG, then randomly assign that day's use to be in any of the three experimental settings that show no, low, or large effects. It could put the user through one or more tasks to measure the effect, and it could be configured to report that data automatically over the long term.
I was considering the idea of creating infrastructure for users to self-test at home and then potentially report their data back to a researcher.
Logistical challenges with a distributed study like this would include:
A more lightweight approach would be to just purchase the EEG device and figure out how to set it up to use yourself. That's probably simpler than helping a whole bunch of users figure out how to get the equipment and software working. You'd then either have to figure out how to quantify your self tests, or just stay tuned to the literature to see if this sort of approach continues to replicate and show robust effects across tests.
An even simpler approach would be to just expose yourself to 1.5 seconds of 9-11 Hz strobe daily on the presumption that sometimes, it'll happen to be sufficiently close to your actual phase and frequency that it'll create an effect, and that it's at least not hurting your learning rate. That's a big pile of assumptions and gives you no feedback, but it's very easy to do.
A further thought:
Wouldn't it be neat if this light intervention could cause the phase and frequency of the person's alpha waves to change in a predictable way?
What if flashing this pattern at 11 Hz at a particular phase, for example, could cause the subject's alpha waves to change to 11 Hz and in-phase? If that in turn caused the effect on learning to improve, then you could potentially make a device like this that wouldn't require measuring the user's alpha waves. It would just synchronize the alpha waves with the flashes, enforcing the learning benefit without requiring observation. That might make this a scalable tool, since then you could have a browser app to deliver this stimulation and wouldn't require electrodes at all.
Edit: emailed the lead author to ask if this is a thing, will post a followup if I hear back
If I was interested in this line of research, that's what I'd focus on: figuring out how to control the user's alpha wave frequency and phase.
faster learning in a visual identification task (i.e. detecting targets embedded in background clutter) compared to entrainment that does not match an individual’s alpha frequency. Further, we show that learning is specific to the phase relationship between the entraining flicker and the visual target stimulus.
Doesn't sound exciting. Habituating people's attention to the right visual frequency helps them on subsequent frequency specific visual tasks.
Yes, the study flickered a square at the subject's alpha wave frequency (~10 flickers/second), or about 10% out of sync. This was called "entrainment."
Then they showed one of two types of swirly dot images for 1/5th of a second, at the same pace, either synced to the peak or trough of the subjects' alpha wave.
The subjects did best at telling apart the swirly dot images if they'd gotten entrained in sync with their alpha waves AND they got shown the swirly dot images at the trough of their alpha waves.
So this isn't like "strobe yourself for 1.5 s and learn ANYTHING 3x faster!!!"
It's "there's this very specific type of visual recognition task that we can make you better at by carefully training you with brain scanners and pacing the task accordingly."
I hope it's clear this summary leaves out a ton of nuance, but I think it does a better job than other summaries I've read of representing the limitations of this study's findings for practical learning purposes.
What's sorely needed is an international drug approval reciprocity treaty. A single organization, say, part of the WHO, would be tasked with periodically vetting national level food and drug approval agencies of signator countries. In exchange for this service, drugs would be instantly approved when just one country approves it.
ETA: It looks like bilateral "agreements" are a thing:
But of course that falls well short of an international treaty. And lots of bilateral agreements strikes me as o(n^2) more complicated than a hub-and-spoke framework.
And I should also add that my general vision for federalism kind of goes in both directions. Namely, I'd like it if each state could be allowed to form its own mini-FDA but the federal government's role would be to "approve the approvers"
Adding - does anyone else wish there was a seamless, streamlined way of recruiting more people into clinical trials so we could bring new treatments to market faster, and while we're at it at least give half the people in the trial an effective treatment?
Like, how about sn annual general consent form, directly sent to clinicaltrials.gov in exchange for a modest tax break?
ACX also links to this paper analyzing federal cancer research, which claims it is so effective it only costs $326 in federal investment cost per life saved.
They claim $326 per life-year (specifically, DALY), not per life. Huge difference!
Yes, from the results section:
The federal investment cost per life-year gained through 2020 was $326 in US dollars.
That's about $20,000 for 60 life-years.
There are two big pieces of pandemic news this week.
One is that there is growing alarm about the dangers of avian flu, or H5N1. Likely mammal-to-mammal transmission has been identified, a lot of wild animals are infected, and there is a real danger that this will become a pandemic. I will cover this in its own post.
The other is that there are trial results for a new Covid treatment, Interferon λ. It looks super effective. Cuts hospitalizations and deaths in half, with no major side effects.
Despite this, there is zero expectation by anyone that it will be available any time soon, and little surprise about this reaction. You see, the trial was done by academics and was in Brazil and Canada. So it doesn’t count. Sorry.
Executive Summary
Let’s run the numbers.
The Numbers
Predictions
Predictions from Last Week: 210k cases (-8%) and 3,150 deaths (-8%)
Results: 238k cases (-6%) and 3,052 deaths (-11%)
Predictions for Next Week: 220k cases (-7%) and 2,750 deaths (-10%).
Last week I forgot to manually adjust Florida for cases, which I’ve fixed. That’s why the percentages above don’t match. Also means my prediction last week for cases was worse than I thought – cases were actually slightly up and I predicted a drop.
I expect deaths to continue to drop on schedule. Valentine’s Day is not a reporting-relevant holiday, although it is still a date it is important not to forget.
Deaths
Cases
Interferon λ
As noted up top: It looks super effective. Cuts hospitalizations and deaths in half, with no major side effects. Despite this, there is zero expectation by anyone that it will be available any time soon, and little surprise about this reaction.
Here is their results summary.
I am completely unsurprised both by our government denying people access to life saving medicine as a matter of course. And also completely unsurprised by the complete indifference of the public to our government indefinitely denying everyone access to life-saving medicine.
Paxlovid was the last gasp of the old ‘people are dying and we upended our lives to try and stop this, perhaps we should unnecessarily delay less than usual in deploying life saving medicine’ principle.
This is standard procedure. The FDA exists to deny people life saving medicine. For years. Instead, during that time, they die. No rush. If there isn’t enough money to justify paying to get through the process, they’ll keep dying forever. It’s fine.
The New York Times puts it this way, via MR:
So this isn’t only about different Covid variants. It goes beyond Covid.
Except it goes nowhere, we won’t have it, unless something changes.
Eric Topol summarizes the results:
Why won’t it be approved here? Again NYT:
As reasons to deny people life-saving medicine? That is completely, utterly murderously insane. The issues here could not be clearer.
Tyler Cowen asks if we have learned nothing. To which I answer, no. We have learned something very important, which is that our institutions have no interest in reforming, or in what would cause people not to die. We have learned that we have the ability to do much better, if allowed to do so. And we have learned that those with the guns will not allow it.
Good to know.
Physical World Modeling
Dr. John Campbell (video plus links) fully buys this metastudy from 16 January claiming definitive very large impacts on Covid-19 hospitalization and mortality from Vitamin D supplementation. He goes so far as to say that not recommending Vitamin D, at this point, appears unethical. The language he uses here comes on stronger than I believe the evidence justifies.
Finally no masks.
The thing is, no, you can’t and also shouldn’t guarantee that this won’t happen again. You don’t know what the threat will look like next time. The response to ‘we did too much prevention given the costs of Covid’ can’t be ‘we can never again contain contain an outbreak of anything no matter what.’
In Other Covid News
Mask mandates are still sometimes a thing for schools, although they now tend to be conditional. Here’s Vashon High School in Washington.
What exactly did Pfizer do? Are they doing anything dangerous or worrisome here?
I was asked via PM on LessWrong this past week to look into the claim that Pfizer was engaging in ‘directed evolution’ research to prepare the vaccine for new variants in advance. I explained this seemed like Obvious Nonsense, as this in no way helps with any meaningful bottlenecks to developing a modified vaccine. At most it buys a few days.
Here is a claim being made (direct link, note source is Project Veritas so lots of salt):
Here is the framed-to-maximize-scare-level quote:
Here is Pfizer’s response in full, bold is mine.
I see no reason to much doubt Pfizer’s explanation. So, should we be worried about putting a new spike protein onto the original virus, within a lab, once that new spike protein is observed in the wild?
I think the answer here is clearly no. This is a good scientific practice allowing different variables to be tested on their own, and poses essentially zero additional risks. As with any generally dangerous thing, it can be difficult to draw the exact right line on what people should be doing or should be allowed to do, and one must worry about slippery slopes and development of bad habits.
I can see worlds in which we would be wise to tell Pfizer they are not allowed to do this as an unfortunate side effect necessary to stop other actions that could cause big problems. I do not however see anything here as a problem on its own.
Singapore ceases remaining Covid-19 prevention measures on Monday.
China
Here’s one visualization of how many Covid deaths there have been in China recently, via counting deaths period.
Remember
Trump and DeSantis compete to distance themselves from Operation Warp Speed and the vaccine (Bloomberg).
The Wuhan Institute for Virology had One Job, which was to help us in the case of a potential pandemic. In particular, a potential SARS-2 pandemic. Why then, asks Alina Chan, did they not share their virus sample database? If nothing else, it shows that this database was not all that useful. Either it was not worth sharing, or there was some reason they couldn’t share it.
Study on the impacts of physical distancing measures on ‘vulnerable population groups.’ Finds all the downsides you would expect, which I’d expect to find in the general population the same way. Such distancing will sometimes be necessary. It sure isn’t cheap in any sense.
ADHD Medication Shortage Update
I continue to get increasing reports of people unable to fill their
methADHD medmethADHD med prescriptions. This continues to be the result of an intentional cap on usage that the DEA intentionally sets (direct link) below the FDA’s estimate of usage.This problem by default will continue to get worse, and increasing amounts of time will be taken up, by exactly the people who need to focus and spend their time well, on securing some of the limited supply. Some will inevitably turn to black markets. We could at least have the common decency to let them bid against each other. I for one am curious how much companies would pay to ensure their workers get Adderall.
Other Medical and Research News
ACX links us to Jacob Shapiro claiming that flashing lights at the proper intervals increases learning by a factor of three (source paper). No, really, that is the claim.
As Scott points out, the cost to buy the setup to try this strategy is merely hundreds of dollars, although you would still need to know how to operate the equipment. If that works, it perhaps pays for itself in one day for one student. Also if it works it would scale to everyone.
We talk about how AI or fusion power or what not would be a huge game changer. This would, if fully real, potentially be bigger, even if the effect only applied to formal learning. And there’s no reason to think this super focused state wouldn’t have tons of other uses as well. Huge if true, complete societal transformation. Can you imagine how much you would learn if you could go into triple speed at any time? How many years of schooling could be either saved or turned into actual useful knowledge and skills, dealer’s choice?
What seems to be completely missing is the proper sense of excitement. If you take this hypothesis seriously, even giving it a 1% chance it would work, you wouldn’t risk waiting around to see what happens. You wouldn’t wait for formal Proper Science to slowly study it. You’d test it, in the real world. If it works, you will know. This is not an effect size one can miss.
So I issue the challenge. Who wants to try this? I am happy to be part of this experiment. If necessary I would be happy to arrange funding.
A great illustration of how much people hate the idea of an ‘experiment.’
Oh my, without the approval of an ethics committee, some people tried to rank some other people in various criteria, including intelligence. On a spreadsheet. The horror.
You see, they were doing an experiment. And it was ‘on’ people.
Indiana lawmakers propose requiring non-profit hospitals to report the average price of every heath care service they provide. Then, if any of them exceeds 260 percent of Medicare’s price for the service, impose a fine of 10% of the hospital’s total patient-service revenue.
Given that Medicare rates cover only 53 percent of the cost of providing care, and then there are fixed costs, and some patients don’t pay their bills (can’t imagine why) there is not much margin of error, if any, left. The math seems incredibly hard.
The first twist is this price cap, as well as the price reporting, applies only to non-profits. The large for-profit hospital networks would have a large competitive advantage over non-profits. Interesting choice.
The second twist is that this is a completely insane level of fine for going over the first limit, and then essentially no further fine for going over all the limits. This presumably creates a separating equilibrium.
If you can make the ‘charge an average of exactly 259 percent more than Medicare pays, on average, for each individual service’ then maybe you can make that work. Seems extremely difficult on multiple fronts.
If you can’t, then I suppose you slap about a 20% excess charge on every bill that isn’t Medicare or Medicaid (since on the other half you’re a price taker), make sure this change is not clearly labeled as the ‘Indiana Medicare Tax Charge,’ and use the revenue to pay the tax. So the taxpayers pay the insurance companies who pay you who pays the government, who uses it to fund Medicare and pay you 53% of the cost of the treatments you provide in exchange.
Not exactly efficient, but those are the breaks, I guess.
Another fun twist is paying out tax funds to physicians in exchange for them not affiliating with hospitals? This is called ‘incentivizing independent practices.’ So the doctors who are making the most money while helping the public the least get bribed for it?
Also note the political calls to stop the ‘experiment’ social media companies are ‘running on our children.’ Same principle.
Mr. Beast paid for a thousand blind people to get surgery to help them see. Good. If your response is to attack him for this, you are a bad person.
Hospitals sometimes think three year olds are ‘too young’ to visit dying relatives? This comes from NYU Long Island, which is no slouch and certainly not cheap.
Periodic reminder that testosterone levels continue to rapidly decrease and few if any are treating this as a serious problem.
Here is a Danish study with strong echoes of the situation I encountered with colonoscopies.
This is not a negative result so much as it is an underpowered study.
The study found a decline in mortality from 13.1% to 12.6%. That’s 4% less death, a potentially really good improvement for an invitation to a screening, depending on how much actual intervention, costs and side effects are involved. This was p=0.06, which is technically more than 0.05, so yes ‘more research is needed’ and all that but it shouldn’t be taken as evidence against treatment and diagnosis being helpful here.
ACX links to meta-analysis of CBT saying it works including as self-help unguided intervention. All the statistical evidence continues to say ‘there is this thing, it makes people better off, it’s freely available, however it’s weird and not so fun, and you’re probably not going to do it.’
ACX also links to this paper analyzing federal cancer research, which claims it is so effective it only costs $326 in federal investment cost per life-year saved. Scott Alexander suggests that if this is accurate perhaps we should be donating to this rather than anything else. That would also lead to claims of ‘for every $326 you can save a life-year!’
That makes this an excellent opportunity to explain several reasons why not.
I’ll say in advance this is based on a quick read, so it’s plausible some of these issues are my misunderstanding of what was going on, if only because it seems so stupid. If I did misunderstand one or more points here, I apologize, but the whole thing seems pretty terrible.
I worry this is actually rather standard for ‘estimates of lives saved per dollar’ calculations. People get the impression ‘if you spend $326 you can save a life-year’ as if your money vanishes, the person is saved and that’s that. Whereas a lot of other people’s real resources are also being consumed that would have otherwise done good, the measurement of past effects is questionable and the forward looking marginal impacts are going to be a lot lower. And that’s in the good scenario.